De-institutionalisation and quality alternative care for children in Europe - Lessons learned and the way forward
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Working paper De-institutionalisation and quality alternative care for children in Europe Lessons learned and the way forward
Find this document online at http://tinyurl.com/d-i-workingpaper
Eurochild is a network of organisations o give children and young people
T
and individuals working in and across in Europe a voice by promoting
Europe to improve the quality of life of participatory methods in child and
children and young people. family services, raising children’s
awareness of their rights and
We envisage a Europe where every child supporting child and youth led
grows up happy, healthy and confident, organisations.
and respected as an individual in his/her
own right. We work : Eurochild currently has 117 full and 36
associate members across 35 European
o promote wide recognition of
T countries. For more information:
children as individual rights holders;
To convince policy and decision Eurochild, Avenue des Arts,
makers to put the best interest of the 1-2 - B-1210 Brussels - Belgium
child in every decision affecting them; T +32 (0)2 511 70 83
To encourage all those working with F +32 (0)2 511 72 98
and for children and their families to info@eurochild.org
take a child-centred approach; www.eurochild.org
Acknowledgments
This Working Paper was written by The work is financially supported by
Michela Costa (Eurochild Policy Officer) Hope and Homes for Children, UK and
with valuable inputs from members of by the European Union Programme
the Eurochild Thematic Working Group for Employment and Social Solidarity
‘Children in Alternative Care’. - PROGRESS (2007-2013). For more
information see: http://ec.europa.eu/
Contact: progress. This publication is produced
Michela Costa, Policy Officer with the support of the European
+32 2 211 05 59 Commission but does not necessarily
michela.costa@eurochild.org express its views.
October 2012
2
Table of contents
Executive summary 4
Glossary 6
1. De-institutionalisation in the European context 8
1.1. The origin and development of institutions in Europe 8
1.2. Transition towards family and community-based care 9
2. Why should we close the remaining children’s institutions in Europe? 10
2.1. Evidence from child development literature and neuroscience 10
2.2. Equity and social inclusion 12
2.3. Human rights framework and EU commitments 14
2.4. Long term cost-effectiveness of reforms 16
3. The way forward: prevention and quality alternatives 18
3.1. Preventing separation of children from their families 18
3.2. Quality family and community-based care 21
3.3. Leaving care 25
4. How can de-institutionalisation be achieved in practice? 27
4.1. Lessons learned at national level 27
4.2. Use of the structural funds 30
5. Conclusion and recommendations 32
References 34
3
Executive summary
Eurochild is a network of organisations factors, disability and discrimination
and individuals working in and across rather than to protection from abuse and
Europe to improve the quality of life neglect.
of children and young people. Our
work is underpinned by the principles Children without parental care
enshrined in the United Nations continue being placed in segregating
Convention on the Rights of the Child. residential care facilities, also known
We have 117 full and 36 associate as institutions, in environments that
members in 35 European countries1. are utterly inappropriate for their
emotional, physical, intellectual and
Eurochild focuses on the inter-linkages social development. We all remember
between poverty, social exclusion the horrors displayed by media and
and children who are in, at risk of documentaries about institutions for
going into, or leaving alternative care2, children in Central and Eastern Europe
and believes that the transition from after the fall of authoritarian regimes.
institutional to community-based care A lot has changed over the last decades,
(‘de-institutionalisation’) is an urgent and several EU countries have taken
priority for EU action3. steps to dismantle their institutional care
systems. However, institutionalisation
The UN Convention on the Rights of of children is still a reality in several
the Child (UNCRC) clearly recognises Member States and much more needs
that the ideal setting for a child to grow to be done before it becomes history
up is within a family environment that in Europe.
provides an atmosphere of happiness,
love and understanding4. The family Despite progress, a dual approach
“should be afforded the necessary continues to prevail in many countries
protection and assistance so that it can currently engaged in reforming their
fully assume its responsibilities within childcare systems. Large numbers
the community”5. of children are transferred into family
and community-based care, but
Two decades after the entry into force institutions are still perceived as
of the UNCRC, these principles are still good enough for certain groups,
unevenly understood and implemented such as children with disabilities.
across the EU. Too many children are Furthermore, a clear disconnection
separated from their families, and too exists between the reforms taking
often without appropriate reasons. place in the childcare system and the
In a climate of financial crisis and situation of adult services: many de-
widespread cuts on essential services, institutionalised children end up being
the entry of children into alternative care re-institutionalised when they grow up,
is frequently linked to socio-economic an experience which is particularly tragic
and detrimental for their well-being.
1 Eurochild, at http://goo.gl/qL62g Member States and candidate countries in relation
2 Eurochild, Call for Action on Quality of Alternative to institutional care reform. The Group’s work
Care for Children Deprived of Parental Care, encompasses children, people with disabilities
March 2010. including people with mental health problems, the
3 Since 2010 Eurochild is also member of the European elderly, families and service providers.
Expert Group on the Transition from Institutional to 4 United Nations Convention on the Rights of the Child
Community-based Care, which aims to serve as (UNCRC), Preamble.
4 an informal advisory body to European institutions, 5 Idem.
