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Orphan Care Model Part 2: We Can Do Better

Traditional orphanages vs. foster care

There have been, in fact, numerous studies over the last half century which compare child development among institutionalized children and those in long term foster care, which consistently demonstrates that children in long term foster care are more well-adjusted than their institutionalized peers. Children raised in institutions are at significantly increased risk for multiple psychosocial problems including- delays in social and emotional development, aggressive behavior, ADHD, as well as an autism-like disorder. Time spent in institutions is associated with reduced IQ, reduced brain development, and even growth retardation, averaging a one month lag in physical growth for every three months spent in an institution when compared with children living in foster care. Features of institutional care which have been identified as contributors to the adverse living environment include- regimented schedules, high ratios of children to caregivers with the subsequent lack of emotional investment by the caregivers in individual children, rotating caregiver shifts and high staff turnover.

The Bucharest Early Intervention Project was the first ever randomized controlled study of long term foster care as an intervention for the social deprivation associated with institutional care of children in Bucharest, Romania. The study demonstrated a much higher incidence of psychiatric disorders in institutionalized children than those who had never lived in an orphanage, but also a clear behavioral beneficial effect of providing high quality long term foster care to formerly institutionalized children.

Millions of orphans every year “age out” of state- and privately-run institutions and are emancipated, usually at age 18. Without basic life or vocational skills, the majority of these children are left to fend for themselves. Regardless of country of origin, institutionalized children are, on average, 5-7 times more likely to have behavioral, cognitive or communication problems than other children. According to the Russian Ministry of Education, 40 % of these children participate in criminal activity, 40% turn to drugs, and 10% commit suicide.

One might reasonably expect better outcomes from the U.S. foster care system. The U.S. system of foster care was designed to be a short-term measure to provide temporary homes while reunification could be arranged. Unfortunately, in many cases children enrolled in the system bounce around from one home to another for years, mimicking the lack of caregiver consistency and disruption of felt security found in so many residential institutions. Appallingly, in 2006 the Los Angeles Times reported similar results as the Russian Ministry of Education: within 4 years of emancipation, 33% of California’s foster children were on welfare, 25% were incarcerated, and 25% were homeless! By age 20, approximately 60% of foster care women in California are or have been pregnant.

Long term foster care and adoption are less expensive than institutional care and consistently produce better outcomes than traditional institutional care and short term foster care in virtually every measure of child development and behavior. One particularly successful foster program in China has documented adoption of children by their fostering families in approximately 50% of cases.

Despite the overwhelming evidence decrying the establishment of new orphanages, many western nongovernmental organizations (NGOs) and religious groups, with noble intentions, perpetuate institutional care in the developing world, and propagate methods of orphan care which are no longer used in their own countries.

Orphaned and Alienated

But what sort of program should be implemented in the absence of an intact family, an unreceptive or even antagonistic community, and when long term foster care and adoption are either not possible or unlikely? This situation is perhaps best exemplified by the estimated 12 million AIDS orphans in Africa today. The AIDS virus steals their education and their childhood as they care for their ailing and dying parents and assume the adult roles of taking care of their younger siblings, and ultimately it steals their parents. It wreaks havoc on their security and emotional well being. The usually strong social safety net built into many African communities to care for the children of others has been stretched and ripped apart in many areas due to the disease.

Infected or not, the orphans of AIDS are stigmatized and alienated from their families and communities. They are often shunned by their extended family and neighbors, and left alone to fend for themselves with little chance of being adopted or fostered. The sentiment is not much better among Westerners, who, until very recently considered HIV to be a “deserved disease” brought about by homosexual and promiscuous behavior. In a 2001 World Vision survey conducted by the Barna Group, only 8% of Americans responded that they would donate money to help children affected by AIDS. What we fail to understand is that in Africa, the fastest growing cohorts for new HIV infection are married women, who contract the disease from their husbands, and young children, to whom the virus is “vertically transmitted” through childbirth or breastfeeding—both of them passive, innocent victims of the disease.

I would submit that the following proposal is an indication for a last resort, but not in the sense of a traditional orphanage. The objective of care in these situations should be to replicate “family” as closely as possible, doing so in a self-sustaining, holistic and culturally relevant manner.

Click Here for Part 3: Almost Homes

Research compiled by Dr. Brad Davidson.  Sources available upon request.