Ending Child Institutionalization

The detrimental effects of institutionalization on a child’s well-being are widely documented. Family based care alternatives such as kinship or foster care, are much more effective in providing care and protection for a child, and are sustainable options until family reunification can take place. The use of residential care should be strictly limited to specific cases where it may be necessary to provide temporary, specialized, quality care in a small group setting organized around the rights and needs of the child in a setting as close as possible to a family, and for the shortest possible period of time. The objective of such placement should be to contribute actively to the child’s reintegration with his/her family or, where this is not possible or in the best interests of the child, to secure his/her safe, stable, and nurturing care in an alternative family setting or supported independent living as young people transition to adulthood.

Countries which have traditionally relied on residential care are now undergoing major transformations to their child care and social welfare policies, in order to move towards family and community based care options. Such transformations are rooted in the research-based evidence of the impact of institutionalization on a child’s development, vulnerability to abuse within residential care settings, and the institution's high operational costs. It is therefore of great concern that the use of residential care is increasing in developing countries with high rates of HIV/AIDS. Such projects are typically funded by foreign donors to the detriment of the local population, and pressure should be placed on the host governments to pursue policies of family based care rather than residential care.

The use of residential care should be strictly limited to specific cases where it may be necessary to provide temporary, specialized, quality care in a small group setting organized around the rights and needs of the child in a setting as close as possible to a family, and for the shortest possible period of time. The objective of such placement should be to contribute actively to the child’s reintegration with his/her family or, where this is not possible or in the best interests of the child, to secure his/her safe, stable, and nurturing care in an alternative family setting or supported independent living as young people transition to adulthood.

Where the separation of parents and child is long-term, the alternative care arrangement should be family based to give the child a sense of security, continuity, stability and belonging by providing certainty on where the child will live for the rest of childhood and who the child’s parents or legal guardians will be. Keeping siblings, cousins and close friends together should be an important consideration in placement decisions. Adolescents, who may find integration into a new family difficult, may benefit from placement in supported independent living arrangements. These arrangements should be fully integrated in the community to which the children belong, with a comparable standard of living.

Any child in a residential care setting must have their needs assessed and planned for, to enable them to return to their families as soon as possible. If a child has become separated from her family in an emergency, documentation, tracing and reunification activities should begin urgently. If a child has been removed from parental care for her safety, support services should be provided to the parents in order to facilitate the return of the child. Children must be kept fully informed and involved in any plans for their care, and encouraged to maintain contact with known relatives where possible.

Residential care services must adhere to stringent standards of documentation and care and be regularly monitored by protection workers to ensure the children have their safety, health, psychosocial, and educational needs met.

The literature in this section deals with examples of countries which are working to develop their child care policies away from using residential care to alternative family care options such as kinship care, fostering, and adoption.

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Estudio de caso de una transición de alto riesgo: Lighthouse Children’s Village

Better Care Network and Kinnected, 01 Dec 2021

La Aldea Infantil Lighthouse se estableció en 2004 como una institución de atención residencial de gestión privada y financiada con fondos privados. En 2014, su donante principal desde hace mucho tiempo tomó la decisión de eliminar gradualmente la atención institucional de apoyo financiero. Este estudio de caso destaca algunas de las señales de advertencia tempranas y el posterior descubrimiento de comportamientos no éticos y delictivos que a veces se pueden observar en un proceso de transición.

Versión inglesa

Au-delà des soins en établissement: Feuille de route pour la réforme du système de protection et de prise en charge des enfants pour les gouvernements d’Amérique latine et des Caraïbes

Hope and Homes for Children, 01 Dec 2021

Au-delà des soins institutionnels fournit un cadre aux gouvernements pour développer leur propre feuille de route pour la réforme et la désinstitutionnalisation du système de protection et de garde des enfants. Nous espérons qu'il inspirera une conversation, guidera le dialogue interministériel et interprofessionnel, soutiendra les groupes multidisciplinaires à tous les niveaux pour encadrer leur propre évaluation et planifier leur propre feuille de route pour le changement.

Webinario: Más allá del cuidado institucional / Webinar: Beyond institutional care

UNICEF Latin America and Caribbean, 01 Dec 2021

Herramienta de Evaluación de Modelos de Atención en Transición

Rebecca Nhep and Hannah Won - Better Care Network & Kinnected, an intitiative of ACC International Relief, with support from Changing the Way We Care, 01 Dec 2021

Esta herramienta tiene como objetivo ayudar a los profesionales a lograr los siguientes objetivos al brindar apoyo técnico a las instituciones en transición:

Versión inglesa

Estudio de caso de las condiciones que conllevan a una transició n segura: Bridges Safehouse

Better Care Network and Kinnected, 01 Dec 2021

Este estudio de caso destaca algunos de los requisitos previos para el punto de partida de una transición exitosa de la atención residencial a un modelo no residencial, muchos de los cuales a menudo se pasan por alto o se subestiman. El estudio de caso se organiza en torno a las distintas etapas de la transición y explora algunos de los temas clave descritos en la Herramienta de evaluación de modelos de atención en transición.

Versión inglesa

Deinstitutionalization and Alternative Care Systems: A Case Study of Children Without Parental Care in Egypt

Amira Hossam Abdel Aziz, 25 Nov 2021

There are several studies that provide evidence for the negative effects of residential care for children. This chapter applies system analysis and child-centric approaches to assess the Children Alternative Care System (CACS) deinstitutionalization in Egypt.

Deinstitutionalization and Alternative Care Systems: A Case Study of Children Without Parental Care in Egypt

Put Children First: Recommendations to End Orphanage Volunteering and the Institutionalisation of Children

Put Children First: End Orphanage Care Campaign, 01 Nov 2021

Research has shown the harm of orphanage care on children’s health, development and wellbeing and how orphanage volunteering is working to perpetuate these institutional systems which separate children from their families and communities. There is now a global movement to end both practices. These key policy recommendations were published as part of the "Put Children First: End Orphanage Care" campaign.

Care Reform in Malawi: A Virtual Study Tour

Emily Delap of Child Frontiers, UNICEF Malawi country office, UNICEF ESARO, Changing the Way We Care, Government of Malawi, 01 Nov 2021

This virtual study tour aims to provide you with an overview of care reform in Malawi from the comfort of your own home. Care reform relates to the care of children. It refers to efforts to improve the legal and policy frameworks, structures, services, supports and resources that determine and deliver alternative care, prevent family separation and support families to care for children well.

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Bringing Donors Along on the Journey: A Preliminary Investigation of Organisational Strategies in Transitioning from Residential to Family Care for Children

Nicole Gilbertson Wilke, Amanda Hiles Howard, David King, Brian Carroll, 01 Oct 2021

The current article investigated the financial impact of transitioning to a family-based model of care, donor engagement practices used in this process, and changes in donor support resulting from the transition.

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Engaging Everyone in the Transformation - Child Rescue Centre and Helping Children Worldwide

Better Care Network and Helping Children WorldWide, 01 Sep 2021

The Child Rescue Centre was the first orphanage in Sierra Leone to successfully complete a transition from residential to family-based care. This case study highlights some of the key dynamics that arose throughout the transition of the orphanage and examines how those dynamics both influenced the transition and determined the type of support provided as well as the most appropriate transition strategy.