Deinstitutionalisation (orphanages and children's institutions)



Deinstitutionalisation in the context of child care 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 state wide. New systems generally cost less than those they replace as many more children are kept within their own family.

The Developed World
Deinstitutionalisation occurred in the US between 1941 and 1980. In the US it was a consequence of the 1935 Social Security Act which allowed Aid to Dependent Children (ADC) to be passed and 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.

Eastern Europe
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.

Africa
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.

Other
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. 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 Programme
This was a scientific study that compared 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 behavioural 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.

Adoption
Domestic adoption is adoption within the home country. Until a country's child protection system is well developed the adoption of children internationally is at risk of corruption.

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 it's cost is up to six times lower once the transition has been funded.