Mapping the number and characteristics of children under 3 in institutions across Europe at risk of harm: EU Daphne Programme 2002–3: Copenhagen, Denmark, 19 March 2004

Mapping the number and characteristics of children under 3 in institutions across Europe at risk of harm EU Daphne Programme 2002-3 Copenhagen, Denmark, 19 March 2004 July 2004 Abstract Research shows that the first three years of life are critical for health and development. Young children (0 to 3 years) placed in residential care institutions without parents are at risk of harm in terms of attachment disorder, developmental delay and neural atrophy in the developing brain. Under the European Union Daphne programme, a mapping project entitled ‘Mapping the number and characteristics of children under three in institutions across Europe’ has been conducted, involving 32 countries of the European Union, accession countries and countries within the European Economic Area. This project concentrates on children aged 0 to 3 years who reside in children’s homes and other residential facilities for more than 3 months without parent(s) or primary caregiver(s). The aim was to estimate the prevalence of young children living in these conditions of adversity. Evidence that such experiences damage children was presented. Keywords Child welfare Child care Rights of the child Child development Europe © World Health Organization 2004 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. 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Report prepared by: Louise Dixon, MSc, Gabriela Misca, PhD Centre for Forensic and Family Psychology, University of Birmingham, United Kingdom July 2004 Contents 2 Introduction .......................................................................................................................1 2.1 Project Team .............................................................................................................1 2.2 Aims and objectives ..................................................................................................1 2.3 Summary of Conclusions ..........................................................................................2 3 Proceedings .......................................................................................................................2 3.1 Session 1 – Effects of institutionalisation for young children...................................2 3.1.1 Consequences of institutionalisation for young children: A review. Presented by Dr Rebecca Johnson ............................................................................3 3.1.2 Effects of institutionalisation on brain and behavioural development in young children: Findings from the Bucharest early intervention project - Dr Sebastian Koga and Prof Charles Nelson ................................................................................3 3.2 Session 2 – European survey results .........................................................................4 3.2.1 Number and characteristics of children under 3 year in institutions across Europe at risk of harm: European survey results - Dr Catherine Hamilton-Giachritsis............4 3.3 Session 3a – Results from partner countries .............................................................6 3.3.1 Denmark – Presentation by Prof Ingrid Leth .......................................................6 3.3.2 France – Presentation by Dr Célia Vaz-Cerniglia .................................................6 3.3.3 Greece – Presentation by Dr Helen Agathonos.....................................................7 3.3.4 United Kingdom – Presentation by Dr Rebecca Johnson .....................................7 3.3.5 Photographic montage of institutions for disabled children in Romania – Presentation by Georgette Mulheir and Dr Delia Mara Pop .................................8 3.4 Session 3b – Results from partner countries (continued)..........................................8 3.4.1 Hungary - Presentation by Dr Maria Herczog ......................................................8 3.4.2 Poland – Presentation by Dr Maria Keller-Hamela ..............................................8 3.4.3 Romania – Presentation by Dr Violeta Stan..........................................................9 3.4.4 Slovak Republic – Presentation by Dr Anna Klimackova ....................................9 3.4.5 Turkey – Presentation by Prof Sezen Zeytinoglu..................................................9 3.4.6 Overview and conclusions from partner data - Prof Kevin Browne ...................10 3.5 Session 4 - Panel of partners ...................................................................................11 3.5.1 Summary of discussion .......................................................................................11 3.5.2 Recommendations ...............................................................................................12 3.6 Closing remarks by Dr Mikael Ostergren, WHO-Europe.......................................12 4 Appendix 1 – Programme ...............................................................................................13 5 Appendix 2 - List of participants.....................................................................................14 July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 1 Introduction Research shows that the first three years of life are critical for health and development. Young children (0 to 3 years) placed in residential care institutions without parents