Policy-making for the diffusion of social innovations: the case of the Barnahus model in the Nordic region and the broader European context

Abstract

The Barnahus model was launched in Iceland in 1998, and it subsequently spread to all the Nordic countries. It is an interagency, co-located model for working with cases of violence and abuse against children that addresses two vital concerns of welfare societies: to process cases through the legal system and to offer support and treatment to victims. The model is currently recommended as a best-practice model on the European level – and understood as representing a radical change in the organisational setup related to such cases. This paper analyses the diffusion and implementation of the model in two different contexts: the Nordic region and the wider European arena, where the model is currently promoted as an important innovation. Drawing on the concept of social innovation, we explore the structural and contextual conditions for the diffusion of the model and discuss its role in the ongoing transformation of welfare societies’ response to children exposed to violence and abuse. We identify the policy-making means by which the model is promoted today and conclude that it can lead to manifold institutional changes, both radical and incremental, and both desired and undesired, depending on how the original idea is translated and adapted in different contexts.

Keywords:

• interagency work
• social innovation
• diffusion
• translation
• implementation
• institutional change
• policy making

Introduction

This article addresses the issue of violence and abuse against children as a growing policy concern and field of intervention for developed welfare societies. This is a field in which national, international and transnational policy processes are increasingly interacting to create momentum for change. In recent years, the issue has received much-needed attention from supranational institutions such as the Council of Europe (CoE) and the European Union, often framed within the “child-friendly justice” paradigm (e.g. CoE 2010). In many countries, and certainly in the Nordic region, the voluntary sector has pushed simultaneously for change in how cases are legally processed and for the development of better support services (see Johansson et al. 2017b). Violence and abuse against children is thus not solely a public policy concern for various welfare states, but increasingly a policy field that cuts across sectors as well as nation-state borders.

At the same time, it is important to recognise that violence and abuse against children represents a “wicked problem” for societies, in the sense that it is complex, unpredictable, and intractable (Head and Alford 2015). It also interacts with other problems such as poverty, mental health issues and substance abuse. Hence, it cannot be dealt with in isolation but needs to be addressed through a broad set of measures spanning different sectors and agencies (Backe-Hansen, Smette, and Vislie 2017).

Paradoxically, in order for ideas to gain popular acceptance and be viewed as solutions to complex or wicked problems, they should not be packaged in a likewise complex manner but rather as ideas that are simple, concrete, memorable and “sticky” (see Heath and Heath 2007). In recent years, some interagency ideas or models for addressing violence and abuse against children have come to be considered more innovative and successful than others. Examples include the Nordic Barnahus model, which we explore in this article, and its primary source of inspiration, the Children’s Advocacy Center model, developed in the United States beginning in the 1980s (see Herbert, Walsh, and Bromfield 2018). Both models can be understood as representing an idea packaged as a compelling and sticky solution to the problem of violence and abuse of children in modern welfare societies. Our analysis here takes inspiration from the field of “social innovation” studies and specifically focuses on the role of policy-making for the diffusion of social innovations – using the Nordic Barnahus model as an empirical case. For this end we study the diffusion of the model in two different contexts and phases; the initial diffusion in the Nordic countries and the later and ongoing diffusion in the wider European context, acknowledging the transnational influence across time and place.

The Barnahus model: core ideas and contexts of diffusion

The Barnahus model was initiated in the Nordic countries as a groundbreaking reform in the way cases of violence and abuse against children are addressed (e.g. Johansson 2012). After its original implementation in Iceland two decades ago, it spread rapidly throughout the Nordic region, and it is now an integrated part of the service landscape (Johansson et al. 2017b). The model combines a penal and a welfare track related to cases of violence and abuse of children. Hence, it represents a “hybrid organisation” (Battilana and Dorado 2010), combining different institutional logics in new ways. It can be described as a inter-agency and multi-professional model. It is founded on ideas about child-friendliness and the “under one roof” or “one-stop-shop” principle. The key aim of the model is to bring together all the professional agencies involved in reported cases of violence and abuse of children in order to ensure a coordinated response. The involved agencies are the police, prosecutorial agencies and health and welfare agencies. Although there are some differences between the Nordic national models, the agencies involved, as well as the overarching aims and tasks, are largely the same. Also common to all Nordic countries is the model’s embeddedness in the child protection and criminal justice systems (Johansson et al. 2017b).

The coordinated response is thought to reduce the strains on the child from participating in the penal process, enhance the quality of the investigations and possibly lead to a higher rate of prosecuted cases and convictions. Another key aim is to ensure that children and families receive necessary support. The key tasks include coordination of the processes related to the child’s forensic interview and medical examination, to assess needs and provide psychosocial support. Barnahus staff are typically social workers or psychologists. Professionals from other agencies, such as healthcare and child-protection case workers, are not employed by the Barnahus, but will come there to perform their case-related work and/or to discuss the case at coordination meetings. In order to facilitate disclosure and avoid secondary victimisation the premises of the Barnahus are designed to be child-friendly. Hence, the model also has a material-aesthetic dimension, as the work takes place in a concrete space, the Barnahus (in English, “the children’s house”) (Stefansen 2017).

