FAQs

Most children in orphanages or other forms of residential care are not in fact orphans. At least four out of five children in residential care have one or both parents alive. Poverty and social exclusion are two of the main reasons why children are unable to live at home. Families often feel that placing their children into care is the only way to ensure that they get an education, enough food and other essentials. Therefore, the appropriate first response to help such children is to support their family and community, providing relevant resources and services so that children can remain with their families.

A smaller percentage of children are placed in residential care due to abuse at home, severe neglect, or when they have no parents or extended family to care for them (due to death or abandonment). These children may not be able to live with their biological families, but other family-based care should be considered such as kinship care or foster care. A very small number of children may legitimately require residential care regardless of what other family-based options are available. Sometimes this is due to psychological issues that may mean that a child will not cope in a family for a period of time and requires centre based care.

Due to the emotional, social and psychological impacts of institutionalisation, residential care should always be the very last resort and only a temporary option.

Whilst residential care has a place and is necessary in some circumstances, removing a child from their family and community is an extreme intervention, which can have some detrimental effects on a child's development. Therefore, it should be used only as a last resort. Residential care can have a range of effects on a child and is somewhat dependent on the age of the child, the length of time they spend in residential care and the structure, standards and environment within the residential care facility. Having said that, no matter how well-run a home is, it is generally accepted that any form of residential care will have some adverse effects on a child. For this reason, family based options are a preference. Where residential care is legitimately in the best interests of a child, then care should be provided in a facility that has high standards, low child to staff ratios, and replicates a family-like environment in order to mitigate detrimental effects as much as possible. Some of the most common and concerning effects of residential care on children include:

DEVELOPMENTAL DELAYS

It is generally accepted that children under 3 should not be placed in residential care due to the damage it can have on their development. Studies have found that residential care affects the way a child's brain develops and causes cognitive and developmental delays which impact language acquisition, social development, emotional development and actually alters the structure of the brain. It may express itself as poor eating and sleeping habits, poor concentration and memory or delays in achieving developmental milestones. This is caused by a combination of factors such as a lack of primary attachments, limited stimulation and reduced physical contact and nurturing. Depending on the length of time spent in residential care, it can lead to permanent delays.

ATTACHMENT DISORDERS 

Attachment is a child's formation of significant and stable emotional connections with the significant people in his or her life. This process begins in early infancy as the child bonds with one or more primary caregivers. If a child is unable to establish these types of important connections before the approximate age of five they may develop an attachment disorder, which will result in the child experiencing difficulties with a wide variety of social relationships throughout their lifetime. A particular shortcoming of residential care is that typically children do not experience the continuity of care that they need to form a lasting attachment with an adult caregiver. Ongoing and meaningful contact between a child and an individual caregiver is almost always impossible to maintain in residential care because of the high ratio of children to staff, the high frequency of staff turnover and the nature of shift work. Indeed, those who have visited an orphanage are likely to have been approached by young children wanting to touch them or hold their hand. Although such behaviour may initially seem to be an expression of spontaneous affection, it is actually a symptom of a significant attachment problem. A young child with a secure sense of attachment is more likely to be cautious, even fearful of strangers, rather than seeking to touch them.

CHILDREN WITH AN ATTACHMENT DISORDER ARE MORE LIKELY TO SUFFER FROM:

• Low self-esteem
• A lack of self-control
• The inability to develop and maintain friendships
• Difficulty with genuine trust, intimacy and affection
• Neediness, clinginess or pseudo independence
• Behavioural and academic problems
• A negative, hopeless and pessimistic view of self, family and society

A LACK OF LIFE SKILLS 

Children living in residential care are often provided opportunities to gain vocational skills through training and scholarships. However, many do not develop key life skills that can only be gained from growing up in a family environment. The World Health Organisation defines life skills as, "the abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life".

Families model social skills to children, teaching them how to negotiate cultural aspects of life and providing them with experience and knowledge of income-generating activities. Within their families, children absorb the values of their culture and develop the skills they will need in adulthood.

