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PART 1CHILD PROTECTION AND ALTERNATIVE CARE MODULESESSION 1: UNDERSTANDING ALTERNATIVE CAREAlternative Care:Care for children without parental care or forwhom parental care is not an option. Alternativecare includes family-based care and residentialcare. Family-based care is a form of alternativecare that involves a child living with afamily other than his/her birth parents andincludes kinship care and formal foster care. Residential care is care provided in anynon-family based group setting includingorphanages, children’s homes, children’svillages and shelters. In Ghana residentialcare facilities are called Residential Homesfor Children (RHCs). Adoption is a permanent solution for achild who cannot be with his/ her biologicalparents and is included under alternativecare but not as a family-based care option.Learning Outcome:By the end of this session, participants willdemonstrate a clear understanding of familybased care, and the different types of familybased care. They will also understand thedifference between the different care opti ons.Time: 45 minMaterials:Background Note 1: Vote with your feet –questions and answersBackground Note 2: Background to alternativecareHandout 1: Fact-sheet on alternative carePPT 1: Understanding alternative careFlip chart and markers4ADDITIONAL MODULE ON ALTERNATIVE CARE OF CHILDRENFacilitator’s Action:Start the session by asking participants who haschildren. Then ask them if they have thoughtabout who would care for their children shouldsomething happen that they could no longertake care of them. What alternative carearrangement would they make? If relativescouldn’t take care of their children, then whatwould be the next alternative? Explain that thismodule is looking at the different alternativecare arrangements for children whose parentsare unable or unwilling to take care of them.Then, ask all participants to stand in the middleof the room. Designate one side of the roomTRUE and the other side FALSE. Ask the firstquestion on Background Note 1: Vote WithYour Feet – Questions and Answers, and askparticipants to “vote with their feet” by choosinga TRUE or FALSE position. When participantshave done this, ask one person from eachgroup to explain their choice. Then provide thenecessary clarification. Do this for each of thequestions.Present slides of PPT 1: Understandingalternative care and open the floor for a briefdiscussion on any concepts that participantsmay need more clarity on. Refer to BackgroundNote 2: Background on Alternative Care toanswer any questions that may arise. Emphasisethat the first priority is to strengthen families sothat children are not separated from parentalcare. If this can’t be avoided then family-basedcare is the next best option, preferably informalkinship care and if this is not possible thenformal foster care. The key message is: a stable,safe and loving family is always the best placefor a child to grow.Distribute Handout 1: Fact-sheet on AlternativeCare and invite comments and discussionsaround some of the issues and statistics. Askwhat is surprising? What was expected?

PART 1CHILD PROTECTION AND ALTERNATIVE CARE MODULEBACKGROUND NOTE 1: VOTE WITH YOUR FEET – QUESTIONS AND ANSWERSSTATEMENTTRUE or FALSE?1.Alternative care forchildren means care inan orphanageStatement is FALSE2. Family-based caremeans a child is caredfor by his or her parents at homeStatement is FALSE3. Most children inorphanages are notorphansStatement is TRUEAlternative care refers to the care arrangement that have to bemade when children’s parents can’t care for them. These arechildren for whom parental care is not an option because parentsare either unwilling or unable to care for them, including beingdeceased. Residential Care in Orphanage is a type of AlternativeCare.Family-based care is the alternative care of children in a familyenvironment. Family-based care includes: Kinship care (living with relatives); and Short term or long term foster care (living in a home with afoster parent, who provides round-the-clock care – in the samecapacity as a biological parent – but is not paid a salary).Assumption is that ‘orphanages’, are there to support orphans, but80% to 90% of the children have a living parent - 80% of childrenin residential care in Ghana have one or both parents living. Themajority of these children could be reunited with their familiesgiven the right support.Poverty is recognised as the main driver of institutionalisationin most countries – including in Ghana. Parents who can’t affordto feed, clothe or send a child to school have little choice andwhen residential care is available they tend to make use of thisopportunity.4. In Ghana, children whoare cared for by theirrelatives are treatedthe same as otherchildren in the familyStatement is TRUE and FALSEIn Ghana, the extended family is considered central to children’slives and extended family members (e.g. grandparents, aunts,uncles, cousins) are actively involved in the care and socialisation ofchildren, stepping in to provide care and support when biologicalparents are unable to do so. Care by relatives offers the benefits ofa family environment and supports the continuation of importantfamilial, communal, and cultural ties.Several studies in Ghana have shown that some children placedin kinship care may face bias, exclusion, or discrimination fromextended family caregivers and community members or may beat risk of neglect, abuse, or exploitation. For kinship care to besuccessful, families need support from communities and localofficials to ensure that children are protected.ADDITIONAL MODULE ON ALTERNATIVE CARE OF CHILDREN5

