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Residential Care and What's In the Best Interest of a Child
by Ronne Rock
Posted on Tuesday, October 10, 2017
When it comes to providing a full continuum of support for orphans and vulnerable children, the topic of residential care has been a lightning rod for more than a century. Opinions are often polarizing, and those who long to serve orphans often find themselves in the crossfire of heated arguments.

UNICEF and other organizations encourage government leaders and judges in developing countries to place children in family settings rather than in group home environments. Orphan Outreach President Mike Douris has seen both the benefits and pitfalls of residential care. He agrees that family-based care for children should always be the priority. “Our focus need never waver when it comes to kids. We need to be diligent in asking ‘what is in the best interest of the child.’  The needs of the child should always be the central focus of the modality of care rather than a general predisposition of a certain philosophical approach.’”

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In March of 2017, a fire that killed 41 young women at a Guatemalan government orphanage made global headlines when it exposed serious negligence on the part of both the government and staff in the care of the children who lived at the facility. Abuse victims and juvenile offenders were placed in the same facility. Judges also placed children into the facility at the request of families unable to manage their children’s behavior. The result was significant overcrowding and an unsafe environment for the children. Little counseling and protection were offered to those suffering from trauma.

In countries like Haiti and India, orphanages are often no more than boarding schools for families wanting to ensure good nutrition and quality education for their children. And decades-old documentaries revealing abuses in eastern European orphanages are still used to advocate for the eradication of all forms of residential care. Douris agrees there is an over-dependence on residential care and that healthy alternatives must replace programs that exploit and oppress children.

But, he warns, the wholesale eradication of residential care is not the answer.

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Since the tragedy In Guatemala, the government facility was closed, and scores of children were either moved to other facilities or reunified with families in a process called “expedited relocation and family reunification.” Special needs children and infants were not provided proper evaluation, and were forced into homes ill-equipped to provide care. And unfortunately, not all of the reunifications have been healthy. “Report upon report of children being returned to families with a history of abuse and neglect are emerging,” Mike shares. “There are confirmed reports that some children who were reunified have indeed died.  Reunification is an important goal for children.  That is the first and ideal situation for a child at risk.  The issue is that when reunification is done with incomplete evaluation, preparation, and follow-up monitoring, the results can be devastating.  This is what happened in Guatemala. There are first-hand accounts of children who were reunified with parents in an expedited and unsafe manner after begging not to be sent home because they knew there would be continued abuse, neglect, and in some cases trafficking.”

Mike explains, “Guatemala is an example of many developing countries who are overly dependent on residential care.  There are just over 300 children in government homes now that the large home in Guatemala has been closed (at one time, the facility housed more than 800 children). The private sector homes now have about 5,000 children in care.  Obviously, a more complete continuum of care is needed - with more options for children.  Foster care is emerging very slowly - and it will be a long time until there is any real capacity to meet the need.  My argument is that the push to close homes before developing a quality alternative is putting children at significant risk.  What is needed is a rational process to develop alternatives and transition children into other viable, quality forms of intervention.  The dependency on residential care will naturally reduce as other alternatives build capacity to meet the needs of children.

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“In the United States, orphan care looks decidedly different than it does in many of these developing countries. States have developed a wide array of alternatives to meet the needs of children in the protective system.  Some mistakenly think that there are no residential programs in the United states. However, group homes and residential programs continue to offer sanctuary and intensive therapy for children who have been traumatized.  Most residential programs provide more intensive care and specialized services, with the goal of providing permanency once the child has their presenting issues addressed.  Foster care is a well-developed form of care and provides family settings for children removed from their homes due to a variety of circumstances.  Foster-to-adopt is the primary way children whose parents lose their rights, due to abuse or neglect, receive forever families.  Family reunification is the primary goal for children, but when that’s not possible the states have well-developed alternatives to provide permanency.