This paper aims to raise awareness alternatives is often less expensive
on the perverse effects of and certainly more effective than
institutionalisation on children and investment in institutional care, but
it calls for comprehensive system additional costs arise during the
reforms, starting with a transition phase of transformation (infrastructure
towards family and community-based costs, retraining and recruitment of
care. The UN Guidelines for the social workers, strengthening of child
Alternative Care of Children clearly protection systems, development of
speak in favour of such evolution: prevention strategies and alternative
“where large residential care facilities services, etc.). Rapid progress only
(institutions) remain, alternatives should happens when additional resources
be developed in the context of an overall are mobilised.
de-institutionalisation strategy, with
precise goals and objectives, which will By financing de-institutionalisation
allow for their progressive elimination”6. and supporting the creation of quality
services for families and communities,
In the past decades, Eurochild the European Structural Funds can
members have been involved in allow Member States to dismantle the
closing down institutions, supporting obsolete system of institutions while
children and families through early shifting towards prevention and high
intervention, prevention services and quality alternative care. Negotiations for
gatekeeping and providing quality the new Cohesion Policy 2014-2020
alternative care. Experience shows that represent an extraordinary momentum
de-institutionalisation is possible for achieving a profound transformation
and States can achieve structural of children’s services across Europe,
transformations in order to offer every and all efforts must be mobilised to
child a better life. Building on these catalyse lasting change.
experiences, the paper collects key
messages and lessons learned Last but not least, the upcoming
which could inspire the restructuring of European Commission
children’s services on the ground. Recommendation on child poverty
and child well-being, due to be
Eurochild strongly believes that the adopted in 2013, creates a window of
EU is in the position to support and opportunity to address the linkages
coordinate Member States’ actions in between poverty, social exclusion and
this regard. The upfront investment in children in alternative care.
de-institutionalisation is absolutely
critical, with immediate positive and Eurochild calls for a renewed political
sometimes lifesaving outcomes on engagement - coupled with an
children in institutions but also long- investment of European and national
term effects for the society at large, resources - to prevent separation of
including reduction of dependency children from their families, to protect
and higher social inclusion. However, the rights of children in alternative care
in many countries an important barrier and to improve the quality of the care
to reforms is the high cost of transition provided to them.
from the old system of institutions to a
reformed one7. Investment in prevention Eurochild, October 2012
and family and community-based
6 Resolution adopted by the General Assembly 64/142, 7 Other obstacles are the lack of political will, the
Guidelines for the Alternative Care of Children, June persistence of evident conflicts of interest, the fear of
2009, par. 23. losing jobs for the care professionals, the tendency to
stigmatise families in difficulty, etc.
5
Glossary
Abandonment Family-based care
Act by which the child has been left with A form of alternative care in which the
no care whatsoever, for example on the child is placed with a family other than
street or in an empty dwelling. Often his/her family of origin (e.g. kinship care,
colloquially used as a synonymous of foster care).
relinquishment, i.e. the act by which the
child has been surrendered to the care Foster care
of others, for example in a maternity Situations where children are placed
hospital8. (See also Separation, below). by a competent authority for the
purpose of alternative care in the
Alternative care domestic environment of a family
Care provided to children who are other than the children’s own family
deprived of parental care. that has been selected, qualified,
approved and supervised for providing
Community-based services such care10. Foster care placements
Services directly accessible at the can respond to a number of diverse
community level, such as: situations (e.g. emergency foster care,
Family strengthening services: temporary foster care, long-term foster
parenting courses and sessions, care, therapeutic foster care, parent
promotion of positive parent-child and child foster care, etc).
relationships, conflict resolution
skills, opportunities for employment Gatekeeping
and income generation and, where Set of measures put in place to
required, social assistance, etc.; effectively divert children from
Supportive social services, such as unnecessary initial entry into alternative
day care, mediation and conciliation care or, if already in care, from entry
services, substance abuse treatment, into an institution11 (e.g. family support
financial assistance, and services for as a prerequisite for the placement of
parents and children with disabilities9. children in alternative care, legal bans,
moratoria and economic disincentives
De-institutionalisation of children for institutionalisation, etc.)
Policy-driven process of reforming a
country’s alternative care system, which Institutional care
primarily aims at: Care taking place in (often large)
Decreasing reliance on institutional residential settings that are not built
and residential care with a around the needs of the child nor close
complementary increase in family and to a family or small-group situation, and
community-based care and services; display the characteristics typical of
Preventing separation of children from institutional culture (depersonalisation,
their parents by providing adequate rigidity of routine, block treatment,
support to children, families and social distance, dependence, lack of
communities; accountability, etc.).
Preparing the process of leaving
care, ensuring social inclusion for
care leavers and a smooth transition
towards independent living.
8 UNICEF, At Home or in a Home? Formal Care and 11
See UNICEF, At Home or in a Home? Formal Care
Adoption of Children in Eastern Europe and Central and Adoption of Children in Eastern Europe and
Asia, 2010, pp. 52- 53. Central Asia, 2010. See also Better Care Network
9 See UN Guidelines for the Alternative Care of website.
Children, June 2009, par. 34.
10
See UN Guidelines for the Alternative Care of
Children, June 2009, par. 29
6
Kinship care Separation
Family-based care within the child’s Separation of children from their parents
extended family or with close friends of following a decision from a competent
the family known to the child, whether authority or agency when there are
formal or informal in nature12. reasonable grounds to believe the child
is at risk15 (removal). In non-functional
Prevention systems, parents in difficulty might
Intervention in the family or community decide to entrust their children to the
that enables children to stay in their care of the State due to insufficient
families as an outcome13, if this is in help or support (e.g. inability to cover
their best interest. Support can be food- or clothes-related expenses, pay
provided in several areas such as rent in order to avoid eviction or bills for
living conditions, family and social water, gas and electricity, etc.)16. In such
relationships, education, physical and circumstances, the term ‘separation’ is
mental health, household economy, etc. preferable to the term ‘abandonment’,
since the latter “tends to imply that
Residential care these children have been completely
Care provided in any non-family-based deserted by their family and have little
group setting, such as places of safety or no hope of being reunited with their
for emergency care, transit centres in parents17”.
emergency situations, and all other
short- and long-term residential care Small group home
facilities, including group homes14. A type of residential care in which a
small group of children live in a house
in the community, and are cared for in
an environment that is as family-like as
possible18.
