and Latin America, researchers from the University of Pittsburgh Office of
Child Development found that improving the social-emotional development of children
in orphanages required interventions and structural changes to promote a more
nurturing relationship between caregiver and child. A recent visit to China
revealed that orphanages in the nation of 1.3 billion people face a similar
challenge of replacing less child-sensitive practices with warmer, more family-like
care – as well as a challenge researchers had not experienced elsewhere.
past five years, China has experienced a shift in its primary orphanage
population from mostly healthy girls to large and increasing numbers of
abandoned children with disabilities whose range of special needs are straining
the capacity of the nation’s social welfare institutes to train staff or hire
specialized staff to care for them.
challenge comes at a time when improving the conditions of orphanages in China
is a work in progress whose prospects for success benefit from a number of strengths,
including more robust foster care and adoption systems, levels of care that are
on the rise, adequate and well-regulated orphanage infrastructure, a
deep-rooted value of family and caring, an emphasis on pragmatic and balanced approaches
to solving complex problems, political support for improving orphanages and an
openness to innovation.
all of the progress China has made with adoption and foster care, the vast
majority of children who get adopted or placed in foster care are those who are
either healthy, young or, if they have disabilities, they are mild, correctable
disabilities," said Junlei Li, PhD, director of the Office of Child Development
(OCD) Division of Applied Research and Evaluation. “Of the children who remain
in the orphanages, nearly 90 percent of the children have moderate to severe
of the fact-finding visit this fall by Dr. Li and OCD Co-Directors Christina
Groark, PhD, and Robert McCall, PhD, was to explore whether their experience
with orphanages in Russia, Nicaragua and El Salvador could be of help to the
government agencies, academics and nongovernmental organizations working to
improve orphanage conditions in China.
“We went to
see if we might contribute in some way,” Dr. McCall said. “We wanted to learn
what their needs are, whether what we’ve learned would be useful in fulfilling those
needs, and to meet Chinese specialists and policy makers who might take a lead
role in modifying what we’ve learned to fit their situation.”
Lesson From Russia
conducted in Russian orphanages found that when conditions were in place to
promote and sustain warm, sensitive and responsive relationships between young
children and with their adult caregivers, the children’s social-emotional and
cognitive development improved.
research was begun nearly a decade ago as an investigation by OCD and a team of
Russian researchers to determine the impact of interventions and structural
changes intended to promote family-like care in Soviet-era orphanages in St.
Petersburg, which for decades had emphad conformity and discipline over
warmth and sensitivity.
were trained and encouraged to be more warm, sensitive and responsive in their
interactions with the children with the idea of integrating loving care into
daily routines, such as feeding, bathing and dressing. 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 some consistency in who was caring for them.
structural changes were also made to the way orphanages operated. The groupings
of children were made smaller – about half the of previous groups – which enabled
caregivers to spend more time with individual children. Similar to families,
these groups included children of different ages, as well as children with
disabilities, in contrast to the more homogenous groups of the past. And
children were allowed to remain in their group for several years.
were significant. Children saw fewer, but more consistent caregivers.
Caregivers substantially improved their responsiveness and involvement with
children. They reported being more satisfied with their work. They also
reported that they had gained confidence in their ability to work with and care
for children with disabilities.
showed significant improvement across all developmental domains. On average,
their developmental quotient rose from 52 to 92, which is the largest increase associated
with a developmental intervention ever reported in child development research.
Their behavioral development also improved. They showed more mature social and
emotional behavior than children who did not receive the intervention. They
were more engaged with caregivers. Even their physical growth improved.
with disabilities made significant developmental gains as well, improving
across every domain. Their average developmental quotient increased from 23 to
42. The DQ for more than 25% of these children rose 30 points and 1 in 7
increased their DQ by more than 40 points.
