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A two part overview and strategy for: Those working with children and youth in care mandated to rapidly* return to family.

* rapid return is characterised by compressed timelines that did not allow for adequate child and family assessment and preparation (Wilke, N. G., Howard, A. H., & Goldman, P. (2020).)

Preventing Orphanhood in India│1


Notes: •

Rapid return is not a recommended practice, however, when it occurs these strategies combined with tools, evidence based research and promising practice to offer ways to help children, families, communities and caretakers. These strategies mitigate but do not fully remove the risks involved in rapid return.

This document is a high level strategy and is not a tool. Our intention is that you combine these action steps with case management, record management, and monitoring/ evaluation tools that you select, adapt to your cultural setting, and constantly evolve.

The strategies are adaptations of the attached 'Model for Alternative Care Reform', to get more depth and explanations of what is involved in each step of the process, please refer to this document.

Please, please work collaboratively instead of alone or in a silo. Transparency, capacity building, collaboration and communication are imperative to be successful with any part of this strategy.

Author: Florence Koenderink, Family Based Solutions Design & Photography: Children's Emergency Relief International (CERI) Use for: Presented by Ian Forber-Pratt, Director of Global Advocacy, CERI on October 30, 2020 for a CAFO Webinar Series. Talk entitled, Practical Steps for Responding to Rapid Return Mandates

Copyright © FlorenceKoenderink2020.


For child care institutions who have been mandated to:

Rapidly* return children and youth to their families. Children not yet ‘home’

* rapid return is characterised by compressed timelines that did not allow for adequate child and family assessment and preparation (Wilke, N. G., Howard, A. H., & Goldman, P. (2020).)


Plan B: Strategy for Childcare Institutions Mandated to Return Children Fast Moving children from an institution back to their own family or into alternative family-based care is a very complex process that requires knowledge and understanding of what it involves. It also takes considerable time to be done properly. If not done properly, the risks to the children are high. Without thorough assessment, planning, preparation of children and the families they go to, and putting in place support and ongoing monitoring, the family is likely to be unable to cope. This can–and often does–lead to the child being sent back to the (or another) institution–another abandonment, which is very traumatising–or to the child being married off, forced to do heavy or dangerous work, being trafficked, ending up living in the street, or being stuck in an unsafe or abusive situation within the family. Just telling a child to pack her things and then dropping her off with her family is not acceptable, it puts the child at serious risk. Unfortunately, the COVID-19 pandemic has led to a growing trend of Governments ordering residential childcare institutions to move children out very quickly. Often in less than 90-100 days, sometimes even within just a few days. This is very worrying. While we all want the transition to family-based alternative care to happen as quickly as possible, ‘as quickly as possible’ does not mean in the shortest amount of time. It means as quickly as it is possible to do safely and in the best interest of the individual children. Work is being done to help decisionmakers understand that putting a deadline on sending institutionalised children back into the community is harmful and dangerous. However, for the institution itself, once the Government order comes, there is no choice but to comply, no matter how much you fear for the consequences for the children. This document was made to provide institutions who are forced to move children out in a very limited time with a strategy. This strategy will help make sure they do as much as possible to improve the chances of successful and sustainable reintegration of children into their families. The strategy laid out in this document should not be used when the process is not under inescapable, unreasonable time pressure.

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The strategy given here assumes a basic understanding of the process of responsible transition of care and provides sped up or adapted versions of the normal steps involved. These normal steps are outlined in the document ‘Model for Alternative Care Reform’. Keeping that document alongside this one will be helpful as a reminder and to get a full picture. If you do not clearly understand what the transition process involves, it is highly recommended that you reach out for training and guidance. You can reach out to the government or to NGOs working in this field. In this condensed strategy, some steps will be combined or moved to different stages. This is to ensure that the most important things are more likely to happen before the child has to move. How much of this you will be able to do, depends on how much time you are given and how much staff you can bring together to take on this challenge. The priority should not be to get children out as soon as possible, but to get as much of the necessary assessments and preparation done before you are forced to move the children out. It is important to understand that it will not be possible to do everything or to put everything in place before the child will have to move. Usually, everything is put in place before a child moves and after the move, the main remaining task is regular monitoring and review of the placement. That will not be the case in ‘rapid return’ situations. Under these circumstances, you have to do what you can before moving the child, and then continue the work to provide training, counselling and setting up of services after the child is back with her family. This needs to happen until everything needed is present and the child is safely integrated into the family.

