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 Care and Protection of Children Affected by Armed Conflict and Disasters

David K Tolfree, 2003

Overview of a research study which provides guidelines for care of separated children in large-scale emergencies, focusing on the negative impact of residential care, extended family care, spontaneous and agency fostering, adoption, and alternative placements for adolescents.

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.

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.

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.

Child Maltreatment in Out of Home Care: What Do We Know Now?

Gail Tittle, MSW; John Poertner, DSW; Philip Garnier, PhD, 01 Dec 2001

This study, conducted by the Children and Family Research Center at the University of Illinois, examines the prevalence, nature, and circumstances of child maltreatment in out-of-home care, with a focus on identifying cases that occurred prior to