ALTERNATIVE CARE FOR CHILDREN

Evidence-based research demonstrates that children fare best when they live with their families in communities. Moving Forward: Implementing the Guidelines for the Alternative Care of Children (2013), builds on the 2009 Guidelines’ core messages emphasizing the critical importance of family-centered care.

However in some circumstances keeping children in their families is not always possible and appropriate alternatives are needed for children without parental care. The HIV and AIDS epidemic has left many communities with large numbers of children without parental care due to illness and death. Communities have taken on this care responsibility in different ways:

Kinship care describes the care provided to children by a relative or extended family member. It is most often an informal arrangement and a common form of care for children who are no longer with their parents. Kinship care is seen as most successful when taken up by immediate relatives as it allows children to continue established relationships and usually allows children to remain in their community. Kinship care is often long term and at times permanent. Family members that provide this care must be adequately supported and able to access social protection system resources for children.

Foster care is usually short term care of children and young people, while permanent placements are being explored. Foster care can offer respite to families that have difficulties caring for children or can be a provision in emergency situations. Foster care should provide an appropriate level of care and support while efforts are made to reunify children with their families or to arrange other permanent placements in a family setting. It should not be prolonged or become a substitute for permanent, stable, family care. Fostering is often formalized and foster families are supported with training and incentives. When formalized, foster care is monitored to ensure children are in safe and secure homes while permanent solutions are found.

Adoption is a permanent process where parenting responsibilities are taken on by someone other than the child’s parents. It is a legal process that gives an adopted child entitlement to all privileges belonging to a natural child of the adoptive parents, including inheritance rights. The process of adoption can be lengthy in order to complete necessary assessments of families, legal work and support to the child through the process. Before being adopted, many children are in other forms of care such as residential or foster care. As adoption is permanent, it is important to ensure that all options to reunite children with their families have been fully explored and that decisions about permanent placements are made in full consultation with the child. Adoptions should also strive to keep siblings together.

Inter-country adoption is a complex decision that should only be made when other alternative community options have been explored fully and it has been determined to be in the child’s best interest. Inter-country adoption is often a common response during conflict or emergency situations. This is not an appropriate time to make permanent decisions about a child’s care. Conflict and emergency situations make it difficult to effectively trace existing family members or to ensure documents and permissions are properly in place. Short term foster care is more appropriate to ensure secure and safe homes for children while conducting family tracing or following proper adoption processes.

Residential care involves institutions that provide care for children and young people. Some institutions are state run and children are placed in their care by state processes. Many others are independent residential care facilities established to care for children in countries affected by conflict, natural disaster or HIV and AIDS. In countries and communities heavily affected by HIV and AIDS, the number of ‘orphanages’ and ‘children’s centers’ has grown in recent years, responding to the huge number of children who have lost one or both parents or are living with families that are unable to care for them. Often these are established by international organizations and sit outside national frameworks for monitoring care.

At times institutions offer to take in children despite the fact that they have surviving relatives. However, research has shown that institutional care is not the best care option for children. Residential care cannot offer children the same level of love and support for their optimum social, physical, emotional and cognitive development. As large numbers of children are often cared for by a small number of paid employees, who change regularly, children experience numerous broken attachments and often have difficulty forming attachments later in life (Bucharest Early Intervention Project (BEIP).

Results from the Bucharest Early Intervention Project (BEIP, 2010) indicate that “early institutionalization significantly derails development, contributes to early adversity and psychological stress… young children [particularly] should be taken out of institutions and put in a family setting”.

Where no family-based or community-based alternatives can be found, residential care should only be an interim, short-term option with the goal of placing children in protective and permanent family settings as soon as possible.  Residential care should be considered a last resort, only after all other alternative care options have been exhausted.

Key messages on alternative care for children:

1. Evidence-based research shows that children do best with their families, living within their communities where they can establish lifelong bonds and develop to their full potential.
2. All care choices for children should depend on the specific circumstances and each case must be decided based on the available options and meet the principle of best interest of the child.
3. Children and young people must be involved in the process of deciding on their long term care.
4. Alternative care placements should keep siblings together wherever possible.
5. Formal and informal care should be carried out along agreed upon guidelinesto promote the safety, protection and development of children and young people.
6. Many children in alternative care placements, whether fostering, adoption or residential care have surviving relatives. Before permanent decisions are made family reunification must be thoroughly pursued.
7. All care placements should be monitored and meet agreed upon standards.
8. Residential care should be a last resort for children and young people and only on a short-term, temporary basis. Residential care removes children from families, communities and their culture. It has long-term negative consequences on social, physical, emotional and cognitive development and it is significantly more expensive than other forms of care.  Children under age 3 should not be placed in residential settings but in family-based settings where alternative care is needed.