Strategic planning for deinstitutionalisation (Part 2)

In the previous course step we recognised how the UN Guidelines for the Alternative Care of Children urge States to develop alternatives to large residential facilities, identified as ‘institutions’. We also considered the manner in which States should develop deinstitutionalisation strategies that would lead to the progressive elimination of children’s residential institutions.

Such deinstitutionalisation strategies require follow-up with concrete plans that clearly lay out the actions to be taken and the resources required. These plans may include activities which, for example, will:

a) Ensure all aspects of a gatekeeping process are integral components of the national child protection system encompassing mechanisms of assessment and individual case planning and management – enabling all those involved in the care of children to make well informed decisions and choices in the best interests of each child;

b) Raise the knowledge, skills, understanding and cooperation of professionals and carers and alleviate the employment fears of current institutional staff;

c) Provide the sufficient investment in basic and specialised family support services to be delivered at community level;

d) Allow for the development of a range of suitable and sustainable family and community based alternative care options, enabling the disruption of processes whereby the “automatic” response is an institutional placement;

e) Develop permanent options for children when family reunification is not possible;

f) Develop and maintain data information systems that will inform practice and further policy development;

g) Build positive community attitudes towards families in difficulty.

Financing deinstitutionalisation

Regarding financial matters, not only will it be important to develop well costed strategies and seek the reallocation of funding away from institutions, but also to deal with how funding is currently obtained. Thus, for example, a system essentially comprising “orphanages” funded by foreign charities will invariably resist reallocation of funds for family strengthening programmes or the development of family-based alternative care. In that case, the strategy will need to include awareness-raising in the donor countries and, if appropriate, requesting bilateral assistance to develop family-based care.

In contrast, where all or most of the care system is publicly funded, the problem may lie in division of responsibilities: e.g. situations where institutional care is centrally funded and resource poor municipalities are required to fund preventive services and/or family-based and family-type care settings. These factors of how the financing of alternative care is organised, as opposed to what amounts should be devoted to it, are regularly overlooked.

Data

So, developing deinstitutionalisation strategies is not a straightforward task. Examining, understanding, and addressing all the issues within a specific context in which institutions have been maintained to date is clearly a complex proposition. In this respect, an element that is essential to carrying out that task is almost always lacking at the outset: trustworthy, comprehensive, and useful data, both quantitative and qualitative. Strategising and planning without knowing at a minimum the numbers and characteristics of the children concerned, where they are, and why they are there would be a high-risk exercise. It jeopardises the appropriateness and effectiveness of the strategy since, among many other things, it precludes accurately planning preventive and reactive services, setting workforce requirements, and foreseeing resources needed.

Summary

In summary, the goal of deinstitutionalisation is to reduce recourse to formal alternative care as a whole and not simply to replace institutions by other “suitable” forms of alternative care. To achieve this goal, deinstitutionalisation must be designed as an integral component of a broad child protection system strategy within which alternative care is an available option for children who are genuinely at risk of serious harm and need protection.