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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United States Government Action Plan on Children in Adversity

United States Government, 19 Dec 2012

The Action Plan on Children in Adversity is the first government wide strategic guidance for U.S. Government international assistance for children. The goal of the Action Plan is to achieve a world in which all children grow up within protective family care and free from deprivation, exploitation, and danger. It has three principal objectives, with Objective 2 specifically focusing on the importance of promoting family care and prevention of family-child separation.

India: Annual Report of the Ministry of Women and Child Development

The Indian Ministry of Women and Child Development, 01 Dec 2012

In its Annual report (2011-2012), the Indian Ministry of Women and Child Development reports on progress in the implementation of the Integrated Child Protection Scheme (ICPS), a new policy and programmatic strategy that specifically articulates the need to move away in approach and services from over-reliance on institutional care and towards responses that support family based care.

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Belarus: System of Detection, Intervention, Care, and Rehabilitation of Children Under 3 with Special Needs

Elena Bogdan, Ministry of Health of the Republic of Belarus, 22 Nov 2012

This presentation to the 2012 Sofia Conference introduces social services available in Belarus for the identification, intervention, care, and rehabilitation of children under the age of 3 with disabilities, in order to prevent their abandonment and placement in institutions.

CEE/CIS: Child Care Systems Reforms in Eastern Europe and Central Asia: Why We Need to Focus on Children Below Three years

Jean-Claude Legrand, Senior Regional Advisor Child Protection, UNICEF CEE/CIS, 21 Nov 2012

This presentation to the 2012 Sofia Conference by Jean-Claude Legrand, Senior Regional Advisor Child Protection, UNICEF CEE/CIS, highlights the situation of children in formal care, with particular concern for children with disabilities, and recommends reform and policy initiatives to improve the childcare systems in Eastern Europe and Central Asia.

Croatia: Positive Communication and Engaged Parenting: Prevention of Institutionalization of Children with Disabilities

Danica Kramarić - Head of Sector for the Promotion and Protection, Croatian Ministry of Health, 21 Nov 2012

This presentation to the 2012 Sofia Conference by Danica Kramarić, Head of Sector for the Promotion and Protection of Health, Croatian Ministry of Health, introduces how positive communication and engaged parenting are key deterrants of the placement of children with disabilities in institutions.

Deinstitutionalization of Children in Bulgaria: Real and Irreversible

Darinka Yankova, Deputy Chairperson of the State Agency for Child Protection, 21 Nov 2012

This presentation to the 2012 Sofia Conference by Darinka Yankova, Deputy Chairperson of the State Agency for Child Protection addresses the challenges and the new vision for the deinstitutionalization of children in the Republic of Bulgaria.

Georgia: Achievements and Challenges in Deinstitutionalization of Children Below 3 years

Irakli Nadareishvili, Deputy Ministry, Ministry of Labor Health and Social Affairs of Georgia,, 20 Nov 2012

This presentation to the 2012 Sofia conference by Irakli Nadareishvili, Deputy Minister, Ministry of Labor Health and Social Affairs of Georgia, highlights the key initiatives of the deinstitutionalization and childcare system reform launched by Georgia in 2005, as well as the challenges faced in this process.

Moldova: Cooperation Between Ministries in Preventing Infant Mortality and Child Institutionalization

Valentina Buliga, Minister of Labor in Moldova, Social Protection and Family, 20 Nov 2012

This presentation to the 2012 Sofia Conference by Valentina Buliga, Minister of Labor in Moldova, Social Protection and Family, introduces Moldova's ongoing collaboration between the Ministry of Health and the Ministry of Labor to reduce infant mortality and the placement of children under the age of 3 in institutions.

Lignes directrices européennes communes sur la transition des soins en institution vers les soins de proximité

Groupe européen d’experts sur la transition des soins en institution vers les soins de proximité, 01 Nov 2012

Document d’orientation sur la mise en œuvre et le soutien d’une transition durable des soins en institution vers les soins de proximité et familiaux pour les enfants, les personnes handicapées, les personnes atteintes de problèmes de santé mentale et les personnes âgées en Europe.

National Survey of Institutions for Children in Rwanda

Hope and Homes for Children Rwanda, 01 Nov 2012

Hope and Homes for Children, in partnership with the Ministry of Gender and Family Promotion (MIGEPROF), has conducted a national survey of all institutions for children in Rwanda to obtain an accurate picture of the current institutional system and the children living within it which can be used to inform decision-making regarding the implementation of the reform strategy and provide a baseline against which progress can be measured in the future.