Notes from the Field

Part 4: Our Results

This is the fourth of a four-part blog series outlining the philosophy behind our work, and the roadmap going forward. (See also pt. 1, pt. 2, and pt. 3.)

Our program may be growing to support whole countries in their nationwide programs, but the most important measure of our success remains the impact on children in the childcare system and in the childcare settings we work with. Third-party evaluation of our results has shown that it improves* developmental outcomes for vulnerable children, as shown across multiple developmental domains:

Intellectual Development

At baseline, 82% of children scored as though intellectually disabled on the Battelle Development Inventory. In less than two years, only 14% of children scored as though intellectually disabled, which reflects a 62% decrease in children presenting as if they had intellectual disability.

Physical Development

Children experienced a 46% increase in height and 34% increase in weight with no changes to nutrition.

Relationship Development

The social-emotional relationship between caregiver and children improved by 150% as noted by the the Caregiver-Child Social/Emotional and Relationship Rating Scale (CCSERRS).

Behavioral Development

Negative behaviors such as aggression, withdrawal, and self-stimulation were reduced by 43% in children.

The Importance of Measurement

In partnership with Duke University, Whole Child developed WCI-QCUALS (Quality of Care in Limited-Resource Settings), a measurement tool that allows agencies to assess the quality of care in childcare facilities. Third-party evaluation by Duke University confirmed that WCI-QCUALS works better than other standardized tools used in limited-resource childcare settings, and that the outcomes from this tool correlate to children’s well-being.

* As measured in five residential care centers in Managua, Nicaragua. (2012 Groark, C. J., McCall, R. B., McCarthy, S. K., Eichner, J. C., Warner, H. A., Salaway, J. and Palmer, K. (2012) The Effects of a Social-Emotional Intervention on Caregivers and Children in Five Central American Institutions University of Pittsburgh Office of Child Development, Prepared for: Whole Child International and the Inter-American Development Bank under Technical Cooperation ATN/KP-12327-NI; 2013 Groark, CJ; McCall, RB, McCarthy, SK, Eichner, JC,Warner, HA, Salaway, J, Palmer, K, Lopez, ME. (2013). “The Effects of a Social–Emotional Intervention on Caregivers and Children With Disabilities in Two Central American Institutions.” Infants & Young Children. Vol. 26, No. 4, pp. 286–305)


Part 3: Our Before & After

This is the third of a four-part blog series which will outline the philosophy behind our work, and the roadmap going forward. (See also pt. 1, pt. 2, and pt. 4.)


  • Children are kept in large groups by age and “graduate” to new caregivers and peers regularly.
  • Caregivers are overwhelmed and don’t know how to connect in a meaningful way with children, considering the constraints of time and the large number of children for whom they are responsible.
  • Children have no personal space or record of the moments and developments that form their identity.
  • Countries overly rely on residential care (orphanages)


  • Children are placed in family-like small groups where primary caregiver relationships are formed and maintained as long as they are in care.
  • Caregivers are trained to use routine moments to connect with each child and feel confident in their ability to provide what the child needs.
  • Caregivers keep records of developmental milestones; children have cubbies for their own things and a binder of progress and past history to help form an identity.
  • Residential care centers are supported in expanding their programs to include services in family reunification and support, running small-scale foster programs, and appropriate monitoring.

The next installment of this series is Our Results: an overview of the developmental outcomes of children in childcare systems after our intervention.

Part 2: Our Methodology

This is the second of a four-part blog series which will outline the philosophy behind our work, and the roadmap going forward. (See also pt. 1, pt. 3, and pt. 4.)

