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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Transforming Orphanage Care: A Case Example in Zimbabwe

Devi Dee, 2004

An informal evaluation of an NGO residential institution in Zimbabwe, based on the opinions of the child residents. Includes recommendations for the improvement of residential care.

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Children in Residential Care: The Zimbabwean Experience

G. Powell, T. Chinake, D. Mudzinge, W. Maambira, and S. Mukutiri, 2004

Analyzes the state of institutional care in Zimbabwe against the national child protection policy. Focuses on the role of donors in the proliferation of institutional care and strategies to better regulate the development and provision of child protection services.

Stockholm Declaration on Children and Residential Care

Participants of the second international conference on Children and Residential Care, 15 May 2003

This document represents the agreements made at the Second International Conference on Children and Residential Care in Stockholm, Sweden, held from 12 to 15 May, 2003. The conference was sponsored by the Swedish Foreign Ministry and the Swedish International Development and Co-operation Agency (Sida). The document includes the principles and actions, regarding children and residential care, that were agreed upon by the participants at the conference.

Children Deprived of Parental Care in Afghanistan - Whose Responsibility?

Westwater International Partnerships, 2003

Situation analysis of Afghan children living in institutional care. Includes detailed recommendations for strengthening policies and services in the child welfare system.

Mapping the number and characteristics of children under three in institutions across Europe at risk of harm

Professor Kevin Browne and Dr Catherine Hamilton-Giachritsis, 2003

This 15-month project aimed to map the number and characteristics of children under three placed in European institutions for more than three months without a parent as this information was previously unknown.

Changing Minds, Policies and Lives: Redirecting Resources to Community-Based Services

Andy Bilson, Louise Fox, Ragnar Gotestam, and Judith Harwin, 2003

Provides an overview of social service provision in Eastern Europe and Central Asia, and provides information on ways to move resources away from institutional care, and into community-based social services. Contains specific examples from Latvia, Iceland, Sweden, Romania and other transitioning countries.

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.