Deinstitutionalisation

This paper discusses the impact of neoliberalism on disability policy and activism. The paper highlights the neoliberalisation of postsocialist disability policy, as well as the convergence between the neoliberal critique of welfare-state paternalism and the advocacy of disabled people’s movement for deinstitutionalisation and direct payments (personal assistance). The discussion is supported by examples from Bulgaria and the United Kingdom. In conclusion, the paper argues that neoliberalism confronts the disabled people’s movement with two difficult tasks: to defend self-determination while criticising market-based individualism, and to defend the welfare state while criticising expert-based paternalism.

—Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.

The European Welfare State crisis since 2008 has shown the weakness of these European welfare systems to cope with a health crisis such as COVID-19, which in turn has not guaranteed the rights and wellbeing of older people. This article aims at shed light on the scarcity of resources in Spin for its care homes and nursing homes system, while analyzing its integrated care failure and the urgent legislative measures implemented to overcome COVID-19 health crisis. At the same time, this paper advocates for a reflexion on ageist practices, so as to foster a debate on the ‘deinstitutionalization’ process of older adults in Spain. In this COVID-19 context, it has become utmost in implementing an older adults’ policy to guarantee older adults rights as vulnerable population; likewise, which has already been done in respect to laws protecting children rights.

Η έρευνα επιδιώκει να καλύψει το κενό των κρατικών στατιστικών δεδομένων σε σχέση, τόσο με τον αριθμό των ιδρυμάτων παιδικής προστασίας που λειτουργούν στην Ελλάδα, όσο και την κατάσταση και τις ανάγκες αυτών. Επίσης επιδιώκει να καλύψει το κενό σχετικά με τον πληθυσμό των παιδιών που ζει στα ιδρύματα κλειστής παιδικής προστασίας και ιδρύματα που φιλοξενούν παιδιά με αναπηρίες στην Ελλάδα. Στόχος είναι τα αποτελέσματα αυτής της έρευνας να αποτελέσουν εφαλτήριο συζήτησης σχετικά με τις πολιτικές που ακολουθούνται στο σύστημα παιδικής προστασίας στην χώρα μας και τις ελλιπείς πρακτικές που εφαρμόζονται για την σταδιακή μετάβαση των παιδιών από την ιδρυματική σε κοινοτικού/οικογενειακού τύπου φροντίδα.

This report focuses on the progress in deinstitutionalisation and community living in the Czech Republic. Particular attention is given to ways how EU funding is utilised in the process and what are the challenges in implementation of UN CRPD artical 19 in the country. The results suggest that deinstitutionalisation is still seen as "a project" and is, in general, only happening when EU Funds are available. Programmes related to deinstitutionalisation are largely subsidised by the EU funds. Although the EU funding supports the reform, the measures at the national level which would initiate the required systemic change are currently incomplete. The infrastructure for a system of financing independent from EU project funding is still not available

Reimagining Crisis Support: Matrix, Roadmap and Policy aims to shift the conversation about personal crisis from one based in mental health discourse to one based in a social model of disability and human rights.

The book's primary thesis is that crisis support can be reimagined as support for decision-making and maintaining an independent life in the community - as provided for under Articles 12 and 19 of the Convention on the Rights of Persons with Disabilities.  Community-based, non-discriminatory conflict resolution and violence prevention are complementary to crisis support but are distinct as they involve more than one person's needs and interests at the same time.

The book explains its key premises and sets out some elements of decision-making support for personal crisis, then explores the Matrix of rights and implementation measures set out in the Convention that provide a scaffolding for a social, human rights-based approach to crisis support.

It then provides a Roadmap of aspirational transformations and strategies that are needed to create the conditions in which reimagined crisis support can be meaningfully realized.  These range from large-scale social justice aims such as Democratize Knowledge and Strengthen Communitarian Practices to Tools such as 'Pilot projects' and 'Evaluate existing support practices'.

A section on Policy addresses key issues for translating the model presented into national policy.  This should be read in conjunction with the chapter on Implementation: Legislative Reform that is included in the Matrix section.

This book is intended for diverse audiences from policymakers to grassroots activists.  It is grounded in both a US context (inevitably as the personal informs the political) and wider perspectives from global networking. 

