Fostering Child Development by Improving Care Quality: A Systematic Review of the Effectiveness of Structural Interventions and Caregiver Trainings in Institutional Care

Abstract

Quality of child care has been shown to have a crucial impact on children's development and psychological adjustment, particularly for orphans with a history of maltreatment and trauma. However, adequate care for orphans is often impacted by unfavorable caregiver-child ratios and poorly trained, overburdened personnel, especially in institutional care in countries with limited resources and large numbers of orphans. This systematic review investigated the effects of structural interventions and caregiver trainings on child development in institutional environments. The 24 intervention studies included in this systematic review reported beneficial effects on the children's emotional, social, and cognitive development. Yet, few studies focused on effects of interventions on the child-caregiver relationship or the general institutional environment. Moreover, our review revealed that interventions aimed at improving institutional care settings have largely neglected violence and abuse prevention. Unfortunately, our findings are partially limited by constraints of study design and methodology. In sum, this systematic review sheds light on obstacles and possibilities for the improvement in institutional care. There must be greater efforts at preventing violence, abuse, and neglect of children living in institutional care. Therefore, we advocate for combining attachment theory-based models with maltreatment prevention approaches and then testing them using rigorous scientific standards. By using approaches grounded in the evidence, it could be possible to enable more children to grow up in supportive and nonviolent environments.

The Impact of Organizational Structure and Funding Sources on the Work and Health of Employed Caregivers in Children’s Homes in Ghana

“…High child-caregiver ratio and increased work load imply that caregivers are even less able to carry out the duties expected of them (Bass et al 2016). Caregiver training can significantly improve the situation and dramatically improve bonding and relationships between children and caregivers (Hermenau et al 2015;Hermenau et al 2017). Thus while we confirm that the small group family-style organizational form is a better option for the children, we also recommend that more has to be done in order for it to better support caregiver work performance and health.…”

Neglect as a Violation of Species-Expectant Experience: Neurodevelopmental Consequences

“…(145) Additional domains that improved in children randomized out of institutional care include physical growth, attachment, stress reactivity, and internalizing symptoms. (34, 38, 40, 146) Earlier removal from the institution led to more dramatic improvements in IQ, language, neural function, stress reactivity, and attachment.…”

Capacitación en salud para cuidadores de hogares convivenciales de niños, niñas y adolescentes

“…Si bien podrían plantearse indicadores de impacto, por el tipo de acción que se presenta y por la multiplicidad de factores que inciden en el resultado final (un mejor estado de salud de los niños), esto conlleva dificultades metodológicas. 28 De todos modos, se educa sobre medidas que tienen ya evidencia suficiente de su efectividad, por lo que, si uno pudiese constatar que su conocimiento e implementación es mayor que antes de la intervención, debiera inferir que hay algún nivel de impacto, aunque no sea posible precisar su magnitud. 29 Además, esta primera experiencia abarcó una proporción pequeña de cuidadores.…”