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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Someone that Matters

Save the Children, 2007

This video by Save the Children highlights key research findings from an assessment on the quality of care in children's homes in Indonesia (2007), jointly published with the Indonesian Ministry of Social Affairs and UNICEF.

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No Place Like Home: A Research Study of the Operations, Management, and Care Offered by Residential Facilities for Orphaned and Vulnerable Children

Built Environment Support Group, BESG, 2007

A study of the management, operations, and care offered by institutions for AIDS orphans in South Africa. It compares the findings of registered and unregistered institutions.

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.

De-institutionalising and Transforming Children's Services: A Guide to Good Practice

Georgette Mulheir & Kevin Browne, 2007

This good practice guide provides a comprehensive description of the steps involved in the process of moving from institutional care to community-based services.

Community Care or the Institution?

Daphetone Siame, 2007

Brief article observing the proliferation of orphanages in Zambia. Points to several models of community-based care as alternatives better able to address the rights and needs of children.

Caring for Orphaned, Abandoned and Maltreated Children: Bucharest Early Intervention Project - Powerpoint Presentation

Charles Nelson, Nathan Fox, Charles Zeanah, Dana Johnson, 2007

A powerpoint presentation on the research findings of the Bucharest Early Intervention Project team. Includes comparisons of children raised in institutional care, vs. children placed in foster care, vs. children raised in the community.

Enhanced Protection for Children Affected by AIDS: A Companion Paper to The OVC Framework

UNICEF, 31 Dec 2006

Outlines how to strengthen social protection, legal protection, and alternative care for children at country level. Contains specific actions that governments and NGO's can take to decrease the vulnerability of children affected by AIDS and respond to instances of abuse, exploitation and neglect.

Assessment and Analysis of the Situation of Children without Primary Caregivers in Vietnam

UNICEF Vietnam , 19 Dec 2006

Overview of institutional and alternative care for Children in Need of Special Protection in Vietnam

“Life Doesn’t Wait”: Romania’s Failure to Protect and Support Children and Youth Living with HIV

Human Rights Watch, 01 Aug 2006

This report by Human Rights Watch is based on field research conducted in Bacău, Bucharest, Constanţa, Giurgiu, and Ilfov counties in February 2006, and follow-up telephone and email contacts through June 2006.