are at risk of harm in terms of attachment disorder, developmental delay and neural atrophy in the developing brain. The neglect and damage caused by early privation of parenting may be equivalent to violence to a young child. Across Europe, infants without parents or in adversity are rescued and placed in institutions for their physical safety, although the extent of this practice is unclear. Under the European Union (EU) Daphne programme, technical experts from the Centre of Forensic and Family Psycholgy at the University of Birmingham, United Kingdom, conducted a mapping project entitled ‘Mapping the number and characteristics of children under three in institutions across Europe’. The 15-month project was carried out in collaboration with the Child and Adolescent Health and Development programme at the WHO Regional Office for Europe. It involved 32 countries who are members of the EU, EU accession countries and countries within the European Economic Area. This project concentrates on children aged 0 to 3 years who reside in children’s homes and other residential facilities for more than three months without their parent(s) or primary caregiver(s). Residential facilities with 11 or more children were operationally defined as an institution. Those with greater than 25 children were classified as large institutions. A distinction between the number in social care institutions and children’s homes for the disabled was made. The aim of the survey was to estimate the prevalence of young children living in these conditions of adversity. Evidence that such experiences damage children is presented. Of the 32 countries, 31 have responded in some way (97%). In addition, detailed information was available on 9 countries. The project also identified the extent of alternative services for young children in need of care and protection (e.g. surrogate family care) and the use of national and inter-country adoption as a response to family poverty or the child being abused, neglected or abandoned. It is hoped that this project will raise professional and public awareness and understanding about children who grow up without parents. 1.1 Project Team • K.Browne (1,2) C.Hamilton-Giachritsis (1), R.Johnson (1), in association with • H.Agathonos-Georgopoulou, M.Anaut, M.Herczog, M.Keller-Hamela, A.Klimackova, I.Leth, V.Stan, S.Zeytinoglu, M.Ostergren (2). 1.2 Aims and objectives • To share information and present findings from a survey of the number and characteristics of children under three years in institutions across Europe at risk of harm. 1 Centre for Forensic and Family Psychology, University of Birmingham, UNK 2 World Health Organisation Regional Office for Europe, Copenhagen, Denmark July 2004 1 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 • To share a detiled account of data collected by individual countries: four EU member states (Denmark, France, Greece and United Kingdom) and five EU accession countries (Hungary, Poland, Romania, Slovak Republic and Turkey). • To provide a working meeting to discuss how the final report of the findings can be refined and presented. • To consider alternatives to institutional care and recommendations for protecting and upholding the rights of the child currently living in institutions. • To identify necessary changes in child care and protection practices and legislation for EU member states. 1.3 Summary of Conclusions This constitutes the first international attempt across Europe to measure and compare the reasons, number and characteristics of children subject to early institutionalisation and privation of parenting, mainly as a result of disability, family poverty, child abuse, neglect and abandonment. It is also the first time the extent of alternative practices to institutional care has been explored across Europe. The amount of intercountry adoption, rather than foster care and national adoption, practiced by some countries should generate concerns for both donor and recipient countries. The project raises awareness about the consequences of early privation of parenting for children under three years, including those with disabilities and from ethnic minorities. It will promote an overriding principle for child care and protection: NO child under three years should be placed in a residential care institution without a parent/primary caregiver. 2 Proceedings Dr Gudjon Magnusson, Director of Technical Support, Reducing Disease Burden, WHO-Europe, welcomed participants to Copenhagen and congratulated the project team on their impressive research. He explained the series of presentaions were planned in order to provide background to the project, present research findings and supply material for discussion. Rapporteurs for the meeting were Louise Dixon, MSc and Gabriela Misca, PhD from the Centre of Forensic and Family Psychology at the University of Birmingham, UK. 2.1 Session 1 – Effects of institutionalisation for young children ¾ Chairperson: Dr Viviana Mangiaterra, World Bank The Chairperson introduced two presentations that provided the background to the research project. These lectures detailed the literature and current research of the consequences and effects of institutionalisation for young children. July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 2.1.1 Consequences of institutionalisation for young children: A review. Presented by Dr Rebecca Johnson, University of Birmingham, United Kingdom (see presentation 1) The aim of this presentation was to consider the literature on the consequences of early privation to children living without parents in institutional residential care. The literature reviewed supports the following conclusions: • Severe deprivation can result in cognitive, social, behavioural and emotional delay. However, some children may recover to within ‘normal’ range with appropriate quality of care, but there is still an impact. • Quality of institution is vital; even ‘good’ institutional care can result in social, behavioural and emotional difficulties. • Return to biological family not necessarily better. • Optimal infant brain development needs the support of a sensitive caregiver. • Room for optimism – evidence that positive change can occur when the child is removed from the deprived institutional environment. 