ISBN 978-1-7377370-2-5
To order paperback or epub version see https://www.reimaginingcrisissupport.org

Spanish translation of the preprint of my paper in the American Psychologist "Improving the Mental Health of Abandoned Children - Experiences from a Global Intervention". Publication name and DOI refer to the original English version: American Psychologist, Vol 75(9), Dec 2020, 1376-1388.

Institutional change explains the change of institutions considered as rules and expectations that govern human interactions and paths of development in society. This conceptual paper describes, with an historical perspective, the most important definitions of institution and of institutional change and shows some theories that analyze these critical topics in economics to assess similarities and differences. The future challenge of institutional scholars concludes this study.

In recent years, the Movement for Global Mental Health (MGMH) and the World Health Organization have worked closely with governments across the global South to redress major treatment gaps to improve access to mental health services. In India, recent reforms include transforming public psychiatric institutions from sites of treatment to research and training institutes, known as ''Centres of Excellence,'' to combat acute manpower shortages and modernize psychiatry. Drawing on ethnographic fieldwork at a public psychiatric hospital in Srinagar, Kashmir, one of the institutions selected to be a future ''Centre of Excellence,'' this article focuses on how these reforms have affected psychiatric institutions themselves. Efforts at modernizing and increasing access to mental health care—that is, emphasizing shortened stays, increasing outpatient treatment, and providing care in the ''community''—depend on quarantining stigmatized, chronically ill, long-term patients who reside in custodial conditions with fewer resources and limited attention from providers. Psychiatrists have a radically different vision for redressing manpower shortages than the MGMH and Indian state, revealing contradictions in the reform process. This paper demonstrates how modernizing mental health care splits mental institutions spatially, ontologically, temporally, and epistemologically, so that the process of modernizing the institution is neither seamless nor complete.

In addition to the nationwide phenomenon of mass incarceration,  there exists a sub-problem in the U.S. of overrepresentation in prisons and jails of those with severe and persistent mental illnesses (SPMI).  The disproportionate imprisonment of those with mental illnesses is one driving force of mass incarceration.  Furthermore, we have reached an era characterized by the “criminalization of mental illness.”  Driving this is another feature of the mass incarceration era, the change in the types of institutions that incarcerate those subject to social control in American society.  With the deinstitutionalization movement, and the closure of mental health institutions (largely brought about by the 1963 Community Mental Health Act),  there has been a shift towards incarcerating the mentally ill in criminal justice institutions such as prisons and jails.  This essay will consider the role mental illness should play in sentencing, and how this might reduce the disproportionate levels of prisoners with mental illness. More specifically, this paper examines the sentencing rules where the defendant has a SPMI, but has failed to successfully meet the insanity defense.

Present article tried to define some concepts of Individual Rehabilitation Plan (IRP) in chronic mental illness people under long term hospitalization condition. Some of them are related to rehabilitation objective, methodology, intervention and functional vital area. Also, the way we put in practice these concepts in our daily work experience. Next, we propose a model of IRP and an Evaluation Inform Resume. It must be concluded with some orientation criteria, which could make easy the professional decisions of the rehabilitation teams about opportunities of egress of a client to other residential alternative opposed to permanent institutionalization in Costa Rican National Psychiatric Hospital of the Social Security Services.

The paper presents an historical critical policy analysis of deinstitutionalisation and the introduction of neoliberal forms of governance in mental health policy. It focuses particularly on a major period of policy reform in the 1980s and 1990s in Victoria, Australia. Many of the particularities of the Victorian experience can be generally observed with deinstitutionalisation throughout the world. In particular, the policy discourse of rights and entitlements, consumer choice and empowerment, at times stood in tension with the service void created by the transition from large, standalone psychiatric institutions, to dispersed forms of service provision outside the hospital. Further, certain policy features could be seen to perpetuate patterns of coercion, abuse and neglect. This article offers a number of potential lessons for mental health law, policy and practice today, which is poised for further advances of neoliberal governance, including through the policy of personalised services, individualised disability funding and human rights-based reform.

OBJECTIVE To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities. Design Systematic review.

POPULATION Adults (aged 18 years and over) with intellectual disabilities. Intervention Deinstitutionalisation, that is, the move from institutional to community settings.

PRIMARY AND SECONDARY OUTCOME MEASURES Studies were eligible if evaluating within any cost-consequence framework (eg, cost-effectiveness analysis, cost-utility analysis) or resource use typically considered to fall within the societal viewpoint (eg, cost to payers, service-users, families and informal care costs).