The idea of a “balanced” model that accords importance to both the legal process and victim support and treatment was emphasised in the early implementation phase, but this idea was subsequently shown to be difficult to realise in practice. Johansson (2011, 2017), for instance, argues that “juridification” is a possible consequence of the model, meaning that the penal process is given priority over other aspects of working with child abuse cases. In turn, this constrains child protection case workers’ discretion or ability to manoeuvre in terms of when and how to intervene to support the child. Hence the model can be seen as a somewhat unstable hybrid organisation (cf. Battilana and Dorado 2010).

The Barnahus model is currently promoted as an innovation and a “good practice” solution on the European level, and several European countries have implemented it on a trial basis or are in the process of establishment. In what sense the model represents a groundbreaking reform is not clear, however. Moreover, little is known about the relationship between the promise of the original and radical idea of Barnahus, on the one hand, and its implementation and policy-diffusion processes, on the other – a relationship this article explores by drawing on the concept of social innovation. To shed light on this issue, we explore what we see as two distinct contexts and phases of diffusion. We argue that in the Nordic countries the implementation of the model was the “end result” of long term processes on both the cultural and institutional level relating to violence and abuse of children. In that region the model is not what ignites a change in the response to this issue but rather a vehicle in bringing out effects from legal provisions and institutional changes that had already been implemented. A key point (that we will illustrate) is that the Nordic countries in many ways represent “cultural peers” (Karstedt 2015) in terms of their similar penal cultures and welfare state institutions relating to the victimisation of children. The Barnahus model can from this perspective be seen as a concrete manifestation of core ideas that already are institutionalised and circulating in relation to children’s needs and rights in this particular cultural context. This differs markedly from the situation in the broader European context where the Barnahus model is currently promoted and under diffusion. We argue that the implementation of the Barnahus model in European contexts could work both as a source for radical change in the societal response to victimised children, and be implemented in ways that largely contrast from what the model implies in the Nordic region. Next we turn to the the social-innovation literature and how it can inform our analysis.

Perspectives on social innovation, policy translation and institutional change

The concept of social innovation is central to our analysis. It is much debated and conceptually ambiguous (cf. Rønning and Knutagård 2015). Several efforts have been made to synthesise its various definitions (Pol and Ville 2009; van der Have and Rubalcaba 2016; see also Aboy, Teasdale, and Fagan 2016). Heiskala’s general definition of innovations is a good place to start. He understands innovations as entailing an idea or a pattern that is defined as new (or perceived as new in the context of application) and that has the effect of changing social practices with the consequence of improved social and/or economic performance (Heiskala 2007, 54). The concept of social innovation often refers to a type of innovation with social aims that meets social needs in new and collaborative ways. Social innovations begin with an identification of unmet needs and ideas about how to meet them. Certain needs, such as hunger or disease, may be obvious, and some may be less obvious or even unrecognised, and Mulgan (2006, 149) specifically mentions the need for protection from domestic violence. As for the Nordic Barnahus model, it seems reasonable to view it as reflecting a pronounced shift in the perception of state agencies’ responsibility towards victims of child abuse – at least in the recognition of the need for a coordinated response. As Mulgan notes, many of the most important innovations “straddle the boundaries between sectors and disciplines” (Mulgan 2006, 151). This is clearly the case with the Barnahus model, which aims to balance what Johansson (2011, 2017) identifies as different institutional logics: the penal logic and the treatment logic. Given the background as well as the key aims of the Barnahus model’s implementation in the Nordic region, the model clearly falls into the category of a social innovation. We argue, however, that for a model to work as a social innovation, it must also have a transformative effect on the problem it aims to solve – and in the case of child abuse, the problem includes a fragmented set of social services and a justice system seen as ill-equipped to handle cases of violence and abuse against children.

We apply an institutional perspective to social innovations, drawing on theories of travelling policy ideas, translation processes and institutional change (Powell and DiMaggio 1991; Czarniawska and Sevón 1996; Djelic and Sahlin-Andersson 2006; Røvik 2016). It could be argued that this perspective combines structural and agency-oriented approaches (cf. Barley and Tolbert 1997). This cluster of theories draws attention to the importance of institutional structures – and thus structural conditions – for policy diffusion, implementation and institutionalisation – but also to how the diffusion of ideas always involves an (active) translation when adapted and implemented in new contexts (Czarniawska and Sevón 1996; Røvik 2016). According to Djelic and Sahlin-Andersson (2006, 17), “carriers” play important roles in these processes, particularly carriers of ideas who operate transnationally:

Carriers are active in structuring flows and patterns of diffusion but they are also translating the ideas they mediate. … Carriers that operate transnationally and global broadcasters tend in particular to generalize and theorize the ideas they champion, thus making them abstract and universally applicable. (Djelic and Sahlin-Andersson 2006, 17)

Against this background, the aim of our analysis is to explore institutional and contextual conditions for policy diffusion and social innovations’ transformative potential, using the problem of childhood victimisation and the Barnahus approach as an empirical case. To explore the transformative potential of the Barnahus model, we draw on Heiskala’s (2007, 67) classification of four different types of institutional change: (1) reproduction, (2) incremental change/evolution, (3) radical change/revolution and (4) chance/uncontrolled change. Reproduction refers to a situation with no or minimal change. Although incremental change can result in virtually the same state of affairs, it can sometimes produce significant changes in the long run, because successive small changes can result in qualitative transformation (cf. Rønning and Knutagård 2015, 11). Radical changes are revolutions in basic institutional arrangements. Finally, chance refers to uncontrolled change: it results from either unintended consequences of human action or unexpected environmental changes.

