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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The relationship between institutional care and the international adoption of children in Europe

Kevin Browne and Shihning Chou, 2008

The study reported by Shihning Chou and Kevin Browne explored the link between institutional care for young children and international adoption, using a survey of 33 European countries. The evidence suggests that, rather than reduce the number of children in institutions, international adoption may contribute to the continuation of this harmful practice. A child rights-based approach to providing alternative care for children separated from their parents is proposed.

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Home Truths: The Phenomenon of Residential Care for Children in a Time of AIDS

Helen Meintjes, Sue Moses, Lizette Berry, Ruth Mampane, 24 Aug 2007

A report on residential care in South Africa in the context of AIDS and an under-resourced social welfare sector.

Sudan: Technical Briefing Paper on Alternative Family Care

UNICEF, 24 Aug 2007

Examines the work of UNICEF Sudan and its partners in addressing the issue of abandonment of babies, institutional care, and the process undertaken since 2003 to develop alternative family care programmes.

Deinstitutionalising and Transforming Children's Services: A Guide to Good Practice

European Commission Daphne Programme in collaboration with WHO Regional Office for Europe and the University of Birmingham, UK, 01 Jul 2007

A clear, concise, and evidence-based summary of the effects of institutional care on children. Identifies key steps to transforming children's services to promote alternative care. Links to training resources at European Union Daphne Project website.

Caring about Poverty

Bilson, A. & Cox, P. , 01 Apr 2007

Examines practice of using institutional care for children in poverty and recommends alternative responses to maintain families.

http://www.crin.org/docs/Caring%20About%20Poverty.pdf

Human Rights in Liberia’s Orphanages

UN Mission in Liberia (UNMIL), 01 Mar 2007

The aim of this report is to review international human rights norms as well as Liberian legislation, and to assess the compliance of orphanages with those standards.

Trialing Gatekeeping Systems in Azerbaijan

United Aid for Azerbaijan (UAFA), 01 Feb 2007

Documents implementation of Azerbaijan's national de-institutionalisation and alternative care programming

Someone that Matters: The Quality of Care in Childcare Institutions in Indonesia

Florence Martin and Tata Sudrajat, Save the Children, Indonesia Ministry of Social Affairs, UNICEF, 07 Jan 2007

Comprehensive evaluation of national responses and level of care standards for children without parental care in Indonesia.

Assessment of HIV/AIDS Vulnerability, Responses, and STI/HIV Prevention, Care, and Support Needs of Institutionalized Children in Vietnam

Jan de Lind van Wijngaarden, 2007

Qualitatively assesses the vulnerability of children living in institutional care in Vietnam. Includes specific recommendations for systems strengthening to reduce vulnerability in various institutional contexts.

Community and Family Models of Care for Orphans and Vulnerable Children in Africa

Jon Singletary, 2007

Unites scripture and evidence to help guide North American Christians in responding the needs of children affected by HIV/AIDS. Identifies the shortcomings of institutional care and outlines specific and better alternatives available for supporting children in Africa. Highlights related resources for follow-up.