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Moving from Residential to Family Based Care:  Lessons Learned

Moving from Residential to Family Based Care:  Lessons Learned . Congressional Coalition on Adoption Institute February 10, 2011 David Tobis, Ph.D. Maestral International. RELIANCE OF RESIDENTIAL CARE. DEVELOPED WORLD HAS MOVED AWAY FROM RELIANCE ON RESIDENTAIL INSTITUTIONS

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Moving from Residential to Family Based Care:  Lessons Learned

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  1. Moving from Residential to Family Based Care:  Lessons Learned Congressional Coalition on Adoption Institute February 10, 2011 David Tobis, Ph.D. Maestral International

  2. RELIANCE OF RESIDENTIAL CARE • DEVELOPED WORLD HAS MOVED AWAY FROM RELIANCE ON RESIDENTAIL INSTITUTIONS • UNITED STATES: children in residential institutions • 1930: 70% • 1980: 5% • DEVELOPING WORLD BETWEEN 2 MILLION AND 8 MILLION CHILDREN IN RESIDENTIAL INSTITUTIONS

  3. EASTERN EUROPE/FSU MADE WORLD AWARE (AGAIN) OF PROBLEMS OF RESIDENTIAL INSTITUTIONS • THE ORPHANAGES OF ROMANIA • “Children arrive healthy and leave disabled.” • PROBLEMS OF ADOPTED CHILDREN • DIFFICULTIES OF REDUCING RELIANCE ON RESIDENTIAL INSTITUTIONS

  4. TOOTHBRUSHES

  5. KIDS IN FACILITY FOR MODERATELY DISABLED

  6. CONSENSUS AND REASSESSMENT CONSENSUS LARGE RESIDENTIAL INSTITUTIONS ARE HARMFUL • IMPERSONAL • REGIMENTED • ABUSE • NEGATIVE OUTCOMES • Homeless, unemployment, crime, suicide • (Soviet model at least successfully channeled people into jobs) • EXPENSIVE • MOST CHILDREN IN NEED ARE NOT SERVED • ALMOST RANDOM WHO IS SERVED

  7. RECENT REASSESSMENT • SMALLER GROUP FACILITIES HAVE MERIT FOR: • Adolescents, and children who don’t want to live in someone else’s family • Children with severe behavior problems • Children in conflict with the law • Children with severe disabilities IF: • LICENSED, MONITORED/EVALUATED AND REGULATED • WELL FUNDED WITH WELL-TRAINED STAFF • PERSONALIZED PROGRAMMING • SHORT-TERM BUT • MANY DO NOT MEET THOSE STANDARDS • VERY COSTLY • MOST CHILDREN IN NEED STILL UNSERVED • ALMOST RANDOM WHO IS SERVED

  8. A LONG-TERM DANGER • CREATION OF RESIDENTIAL INSTITUTIONS IN SOVIET UNION • WORLD WAR I • CIVIL WAR • EPIDEMICS • FAMINE CURRENT SITUATION IN AFRICA • EPIDEMICS: HIV/AIDS • WARS • HUNGER • Patterns now will last far into the future

  9. BENEFITS OF FAMILY BASED CARE • BETTER OUTCOMES FOR CHILDREN • LESS EXPENSIVE PER CHILD • BUT NEED TO SERVE MORE CHILDREN • PRESERVES FAMILIES • ONCE BOND BROKEN, HARD TO REPAIR • PREVENTIVE BUT HARD TO CONVINCE DONORS No Bricks and mortar or name on a plaque HOW TO OVERCOME BARRIER Government Regulation Research on harm of institutions

  10. PRINCIPLES FOR A STRATEGY TO CREATE FAMILY BASED CARE 1. BUILD ON WHAT EXISTS 2. CREATE A SYSTEM NOT ISOLATED PROGRAMS 3. HAVE THE GOVERNMENT INVOLVED FROM START 4. INVOLVE PARENTS AND YOUTH IN ALL PHASES 5. CREATE FAMILY CARE PROGRAMS BEFORE REDUCING RELIANCE ON RESIDENTIAL CARE 6. LEGISLATION IS EASY/IMPLEMENTATION IS HARD Malawi: Mapping, Assessment and costing 7. MAKE EVALUATION CENTRAL FROM THE START

  11. STEPS TOWARD FAMILY-BASED CARE (ROUGHLY IN THIS ORDER) 1. CHANGE PUBLIC OPINION 2. STRENGTHEN SOCIAL WELFARE INFRASTRUCTURE 3. CREATE PILOT PROJECTS -FAMILY SUPPORTS (cash and non-cash) -TO REDUCE FLOW INTO RESIDENTIAL CARE -TO REINTEGRATE CHILDREN INTO COMMUNITY 4. REDESIGN, CONVERT OR CLOSE INDIVIDUAL FACILITIES 5.CREATE A NATIONAL SYSTEM OF COMMUNITY- BASED SERVICES

  12. WHAT HAS BEEN HAPPENING ? • EASTERN EUROPE/FSU • EFFORTS TO CREATE COMMUNITY ALTERNATIVES BUT CONTINUED RELIANCE ON RESIDENTIAL INSTITUTIONS • SOME SUCCESSES, e.g. • ROMANIA: • LONG-TERM FUNDING • SIGNIFICANT FUNDING • POLITICAL PRESSURE (ACCESSION TO EU) • LITHUANIA • Created community services before deinstitutionalizing (e.g. day program for disabled) • Government support and commitment to fund from the start • Evaluation to show benefit and impact

  13. What is happening in Africa? • PROLIFERATION OF UNREGULATED, OFTEN UNLICENSED, GROUP HOMES • Expensive • Random who gets placed • Unregulated • In Tunisia: if government doesn’t fund, it believed it doesn’t have a right to regulate • Can lead to unregulated adoption or illegal trafficking

  14. SOME EXCELLENT FAMILY AND COMMUNITY BASED CARE PROGRAMS • Malawi: Cash transfer for those who cannot work • Rwanda: Reintegration of street children • Hope and Homes • Kenya: Stop Sexual Violence Against Children Campaign • BUT • These programs reach a very small segment of those in need. • They lack government funding; are not sustainable

  15. WHAT IS NEEDED ? • COORDINATION AMONG DONORS, GOVERNMENT, NGOs • THE WAY FORWARD INITIATIVE HAS POTENTIAL TO REALLY BE THE WAY FORWARD • REDIRECT RESOURCES FROM GROUP CARE TO FAMILY-BASED CARE • MONITOR AND REGULATE GROUP CARE • STRENGTHEN EACH PART OF THE CONTINUUM OF CARE • PREVENTION • FAMILY-BASED CARE • OUT-OF-HOME CARE • ADOPTION (DOMESTIC AND INTERNATIONAL) A CAUTION: PLAN WELL AND LISTEN

  16. BE CAREFUL • PHOTO OF AMEMENIA FUEL

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