Methods: A systematic search of six electronic databases was conducted for articles published in peer-reviewed journals. Studies were included in this review if they met the following criteria: 1) samples in which at least 80 percent were children who were orphans or living in institutionalized settings (baby homes, orphanage etc.) 2) studies conducted outside of the USA, Canada or Western Europe; and 3) measured psychosocial (i.e.mental health, self-esteem) or child developmental outcomes. All types of research designs were included. Electronic database search produced 270 abstracts of which ten studies met the inclusion criteria for this review. Methodological quality and outcomes were rated as described in the conference abstract. Studies were compared by overall quality rating and by outcomes.
Results: Interventions to improve the psychosocial and developmental outcomes of orphaned and institutionalized children fell into two categories: institution-based change targeting infants and young children that measured developmental outcomes, and community-based programs targeted to school-aged orphans affected by AIDS-related parental mortality that measured psychological (anxiety, depression, self-esteem, etc) outcomes. Of the five institution-based interventions, three involved comprehensive modifications that targeted structural changes within targeted orphanages in Latin America, Romania, and Russia; the two other interventions were brief child-focused programs delivered within the orphanage setting. In contrast, the community-based interventions, all of which were implemented in African nations, were time-limited programs implemented mostly in school settings. Overall, the study designs of institute-based interventions were stronger methodically than the community-based interventions. Nine of the ten interventions significantly improved children's development or psychological well-being; however, half of the studies had significant methodological limitations.
Conclusions and Implications: This review provides evidence of a troubling divide in efforts to improve the continuum of care for orphaned and vulnerable children worldwide. The focus on community-based interventions for children affected by AIDS-related mortality has ignored programs to improve outcomes for infant and young children; conversely, institute-based interventions could benefit by developing community-based programs for school-aged orphaned children. Thus, this review provides an important contribution to the global child welfare field by bringing these two bodies of knowledge together and evaluating the quality of the evidence to date. The results suggests there are effective ways to improve the quality of institutions for children who may not have the option of family-based care, as well as programs that can help address the psychosocial needs of orphans who remain in the community.
