Institutionalisation and deinstitutionalisation of children 1: a systematic and integrative review of evidence regarding effects on development – Millions of children worldwide are brought up in institutional care settings rather than in families. These institutions vary greatly both in terms of their organizational principles and structure and in terms of the quality of care provided. Although institutions are universally recognized as providing sub-optimal care-giving environments, a consensus is still needed on how to interpret the evidence relating to the size, range, and persistence of the effect of institutional care on the development and wellbeing of children. This absence of consensus has led to disagreement as to whether the policy should focus on eliminating, transforming, or improving institutions.