2.1.2 Effects of institutionalisation on brain and behavioural development in young children: Findings from the Bucharest early intervention project - Dr Sebastian Koga and Prof Charles Nelson, University of Minnesota, USA (see presentation 2) This presentation described the preliminary results from the Bucharest Early Intervention Project, a prospective, longitudinal study designed to examine the effects of institutionalization on brain and behavioural development in young children. The baseline findings show that institutional rearing has adverse effects on physical, neurological, linguistic, cognitive, and social-emotional development. An intervention is also briefly described – placement in familial care - designed to ameliorate the effects of such institutionalization. Ultimately, the study is designed to address the question of how much developmental recovery is possible in young children removed from institutions and placed with families. Question and discussion session Professor Nelson and Dr Koga suggested that, based on their research findings, the implications for policy are never to place children in institutions, not even institutions that are deemed to be of ‘good’ quality. Of course, if there is a view to return children to their biological families, then professionals will need to work closely with such families to fully prepare and empower them, to ensure the transition is as successful as possible. The topic of prevention being more cost effective for policy makers than prevention at secondary or tertiary level was broached. Professor Nelson and Dr Johnson both raised the point that very good foster care is actually less expensive than institutionalisation. Professor Nelson highlighted the importance of investing in our children at a young age in order to reap the rewards of raising healthy children at a later date. All presenters agreed that the costs of dealing with the effects of institutionalisation are far more expensive than preventing them in the first instance. July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 2.2 Session 2 – European survey results ¾ Chairperson: Dr Viviana Mangiaterra, World Bank 2.2.1 Number and characteristics of children under 3 year in institutions across Europe at risk of harm: European survey results - Dr Catherine Hamilton-Giachritsis, University of Birmingham, United Kingdom (see presentation 3) Dr Hamilton-Giachritsis presented the results from the survey on behalf of the project team. The aim was to present the preliminary findings of the EU Daphne /WHO-Europe funded survey of the number and characteristics of children under 3 years living without a parent in institutionalised residential care and to consider the provision for alternative care of children in need of protection in 32 European countries. Findings: For the 31 European countries who responded, it was estimated that approximately 23 000 children under 3 are institutionalised in residential care across Europe. Considering the estimated population of children under 3 in Europe (22 million), this represents 11 children per 10 000 under three living in institutions for more than three months. There was no overall significant difference between the responding EU and other countries for the proportion of children under 3 in institutional care. However, there was great variation between different countries: two countries had no children under 3 in institutions, twelve countries had institutionalised less than 10 children per 10 000, nine countries had between 10 and 30 children per 10 000 in institutions and alarmingly, seven countries had between 31 and 60 children per 10 000 in institutions. A comparison on the reasons for children being taken into care showed significant differences. In the EU, the vast majority (69%) of children were placed in residential care institutions because of abuse and neglect; 4% due to abandonment, 4% because of disability and 23% for social reasons (such as parents in prison). No biological orphans (i.e. without living parents) were placed in institutions. By contrast, in the other surveyed countries, 14% were placed in institutions due to abuse or neglect; 32% were abandoned; 23% because of disability; 25% were social ‘orphans’ placed because of family ill-health and incapacity; and 6% because they were true biological orphans. Among the recommendations based on the present survey and following the principles of the United National Convention of the Rights of the Child (UNCRC) are: • Increase awareness of short and long-term consequences for children living without a primary caregiver in institutional care. • Consider reasons WHY children are being placed in institutional care and for how long? (‘Economic