Systems That Need to Change

18.11.12

One of the main reasons the deinstitutionalisation process is so complex is that it requires major changes to entire systems of looking after children.  One of the mistakes commonly made is to believe that deinstitutionalisation is simply about developing social services that are targeted at specific groups of children.  Although this is one component of the change needed, in fact the process should ideally start with Health and Education services.

Lumos' research into the barriers to desinstitutionalsiation provides a little more detail the challenges faced in changing health, education and social services and in reforming legal and financial structures to make it possible to support all children who are vulnerable.

HEALTH SYSTEMS

Many countries do not have systems of community nurses, or health visitors, who visit families at home every time a new baby is born.  Without this system, it is difficult to identify problems early on and intervene to prevent a crisis.  Often the health services are reaching children when they are already seriously ill or malnourished.

All countries in the world except two have signed and ratified the UN Convention on the Rights of the Child, which includes a child's right to free healthcare.  Despite this, in many countries, healthcare is not provided for free and because of this, poor families put off going to the doctor until a child is seriously ill.  When a child who is very ill is admitted to hospital, families are often accused of neglecting their children.  As a result, children are admitted to institutions because it is believed that this will be safer than keeping them in the family.  But there is a difference between willful neglect and the neglect caused by grinding poverty.

In some countries, it is still the case that hospitals separate babies from their mothers at birth and keep them in separate wards.  For any mother who is considering giving up her child, this is a dangerous practice.  The early time spent together can have a dramatic impact on forming a bond between mother and child.  As a result, the mother is less willing to give up her child.

Many countries do not provide health education to prospective parents or new parents.  Because of this parents can miss signs of serious illness and their children can be at risk of severe harm.

In some countries, paediatricians resist the process of change because they do not accept the scientific evidence of the harm to early brain development caused by institutionalisation.  These paediatricians represent a strong lobby, because their views on child health and development are respected by politicians and society alike.

In many countries, it is still the case that doctors in hospitals advise parents to place their children with disabilities in institutions. There is a residual belief that the State knows better how to care for children than do their parents.  Young parents who are devastated by the news that their child has a disability are likely to take the advice of the doctors.

It is often the case that different professional departments work in isolation.  Medical professionals in many countries are not compelled to work in cooperation with social workers in addressing the needs of children in socially vulnerable families.  This means that poor families and children often fall between the gaps of service provision.

EDUCATION SYSTEMS

Many countries still run parallel systems of 'mainstream' education for children without disabilities and 'special' education for those who have disabilities.  The special education system is usually provided in residential special schools.  These schools are often situated some distance away from the children's families.  If families are poor it can be difficult to visit and gradually relationships break down.

Moving towards combining these systems requires the development of inclusive education.  This means that schools in the local community adapt their physical spaces and their teaching practices to ensure they can provide a good education to all children, including those with disabilities.  This change raises a whole series of challenges.

The process of assessing children with special educational needs is flawed in many countries.  Often an educational delay, which can simply be due to a child not having attended kindergarten, is misdiagnosed as a learning disability.  As a result, children as young as seven years old are separated from their families and sent to residential special schools.  Since many countries do not provide kindergarten places for free, this practice particularly disadvantages children from poor families, or those who are brought up in a different language to the one spoken in school.  In Central and Eastern Europe in particular, Roma children are extremely over-represented in residential special schools, due to a combination of discrimination and poverty.

Communities and particularly parents can be hostile to the inclusion of children with disabilities in their local schools.  Some wrongly believe that this will lower the academic quality of the education provided to their children.

Additional specialised teachers are needed to provide support to children with disabilities in local schools.  This requires additional personnel, but also adapted lesson plans and modified structures for assessing children's progress.  In some countries, if children do not receive a sufficient grade at the end of the year, they cannot progress and have to repeat the year.  Some teachers and school principals initially reject inclusive education, particularly if their school is judged on the academic grades of its students.  Therefore moving to inclusive education requires changes in attitudes and a significant investment of resources.

SOCIAL SERVICES

In many countries there are too few social workers to meet the needs of the community.  Social work is often an undervalued and under-resourced profession.  With high caseloads and few resources, social workers often feel able only to respond to the most serious of crises.  And often the only response they can give is to take a child from its family and place it in an institution.