As far as social innovations are concerned, the relevant types of change are cumulative, incremental change with qualitative consequences and radical or “deep” reform (cf. van Gestel et al. 2018). To determine where the Barnahus model sits in this respect, we need to understand the specific context in which it is implemented and meant to address. Drawing on Rønning and Knutagård (2015, 14), we understand context as a set of situational opportunities and constraints in the form of history, traditions and institutional structures.

Empirical basis of the analysis

Our starting point is that policy diffusion and implementation are increasingly shaped beyond the boundaries of nation-states and across sectors (cf. Djelic and Sahlin-Andersson 2006; Powell 2007; Cotterell 2012). This means that our analysis encompasses not only national public policy based on the Barnahus model but also policy making shaped by a mixture of sectors, and that includes both national and international “hard” regulation and transnational “soft” regulation relating to the Barnahus model.

We analyse two phases of the diffusion of the Barnahus model. The analysis of the first, Nordic phase is based on a rereading of available research on diffusion, implementation and institutionalisation, with a focus on institutional and contextual circumstances and not the chronology of events leading up to the model’s implementation.

The second phase relates to the broader European context and the role of national and transnational agents as “innovation drivers”, or carriers of the Barnahus idea, in the promotion, diffusion and policy-making process of the Barnahus model. The analysis of this phase is based on European-level policy documents, developed by the PROMISE network, which was established in 2015 with the aim of promoting the Barnahus model throughout Europe. The network receives funding from the European Union and other sources, and it plays a leading role in what it terms “the European Barnahus Movement”, launched in June 2017 at a conference hosted by the European Committee of the Regions.¹ It can be interpreted as a social or moral movement – collectively and normatively engaged in promoting the Barnahus model as an innovation in the field of violence and abuse against children, and strongly characterised by specific narratives and storytelling that portray the Barnahus model as a success (cf. Davis 2002).

PROMISE has developed an online platform comprising a newsletter, a series of webinars and a set of policy documents. This article offers an analysis of these documents because they provide important context for and details about the policy-making and advocacy work carried out through the network. The documents are aimed at stakeholders and professionals in countries in the process of establishing and implementing the Barnahus model or a comparable model. Individual documents describe the history of the Barnahus model (Wenke n.d.), core elements of the model (PROMISE 2017), how stakeholders can proceed in order to gain support in their respective countries (PROMISE n.d.) and the international conventions and regulations that are recognised as supporting the Barnahus model (O’Donnell n.d.). Our reading of these documents focuses on both the strategies for diffusion and policy making of the Barnahus model and how the Barnahus idea is negotiated through them. Our analysis deals primarily with the first two documents, because they most clearly demonstrate the role of storytelling in the “European phase” of the diffusion process.

The Nordic phase: successive policy development and a favourable context

The Barnahus model was first implemented in Iceland in 1998. Sweden and Norway followed suit in 2006 and 2007, and Denmark and Finland implemented the model in later years. Denmark implemented it in 2013, and Finland has been piloting the Barnahus model since 2014, although it implemented a similar model in forensic-psychology units at larger hospitals as early as 2008 (see Korkman, Pakkanen, and Laajasalo 2017). Even though the time of establishment and numbers of national Barnahus differ across the Nordic countries, the diffusion of the Barnahus model has been rapid and extensive within the Nordic region (Johansson et al. 2017b). Across the region, with the exception of Finland, the model very quickly became standard procedure in cases of violence and abuse against children, and a distinct professional field has developed in each country and on the Nordic level (Stefansen 2017). This field encompasses a set of institutions with specific roles, identities and boundaries with respect to other services. However, there are more detailed differences in target groups, organisational affiliation and involved services. The national models can subsequently be understood as different materialisations or interpretations of the original idea of the Barnahus model (Johansson et al. 2017a), illustrating the general point that diffusion always entails transformation of the source model (Røvik 2016). The model is also regulated differently (Johansson et al. 2017b).

As noted by Stefansen et al. (2017), the Barnahus model is today consolidated, formalised and scaled up in the Nordic context. The concrete processes leading up to the model’s implementation in the Nordic countries are described in national reports and by Johansson et al. (2017b). We will not review these processes here; instead, we investigate the role of societal and institutional contexts in the rapid diffusion of the model in the Nordic countries. We highlight what we see as the broader developments that apply across countries.

First, there was a clear and shared understanding that the situation for victimised children had to change. In some countries, the call for action from state authorities was spurred by high-profile cases in which the system had failed. For example, in the 1990s, Norway’s Bjugn case involved suspicion of the sexual abuse of a large number of children in a kindergarten in a small rural community. Moreover, Denmark’s implementation of Barnahus arose from the disclosure of a number of shocking cases of child abuse and neglect (see Søbjerg 2017). Nongovernmental organisations, and especially Save the Children, played an important role in voicing criticisms of the system and in launching the discussion of the Barnahus model as a solution in Sweden (Diesen 2002; Thornblad 2006), Norway (Skybak 2004) and Denmark (Johansson et al. 2017b, foreword). This common understanding of unmet needs is the basis of evaluation studies from both Norway (Bakketeig et al. 2012; Stefansen, Gundersen, and Bakketeig 2012) and Sweden (Åström and Rejmer 2008; Kaldal et al. 2010). In Denmark, the Barnahus model was part of a larger set of legislative reforms known as the Abuse Package (Overgrebspakken in Danish); these reforms followed a series of reports on how the response to child-abuse cases could be improved to address the complex needs of children and young people (see Johansson et al. 2017b, appendix).