12
UN Guidelines for the Alternative Care of Children, 16
See Hope and Homes for Children Romania, Best
June 2009, par. 29. Practice Guide for the Prevention of Child Separation
13
See Hope and Homes for Children Romania, HOW from Families, 2012, p 6.
TO DEINSTITUTIONALISE? HHC model for DI – brief 17
See UNICEF, At Home or in a Home? Formal Care
description of process, 2012. and Adoption of Children in Eastern Europe and
14
UN Guidelines for the Alternative Care of Children, Central Asia, 2010, p. 7.
June 2009, par. 29. 18
See Save the Children UK, Child protection and Care
15
UN Guidelines for the Alternative Care of Children, Related Definitions, October 2007.
June 2009, par. 39.
7
1. De-institutionalisation
in the European context
1.1. The origin and development
of institutions in Europe
Until the development of public social of children with disabilities was almost
systems, families and communities automatic, while the model of care was
shouldered the main responsibility predominantly medical and focused
for taking care of their children and on deficiencies to be treated, instead
relatives. Between the 19th and the 20th of individual rights and needs to be
century a paradigm shift took place in fulfilled. The same medical approach
the culture of services across Europe, was used also for the care of newborns
as the State began to assume and young children under the age of
responsibility to provide food, shelter, three, clearly lacking understanding of
clothing and treatment for different attachment theories and the importance
categories of individuals. Large of individualised care.
residential facilities were established
for children without parental care, It is hard to outline a common definition
persons with mental health problems, of ‘institutions’ applicable to the wide
persons with disabilities and old people, diversity of national contexts across
often hosting hundreds of users. Europe. However, a few recurring
elements seem to characterise
Initially seen as a positive intervention institutional care and constitute what
by public authorities, institutionalisation has been referred to as ‘institutional
rapidly became a ‘one size fits all’ culture’19:
solution for all sorts of social issues:
poverty, disability, social exclusion, lack epersonalisation
D
of services in the community, parents’ Rigidity of routine
inability to reconcile family and work, Block treatment
neglect and abuse. In socialist regimes Social distance
from Central and Eastern Europe,
‘dysfunctional’ families and individuals Dependence, lack of accountability
were often perceived as not willing to and social, emotional and
be integrated into the society. Parents’ geographical isolation are also typical
difficulty to care for their children was of this kind of care settings. Size and
seen as an individual failure to be solved number of residents are not the only
through State intervention, with public elements to classify a residential care
authorities openly encouraging parents facility as an institution, although they
to place their children in institutions and do appear to be proportionally related to
even using it as a measure to sanction the presence of an institutional culture:
dissenting behaviour. “the larger the setting, the fewer the
chances are to guarantee individualised,
As a consequence, large-scale, needs-tailored services as well as
segregating institutions proliferated participation and inclusion in the
across the region. The institutionalisation community”20.
19 R
eport of the Ad Hoc Expert Group on the Transition 20
Report of the Ad Hoc Expert Group on the Transition
from Institutional to Community-based Care, 2009, p. 9. from Institutional to Community-based Care, 2009, p. 9.
8
1.2. Transition towards family
and community-based care
Nowadays, there is growing consensus De-institutionalisation, therefore,
that institutional care is simply not is a strategy to get children out of
compatible with a human rights institutions but also to avoid new
approach. The mass-treatment typical placements. A thorough assessment
of institutions is utterly inadequate of the needs of each child should
for providing services in a modern be conducted to provide alternative
society, failing to recognise individual care solutions based on his/her best
requirements or empower users, families interest. Reforms should tackle the
and communities. Certainly, it is not a root causes of neglect, abuse and child
suitable system to meet children’s abandonment, and aim at preventing
rights and developmental needs. unnecessary separation of children from
their families through a broad range of
A number of countries have started to support measures.
progressively dismantle their institutional
care systems re-integrating children in The ultimate goals of the systemic
their families and communities, but the reforms are therefore to prevent the
process is still far from completion. need for alternative care, to protect the
De-institutionalisation – also known rights of children living in alternative
as the transition from institutional care and to improve the quality of the
to family and community-based care provided to them. The Guidelines
care - can be defined as a policy- for the alternative care of children, a
driven process of reforming a country’s United Nations framework (hereafter
alternative care system, which primarily referred to as ‘UN Guidelines’) shall
aims at: represent the fundamental framework
of reference21.
ecreasing reliance on institutional
D
and residential care with a
complementary increase in family and
community-based care and services;
Preventing separation of children from
their parents by providing adequate
support to children, families and
communities;
Preparing the process of leaving
care, ensuring social inclusion for
care leavers and a smooth transition
towards independent living.
21
UN Guidelines for the Alternative Care of Children,
June 2009
9
2. Why should we close the remaining
children’s institutions in Europe?