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Transition Team, Recruitment & Capacity Building Someone needs to oversee and manage the work before and after moving the children. Usually, an external transition manager is recruited and as the transition process progresses the staff involved in work will gradually grow as needed. In a fast process, there is no time to do this gradually. To assess and prepare all children and families–or as many as you can manage–you are going to need as many people as you can get. You need to appoint someone to manage this process and the team working on it. There is no time for well-organised recruitment. Often, the manager or the director of the institution is the most appropriate person for this because he or she already knows all the children and the staff. Under these circumstances, the manager’s job will be almost entirely about getting the children out anyway once the order comes. Then, as many people as possible need to assigned to help with all the necessary work. You can reassign staff within the institution. If the institution is part of a larger organisation, reassign any staff that can be moved without creating situations of high risk or deprivation to the organisation and those it serves. If that is not possible, consider looking into very quick recruitment of temporary staff, if funds can be found to pay for the salaries. Make sure to still do background checks to see whether people are suitable to work with children. Where possible, people with experience in social work, psychology, and/or child development should be found. However, if there are some trained and experienced people present, they can help train and mentor people without experience in these fields to the level needed to take care of specific tasks. It is important to make sure that there are still people available to take care of the children while all this is going on. However, the work needed to prepare for moving children out needs to be a priority over almost everything else.

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Staff who are already familiar to or have a relationship with individual children, for whatever reason, should be matched with these children if they do assessments. This is because an existing relationship will make it easier to make the child feel comfortable and to get the information needed in the assessment. If there is a combination of staff working within the institution and staff normally working outside the institution being involved in the preparation work, those ‘outside’–who normally do not have direct contact with the children–should be assigned to do the assessments and home visits of the families. This is to reduce the chance of the Coronavirus being introduced into the institution by people going out in the community. The person doing the family assessment should be matched with the caseworker/psychologist assessing the child to work together on getting a full picture and writing a care plan. If possible, assessments of families should mainly take place over the phone or through video calling for Corona safety. However, at least one visit to the home needs to happen to assess the conditions of the living space and to witness family interactions. On these visits, protective equipment needs to be provided and apart from a tour of the house, conversation with the family should happen outside, properly distanced. All (newly assigned) staff involved in the preparation work will need to receive training. Because of the short time available, this training needs to happen as soon as possible and will have to be intensive. They will need training on: Individual assessment of children Assessing families Identifying strengths and needs Writing a care plan Child development Trauma-informed care (understanding the effects of growing up in an institution, the psychological and behavioural problems it causes. and how to deal with this) • How to prepare children for moving out • • • • • •

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The Children Usually, the children are told–in an organised, controlled way–about the plan to move them out of the institution at a relatively late stage. This is because it is necessary to have clear and concrete information to give the children that will help reassure them and help them understand what is going to happen. When there is a Government mandate to quickly move children out of institutions, the luxury of waiting to tell the children is no longer present. Children need time to get used to the idea of such a big change, and you need time to prepare them for moving out. So, as soon as the institutions receive the order to move the children out, a clear and reassuring message needs to be formulated. A message that is appropriate to the age and level of understanding of the children involved. You may need different ways of explaining things for different age groups or groups with different levels of development. As mentioned in ‘Model for Alternative Care Reform’ whether they are told as one group or as several groups, all children need to be told at the same time. You will find the explanation of why this is the case in that document under ‘Awareness-Raising & Advocacy.’ This message should explain that you are not trying to get rid of the children, but that the Government (or whoever issued the order) has decided that the children will be happier and healthier if they are not living in the institution. You should emphasise that you will gather information to make sure every child will go to the place that is best for him or her and that you will talk with the children individually to hear from them what they think would be a good place to live. This helps them understand the purpose of the individual assessments and make them feel less powerless. Explain that right now, you do not know where children will go or on what day they will leave, but that you will tell them as soon as you know. Also explain that while some children might leave sooner than others, this is no reflection on children’s worth and that no child will be left behind (and you need to make sure that this is true).

