Myth Buster: common myths about deinstitutionalisation

What do you mean by ‘institutions’ for children?

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Institutions are segregating residential care facilities for children without parental care. By ‘segregating’ we mean they are usually isolated from the local communities, and break children’s ties with their biological and cultural origins. In some cases, these are very large settings – hosting up to hundreds of children – but size is not the only element to define them. Not all residential care facilities are institutions: it depends on the type of environment provided.

Institutions are impersonal, impose a rigid routine, lack attachment and affection, and do not allow the individual care and attention indispensable for a child to thrive. Children are often placed indefinitely, and there is no parallel effort to maintain on-going relations with the biological parents or, if this is in the best interest of the child, to reintegrate children into their family of origin. Children’s cognitive, social, emotional development can be severely damaged by growing up in an institution – particularly if compared to children who grow up in a family1.

According to international standards2, children without parental care should be cared for in a setting as close as possible to a family or small group situation. The very nature of institutions makes them ill-equipped to reproduce a warm, nurturing environment. And yet, despite the bulk of evidence, children across Europe continue to
be placed in poor quality, segregating residential care facilities – including baby homes for children under three3.

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1           Eurochild Working Paper “Deinstitutionalisation and quality alternative care for children in Europe – Lessons learned and the way forward”, 2014.
2            Resolution adopted by the UN General Assembly 64/142, Guidelines for the Alternative Care of Children, June 2009.
3              UNICEF, At Home or in a Home? Formal Care and Adoption of Children in Eastern Europe and Central Asia, 2010.

What do you mean by ‘deinstitutionalisation’?

 

Deinstitutionalisation is not only about closing institutions. First and foremost, it requires a paradigm shift and a change in mentalities, with an emphasis on children’s rights and quality of care. The process entails a comprehensive transformation of child protection systems that starts with reinforcing all kinds of family and parent support services, to ensure that separation of a child from his/her family really is a last resort.

When separation is clearly in the best interest of the child, such as in cases of neglect or abuse, different options should be available depending on the child’s situation and needs. These can include kinship care (family-based care within the child’s extended family or with close friends), foster care, family-like placements, small group homes, supervised independent living, national adoption, etc. Before closing institutions, high-quality alternatives need to be in place following a step-by-step process. Whenever appropriate, efforts should be made to reunite the child with his/her biological family, who should receive on-going support.

Institutions are needed to take care of orphans

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Contrary to common belief, the large majority of children placed in institutions are not orphans but have one or even both parents. Often, children are not even formally abandoned but temporarily placed by parents in difficulty. Occasionally parents are even encouraged to abandon their children straight after delivery, falling victim to the prejudices of hospital and maternity ward staff (e.g. single mothers, teenage parents, parents of Roma origin, parents of children with disabilities, etc).

Institutions have improved a lot in the last years: why close them now?

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It may be true that most children living in institutional care in Europe are not deprived in a material sense. Across the EU, many countries have modernised buildings and professionalised care services. But even institutions with the best possible facilities are not a replacement for a family environment.

Children need long-term, secure relationships with caring adults, as well as an understanding of family life such as the give and take, the sharing of responsibilities. They are then better equipped to pass this on to their own family when the time comes. Even in the best run institutions, staff can not give children the one to one care and attention they need to develop.

It is important that money is not used for cosmetic improvements to the existing infrastructure, but for a complete systemic reform financing prevention measures and family and community-based alternatives.

If institutions are closed, where will all the children go?

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There is a difference between simply ‘closing institutions’ and ‘achieving deinstitutionalisation’: closing institutions hastily and without developing high-quality alternatives can be very dangerous for children, and cause their rights to be further violated. The decision to move a child from an institution into a new placement is a delicate transition that needs careful planning and support.

There is no ‘one size fits all’ solution to decide where the children will go. Every child has individual needs and wishes, along with a unique personal history. In-depth evaluation and consultation with all actors involved (the child, his/her parents and siblings, the enlarged family, social workers, etc.) are key to success. In some cases, children are able to move back to their biological parents (‘reintegration’), while in other cases they will live with relatives or close friends (‘kinship care’), with a foster family or in a family-like placement. Foster parents should receive training to understand the needs of the child and his/her experience living in an institution. Sometimes small group homes or supervised independent living are appropriate alternatives, always depending on the child’s need, age and circumstances1. However, we are persuaded that family-based care should be the only option at least for infants and very young children (e.g. 0-3)2. The guiding principle is always to pursue the best interest of the child.

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1 UNICEF, At Home or in a Home? Formal Care and Adoption of Children in Eastern Europe and Central Asia, 2010, p. 19: “there is a growing consensus among child protection experts that small-scale residential care, in the form of small group homes in family-like environments, and used as a temporary or at times last resort, may sometimes be in the best interests of the child. (…) It may also be in some adolescents’ best interest to live independently, and they should be given that option with proper support”.

2 UNICEF, Call for Action: End placing children under three in institutions, 2011. It should be noted that, according to the UN Committee on the Rights of the Child, the working definition of early childhood should encompass all children below the age of eight: Committee on the Rights of the Child, General Comment No. 7 – Implementing child rights in early childhood, 2005, par. 4.

What about children with severe disabilities, or children who have challenging behaviours?

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For a long time, the predominant approach to disability was the medical model: children with disabilities were treated as ‘patients’ with illnesses and deficiencies to be cured, instead of individuals with human rights entitlements. Many were placed outside the family straight after birth and spent their entire life in segregating institutions. Luckily, a lot has changed in the last decades and many countries have signed and ratified UN
Conventions that require all children to be treated with dignity1. Nevertheless, deinstitutionalisation of children with disabilities or challenging behaviours is sometimes perceived as worrisome or even impossible.