Though Whole Child’s program has evolved over time, many of our elements have stayed the same. Among these are the “Five Essential Childcare Principles” listed on our “Program” page — these core ideas have remained at the center of our work since 2004. The other key elements on that page remain the same also, but as we have shifted our focus to the comprehensive support of national governments, we have also been able to focus the elements of our program into six key steps for building the capacity to create meaningful, sustainable change:

  1. Local academic community
    • University faculty receive training and mentoring in order to update their academic knowledge.
    • Updating this knowledge at the academic level ensures a pipeline of local professionals with the knowledge and skills they need, in perpetuity.
  2. Government decision-makers
    • attend Whole Child’s university course on best practices in limited-resource settings.
    • receive hands-on support and mentoring to implement the necessary changes across the system of care for children.
  3. Childcare center and residential care directors
    • attend our university certificate program on best practices in childcare in limited-resource settings.
    • receive support and mentoring to implement relationship-centered, evidence-based best practices in centers.
  4. Government supervisors of childcare centers
    • receive two years of training and hands-on support focused on creating capacity to be the leaders on implementation and monitoring of quality in residential care and early-childhood care and development centers.
  5. Children’s Direct Caregivers
    • receive nine months of training to improve quality of care and strengthen relationships with children.
    • receive hands-on support to implement the changes in childcare practices in their centers.
  6. Residential Care Centers
    • in addition to the implementation of best practices described in bullet 3, we work with residential care centers to broaden the scope of their work to include family reunification and support, running small-scale foster programs, & appropriate monitoring.

The next installment of this series, “Our Before & After,” paints a brief picture of what a typical childcare system looks like before we arrive, and what a system looks like after we have completed our work.

Part 1: The Problem & Our Solution

For nearly two years, many of us at Whole Child have been engaged in a strategic planning process aimed at figuring out how to effectively and cost-effectively expand the program we’ve been developing and evaluating for 14 years. It’s provided clarity to help plan for the future, and has fed the development of our current project in El Salvador, recently supported by a $4.9 million USAID award.


This is the first of a four-part blog series which will outline the philosophy behind our work and the roadmap going forward. (See also pt. 2, pt. 3, and pt. 4.)

The problem we’re solving has not changed much since Whole Child was founded in 2004. Millions of vulnerable children around the world suffer from a lack of stable, nurturing relationships in low-quality care settings. This is particularly true for children in developing countries growing up in residential care and those from low-income families who spend the majority of their day in early childcare centers. These children’s developmental needs are often not met, resulting in stunting, high levels of criminality, and other adverse outcomes — reinforcing the cycles of poverty and child abandonment through generations.

Current systems tend to be over-reliant on residential care, but replacing residential care has many obstacles. In particular, residential care is generally funded by individual charities whose resources cannot simply be transferred to family-based systems. In addition, the existing social-workforce is inadequate to respond to child protection needs and supervision of family-based care.

Our solution, in its entirety, and at all levels, focuses on building capacity within and building upon a country’s existing government infrastructure, with decision-makers and supervisors being our main focus. In addition, we train and mentor local academia, center directors, and caregivers. Working in early-childhood centers, residential care centers, and foster care programs, we implement evidence-based best practices in relationship-centered care, establishing such care as a national standard.

Within residential care centers, in addition to the implementation of best practices, we work collaboratively to expand the breadth of their services to include family reunification and support, running small-scale foster programs, and appropriate monitoring. This leverages existing resources within the existing residential-care community while safely reducing the number of children outside of family-based care.

Read on in the series to explore (2) Our Methodology; (3) Our Before & After; and (4) Our Results.


Planning Retreat with ISNA

Hola from El Salvador! Whole Child International staff members recently gathered for a two-day planning workshop at the beautiful Santa Leticia on August 22-23, 2018 with ISNA, the Salvadoran government’s Institute for Integral Development for Children and Adolescents.

This retreat was part of the beginning process of implementation for the Protection and Quality of Care for Children project. The project is a five year, $7.4 million project of which USAID is contributing $4.9 million. The workshop consisted of 14 members of ISNA, including the three members of the senior management team: Carlos Tito Lopez, Deputy Director for Promotion of Children’s Rights; Maria de la Paz Yanes, Deputy Director for Children’s Protection; and Samuel Carias, Deputy Director of the National Network of Shared Assistance.