PART 1CHILD PROTECTION AND ALTERNATIVE CARE MODULE5. Formal foster caremeans a child is put inthe permanent care ofa foster parent until heor she turns 18Statement is FALSE6. It doesn’t matter if afoster parent is rich orpoor, what is important is that the personis willing and able toprovide a stable, secure and loving familyhome for a childStatement is FALSE7. Parents are allowed tomake arrangementsdirectly with the orphanage to care fortheir childrenStatement is FALSEFormal foster care is a family-based care placement option. It ismeant to be a short-term solution until a more permanent optionis found e.g. child is returned to birth family or adoption. Thisrequires tracing and actively working with the child’s biologicalfamily from the moment the child is placed in care. In some cases,if it is in the best interest of the child, the placement may be longterm up until the child turns 18 or completes schooling, but this isnot its primary purpose.Foster parents can be rich or poor, educated or uneducated,married or single, able-bodied or living with a disability. What isimportant is that the person is willing and able to provide a stable,secure and loving temporary family home for a child.People who are interested in becoming foster parentsmust enquire at DSW for more details. They will undergo acomprehensive screening process, including an inspection of theirhome, to determine if they are suitable. It is important that theirchildren and extended family members support their decision.Foster parents do not receive any payment for the service. In somecases DSW may assist the family to access support from NGOsto pay for additional costs like schooling or medical care andequipment for children with disabilities.Residential care is a formal alternative care option. Thismeans that placement has to be done through a competentadministrative authority (DSW) and the court (care order). In orderto ensure that children only end up in formal alternative care as alast resort a formal and thorough screening process needs to be inplace (part of the “gatekeeping” process) to assess whether therereally is a need for placement.Some residential homes/orphanages have set up the institution asa business that access funding from international and local donorsand they will actively “harvest” children by approaching parentsdirectly to place their children in the Home. The more children theyhave, the more funding they can attract.6ADDITIONAL MODULE ON ALTERNATIVE CARE OF CHILDREN