Children who grow up in residential care may learn life skills about how to function and survive in a residential setting, yet do not gain the right skills to live in a family or community. This means that many children that grow up in residential care struggle to make successful transitions into the community. They grow up in a world of children and caregivers, and are not socialised into the broader social structures and hierarchies that exist within their society and culture.

Children in long-term care have lacked the role modeling that happens in a family and in a community. They often don't know how to appropriately relate to different figures in the community, relate to different people according to their social status and can be perceived as rude, disrespectful and inappropriate. This frequently impacts their adulthood, affecting their ability to develop meaningful relationships, gain and retain employment, and it often affects their marriages.

INSTITUTIONALISED BEHAVIORS 

Institutionalised behavior is essentially a deficit in social and life skills. It develops when an individual lives apart from normal society and is deprived of responsibility, independence and decision-making opportunities. When children do not grow up in a natural family environment, they are not involved in normal family situations where they would develop these life and social skills. As a result many become institutionalised.

The nature of managing numerous children in one facility leads to the development of schedules and routines which can be very rigid and inflexible. Children are 'shepherded' from one activity to another and are given little opportunity to exercise choice or develop decision-making skills. This is in contrast to growing up in a family where children have more involvement, freedom and flexibility and also learn to negotiate decisions in the context of a family and community. As such, when children leave residential care, they are often unable to make decisions, lack initiative and independence, are irresponsible, struggle to hold down jobs and move from program to program where they can live within a rigid structure which is what they are best able to cope with.

Some children with institutionalised behaviors present with 'quasi autistic' behaviours such as self-stimulation, rocking and head-banging. They may also engage in attention seeking behaviours, especially those that experience a lack of attention from staff. Children with institutionalised behaviours are often inept at social interactions and are perceived as acting odd, awkwardly, or inappropriately in social settings. This impacts their life once they leave the facility, making it more difficult for them to develop relationships and long-term support networks.

A LACK OF LIFE LONG RELATIONSHIPS AND NETWORKS 

People were designed to live in relationship with others and our primary relationships of family, close friends and community are designed to be life-long. These relationships are not only instrumental in childhood but also in adulthood.

In most cultures, family and extended networks play an important role in major life events such as marriage, childbirth and child rearing. They are also instrumental in finding jobs, providing living arrangements and social safety nets. In many cultures, identity is often tied to your family line and the way to legitimise someone is to discover which family they are from. This is in direct opposition to western society, where our identity is closely linked to our profession and education.

When a young person leaves residential care at 18yrs old (give or take) they lack these life-long relationships and support networks. They have no family to legitimise them and they are often stigmatised as a result. This can be very isolating and frightening for care leavers and many have expressed extreme fear and anxiety at the thought of leaving. Although children may retain some contact with the residential care staff once they leave, it is unrealistic to expect that staff can assume these roles of the family and social support network for each care leaver on an ongoing basis.

HIGH RISK OF ABUSE 

Children are generally placed in residential care to keep them safe and provided for. Unfortunately, statistics show high rates of abuse in residential care, often unbeknownst to orphanage founders and directors.

It is important to consider that not all abuse is at the hands of adults, it is also common for children to abuse each other. Having non-related children of varying ages and both genders, who come from troubled backgrounds and are all living together exacerbates this. Orphanages are often positioned away from community and therefore out of site. This provides little protection for children as abuse can go unreported and unseen. People naturally think children are safe in orphanages; therefore they don't scrutinise practices within orphanage. All of these factors in combination place children in residential care at risk of being abused.

Some of the factors that make children particularly vulnerable to abuse in orphanages include: 

• Many orphanages are unregistered and are therefore not being monitored or regulated
• Adults who seek to abuse children can prey on orphanages, seeking opportunities to work with these children as either staff or volunteers. Orphanages that rely on volunteers and visitors for funds and staff are particularly vulnerable to being targeted by abusers. • Many orphanages do not have child protection policies or good staff and volunteer screening procedures
• Placing non-related children who may have come from abusive backgrounds in the same home can lead to children abusing one another
• Orphanages are often isolated and out of the sight of the broader community giving little opportunity for outsiders to notice children who are being abused
• There is often an assumption that children are safe in orphanages, which leads to signs of abuse being overlooked.
• Many children are unaware of their rights and don't know how to report abuse when it happens Whilst abuse can happen in family-based care, many of the above-mentioned risk factors associated with residential care don't occur in a family-based context, therefore the rate of abuse has been found to be significantly lower.

