Summary of the impact

The worst of institutional child care came to the attention of the public and policy-makers in the 1990s following the fall of Ceauşescu in 1989 when pictures of children in Romanian orphanages were broadcast around Europe and America. Following this, a series of projects at the University of Birmingham (funded by the European Union Daphne programme and the World Health Organisation Regional Office for Europe) charted the extent and consequences of institutionalised care for children across Europe, and devised best practice recommendations for deinstitutionalisation. Among the key findings were that institutionalisation was much more widespread across the EU than previously thought; that it is particularly harmful before the age of three; and that alternative care with superior outcomes for children is also less expensive to implement. During the REF period the research team has significantly expanded their role in disseminating their findings, producing policy reports and briefings, and in providing training. During this time their key findings have made a major contribution to changes in child-care policy recommendations by NGOs such as UNICEF and the UN. Following discussion at the UN General Assembly in 2009 specific guidelines were produced for all 193 member states, which implemented key recommendations from the research about the timing of deinstitutionalisation and how to achieve it (`Guidelines for the Alternative Care of Children', 2009). Their research has led to changes to national child-care policies in a number of countries, including the Czech Republic, Hungary and Serbia. Through the activity of UNICEF the impact is now extending beyond Europe to central and South America. These changes have demonstrable benefits for the health and psychological welfare of children, as well as bringing cost savings to the national childcare systems that implement them.

Underpinning research

The University of Birmingham team jointly led by Prof. Kevin Browne (UoB 1992-2007) and Dr Catherine Hamilton-Giachritsis (senior lecturer, at UoB from 1993) undertook three European Union Daphne funded projects, supported by the World Health Organisation Regional Office for Europe (2003-2008). The key outcomes were the first large-scale assessment of the number of children in European institutions, the identification of best practice in deinstitutionalisation, and the development of an international training pack to enable implementation of this best practice [refs 1 and 2]. Key conclusions from the work were that: a) young children under the age of three years should not be living in institutional care [refs 4, 5] b) it is more cost effective to have a child of any age in alternative family care (e.g., foster care), including disabled children [ref 4] and c) countries with lower GDP, lower health expenditure and younger mothers had higher levels of parental abandonment [refs 3, 4].

The first project collected data from Governments and identified that this problem exists in most of the 33 European countries surveyed [refs 3, 6]. Overall there were 23,099 (approximately 11 per 10,000 children) children less than 3 years old in institutional care, and this problem included 31 countries in Europe. Thus, the project was critical in highlighting that institutional care for children was a problem across the entire EU and not confined to (then) EU accession countries, as previously thought. The second project identified good practice in deinstitutionalisation of children under 5 years and led to the development of a Training Pack on Best Practice for the Deinstitutionalisation of Children [ref 2]. This training pack was supported by EU Daphne, World Health Organisation and UNICEF, and distributed widely across Europe. The findings and reviews of the first two projects emphasised the wide-spread nature of institutionalised care and the urgent need to change policy and practice (disseminated via two European conferences, leaflets to the EU Parliament in four languages, a website, etc.). This formed the basis of the third project, where free training was offered to the eight European countries with the highest rates of young children in institutions. The team conducted free two-day training events for government and practitioner groups in eight European countries (Latvia, Estonia, Belgium, Hungary, Lithuania, Slovak Republic, Romania, Poland; i.e., 16 days training in total; 2006-2007). These were organised with practitioners, local experts and the WHO offices, with the aim of informing policy and an invited presentation was given at EU/UNICEF meetings. These were run by the research team plus a local expert and in conjunction with the local WHO officer in order to maximise impact.

References to the research

Research grants
a. Browne, K.D., Hamilton-Giachritsis, C.E., Leth, I., Agathonos-Georgopoulou, H., Anaut, M., Herczog, M., Keller-Hamela, M., Klimackova, A., Mulheir, G., Stan, V., and Zeytinoglu, S. (2006). `Training and dissemination on institutional care in Europe and good practice in the deinstitutionalisation of young children'. European Commission EU Daphne Programme. €120,430. Awarded 2005; project dates 2006-2007.

b. Hamilton-Giachritsis, C.E., Browne, K.D., Leth, A., Agathonos-Georgopoulou, H., Anaut, M., Herczog, M., Mulheir, G., Klimackova, A., Keller-Hamela, M., and Stan, V. (2004) `Identifying Best Practice in the de-institutionalisation of children under 5 years from European institutions.' European Commission EU Daphne Programme. €145,882. Awarded August 2003, project 2004-2005.

c. Browne, K.D., Hamilton-Giachritsis, C.E., Leth, A., Anaut, M., Agathonos-Georgopoulou, H., Zeytinoglu, S., Stan, V., Klimackova, A., Herczog, M., and Keller-Hamela, M. (2003). `Mapping the number and characteristics of children under three in institutions across Europe at risk of harm'. European Commission EU Daphne Programme. Euro 126,698.10.

