Experts roundtable presentations june 6 2012 european parliament
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Experts roundtable presentations june 6 2012 european parliament



Experts roundtable presentations june 6 2012 european parliament

Experts roundtable presentations june 6 2012 european parliament



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  • In 2008,CoE issued a set of recommendations governing the rights of children in institutions. In 2010, they issued.............. Poor implementation.
  • She concluded that even though these international child rights instruments apply to children in institutions they are routinely violated throughout Europe. These are however useful instruments for guiding the DI process.

Experts roundtable presentations june 6 2012 european parliament Experts roundtable presentations june 6 2012 european parliament Presentation Transcript

  • 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 Presentations3-9 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 EUROCHILD10-25 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 Lancashire32-45 Investing in Our Future: The Practical Implications of Childcare Reform • Dr. Delia Pop • Director of Programmes, Hope & Homes for Children
  • Fundamental rights and theirapplication to children in institutions Dr. Maria Herczog Ph.D. Member of UN Committee on the Rights of the Child President of EUROCHILD European Parliament 6 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 crucialChildren without parental care: urgent need for action(2010)- violation of rights – old and new risks
  • Child Rights Strategy of CoEThe programme will focus on four strategicobjectives:1. promoting child-friendly services andsystems;2. eliminating all forms of violence againstchildren;3. guaranteeing the rights of children invulnerable situations; 4. promoting childparticipation
  • 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 European Parliament June 6, 2012 Charles H. Zeanah, M.D.
  • Brain Development in Early ChildhoodVideo will play on next page
  • What builds healthy brains?Nurturing and responsive relationships
  • Why institutional rearingmight be bad for the developing brainLimited opportunities to form selectiveattachments lack of psychological investment by caregivers rotating shifts high child/caregiver ratioInsensitive care regimented daily schedule non-individualized careIsolation limited response to distress unchecked aggression
  • Institutional rearingChildren raised in institutions areat dramatically increased risk fora variety of social and behavioralproblems: disturbances of attachment indiscriminate behavior emotional and behavior problems inattention/hyperactivity deficits in IQ and executive functions syndrome that mimics autismDevelopmental problemsbelieved to result fromdeprivation inherent ininstitutional care
  • Foster Care vs. 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*Randomized Controlled Trial
  • Bucharest Early Sf MariaIntervention Project Sf Vasile Sf Andrei Controceni Sf Ecaterina Giulesti Study Design 136 Institutionalized Children (6-30 months) Community Care As Usual Foster Care n=72 n=68 n=68 Assessments at 30, 42, 54 months Follow-ups at 8 and 12 years
  • Main effects of intervention Cognitive development Higher IQs Enhanced expressive and receptive language Physical development Greater height and weight Reduced stereotypies Emotional development More positive emotion expressed Less anxiety and depression Social development Enhanced competence More secure attachments Fewer attachment disorders Fewer psychiatric symptoms and less impairment Larger, more mature and better functioning brains
  • IQs of Children in Foster Care and Care as Usual groups by age at placement 100 90 80 70 30 mo 42 mo 54 mo
  • Age at placement and language at 42 months 1 0 IG FC>29m FC>24m FC>16m FC<15mReynell z score -1 -2 Expressive Receptive -3 -4 Age of foster placement
  • Distribution of electrical activityC across the scalp by timing and group FCG > 24 CAUG 3.80μV2 FCG < 24 NIG 2.44μV2
  • Worldwide investigations of familyplacement 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.”
  • Aren’t the outcomes different in better quality institutions?In better quality institutions: 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)
  • Institutional Care vs. Foster Care in Washington, D.C. Measures Results Intelligence Family > InstitutionLanguage/Communication Family > Institution Skills of daily living Family > Institution Socialization Family > Institution Adaptive Behavior Family > Institution More institution resembled a family, better outcome Jones Harden (2002)
  • Attachment mediates intervention effects of psychopathology 42 mo. Security of AttachmentFCG vs. CAUG ✕ 54 mo. Total Psychiatric Symptoms Psychiatric Impairment
  • Conclusions about institutional rearing and child developmentChildren raised in institutions have compromiseddevelopment across most but not all domains.Placement in families leads to developmental gainsSooner children are placed in families the better, butcomplete recovery is rare after 6 months of age Evidence for sensitive periods in some domains
