Early Institutionalization Intervention Impact Project: Cultural factors when designing and implementing research on institutional care

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

Abstract

Despite evidence that institutional care is harmful to the development of young, it remains the most common form of care for orphaned, abandoned and maltreated children throughout much of the world. Only one randomized controlled trial (RCT) of foster care versus institutional care has been conducted to date (the Bucharest Early Intervention Project). Limitations of that study include 1) children had been exposed to institutional rearing for almost two years (average 22 months) before the intervention commenced, 2) foster care was enhanced but institutional care was not, and 3) concerns about generalizability of findings from severe deprivation in institutions in Bucharest to higher quality institutional care (e.g., smaller group sizes, better staffing ratios) in other countries. There is a need to study differences in care in settings in which institutional deprivation is less severe and infants in institutions can be assessed in the first months of life. In addition, it is important to work closely with local child protection services so that the intervention is culturally congruent. Here, we describe a new study of enhanced foster care to enhanced institutional care in Sao Paolo, Brazil, designed to address previous limitations. For five years, we worked with local NGOs, family court judges, and child protection to plan an intervention to address critical scientific questions and meet the needs of local authorities. This presentation will provide an overview of the history, design and preliminary results.
Hypotheses
1) Attachment security at 12, 24 and 36 months will be greater in the foster care group than in the care as usual group.
2) Quality of care provided by foster parents will be greater than quality of care provided by institutional caregivers after Attachment Videofeedback Intervention (AVI) training.
3) EEG power, IQ, positive emotional responsiveness, and physical growth will be greater in foster care versus care as usual group.
Study population: 200 children less than 24 months taken into care by CPS in Sao Paolo are randomized by family court judges into foster care (developed by project staff) or to care as usual (institutional care/abrigos). In addition, 100 children less than 24 months of age are being recruited from childcare centers as a comparison group.
Methods: This RCT compares enhanced foster care to enhanced institutional care. Randomization occurs within the first hours of the child coming into care.
Enhancement of care will involve administration of the AVI to foster parents and shelter caregivers within the first month of placement. AVI is a video review intervention that is administered in the “home” setting.
Measures (baseline, 12, 24, 36 months) include observational ratings, caregiver reports, and child assessments to capture attachment, EEG power, IQ, positive emotional responsiveness, growth variables, as well as caregiver child interaction. Primary outcome is security of attachment.
Results: Main effects will determine if there are differences between foster care and shelter care. We will examine mediators and moderators of outcomes. An economic analysis will determine the relative costs of care of foster care and shelter care.

Authors

• Charles H Zeanah, Tulane University
  Presenting Author

• Melissa MIddleton, Tulane University

• George M Tarabulsy, University Laval

• Chantal Cyr, Université du Québec à Montréal (UQAM)

• Edson Amaro, Pensi Institute

• Charles A. Nelson, Harvard Medical School

• Nathan A Fox, University of Maryland - College Park