Research and Program Outcomes

Outcomes : Orphanage Evaluation Brief : GGK Orphanage-Foster Care Report : Healthy Start Program

The Experience and Outcomes of the
Growing Great Kids Curriculum Training
for Filipino Caregivers and Foster Parents

A Preliminary Report

CULTURAL CONTEXT

Traditionally, the strong family system has been the bedrock of Philippine society. This system affects all areas of life from business to education to marriage and social life. It is marked by love, commitment, and interdependence. The elderly are cared for within the confines of the home. Child care is provided not only by parents but also by an intergenerational support system.

Much of this traditional value system has changed due to social and economic constraints in the past three decades. Filipino children in crisis situations who have entered child-caring institutions have often not benefited from the positive aspects of Filipino family culture. They have come from families built on unstable foundations or from those that were never really properly formed. When these families break down, these children are largely left on their own and become wards of the state or go to alternative placements. Poverty, the absence of even the barest of shelter, severed familial ties, and the overwhelming responsibilities of solo parenthood are the main triggers for the surrender of children to such centers.

PROGRAM HISTORY

The Growing Great Kids program was initiated in response to the need articulated by both government and non-government agencies to provide caregivers and foster parents the appropriate training so that they in turn can provide the best possible care to children who have been put into alternative placement.

The Consuelo Z.Alger Foundation, the lead agency in the Philippines for the GGK program, commissioned in 2000 a study to determine the needs of child caring institutions and foster agencies and to recommend programs that would respond to these needs(1). Among other things, the study noted the following inadequate caregiver-child relationships and caregiving practices among the agencies surveyed:

• Non-responsive, cold and distant caregiver-child relationships.
• Caregivers are overwhelmed and harassed by tasks, with no time to interact with children.
• Caregivers not aware/insensitive to child cues, needs and desires.
• Caregivers are reactive and global in interaction with child.
• Caregivers are consistently emotionally unavailable for the child.
• Caregivers unable to express and negotiate feelings.
• Repressed and highly volatile when stressed by home/institutional situations.
• Caregivers not engaged in activities with children to support cognitive, socio-emotional and language development.

The study also noted the lack of support for caregiver efforts. The caregivers receive trainings based on what is available, rather than what they need for skills upgrading. Thus the GGK program was launched with this vision:

“CAREGIVER PRACTICES IN EVERY CHILD PLACEMENT SERVICE FACILITY MEET THE FUNDAMENTAL NEEDS OF EVERY CHILD DURING EARLY CHILDHOOD.”

PROGRAM/TRAINING DESIGN AND DEVELOPMENT

Great Kids Inc., a collaborative partner with the Consuelo Foundation for the Healthy Start Philippine Program, was tapped to develop a new curriculum aimed at enhancing caregiver competencies in providing both ongoing nurturing relationships with and developmentally appropriate, early learning experiences for children under alternative placement.

The first curriculum was tested in 2000 among 4 non-government agencies. Based on the results of this pilot testing and the findings of the 2001 study on caregiver needs and program development priorities, a revised curriculum was launched in 2001. The new curriculum was used in 2 non-government agencies—a foster care agency and a receiving home-- and 1 government residential shelter. A team of future trainers from each organization was identified to participate in a Train-The-Trainer Institute. They then became responsible for training the caregivers from their respective agencies. Twelve foster parents were trained by the Parenting Foundation Inc; 12 caregivers at Cribs Inc.; and 11 caregivers at the Reception and Study Center of the Department of Social Welfare and Development.

The Growing Great Kids for Child Caregivers training program is composed of 32 modules to be completed within six to eight months. Each module has activities and interactive discussions that actively engage participants. Caregivers are expected to practice their learning through guided assignments. Training content is centered on equipping participants with 10 competencies.

These competencies are:

• Understanding the importance of a secure attachment for all babies and demonstrating the capacity to care for and respond to infants and toddlers in ways that support the development of such attachments.
• Possessing the basic knowledge of infant/toddler developmental stages and tasks and prioritizing the need to provide stimulation and care practices which support healthy growth and development.
• Understanding the temperamental characteristics of children and adapting care practices to enhance each child’s potential/strengths.
• Understanding the difference between discipline and punishment and providing limit setting and child guidance which will enhance the child’s ability to self-regulate and respect others.
• Relating to children with respect, empathy and compassion and in turn teaching them to interact with others in the same way.
• Providing caregiving that supports child health, nutrition and safety, recognizing the need for outside intervention when appropriate.
• Understanding and respecting each child’s right to know his family and cultural heritage and providing documentation which will support the child’s self-worth and identity.
• Demonstrating proficiency in doing activities with children which support their social-emotional, cognitive, language and physical development.
• Understanding one’s own needs as a caregiver and reaching out for support and guidance as needed to benefit one’s self and the children being cared for.
• Working cooperatively as part of a case management team enabling the caregiver to perform multiple assigned tasks, always putting the needs of the child first.

