leaves little doubt that children living in orphanages and other institutions
around the world are at higher risk of experiencing developmental setbacks that
can have a lasting impact on their lives. The evidence is not lost on many of
the nations that rely on orphanages to care for children without parents. But
for them, it’s not a question of whether they should address the problem or
even what can be done to solve it. What they struggle to answer is how to
overcome challenges ranging from cultural to financial that stand in the way of
implementing what science tells them will help improve the outcomes for
millions of children in their orphanages.
a practice and policy standpoint, almost everybody agrees that the goal is to
provide every child with a loving, committed family. We also have evidence that
improving the environment within institutions can improve the outcomes of the
children who remain there," said Christina Groark, Ph.D., co-director of the
University of Pittsburgh Office of Child Development (OCD). “The issue for many
nations is how to get there from where they are now. Developing a system of
family alternatives is not an easy task.”
in the development of such children rose after the fall of Romanian strongman
Nicholae Ceausescu revealed the appalling conditions within the institutions
where thousands of children had been raised without adequate nutrition, medical
care, sanitation, or caretaking. The revelations led to a sharp increase in
adoptions from orphanages worldwide, greater interest in studying the
development of institutionalized children, and a willingness among more nations
to explore alternatives to the orphanages they long relied upon to care for
children without parents.
challenges those nations face were among the topics addressed by 25 of the
world’s leading experts on vulnerable children at a 2009 conference held at
Leiden University in the Netherlands, which was convened by OCD and international
colleagues to examine what is known about children’s development as well as
policy and practice. Publications that emerged from the project detail the
developmental deficits institutionalized children tend to exhibit, the
conditions that contribute to them, what can be done to address the problem,
and the obstacles that confront countries attempting to build a system of
report that exposure to substandard care in an institution can?have a lasting
developmental impact on children, including problems forming healthy
attachments?and deficits in neurological and?cognitive abilities and physical
growth. And children who spend time in an institution during their first few
years of life tend to be the most vulnerable.
surprisingly, the research also shows that in most cases it is better for
children’s outcomes if they are able to be placed in a family environment
outside of the institution or avoid spending any time in an institution
whatsoever. For example, children adopted from orphanages show marked
improvement in physical growth, attachment, and their cognitive and behavioral
development, although the recovery is not always complete.
are also more likely to have long-term problems with behavior, executive
function, and social skills if they are not able to leave the institution by a
certain age. The age at which the “step” occurs varies depending on the severity
of the orphanage experience and other factors. But studies suggest that when
institutionalized children are adopted before the step occurs they tend to have
rates of problems similar to children who have never lived in an institution.
many countries, a child welfare system, and the professional infrastructure and
family support that family alternatives to institutions require, either don’t
exist or are underdeveloped. And in many cases, political, administrative,
financial, and cultural challenges complicate the process of developing them.
factors make it difficult to recruit adoptive or foster parents. In some
countries, for example, there is resistance among parents to raise someone
else’s child based on religious beliefs, culture, social customs, or other
factors. Also, financially strapped families are often less willing to adopt
and many nations lack systems for providing them with financial assistance and
other support that would encourage them to do so.
children in institutions throughout the world have at least one parent. There
are many reasons why parents relinquish their children to institutions,
including poverty, which plays a major role. Yet, many countries lack
preventative interventions, such as basic services, assistance, and early
family support programs, that could help reduce the number of families who give
up their children to orphanages or other institutions.
or mental disability also increases children’s likelihood of being
institutionalized. In Central and Eastern Europe and the Commonwealth of Independent
States, for example, children with disabilities are 46 times more likely to end
up in an institution than those without disabilities. And in most countries,
parents willing to adopt strongly favor typically functioning children, making
it difficult to place institutionalized children with disabilities in alternative
lack of professional services infrastructure to train, support, and provide
services to families is yet another obstacle many countries face in trying to
prevent children from entering orphanages or other institutions.
of the necessary components of having a comprehensive child welfare system is
that you need a professional infrastructure,” Dr. Groark said. “You need social
workers and psychologists who know how to deal with all of the risk factors
that cause families in those countries to give up their children. Infrastructure
like that isn’t developed overnight.”
are signs of progress, however. For example, children are now adopted
domestically at higher rates than in the past in some countries, such as Brazil
and China. And in India, China, and a few other nations, more children who
traditionally have been difficult to place are being taken into domestic family
child welfare reform takes time. And the inescapable reality is that millions
of children remain in orphanages and other institutions throughout the world,
even in nations that are making progress toward building a professional child
welfare system of family care alternatives.
for example, had the political will to create a child welfare system of family
care alternatives and invested considerable resources to build it. After five
years, 5,000 children had been placed in foster care. But another 45,000
children remained in orphanages.
is hope for such children, however. Studies suggest conditions within
orphanages and other institutions can be substantially improved, resulting in
better developmental outcomes for both typically functioning children and those
with disabilities. In St. Petersburg, Russia, for example, OCD and Russian
researchers designed and implemented interventions and structural changes to create
an environment of family-like care in Soviet-era orphanages, which for decades
had emphad conformity, discipline, and a business-like, perfunctory
approach to care that lacked the warmth and sensitivity that children raised in
a typical family would be expected to receive.
were trained and encouraged to be more warm, sensitive, and responsive in their
interactions with the children. They were taught how to position and interact
with children in their care who had disabilities. For the first time, primary
caregivers were designated and their schedules adjusted to give children
consistency in who was caring for them.
structural changes were also made. For example, the groupings of children were
made smaller, which enabled caregivers to spend more time with individual children.
And the groups included children of different ages, as well as children with
improved significantly and the interventions continue today with local funding.
Most importantly, children show substantial improvement across all
developmental domains, including sizable increases in their developmental quotients,
and improvement in their behavioral development, their engagement with
caregivers, and even their physical growth. “They’ve maintained that
intervention on their own budget for six years and it still works,” said OCD Co-director
Robert McCall, Ph.D. “The care giving is better by measurement and the
children’s development is still better by measurement.”