1. Ending institutionalisation Ensuring better outcomes for children

2. A European problem • One million children in institutions in the European region due to poverty, ethnicity, disability • Institutionalisation causes severe harm to the health and development of children • Outcomes are extremely poor – 10 times more likely to be trafficked; high levels of suicide, criminality, involvement in prostitution

3. The Solution • Strengthened/more accessible universal services (community health and education) • A range of targeted community based services that support the family • A continuum of substitute family care • Specialist residential care in small group homes for minority of children with complex needs • Changes in attitudes – society, politicians, professionals • Reinvestment of resources

4. Changes in development when moved from institutions to foster care

5. Changes in behaviour on moving from institution to foster care

6. Challenges and pitfalls Getting from where we are now to where we want to be – negative unintended consequences • Setting target for 50% reduction • - easy to place children (cheaper services) • - reduce staffing and budget • - amalgamate institutions • - inappropriate placements and trauma • - reduced overall budget spent on children • - insufficient funding available for children with disabilities

7. Challenges and pitfalls • Limited placement options • - continued reliance on too much residential care (expensive services, poorer outcomes) • - insufficient focus on family support • - reform considered too expensive

8. Challenges and pitfalls • Focus on buildings • - inappropriate use of buildings for new services • - costly investment in such buildings • - poor outcomes for children

9. Challenges and pitfalls • Insufficient funding for the whole reform process • - results in partial reform – usually the most vulnerable children are left behind • - running two parallel systems – reform is seen as too expensive • - overall numbers in care rise • - need for proper costing of reform and understanding of cost benefit

10. Challenges and pitfalls • Statistics disguising the real situation • - some children not included in statistics on institutionalisation – therefore no plans for them • - over-estimation or under-estimation – a challenge for planning for future need • - numbers in institutions do not show the dynamic flow through the system

11. Challenges and pitfalls • Different message and priorities from international donors and policy makers • - conflicting reform programmes • - inefficient use of funding • - increases resistance to reform

12. Lumos’ approach

13. 10 elements of deinstitutionalisation

14. Admissions/year per 10,000 of child population

15. Number of children in residential care/10,000

16. GDP per capita (USD)

17. Cost per child per year of different forms of care

18. Under-estimated need in DI • Communication strategy • Management structure and resources • Professional development • Transitional costs • Community involvement • Self-advocacy • Partnership with parents • Frontline social work

19. Contacts georgette.mulheir@lumos.org.uk www.lumos.org.uk