Children who are cared for in a facility outside their family home, also referred to as residential care.
Institutionalization is the placing of emotionally or physically handicapped children in a therapeutic facility outside of the home. In 1990, the American Public Welfare Association estimated that just over 400,000 children were living in residential care in the United States. However, three-quarters of those children are in foster care. Only 16%, or 65,000, are in group homes, residential treatment centers, or psychiatric hospitals. Group homes may have as few as four children; residential treatments may have 100 or more young people housed in groups of 8-12 and supervised by house parents or childcare personnel.
Child welfare experts differ widely on the long-term effects of institutionalization. A shortage of research funds means that little solid evidence exists to support one side or the other. While laws exist to provide out-of-home placement, the legal system often discourages it. Although many improvements have been made in the quality of residential care, some experts believe that incidence of neglect or below-standard care still exist. Of particular concern is the lack of proper staff training. Fortunately, the traditional training school with a custodial shift-work staff is being replaced by smaller group homes with a family-type atmosphere and a highly skilled staff who live with the young residents.
With an emphasis on rules, chores, schedules, neatness, cleanliness, and order, the best institutional care offers emotionally and physically handicapped children a better chance at life. They can learn new skills, improve behavioral and psychological problems, and develop self-esteem. In a protected environment abused children can learn to think of adults as kind and dependable.
In choosing the proper residential treatment, parents should look for these criteria: a nurturing live-in adult staff; a family-style arrangement; low youth-to-adult ratios; high rates of positive interactions between youths and adults; psychologically informed treatment planning; ongoing evaluation and formalized after-care plans. Whenever possible, the child should be involved in his or her assessments.
Physically handicapped children and those with mild emotional or behavior problems benefit from a therapy protocol that minimizes the fact of institutionalization. However, severely disturbed children require a highly controlled environment. Safety is of primary importance so that the children are protected from abuse, drugs, and suicide attempts. Opportunities for running away must be minimized. Bedroom doors should open into the hallway to prevent barricades.
Institutionalization for emotionally disturbed children and adolescents is usually not meant to provide long-term treatment. The average stay ranges from several months to two years. Physically handicapped children generally remain in residential care until they are able to live on their own, or for the rest of their lives, depending on the severity of the handicap. In any case, the institution should stay in close contact with the child's parents and encourage visitation.
When the child is institutionalized to protect him from abusive parents, it is not unusual for him to enter a mourning period. Regardless of what pain the parents have inflicted, the child will often remain staunchly loyal to them. Social workers and group home parents should not challenge this loyalty in any way. Social service workers often feel angry or resentful towards the abusive parents, which further complicates the worker's mandated goals: reunite the family while protecting the child.
Deciding to place a child in a treatment center is fraught with emotion. Parents may face criticism from friends and other family members. It is helpful to know
Ainsworth, Frank, and Leon C. Fulcher, eds. Group Care for Children: Concept and Issues. New York: Tavistock, 1981.
Blomquist, Geraldine M. Coping as a Foster Child. New York: Rosen Publishing, 1992. [For children]
Ayres, Carole Briggs. "Tough Choice." The Exceptional Parents 23, no. 4, p. 24, April-May 1993.
Weisman, Mary Lou. "When Parents Are Not in the Best Interests of the Child." Atlantic Monthly 274, no. 1, p. 42, July 1994.
The Children's Defense Fund
Address: 25 E Street N.W.
Washington, DC 20001
Telephone: (202) 628-8787
Child Welfare League of America
Address: 440 1st Street N.W., Suite 310
Washington, DC 20001
Telephone: (202) 638-2952
FAX: (202) 638-4004
National Association of Homes and Services for Children
Address: 1701 K Street N.W., Suite 200
Washington, DC 20006
Telephone: (202) 223-3447