A Europe of Rights? The role of MEPs in ending the institutionalisation of children

Experts Roundtable, European Parliament, 6 June 2012

Co- Chaired by Mairead McGuinness MEP and Arki Busson, Founding Chair of ARK

Table of Contents for Background PowerPoint Presentations

3-9 Fundamental rights and their application to children in institutions • Dr. Maria Herczog Ph.D.• Member of UN Committee on the Rights of the Child, President of EUROCHILD

10-25 Institutionalization in Early Childhood Impact on Child Development • Charles H. Zeanah, M.D.

26-31 The Economic Case for Policy Change• Dr Andy Bilson• Professor of Social Work, University of Central Lancashire

32-45 Investing in Our Future: The Practical Implications of Childcare Reform• Dr. Delia Pop • Director of Programmes, Hope & Homes for Children

Fundamental rights and their application to children in institutions

Dr. Maria Herczog Ph.D.Member of UN Committee on the

Rights of the ChildPresident of EUROCHILD

European Parliament6 June 2012

Child rights based approach• UN CRC is a comprehensive, - universally agreed set of non-negotiable

standards and obligations, covering all children • Core principles: - non-discrimination;

- devotion to the best interests of the child; - the right to life, survival and development;- respect for the views of the child

• Children living in (alternative) residential care need special provisions

within this framework as they are a very vulnerable group often with complex and challenging needs, diverse groups of children

• Articles of the UN CRC specifically relevant in this context: Art 7, 8, 9, 12,18,19, 20, 24, 25, 26, 28,31

UN Guidelines for the Alternative Care of children

• UN CRC based guidelines adopted by GA in 2009

• Child rights in alternative (residential care) has to be granted based on standards, quality care and services, listening to children and taking into consideration their views, family contact, reunification if possible, preparation for leaving, after-care if needed,

EU on child rights

• Children’s rights form part of the human rights that the EU and EU countries must respect (Commission communication)

• An EU Agenda for the rights of the child (2011): reinforce the full commitment to promote, protect and fulfill the rights of the child in all relevant EU policies and actions

• EU Action to protect children from violence and when they are vulnerable

• Fundamental Rights Agency: indicators to measure well-being of children based on the implementation of their rights

Council of Europe

• Rights of Children in residential institutions (2008) outcomes on the implementation of Rec(2005)5

- Few countries established national standards- Monitoring system in place in most countries in

principle, responsibilities and accountability a severe problem, children are often not heard

- Support to families, preparation for leaving and after-care crucial

Children without parental care: urgent need for action(2010)- violation of rights – old and new risks

Child Rights Strategy of CoE

The programme will focus on four strategic objectives: 1. promoting child-friendly services and systems;2. eliminating all forms of violence against children;3. guaranteeing the rights of children in vulnerable situations; 4. promoting child participation

Implementing child rights in institutions

• Referral, assessment, placement decision, involvement of all actors

• Placement, quality of care, rehabilitation, family contact and support,

• Review, preparation for leaving, reunification, after-care

• Documentation, evaluation, accountability, research, data

 

Institutionalization in Early Childhood Impact on Child Development 

Charles H. Zeanah, M.D.

European ParliamentJune 6, 2012

Brain Development in Early Childhood

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Nurturing and responsive relationshipsWhat builds healthy brains?

Limited opportunities to form selective attachments lack of psychological investment by caregivers rotating shifts high child/caregiver ratio

Insensitive care regimented daily schedule non-individualized care

Isolation limited response to distress unchecked aggression

Why institutional rearing might be bad for the developing brain

Institutional rearing

Children raised in institutions are at dramatically increased risk for a variety of social and behavioral problems: disturbances of attachment indiscriminate behavior emotional and behavior problems inattention/hyperactivity deficits in IQ and executive functions syndrome that mimics autism

Developmental problems believed to result from deprivation inherent in institutional care

Author Foster Care Institution Country Goldfarb (1943) 20 20 US Goldfarb (1944) 40 40 US Goldfarb (1945a) 15 15 US Goldfarb (1945b) 70 70 US Levy (1947) 129 101 US Dennis & Najarian (1957) 41 49 Lebanon Provence & Lipton(1962) 75 75 US Roy et al. (2000) 19 19 UK Harden et al. (2002) 30 35 US Ahmed et al. (2005) 48 94 Iraqi Kurdistan Nelson et al. (2009)* 68 68 Romania