In addition to the INSA participants, the Founder & CEO of Whole Child International, Karen Spencer, participated in the workshop along with Pete La Raus, the Chief Operating Officer, and Sonia Silva, the Whole Child Country Director in El Salvador. In total, 25 people were actively involved in two days of planning.

The planning focused primarily on the first activity of the project, a comprehensive evaluation of the child protection and childcare system in El Salvador. The project will span five years, but the planning retreat focused on the first year of implementation to build the foundation for future activities. Together, participants established concrete and reliable channels of communication, accountability, and transparency. The two organizations identified major milestones, due dates, key personnel, and resources required. More importantly, the workshop solidified both parties’ commitment to work together to develop and implement the project. Whole Child International intends to have a finalized work plan for the first year coming shortly.

We’re looking forward to building on our previous work with ISNA, and to make the foundation for this and future projects even stronger.

Pictured: our staff and the ISNA team together, and a subset of participants discuss the project.


Special Visit from our Board of Directors and Donors

If you were to visit El Salvador, you would find a country full of lush vegetation, stunning beaches, and a dynamic, vibrant, and welcoming culture.  However, El Salvador faces considerable challenges when it comes to caring for vulnerable children amidst an environment riddled with gang violence and influence. A lack of relationship-centered, high-quality care for the most vulnerable children continues to be a major challenge.

This month, Whole Child International welcomed our Board of Directors and key donors to see our work in San Salvador. Our trip focused on providing context about the country and explaining the plight of children growing up in residential centers and those who spend their days in early childhood care centers. As the Board of Directors and donors visited each site, they received a small glimpse into what life is like for children growing up in El Salvador without loving families to surround them.

Prior to visiting the centers, our donors and board members were reminded of typical practices that unknowingly contribute to stifling childhood development. Care centers in El Salvador, like many other countries, emphasize efficiency and cleanliness to maintain order, rather than prioritizing emotional needs. This approach detracts from establishing a more family-like, relationship-centered setting that occurs when children of different ages are grouped together with supervision from a consistent and dedicated caregiver. Visiting several different childcare centers allowed our board and donors to understand these problems and see the benefit of Whole Child’s work firsthand.

In addition to site visits, this trip presented many opportunities to continue building relationships with key government partners, USAID officials, ISNA, and the US Ambassador to El Salvador, Jean Manes. Our visitors also had the chance to visit the beautiful area of Suchitoto, a historical town with stunning mountain views, and enjoyed the lovely hospitality at Hotel Los Almendros de San Lorenzo.

We are so grateful to have such wonderful board members and donors who actively engage with our work! Special “Thank You” to each of them for participating in this experience and offering their input and expertise on how we can continue to strengthen our approach within El Salvador.

Pictured: Five of our board members enjoy El Salvador’s natural beauty; a lunch with key donors; and a stunning view of Suchitoto.


Karen Spencer Receives Honorary Fellowship at University of Northampton

On July 24, 2018, our Founder & CEO Karen Spencer received an Honorary Fellowship from the University of Northampton. This honor acknowledged her impact as a social entrepreneur for her work and dedication at Whole Child International by improving care for vulnerable children around the world.

“To be recognized in this way is a wonderful and humbling personal honor, but I’m also proud that the work of everyone at Whole Child is being recognized in this way by such a fine academic institution as the University of Northampton,” said Karen of this special opportunity.

In 2013, Ashoka chose the University of Northampton to be a “Changemaker Campus” focused on encouraging students to tackle social problems throughout their undergraduate experience, and as part of their growing careers. Karen’s position as an Ashoka Fellow made her especially proud to speak to this graduating class of young changemakers.

