This interview is a translation from Dutch Zorgvisie and SeederDeBoer

After a career as a child and youth psychiatrist and director in the youth mental health sector, Peter Dijkshoorn is now National Ambassador Learning Youth System for VNG and VWS. A role in which he can pursue his dream. ‘In my dream, everyone understands that it can get to the point where you shortchange your child’.

What does your dream look like?

‘In my dream, all children grow up happy and safe at home. That means I advocate zero out-of-home placements. I am regularly told: zero, that doesn’t make sense. But ethically, in my view, that is the only thing you can strive for. Children have the right to grow up with their own parents and parents have the right to have their children with them. Sometimes that is not possible and then a measure may be justified, because we as a society also have a mandate to support or intervene when things go wrong. But we know by now that we also cause harm with out-of-home placements and that very often these children do not fare better outside the home. We must therefore ensure that we as a society get better and better at allowing more and more children to simply grow up happily at home. There are currently 40 thousand children placed out of home. Then you can say: let’s go for 20 thousand. But then what do you actually say to the others? Sorry, we can’t help you? Or do you want to be able to say: we will continue to do our best? I think the latter.’

What gave you the idea to aim for zero out-of-home placements?

‘In 2018, I was invited to attend the Zero Suicide Summit, in Rotterdam. There were eighty people there from all over the world, all striving for zero suicides. It was three years after the transition of youth care to municipalities, not the most enjoyable time. The energy at this meeting was amazing. Everyone was fanatical, everyone had ideas and stories. I thought: why is it so much fun here? Because they are going for a very big goal! When I got home, I immediately started brainstorming with two colleagues and that’s where the Movement of 0 was born. ‘We aim for zero out-of-home placements, zero children dying of eating disorders, zero children in segregation cells, and you name it.’

What needs to change in our thinking to prevent out-of-home placement?

‘At a Movement of 0 meeting, a mother told her story. She said she had been abused as a child; her father was an alcoholic. She suspected that a boyfriend of her little son was in a similar situation. One day she gathered courage and rang the doorbell; the father answered. She said: ‘Your son sometimes comes to play with us and I am worried. Is there anything I can do, as I have experience of this.’ She was then allowed to come in and help arrived. Because she was completely non-judgemental, those people felt the space to engage in conversation. In my dream, everyone understands that it can get to the point where you shortchange your child and maybe even abuse them. In my dream, people dare to accept help and ask for help themselves. And then they are not threatened with out-of-home placement, but said: how good of you to raise the alarm.’

You are National Ambassador for Learning Youth System. What is a learning youth system?

‘A system that has the ambition to get better, again and again. And getting better should always benefit the child. That means making sure that we start providing better solutions in the daily lives of parents and children for children to grow up happily at home, and developing and utilising better solutions within care. All parties – individual professionals, but also care providers, professional organisations, training and the municipalities – must take their roles with these goals in mind. We need to be curious together: how can things be done better? We need to tolerate together that sometimes something does not work out. And when something doesn’t work out, we need to see what we can learn from it.’

Suppose we no longer place children out of the home. How can we still help them?

‘Behavioural problems in children are often caused by trauma. Since 2000, approximately, good trauma treatment has been available. We now know that parents are often traumatised too, and that this is where the basis for the children’s behavioural problems and trauma lies. Think PTSD or a history of abuse or maltreatment. At some clinics, it is common to admit an entire family for about six weeks. After that, they all go home. Then you’re not done, but often you’ve come a long way. What we also learn from this family trauma treatment is that families often make progress by understanding their situation. For instance, if a family is reported by the Child Protection Board and there is no place yet, one of the explanations given at intake is about the window of tolerance. If people are traumatised, they have a small window of tolerance. Something only has to happen or they derail. They freeze or give a big mouth or start hitting. This appears to be an explanation that people recognise. Then, when it is their turn for admission, things often go better. Because they understand where things are going wrong.’

Do we have enough knowledge to provide better help to children and parents?

‘We know better and better which knobs we can all turn. We know that housing problems, poverty and parental trauma play a role. Expert teams, which get involved in complex cases, have for some time had a monitor at their disposal in which they collect data. That data recently showed that in 60 per cent of children, problems escalated after they were first expelled from school. That’s the kind of data we can do something with. If we see that things are derailing at that point, we need to think about how to prevent a school expulsion or how to better support the child if that happens. In the coming years, we need to optimise that database by looking at: which data are useful, which are not and which are still missing. And we need to learn from our mistakes.’

Is a change in mentality also needed among social workers?

‘If you scare parents that you might take their child away, then you end up in a position where counselling becomes difficult. So we need to have that conversation differently. We also know that families do better if you keep calm and give people space. Social workers need to start feeling safe about a child staying at home. So does the director of the social worker and the councillor of the municipality where the child lives. Everyone needs to come to understand that it may be better to leave a child at home, where they may suffer another blow, than to take them out of the home. They have to learn to weigh up better and get comfortable with that and that is new.’

Doesn’t this make youth aid even more expensive?

‘I think we have plenty of money, that the quality has to improve and then it will be cheaper. Take family trauma treatment, for example, which takes six weeks and costs 1,200 euros a day. About 50 thousand euros in total. Somewhere else, a child is admitted for a year. The cost per day is lower, but the child is admitted for a year. Then the cost is much higher. And it helps less. If we treat families in more places, the overall cost goes down. You need fewer people or the waiting lists get shorter. And: you get better results. So you also get closer to my dream.’

How did you come to be so driven?

‘The first suicidal boy I met in my life was a boy my father had brought home. I got to know his story, the then terrible stay in a boarding school for children placed out of home. My father was a headmaster at a technical school and cared about the fate of children in trouble. So I think I got the desire to help from home. We also had several oncologists in the family, who were always working to improve care for their patients. Later, when I started working in youth welfare, I didn’t see that striving for better at all, it was rather very hard mopping up. I marvelled at that and always kept looking for how things could be better.’

So how could things be better, for example?

‘Around 2000, we were constantly struggling with waiting lists. We kept getting money added, but that didn’t help enough. Then I thought: but what can we do ourselves? Well, for instance: a psychological test was done for every child who applied. Then we checked: is that always useful? So, no. By taking a critical look at when we were going to do a psychological test and when not, we were able to treat thirty extra children every year. What also played a role: vulnerable families remained endlessly in care. Finger-to-the-wrist contacts, we called it. Care workers, usually people with big hearts, did not dare to let go of those families. A lot of hours went into that. Then we said: discuss with those people that you are going to stop because things are going well, but that they can always call if there is something wrong. And if this idea makes you nervous, call them every three months. Cost you ten minutes. Then we had no more finger-to-the-wrist contacts, but we did care. And we could help additional children again. We helped twice as many families for the same money as teams with the same budget’

Someone called you a Don Quixote. Do you see yourself that way?

‘Sometimes, yes. But it’s been a long time since I read the book. Was he fighting windmills and was it bullshit, or was he fighting for a good cause? I think I’m fighting for a good cause, that together with others I’ve already achieved quite a lot and so in the end it makes sense.’

Peter Dijkshoorn (The Hague, 1955) worked as a child and adolescent psychiatrist for 30 years. In 2005, he joined Accare, where he treated children and adolescents but was also involved in shaping and improving care, first as director Drenthe/Overijssel, then as director. From 2014, he additionally served as a board member of GGZ Nederland. In 2020, he retired from both organisations. Since then, he has been National Ambassador Learning Youth System for OZJ/VNG/VWS. Recently, he also became a member of the steering committee of the national agenda on suicide prevention.