207 – The Harms of Institutionalizing Children

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Dr. Sandie Morgan and Dave Stachowiak are joined by Leonie Webster, a U.K. trained healthcare and clinical professional. They discuss the downfalls of institutionalized living and a harm reduction model that could provide a solution.

Key Points

  • Typical consequences of institutional living can include disturbances or delays in psycho social relationships, learning, cognitive development, physical growth, speech, social development, emotional intelligence, or boundary setting.
  • Having a primary caregiver to respond to infants will promote healthy cognitive development, but in institutional settings there lacks consistency of employed caregivers, which promotes one of the greatest challenges in long term institutional living.
  • Leonie considers introducing a harm reduction model that includes three preventative subgroups, and is evidence-based in its approach, while remaining child-focused and trauma informed.


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Dave [00:00:00] You’re listening to the Ending Human Trafficking podcast. This is episode number 207, The Harms of Institutionalizing Children.

Production Credits [00:00:09] Produced by Innovate Learning, maximizing human potential.

Dave [00:00:30] Welcome to the Ending Human Trafficking podcast. My name is Dave Stachowiak.

Sandie [00:00:35] And my name is Sandie Morgan.

Dave [00:00:38] And this is the show where we empower you to study the issues, be a voice, and make a difference in ending human trafficking. Sandie, one of the things that I so appreciate about our work together is just how many amazing and wonderful partnerships you have built around the world. And not only are those partnerships and friendships, but just how much we are able to learn from so many of the different people and organizations that you’ve had the privilege to work with over the years, and today’s no different right.

Sandie [00:01:09] Absolutely. And I have to say too, Dave, that it was such a pleasure to be on your podcast to talk about overlapping networks and this is an example of overlapping networks. I have been partnering with Open Gate International and then they introduced me to our guest today, Leonie Webster, who is a UK trained health care clinical professional, a certified nurse, midwife practitioner, and she has academic and professional expertise in neonatal, and attachment deinstitutionalization, trauma-informed care, policy and reform for prevention of child maltreatment, and it goes on and on. And she’s got 20 years of experience serving internationally. And in fact, lived in Honduras for seven years. I’m very excited to welcome Leonie to our show.

Leonie [00:02:12] Thank you for having me.

Sandie [00:02:14] Alright. So, we’re going to talk about some of your work, but let’s talk a little bit about your own personal experience and especially what you learned by living in Honduras for seven years and one of the biggest takeaways.

Leonie [00:02:30] Yes wow, where do we start? That’s a loaded question. Yes, I first went to Honduras in 2003, mainly for a short time missions’ trip to go and observe clinical need within the remit of midwifery and obstetrics. And I was thrown into the arena of orphan and vulnerable children because the clinic that I worked in was next door to an orphanage, a residential facility. And I quickly became aware of the huge needs for legally orphaned and vulnerable children at high social risk, especially in a country with high conflict and political instability.

Sandie [00:03:22] So, you were there. And were you working all the time in the orphanage?

Leonie [00:03:30] I was invited to partner with some international missionaries who were looking after 17 children in a very small beautiful Christian orphanage. And I quickly saw the realities of early institutional living for children who were legally abandoned or orphaned.

Sandie [00:03:55] And what were some of those consequences for those children in their development?

Leonie [00:04:01] So, when I was working in the orphan place, a typical affects and consequences of institutional living largely depends on the age of the entry and how long the child remains in the residential [00:04:15] facility. But I saw a catalogue of symptoms and behaviors amongst the children psychosocial relationship problems, learning delays, cognitive development delays, disturbances and delays in physical growth, speech, social development, low emotional intelligence, and inappropriate lax or absent boundaries setting. [26.5s] Many of these behaviors just seemed normal amongst the children. Also, just incidences of anxiety, withdrawal, depression. It was really quite apparent very quickly that all was not well within the walls of a Christian residential facility.

