1.
Georgette Mulheir
Chief Executive,
Lumos
Toward a Society in which Children Can
Grow Up in Families
Building on the Experience of Promoting Family
Protective Care in Central and Eastern Europe

2.
Institutionalisation of
children
a global problem

3.
Institutions are established to care for
‘orphans’
More than 90% in Europe are not orphans
(overall 80% globally)

4.
• Science proves the harm caused by institutions
• Dramatic impact on Early Brain Development
• Increased risk of all forms of abuse
• Increased mortality risk, especially disabled children
• Extremely poor outcomes for children

5.
The harm caused by
institutionalisation
These images from the Bucharest study show the decreased electrical
activity in an institutionalised child’s brain. The colour orange indicates
high activity.
EEG level: An institutionalised
child
EEG level: A never-institutionalised
child

6.
Adults who spent their childhood in
institutions were:
 10 times more likely than their peers to be involved in
prostitution
 40 times more likely to have a criminal record
 500 times more likely to commit suicide

7.
Outcomes for children with disabilities
One study found that of children under three in
institutions across Europe:
• 0.29% of children without disabilities died
• 28% of children with disabilities died
Children with disabilities were 100 times more likely
to die in the institution than those without
disabilities.

8.
Why are the outcomes for
children so poor?
• Children cannot form an attachment – essential to healthy development
• High personnel costs mean limited time with children
• Impossible to respond to individual needs
• Abusive methods of behaviour control
• Isolated from the community – children do not learn skills to survive in the outside world
• No family/social network when leave institution
• Desperate for love and affection – open to abuse and exploitation

9.
The scale of the
problem
European Union:
150,000
Russia:
600,000
Ukraine: 120,000
Brazil 50,000There are eight million children
in institutions around the world

10.
Global picture in numbers

11.
5.5
16
49
21
39
0
10
20
30
40
50
60
England Japan Czech Republic Bulgaria Moldova
Rate of children in institutions per 10,000
rate of children 0-18

12.
0 0
7
38
29
0
5
10
15
20
25
30
35
40
England Sweden Japan Czech Republic Bulgaria
Rate of babies in institutions per 10,000
children 0-3
0 0

13.
Successful
deinstitutionalisat
ion includes…

14.
Developing community services to
replace institutions

15.
Preventing children from entering
institutions

16.
Removing all children currently
resident – to family based care

17.
Ring-fencing and transferring
resources

18.
Capacity and expertise to manage major
change

19.
Changing attitudes, polices and
practices

20.
Empowering children and families to
take a lead role in changing attitudes
and practices

21.
Lumos’ work at
national-level

22.
An example from Moldova

23.
Number of children in institutions
in Moldova 2007-2014

24.
Number of children in the
institution in Floresti from 2007 -
2014

25.
Number of children in institutions
in Ialoveni County from 2007-
2014

26.
Number of children in institution
no. 2 in Chisinau from 2007 -
2014

27.
Number of children in the institution in
Orhei from 2007 - 2014

28.
Number of children in foster care in
Moldova
282
372
421
440
581
660
735
850
0
100
200
300
400
500
600
700
800
900
2007 2008 2009 2010 2011 2012 2013 2014

29.
Number of children in foster care in
Ialoveni region
3
6 6 6 6
12
18
28
0
5
10
15
20
25
30
2007 2008 2009 2010 2011 2012 2013 2014

30.
Number of children in foster care in
Floresti region
9 9
13 13
19
37
45
60
0
10
20
30
40
50
60
70
2007 2008 2009 2010 2011 2012 2013 2014

31.
Number of children with disabilities in Moldova
educated in inclusive vs segregated schools
3148
2549
2300
1807
1538
1253
1604
2258
4495
7660
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
Segregated residential special schools Inclusive mainstream schools

32.
51%The number of children with disabilities separated from their families and
living in residential special schools has reduced by 51% in five years
511%The number of children with disabilities educated in inclusive mainstream
schools has increased by 511% in five years

33.
Cost savings over time
-example from Moldova

34.
Cost/child/year in different placements
(in Euros)
4100 3881
3382
475
831
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Institution Small group
home
Foster care Family support Inclusive
education
Cost per
child per
year

35.
Cost/child over 12 years (in Euros)
49200 46572
40584
1425
9972
0
10000
20000
30000
40000
50000
60000
Institution Small group home Foster care Family support Inclusive education
Cost per
child over
12 year
period

36.
Two care options for 13,000 children
13,000 children in institutions = €639,600,000
13,000 children cared for in the community =€79,405,950
Only 12% of expenditure on institutions
Savings invested have:
introduced inclusive education in 40% of schools in the
country
Reduced infant mortality from 14/1000 to 9/1000

37.
An example from
Bulgaria

38.
Number of children in institutions in
Bulgaria
6730
5695
4755
4122
3113
2721
0
1000
2000
3000
4000
5000
6000
7000
8000
2009 2010 2011 2012 2013 2014

39.
Number of babies in institutions in
Bulgaria
2455
2319
2087
1204
975
0
500
1000
1500
2000
2500
3000
2010 2011 2012 2013 2014
Number of babies in institutions

