1. An institution is no place to call home Presented by Victor Groza, PhD The Grace F. Brody Professor of Parent-Child Studies Mandel School of Applied Social Sciences Case Western Reserve University Cleveland, OH USA victor.groza@case.edu

2. No baby in a family sleeps in a room with many other babies 2

3. 3 COMPARISON OF FAMILY FOSTER CARE TO INSTITUTIONAL CARE FAMILY CARE  love  affection  structure  1:1 attention  individual focus  belonging to an extended system of relations  stimulation through relationships INSTITUTIONAL CARE  acceptance/tolerance  distance  routine  1:8-35 attention  group focus  belong/identify to the group  stimulation thru programs

4. It can feel like jail 4

5. 5 Health Issues  Infectious Disease  Malnutrition  Developmental Delays  Behavioral Disorders

6. Can deform you 6

7. 7 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.

8. Make you not know your sibling 8

9. 9 Infectious Diseases  Intestinal Pathogens (15 – 35%) –giardia lamblia, ascaris lumbricodes, trichuris trichiura  Skin infestation – scabies with secondary impetigo  Tuberculosis (2 – 19%)  Hepatitis B and C (1-5%, 15-50%)  Syphilis (20 – 30%)  HIV (0.8%, 0.2%)  Malaria

10. 10 Immunization  Significant risk of immunization failure exists

11. 11 Hazards to Early Brain Development  Malnutrition  Institutionalization  Lead poisoning  Hypothyroidism  Maternal intake of drugs and alcohol  Infectious Diseases  Head Injuries  Genetic disorders  Prematurity and Newborn Asphyxia  Malignancies  Congenital Heart Defects  Disasters

12. 12 Long Term Effects of Malnutrition THE GALLER STUDY  Prospective, longitudinal cohort study  Exposure group: 185 children with severe malnutrition during the first year of life  Control group: 185 children with no malnutrition

13. 13 Long Term Effects of Malnutrition THE GALLER STUDY: RESULTS  No significant difference in physical growth  Children exposed to malnutrition had an increased risk of cognitive deficits –learning disabilities, attention deficits –noted at 9 - 10 years of age

14. Keeps you locked in 14

15. 15 Developmental Delays Rule of thumb: Institutionalized children experience 1 month of mixed developmental delay for every 3-4 months of institutionalization.

16. 16 Developmental Outcomes in International Adoptions  Resilient Rascals  Wounded Wonders  Challenged Children

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23. 23 Stereotypical behaviors  Repeating the same movement over & over  rocking, slapping, pinching, moving hands, face guarding or wrist slapping  Prevalence –84% displayed 1 or more behavior 67% rocked and 19% moved hands –98% improve in first 11 months after family placement –41% retain some behaviors 3 years post-adoption  Self-stimulating  Self-comforting  Degree of improvement negatively correlated with length of institutionalization

24. 24 Other Problems  Attachment disorder  Tactile Defensiveness  Feeding and eating disorders/behaviors  Stereotypical behaviors  Lack of self-regulation  “ADHD/ ADD” (Hypervigilance)  Sleep difficulties  “Autism”  PTSD

25. Feeding promotes attachment & sensory development 25  Feeding babies by putting a bottle in their mouth and propping it up thwarts attachment and promotes sensory problem.  Holding promotes absorption of food.  Propping results in some milk/formulat going into the baby but some milk is lost on blankets

26. 26 Eating problems  Prevalence 65% Decrease over time  Difficulty with textures (particularly solids) Directly related to orphanage life  Overeating Physiologic need Lack of self-regulation and sense of satiety

27. 27 Trauma Children in institutions  Neglect  Physical Abuse  Sexual Abuse It is unclear the percent of abuse experienced by children; it is clear that the vast majority suffer the effects of neglect from institutionalization. Studies estimate that 25% to 30% of older children (3 or older) are physically or sexually abused; another 60% witness abuse or neglect.

28. Makes me sad 28

29. 29 Attentional Difficulties  Consistent correlated with length of institutionalization  Negatively correlated with the HOME environment score

30. 30 Learning  Educational Difficulties

31. 31 Peer Relationships  Prevalence –32% have peer problems  Orphanage children felt less social support from peer group or a close friend

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33. 33 Behavioral Research  All studies found that previously institutionalized children had significantly more behavioral problems than noninstitutionalized peers  Length of institutionalization is positively correlated to the number of behavioral problems

34. Children do best in a family Even children with handicaps 34

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39. 39 Survivor Behavior—Indiscriminate friendliness Children do not differentiate between strangers and friends May be functional in the orphanage setting but puts children at risk outside of the orphanages, in schools or in their families Less than 1% in children raised in families but over 95% in children raised in institutions

40. 40 If institutions are so bad... Small Group Activity  What are the benefits for living in an institution? –For the child –For the family –For the community  How could we build these benefits into services so institutions would be less used?