1. PROFESSOR KEVIN BROWNE & DR SHIHNING CHOU CENTRE FOR FORENSIC & FAMILY PSYCHOLOGY SCHOOL OF COMMUNITY HEALTH SCIENCES UNIVERSITY OF NOTTINGHAM MEDICAL SCHOOL KEVIN.BROWNE@NOTTINGHAM.AC.UK The Number of Children in Residential Care Institutions in Europe and Central Asia: Cause for Concern Prague November 2015

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

3. Proportion of all children under 3 years who are in institutional care, 2003 (blue lines are estimates).

4. United Nations General Assembly Report of the Human Rights Council on its 11 th Session (A/HRC/11/37, Section 11/7, p.23) – Guidelines for the Alternative Care of Children (2010) – Related Publications

5. Institutional care without a parent causes physical harm and neural damage to all young children.

6. Infants my be imprisoned behind their cot bars for up to 18 hours a day

7. Extent of Institutional Care of Infants and toddlers and the ‘orphanage’ myth UNICEF estimate 44,000 young children under 3 in Eastern Europe and Central Asian ‘Children’s Homes’. In 2003, our EU survey of member states and accession countries showed 23,000 young children under 3 without a parent in institutional care (for more than 3 months). ‘infant homes’ often provide a non stimulating clinical environment for toddlers and young children up to 4 years of age. Vast majority (94 to 96%) of children in ‘orphanages’ have at least one living parent, often known to the authorities

9. All Children under 18 years in Care 2013: % residential care, % foster care and total number

10. Young Children under 3 years in Care 2013: % residential care, % foster care and total number

11. Country with children under 3 In Residential Care - 2013 Proportion per 10,000 Change since 2003 per 10,000 Country with children under 3 In Residential Care - 2013 Proportion per 10,000 Change 2003 per 10,000 Monaco67No info.Sweden*7 Latvia54Germany6 Lithuania45Montenegro6-5 Bulgaria43-7Turkmenistan*5 Czech Republic38-22Italy*5-3 Malta32+5Netherlands5-11 Belarus27-18Kyrgyzstan*4-2 Belgium*26-30Tajikistan*4+2 Russia*24-15Georgia3 Moldova16+4Kosova3No Info. Albania*15+7Serbia*20 Kazakhstan*15Turkey20 Romania14-20Spain*2-21 FYR Macedonia14Uzbekistan*2 Hungary12-32Azerbaijan1-4 Slovak Republic*10-21Denmark1-6 Estonia10-16Norway<1 Croatia10+2Ireland0-6 Poland10+1Cyprus0-4 Austria10+7UK0 Armenia10No info.Slovenia00 Finland9-19Iceland00 Bosnia & Herz*9+2Total (45 countries)12.8-1.6

12. Country with children under 3 In Foster Care - 2013 Proportion per 10,000 Country with children under 3 In Foster Care - 2013 Proportion per 10,000 Monaco0Sweden*28 Latvia28Germany30 Lithuania38Montenegro2 Bulgaria25Turkmenistan*na Czech Republic41Italy*4 Malta36Netherlands28 Belarus31Kyrgyzstan*na Belgium*naTajikistan*2 Russia*3Georgia8 Moldova2Kosova17 Albania*naSerbia*19 Kazakhstan*naTurkey1 Romania59Spain*2 FYR Macedonia6Uzbekistan*16 Hungary59Azerbaijan1 Slovak Republic*59Denmark20 Estonia13Norway37 Croatia12Ireland28 Poland43Cyprus9 Austria30UK38 Armenia0Slovenia6 Finland27Iceland8 Bosnia & Herz*1Francena

13. Countries with significantly less children under 3 in residential care above changes in birth rates (n=12) HUNGARY CountryChange Since 2003 Hungary-32 per 10,000 Belgium-30 Czech Republic-22 Slovakia-21 Spain-21 Romania-20 Finland-19 Belarus-18 Estonia-16 Russia-15 Netherlands-11 Bulgaria-7

14. Countries with significant more children under 3 in residential despite changes in birth rates (n=8) CountryChange since 2003 Austria+ 7 per 10,000 Albania+ 7 Malta+ 5 Moldova+ 4 Croatia+ 2 Bosnia and H.+ 2 Tajikistan+ 2 Poland+ 1

15. Countries with children under 3 Years are overrepresented in institutional care CountryTotal number in Residential Care (<18) Rate per 10,000% of Children under 3 Latvia345,8375118.1 Armenia690,5281313.1 Bosnia & Herzegovina 773,000913.6 FYRO Macedonia463,561728.1 Bulgaria1,178,7084715.6 Kosovo*583,612219.4 Albania7,300,415126.7 Turkey22,761,702123.8

16. Reasons for institutionalisation

17. SOCIAL REASONS FOR RESIDENTIAL CARE Lack of community nurses and social workers Lack of home based assessments of children in need and their families Lack of free universal prevention services to reduce child abuse, neglect and abandonment (eg; positive parenting & counselling programs and community mental health and addiction services) Weak targeted interventions with families high risk of child abuse, neglect and abandonment. Slow development of therapeutic foster care. The health sector must be involved to prevent separation and sustain reunification of children with their parent(s)

18. Transforming of children’s services COMMUNITY SERVICES FOSTER CARE RESIDENTIAL CARE Pyramid of services to children and families

19. Manual on the Better Care Network: Mulheir, G., Browne, K. and Associates (2007). De-Institutionalising And Transforming Children’s Services: A Guide To Good Practice. From Kevin.browne@nottingham.ac.uk OR www.crin.org/bcnKevin.browne@nottingham.ac.uk

20. Institutions transformed into polyclinics of non residential services for children and mother & baby units

21. Day care facilities for children with and without disabilities

22. Mother-Baby Units to replace Baby Homes No child under three in residential care without a parent