This interview focuses primarily on the mental health needs of children in care and, in this objective, has been divided into three sections, exploring institutional care, family and community-based care, and the context in South Asia, respectively.
Children in institutional care have suffered significant trauma in separation, as well as with issues embedded in dysfunctional families, prior to entering care. What are some of the impacts of institutional care on the mental health of children? How do they influence their growth and developmental outcomes?
First, I think the term ‘institution’ is in danger of being misunderstood. Does it simply mean a children’s home as opposed to a family? Is there a certain size at which a home becomes institutional? Or is the definition more about the experience of those ‘living’ in a home? There are many excellent examples throughout history where residential care homes for children and young people equip those people very well for adult life.
In some cases, the quality of experience may even exceed the quality of ordinary family life. Perry and Szalavitz (2006) have made the point in the book The Boy Who Was Raised as a Dog that the size of a typical family group, which has daily contact with each other, has massively declined in the USA and other countries during the last 100 or more years.
They also say that what traumatised children need most is a healthy community to buffer their pain. Ludy-Dobson and Perry (2010) showed that a central factor in a child’s development and recovery from trauma is the number of positive relational interactions taking place every day. The interactions might include caregivers, other family, peers, schoolteachers and so on.
A high level of positive interactions may be more possible to achieve in a small therapeutic group home than a foster family. However, we also know that there is a history of poorly run residential homes where positive interactions are not the norm. We know that in ineffective homes, children and young people with significant problems can be a bad influence on each other.
I think one of the most important things is, understanding what a child needs and where those needs can be best met.