Sandie [00:05:03] And I think I want to make it really clear that all of this is well-intentioned and the basic life needs are there. There’s food, there’s a place to lay your head, there’s safety, the doors are locked, but something happens in the institutionalization of children that interferes with their normal development. And we took a team here from Vanguard to Romania one year, and one of the activities that our students did as part of touched Romania, we visited a hospital, a state-run hospital, and spent two hours holding and playing with babies and toddlers. And this was an everyday outreach activity because in the state-run facility for those babies and toddlers, there was very little staff to do that for those babies. And that’s an important aspect of their normal development, play and being held is important.

Leonie [00:06:18] Absolutely. And not only being held but being seen and being valued. And I think one of the greatest challenges of long-term institutional living is for the most part it’s run by lay personnel employers, so the children remain in a constant state of uncertainty and anxiety because they’re not parenting. And then also, there’s no guarantee that that primary caregiver the employment of the orphanage is not going to leave. So, these children who are already vulnerable and have often have symptoms of PTSD, they have no certainty that the one person who was caring for them right now will remain, so obviously an orphanage losing employers have large amounts of children to look after and certainly chose and needs of the organization often supersede the needs of the child. So, lack of autonomy, lack of individuality, lack of connection and one on one care is really lacking. Subsequently, the harmful effects on the children.

Sandie [00:07:36] Well and some cultures have a different way of approaching child rearing as well. I lived in Greece for 10 years and my background in pediatrics made me especially close to the women having babies. And so, I would find myself in the hospital with someone and their newborn and I would have older members of the family there. And when the baby was in the bassinet, I’d run over and pick the baby up and they would say no no no don’t do that the baby will want to be picked up all the time. And that was a tradition passed down from generation to generation. So, that becomes part of how children are raised in those kinds of institutionalized settings to0 based on cultural practices. Is that right?

Leonie [00:08:29] That’s right. And I come across incidences like this quite frequently, Dr. Sandie, instances of conflict of desiring to do what is right on behalf of the child, best practice initiatives for the child, wrestling with the culture of whatever nation that we’re in. My question often is, how do we as international, professional NGO workers, how do we respond when cultural norms impinge upon evidence-based findings or worse impede upon human rights and human development of the children in our care?

Sandie [00:09:11] Well, do you have a good answer for that? Oh, that’s a great question, let’s break it down. Let’s talk about the evidence. Let’s give a couple of examples of the evidence.

Leonie [00:09:25] Well, when we’re dealing with young babies, infants, and neonates, obviously the formative years are incredibly important. They are the building blocks and the structures of which cognitive development will continue. So, ideal best practice would be with the parents. It would be with a primary caregiver, a member of the family, or an extended member of your family, someone who will when you cry, they will come. They will meet your needs. There’s eye contact, there’s touch, there is comfort, there is immediate response to hunger, and there’s love. We speak a lot about best practice initiatives when child rearing and raising children, but ultimately children were designed to receive love. And sadly, in institutional settings, love from a committed parent is absent and we exchange love for management. So, these young infants, neonates, children under three their building blocks, their foundational pathways are severely hindered in the absence of a primary caregiver and love.

Sandie [00:10:49] I absolutely agree. I understand that developing an attachment to a primary caregiver, whether it’s a parent or a stable caregiver, is a primary goal for an infant for them to learn that when they cry someone sees them, someone hears them, and responds. And when we don’t respond, that reinforces distress and anxiety. And it doesn’t promote a healthy cognitive development either. I’m always encouraged when I see parents, new parents especially, and caregivers that are working in institutions, hospitals that are so willing to stop whatever they’re doing and attend to a newborn because that newborn learns that they’re important, that they’re valued. If we wait and show up when they’re 12 years old and tell them you’re beautiful and you’re valued, we’re a little late to the game. So, how can we begin to change our programs because we have thousands of orphanages that will need to come up to speed to better serve those that they really intentionally and with good intentions want to help. What steps can we take?

Leonie [00:12:25] Well I don’t think there’s a blanket response to how we can avoid the harmful consequences of institutionalized living. What I believe we can do is introduce a harm reduction model which is evidence based in its approach, which is child focused and trauma informed. . And those harm reduction framework models can be broken into three preventative subgroups. First subgroup the primary prevention measures. They may come as provision and access to preventative measures such as family planning pre and post-natal maternity health service and access to those. Simple things like the elimination of poverty, the prevention of child exploitation and early marriages, the provision and access to multidisciplinary support teams and wraparound cares for single parents. And then also enhance training into the prevention of trauma abuse and neglect within residential setting through evidence based, trauma informed training for direct primary care givers.