2.1. Evidence from child development
literature and neuroscience
Research has largely demonstrated and impersonality typical of this form
that institutional care is harmful for all of care, the insufficient children-staff
individuals but in particular for children22, ratio, the limited availability of qualified
causing long-term effects on their professionals and the inherent nature
health and psychosocial development23. of shift work24. Under-stimulation can
Children need much more than decent cause long-lasting deficiencies in terms
material conditions: even the most of motor skills and physical growth25,
modern and well-equipped institutions while absence of interaction and other
fall short to provide the stimulation unresponsive care-giving practices
and individualised attention, the result in poor cognitive performance
educational and professional and lower IQ scores, particularly when
counselling, and when needed institutionalisation takes place at an
the customised early therapy and early age26.
rehabilitation indispensable for a
child to thrive. Institutional care is particularly
dangerous for infants between 0
Children growing up in institutions and 3 years: “Early childhood, the
are deprived of the possibility to period from 0 to 3 years, is the most
develop a continuous attachment to a important developmental phase in
primary caregiver, due to the rigidity life. The interactive influence of early
22 OHCHR, Forgotten Europeans, Forgotten Rights – damage”. Report of the Ad Hoc Expert Group on
The Human Rights of Persons Placed in Institutions, the Transition from Institutional to Community-Based
2011, p.6. Care, 2009, p. 12.
23 K. Browne, The Risk of Harm to Young Children in 26
R. Johnson et al, Young children in institutional
Institutional Care, Save the Children, 2009, pp. 9 – 17. care at risk of harm, 2006. See also the Bucharest
24 J. Williamson, A. Greenberg, Families, Not Early Intervention Project, which examined the
Orphanages, Better Care Network Working Paper, effects of institutionalisation for brain and behavioral
2010, pp. 5 - 6. development on a sample of young children. Results
25 “The effects of institutionalisation for children - even showed that children raised in institutional care have
where the institutions in question have good material significantly lower IQs. Bucharest Early Intervention
conditions and qualified staff - can include poor Project, Caring for Orphaned, Abandoned and
physical health, severe developmental delays, (further) Maltreated Children, 2009, PowerPoint available
disability, and potentially irreversible psychological http://goo.gl/kQLVy.
10experience and gene expression affect of several institutions for children with
the architecture of the maturing brain. disabilities unveiled a shocking scenario
(…) Impact on physical and cognitive of malnutrition and negligence, resulting
development, on emotional security and in an appalling number of child deaths29.
attachment, on cultural and personal
identity and developing competencies In the same line, the UN Secretary
can prove to be irreversible”27. The General’s study on Violence against
harmful effects of institutionalisation Children explicitly recommended
are evident also on older children, often that family-based care should be the
proportionally to the length of stay. only option for infants and very young
children30. Finally, the UN Committee
Furthermore, institutions display a grim on the Rights of the Child recognised
record of neglect, abuse and violence. that institutions are a particular setting
In 2009, Eurochild’s member Nobody’s “where children with disabilities are more
Children Foundation conducted a survey vulnerable to mental, physical, sexual
to illustrate the patterns of violence and other forms of abuse as well as
against children in institutions, reporting neglect and negligent treatment”31.
an incidence of sexual abuse equal to
twice that in the general population28. In
another Member State, the inspection
27
UNICEF, Call for Action: End placing children under dimensions of the violence against children raised in
three in institutions, 2011. According to the UN the residential institutions, Warsaw, 2009-2010.
Committee on the Rights of the Child, the definition 29
Y. B. Tavanier, Someone must be held responsible,
of early childhood should be extended to encompass Bulgarian Helsinki Committee, 24 September 2010.
all children below the age of eight: Committee on 30
United Nations Secretary-General, Report on Violence
the Rights of the Child, General Comment No. 7 - against Children, 2006, par. 112.
Implementing child rights in early childhood, 2005, 31
UN Committee on the Rights of the Child, General
par. 4. Comment No. 9 - The rights of children with
28
Nobody’s Children Foundation, Sexual violence disabilities, 2006, par. 47.
against children - Study of the phenomenon and
112.2. Equity and social inclusion
Not only too many children still enter of factors, such as: poverty, inadequate
the system of institutional care: too housing, single parenthood, lack of
often, they are separated from their gynaecological coverage and family
families without appropriate reasons. planning (resulting in unwanted/
Poverty, ethnic origin and disability unmonitored pregnancies), lack of
are still important factors leading to the parenting skills, lack of access to welfare,
placement of children across Europe, lack of support from the extended family,
proving the need to act upon the issue unemployment, lack of access to day-
as a fundamental question of non- care and specialised services for children
discrimination and equal opportunities. with disabilities, health conditions of
According to recent studies, children children or parents, substances misuse,
of Roma origins are overrepresented in stigma and discrimination. If these
institutional care in several EU countries factors are not properly addressed, the
and experience less favourable treatment situation in the family can escalate and
during their stay in the alternative care lead to neglect, abuse and violence.
system, as well as lower chances to be
transferred into family-based settings32. To complicate matters, institutions
often put a label of stigma on children -
Mostly, the cause for institutionalisation regardless of their age or circumstances
is not a single issue but a combination - and heavily reduce the chances of
32
European Roma Rights Centre, Bulgaria Helsinki
Committee, Milan Šimečka Foundation and
osservAzione, Life Sentence: Romani Children
in Institutional Care, 2011.
12successful future integration. The The impact of the economic crisis
effects of institutionalisation are likely is clearly perceptible across Europe,
to continue after the child reaches and its effects will be felt long after
eighteen years old, triggering a range of the economy has started to recover.
problems in adulthood and affecting the Rising unemployment and widespread
youngster’s adaptation to “other related cuts on social benefits and services
environments, like that of the educational are hitting hard on the most vulnerable
system, and later, the very adaptation to families, putting a growing pressure
social and professional life”33. As a result, on parents’ ability to provide for their
the population of care leavers ranks children. Anecdotal evidence35 already
particularly high on statistics of school shows an increase of referrals to the
dropouts, unemployment, homelessness, child protection system, with worrying
criminality and unstable parenting indications that some families are forced
patterns34, originating a vicious circle to place their children in alternative care
of intergenerational transmission of because of long-term unemployment and
poverty and social exclusion. severe material deprivation - including
malnutrition and homelessness36.
