Effects of Institutional Care

Institutionalising children has been shown to cause a wide range of problems for their development, well-being and longer-term outcomes. Institutional care does not adequately provide the level of positive individual attention from consistent caregivers which is essential for the successful emotional, physical, mental, and social development of children. This is profoundly relevant for children under 3 years of age for whom institutional care has been shown to be especially damaging.

Common issues for children in institutional care are a significantly increased risk of sexual and physical abuse, a lack of stimulation, and harsh discipline. Children in institutions are less likely to attend school, and are frequently isolated from their traditional communities. Long periods in an institution make it harder for a child to assimilate back into a family and community, and deny them access to the life-long attachments and community support systems that family relationships and communities can provide. For funders and implementing bodies, care in the community is a significantly more effective and sustainable use of resources since it avoids the high maintenance costs of institutions, and prevents many of the problems posed by institutional care.

It is widely accepted that institutions should be used as a last resort only. Countries which have traditionally relied on institutional care are now transforming their institutions into small family style group homes and actively pursuing preferences for community-based care options based around small family style units. This policy shift is urgently required in HIV/AIDS affected countries which are taking a backward step in resorting to the use of institutions to care for children orphaned or affected by the disease.

The body of literature contained in this section provides in-depth explanations of the damaging effects of institutionalisation on children and provides recommendations for alterative community care options.

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Interpersonal trauma and associated psychopathology in girls and boys living in residential care

Sophia Fischer, Claudia Dölitzsch, Klaus Schmeck, Jörg M. Fegert, Marc Schmid - Children and Youth Services Review, 16 Jun 2016

The present study aimed to assess the relationship between interpersonal traumatic experiences and specific psychopathological symptoms in a high-risk population of girls and boys living in youth welfare institutions in residential care in Switzerland.

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Previous Institutionalization Is Followed by Broader Amygdala–Hippocampal–PFC Network Connectivity during Aversive Learning in Human Development

Jennifer A. Silvers, Daniel S. Lumian, Laurel Gabard-Durnam, Dylan G. Gee, Bonnie Goff, Dominic S. Fareri, Christina Caldera, Jessica Flannery, Eva H. Telzer, Kathryn L. Humphreys, and Nim Tottenham - The Journal of Neuroscience, 15 Jun 2016

This study examines the effects of early institutional care on infants' brain development.

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Does Size Matter? Comparing Medium-Term Cost-Effectiveness of Group Homes with Institutional Care in South Korea

Choong Rai Nho, Seokjin Woo, Hyunah Kang, JongSerl Chun and Ick-Joong Chung - Asian Social Work and Policy Review, 15 Jun 2016

Using unique 5-year longitudinal data on Korean children in group homes and those under institutional care, this paper compared the medium-term cost-effectiveness of group homes and that of institutional care facilities in terms of developmental outcomes.

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“It is My Dream to Leave This Place” Children with Disabilities in Serbian Institutions

Human Rights Watch, 08 Jun 2016

This report from Human Rights Watch focuses on the institutionalization of children with disabilities in Serbia.

The Illusion of Protection

Halyna Postoliuk - Opening Doors for Europe's Children, 01 Jun 2016

Maxim’s story illustrates the problems with institutional care and the stagnation often seen in the child protection system.

Alternative Child Care and Deinstitutionalisation in Asia: Findings of a desk review

Catherine Flagothier -- Catherine Flagothier, 01 Jun 2016

This desk review examines the reasons children are being placed in care, evaluates the types of care in the region, and discusses regional efforts towards deinstitutionalisation.

Ending institutionalisation: An assessment of the outcomes for children and young people in Bulgaria who moved from institutions to the community

Lumos, 01 Jun 2016

This report shares outcomes to date for a group of 1,292 children and young people with disabilities who have transitioned out of large residential institutions (institutions) into small group homes (SGHs) in the community.

Altruistic Exploitation: Orphan Tourism and Global Social Work

Karen Smith Rotabi, Jini L. Roby and Kelley McCreery Bunkers - British Journal of Social Work, 30 May 2016

Based on an exhaustive review of the global literature and utilising an innovative theoretical framework of ‘altruistic exploitation’, the authors explore the ironic juxtaposition of benefits and harms associated with orphan tourism to the various stakeholders.

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Country Care Review: Serbia

Better Care Network, 23 May 2016

This country care review includes the care-related Concluding Observations adopted by the Committee on the Rights of Persons with Disabilities.

Dignifying Hidden Lives: The Institutionalization of Any Impact Child Development

Messias Silvano da Silva Filho, Jose Antonio de Lima Neto, Ivana Rios Rodrigues, Modesto Leite Rolim Neto - Current Pediatric Research, 16 May 2016

The results of this study suggest that the removal of a child from an institution and its transfer to an improved care environment can lead to a reduced risk of psychopathology, as well as promoting a better social, emotional and cognitive development.