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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The Promise of a Future: Strengthening Family and Community Care for Orphans and Vulnerable Children in Sub-Saharan Africa

Kerry Olson, Ruth Messinger, Laura Sutherland, and Jennifer Astone , 2005

A brief document advocating for the strengthening and support of community based responses to children and families affected by HIV/AIDS in Africa.

Capacity Building in Social Policy Reform in Moldova

David Larter and Eugenia Veveritsa , 2005

This paper analyses the financial costs of residential services as compared to community-based services in Moldova. It also addresses the negative effects of institutional care on the well-being of children and society as a whole.

Cost Benefit Analysis of Children in Care - Moldova.doc

Family Matters: A Study of Institutional Child Care in Central and Eastern Europe and the Former Soviet Union

Richard Carter - EveryChild, 2005

A report discussing the advent and perpetuation of institutional care in Central and Eastern Europe and the Former Soviet Union prior to and since the end of the communist regime. It also provides examples of family-based care as models of care to substitute institutional care and offers recommendations to donors, NGOs and governments for child care reform based on their experience in CEE and FSU.

Leaving Care

National Youth In Care Network, 2005

This one-page document identifies some difficulties that youth face in leaving institutional care. Offers recommendations to assist financial, emotional, and educational preparation for emancipation.

Children in Institutional Care: The Status of their Rights and Protection in Sri Lanka

Save the Children Sri Lanka and Save the Children Canada, 31 Dec 2004

A situation analysis of children in institutional care that includes policy implications and key recommendations.

Attachment in Institutionalized and Community Children in Romania

Charles H. Zeanah, Anna T. Smyke, Sebastian F. Koga, Elizabeth Carlson, 31 Dec 2004

This study examined attachment in institutionalized and community children 12 – 31 months of age in Bucharest, Romania.

Children in Institutions: Prevention and Alternative Care

Bragi Gudbrandsson, 2004

This report contains an overview of alternative care in Europe, the effects of institutions on children, statistical information and the different approaches of child protection systems within Europe. It includes reforming institutional care, foster care, post-care support, and the role of the social worker.

The Right to Live in a Family and Community: Homes for Children and Teenagers in Brazil

The Research Institute of Applied Economy (IPEA) and the National Council of the Rights of the Child and Adolescent (CONANDA), 2004

This research study provides statistical information on institutional care of children under the age of 12 in 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.

Transforming Orphanage Care: A Case Example in Zimbabwe

Devi Dee, 2004

An informal evaluation of an NGO residential institution in Zimbabwe, based on the opinions of the child residents. Includes recommendations for the improvement of residential care.

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Children in Residential Care: The Zimbabwean Experience

G. Powell, T. Chinake, D. Mudzinge, W. Maambira, and S. Mukutiri, 2004

Analyzes the state of institutional care in Zimbabwe against the national child protection policy. Focuses on the role of donors in the proliferation of institutional care and strategies to better regulate the development and provision of child protection services.