Dr. Eunice Lumsden, Head of Early Years at the University of Northampton, was quoted as saying: “Countess Spencer is a true ‘changemaker’ in every sense and a pioneer in her work with the world’s most vulnerable children. Her contribution to enriching the life of others is immense and her knowledge about the importance of a holistic approach to early childhood is outstanding.”

In her remarks addressing the faculty, staff, and 2018 graduating class, Karen thanked the university and shared encouragement with attendees. Karen advised the graduates to pursue their dreams, regardless of possible humble beginnings or any failures along the way. She offered challenging yet important advice by saying, “Embrace your own failures. Within my biggest failures was the knowledge and experience that led to my biggest successes.”

Pictured: Karen Spencer receiving her diploma, and posing with Reverend Richard Coles, Charles Spencer, and Vice Chancellor Nick Petford.


Honoring Mother Figures with the #LikeaMothertoMe Campaign

Celebrating the mother figures in our lives begins with a simple acknowledgement of their value and impact. As part of our ongoing effort to shine a light on the work of surrogate mothers and caregivers of all kinds, Whole Child International created a social media campaign for Mother’s Day 2018 called #LikeaMothertoMe.

The campaign encouraged people to share their favorite stories and memories honoring mother figures and the impact that these special individuals have made on their lives.

Our Founder & CEO Karen Spencer shared her inspiration behind the campaign by saying, “I founded Whole Child from a desire to ensure that the most vulnerable of children could experience love and connection. Whole Child is about the centrality of a mother figure in a child’s life. A relational bond for a child is not a luxury, it is the most basic of human needs.’’

Campaign participants shared photos, videos, and stories of their important mother figures.  Many individuals, from the United States to the United Kingdom, participated in the #LikeaMothertoMe campaign, including special friends of Whole Child, Reverend Richard Coles and Elsa Chahin of Pikler USA. Thank you to all who shared!

A few notable posts. . .

 “The women who meant the most to me … were not necessarily the ones who had achieved the greatest financial or professional success. The ones who had the most impact on me were those who cared the most, who took time out of their day to chat with me, to listen and talk and laugh with me.” – WCI COO, Pete La Raus

 “Being #LikeaMothertoMe can be to your neighbor’s kids, to your best friend’s babies, to the foster kiddos in your church, community, your circle. My momma was always a momma to my friends. To this day, she still feels like home to them!” – Liza Rademacher

A crucial part of our work at Whole Child is celebrating and uplifting the many caregivers who serve as mother figures to the children in their care. Cultivating this type of impactful relationship between a child and a mother figure (or caregiver) is the mission of our organization. Today and every day, we honor those who fill the role of #LikeaMothertoMe.


Senior Policy Director Gary Newton Delivers Commencement Address

On July 28, 2018, Whole Child International Senior Policy Director, Gary Newton, gave the commencement address at the University of Notre Dame’s Eck Institute for Global Health. Graduates received a Master of Science in Global Health. Gary and Dr. Bernard Nahlen, the Institute director, are long time colleagues in the field of international development.

Gary used his speech to shift the focus of graduates who have been mainly immersed in the world of preventable childhood disease to the world of preventable childhood adversity. He used two recent high profile cases of childhood adversity – children lost in a cave in Thailand and children separated from parents at the US-Mexico border – as an entrée into the world of vulnerable children globally. To underscore the point that adversity in early childhood should be a core global health concern, Gary talked about the serious long-term health consequences of toxic stress that children can suffer from separation, neglect and abuse. While we are the cause of toxic stress, Gary said, we are also the prevention and cure — stable, nurturing, responsive caregiving is the antidote to toxic stress. He mentioned that this is what Whole Child International specializes in, attachment-based, relationship-centered care.

Gary concluded by saying:

“For you all on the cusp of great careers in global health, I hope and pray that you use your leadership, wisdom and wherewithal to:

Respond to the humanitarian emergency of children suffering from preventable disease and preventable violence, abuse and neglect.

Protect vulnerable children from collateral damage caused by bad public policy, political indifference and adults behaving badly.

