New directions in orphan and vulnerable children policy and research: A focus on supporting "suitable" institutions when placement is "necessary" for a child.

As the number of children without parental care continues to increase in resource-poor countries, it is important not to discount institutional care as an option before conclusively assessing whether these structures have systematic negative impacts on the millions of children for which they provide care. An almost universal emphasis and focus on deinstitutionalizing children in the face of the urgent necessity for large-scale measures to care for the global orphaned population puts millions of children at risk of deprivation, degradation, and early death. Deinstitutionalizing children in underresourced countries without alternate systems in place could leave many children behind. This article proposes an equal assessment of suitability and necessity of all alternative care options, without relegating institutions as a last resort. Institutional care should be considered as no less suitable in certain cases and for certain children than other options, especially when there is a serious need for such an option in some parts of the world. In addition, recent research challenges early conclusions, shows variability in international institutions, and also documents positive effects of interventions seeking to improve institutions. The Convention of the Rights of the Child and its implicit "last resort" language, as well as subsequent global policies that also use this language, do not create a constructive way of approaching alternative care solutions for any children without parental care. Instead, policymakers and practitioners should establish individualized care plans for all children without parental care, regulate their admission to institutions with periodic reviews of the necessity and appropriateness of their placement, and develop standards for "suitability" of institutions to improve conditions.