Second, the establishment of Barnahus in the Nordic countries took place during a period when the states developed comprehensive and wider policies to combat domestic violence. In Norway, the year 2003 marked a decisive shift. In that year, the first governmental report on violence against women was published (Norwegian Ministry of Justice and the Police 2003), setting a clear agenda for the improvement of services and penal processes relating to domestic violence. Since 2003, there has been a marked intensification in Norway of the production of steering documents on domestic violence and the related topic of violence and abuse against children, and public expenditure has increased profoundly in the same period. Similar developments have been seen across the Nordic region, although the specific framing of the need for special measures for victimised children has differed from country to country. In Sweden, for instance, the need for special measures for children has been addressed both from a domestic violence perspective, focusing on men’s violence against women and children, and as a separate issue relating to adults’ violence against and abuse of children in general. Still, the overall picture is that the establishment of Barnahus in the Nordic region has occurred in a context of heightened awareness and political agreement regarding the welfare state’s responsibility to address child abuse and violence.

Third, the Nordic countries share a historical legacy relating to the treatment of victimised children in the court system, often referred to as the Nordic model (Myklebust 2017, 97). This model reflects the understanding that children are especially vulnerable and that care must be taken to avoid retraumatisation. In the Nordic criminal justice system, children give their witness statements not in open court but outside of the court – today, in Barnahus. In court, video-recorded statements are accepted as evidence in chief without the presence of the child. This long-standing tradition was implemented in Norway in 1926 – making Norway the first European country “to statutorily outline how investigative interviews in sexual abuse cases should be conducted” (Myklebust 2017, 101). The age limit for testimony in open court varies somewhat between the Nordic countries, but it is for instance 16 in both Norway and Sweden, reflecting a common commitment to protecting youths as well as younger children from the burden of involvement in legal proceedings. Also worth mentioning here is the long history of strict regulation of violence against children in all the Nordic countries, with (close to) zero tolerance for corporal punishment by parents since the 1960s and 70s and strengthened in the decades since. The first law banning corporal punishment by parents was implemented in 1966 in Sweden and 1972 in Norway. In Sweden, all forms of violence against children were banned in 1979, making it a pioneer country in formally protecting children from violence (Gelles and Edfeldt 1986). Moreover, prior to the establishment of Barnahus in Sweden, several legal reforms and initiatives had been undertaken to support crime victims’ rights and strengthen children’s rights across legal fields and professional sectors (cf. Johansson 2011).

We understand these legal developments as constituting a favourable context for the implementation of the Barnahus model – in many ways, the model can be seen as a continuation of previously established lines of thought that failed to protect children because they lacked a corresponding institutional structure. In fact, in Norway the Barnahus model was initially presented as a new model for conducting child forensic interviews, not a comprehensive reform of the way such cases were handled (Bakketeig et al. 2012).

In our view, these institutional and contextual factors combined to a specific cultural climate and opportunity structure that facilitated the diffusion process of the Barnahus model in the Nordic context. The Barnahus idea fitted well into these broader institutional discourses and successive policy changes. In this perspective, the implementation of the Barnahus model in the Nordic context can be seen as embedded in a longer tradition of successive policy development concerning violence and abuse against children, compared to the more “top-down” policy transfer process in the broader European context, analysed in the next section.

The European phase: storytelling, standard setting and uncertain transformative potential

Following the extensive Nordic diffusion and implementation, the Barnahus model is currently being promoted as an innovation in the field of violence against children and child-friendly justice on the European level (European Union 2017). Strong initiatives are now being undertaken in Europe, where “innovators” work to legitimise the model and to push powerful stakeholders and states to take action and ultimately adopt the Barnahus model and its underlying principles. In parallel, there is an ongoing diffusion of the model throughout Europe as well as policy creation in the form of both hard and soft regulatory frameworks and standards, of which some illustrative examples will be analysed in the following. In this ongoing process, a network of stakeholders – the PROMISE project – plays a key role, which our analysis will demonstrate. The aim of this analysis is to delineate the policy strategies this network employs and how they affect the Barnahus idea and its transformative potential.

PROMISE is a partnership of organisations, professionals and experts from several European and Nordic countries. These actors promote the Barnahus model throughout Europe and in other parts of the world. It is cofunded by the European Union and managed by the Children at Risk Unit in the Council of the Baltic Sea States Secretariat. In the first phase of the initiative (2015–2017), eleven European countries participated with the aim of establishing Barnahus or similar arrangements in their respective countries. The initiative has recently entered its second phase (2017–2019), that is, the implementation phase, with the objective of intensifying and promoting progress in the European establishment of the model and to encourage the application of quality standards, tools and guidance developed during the first phase.²

The diffusion processes of the Barnahus model raise questions related not only to the possibility of scaling up the model but also to way in which the many different contexts for adaptation will affect the establishment and implementation of the model and, importantly, to the transformative dimensions of the original idea of the Barnahus model. This is not communicated in the core PROMISE documents, which simply mention (and take-for-granted) that the model is an integral part of both the child protection and criminal justice systems (Wenke n.d.). This contrasts with the emerging scholarship on the model (see Johansson et al. 2017b; Stefansen et al. 2017), which emphasises the role of the wider institutional landscape in the model’s effects as well as more specific organisational structures.

