Deinstitutionalization strategy and implications for south asia Dr. Nilima Mehta

Concept & Process: Deinstitutionalization Reforming Child Care Systems where community and family based care is the first priority and an institutional care is the last option Release of institutionalized children into the care of family and community Reunification with the family & Reintegration into the community Transitioning out of Institutional Care to family based alternative care needs family support, adequate preparation of the child & life skills education Goal- Reunification with the child’s family or an alternative family

Institutional Care Poverty- It shouldn’t be the only reason for institutional care Gate Keeping- An important component for prevention Community Based family oriented Alternative Care programmes for family support & strengthening as a preventive strategy in institutions Institutional Care may be necessary for some children due to compelling circumstances Minimum standards of Care moving to quality standards of Care Prevention: Primary, Secondary & Tertiary

Mental Health Concerns Importance of Relationships & Attachments in a Child’s Life Negative Impact of Long term institutional Care: Self- Esteem, Sense of Self & Identity Issues Multiple Caregiving Failure to Trust Sense of Security Emotional Resilience Externalizing or Internalizing of Negative Experiences

Emotional Deprivation Separation Anxiety Maternal Deprivation Low Self Esteem Anonymity & Lack of personal attention Failure to Trust SOME OF THE NEGATIVE IMPACTS OF LONG TERM INSTITUTIONALIZATION OF THE CHILD Interpersonal Relationship Problems Developmental Delays Excessive Routinisation and Regimentation Difficulty in mainstreaming & adjusting in society Segregation & Isolation from Society Physical Abuse and Trauma

Process of Deinstitutionalization Family Assessment/ Home Investigation Report Case Management Individual Care Plans- Unique to each child Ongoing Review of the Care Plans Preparation for the reunification & reintegration with the family Child Participation in Decisions which impact her/his life

Alternative Care Options Reunification with the birth family Adoption for the child who is legally free for adoption Kinship Care with the extended family Foster Care Sponsorship Community Outreach Programmes Day Care/ Night Shelters Group Homes Institutionalization as a last option

Community Based Rehabilitation Strategies Empowerment Programmes for the community Mental Health Interventions Education Health Awareness Family Strengthening, Support & Counselling Coordination & Collaboration from Policy to Practice

Way Forward Advocacy for Alternative Care from the macro to micro level Policy Development on Alternative Care Intervention Programmes at the practice level Facilitating access to community services and resources Training, Orientation, Sensitization to bring about a mindset change/ paradigm shift in child protection Monitoring, Supervision & Follow Up after Deinstitutionalization “Institutional Mindset Change” Mapping of Vulnerable Groups and Resources