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July 6, 2000

Study of Russian orphanages may impact facilities there as well as child care centers internationally

Study of Russian orphanages may impact facilities there as well as child care centers internationally

At first, Robert B. McCall didn't notice anything strange about the way caregivers in a Russian orphanage were feeding their charges. Then he watched a visiting mother feed her own child.

The mother sat facing her baby — talking to him, smiling, pausing to let him swallow before giving him another spoonful. Caregivers, in contrast, sat side by side with children, quickly and silently feeding them with a utensil that resembled a small shovel. There was no eye contact, and much of the food ended up on the children's bibs.

"It's not abusive, but it's typical of the lack of social responsiveness you see in caregiving behaviors over there," said McCall, who is co-director with Christina J. Groark of Pitt's Office of Child Development (OCD).

Groark and McCall are leading an OCD project to improve the social responsiveness and staffing patterns of caregivers at Russian orphanages, and to study the social, emotional, physical and mental health of the infants and toddlers in their care.

Research will focus on orphanages in St. Petersburg, Russia, where children up to 4 years of age reside. About half of the children have disabilities, ranging from cerebral palsy to fetal alcohol syndrome.

Funded by a $2.8 million grant from the National Institute of Child Health and Human Development as well as grants from the Howard Heinz Endowment and the International Assistance Group, the project could have wide-ranging implications for child care internationally, researchers say.

"Our hope," Groark said, "is that we can make improvements in the Russian baby homes that are sustainable and long-lasting, but also that the methods and systems we develop can be applied to child care centers here in the United States. Our Russian colleagues are hoping that they can adapt these improvements to baby homes outside St. Petersburg and even in other eastern European cities."

American child care advocates would love to get their hands on research results proving that children benefit from better-trained, better-paid caregivers, said McCall. "Right now, there is no very good demonstration of that, from the point of view of well-documented research," he said.

That's why the U.S. government is funding a project that will most immediately benefit Russians, the OCD co-directors said. "There is a humanitarian aspect to it," Groark noted, "but our federal government also recognizes that, with welfare reform, it will have to put more money into child care as more parents go off to work and there's no one at home to take care of the kids."

While the Russian system is in some ways a throwback to the America of 30 years ago, with an emphasis on orphanages rather than day care, conditions at the St. Petersburg "baby homes" are not so dissimilar from those at an average U.S. child care center, according to Groark and McCall. Caregivers are mainly women either in their early 20s or middle aged, without college degrees. Pay is low, the equivalent of $1.20 an hour. Staff turnover is high. But facilities are clean and uncrowded.

"It's not like the Romanian orphanages that were uncovered a decade or so ago, where things were dismal in every respect," McCall said. "The kids in these St. Petersburg baby homes are well-fed. They get good medical care. They have toys and equipment — in some cases, they have more Fisher-Price stuff than the average kid in an American suburb. And they have roughly enough caregivers.

"Everything is okay, except that a kid who comes in before 4 months of age and who leaves after 2 years will have had 60-100 different caregivers, and it's unusual for a kid to see the same caregiver on two consecutive days. Also, the care tends to be extremely perfunctory."

Workers at Baby Home #13, the main home to be studied, seldom speak to their charges and respond to their behavior an average of only 2.3 minutes over a 3-hour period, the OCD project has found. Babies seldom cry, and soon learn to conform to rules.

"If caregivers never respond to you, you learn that there's no use in trying to interact with them," McCall said. "And how do you learn to develop relationships when the cast of characters is always changing?"

It's not that Russian caregivers are unfeeling — indeed, the opposite usually is true, Groark pointed out.

"Many of the children in these homes who are severely disabled don't relate back to the caregivers, and some die. Healthier children are more likely to be adopted by foreigners, or they may go back to their birth families. So, these women don't want to become too attached to the children they work with," she said.

"We're counseling the caregivers about this. In training sessions, we'll talk to them about the importance of emotional attachments in the healthy development of children, and how these kids may come and go but they do benefit from social interaction and seeing the same faces over time."

OCD staff are comparing notes with American hospice workers, who by definition work with people about to die. "The question is, can we translate what they've learned to a baby home environment?" McCall said.

Some caregivers at Baby Home #13 wondered aloud whether providing an emotionally supportive environment might actually harm children who move on to the next level of orphanages, because conditions in the latter generally are worse.

"Rather than dismiss their concern," McCall said, "we came home and contacted three of the world's authorities on this. Then we could go back and tell the caregivers, 'The preponderance of evidence is that older children are likely to fare better in a worse environment if they've experienced a healthy environment at a younger age.'"

Since 1996, Groark and McCall have been going to St. Petersburg once or twice a year, staying for weeks at a time. "Bob and I aren't seen as visitors anymore," Groark said. "When we go over there, we buy our food in their markets, we negotiate their public transportation — or lack of it — and we live in apartments that are within walking distance of the baby home, just as the caregivers do. We had to be able to witness everything, to be there at the center during all of the shifts to observe staffing patterns and details of the ways care is provided."

McCall, Groark and their Russian co-researchers drew up charts detailing staffing assignments and where children were located according to ages and disabilities. Under the system they are developing, pairs of caregivers will work with the same groups of children every week.

OCD will instruct teams of Russian "trainers," who in turn will teach caregivers practices recommended by America's Council for Exceptional Children and the National Association for Young Children. Researchers will view videotapes of interaction between caregivers and babies, and of staff supervision.

Development of infants in Baby Home #13 will be monitored and compared with that of children in other homes. Adopted children will be followed up and compared to children adopted from the same orphanage before the intervention, and those adopted from other baby homes. Other comparisons will be made with foreign-born children adopted by families in Minnesota and American parent-reared children in Connecticut.

"We'll start the intervention this fall," McCall said. "We have every reason to believe that the [Russian] children will show some benefits fairly quickly. The question is, how long will those benefits last? And, how early do changes have to be made? Studies in Romania indicate that kids who are adopted [by foreign parents] before they've been in an orphanage for six months have no more problems than children in their adoptive country. However, kids who spend more than six months in those orphanages do have increased problems. They may have difficulty in making friends or they may be indiscriminately friendly. They may be exceedingly shy or very aggressive."

OCD researchers are cautioning Baby Home #13 staff to expect disruptive side effects from the project, Groark said.

Currently, the Russian infants and toddlers do what they're told. "When it's nap time, whether they're sleeping or not, they lay there and they're quiet. How often does that happen in an American home, never mind in an American child care center?" Groark asked, laughing. "We've warned our Russian colleagues that when you begin encouraging these children to be creative and independent, the staff will probably pay a price. It may not be possible anymore for one adult to easily supervise eight babies and toddlers."

— Bruce Steele

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