The literature on social innovations often focuses on the process of innovation, that is, how established elements are combined in new ways to create new working practices of higher efficiency and quality (e.g. Mulgan 2006). The process of innovation could, however, also include how a model is launched, diffused and governed, all of which affect the success of a new model. We view the ongoing European diffusion process as strongly linked to the activities and documents produced within the framework of the PROMISE project, and argue that the current European diffusion is characterised by storytelling about the Barnahus idea and formalisation of the Barnahus principles through standard setting. Storytelling and standard setting are thus the means by which PROMISE launches, promotes and works to diffuse the Barnahus idea – it is their policy-making strategy. This strategy can be interpreted as a form of policy making through the creation of a narrative, where standard setting becomes a part of Barnahus storytelling, as an important mechanism for creating both legitimacy and enabling further diffusion of the model. Stories are powerful both externally and internally because they speak to people’s emotions and morality and work to form a collective identity for organisations and actors that want to be part of the European Barnahus movement (cf. Davis 2002). Prior and colleagues similarly discuss “policy as narrative” to show how policy stories are important for the framing of policy problems and their solutions (Prior, Hughes, and Peckham 2012). Through storytelling and standard setting, the core principles and promised effects of the Barnahus model are constructed in a particular and sticky way, as illustrated in the quote below.

The [PROMISE] project promotes a one-stop approach limiting the number of interviews of child victims and reducing risks of secondary victimisation in the course of investigations and proceedings. This approach ensures comprehensive care, treatment and support of child victims while it enhances the probative value of children’s testimonies, respecting fundamental principles of due process and fair trial. (Wenke n.d., 3)

The Barnahus narrative created by PROMISE revolves around the model’s establishment, implementation and diffusion in the Nordic region as well as in some European countries that have established Barnahus or taken clear steps towards doing so; the PROMISE narrative offers examples (stories) from the different countries. The core document outlining the idea and establishment of Barnahus is entitled “Enabling Child-Sensitive Justice: The Success Story of the Barnahus Model and Its Expansion in Europe”. It is based on key informant interviews with promoters of the Barnahus model in the Nordic countries as well as in the European countries that are partners of or participating in the PROMISE project. The story is thus told by the most active institutional entrepreneurs, and it mirrors their positive viewpoint.

The report provides an overview of how the Barnahus model has emerged and gradually expanded in Europe. It documents how government officials, practitioners, advocates and entrepreneurs have promoted the model, unyielding even when confronted with doubts, obstacles and adversities. The study analyses how they succeeded in this process and identifies the principle factors and dynamics that enabled them to innovate practice. ... In particular, the study explores the vital role of entrepreneurs and change makers who pioneered the Barnahus and comparable models in their countries or internationally. (Wenke n.d., 2)

The PROMISE narrative places a strong emphasis on individuals and organisations that champion the Barnahus model when explaining important factors of the model’s success and continuous diffusion, first in the Nordic region and currently in Europe and beyond. These actors include, for example, the director of the Government Agency for Child Protection of Iceland and the founder of the first Barnahus in Iceland, the Queen of Sweden and the Childhood Foundation, Save the Children, Ministers of Justice and Children’s Commissioners, experts and advocates from academia, and more (Wenke n.d.).

In most countries that have set up Barnahus, entrepreneurs, high-level advocates and experts were invited from abroad to address multi-disciplinary and interagency audiences, including at the high levels of the public administration. Events that could count on the attendance of the Queen of Sweden or Barnahus pioneers from the Nordic countries had a particularly strong convening power. In many countries, these high-level advocates lent vital support to the national processes for the establishment of the Barnahus and generated a remarkable momentum for change. (Wenke n.d, 21)

These agents then play the role of the heroes in the Barnahus narrative. Many of the individual agents and organisations have been innovation drivers from the first stages of the Nordic diffusion and are continuing their work in the ongoing European-diffusion phase. Moreover, the number of agents actively involved in the movement has increased. For these agents, the PROMISE network constitutes an important arena, together with international organisations and conferences.

Regional and international organisations and fora have played also an important role in supporting the establishment of new Barnahus in European countries. They include in particular the Council of Europe, the European Commission and the Council of the Baltic Sea States. International and European conferences offered fora where the Barnahus model was presented and promoted as an outstanding example of good practice. They include the traditional child protection conferences organised in the Nordic countries as well as the International Society for the Protection of Children from Abuse and Neglect (ISPCAN). (Wenke n.d, 24)

Clearly, these Barnahus promoters and fora for exchange are seen as highly important for the diffusion of the model. But how does the storytelling and standard setting produced within the framework of the PROMISE project affect, negotiate and reconstruct the meaning of the original Nordic Barnahus idea?

First, the flexibility of the model is emphasised and characterised as an inherent part of the Barnahus model, evident in several of the documents and standards produced by PROMISE (Wenke n.d.; PROMISE 2017). This emphasis is central to the construction of the idea as a simple, compelling and sticky solution to the problem of violence and abuse against children. The Barnahus model is described as desirable – and possible – in any context and as an idea that can take many forms.