33
Hope And Homes For Children Romania, Save The 35 See Eurochild Report, How the economic and
Children Romania, Procedure Guide for the Social financial crisis is affecting children & young people
Integration of Youngsters Leaving the National Care in Europe, January 2011.
System/H.H.C. Romania, Baia Mare: Europrint, 36 C. Hadjimatheou, The Greek parents too poor
2006, p. 9. to care for their children, BBC World Service, 10
34
See also E. Munro, M. Stein (eds.), Young People’s January 2012, at http://goo.gl/qWBk5, See also
Transitions from Care to Adulthood, International Spiegel TV: http://goo.gl/4ZNsQ.
Research and Practice, Jessica Kingsley, 2008.
132.3. Human rights framework and EU commitments
The EU and the Member States have The rights and principles enshrined
important responsibilities concerning in the UNCRPD do not replace, but
protection and promotion of children’s reinforce the provisions of the UNCRC:
rights. All Member States have ratified the UNCRPD’s Preamble clarifies that
the UN Convention on the Rights of “children with disabilities should have
the Child (UNCRC), while following the full enjoyment of all human rights and
entry into force of the Lisbon Treaty fundamental freedoms on an equal
the promotion of the rights of the child basis with other children”, and recalls
became one of the objectives of the “obligations to that end undertaken by
Union. The treaty also incorporates the States Parties to the Convention on the
Charter of Fundamental Rights, which Rights of the Child”40.
states that “every child shall have the
right to maintain on a regular basis a In addition to international covenants,
personal relationship and direct contact non-binding instruments such as the
with both his or her parents, unless that UN Guidelines for the Alternative
is contrary to his or her interests”37. Care of Children represent an essential
reference, clarifying that “States should
In addition, the EU and a majority develop and implement consistent and
of Member States have ratified the mutually reinforcing family-oriented
UN Convention on the Rights of policies designed to promote and
Persons with Disabilities (UNCRPD), strengthen parents’ ability to care
which upholds the equal right of all for their children”41. The Council of
persons with disabilities to live in the Europe Recommendation on the
community38. Art. 23 of the UNCRPD rights of children living in residential
provides a clear framework of reference institutions42 establishes important
concerning children and alternative principles to be applied whenever a
care: “States Parties shall, where the child is placed outside the family, while
immediate family is unable to care for a the WHO European Declaration on the
child with disabilities, undertake every Health of Children and Young People with
effort to provide alternative care within Intellectual Disabilities and their Families
the wider family, and failing that, within puts emphasis on the right to grow up in
the community in a family setting”. The a family environment43.
Convention clarifies that “in no case shall
a child be separated from parents on the In parallel to legal requirements,
basis of a disability of either the child or there is a clear connection between
one or both of the parents”39. de-institutionalisation and political
37
Charter of Fundamental Rights of the European 41
UN Guidelines for the Alternative Care of Children,
Union, art. 24. June 2009, par. 33.
38
UN Convention on the Rights of Persons with 42
Council of Europe, Recommendation on the rights of
Disabilities (UNCRPD), art. 19. children living in residential institutions, 2005.
39
UNCRPD, art. 23. 43
WHO, European Declaration on the Health of Children
40
UNCRPD, Preamble. and Young People with Intellectual Disabilities and
their Families, 2010.
14commitments undertaken by the EU The disproportionate representation
across different policy areas. Within of Roma children in institutions
the Europe 2020 strategy to become should also be a major concern when
a smart, sustainable and inclusive implementing the EC Communication
economy in the coming decade, the ‘An EU Framework for National Roma
EU and the Member States have Integration Strategies up to 2020’47.
pledged to deliver high levels of social The long-term benefits of high-quality
cohesion and identified specific targets education and care in early years for
for improving education and fighting children coming from a disadvantaged
against poverty and social exclusion44. background were also outlined by the
EC in a Communication on Early
The links between poverty and children Childhood Education and Care48.
in alternative care must be taken into
account by the Europe 2020 Strategy. Regrettably, recent work of the European
The European Platform against Poverty Commission’s DG Justice hasn’t given
and Social Exclusion acknowledged due attention to children in/at risk of
that over 20 million children are at risk entering alternative care, who were not
of poverty in today’s Europe45: Eurochild singled out as a vulnerable group nor
advocates that the upcoming European were acknowledged by the EU agenda
Commission’s Recommendation on on the rights of the child49. Current
Child Poverty and Well-being should efforts addressing priority groups such
include a strong commitment for the de- as missing children, children victims
institutionalisation of children, including of violence, trafficked or sexually
prevention and support to vulnerable exploited should be more underpinned
families. by a comprehensive strategy to support
families and children at risk and prevent
The European Commission made children and infants from being taken
further commitments towards de- into care, as this group of children is
institutionalisation in the context of the particularly likely to be experiencing the
European Disability Strategy 2010- most extreme violations of their rights.
2020, by proposing to use Structural The 2011 report of the EU Agency for
Funds and Rural Development Fund Fundamental Rights, in fact, outlined the
to support community-based services persistence of several cases of violence
and pledging to raise awareness of the against children in institutions across EU
situation of persons with disabilities Member States, which was recognised
living in residential institutions, especially as a particularly heinous form of child
children and elderly people46. abuse50.
