Late in 2007, Whole Child graduated its first “class” of 78 orphanage caregivers and others at our training site in Managua. The graduates had successfully completed a regimen of 10 intensive training sessions. The caregivers had also undertaken a year of hands-on technical support from our U.S.-based trainers in the orphanage setting. We had come to know each other well, but none of us anticipated the powerful emotional experience that was in store.

Over three days the caregivers, each of them taking her usual training day away from the children, marched across the training room to receive certificates of completion. For many of these women, this would be the first graduation of their lives. And yet their joyful tears meant more than the accomplishment of a training regimen. The certificates they held also symbolized the very visible improvements we have all been seeing in the children in recent months, and spoke directly to the contribution these women have themselves made to the Whole Child program.

The Phase I Pilot Institution

Whole Child’s first year of operation focused on the largest children’s institution in Managua, Nicaragua. With a caregiving staff of 85 and around 100 children, it was and continues to be an ideal site for our pilot intervention and evaluation, as it seemed to exhibit caregiving practices and outcomes that are typical of orphanages around the world. As such, the lessons learned in the pilot year have been invaluable in the refinement of our program, and will inform our work as we expand to new orphanages, countries, and regions of need.

As is further described elsewhere in our website, our fundamental principles of responsive caregiving are based in child development science that is well established but which is generally not applied in orphanage settings. We focus on primary caregiving, continuity of care, small group size, and freedom of movement, creating an environment that presents children with pathways for healthful child development.

Our approach began with a careful and detailed administrative dialogue to gauge the organization’s needs and ensure that the administrators were invested participants in the process of change. To ensure that the administrators understood the challenges as well as the potential rewards of our partnership, in the pilot phase the administrative training centered on a site visit to our partner organization in Budapest, Hungary, the Pikler Institute. This training was also attended by key representatives of the Nicaraguan Ministry of the Family, which oversees the country’s orphanages, as well as a representative from UNICEF. The Pikler Institute has more than sixty years’ experience in creating positive outcomes for orphaned children. But most striking for visitors from third-world orphanages is that Pikler has built its effective systems for use in the resource deprivation that is characteristic of children’s institutions around the world.

In November 2006, we began caregiver training sessions and intensive hands-on technical support. Under the oversight of Whole Child’s program team, the training was conducted by U.S.-based caregiver trainers Consuelo Espinosa and Edilma Serna, who brought indispensable experience and compassion to our program in its first full year. Consuelo and Edilma flew to Managua once per month, spending a week conducting training sessions and assisting caregivers with implementing the lessons in the orphanage setting. The strong, trusting relationship they built with the caregivers helped the caregivers cope with the changes they were experiencing, and played a significant role in the concrete changes we saw in the children. Future training teams will be stationed in-country to further build these strong relationships while enabling us to simultaneously work in multiple institutions.

The program of institutional change also includes minor facility improvements and major organizational changes such as the reduction of group size, the normalizing of caregiver schedules, and the gradual elimination of caregiver rotation between wards.

The Spartan environment of a typical orphanage day room, before intervention, reflects rigid, enforcement-based administrative priorities. Generally toys are kept out of reach (though often within view) to reduce disciplinary challenges. The image creates profound context for the below image, taken near the end of the pilot program. The play space features safe spaces for children to play and explore freely while caregivers focus on other children. This environmental transformation is crucial, but not necessarily expensive — sometimes all that is needed are safe, gated areas and inexpensive, basic playthings.

What is not seen in this photograph is the caregiver, who has been freed by the children’s constructive play to focus on each child individually. She may be diapering, changing clothes, feeding, or bathing — and as long as the other children are contentedly playing within her sight, she is able to focus exclusively on the one child she is administering. That undivided attention is key to the child’s ultimate feeling of love and attachment, which will allow the child to create functional relationships throughout his or her life.

The orphanage consists of eight little “hogares” (homes), each of which initially housed children separated into age- and gender-based wards. In one hogar, we established a pilot house where we stationed dedicated caregivers who would no longer float between groups and created a permanent home for children of mixed ages and gender. In the pilot house we began the process of assigning a primary caregiver to each child, who will be a major presence in that child’s life, document major events and developmental benchmarks, and bear primary responsibility for the child’s emotional well-being as long as he or she remains at the institution. Relationships between the children and their primary and other caregivers developed through the training, as caregivers learned to turn their focus to the child during everyday activities described above.

As the year progressed and more groups were transformed, the children’s living environment was not the only thing visibly changing. The children’s behavior began to lose characteristic symptoms of institutional life, such as “self-stimulation” (like rocking or head-banging); arbitrary friendliness with strangers; and violent acting-out against peers. These changes have come very gradually, and have visibly improved staff morale and a sense of camaraderie at the orphanage. For our effort to establish a completely new professional culture in these institutions, these are optimistic and hopeful signs.

Full Implementation in Nicaragua and Beyond

We are now readying our program for full implementation, and have invited administrators at four more Managuan institutions to join us for administrative training beginning next month. We expect to begin working with at least three qualifying institutions in February, and three more midway through 2008.

The Nicaraguan government has asked us to bring our program to all 83 of its children’s institutions, and in neighboring El Salvador we expect to sign a similar agreement next month. There is much work to be done, and we are just getting started.

The biggest hurdle now is continued funding. Please support our work if you can, knowing that the firmer our foundation is now, the more aggressively we will be able to establish ourselves in new countries and regions of service. Thank you for reading, and please return to this page often for updates as we continue to develop our program and expand it through Latin America and beyond.