The Institute for Child Development
Building Romania’s Child Development Infrastructure
To reach this point, Romania needed to address the harrowing conditions in which its abandoned and orphaned children lived. Historical and political forces had created a tragic legacy of institutionalization for these children, with 100,000 languishing in orphanages that provided meager emotional, social, or physical stimulation. Recent social policy changes have introduced a process of mass deinstitutionalization. Sixty-thousand children have now been reunited with their birth families or settled in foster families or group homes. The remaining 40,000 will soon follow.
However, this success has generated a massive and urgent new need: Community placement does not erase the imprint of severe, early deprivation. The effects linger in aggressive behavior, inattention, hyperactivity, and disturbed attachment, among other dramatic developmental problems. While significant progress has been made, Romania does not yet have a child development infrastructure capable of adequately addressing these problems. Establishing one is imperative if formerly institutionalized children are to be successfully integrated into their new families and helped to reach their full potential. Further, services that benefit deinstitutionalized children will help many others as well. The problems that beset these children – attention deficit disorder, anxiety, learning disorders, for example – can emerge for numerous reasons other than institutionalization. By developing a robust child development infrastructure and sound public policy to support it, Romania will benefit all of its special needs children.
Toward an Institute for Child Development
An exciting collaboration has taken shape that can put the structure and resources in place to support the systematic, coordinated, long-term effort required to bring Romania’s child welfare system, as well as its general knowledge of child development and pediatrics, up to current European standards. This collaboration involves the clinical and scientific leaders from the Bucharest Early Intervention Project (BEIP - see) and their Romanian partners, foremost among them SERA Romania, the country’s oldest and most respected nongovernmental organization (NGO) involved with child health and welfare. The BEIP is a longitudinal, prospective study probing the impact of early deprivation on Romania’s institutionalized children and the potential healing effects of placing children in foster families. SERA Romania has served as the BEIP’s Romanian administrative partner and has worked tirelessly to facilitate the project. It has been an essential partner in the BEIP’s efforts.
Since its inception in 2000, the BEIP has become a vital source of information and resources for Romania’s child health and protection communities. As such, it has begun to educate local professionals and establish a unique knowledge base specific to Romania’s formerly institutionalized children. Furthermore, its findings have influenced policy. The BEIP has documented the profound adverse effect of early deprivation on a child’s emotional, behavioral, and cognitive development. It has also demonstrated that high-quality foster care can ameliorate some of the problems. These findings have begun to have major impact on policy reform in Romania, as well as in other countries where institutionalization of young children is still being practiced.
To build on this momentum and leave a legacy from the BEIP that is permanent and focused on long-term improvement, the BEIP’s leadership and its Romanian partners have conceived the Institute of Child Development (IDC), a non-political, science-based national resource serving the needs of Romania’s most vulnerable children. The IDC will coordinate the research, training, clinical services, and dissemination required to create and sustain a modern and effective child welfare system in Romania.
A Model of Excellence
The IDC will be modeled after the Developmental Medicine Center (DMC - see) at Harvard-affiliated Children’s Hospital Boston, where BEIP principal investigator Charles A. Nelson, PhD, is director of research. The DMC is one of the premier facilities dedicated to improving the lives of children with developmental disorders and their families in the United States. It has pioneered a model of integrated and collaborative clinical services, research, and training designed to provide better diagnoses, treatments, and, ultimately, cures.
The IDC will import this integrated model to Romania and will build the local infrastructure and critical mass of local expertise necessary to respond to the changing needs of the nation’s child population in a self-sufficient, effective, and sustainable manner. The IDC itself will become a model of excellence for other nations.
Steps toward establishing the IDC have already been taken. With the help of a $900,000 grant from the John D. and Catherine T. MacArthur Foundation and the support of SERA Romania and other partners, the IDC’s founders have:
§ Secured and begun renovating permanent space at St. Catherine’s Placement Center
§ Defined the IDC’s organizational structure and formally named Dr. Bogdan Simion as director general for a period of two years, 2005-2007
§ Conducted child development seminars the Ministry of Labor has recognized as continuing professional education
§ Received clinical certification from Sector 1 Department of Child Protection, which finished renovating a clinical center, Pavilion 4, on the premises of St. Catherine’s
§ Implemented model research and case management projects
§ Received backing from numerous governmental and professional groups, including Institute of Maternal and Child Health, National Authority for Child Protection and Adoption, Bucharest City Council, Romanian College of Physicians, Romanian Society for Pediatrics, Romanian Academy of Sciences, and local departments of child protection.
The IDC is now seeking the substantial resources it will need to seed all aspects of its vision, as described below. The long-term goal is to be self-sustaining in three years and to demonstrate the impact of the Institute model so that the Romanian government will embrace and absorb the IDC, making it the centerpiece of the nation’s child welfare efforts.
The Institute Concept
The Institute for Child Development will implement a broad set of activities designed to establish a self-sufficient, local capacity to meet the many needs of formerly institutionalized children and others with parallel needs. It will recruit Romanians trained abroad to fill the leadership positions of directors of research, education, and medicine. As shown in the organizational chart on the next page, these individuals will report to the executive director. The director of research and the medical director will manage the research lab and clinical services, respectively.
