Hope and Homes for Children welcomes the new Lancet Group Commission
Authors: Mark Waddington
Journal: The Lancet Psychiatry (2020)

The Lancet Group Commission1Boyce N Godsland J Sonuga-Barke E The institutionalisation and deinstitutionalisation of children: the Executive Summary from a Lancet Group Commission.Lancet Child Adolesc Health. 2020; (published online June 23.)https://doi.org/10.1016/S2352-4642(20)30089-4Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar on the institutionalisation and deinstitutionalisation of children is important because it presents further evidence that placing children in institutions is unnecessary and harmful, and that family-based alternatives exist that deliver far better outcomes. The Commission is also important because of its timing. Amid a global pandemic, it is too easy to view the need for reform of care for children as a separate or lower priority than the public health response. Supporting families to care for children is a fundamental element in ensuring the success of any public health response and is essential in strengthening the capabilities of communities to deal with shocks. Whether as part of an emergency response or as long-term social policy initiatives, child care and child protection should not be viewed as costs but as investments. With this in mind, on behalf of Hope and Homes for Children, I offer the following reflections on the Commission. Reform of care for children and investment in family-based care are crucial issues, because they deliver multiple dividends to the child-care sector and to broader society over time.2Bunkers K Country care profile. Better Care Network and UN Children's Fund, Rwanda2015https://bettercarenetwork.org/sites/default/files/Country%20Care%20Profile%20-%20Rwanda_0.pdfDate accessed: June 25, 2020Google Scholar These changes are fundamental to building more effective child protection systems and yield substantial benefits to initiatives to improve child health and education and to address child poverty. In this regard, the effect of moving to family-based care is rapid, but also has intergenerational benefits. The converse is also true. Underinvestment in family-based care for children and reliance on institutions leads to lifelong secondary consequences for children when they leave institutional care as young adults.3Stein M Research review: young people leaving care.Child Fam Soc Work. 2006; 11: 273-279Crossref Scopus (257) Google Scholar These consequences include increased likelihood of long-term dependency on state welfare support, especially for housing and unemployment, increased incidence of sex work and suicide, and increased likelihood of the children of those who had themselves been institutionalised being taken into care. These are all expensive human and financial costs that can be transmitted across generations. Family-based care is not more expensive than institutionalised care.4Ward H Holmes L Soper J Costs and consequences of placing children in care. Jessica Kingsley Publishers, London2008Google Scholar, 5Desmond C Approaches to caring, essential elements for a quality service and cost-effectiveness in South Africa.Eval Program Plann. 2002; 25: 447-458Crossref Scopus (16) Google Scholar After initial investment, family-based care rapidly becomes cheaper and much more cost effective. Hope and Homes for Children has been at the forefront of developing practice for family-based care internationally for more than 20 years. In every location we operate in globally, the costs of properly supported, quality family-based care have been less per child than the cost of confinement in an institution, and the outcomes have been substantially better for the child, with additional benefits for both siblings and parents.6Tobis D Moving from residential institutions to community-based social services in central and eastern Europe and the former Soviet Union. The World Bank, Washington, DC2000Crossref Google Scholar Put simply, investment in family care delivers much more benefit, and causes much less harm, than the expensive costs of building and running institutions. The humanitarian crisis precipitated by the COVID-19 pandemic is playing out in households behind closed doors. The progress that had been made in tackling extreme poverty and other global development challenges is being reversed. Worldwide, probable deaths among children aged 5 years and younger resulting from the disruption caused by the pandemic have been estimated to be 1·2 million in just 6 months.1Boyce N Godsland J Sonuga-Barke E The institutionalisation and deinstitutionalisation of children: the Executive Summary from a Lancet Group Commission.Lancet Child Adolesc Health. 2020; (published online June 23.)https://doi.org/10.1016/S2352-4642(20)30089-4Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar The humanitarian response is struggling to deal with this. Those countries with established or active commitments to family-based care are better able to mitigate and prevent this impact because they have the pre-existing infrastructure and relationships to facilitate engagement with people at a household level. In this regard, family-based care builds more resilient communities. This online publication has been corrected. The corrected version first appeared at thelancet.com/psychiatry on November 18, 2020. This online publication has been corrected. The corrected version first appeared at thelancet.com/psychiatry on November 18, 2020. I am Chief Executive Officer of the charity Hope and Homes for Children. Hope and Homes for Children is the Global Fundraising Partner of RELX, owner of Elsevier, which publishes the Lancet journals. Institutionalisation and deinstitutionalisation of children: the Executive Summary from a Lancet Group CommissionThis Lancet Group Commission advocates global reform of the care of separated children through the progressive replacement of institutional provision with safe and nurturing family-based care. It provides essential information on both the global scale of institutionalisation and its physical, social, and mental health consequences. It presents a pragmatic roadmap for carefully managed change. Here we outline the ten key messages from the Commission. Full-Text PDF Correction to Lancet Psychiatry 2020; 7: 667Waddington M. Hope and Homes for Children welcomes the new Lancet group Commission. Lancet Psychiatry 2020; 7: 667—In this Correspondence, the fifth sentence of the first paragraph should read "Whether as part of an emergency response or as long-term social policy initiatives, child care and child protection should not be viewed as costs but as investments." This correction has been made to the online version as of Nov 18, 2020. Full-Text PDF