Standards of Care and Mental Health of Institutionalised Children

1. Standards of Care and Mental Healthof InstitutionalisedChildren Jean-Luc DOUILLARD Clinical Psychologist Regional health program coordinator Hospital of Saintes France New Delhi March-14 2014

2. Working together for child protection • Improve our knowledge • Share our good practices • Encourage politicians to pass laws and to enforce them • Better identify and take better care of children who suffering • Improve initial and continuing training of caregivers • Reduce mortality in children and adolescents

3. Some basic principles to take care • We have first to enact laws for the protection of children and apply them in each country in the best interests of each child • Protocols must be written and a social organization must exist for a collaborative evaluation in each decision of placement • Many actions of prevention and education to health must exist in each country since birth to adolescence at the same time that actions of parenting support

4. We must do more researches and exchanges, we have to take more political decisions and social institutions have to more engage with local associations • Each child at risk should receive high quality care in each country of the world , and his rights must be respected, a girl with the same care that a boy ! • The society is changing very quickly, we must adapt our practices together with a great respect of each culture and religion, and now with reality and tools of the digital world • We have all to form and to recognize the caregivers and the volunteers for the great work they do all days

5. Specific duties In decisions, procedures, and methods of placement • The right to their own identity and personalized project in the institution, equality of chance and respect for ethnic, religious, cultural, family, and social origins • The right to be placed with his brothers and sisters if it is possible and to maintain regular contact with people close to him • The right to quality care, especially with psychotherapies, athletic or artistic practices

6. The right to education and job training opportunities on the same basis as other children to become a citizen of the world, active and responsible • The right to be respected for their human dignity and their physical integrity, including protection against corporal punishment and all forms of violence • The right to enforce its rights to an identifiable, impartial and independent authority and to participate in making decisions that affect them

7. How to do that ? • All welcoming institutions for children and adolescents must be identified , accredited and regularly assessed by a competent public authority • Each child must have a placement based on his own abilities, skills and autonomy of each child, preparing for better future to life outside the institution for the future • The internal life of each institution shall ensure the possible development of the child, whether mental, emotional or physical

8. They need stability of ties, many possibilites of creations, many relationships with other children in their families, in their occupations, games • They need much time and different spaces to be able to think of themselves • They need caregivers whose accept to be authentics and in the same way, robust, reliable and that know each other very well and that talk to each other

9. Small units to a mode almost family life should be encouraged • Diversity, multiple competence , stability fool staff are important standards. children must be able to attach without fear, let go to their defense mechanisms and rebuilt with new benchmarks, more stable, and allow themselves to have real prospects • Multidisciplinary teams must be provided with adequate resources in accordance with international codes of deontology

10. Their living spaces should be safe, comfortable (everyone should have their own space to invest) • They must have access to appropriate and varied psychotherapies • They must have rituals of meeting and separation to grow, focus, then separate without tearing again, this is a challenge !

11. In France • Children who are the subject of an act of abuse (victims of physical abuse, sexual abuse, emotional abuse, severe neglect with serious consequences for their physical and mental development) • Children who have to face a situation of risk associated with conditions of life likely to endanger their health, safety, morals, education, without necessarily being abused • Foster children by a parent who does not want or can not care for him • The orphaned or abandoned children • Delinquent children

12. 100,000 children are declared at risk annually in France • Social services 55,000 children are in institutions in France from birth to 21 years • Host Families 70 000 children annually, family assistant has agréement for 5 years by the General Council • There is a specific law for the protection of children up to 21 years which is The Judicial Protection of Youth(383,000 children and young adults (92,000 criminal justice and 291,000 children at risk or youth protection major)

13. Each department is responsible for the organization supported under the responsibility of the state • There are also specialized institutions for juvenile offenders • Children and adolescents with severe personality disorders or psychiatric disorders or somatic diseases are treated in specialized hospitals • For the social institutions, a National Observatory for Children in Danger created in France for 10 years (ONED)

14. Social child's home 1115 small or big structures, between 10 and 65 places 75 percent have less than 30 seats They are public or associative • Children's homes 210 small or big structures between 10 and 120 places • Social nurseries 31 small institutions between 10 to 30 places Mostly children from 0 to 3 years • Holiday villages 21 structures about 40 and 60 places • Places to live 385 structures between 3 et 7 places

15. Orphans and abandonned children • 2100 Children • They are necessarily subject to an adoption, they are welcomed by a host family awaiting adoption • This is the state that is responsible • The suffering of these children is more difficult to support, narcissistic wounds are very deep and multifaceted

16. They are more vulnerable to psychological distress and the impact of trauma for each orphaned child must be correctly evaluate, it will depend on : The age and sex of the child at the time of loss The nature and quality of the links before the break The context of early breaks Violence suffered The quality and diversity of care Self-esteem and resilience of each child and the quality of care

17. Somatic disorders Eating disorders, skin lesions, respiratory disorders, digestive disorders, sphincter disorders, psychomotor disorders Attachment disorders Unable to attach or permanent fusion attachment Behavioral and thinking disorders Mood disorders, delinquency, impulsivity, inhibition, violence, failures in learning Against self-injury and suicide attempts Cuts, burns, bites….Prostitution, drug addiction, homelessness Suicide Psychiatric disorders Anorexia, anxiety neurosis and traumatic childhood psychoses The most frequent disorders

18. The limits of our practices • Difficulties in identifying children who need care • Difficulties for individualized and multidisciplinary assessments, concerted • The lack of trainings for the caregivers and the lack of places in institutions • The lack of courage of some governments to enact key legislation and to give much money for child protection

19. The lack of knowledge of resources in the territories and too small links between professional in institution and volunteers in associations • Lack of time and clinical reflections • The urgency of certain crisis situations, and sometimes impossible to anticipate. • Suicidality, major in abandoned or orphaned children, especially orphans by suicide

20. The lack of resources to develop new projects and build small structures with proper guidance in a society who has changed The increase in intra family violence situations Increasing insecurity and poverty Each child is different than another, for the same history, they will not react by the same way, we need to adapt our practices There is no suffering that can not be appeased with quality care