Changing Practices:
Best Practice & Deinstitutionalisation


WHAT IS BEST PRACTICE IN THE CARE OF CHILDREN?

 

Best practice in the care for vulnerable children should always be guided by the principles of the best interests of the child. Services should be designed and offered based on the needs and interests of children, not based on the mandate or vision of an organisation. Services should be designed and delivered with recognition of the broader rights of the child and not unnecessarily cause a rights regression. Services should be appropriate to the need and aim to be as least invasive and disruptive as possible.

In most cases where there is a child in need, there is a family in crisis. Many programs that seek to care for children only focus on the child, treating him or her as an isolated individual. This leads to services that completely erase the parents, families and community from the picture and often the child's life.
The truth is that every child has a context, which is their family and their community. We need to recognise and validate the important role that the family and community plays in child welfare and child protection. Where families are struggling, or communities are facing poverty, we need to seek to strengthen both the family's and community's ability to care for and protect their own children rather than removing their children from them. This approach is called family strengthening and family preservation. 

When a child is identified as at-risk, a thorough assessment should be conducted by trained, competent and authorised personnel. They should assess the situation of the child and their family, determine what their real needs are and determine the least invasive form of support that can be offered. Preference is given to, where possible, preserving families and avoiding separation. This is what we call gate keeping and its practice prevents residential care from being used as a first resort or as the only form of assistance given to families.

When a child has to be removed from their family, or they have no immediate family to care for them, and alternative care needs to be arranged, it is important that we look for placements according to the continuum of care. The continuum outlines the types of alternative care in a preferential order, starting with the least disruptive option all the way through to the most disruptive option for the child. The continuum is as follows:


Parental care

Kinship care (extended family in the same community)

Distant kinship care (extended family located elsewhere)

Foster care (in own community)

Foster care (in another community)

Pagoda or faith based care

Group home care

Family-like residential care

Larger residential care

When all other forms of family and community-based care options on the continuum have been deemed not in the best interest of the individual child, then residential care might be the most appropriate option. Preference should be given to small family like facilities that adhere to high standards of care, are legally registered, have qualified staff, good child protection policies, and facilitate the child to continue to participate in community and cultural life outside of the residential care centre.

All forms of residential care should have a reintegration program that helps each child develop a plan to ensure they are able to be reintegrated into the community as soon as possible. This plan should be developed as soon as a child enters care and should be overseen and monitored by a competent staff member. Each child should at minimum have an annual review to determine if they are ready to be reintegrated. If they're not ready, their reintegration plan should be updated and continually implemented.

Many residential care centres talk of reintegration as the act of leaving care at 18 years old. In fact, reintegration is not an event. It is a process and it should not exclusively be used as a way to graduate children who reach 18 out of the home. It should be the goal for every child as soon as it is in their best interest, in accordance with the accepted standard that residential care should be 'temporary'.

All alternative care placements should be monitored regularly to ensure children are safe and well integrated into the family and community. Good monitoring prevents potential abuse and mistreatment as well as acts as a preventative measure against placement breakdown. This is because any issues that are causing the child or the family stress can be identified early on and addressed before placement breakdown becomes imminent. Monitoring should be undertaken by trained and competent staff members who have developed a good relationship with the child and family.

SUPPORTING DEINSTITUTIONALISATON


Deinstitutionalisation is a process of transitioning from institutional to community-based child welfare systems. Deinstitutionalisation requires on one hand the closing down of institutional services and on the other hand the development of new community based services for children and their families.

Deinstitutionalisation also includes the process of reintegrating children who are living in long-term residential care back into their communities. Ideally this means reunifying them with their families and where that is not possible placing them in an alternative care arragnement according to the alternative care guidelines and continuum.

Deinstitutionalisation is a complex process, which needs to be well planned and implemented. The following 10 principles of deinstitutionalisation have been taken from Lumos, a key organisation working towards the deinstitutionalisation of child welfare services in Europe and other parts of the world.

Lumos’ 10 principles of deinstitutionalisation (wearelumos.org)

Children (and their families) should be full partners in the transition process. They should be actively involved and consulted in the development, delivery and evaluation of the services they receive and provided with appropriate information in a manner which they can understand.

The necessary steps should be taken to prevent the placement of individuals into institutions. Holistic policies are necessary for the support of families and other informal carers as well as for strengthening the inclusive capacities of communities.

A range of available and affordable high-quality services in the community to replace institutional care needs to be built up. They should provide support for family and informal carers, starting with their individual needs and preferences. Their purpose is to prevent further admissions to institutional care, to provide placements for the persons currently in institutions and also to benefit those people who live in the community (with their families or otherwise), but without adequate support.

Institutions should be closed down in a way which ensures that no child is left behind in unsuitable conditions and any risk of trauma linked to a change in their living environment is minimised. Those with the highest support needs should be given priority and planning should include the preparation of a plan for each child and the assessment of the training needs of staff wishing to work in the community. 

Processes of transition from institutional to community-based care typically take many years. Meanwhile, many children continue to live in unsuitable, harmful conditions. Therefore, some renovation of existing institutions may be required but should be limited to what is strictly necessary to look after the best interests of the child during transition. 

It is vital to ensure the availability of sufficient and well-trained staff with skills appropriate for community-based care, which is based on partnership, inclusive attitudes and an inter-disciplinary approach. This may involve retraining and re-qualification of staff who previously worked within the institutional culture. By redeploying the personnel who can be trained to work in the community, resistance to the process of reform can be reduced.

A residential care facility is extremely costly. As far as is possible, and in the best interests of children, these resources should be transferred from the existing institution to new services. Re-use of existing resources ensures that the reform process is less expensive and more sustainable. Budgets for running costs can be transferred to cover the costs of running services in the community, such as small group homes and family support centres; at times, buildings can be reused for other purposes (where they are appropriately located and in sufficiently good condition).

Systems of quality control should concern both the process of transition and the resulting services, with a clear focus on user satisfaction. The involvement of children, their families and their representative organisations in the monitoring of quality is crucial.

Issues concerning transition from institutional to community-based care must be addressed across all the relevant policy areas, such as employment, education, health, social policy and others. Such a holistic approach should guarantee coordination and policy consistency across different branches of government as well as continuity of care, e.g. between childhood and adulthood.

The transformation process needs to be accompanied by efforts to ensure that key professional bodies support it in terms of the values which they transmit to their current and potential members, as well as to the society at large. Simultaneously, the awareness of non-professional decision-makers and opinion-makers and of the broader public should be raised in order to ensure the consistency of their attitudes with the desired values.