A socioemotional intervention in a Latin American orphanage

New insights into the behavioral structure of Pikler educators: An application of T-pattern detection and analysis with THEME

Introduction

The recent generalization of early childhood schooling has given rise to a need for the development of rigorous, specific training programs aimed at early education professionals (0-3 years of age). This work emanates from the unique nature of Pikler-Lóczy education as a reference for early childhood education centers, and its expertise in providing quality care in an everyday classroom situation. The aim of the study is to use T-pattern detection and analysis, within the framework of observational methodology, to identify relevant aspects of the choreography followed by Pikler educators during breakfast, and thus provide substantial material with a view to creating a training plan.

Methods

Two expert educators in Pikler-Lóczy education were directly and systematically observed in their own classrooms, following a nomothetic, follow-up and multidimensional design. The observation instrument underwent a molarization process so that the detected elements would be more significant and understandable for novice educators.

Results

Using THEME, the invariant aspects of the educators' behavior were analyzed. The significance level for the critical interval was the THEME default (α = 0.005). The results show: on the one hand, changes expected in T-patterns in accordance with the observation instrument molarity; and on the other hand, stability in terms of the comparison between the two educators.

Discussion

These results help us to identify the complex structure of the breakfast choreography, and how educators establish interaction with children. In addition to specific issues pertaining to Pikler-Lóczy education, the conclusions highlight the advantages of using T-pattern analysis within the framework of observational methodology, in order to dissect a mealtime routine in its natural context, and explain components of early childhood education intervention that satisfy basic childhood needs. This constitutes a starting point from which to generate instructive material for the training of professionals working in early education.

Sustainability of effects and secondary long-term outcomes: One-year follow-up of a cluster-randomized controlled trial to prevent maltreatment in institutional care

BACKGROUND

Many orphans in East Africa are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. We report on the extension of a cluster-randomized controlled trial aiming to replicate and show sustainability of previous found effects and to discover long-term effects of the intervention Interaction Competencies with Children-for Caregivers (ICC-C) 12-months after the intervention's conclusion.

METHODS

Conducting a robust 2x3 analysis of variance, we investigated the changes over time in the waitlist orphanages (n = 75, 62.7% female, Mage = 37.63 years, SDage = 11.81), which participated in the intervention after first follow-up and in the initial intervention orphanages (n = 81, 61.7% female, Mage = 38.73 years, SDage = 11.94).

RESULTS

The caregivers in the waitlist orphanages reported less reported levels of maltreatment (d = -0.09), fewer positive attitudes towards violent discipline (d = -0.44) and increased childcare knowledge (d = 1.26) three months after intervention, replicating our findings of the initial intervention condition. In addition, these effects were maintained in the intervention orphanages 12 months post intervention. Furthermore, we found long-term improvements in negative caregiver-child relationship (d = -0.83), caregivers' stress level (d = -0.98) and their mental health problems (d = -0.61).

CONCLUSIONS

The replication and maintenance of the intervention effects and first hints to additional long-term effects substantiates the effectiveness of ICC-C. As long as alternative care cannot be provided for all children in need, brief caregiver trainings can make an important contribution to enlarge the opportunities for many children.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03594617. Registered on 20 July 2018.

Marte Meo Counselling given to African caregivers of institutionalised infants a three-case study

BACKGROUND

Studies from Western countries state that video interaction guidance programmes can support caregiver sensitivity in infant-caregiver dyads.

OBJECTIVES

The aim of this study was to investigate if Marte Meo, which is such a programme, could contribute to increasing emotional and social support towards motherless infants at an institution for motherless infants in rural Africa.

METHOD

Three caregivers participated in five Marte Meo Counselling sessions. The first guidance naïve film and the last film were analysed qualitatively and quantitatively and organised according to two supportive categories: 1) caregiver responds to infants' initiative, 2) caregiver takes initiative to supportive interaction, and two non-supportive: 3) caregiver behaves in an intrusive manner and 4) caregiver does not respond to the infants' initiative.

RESULTS

After receiving Marte Meo Counselling, all three caregivers showed impressive augmentation of awareness and sensitivity in their care towards the infants' emotional and social needs.

