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Institutionalisation and deinstitutionalisation of children 2: policy and practice recommendations for global, national, and local actors
Open accessAbstract
Worldwide, millions of children live in institutions, which runs counter to both the UN-recognised right of children to be raised in a family environment, and the findings of our accompanying systematic review of the physical, neurobiological, psychological, and mental health costs of institutionalisation and the benefits of deinstitutionalisation of child welfare systems. In this part of the Commission, international experts in reforming care for children identified evidence-based policy recommendations to promote family-based alternatives to institutionalisation. Family-based care refers to caregiving by extended family or foster, kafalah (the practice of guardianship of orphaned children in Islam), or adoptive family, preferably in close physical proximity to the biological family to facilitate the continued contact of children with important individuals in their life when this is in their best interest. 14 key recommendations are addressed to multinational agencies, national governments, local authorities, and institutions. These recommendations prioritise the role of families in the lives of children to prevent child separation and to strengthen families, to protect children without parental care by providing high-quality family-based alternatives, and to strengthen systems for the protection and care of separated children. Momentum for a shift from institutional to family-based care is growing internationally—our recommendations provide a template for further action and criteria against which progress can be assessed.
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“The global community is unanimous in supporting this agenda (Geneva Working Group, 2013; Goldman et al., 2020; UN General Assembly, 2019; van IJzendoorn et al., 2020).”
From Residential care as an alternative care option: A review of literature within a global context (2022) · cites this paper as Goldman et al., 2020
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“Increases in orphanhood that are associated with COVID-19 occur against a backdrop of more than 140 million existing orphans in need of global health and social care prioritisation.28”
From Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study (2021) · cites this paper as [28]
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“We adjusted for possible clustering of deaths between parents using an estimate of secondary attack rates and age-specific infection–fatality ratios to provide unduplicated counts for children losing one parent (single orphan) or both parents (double orphan; appendix p 4).24”
From Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study (2021) · cites this paper as [24]
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Hillis, S. D., Unwin, H. J. T., Chen, Y., Cluver, L., Sherr, L., Goldman, P. S., Ratmann, O., Donnelly, C. A., Bhatt, S., Villaveces, A., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01253-8 · Cited by 317
“28 Negative socioeconomic impacts are strongly associated with adult deaths.”
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Metadata
- Authors
- Goldman, P. S., Bakermans-Kranenburg, M. J., Bradford, B., Christopoulos, A., Ken, P. L. A., Cuthbert, C., Duchinsky, R., Fox, N. A., Grigoras, S., Gunnar, M. R., Ibrahim, R. W., Johnson, D., Kusumaningrum, S., Agastya, N. L. P. M., Mwangangi, F. M., Nelson, C. A., Ott, E. M., Reijman, S., van IJzendoorn, M. H., Zeanah, C. H., Zhang, Y., & Sonuga-Barke, E. J. S.
- Affiliations
- United Nations Children's Fund (US)
- University of Cambridge (GB)
- University of Maryland, College Park (US)
- University of Minnesota (US)
- German Jordanian University (JO)
- University of Indonesia (ID)
- Catholic Relief Services (US)
- Boston Children's Hospital (US)
- University of Oxford (GB)
- Tulane University (US)
- University of Southampton (GB)
- King's College London (GB)
- Corresponding author
- Sonuga-Barke, Edmund J S
- ORCID
- Venue
- The Lancet Child & Adolescent Health
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 4
- Issue
- 8
- Pages
- 606-633
- ISSN
- 2352-4642 (ISSN-L)
- PMC
- PMC7311356
- OpenAlex
- W3036972655
- Cited by
- 140
- References
- 76
- Citations by year
- 2026: 29 · 2025: 23 · 2024: 20 · 2023: 19 · 2022: 22 · 2021: 16 · 2020: 11
- FWCI
- 3.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet Child & Adolescent Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- ePrints Soton (University of Southampton) (acceptedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Social Sciences › Sociology and Political Science › Child Welfare and Adoption
- Social Sciences › Development › Poverty, Education, and Child Welfare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child and Adolescent Health
- Keywords
- deinstitutionalization, family-based care, child welfare system, foster care, adoption, kafalah, child separation from family, child protection, best interests of the child, policy recommendations, child mental health, orphans
- MeSH terms
- Child, Child Advocacy, Child Health Services, Deinstitutionalization, Health Policy, Humans, Institutionalization, Global Health, Practice Guidelines as Topic
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