Institutionalization of Children with Disabilities in Croatia: Social Workers' Perspectives

Background & Purpose: It is a widely accepted international proposition that the family represents the optimal environment for children, fostering the development of affection, positive interactions and stimulating conditions for child development (e.g., Bowlby, 2010). Despite this recognition, many children with disabilities (CwDs) reside not with their families, but in institutional settings (UNICEF, 2015). While an international movement toward deinstitutionalization has gained momentum in recent decades, rates of institutionalization of children have remained stagnant in certain regions such as Eastern Europe and have trended upward within particular nations, including Croatia (Browne & Chou, 2015). Understanding decisional processes leading up to institutionalization is instrumental to the goal of ensuring CwDs have every opportunity to remain with their families. Often in Croatia, social workers are directly involved in decision making around institutionalization as brokers of social services and supports that families are entitled to access according to international law (United Nations General Assembly, 2007). For this reason, social workers’ perspectives are particularly relevant as governments attempt to implement socially just and culturally sensitive policies to support children and families. The current study aims to advance understanding of social workers’ perceptions of the circumstances necessitating and preventing the placement of children with disabilities in institutions.

Methods: This retrospective study employed one focus group (n=7) and many semi-structured individual interviews (n=12), informed through an ecological framework (Bronfenbrenner, 1970), to gain insights into social workers’ perceptions around institutionalization of CwDs. Participants included social work professionals from six regions in Croatia (urban and rural) who possessed experience and continued to be engaged in in service provision to CwDs (ages birth to 18) and their families. All research participants were female and their professional experience ranged from 1-25 years (M=19.7 years). Thematic analyses of the transcripts were conducted by three researchers, employing multiple methods of triangulation to increase interpretational rigor. 

Findings: Participants reported that institutionalization of children with disabilities resulted from circumstances involving parents, children and families, as well as from inadequate alternative child welfare services. According to participants, the purpose of institutionalizing children with disabilities was to (1) meet the medical and educational needs of children and (2) extend services that enhance disability-specific caregiver competencies among parents of children with disabilities. Conversely, circumstances preventing institutionalization of children involved availability and expansion of alternative welfare services for children with disabilities, social welfare rights, implementation of legal instruments for family protection, and reform of the child welfare system.

Conclusion: In effort to prevent separation of children with disabilities from their families, results suggest a need for continued monitoring of deinstitutionalization of children with disabilities, alongside increased availability, accessibility, and quality of childcare and family support services.  Future research must consider the accounts of both parents and children to understand how services, supports and interventions can be better tailored to address the needs of families engaged with social service providers – ultimately, reducing the number of CwDs placed in institutional settings.