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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Designing Research to Study the Effects of Institutionalization on Brain and Behavioral Development: The Bucharest Early Intervention Project

Charles H. Zeanah, Charles A. Nelson, Nathan A. Fox, Anna T. Smyke, Peter Marshall, Susan W. Parker, Sebastian Koga, 2003

This paper provides an overview of the largest longitudinal investigation of institutionalized children less than 2 years old ever conducted. The Bucharest Early Intervention Project is an ongoing randomized controlled trial of foster placement as an alternative to institutionalization in abandoned infants and toddlers being conducted in Bucharest, Romania.

Participation, Rights and Children in Care in China

Andy West, 2003

This paper defines concepts and highlights key topics around orphaned and vulnerable children. It stresses the importance of creating a child-friendly environment and utilizing a holistic approach to care, both which identify children as central participants in decision-making about care and placement.

A Last Resort: A Growing Concern About Children in Residential Care

Andrew Dunn, Elizabeth Jareg, and Douglas Webb, 2003

This paper outlines the International Save the Children Alliance’s position on residential care. It addresses the proliferation of residential care, its negative impact on children and the need for international attention. The paper presents the work of Save the Children and other agencies in order to highlight relevent issues and to provide a guide for those working with separated children.

Investigation into the Condition of Shelters in Rio de Janeiro

Brazilian Association Terra dos Homens (ABTH) and Exola, 2003

This research study provides statistical information on institutional care of children under the age of 12 in Rio de Janeiro, Brazil. Interviews with institutions and children are conducted, and reasons for separation from family, length of time in care, status of family relationship, religious orientation and financial support of the institutions are highlighted.

Leave No Child Out Campaign

NGO/UNICEF Regional Network for Children (RNC), 2002

This paper examines the negative impact of institutional care in central eastern Europe, the Commonwealth of Independent States and the Baltics region. It promotes community-based care alternatives and provides statistics. It also includes a list of useful resources addressing orphaned and vulnerable children.

Institutions vs. Foster Homes: The Empirical Base for a Century of Action

Richard P. Barth , 2002

A review of institutional care and family-centered care with a discussion of both positive and negative aspects of group care. This review paper is primarily focused on showing the inefficacy of group care and recommending other forms of care such as kinship care and even foster care as options that are more cost effective and better for children’s development.

Reunification and Reintegration (De-Institutionalization) of Children in Ethiopia

Jerusalem Association Children’s Homes, 2002

This paper provides a guideline for the implementation of reunification and reintegration programs for agencies providing institutional care for orphans. It outlines the different strategies and activities an organization in Ethiopia used to transition from institutional care to community-based childcare projects.

Children in Residential Care and Alternatives: Children at Risk Guidelines (Volume 5)

Glen Miles and Paul Stevenson, 2001

A series that provides a framework for good practice and guidelines for those who work in the area of child development policy. The series delves particularly into residential care and other alternatives of care and makes suggestions for reform by evaluating 6 case studies of good practice examples.

Children and Disability in the Context of Family Breakdown in Central and South Eastern Europe and the Former Soviet Union

Elayn Sammon, 2001

A study on children with disabilities in the context of family breakdown. Includes overviews and statistics from 10 countries, a call for strengthened family support services, and draft guidelines on how child agencies can better mainstream these issues into their work.

Rwanda Country Report

2001

Country report of Rwanda on the situation of children in residential care in anticipation of the Second International Conference on Children and Residential Care: New Strategies for a New Millennium, to be held in Stockholm 12 – 15 May 2003.