PROGRAM OUTCOMES

An evaluation study by an independent consultant was conducted in 2002 to look into the impact of the training among the caregivers and foster parents(2). The participants cited many perceived positive effects on their knowledge, attitudes and practices, including:

• Increased knowledge about child care and development.
• More responsive and sensitive to the needs of the child.
• More patient in spite of fatigue and stresses of caregiving.
• More conscious about their behavior towards every individual child.
• Now convey love and care through holding and personal response to child’s cues.
• More concrete grasp of what it means to “always put the needs of the child first.”
• More competent, specifically more responsive/interactive, creative and skillful care practices.
• Recognize from training the impact they have on each child’s development and future functioning, enhancing job satisfaction.

To document changes in caregiving practices that are specific applications from the Growing Great Kids for Child Caregivers training, Great Kids Inc. conducted observation visits among participants of the three partner agencies after the training program. Using an observation scale designed specifically for the observation visits, caregivers and foster parents were observed in their natural surroundings. The parameters of observation focused on the following areas:

• Creating a Safe Physical Environment
• Providing Basic Care
• Supporting Cognitive Development and Learning
• Fostering Social-Emotional Development
• Supporting Early Language Development

For each of the parameters, behavioral indicators are enumerated so that it is easier for the observer to check if a behavior or practice is exhibited during the visit. These behavioral indicators conform to specific topics in the GGK curriculum. For practices that were not exhibited during the observation visits, the respondent-caregiver was drawn out to relate her experiences or usual practices in relating to the child. Positive caregiving practices were provided accentuation while practices or perceptions relating to the child that were not appropriate were further clarified and additional information and coaching was provided to the caregiver.

Below are results of the observation visits conducted among the three participating agencies. (If you are reading this report in an electronic format, the findings for each of the 3 organizations studied begin at the top of a page.)

PARENTING FOUNDATION INC.

Six foster parents of the Parenting Foundation were observed during two rounds of visits to their homes. Foster homes that were visited belong to the category, “subsidized homes.” Each family with a foster child receives a subsidy of 1,800 pesos ($34 US) a month, plus expenses for education and medical needs. The foster parents belong to the upper level of the low-income strata, meaning that family members are not at the subsistence level because they have regular income sufficient to meet the needs of all members.

In most families, there is more than one family member who contributes to the family income. Several generations of relatives live in one house or in one compound. Of the six homes that were visited, four lived in squatter communities whose lots were later awarded to them by the government. One is renting a one-room apartment and one lives in a compound owned by relatives. Two of the homes include just nuclear families but are surrounded by relatives.

A. Creating a Safe Physical Environment

Typical of houses in a low-income community, the foster homes are small. The smallest house visited is approximately 15 sq. meters for 4 family members; the biggest is about 80 square meters. None of the houses have yards or gardens. Ventilation is a problem for all homes, especially during the summer months. There is no tap water except for one house. For five homes, water is bought from vendors by the gallons or drums. Drinking water is either boiled or bought from a safe source. Soiled diapers and other garbage are put inside plastic bags and taken away on a daily basis. What is interesting to note is the creativity of the foster homes in providing a safe environment for the children under their care. For example, young infants are brought out for sunshine walks in the basketball court or to the neighbors to socialize. In the case of one foster mom, since her house is so small the infant cannot use his walker, she or other members of his family bring the child to the basketball court where he is given his morning and afternoon exercise. Young children are carefully watched when going up or down the stairs since these are not gated. Having a watchful eye on the foster child is not a problem, according to the foster moms, as they can rely on their own children or other relatives to take over if they are busy with housework. In two of the homes with infants below eight months, there were homemade mobiles put up in the area where the infant sleeps.

B. Providing Basic Care

The following practices were observed among all of the six foster homes that were visited:

• Well-balanced meals/snacks served on regular schedule.
• Cooking and eating area is clean.
• Sanitary preparation of food.
• Caregiver talks with the children and provides social time during mealtime.
• Nap/rest is scheduled daily.
• Children’s schedule of activities permits caregiver to successfully handle basic routines.

During the observation visits, foster moms have consistently shown the value they place on grooming and cleanliness of the children. Diapers are checked and changed often enough.
Children’s private areas and hands are washed/wiped after toileting. Toilet/ diapering area is clean and has clean water. A different sink is used for diapering/toileting and for food preparation. All of the young children are cleaned in the morning, after messy play and eating and shortly before bedtime. Teeth are brushed at least twice a day. Washing the child’s hands before eating is not a practice among five foster moms. Only one caregiver has consistently shown that she washes the child’s hands before eating.

