Karen Spencer’s organization, Whole Child International (Niñez Integral in Spanish), is working at every level of the childcare, and particularly, orphanage system, to improve quality of care and ultimately improve outcomes for the most vulnerable children. Through methods backed by scientific research, Karen is working to lift an international taboo on working with orphanages and improve quality of care in existing centers, all while educating caregivers and government officials in methodologies of care that put relationships and children’s development first.
The New Idea
Through her organization Whole Child International, Karen Spencer is working to make sure that close emotional relationships are at the heart of childcare, no matter where the child grows up. Research has shown that a close relationship with a primary caregiver and high-quality emotional attachment do more to affect a child’s growth and development than any other factor. With this in mind, Karen Spencer is addressing institutional care – orphanages and childcare centers - in low resource environments, teaching every actor involved within the system to prioritize relationships first and improve overall quality of care
Whole Child’s best practices emphasize responsive care-giving, continuous primary care, small groups, open space for play, and individuality and identity. The changes require no additional resources but result in much better outcomes for the child. By making simple changes such as prioritizing play over order and cleanliness, or writing daily journal entries that track a child’s individual growth and identity, caregivers can create environments that, while institutional by nature, are closer to a traditional home experience for the child. Instead of thinking about infrastructure and the building, Karen stresses that the most important aspect of child care should be the human relationships themselves.
To spread these best practices, Whole Child is teaching them to everyone involved with institutionalized children, from the caregivers to the highest government officials. The organization has developed a nine-month caregiver training program of classes complemented by on-site technical assistance. This program also serves to promote the dignity of care-giving as a profession, changing the way that these women and others think about their responsibilities. Whole Child has also developed a university-accredited certificate program which is offered to center directors and government personnel. Taught by a combination of by local professors and visiting experts, the program builds up local academic capacity in child-care teaching over time while reducing Whole Child’s cost in training trainers. It also makes the program highly replicable worldwide. By improving orphanages, Whole Child is challenging an international taboo against funding institutional care. Almost all major global organizations that work with children have taken a “last resort” approach to orphanages, claiming that because foster or family care has traditionally been the most desirable solution, they have decided not to fund any efforts to improve the current orphanages. Whole Child is leveraging its high quality research to lobby to bring improvements in orphanage practices back to the discussion table.
Over 7 million children worldwide are living in orphanages or institutional care, and even more spend the vast majority of their time in institution-like childcare centers. In many of these institutions, children are passed through a system that emphasizes efficiency and pays little attention to the child’s emotional relationships. By the time they reach age five, children institutionalized under conventional practices will have often been exposed to between 50 and 70 caregivers. These practices have damaging repercussions, including an extremely high incidence of attachment disorder and other developmental problems. Children who have been raised in orphanages are much more likely to be involved in juvenile delinquency, prostitution and gang affiliation. They are more likely to experience failed adoptions and to someday abandon their own children, and many suffer from drug and alcohol addiction.
While caregivers in orphanages and childcare centers for the most part strive for the best for the children they care for, they simply lack knowledge of best practices. Especially in the developing world, caregiving is looked down upon as a profession for the uneducated. Caregivers are not treated as professionals or provided with training. Many caregivers are illiterate, and their schedules are not designed for quality care; many work three 24-hours a day in a row, and then alternate with three days off. Marginalized at the bottom of the professional pyramid and disenfranchised by government officials who do not understand the problem, they fall back on “factory-line” methods for providing care, rather than giving children the necessary personal attention.
Because traditionally orphanages have failed children, almost all major global organizations interested in child-care have adopted a “last resort” policy and have withdrawn funding and support from orphanages, hoping that this will motivate governments to shift to a family-based system. The prevailing wisdom says that orphanages damage children and cost more than other models, so international organizations have simply refused to fund programs related to orphanages. But the sheer quantity of children needing homes, and the reality that the governments are often not currently funding the orpahanes, means that, regardless of whether or not the government hopes to adopts a family-based system, millions of children remain living in residential institutional care. With the current policies, these children are systematically excluded from global funding, and orphanage improvements are boxed out of the child wellness discussion.
Struck by the scale of the problem of childcare in the developing world, Karen Spencer founded Whole Child in Nicaragua in 2004, hoping to find a way to transfer best practices to low-resource settings. Through an extensive pilot, the organization worked in 7 orphanages in Nicaragua to perfect the methodology and learn how best to partner with governments. Today, the organization uses a highly replicable ‘train the trainer’ approach to bring her scientifically-proven best practices to every level of the childcare system. This methodology is based on five guiding principles.
