Overview of Supporting CHILDREN OUTSIDE FAMILY CARE
Most vulnerable children in developing countries live with their families in communities. The vast majority of children, even those referred to as ‘orphans’, have and live with a surviving parent, often their mother. However, HIV and AIDS have severely tested the capacity of families to care for their children. Poverty, parental illness or loss, migrant labor and other stressors can result in children and youth being separated from their families, being cared for by extended family or community members or living in a range of circumstance outside of family care.
Children living outside of family care typically lack adequate adult protection and are highly vulnerable to poverty, abuse, exploitation, and to engaging in higher-risk activities that lead to HIV. Research indicates that children living outside of family care are more likely than those living with parents to begin sexual activity at a younger age and less likely to have access to information and services to reduce their risk of HIV through sex or drug use. (2)
Children living outside of family care
While family-centered care for children is ideal, it is vital to remember that some children do not live within a family setting in a community. The environments faced by these children and youth are very challenging in different ways:
- Children living on the street have poor access to health care, education, food and safe shelter and are highly vulnerable to communicable infections, including HIV. The United Nations defines street children as children and youth for whom the street has become their home or source of livelihood and who are inadequately protected or supervised by adults. Various factors push children onto the street, including poverty, abuse, loss of parents to AIDS or other causes, loss of property and food insecurity.
- Children who work away from home such as on commercial farms, in the manufacturing industry or as domestic servants may be in working environments that increase their vulnerability. They may have limited contact with their families and lack the family and community safety nets that provide protection to other vulnerable children.
- Children in prisons and detention centers may be more vulnerable to physical and sexual abuse. There is little information and evidence about children living in this setting. They may live there because their mother is in prison. Older children may be there because of offences committed.
- Children in conflict situations, emergencies or disasters may lose or become separated from families and communities. They may lose their homes or entire community structures, leaving them unprotected and at risk for exploitation, trafficking and other abuses. Some may be forced to become child soldiers. Others, particularly women and girls, may be subjected to sexual violence. Conflict and HIV have been called a double emergency for children, increasing their vulnerability through loss of parents, caregivers and communities.
- Children living in residential care or institutions are removed from families, communities and their culture. There is increasing evidence of negative, long-term consequences of institutional living on children’s cognitive, social and emotional development.
To identify the most effective evidence-based responses for supporting children living in such a variety of adverse situations, The U.S. Government held an Evidence Summit on Protecting Children Outside of Family Care in December, 2011. The summit brought together researchers, academics and program staff, and from analysis of the summit’s key findings emerged The U.S. Government Action Plan on Children in Adversity – A Framework for International Assistance: 2012–2017. The Action Plan promotes 3 principle objectives, each with a core outcome for protecting children in adversity:
Principle objectives and core outcomes:
- Build strong beginnings – with the core outcome of significant reductions in the number of children not meeting age-appropriate growth and development milestones.
- Put family care first – with the core outcome of significant reductions in the number of children living outside of family care by placing them in appropriate and protective family care.
- Protect children from violence, exploitation, abuse, and neglect – with the core outcome of significant reductions in the number of children who experience sexual violence or exploitation.
Meeting these principle objectives requires a systems approach to social protection – strengthening the social welfare system and workforce at all levels from family and community to civil society (non-governmental organizations, faith-based organizations, community-based organizations) to government Ministries of Social Welfare.
To achieve core outcome number 2 – significant reductions in the number of children living outside of family care by placing them in appropriate and protective family care – The USG plan recommends several key actions:
- Support and enable families to care for their children; prevent unnecessary family-child separation; and promote appropriate, protective, and permanent family care.
- Strengthen the capacity of national poverty alleviation programs to prevent family-child separation, support family reunification and reintegration, and promote permanent and protective family care.
- Support and strengthen interventions and national systems for care reform and deinstitutionalization that prevent unnecessary family separation and support permanent and protective family care for children outside of families, including family reintegration, foster care, kinship care, and domestic and international adoption.
- Support identification, documentation, tracing, and reunification programs for children separated from families, particularly those affected by disaster and conflict.
- Provide family support services and raise awareness on better care alternatives to reduce the flow of children into institutions, paying particular attention to the needs of children and families with disabilities.