“There is a significant push to develop foster care in developing countries, which has resulted in much demonization of residential care.  Studies from major universities have demonstrated significant impact on brain development in children who are in institutional settings.  Those reports are used by many advocates who are pushing for the closure of all residential programs." Those advocates often assert that foster care and family reunification are the only ways to address the needs of children in the protection system. However, the statistics from a Duke University study measuring outcomes for both children in foster care and children in residential care reveal that children in quality residential care and those in quality foster care show similar outcomes. “It doesn’t mean that the foster care model is inadequate or residential is the best for every child, but it does clearly indicate that any program of care for a child, when managed well and focused on best practices, can result in good outcomes for children,” Mike continues.


But do models of high quality residential and foster care exist for children? Mike nods. “There so many wonderful programs for children around the world, run by very dedicated individuals who do it for the right reasons and who pursue excellence on behalf of the children they serve.  In Guatemala, for example, we at Orphan Outreach have the privilege to partner with Hope & Future, a home for young mothers and children who have been victims of sexual exploitation and trafficking. And in India, we support a residential and community care program for both children and families infected or affected by HIV.” In both programs, care is holistic, individualized, and Christ-centered.

“That is why it breaks my heart to hear those who would demonize and question all residential care providers and stereotype them as exploiting children for money and enriching themselves at the expense of children.  Of course, there are many bad actors out there – and they need to be closed - but there are many who are providing care at great personal cost because they love the children they serve.”


Orphan Outreach supports programs that reflect the full continuum of care.  The global nonprofit is working directly with governments in developing countries to establish best practices for the care of traumatized children and to develop privatized foster care models as an alternative to residential care.  The ministry is also at the forefront of mobilizing local churches in both the United States and developing countries around the world to engage in orphan care, from advocacy and mentoring to foster care and adoption. “Most developing countries do not have a developed foster care system or an adoption culture,” he says. “It is essential that we come alongside those countries to help raise up future leaders who will truly advocate for the rights of children in their own communities – who will open their homes or invest deeply in residential programs, become foster families, adopt or provide support to struggling families in their communities.

“My contention is that we need the full continuum of care for orphans and vulnerable children, with a goal of providing families for as many children as possible.  But the reality is that there will always be a greater need for families than there are families who have the capacity to care for orphans and vulnerable kids.  So, high-quality residential and foster care are essential.  Yes, there are residential programs that are truly horrible and incompetent.  But the reality is there is also abuse within foster care systems and corruption in adoption. Those issues need to be exposed and addressed.  The goal for everyone who advocates for children is quality of care throughout the full continuum care and to let the needs of the children guide us in the modality of care that is needed.”

Mike adds that not all children who have been traumatized due to abuse or neglect are able to function well in a traditional family environment. “I’ve been working with children for four decades now, and I’ve seen time and time again children who prefer a group setting in order to find healing.  The intimacy of a family can be too triggering and difficult for some children.”


The full continuum of care, as Mike notes, begins with family preservation – of empowering and equipping vulnerable families to better care for their children so that those children may remain in their own homes. If that family structure is disrupted due to abuse, neglect, or death, the child needs a safe home to receive nurturing, healing, and worth. That home may be with relatives, a foster family, or it may be a high-quality group home. And if the child is declared an orphan, either because the parents have died or the courts have removed parental rights, then adoption is the hope and dream for those children. When adoption is not possible for any reason, a well-developed system offering the most comprehensive range of care is needed to provide the best form of permanency, meeting the unique needs of every child.

“We need balance and quality care,” Mike says. “Let the needs of the kids dictate what kind of care that is needed, rather than a predetermined philosophical bent, which lends itself to political correctness instead of embracing the complexity of the reality on the ground.  Too often we want to define a problem with a headline and solve it with a tweet.  But the issues we face in meeting the needs of children are complex.  To provide quality care for children, it is essential to embrace that complexity and not over-simplify it, or we are at risk of not fulfilling our mandate to care for children who are depending on us to serve them well.”


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