SEARCH We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches and handsearching of the references of the eligible studies. We assessed study quality using the Critical Appraisals Skills Programme suite of tools, excluding those judged to be of poor methodological quality.

RESULTS Two studies were included; both were cohort studies from the payer perspective of people leaving long-stay National Health Service hospitals in the UK between 1984 and 1992. One study found that deinstitutionalisation reduced costs, one study found an increase in costs.

CONCLUSION A wide-ranging literature review found limited evidence on costs associated with deinstitutionalisation for people with intellectual disabilities. From two studies included in the review, the results were conflicting. Significant gaps in the evidence base were observable, particularly with respect to priority populations in contemporary policy: older people with intellectual disabilities and serious medical illness, and younger people with very complex needs and challenging behaviours.

PROSPERO registration number CRD42018077406

Peer-reviewed Health Research Board evidence review (report).
Submitted to the Health Research, 2018

McCarron, M., Lombard-Vance, R., Murphy, E., Sheaf, G., O'Donovan, M-A., McCallion, P., Webb, N., Stancliffe, R., Normand, C., Smith, V., May, P.

The purpose of this review is to systematically evaluate the evidence on quality of life outcomes and costs associated with a move from a congregated setting to a community living arrangement for people with intellectual disability. The right to live independently in a place of one’s own choosing is a core value of the United Nations Convention on the Rights of Persons with Disabilities. Ireland is in the process of implementing a new phase in its efforts to reduce the reliance on institutional residential arrangements for people with intellectual disability. In particular, there has been a focus on moving people from what are widely referred to as ‘congregated settings’ (institutions with 10 or more residents) to ‘community living arrangements’ (where each unit contains no more than four residents). The Department of Health in Ireland requested this review to inform Ireland’s ongoing deinstitutionalisation process.

Although there is a large body of studies examining quality of life outcomes of residential moves by people with intellectual disability, small samples, a lack of systematic design, incomplete data, and variations in what was measured over different time frames mean that few studies were worthy of inclusion in a systematic review, and even fewer met the criteria for meta-analysis. Nevertheless, this evidence review does offer some support for the hypothesis that moving from an institutional residential setting to a community residential setting is associated with improved quality of life for adults with intellectual disability. There is no clear evidence on the cost-effects of residential moves, and few conclusions can be drawn for people who have highly specialised support needs. There were some findings suggesting that people with severe or profound intellectual disability either experienced a generally improved quality of life or experienced a lack of improvement, but not a deterioration in quality of life, following a move to a community setting.

There is a need for longitudinal studies – and agreed standardised variables and measures – that examine adequately sized representative samples of people with intellectual disability where there is the potential to gather baseline (pre-move) data; follow individuals at several time points; examine health-related, community participation, and life satisfaction variables; and control for the effects of changing health and independence needs. Comparison of cost-effects requires measurement from the broadest possible perspective, incorporating both formal (residential, health, and social care, out-of-pocket costs) and informal (unpaid carer) cost domains in ways that illuminate the relationships between specific types of residential settings and associated utilisation.

This desk review is part of a wider study commissioned to SOS Children’s Villages International by the European Commission. The overall study aims to map the issue of alternative care and deinstitutionalization in countries in Asia, South and Central America, and Africa. It also seeks to increase the evidence on child protection, alternative care and deinstitutionalization and on how this can be addressed, in order to potentially inform future initiatives in these continents, at country or regional level. The study comprises three continental desk reviews and six field-based case studies. This report is the desk review on alternative care and deinstitutionalisation in Africa. It is accompanied by two country case studies: one focussing on Nigeria and one on Uganda. The results of the regional reports and case studies are synthesised in a report entitled Towards the Right Care for Children: Orientations for reforming alternative care systems. Africa, Asia, Latin America (European Uni...

Background: Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments. Methods: We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011. Results: Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals. Conclusions: It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.