40.
Number of children in foster care in
Bulgaria
221
391
580
1943
2304
0
500
1000
1500
2000
2500
2010 2011 2012 2013 2014
Number of children in foster care

41.
Admissions to institutions for children in
Bulgaria
3170
2930 2855
2708
2099
1044
0
500
1000
1500
2000
2500
3000
3500
2009 2010 2011 2012 2013 2014
Admissions to institutions in Bulgaria

42.
% of admissions of children in Foster Care
vs. Residential care in Bulgaria
[値]%
[値]%
[値]%
[値]%
0
10
20
30
40
50
60
70
80
2012 2013
% in Foster Care % in residential institutions

43.
An example from the
Czech Republic

44.
Number of children in institutions in the Czech Republic

45.
Admissions to institutions for children in the Czech Republic

46.
3.1
3.8
4.8
5.1
5.6
6.2
6.6
6.7
6.8
8.1
8.4
9.0
10.9
14.4
0.0 5.0 10.0 15.0 20.0
Královéhradecký County
Pardubický County
Olomoucký County
Jihomoravský County
Plzeňský County
Zlínský County
Czech Republic (nationally)
Středočeský County
County vysočina
Liberecký County
Moravsko-slezský County
Jihočeský County
Karlovarský County
Ústecký County
Admissions to children homes per 10,000 children
aged 3-18 in 20012/2013

47.
4,613
4,884
5,174
5,727
6,722
7,021
7,463 7,651
8,606
9,771
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Number of children in foster care and guardianship in
the Czech Republic
Foster care

48.
0 3
29
108
302
498
0
100
200
300
400
500
600
2011/01/01 2012/01/01 2013/01/01 2014/01/01 2015/01/01
NUMBER OF CHILDREN IN SHORT-TERM
FOSTER CARE IN THE CZECH REPUBLIC

49.
Capacity of community-based family support
services has grown significantly in recent years
76
322
0
50
100
150
200
250
300
350
2006 2014
Number of registered social-
activation services for families
with children in the Czech
Republic
20
200
0
50
100
150
200
250
2006 2014
Estimated number of families
that can be supported by social-
activation services for families
with children in Pardubice
country

50.
Increased capacity in preventive social work has already
had impact on Children‘s Homes
Admissions to children homes in Pardubice
county have decreased significantly
No preschool child admitted to children‘s
home in Pardubice in 2012/2013
56
17
0
10
20
30
40
50
60
2004/2005 2012/2013
Number of admissions to
children's homes in
Pardubice county
16
18 18 18
8
10
6
14
0
0
5
10
15
20
25
2005
2006
2007
2008
2009
2010
2011
2012
2013
Admissions of preschool
children to Children's
homes in Pardubice county

51.
Capacity of community-based support
services to families with children with
disabilities has also been increasing…
2,703
2,984 2,933
3,779
2000
2200
2400
2600
2800
3000
3200
3400
3600
3800
4000
2009 2010 2011 2012
Number of users of early intervention (raná péče) in the Czech
Republic

52.
Increased capacity of community-based support services to families
with children with disabilities has led to almost 30% decrease in
numbers of children in disability care homes in 4 years
1063
926
834
769
600
650
700
750
800
850
900
950
1000
1050
1100
2009 2010 2011 2012
Number of children in disability care homes

53.
Costs of different types of service/placement
1 040 (29 tis.)
8 850 (245 tis.)
15 700 (430 tis.)
10 900 (299 tis.)
22 400 (614 tis.)
0 5,000 10,000 15,000 20,000 25,000
Community-based family support service
Long term foster care
Short term foster care
Children's home
Baby institution (Pardubice county)
Cost for one placement/bed per year (in Euro and
CZK)

54.
Cost of the ‘average’ case:
Placement in baby
home for 4 months
Placement in short-term
foster care for 4 months
2 years of community-based
family support services
7 467 (204 tis.)
5 233 (144 tis.)
2 080 (57 tis.)

55.
Community-based system: alternative placements to
85 beds in Baby homes
8
358 (9 820)
9
42 (1 163)
24
25 (684)
4 6 (168)
2
5 (141)
26 408 (11 185)
8 71 (1 940)
4 63 (1 721)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Number of placements Yearly costs in thousands
EURO/CZK
Alternative placements/services - numbers and costs
Foster care for children with
disabilities
Long term foster care
Short term foster care
Home with support of early
intervention and family
support
Home with support of early
intervention service
Home with family support

56.
Annual budget for current and new
systems
1 748
(47 900)
979
(26 825)
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
85 beds in baby homes Community-based system
Yearly costs for placements in baby homes and
alternative placements (thousands EURO and
CZK)

57.
The new system will be able to help more
children for the same budget
The community based system costs less
approx. 770 thousand
EURO (21 100 tis. Kč)
could be saved
annually
approx. 740 families
could be supported
by community- based
family support
services with this
money
100 100
740
0
100
200
300
400
500
600
700
800
900
85 beds in baby homes Community-based system
Children served with the same budget
Children yearly served thanks to the beds in baby homes
Children in the community supported thanks to lower costs of alternative
placements/services
Therefore more children can be helped with the same budget

58.
Types of Fostering 1
There are various types of foster care available:
Emergency
Where children need somewhere safe to stay for a few days
Short –Term
Where carers look after children for a few weeks or months, while plans are in made for
the child’s future.
Short –Breaks
Where children with disabilities, special needs or behavioural difficulties enjoy a short
stay on a pre-planned regular basis with a foster family, and their parents have a short
break for themselves.
Remand Fostering
Where young people are remanded by the court to the care of a specially trained foster
carer.