Social workers often lack the tools and skills to carry out comprehensive assessments of children and families, in order to identify the best plan to ensure the child can be cared for in the family, without being at risk of harm.

Social workers often cite a lack of community based alternatives as a reason for placing a child in an institution.  Many say they would prefer an emergency foster placement for a child, but none exists, so their only option was an institution.  Their initial aim was to place the child in the institution as an emergency, whilst finding a better solution.  But once the child is in the institution, the social worker believes he or she is 'safe' and moves on to the next crisis.  As a result, an initial emergency placement turns into a long stay.

Social worker training in many countries is based primarily on theory and lacks sufficient training in how to implement that theory in practice.  Often social workers are given little professional supervision and ongoing training.  They often have to make a decision about a child on their own, without additional professional input.  This can be a heavy burden to carry.

Social workers often have limited access to resources such as transport and telephones.  As a result, some do little field work, whilst others use their own cars and telephones to deal with emergencies.  In some cases, social workers have been known to hitch lifts to deal with emergency child protection cases.

Often, social work teams are generic rather than specialised, so one social worker may be dealing with poor families, child abuse, older people and adults with disabilities.  It is impossible in this situation to provide the best support to children with complex needs.

Often social works lack specialist skills in identifying and addressing child abuse and neglect.  As a result, many cases go undetected until they reach crisis point.

LEGAL STRUCTURES

Many countries have not developed a system of family court judges, or judges who are trained to address cases of children and families.  As a result, insufficient time is granted to such cases and courts often feel like unfriendly environments for children.  Busy judges often approve the recommendations of social workers without too much probing the details of the case.

In many countries, there is no system to compel different agencies, such as health, the police, social services and education, to work together to protect children.  Procedures for reporting and referring cases of child abuse and neglect are often unclear.  As a result, serious cases of abuse often go undetected or are not addressed quickly enough.  

The response to child abuse can often compound the trauma children suffer.  In many countries, children who have been abused are placed in institutions together with children who have committed serious criminal offences, including violent offences, and other children with behavioural problems.  This can place them at risk of further abuse.

Few countries have developed systems of alternatives to custody for children and young people who commit minor offences.  As a result, they are placed in institutions together with those who have committed serious offences. They are then more likely to reoffend.

In many countries, the legislation and regulation governing the care and protection of children is not harmonised.  Often, many different laws cover issues related to children.  Some articles conflict with each other and there are often gaps in legal provisions.  At times, legislation limits the care that can be provided to children.  For example, some countries have no legal provision for foster care at all, whilst in others, foster care is limited only to children who do not have disabilities.

FINANCING STRUCTURES

Changing systems always costs money.  Because of this governments are reluctant to make changes they feel they cannot afford. At a time of global financial crisis it is even more difficult to convince government to invest in what seem like experimental ideas.  Often, services required in the community to support vulnerable children and families are cut to save money, at the very time these services are needed most.

One of the greatest challenges to financing change is that those responsible for managing change on a massive scale, lack the tools to estimate how much money will be needed.  Costs can be over-estimated, making governments reluctant to agree, or under-estimated, resulting in partial implementation of change, as a result of which some children miss out.

Moving from a system of large institutions to community based services requires significant investment in new infrastructure.  Even if old buildings can be sold to pay for some of the new services, capital investment is needed up front to build new small group homes, day centres and to adapt schools to make them inclusive. External donors often place limitations on the way in which their funds may be used.  Some donors will not fund infrastructure, but only human resources.  Whilst other donors might fund infrastructure, but will not cover costs involved in managing change.

Few Ministries of Finance become actively involved in the planning and implementation of changing services for children and families.  Often the mechanisms of financing services are rigid and need to be altered in order to sustain new services.  For example, in many countries, institutions are funded from the central State budget, whilst community support services must be funded by the local authority's own budget.  There is therefore no incentive for local authorities to support children to stay in their families, whilst it is financially advantageous to them to send children away to centrally funded institutions.  Many countries find it challenging to develop mechanisms to transfer resources from institutions to community based services.

One of the main reasons the deinstitutionalisation process is so complex is that it requires major changes to entire systems of looking after children.

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RESEARCH
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