orphans’ or ‘social orphans’ or ‘biological orphans’). • Further develop community support services for families as a preventative strategy. • Promotion of foster care and national adoption. • International adoption to be used as a last resort and only when proven to be in the best interest of the child (UNCRC). July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 • All placement decisions to consider optimal developmental time-frames of the child and effects of relocation. • Monitor the format of institutions on offer for child protection (large & impersonal OR small & family based). • More effective use of resources for children. Capacity build foster and adoptive care and rehabilitation of families at less cost than institutional care. Questions and discussion session Dr Mikael Ostergren reiterated that the purpose of the study was not to make a comparison between EU member countries and accession countries, but rather to explore issues among the surveyed groups. Whilst, at an individual country level there may be problems that are present for some countries and not others, the aim was to simply identify such matters. Dr Vivianna Mangiaterra also concluded that exploring this issue world-wide is very important, providing professionals with the opportunity to collect data, share experiences and learn from each other. This research will therefore have important implications for policy development. The question was asked why countries such as Spain and Italy who have relatively high numbers of children in institutions themselves, show high rates of incoming inter country adoption. The consensus was that national adoption laws, assessments and monitoring are more stringent than international laws and policy on adoption. Immigration policies in some countries may make it easier to adopt a child from another country. Dr Hamilton-Giachritsis noted that the intake of children into institutions in EU member states was mostly due to child abuse and neglect, whereas the main issue in the other European countries surveyed was poverty. Thus, it is important to examine countries at an individual level before making decisions on practice or policy. This raised the issue of best practice with those children suffering from child abuse and neglect within their family unit. Professor Browne stated that as the detection of child abuse and neglect increases in countries, a public health approach sould be promoted, increasing the work that health and social care professionals do with families and foster carers, rather than resorting to institutionalising children. The Convention on the Rights of the Child states that services should be provided to families who are having difficulties bringing up their child. At community level all families with problems and parents supected of abusing and/or neglecting their child should be comprehensively assessed. If rehabilitation or intervention is deemed necessary and feasible with parents then the child may be placed in short term foster care. The aim is to then re-introduce the child to the family, but only when the family environment has been assessed as safe. Only when a poor prognosis of the parents has been determined should a child be removed into long term foster care and/or adoption. Dr Hamilton-Giachritsis added that if we remove a child from his/her family home then it is our responsibility to ensure that the care placement is an improvement on the previous environment and one in which that child can grow (i.e.: a family based placement). July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 2.3 Session 3a – Results from partner countries ¾ Chairperson: Dr Viviana Mangiaterra, World Bank This session provided an opportunity for 9 partner countries to present and discuss their individual results in detail. Four EU member states (Denmark, France, Greece and UK) presented first (session 3a) and five accession countries (Hungary, Poland, Romania, Slovak Republic and Turkey) followed (session 3b). The information included a country survey together with interviews and observations of institutions caring for social disadvantaged and disabled young children (0-3 years). The quality of these institutions was evaluated in terms of protecting and upholding the rights of the child. 2.3.1 Denmark – Presentation by Prof Ingrid Leth, University of Copenhagen (see presentation 4) The presentation focussed on children under three in institutions in Denmark. In December 2002, there were 102 children in institutions (54 girls and 48 boys) which represent 1/5 of the children under three who are placed outside their homes; 4/5 are placed in foster care. There are 18 institutions for small children and no ethnic minority group over represented among children outside their homes. The main causes for children being placed in institutions are: parents with drug abuse, mentally ill parents, child abuse and neglect, or a combination of these causes (82%) as well as disabled children (9%) and other reasons (9%). The length of stay in the institution ranges from two up to 27 months (based on visits to eight different institutions). However, the foster family placements contribute significantly to the service provision for children separated from their parents. The main characteristics of the foster family placements outlined are: • Placement in foster families can be procured by the municipalities or the counties. • 16 private fostering organisations collaborate closely with the authorities. • They establish contact with foster families and will organise everything regarding the placement of the child in a foster family. • Private organisations are authorised to inspect the foster families and carry out the duties otherwise managed by the authorities. • The drop out of foster families is estimated to be approximately 16%. 