Details of the impact

Raising international awareness and changing international guidelines. On the strength of this and other work, University of Birmingham was confirmed as a WHO Collaborating Centre for Child Care and Protection in 2006-2010, as part of which the group were invited to develop policy briefings and fact sheets to disseminate the research findings to governments, NGOs and other relevant policy-makers. The University of Birmingham work was widely cited at a conference for European Ministers Responsible for Family Affairs (May 2006) as a "major contribution" to the issue of children in institutions and this prominent endorsement has fed into the impact that has occurred since (corroborative reference 8, pps, 9-10).

In 2007-8 the principal outcomes of the research and the manual for deinstitutionalising young children into family-based care to reduce harm was disseminated in 20 European and CEECIS countries by the research team. A monograph prepared by the research team summarising their own and other relevant research was presented by UNICEF as part of the case put to the UN General assembly leading to the Guidelines for Alternative Care published in 2009 (corroborative reference 1). Among other outcomes of the group's research, the conclusion that children younger than 3 should not be in institutional care has been the basis for numerous subsequent campaigns and recommendations for best practice, including: the report from a high-level conference on Children without Adequate Parental Care in 2009 (corroborative references 2 & 3), with participants including Save the Children, UNICEF, Better Care Network); a worldwide campaign by Save the Children, UNICEF and Everychild and other non-governmental organisations to end the institutional care of children less than 3 years, outlined in a working paper (corroborative reference 4 cites research references 5&6); the `At home or in a home' report, 2010 (corroborative reference 5, background reading); and `The rights of vulnerable children under the age of three' by United Nations Human Rights Office of the High Commissioner (corroborative reference 6: footnote 1 on page 5 refers to research references 2 & 6). It has also motivated further investigation, including: a survey by Eurochild (in 2009, updated in 2010) in 30 countries, that resulted in calls for legislation across Europe banning children under 3 in institutions; a 2012 UNICEF report that called for these concepts to be applied to Eastern Europe and Central Asia (CEECIS). This has drawn widely on the University of Birmingham findings (e.g., corroborative reference 7: 21 citations of research refs. 2,5 &6, e.g., pp. 116-117).

Changes to care systems and government policies in multiple countries.
In 2009, the UN General Assembly Report of the Human Rights Council in its 11^th Session produced `Guidelines for the Alternative Care of Children' for 193 Member States. The Guidelines use a number of concepts put forward by the group's research, particularly the cut off of 3 years. In turn, this has led to changes in many countries across those member states, including:

• Lithuania: Undertook their own national review of institutionalisation and ways to end it as a direct result of work of the Birmingham group (corroborative reference 9, pp.7-8), and have subsequently changed national policy and practice.
• Bulgaria: Developed a National Strategy for the Child (2008-2018) and associated Action Plan for Deinstitutionalisation, which determined that 105 institutions should be reformed and restructured, further stating that by 2014, no child under three should be in institutional care (corroborating reference 7).
• In Romania and Serbia, legislation has been passed making it illegal for infants to be in institutional care (under 2 years in Romania [Law No.272/2004; Romanian Social Welfare Law 2011], under 3 years in Serbia [Serbian Social Welfare Law 2011). The Romanian National Strategy for Protection and Promotion of Children's Rights 2008-2012 aims to prevent the separation of children from their parents. In Serbia, between 2005 and 2011, the proportion of under 3 year olds in institutional care had decreased by 81% (corroborating reference 7, e.g., pps. 91. 140,).
• Czech Republic: In 2009 the government implemented the National Action Plan to Transform and Unify the System of Care for Vulnerable Children from 2009-2011, including a clear preference for child care in a family rather than an institutional environment and reference to UN guidelines).
• Hungary: Increased demand for foster care resulting from the decreased number of children's homes (especially infant homes) in turn led to an amendment to the Child Protection Act regarding fostering, 1 January 2011.

