Effects of Institutional Care

Institutionalising children has been shown to cause a wide range of problems for their development, well-being and longer-term outcomes. Institutional care does not adequately provide the level of positive individual attention from consistent caregivers which is essential for the successful emotional, physical, mental, and social development of children. This is profoundly relevant for children under 3 years of age for whom institutional care has been shown to be especially damaging.

Common issues for children in institutional care are a significantly increased risk of sexual and physical abuse, a lack of stimulation, and harsh discipline. Children in institutions are less likely to attend school, and are frequently isolated from their traditional communities. Long periods in an institution make it harder for a child to assimilate back into a family and community, and deny them access to the life-long attachments and community support systems that family relationships and communities can provide. For funders and implementing bodies, care in the community is a significantly more effective and sustainable use of resources since it avoids the high maintenance costs of institutions, and prevents many of the problems posed by institutional care.

It is widely accepted that institutions should be used as a last resort only. Countries which have traditionally relied on institutional care are now transforming their institutions into small family style group homes and actively pursuing preferences for community-based care options based around small family style units. This policy shift is urgently required in HIV/AIDS affected countries which are taking a backward step in resorting to the use of institutions to care for children orphaned or affected by the disease.

The body of literature contained in this section provides in-depth explanations of the damaging effects of institutionalisation on children and provides recommendations for alterative community care options.

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Effect of Foster Care Intervention on Trajectories of General and Specific Psychopathology Among Children With Histories of Institutional Rearing

Mark Wade, Nathan A. Fox, Charles H. Zeanah, Charles A. Nelson - JAMA Psychiatry, 26 Sep 2018

The aim of this study was to examine trajectories of latent psychopathology factors—general (P), internalizing (INT), and externalizing (EXT)—among children reared in institutions and to evaluate whether randomization to foster care is associated with reductions in psychopathology from middle childhood through adolescence.

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Use of Hierarchical Measures of Psychopathology to Capture the Long (and Wide) Shadow of Early Deprivation in the Bucharest Early Intervention Project Analysis

Jonathan D. Schaefer - JAMA Psychiatry, 26 Sep 2018

It has long been recognized that early adversity represents a strong risk factor for the development of later psychopathology.

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Early Caregiver-Child Interaction and Children's Development: Lessons from the St. Petersburg-USA Orphanage Intervention Research Project

McCall RB, Groark CJ, Hawk BN, Julian MM, Merz EC, Rosas JM, Muhamedrahimov RJ, Palmov OI, Nikiforova NV - Clinical Child and Family Psychology Review, 08 Sep 2018

This study reviews a series of interrelated studies on the development of children residing in institutions (i.e., orphanages) in the Russian Federation or placed with families in the USA and the Russian Federation.

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Leaving alternative care: Building support systems for young people

Perera W.D.P. - Institutionalised Children Explorations and Beyond, 06 Sep 2018

This article from the Institutionalised Children Explorations and Beyond Special Issue on Aftercare explores the outcomes for young people who have transitioned out of alternative care and into independent living in Sri Lanka and the need for policy changes to better meet their needs.

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Mental and emotional health needs of orphaned and separated youth in New Delhi, India during transition into adulthood

Atluri Namratha, Pogula Mounika, Chandrashekar Riti, Ariely Sumedha Gupta - Institutionalised Children Explorations and Beyond, 06 Sep 2018

This study from the Institutionalised Children: Explorations and Beyond Special Issue on Aftercare describes the mental health outcomes and transition experiences of a group of young adults who are currently transitioning (aftercare) or have already transitioned (alumni) out of a residential care organisation for orphaned and separated children (OSC) in New Delhi, India.

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Lumos Stories: Together We Stared at the Moon

Lumos, 06 Sep 2018

This film from Lumos is about the people who know that there is an alternative to institutional care, and who are working hard to make it happen.

Are We Serving Orphans? How churches are transitioning to best-practice care

Ellen Livingood - Postings, 01 Sep 2018

This article by Ellen Livingood in Volume 13, Issue 9 of Postings describes the ways in which Christian churches and faith communities are moving away from orphanage volunteering to supporting other forms of care for children.

Children and adolescents in institutional care versus traditional families: a quality of life comparison in Japan

Takahiro Nakatomi, Shuhei Ichikawa, Hideki Wakabayashi, Yousuke C. Takemura - Health and Quality of Life Outcomes, 28 Jul 2018

This research compared the quality of life (QOL) of children and adolescents in Japan who live in Children’s Homes (CHs) with that of children and adolescents living in traditional families.

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The hazards of out-of-home care for children experiencing adverse home environments

Charles A Nelson - The Lancet, 26 Jul 2018

This article explores the impacts of two common forms of early childhood adversity, maltreatment and placement in institutional care, on children's behavioral, psychiatric, and physical health into adulthood.

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Nutritional Status of Children Residing at an Orphanage in Puducherry

Kannan K., Rajini S., Kameshvell C, Jayalakshmi G., Jenith, Karthikeya - Indian Journal of Public Health Research & Development, 21 Jul 2018

The aim of this study was to assess the nutritional status of children residing at an orphanage.

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