CONCLUSION

We found indications that professional caregivers of institutionalised infants in an African country can profit on Marte Meo Counselling, showing positive effects on augmenting caregivers' sensitivity towards the infants, and thereby meet the infants' need of emotional and social support.

Early Deprivation Revisited: Contemporary Studies of the Impact on Young Children of Institutional Care

There is clear evidence that early deprivation in the form of early institutional care affects children both immediately and long after they are removed from the institution. This article reviews the modern literature on the impact of institutional care from animal models to longitudinal studies in humans. Importantly, we examine the current understanding of neuroendocrine regulation in the context of early deprivation. We discuss the opportunities and limitations of studying the effects of deprivation in previously institutionalized children, review behavioral findings and related neurobiological studies, and address the physical health ramifications of institutional care. Finally, we touch on future directions for both science and intervention.

CAREGIVER SENSITIVITY AND CONSISTENCY AND CHILDREN'S PRIOR FAMILY EXPERIENCE AS CONTEXTS FOR EARLY DEVELOPMENT WITHIN INSTITUTIONS

The current study addressed whether two institution-wide interventions in St. Petersburg, Russian Federation, that increased caregiver sensitivity (Training Only: TO) or both caregiver sensitivity and consistency (Training plus Structural Changes: T+SC) promoted better socioemotional and cognitive development than did a No Intervention (NoI) institution during the first year of life for children who were placed soon after birth. It also assessed whether having spent less than 9 versus 9 to 36 months with a family prior to institutionalization was related to children's subsequent socioemotional and cognitive development within these three institutions. The Battelle Developmental Inventory (J. Newborg, J.R. Stock, L. Wnek, J. Guidubaldi, & J. Svinicki, 1988) was used to assess the socioemotional and cognitive functioning of children in NoI (n = 95), TO (n = 104), and T+SC (n = 86) at two to three time points during their first 6 to 12 months of residency. Results suggest that improving caregiver sensitivity can improve the cognitive development of infants in the first year of institutionalization whereas improving caregiver consistency in addition to sensitivity is more beneficial for socioemotional development than is sensitivity alone. Similarly, for children in T+SC, longer time with a family prior to institutionalization (consistent caregiver, unknown sensitivity) was associated with better socioemotional, but not cognitive, baseline scores and more rapid cognitive than socioemotional development during institutionalization. These results suggest caregiver sensitivity is more highly related to cognitive development whereas caregiver consistency is more related to socioemotional development in the first years of life.

Adaptation to Spanish and criterion validity of a scale for the screening of emotional and behavioral problems in early childhood

Introduction: Early identification of emotional and behavioral risk in children can contribute to the development of strategies that promote mental health from early childhood. In Colombia, we do not count with a validated screening tool for emotional and behavioral problems in this population. Objectives: To identify, adapt, and establish evidence for the criterion validity of a screening tool for emotional and behavioral problems in less than 6-year-old children. Materials and methods: We selected the Early Childhood Screening Assessment (ECSA) after a literature review and expert consensus and then we undertook its linguistic adaptation. For criterion validity, we used the Receiver Operating Characteristic (ROC) comparing the scale with the Child Behavior Checklist (CBCL 1,5-5). The sample included 206 caregivers of children between 1.5 and 6 years of age from the city of Tunja and the municipality of Sopó. Results: The ECSA showed a good correlation with the total t-score of the CBCL 1,5-5 (Spearman rho= 0,75, p<0,01). The scale showed a sensitivity of 86% and a specificity of 82% at a cut-off point of 24. Conclusion: In this first adaptation to Spanish and validation study of the ECSA scale, we found good sensitivity and specificity values for the screening of emotional and behavioral problems in early childhood.

Development of children adopted to the United States following a social-emotional intervention in St. Petersburg (Russian Federation) institutions

This study is a post-adoption follow-up of a social-emotional intervention in St. Petersburg, Russian Federation Baby Homes (BHs). Children previously resided in BHs and received Care as Usual (CAU, N=220), Training Only (TO, N=94), or Training plus Structural Changes (T+SC, N=45). This study examined intervention effects 0-6.5 years post-adoption to the USA, at age 9 months to 7 years old. Adoptive parents completed questionnaires on their child's social and behavioral development. Intervention graduates had better attachment security, less indiscriminate friendliness, and fewer behavior problems than CAU graduates. Children who had longer exposure to intervention conditions had better attachment security, but poorer executive function, externalizing and internalizing problems, and competence. Thus, although post-institutionalized children were generally functioning in the normal range in early childhood and effect sizes were small, a social-emotional intervention in institutions is associated with modest benefits to attachment and behavior problems and apparent decrements to executive function.

