From child institutions to family reunification: challenges and opportunities in building family-centred care

Abstract

Background: At least 2·7 million children worldwide are estimated to live in institutional care, with former Soviet Union countries having the highest rates of child institutionalisation in the world. In response, many countries are supporting family reunification as a primary de-institutionalisation strategy. Previous literature shows that the family offers a better environment for children and adolescents, yet little is known about the challenges and opportunities encountered by families upon reintegration. Research on how traumatic experiences associated with institutionalisation and de-institutionalisation affect family reunification is also scarce. Methods: Children and adolescents aged 8–16 years and their parents or next of kin (n=47) were recruited through five child institutions in Azerbaijan. Semi-structured interviews included questions about children's and caregiver's experiences during the readjustment process. Four coders thematically coded the interviews. Findings: Both adolescents and caregivers emphasised a desire to be reunited. Conversely, young people often manifested behavioural issues (ie, social withdrawal, emotional dysregulation, and overtly aggressive behaviours) after reunification; caregivers further struggled to respond to these reactions. Accordingly, family members discussed their goals and challenges associated with reunification, primarily focusing on a desire to build a better sense of familial trust and communication. Family members also highlighted the importance of learning to manage unexpected role conflicts and contradictory conceptions of authority, particularly among male adolescents. Interpretation: To improve the emotional and psychosocial wellbeing of reunifying children and their caregivers, deinstitutionalisation strategies can incorporate culturally responsive, trauma-informed, and attachment-based interventions, which can heal relational traumas and further equip children and caregivers with coping, stress management, and emotional regulation skills. Funding: The study was funded by the Center for Health Administration Studies at the University of Chicago.