The IDC’s activities will be administered through three interrelated departments:
Research and Development: The existing knowledge infrastructure on child development in Romania is scarce and must develop rapidly to address the enormous challenges confronting Romania today and to equip the country’s child advocates, policymakers, and clinicians to deal with future needs as they evolve. Only a local knowledge base can inform effective, evidence-based programs, interventions, and policies over the long term. To address this need, the IDC will:
Research seminars, outreach programs, and publications will further expand the Center’s reach. The goal is to develop the critical mass of expertise necessary to achieve and maintain progress in the areas of child health, development, and protection.
Clinical Services and Training: The goal of the IDC’s clinical services is not only to provide evidence-based, scientifically driven care to its patients but also to generate effective interventions that can be replicated in clinics across the country – indeed, throughout the world. Empirical knowledge of the factors that facilitate a child’s development following profound social and emotional depravation remains rare, so few specific, validated treatments exist. The IDC’s integrated clinical and research branches perfectly position it to develop, pilot, and disseminate these sorely needed treatments.
The IDC clinical services will include general pediatrics, child psychiatry, child psychology, physical therapy, speech therapy, audiology, and electrophysiology, among others. A clinic has already been established with funding from the Sector 1 government and SERA Romania. As the clinic is integrated into the IDC structure, it will be organized according to the “hub and spoke” model developed by the Children’s Hospital/Harvard DMC. Patients will be evaluated, and then referred to one of a series of specialty services within the clinic (the “spokes”). The emphasis will be on expert diagnosis, treatment, and family support:
Intensive training of professionals in areas of specific relevance to vulnerable child populations will be a key component of the clinical work. Training will provide hands-on experience for pediatricians and other practitioners who will work with the IDC’s special population and have the opportunity to collaborate with its researchers on clinical research projects. Such collaboration between research and clinical practice will integrate traditionally disparate domains, leading not only to better services for children already exhibiting problems but also to early intervention strategies that place at-risk children on a healthy developmental path.
Education, Training, and Dissemination: This department will train and educate community-based practitioners, provide information on child development to parents, and disseminate information, including research findings, to key government officials, the media, and the general public. It will also coordinate regular integrative conferences and workshops, nationally and regionally, and oversee translation of textbooks, research articles, and other educational materials for clinicians and academics. A major goal of these outreach efforts is to provide the Romanian child health and welfare community with the sound scientific information necessary to make good policy decisions.
Training is also needed to identify at-risk children in need of preventive services. The dearth of quality assessment and evaluation tools available to Romanian practitioners complicates the task of identifying at-risk children, as well as of properly assessing those already showing signs of developmental disorders. Thus, the IDC will make training pediatricians in state-of-the-art evaluation tools, including those piloted by the Institute, a priority. The IDC will provide this training in conjunction with international partners; pediatricians who choose to participate will qualify for referrals of patients from the Institute’s clinical department.
Perhaps the most significant of the department’s activities will be bi-annual integrative conferences that unite government child protection officials, child protection workers, researchers, and pediatricians and other practitioners. These conferences will provide a regular forum for the diverse agents in child welfare to share information, discuss the latest research findings and their implications, exchange resources and ideas, and form networks of support and collaboration. The conferences will provide all the specialists involved in child welfare with an opportunity to make their needs and concerns known and to receive guidance and perspective from one another. Since many government services have been radically decentralized in reaction to the bureaucratic centralization of the Communist era, this type of regular information exchange will enable the child welfare system to act as an integrated whole, informed by research and by the experience of practitioners. It is a perfect expression of the IDC’s integrated, locally based model for providing a better life for the nation’s most vulnerable children.
Realizing the Vision
The IDC has the potential to fast-forward the transformation of Romania’s child welfare system. Thanks to SERA Romania and others, the dysfunction of the institutional era has given way to a humane approach to housing, rearing, and treating the country’s abandoned and orphaned young. Scientific understanding of this special population – and, by extension, other high-needs children – is growing and an indigenous capacity to develop and implement evidence-based diagnosis, treatment, and follow-up services is emerging and informing policy decisions. But this is only the beginning. With a comprehensive, integrated research, treatment, and training institute in place, Romania will be poised to not only provide the best medical and psychological services to its own special-needs children but also lead the world in establishing models of care for children who have suffered profound early deprivation, whatever the cause.
SERA Romania has consistently sought better lives for Romania’s vulnerable, institutionalized children. As one of the prime forces pushing reform, it has harnessed financial resources, exerted political influence, and forged collaborations with child development professionals to reduce the number of institutionalized children, develop new services, and improve conditions for those still institutionalized. For these reasons, the scientists proposing the IDC view SERA Romania as not just an ideal partner but a necessary partner in establishing the Institute. We invite you to partner with us to secure the financing necessary to launch the IDC and sustain it over the next three years. After three years, we believe the IDC’s track record of success will qualify it to receive “Institution of Public Benefit” status from the government, entitling it to a percentage of the national child health budget and making it self-sustaining.