Children that are placed in residential care often come from situations of poverty and vulnerability. Being placed in an orphanage does not eliminate but can in fact exacerbate their vulnerabilities, both during and after their time living in residential care.

The psychological, emotional and physical impacts of living in residential care, combined with the lack of protection and support of a family, means that these children are vulnerable to abuse, discrimination and exploitation. The impact that institutionalisation has on a child can result in them less able to find work or to develop social relationships. This makes them hyper-vulnerable and at high risk of trafficking, drug abuse, criminal activity, prostitution and other social issues. They are also especially vulnerable to exploitation and abuse as they are less aware of their rights and accustomed to following instructions without question.

Gate-keeping is the process of preventing the unnecessary institutionalisation of children through stringent pre-admission screening and assessments. When a child is identified as in need of assistance, gate keeping ensures that their real needs are identified and that appropriate services are found and offered to the child with as little disruption to their life and family as possible. Therefore, gate-keeping prevents residential care from being used as a solution to poverty and education issues. It ensures that only children who legitimately cannot live in family or communities are admitted into residential care.

Family strengthening seeks to support families to ensure that they are able to meet the needs of their children within their community and prevent family breakdown and separation. Family strengthening programs may assist families with accessing schooling, medical care and provide services for children with special needs. Family strengthening may also seek to ensure families have adequate income, food security and access to childcare where necessary. Family strengthening seeks to prevent crises from developing which could result in family breakdown and the placement of children into residential care.

Family preservation services are short-term intensive support services for families in crisis who are at risk of imminent breakdown. The aim of family preservation is to de-escalate the crisis, find solutions to underlying problems and connect the family with ongoing family strengthening services to prevent family breakdown.

Residential care is accepted as a necessary part of the alternative care continuum; however it is considered a last resort and temporary option for children for whom family or community-based care is not appropriate. When residential care is necessary, small facilities that try to provide family-like environments are preferred over large institutions. Residential care should always be appropriately registered with the government, meet the minimum standards of the country, have a reintegration process and policy, have good case management systems in place and should encourage children to, as much as possible, participate in normal community life.

The alternative care continuum outlines the different types of out-of-parental-care options for children who cannot stay with their biological families regardless of support offered. The continuum represents a preferential ordering of care options beginning with the least invasive and disruptive measures to the most extreme.

The continuum of care options is:

Kinship care - when a child is cared for by their relatives or 'kin'
Foster care - when a child is cared for by a family that is not part of their extended family. It is always the preference for a foster family to be from the child's own community and if not, as similar as possible.
Emergency foster care - when a child needs to be urgently placed in care for reasons of safety they may be place in emergency foster care whilst a social worker prepares a care plan
Group Home - A typical house in the community which provides residential care for a small group of children (under 10) staffed by paid caregivers.
Small residential care facility - residential care that provides a family-like environment with low staff-to-child ratios and high standards of care
Institutional care - large residential care facilities

All of the above options are generally considered temporary care. The exception is foster and kinship care which in some countries can be permanent where the expectation of the families and child is that it will be a life-long relationship equal to legal adoption.

The goal with any child who enters alternative care is to achieve a permanent solution for them as soon as possible with preference given to national solutions, to avoid disruption to the child's life and relationships. Permanent, national solutions would be local adoption or reunification with their biological family. Whilst international adoption is a permanent, non-national solution.

Although an orphanage may meet a child's physical needs, there is overwhelming evidence that it consistently fails to meet a child's social and emotional needs. For the past 60 years child development specialist and researchers have concluded that residential care cannot properly meet children's emotional or social needs. Despite this, residential care remains the first, or often only, option given to children in adversity in many developing countries.

The United Nations Convention on the Rights of the Child (UNCRC) is a legally binding international rights treaty that outlines the comprehensive rights of children. It was adopted by the UN General Assembly in 1989 and has been ratified by all but three countries worldwide. When a country ratifies the UNCRC it commits to progressively implement the articles of the CRC by changing legislation and developing policies and frameworks for implementation. Countries periodically report their progress to the CRC committee and receive feedback and recommendations.