Foster Care vs. Institutional Care

*Randomized Controlled Trial

Study Design

Sf EcaterinaSf Andrei

GiulestiSf Vasile

Sf MariaControceni

136 Institutionalized Children (6-30 months)

Foster Caren=68

Communityn=72

Care As Usualn=68

Assessments at 30, 42, 54 monthsFollow-ups at 8 and 12 years

Bucharest Early Intervention Project

Main effects of intervention

Cognitive developmentHigher IQsEnhanced expressive and receptive language

Physical developmentGreater height and weightReduced stereotypies

Emotional developmentMore positive emotion expressedLess anxiety and depression

Social developmentEnhanced competenceMore secure attachmentsFewer attachment disorders

Fewer psychiatric symptoms and less impairment

Larger, more mature and better functioning brains

30 mo 42 mo 54 mo70

80

90

100

IQs of Children in Foster Care and Care as Usual groups by age at placement

Age at placement and language at 42 months

2.44μV2

3.80μV2

CDistribution of electrical activity

across the scalp by timing and group

CAUGFCG > 24

NIGFCG < 24

Worldwide investigations of family placement following institutional rearing

Consensus statement (2012) from European and American investigators studying children in institutions:

“…research findings applied to clinical and policy recommendations suggest ‘the earlier the better’ rule for enhanced caregiving is a reasonable conclusion.”

Growth and intellectual retardation are reduced (but not eliminated)

Social and emotional development remain severely compromised. Greece (Vorria et al., 2003), U.K. (Tizard et al., 1975)

Aren’t the outcomes different in better quality institutions?

In better quality institutions:

Measures Results

Intelligence Family > Institution

Language/Communication Family > Institution

Skills of daily living Family > Institution

Socialization Family > Institution

Adaptive Behavior Family > Institution

Institutional Care vs. Foster Care in Washington, D.C.

Jones Harden (2002)

More institution resembled a family, better outcome

Attachment mediates intervention effects of psychopathology

FCG vs. CAUG54 mo.

Total Psychiatric Symptoms

Psychiatric Impairment

42 mo. Security of Attachment

✕

Conclusions about institutional rearing and child development

Children raised in institutions have compromised development across most but not all domains.

Placement in families leads to developmental gains Sooner children are placed in families the better, but

complete recovery is rare after 6 months of age Evidence for sensitive periods in some domains

The Economic Case forPolicy Change

Dr Andy Bilson

Professor of Social Work

University of Central Lancashire

The direct cost of institutional care Comparison of direct costs including social work support

e.g. annual costs in UK (2005-6):

e.g. In Montenegro “The average annual costs in 2003 for a child without disabilities and aged under three years were 41,051 euros for residential care and 13,124 euros for foster care. For a child with disabilities of the same age, the average annual costs were 43,017 euros for residential care and 30,998 euros for foster care.”

Foster care £55,608Kinship care £20,220Own parents £8,064Residential unit

£141,768

Independence

£30,096

Increasing Cost & Expenditure: England

House of Commons Children, Schools and Families Committee. Looked-after Children: Third Report of Session 2008–09

Indirect costs Lower IQ

75 studies covering 3,888 children 19 countries - IQ 20 points lower in institutions

Higher mortality & suicide Finland 3 fold risk of dying before 25,

Russia 1 in 10 care leavers commit suicide, Sweden 4 to 5 times more likely to be hospitalised for suicide attempts

Poor education Evidence in Austria, England,

Hungary, Ireland, Netherlands

Crime England 27% of the adult prison

population has spent time in care

Unemployment Evidence in Austria, England,

Hungary, Ireland, Netherlands, Sweden

Homelessness England 1 in 5 end up homeless

Mental Illness Sweden between 5 and 8 times more

likely to be hospitalised in teens and 4 to 6 times in young adulthood

Early pregnancy and own children in care Evidence in Sweden, England

Drugs, prostitution, autism …

“Outcomes are poor even when compared to other children with roughly comparable backgrounds and problems.” [Source: UK

Parliament 2009 ]

Alternatives Invest in support for families and

communities e.g. in a number of countries (Bulgaria, Romania, Georgia, Ukraine, Russia)

projects have found that up to 80% of children at risk of entry to institutional care require only short term support to prevent entry such as help to claim entitlements, to get legal papers etc.

e.g. in Moldova reasons for children entering institutions were assessed and in one area the reason was the lack of transport to take children to school. A bus was provided for local villages and reduced entry to institutions

e.g. where children are left with grandparents or other relatives whilst parents work in other countries provide support for these carers

Develop alternative family based placements Develop supported kinship care, foster care, and national adoption. e.g. in Ukraine even children with disabilities can be fostered because the

financial incentives make this attractive

Issues and ChallengesIssues

There is a clear economic and social case for reform

Cost benefits are potentially very high Supporting continued use of institutions is

untenable and leads to social exclusion

Some Challenges Large scale grants need extensive support for

the implementing infrastructure and effective monitoring

Brings a focus on wicked problems – e.g. social inclusion of Roma minorities

Requires multi-disciplinary and community work

Investing in Our Future

The Practical Implications of Childcare Reform

Dr. Delia Pop Director of Programmes

Who are the children in institutions?