All of the foster moms showed awareness of children’s health status, providing details of each child’s medical history. All of them are using the Ages and Stages Questionnaire, a developmental screening tool that was introduced during the GGK training.

Unlike in a residential shelter, the foster children do not have their own cots or beds. They sleep with their foster moms, either on the same bed or on the floor with other members of the family, which is a common practice among Filipinos. In four out of six cases, the child shares bath towels with other children.

C. Supporting Cognitive Development and Learning

During the rounds of visits, all of the foster moms were able to recognize signs of over and under-stimulation among children and showed respect for children’s need for time to get used to the visitors in their homes.

All of the homes have their share of toys, most of them store-bought. As mentioned, in two homes with young infants, homemade mobiles were put up (a practice promoted in the Growing Great Kids curriculum). All of the foster moms with children above three years have toys for teaching shapes, colors, animals and letters. An indicator that these toys are used by both foster moms and children is the ability of the children to identify some shapes and colors when asked by the foster mom. When the foster children were able to answer correctly, the foster moms showed their appreciation either by hugging the child or by clapping. They cited games they teach their children that build on the GGK child development/early learning activities.

Across the six foster moms, they were not able to identify the correct term for each of the six brain builders as taught during the training. However, they were able to explain the usefulness of each toy in supporting a child’s cognitive development. Musical experiences, through dances and songs, are regularly provided for children of all ages. In three cases, dances and songs were introduced and taught to the children, not by the foster moms, but by their daughters.

D. Fostering Social-Emotional Development

Five out of six foster moms stated expectations that were realistic and based on developmental the stage and ability of each child. One foster mom, during the first visit, voiced opinions which were not appropriate. During the first visits, she said the 4-month baby gets angry/jealous when she talks about a former foster child. She also expressed at that time that her baby does not need toys but during the second visit, having been provided with feedback and support, she had already made a mobile for her child and showed the toys that she has been using to foster child development.

Five of the six caregivers do not spank their foster children. They said that spanking is their last resort in disciplining their children and couldn’t remember the last time they used spanking. Only one foster mom uses spanking as a disciplining method. According to her, her foster child seemed to be testing her limits. When verified with the assigned social worker, she validated that the foster child has shown marked improvements since being placed in his current home, both at the cognitive and behavioral levels. He is scheduled for testing, one of which is to check if he is a special needs child.

All of the caregivers have demonstrated the ability to help the child resolve conflict with other children in the homes. When promising rewards for good behavior, they make sure that they fulfill their promise because according to them, “the child remembers.” They showed respect for the child’s feelings by not forcing them to put up a show of their talents in front of the observer. The children were allowed time to be at ease with the visitors. According to three caregivers, they allow their foster children to make their own choices, as long has these are not harmful.

E. Supporting Early Language Development

The following behaviors were observed among all six foster moms:

• Talks to children during routine caregiving.
• Mostly interacts and talks with children at their physical level.
• Maintains eye contact when talking to them, face is expressive.
• Regularly takes children for a walk outdoors.
• Points out and names items and activities the child is interested in.
• Encourages children to use words, by asking questions and encouraging them to repeat words.
• Helps children enjoy language, by singing with them.
• Gives clear directions for toddlers, and demonstrates to them for further clarity.

In all of the homes visited, the TV plays an important role in entertaining the children. The children watch TV on the average of two hours a day, most of these shows being cartoons. But since the caregivers watch other shows after the cartoons, the foster children are exposed to TV for a much longer time.

CRIBS HOME FOR CHILDREN

There were six training participants observed, five of which were observed during the first and second round of visits. Four out of six are graduates of medical allied profession - nursing (1); midwifery (2); and radiology technician (1). One is a college graduate with a degree in history while the last one is a high school graduate. During the first round of visits, there were eight children in the Toddlers room; seven in the Crawlers area; and five in the Small World, the young Infants section of the orphanage. During the second round, there were four children in the Toddlers area; four in the Crawlers section; and three in the Small World. (Typically this orphanage cares for significantly larger numbers of children.)

A. Creating a Safe Physical Environment

The facilities for young children at CRIBS are divided into three sections. The Small World is designated for young infants who are not yet able to crawl or stand up on their own. The Crawlers, as the name indicates, is for children who are already able to crawl around and explore. Once able to steadily walk on their own, the child is transferred to the Toddlers section. He will stay there until he is reunited with his family or adopted. At any point of the child’s stay at CRIBS, the baby can be fostered.

