Implementing changes in institutions to improve young children's development

Abstract

An estimated 8 million children, mostly birth to approximately 6–8 years of age, live in institutions worldwide. While institutional environments vary, certain characteristics are common, including relatively large groups; high children:caregiver ratios; many and frequently changing caregivers; homogeneous grouping by age and disability status; periodic graduations to new groups of peers and caregivers; and an “institutional style of caregiving” that minimizes talking, provides rather dispassionate perfunctory care, and offers little warm, sensitive, contingently-responsive caregiver-child interactions. The development of children in residence is usually delayed, sometimes extremely so, in every physical and behavioral domain. Although efforts are being made in many countries to care for children without permanent parents in family environments (e.g., domestic adoption, foster and kinship care, reunification with biological parents), it is not likely that transitions to family alternatives will be completed in all countries in the near future; thus, institutions are likely to exist for many years if not decades. But institutions need not operate in the current manner; they can be modified to be substantially more family-like in structure and in the behavior of caregivers. Research indicates that when such changes are made the development of children, both typically developing and those with special needs, is improved substantially. Based on the available literature and the authors' experience, this paper describes steps that can be taken to implement such changes in residential institutions for infants and young children.

Risk and Developmental Heterogeneity in Previously Institutionalized Children

“…In contrast to physical health and safety, the team found that the “social and emotional interactions between caregivers and children [were] extremely limited and noticeably deficient”. These observations, that although health care, nutrition, and safety needs are often met, necessary maternal input is lacking, are highly similar to observations of other institutions (Groark & McCall, 2011; Groark, McCall, Fish, et al, 2011; Smyke, et al, 2007; Tirella, et al, 2008; Vorria, et al, 2003; Zych, 2006). While these observations valuably provide a general understanding of institutional characteristics, a large challenge to parents and scientists alike is that often very little information about experiences in the orphanage for an individual child is available.…”

The Effects of a Social–Emotional Intervention on Caregivers and Children With Disabilities in Two Central American Institutions

“…Efforts to provide the best possible environment for all children, including those who must remain in institutions, are consistent with international principles of children's rights and the humane thing to do, as long as efforts continue to develop family alternatives for all children (Groark & McCall, 2011a, 2011bMcCall, in press). Efforts to provide the best possible environment for all children, including those who must remain in institutions, are consistent with international principles of children's rights and the humane thing to do, as long as efforts continue to develop family alternatives for all children (Groark & McCall, 2011a, 2011bMcCall, in press).…”

“…This is not a trivial accomplishment (Groark & McCall, 2011a, 2011b. This is not a trivial accomplishment (Groark & McCall, 2011a, 2011b.…”

From Maid to Mother: Transforming Facilities, Staff Training, and Caregiver Dignity in an Institutional Facility for Young Children in Nepal

“…The nature of institutional care, with regimented schedules, high child–caregiver ratios, and changing caregivers, limits opportunity for reciprocal and stable interactions between children and caregivers and puts children at risk in various domains of development, such as physical, cognitive, and socioemotional (Bakermans‐Kranenburg, van IJzendoorn, & Juffer, ). Children raised in institutional environments tend to be delayed physically and behaviorally (Gunnar, ; MacLean, ), with problems in cognitive processing, emotional regulation, and relationships with others that persist into adulthood (Julian, 2009, as cited in Groark & McCall, ).…”