International Study Recommends Phase-Out of Institutions for Children

Photo of an institution for children in Kazakhstan. Photo: Human Rights Watch

A major new review of the effects of raising children in institutions — and the effects of getting those children into family-based care — concludes that institutionalization should be phased out.

More than six million children may be living institutions across the globe, according to an estimate published in the British medical journals The Lancet Psychiatry and The Lancet Child & Adolescent Health.

On Tuesday, those journals published the results of a peer-reviewed meta-analysis of the literature in the field, and makes several policy recommendations to improve the outcomes for these children.

“Institutions provide suboptimal care and are associated with substantial developmental delays in physical growth, cognition, attention, socioemotional development and mental health,” according to a news release announcing the study. “Children can rapidly recover when they are moved into a family environment, although some effects might last into adulthood.”

In the United States and many other countries, at least, most child advocates already back efforts to keep children living with parents, other close relatives or other family-like settings rather than placing them in traditional orphanages and other forms of institutional care. The Family First Prevention Services Act, which passed in 2018, halts federal funding for group homes and institutional placements after two weeks, with a few notable exceptions for specialized programs. 

But in some countries, the report notes progress is slow or even going in the wrong direction. Even in the United States, where overall use of group settings for foster youth declined by 12% between 2011 and 2017, there were 20 states that saw those placements increase. 

Ten of those states saw an increase of 20% or more. New Hampshire nearly tripled the number of children in congregate care during this time frame.

The authors reviewed 308 studies from the past 65 years, which were conducted across 68 countries and involved over 100,000 children removed from their home, and compared the development of children in institutional care to those raised in family settings.

Children in institutional care strongly lagged behind their peers in physical growth, cognition and attention, and to a lesser degree, in emotional development and mental health. Children placed in institutions in their first two years were associated with larger developmental delays. 

These effects can be rapidly reversed in the years immediately after deinstitutionalization (particularly in physical and brain growth), the study notes, although substantial impairment can persist for the most seriously affected children over the longer term.

The authors call for every effort to be made to minimize children’s exposure to institutional care. To help achieve this, the authors say every effort should be made to minimize exposure to institutional settings. Funding should be shifted from institutional programs to family-centered ones, and eventually eliminate institutions altogether.

“The global intent to provide optimal care for separated children has never been greater,” the report said. “It is essential that governments, voluntary organizations, and health and social care professionals work together so that action is not taken precipitately, with potentially unintended adverse consequences, but is instead timely, sustainable, and child-centred.”

A webinar tomorrow will further discuss the study’s findings, and to launch the Commission on the Institutionalization and Deinstitutionalisation of Children. Click here to register.

Chronicle of Social Change staff reports

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