In some places, the model has been established by law, by contract or through an agreement, as a pilot, a project or a permanent body. In some places, it has been set up as a public institution whereas it is affiliated to a private organisation in others. It can take the form of a stand-alone institution or be hosted by the police, the health care sector or other services. The institutional leadership differs from country to country. The establishment is possible at the local, regional or national level. This degree of flexibility that is an inherent part of the model has facilitated the establishment of Barnahus and comparable models in many countries as the details of the institutional affiliation and set up can be defined on a case-by-case basis according to the existing local, regional or national structures and needs. (Wenke n.d, 53–54)

Consequently, aspects such as organisational affiliation, institutional tensions and dilemmas in practice are not acknowledged or problematised. Moreover, the problems of sustaining the model in circumstances where it does not fit particularly well are not communicated. There are examples in the literature of implementation problems. Søbjerg and Thams (2016) has described how the Barnahus model that was set up in Greenland’s capital, Nuuk, in 2011 was replaced by a competence centre offering consultation to local professionals and by a “travelling team”. The remodelled approach is described as better suited to life in the circumpolar North, given the vast geographical distances between local communities and Nuuk. Comparably, implementation problems are likely to occur in countries lacking surrounding institutional structures for child protection, or where the criminal justice system differs markedly from the principles of the original Barnahus idea. However, this is largely concealed by the PROMISE storytelling, due to its emphasis on (abstract) flexibility and universal applicability.

In our interpretation, the Barnahus model’s ongoing diffusion is what makes it a “success story” in the narrative of the PROMISE documents – irrespective of the manifold translations and adaptations of the Barnahus idea that such diffusion involve. The focus is first and foremost on establishing the model. Establishment is then characterised as equivalent to success, and the positive outcomes or “evidence base” of the model are more or less taken for granted.

In the storytelling, evidence of positive outcomes, mainly with reference to national evaluations from Nordic contexts, is described as compelling and important in order for the model to gain support and spread further.

The convincing nature of the model is substantiated by compelling evidence. As noted by the informants and contributors to this study, the availability of positive evaluations and other empirical data has yielded important support for the establishment of the model in many countries. Evidence demonstrates that the model enhances the outcomes for child victims of violence and safeguards their rights in the context of investigations and proceedings and in accessing treatment and support for their recovery and rehabilitation. (Wenke n.d, 18)

This illustrates how evaluations and other studies are used to legitimise the model and how that in turn is seen to affect the diffusion process. Moreover, it is argued that “the model holds measurable and notable benefits for the child welfare and the justice systems”, which have enabled “eased consensus building across different ministries, political parties and professional societies” (Wenke n.d, 18–19). The evidence base of the model, and the studies referred to as support for this argument, are thus portrayed in a unified, generalised and legitimising way that conceals the more nuanced and varied dimensions of the cited evaluation research and results (cf. Åström and Rejmer 2008; Kaldal et al. 2010; Bakketeig et al. 2012; Stefansen, Gundersen, and Bakketeig 2012). In our interpretation, this shows how the Barnahus idea – including its effects – is narrated in a convincing and simplified way rather than represented as a complex and varying interagency structure and practice characterised by inherent institutional tensions and power dynamics (cf. Johansson 2011, 2017). It is illustrating that the difficulties to fully comply with children’s rights, for instance children’s right to information (e.g. Kaldal et al. 2017) is not mentioned, not either the fact that many promised effects are not met or still unknown of.

The Barnahus narrative focuses also on how to achieve a well-functioning structure and practice by presenting examples of “good practice” from the Nordic countries and some other European countries and by issuing quality standards and tracking tools for self-evaluation.

The European Barnahus quality standards, developed by PROMISE, are described as offering “groundbreaking guidance”. They are voluminous and have been published in both longer and shorter versions, and contain 10 standards in total. The first standard declares the key principles to guide all involved agencies’ activities in a Barnahus, namely; the best interests of the child (1.1.), the child’s right to be heard and receive information (1.2.), and to avoid undue delay (1.3.). Standard 2–3 declares that Barnahus should rest on a multidisciplinary, collaborative approach (2) and embrace an inclusive target group (3). Standard 4–10 states the more specific environment and services to be provided at or by Barnahus, including; a child friendly environment (4), interagency case management (5), forensic interviews (6), medical examinations (7), therapeutic services (8), capacity building (9) and preventions in terms of information sharing, awareness raising and external competence building (10) (PROMISE 2017). In relation to each standard, illustrative examples (stories) are given from Nordic countries, including specific Barnahus operations in the Nordic region, but also a few European set-ups, for instance in Tallin and Zagreb (PROMISE 2017). In addition, the quality standards have a complementary “tracking tool” designed to be used by Barnahus operations and professionals as a self-evaluation tool based on the standards. At the same time, because it is stated that the European standards represent “the first attempt to define the principles and good practice standards for services that want to operate according to the Barnahus model”,³ it is important to note that several earlier attempts have been made to define the principles of the Barnahus model, or of similar arrangements of multiagency work for victimised children (e.g. Save the Children Sweden 2009; Council of Europe 2010; Danish National Board of Social Services 2015; POD 2016; National Children’s Alliance 2017). From this perspective, the European standards could be interpreted as adding to the list of a softer form of policy-making and standard setting related to the Barnahus model. However, we interpret the ambition behind the creation of the European standards as more comprehensive and as a legitimising and standardising source for stakeholders and practitioners, not only in the ongoing European diffusion but also translated back to the Nordic region. For example, PROMISE offers help with language translation of the standards. Currently, the European standards are being translated into Bulgarian, Estonian, Finnish, German, Greek, Hungarian, Romanian and Swedish.⁴