This qualitative study explores institutional and community-based mental health services in Albania today. It was carried out in central  and southeastern (Elbasan, Korče, and Tirana) Albania between June 1 and September 1, 2013. Information was collected through 44 semi-structured interviews with mental health professionals, family caregivers, and advocates identified through convenience sampling and online research. 30+ additional hours of participant-observation were completed with psycho-social staff and residents at the Sadik Dinci Psychiatric Hospital in Elbasan, Albania. The comparative cases of de/institutionalization of children and Albania’s elderly population were also explored. Based on data collected, Albania’s low rates of psychiatric institutionalization can be said to reflect the chronic underfunding of the mental health sector and not extensive deinstitutionalization efforts or the successful creation of community-based alternatives to institutional care. Western models of service provision such as the Community Mental Health Center and the Supported Home are only partially implemented. Major challenges related to funding, acceptability, accessibility etc. affect Albania’s vulnerable populations and a trend towards re/institutionalization looms if community-based care cannot be properly supported.

Persons with mental illness are incarcerated in prisons across the United States at disproportionate rates compared to the general population. Understanding why this is so requires an examination of how society in general has treated persons with mental illnesses. This article relates a history of neglect and stigmatization in examining the entities responsible for care of persons with mental illnesses, including the family, asylums and prisons.
The article identifies trends of institutionalization, deinstitutionalization, and transinstitutionalisation, whereby large amounts of inpatients with mental illnesses moved out of psychiatric institutions, into the streets, and then into the criminal justice system. The article also analyses socioeconomic factors bearing on mental illness as a cause of crime, the high arrest rates and prison conditions experienced by those with mental illness, and public perceptions and myths about persons with mental illnesses.
The article claims the impact of social control via the criminal justice apparatus – policing, imprisonment, and subsequent labeling – is a predominant cause of the high rates of imprisonment. It is suggested that in order to reverse the trend towards the mass incarceration of those with mental illnesses, we should reject calls for a return to the asylum. Instead, our focus should be on providing community-based treatment and interventions that address the socioeconomic causes of crime.

AUTHORS: McCarron, M., Lombard Vance, R., Murphy, E., May, P., Webb, N.,
Sheaf, G., McCallion, P., Stancliffe, R., Normand, C., Smith, V., O'Donovan, M-A.

- OBJECTIVE To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities.

- DESIGN Systematic review.

- POPULATION Adults (aged 18 years and over) with intellectual disabilities.

- INTERVENTIONS A move from residential to community setting.

- PRIMARY AND SECONDARY OUTCOME MEASURES Studies were eligible if evaluating effect on QoL or life quality, as defined by study authors.

- SEARCH We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches. We assessed study quality using the Critical Appraisal Skills Programme suite of tools, excluding those judged to be of poor methodological quality.

- RESULTS Thirteen studies were included; eight quantitative studies, two qualitative, two mixed methods studies and one case study. There was substantial agreement across quantitative and qualitative studies that a move to community living was associated with improved QoL. QoL for people with any level of intellectual disabilities who move from any type of institutional setting to any type of community setting was increased at up to 1 year postmove (standardised mean difference [SMD] 2.03; 95% CI [1.21 to 2.85], five studies, 246 participants) and beyond 1 year postmove (SMD 2.34. 95% CI [0.49 to 4.20], three studies, 160 participants), with total QoL change scores higher at 24 months comparative to 12 months, regardless of QoL measure used.

- CONCLUSION Our systematic review demonstrated a consistent pattern that moving to the community was associated with improved QoL compared with the institution. It is recommended that gaps in the evidence base, for example, with regard to growing populations of older people with intellectual disability and complex needs are addressed.

- PROSPERO registration number CRD42018077406

Despite some superficial heterogeneity, higher education institutions around the world share core structures. According to critics such as Ivan Illich, the ossification of these institutional forms has ended up impoverishing the practices they were originally intended to support. This article assesses the grounds for these claims and associated construction of alternatives. It identifies three significant features of the institution: gates-the controls on admissions to the university; roles-the distinctions drawn between students, lecturers and other actors; and badges-the processes and artefacts of validation of student learning and scholarship. These three features are seen to have varying forms, levels of rigidity and loci of control, and have ambiguous impacts on equality and fairness, and on the core purpose of the university to promote human understanding. Implications are drawn out for the future of the university, and for current initiatives that are attempting to subvert these structures and create alternative models.

This article starts with a brief overview of the history of housing for people with intellectual disability in Austria. The system of care and Austrian disability policy are also examined, focusing on implementation of deinstitutionalisation and community living. The following analysis of services provided in the field of housing for people with intellectual disabilities shows that support is provided in undistinguished, generalised service packages based on a competency model. Academic research on community living is quite rare in Austria, and fails to take into account the subjective perspective of people with intellectual disabilities.

