Introduction: This document presents the policies of Whole Child International for the five-year period, 2018-2022. Increased financial support from public and private sector partners is enabling modest organizational, programmatic, and geographic growth during this period. As Whole Child grows and becomes involved more broadly in policies and practices that improve care, protection, and development of vulnerable children, we will continue to prioritize relationship-centered care – responsive, consistent care that engenders stable attachments and trusting bonds between children and their primary caregivers in a variety of settings.
Purpose of policy statement: These policies are the framework within which Whole Child supports technical assistance, training, and research to respond to needs of local partners. They also underpin Whole Child advocacy and communications to ensure their coherence and consistency.
Whole Child’s role: These policies are consistent with Whole Child’s role as a non-governmental organization — to help local partners proceed along the path of care reform. The point of care reform is to implement policies and practices that move the most vulnerable children from bad to increasingly better care and result in demonstrable improvements in the quality of care that can be plausibly associated with improvements in child well-being.
Whole Child performs this role by collaboratively strengthening local capacity. Whole Child helps partners evaluate policy and practice options in terms of workforce, systems, and data requirements; cost; and, most importantly, degree of sustainable impact on vulnerable children and families.
Whole Child’s comparative advantage: Policies are aligned with Whole Child’s comparative advantages in the international development community, which include:
- Our expertise in relationship-centered care, a priority on which relatively few NGOs focus.
- Our knowledge of institutional and residential care.
- Our demonstrated capacity to:
- Develop viable care models for use in low-resource settings.
- Apply tested models to improve the quality of care.
- Work in settings marked by high levels of violence, displacement, and poverty.
- Work collaboratively with the public and private sectors, NGOs, and academia.
- Our potential to:
- Assist partners with the development of pragmatic, nuanced care policies.
- Adapt relationship-centered residential care to a range of care settings.
- Support transitions from institutional to family-based care.
Policy alignment with global norms and standards: Whole Child policies are guided by the Convention on the Rights of the Child (CRC), which emphasizes the preeminent importance of children growing up in a “family environment,” and, for any child “temporarily or permanently deprived of his or her family environment,” calls for “alternative care” including, “foster placement, kafalah of Islamic law, adoption, or if necessary placement in suitable institutions.” Whole Child policies are aligned with the UN Guidelines for the Alternative Care of Children, which outline good practice in the provision of alternative care including the provision of residential care.
Policy refinement: Experience and evidence in key areas of care reform are limited. The development of policy in care reform is necessarily an iterative process. Whole Child will revise policies periodically as we accrue additional experience and data. We welcome and value comments on these policies and will factor them into future revisions.
Whole Child Policies
Policies to guide our strategic growth are categorized as:
- Policy goals
- Policy principles
- Policy on institutional care
- Policy objectives
- Political and development policies
1.0 Policy goals
Whole Child contributes to broad, long-term policy goals, including:
1.1 To end violence, abuse, and neglect of children wherever it occurs — in institutions, churches, schools, families, households, communities, the street, or, when children are displaced, migrating, trafficked, on the move.
1.2 To embed children without a safe, nurturing family within one, and to prevent children from being separated from family in the first place.
1.3 To provide the services and support that parents and caregivers need to succeed and that families require to remain intact and viable.
1.4 To ensure vulnerable children have the care, rights, and opportunities they require to overcome adversity and disadvantage and thrive as students, parents, and productive citizens.
2.0 Policy principles
2.1 Care reform policies and practices must lead to demonstrable improvements in the quality of care, which, in turn, must be plausibly associated with improvements in children’s well-being and developmental outcomes.
2.2 Care reforms must stand a realistic chance of being scaled up and sustained with local human and financial resources.
2.3. Successful reform is contingent upon expanding, training, remunerating and recognizing the social service workforce.
3.0 Policy on institutional care
End institutionalization: Whole Child joins the global community in calling for an end to large-scale, impersonal institutional care. Evidence of its harmful effects on young children is irrefutable.
Whole Child supports:
- The immediate closure of irredeemable institutions.
- Tighter regulation and oversight of remaining institutions.
- Mitigating harm and building resilience in children stuck in institutions.