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In some places, the order given is to move all children out of the institution, while in other places it may only be to return children who have families to their family. In the latter case, the message needs to be adjusted a bit from what was suggested in the previous paragraph. You need to explain that you will look into whether children can return to their families while reassuring that children who do not have family or who cannot go back to theirs will still be cared for where they are. Let the children know that you will inform them as soon as you know whether they will be able to go back to their family and that you will discuss this with them. Particularly if there will only be very few children left after all the children with families have returned to them, you should consider organising alternatives–such as adoption or foster care–for these children after the deadline of the Government order has passed and the other children have moved out. If you know that you will move these children out to alternative placements too, the message becomes the same as the one first given, only you explain that children who cannot go back to their families will move at a later stage. As soon as the children have been informed that they will move out of the institution, you need to start preparing them for this big change. Things like counselling to help them deal with the shocking news, working on life stories, and gathering documentation on memories from life in the institution can start immediately. And as soon as you know where the child will go, you can help her become familiar with the people who will be caring for her and with the place where she will go to live. A word of caution: while it is entirely possible to move children with severe physical and intellectual handicaps into families (their own or alternative ones), this process CANNOT be rushed. Rapid return is not an option for these groups of children. Especially if they have been spending all their time in the same room–or even in their bed–for years. In these cases, a very slow and careful preparation period is needed. Without that, children like this have died from psychological shock. So you need to request an extension of the deadline for this group of children.

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Awareness-Raising & Advocacy Awareness-raising in the community, to reduce misconceptions about stigma and discrimination of certain groups of children, needs to start immediately and on as large a scale as possible. This is because the dangers of not eliminating stigma and misconceptions outlined in ‘Model for Alternative Care Reform’ will all still play a big role and are likely to cause placement breakdown or put children at risk in other ways. With a mandated rapid movement of children out of institutions, the Government is already behind the process, so there may be less need for advocacy. However, if possible, some advocacy should still take place. Particularly with regard to helping Government departments understand the essential need for policies of family strengthening and community services to make the return of children to their families sustainable.

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Individual Assessments Usually, the process of individual assessments is long. It requires building a relationship of trust with the child, combining assessment with counselling, and having assessments take place in the form of conversations rather than just lists of questions to be answered. This is to gain as much information as possible without causing serious stress for the child–in most cases, the child will not be aware of being assessed and does not know yet that there are plans for transition of care at this stage. With a very tight deadline, this is not possible. There will be no choice but to do intensive individual assessments while helping the child understand why all these questions are being asked and still providing some counselling along the way. Particularly if the child becomes distressed. A result of this will be that you will most likely not be able to get all the information you need from the child, particularly information that is sensitive or scary to the child. It requires an established relationship and a high level of trust to get the child to open up about these things, and there is no time to build these. However, given the circumstances, you will just have to work with what you can get. Although you are under a lot of time pressure, this should not lead to an attempt to do a complete individual assessment of a child in one conversation. There will still be a need to talk to each child and go over various things several times. And as explained in ‘Model for Alternative Care Reform’ individual assessment of children involves more than just talking with the children themselves. For greater efficiency of the overall process, it is helpful to try to determine in the first conversation whether the child is eager to be reunited with family or whether she is does not like this idea. Children who are eager are likely to still have a connection to their family, and that connection is likely to be a positive one. The viability of the child’s return still needs to be assessed further but fasttracking or prioritising these children will help move things along.

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It can help to have people doing the assessments report at the end of every day on which children were eager and which were resistant to adapt the planning on how to approach each of these groups. Children who are resistant should receive counselling to try to find out where this resistance comes from, whether there are risks or dangers that make a return inadvisable, or whether it is a different fear or anxiety (perhaps just the idea of a big change). Because the assessments–usually of many children–need to take place in a very short time, it is very important to make sure there is an easy system to capture all the information collected. There will not be time to put together elaborate reports on every conversation with a child. So there should be a clear protocol for the information that needs to be gathered in the assessments. It helps to have a template (or a CRM-style online system) where gathered information for each child can be filled in quickly and easily–without losing essential information–after each assessment. It is not a good idea to do several assessments in a row and then try to remember what each child said and fill in the information. The same goes for the assessments of the families. As explained in ‘Model for Alternative Care Reform’, the work does not end with gathering answers to a long list of questions and documenting them. This information needs to be analysed, discussed by a group of people with expertise in casework and psychology, and a detailed care plan needs to be written. This is not something you can skip or only do partially. If you do not develop a proper care plan, you put the child at serious risk.

