japan presentation june 2nd final
TRANSCRIPT
Georgette MulheirChief Executive, Lumos8 June 2015
Toward a Society in which Children Can Grow Up in Families
Building on the Experience of Promoting Family Protective Care in Central and Eastern Europe
Institutionalisation of children
a global problem
Institutions are established to care for ‘orphans’
More than 90% in Europe are not orphans (overall 80% globally)
• Science proves the harm caused by institutions
• Dramatic impact on Early Brain Development
• Increased risk of all forms of abuse
• Increased mortality risk, especially disabled children
• Extremely poor outcomes for children
The harm caused by institutionalisation
These images from the Bucharest study show the decreased electrical activity in an institutionalised child’s brain. The colour orange indicates high activity.
EEG level: An institutionalised child
EEG level: A never-institutionalised child
Adults who spent their childhood in institutions were:
10 times more likely than their peers to be involved in prostitution
40 times more likely to have a criminal record
500 times more likely to commit suicide
Outcomes for children with disabilities
One study found that of children under three in institutions across Europe:
• 0.29% of children without disabilities died
• 28% of children with disabilities died
Children with disabilities were 100 times more likely to die in the institution than those without disabilities.
Why are the outcomes for children so poor?
• Children cannot form an attachment – essential to healthy development
• High personnel costs mean limited time with children
• Impossible to respond to individual needs
• Abusive methods of behaviour control
• Isolated from the community – children do not learn skills to survive in the outside world
• No family/social network when leave institution
• Desperate for love and affection – open to abuse and exploitation
The scale of the problem
European Union: 150,000
Russia: 600,000
Ukraine: 120,000
Brazil 50,000There are eight million children in institutions around the world
Global picture in numbers
5.5
16
49
21
39
0
10
20
30
40
50
60
England Japan Czech Republic Bulgaria Moldova
Rate of children in institutions per 10,000
rate of children 0-18
0 0
7
38
29
0
5
10
15
20
25
30
35
40
England Sweden Japan Czech Republic Bulgaria
Rate of babies in institutions per 10,000
children 0-3
0 0
Successful deinstitutionalisation includes…
Developing community services to replace institutions
Preventing children from entering institutions
Removing all children currently resident – to family based care
Ring-fencing and transferring resources
Capacity and expertise to manage major change
Changing attitudes, polices and practices
Empowering children and families to take a lead role in changing attitudes and practices
Lumos’ work at national-level
An example from Moldova
Number of children in institutions in Moldova 2007-2014
Number of children in the institution in Floresti from 2007 -2014
Number of children in institutions in Ialoveni County from 2007-2014
Number of children in institution no. 2 in Chisinau from 2007 -2014
Number of children in the institution in Orhei from 2007 - 2014
Number of children in foster care in Moldova
282
372
421440
581
660
735
850
0
100
200
300
400
500
600
700
800
900
2007 2008 2009 2010 2011 2012 2013 2014
Number of children in foster care in Ialoveni region
3
6 6 6 6
12
18
28
0
5
10
15
20
25
30
2007 2008 2009 2010 2011 2012 2013 2014
Number of children in foster care in Floresti region
9 9
13 13
19
37
45
60
0
10
20
30
40
50
60
70
2007 2008 2009 2010 2011 2012 2013 2014
Number of children with disabilities in Moldova educated in inclusive vs segregated schools
31482549
2300
18071538
12531604
2258
44957660
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
Segregated residential special schools Inclusive mainstream schools
51%The number of children with disabilities separated from their families and living in residential special schools has reduced by 51% in five years
511%The number of children with disabilities educated in inclusive mainstream schools has increased by 511% in five years
Cost savings over time -example from Moldova
Cost/child/year in different placements(in Euros)
4100 3881
3382
475
831
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Institution Small group home
Foster care Family support Inclusive education
Cost per child per year
Cost/child over 12 years (in Euros)
49200 46572
40584
1425
9972
0
10000
20000
30000
40000
50000
60000
Institution Small group home Foster care Family support Inclusive education
Cost per child over 12 year period
Two care options for 13,000 children
13,000 children in institutions = €639,600,000
13,000 children cared for in the community =€79,405,950
Only 12% of expenditure on institutions
Savings invested have:
introduced inclusive education in 40% of schools in the country
Reduced infant mortality from 14/1000 to 9/1000
An example fromBulgaria
Number of children in institutions in Bulgaria
6730
5695
4755
4122
31132721
0
1000
2000
3000
4000
5000
6000
7000
8000
2009 2010 2011 2012 2013 2014
Number of babies in institutions in Bulgaria
24552319
2087
1204
975
0
500
1000
1500
2000
2500
3000
2010 2011 2012 2013 2014Number of babies in institutions