Training Alone Not Enough
important lesson from the study was the importance of making structural changes
to the orphanage. “We believe that for training to work there has to be follow
up and supervision,” Dr. Groark said. “But we learned from our experiences in
Russia that training and follow-up alone doesn’t work as well as when you make
structural changes, such as changing staffing patterns so children are cared
for by the same set of caregivers to provide stability.”
reported that although children’s development improved in orphanages where only
training was provided, the gains were much lower than those experienced by children
in orphanages where training was supported by structural changes that offered
caregivers better opportunities to practice what they were taught.
findings not only have implications for orphanages in nations engaged in
improving their conditions, but also for early childhood policy and practices
in the United States, where training for teachers, social workers and others
who work with young children is increasingly emphad, but making key
structural changes to the environments in which they work is not.
years, China has been looking at ways to create settings within its orphanages
that promote more child-sensitive, family-like care.
in China generally have adequate infrastructure, staffing and funding. Steady
progress is being made in the nation’s adoption and foster care systems as
alternatives to the placement of children in orphanages, including children
with mild disabilities.
care in these orphanages, however, differs from family-like care in several
important ways. Orphanages, for example, tend to group children by age and
segregate those with disabilities in separate wards. Assigning primary or
permanent caregivers to groups of children is uncommon. Instead, children are
cared for by different caregivers who change shift to shift, year to year.
These caregivers, who often have little time to devote to individual children,
typically perform their duties with little talking and one-on-one or
is made more challenging by the dramatic increase in the proportion of children
with disabilities who now reside in China’s orphanages. The recent surge in
this population has come about for several reasons. There are, for example, few
resources available to parents to help them care for a child with disabilities
at home. The lack of high-quality prenatal care and birthing procedures also
contribute the rising number of infants with disabilities, evidenced by a rising
number of children with cerebral palsy, a condition often triggered by
preventable trauma to the brain sustained during birth. And China’s rule
limiting family to one child still creates a climate in which families
favor keeping the most “viable” infant. Previously, the rule led to an increase
of girls being placed in orphanages as a result of families preferring to have
their only child be a male. When the rule was relaxed to allow families to
adopt a second child, the number of abandoned girls declined, but the
percentage of children with disabilities in the orphanages increased.
innovative efforts are underway in China to create more family-like care within
the orphanages. Some, for example, have implemented supplemental programs, such
as separate activity rooms where children are given a few hours of individual
attention from trained nannies. Such supplemental programs serves only a
limited number of children in each orphanage and requires ongoing foreign
investment to pay for the additional staff.
They do not create the level of structural change the Russia study found
to be an essential to producing significant developmental gains among children.
Appetite For Collaboration
by OCD researchers this fall succeeded in gaining a working knowledge of the
needs of orphanages in China, the efforts to improve conditions within the
orphanages, and the key players in government, academia and elsewhere who are
involved in promoting change.
that nearly all Chinese stakeholders accept the research evidence that
family-like care leads to better outcomes for children, including children with
disabilities. OCD researchers were asked to write an article on that topic for
a government journal that is required reading for civil affairs government
personnel and others who work with young children. OCD is also exploring the
possibility of collaborating with Half the Sky Foundation, a nongovernmental agency
working in China that provides supplemental programs to orphanages. The talks
to date have focused on developing a tool to assess the quality of care in
orphanages, including caregiver-child interactions and relationships, and on
piloting the kinds of structural changes in orphanages OCD found were critical
to achieving more nurturing care-giver-child relationships in Russia and Latin
researchers learned there is wide agreement in China that the nation does not
lack ideas, commitment to family-like care or small-scale experiments intended
to promote family-like care in orphanages. What the nation needs most, they
were told, is a systematic effort to examine small-scale demonstrations that
exist, understand what works and what doesn’t, and develop effective strategies
for bringing the best practices up to scale. If OCD were to have a role in a
Chinese-directed collaboration, one possibility would be to help nurture the
existing orphanage experiments toward broader implementation.
most important, OCD researchers wanted to gauge whether there is an openness
and readiness in China for collaboratively creating family-like settings in
orphanages to improve the development of children with disabilities, which can
involve difficult decisions and hard work. “That was our big question,” said
Dr. Li. “And the answer was, Yes.”