Psychosocial and Health Determinants of Placement of Children Requiring Nursing Care in Child Protection Centers

Abstract

Children requiring nursing care represent an exceptionally vulnerable population within the child protection system. These children often experience severe health conditions, chronic illnesses, developmental disorders, neurological impairments, or combined psychosocial disadvantages requiring long-term multidisciplinary care. Decision-making regarding their placement into centres for children and families is influenced not only by the child’s health condition but also by psychosocial, familial, and systemic determinants affecting the child’s overall well-being and best interests. The purpose of this study was to analyse the psychosocial and health-related determinants involved in the decision-making process concerning the placement of children requiring nursing care into centres for children and families and to identify the dominant risk factors influencing professional decision-making practice. Materials and Methods. The study was designed as a qualitatively oriented empirical investigation based on document analysis. The research sample consisted of 87 anonymized administrative and professional documents concerning children proposed for placement into centres for children and families. The analysed material included social reports, medical documentation, psychological and psychiatric assessments, decision-making records, and accompanying professional documentation related to the child’s health and psychosocial condition. Data were analysed using qualitative content analysis involving open and thematic coding. The analysis focused on identifying health-related, psychosocial, familial, and systemic determinants influencing decisions regarding child placement. Results. The analysis identified several interrelated determinants entering the decision-making process. Dominant factors included severe health conditions of the child, the need for specialized nursing care, psychological and behavioural problems, insufficient parenting competencies, unstable family environments, adverse socio-economic conditions, and systemic limitations related to the availability of specialized services. In most analysed cases, risk factors occurred cumulatively rather than in isolation. Serious health problems were frequently combined with neglect of care, family instability, poverty, parental substance abuse, domestic violence, or insufficient cooperation with professionals. The findings further demonstrated that social reports and expert assessments played a crucial role in the interpretation and construction of the best interests of the child and significantly influenced decisions regarding the form of care provided. Systemic determinants, including institutional capacity, regional accessibility of services, and the availability of multidisciplinary healthcare support, also substantially affected decision-making practice. Conclusions. Decision-making regarding the placement of children requiring nursing care into centres for children and families represents a highly complex multidisciplinary process determined by the interaction of health-related, psychosocial, familial, and systemic factors. The findings highlight the need for strengthening multidisciplinary cooperation, trauma-informed approaches, familycentered care, and community-oriented services for children with complex healthcare and psychosocial needs. Greater methodological support for social workers and the development of preventive interventions aimed at stabilizing family environments and strengthening parenting competencies also appear essential.