Institutional Care

by

Catherine Hamilton-Giachritsis, Manuela Garcia Quiroga

• LAST REVIEWED: 28 April 2017
• LAST MODIFIED: 25 February 2014
• DOI: 10.1093/obo/9780199791231-0098

Introduction

In the early 21st century, increasing attention has been paid to children cared for in institutional settings. Initially, much of the focus was on European Union member states (i.e., western and central Europe), but increasingly attention has shifted to Central and Eastern Europe and Central Asia (CEECIS) and beyond (e.g., South America, Africa). The issue first came to prominence following the fall of Nicolae Ceauşescu in 1989, when pictures of children in Romanian orphanages were widely distributed in the media. However, subsequent studies showed that the overuse of institutional care was occurring across Europe and beyond. Research following those first Romanian orphans, including those adopted internationally, highlighted the sometimes extreme damage done (particularly to young children and babies) by being cared for in an institutional setting. This includes social, emotional, behavioral, and neurological changes. Hence, following discussion at the UN General Assembly in 2009, specific guidelines were produced for all 193 member states, which implemented key recommendations from research (Guidelines for the Alternative Care of Children, 2009). Since then the United Nations Children’s Fund (UNICEF) and the Office of the United Nations High Commissioner for Human Rights (OHCHR) published a “call to action” in 2011 to end all use of institutional care for children under the age of three years. These developments have led to changes in national childcare policies in a number of countries, including the Czech Republic, Hungary, and Serbia. Furthermore, through the activity of UNICEF, the impact is now extending beyond Europe to Central and South America. Key issues to consider when thinking about the institutional care of children include the size, type, and ethos of the institution. For example, a small family-type care home that focuses on good relationships and encouraging attachment will be very different to a very large institution with a poor physical environment that focuses on ensuring that children are fed, clean, and quiet, with minimal social interaction. Furthermore, there may well be cultural variations in types of institutions and ethos, but these have been relatively underresearched to date. In addition, although the UN Guidelines have noted the risk to children less than three years of age, on the basis of the available research, it could still be argued that even somewhat older children should not be cared for in such settings.

General Overviews

There is fairly limited literature on the topic of children in institutions, compared to other areas of research. Thus, it is important to include the “gray literature” (e.g., United Nations Children’s Fund [UNICEF] publications), as well as journal articles and books. The gray literature is more focused on legislation and social policy but includes references to relevant research work. Thus, the following articles, books, and online resources will provide a starting point for interested readers. Research projects to establish the rates of children in institutional care across Europe include UNICEF Innocenti Research Centre 2009, Hamilton-Giachritsis and Browne 2012, and Browne, et al. 2005. In particular, the TransMonEE Database 2013 provides access to key indicators as to how the situation has changed year by year on a wide variety of indicators, which includes data on institutional care but also looks more broadly to other indicators of welfare. In contrast, the latter two papers provide data related only to institutional care. Taken from a large-scale research project (also published elsewhere), the data given for European Union (EU) member states include the reasons why children are taken into institutional care and the cost of different forms of care. For a wider overview of the process through which the current situation in Europe has been reached, a good source is OHCHR 2012, The Rights of Vulnerable Children under the Age of Three. Looking beyond the EU, an in-depth analysis of the central and eastern Europe and central Asia (CEE/CIS) region was undertaken and published in UNICEF 2010, also reviewing the key research in the area. Both this and the OHCHR 2012 are excellent for summarizing the key features of the situation, the progress to date, and the challenges ahead. Other data for South and Southeast Asia, but also including African nations, comes from the POFO: Positive Outcomes for Orphans initiative led by researchers at Duke University in Durham, North Carolina, America. Publications from the work focus on outcomes (see Impact of Institutionalization), but the website gives a general overview of the rates and difficulties. The Latin American situation was generally reviewed in another Innocenti report (UNICEF Innocenti Research Centre 2003), which despite its age remains one of the few reports to consider these geographical areas. However, UNICEF is undertaking new work in South America, and therefore it is to be expected that reports will follow shortly.

• Browne, Kevin D., C. E. Hamilton-Giachritsis, R. Johnson, et al. “A European Survey of the Number and Characteristics of Children Less Than Three Years Old in Residential Care at Risk of Harm.” Adoption & Fostering 29.4 (2005): 23–33.

  DOI: 10.1177/030857590502900405

  This paper reports on one of the few research studies that identified the extent of institutional care in Europe, with data collected from thirty-three governments. It provides data on who is being cared for, where, and for how long, including the overrepresentation of some groups (e.g., gender, Roma).

• Hamilton-Giachritsis, Catherine E., and Kevin D. Browne. “Forgotten Children? An Update on Young Children in Institutions across Europe.” Early Human Development 88.12 (2012): 911–914.

  DOI: 10.1016/j.earlhumdev.2012.09.018

  This article provides an update on a series of projects that have highlighted the issue of institutional care in Europe. It is useful for a general overview, including rates, reasons for care, costs, and ways to move forward for thirty-three countries in Europe.

• TransMonEE Database 2013.

  This webpage provides access to four hundred economic and social indicators for child welfare and has publications such as TransMonEE 2012—Key Features, which reviews rates and reasons for institutional care of children. This database is probably the biggest resource of its kind.

• UNICEF. At Home or in a Home? Formal Care and Adoption of Children in Eastern Europe and Central Asia. Geneva, Switzerland: UNICEF Regional Office for Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS), 2010.

  This document provides rates of children in institutional care in central/eastern Europe and the Commonwealth of Independent States. It also reviews the progress made since the year 2000, highlights the continued overuse of institutional care for children with disabilities, and looks at the way forward.

• United Nations Office of the High Commissioner Human Rights (OHCHR). The Rights of Vulnerable Children under the Age of Three: Ending Their Placement in Institutional Care. Geneva, Switzerland: OHCHR, 2012.

  This is a key text, which includes explanations of the role of the United Nations Convention on the Rights of the Child. It is an extensive review based on relevant research and country reports of how the situation has changed over time. It also identifies key targets for progress.

• UNICEF Innocenti Research Centre. Children in Institutions: The Beginning of the End? The Cases of Italy, Spain, Argentina, Chile and Uruguay. Innocenti Insight 8. Florence: UNICEF Innocenti Research Centre, 2003.

  This publication explores different initiatives to prevent the institutionalization of children in five countries (Argentina, Chile, Uruguay, Italy, and Spain). It includes both public and private initiatives, as well as local and national policies. Although published in 2003, it is still one of the few documents concerned with Latin America.

• UNICEF Innocenti Research Centre. Innocenti Social Monitor 2009: Child Well-Being at a Crossroads; Evolving Challenges in Central and Eastern Europe and the Commonwealth of Independent States. Innocenti Social Monitor. Florence: UNICEF Innocenti Research Centre, 2009.

  The Innocenti Social Monitor reports are published annually, giving a useful overview of many aspects of child welfare (including institutional care) for central and eastern Europe and the Baltic states. In 2009, the Social Monitor looked closely at institutional care across the region. Good general reference.

• POFO: Positive Outcomes for Orphans.

  This website outlines the Positive Outcomes for Orphans initiative, a longitudinal study of six- to twelve-year-olds in Africa and South Asia. This is a useful resource giving access to a wide range of publications but also providing detailed information on the methodology and survey instruments, which can feed into other research.