Experience shows that, with appropriate support, children with disabilities can fully enjoy their rights with respect to family life. This means preventing the abandonment of children with disabilities by providing education and psychological/material support to their parents, and the necessary equipment for allowing life in the community (for instance care assistance in the home, respite services, day-care facilities directly accessible at community level, etc). It implies also access to family-based alternatives, such as kinship care and foster care, when the immediate family is unable to care for the child2.

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1              United Nations Convention on the Rights of the Child (UNCRC), and United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).
2              UNCRPD, art. 23. See also UN Committee on the Rights of the Child, General Comment No. 9, The rights of children with disabilities, 2006.

Institutions are cheaper than family and community-based care: in times of crisis we should save public funds.

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First and foremost, children’s quality of life should be a primary concern and never become subsidiary to economic considerations. But even besides the human rights argument, it can be proven that the cost-effectiveness of institutions is a myth. Institutions are cheaper because they provide poor quality of care: in countries with well-equipped residential care services, the costs are likely to be higher or comparable to family and community-based alternatives 1.
To complicate matters, children that have grown up in an institution often carry a heavy stigma and face enormous challenges integrating in society as adults. Early intervention, family support, reintegration and high quality alternative care can help to prevent poor outcomes such as early school leaving, unemployment, homelessness, addiction, anti-social behaviour or criminality. These kinds of structural reforms can therefore have a positive long-term impact on children, the public purse and society as a whole.

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1 Eurochild Working Paper “Deinstitutionalisation and quality alternative care for children in Europe – Lessons learned and the way forward”, March 2014.

What if foster parents do it just for money?

 

Research proves that family and community-based care is a far better solution for children than institutions1. Having said that, it is clear that no system is safe from the risk of neglect or abuse. Comprehensive assessments must be carried out on the suitability of family-based carers prior to the placement of children into a foster home. On-going quality control and monitoring are also essential.

But it is important to note that payment does not necessarily undermine genuine motivation from prospective foster families. Indeed, in today’s society most families require a double income to make ends meet. Hosting a foster child can be costly and this has to be compensated. Foster parents may also be specially trained professionals – especially those who are caring for children who may be juvenile offenders or have particularly challenging behaviours. To ensure the best interest of children, training, support and monitoring must be ongoing and include a careful evaluation of the situation also in case of assignment to kinship care or later reintegration into the biological family.

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1 Eurochild Working Paper “Deinstitutionalisation and quality alternative care for children in Europe –
Lessons learned and the way forward”, March 2014.

If we close down all the institutions, many people will lose their jobs.

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Institutions can play an important role in the local economy, especially where they are located in remote areas. It is important to work with the employees of institutions prior to closure so they fully understand the rationale behind the changes. Wherever possible, staff should be retrained and redeployed into new forms of family and community-based care and services. Sometimes the very people that lose their jobs in the closure of institutions become the best champions of children’s rights in the future.

Does it mean that families are always better?

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Unfortunately not. The placement of a child outside of the biological family in some cases is unavoidable. All possible forms of support should be provided to parents, but in cases of abuse, neglect and risk for the child intervention is needed. In these cases, alternative care solutions must be found for the child that ensure high quality and continuity, always listening to his/her needs and preferences. Placement in institutions should be avoided at all costs.

Institutional Care is a problem only in Central and Eastern Europe

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Institutional care is widespread in several countries in the Northern and Western part of Europe. On the surface, the situation may seem less dramatic – institutions do meet children’s basic needs, buildings are clean, warm and nicely decorated, and staff are usually trained.

Yet, many institutional features remain: facilities often accommodate a high number of children and are isolated from the community and fail to offer individualised care. Due to lack of community-based services, specialised support and access to inclusive education, children with disabilities often end up in institutional care. Austerity measures and budgetary cuts have further aggravated the situation. Community-based services are under-resourced and are unable to respond to the real needs of families. This has led to children’s further institutionalisation or reinstitutionalisation.

Institutions provide an important source of employment, which can create resistance to reform. In addition, the negative impacts of institutional care on children are not always well known across the Western and Northern Europe. It is particularly worrying that children under the age of 3 are still being institutionalised despite evidence that institutionalisation can have irreparable damage in infants’ brain development1. Institutions in Western and Northern Europe are still widely perceived as a permanent and safe solution for children.

Furthermore, new institutions are being opened or old ones refurbished to accommodate migrant, unaccompanied and separated children .

Governments in this region have not included the transition from institutional to community-based care as a priority in their Operational Programmes for the Structural Funds.

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1           The Rights of Vulnerable children under the age of three; Ending their placement in institutional care. OHCHR, Europe Regional Office

Institutional care is a suitable solution for unaccompanied and separated migrant children arriving to Europe

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Europe must do better for migrant, unaccompanied and separated children who have travelled to Europe for whatever reason – to seek a better life, because of armed conflict or persecution. Children, regardless of how they ended up in a country, must be afforded the same care and protection as nationals of that state. We encourage States to provide as much assistance as possible in tracing, reuniting and keeping children with their parents or extended families.

It is clear that institutional care has a lasting harmful effect on the emotional, physical and cognitive development of children and it cannot provide the individualised care that is needed to ensure children’s recovery and meaningful integration into society. The Opening Doors campaign partners and civil society organisations call upon all States to ban the use of institutional care as a means to meeting the basic needs of migrant, unaccompanied and separated children. The types and quality of care should be the same for all children regardless of their migration status. Furthermore, States should end the practice of immigration detention of children as it discriminates and criminalises children on the basis of their migration status.

EU should guarantee that all EU funds are used to support family and community-based care alternatives, for all children.