Skin-to-skin contact, for 25 to 120 minutes after birth, early suckling, or both positively influenced mother-infant interaction 1 year later when compared with routines involving separation of mother and infant.

Attachment has been assessed in the extreme environment of orphanages, but an important issue to be addressed in this chapter is whether in addition to standard assessment procedures, such as the Strange Situation, the lack of a specific attachment in some institutionalized children should be taken into account given the limits to the development of stable relationships in institutionalized care. In addition, this chapter discusses disinhibited or indiscriminately friendly behavior that is often seen in institutionalized children. Enhanced caregiving quality alone appears to be insufficient to diminish indiscriminate behavior, at least in some children, as evidenced by the persistence of indiscriminate behavior in children adopted out of institutions into adoptive families. We suggest that the etiology and function of indiscriminate friendly behavior may be different for institutionalized versus not-institutionalized children. In the first case it may reflect a distortion or disruption of early attachment relationships, in the latter case it is likely to result from the lack of expected input in the form of contingent interactions with a stable caregiver in early life. We try to delineate infant and caregiver characteristics that are associated with secure attachment in institutional settings, given the inevitable fact that large numbers of infants worldwide are being raised, and will be raised, in contexts of institutional care. We conclude that much further study is needed of the development of children’s attachments following adoption out of an institutional setting.

Existing over many centuries, adoption has been challenged in recent years by evidence about practices that do not respond to the principles, ethics and laws under which it should be enacted. Written from a multidisciplinary and international perspective, this article outlines the place of adoption in the child protection system, as well as its core elements of permanence and stability. Recent demographic changes in adoption throughout the world are first examined. The negative consequences of children's exposure to early adversities and the post-adoption developmental trajectory of adopted people are also summarized. The focus of the argument is that adoption provides a legitimate model for the alternative care of children if undertaken within a rights and ethics framework that emphasizes children's best interests, as set out in international conventions and national laws. Implications for adoption policy and practice are presented.

This article describes a unique study that attempts to promote positive social-emotional relationships and attachment between caregivers and children in orphanages in St. Petersburg, Russia. The children who reside in these orphanages are typically between birth and 48 months of age; approximately 50% are diagnosed with disabilities, and approximately 60% leave through foreign adoption. Initially, their orphanage caregivers showed a high level of current anxiety and depression and were detached from and communicated little with the children. Likewise, during baseline observations, the children demonstrated poor attachment behaviors such as indiscriminant friendliness, lack of eye contact with adults, aggression, and impulsive behavior. Two interventions were used in a quasiexperimental design: (a) training of caregivers to promote warm, responsive caregiving and (b) staffing and structural alterations to support relationship building, especially increasing the consistency of caregivers. The methodology required that both the training and staffing interventions be provided to one orphanage, only the training to a second, and neither to a third. (At any one time, ns = 80-120 in each condition.) Initial informal observations reveal positive behaviors for both the caregivers and the children, such as increased two-way conversations, animated and enthusiastic emotional responses, and positive social and language interactions. Early data analyses show an increase in the consistency and stability of caregivers and increased scores for caregivers on every subscale of the HOME Scales. Children showed improvements in physical growth, cognition, language, motor, personal-social, and affect, with children having severe disabilities improving the most. The implications of these findings suggest that training staff with modest educational backgrounds and structural changes are effective, can increase socially responsive caregiving behaviors, and improves social interactions of children, at least temporarily. ©2005 Michigan Association for Infant Mental Health.

This article details an early intervention program in orphanages in St. Petersburg, Russian Federation. The program is based upon the analysis of the orphanage system and statistical data on children, personnel, and their interaction. The results of observations conducted before the intervention showed crucial deficits of the caregiving staff with respect to their stability and consistency, as well as responsiveness and emotional availability. Instead, the caregivers focus attention on medical care, education, and daily routine caretaking. This article outlines the guiding principles for the institution-wide early intervention program, with the aim for each child having an early experience of ongoing interaction with his/her own close and emotionally available adults. The outlined program guiding principles were supported by a St. Petersburg, Russian Federation-Pittsburgh, USA joint project with two main interventions: training of caregivers and structural changes in the orphanage to promote family-like conditions for children. An overview of the training intervention is described in a parallel article (Groark, Muhamedrahimov, Nikiforova, Palmov, & McCall, in press). The structural changes intervention was aimed at improving stability and consistency of caregivers and creating a more family-like environment that would support relationship building. Specifically, it consisted of smaller group sizes, integration by age and disability status, primary caregivers who were present every day, Family Hour, pullout groups, and team-like staff organization. Observations and early data analysis show the effective implementation of the structural changes intervention, an increase in the consistency and stability of caregivers, and changes in children and caregivers.RESUMEN: Este artículo presenta en detalle un programa de temprana intervención en orfanatos de St. Petersburg, en Rusia. El programa se basa en el análisis del sistema del orfanato y la información estadística sobre los niños, el personal que trabaja allí, así como la interacción entre unos y otros. El resultado de las observaciones que se llevaron a cabo antes de la intervención mostraron déficits cruciales del personal que presta el cuidado, en cuanto a su estabilidad y consistencia, así como su sensibilidad y disponibilidad emocional. En vez de todo eso, el personal centraba su atención en el cuidado médico, la Institution-Based Early Intervention Program • 489educación y la rutina del cuidado diario. Este ensayo describe los principios guías de los programas de tempranas intervenciones en instituciones en general, con la meta de que cada niño tenga una temprana experiencia de continua interacción con la más cercana y emocionalmente disponible persona. Los principios aquí descritos fueron apoyados por estas dos principales intervenciones del programa conjunto entre St. Petersburg, Rusia, y Pittsburgh, EEUU: entrenamiento de quienes prestan cuidado y cambios estructurales en los orfanatos, con el fin de promover para los niños condiciones semejantes ...