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 Effects of Improving Caregiving on Early Development

Christina Groark, Robert McCall, Rifkat Muhamedrahimov, Natalia Nikoforova and Oleg Palmov, 2003

Through a review of orphanages in St. Petersburg, Russia, this study examines the causal roles of consistency in caregivers and appropriate caregiving behaviors in the social, emotional, and development of young children.

The Care and Protection of Children Affected by Armed Conflict and Disasters

David K Tolfree, 2003

Overview of a research study which provides guidelines for care of separated children in large-scale emergencies, focusing on the negative impact of residential care, extended family care, spontaneous and agency fostering, adoption, and alternative placements for adolescents.

Leave No Child Out Campaign

NGO/UNICEF Regional Network for Children (RNC), 2002

This paper examines the negative impact of institutional care in central eastern Europe, the Commonwealth of Independent States and the Baltics region. It promotes community-based care alternatives and provides statistics. It also includes a list of useful resources addressing orphaned and vulnerable 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.

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.

Rwanda Country Report

2001

Country report of Rwanda on the situation of children in residential care in anticipation of the Second International Conference on Children and Residential Care: New Strategies for a New Millennium, to be held in Stockholm 12 – 15 May 2003.

Children in Residential Care and Alternatives: Children at Risk Guidelines (Volume 5)

Glen Miles and Paul Stevenson, 2001

A series that provides a framework for good practice and guidelines for those who work in the area of child development policy. The series delves particularly into residential care and other alternatives of care and makes suggestions for reform by evaluating 6 case studies of good practice examples.

Children and Disability in the Context of Family Breakdown in Central and South Eastern Europe and the Former Soviet Union

Elayn Sammon, 2001

A study on children with disabilities in the context of family breakdown. Includes overviews and statistics from 10 countries, a call for strengthened family support services, and draft guidelines on how child agencies can better mainstream these issues into their work.

Survey on Child Abuse in Residential Care Institutions in Romania

Ecaterina Stativa, 2000

Report assessing the overall features of children in residential care institutions with consideration for families of origin, gender, socioeconomic status and type of institution.

Children in Need - A Study of Children in Institutional Homes in Ghana (Additional Information)

Nana Araba Apt, Ebenezer Blavo, Stephen Wilson - Center for Social Policy Studies, University of Ghana, 01 Apr 1998

This document provides supplemental information to a study conducted on the situation of children in institutional homes in Ghana.