2.3.2 France – Presentation by Dr Célia Vaz-Cerniglia, University of Lyon (see presentation 5) The presentation outlined the historical and current context of institutional childcare within the French system of child welfare. The main feature of the child welfare system is that placing children in institutions represents the most important public expenditure. Since 1989, the number of children cared for in institutions and in foster families remained constant at approximately 135 000. The characteristics of seven institutions for children in care (under 3 years old) visited in France were outlined. These comprised: one social institution and two medical institutions for children with disabilities; two small social institutions and two large social institutions acting as emergency care placements. Among the features of childcare system were: July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 • The lack of foster placements. • The environment of the institutions was inadequate (i.e.: with ‘ancient’ rooms, inappropriate or even lack of bathrooms). • However, there was sustained effort to put the children back with their families (i.e.: through reception centres for women and their children under 3 years old). • Some institutions specialise in caring for disabled children. • The ethic origin of the child is not listed when the child enters the institution. • There is an increasing number of children coming from foreign countries. 2.3.3 Greece – Presentation by Dr Helen Agathonos, Institute of Child Health (see presentation 6) The presentation outlined as the main characteristics of state institutional care for children in Greece the following: • Changing residential task: downward trend of institutional care and an increasing need for alternative schemes. • Remaining state institutions for children: large in size (25-80 children). • Smaller residential homes run by NGO's and Church affiliated organizations. • Long stays. • Poverty as a major reason for entry. • Low turnover of child care staff. Lifetime employment in the civil sector • Ratio of residential vs. foster care is 4:1. Two types of institutions were described and analyzed: one for children with disabilities and one for healthy children, underlining both their positive and negative characteristics as well as domains where further improvements can be made. 2.3.4 United Kingdom – Presentation by Dr Rebecca Johnson (see presentation 7) The outlined conclusions for the United Kingdom partner observations are: • Official estimates were that 65 children under 3 may be in small institutions with or without a primary caregiver. • However, no evidence was found of institutions (more than 11 children) with children under 3 years. • This reflects three decades of policy to separate children from parents only as a last resort and that no child under the age of 7 years should be in an institution without a parent or primary caregiver. July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 2.3.5 Photographic montage of institutions for disabled children in Romania – Presentation by Georgette Mulheir and Dr Delia Mara Pop, Hope and Homes for Children A photographic montage of disabled children living in residential care institutions in Romania (taken with permission) were delivered to the audience to provide knowledge of how these children lived and the conditions of the institutions in which they resided before closure. This was constrasted with photographs of the children in their new placements of small children’s homes (11 to 14 children in each) and some foster families. 2.4 Session 3b – Results from partner countries (continued) ¾ Chairperson: Dr Helen Agathonos, Institute of Child Health, Greece 2.4.1 Hungary - Presentation by Dr Maria Herczog, National Institute of Criminology (see presentation 8) The presentation provided an historical background of the residential child care in Hungary, and described the main characteristics of infant homes. The out of home care for children is currently characterised by placement priorities based on extended family, substitute family, adoption, foster care, group home, institution options. The characteristics of infant homes were illustrated through two case studies. 2.4.2 Poland – Presentation by Dr Maria Keller-Hamela, Nobody’s Children Foundation (see presentation 9) This presentation outlined the historical background of residential care services for children in Poland. At the present, the main care institutions for children under 3 are ‘young children’s homes’ (in 2001 there were 40 such homes in Poland, taking care of 1485 children under 3). Other institutions, such as ‘social care homes’ or ‘care and treatment institutions’ may also admit very young children, though they are primarily designed for children under 18. Moreover, ‘pre- adoption wards’ are being established at children’s hospitals (there are no data available concerning their number). These are designed for newborns left at maternity wards by their mothers who have put them up for adoption. In most cases, infants remain at such wards for six weeks, i.e. for the period when – according to the Polish law – the mother may officially (in court) state her will to entrust her child to an adoptive family. Apart from care institutions, there are foster families, including family emergency services established primarily for children under 10 (there were 315 such services in 2002) – these are foster families that take care of the child temporarily (for up to 12 months) in crisis situations. There are also the so called ‘family children’s homes’ taking care of 4-8 children (in 2002 there were 197 such homes, with 35 children under 3 in their care). In recent years significant change has occurred in the child and family protection system. Many tasks in this field have begun to be assigned to nonpublic institutions, such as NGOs or church organizations. The state has ceased to be the sole provider of help though it still remains the most important one. July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 The presentation concludes by describing the characteristics of a large multi-function institution, the ‘Young children’s home’ in Warszawa by contrast with a small multi-function institution, the ‘Social care home for children’ in Olsztyn. 2.4.3 Romania - Presentation by Dr Violeta Stan, University of Timisoara (see presentation 10) The presentation provided a brief historical background on the child protection services and the legal framework in Romania and a detailed presentation of the 2001 – 2004 Governmental Strategy Concerning the Protection of Children in Difficulty with its emphasis on developing alternatives to residential care for children. The recent changes were illustrated through a comparative analysis of two Placement Centers for children under 3. 2.4.4 Slovak Republic – Presentation by Dr Anna Klimackova, National Gender Centre (see presentation 11) The presentation provided the context of institutional childcare for children under 3 in Slovakia, the legal provisions for institutions, their capacity and organisation. The new trends in Slovakia are: • Transformation of children´s homes into family type institutions. • More support for foster care and adoptions. • Support for the community centres in areas with high concentration of Roma population. Among the recommendations outlined in the presentation are: • To improve social work activities. • To improve the quality of community work with families at risk. • To develop and implement prevention programs. • To intensify foster care. 2.4.5 Turkey – Presentation by Prof Sezen Zeytinoglu, University of Ege (see presentation 12) The presenation focussed on the context of institutional care and the description of two childcare institutions in Turkey. Total number of children and adolescents in social care institutions in Turkey amounts to 18 495: from which 9 100 children are 0-12 years old and 9 395 are adolescents 13-18 years old. The total number of children in foster family care is only 530. The two institutions described were: • Institution 1 in Ankara: a very “large” institution housing 594 children and adults (with specific or multiple disabilities, including severely disabled persons). There were seven 0-3 years olds in the Institution and they were placed in the same sleeping room with 30 other severely disabled children of different ages (who were almost always in bed). There were 3 caretakers for 37 children in the unit and during night time there were 2 caretakers for 37 people. July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 • Institution 2 in Istanbul: A residential & daily serving institution for social care and rehabilitation of spastic children and adults which was established in 1976 and moved to its present complex in 1996. It was established and operates through a joint agreement among DSSCP, Turkish Foundation for Spastic Children (TFSC) and Sakıp Sabancı & Family Foundation (VAKSA). This was also a “large” institution, but the number of residential clients is 10 times less than Institution 1. The number of residential clients was 59 (all spastic persons of different ages), 43 of them are spastic children (aged 2-18), 3 of them are within the 0-3 years old range (2 males and 1 female) 2.4.6 Overview and conclusions from partner data - Prof Kevin Browne, United Kingdom (see presentation 13) The in-depth study of the quality of institutional care for children in four EU member states and five non-EU countries demonstrated large variations in the numbers of available staff, physical environment, overcrowding, cleanliness and hygiene, bathroom, play and recreational facilities and carers job satisfaction/ enjoyment. There was a significant positive correlation between high ratings for these factors and the levels of stimulation and individualised care the children received. There was vast variation in the availability of alternative services from having no foster care and family rehabilitation to the exclusive use of these approaches to children in adversity. This is despite the fact that institutional care costs between 2 and 3 times as much as surrogate family care in all the countries surveyed. In 14 countries, children were adopted straight from institutional care and in five of these countries a significance proportion of these were intercountry adoptions. Overall, seven countries gave up a large proportion of adopted children for intercountry adoptions. Conversely, 12 EU member states received hundreds (and in some cases thousands) of intercountry adoptions per year, in addition to promoting national adoptions. Overall, the research supports the idea that ideally