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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Webinar Recording: Introduction to the Transitioning Care Assessment Tool

Better Care Network and ACC International Relief, 06 Aug 2020

This launch webinar provided an introduction to the Transitioning Models of Care Assessment Tool, an assessment framework that assists practitioners to identify and analyze key starting point dynamics and determine the implications for strategy in supporting organisations to transition from an institutional to non-institutional model of care.

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Transitioning Models of Care Assessment Tool (PDF Version)

Rebecca Nhep and Hannah Won - Better Care Network & Kinnected, an intitiative of ACC International Relief, with support from Changing the Way We Care, 06 Aug 2020

This tool is designed as an assessment framework that assists practitioners to identify and analyze the key starting point dynamics and determine implications for strategy in their work to transition an organization's model of care of children from institutional to a non-institutional model.

See Online Version

Is the deinstitutionalisation of alternative care a ‘wicked problem’? A qualitative study exploring the perceptions of child welfare practitioners and policy actors in Thailand

Justin M Rogers, Victor Karunan - International Social Work, 23 Jul 2020

This study examined deinstitutionalisation in Thailand. Qualitative interviews were conducted with a total of 27 child welfare practitioners and policy actors to explore their perceptions of Thai alternative care provision.

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The Role of Small-Scale Residential Care for Children in the Transition From Institutional to Community-Based Care and in the Continuum of Care in the Europe and Central Asia Region

Stela Grigoras - UNICEF Europe and Central Asia Regional Office (ECARO), 01 Jul 2020

This White Paper summarizes evidence on the current use and impact of small-scale residential care (also: ‘SSRC’) and offers guidance on how to enable all children to grow up in a loving and stable family environment. It aims to promote better decisionmaking among policy-makers, local governments, non-governmental organizations (NGOs), as well as child welfare and other, allied practitioners of the establishment.

Institutionalisation and deinstitutionalisation of children 1: a systematic and integrative review of evidence regarding effects on development

Marinus H van IJzendoorn, Marian J Bakermans-Kranenburg, Robbie Duschinsky, Nathan A Fox, Philip S Goldman, Megan R Gunnar, Dana E Johnson, Charles A Nelson, Sophie Reijman, Guy C M Skinner, Charles H Zeanah, Edmund J S Sonuga-Barke -The Lancet Psychiatry, 23 Jun 2020

This paper reviews the literature on child institutionalisation and deinstitutionalisation from a global perspective. This review included a survey of historical and cultural trends and estimates of current numbers of children in institutional care, a systematic review and meta-analysis of developmental sequelae, and a largely qualitative review of factors found to predict individual variations in such outcomes.

A child’s right to family

Joan Kaufman - The Lancet, 23 Jun 2020

In this commentary piece for The Lancet Psychiatry, Joan Kaufman highlights some key findings and recommendations from the Lancet Group Commission on the institutionalisation and deinstitutionalisation of children.

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Institutionalisation and deinstitutionalisation of children 2: policy and practice recommendations for global, national, and local actors

Philip S Goldman, Marian J Bakermans-Kranenburg, Beth Bradford, Alex Christopoulos, et al - The Lancet Child & Adolescent Health, 23 Jun 2020

In this second part of the Lancet Group Commission on institutionalisation and deinstitutionalisation of children, international experts in reforming care for children identify evidence-based policy recommendations to promote family-based alternatives to institutionalisation.

Children in institutional settings

Anne Longfield - The Lancet Child & Adolescent Health, 23 Jun 2020

In this commentary piece, Anne Longfield, Children’s Commissioner for England, explores the use of children's care homes in England and the need for improved supports to prevent placement in children's home and to provide for the needs of children and young people who are placed in these homes.

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Lancet Group Commission on the institutionalisation and deinstitutionalisation of children

Lumos Foundation, King’s College London, and Maestral - The Lancet Child & Adolescent Health and The Lancet Psychiatry, 23 Jun 2020

This Lancet Group Commission, published between The Lancet Child & Adolescent Health and The Lancet Psychiatry, advocates global reform of the care of separated children through the progressive replacement of institutional provision with safe and nurturing family-based care.

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If not now, then when? The importance of intervening early to provide family-based environments for all children

Aisha K Yousafzai - The Lancet Child & Adolescent Health, 23 Jun 2020

In this commentary piece, Aisha K Yousafzai - of the Department of Global Health and Population at the Harvard TH Chan School of Public Health and the and Department of Paediatrics and Child Health at Aga Khan University - notes that "the evidence presented [in the Lancet Group Commission on the institutionalisation and deinstitutionalisation of children] and their call to action to ensure abandoned children can thrive in family-based care environments rather than in institutions matters now more than ever as the global community addresses unprecedented challenges to ensure a generation of children are not left behind with respect to their survival, health, development, learning, and safety."

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