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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A Last Resort: A Growing Concern About Children in Residential Care

Andrew Dunn, Elizabeth Jareg, and Douglas Webb, 2003

This paper outlines the International Save the Children Alliance’s position on residential care. It addresses the proliferation of residential care, its negative impact on children and the need for international attention. The paper presents the work of Save the Children and other agencies in order to highlight relevent issues and to provide a guide for those working with separated children.

Changing Minds, Policies and Lives: Redirecting Resources to Community-Based Services

Andy Bilson, Louise Fox, Ragnar Gotestam, and Judith Harwin, 2003

Provides an overview of social service provision in Eastern Europe and Central Asia, and provides information on ways to move resources away from institutional care, and into community-based social services. Contains specific examples from Latvia, Iceland, Sweden, Romania and other transitioning countries.

Investigation into the Condition of Shelters in Rio de Janeiro

Brazilian Association Terra dos Homens (ABTH) and Exola, 2003

This research study provides statistical information on institutional care of children under the age of 12 in Rio de Janeiro, Brazil. Interviews with institutions and children are conducted, and reasons for separation from family, length of time in care, status of family relationship, religious orientation and financial support of the institutions are highlighted.

Creating a Protective Environment For Children

Anna Nordenmark, 2003

This report is the result of a seminar held in Kazakhstan 2004. It focuses on social welfare sector reform, and includes topics such as expanding legislative agendas and financing frameworks, as well as gate keeping. Case studies of reform processes from Romania, Tajikistan and Serbia are discussed. Includes conference agenda.

Children Deprived of Parental Care in Afghanistan - Whose Responsibility?

Westwater International Partnerships, 2003

Situation analysis of Afghan children living in institutional care. Includes detailed recommendations for strengthening policies and services in the child welfare system.

Reunification and Reintegration (De-Institutionalization) of Children in Ethiopia

Jerusalem Association Children’s Homes, 2002

This paper provides a guideline for the implementation of reunification and reintegration programs for agencies providing institutional care for orphans. It outlines the different strategies and activities an organization in Ethiopia used to transition from institutional care to community-based childcare projects.

Lives Apart: Family Separation and Alternative Care Arrangements during El Salvador's Civil War

Ralph Sprenkels, 2002

This report details the situation of disappearing children during the El Salvadorian civil war. It describes the process of tracing and reunifying children with their families, as well as alternative care arrangements for separated children.

Institutions vs. Foster Homes: The Empirical Base for a Century of Action

Richard P. Barth , 2002

A review of institutional care and family-centered care with a discussion of both positive and negative aspects of group care. This review paper is primarily focused on showing the inefficacy of group care and recommending other forms of care such as kinship care and even foster care as options that are more cost effective and better for children’s development.

Romania's Abandoned Children Ten Years After the Revolution

U.S. Embassy Bucharest, Romania, 01 Feb 2001

An account of the massive child welfare crisis in Romania which erupted from a movement in Romania during its communist regime to institutionalize thousands of children. This paper also reports the efforts of NGO’s, PVO’s and the international communities to reverse the damage after the fall of communism and also where the efforts need to be directed.

A Participatory Review of the Reunification, Reintegration, and Youth Development Program of the International Rescue Committee in Rwanda

John Williamson, Jill Donahue, and Lynne Cripe, 2001

A paper describing a program developed by the IRC in Rwanda for orphans and vulnerable children and youth with a particular focus on minimizing placement of children into centers and finding durable solutions for those already in institutions. The paper discusses IRC’s strategies, and the different components of the program, evaluates the program in the context of Rwanda and offers recommendations to those interested in emulating IRC’s Rwanda program.