Deinstitutionalisation (orphanages and children's institutions)
Deinstitutionalisation is the process of reforming child care systems and closing down orphanages and children's institutions, finding new placements for children currently resident and setting up replacement services to support vulnerable families in non institutional ways. It became common place in many developed countries in the post war period. It has been taking place in Eastern Europe since the fall of communism and is now encouraged by the EU for new entrants. It is also starting to take hold in Africa and Asia although often at individual institutions rather than statewide. New systems generally cost less than those they replace as many more children are kept within their own family.
- 1 Countries involved
- 2 Why orphanages are being questioned
- 3 Priorities for children living in institutions
- 4 Longer term replacement services
- 5 References
- 6 External links
The Developed World
Deinstitutionalisation occurred in the US between 1941 and 1980. In the US it was a consequence of the Social Security Act of 1935 (SSA), which allowed Aid to Dependent Children (ADC) to be passed, and meant that children could no longer be removed from their families due to poverty alone. It occurred over a similar period in Western European and some South American countries.
Deinstitutionalisation is currently most common in the former Soviet Bloc. Increasingly the institutions that remain in Eastern Europe are occupied by disabled children who can be harder to place in the community. Completing their closure and supporting the development of places they can be cared for in the community is seen as a priority by the EU and that has encouraged many countries wishing to accede to it including the Czech Republic, Romania, whose orphanages are the most infamous in the world, and Bulgaria. It is also happening in Hungary where no new children can be placed in orphanages, Moldova, Ukraine, Belarus and Bosnia. Azerbaijan has established a Department for De-institutionalisation and Child Protection. Russia is also recognising children should be brought up in families but is not yet closing institutions.
The majority of orphanages in Africa are funded by private donors and are often not part of a larger coherent child protection system. In Africa deinstitutionalisation has support from the Governments of Rwanda and Ghana and Ethiopia however as the governments do not run the institutions the process can be more complex. Sudan is also making moves towards deinstitutionalisation with the partial closure of Mygoma Orphanage and the setting up of foster placements for babies abandoned there consistent with the principle of Kafala.
There are some small scale moves to increase the number of family based placements in China but this is not yet a large scale movement. It is now a priority of NGO's in Nepal or in Cambodia. In Haiti there are moves to move children out of orphanages and back to their families, but not as part of a wider deinstitutionalisation programme.
Why orphanages are being questioned
More than 4 out of 5 children living in institutions are not orphans. This amount rises to 98% in Eastern Europe. The nature of orphanages means that they often fail to provide the individual sustained attention and stimulation a child would get from growing up within a family. In many cases the children living in them are at risk of harm. There are also many reports of orphanages being abusive or having very high death rates. They are a particular issue for babies and children under three years old as they can stop them making the attachments that they should. These attachments can be broken by staff changing jobs and children moving to other rooms as they get older. In reality a very small proportion of AIDS orphans are in orphanages and there is no way orphanages could be a sustainable option for all AIDS orphans, even if it was desirable.
The Bucharest Early Intervention Project
This is a scientific study that compares the development of children raised in institutions with children raised in birth families and foster care. The study took random samples of 208 children and followed their physical growth, cognitive, emotional and behavioral development over a number of years. The study found:
- For every 2.6 months spent in a Romanian institution a child falls behind one month of normal growth
- Institutionalised children had significantly lower IQs and levels of brain activity than the other children, especially those who were institutionalised at a young age
- Children in institutions were far more likely to have social and behavioural abnormalities, including aggressive behaviour problems, attention problems and hyperactivity and a syndrome that mimics autism.
- This syndrome and the behaviours disappear when the child is placed in a family.
Priorities for children living in institutions
It is considered important that all institution-to-home transitions must be accompanied by adequate preparation through individual and group counseling. The development of social work teams to manage fostering and adoption programs is also considered important.
Reunification with family
When possible, children are reunited with their birth or extended family. This may require short term psychosocial or financial support but is generally seen as the ideal.
Support to transition into independent living
Children transitioning out of care and into the community may need significant support as their life skills may be limited. Failure to prepare them can cause a significant number of them to return to institutions in later life or end up in crime or prostitution.
Long term fostering
Long term fostering, defined as fostering for over a year, can often bridge the time between the closure of an institution and independent life.
Small group homes
Small group homes or family type homes - ideally with 8 or fewer children - can provide life-time care for the most disabled children or act as a half way house where children leaving an institution can learn to live in a family.
Longer term replacement services
The majority of orphans are absorbed within their own extended families. This is commonly known as alternative family care. Many efforts for the long term care of children without parental care have this at their heart. Successful deinstitutionalisation is accompanied by building the capacity of social services to run fostering and adoption services for new children at risk of separation. Other support structures for families at risk of separation can include facilities such as day care centres for disabled children or young babies. These can allow a mother to go to work so that she can earn a wage and support her family. After school clubs may also meet a similar need.
