Health
7:00 am
Tue June 29, 2010

Overseas Orphan Research Rocks the Conventional Wisdom in the US

Dr Phyllis Crain and one of the residence counselors talks with a boy outside a cottage at Crossnore.
Dr Phyllis Crain and one of the residence counselors talks with a boy outside a cottage at Crossnore.
Credit Rose Hoban

When you say the word ‘orphanage’ what comes to mind for many people, are gloomy places of abuse and neglect, where kids are warehoused after losing family. For years, the assumption has been that foster families provide better care for kids in need than any institution could. But new research from overseas is challenging those beliefs – findings that kids in orphanages can do as well or better as kids taken into families. Now, that research is being embraced in the U S. And it’s starting to influence the policy dialogue about what to do with kids who need care outside their homes. 



Images of orphanages recur throughout literature. From Dickens’ Oliver Twist to Lil’ Orphan Annie, the enduring message is that orphanages are places of deprivation and despair, where kids do hard labor without love or reward.

"I hated it. I resented it, I won't even lie," says June Tibeleka, a medical student at Duke now. When she was growing up in Uganda, her father died of AIDS. In much of the world, kids who lose one parent – especially a breadwinner father – are considered orphans. Tibeleka’s mother was left destitute after his death. To survive, she sent eight-year-old June and two of her sisters away to a school where the girls had to fend for themselves… like hauling their own water for bathing and drinking. "It was a long distance, and we’d have to go take buckets, you know, on our heads, go down to the swamp, bring the water up, carrying it on our heads," Tibeleka says. "If you could see the buckets we carried, because we had to maximize, ugh, water... it was... when I think about it now I wonder how we got through it."


Amazingly, though Tibeleka says she’s grateful for the experience.

"Because I have been through it I can I can go through anything and still be happy," she says.


It’s estimated there are about 45 million kids worldwide who’ve lost either one or both parents or who have little social or financial support in their immediate families. Kate Whetten is a global health researcher who heads the center for public health policy at Duke University. Last year, she published results of a long term study looking at how kids in five poor countries fared over time. She looked at kids placed with foster caregivers in the community as well as kids who ended up in so-called orphanages. Almost all of the 3000 kids she followed lived in extremely poor communities.

"The results that we got just kept coming out so strongly that kids in the institutions were doing – and again, that word like-orphanage conjures up a stereotype that we have in our heads – that those kids at the aggregate level were doing as well or better than kids who were in the communities," Whetten says.


Over time, kids in institutions did better on health and emotional outcomes, cognitive development and educational attainment. Whetten says care in those orphanages – didn’t look like the stereotype, with harridans as caregivers.

"Half, or more of the caregivers aren’t paid caregivers," Whetten says. "They are there as women who perhaps for whatever reason, had been kicked out of their communities, out of their families, maybe because of disease, [maybe because of something else that is going on,] and so they decide to come and stay there, so they do have a long-term caregiver. It's not the model where a person is paid to come in and out although that happens also."


Whetten says she didn’t go looking for a comparison of orphanages versus foster care, even though that’s what she found. She published her paper last year and started work on a follow up study.  Then Whetten started hearing from people in this country who run residential care facilities. They saw her data as affirming what they’re doing here. Crossnore is one of those residential care facilities in the mountains of Western North Carolina. It was started ninety seven years ago but current director Phyllis Crain, says little has changed.

"It was moonshine that was really destroying the family, and today it's meth labs, would be the common denominator," Crain says. "So we have, you know, huge sibling groups that are removed from homes where shacks where the kitchen is a meth lab."


Since coming to Crossnore a decade ago, Crain has raised money to improve the grounds and build new cottages for residents. She also started a on-site school that has therapy facilities in the same building. She says education is key for helping these kids succeed.

Crain: My children… it's not uncommon here at Crossnore have been at either six or eight foster homes before they even come to me.


Entrance testing at Crossnore has shown that kids arriving there are, on average, two and a half years behind their peers in school achievement.

"What I see, If a child is able to be with us, and especially through part of middle school and through high school, we can help them make up, and close for 2 1/2 or three year gap," Crossnore says. "Bring them up to their age mates, help them get their high school diploma. And then we have a host of scholarships that we help these children go into college."


Walk into the sun-lit cafeteria at Crossnore and you’ll meet dozens of kids who have big dreams and want to tell you about them. Most of the older kids go on to college or other post-secondary education. 17-year-old Anthony will finish high school this summer. His dad has been in and out of prison, and his mom has substance abuse issues. Anthony was way behind when he arrived at Crossnore about three years ago, but he’s heading to a technical college this fall.

Anthony: My family really loves this place. They have been really thankful I've been here, and they definitely recognize that it's been life-changing for me.
Hoban: Have they been able to get services here too?
Anthony: Family counseling.
Hoban: Yeah?
Anthony: Yeah, me and my grandparents had family counseling sessions here. It’s been off and on, but the family counseling sessions we did have were really tremendously helpful.


Only about a quarter of teenagers in foster care ever graduate high school and they have all kinds of problems as young adults. But policy in the US has, for years, favored foster care over residential settings. And that’s where the money goes too.

"Children do better in family-like settings," says Fred Wulczyn, who does research at Chapin Hall, an institute at the University of Chicago that focuses on child welfare issues. He says kids don’t do as well with hired caregivers who come and go. "Kids are, in effect, wired to relate to a care giver," he says. "There is a fairly robust literature in the neuro-developmental world that says some of the basic behavior and regulatory mechanisms that children develop early in life are predicated on a stable relationship with a single caregiver."


Wulczyn and other researchers say evidence indicates kids don’t get those kinds of stable relationships in residential care. Plus, it’s more expensive than foster care. But when pressed, Wulczyn and others admit no one really knows what works best for kids who’ve been neglected or abused, and who need to live outside their families. Wulczyn says in the U S, we’ve underfunded the child care system, and we’ve haven’t put the resources towards finding out what does work…

"A little bit of knowledge is dangerous thing," Wulczyn says. " St what point does the government assume a set of responsibilities to not simply talk about the best interest of the child but to have the knowledge it needs to actually act in the best interest of the child?"


And that’s part of the reason Whetten’s research on orphans in other countries has been reverberating here. It contradicts what’s been the accepted wisdom driving child care policy in the U S for years. Whetten is gearing up for a continuation of her study of kids in residential care. But this time, she plans to include American kids in the study groups as well.