Fostering Child Development by Improving Care Quality: A Systematic Review of the Effectiveness of Structural Interventions and Caregiver Trainings in Institutional Care

Quality of child care has been shown to have a crucial impact on children's development and psychological adjustment, particularly for orphans with a history of maltreatment and trauma. However, adequate care for orphans is often impacted by unfavorable caregiver-child ratios and poorly trained, overburdened personnel, especially in institutional care in countries with limited resources and large numbers of orphans. This systematic review investigated the effects of structural interventions and caregiver trainings on child development in institutional environments. The 24 intervention studies included in this systematic review reported beneficial effects on the children's emotional, social, and cognitive development. Yet, few studies focused on effects of interventions on the child-caregiver relationship or the general institutional environment. Moreover, our review revealed that interventions aimed at improving institutional care settings have largely neglected violence and abuse prevention. Unfortunately, our findings are partially limited by constraints of study design and methodology. In sum, this systematic review sheds light on obstacles and possibilities for the improvement in institutional care. There must be greater efforts at preventing violence, abuse, and neglect of children living in institutional care. Therefore, we advocate for combining attachment theory-based models with maltreatment prevention approaches and then testing them using rigorous scientific standards. By using approaches grounded in the evidence, it could be possible to enable more children to grow up in supportive and nonviolent environments.

CAREGIVER-CHILD INTERACTION, CAREGIVER TRANSITIONS, AND GROUP SIZE AS MEDIATORS BETWEEN INTERVENTION CONDITION AND ATTACHMENT AND PHYSICAL GROWTH OUTCOMES IN INSTITUTIONALIZED CHILDREN

This report describes a secondary analysis of data from a comprehensive intervention project which included training and structural changes in three Baby Homes in St. Petersburg, Russian Federation. Multiple mediator models were tested according to the R.M. Baron and D.A. Kenny () causal-steps approach to examine whether caregiver-child interaction quality, number of caregiver transitions, and group size mediated the effects of the intervention on children's attachment behaviors and physical growth. The study utilized a subsample of 163 children from the original Russian Baby Home project, who were between 11 and 19 months at the time of assessment. Results from comparisons of the training and structural changes versus no intervention conditions are presented. Caregiver-child interaction quality and number of caregiver transitions fully mediated the association between intervention condition and attachment behavior. No other mediation was found. Results suggest that the quality of interaction between caregivers and children in institutional care is of primary importance to children's development, but relationship context may play a less direct mediational role, supporting caregiver-child interactions.

The crucial role of the micro caregiving environment: Factors associated with attachment styles in alternative care in Chile

The distribution of attachment styles has been shown to differ between groups of children living with their parents and children placed in alternative care (AC), defined as residential or foster. However, this is the first study in Latin America to explore possible factors affecting the quality of attachment in children living in both residential and foster care. Two groups of children (N=57) were compared: one group living in Residential Homes (RC) and the other in Foster Care (FC) in Chile. Children's, caregivers' and structural factors (e.g., child: caregiver ratios) and their links with attachment styles were investigated. The micro caregiving environment (i.e., the specific individual child caregiver relationship), especially the caregivers' engagement, sensitivity, disciplinary control and affection, as well as some structural factors (i.e., child: caregiver ratios), were linked to attachment security in children. Specifically, better emotional caregiving and lower child-caregiver ratios were associated with higher rates of secure attachment. The association between quality of care (as measured by the HOME inventory) and attachment styles seems to be influenced by caregiver relationships (as measured by CCSERSS). Caregiver relationship factors (i.e., affection, engagement and sensitivity) directly impact the quality of the attachment children establish with them while living in AC. However, the relationships that caregivers establish with children under their care can be facilitated by good quality structural factors, particularly child-caregiver ratios.

