This chapter from the book 'Rutter's Child and Adolescent Psychiatry' focuses on foster care and residential care practices around the world and the benefits and challenges of supporting foster care interventions, transitioning away from the use of institutional care.
Summary
Children who cannot be looked after by their parents or close relatives often end up being cared for by state-run organizations. In many parts of the world, orphaned young infants are put into institutions that lack good quality intimate social relationships and cognitive stimulation. The effects on physical, neurobiological, cognitive and social development are often profound, with environmentally determined patterns of development seldom otherwise seen, such as quasi-autism and indiscriminate social behavior. Placement of such children into good-quality foster or adoptive care can lead to considerable catch up, but often social difficulties remain. A different kind of residential care is seen for looked after children who are too difficult to foster; again the outcomes are not good, often for several reasons, as such group-care homes are often not containing and may be prone to abusive practices. In contrast, foster care is usually associated with better outcomes, including the development of secure new attachments. New interventions to support foster-carers are proving successful, but there is a long way to go in improving institutional care and promoting better alternatives for the most vulnerable children.