59.
Types of Fostering 2
Long –Term and Permanent
It is not appropriate for some children who have regular contact with
their own families to be adopted and they may be placed with long
term foster carers
“Family and Friends” or “Kinship” Fostering
Where children who are looked after by a local authority are cared for
by people they already know. This can be very beneficial for children.
Private Fostering
Where the parents make a private arrangement for the child to stay
with someone else who is not a close relative and has no parental
responsibilities, and the child stays with the private foster carer for
more than 27 days. The local authority must be informed about the
arrangements and visit to check the child’s welfare.

60.
Types of Fostering 3
Mother and Baby Placements
These are specialist placements with carers who can offer a
parent and her young baby accommodation. The carer will
provide stability, advice and the help needed to enable the
mother to develop the skills required to be a parent. The
carer may also be involved in the assessment of the parent’s
ability to meet the child’s needs independently in the long
term.

61.
Types of Fostering 4
Treatment Foster Care
• This is specialist foster care to meet the needs of children and
young people with emotional difficulties and displaying
challenging behaviour.
• Different models used including Multi-Dimensional Treatment
Foster Care and Keep
• Both children and foster carers are provided with high levels of
support including therapeutic support and support available 24
hours a day
• For older children this model can be an alternative to
residential care for children who have found it hard to settle in
mainstream foster placements

62.
Planning the transfer of resources

63.
A range of community based
services is needed to replace
institutions
Most are cheaper
Some are more expensive

64.
Why does an
institutional
system cost
so much?
24-hour
care - many
personnel
Building
maintenance
costs
More
children in
institutions
than need to
be in care
Financial
incentives to
bring more
children in
(budget per
child)

65.
Belief that institutions are an
‘economy of scale’:
Put all the children together and it will cost
less
However the evidence suggests otherwise

66.
Universal:Children’s Centres – around £600 per user
Parenting
programme
(e.g. Triple P)-
£900- 1,000 per
PEIP -£1200-
3000 per
Family Nurse Partnerships,
Family Functional Therapy
&KEEP- £3000 per family a
year
Multi-Systematic Therapy- £3-10,000 per intervention
Family Intervention Services- £8-20,000 per family per year
Child looked after in foster care -£25,000 per
year placement costs (plus additional services)
Multi-dimensional Treatment Foster
Care- £70,000 per year for total package
It is vital that children
and young people
receive the right
services at the right
time. These figures are
intended to be
illustrative
Child looked after in children's home -
£125,000+ per year placement costs
Child Looked after in secure
accommodation - £134,000+ per year
placement costs
Costs increase as
children get older.
Increasing related
costs such as
healthcare and
the criminal
justice system
make it clear
joined up working
is a core part of
cost effectiveness
Cost
Universal: Schools - £5400 per pupil
CostperChild/Family
Severity of assessed need
Information Services -
Around £34 via
telephone helpline
Around £2 via digital
services
High relative costs of intervention for small group of
looked after children and those on the edge of care

67.
Institutions have three types of
resources that should be reinvested
in community services:
Financial (annual budget and donations)
Human (institution personnel)
Material (buildings, land, vehicles,
equipment)

68.
If not, as numbers in institutions
reduce, resources disappear from
the system…

69.
Outcomes

70.
Improved development following move
from institution to foster care
0
10
20
30
40
50
60
70
80
90
100
Height Walking Speech Cognitive
Average/above when
placed
Average/above now

71.
Changes in behaviour on moving from
institution to foster care
0 20 40 60
Enuresis
Food issues
Nightmares
Lying
Stealing
Aggression
Self-harm
Very frequent now
Very frequent when
placement began

72.
Research among homeless population in Prague*:
• High numbers of homeless young people with history of
institutional care
• Almost no cases of young people who were in Foster care
*Source: PRUDKÝ, L. a ŠMÍDOVÁ, M. Kudy ke dnu: analýza charakteristik klientů Naděje, o.s., středisko Praha, Bolzanova. Vyd. 1.
Praha: Socioklub, [2010] dotisk, 135 s. Sešity pro sociální politiku. ISBN 9788086140681.
Outcomes of residential vs foster care in The
Czech Republic

73.
Belief that material
conditions can replace a
family’s love and
nurturing…
- An Institution Director
“Our children have everything
they need: their own rooms,
TV, internet, air-conditioning
and a mini-bar. They have the
best teachers. They visit the
US, Austria,
Switzerland. What would they
have if they were at home?”

74.
The difference it makes
https://vimeo.com/126264012

75.
Thank y u
Georgette Mulheir
Georgette.Mulheir@wearelumos.org
+44 (0)20 7253 6464