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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Global Charter on Children’s Care Reform: Child Friendly Version

U.K. Foreign Commonwealth and Development Office and Global Campaign on Children's Care Reform Working Group, 25 Aug 2025

In January 2025, the Foreign Secretary of the United Kingdom launched a bold an

Institutions: accountability as a key to reforming children’s alternative care

Jennifer Davidson, 04 Jul 2025

Drawing on the panel and discussions at the Global Study’s Global Conference on Justice for Children Deprived of Liberty 2024 Geneva event, this chapter outlines key elements required for deinstitutionalisation for effective children’s care reforms that are accountable to children. It proposes a two-pronged approach of systems change reforms reinforced by accountability mechanisms to achieve this for children in institutions specifically for care purposes.

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Formative and Summative Evaluation of the Childcare and Deinstitutionalization Reforms

UNICEF and Coram International, 01 Jul 2025

This report presents the main findings, conclusions, and recommendations of a formative and summative evaluation of the childcare and deinstitutionalisation reforms in North Macedonia for the period of 2009 2022. The evaluation was commissioned by the United Nations Children’s Fund (UNICEF) Europe and Central Asia Region Office (ECARO), as part of its multi-country evaluation of the impact of national child care reforms across eight1 countries in Europe and Central Asia and was conducted by Coram International.

Child Sponsorship and Transition: Interview with Laura Horvath - Helping Children Worldwide

Better Care Network, Transforming Children's Care Collaborative, Helping Children Worldwide, 30 Sep 2024

In this interview, BCN’s Senior Technical Advisor, Rebecca Nhep, speaks with Laura Horvath, from Helping Children Worldwide, about the impact of child sponsorship programs on the transition of residential care services and post transition family strengthening programs.

Kenya Conference of Catholic Bishops Support for Care Reform: Situational Analysis of Catholic Church Children’s Charitable Institutions in the Archdiocese of Kisumu and Mombasa: Summary Report

Changing the Way We Care, 26 Sep 2024

This study aimed to gather data on Catholic Church Children’s Charitable Institutions (CCI) operations in Kenya, the children they serve, and the challenges they face, to inform future care reform strategies.

Podcast: Why the Move from Orphanages to Family Homes is an African Ideal - Revolutionizing Child Welfare in Sierra Leone

Helping Children Worldwide, Laura Horvath, Emmanuel M. Nabieu, Yasmine Vaughan, Melody Curtiss, 07 Jul 2024

Listen to transition support experts David Musa and Yatta Palmer of the Child Reintegration Centre (CRC) explain how transition is getting more children home to family and learn about the challenges, successes, and the powerful role of the CRC in revolutionizing child welfare in Sierra Leone.

Why the Move from Orphanages to Family Homes is an African Ideal: Revolutionizing Child Welfare in Sierra Leone

A avaliação e gestão de caso no contexto das reformas dos cuidados alternativos na África Oriental e Austral

Changing the Way We Care, 30 Jun 2024

Este artigo explora o papel da avaliação e gestão de caso no contexto das reformas do sistema de cuidados alternativos. Oferece princípios transversais de boas práticas, as etapas essenciais e descreve os fatores críticos envolvidos nas práticas de avaliação e gestão de caso eficazes. Baseando-se na literatura da região, o artigo visa fornecer uma orientação abrangente aos profissionais e às partes interessadas envolvidas nos cuidados, no bem-estar e na proteção das crianças. O anexo fornece detalhes dos recursos de avaliação e gestão de caso da região da África Oriental e Austral e também em outros lugares.

Child Sponsorship and Transitioning Residential Care Services

Better Care Network, Transforming Children's Care Collaborative, Casa Viva, 30 Jun 2024

In this interview, BCN’s Senior Technical Advisor, Rebecca Nhep, speaks with Phil Aspegren, Founder of Casa Viva, about transitioning residential care services with child sponsorship funding models.

International Conference: Child Protection and Care Reform in the Context of Moldova

Changing the Way We Care, UNICEF, CCF Moldova, Moldova Ministry of Labor and Social Protection, Keystone Moldova, Partnerships for Every Child, 15 May 2024

The Moldova Ministry of Labor and Social Protection, in cooperation with CTWWC Moldova and local partner CCF Moldova, organized an international conference on March 21, 2024. More than 100 participants, representing the wide array of care reform actors and decision makers in the central and local government, NGOs, academia and international experts, reviewed findings of the Bucharest Early Intervention Project and national research conducted in 2023 on the potential for a moratorium on placing children 0-6 in institutional care.

International Conference: Child Protection and Care Reform in the Context of Moldova – EU Association Agenda

POLICY BRIEF: Ending the Placement of Children Aged 0-6 Years in Residential Care in the Republic of Moldova

Changing the Way We Care, 13 May 2024

This is a tool that ensures all components of child protective care: health, adequate nutrition, care, safety and early education, through the intersectoral collaboration between the Ministry of Labor and Social Protection, the Ministry of Health, the Ministry of Education and Research and local public administration authorities.