Young mothers may be ostracized by their families. A mother and baby support arrangement can assist them in their early days together. This can be enhanced with counselling to the grandparents and extended family. This is a much shorter intervention which keeps families together at less cost and without harm to the child. Hasty deinstitutionalisation, closing the institution and reuniting the children, without properly thought out alternatives can be detrimental.
Setting up new services is not only considered better for the social, physical and cognitive development of children, but its cost can be as low as one-sixth the cost of institutionalized care once the costs of making the transition have been funded.
- Jones, Marshall B (September 1993). "Decline of the American Orphanage: 1941-1980". Social Service Review. 67 (3): 459–480. doi:10.1086/603999. JSTOR 30012508.
- Crenson, Matthew A. (2001). Building the invisible orphanage: a prehistory of the American welfare system. Cambridge, Massachusetts: Harvard Univ. Press. ISBN 978-0674005549.
- Baker, C. Truett (2010). Welcoming the children: history and programs of Arizona Baptist Children's Services, 1960-2002 (2nd ed.). Arizona Baptist Children's Services. ISBN 978-1453562901.
- Innocenti Research Centre (2003). Children in institutions: the beginning of the end? : the cases of Italy, Spain, Argentina, Chile and Uruguay (PDF). Florence, Italy: UNICEF International Child Development Centre. ISBN 978-88-85401-86-0. Retrieved 23 August 2011.
- "At Home or in a home? Formal care and adoption of children in Eastern Europe and Central Asia" (PDF). UNICEF. September 2010. Retrieved 29 August 2011.
- Walker, G. (23 March 2011). "Postcommunist Deinstitutionalization of Children With Disabilities in Romania: Human Rights, Adoption, and the Ecology of Disabilities in Romania". Journal of Disability Policy Studies. doi:10.1177/1044207310394853. Archived from the original on 2 February 2016. Retrieved 23 August 2011.
- Contiguglia, Cat (27 October 2010). "Foster care faces strain". The Prague Post. Archived from the original on 20 January 2011. Retrieved 23 August 2011.
- "Moving Children out of harmful institutions and back into families". Absolute Return for Kids. Archived from the original on 29 September 2011. Retrieved 23 August 2011.
- Pertman, Adam (20 July 2000). "Vermont adoption case outrages Romanians". Rutland Herald. Retrieved 23 August 2011.
- Levin, Angela (15 November 2010). "My glimpse of hell and the pitiful children who have been betrayed". The Daily Telegraph. London. Retrieved 23 August 2011.
- "Three Bulgarian girls in orphanage accuse their teachers of abuse". FOCUS Information Agency. 6 August 2011. Archived from the original on 22 March 2012. Retrieved 23 August 2011.
- Uzunova, Bistra; Welle, Deutsche (29 January 2011). "Bulgaria's Children of a Lesser God". Standard. Retrieved 23 August 2011.
- "Bulgaria: Bulgaria to Start Moving Children from Orphanages" (Press release). Novinite. 1 November 2010. Retrieved 23 August 2011.
- "Deinstitutionalisation of children services". European Social Network. Retrieved 23 August 2011.[permanent dead link]
- "Swedish Government's Human Rights Website" (PDF) (in Swedish). Ministry of Foreign Affairs. Retrieved 23 August 2011.
- S., Penny (24 June 2011). "Overwhelming Task of Providing Care for Orphans in Moldova". Retrieved 23 August 2011.
- "Supporting Azerbaijani deinstitutionalisation efforts". European Social Network. Archived from the original on 3 August 2012. Retrieved 23 August 2011.
- "United Nations Children's Fund (UNICEF) Azerbaijan Office Representative Hanna Singer draws attention of society to challenges of children". UNDP Azerbaijan Development Bulletin. 9 April 2005. Archived from the original on 8 October 2011. Retrieved 23 August 2011.
- Denisov, Anton (27 August 2011). "Fostering the future through families". RT. Retrieved 13 February 2012.
- "Ministry of Gender and Family Promotion - WORKSHOP OF THE DEINSTITUTIONALISATION PROJECT". Migeprof.gov.rw. Archived from the original on 17 March 2012. Retrieved 23 August 2011.
- "Orphan Aid Africa". Oafrica.org. Archived from the original on 30 March 2012. Retrieved 23 August 2011.
- "Orphans and Vulnerable Children" (PDF). Archived from the original (PDF) on 27 September 2011. Retrieved 23 August 2011.
- "15 orphanages closed down". ModernGhana.com. Retrieved 23 August 2011.
