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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Study of the Responses by Faith-based Organizations to Orphans and Vulnerable Children

Geoff Foster, 2006

A study that looks at the response of faith-based organizations in Kenya, Malawi, Mozambique, Namibia, Swaziland, and Uganda. The report contains statistical information, and details positive care practices to build on, and negative examples to avoid.

Focus on the Right of Children with Disabilities to Live in the Community

Ines Bulic, Geert Freyhoff, Judith Klein, and Camilla Parker, 2006

Advocates for the right of children with disabilities to live in the community. Provides recommendations on how to ensure a successful transition from institutional to community-based care. Focuses on the importance of family support and the right to education.

Provisional Protective Measures: The Principles to Be Observed During the Institutionalization of a Child (1 of 3)

International Social Service and International Reference Center for the Rights of Children Deprived of their Family (ISS/IRC), 2006

A brief 2-page overview of what steps should be taken if and when a social worker or other community worker admits a child to a residential institution.

Home Truths: Children's Rights in Institutional Care in Sri Lanka

International Save the Children Alliance, 31 Dec 2005

Results of a survey examining the quality of institutional care in Sri Lanka. Highlights gaps in existing policies and procedures.

Positively Abandoned: Stigma and Discrimination against HIV-Positive Mothers and their Children in Russia

Human Rights Watch, 01 Jun 2005

Russia is home to one of the fastest-growing AIDS epidemics in the world, but the government has done little to address the problem.

Study of Children in Children's Homes in Nepal: Volume 1: Main Text

Rabi Bhawan, 2005

Reports on the status of children living in residential facilities in Nepal. Includes detailed survey instruments in appendicies.

Protecting the Rights of Children in Residential Care: Uncovering a Culture of Abuse

Jacqueline Ramdatt, 2005

Describes and analyses abuse in institutional care using a case study of a home for girls in the developed world.

A European survey of the number and characteristics of children less than three years old in residential care at risk of harm

Kevin Browne , 2005

This report presents the survey Kevin Browne and colleagues conducted in 33 European countries to identify the number and characteristics of children less than three placed in residential care without their parents for more than three months during the year ending December 31, 2003. The purpose was to assess the rate and cost of residential care as a response to children in adversity.

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The Promise of a Future: Strengthening Family and Community Care for Orphans and Vulnerable Children in Sub-Saharan Africa

Kerry Olson, Ruth Messinger, Laura Sutherland, and Jennifer Astone , 2005

A brief document advocating for the strengthening and support of community based responses to children and families affected by HIV/AIDS in Africa.

Capacity Building in Social Policy Reform in Moldova

David Larter and Eugenia Veveritsa , 2005

This paper analyses the financial costs of residential services as compared to community-based services in Moldova. It also addresses the negative effects of institutional care on the well-being of children and society as a whole.

Cost Benefit Analysis of Children in Care - Moldova.doc