and in future no child under 3 years in institutional residential care should be without a primary caregiver. However, in the short-term before deinstitutionalisation and residential care is used as an emergency measure, it is essential to: • Recognise the rights of the child. • Optimise the environment. • Be aware of the likely consequences of institutionalization. • Recognise requirements for secure attachment formation and developmental progression. • Focus on meeting all the child’s needs (individuality and stimulation). • Focus on moving them into appropriate family placement with GOOD QUALITY care as soon as feasible. • Prepare children for placement change, recognising prior, current and future attachment figures. Questions and discussion session The question of whether professionals should invest resources to improve and empower institutions rather than offering foster care placements was raised. The general consensus was that July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 it is important to empower the parents, investing the countries’ money into the parents rather than developing a parallel institutionalisation system. Professor Browne noted that whilst no one is claiming that all institutions are bad, there should never be a need to place a young child in an institution for over three months. Significant progress can be made within a three-month period to allow a child to be reunited with its parents. It has been demonstrated that regardless of the quality of the institution, placing a child of under three years in an institution for longer than three months is damaging to their development. Professor Browne continues to state that institutions keeping a child under 3 years of age for longer than three months are abusing that child. 2.5 Session 4 - Panel of partners A general discussion was held between the audience and the panel of partners regarding possible suggestions for change. ¾ Chairperson: Dr Helen Agathonos, Institute of Child Health, Greece 2.5.1 Summary of discussion The question as to whether institutions were evaluated by an area-wide surveillance system was raised. It was the consensus that whilst certain legislation is beginning to be dispersed to EU member states about the quality of institutions and inspections, it is difficult to ensure that this legislation is upheld. A problem does not exist with the lack of laws put in place for child protection but in evaluating the implementation of these laws with empirical evidence. One main problem cited is that in most countries a governmental body is responsible for this service and the same body is responsible for the inspection procedure. It was suggested that using an independent body would improve the evaluation system. In additon, it was stated that legislation cannot change anything if no one is accountable for ensuring that this legislation is upheld. Some participants raised the question of inter-country adoption because of the possible effects this may have on reducing funds and services to biological parents in need. It was felt that this debate extended beyond the scope of the meeting; however, it was proposed that indepth empirical studies reviewing inter-country adoption and its effects be conducted. Stemming from the above debate, it was stated that inter-country adoption should be an evaluated process, monitoring the consequences for the child and the agencies involved in inter- country adoption to reach valid conclusions. It was agreed that follow up was a good idea and recommended that this process should be applied to all institutionalisation processes, including return to biological parents and placements within foster care. 2.5.2 Recommendations It is recommended as an overriding principle for child care and protection that NO child under three years should be placed in a residential care institution without a parent/primary caregiver. When high-quality institutions are used as an emergency measure, it is recommended that the length of stay should be no more than 3 months. July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 2.6 Closing remarks by Dr Mikael Ostergren, WHO-Europe Dr Mikael Ostergren closed the meeting, thanking both the researchers and the audience for an exciting day. Dr Ostergren stated that on behalf of WHO Copenhagen, he felt privileged to have hosted the meeting. WHO-Europe regards children in institutions as an issue for public health and the Organization’s aims are to provide evidence and guidelines to member states who can then decide how to act upon this information. July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 3 Appendix 1 – Programme 08.30 - 09.00 Registration ¾ Morning Sessions: Chairperson: Dr Viviana Mangiaterra 09.00 - 09.10 Opening and welcome Gudjon Magnusson, Director, Reducing Disease Burden, WHO/Europe 09.10 - 09.30 Consequences of institutionalisation for young children: a review Rebecca Johnson 09.30 – 10.00 Effects of institutionalisation on brain and behavioural development in young children: Findings from the Bucharest early intervention project Sebastian Koga Charles Nelson 10.00 – 10.10 Questions 10.10 – 10.30 Number and characteristics of children under 3 years in institutions across Europe at risk of harm - survey results Catherine Hamilton- Giachritsis 11.00 – 11.15 Questions and discussions 11-15 – 12.15 Results from partner countries Denmark France Greece United Kingdom Ingrid Leth Celia Vaz-Cerniglia Helen Agathonos- Georgopoulou Rebecca Johnson 