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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
30
25
25
20
18
15
Per 10,000
10
9
5
5
0
England
Bulgaria
Montenegro
Sweden
Number of children in residential
care/10,000
90
85
80
70
60
50
Per 10,000
40
30
20
20
Sweden
Montenegro
20
10
10
0
England
Bulgaria
GDP per capita (USD)
40,000
37,904
36,495
35,000
30,000
25,000
20,000
GDP per capita USD
15,000
13,929
13,332
10,000
5,000
0
United Kingdom
Bulgaria
Sweden
Montenegro
Cost per child per year of different
forms of care
200,000
180,000
177,823
160,000
140,000
120,000
109,590
Residential care
100,000
Foster care
At home with support
80,000
60,000
46,181
37,981
40,000
14,828
20,000
4,100
Sweden cost/year €
UK cost/year €
Contacts
[email protected]
www.lumos.org.uk