Institutionalisation and deinstitutionalisation of children 2: policy and practice recommendations for global, national, and local actors

Philip S. Goldman, Marian J. Bakermans-Kranenburg, Beth Bradford, Alex Christopoulos, Patricia Lim Ah Ken, Christopher Cuthbert, Robbie Duchinsky, Nathan A. Fox, Stela Grigoras, Megan R. Gunnar, Rawan W. Ibrahim, Dana Johnson, Santi Kusumaningrum, Ni Luh Putu Maitra Agastya, Frederick M. Mwangangi, Charles A. Nelson, Ellie M. Ott, Sophie Reijman, Marinus H. van IJzendoorn, Charles H. ZeanahYuning Zhang, Edmund J.S. Sonuga-Barke*

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review

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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.
Original languageEnglish
Pages (from-to)606-633
Number of pages28
JournalThe Lancet Child and Adolescent Health
Issue number8
Early online date24 Jun 2020
Publication statusPublished - Aug 2020


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