UNICEF explains that South Africa is experiencing the highest burden of HIV in the world, with over 5.7 million people currently infected. Parents are dying and leaving behind orphaned children. There are an estimated 3.7 million orphans in South Africa, about half of whom have lost one or both parents to AIDS. There is evidence of “ubuntu” among relatives and friends but a wide diversity of circumstances leads to the separation of children from their families. Many abused, neglected and abandoned children land up in children’s homes.
Statistics on children in institutional care are not complete, but it is known that there are 345 registered children’s homes in South Africa, looking after some 21,000 children. These facilities qualify as ‘child and youth care centres’, a provision of the new Children’s Act that establishes a system of specialised alternative childcare programmes with proper standards and governance structures.
In terms of the South African child care policy, institutionalisation is option of last resort. Children should be placed in institutions only in exceptional circumstances. Thus, it is only practiced when all home and community options are considered inappropriate. As such the Children’s Act provides for placement orders (made by the court) to lapse on expiry of two years from the date the order was made. The order can however, be renewed for another two years upon justifying why the child could not be reunited. There is even a provision for the order to terminate earlier in the event of appropriate reunification arrangements being made or when there is another approved suitable community placement.
Government makes provision for securing stability in the life of the child by placing the child in alternative care for a limited period to allow for the reunification of the child and the parent or caregiver with assistance of the designated social worker. This is clearly for the positive developmental needs of the child. Research in the UK and elsewhere has shown that long-term institutionalisation of children impinges on their linguistic, intellectual and educational performance. Pringle (1980) demonstrates that despite the fact that different research methods and different institutional settings have been used, there is considerable agreement that many children in long-term residential care function less well than their peers.
Young children who remain in institutions tend to crave affection, to cling to visitors and later on to make indiscriminate friendships and to have difficulties in forming lasting relationships. Early and prolonged institutional care has also been shown to work against successful fostering later on.
In consequence, children who have been deprived of a normal home experience difficulties, especially during adolescence and adulthood, in accounting for themselves. Ordinary personal questions such as ‘where do your people live?’ or ‘what does your father do?’ become loaded and embarrassing. In confused panic, inventions about imaginary relatives may be produced because the deprived youngster knows little or nothing about his own background. This adds to his feelings of insecurity in personal relations and may lead him either to shun them or to weave a web of lies when faced with the need to account for himself.
However, the South African context is such that institutionalization of children is inevitable. We have witnessed that children’s development is so gravely at risk in the worst families – which reject, ill-treat or batter the child – that even an institutional upbringing may be preferable. It has been found that the major cause of institutionalisation of children here has been the lack of resources to boost community support systems. Most children come into care because of abandonment, abuse or neglect because families cannot cope with challenges of daily living. Thus, the reason foster care and adoption have not been effectively practised is that each additional child makes the family poorer. In our case, as in the circumstances of other institutions in South Africa, this has resulted in bed blocking; situations where certain children stays in care until they are majors because this is the only place they can call ‘home’.
Employing the services of professional childcare workers, social workers, psychologists and occupational therapists on site, our home has created a ‘therapeutic community’ to remedy and rehabilitate the hurt, confused and damaged child. As in normal family, children here learn as they grow older that they are expected to reciprocate: by delaying their demands for immediate or exclusive attention; by controlling their anger and selfishness; by considering the feelings of others; and by conforming to social expectations. Our programming is aimed at avoiding ‘warehousing of children’, but strengthening their emotional resilience and increasing their capacity for learning. This will help them to adapt to a rapidly changing world.
Epworth Children’s Village has proved that the ill-effects of institutionalization can be minimised or even avoided, provided major changes are made in institutional policy as well as in the daily regime. Our deinstitutionalisation strategy has therefore been anchored on effective tracing, reunification and reintegration as processes on a continuum. These processes ensure that children remain integrated; maintain contact with society for which they are being prepared.
Epworth Children's Village Occupational Therapy and Psychology also assists children by mentoring each child there by promoting academic perseverance and encouraging tertiary education. We assist disadvantaged students from early development and continuing through high school graduation as a way of nurturing each child into independence.
Tracing of families, relatives or looking for foster parents for the children in residential care can be a laborious process that requires professional determination. Our experience is such that some family members avoid identification fearing that the child will be immediately discharged into their care. In most cases the family circumstances require intensive intervention before the child is brought into the picture.