Number of children in foster care in Bulgaria
221391
580
1943
2304
0
500
1000
1500
2000
2500
2010 2011 2012 2013 2014
Number of children in foster care
Admissions to institutions for children in Bulgaria
31702930 2855
2708
2099
1044
0
500
1000
1500
2000
2500
3000
3500
2009 2010 2011 2012 2013 2014
Admissions to institutions in Bulgaria
% of admissions of children in Foster Carevs. Residential care in Bulgaria
[値]%
[値]%
[値]%
[値]%
0
10
20
30
40
50
60
70
80
2012 2013
% in Foster Care % in residential institutions
An example from theCzech Republic
Number of children in institutions in the Czech Republic
Admissions to institutions for children in the Czech Republic
3.1
3.8
4.8
5.1
5.6
6.2
6.6
6.7
6.8
8.1
8.4
9.0
10.9
14.4
0.0 5.0 10.0 15.0 20.0
Královéhradecký County
Pardubický County
Olomoucký County
Jihomoravský County
Plzeňský County
Zlínský County
Czech Republic (nationally)
Středočeský County
County vysočina
Liberecký County
Moravsko-slezský County
Jihočeský County
Karlovarský County
Ústecký County
Admissions to children homes per 10,000 children aged 3-18 in 20012/2013
4,6134,884
5,174
5,727
6,7227,021
7,463 7,651
8,606
9,771
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Number of children in foster care and guardianship in the Czech Republic
Foster care
0 329
108
302
498
0
100
200
300
400
500
600
2011/01/01 2012/01/01 2013/01/01 2014/01/01 2015/01/01
NUMBER OF CHILDREN IN SHORT-TERM FOSTER CARE IN THE CZECH REPUBLIC
Capacity of community-based family support services has grown significantly in recent years
76
322
0
50
100
150
200
250
300
350
2006 2014
Number of registered social-activation services for families
with children in the Czech Republic
20
200
0
50
100
150
200
250
2006 2014
Estimated number of families that can be supported by social-activation services for families
with children in Pardubice country
Increased capacity in preventive social work has already had impact on Children‘s Homes
Admissions to children homes in Pardubice county have decreased significantly
No preschool child admitted to children‘shome in Pardubice in 2012/2013
56
17
0
10
20
30
40
50
60
2004/2005 2012/2013
Number of admissions to children's homes in Pardubice county
1618 18 18
810
6
14
00
5
10
15
20
25
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
Admissions of preschool children to Children's homes in Pardubice county
Capacity of community-based support services to families with children with disabilities has also been increasing…
2,703
2,984 2,933
3,779
2000
2200
2400
2600
2800
3000
3200
3400
3600
3800
4000
2009 2010 2011 2012
Number of users of early intervention (raná péče) in the Czech Republic
Increased capacity of community-based support services to families with children with disabilities has led to almost 30% decrease in numbers of children in disability care homes in 4 years
1063
926
834
769
600
650
700
750
800
850
900
950
1000
1050
1100
2009 2010 2011 2012
Number of children in disability care homes
Costs of different types of service/placement
1 040 (29 tis.)
8 850 (245 tis.)
15 700 (430 tis.)
10 900 (299 tis.)
22 400 (614 tis.)
0 5,000 10,000 15,000 20,000 25,000
Community-based family support service
Long term foster care
Short term foster care
Children's home
Baby institution (Pardubice county)
Cost for one placement/bed per year (in Euro and CZK)
Cost of the ‘average’ case:
Placement in baby home for 4 months
Placement in short-term foster care for 4 months
2 years of community-based family support services
7 467 (204 tis.)
5 233 (144 tis.)
2 080 (57 tis.)
Community-based system: alternative placements to 85 beds in Baby homes
8
358 (9 820)9
42 (1 163)24
25 (684)
4 6 (168)2
5 (141)
26 408 (11 185)
8 71 (1 940)
4 63 (1 721)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Number of placements Yearly costs in thousands EURO/CZK
Alternative placements/services - numbers and costs
Foster care for children with disabilities
Long term foster care
Short term foster care
Home with support of early intervention and family supportHome with support of early intervention service
Home with family support
Annual budget for current and new systems
1 748(47 900)
979(26 825)
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
85 beds in baby homes Community-based system
Yearly costs for placements in baby homes and alternative placements (thousands EURO and CZK)
The new system will be able to help more children for the same budget
The community based system costs less
approx. 770 thousand EURO (21 100 tis. Kč)
could be saved annually
approx. 740 families could be supported
by community- based family support
services with this money
100 100
740
0
100
200
300
400
500
600
700
800
900
85 beds in baby homes Community-based system
Children served with the same budget
Children yearly served thanks to the beds in baby homes
Children in the community supported thanks to lower costs of alternative placements/services
Therefore more children can be helped with the same budget
Types of Fostering 1
There are various types of foster care available:
Emergency
Where children need somewhere safe to stay for a few days
Short –Term
Where carers look after children for a few weeks or months, while plans are in made for the child’s future.
