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

Email: k.d.browne@bham.ac.uk; kdb@euro.who.int

Birmingham University

WHO Collaborating Centreon Child Care and Protection2006

Florence meeting 13-14 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)

LegislationNational Child Protection Laws/Policies

LegislationNational laws/policiesLocalProfessional

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

betweenchild protection andfamily 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 CareCare in CommunityFamily 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).

0 10 20 30 40 50 60 70

Slovenia

UK

Norway

Turkey

Austria

Greece

Cyprus

Ireland

Denmark

Albania

Croatia

Poland

Netherlands

Portugal

Spain

Hungary

Estonia

Malta

France

Slovak Republic

Romania

Latvia

Lithuania

Belgium

Czech Republic

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

Proportion of children under 3 years in institutions *refers to estimates,

Country 2003 Proportionper 10,000

No u3 in institutions

Country 2003 Proportionper 10,000

No u3 in institutions

Czech Rep. 60 1 630 Poland 9 *1 344

Belgium 56 *2 164 Croatia 8 144

Latvia 55 395 Albania 8 *133

Bulgaria 50 1 238 Sweden 8 (*213)

Lithuania 46 458 Denmark 7 133

Hungary 44 773 Germany 7 1 495

Romania 33 2 915 Ireland 6 *95

Slovak Rep. 31 502 Cyprus 4 *15

Finland 28 (*466) Austria 3 *37

Malta 27 44 Greece 3 114

Estonia 26 100 Turkey 2 850

Spain 23 *2 471 Italy 2 *310

Netherlands 16 1 284 Norway <1 (17)

Portugal 16 714 UK <1 (*65)

France 13 *2 980 Slovenia 0 0

Iceland 0 0

Birmingham University

Child Care and Protection Unit, 2006

Reasons for institutionalisation in 2003

Reasons For Institutionalisation Of Children Under The Age Of Three - EU Member States

0% 4% 4%

69%

23%orphan

abandoned

disabled

abused/neglected

other

Reasons For Insitutionalisation Of Children Under The Age Of Three - other surveyed Countries*

6%

32%

23%

14%

25%orphan

abandoned

disabled

abused/neglected

other

Ratio of national to international adoptions 2003

0% 20% 40% 60% 80% 100%

Slovenia

Austria

Slovak Rep.

UK

Turkey

Hungary

Estonia

Germany

Romania

Bulgaria

Malta

Lithuania

Italy

Cyprus

Ireland

France

Spain

Latvia

Belgium

Luxembourg

Sweden

Norway

Finland

national

international(incoming children)

international(outgoing children)

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)

Latvia 55 (1) 77 (1)

Bulgaria 50 (2) 47 (3)

Lithuania 46 (3) 56 (2)

Hungary 44 (4) 13 (6)

Romania 33 (5) 31 (4)

Slovakia 31 (6) 5 (7)

Estonia 26 (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)

Luxembourg 98 Norway

Denmark

98

96

Finland 92 Iceland

Ireland

93

69

Belgium 87 Cyprus

Italy

68

62

Spain 77 Germany

UK

28

5

France 75 Austria

Sweden

3

2

Malta 56 Greece

Slovenia

1

0

Average 64 Average 38.5

Birmingham University

Child Care and Protection Unit, 2006

A third of children in residential care have some form of disability

C.Pritchard, K.Browne1, G.Mulheir, C.Hamilton-Giachritsis, H.Agathonos-Georgopoulou,

M.Anaut, M.Herczog, M.Keller-Hamela, A.Klimackova, I.Leth1, M.Ostergren1, V.Stan,

S.Zeytinoglu 1World Health Organisation Regional Office for Europe, Copenhagen

EU Daphne/WHO Training Programme, 2006 Florence Seminar 13-14 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

4

5

6

7

8

9

10

3

2

1 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)

0

0.5

1

1.5

2

2.5

3

3.5

Front Cent Pariet Occip Temp

Institution

Community

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.

CHDCHD

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