Forgotten children? An update on young children in institutions across Europe
Introduction
Six years ago in the British Medical Journal, cause for concern was expressed by the authors [1] on the ‘Overuse of institutional care for children in Europe.’ An estimated 43,842 (14.4/10,000) children less than 3 years resided in institutional care within 46 countries of the WHO European and Central Asian region. Within Europe, it was found that institutional care of young children was not restricted to countries in transition but was common throughout the entire region, with less than 4% registered as biological orphans [2], [3]. The majority were placed there due to child maltreatment, parent ‘abandonment’ or because of a disability, despite the knowledge that institutional care is a very poor substitute for positive family care, increasing the risk of development delay, attachment difficulties, neural growth dysfunction and mental health disorders.
Six years on, the United Nations General Assembly Report of the Human Rights Council in its 11th Session produced ‘Guidelines for the Alternative Care of Children’ for 192 Member States. Paragraphs 21 and 22 highlighted the need for member states to adopt a “deinstitutionalization objective and strategy” particularly for children under the age of three years [4] (see Table 1). In a similar vein, one of UNICEF's top priorities is to ensure that babies are not cared for in institutional settings. Alongside international work done by UNICEF [5] and non-governmental organisations (e.g., Every Child, Save the Children), the Brazilian government and the CRC committee, a series of projects devised by the authors and funded by the European Union Daphne programme and the World Health Organisation Regional Office for Europe have highlighted this issue in Europe and helped to raise the profile of these forgotten children.
Section snippets
The projects
The worst of institutional care was brought to public attention in Romania during the 1990s after the fall of Ceauşescu in 1989, when pictures of severely deprived, malnourished and poorly cared for children were shown around the world. However, as outlined in the original article, in 2003 the first of the three projects led by the two authors (with a large team of partners across Europe2
Why are children in institutions?
For EU countries, for more than two-thirds this reflected issues of child maltreatment, whereas child abandonment (approximately one-third) and disability (approximately one-quarter) was more common in the other countries which also had lower GDP, lower health expenditure, younger mothers and a higher rate of termination of pregnancies. Thus, we must be very cautious about our interpretation of why some parents feel unable to maintain care of their own children and take the undoubtedly
The dangers of institutional care
Why is this so concerning? In summary, the role of families and early relationships in the positive development of children is widely recognised, leading to a reduction in risk of anti-social behaviour and violence to others, both in and outside of the home. Optimal child development requires the opportunity for frequent one-to-one interactions with a consistent caregiver. In contrast, it is known that extreme early deprivation of sensitive and consistent parenting leads to attachment disorder
Good practice in deinstitutionalising children
Thus, having established the rate of babies and small children in institutions, the two subsequent projects identified ways in which young children were being moved out of institutions and returned to family-based care in seven European countries4 and established a model of good practice which was initially offered to the eight European countries5
The way forward
At a societal level, the subject of child protection is one of the priorities of the European Community. Member states are increasingly committed to implementing both preventative measures and protective services for abused and neglected children, with reference to the Convention of the Rights of the Child (i.e., what is in the best interests of the child). Therefore, the general public, media, policy makers, health and social workers in all European countries should be interested in the
Role of the funding source
The three projects were funded 80% by the European Union Daphne programme and 20% by the World Health Organization Regional Office for Europe. The EU role was funding and review of the project only; they encourage publication of the material in peer-review journals. The World Health Organisation Regional Office for Europe was involved in the planning and ethical review of all three projects reported in this update review, as well as involvement in data collection (lead: Dr Mikael Ostergren).
Disclosure statement/conflict of interest
No authors have any financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
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The family foster care system in Ireland – Advances and challenges
2019, Children and Youth Services ReviewCitation Excerpt :Of special note is that the major change happened while Ireland was still a strongly Catholic country (it is less so now). There are other Catholic countries in Western Europe (for example, Portugal and Belgium – see Hamilton-Giachritsis & Browne, 2012; Barbosa-Ducharne, 2018) which still rely very heavily on residential care, reflecting perhaps a tenacious belief that ‘foster homes are dangerous places’ (Hazel, 1976, p. 321). This paper sets out to give a rounded view of the Irish foster care system as currently constituted.
Reforming child institutional care in the Post-Soviet bloc: The potential role of family-based empowerment strategies
2014, Children and Youth Services ReviewCitation Excerpt :Large Soviet-style child institutions are usually characterized by over-crowding and minimal medical, educational, and social services, which often result in high mortality and morbidity rates, and severe developmental delays among children (Bernstein, 2001; Morrison, 2004). In addition to putting children at risk for abuse and neglect, institutionalization has been criticized for: 1) depriving children of family-level protective factors crucial to emotional, cognitive, and overall psychosocial development; 2) isolating children from socializing experiences in the community; and 3) for costing more than family-based care (Browne, 2005; Hamilton-Giachritsis & Browne, 2012; Mulheir & Browne, 2007). Living and growing up in institutions also poses tremendous harm to child's normal psychosocial functioning and mental wellbeing (MacLean, 2003; Nelson et al., 2007; Vorria, Rutter, Pickles, Wolkind, & Hobsbaum, 1998a, 1998b; Vorria et al., 2006).
Home visit scheduling for family interventions: a child protection case study
2023, International Transactions in Operational ResearchA Systematic Review of Reviews of the Outcome of Severe Neglect in Underresourced Childcare Institutions
2020, Trauma, Violence, and Abuse
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