IMPACT OF A SUPPORT GROUP FOR THE CAREGIVERS AT AN ORPHANAGE IN TURKEY

This study examined the effectiveness of a 20-session training and supervision support group for caregivers working at an orphanage in Istanbul. The support group's goals were to promote sensitive and responsive caregiving in an institutional setting, to decrease the stress level of the caregivers, and to increase the quality of the relationship between caregivers and children. Thirty-six children (15-37 months) and 24 caregivers participated in this study. Comparison of the pre- and posttest measures of the caregiver intervention and control groups indicated that the intervention yielded successful outcomes. Caregivers in the intervention group displayed significant decreases in the amount of psychological symptoms that they reported and in their emotional burnout levels. Their sense of self-efficacy also improved. In addition, at the end of the 5-month training program, positive developments were observed regarding children's development and problem behaviors. Having regular visitors also was found to be a significant predictor for better developmental outcomes for the children under institutional care.

Seeing the trees within the forest: addressing the needs of children without parental care in the Russian Federation

In this essay, we comment on the dominant practice in high-resource societies of placing children without biological parental care (CwoBPC) into substitution families, and the promotion of this solution as evidence-based and state of the art. As the Russian Federation has formulated and is now addressing in matching legislation, it possibly overestimated the role of substitution families and underestimated the importance of specialized institutions in addressing the CwoBPC issue. Although we do not question the overall benefit of placing all CwoBPC in adequate family settings, we question the specifics of its realization in particular societies, including that of modern Russia. We argue for the importance of a mixed model, in which informed and supervised family placements are combined with high-quality family-environment institutional settings as the most appropriate model for middle- and, perhaps, even high-resource societies, especially for young children and children with disabilities. Diversifying placements based on the individual needs of each CwoBPC, especially children with special needs, is what is best for these children.

Culturally sensitive adaptation of the concept of relational communication therapy as a support to language development: An exploratory study in collaboration with a Tanzanian orphanage

BACKGROUND

Orphans and other vulnerable children (OVC) who grow up in institutional care often show communication and language problems. The caregivers lack training, and there are few language didactics programmes aimed at supporting communication and language development in OVC in institutional care in Tanzania.

OBJECTIVES

The purpose of the study was to adapt the German concept of relational communication therapy (RCT) as a support to language development in a Tanzanian early childhood education context in a culturally sensitive way. Following the adaptation of the concept, a training programme for Tanzanian caregiver students was developed to compare their competencies in language didactics before and after training.

METHODS

A convergent mixed methods design was used to examine changes following training in 12 participating caregiver students in a Tanzanian orphanage. The competencies in relational language didactics were assessed by a self-developed test and video recordings before and after intervention. Based on the results, we drew conclusions regarding necessary modifications to the training modules and to the concept of RCT.

RESULTS

The relational didactics competencies of the caregiver students improved significantly following their training. A detailed analysis of the four training modules showed that the improvement in relational didactics competencies varied depending on the topic and the teacher.

CONCLUSION

The results provide essential hints for the professionalisation of caregivers and for using the concept of RCT for OVC in institutional care in Tanzania. Training programmes and concepts should not just be transferred across different cultures, disciplines and settings; they must be adapted to the specific cultural setting.

The development of postinstitutionalized versus parent-reared Russian children as a function of age at placement and family type

A total of 149 children, who spent an average of 13.8 months in Russian institutions, were transferred to Russian families of relatives and nonrelatives at an average age of 24.7 months. After residing in these families for at least 1 year (average = 43.2 months), parents reported on their attachment, indiscriminately friendly behavior, social-emotional competencies, problem behaviors, and effortful control when they were 1.5-10.7 years of age. They were compared to a sample of 83 Russian parents of noninstitutionalized children, whom they had reared from birth. Generally, institutionalized children were rated similarly to parent-reared children on most measures, consistent with substantial catch-up growth typically displayed by children after transitioning to families. However, institutionalized children were rated more poorly than parent-reared children on certain competencies in early childhood and some attentional skills. There were relatively few systematic differences associated with age at family placement or whether the families were relatives or nonrelatives. Russian parent-reared children were rated as having more problem behaviors than the US standardization sample, which raises cautions about using standards cross-culturally.

Attachment Styles in Children Living in Alternative Care: A Systematic Review of the Literature

Background

A large number of children are currently living in Alternative Care. The relationship they establish with their temporary caregivers can play a significant role in their development. However, little has been published regarding attachment with temporary Caregivers.