Whole Child emphasizes (1) responsive care-giving, where caregivers shift their focus away from efficiency and cleanliness and instead work to listen, understand, and respond to the developmental and emotional needs of each child. Whole Child also values (2) continuous primary care. Each child must be able to form an attachment to an adult caregiver, and maintaining this relationship is made a top administrative priority. On the child’s birthday, when she needs medical attention, or during any other key activity normally led by a parent, the primary caregiver takes the lead. This prioritization of a single relationship is a key difference from traditional practices, which usually divide up responsibilities across different caregivers, and pass children from group to group as they grow up. The organization also teaches child care centers to create (3) the smallest groups possible without increasing staffing, an action which may be as simple as breaking up a 20-child, 2-caregiver group into two groups of 10 children and one caregiver. (4) Freedom of movement – allowing children open space to play instead of locking them in cribs - is prioritized over housekeeping and efficiency, so that children can discover and grow organically. Finally, Whole Child teaches caregivers to make (5) individuality and identity an administrative priority. Providing children with a space to store their own belongings, celebrating birthdays individually, and having the primary caregiver keep a journal about the childhood’s individual developments are small changes with important, lasting consequences for children’s self esteem and sense of identity. When Karen’s changes are implemented, children begin to act less like traditional institutionalized children; clamoring for attention indiscriminately from whatever adult happens to notice them, and more like those raised in traditional contexts; looking to their primary caregiver for cues and trusting the people who know them best for guidance.
Whole Child works across the entire value chain, changing not only caregivers but also the directors of orphanages and government officials. For caregivers, Whole Child has created a nine-month training program that includes classes once a month and significant technical assistance. This training teaches caregivers Whole Child’s five principles, and then reinforces them in their own childcare setting. When caregivers finish the program, they receive a graduation certificate, for many the first certificate of such kind they’ve ever received. The course both teaches caregivers best practices and elevates their status to one of dignity.
For care center administrators and orphanage directors, Whole Child trains local universities to offer a seven-month university certificate course, Best Practices in Childcare for Practitioners, which teaches a best-practice and child-rights-based approach to childcare.
For government officials and early childhood funders, Whole Child offers a five-month university certificate course, Management in Childcare, to help them understand the context, best practices, and perspectives in the child care discussion. Karen has worked to get entire governments involved in the country’s childcare practices. The first lady of El Salvador is currently enrolled in this course, as are all of the country’s Supreme Court justices and several other important government officials.
Whole Child has also developed the Training for Implementation, Monitoring and Evaluation. This adult learning training course focuses on how to implement best practices in childcare settings with limited resources, offered to local government technical staff who will provide training and technical assistance to all participating childcare centers and evaluate and monitor care centers in the post-intervention period. The training is attended three days per week for five months in conjunction with the University certificate program in best practices in child care in limited resource settings.
Whole Child ensures that the government is a conscientious player in the childcare discussion, working to create a class of informed and empowered government officials with respect to children’s rights and care. By investing in the universities and the existing stakeholders, Whole Child works to catalyze a shift in the types of practices being utilized in child care centers.
Karen is convinced that if Whole Child wants to persuade the international community to invest in improving child care centers, it is critical that she demonstrate through third party research that her interventions are effective. Since the beginning, Whole Child has worked with the University of Pittsburgh to measure children’s development, social-emotional progress, and behavioral development, as well as height and weight, which have interestingly shown marked improvement due to Whole Child’s intervention, even though the intervention does not include a change in nutrition. Whole Child also takes special interest in impact for children with disabilities, as children with disabilities are more likely to be placed in institutions and less likely to be adopted out of them. Now, the organization is working with Duke University’s Global Health Institute to design a study that will break down, component by component, the impact of Whole Child’s work, in order to effectively identify the most cost-effective and impactful aspects of their programming.
Whole Child piloted its approach in Nicaragua, where it worked with 7 orphanages serving 300 children and 3 child-care centers serving an additional 150. Whole Child’s work has led to marked child development improvements, as well as social-emotional and behavioral progress and, even though Whole Child’s interventions do not include changes in nutrition, improved weight and height as well. Measured by the Battelle Development Index, the scores of the children assisted by Whole Child’s interventions since 2006 have rose by 30%. In 17 months scores in the areas of physical, cognitive, linguistic, and social-emotional development increased by 19%., height increased by 24% and weight by 18%. This raised children from scores associated with being clinically intellectually disabled and severely delayed to most falling within the normal range for their age.