- "Lessons Learnt During De-institutionalisation 2007/8" (PDF). OrphanAid Africa. Retrieved 3 December 2012.
- "Children's Investment Fund Foundation". Ciff.org. Archived from the original on 5 October 2011. Retrieved 23 August 2011.
- "UNICEF Humanitarian Action Report 2005" (PDF). Retrieved 23 August 2011.
- "Background to COCOA - Care of China's Orphaned and Abandoned children". COCOA. Archived from the original on 7 August 2011. Retrieved 23 August 2011.
- "News in Nepal: Fast, Full & Factual". Myrepublica.Com. 12 June 2011. Archived from the original on 17 September 2011. Retrieved 23 August 2011.
- Ian Birrell (11 April 2011). "Orphanages in Haiti and Cambodia rent children to fleece gullible Westerners | Mail Online". London: Dailymail.co.uk. Retrieved 23 August 2011.
- "Online library: Save the Children UK". Savethechildren.org.uk. 27 July 2009. Archived from the original on 27 September 2011. Retrieved 23 August 2011.
- Browne, K.; Hamilton-Giachritsis, C; Johnson, R; Ostergren, M (February 2006). "Overuse of institutional care for children in Europe". BMJ. 332 (7539): 485–7. doi:10.1136/bmj.332.7539.485. PMC 1382554. PMID 16497769.
- "The Risk of Harm to Young Children in Institutional Care". Retrieved 23 August 2011.
- "Abandoned to the State: Cruelty and Neglect in Russian Orphanages" (PDF). Save the Children. Retrieved 23 August 2011.
- "Sudan". Doctors Without Borders. 8 May 2006. Archived from the original on 27 September 2011. Retrieved 23 August 2011.
- "Keeping Children Out of Harmful Institutions" (PDF). Save the Children. Archived from the original (PDF) on 29 December 2016. Retrieved 23 August 2011.
- "Mark Canavera: Moving Beyond "AIDS Orphans"". Huffingtonpost.com. 6 August 2011. Retrieved 23 August 2011.
- "The Bucharest Early Intervention Project" (PDF). Retrieved 23 August 2011.
- "Microsoft Word - 4.6.07 manual" (PDF). Archived from the original (PDF) on 21 March 2012. Retrieved 23 August 2011.
- "Report on Wilton Park Conference WP1010" (PDF). Child Rights International Network. Retrieved 3 December 2012.
- "Child's i Foundation". Childsifoundation.org. 12 August 2011. Archived from the original on 7 October 2011. Retrieved 23 August 2011.
- "Reuniting Children With Their Families" (PDF). Unicef. Retrieved 29 August 2011.
- "Children Leaving Care; For Barnardo's Every Child Matters". Barnardos.org.uk. Archived from the original on 27 August 2011. Retrieved 29 August 2011.
- "Joseph Aguettant on Nepali adoption". BBC News. 4 February 2010. Retrieved 29 August 2011.
- "The United States and UNICEF wage war against international adoptions | Washington Times Communities". Communities.washingtontimes.com. 3 August 2011. Retrieved 23 August 2011.
- "Development of alternative services including foster care in context of child protection system reform – experience of Bulgaria" (PDF). SAPI. Retrieved 29 August 2011.
- "De-Institutionalising and T... | Terre des hommes – Child Protection in Europe". Tdh-childprotection.org. Retrieved 23 August 2011.
- "Hope for the abandoned - Europe, World". The Independent. 9 September 2004. Retrieved 23 August 2011.
- Roby, Jini L. (2011). "Children in Informal Alternative Care" (PDF). Child Rights International Network. United Nations Children’s Fund. Retrieved 3 December 2012.
- "Real lives - Alternatives to institutionalisation of children". UNICEF. Retrieved 23 August 2011.
- "Friends of Bulgaria - Mogilino - Reactions". Sitekreator.com. Archived from the original on 29 September 2011. Retrieved 23 August 2011.
- "A Study of Institutional Childcare in Central and Eastern Europe and the Former Soviet Union" (PDF). EveryChild. p. 35. Retrieved 23 August 2011.
- "Return to Investment in Child Welfare Reform" (PDF). USAID. 10 April 2009: 4. Retrieved 23 August 2011.
- Organizations involved in Deinstitutionalisation
- Hope and Homes for Children
- Hope for Himalayan Kids
- The Esther Benjamins Trust
- Care for Children
- Orphan Aid Africa
- Next Generation Nepal
- SERA France
- Chernobyl International
- Replace Campaign
- Children's Emergency Relief International
- Resources for professionals
- Better Care Network - Many DI resources
- 10 steps to DI - Nepal
- Experiences from Ghana
- Ending the Institutionalisation of Children Globally – the Time is Now