Promoting the Rights of Children with Disabilities, UNICEF

environments. Even in a well-staffed institution, achild rarely gets the amount of attention he or shewould receive from their own parents and families, orfrom substitute caregiver families in the community. 50In addition, children in these settings are denied theimportant benefit of modelling by other children,which is critical for learning.Under the CRC, children, including children withdisabilities, have the right to be cared for by theirparents (article 7) and not be separated from theirparents unless a competent authority determinesthis to be in the child’s best interests (article 9). Inthis regard, there is little evidence to suggest that thebest interests of a child with a disability are promotedthrough segregated structures or facilities rather thanin an inclusive society in which all children are able toexperience and benefit from diversity.This is reinforced by the CRPD (article 23), whichrequires: “States parties shall undertake that wherethe immediate family is unable to care for a child withdisabilities, to take every effort to provide alternativecare within the wider family, and, failing that, withinthe community in a family setting.”Furthermore, article 25 of the CRC states: “whena child has been placed for the purposes of care ortreatment, she/he has a right to a periodic reviewof treatment provided and all other circumstancesrelevant to the child’s placement.” The availableevidence suggests, however, that such reviews rarelytake place.Once institutionalized, adolescents and youngpersons with disabilities are also at increased risk ofneglect, social isolation and abuse. The World Reporton Violence against Children, for example, presentsevidence on the incidence of violence in relation tothe provision of care, including by institutional staff;violence represented by a lack of care; and bullyingand physical violence by other children. 51In almost all countries in Central and Eastern Europeand the Baltic States, the number of children inpublic care increased after transition. The numberof children with disabilities living in institutions roserapidly during the early transition years, doubling andtrebling their numbers over a short period. At theend of the 1990s, close to 1 million children (about1 per cent of all children) were reported to be livingin institutions in the 27 countries of the CEE/CISand Baltic States, including 317,000 children withdisabilities. 52 Medical conditions such as epilepsy,cleft palate and scoliosis are sometimes consideredsufficient reason for the unnecessary placement ofchildren in a long-term residential facility. 53 A varietyof reasons are given to justify such institutionalization:professionals may insist that institutions will providethe most effective care; there is a lack of supportfor families to allow them to care for these childrenat home; few services and supports exist in thecommunity to help parents address the needs ofthese children. Combined, these factors often resultin parents having little option but to assign theirchildren to residential care.Trends like these were seen in the RussianFederation, where economic hardship following thetransition contributed greatly to problems faced bychildren with disabilities and their families. Withfewer resources available to them in the community,more and more parents were forced to place childrenin institutions; in turn, the budgets of the institutions,already stretched, were required to cover the costsof an increased number of children. 54 In 2002 morethan 200,000 children were living in 1,439 boardingschools (internats), although only 11 per cent ofthem were orphans, and a further 30,000 childrenwith severe physical and intellectual impairments,half of whom were orphans, were cared for outsidethe education system in 151 boarding homes run bysocial protection agencies. A further 20,000 youngchildren, mostly abandoned, lived in 249 infant homesrun by health authorities. 55The practice of institutionalization is by no meansrestricted to Central and Eastern Europe and the CIS.Recent reports examine conditions in institutions, forexample in Latin American countries, 56 as well as inthe Middle East and South-Eastern Europe. 57For countries with a strong tradition of institutionalprovision, a major priority must be to developappropriate services and financial supports in thecommunity, especially to prevent abandonment andneglect.Wherever possible, if children cannot livewith their own families they should be in alternativefamily situations, that is, living in ordinary homesin the local community. These families should besupported by experienced professionals and shouldbe financially rewarded for their work and care.The children should receive appropriate educationtailored to their needs, preferably in a regular schoolwith appropriate support or, failing that, in a specialclass or special school. Continuing contact with thenatural family needs to be maintained, with a viewto their resuming care for the child at some pointin the future, this time with additional support fromprofessionals in the community. In the meantimeprofessionals like these should be recruited andtrained. In many cases there is scope to increasethe capacity and involvement of other existing socialnetworks, including faith-based groups and tradeunions, in support of such initiatives.Many countries in Central and Eastern Europe and theBaltic States have begun to address these problemsand to develop alternatives to institutional care, suchas adoption, fostering and guardianship. However,the pressure for institutional placement remainsstrong. Outside this region, a number of countrieshave closed all their residential institutions for childrenwith disabilities and developed the kind of provisionInnocenti Digest No. 13Promoting the Rights of Children with Disabilities18