The  European  Expert  Group  on  the  transition  from  institutional  to  community-based care (hereinafter: the “EEG”) introduces the Report on the Transition from Institutional Care to Community-Based Services in 27 EU Member States (hereinafter: the “Report” or the “Study”). This Study comes to mark 10 years from the publication of  a  first  important Report1, mandated by EU-Commissioner Vladimir Špidla to address the issues of institutional care reform and find solutions for more humane, person-centred, and individualised models of care.

En la presente investigación, se evalúa de forma descriptiva, el programa de desinstitucionalización del Hospital Nacional Psiquiátrico (HNP), Caja Costarricense de Seguro Social (CCSS), usando como indicador, el desempeño psicosocial de un grupo de personas con enfermedad mental persistente desinstitucionalizadas que atravesaron un proceso de rehabilitación intrahospitalario (unidades de larga estancia) y extrahospitalario (hogares transitorios) y fueron reubicados en la comunidad, en el modelo residencial del Programa de Convivencia Familiar del Consejo Nacional de Rehabilitación y Educación Especial (CNREE). Se concluye que un alto porcentaje de los y las participantes presenta indicadores muy satisfactorios de desempeño psicosocial en la comunidad y a lo interno de su residencia, los resultados permiten demostrar, no sólo la importancia de los programas de rehabilitación institucionales bajo una política de desinstitucionalización, sino también, la necesidad de crear nuevas opciones residenciales, alternativas a la institucionalización psiquiátrica

During the COVID-19 pandemic, discussion re-emerged in many places, among them Poland, about how institutions that provide nursing home care (NHC) contribute to the social isolation of their residents; deinstitutionalisation (DI) as an alternative to collective forms of housing, in the form of sheltered housing and assisted housing, was brought to the fore. The aim of the research was to analyse these forms of housing in terms of the way deinstitutionalisation is perceived and understood by the creators of protected and assisted housing for people with disabilities. The applied perspective is the concept of the permeability of an institution, placed on a continuum between "permeable" and "total". The research also employed a critical discourse analysis, which included 20 statutes concerning protected and assisted housing. The results of the analysis indicate that there is a practice of transferring elements of institutional thinking and limiting human rights to those forms of housing that are intended to be an introduction to (or an implementation of) the idea of DI. The concepts of sheltered and assisted housing still include many features that may be identified with "total" institutions on the permeability continuum.

The aim of this study is to identify the perceptions of potential short-term international tourists concerning
children’s residential care in Cambodia. Respondent’s perceptions will be compared with the findings of
existing research on this topic and the views of experts in the field. International volunteering has been
identified as a key driver in the expansion of orphanages and children’s residential centers in Cambodia and
other developing countries, and the growth of these institutions has been well evidenced as contributing to a
number of negative outcomes for children. The study’s aim of better identifying potential short-term international
volunteer’s perceptions about the orphanage situation in Cambodia can hopefully contribute towards current
efforts to raise awareness amongst potential volunteers and reduce the popularity of this damaging tourist
activity.

The deinstitutionalisation of mental health services in Australia happened first and most rapidly in the state of Victoria in the final decades of the 20th Century. A period of immense economic and social policy reform accelerated the shift. While principles of human rights and citizenship appeared to guide policy change, the same principles could be undermined in the vacuum of services created by deinstitutionalisation and the broader restructuring of the welfare state. One expression of this pitfall, was an increase in violent encounters between police and those with psychosocial disability. At the same time, rights-based mental health law, despite increasing procedural safeguards for involuntary psychiatric intervention, could be seen to perpetuate differential treatment of persons diagnosed with mental disorder. This article will examine the intersections of policing and mental health policy to look at ways that boundaries of normality and disablement were contested during a transitional period of mental health law and policy.

The article is set in the backdrop of the continuum of alternative care, more aptly put as family-based care for children in need of care and protection. It begins by taking into account the emerging trends in deinstitutionalisation and alternative care avenues nationally and internationally. The earlier article published in this journal in March 2016 brought to light Miracle Foundation's Method as a way of transforming institutions into loving children's homes that provide family-like care for children in need of care and protection. This article traces the journey of the organisation further, where Miracle Foundation's work on childcare has evolved as a methodology rooted in all family-based care options of resettlement of children, adoption, foster care, sponsorship, family strengthening and geared towards providing a safe and loving family for every child. The article elucidates on the preparatory phase undertaken by the organisation prior to the onset of family-based care program. Further describes the steps taken and initiatives rolled out. As the programs progress, a detailed purview of the outcomes, learning and lessons learnt will be taken up in a subsequent research article.