  • The Economic Case for Policy 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): Foster care £55,608 Kinship care £20,220 Own parents £8,064 Residential £141,768 unit Independence £30,096 e.g. In Montenegro “The average annual costs in 2003 for achild without disabilities and aged under three years were 41,051euros for residential care and 13,124 euros for foster care. For achild with disabilities of the same age, the average annual costswere 43,017 euros for residential care and 30,998 euros forfoster care.”
  • 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  Unemployment  75 studies covering 3,888 children  Evidence in 19 countries - IQ 20 points lower in Austria, England, Hungary, Ireland, institutions Netherlands, Sweden Higher mortality & suicide  Homelessness  Finland 3 fold risk of dying before  England 1 in 5 end up homeless 25, Russia 1 in 10 care leavers commit suicide, Sweden 4 to 5 times more  Mental Illness likely to be hospitalised for suicide  Sweden between 5 and 8 times attempts more likely to be hospitalised in Poor education teens and 4 to 6 times in young adulthood  Evidence in Austria, England, Hungary, Ireland,  Early pregnancy and own Netherlands children in care Crime  Evidence in Sweden, England  England 27% of the adult prison Drugs, prostitution, autism  population has spent time in care … “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 exclusionSome 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 FutureThe Practical Implications of Childcare Reform Dr. Delia Pop Director of Programmes
  • Who are the children in institutions? 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 Their families in most cases are disempowered and struggle to cope with a range of risk factors:Children at risk • Poverty, without adequate living conditions, lacking• 52.67% boys and 47.33% girls housing, secure income/employment• 39.69% have a range of medical and developmental • Single parent families (mostly mothers) conditions • Poor parenting skills and family planning• Come from rural and urban areas in equal • Lack support of extended families proportions • Discrimination due to illness or ethnicityAre placed in institutions from: In certain country contexts:• 27.50% from maternity and hospitals • Substance abuse (alcohol/drugs)• 20.41% from families • Family violence• 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 Inaction Family in Crisis Pcmn Isu n a i ii l e etnt t s n o •Unsustainable •Loss of •Children’s •Children are source of income income, housing wellbeing at risk separated from •Marginalisation •Discrimination •Capacity to their families •Ill/health issues •Disability intervene and •Families remain •Lack of access to •Lack of medical achieve positive vulnerable and at basic services support, welfare changes in a risk assistance, etc. short period of •Poor family and time is reduced social •Family relationships breakdown •Poor parenting •Parents’ capacity skills to provide adequate care to children at critical level
  • Consequences• Stunted • Attachment growth disorders• Ill/health Physical Emotional Development development Cognitive Long term Development institutionalisation• Lower IQ • Up to 20% of• Loss of children potential average 14 years in care
  • 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 InstitutionaComplex lisation social & “oneeconomic solution fitsproblems all” Up to20% Use of scarce children spend resources 14 years in ineffectively residential care
  • 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 ReformClosing and replacing residential care in large institutions with a range ofalternative services designed to match children’s needs and realise theirrights: • 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-institutionalisation Reduced number of children placed in care Earlyintervention Permanency and family through support adoption Institution closure Family based Efficient care with allocation of better resources outcomes
  • ACTIVE Family SupportInputs Outputs Outcomes Impact • €441,560 • 255 • 250 • 224 families families families and 499 and 489 and 441 children children children supported remained with together significant outcomes
  • Return on Investment €441,560 (€921/child) 441 children with improved €4,123,250 outcomes saved in institutional care costs
  • De-institutionalisation # of Monthly TOTAL TOTAL % Children Per Child Monthly AnnualNational level 75% 45 €265 €11,925 €143,100County level 25% 15 €292 €4,380 €52,560 €16,305 €195,660
  • De-institutionalisation
  • De-institutionalisationAdditional costsCapital investment - purchase, renovation, furnishing and equipping of smallfamily home €120,000Purchase of vehicle for mobile team €5,000Transitional costs provided by local governmentCovering income lost by the Institution due to decrease in number of children €16,500 eurosInstitution – 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 childrenand serves more than twice as many beneficiaries