The Small World is an air-conditioned room; the other rooms are not although these are well-lighted and have good ventilation because of numerous screened windows. In both the Small World and Crawlers section, there is a center mat for children to be brought down when awake. The Toddlers room is covered in rubber mats. The walls are painted brightly with cartoon characters and animals.

The floors are mopped at least twice daily by a staff member. Tables and chairs in the Toddlers area are cleaned and washed after each activity. The toys are regularly washed and dried, while the “chew” toys are washed daily. The furnishings are safe and in good repair. Medicine, cleaning supplies and other hazardous materials are placed in rooms where the children do not normally play and explore.

Electrical outlets and cords are covered/kept away from children. The electrical outlets cannot be reached by toddlers or crawlers. CRIBS has emergency plans and these are discussed with the staff. However, their drill is not practiced with the children.

B. Providing Basic Care

Food and formula preparation is not the responsibility of the caregivers observed. CRIBS has different staff members handling this responsibility. The menu is prepared by a nutritionist/dietician which the assigned cook follows. The cooking area is separated by a door that is always closed. The caregiver-in-charge is responsible for meeting the health and medical needs of the children. She takes care of monitoring the children’s temperatures as well as administering medication.

Serving of meals and snacks are served on a regular schedule. During meal times, some of the staff with non-caregiving functions helps the caregivers feed the children. During this time, they talk with crawlers and toddlers and provide social time.

With volunteers around, and if the caregiver is not attending to something else, some of the children at the Small World are held while being bottle-fed. It was observed during the two rounds of observation that bottle propping remains a practice, even though the GGK training encourages caregivers to hold infants during feeding whenever possible. It is commonly believed that babies should be encouraged, at an early age to learn to hold their bottle while feeding, to support their physical development.

Each child has her/his own crib, cot or bed with clean linen. For children at the Crawlers and Toddlers, they have their own storage cabinets for their clothes. Infants at the Small World share the same clothes but all are newly washed before each use.

Each of the sections follow a daily routine which is set up by the ECD coordinator. Nap/rest is scheduled daily. Children are transitioned to naptime with quiet activities. One caregiver at the Toddlers section likes to sit by the children and sing them a few songs and tap (“tapik”) a child to sleep. Each child has their own crib or cot with the beddings changed at least once a day.

Diapers are checked and changed once detected as full or wet. Soiled diapers are disposed of in a waste can with cover and these are removed from the room at least twice daily. For the toddlers who are being toilet trained, they are asked to sit in the potty chair in the morning for about 15 to 20 minutes although this is sometimes shorter because the child would want to get up. During the observation, no child at the Toddlers area was scolded by the caregiver for soiling his diaper.

The Toilet/diapering area is clean (does not smell) and has clean water. The children’s private areas and hands are washed/wiped after using the toilet or a diaper change. All of the caregivers were observed to wash hands with soap after each diapering or when helping children with toileting.

For the children’s personal hygiene, the Toddlers brush their teeth and take a bath twice a day. Infants’ mouths are cleaned using clean cloth or cotton. The children are observed to be clean (and smell clean too) without any serious skin diseases except diaper rashes which are treated with topical ointments. All of the caregivers give attention to the children’s personal grooming, combing the children’s hair after a bath and occasionally dabbing cologne.

During mealtimes, bibs are available and used for infants and toddlers. They wash their hands before mealtime.

All of the caregiver show awareness of children’s health status since this is one aspect that they document during their shift.

Each of the caregivers is now assigned children for which she is responsible for forming a special bond and providing additional stimulation. They are also responsible for the developmental screening of the assigned children. Children with delays are referred to volunteer physicians for a more thorough assessment.

Five out of the six caregivers said that they have undergone CPR training. During the second round of visits, the GKI observer was informed that two staff members will undergo an intensive first aid training which will include CPR training. The two staff members will then re-echo their learning to the rest of the staff.

Regular caregivers of CRIBS are required to undergo an annual physical check-up. Contractual caregivers are required to submit results of their medical check-up before they are assigned caregiving functions.

C. Supporting Cognitive Development And Learning

In each of the three sections, age appropriate play activities are now part of the daily schedule along with doing GGK developmental activities during routine care, such as diapering and bathing. These activities are determined by the ECD coordinator. In the interval between the first and second round of visits (a period of almost three months), the daily activities were changed once. A surprising change during the second round of visits was the crib/wall hangings that were put up to stimulate children’s interest. Some of the toys put up were the homemade toys the participants made during their training.