CHILD PROTECTION AND ALTERNATIVE CARE MODULEADDITIONAL MODULE ON ALTERNATIVE CARE OF CHILDREN7

PART 1CHILD PROTECTION AND ALTERNATIVE CARE MODULEBACKGROUND NOTE 2: BACKGROUND ON ALTERNATIVE CAREWhat is Alternative Care?Alternative care refers to the care arrangementsthat have to be made when children’s parentscan’t care for them. These are children forwhom parental care is not an option becauseparents are either unwilling or unable to carefor them, including being deceased.alternative care solution for a child who cannotbe with his/ her biological parents. Familybased care should be a temporary option tocare for children with the goal of reuniting thechildren with their families.Formal and Informal Alternative CareAlternative care can be informal or formal.Types of Alternative CareThere are two main types of alternative care:family-based care and residential care.Family-based care is where the child lives in afamily environment but is cared for by someonewho is not a biological parent such as a relative,close family friend or foster parent. Familybased care is the preferred alternative careoption for children because it helps ensure thatchildren grow up in a stable, safe and caringfamily.Residential care is care provided in anynon-family based group setting includingorphanages, children’s homes, children’svillages and shelters. In Ghana residentialcare facilities are called Residential Homes forChildren (RHCs). Regardless of name, residentialcare has the same features: Unrelated children live in the care of paidadults. Children are separated from their familyand often their community. In many cases,they do not have the opportunity to bondwith a caregiver. Facilities are usually run according toworkplace routines instead of respondingto children’s individual needs, and havean ‘institutional’ rather than a domestic orhomely feel.Residential care can be considered as alast resort temporary solution only if noimmediate family-based care placementis found, while a longer-term family-basedalternative or permanent care solution likeadoption is arranged.Adoption is also a type of alternative care butis not family-based care as it is a permanent8ADDITIONAL MODULE ON ALTERNATIVE CARE OF CHILDRENInformal care refers to any private arrangementprovided in a family environment, where thechild is looked after on an ongoing or indefinitebasis by relatives (kinship care) or by others intheir individual capacity.Formal care is all alternative care in whichplacement has been ordered by a competentadministrative body (the Department of SocialWelfare) and court. Residential care is alwaysconsidered formal care even if the necessarycourt orders have not been obtained. In Ghana,placements in residential care without thenecessary authority are illegal.Reasons children end up needingalternative careChildren can be separated from parental carefor many reasons including: Death of one or both parents Abandonment by parents Ensuring access to education and otherbasic services as well as food and othernecessities Medical treatment or other specialised carefor the child (e.g. disability) Administrative or court decision thatremoval from parental care is in child’s bestinterest (abuse, neglect or exploitation) Voluntary placement by parents ontemporary basis (e.g. sudden emergency,unable to cope) Temporary or permanent incapacityof parents (e.g. imprisonment, illness,unemployment,migrationforwork,disability) Exploitation and other forms of abuse orneglect (e.g. child trafficking) Parents giving up their child permanentlyfor adoption (permanent relinquishment)

PART 1CHILD PROTECTION AND ALTERNATIVE CARE MODULEThe activities of the Child Protection Toolkitare focused on addressing the immediate andunderlying causes of child protection violationsmany of which might result in children beingseparated from their parents.Children at High Risk of Placement inResidential Care in Ghana Child with severe/multiple disabilities Child of single parent with mental disabilityor substance abuse problem Child from large poor family unable to payfor school fees and other material needs Baby of mother who died in childbirth(cursed/evil) Child with physical abnormality/differencee.g. 6 toes, born with full set of teeth or fullhead of hair (witch/wizard) Baby of teenage single motherNote to the facilitatorAsk participants if there are other reasons thatputs children at risk of placement in residentialcare apart from those listed above.Principles of Necessity and Suitabilityin Alternative CareThe principles of necessity and suitability arefound in the UN Guidelines on Alternative Care,2009.In order to ensure that children only end up informal alternative care as a last resort a formaland thorough screening process needs to bein place (part of the “gatekeeping” process)to assess whether there really is a need forplacement i.e. is it necessary?For many children separation from parentsmight not have happened if community-basedsupport services were available. Financialand material poverty, or conditions related topoverty, should never be the only justificationfor removal of child from parental care butshould be seen as a signal for the need toprovide appropriate support to the family.Services need to be in place to PREVENTchildren being admitted to formal alternativecare settings.The principle of suitability is about ensuringthat, when alternative care is required, it issuitable for providing quality care that willmeet the child’s needs, circumstances andwishes. A range of alternative care optionsare needed (including kinship care, foster care,residential care and adoption) if we are to meetthe ‘suitability’ principle. Again, the decision asto the most appropriate placement should bemade as a result of the screening process.ADDITIONAL MODULE ON ALTERNATIVE CARE OF CHILDREN9