44
European Commission Communication ‘EUROPE 47 European Commission Communication ’An EU
2020 - A strategy for smart, sustainable and inclusive Framework for National Roma Integration Strategies
growth’, March 2010. up to 2020’, April 2011.
45
European Commission Communication ‘The 48 European Commission Communication ‘Early
European Platform against Poverty and Social Childhood Education and Care: Providing all our
Exclusion: A European framework for social and children with the best start for the world of tomorrow’,
territorial cohesion’, December 2010. February 2011.
46
European Commission Communication ‘European 49 European Commission Communication ‘An EU
Disability Strategy 2010-2020: A Renewed Agenda for the Rights of the Child’, February 2011.
Commitment to a Barrier-Free Europe’, 50 European Union Agency for Fundamental Rights
November 2010. (FRA), Annual Report ‘Fundamental rights: challenges
and achievements in 2010’, 2011, pp. 70-72.
152.4. Long term cost-effectiveness of reforms
There is a common misperception that box below). Nonetheless is it important
large residential settings are much to remember that high quality family
cheaper than family and community- and community-based care can be
based alternatives. The concept of expensive, particularly for children with
‘economy of scale’ is often recalled in complex and special needs. The quality
this regard, with scarce consideration for of life of the child should be recognised
quality standards and fundamental rights as an essential component of the cost-
entitlements. benefit analysis.
The comparison is of course flawed. However, quite aside from the human
Poor quality institutional care can be rights argument, providing the best
cheaper than high quality family and quality care alternatives possible is
community-based care51 but is likely cost-effective from a complete systems
to be more costly to public authorities approach. A comprehensive reform of
in the long-term due to social welfare, children’s services - with a strong focus
health and public security costs. In on early intervention, family support
countries with well-equipped residential and re-integration - can allow public
care services, the costs are likely to authorities to make substantial savings
be higher or comparable to family and in the long-term.
community-based alternatives (see
51
“Community-based alternatives (…) can provide the basis of comparable needs of residents and
better results for users, their families and the comparable quality of care”, Report of the Ad Hoc
staff while their costs are comparable to those Expert Group on the Transition from Institutional to
of institutional care if the comparison is made on Community-based Care, 2009, p. 5.
16Comparing the cost of alternative care solutions
According to a UK study from 2008, costs of all aspects of social care
the average cost for maintaining a child (capital and revenue costs). The
for a week in a residential placement is publication indicates that the average
4.5 times that of an independent living cost of residential care is £2,689 per
arrangement, 8 times that of the cost for child per week, as compared with
foster care, 9.5 times that of a placement foster care which is £67653.
with family and friends, and more than
12.5 times that of a placement with own A report from the Estonian National
parents. 8 children could be placed in Audit Office showed that the state
foster care for every child placed in a pays between 10,000 and 16,000
residential unit52. kroon per month for each child raised
in a substitute home, compared to
The Department of Health in England 3000 kroon per month for each child
funds research every year into the unit in foster care54.
52
H. Ward, L. Holmes, J. Soper, Costs and 53
University of Kent, Personal Social Services Research
consequences of placing children in care, Jessica Unit, Unit Costs of Health and Social Care 2010,
Kingsley Publishers, 2008, in Report of the Ad Hoc (Compiled by L. Curtis), 2010, pp. 106 - 108.
Expert Group on the Transition from Institutional to 54
Estonian National Audit Office, at:
Community-Based Care, 2009, p. 13. http://goo.gl/tEGmN.
173. The way forward: prevention
and quality alternatives
3.1. Preventing separation of
children from their families
Comprehensive prevention strategies ervices for parenting capacity-
S
can be extremely effective to ensure building;
child well-being, build positive social Emergency services to work with
capital and ensure that no child is taken parents at risk (e.g. counselling,
into alternative care as a consequence parenting support, emergency
of poverty, disability, prejudice or social reception centres where children at risk
exclusion. Support services must be of neglect or abuse can be placed on
put in place to strengthen parental a short term basis, emergency foster
responsibility, empower families most at- care);
risk and avoid escalation of problems. Out of school programmes, after
school care;
Universal measures and benefits Specialised services and financial
should be coupled with targeted support for children with special/
support for families and children at risk. complex needs (including educational
A broad range of services should be centres and temporary foster care
available in order to address problems offering respite to parents);
arising at different stages, including: Community centres for facilitating
the search of employment for both
amily planning;
F children coming out of institutions
Pre-natal care; (young adults) and family/community
Preventing abandonment at birth members.
(e.g. emergency support at the level
of maternity wards – social workers, The services can be concentrated in a
psychologists, medical professionals local centre (‘one-stop-shop’ model),
etc., rooming in55, breastfeeding serving the whole community and
support, Mother and Baby Units, parent providing a wide range of options for
and child foster care placements, etc.); help and support, while at the same
Early childhood services (e.g. day-care time encouraging inclusion56. Financial
centres where children can learn and transfers, child benefits, disability
play while their parents find work to allowances, social housing and other
support their family, early education for anti-poverty measures are also crucial to
children with disabilities, etc.); prevent family separation.
55 Rooming in’ is an arrangement in a hospital whereby 56
Hope and Homes for Children, Preventing family
a newborn infant is kept in a crib at the mother’s breakdown, at: http://goo.gl/3PRFg.
bedside instead of in a nursery.
