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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Selected Innovations and Lessons Learned from UNICEF Programme Cooperation

UNICEF , 20 Jan 2011

Particularly relevant to alternative care issues is the highlighted section on the Bulgarian experience of integrating advocacy, fundraising and communication in order to influence the deinstitutionalization of children without parental care in Bulgaria.

Reforming the Romanian Child Welfare System: 1990 - 2010

Adrian V. Rus, Sheri Parris, David Cross, Karyn Purvis, Simona Draghici - Revista de cercetare si interventie social, 2011

This article reviews the series of major changes undergone by the Romanian child welfare system from 1990 to 2010, including the laws and governmental reform measures enacted, the shift in child population among various Romanian institutions and foster care homes, types of institutions available to children, level of care, shift in reasons for child abandonment, changes in ways children are routed through the system, and how these changes have effect children’s development, health, and psychological well-being.

Child Protection in the Philippines: A Situational Analysis

Save the Children , 2011

This situational analysis was commissioned by the Child Protection Initiative as a preliminary exercise to develop evidence-based recommendations to guide Save the Children in the Philippines to develop interventions. Priority areas are children in residential care, children in armed conflict and disasters, children in situations of migration (including for trafficking purposes), and children in exploitative and hazardous work conditions.

Push and Pull Factors of Institutionalization of Children: A Study Based in the Eastern Province of Sri Lanka

Nirekha De Silva and Asitha G. Punchihewa , 2011

This research on the institutionalization of children in the Eastern Province of Sri Lanka was carried out by Save the Children with the support of the Department of Probation and Children Care Services and National Institute of Social Development.

Cabinet Brief: Strategy for National Child Care Reform

The Ministry of Gender and Family Promotion (MIGEPROF), Rwanda, 2011

This brief was prepared by the Rwandan Ministry of Gender and Family Promotion (MIGEPROF), requesting the Cabinet to approve the proposed child care reform strategy and to support its implementation.

World Report on Disability 2011

World Health Organization (WHO) and the World Bank, 2011

The first ever World report on disability, produced jointly by WHO and the World Bank, suggests that more than a billion people in the world today experience disability. This report provides the best available evidence about what works to overcome barriers to health care, rehabilitation, education, employment, and support services, and to create the environments which will enable people with disabilities to flourish. The report ends with a concrete set of recommended actions for governments and their partners.

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The Rights of Vulnerable Children Under the Age of Three: Ending their placement in institutional care

Dainius Puras - The Regional Office for Europe of the Office of the United Nations High Commissioner for Human Rights (ROE OHCHR), 2011

This document was commissioned by the Regional Office for Europe of the Office of the United Nations High Commissioner for Human Rights (ROE OHCHR). One of its aims was to stimulate discussion at the Sub-Regional Workshop on the Rights of Vulnerable Children Aged 0 to 3 Years in Prague on 22 November 2011.

Children without Appropriate Care: Participant Manual for Asia and the Pacific

Louise Melville Fulford, 31 Dec 2010

This manual offers a training session targeted at policy makers, professionals and paraprofessionals who are already working on programs to support children without appropriate care, or who may begin work in this area. This workshop focuses on children in developing contexts, who require support within their families and those who need an alternative care placement.

Better health, better lives: children and young people with intellectual disabilities and their families

World Health Organization, Regional Office for Europe, 07 Nov 2010

The purpose of this paper is to provide background information and offer pragmatic steps in relation to priority no. 3 of the European Declaration on the Health of Children and Young People with Intellectual Disabilities and their Families: “To transfer care from institutions to the community”. The paper was produced in preparation for the conference in Bucharest, Romania 26-27 November, 2010.

Improving Care Options for Children in Ethiopia through Understanding Institutional Child Care and Factors Driving Institutionalization

Family Health International , 01 Jun 2010

Findings and recommendations of the first national study of its kind in Ethiopia to study child care institutions, institutionalized children, and factors driving institutionalization.