During play activities, the caregivers now spend most of their non-routine caregiving time on the floor interacting with the children. They take out the children from their cribs when they are awake and ready to play. The crawlers and toddlers are allowed ample opportunities to explore their environment safely. When they were attending to a fussy or crying child, all of them were able to comfort and pacify the child. When two children fight over toys, the most common method used by the caregivers is redirection. Children are seldom left unsupervised and if they are, only for a very brief period of time.

There is now a lot of physical contact, praising, and applauding between the caregivers and children. Two caregivers stand out for their ability to engage the children in play activities, their interaction showing distinctly the 4 Steps to Success by first getting the child’s attention.

They are very verbal with the children, using the Play-by-Play Daily Do, describing in joyful tones the things that children are seeing or experiencing.

D. Fostering Social-Emotional Development

All of the caregivers observed displayed the following characteristics:

• Use physical contact to show affection to all children.
• Demonstrate empathy for the children.
• Praise and attention are given for good behavior.
• Praise children for being kind and helpful to others.
• Often smile at, talk to, and listen to children.
• Use a pleasant tone and non-dictating manner.
• Do not use physical punishment. Uses alternatives to physical punishment, mostly redirection.

In dealing with the children, the caregivers expressed their understanding of the unique characteristics of the children under their care, narrating that they now adjust their caregiving style depending on the child they are caring for. One caregiver shared that sometimes she verbally compares the children but is aware that she should not be doing this.

During the first round of visits, only one caregiver said that sometimes she does not say goodbye to the children (who are awake) when her shift ends. The rest said that they wave or approach the kids individually to prepare them for the change in shifts. During the second observation, all of them said that they greet children to help them adjust to their arriving/leaving.

E. Supporting Early Language Development

The following characteristics were observed for each caregiver:

• Talks to infants and toddlers during routines.
• Responds to sounds infants/toddler makes, repeating what they say, adding words and ideas when appropriate.
• Maintains eye contact when talking to children.
• Interacts and talks with children at their physical level.
• Encourages toddlers to use words, by asking questions and encouraging them to repeat words.

If weather permits, infants are taken out for daily exposure to natural light in the morning and to allow them to experience new things. The weekly activities of toddlers and crawlers include scheduling outdoor activities. Outdoor activities were observed during the first and second visits, indicating the consistency of this practice.

Story-telling and reading are scheduled activities for toddlers and crawlers on a daily basis. TV and video showing has been reduced to 1 hour and a half twice a week. Two caregivers were observed supervising the children during this activity. During this activity, it was observed that the caregivers still did not join children in TV viewing (by asking questions or adding information), but did respond to the children when they were asked. (Previously the TV was left on at a very loud volume for much of every day.)

RECEPTION AND STUDY CENTER HOME FOR CHILDREN

The participants of the GGK training are regular employees deployed at the Nursery Cottage caring for infants and young children below three years old. Out of the 11 training participants, seven were observed although there were only five who were observed during both the first and second rounds of visits. This was due to the unavailability of staff during the scheduled visits, particularly during the second round conducted during the first week of May. This period coincided with the scheduled vacation leave of certain staff members.

Among the seven staff members that were observed, five are graduates of a midwifery course, one is a nurse, and one reached her first year of college. Three are not directly involved in caregiving functions. One holds the administrative role as head of the cottage; the second is in-charge of the Activity Center; and the third staff member is assigned to the formula room and is responsible for food preparation. But all of them help the assigned caregivers during mealtimes.

During the first round of visits, there were eight children in the Infants section with one caregiver and 11 in the Toddler area with two caregivers. During the second round, there were 11 in the Infants room with one caregiver and 13 in the toddler area with one caregiver. There were practicumers who were assisting the caregivers during the first round of visits. During the second round, practicumers were present only during the first day of the visits. The caregiver-child ratio varied on a day-to-day basis, depending on the admission and health situations of children. Children who are sick are referred to and confined at the Infirmary.

A. Creating a Safe Physical Environment

The children are segregated by age group and abilities. The Infants Room is for children below one year old, but some older infants stay longer if they have to overcome some developmental delays that a transfer might intensify. The Toddlers Room has two sections: one for the older toddlers and the other for younger toddlers. The separation, according to the staff, is meant to protect the younger toddlers from the rough play of the older ones. The younger toddlers also still use cribs while older ones sleep on children’s cots with low railings.

On the physical lay-out of the cottages, there are enough pieces of furniture to meet basic needs of children for eating and sleeping. Children are taken to the kitchen area for their snacks and meals. There is enough child-sized furniture to accommodate all during mealtimes. The furnishings are safe and in good repair. There are cabinets to store children’s own things. Clothes are shared by children but are newly washed if used by another. Children from the Infants section who are being prepared for transfer to the Toddler area take their meals with the other older children.