Short –Breaks
Where children with disabilities, special needs or behavioural difficulties enjoy a short stay on a pre-planned regular basis with a foster family, and their parents have a short break for themselves.
Remand Fostering
Where young people are remanded by the court to the care of a specially trained foster carer.
Types of Fostering 2
Long –Term and Permanent
It is not appropriate for some children who have regular contact with their own families to be adopted and they may be placed with long term foster carers
“Family and Friends” or “Kinship” Fostering
Where children who are looked after by a local authority are cared for by people they already know. This can be very beneficial for children.
Private Fostering
Where the parents make a private arrangement for the child to stay with someone else who is not a close relative and has no parental responsibilities, and the child stays with the private foster carer for more than 27 days. The local authority must be informed about the arrangements and visit to check the child’s welfare.
Types of Fostering 3
Mother and Baby Placements
These are specialist placements with carers who can offer a parent and her young baby accommodation. The carer will provide stability, advice and the help needed to enable the mother to develop the skills required to be a parent. The carer may also be involved in the assessment of the parent’s ability to meet the child’s needs independently in the long term.
Types of Fostering 4Treatment Foster Care
• This is specialist foster care to meet the needs of children and young people with emotional difficulties and displaying challenging behaviour.
• Different models used including Multi-Dimensional Treatment Foster Care and Keep
• Both children and foster carers are provided with high levels of support including therapeutic support and support available 24 hours a day
• For older children this model can be an alternative to residential care for children who have found it hard to settle in mainstream foster placements
Planning the transfer of resources
A range of community based services is needed to replace institutions
Most are cheaper
Some are more expensive
Why does an institutional system cost so much?
24-hour care - many personnel
Building maintenance
costs
More children in institutions
than need to be in care
Financial incentives to bring more children in
(budget per child)
Belief that institutions are an ‘economy of scale’:
Put all the children together and it will cost less
However the evidence suggests otherwise
Universal:Children’s Centres – around £600 per user
Parenting programme(e.g. Triple P)-£900- 1,000 per
PEIP -£1200-3000 per
Family Nurse Partnerships, Family Functional Therapy &KEEP- £3000 per family a year
Multi-Systematic Therapy- £3-10,000 per intervention
Family Intervention Services- £8-20,000 per family per year
Child looked after in foster care -£25,000 per year placement costs (plus additional services)
Multi-dimensional Treatment FosterCare- £70,000 per year for total package
It is vital that children and young peoplereceive the right
services at the right time. These figures are
intended to be illustrative
Child looked after in children's home -£125,000+ per year placement costs
Child Looked after in secure accommodation - £134,000+ per year placement costs
Costs increase as children get older. Increasing related
costs such as healthcare and
the criminal justice system make it clear
joined up working is a core part of
cost effectiveness
Cost
Universal: Schools - £5400 per pupil
Co
st p
er C
hild
/Fam
ily
Severity of assessed need
Information Services -Around £34 via telephone helplineAround £2 via digital services
High relative costs of intervention for small group of looked after children and those on the edge of care
Institutions have three types of resources that should be reinvested in community services:
Financial (annual budget and donations)
Human (institution personnel)
Material (buildings, land, vehicles,
equipment)
If not, as numbers in institutions reduce, resources disappear from the system…
Outcomes
Improved development following move from institution to foster care
0
10
20
30
40
50
60
70
80
90
100
Height Walking Speech Cognitive
Average/above when
placed
Average/above now
Changes in behaviour on moving from institution to foster care
0 20 40 60
Enuresis
Food issues
Nightmares
Lying
Stealing
Aggression
Self-harmVery frequent now
Very frequent when placement began
Research among homeless population in Prague*:
• High numbers of homeless young people with history of institutional care
• Almost no cases of young people who were in Foster care
*Source: PRUDKÝ, L. a ŠMÍDOVÁ, M. Kudy ke dnu: analýza charakteristik klientů Naděje, o.s., středisko Praha, Bolzanova. Vyd. 1. Praha: Socioklub, [2010] dotisk, 135 s. Sešity pro sociální politiku. ISBN 9788086140681.
Outcomes of residential vs foster care in The Czech Republic
Belief that material conditions can replace a family’s love and nurturing…
- An Institution Director
“Our children have everything they need: their own rooms, TV, internet, air-conditioning and a mini-bar. They have the best teachers. They visit the US, Austria, Switzerland. What would they have if they were at home?”
