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

Abstract

Worldwide, millions of children live in institutions, which runs counter to both the UN-recognised right of children to be raised in a family environment, and the findings of our accompanying systematic review of the physical, neurobiological, psychological, and mental health costs of institutionalisation and the benefits of deinstitutionalisation of child welfare systems. In this part of the Commission, international experts in reforming care for children identified evidence-based policy recommendations to promote family-based alternatives to institutionalisation. Family-based care refers to caregiving by extended family or foster, kafalah (the practice of guardianship of orphaned children in Islam), or adoptive family, preferably in close physical proximity to the biological family to facilitate the continued contact of children with import ant individuals in their life when this is in their best interest. 14 key recommendations are addressed to multinational agencies, national governments, local authorities, and institutions. These recommendations prioritise the role of families in the lives of children to prevent child separation and to strengthen families, to protect children without parental care by providing high-quality family-based alternatives, and to strengthen systems for the protection and care of separated children. Momentum for a shift from institutional to family-based care is growing internationallyour recom mend ations provide a template for further action and criteria against which progress can be assessed.

The Situation of Institutional Care: Reflections and Lived Experiences of Inmates in Child Care Centers of Southern Ethiopia

“…Worldwide, millions of children live in institutions, which runs counter to both the UN-recognized right of children to be raised in a family environment, and the physical, neurobiological, psychological, and mental health costs of institutionalization and the bene ts of deinstitutionalization of child welfare systems (Goldman, Kranenburg, Bradford, et al, 2020). Institutional care is provided within a congregate living environment designed to meet the functional, medical, personal, social, and housing needs of individuals who have physical, mental, and/or developmental disabilities.…”

Rapid return of children in residential care to family as a result of COVID-19: Scope, challenges, and recommendations

“…This typically will include measures to prevent the transmission and spread of the disease including social isolation. A human resources plan focused on essential staff should be prepared and followed, and visits by volunteers and others prohibited ( Goldman et al, 2020 ). Staff should work together with public health authorities to plan for when children and/or staff become infected.…”

“…In situations where governments have mandated rapid return of children, it is recommended that governments facilitate a case management process with all children and families. Every child and family should be assigned a caseworker, each child should have a case file, and every child and family should be part of making a case plan based on a thorough assessment ( Goldman et al, 2020 ). Monitoring should be frequent, especially in the early stages of placement, and the wishes of the child need to be taken into account ( Mateos Inchaurrondo et al, 2018 ).…”

“…However, transitioning children out of institutions and into households is a complex process with significant risk of harm if not performed carefully. All deinstitutionalization efforts should be supported by practice standards, adequate resources, support and monitoring, and sufficient time to ensure the safety and wellbeing of each child involved ( Goldman et al, 2020 ).…”

Enhancing diurnal cortisol regulation among young children adopted internationally: A randomized controlled trial of a parenting-based intervention

“…Some countries rely on foster care rather than institutional care when children cannot be cared for by their parents. Although foster care is generally a preferable environment to institutional care (Dozier et al, 2014; Goldman et al, 2020), foster caregivers vary in their commitment to children (Dozier & Lindhiem, 2006) and in their responses to children's cues (Bernard & Dozier, 2011). In addition, children adopted from foster care often have experienced repeated disruptions in their early attachment relationships (Almas et al, 2020), with more placement changes associated with greater problems regulating behavior (Lewis, Dozier, Ackerman, & Sepulveda-Kozakowski, 2007; Oosterman, Schuengel, Slot, Bullens, & Doreleijers, 2007).…”