A multi-level analysis of the Bucharest Early Intervention Project: Causal effects on recovery from deprivation

• In Event: Intervention for young children with a history of deprivation: International perspectives on an ongoing problem

Abstract

The Bucharest Early Intervention Project (BEIP) is the first randomized controlled trial (RCT) of foster care as an alternative to institutional care (ClinicalTrials.gov Identifier: NCT00747396). Here, we synthesize nearly 20 years of follow-up assessments of children in the BEIP, providing a robust determination of the intervention effect size across timepoints and developmental domains to quantify the overall effect of the foster care intervention on children’s outcomes across ages and examine sources of variation in this effect, including domain, age, and sex assigned at birth.
Hypotheses
1. Using conservative intent-to-treat analyses, we hypothesize that children randomized to foster care (foster care group [FCG]) would have better functioning than those randomized to care as usual (CAUG) across assessment waves and the domains of cognitive functioning, physical growth, brain electrical activity (EEG: relative alpha power), and psychopathology.
2. We explore moderators of the overall effects of the intervention (we expected larger differences in cognitive functioning and psychopathology related to physical growth). We also explored whether the effect of intervention varied as a function of age and biological sex.
3. We hypothesize that earlier age of placement and stable placements would be associated with better functioning across domains for FCG children.
Study population
This study is a randomized controlled trial with a final sample included 136 children (mean age at baseline [SD]=20.74[7.40] months; 51% female]) who had been abandoned at or shortly after birth and placed in institutions. Half of these children were randomized to the FCG and the other half to the CAUG (i.e., continued institutional care). Within the FCG, the mean age of placement into a study-sponsored foster care family was 22.63 months (range = 6.81-33.01). Of the 136 participants, 130 (FCG=65, CAUG=65) completed at least one of these follow-up assessments. Overall, these 130 participants provided 7,088 observations (FCG=3,628, CAUG=3,460) between the 30-month to 16- to 18-year follow-up waves across the domains of cognitive functioning, physical growth, brain electrical activity, and psychopathology.
Methods
In this study, we comprehensively analyzed over 7,000 observations collected from infancy through adolescence in participants of the BEIP. We used a conservative intent-to-treat approach to examine the causal effects of the RCT for 136 children residing in institutions in Bucharest, Romania (baseline age 6-31 months) randomly assigned to foster care (n=68) versus care as usual (n=68). At ages 30, 42, and 54 months, and 8, 12, and 16-18 years, children were assessed for IQ, physical growth, EEG, and symptoms of five types of psychopathology.
Results
Children randomized to foster care had better cognitive and physical outcomes and less severe psychopathology than did care-as-usual children. The magnitude of these effect sizes remained stable across development. The foster care intervention most influenced IQ and disorders of attachment/social relatedness. Children benefit from placement in families following institutional care. The benefits of foster care for previously institutionalized children were remarkably stable across development.

Authors

• Kathryn L. Humphreys, Vanderbilt University
  Presenting Author

• Lucy Sobey King, Stanford University

• Katherine Leigh Guyon-Harris, University of Pittsburgh

• Emilio Alejandro Valadez, University of Maryland - College Park

• Anca Radulescu, Tanner Foundation

• Nathan A Fox, University of Maryland - College Park

• Charles A. Nelson, Harvard Medical School

• Charles H Zeanah, Tulane University