This study focuses on the roles of rhetoric and of the various actors in institutionalisation and
deinstitutionalisation attempts. Our paper jointly investigates the process whereby budgeting became
institutionalised between 1930 and 1960 and the attempts of the CAM-I to deinstitutionalise it from 1990.
Paradoxically, the same two arguments have been used to support the institutionalisation of and the attempts to
deinstitutionalise budgets. Firstly, in the 1930’s the turbulence of the environment is used a rhetorical argument
to support the implementation of budgeting. Since 1990, the turbulence of the environment has generated a
feeling that budgeting should be abandoned. Secondly in the 1930’s and 1950’s budgets contributed to the
emancipation of managers, while since 1990 they have been deemed as rigid frameworks preventing managers
from acting freely. These contradictions reveal that we can not explain such changes by the rhetorical schemes
alone. The network of actors in which these schemes are embedded has a large part in the influence of rhetoric in
the change from one institutional order to another. It is particularly the actors to whom these rhetorical schemes
are addressed which give them their meanings. Finally, the similarities between the rhetoric used can be
explained if we analyse it as the means to transcend the fluctuating contradictions of institutional logics.

This is the text of a presentation prepared for the ‘Disability Studies in East Europe – Reconfigurations’ seminar series organised by a disability studies group at the Jagiellonian University, Poland. The seminar took place online on 27 May 2022. In the presentation, I discuss a framework for a critical and historically informed analysis of disablement in the postsocialist region of Central and Eastern Europe. The framework brings together disability studies, Nancy Fraser’s theory of social justice, and critical studies of postsocialism. This helps understand disablement in the postsocialist region in terms of intersections between state socialist legacies and postsocialist neoliberal transformations in the economic, cultural, and political spheres. Specific instances of disablement are explored, including continuing institutionalisation, retrenchment of public support, medical-productivist framing of disability, overvaluation of self-sufficiency, and depoliticisation of disability organising.

There are several studies that provide evidence for the negative effects of residential care for children. This chapter applies system analysis and child-centric approaches to assess the Children Alternative Care System (CACS) deinstitutionalization in Egypt. The study attempts to answer these questions: What is the assessment framework for the CACS considering the international frameworks? What are the strengths and the gaps within the CACS in Egypt? The study conducted systematic review for literature on alternative care for children, used participant’s observation and applied qualitative methodological approaches which are based on a purposive and snowball sampling techniques. The study highlights the lack of variety of care options, mechanisms of gatekeeping, and family reintegration. The study’s main recommendation is to have a holistic alternative care strategy guided by deinstitutionalization and not only focusing on alternative families’ program as a main intervention to improve the system.

This report presents the results of a pilot application of the PA Checklist – a new tool designed for assessing personal assistance (PA) schemes from the perspective of independent living. The checklist was created at the European Network on Independent Living (ENIL) to help advocates around the world to fight for better PA and to monitor the implementation of Article 19 of the UN Convention on the Rights of Persons with Disabilities. It was developed as part of the project ‘User-Led Personal Assistance in the European Union: A Critical Comparative Analysis’, led by Dr Teodor Mladenov. The PA Checklist was co-produced with PA users and independent living advocates to measure the degree to which PA schemes support independent living.

Abstract. Institutional change explains the change of institutions considered as rules and expectations that govern human interactions and paths of development in society. This conceptual paper describes, with an historical perspective, the most important definitions of institution and of institutional change and shows some theories that analyze these critical topics in economics to assess similarities and differences. The future challenge of institutional scholars concludes this study. Keywords. Institutions, Institutional theory, Deinstitutionalization. JEL. D02, E02, G20, I20.

A collection of articles, journals and contributions from the IFCO 2014 European Conference held in Waterford Institute of Technology, Waterford, Ireland in August 2014.
Theme: Ensuring the Rights of the Child and Family-based Services
Organisers: Danielle Douglas & Jean Anne Kennedy, representing IFCO (International Foster Care Organisation)