Objective

The aim of this review is to analyse the existing published studies regarding attachment styles in children living in alternative care (Children’s Homes and Foster Care). The review analyses rates of attachment styles and associated factors (including characteristics of settings, children and caregivers) in both settings.

Methods

A systematic literature review was conducted searching electronic databases for peer reviewed publications in different languages. Studies considering attachment in children living in Children’s Homes or Foster families at the time of the study were included.

Results

Overall, 18 articles reporting 13 studies met the inclusion criteria. The results are presented in terms of characteristics of the studies, rates of attachment in different settings and possible mediating factors. Implications for practice and research are discussed.

Conclusions

Attachment styles in children living in alternative care differ from those observed in children living with biological or adoptive families, however several factors can mediate this outcome (including characteristics of settings, children and caregivers). Most research has been conducted in Europe and USA. Therefore, further research is needed in less developed countries in order to guide local policies for better care.

Global research, practice, and policy issues on the care of infants and young children at risk: the articles in context

This Special Issue includes articles that contribute to (a) the global research base pertaining to the development of infants and toddlers at risk, primarily those who are institutionalized in lower resource countries; (b) interventions in institutions and to promote family alternatives to institutionalization; and (c) attempts to create modern child welfare systems emphasizing family care in entire states and countries. This introduction places these articles into the broader contexts of the literature in these three domains of interest. Across the world, urbanization, migration, armed conflict, epidemics, and famine disrupt families. Add poverty, abuse, neglect, and parental incapacity due to substance abuse and mental health problems, and the result is millions of children without parental care who come under governmental responsibility, often to be reared in institutions, and at risk for long-term developmental deficiencies and problems. Over the last 2 decades and especially recently, national and international governments and nongovernment organizations have increased efforts to help such children, especially those in low-resource countries. Two types of efforts have been made: one to improve the quality of care provided by institutions and the other to minimize the use of institutions and promote family residential care alternatives. The latter effort includes preventing family separations in the first place, reunification of children with birth families, and developing systems of kinship care, foster care, and adoption. This Special Issue of IMHJ is devoted to reports pertaining to issues in the research knowledge base, program practices, and countrywide policies for infants and young children at risk. We attempt in this introduction to place these reports in the broader context of this field, identify their unique contributions, and highlight lessons learned that can contribute to improved care practices and better child welfare systems.

Improving care quality and preventing maltreatment in institutional care - a feasibility study with caregivers

Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and 3 months following the training workshop. The results showed high demand, good feasibility, high motivation, and acceptance of caregivers. They reported improvements in caregiver–child relationships, as well as in the children’s behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, 1 month before, and 3 months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach.

From maid to mother: transforming facilities, staff training, and caregiver dignity in an institutional facility for young children in Nepal

This article provides a case study of a project to improve the health, safety, and development of children birth to 6 years old in a large orphanage in Nepal. Two interventions were conducted: improvement of physical infrastructure and training, mentoring, and support for caregiving staff. As a result of these interventions, positive outcomes in terms of children's health and development have been observed, including reduction of communicable diseases and increased social interactions with caregivers. As part of the new training initiative, the caregivers began to meet regularly to share their ideas and experiences, and came to realize their vital role in the holistic development of the children in their care. One important change was a greater sense of dignity for the caregivers. The caregivers were formerly called Maids (Aaya), but asked to be called Mothers (Aama). The project also faced challenges, including communication barriers related to organizational structure.

The consequences of early institutionalization: can institutions be improved? - should they?

BACKGROUND AND SCOPE

The focus of this review is on institutionalized children, one of the most inequitably and severely treated groups of children. Although institutions vary, many share some common characteristics, including large groups, high children: caregiver ratios, many and changing caregivers, and caregiver-child interactions that lack warm, sensitive, contingently-responsive, and child-directed behaviors. Resident children develop poorly physically, mentally, and social-emotionally, but those adopted from institutions display substantial catch-up growth in many domains of development. If they are adopted at an early age, there have been no long-term consequences of institutionalization yet measured; but if institutionalization is prolonged, they display higher rates of long-term deficiencies and problems in many domains.