12.15 – 12.30 Photographic montage presentation of an institution for disabled children in Romania Georgette Mulheir Delia Mara Pop ¾ Afternoon Session: Chairperson: Dr Helen Agathonos-Georgopoulou 13.30 – 14.45 Results from partner countries Hungary Poland Romania Slovak Republic Turkey Maria Herczog Maria Keller-Hamela Violeta Stan Anna Klimackova Sezen Zeytinoglu 14.45 – 15.30 Overview and conclusions from partner data Kevin Browne 15.50 – 16.45 Panel of partners: General discussion and suggestions for change 16.45 – 17.00 Recommendations 17.00 Closing remarks Mikael Ostergren July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 4 Appendix 2 - List of participants ¾ Participants Austria Dr Werner Hilweg SOS Children’s villages, Herman Gmeiner Academy Bulgaria Mrs Vessela Banova State Agency for Child Protection, Sofia Mrs Vanya Ganozova EveryChild Bulgaria Dr Grete Thoroe Pedersen CARE International Croatia Mr Aleksandar Sunko Embassy of the Republic of Croatia, Copenhagen Dr Gordana Sunko Paediatrician Czech Republic Dr Milan Paek Deputy Minister for Health Care, International Relations and European Integration Dr Iva Truellov Department of Health Care for Mothers and Children Denmark Mrs Christina Barford Ministry of Social Affairs Ms Laila Dreyer Espersen Institute of Social Research Ms Charlotte Guldberg Skodsborg Observationshjem Mr Jens Asger Hansen "Jacob Michaelsens Minde" Child and Youth Care Institution July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 Ms Maja Helweg-Jørgensen Stendyssehaven observationshjem Ms Kirsten Jepsen Glostrup observations og behandlingshjem Mr Otto Juhl Bagsvaerd observationshjem Ms Inger Kjeldgaard Institute of Psychology, University of Copenhagen Dr Jill Mehlbye Institute of Local Government Studies Dr Helle June Nielsen Glostrup observations og behandlingshjem Ms Inger Poulsen University Clinic, Institute of Psychology, University of Copenhagen Mr Lars Stilling Netteberg Save the Children, Denmark Dr Anne Tang Save the Children, Denmark Dr Sine Widriksen "Jacob Michaelsens Minde" Child and Youth Care Institution Mr Klaus Wilmann Børnerådet (Council for Children) Greece Dr Antigone Kontopoulou Babies Centre, Metera Hungary Dr Csilla Lantai Ministry of Health, Social and Family Affairs Dr George Virag National Institute of Criminology July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 Iceland Mr Bragi Gudbrandsson Government Agency of Child Protection, Reykjavik Italy Dr Cristina Ranzato Epidemiology and Community Medicine Unit, University of Padua Latvia Dr Gunta Viksne Secretariat of the Minister for Special Assignment for Children and Family Affairs Lithuania Mrs Genovaite Paulauskiene Division of Personal Health, Mother and Child’s Health Care Subdivision Norway Ms Sissel Bye Ytteborg Ministry of Children and Family Affairs Ms Eirunn Lysø Ministry of Children and Family Affairs Romania Dr Carmen Duca General Direction for Child Protection Dr Sebastian Koga Institute of Child Development Dr Delia Mara Pop Hope and Homes for Children Dr Christian Posch SOS Children’s villages Dr Oana Miruna Stoicanescu Child Neurologist Turkey Professor Esin Konanc Child Psychologist July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 United Kingdom Dr Richard Carter EveryChild, London Ms Louise Dixon (Rapporteur) Centre for Forensic and Family Psychology, University of Birmingham Dr Gabriela Misca (Rapporteur) Centre for Forensic and Family Psychology, University of Birmingham Ms Georgette Mulheir Hope and Homes for Children United States of America Professor Charles Nelson University of Minnesota ¾ Partners in the DAPHNE Project Denmark Professor Ingrid Leth Department of Psychology, University of Copenhagen France Dr Marie Anaut l’institut de Psychologie, Université Lumiere-Lyon2 Dr Célia Vaz-Cerniglia Universite Lumière, Lyon Greece Dr Helen Agathonos-Georgopoulou Institute of Child Health, Athens Hungary Dr Maria Herczog National Institute of Criminology Poland Dr Maria Keller-Hamela Nobody's Children Foundation, Warsaw Dr Maria Kolankiewicz Faculty of Education, Warsaw University July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 Romania Dr Violeta Olivia Stan Department of Child & Adolescent Psychiatry, University of Medicine, Timisoara Slovakia Dr Anna Klimackova National Gender Center, Bratislava Turkey Dr Sezen Zeytinoglu Ege Üniversity, Department of Psychology United Kingdom Professor Kevin Dominic Browne Forensic Psychology Programme, School of Psychology, University of Birmingham Dr Catherine Hamilton-Giachritsis School of Psychology, University of Birmingham Dr Rebecca Johnson School of Psychology, University of Birmingham ¾ European Commission Ms Mariela Neagu Task Manager on Child Protection, Romania ¾ UN Agencies UNICEF Mr Ole Kyed Chairperson UNICEF National Committee, Denmark World Bank Dr Viviana Mangiaterra Human Development Network WHO Regional Office for Europe Ms Elizabeth Forsythe Intern, Child and Adolescent Health and Development Dr Gudjon Magnusson Director, Technical Support, Reducing Disease Burden July 2004 Mapping the number and characteristics of children under three in institutions across Europe at risk of harm- Copenhagen, Denmark, March 2004 Dr Mikael Ostergren Regional Advisor, Child and Adolescent Care and Development Ms Helle Rink Programme Assistant, Child and Adolescent Care and Development Ms Ewa Spasowski Intern, Child and Adolescent Care and Development Ms Oana Roman (Translator) WHO Liaison Officer, Romania July 2004