Transforming Institutional Care

The detrimental effects of institutional care on a child’s well-being are widely documented. Community 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. Institutional care should only be used as a short-term last resort for children over the age of 3, when all other options have been exhausted.

Countries which have traditionally relied on institutional care are now undergoing major transformations to their child care and social welfare policies, in order to move towards community care options. Such transformations are rooted in the research-based evidence of the impact of institutions on a child’s development, vulnerability to abuse within institutional settings, and the institution's high operational costs. It is therefore of great concern that the use of institutions 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 community rather than institutional care.

Institutions should be divided into small group homes in order to provide care which more closely resembles a family structure, with the close supervision of consistent adult caretakers, and with siblings, cousins and friends kept together. Adolescents, who may find integration into a new family difficult, may benefit from small group home care or supported independent living arrangements. Such homes should be fully integrated in the community to which the children belong, with a comparable standard of living. Any group home 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.

Any child in an institution 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.

The literature in this section deals with examples of countries which are working to develop their child care policies away from using large scale institutions to alternative community care options such as kinship care, fostering, and small group homes.

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Nutritional Status Assessment of Orphanage Children in Rawalpindi

Mehwish Riaz, Naila Azam, Humaira Mehmood, Raima Asif, Nazish Khan, Fatima Ali Raza Mughal, 31 Dec 2022

The objective of the study was to evaluate the health and nutritional status of four registered orphanages of Rawalpindi, to find frequency of nutritional deficiencies by physical examination findings and to assess their dietary intake and contrast it with individual recommended daily allowances.

Emotional Psychological Impact of Institutionalization on Children and Early Adolescents

María del Carmen Manzo Chávez, 2022

The causes of institutionalization are multiple and the impact it causes is reflected in different areas such as the development of the child in general, such as mental, psychic structuring, health, and nutrition. Psychologically, children present alterations in their cognitive, emotional, sexual, and social domains with a high probability of developing several pathological conditions. This chapter presents an overview of this phenomenon based on several research investigations carried out in Spain, Latin America, and Mexico.

Child and Adolescent Development in Risky Adverse Contexts

Transitioning Residential Care Services Video Case Studies

Better Care Network in partnership with Kinnected, 14 Dec 2021

These video case studies were developed as a part of the Transitioning Models of Care As

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

Beyond Institutional Care: A roadmap for child protection and care system reform for governments in Latin America and the Caribbean

Hope and Homes for Children, 01 Dec 2021

This report provides a framework for governments to develop their own roadmap for child protection and care system reform and deinstitutionalisation. The authors hope that it will inspire a conversation, guide inter-ministerial and cross society dialogue, support multidisciplinary groups at all levels to frame their own assessment, and plan their own roadmap for change.

Changing the Way We Care in Guatemala

Changing the Way We Care Guatemala, 01 Dec 2021

This two-pager highlights 2018-2020 results of the The Changing the Way We Care℠ (CTWWC) initiative for decision makers, government officials, media, other institutions or organizations working with children and adolescents, and private and public counterparts. CTWWC was formed in 2018 to transform care systems and demonstrate sustainable change at scale in 5 to 7 countries, including Guatemala, Kenya, Moldova, India, and Haiti. In Guatemala and around the world, more than 80-90% of children and adolescents living in orphanages (referred to as “protection homes” in Guatemala) have at least one living parent.