The diffusion of ideas is closely linked with and sometimes hard to differentiate from policy making, standard setting and transnational regulation more broadly (Djelic and Sahlin-Andersson 2006, 17–18; Johansson 2016). Even if it was not the case when the model was first introduced in the Nordic region, it has gradually become harder to think of the Barnahus model as something separate from all the policies and regulations surrounding it. These regulations are also part of the PROMISE initiative’s storytelling when narrating the Barnahus model as a success story and promoting its diffusion throughout Europe and beyond. International and European (hard) regulations, together with soft regulations on both national and European levels, are drawn on to legitimise and support the evidence base of the Barnahus model. The “PROMISE Compendium of Law and Guidance” (O’Donnell n.d.) is a clear marker, intended to provide authoritative guidance and narrated as legal support (read “evidence”) for the Barnahus work. The compendium provides an overview of central legal frameworks such as the Victims’ Rights Directive, the Child Sexual Abuse Directive, the Trafficking Directive, the Council of Europe Trafficking Convention, the Lanzarote Convention, Optional Protocol to the UNCRC on the sale of children, and the Palermo Convention, to “show the way and extent to which each instrument contains particular obligations to child victims and witnesses of violence”.⁵ As argued in the compendium:

European Union (EU) and international laws, in particular, the Council of Europe and UN laws, establish important legal obligations for addressing the needs and rights of child victims or witnesses of violence, through instruments concerning criminal justice proceedings and/or children’s rights, including the right of a child to protection from violence. Authoritative guidance from the EU, the Council of Europe, and the UN also play an important role. They help legal professionals, including judges, with the interpretation of the law; they support policy makers in establishing processes to respect and fulfil these obligations; and they support practicioners in their daily work. (O’Donnell n.d, 3)

The regulations seem to play the important role of legitimising mechanisms and innovation drivers in the continuous diffusion process of the Barnahus model in Europe. However, we know quite little about the actual impact of the different regulations, if by impact we mean how they (may) influence the actual implementation of the model and the wider institutional and legislative context that the model relates to and depends upon.

Discussion: incremental change or radical transformation?

In the Nordic countries, the Barnahus model now has a twenty-year history. In terms of diffusion, it is a definitive success; it is established throughout the Nordic region and has become a self-evident part of the institutional landscape related to violence and abuse of children. Moreover, a distinct professional field related to the Barnahus model has emerged (cf. Stefansen et al. 2017). The model has “progressed from the margins to the mainstream”, to use Mulgan (2006, 145) formulation. This differs markedly from the situation in other European countries that have shown interest in the model, where the Barnahus model largely remains at the margins. Whether the model will diffuse and scale up within the broader European context is very much an open question. According to Mulgan (2006, 154), two necessary conditions for scaling up are a propitious environment and an organisational capacity to grow. As we have shown, in the Nordic countries these conditions have largely been present, but the conditions will most likely differ across Europe, which includes countries with substantial differences in culture, economy, institutional environments and welfare systems for child protection and criminal justice.

With respect to the institutional and contextual background in the Nordic countries, our interpretation is that the Barnahus model represents in many ways a continuation of broader discourses and policy developments rather than a clear break with them. It is, for instance, premised on the principle of zero tolerance for violence and abuse of children, present in national legislation since the 1970s, and the principle that victimised children should be protected from giving testimony in open court, which has a long history in the Nordic region. It is also premised on the existence of extensive child protection and support services for victimised children. In terms of recognising the violence and abuse of children as a social problem, children’s rights in general and the needs of child victims for special measures and psychosocial support, the implementation of the model is in a sense a result of broader cultural changes rather than a catalyst for change. The model can thus be understood as a form of incremental change or evolution. It does not radically transform the state’s role and responsibilities in child abuse cases. As a social innovation, it rests within an institutional structure formed by previous policies and regulatory changes.

However, there are also evidence of institutional changes in terms of policy-making that followed the implementation of the Barnahus model within the Nordic region. Changes in national regulations have followed that differ between the Nordic countries. In both Iceland, Sweden and Norway the model was introduced without any specific Barnahus regulation or national legislative changes connected to the implementation. Gradually, changes have been made in procedural law, as well as amendments concerning forensic interviews and national guidlines for Barnahus in Norway. In Iceland, institutional changes have followed through amendments in both social welfare legislation and criminal procedural law that are interpreted as supportive of the Barnahus operation, as well as guidelines and standards for the Barnahus practice. In Sweden, there have been issued national guidelines and criteria for Barnahus after the implementation, although not legally binding. While in Denmark, where the model was implemented a few years later than in Sweden and Norway, the establishment occured simultaneously with the implementation of a specific Barnahus law, changes in social welfare legislation and the issuing of quality standards (Johansson et al. 2017b).

