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Deinstitutionalisation is the process of reforming child care systems and closing down orphanages and children's institutions, finding new placements for children currently resident and setting up replacement services to support vulnerable families in non-institutional ways. It became commonplace in many developed countries in the post-war period. It has been taking place in Eastern Europe since the fall of communism and is now encouraged by the EU for new entrants. It is also starting to take hold in Africa and Asia although often at individual institutions rather than statewide. New systems generally cost less than those they replace as many more children are kept with their own family.
Deinstitutionalisation is currently most common in the former Soviet Bloc. Increasingly the institutions that remain in Eastern Europe are occupied by disabled children who can be harder to place in the community. Completing their closure and supporting the development of places they can be cared for in the community is seen as a priority by the EU and that has encouraged many countries wishing to accede including the Czech Republic, Romania, whose orphanages are the most infamous in the world, and Bulgaria. It is also happening in Hungary where no new children can be placed in orphanages, Moldova, Ukraine, Belarus and Bosnia. Azerbaijan has established a Department for Deinstitutionalisation and Child Protection. Russia is also recognising children should be brought up in families but is not yet closing institutions.
More than 4 out of 5 children living in institutions are not orphans. This amount rises to 98% in Eastern Europe. The nature of orphanages means that they often fail to provide the individual sustained attention and stimulation a child would get from growing up within a family. In many cases the children living in them are at risk of harm. There are also many reports of orphanages being abusive or having very high death rates. They are a particular issue for babies and children under three years old as they can stop them making the attachments that they should. These attachments can be broken by staff changing jobs and children moving to other rooms as they get older. In reality a very small proportion of AIDS orphans are in orphanages and there is no way orphanages could be a sustainable option for all AIDS orphans, even if it was desirable.
An example from Romania: The Bucharest Early Intervention Project is a scientific study that compares the development of children raised in institutions with children raised in birth families and foster care. The study took random samples of 208 children and followed their physical growth, cognitive, emotional and behavioural development over a number of years. The study found:
1. For every 2.6 months spent in a Romanian institution a child falls behind one month of normal growth.
2. Institutionalised children had significantly lower IQs and levels of brain activity than the other children, especially those who were institutionalised at a young age.
3. Children in institutions were far more likely to have social and behavioural abnormalities, including aggressive behaviour problems, attention problems and hyperactivity, and a syndrome that mimics autism.
4. This syndrome and the behaviours disappear when the child is placed in a family.
It is considered important that all institution-to-home transitions must be accompanied by adequate preparation through individual and group counseling. The development of social work teams to manage fostering and adoption programs is also considered important.
When possible children are reunited with their birth or extended family. This may require short-term psychosocial or financial support but is generally seen as the ideal.
Children transitioning out of care and into the community may need significant support as their life skills may be limited. Failure to prepare them may cause a number of them to return to institutions in later life or end up in crime or prostitution.
Domestic adoption is adoption within the home country. Until a country's child protection system is well developed the adoption of children internationally is at risk of corruption.
Long-term fostering, defined as fostering for over a year, can often bridge the time between the closure of an institution and independent life.
Small group homes or family type homes — ideally with eight or fewer children — can provide life-time care for the most disabled children or act as a halfway house where children leaving an institution can learn to live in a family.
Some groups and NGOs that either specialise in deinstitutionalisation or have been involved with it include Lumos, Hope and Homes for Children, The Bulgarian Abandoned Children's Trust, UNICEF, the Bulgarian Helsinki Committee, Replace Campaign and Children's Emergency Relief International.
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