The UNCRC outlines the basic rights of children including the right to life, to an identity, to be raised in their family and culture, to express opinions, and to be protected from abuse and exploitation. The UNCRC also recognises the importance of the family for the 'full and harmonious growth and development of the child' and obliges states to allow parents to raise their children and to also support them in that role. For children who cannot reside with their parents, or where it is not in the best interests of the child, the UN developed the Alternative Care Guidelines to give specific guidance pertaining to children who are in out-of-parental care whilst still protecting their broader rights.

Ratifying the UNCRC is one of the catalysts for governments around the world overhauling their child welfare and child protection systems, particularly where an overreliance on institutional services is causing family separation and denying children the right to live with their families or grow up in a family and cultural group. As governments implement child protection and child welfare reforms, NGOs will be required to shift their programming to align with new frameworks and policies that prioritise family-based care and non-institutional services that preserve families.

In the context of residential care, deinstitutionalisation is the process of reforming child welfare systems and moving away from institutional-based services towards family and community based services. This usually means developing services to replace residential care, such as kinship care, foster care and family preservation services as well as reintegrating children who are currently in residential care back into families and communities.

Reunification is the process of reuniting children with their original families. It is not simply the act of returning a child home, it is a broader process that includes child and family consultation, assessments, developing care plans and rebuilding bonds through home visits etc. It is outworked by trained social workers and the timeframe for reintegration is dependent on the individual situation of each child and family. Reintegration is the process of preparing a child to return to life in the community/family, not necessarily their family of origin.

Reintegration preparation should begin as soon as a child enters residential care. It is a process of identifying the obstacles that need to be overcome for the child to leave residential care and then actively working towards these goals, ensuring that the child has the necessary skills to function in society and community and achieve full social integration.

Often people are concerned that children in foster care will be abused or treated as second-class citizens and domestic servants. Whilst there may be a risk of this happening in foster care, the way to minimise that risk is by having good screening, foster family training and ongoing monitoring of foster care placements.

Foster families are screened and selected according to strict criteria. This criteria and screening process helps to ensure that families who are seeking to foster children for financial payments, for domestic labor or other similar reasons, are rejected. Foster families that are selected are then trained in child rights, child development, behaviour management and other relevant areas. This training is provided on an ongoing basis.

Foster placements are considered temporary, and as such, must be regularly monitored. Social workers visit the children and foster families and also speak with schoolteachers and local community representatives to monitor the placement. Children are also able to select a safe family in the community who they can go to if they experience a problem in their foster family. Children are taught how to raise concerns of mistreatment should it happen as well as protective behaviours. Overall, the rates of abuse in foster care are significantly lower than in residential care and with good screening and monitoring these risks are further minimised.

Whilst research and information on the potential harm of residential care and the actual situation of residential care worldwide has been around for many years, information has been slow to reach the average person. It is important for us to share these messages and encourage others to think about these issues. As this information becomes mainstream knowledge, it will shape practices, donor habits and choices. In return, it will impact the care options and standards of care available to children in difficult situations around the world.

You can become an advocate for families and share your knowledge with others.

Generally, volunteering in orphanages should be discouraged. What has been labeled 'orphanage tourism' is a child protection risk, it encourages the proliferation of residential care, compounds the myth regarding the number of children who are orphaned and in need of adoption and feeds the unscrupulous orphanage business, which separates children from their families to generate funds from donors and tourists. Children are often expected to perform for guests, beg in the streets or hold 'orphan events' to raise funds for their own care. This is highly unethical and exploitive and tourists and volunteers unwittingly create a market for such practices through their visiting and volunteering.

Children in residential care should be supported and cared for by permanent national staff that share the same language and culture as the child and are able to provide stability of care. People who have no ongoing connection to an orphanage as a long-term donor, partner organisation or supporting organisation should not expect to visit orphanages. Orphanages are the private homes of the children living there and their privacy should be protected and respected.

