Implementing Changes in Institutions to Improve Young Children's Development

Decision-Making Mechanism of Joint Activities for the Elderly and Children in Integrated Welfare Facilities: A Discussion Based on "Motivation-Constraint" Interaction Model

In China, joint activities for the elderly and children in integrated welfare facilities lack systematic decision procedures. By learning from the "leisure constraint" theory, the study puts forward six influencing indicators of motivation and constraint in the aspects of preliminary coordination, activity space and effect. By using semi-structured interviews and questionnaire surveys analyzed by deviation value computation, the study analyzes the evaluation value of influencing factors in the decision procedure of potential activity cases, where administrators and nurses act as two decision makers. Further, it discusses the decision-making mechanism based on the "motivation-constraint" interaction model. Firstly, it analyzes the dominant forces in the decision procedure, which are "motivation oriented", "negotiation oriented" and "constraint oriented". Secondly, it reveals that administrators and nurses as two decision makers tend to give positive motivation evaluations and deliberative constraints evaluations, respectively. Additionally, it analyzes the decision procedures of activities with distinct feasibility differentiation. Thirdly, it positions the levels of occurrence potential as "should occur", "occurred but should be improved", "potentially could occur" and "hard to occur". Eventually, it analyzes the requirements and potential for joint activities under different service modules, which provides a theoretical foundation for the systematic planning and development of the joint activities.

Adaptation of babies in three types of placement: An ethological approach

The present pilot study focuses on the adaptive processes of babies who are placed during their first months of life. It used an ethological approach to explore the behavioural adjustment of 19 infants from their arrival in placement through their first 6 weeks in Residential Care (RC; France), a Foster Family (FF; Québec) or an Infant-Mother Centre (IMC; Québec). Direct observations were conducted once a week during feeding sessions. Observed behaviours were as follows: sleep-wake state, self-soothing, burp, visual exploration, motor activity, facial and vocal expressions. Then, a Kruskal-Wallis test was conducted to examine differences in babies' adaption as a function of placement setting. Results showed that, in RC, the duration of the post-feeding phase is the shortest. Moreover, these institutionalized babies showed the most modes of self-protection and the fewest vocalizations. By contrast, babies placed in the IMC spent the least time in withdrawal, expressed motor activity more regularly and were never placed back in their recliner before burping. Larger differences appear comparing placement in RC and that in the IMC, the placement in FF showing intermediate results.

INTERAÇÕES DE BEBÊS EM ACOLHIMENTO FAMILIAR E INSTITUCIONAL: DOIS ESTUDOS EXPLORATÓRIOS

Partindo de pressupostos histórico-culturais e sociointeracionistas, que entendem as interações do bebê com seus cuidadores como pilares sobre os quais se estruturam e se desenvolvem complexas funções do psiquismo humano, buscou-se investigar como se constituem as interações de bebês em programas de acolhimento familiar e institucional. Para tanto, foram realizados estudos exploratórios e longitudinais por meio de três videogravações mensais, com dois bebês: um em acolhimento familiar acompanhado de um a três meses de idade; e uma em acolhimento institucional, de três a cinco meses. Categorias de observação foram quantificadas. Resultados apontaram os cuidados básicos como eixos condutores das interações em ambos os contextos, embora na família acolhedora houve maior amplitude e sobreposição de outros tipos de enredos interativos. Discutiu-se o modo como os campos interativos dos bebês se configuraram em articulação com elementos de natureza histórica e semiótica, que se atualizaram nas situações. A importância da formação dos cuidadores quanto ao importante papel das interações e mediação foram sinalizadas, bem como as limitações do estudo e necessidade de novas investigações com amostras maiores.

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.

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.

Research on Institutionalized Children: Implications for International Child Welfare Practitioners and Policymakers

This paper reviews the empirical literature on the effects of institutionalization on young children’s development from the perspective of global child welfare practice and policy. It considers the characteristics of typical institutions, how to assess the quality of care in institutions, the level of physical and behavioral/mental development of infants and young children while residing in institutions, the crucial role of caregiver–child interactions in children’s development, the potential of children to developmentally improve when institutional caregiver–child interactions improve or children are transferred to families, and the influence of the quality of care on children’s development regardless of context. Several controversies are considered in a balanced fashion and from the standpoint of the nature of the evidence, such as care as typically practiced versus more ideal care, intercountry adoptions, improving institutions, and volunteers in institutions. Implications for practice and policy are identified throughout, especially factors that characterize successful large-scale attempts to transition from institutionalization to a system of family alternatives.

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.

Nonhuman primate models of depression: effects of early experience and stress

Depression causes significant morbidity in the human population. The Diathesis-Stress/Two-Hit model of depression hypothesizes that stress interacts with underlying (probably genetic) predispositions to produce a central nervous system that is primed to express psychopathology when confronted with stressful experiences later in life. Nonhuman primate (NHP) studies have been extensively utilized to test this model. NHPs are especially useful for studying effects of early experience, because many aspects of NHP infancy are similar to humans, whereas development occurs at an accelerated rate and therefore allows for more rapid assessment of experimental variables. In addition, the ability to manipulate putative risk factors, including introducing experimental stress during development, allows inference of causality not possible with human studies. This manuscript reviews experimental paradigms that have been utilized to model early adverse experience in NHPs, including peer-rearing, maternal separation, and variable foraging. It also provides examples of how this model has been used to investigate the effects of early experience on later neurobiology, physiology, and behavior associated with depression. We conclude that the NHP offers an excellent model to research mechanisms contributing to the Diathesis-Stress/Two-Hit model of depression.

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.

Reduced nucleus accumbens reactivity and adolescent depression following early-life stress

Depression is a common outcome for those having experienced early-life stress (ELS). For those individuals, depression typically increases during adolescence and appears to endure into adulthood, suggesting alterations in the development of brain systems involved in depression. Developmentally, the nucleus accumbens (NAcc), a limbic structure associated with reward learning and motivation, typically undergoes dramatic functional change during adolescence; therefore, age-related changes in NAcc function may underlie increases in depression in adolescence following ELS. The current study examined the effects of ELS in 38 previously institutionalized children and adolescents in comparison to a group of 31 youths without a history of ELS. Consistent with previous research, the findings showed that depression was higher in adolescents than children with a history of ELS. Additionally, functional magnetic resonance imaging results showed atypical NAcc development, where the ELS group did not show a typical increase in NAcc reactivity during adolescence. Consequently, the ELS group showed NAcc hypoactivation during adolescence, and lower NAcc reactivity was correlated with higher depression scores. The results have important implications for understanding how ELS may influence increases in depression via neural development during the transition to adolescence and highlight the importance of identifying at-risk individuals in childhood, a potential critical period for depression-targeted intervention.

Risk and developmental heterogeneity in previously institutionalized children

This article presents an overview of the developmental outcomes of children adopted from institutional care. The author describes how institutional care is a risk factor for typical human development and describes the areas of development, both behavioral and neurobiological, that are most vulnerable to this risk. Also described is variation in outcome and resilience, where some children thrive despite exposure to adverse rearing conditions. The author concludes with an emphasis on heterogeneity in outcome, describing how the risk associated with institutional care is not a deterministic factor but rather an influential one.

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.