18High quality, free and accessible pre- and post-natal care and health visits are
good examples of providing services to families in their homes and on an outpatient
basis. A specially trained ‘health visitor’ uses a public health approach that is non-
stigmatising, universal, and helps to identify children at risk. The health visitor has
an obligation to refer the family to social services if needed. Hospital social workers
are another way of preventing institutionalisation of new-borns, by providing the
necessary information and support to the pregnant woman at risk and to her family
prior or after the baby is born. The Sure Start program also offers community-based
programs for families – primarily mothers – with young children57.
It should be specified that family- On the contrary, failure to support
support policies are not synonymous children coming from specific family
with retrogressive or moralistic policies structures can be an important
defending a traditional definition of reason for institutionalisation. In some
family. Inclusive family policies must countries, 68% of the children entering
put children at the very centre, while the alternative care system come from
avoiding stigmatisation of parents and single parent families (especially single
discrimination between different family mothers), who face higher levels of
structures and family forms (e.g. lone- poverty and social exclusion58. Measures
parent families, unmarried couples, same- to promote inclusive family policies,
sex partners or parents, families having a granting non-discriminatory access to
migrant or refugee background, families social benefits, can play a pivotal role in
belonging to ethnic minorities, etc.). preventing the need for alternative care.
FARA Romania has been working with abandoned and orphaned children and
young people for 20 years, setting up family style homes, foster parents systems
and programmes to re-integrate young people into society. In order to ensure that
children with complex needs are not abandoned by their birth family, FARA Romania
developed specialist learning and development centres where both the child and
his/her family are provided with the support required to prevent separation. These
services have proven to be vital both for the children and for the parents, who are
now able to better cope with their child59.
57
Sure Start Children’s Centres, at: http://goo.gl/c4w0E 59
FARA Romania, at: http://www.faracharity.org/
58
Data from Lithuania.
19Funded by the EU’s DAPHNE Programme, the project of the Social Activities and
Practices Institute (SAPI, Bulgaria) A smack-free home for every child aims to raise
parents’ awareness of the negative consequences of corporal punishment and any
other cruel behaviour towards young children (aged 0-3) in the home environment,
whilst at the same time enhancing parents’ practical knowledge on positive discipline
methods. The target groups are:
xpectant parents and parents of children under 3 years old;
E
Parents at risk of child abuse (due to social exclusion, addiction, financial hardship,
past experience of violence, etc.);
Professionals who work with parents;
Policy- and decision-makers.
Together with its partners Nobody’s Children Foundation (Poland), the Children
Support Centre (Lithuania) and the Dardedze Centre (Latvia), SAPI raises
awareness of corporal punishment’s harmful effects, runs a ‘train-the-trainers’
programme and other educational activities for parents as well as seminars and
conferences60.
To make sure that the out-of-home Gatekeeping refers also to measures
placement of children is seen as specifically aimed at reducing the
a measure of last resort, efficient number of children entering institutions.
gatekeeping measures must be put This can be achieved through legal
in place - for instance, by ensuring measures (i.e. bans and moratoria - to
that measures of family support are be introduced gradually and in parallel
implemented as a prerequisite before to the development of quality alternative
children can be moved into alternative care), as well as economic measures
care. “Put differently, the separation of a - for instance, by creating incentives for
child and his or her parents would only local authorities to provide preventative
be possible if all other means of support community services instead of covering
have been proven to be ineffective”61. the costs of (generally more expensive)
institutional placements.
60 Social Activities and Practices Institute, and Alternative Care. Final Report, Council of Europe
at: http://goo.gl/NSXqa. Working Group on Children at Risk and in Care, 2004,
61 B. Gudbrandsson, Children in Institutions: Prevention p. 48.
203.2. Quality family and community-based care
In parallel to the progressive are placed by a competent authority
dismantlement of institutions, it is a duty for the purpose of alternative care in
of public authorities to ensure access for the domestic environment of a family
children to family and community-based other than the children’s own family
alternative care. Whenever separation that has been selected, qualified,
from the parents is in the best interest of approved and supervised for providing
the child, an accurate evaluation must such care;
be carried out to identify appropriate Other forms of family-based or family-
solutions. This assessment of each like care placements;
situation must be done on an individual Residential care: care provided in any
basis, taking into account children’s non-family-based group setting, such
opinions and preferences in accordance as places of safety for emergency
with their evolving capacity. In light care, transit centres in emergency
of modern attachment theories and situations, and all other short- and
evidence from neuroscience62, Eurochild long-term residential care facilities,
is persuaded that family-based care including group homes;
should be the only option for babies Supervised independent living
and young children (age group 0-3). arrangements63: young people living in
a flat, typically under supervision and
With respect to the environment where with support from a municipal contact
it is provided, alternative care may take person.
the form of:
Independently from the type of
inship care: family-based care within
K alternative care solution identified as the
the child’s extended family or with close most appropriate for the child, quality
friends of the family known to the child, must be regularly monitored following a
whether formal or informal in nature; clear framework of reference focused on
Foster care: situations where children outcomes for children.
SOS Children’s Villages, IFCO and FICE developed a set of quality standards
for out-of-home child and youth care in Europe, covering the four phases of
decision-making, admission, care-taking and out-of-care/leaving care. The method
of ‘storytelling’ chosen for data collection ensured direct participation of the
interviewees in creating the basis for the standards. The research items were stories
of good practices from parties who have experienced alternative care: children and
young people, parents, caregivers, social workers, lawyers, etc. A total of 332 stories
from 26 countries were collected and analysed. The standards have been widely
recognised at national level and by the international community working in Europe
as a key contribution to the development of policies and practice for children in
alternative care64.