PART 1CHILD PROTECTION AND ALTERNATIVE CARE MODULEHANDOUT 1: FACT-SHEET ON ALTERNATIVE CAREGlobal situation: Most children without parental care are cared for by extended family or those known to themin informal kinship care arrangements. However, millions of children still live in orphanages/institutions worldwide. One estimate putsthe total at up to eight million children. Globally 80% to 90% of children in ‘orphanages, haveone or both parents living. The majority could be reunited with their families given the rightsupport, so it is a myth that ‘orphanages’ are there to support orphans. Unfortunately, onceorphanages take root in a country they are very difficult to close down and reunify childrenwith their families. Poverty is recognised as the main driver of child institutionalisation in most countries. Parentswho cannot afford to feed, clothe or send a child to school often believe they have little choicebut to send their children to an institution where they can access food, shelter, education,health and other basic services. This is particularly common in the case of children withdisabilities, or children with specialist medical requirements, because families do not haveaccess to the right support services or because there is no inclusive education in the local area. Formal foster care is main form of formal alternative care in the US, UK and most other Westerncountries and some counties in Africa like South Africa. In these countries residential homesare only for children with severe behavioural or emotional disturbances and need short-termcare in a contained, therapeutic environment. Trained, professional workers – child and youthcare workers and social workers - provide the care in small residential facilities (usually notmore than 10 children).Situation in Ghana: 17% of children in Ghana live with extended family/kinship care and not parents. Before 1996, orphanages were not common in Ghana but increased exponentially between1996 and 2006:- In 1996 there were only 13 orphanages with about 250 children.- In 2006, there were 148 orphanages with about 4 500 children in care.- In 2016 there were an estimated 3,586 children in 115 orphanages. This decrease is due tothe efforts of the Department of Social Welfare’s Care Reform Initiative (CRI). It has been a very challenging process to close down orphanages in Ghana because donorslike to fund and be associated with “beautiful” orphanages, and for some people, running anorphanage is a lucrative business. In Ghana more than 80% of children in orphanages have one or both parents living. Povertyis also the main driver of children ending up in residential care/orphanages in Ghana. Mostchildren in residential care in Ghana are there for reasons related to poverty, not because ofsevere behavioural or emotional issues. Formal foster care is undeveloped and underutilised in Ghana. In 2016, there were only about40 DSW approved foster parents in Ghana, with 32 children in foster care.10ADDITIONAL MODULE ON ALTERNATIVE CARE OF CHILDREN

PART 1CHILD PROTECTION AND ALTERNATIVE CARE MODULEPOWERPOINT 1: UNDERSTANDING ALTERNATIVE CAREWhat is Alternative Care? Care for children who are not under the re?Where parents are unwilling or unable toprovide care, alternative care arrangementsmay have to be foundUN biologicalGuidelineson Alternative Care, 2009Care for children who are not under the custody of theirparentsAlternative Care Types:provide guidance on how States can meet Family-based care – kinship care & fosterthese obligationsAlternative Care Types:care Family-based care – kinship care & foster care Residential care – Residential Homes forWhat does the Ghana Child & Family Residential care – Residential Homes for Children (RHCs), orphanages, children’s homes, shelters,Children (RHCs), orphanages, children’sWelfare Policy say about Alternativechildren’s villages, transit homeshomes, shelters, children’s villages, transitCare?homesFormal and Informal Alternative Care: FormalInformalcareAlternative Care:and– kinshipInformal Formalcare,residential careInformal– foster– kinshipcare Formal – foster care, residential careStrategy 4.1: Alternative care - when child’sfamily is not an option Ensure child is maintained in own family asmuch as possible. Only remove child in case of immediateWhy is Alternative Care a Childdanger.Protection Issue? Place child with his or her family, in sameWhy is Alternative Care a Child Protection Issue?commun

Kinship care: Family-based care within the child's extended family or with close friends of the family known to the child. Kinship care arrangements are also sometimes referred to as informal foster care. Residential Care: Residential Care is care provided for children in any non-family-based group setting, such