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Training for Families As soon as family assessment and individual assessment together have shown that a return to the child’s family (whether her parents or extended family members) is in the child’s best interest, preparation and training of the relevant family members need to start. To be suitable to take in the child, the family members need to agree to continued monitoring–and support where necessary–after the child has been placed. Otherwise, it is not possible to ensure the child is safe and well there. Training of family members should include: • Positive parenting and disciplining techniques • Understanding the effect of institutionalisation on the child, the behaviour that this is likely to cause, and how to deal with this effectively • Any special care needs of the children, such as HIV management, understanding developmental delays and how to handle them, understanding treatments and therapies needed by the child and being able to support them • Awareness of services/support available and how to access them • How and whom to ask for help when needed It is essential to find out what the original reason was for the child ending up in the institution and that reason needs to be addressed, whether through financial support, through counselling or training, or through connecting the family with available services and support. If you do not address the original reason for institutionalisation, it will almost always still be a problem, and it is almost certain to lead to a placement breakdown, even if initially things seem to go well.

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It is important to be aware that most of the families of children in institutions will be worse off now, because of the COVID-19 pandemic or the restrictions put in place to prevent its spread, than they were when they placed their child in an institution because they felt unable to raise him themselves. If you do not acknowledge and address this, the chance of successful reintegration of the child into the family is very small.

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Making Sure Services Are Available The short time given to move the children out of the institution will almost certainly not allow for the design and setting up of the community services necessary to support the children and their families. However, you can create an overview of the services that are already provided and contact the service providers to develop partnerships, ensuring you can refer families there and that they will receive help from them. This partnership can even extend to the service providers helping with the process of moving out the children if they can be persuaded. After discussing with your team what is needed, it may also be worth looking into whether there are organisations in the relevant areas that might be willing and able to design and set up support services in the community, while you focus on preparing children and families for the transition of care. This does not mean that your part in the design and development of services can just be ignored or left out. It just means that this will most likely need to be postponed and done once the children have moved out of the institution. At which point, it will also be possible to redirect resources from the institution into these services.

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Children Who Cannot Go Back to Their Family As mentioned above, the order received from the authorities is not always the same. Sometimes, it only demands children with families to be returned to them, in other cases it demands that all children are moved out of the institution. In the latter case, the information in this section will have to be part of your strategy. In the former case, you may want to consider finding or setting up family- or community-based placements for the remaining children after the order deadline has passed and many of the children have moved out of your institution. If you are considering this, it would also be useful to look through this section. In most cases, most children will be able to return to their family, with the right preparation and support. However, that does not mean that this is possible for or in the best interest of all children. When the individual assessments are done, an overview needs to be made of how many and which children cannot go back to their family. For these children, different placements can be considered. For example: • Supported living (children aged 16 and over living in small groups within the community, with a mentor who helps them develop the skills needed to live independently) • Adoption • Foster care Unless things like supported living arrangements and foster care are already in place, and accommodation is available and foster parent and mentors have been selected, assessed, and trained, it will not be possible to put them into place within the time given by the Government to get the children out. You will need to appeal to the authority giving the order to extend the deadline for these children, so you can develop the placements they need. 13 | Working with children mandated to rapidly return to family


It is during the stage of developing these alternatives to returning children to their families that redirection of resources–human, financial and material–will come into play. While you are fighting to get everything done before the fastapproaching deadline to move most children out, you will not be able to spare the human or other resources and put them elsewhere. Once that deadline has passed and a significant number of children has moved out of the institution, there is more room to provide staff with the necessary training for their new jobs and to move people and materials around to places where they will do the most good in the new system. This is explained in more detail in ‘Model for Alternative Care Reform.’ It is generally not possible to free a child up for adoption–making sure that all requirements are met–in the short time given in the rapid return orders, let alone getting them adopted. So for these children, a deadline extension is also necessary.

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Monitoring & Evaluation The monitoring and evaluation of the stages of awareness-raising & advocacy, capacity building, etcetera would be helpful and would make work more effective, however, it may not be realistic when there is so little time and so much work to do with a limited number of people. Monitoring, review, and continued support of children returned to their families– and children moved to alternative placements if relevant–cannot, under any circumstances, be left out. This is an essential part of making sure that children are safe and finding their place in their family, and that the family is coping with having the child back in their midst. As mentioned before, it is unlikely that you will have everything necessary to support the family in place when the child moves out of the institution. So work needs to continue to reach that point. Along the way, you need to regularly assess and review whether the child is safe and thriving, whether needs are changing, and whether he needs more or different support to give the reintegration a chance of success. Any time you discover this is the case, you need to write and agree on a new care plan with the family, and the support provided needs to be adjusted. Monitoring and review should continue until the family and the child have needed no support or intervention through your organisation for at least 6-12 months and are doing well.