The tables and chairs are cleaned and washed after each activity. There are personnel hired to do janitorial and laundry services. The floors are cleaned and mopped with disinfectant more than once daily as observed during the visits. The staff assigned to the Formula Room also helps out in the cleaning of the kitchen area.

There are enough toys for children to play with, as well as materials like slides, tricycles, and walkers to stimulate large muscle skills. There are colorful displays on walls and ceilings for children to look at. During the second visit (at an interval of three months), these displays were changed. At the center of each room are big cushioned mats for children to crawl or play on when they are awake. The rooms have good lighting and are air-conditioned. However, there is an area in the infant’s room which is not reached by the air-conditioning. During the second round of visits, which happened during a summer month, the baby assigned to a cot at that warm area was visibly uncomfortable. However, the caregiver assigned at that time placed the baby on the center mat once he was awake.

Designated staff undergoes annual disaster drills although these are not practiced with children. Staircases are gated; the yard where children play is fenced. Phone and transportation are available for emergency cases. There is an Infirmary manned by medical professionals for RSCC children who are sick. The Infirmary also provides regular check ups and immunization. Children who need special medical attention are transferred to the Infirmary so as to prevent the spread of diseases and for the sick child to be given special attention. For cases requiring special medical and dental attention, children are brought to a designated government clinic or hospital.

While most electrical cords are kept away from children, the air-conditioner cord and outlet in the toddler’s room could be reached by a really persistent child. The curtain rods in both rooms also pose a potential danger as these are not securely fixed. Energetic children might be able to tug them down. A major concern is the presence of mice in the cottage. They were evident at the infant’s room during the second visit, with the mice scurrying along sides of the rooms and sometimes running over some toys. The staff said that this is a persistent problem and that they are looking for alternatives to safely kill the mice without compromising the children’s health.

Caregivers ensure that the play area is safe for children of different ages. If there is only one caregiver assigned, children take turns in using the center mat. Smaller infants or toddlers are not allowed to play unattended in the center mat together with more mobile and active children.

Indoor and outdoor areas are cleared of breakable and unsafe items so children can play/crawl with few restrictions. Some cabinets are locked with pieces of cloths so that children will not be able to play with supplies inside.

Caregivers follow a set of daily activities and routines, mostly indoors. During the first round of visits, half of the children (5) were taken out for morning walks inside the RSCC compound. The morning walks lasted for almost an hour. According to the caregiver, this normally happens when there is another caregiver assigned in the Toddlers Room to take care of those who are not able to go out. During the second visit, the morning activity was not observed although four children went outside to attend a party held at the compound. According to the staff, toddlers are exposed to RSCC activities like flag ceremonies and parties.

Exposure to natural light and fresh air on a daily basis is not part of the routine of children at the Infants section. The main constraint, according to the caregivers, is lack of manpower.

B. Providing Basic Care

Meals and milk are prepared at the cottage by the person assigned to the Formula room. The assigned staff follows a menu prepared by the RSCC dietician. She is also responsible for keeping the cooking area clean. On both rounds of visits, the Formula Room was observed to be clean and smelling of disinfectant.

During mealtimes, all of the toddlers eat at the same table. Each of them is provided a bib. Before eating, a staff member leads a prayer. The younger toddlers are assisted by staff members during meal times, making the activity a social time for all. As mentioned, children from the Infants room who will soon be transferred to the Toddlers join the group during mealtimes. At least three staff members were present to assist the children.

During the first round of visits, it was observed that washing the children’s hands before mealtime was not a practice. However, during the second round of visits, it was observed that the children were asked to wash their hands first before eating, using a chair to reach the sink at the kitchen area. The head of the cottage has submitted a proposal to the RSCC management so that kiddie-sized washstands can be installed to facilitate this practice. Materials were already identified by RSCC for use in the cottage. A GKI director has committed to shoulder the labor and other expenses related to the installation of the wash stands.

Bottle propping is still a practice in the Infants Room. According to the caregivers, while they know that it is better that infants are held and talked to while being bottle-fed, it is not possible given their other responsibilities. But if there are not pending chores, they see to it that they hold an infant while feeding him.

Nap/rest is scheduled daily. Children are transitioned to naptime, using lullabies played on the radio and dim lights.

There are no designated cribs or cots for children but bedding is washed if used for another child. The beddings for the center mats are changed at least once during the caregiver’s shift or more often if soiled. Once the caregiver detects that a child needs to be changed, she changes the soiled diaper without a fuss or without scolding him. The toilet/diapering area is clean and has clean running water. The children’s private areas and hands are washed/wiped after using the toilet. The caregiver washes her hands with soap after each diapering or when helping children with toileting. This is a consistent practice among all caregivers observed. Diapers are disposed of properly in a can and are removed at least twice during the shift to avoid foul smell.

