1. 1 « Care for children: a matter of institution »? April 20 2007 Brussels --------------------- "Desinstitutionalisation in France, a good practice ?" ------------------- Marie ANAUT Professor Psychologist ------------- University of LYON-2 FRANCE

2. 2 European research Data from 2 research programs : –Program “Daphne” U.E. –WHO Regional Office for Europe (OMS) General Coordination : Univ. Birmingham Research with 9 European partner countries => comparative studies

3. 3 Methodological aspects Phase 1: "Number and characteristics of children less than 3 years living in sanitary et social institutions, at risk of arms" ------------------------------------  Study of modalities to take care of children (relationships, life conditions…) Phase 2: « Study of children les than 5 years, leaving institutions or moving from placement " ------------------------------ => Study of trajectories of each children leaving institutions (relational characteristics, families aspects…) Institutions : residential social care - children’s homes for children less than 5 years; Modality : Visiting the institutions, interviews, directly observations and questionnaires…

4. 4 Data of General research (1) 31 countries compared : 23 500 children ( under 3 years) placed in institutions during more than 3 months Population of under 3 years : 18 million => Average : 13 children for 10 000 Disparity between countries For 31 European countries studied (U. E. and Non U. E.) 2 countries have not children less than 3 years in institutions 14 countries have less than 10 children for 10 000 7 countries have less than 29 children for 10 000 8 countries have more than 30 children for 10 000 France : 13 for 10 000 (2980 for 2 294 439 children under 3)

5. 5 Data of General research (2) The European countries of the study : U.K. (univ. Birmingham : Kevin BROWNE) coordinator ; Denmark, France, Greece, Poland, Hungary, Romania, Czech Republic, Slovakia, Turkey. Reasons of placements in institutions European Union CountriesNon E. U. Countries 69 % abuse and neglected 4 % abandon 4 % disability 24 % socials reasons (eg. parents in jail) < 1% orphans 14 % abuse and neglected 32 % abandon 23 % disability 25 % socials reasons 6 % orphans

6. 6 FRANCE : Nationals Characteristics General political aspects => to privilege placement of children less than 5 years in foster families But : Lack of foster families Some children less than 5 years in institutions in order to not separate them from their sibling(s). Structures of “emergency placements":  Sometimes children stay in emergency placement institutions more than 3 months, sometimes for 1 year… Not enough institutions for mother and child…

7. 7 Institutions analysed : from Rhône-Alpes area 7 institutions in phase1 and 4 in phase 2 --------------- 80 Questionnaires in phase 1 45 Questionnaires in phase 2 : -25 children with "social problems" -20 children with "handicap situation"

8. 8 The INSTITUTIONS of the STUDY (FR) Little Institutions "pouponnière“for > 40 children (babies) : Possible stay for some Mother and Child Children social case (less than 3 years) Children with disability (0-3 years and more) Big institutions with sub-structures : Emergency Placement "Pouponnière" (0-3 years) : 52 children in 4 units. Mother and Child homes : 42 mothers and 42 children Children homes unit for : 4-12 years et 12-18 years Medical Specialised Institutions : Children in handicap situation (polyhandicap…)

9. 9 STUDY in PHASE 2: Children less than 5 years leaving or changing from institution… in France

10. 10 Characteristics of children placed in institutions –Majority of children in “emergency placement" –90% of children in “judiciary placement" –Some children hospitalised before the placement –A few children placed with her mother –A few children waiting for adoption.

11. 11 Causes of admissions in institutions Causes of placement (by order of frequency): –1) Negligence / careless –2) "Abandonment" (in fact and/or to be adopted) –3) Psychiatric problems of their parents –4) Maltreatment –5) Violence in family

12. 12 Before admission in institution In a large majority children were leaving in biological family Family Context : poverty, socio-educative and psychological inadequacies, social isolation problems.

13. 13 Characteristics of biological families A lot of single parent families and/or separated parents Many families with very feeble financial income (poverty) Violence in the family Alcoholism, drug addiction Mental illness (psychiatric problems)

14. 14 Duration of placement in institution –Duration of the stay very variable : from 2 months => to about 12 months –Legal duration for children who are waiting for being adopted is : 2 months (minimum). –Children with disability stay longer than others in institutions.

15. 15 Criterion of decision for leaving or changing from institution ? Medical, social and psychological evaluation for the child and his family Collective decision by multidisciplinary staff of Social Services (ASE: Aide Sociale à l’Enfance). Juridical decision (by Judge) for “juridical placements", after ASE’s proposition or from an other service. Preservation of relations with siblings.

16. 16 Children’ orientation after leaving institution ? 1) Placement in Foster Family : 61 % 2) Return to biological family (mother and/or father) : 25% 3) In care to relatives (grants-parents…): 11% 4) National adoption : 3%

17. 17 Children followed up after de-institutionalisation ? –Children who return with their parents or relatives are almost all followed by social services "in natural context" (AEMO). –Children in care of foster families are followed by social services (by ASE). –Often social workers keep changing, a second service replace the first. –In case of new placement (F.F.), family links with natural family are preserved (parents & siblings).

18. 18 Practices to be improved ?(1) (cf. attachment theory) –Privilege mother and child’s links by increasing homes or units for “mother and child“ –Promote “emergency foster families" for children less than 3 years –Systemise children’s “life story book" (photos, transition objects…) -Preserve stability of links between child and relatives (nanny, nursery or school, neighbour …)

19. 19 Practices to be improved ? (2) - Reduce the duration of the children’s stay in institutions : => less than 3 months for all children -Reduce the period for family’s evaluation and take a decision more quickly for the children’s orientation => Use and/or create tools of evaluation… -Carry out medical and psychological assessment more systematically : => Appraise the specific needs of children => Estimate relatives and family resources => Review of community and alternatives service’s resources

20. 20 Practices to be improved ? (3) -Growing public awareness of consequences of early separations with care givers. -Estimate the possibility to develop new services (day care…). -Make the medical and social staff sensitive to attachment theory… -Training… => The 10 steps of good practices