Because Whole Child’s approach is based on educating those who work with the orphanages in each country, the strategy is highly cost-effective and replicable. Once local universities have been trained to offer the workshops, the organization does not need to remain physically present in the country. The organization has also developed a comprehensive tool, called the WCI QCALS, which provides evaluation services for child care practices in limited-resource settings, in order to magnify its impact. Use of the tool is open source and requires four hours on-site or two-hours with a smart phone. The app, which was developed in partnership with Duke University, will be available free of charge to organizations worldwide in order to set a clear standard for evaluation in limited-resource contexts.
In its pilot efforts in Nicaragua, Whole Child initially struggled to transition responsibility to the Nicaraguan government. This year, however, the organization will expand to El Salvador, where Whole Child and the government have developed a clear plan for a six-year nationwide partnership, which involves starting with the government training course, then moving to the more hands-on levels, influencing 13 orphanages and 200 childcare centers in the country, and with a clear six-year funding exit strategy for Whole Child. The program will be financed 50% through the IDB and the local government, representing the organization’s strategy of bringing larger international actors on board and moving toward a more diversified funding portfolio. The organization is also in talks to work in Ecuador and Peru, and is in discussion to consultant in Liberia, where Ebola has doubled the country’s number of orphans.
Karen’s staff currently consists of 45 members, 3 in the United States and the rest in Central America. Worldwide, Whole Child is leveraging its research to bring improvements in orphanage practices back to the table. Karen believes that after decades of rejecting the possibility of investing in orphanage practices, the international community is finally beginning to be receptive to the possibility of rethinking this policy. She is working to hire a full-time policy staff member, who will support her current staff and continue Whole Child’s lobbying for change and work directly with governments and international organizations.
Karen Spencer has always placed a high value on children, family, and high quality relationships. The daughter of a Canadian park administrator who was constantly being relocated, she lived in 10 completely different locations before the age of 18. While she made new friends everywhere she went, there was never enough time to develop long-lasting relationships, so those with her parents and her two brothers were critical for her development. In her early twenties, the birth of Karen’s first daughter was a life-changing moment for her, and she became passionate about being the best mother she could possibly be. She took parenting classes, read every book available to her, and became completely devoted to her children. This parenting quest began her search for knowledge that would ultimately lead her to found Whole Child International. At a parenting class in Los Angeles, Karen was exposed to the childcare methods of the Pikler Institute, an orphanage in Hungary. Even then, in 1998, she became fascinated by the philosophies of emphasizing quality human relationships and child centered approaches. In 2003, when she and her husband decided to separate and he took their daughters on their first dad-only vacation, Karen decided to take the time to go visit the Pikler Institute herself.
Inspired by what she learned at Pikler, Karen reached out to Unicef in New York, thinking she would sponsor a trip for some specialists to visit Pikler and learn about their approach to childcare. However, as she began to talk to organizations in New York and Washington DC, Karen found that no one was interested in getting involved, because none of these organizations worked with orphanages. Karen became increasingly frustrated and unsatisfied with the global attitudes toward orphanages, and began to do her research. She visited 51 orphanages in 11 countries, and put together a team that could help her begin to understand the problem. What she encountered shocked her. In every country she found antiquated “factory line” practices, undervalued and uneducated caregivers, and most profoundly, a total dearth of stable, high quality relationships. More than anything, she was frustrated by the international community which, due to the belief that orphanages should be places of “last resort”, was ignoring the reality of millions of children living in residential institutions.
Karen began Whole Child as a response to the problems she had seen worldwide. Working with the Nicaraguan government, she and her team began developing a methodology that gleaned the key insights from Pikler - high quality stable relationships and child-based care - and adapted them for the limited resource contexts orphanages faced in Central America. Working with major universities, both local and international, the program evolved into something new, and she began to convert the realities of their experiences in Nicaraguan orphanages into best practices that were effective, cost-efficient and scalable. Today, Karen’s work has grown from the desire to fund a week-long trip for Unicef workers into an international project which works at every level of the child care system to generate change for children in stark conditions. She remains committed to the belief that every child can experience high quality stable relationships, even if his or her circumstances are far from ideal. Karen is a co-author of articles published in the peer-reviewed Infant Journal of Mental Health, and Perspectives in Infant Mental Health. She is also a member of the Clinton Global Initiative.