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For those caring for:

Children who have been rapidly returned to their families. Children already ‘home’ Turning rapid* return into reintegration

* rapid return is characterised by compressed timelines that did not allow for adequate child and family assessment and preparation (Wilke, N. G., Howard, A. H., & Goldman, P. (2020.


The COVID-19 pandemic has caused tens of thousands of children

worldwide to be moved out of institutions and returned to their families with little or no preparation or support. This happened because of a government mandate, because people running ‘orphanages’ for profit no longer found it profitable when income from visiting volunteers and donors dried up. In some cases, although the institution provided year-round care for the children, it called itself a school and schools were closed as part of lockdown restrictions. Whatever the reason for the rapid return of children to their families, it poses significant risks to the children. In certain situations, children were told to pack their things and dropped off at the home of their family with whom they had not been in contact for years. Moving children from an institution back to their own family or into alternative family-based care is a very complex process that requires knowledge and understanding of what it involves. It also takes considerable time to be done properly. If not done properly, the risks to the children are high. Without thorough assessment, planning, preparation of children and the families they go to, and putting in place support and ongoing monitoring, the family is likely to be unable to cope. This can–and often does–lead to the child being sent back to the (or another) institution. The child experiences this as another abandonment, which is very traumatising. Or it can lead to the child being married off, forced to do heavy or dangerous work, being trafficked, or living in the street. The child can also end up being stuck in an unsafe or abusive situation within the family. A lot of work is being done to prevent having children moved out of institutions very quickly, and to raise awareness about the dangers connected to rapid returns. Hopefully, this will be effective in preventing more of them, however, this does not improve the situation of children who have already returned to their family. The strategy in this document provides guidance on what is necessary to give children who have been returned to their families with little or no preparation or support a chance of properly reintegrating into their family and finding their happily ever after there. This strategy should only be used to help children who have already returned to

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their families. It is NOT a way to skip the stages involved in the responsible handling of the transition to family-based care and to speed things up. Moving a child into a family (their own or an alternative one) without the preparations explained in ‘Model for Alternative Care Reform’ puts a child at serious risk. While using the strategy laid out in this document will mitigate this risk to a certain extent, it will not completely remove it. It is important to be aware of the difference between reuniting a child with his family and reintegrating a child into his family. Reuniting a child, or taking a child from an institution and dropping him off at his family home, will not give the child or the family much chance of success. The situation will often not be sustainable. The chances of problems arising out of stress, fear, and challenging behaviour leading to a placement breakdown are high. The aim needs to be reintegration. This means the preparation, planning, training, guidance, support and monitoring needed are there to help the child really find his place inside the family again. And also to help the family cope with having the child in their midst again. When the child has already returned to his family, the steps usually taken before a child is moved and needed to give the placement a chance of success have to take place with the child already in the family.

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Create and Train a Team If your organisation is going to be involved in helping formerly institutionalised children reintegrate into their families, you will need to put together a team. The team should include members with knowledge and experience in child protection, casework, and psychology. It needs to be big enough to handle the workload of supporting the relevant number of children and families in your area. So, you will need to start by gathering data from your area or district to find out how many children were moved out of institutions and returned to their families with little or no preparation. This will give you an indication of the workload that you will be dealing with and how much staff you need to handle it. All staff will need to receive training, particularly to help them understand the specific risks involved in the rapid return of children to their families. They will need training on: • Individual assessment of children • Assessing families • Identifying strengths and needs • Writing a care plan • Child development • Trauma-informed care (understanding the effects of growing up in an institution, the psychological and behavioural problems it causes. and how to deal with this) • The risks that children face when moved back to their family without assessment and preparation • The support services available to which they can refer families to help them cope better • Safety measures to prevent infection or spreading of COVID-19 because numerous house visits will have to be made; this is a serious concern and staff members should be provided with protective equipment 18 | Working with children mandated to rapidly return to family


• Protocols for o

Making house visits

o

Doing assessments

o

Writing care plans

o

Providing counselling

o

Providing training

o

Reporting

o

Monitoring and review

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Trace Children The first step in the work will be finding the children. This starts with requesting information or records from an institution that sent its children home, or from the authorities that issued the order for the move for each child. This sounds straight forward enough but may already form a significant challenge. If it is not possible to get information from these sources, you can try finding out more from the school the child attended. You can also try to get information from people living near the institution who might have interacted with the children there. Once you have received or gathered information about the probable location of the child, you will need to check whether he is actually there. Because sometimes, that will not be the case. If the child is not where he was expected to be, try to gather more information from the people there–family, neighbours and other community members. Ask whether the child has been there and where the child might be now. As mentioned before, the child may have been trafficked, married off, sent to earn money somewhere. He may also have been thrown out of the house or have run away and now be living in the streets. In these cases, it can be very hard to find the child again, but you must make every effort to find out where each and every child is. It can be useful to seek the help of local antitrafficking organisations, or organisations working with street children if you are unable to find certain children.