The children are cleaned/take a bath twice a day. They are cleaned and their clothes changed after each meal. Tooth brushing is practiced twice a day among the toddlers.

All of the caregiver showed awareness of children’s health status. When asked, they can immediately identify a child who has been recently ill or who is not feeling well. All of the children’s temperatures are monitored daily as well as their medicine intake. Each of the caregivers is aware of the health status of all the children during their stint.

Although the caregivers are not responsible for conducting the developmental screening of the children (this is assigned to another RSCC staff), each caregiver is apprised of the screening results. When asked if they know the children who have developmental delays, all of the caregivers were able to identify the children and their particular delays. Each staff member of the cottage is assigned a delayed child to provide special attention/stimulation to.

All of the RSCC regular staff undergo an annual medical check up and those interviewed said that they are in good health.

Six out of seven interviewed have allied medical background. They have taken first aid courses. Two mentioned that they have not taken any CPR training.

C. Supporting Cognitive Development and Learning

Caregivers follow a daily schedule of activities, spending most of their non-routine caregiving time on the floor interacting with the children. If there are enough caregivers, children of varying ages are allowed to play together in the center mat. For safety reasons, younger children are not allowed to play together with older ones if the caregiver thinks she cannot handle all of the children at the same time. Because of this safety consideration, some children are kept in their cribs even when awake. But when they become fussy, it was observed that caregivers comfort and pacify the children and if needed, bring them out of the crib.

Games and activities for concept development are scheduled and conducted one-on-one by the cottage staff member in charged of the Activity Center. She schedules age and developmental appropriate activities for each child to help them keep pace with normal development. According to her, her goal is to provide at least 20-30 minute one-on-one interaction with each child on a daily basis. Sometimes she said, when this is not possible, she conducts group activities for older children. She also enlists the help of volunteers and practicumers to provide this one-on-one stimulation.

There was a variety of activities scheduled during the first round of visits, particularly for the Toddlers group. A swimming activity, a visit to the nearby shopping mall, and slide play were scheduled separately each day. Across the board, the caregivers observed followed the 4 Steps to Success when conducting activities as well as demonstrating their understanding of the children’s different temperamental characteristics.

The visit to the shopping mall showed the ingenuity of the cottage staff and management in using their resources. Since RSCC is within walking distance of a shopping mall, the staff organized a mall tour during the first open hour to avoid the shopping crowd. There were six or seven children who were brought out, (a new experience for children and staff) each accompanied by a staff who was spending her personal money to treat the child. One caregiver was impressive in her handling of a fearful child who was reluctant to enter the mall. When the child didn’t want to go inside the mall, she didn’t push him. They stayed for a few minutes outside the building, as she told him of the exciting things he would see inside. She held the child close to her, giving him time to adjust to this new, unfamiliar environment. It took her more than 30 minutes to coax the child out of his fear of new things, but eventually, he relaxed enough to walk and explore on his own.

Overall, the caregivers observed showed that they recognize signs of over- and under-stimulation among children. In resolving conflict among the toddlers, they most often use E-Caregiving and redirection. They take pride in the children’s accomplishments and show their appreciation by applauding or praising. The children are exposed to music, either through the radio, TV, or by the caregiver’s singing.

D. Fostering Social-Emotional Development

The caregivers displayed the following characteristics:

• If not attending to another child, the caregivers respond promptly to cues provided by young infants, either by approaching the baby and checking with him or by picking him up. If she cannot attend to the baby immediately, she calls his or her name, and talks to him.
• Caregivers provide many opportunities for close contact with young infants.
• They use physical contact to show affection to all children.
• Praise and attention are given for good behavior.
• Caregivers often smile at, talk to, and listen to children.
• Seem relaxed, voices are cheerful.
• Caregivers respect individual temperaments of children by varying styles of interaction with the children.

What hinders responding promptly to the children is the low caregiver to child ratio. One caregiver explained that as much as they would like to attend to a crying child, they cannot do so if two or three are already crying. So they have to assess which one needs the most urgent attention, gauging by the quality of the child’s cry.

A scenario in the Toddlers section illustrates how the caregiver-child ratio is a challenge. During the second round of visits, it was observed that two of the young toddlers were kept in their cribs even when awake. One of them cried for a long time (probably for more than 5 minutes) before the caregiver (who was changing a child’s diaper at that time) was able to enter the area and attend to the child. When the lone caregiver (for 12 toddlers) did take the two young toddlers out of their area to play with the older ones, one young toddler cried three times during the two-hour observation as he was crushed/bumped into by children or his toy was snatched away. To the credit of the caregiver, she comforted the crying child effectively and talked to the “culprit” child and redirected his attention to another toy.

