ending institutionalisation ensuring better outcomes for children
TRANSCRIPT
Ending institutionalisation
Ensuring better outcomes for children
A European problem
• One million children in institutions in the European region due to poverty, ethnicity, disability
• Institutionalisation causes severe harm to the health and development of children
• Outcomes are extremely poor – 10 times more likely to be trafficked; high levels of suicide, criminality, involvement in prostitution
The Solution
• Strengthened/more accessible universal services (community health and education)
• A range of targeted community based services that support the family
• A continuum of substitute family care• Specialist residential care in small group homes for
minority of children with complex needs• Changes in attitudes – society, politicians,
professionals• Reinvestment of resources
Changes in development when moved from institutions to foster care
Changes in behaviour on moving from institution to foster care
Challenges and pitfalls
Getting from where we are now to where we want to be – negative unintended consequences
• Setting target for 50% reduction • - easy to place children (cheaper services)• - reduce staffing and budget• - amalgamate institutions• - inappropriate placements and trauma• - reduced overall budget spent on children• - insufficient funding available for children with
disabilities
Challenges and pitfalls
• Limited placement options• - continued reliance on too much residential
care (expensive services, poorer outcomes)• - insufficient focus on family support• - reform considered too expensive
Challenges and pitfalls
• Focus on buildings• - inappropriate use of buildings for new
services• - costly investment in such buildings• - poor outcomes for children
Challenges and pitfalls
• Insufficient funding for the whole reform process
• - results in partial reform – usually the most vulnerable children are left behind
• - running two parallel systems – reform is seen as too expensive
• - overall numbers in care rise• - need for proper costing of reform and
understanding of cost benefit
Challenges and pitfalls
• Statistics disguising the real situation• - some children not included in statistics on
institutionalisation – therefore no plans for them
• - over-estimation or under-estimation – a challenge for planning for future need
• - numbers in institutions do not show the dynamic flow through the system
Challenges and pitfalls
• Different message and priorities from international donors and policy makers
• - conflicting reform programmes• - inefficient use of funding• - increases resistance to reform
Lumos’ approach
International level
• Spidla report on transition from institutional to community based care – endorsed by EC
• Common European Guidelines and Toolkit on deinstitutionalisation – endorsed by two General Directors of EC
10 elements of deinstitutionalisation
Admissions/year per 10,000 of child population
England Bulgaria Montenegro Sweden0
5
10
15
20
25
30
5
25
18
9
Per 10,000
Number of children in residential care/10,000
England Bulgaria Sweden Montenegro0
10
20
30
40
50
60
70
80
90
10
85
20 20
Per 10,000
GDP per capita (USD)
United Kingdom Bulgaria Sweden Montenegro0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
36,495
13,332
37,904
13,929
GDP per capita USD
Cost per child per year of different forms of care
Sweden cost/year € UK cost/year € -
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
177,823
109,590
46,181 37,981
14,828
4,100
Residential careFoster careAt home with support