Their families in most cases are disempowered and struggle to cope with a range of risk factors:• Poverty, without adequate living conditions,

lacking housing, secure income/employment• Single parent families (mostly mothers)• Poor parenting skills and family planning• Lack support of extended families• Discrimination due to illness or ethnicity

In certain country contexts:• Substance abuse (alcohol/drugs)• Family violence

Children in institutions• 54.12% boys and 45.88% girls• 20.98% have a range of medical conditions• Come from urban and rural areas in equal proportions

Children at risk• 52.67% boys and 47.33% girls• 39.69% have a range of medical and developmental

conditions• Come from rural and urban areas in equal proportions

Are placed in institutions from:• 27.50% from maternity and hospitals• 20.41% from families• 19.39% temporary placed at the request of parents• 18.09% are relinquished by parents• 10.27% parents deprived of parental rights• 2.46% parents missing, dead or imprisoned• 1.88% are abandoned and found

Reliance on InstitutionalisationFamily at Risk

•Unsustainable source of income

•Marginalisation•Ill/health issues•Lack of access to basic services

•Poor family and social relationships

•Poor parenting skills

Inaction 

•Loss of income, housing

•Discrimination•Disability•Lack of medical support, welfare assistance, etc.

•Family breakdown•Parents’ capacity to provide adequate care to children at critical level

Family in Crisis

•Children’s wellbeing at risk

•Capacity to intervene and achieve positive changes in a short period of time is reduced

Placement in Institutions

•Children are separated from their families

•Families remain vulnerable and at risk

Consequences

• Up to 20% of children average 14 years in care

• Lower IQ• Loss of

potential

• Attachment disorders

• Stunted growth • Ill/health

Physical Development

Emotional development

Long term institutionalisation

Cognitive Development

Other Consequences• Families remain vulnerable and the root

causes which led to children’s separation are not resolved

• Economic costs – long term expenditure in direct costs of institutionalisation with very poor outcomes for children

• Social costs – marginalisation, isolation, lack of opportunities, increased risk for the cycle to be repeated

Separation

Institutionalisation “one solution

fits all”

Up to20% children spend 14 years in residential care

Use of scarce resources

ineffectively

Complex social & economic

problems

Are the consequences inevitable? • Some are inevitable but many can be avoided• Children can survive a great deal when appropriately cared

for• We can avoid the consequences even when resources are

limited by carefully thinking how resources are allocated• Children’s care is not cheap but resources can be allocated

efficiently• Efficient interventions need to be identified and the

“production line needs to be replaced with baking the cake”

De-institutionalisation – the Engine for Childcare Reform

Closing and replacing residential care in large institutions with a range of alternative services designed to match children’s needs and realise their rights:

• Prevention services, supporting children and their carers at home• Mother and Baby Units, Emergency Reception Centres • Adoption• Family based alternative care: kinship care, foster care, assisted living and • Short/medium and/or long-term residential care in small group homes

De-institutionalisationReduced number of children placed in

care

Permanency through adoption

Family based care with better outcomes

Efficient allocation of resources

Early intervention and family support

Institution closure

ACTIVE Family Support

Inputs

• €441,560

Outputs

• 255 families and 499 children supported

Outcomes

• 250 families and 489 children remained together

Impact

• 224 families and 441 children with significant outcomes

Return on Investment

€4,123,250saved in

institutional care costs

441 children with improved outcomes

€441,560

(€921/child)

De-institutionalisation

De-institutionalisation

De-institutionalisation Additional costsCapital investment - purchase, renovation, furnishing and equipping of small family home €120,000Purchase of vehicle for mobile team €5,000  Transitional costs provided by local government Covering income lost by the Institution due to decrease in number of children   €16,500 euros

Institution – supported on average of 75 children/year, at a total annual cost of €195,660 (€2,609/child)

New system – supports on average 190 children/year, at a total annual cost of €164,500 (€866/child). Most importantly it provides better outcomes for children and serves more than twice as many beneficiaries