Examples from the WHO Information and Training Package on the Prevention of Child Abuse and Neglect Professor Kevin Browne and Dr Cecilia Pritchard WHO Collaborating Centre on Child Care and Protection, University of Birmingham Birmingham University WHO Collaborat ing Centre on Child Care and Protection 2006 Florence meeting November 2006

Books that support the WHO training and information pack on the prevention of child abuse and neglect

Prevention of Child Abuse and Neglect Module 9: Legal Aspects Aim: Provide knowledge on legal framework for child protection Birmingham University Child Care and Protection Unit, 2006

Birmingham University Key Components of Child Protection Systems Awareness/ Knowledge Legal System Services Data Media Education Advocacy Courts CAN Laws Enforcement Report/ Investigation Tertiary/Treatment Protection/ Placements Prevention _Primary_ Victims Shelters_ _Foster Care_ Group Homes _Adoption_ ? Institutions ______Custody Laws___ ____Reporting Laws____ Mandatory services(system) Secondary Offenders Adopted from Balachova, Bonner & Chaffin, 2000

Legal Framework Birmingham University Child Care and Protection Unit, 2006 Standards and Guidelines International (CRC) Legislation National Child Protection Laws/Policies Legislation National laws/policies Local Professional

Causes of child abandonment by the family  Very serious economic problems  Mother’s lack of formal education  Few specialist services in local communities (e.g. to visit pregnant mothers)  Lack of sexual education and family planning  Poor housing and homelessness  Teenage parenting  Poor preparation for birth and traditional practices of peri-natal care Birmingham University Child Care and Protection Unit, 2006

Birmingham University Child Care and Protection Unit, 2006

Recommendations to Prevent Child Abandonment  Home visits to pregnant mothers by health professionals  Screening pregnant mothers at 20 weeks  Social services for high risk mothers  Social care and counselling in maternity units  Mother’s identity confirmed and child given identity before leaving hospital  Baby-friendly hospitals  Parent education and family planning Birmingham University Child Care and Protection Unit, 2006

Placement Decisions Birmingham University Child Care and Protection Unit, 2006 Keep balance between child protection and family preservation

Protection/Out of Home Placements Birmingham University Child Care and Protection Unit, 2006  Institution ?? No child under 5 should be in institutional care  International Adoption Last resort Only in the best interests of the child Institutional Care Care in Community  Family Support with Day care/therapeutic interventions  Care by Non-offending parent (in the absence of the offender)  Kinship Care (grandparent/other relative)  Foster / therapeutic foster home  National Adoption - Only 4% are true orphans!

Birmingham University Child Care and Protection Unit, 2006

Proportion of all children under 3 years who are in institutional care, 2003 (blue lines are estimates).

European survey on young children in institutional care resulted in national surveys

Proportion of children under 3 years in institutions * refers to estimates, Country 2003Proportion per 10,000 No u3 in institutions Country 2003Proportion per 10,000 No u3 in institutions Czech Rep Poland9*1 344 Belgium56*2 164Croatia8144 Latvia55395Albania8*133 Bulgaria Sweden8(*213) Lithuania46458Denmark7133 Hungary44773Germany Romania Ireland6*95 Slovak Rep.31502Cyprus4*15 Finland28(*466)Austria3*37 Malta2744Greece3114 Estonia26100Turkey2850 Spain23*2 471Italy2*310 Netherlands Norway<1(17) Portugal16714UK<1(*65) France13*2 980Slovenia00 Iceland00

Birmingham University Child Care and Protection Unit, 2006

Reasons for institutionalisation in 2003

Ratio of national to international adoptions 2003

International adoption promotes institutional care of young children in donor countries (Browne et al., 2005) Country Ranks in ( ) Children under 3 in institutional care (rate per 10,000) International adoption (% of total adoptions) Latvia55 (1)77 (1) Bulgaria50 (2)47 (3) Lithuania46 (3)56 (2) Hungary44 (4)13 (6) Romania33 (5)31 (4) Slovakia31 (6)5 (7) Estonia26 (7)25 (5)

International adoption promotes institutional care of young children in host countries (Browne et al., 2005) Countries >12 children per 10,000 in institutional care International adoption (% of total adoptions) Countries <8 children per 10,000 in institutional care International adoption (% of total adoptions) Luxembourg98Norway Denmark Finland92Iceland Ireland Belgium87Cyprus Italy Spain77Germany UK 28 5 France75Austria Sweden 3232 Malta56Greece Slovenia 1010 Average64Average38.5

Birmingham University Child Care and Protection Unit, 2006 A third of children in residential care have some form of disability

C.Pritchard, K.Browne 1, G.Mulheir, C.Hamilton- Giachritsis, H.Agathonos-Georgopoulou, M.Anaut, M.Herczog, M.Keller-Hamela, A.Klimackova, I.Leth 1, M.Ostergren 1, V.Stan, S.Zeytinoglu 1 World Health Organisation Regional Office for Europe, Copenhagen EU Daphne/WHO Training Programme, 2006 Florence Seminar November 2006 Introduction to the 10 Step Model of Good Practice for De-institutionalising Young Children into Family Care

Good practice manual to deinstitutionalise and transform children’s services

Training and dissemination Training events planned for 2006 in those countries with the highest rates (30+ per 10,000) of young children in institutional care –Czech Republic, Belgium, Bulgaria, Latvia, Lithuania, Hungary, Romania, Slovakia Supported by a training manual entitled ‘De- institutionalising and transforming services for children: A guide to good practice’

STEPS TO DE-INSTITUTIONALISATION Raising awareness Country/regional level analysis Design services Planning transfer of resources Preparing & moving children Preparing & moving staff Logistics Monitoring & evaluation Managing the process Analysis at institution level

EEG Recordings from a Young Child

EEG Activity Across Regions of the Child’s Brain (Bucharest Early Intervention Project - Nelson and Koga, 2004)

Evidence from Brain Scans

Transforming of children’s services COMMUNITY SERVICES FOSTER CARE RESIDENTIAL CARE Pyramid of services to children and families: There are pitfalls in attempting to reduce residential care

What does an individual child need as an alternative to institutionalised care? Local services: what health and social facilities are available to ensure a young child’s needs are being met free of charge (home visits by professionals?) Assessment of each family in relation to their child needs, parent’s capacity to meet the needs, social and economic factors inhibiting the parent’s capacity Support for families, financial, practical and emotional Rehabilitation of families assessed as being high risk of harming the child physically, sexually or emotionally through abuse or neglect Foster Care of a high standard to care for the child and act as a role model to parents being rehabilitated Adoption only after rehabilitation of parents and extended family interventions have failed Free Legal Representation for parents and child involved in public care proceedings

Prevention of Harm to Abandoned and Maltreated Children Mother and baby units offer support and shelter to mothers high risk of abandoning their children. Alternative family based care for abandoned young children and babies (foster care). Surrogate family apartments for abandoned children (consider national adoption). Integration of children with and without disabilities. CHD

The problem of teenage parenting in the UK – no one has recommended international adoption as a solution