El acogimiento residencial terapéutico

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International Perspectives on Residential Care for Children:

Is a Paradigm Shift Required?

Catherine Hamilton-Giachritsis, Carlos Silva Peixoto, Manuela Garcia-Quiroga and Rita Ferreira

Introduction

In 2009, the United Nations General Assembly published Guidelines for the Alternative Care of Children aimed at all 193 member states, followed in 2011 by a call for the end of all residential care1 for children under the age of three years by the United Nations Children’s Fund (UNICEF) and the Office of the United Nations High Commissioner for Human Rights (OHCHR). These statements led to a series of positive changes worldwide for babies and young children. In Europe, Central and South America the focus moved to providing more individualised care, such as via foster homes, where emotional needs could more easily be met and a move away from large scale ‘institutional’ care predominantly focused on physical needs. This was undoubtedly a positive development in the care of small children, although there have been variations in the extent and pace to which different countries have adapted to these changes.

However, looking across the full age range of childhood, the picture may be somewhat more complex and less well-understood. Aside from the fact that providing a foster home for every child in alternative care is unlikely to be feasible in many places, there are also cultural and paradigm variations that need to be accounted for. For example, an “institution” or “children’s home” in one country may tend to be small, nurturing, family-type care homes, whereas in another it may refer to the very large building with staff concerned with managing large numbers of children. Some of these differences may arise from underpinning theoretical perspectives informing different paradigms over time, such as the development of attachment theory (Bowlby, 1951, 1969/1982) shifting the paradigm to highlight the importance of emotional care. Political and ideological influences have also played a part; for example, Carter (2005) outlines the impact of communist states in Central and Eastern Europe on residential care of children. In addition, there may be cultural variations that impact on the paradigm, including the extent to which the whole community is seen as responsible for the care of these children and common forms of emotional expression within a culture (Maudi, Aujoulat, Wintgens, Matonda ma Nzuzi, & Pierrehumbert, 2012). Thus, although the idea that large scale institutions focused on physical needs are suitable is largely (thankfully) outdated, whether there is a need for a paradigm shift to take a therapeutic paradigm to residential

1 Note about terminology: A variety of terminology is used to refer to residential care worldwide, including institutionalisation, family-type home, care home, alternative care, children’s home, out of home care. For the purposes of this chapter, we will use the term “residential care” to refer to care for children who are looked after out of their home, not by their birth parents whether due to the loss of parents or following removal for their safety. We are not including reference to educational residential settings.