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Assess Both the child and the family should be assessed before you write a care plan, which should happen before a child is moved out of the institution. However, in the case of rapid returns, this was usually skipped and still needs to happen. There has to be an Individual Assessment of the child. The assessment includes all his likes and dislikes, his strengths and challenges, and his thoughts and opinions on what it is like to live with his family again. And there also has to be a detailed assessment of the family, their living conditions, family structure, ability to cope with raising their children and any other strengths and challenges. They too should be encouraged to be open about what it has been like to have the child back in their midst and whether they feel they need any support. If the assessment of the child indicates that he needs urgent medical care– because the family had not been properly informed of the child’s needs or because they cannot afford the medical care required–you should give this top priority. Before doing anything else–including continuing the assessment– the child should be taken to a doctor and provided with the care he needs. It is essential to find out what the original reason was for the child ending up in the institution. That reason needs to be addressed, whether through financial support, counselling or training, or connecting the family with available services and support. If you do not address the original reason for institutionalisation, it will almost always still be a problem. Even if things seem to go well initially, it is almost certain to lead to a placement breakdown. It is important to be aware that most of the families of children in institutions will be worse off now than they were when they placed their child in an institution because they felt unable to raise him themselves, because of the COVID-19 pandemic or the restrictions put in place to prevent its spread. If you do not acknowledge and address this, the chance of successful reintegration of the child into the family is very small. 21 | Working with children mandated to rapidly return to family


As explained in ‘Model for Alternative Care Reform’, the work does not end with gathering answers to a long list of questions and documenting them. This information needs to be analysed, discussed by a group of people with expertise in casework and psychology. Then, you need to write a detailed care plan. You cannot skip this step or only do it partially. Without a proper care plan, you put the child at serious risk. While assessment of children and their families can lead to a list of actions for providing support and guidance to enable the integration of the child into the family, this is not always the outcome. Sometimes the assessment will make it clear that it is not safe or in the child’s best interest for him to stay with his family–or, in the case of children found in other locations, for them to return to their family. In these cases, you should skip ahead to ‘Organising Alternative Care if the Family Situation Is Not Safe’.

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Retroactive ‘Preparation’ Even though preparation should happen before a child is moved, the fact that it is too late for that, does not mean you can skip the things mentioned here. They are essential in improving the chances of successful reintegration.

Counselling Usually, there is a considerable period of preparation involved in moving children out of an institution. This gives both the child and the family the chance to get used to the idea of this big change and allows them to become more familiar with each other before they live together again. Skipping this preparation stage can have very serious effects on the emotional well-being of both the child and the family. It can make the adjustment to the new situation very challenging. Because of this, the child and the other family members should be offered counselling separately–and possibly together as a group as well–to help everyone process and deal with what has happened. Allowing the different family members and the child to express their fears, frustrations, hopes, dreams and possibly even anger at what is happening can help them all relate to each other much more positively and make it easier to adapt to the new situation. Depending on the background and experiences of the children, they may require counselling for quite some time. A word of caution: while it is entirely possible to move children with severe physical and intellectual handicaps into families (their own or alternative ones), this is a process you CANNOT rush. Rapid return is very dangerous for these groups of children. Especially if they have been spending all their time in the same room–or even in their bed–for years. . In these cases, you need a

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very slow and careful preparation period. Without this period, children like this have died from psychological shock. If you encounter a child like this who has suddenly been returned to his family, you will need to provide very intensive counselling by a psychologist with extensive experience working with children with developmental delays experiencing extreme trauma. This expert will have to work with the child to try to relieve the trauma and the shock before it becomes so overwhelming that the child loses the will to live. The child’s family will also need counselling to help them understand what the child is going through, and possibly to help break down stigma or misconceptions about why the child is behaving the way he is.