The Children’s Act provides that a designated social worker facilitating the reunification of a child must investigate factors which caused the child to leave home; address those causes and take precautionary action to prevent a recurrence; and provide counselling to both the child and the family before and after reunification. Reunification is a relatively short process which follows after effective social work intervention. The success of the pre-placement intervention is determined by the efficacy of the social work services- their consistency and sufficiency which will determine the stability of the placement. Thus, in the absence of effective support from the statutory social workers our institutional social worker runs support programmes to create conducive conditions for effective reunification.
This is the opportunity to maintain continuous, frequent and regular contact with an adult outside the institution which enables the child to cope with them. We have found this to be true even when own family had been indifferent or rejecting, and when the child had never lived permanently with the parental substitute. What seems crucial is that the child will have found someone who cares sufficiently to maintain a stable and enduring relationship. The child needs to feel that he matters as an individual; that he is valued for his own sake and not only by someone who is paid for the job of caring for him fairly and impartially.
Upon satisfaction with the degree of integration, the social worker makes recommendations for placement. In our case this reintegration process is given adequate professional post-placement support to ensure the health, safety and security of children during at least two years of initial bonding.
That childcare is no longer simply a matter of physical care, but a mixture of child-focused, professional-intensive processes aimed at providing effective therapy, holistic child development and eventual reintegration.
Through the process of matching children to families we now realize that childcare services must be culturally relevant as institutions operate in representative capacity for those communities they serve.
Professional post-placement support and material provision are integral components of reunification for the most deprived families.
Training and support for foster families need to be carried out as a continuous process to ensure effective resettlement of children.
Above all, we now realise that staff members also need ‘deinstitutionalization’. They need to appreciate that they are not meant to create ‘good’ children for the institution but rather a relevant institution that serves society. This project gave our organisation introspection into our practice and put us into a constantly evolving staff development mode.
(a) High staff turnover among ‘designated social workers’: Decisions about placements have often been delayed while new staff becomes familiar with the case. We have had children’s files transferred to two or three social workers a year who would all leave without having contact with the child. In this regard, case supervision by the statutory social workers is impossible. We thus have had to rely on our institutional social worker who would then call on the statutory social worker on all legal processes.
(b) Insurmountable caseloads: The designated social workers’ capacity is all devoted to dealing with crisis work because of inadequate staff and resources. In our case tracing, reunification and reintegration which are functions of statutory social workers could only be done by our internal social worker and staff. This is usually complicated by inadequate case recording by statutory social workers. Post-placement support is also done by our institutional social worker to ensure effective integration. The institution is not funded to carry out any community outreach work including post-placement support, yet if it gives up on the children placements breakdown would be unevitable.
(c) Marginal institutional grants that do not match statutory standard service requirements limit institutional capacity to implement effective programmes. Tracing, reunification and reintegration processes are integral components of an effectively managed care programme. While statutory social workers are too few or too busy to do it, institutions are not funded to do so either. South Africa has very fine childcare policies, but effort needs to be put towards resource allocation and matching policy to practice. As it is, there is a fine policy on reunification which is structurally neglected yet institutions are not funded to implement it.
Every child in care receives a comprehensive pathway plan that maps out a clear route to independence.
A multi-disciplinary team must designate an adviser who will coordinate the provision of support and assistance to meet the needs of the young person. Particular emphasis will be placed on helping the young person into education, training or employment.
Continuing assistance for care leavers aged 18 to 21, especially with education and employment, will be provided. Assistance with education or training continues to the end of the programme, even if it takes some past the age of 21.
Children depend on adults for their well-being, care and education; they have no vote or voice in the running of the community, either at local or national level; and resources devoted to them are society’s investment in tomorrow’s parents. For all practical purposes of social policy, we must act on the assumption that the environment is of over-riding importance and that the early years of life are particularly vital. The implication of piecemeal social investment is high crime rate, drug abuse, alcoholism, HIV/AIDS and eventually diminished morality. Hence a long-term policy for children must be based on improving the quality of family care and of education from cradle through adulthood. This requires a different attitude to parenthood and child rearing and a willingness to provide adequate services for families and children.
In this well written learning brief Epworth Children's Village explains the reasons why children end up in institutions like Epworth and what has to be done to return them to their families if possible. They explain the challenges of the field as well their most important lessons learned. We found this brief so helpful that we asked them to develop it further for our Hands-on publication - look out for it on our website in our next edition to be published in June 2013.