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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Effects of an Intervention to Promote Socioemotional Development in Terms of Attachment Security: A Study In Early Institutionalization in Chile

Felipe Lecannelier, Jaime R. Silva, Marianela Hoffmann, Rolando Melo and Raquel Morales, 12 Mar 2014

Infant Mental Health Journal has published an important Special Issue on Global Research, Practice, and Policy Issues in the Care of Infants and Young Children at Risk. This article reports on a quasi-experimental study commissioned by the Chilean government that had two general aims: (a) to assess infants’ psychoaffective developmental levels and (b) to evaluate whether an intervention based on the promotion of socioemotional development modifies the infant's psychoaffective development.

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Psychopathology in Young Children in Two Types of Foster Care Following Institutional Rearing (Romania)

Florin Tibu, Kathryn L. Humphreys, Nathan A. Fox, Charles A. Nelson and Charles H. Zeanah, 12 Mar 2014

Infant Mental Health Journal has published an important Special Issue on Global Research, Practice, and Policy Issues in the Care of Infants and Young Children at Risk. In this study the authors assessed internalizing disorders, externalizing disorders, and attention deficit hyperactivity disorder (ADHD) in 54-month-old children living with foster families in Bucharest, Romania.

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Global Research, Practice, and Policy Issues on the Care of Infants and Young Children at Risk: The Articles in Context

Robert B. McCall, Christina J. Groark and Niels P. Rygaard, 12 Mar 2014

This introductory article of a Special Issue of Infant Mental Health Journal on Global Research, Practice, and Policy Issues in the Care of Infants and Young Children at Risk provides a useful overview, placing the articles in the broader contexts of research on institutionalized children and different initiatives to prevent inappropriate care, either through addressing the quality of the care provided or ensuring the appropriateness of the type of care environment provided.

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Maltreatment and Mental Health in Institutional Care—Comparing Early and Late Institutionalized Children in Tanzania

Katharin Hermenau, Tobias Hecker, Thomas Elbert and Martina Ruf-Leuschner, 12 Mar 2014

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From Maid to Mother: Transforming Facilities, Staff Training, and Caregiver Dignity in an Institutional Facility for Young Children in Nepal

Amy Conley Wright, Dhirendra Lamsal, Mukunda Ksetree, Aalok Sharma and Kenneth Jaffe, 11 Mar 2014

Infant Mental Health Journal has published an important Special Issue on Global Research, Practice, and Policy Issues in the Care of Infants and Young Children at Risk. This article provides a case study of a project to improve the health, safety, and development of children birth to 6 years old in a large orphanage in Nepal.

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Residential Care for Abandoned Children and their Integration into a Family-Based Setting in Uganda: Lessons for Policy and Programming

Eddy J. Walakira, Eric A. Ochen, Paul Bukuluki and Sue Alllan, 11 Mar 2014

Infant Mental Health Journal has published an important Special Issue on Global Research, Practice, and Policy Issues in the Care of Infants and Young Children at Risk. This article describes a model of care for abandoned and neglected infants in need of urgent physical, social, and medical support as implemented by the Child's i Foundation, an international, nongovernmental organization operating in Uganda.

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The Right of Boys and Girls to a Family. Alternative Care. Ending Institutionalization in the Americas

Inter-American Commission of Human Rights, 05 Mar 2014

This report by the Inter-American Commission on Human Rights (IACHR) analyzes children’s right to live and be raised by their families, and establishes the resulting obligations for States when it comes to supporting and strengthening families’ ability to raise and care for their children.

Better Care Network Strategic Plan 2014 - 2017

Better Care Network, 28 Feb 2014

In 2013, Better Care Network (BCN) initiated an important process of developing a new Strategic Plan identifying the main strategic focus for its work over the next four years (2014-2017). The plan is based on an analysis of BCN’s achievements to date, the strategic areas in which BCN can have most impact in the future by working with key actors to strengthen the response to children without adequate family care.

Save the Children: Position Statement on Families

Save the Children, 28 Feb 2014

This position statement by Save the Children highlights the central place of families in numerous international legal instruments and how the concept has been understood. It also clarifies its own understanding of families and reviews key provisions under international law regarding their crucial role and responsibilities, and that of States towards them.

Children's Reintegration: Longitudinal study of children's reintegration in Moldova

Dr Helen Baños Smith, 28 Feb 2014

This important report documents a 22-month longitudinal study of the reintegration of children in residential care in Moldova.