Improving Institutional Care: Lessons Learned from Russia

1. Improving Institutional Care: Lessons Learned from Russia Victor Groza, Ph. D. Grace F. Brody Professor of Parent-Child Studies Mandel School of Applied Social Sciences Case Western Reserve University Cleveland, OH, USA

2. Alternative Care GuidelinesMinistry of Women’s Affairs • Fill basic and psychosocial needs of children for their wholesome growth & development. • Enable children to develop skills to be self-reliant.

3. This is not to criticize staff • Staff do the best job they can • This is not about what staff are doing wrong, but what can be done better to help children

4. No baby in a family sleeps in a room with many other babies

5. Risks to Children for same-age placement in rooms • Too many children for too few caregivers • Staff do the best that they can given the situation; it is not about the staff but what is best for the children • Babies need more than food, clothing and shelter; they need to be held when food, comforted when they cry, talked to when they are awake, and to attach to at least one caregiver

6. During the first three years of life, brain development occurs which is crucial to focusing attention and cognitive skills that are crucial for planning, problem solving, critical thinking and good judgment.

7. Consequences of the risks • Changes in the brain • Immunization failure • Developmental problems • Institutionalized children experience 1 month of mixed developmental delay for every 3-4 months of institutionalization. • Attachment problems

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10. Feeding promotes attachment & sensory development

12. Survivor Behavior—Indiscriminate friendliness

13. What can be done to improve quality of life? • Mixed age groups in each room • One consistent staff for each room • A daily program of activities

14. Mixed Age Groups • Replicates family life • Gives older children opportunity to observe an adult caring for a younger child • Allows older children to participate in care giving • Keeps siblings in the same location • Different type of stress on care givers

15. One consistent caregiver • Allows care giver to know children • Allows children to know caregiver • Promotes attachment

16. A daily program of activities • Children need structure every day during waking hours, including weekends • Should be posted for all to see • Should include children in choosing after-school and weekend activities • Allows volunteers to participate in the life of children beyond basic caregiving

17. Major findings in russia • Children showed improvements in physical growth, cognition, language, motor, personal-social, and affect, with children having severe disabilities improving the most.

18. Training implications • Ongoing training of caregivers to promote warm, responsive care giving. • Caregivers needs to be more emotionally available for children. • Aim for each child having an early experience of ongoing interaction with his/her own close and emotionally available adult.

19. For discussion • Reactions to information • What would be the barriers to implementing the changes?

20. References • Groark, C. J., Muhamedrahimov, R. J., Palmov, O. I., Nikiforova, N. V., & McCall, R. B. (2005). Improvement in early care in Russian orphanages and their relationship to observed behaviors. Infant Mental Health Journal, 26(2), 96-109. • Muhamedrahimov, R. J., Palmov, O. I., Nikiforova, N. V., Groark, C. J., & McCall, R. B. (2005). Changing social environment for young children living in Baby Homes. In V. M. Behterey (Ed.), Contemporary Psychology, Conference Abstracts (in Russian), (pp. 251-255). Kazan: Centre of Innovative Technologies, Kazan State University. • The St. Petersburg-USA Orphanage Research Team (2008). The effects of early social-emotional-relationship experience on the development of young orphanage children. Monographs of the Society for Research in Child Development, 73, Serial No. 291(3).