Sandie [00:13:42] So, that first module then is really aimed at strengthening the family base, that mother, so that they can keep their child?

Leonie [00:13:52] Absolutely, and then also we have a model here in the UK. We have foster placements for both mother and baby. So, let’s say, a young mom with three children is abandoned by her partner. He leaves and she’s left home alone with three children, she does not have a career, she doesn’t have an education. How is she going to be self-sufficient and provide for her family? And what we found here in the UK, that the provision of foster homes for mother or parent and child really does help. Usually within the first 12 months just helps provide a safe place for mother and child until the mother can gain employment and find a secure home.

Sandie [00:14:42] Wow that’s great. Okay, second?

Leonie [00:14:47] There’s secondary preventative measures would be provision and access to professional aid community-based family care models. For example, reunification of accurately placed deinstitutionalization when biological family options are feasible and safe. And then also to implement explicit measures to provide training for staff. We don’t want to criticize the staffing institutions who are doing their best. What I found is most of them are sincerely there to help and to serve and care deeply about their children, but they lack professional evidence-based knowledge to best meet the means, the holistic needs of the children in their care.

Sandie [00:15:37] That’s so important and that respect will help build bridges to equipping people with more informed approaches to the developmental needs, not just keeping the child fed and clean.

Leonie [00:15:56] Absolutely.

Sandie [00:15:58] And the third?

Leonie [00:16:00] The tertiary preventative measures, I believe we can do this through the creation and implementation of quality residential care professional standards and guidelines quality care commission. For the most part residential facilities are ungoverned, they’re unsupervised. No one knows what the level of care happens behind closed walls. We could include increase in personal standards for all primary caregivers. The staff, we can implement mandatory criminal background checks for the staff on the frontline caring for orphans and vulnerable children. The caregivers themselves, they should have a job description, have a written copy or have it read to them regularly because we found that many of the primary caregivers in institutionalized orphanages and residential homes are illiterate. Do they know what is expected of them in their job? And how can we help support them as they deliver primary care to the children? And then also and this is a really important issue I believe, Dr. Sandie, if the accreditation and licensing of all front-line residential facilities to motion care facilities to document how they’re going to meet the needs of the infants and children in their care.

Sandie [00:17:29] Wow. So, knowledge is really a basis for helping build a stronger environment for these kids who have been placed there through adverse experiences in their lives. And we want the best for them, we don’t want them to grow up with weakened emotional development, psychosocial development, and even physical development cognitive development. So, providing better training for the people that care for them is a key piece of that. I wonder if there is any support for helping an institution that maybe has 50 100 children move to a more kinship-based model. I mean it’s great for us to say wow that’s not healthy, but then there is no place in that country, in that community to place those children. How do we move to that model?

Leonie [00:18:36] Well that’s a very challenging question and what I believe we can do first and foremost is how we can improve service within the confines of the existing residential facility. Can we instead of having all boys in one area and girls separated and the other, let’s say 100 boys at one side, 100 girls at the other. Can we bring back sibling groupings together if it is safe and there’s no physical or sexual maltreatment between the siblings? Can we bring the family, the siblings, back together within the safety and protection of the residential facility? Can we advocate and find social workers to seek out existing biological family members or a neighbor or someone in their community and start the process of accurately paced deinstitutionalization. I say accurately pace, Dr. Sandie, because if we jump in too quickly are, we just going to say okay in a month we’re going to close this residential facility where did the children go. So, I say accurately paced institutionalization because it requires a lot of planning, it requires a multidisciplinary team approach to find existing family members, to find somebody in the community willing to take the child and their siblings. And let’s be honest, if we can pay to fund them to live 16, 18 years in an institution, can we not redistribute those funds for them to be cared for in the community?

