Interim Care Alternatives and Foster Care

2. Interim Care Alternatives and Foster Care Prof Lorraine Sherr, Chair, Royal Free and UC Medical School, London Ghazal Keshavarzian, Vice Chair UNICEF Dr Jane Aronson, Found Worldwide Orphan Foundation Hope Cooper, Vice President for Public Policy Child Trends Judy Ndungu, Ministry of Gender, Kenya Dr Charles A. Nelson, Harvard University John Okiror, Uganda VianneyRangira, Rwanda

3. Care • Specifically good quality care is vital for healthy optimum child development. • Children need to be loved and to have a nurturing environment with dependable adults who are • consistently available for them to form adaptive relationships • The can rely on for receipt of love, care, protection and • Provide a stimulating growth environment.

4. Alternative care arrangements need to be viewed in a cultural context. • In the presence of extreme stressors many traditional systems are put under strain Seeley, AIDS Care Safety Net with holes

5. METHODOLOGY • Expertise • Experience • Good practice models • Evidence Interim Care Foster care Institutional care • Dismantling institutions

6. Types of Interim Care Broadly four categories: • Emergency/spontaneous foster care/family placement • Emergency rescue/reception centres • Small group homes (temporary placement or permanent based on the needs of child) • Family type homes (temporary placement only)

7. What needs to be in place to support interim care? • Counseling support services (psycho-social) • Parenting classes • Mother and baby homes (supporting mothers at risk of abandoning babies, i.e., teenage mothers, victims of rape) • Education support services (refer to Kenya document • Day Care Centers (monitored/regulated) • Respite care • Medical care (including treatments such as ARVs, nutritional support – refer to Kenya document) • Cash transfer programme (i.e., Kenya, Ghana) • Child specific support services (education, healthy lifestyles, counseling, legal rights) • Community hubs (provide support around malnutrition, livelihood) • Family Tracing and Reunification (See: Interagency Guidelines).

8. Interim care Benefits • Better outcomes than children placed in long-term institutional care • Gives a sense of uniqueness for the child • Safe and supportive environment while maintaining relationships with biological family • Supports child development • Equips children for independent living • Cost effective Concerns • Trauma of separation from family • Potential for abuse in foster family • Potential for ambiguous legal circumstances • Confusion about identity and cultural ideologies • Negative motives for foster caregivers • Labor intensive (need support in supervision, monitoring, standards)

9. RESIDENTIAL CARE AND GUIDELINES • Group care should not bethe first-choice placement option • Importance of early child development • Priority to community-based solutions • Foster careenhances outcomes for institutionalized children • Rigorous admission procedure and safeguards • Siblings placed together • In emergency and non-emergency, group care or similar institutions have been arranged. • Properly managed with staff that adhere to guidelines and standards • Some countries specifically exclude institutional care • Policy for dismantling important – see Rwanda

10. KEY GAPS AND CHALLENGES - INTERIM CARE • Policy framework: Build the policy framework to support interim care – very weak in most African countries • Social welfare capacity building: Need to build social work capacity • Planning: Need proper planning strategies in place at the beginning • Monitoring:mechanisms in place • Data collection: Weak data collection • Children with special needs: More attention special needs in interim care • Awareness raising: Need more advocacy and awareness

11. Guiding Principles: INTERIM CARE • For all separated children until reunited or provided permanent care placement • Government policies need to be in place: (1) plan action for interim care; (2) national minimum standards for interim care; (3) monitoring and evaluation system for interim care (4) long term planning after interim care • All placements must be documented to facilitate ongoing tracing and reunification • Must be of minimum quality, screened, monitored, and supported • Work within national laws and community systems • Family and community-based approach should be the guiding philosophy • Rights based approaches should inform strategy • Keep siblings together . • Children should be part of the decision-making process and well informed. • Interim care must be linked with family support and preventive services  

12. Foster care Benefits • Better outcomes than institutional care • Safe and supportive • Supports child development • Cost effective • Equips children for independent living Concerns • Trauma of separation • Potential for abuse • Potential for ambiguous legal circumstances • Confusion about identity • Negative motives for foster caregivers • Labor intensive

13. Key gaps and challenges of foster care • Policy framework: need to build the policy framework to support foster care – very weak in most African countries • Social welfare infrastructure: Need to build social work capacity to ensure selection of secure families and pre/post placement monitoring and support • Data collection: weak data for formal and informal foster care • Children with special needs: More attention is needed for children with special needs in foster care system • Resources: need more resources

14. Key Recommendations for foster care • Mentoring • Coordination • Government policies need to be in place: (1) plan action for foster care; (2) national minimum standards for foster care; (3) monitoring and evaluation system for foster care • Community awareness raising • Focus on reunification • Safety throughout

15. UNDERSTANDING INSTITUTIONALIZATION • Associated with emotional and developmental problems, yet proliferation rather than a reduction. • Uganda: 212 institutions reported (only 60% appropriately approved) • Rwanda: 37 registered baby homes. • Compounded - may be inhabited by children who are not orphans • Incentives were food in situation of dire poverty, school fee payment in countries without free education. • It may be that homes hold out promise to the poor. • Institutional care should not be a substitute for poverty alleviation • Bring additional problems (orphan tourism Richter 2010)

16. Brain development impacted by institutionalised care • Appears to reduce and/or alter metabolic, physiological, and neurochemical activity. • Changes documented

17. A systemic review Impact on cognitive development generated 227 hits and then 42 studies

20. 96% negative cognitive /behavioural problems • Pre-existing factors may contribute • RCT to subsequent alternative care • Removal associated with fewer problems • Experience of Rwanda – process of dismantling