- Redeploying human and financial resources from institutional to family-based care.
Institutional vs. residential care: Whole Child policy distinguishes between institutional and residential care. Residential care is small-scale, relationship-based care that emulates a family environment. Residential care has a role in virtually every country, including high-income countries with child welfare systems regarded as the most advanced. Whole Child supports locally led efforts to determine the optimal role for residential care be it treatment, emergency protection and safety, or interim care for institutionalized children on hold awaiting family placement.
Care transitions: Whole Child supports transitions from institutional to family-based care. Experience shows that transitions are complex, costly, and time consuming. In most countries, under the most hopeful scenarios, it will likely take years to generate the awareness, political will, funding, systems, and human capacity required to provide currently institutionalized children with safe, permanent family-based care and stem the flow of additional children into institutions.
Relationship-centered residential care: A vital interim step in some transitions is to convert institutional to residential care. This step involves changing operational policies and care giving practices in institutions. Whole Child calls this approach relationship-centered residential care. Research has shown such an approach can mitigate the harm of institutional care and improve developmental outcomes for children.
The sad reality for millions of children is that many will be in institutions for a long time. One estimate is that it will take until 2050 to place all children in families. In the meantime, Whole Child policy is not to forsake such children. They deserve safety, protection, and the best care possible under the well-known constraints of institutions. By being in an institution, children have been put in jeopardy. By neglecting them in institutions, they suffer double jeopardy.
Violence against children: A growing body of survey research documents high levels of violence against children. The prevalence of household- and community-based violence underscores the care with which transitions must be implemented. Carefully vetting families to confirm they have the capacity to provide safe, high-quality care requires system strengthening and investment in the social service workforce.
Whole Child policy is to help partners ensure that:
- Viable family-based care models are designed, tested, and scaled before institutional care is dismantled.
- Systems and human capacity to manage cases, support families, and track children are established before institutions are closed.
- Quality relationship-centered residential care is provided while the capacity to provide quality family-based care is developed.
- Deinstitutionalization is evaluated primarily in terms of improvements in the well-being of children in family care and not solely by the number of institutions closed, the number of children deinstitutionalized, or the number of children placed in families.
4.0 Policy objectives
4.1 Assist partners transition from overuse of institutional care to primary use of family-based care under the proposition that transitions are most effective when:
- Triage ensures children suffering the worst institutional care are first to get better care.
- Awareness is high of the developmental damage institutionalization can cause children.
- Practitioners of institutional care support, lead, or, at least don’t impede, transitions.
- Institutional care is seen as a temporary precursor to family care for most children.
- Knowledge of the epidemiology of violence against children informs care plans.
- Scaling-down of institutional care is synchronized with the scaling-up of family care:
- The pace of transitions is calibrated to the availability of vetted, supported families.
- Systems and human capacity to monitor children post-institutionalization and support families, caregivers and children are in place prior to
- Residential care resources and human capacity can be re-directed to day and family care.
- Child separation is prevented and the need for institutional care lessened by adequate support for at-risk families, including, but not limited to:
- Access to essential community-based services e.g. health (including mental health), nutrition, housing, education, water and sanitation.
- Quality day care that allows women heading vulnerable households to work.
- Social protection and poverty alleviation interventions.
- Transition progress is measured by improvements in children’s well-being in family care.
4.2 Assist partners in accelerating comprehensive care reform under the proposition that reform is most effective when:
- Political accountability for poor and vulnerable children is clear.
- Advocated by local champions, practitioners, politicians, etc.
- Tailored to the stage of care reform, e.g. early, middle, late.
- Nuanced to country-specific capacities, opportunities, and constraints.
- Legal constraints to reform are identified and lifted.
- Informed by assessments of political will, workforce capacity, and funding.
- Based on available evidence, which is typically limited.
- Tested alternatives are ready to replace outgoing status quo
4.3 Increase the use of relationship-centered care (RCC) in families and households.
- Family-based care is optimal and in children’s best interests, but quality of family care varies, is often unmonitored and unsupported, and can even be harmful.
- To strengthen care capacity, many families need help.
- The RCC approach can improve caregiving at the household level.
- Such improvements are fundamental to successful care transitions.