Since physical punishment within RSCC is not an acceptable discipline method, the caregivers said that they tell the child that what she did was wrong and then re-direct his attention. In the Toddlers Room, time-out is also practiced. To prepare the children for transition between activities, routines are used by the caregivers. For example, to halt play and transition them to meal time, they bring out big laundry baskets for the children to fill with toys, constantly mentioning the word “pack-up.” Once the toys are cleared, the caregiver announces that it is time to line-up, and one-by-one in a line, the children move from the Toddlers room to the kitchen area.

E. Supporting Early Language Development

It is in this aspect that there is a range of differences between the caregivers. Although all of them were observed to be talking to infants and toddlers during routines, some are talking about what they are doing or experiencing (e.g., water is cold isn’t it) while others are giving directions (e.g., open your mouth). Some are more talkative than others, their faces more expressive when talking or interacting with children. But all maintains eye contact when talking to children, mostly interacting and talking at the children’s physical level. They encourage toddlers to use words, by asking questions and encouraging them to repeat words. The caregivers are aware that most of the delays of their children are on language so they expressed their new understanding that children need to experience talking and conversing to learn words and how to communicate.

Use of Television/videos, as scheduled, is for no more than 30 minutes at a time and for no more than a total of 2 hours daily. It was not observed how caregivers participate during TV/video viewing.

CONCLUSIONS: IMPACT OF
GROWING GREAT KIDS TRAINING PROGRAM

While it is clear that a loving home is no substitute for institutional care, the reality is that millions of infants and young children around the world spend months or years, critical to their life-long development and functioning in such care facilities. The observation visits, described above, show that the three agencies and their caregivers are now aware of what children most need from them in order to thrive and are providing the best possible care to insure their well-being. They have creatively re-organized their physical environments and have re-allocated their human resources to better respond to the needs of the infants and young children in their care. Following this one-year intervention process, there are now practices and systems in place that are clearly fostering the cognitive, socio-emotional and language development of the children residing with the participating organizations. These improved care practices have the potential to make profound differences in how capable, respected and valued these children will feel as adults, influencing the types of contributions they will make to our global community as they mature.

Some of the most note-worthy outcomes of the training program related to caregiving knowledge and practices are:

• Awareness of the need for every child to form a secure attachment relationship with a primary caregiver.
• Awareness of the cues and signals of infants/young children and their meaning.
• Prompt, as possible, response to the needs and wants of infants.
• Talking to and playing with children during routine care to provide social, cognitive and language stimulation.
• Recognition of the child’s need for security, exploration, and self-discovery.
• Demonstrating empathy while providing care, teaching and playing with children.
• Including age-appropriate developmental activities in the child’s daily routines.
• Appreciation of temperamental characteristics.
• Adapting care practices to suit a child’s temperament.
• Reductions in television time and noise levels.
• Attention to safety.
• More floor and outdoor time with caregivers(less time in cribs).
• Acknowledging a child’s successes and learning with claps, smiles and praise.
• Conducting regular developmental screening to determine focus for developmental stimulation.

All of the foster parents and caregivers report that their increased understanding of nurturing caregiving practices, early childhood development and learning and the important role they play in the lives of the orphaned children, have had a significant impact on their relationships with the children in their care . Their feelings of pride, confidence and competence in their new knowledge and skills are apparent as they talk about the importance of the work they are doing. This positive response to the GGK trainings was not only verbalized to the GKI observer during the observation visits but also to the social workers and GGK trainers who have regular contact with the training participants.

After the GGK training seminars, Parenting Foundation is now requiring all prospective foster parents to undergo the GGK training as one of their accreditation requirements. Parenting Foundation is now planning the training for a third batch of foster parent trainees. The Department of Social Welfare and Development has requested the funding agency - Consuelo Foundation - to support another batch of trainers to be trained as they would like to expand the training coverage to all of the regional RSCCs. This will be the first step in this expansion process.

Footnotes

1 Casals, Ma. Risa. Program Framework Development for Foster Care and Institutionalized Placement of Children. A Report funded by the Consuelo Z. Alger Foundation. 2001.

2 Marco, Jesus M. GGK Orphanages and Foster Care Training Pilot Project: A Process Evaluation. A study commissioned by the Consuelo Z. Alger Foundation. 2003.

Outcomes : Orphanage Evaluation Brief : GGK Orphanage-Foster Care Report : Healthy Start Program

Overview : A Global Approach : Orphanage Training Programs : Adopt An Orphanage : Research & Program Outcomes