Training Parents It may be hard to persuade families of the need for training to take care of their own children. However, the children returning to the family are not the same as they were when they left. The children have been institutionalised, and this has profound effects on their development and their behaviour. If their family does not get help to understand and be prepared for this, and has not learned how to deal with it, the child will probably not be safe living with the family. They may also end up being kicked out of the house, which is an extremely traumatic experience for the child. This risk exists because the trauma and improper brain development experience by the child are very likely to lead to challenging behaviour, which without understanding is often seen as badness, disobedience, ungratefulness, or even as possession by evil spirits. Part of the training given to parents should include explaining to family members the need to agree to continued monitoring–and also support where necessary. Otherwise, it is not possible to ensure that the child is safe and well there.

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Training of family members should include:

• Positive parenting and disciplining techniques • Understanding the effect of institutionalisation on the child, the behaviour that this is likely to cause, and how to deal with this effectively • Any special care needs of the children, like HIV management, understanding developmental delays and how to handle them, understanding treatments and therapies needed by the child and being able to support them • Awareness of services/support available and how to access them • How and whom to ask for help when needed

Providing Support and Services Just expecting the family to take care of the child, when previously they felt unable to, to the point of sending the child to an institution, is not realistic. Most families will need significant support services. The services they need will depend on the local situation, the family situation, what the children need, and what is already provided for. However, it is important to realise that the range of services that need to be in place is extremely wide. It ranges from general things like schools and healthcare that are accessible, to specialised services like community-based rehabilitation, support for HIV management, income support. It also includes various forms of support for parents who struggle to care for their children without it, such as treatment for addiction or counselling to overcome trauma. Again, usually an overview would have been made long before children are moved out of what services are available in the community and which ones are not available yet, but are necessary for families to be able to successfully care for their children. Since this did not happen before it will need to happen

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now. Get in contact with organisations providing relevant services to see if you can form partnerships. And investigate ways of designing and setting up new services either by yourself or in cooperation with other organisations. When designing services, you need to take the necessary services as the basis for the planning, not what is already there or most convenient to provide. When something is already available, that is great and very helpful. But if the child or family needs something that is not available, you will have to make sure that it will be arranged, or the placement of the child is likely to break down. Services need to be designed in a way that is inclusive and accessible to everyone in the community. Children with and without disabilities or other special needs should be able to make use of the services provided without discrimination or segregation.

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Organise Alternative Care if the Family Situation Is Not Safe With the support outlined in this strategy, most children will be able to stay with their family. However, that does not mean that this is possible for or in the best interest of all children. After the individual assessments, an overview needs to be made of how many and which children cannot safely stay with their family. And for children in a situation outside of their family, you need to assess whether it is possible and safe for them to return to their family. If living with their family is not an option, different placements can be considered. For example: • Supported living (children aged 16 and over living in small groups within the community, with a mentor who helps them develop the skills needed to live independently) • Adoption • Foster care Again, you will need to see whether these alternative care placements are already available, or whether you–or another organisation–could and should set them up to make sure that all children can grow up safely in a family or within the community.

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Awareness-Raising & Advocacy Raising awareness in the community to reduce misconceptions about stigma and discrimination of certain groups of children needs to start immediately and on as large a scale as can be managed. This is because the dangers of not eliminating stigma and misconceptions outlined in ‘Model for Alternative Care Reform’ will all still play a big role. They are likely to cause placement breakdown or put children at risk in other ways, even when the children have already returned to their families. Raising awareness in the community is also necessary for the dangers of child marriage, and the vulnerability of certain children to being trafficked–and the life this often leads to. Advocacy is needed particularly to help Government departments understand the essential need for policies of family strengthening and community services to make the return of children to their families sustainable.

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Establish Monitoring and Review Monitoring, review, and continued support of children returned to their families–and children moved to alternative placements if relevant–cannot, under any circumstances, be left out. This is an essential part of making sure that children are safe and finding their place in their family. It’s also essential to make sure the family is coping with having the child back in their midst–a situation that can change over time. Along the way, you need to regularly assess and review whether the child is safe and thriving, whether needs are changing, and whether more or different support is needed to give the reintegration of the child a chance of success. Anytime you discover that this is the case, you must write and agree on a new care plan with the family, and the support provided needs to be adjusted. Monitoring and review should continue until the family and the child have needed no support or intervention through your organisation for at least 6-12 months and are doing well.

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Copyright © Florence Koenderink 2020.

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