Deinstitutionalisation (orphanages and children's institutions)

Deinstitutionalisation occurred in the US between 1941 and 1980.[1][2] In the US it was a consequence of the Social Security Act of 1935 (SSA), which allowed Aid to Dependent Children (ADC) to be passed, and meant that children could no longer be removed from their families due to poverty alone.[3] It occurred over a similar period in Western European and some South American countries.[4] The current alternative in the US is known as the Foster Care system.

Deinstitutionalisation is currently most common in the former Soviet Bloc.[5] Increasingly the institutions that remain in Eastern Europe are occupied by disabled children who can be harder to place in the community.[6] 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,[7] Romania, whose orphanages are the most infamous in the world,[8][9][10] and Bulgaria.[11][12][13][14] It is also happening in Hungary where no new children can be placed in orphanages,[15] Moldova,[16] Ukraine, Belarus and Bosnia. Azerbaijan has established a Department for De-institutionalisation and Child Protection.[17][18] Russia is also recognising children should be brought up in families but is not yet closing institutions.[19]

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[20] and Ghana[21][22][23][24] and Ethiopia however as the governments do not run the institutions the process can be more complex.[25] 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.[26]

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.[27] It is now a priority of NGO's in Nepal[28] or in Cambodia.

This is a scientific study that compares 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 behavioral 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.[36]

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.[40]

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.[41]

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.[42][43]

Long term fostering, defined as fostering for over a year, can often bridge the time between the closure of an institution and independent life.[44]

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.[45][46]