Some of the institutional changes that are now implemented or under way in the Nordic national models result from transnational exchange among the Nordic countries, illustrating how ideas pertaining to the Barnahus model still travel in this context. One example is the evolving discussion and construction of the target group for the Barnahus model. Among the Nordic countries, the specific target group for Barnahus varies somewhat (see Johansson et al. 2017a; Johansson et al. 2017b, appendix), and it has changed during the diffusion process. In Iceland, for example, the target group was initially child victims of sexual abuse, but in 2015, inspired by the target groups in Sweden, Norway and Denmark, it came to include child victims of physical abuse and/or domestic violence. Still, it seems reasonable to view the change towards a more inclusive target group as representing a cumulative form of change rather than a radical transformation in itself. The same is the case for other forms of institutional change pertaining to the Barnahus model in the Nordic context.

How can we understand the transformative potential of the Barnahus model on the European level? First, it must be underlined that the European implementation process still is at an early stage, and needs to be further empirically investigated. An important difference compared to the longer tradition of successive policy development described for the Nordic phase of diffusion, is the fact that the regulations used as innovation drivers are at international and transnational levels instead of national legislation and policy reforms. How the implementation processes in specific European contexts will develop and (may) in turn influence national level policy-making is therefor still uncertain. However, some manifestations of the PROMISE network’s and broader European Barnahus Movement’s policy-making strategies do exist. At the homepage of PROMISE, country specific news regarding the European establishment and implementation of the Barnahus model are listed as “progress by country”. Information to read is, for example, several new Barnahus openings in European countries like Ireland, Spain, Poland, and Moldava; that a Hungarian Barnahus Act came into force 1 January 2019; that the legal frameworks around hearing the child in court is under review in Romania in accordance with the European Barnahus quality standards; that the Scottish government has committed to explore the application of Barnahus and aims to ensure that children do not have to give evidence in court. Also, the transnational policy transfer from the Nordic region to the European context is evident from the news given, for example illustrated by headlines like “Barnahus Linköping trains Cyprus on therapy models for cases of child abuse” and “Latvian police and psychologists receive training from Icelandic experts on forensic interviews of children at the Barnahus”. ⁶ This indicate that the policy-making strategy at the European level, currently focused on diffusion and establishment, may lead to more specific and potentially radical institutional changes in the form of changes in national-level laws, regulations, and welfare systems for child protection and criminal justice, including aspects like new structures for court proceedings regarding children’s testimonies, standards and methods for risk assessments, forensic interviewing, and therapy etc.

From what we have described above, the potential for radical changes following from the implementation of the Barnahus model might be stronger when challenges are more demanding. However, bearing in mind the historical legacy and successive policy changes in the Nordic region, radically new approaches to the problem of violence and abuse of children will most likely be a much longer process and not solely related to the implementation of the Barnahus model. Again, it is important to acknowledge the risk of large discrepancies between the idea and actual institutional changes, as well as the potential for desired and undesired transformations. The implementation and adaption of the Barnahus model in European contexts are evidently a highly important topic for further empirical research.

Conclusion

We conclude that the model – as a social innovation – can lead to manifold institutional changes, both incremental and radical, and both desired and undesired, depending on institutional circumstances and contextual conditions and on how the original idea is translated and adapted in different contexts. The implementation could also result in no or minimal changes, for instance if it leads to superficial implementations or if it faces serious resistance. The idea that the model itself represents a radical transformation is compelling, but a more nuanced account of its potential is necessary.

We thus stress the importance of acknowledging not only policy diffusion but also the implementation and actual institutional changes from a longer time perspective in the study of social innovations. By studying the diffusion and implementation of the Barnahus model in two different phases and contexts we illustrate how policy making is shaped transnationally, across time and space. Previous research has emphasised the power of narrative and stories in “framing” policies. Similarly, our analysis shows how the European phase of Barnahus diffusion and policy making is currently informed by storytelling, the important elements of which include not only the use of evidence from evaluations and research in Nordic contexts (cf. Stevens 2011), but also the engagement in standard setting and the flood of regulations created and transformed into a persuasive and authoritative form of support or “evidence” for the Barnahus model as an innovation and success. All the regulations surrounding the Barnahus model increasingly play an important and legitimising role in the diffusion process of the Barnahus model and in framing it as both a success story and a flexible and easily adaptable model. Yet, we still know very little about the actual impact of the different regulations associated with the Barnahus field, especially over time, on the institutional set-up and legislation that is integral to the Nordic Barnahus model. From this perspective, it is important to engage in further study and reflection on the role of regulations in the ongoing and continuous implementation phase in different contexts, European as well as Nordic.

Notes

1 See https://cor.europa.eu/en/events/Pages/Launching-the-European-Barnahus-Movement.aspx, accessed 13.07.2018; http://www.childrenatrisk.eu/promise/, accessed 10.04.2018.

2 http://www.childrenatrisk.eu/promise/, accessed 10.04.2018.

3 http://www.childrenatrisk.eu/promise/publications/, accessed 10.04.2018.

4 See http://www.childrenatrisk.eu/promise/publications/, accessed 17.07.2018.

5 http://www.childrenatrisk.eu/promise/lawandguidance/, accessed 12.02.2019.

6 http://www.childrenatrisk.eu/promise/eubarnahus/, accessed 14.02.2019.