When someone is a long-term partner of an orphanage, visiting and volunteering should be in accordance with strict child protection policies and codes of conduct. Volunteers should never assume caregiver roles in children's lives as this can exacerbate attachment disorders. Volunteers should never be alone with children or enter their private spaces. Volunteers should never take children offsite when unaccompanied by staff. Volunteers should be screened, including police checks and working with children's cards prior to approval. Overall, volunteering in the community is preferable to volunteering in an orphanage.

Before commencing support for an orphanage, or committing to ongoing support, donors should do 'due diligence' checks to ensure the orphanage they are supporting is abiding by relevant laws, standards and utilises ethical practices. If your due diligence checks confirm that the project you are supporting is ethical, legal, of high standard and is functioning as a last resort and temporary care facility, then it is a worthwhile project to support. If, however, due diligence checks raise concerns or problems, you should attempt to talk to the orphanage directors and encourage them to explore and implement changes in practice. If they are unwilling to embrace changes to meet standards, laws and align with the alternative care continuum, then you need to re-evaluate your support.

We recommend that if you decide to stop supporting a project, you give them due notice to ensure the children are not placed at greater risk of neglect or exploitation. ACCI has an orphanage checklist that can guide you through a due diligence check. This is available on the Kinnected page of the ACCI website.

In the event that a residential care facility reintegrates all the children who were residing there and subsequently closes down, the buildings can be used for a whole range of other programs and initiatives aimed at keeping children in families. They can be used as a base for staff to establish and monitor kinship and foster care networks or provide services to strengthen families and communities.

For example, they can be used as community-learning centres and provide services such as:
• Pre-School Program/ Education Programs
• Youth Club
• Kids Club
• MED courses and Vocational Training
• Parenting Classes
• Health Classes
• Community Projects (e.g. Community Gardens)

Buildings need to be assessed for suitability and proximity to the community. These are the most important factors when deciding what the building can best be used for post-transition.

Useful Documents

ACCI Docs

• Kinnected Info Pack
• Ethical Volunteering
• Orphanage Checklist
• Due Diligence Guidelines
• FAQ's
• Changing Mindsets and Practices
• Short-Term Missions Manual

Key Resources

• Family Reintegration (ISS)
• 10 Steps Forward to Deinstitutionalisation (Terre des hommes)
• Case Management Practice (Save the Children)
• Child Protection & Juvenile Justice System (CHILDLINE India Foundation)
• De-institutionalising and Transforming Children’s Services (Daphne Programme)
• Economic Strengthening for Vulnerable Children (USAID / Save the Children/ AED)
• Every Child Deserves a Family (EveryChild)
• From Faith to Action (Firelight Foundation)
• Families not Orphanages (Better Care Network) 
• Family Strengthening & Support (Save the Children)
• The Integrated Child Protection Scheme (India)
• Institutions vs. Foster Homes (Jordan Institute for Families)
• Keeping Children out of Harmful Institutions (Save the Children)
• Kinship Care (Save the Children)
• A Last Resort (Save the Children)
• Misguided Kindness (Save the Children)
• Implementing the Guidelines for the Alternative Care of Children (CELCIS)
• National Plan of Action for Orphans and Vulnerable Children, South Africa (Save the Children)  
• Children's Reintegration, Moldova (Family for Every Child)
• Scaling Down (EveryChild)
• Stockholm Declaration on Children and Residential Care (2003)
• A Study of Attitudes Towards Residential Care (MoSVY, Cambodia)
• The Risk of Harm to Young Children in Institutional Care (Save the Children)
• Toolkit for Positive Change (Save the Children)
• Convention on the Rights of the Child (UN)
• Guidelines for the Alternative Care of Children (UN) 


Links

Resource Centres:

Below are some really informative websites and online resource centres. Here you will find lots of great resources including articles and research papers, toolkits, and examples of effective programs.


Country or region specific websites

Whilst you will be able to find a lot of country specific information on the above resource centre's sites, the following links are region or country specific. Here you might find regional initiatives, alternative care frameworks and policies for particular nations as well as information about organisations that have a strong presence in those regions.

• Changing Mindets and Practices