62 See Attachment theory by John Bowlby, 1969. 64
SOS Children’s Villages, IFCO and FICE,
See also K. Browne, The Risk of Harm to Young Quality4Childen Standards for out-of-home
Children in Institutional Care, Save the Children, 2009. child care in Europe, 2007.
63 UN Guidelines for the Alternative Care of Children,
par. 29. 21In 2002, the UK Government developed a set of National Minimum Standards for
Foster care and Fostering Regulations, providing a framework of quality in which
all fostering providers, local authorities and NGOs should develop their fostering
services65.
The UN Guidelines for the Alternative in daily activities. There can be a lack
Care of Children specify that, if residential of attachment and warmth to living
facilities are put in place, these should environments if small group homes
be small and be organised around the are kept tidy and orderly, but without
rights and needs of children, in a setting personalising children’s spaces and
as close as possible to a family or small without any efforts to make the children
group situation66. feel ‘at home’. Job cuts reducing the
personnel often lead to a chronic under-
According to Eurochild members’ staffing in small group homes and impact
experience, when children are placed negatively on children’s quality of life
in new, smaller residential homes the and basic care. If new habits, mentalities
managers of these services are key and ways of working with children are
in relation to their running and the not introduced, then a new system of
way in which children will be socially family-like alternatives can easily turn into
involved and encouraged to participate “small institutions”67.
65 UK Government, Department for Education, 66 UN Guidelines for the Alternative Care of Children,
Fostering Services: National Minimum Standards, par. 123.
2011, at: http://goo.gl/AHnhj. 67 Hope and Homes for Children Romania, 2012.
22Since 1997 the ‘For Our Children’ Foundation (Bulgaria) is active in recruiting
foster parents and providing support to future foster carers throughout the entire
process and afterwards. This support includes:
Telephone consultations to clarify the general motivation and possibilities that
foster caring offers;
Information meetings - meeting the candidates and their families to talk about
foster care, the opportunities it provides to families and its positive effects for
children;
Providing support to collect the documents needed;
Assessing foster candidates’ capacity, capabilities and parental skills;
Training for candidates to understand what children expect and to learn more
about abandonment effects and children with special needs;
Presentation to the Commission in charge to approve applications in the
municipality;
‘Matching’ the child with the candidate foster parents;
Holding professional consultations by social workers and psychologists before and
after the foster care placement (when the family experiences difficult situations,
dilemmas or problems);
Supporting trainings in order to help the approved foster carer to learn new things
and provide quality care to children68.
Working together with the Kyustendil Municipality, the Cedar Foundation (Bulgaria)
successfully closed an institution for children and young adults with intellectual
disabilities even before the official start of the overall de-institutionalisation reform in
the country.
Four semi-detached houses built by the Cedar Foundation and two flats provided
by the municipality were turned into six small group homes in which the 24 former
residents of the institution now live – 4 in each. The services are State-funded, but
the Cedar Foundation has hired additional staff to ensure the quality of care and to
meet the individual needs of every child or young adult, thus bringing the number of
staff to double the mandatory number required by the national methodology for this
type of service. Three of the children are now attending mainstream school and all
of them participate in various activities such as attending a day-care centre, dance
classes and educational sessions outside of their homes. The continuous efforts
and initiative to socially integrate the children and young adults in the community is
paying off, as the community starts to perceive these children and young adults as
community members with the same rights to inclusion and well-being69.
68 For Our Children Foundation, at: 69
CEDAR Foundation, at:
www.detebg.org/en/. www.cedarfoundation.org/en/
23Opened by Hope and Homes for Children Romania as a prevention service, the
Mother and Baby Unit in Sighetu Marmației (Maramureș County) aims to prevent
the separation of children from their mothers due to difficult circumstances by
providing short term (up to one year) accommodation and by teaching them life skills
necessary for independent living.
The Mother and Baby Unit (MBU) functions in cooperation with the county’s other
prevention services as well as with relevant community actors (such as employers
and/or employment agencies) in order to provide a continuum of services for the
mothers and their babies. The mothers, who are referred to the MBU or request help
themselves, are at risk of separation from their child/children due to different reasons,
the most frequent being lack of financial means, lack of acceptance by the larger
family (especially if children are born out of wedlock) and abuse from the family,
the father of the child/children or the current partner. Out of the 41 mothers and 71
children who benefited from the services of the MBU, 97% were reintegrated in their
communities with steady jobs (and therefore steady incomes) and with places to live
(either rented or purchased, or with the birth/extended family)70.
ARK’s de-institutionalisation programme in Stara Zagora (Bulgaria) focused on
the prevention of abandonment and the development of alternative care services to
enable the closure of institutions for children.
The development of a small group home service was a critical component of
the programme: “In order to promote de-institutionalisation, a range of alternative
services are required. Family placement through reintegration to family, adoption
or foster care will always remain the preferred option when planning for children in
care. However, there are a significant number of children currently living in institutions
who are unlikely to be reintegrated or placed with foster or adoptive families in
the foreseeable future. In order to ensure that these children are not ‘left behind’
and to make comprehensive de-institutionalisation possible, there is a need to
develop alternative residential care services. The small group home service in ARK’s
programme was designed with the aim of providing the best quality care possible
for as long as necessary, pending the development of other services and whilst
continuing to work actively to find family placements for all the children”71.
70 Hope and Homes for Children Romania, at: 71 ARK Bulgaria, There’s no place like home - Creation
http://hhc.ro/en/projects/. of a small group home service in Stara Zagora,
Bulgaria, 2006-2009.
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