4.4 Increase the use of relationship-centered care in day care as a key component of Early Childhood Care and Development (ECCD).
Strengthens children’s resilience and facilitates healthy social-emotional development.
- Enables women heading poor households to work while children are safe.
- Income earned by women alleviates poverty and helps prevent family breakdown and child separation leading to institutionalization, living on the street, or irregular migration.
4.5. Increase the use of relationship-centered care in institutions as an essential element of care reform.
- Transitions from institutional to family-based care take time:
- Care reform — and poor and vulnerable children — are typically a low political priority.
- An estimated 2.7 million children — likely many more — are in institutions globally.
- Addressing poverty and other root causes of institutionalization is costly and complex.
- Developing family care with the requisite support/monitoring systems is costly/complex.
- Legal constraints to institutions transitioning to family based care must be lifted.
- The institutional care sector may naturally resist its reconfiguration or dismantling.
- Extreme care is required for transitions in settings marked by endemic violence.
- Many children will be in institutional care a long time awaiting better, safer care options.
- Under the CRC, such children have the right to care in “suitable institutions.”
- Some institutions are suitable, others can be made so, some should be closed immediately.
- Institutions can be made “suitable” by introducing relationship-based residential care.
- Relationship-based residential care:
- Is an ethical imperative as long as children have no better family care option.
- Is intended to be temporary, a transitional phase in the continuum of care.
- Constitutes incremental progress from bad to increasingly better care.
- Mitigates harm from institutional care.
- Prepares children for integration into families and improves chances of permanency.
- Mitigates harm from institutionalization and strengthens resilience.
- Lessens children’s propensity towards aggressive or violent behavior.
4.6. Increase relationship-centered care for children with disabilities.
- There are more than 90 million children with disabilities globally.
- Children with disabilities are among the most vulnerable,g.:
- They are most likely to experience physical abuse.
- They are least likely to attend school and access medical services.
- Whole Child implemented a successful relationship-centered residential care approach for children with disabilities.
- This experience can serve as a foundation from which to explore family care options.
- Whole Child will review recent literature and confer with key disability rights groups to evaluate whether and how we can help improve care for children with disabilities.
5.0 Political and development policies
Care reform depends upon policy reform in the broader political and development context in which we work. Whole Child therefore advocates the following policies that are fundamental to achieving lasting, significant improvements in the lives of poor and vulnerable children and families:
5.1 Elevate the political priority of vulnerable children and families.
- Children are touted as society’s hope, promise and future, yet are a low political priority.
- Political constraints to reform may be more difficult to address than technical constraints.
- Improvements in children’s well-being rely on good governance and civic engagement.
- There is experience and some evidence on how to boost children up national political agenda.
- Without greater political priority, public investment in children will be inadequate.
- Without greater public investment, the social service workforce will be too small to implement and scale care reform.
5.2 Put family strengthening and preservation at the core of development strategies.
- Families are the infrastructure on which economic growth and social stability are built.
- Stable, resilient families contribute to stable, resilient nations.
- Upstream investments in family strengthening help avoid downstream costs of conflict, violence, adversity, displacement, child separation, institutionalization, irregular migration.
5.3 Build state capacity to count, assess, triage and respond to their most vulnerable children.
- Budget constraints force prioritizing responses among a host of competing, compelling needs.
- Cost and feasibility of intervening to alleviate suffering are key factors in policy choices
- Social service workers are the intervention; strengthening the workforce is key.
5.4 Increase accountability of local government for the provision of essential community-based services to vulnerable children and families such as health, education, water, sanitation and housing.
- Lack of basic services exposes children to multiple vulnerabilities and disadvantages.
- Access to basic services is vital to healthy early childhood development.
- Access to basic services weakens the appeal of institutional care.
- National governments committed to deliver such services under the SDGs.
5.5 Alleviate poverty, the principle preventable root cause of much that plagues children.
- Poverty is a major contributor to family failure and child separation.
- Poverty is a major cause of institutionalization of children.
- Poverty exacerbates violence against children.
- Poverty limits public resources available to care for, protect and ensure healthy development of children.
- Poverty drives migration with its attendant risks.