- Support deinstitutionalization programs that facilitate placement of children in appropriate, protective, and permanent family care, where possible, and ensure that monitoring and support services are consistently available to families and children.
- Support food security and household economic strengthening “plus” strategies for vulnerable families that can be taken to scale, with a focus on improving caregiving environments and preventing unnecessary family-child separation.
- Support programs to improve parenting and caregiving skills, reduce harmful behavior and toxic stress within families, and increase community awareness of good parenting and caregiving practices.
- Promote equitable access to educational opportunities in safe and appropriate learning environments.
- Support the development of national systems for identifying, enumerating, and documenting children outside of family care, including approaches that can be used rapidly in emergencies.
Why is shelter and care support important?
HIV/AIDS has increasingly strained families, extended families and communities in their efforts to care for children. In many areas, AIDS has increased the number of children requiring care and support. It is estimated that families and communities bear 90% of the financial cost of caring for infected and affected children in areas hardest hit by AIDS. Very often these families receive little external assistance.
Many caregivers experience extreme stress or ‘burnout’ and need various types of community support. Older caregivers may need particular assistance. Programs must support the vital role of parents and caregivers in caring for children, and strive to address their needs through family-focused interventions that integrate health, education, psychosocial, economic strengthening and social services.
Mothers’ health and well-being is critically important — both for their own well-being and for healthy child development, particularly for young children. The health of female caregivers has been shown to be especially important for household welfare indicators, highlighting the need to ensure that support services for caregivers are included when developing vulnerable children’s programs. (JLICA 2008).
Adequate shelter and care is important to provide security and stability for all children and families. For children to feel and be safe, they need to know that where they live is protected from danger. This protection is often lacking for marginalized groups such as children on the street, children in conflict or emergency situations and other children living outside of family care.
How should shelter and care be delivered?
Ideally, children should live in families within their communities. Evidence is clear that children who are cared for within families have better health, education, nutritional status and overall child development.
When no family or extended family can be found to care for a child, a child may be placed with another family in the community. Placement with another family may involve fostering or adoption.
If no other alternative care options are available, a child may be temporarily placed in residential care as a last resort. This should be short-term with the goal of moving the child back into family and community care as quickly as possible. Increasing evidence shows that residential/institutional care often has long-term negative consequences on children’s cognitive- and psychosocial-development and ability to form attachments. Implementing the Guidelines for Alternative Care for Children states that “children under age three requiring alternative care should be placed in family-based settings.” In addition to the negative social and emotional consequences of residential care, financial costs of residential care are estimated at 10-12 times as much as supporting children in family and community settings.
Quality and Standards of care
Care and support to children and families must be high quality. Standards of care establish precise criteria that must be met to achieve a desired level of quality. Increasingly, governments are setting national standards for the care and support of vulnerable children that should guide programming. The Quality Improvement Initiative for OVC Programs (QI) is another resource that brings together national government and civil society partners with OVC program and quality improvement experts.
Key Shelter and Care Activities and Messages
- Support children to live with their families within communities. Children fare best when they live with families, extended families or other families in their community. Most children affected by HIV and AIDS have some surviving family member(s) or extended families including parents, grandparents, aunts, uncles, brothers/sisters or adults in the community.
- Target interventions to particular needs and vulnerabilities of children living outside of family and community care. Street children, children in prisons, children who work away from home, such as domestic servants or commercial farm workers, and children in conflict and emergency situations all have different needs and levels of vulnerability to HIV, depending on context.
- Consider institutional care as a last resort and only as a temporary option with the goal of moving the child back into a family and community environment. Children under age three should not be placed in any form of institutional or residential care but, instead, placed in a family-like setting. A temporary exception might be to keep siblings together. (3)
- Include support for parents and caregivers, including older carers/grandparents. Caregivers often need support for stress, burnout, financial strains and their own health care. Vulnerable Children’s programs should include family-centered approaches that integrate health, education, and social services for all family members.
- Link shelter and care programs with economic strengthening opportunities and social protection measures to reduce family poverty and support families to be able to stay together.
- Require programs to adopt standards of care, with specific criteria to be met, to provide high quality shelter and care.