Improved outcomes for children and decreased costs of care.

• The long-time reduction in cost for Governments shown by the UoB research (based on data provided by 33 governments) has been outlined by UNICEF (corroborating reference 7, p.118, citing research references 4 & 6). The research found that Governments' reported spending showed institutional care is three times more expensive than foster care for children without disabilities and twice as expensive for those with disabilities.
• As well as financial gains, longitudinal research on Romanian orphans has clearly shown the improved social, cognitive and emotional outcomes for children moved into family based care and the need for this to occur at an early age (research reference 5). For example, research has shown those children moved before the age of six months are able to catch up on all areas of development. Children who are moved at a later stage (e.g., four years) are able to get close to or within the normal range on many aspects of development, but continue to show difficulties with interpersonal, social and peer relationships even aged 16 years. Most children moved at a later state are generally unable to catch up on their development. Thus, early movement of children from such environments is crucial. This is a long-term impact of the research, the significance of which increases over time, and as the recommendations are followed in ever more countries.

On-going impact: Disseminating the ideas to Central and Eastern Europe and Central Asia (CEECIS). UNICEF has used the outputs from the University of Birmingham research and commissioned a monograph by a member of the research team outlining the research knowledge base (based on the University of Birmingham research; corroborating reference 10) and argued that these methods and concepts need to be applied to CEECIS. They note that currently more than 15,000 babies and young children per year are being taken into care; that is "every hour, approximately two young children, mainly babies, are separated from their parents and sent into institutional care in Central and Eastern Europe and Central Asia" (corroborating reference 7, p.5). 2013: UNICEF has begun to move the work into South American and other countries, with the work from this research contributing to their approach.

Sources to corroborate the impact

1. United Nations General Assembly Report of the Human Rights Council on its 11^th Session (2009; A/HRC/11/37, Section 11/7, p.23) - Guidelines for the Alternative Care of Children.
2. Save the Children, UNICEF, Better Care Network (November 2009). The neglected agenda:Protecting Children without Adequate Parental Care. (footnote xxxiii refers to research reference 5; plus background reading refers to University of Birmingham work)
3. The Neglected Agenda: Protecting Children without Adequate Parental Care conference, Wilton Park, West Sussex, UK (2009). 30 Nov.-3 Dec. 2009. http://www.wiltonpark.org.uk/
4. The UNICEF Better Care Network Working Paper September 2010 (http://www.crin.org/docs/Families%20Not%20Orphanages.pdf) cites this research three times (research ref.6; ref 13 on page 7 is a direct quote from University of Birmingham research; Footnote 15: research ref 5).
5. UNICEF (September 2010). At home or in a home? Formal care and adoption of children in Eastern Europe and Central Asia UNICEF Regional Office for Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS).
   http://www.unicef.org/ceecis/At_home_or_in_a_home_report.pdf (cites research references 2, 5, 6 plus a presentation from the research team in Lisbon, Portugal, 18-21 November 2007).
6. United Nations Human Rights Office of the High Commissioner (2012). The rights of vulnerable children under the age of three. Ending their placement in institutional care. http://www.europe.ohchr.org/Documents/Publications/Children_under_3__webversion.pdf (e.g., footnote 1 on page 5 refers to research references 2 and 6; plus others e.g. page 28 footnote reference 53 refers to research reference 2)
7. 7. UNICEF (2012). Children Under the age of Three in Formal Care in Eastern Europe and Central Asia. A rights based regional situation analysis. (Multiple citations of the UoB research, and other papers following from the UoB research. Research references 2,5 and 6 cited 21 times; e.g., pp. 116-117 cite research references 2, 4, 6).
8. Council of Europe Conference of European Ministers responsible for Family Affairs, Portugal (Gudbrandsson, 2006; Rights of Children at Risk and in Care, pp.9-10).
9. Institute for Social Research/Ministry of Health of the Republic of Lithuania/UNICEF (2005). Every Child Counts. Vilnus: UNICEF.
10. Browne, K.D. (2009). The risk of harm to young children in institutional care. London: Save the Children UK. http://www.crin.org/docs/the_Risk_of_Harm.pdf