Sandie [00:20:14] Wow that is such a great plan to move towards back in episode 161, Brandon Stiver in Tanzania talked to us about how his own family totally changed their perspective on caring for orphaned children and they became leaders in a family-based care plan that was so much better than the orphanage they planned they had originally been involved in. So, I think there are examples out there for us to use to move into that, but you’re warning that it is accurately paced that is critical. You also mentioned redirecting funds, so can we talk about how the faith-based community might be able to lead that? Do you have some ideas?

Leonie [00:21:14] Absolutely. Well we’re told in research that about 68, 70 percent of all international residential facilities, orphanages, are actually funded partly or fully through the church. So, that is a great example of the magnitude of help that the churches are currently involved in. But it also begs the question as to why as the church we keep building orphanages, when we have six decades of research to say that institutions are the least appropriate environment for child rearing? And this is a dial up question that I like to have with church leaders, with mission schools, or faith-based NGOs is can we, instead of raising funds for an orphanage, let’s say there’s 100 children. Can we not break down that hundred children and the cost it takes, let’s say it cost twenty thousand dollars a year, can we not break that down into subgroups and provide let’s say 200 dollars a month long term investment it has to be a long term, Dr. Sandie, because we found that some churches will come on board and say yes we want to give, we want to support the family. So, we would move the children out of the institution, we’ve placed them in foster care put them three or four years down the road the church withholds their funds, or they stop sending the money and then the family are at increased risk. So, what we say is we would really like the church to redistribute the funding and support of Christine orphanages but exchange that for long term investment into family-based community placed homes. But it has to be long term, so we ask them usually for a 10-year commitment. Are you willing to commit to this community in Tanzania, in Ethiopia, in Guatemala, whatever nation that you’re in, can you as a church commit for 10 years? And at first, I get some wide eyes and big looks, but when I explain that the children’s lives are dependent upon your 200 dollars a month, we can’t just give in part, we have to give lavishly.

Sandie [00:23:45] Wow. I love that. And here’s the thing. We were designed to be part of a family. We are hard wired for family. In my work here in the U.S. with victims of commercial sexual exploitation, we often lament how, we don’t even use the word rescue anymore, we recover a child and then they go back to that environment because, and the girls have often explained to me well that’s my family. And it’s a whole different definition of a family, but it’s the same person every day providing for their needs, and that’s how they define family. So, how do we begin to build models that support how we’re hard wired for family. That is a great plan. Leonie, I am so grateful for your voice on this. We’re going to stay in touch, we’re going to keep coming back to this issue because it’s so important. I recently had a conversation with a brand-new dad, who the baby was born, and he learned that the baby already recognizes mother’s voice because Mom’s been carrying the baby for nine months, but it takes two weeks every day of that baby hearing Dad’s voice to be able to recognize. We have to be there every day, so we create that kind of attachment. Thank you so much, and we look forward to having you back on.

Leonie [00:25:23] Thank you for having me.

Dave [00:25:25] Leonie and Sandie, what an incredible conversation. Sandie, I’m just always struck by how many aspects of this there are for us to consider on really being able to reduce and hopefully end trafficking. And I hope that you’ve been touched by this conversation as well and we would invite you to take the next step or perhaps to take the very first step going over to the endinghumantrafficking.org Website. When you do that, you can download a copy of Sandie’s book, The Five Things You Must Know, a quick start guide to ending human trafficking. It will teach you the five critical things that Sandie has identified that you should know before you join the fight against trafficking. You can get it again at endinghumantrafficking.org. And if you’ve been listening to this show for a bit, two invitations for you. First if you’d take a moment to rate or review the show on whatever platform you used to listen to the show on. And also, more importantly, if you know someone, a colleague, a friend, a peer, perhaps someone you’re in a religious community with who would benefit from discovering many things we talk about in the show. We’d invite you to pass along the show to them because we are working to of course study the issues, be a voice, and make a difference in ending human trafficking. Sandie, always a pleasure and I’ll see you again in two weeks.

Sandie [00:26:50] Thanks, Dave.

Dave [00:26:51] Thanks, everyone. Take care.

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