METHODS

This review is based on a database search of the literature, focusing on the development of children while residents, and the development of post-institutionalized children who have been transitioned from institutions to family care. It also draws on the reports and findings of the St. Petersburg-USA Orphanage Intervention.

FINDINGS

A combination of theories pertaining to attachment (especially caregiver attachment to the infant/toddler), chronic stress, and genetics may explain these outcomes. It appears that caregiver-child interactions are a major contributor to children's outcomes, and interventions in institutions that improve such interactions produce substantial increases in children's physical, mental, and social-emotional development, including for children with disabilities.

CONCLUSIONS

Deinstitutionalization and the creation of comprehensive professional child welfare systems emphasizing family care alternatives is a preferred goal, but this is likely to take many low-resource countries decades to develop. If substantial numbers of children remain in institutions despite best efforts to find families for them, improving the institutions might help to provide all the children with the best care possible under the circumstances.

Structure, Caregiver–Child Interactions, and Children’s General Physical and Behavioral Development in Three Central American Institutions

This article describes structural characteristics and caregiver–child interactions ( N = 34) in three Central American institutions for infants and young children ( N = 79) and relates differences in these characteristics to differences in children’s physical, behavioral, and cognitive development. Generally, the institution with the smallest group size, fewest children per caregiver, and a few consistent caregivers had children with the best physical, behavioral, and cognitive development; this institution also had many temporary volunteers who played with the children. Differences in the quality of caregiver–child interactions were not directly related to children’s development, but the potential benefit of high-quality interactions may have been minimized by a high children:caregiver ratio in one institution, and the presence of volunteers to play with children may have compensated for and/or minimized the display of higher-quality interactions by staff caregivers in another institution.

Research, Practice, and Policy Perspectives on Issues of Children without Permanent Parental Care

This chapter presents conclusions, trends, conceptual analyses, hypotheses, and speculations regarding some fundamental issues of research, practice, and policy that are largely unsettled or controversial. As such, the chapter is not a summary of Chapters 1-8, but rather contains interpretations and opinions of the author intended to elevate the priority of certain issues, suggest hypotheses to be studied, and propose practice and policy steps to be considered.

Research, Practice, and Policy Perspectives on Issues of Children without Permanent Parental Care

This chapter presents conclusions, trends, conceptual analyses, hypotheses, and speculations regarding some fundamental issues of research, practice, and policy that are largely unsettled or controversial. As such, the chapter is not a summary of Chapters 1-8, but rather contains interpretations and opinions of the author intended to elevate the priority of certain issues, suggest hypotheses to be studied, and propose practice and policy steps to be considered.

Implementing Changes in Institutions to Improve Young Children's Development

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.

Characteristics of environments, caregivers, and children in three Central American orphanages

This study provides descriptive empirical information on the environments, organizational structure, caregivers, caregiver-child interactions, and children's general behavioral development and problem behaviors from three institutions for young children in Central America. While the institutions were clean, they were physically sparse and had Infant-Toddler Environmental Rating Scale (ITERS; T. Harms, D. Cryer, & R. Clifford, 2006) and Early Childhood Environmental Rating Scale (ECERS; T. Harms, R. Clifford, & D. Cryer, 2005) scores that averaged 1.62 (7 = highest). Caregivers provided routine caregiving with limited emotion, responsiveness, support, empathy, or guidance. Caregivers tended to work long hours and then were off 2 to 3 days, and children periodically graduated to new wards, so there was little stability of caregivers in children's lives. Children's average Battelle Developmental Inventory Total Developmental Quotient = 58 to 63, which would be considered mildly-moderately retarded in noninstitutional U.S. populations; no child scored >90, 80% scored <70, and nearly half scored <60. Children displayed high frequencies of indiscriminate friendliness, noncompliance, and provocative and aggressive/violent behaviors. These data and that of a few other studies represent the only comprehensive, empirical description of institutions for young children, which constitutes the independent variable (institutionalization) for a burgeoning literature on postinstitutional adopted children. Results are consistent with the hypothesis that a lack of warm, sensitive, contingently responsive interactions with relatively few consistently available caregivers may be a major contributor to delayed contemporary development and persistent deficits and problems observed in some postinstitutional adopted children and adolescents.