The history of child welfare in this country has been rife with persistent dichotomies about outcomes and best practices in child protection. These “all or nothing” approaches to child protection are dangerous in a number of ways. The language about what is “best” often ignores what is best for a particular child. These arguments rely on invoking an aggregate group of children and completely ignoring the individual child with a set of unique needs.
The idea that “all children should be deinstitutionalized” does not allow for a useful discussion about children who need long-term, in-patient or other institutional care because they are a danger to themselves or others, or because their particular needs are so complex that they cannot safely be cared for in a homebased setting. It is better to look at what resources each particular child needs and ensure that those resources are readily available, of high quality, and designed specifically to promote the safety and well-being of each individual child. This could mean increasing in-home care for some children whose families, with support, can provide the very best care for that child. It can also mean that viable out-of-home options must be created when the child’s needs cannot be met in the home. Moving forward, we must determine, in a consistent and productive way, which child needs which services and how we can best redirect resources to promote the best outcome for an individual child.
Are all institutions that house children inherently bad? Should we abolish all institutional forms of care for children? What happens to children who cannot stay in their biological family or safely remain in foster or kinship care? These are the questions that must be asked if we are to take a truly child-centered approach to protecting vulnerable children. Our job is to ensure that each child is placed in the best setting to promote the safe and sustainable growth of mind and body. We are not promoting some Draconian idea of the poor house or the orphanage. We are promoting an open discussion about what to do when a child needs an institutional setting to meet his or her needs.
We are in full agreement that there are far too many instances where out of home care settings are far more dangerous for a child than remaining in a family setting. Whether it is unscrupulous orphanages that are trafficking children in Haiti or an ill-maintained “children’s home” in Guatemala that cost the lives of forty girls, the answer is not to reject the idea of institutionalization because of hazardous practices. The answer is that we need to examine what resources are needed to provide appropriate institutional care, monitor outcomes, and ensure that children are not languishing in out of home care.