And, enable vulnerable children to enjoy the health, rights and opportunities they are due — and which they require — to thrive and contribute a full measure of talent to family, community and nation.”

Congratulations to graduates for their hard work and accomplishments, and to Gary for delivering such an important and timely commencement address.

Photo by Peter Ringenberg/University of Notre Dame


USAID Awards Whole Child International $4.9 Million for Work Improving El Salvador Childcare System

Whole Child International announces the receipt of a $4.9 million award from USAID to support its program in El Salvador.

The program, known as the Protection & Quality of Care for Children Project, is a five-year collaboration with the government of El Salvador and other partners that will bring high quality, relationship-centered care to an estimated 20,000 children in 252 childcare centers and 54 residential care centers. Efforts will focus on building government ministries’ capacity to manage child protection systems and promote child development through socio-emotional development of vulnerable children. By creating caregiving environments that enable stable, nurturing relationships for every child, regardless of the setting in which they are raised, developmental outcomes will improve.

Whole Child will be responsible for contributing $2.5 million in matching funds over this five-year funding period. The total of $7.4 million will allow full program implementation across the nation and its system of care. With its focus on quality caregiving, the program will train and support multiple levels of stakeholders, from leaders of Salvadoran government ministries, to administrators of centers, to caregiver supervisors, to the caregivers who work with the children every day. Another focus of this project will be assessing deinstitutionalization efforts to date and supporting government efforts to pilot innovative approaches to increase the number of children in family-based care.

Whole Child’s partners at Duke University will evaluate the Protection & Quality of Care for Children Project.


Whole Child & Salvadoran Government Leaders Tour Salvadoran Childcare Centers

Last week, members of the executive team of Whole Child in Los Angeles visited our El Salvador mission. Karen Spencer, founder and CEO, Pete La Raus, COO, and Nadia Ammar, Director of Individual Giving, worked with the El Salvador team and our partners on program implementation and our plans for moving forward.

The delegation visited two childcare centers and three residential child protection centers which are all part of the child protection system overseen by ISNA, the Salvadoran government’s child protection ministry. ISNA’s Executive Director, Elda Tobar Ortiza, accompanied them during the visit along with the deputy directors for the protection and promotion of children’s rights. The team visited Centro de Desarrollo Integral San Rafael (San Rafael Center for Integrated Development); Centro de Bienestar Infantil Santa Anita (Santa Anita Center for infant well-being); Hogar del Niño San Vicente de Paul (Children’s Home San Vicente), Hogar de la Niña Santa Luisa de Marillac (Santa Luisa de Marillac girl’s home); and Hogar Dr. Fray de Jesús Moraga (Dr. Fray de Jesus Moraga home).

During the visit, the representatives from ISNA and Whole Child discussed at length how to continue to improve early childhood care and development (ECCD) as well as how to take the next steps together, affirming the need to continue to improve quality of care and that the care is relevant and appropriate in a variety of different environments and contexts. The Whole Child team also held multiple internal meetings to ensure that we continue to innovate and stay on the cutting edge of childcare and best practices, both in El Salvador and beyond.

Pictured (l-r): Ma de la Paz Yánez (ISNA), Pete La Raus, Nadia Ammar, Karen Spencer, and Sonia Silva (Whole Child), and Elda Tobar (ISNA).


A Royal Visit to Buckingham Palace

Earlier this month, Karen had the honor and privilege of being invited to Buckingham Palace by Her Majesty The Queen to attend the Commonwealth Diaspora Reception. This reception recognized individuals who have made a positive contribution to business, community, and culture. Karen was recognized for her commitment and influence in working to improve the quality of childcare for the world’s most vulnerable children.

This 65-year tradition is an important and symbolic event that unifies influential individuals from nearly every geographical region, religion and culture. The Commonwealth organization embraces diversity among its “52 countries and almost 2.5 billion people.”

Throughout the evening, Karen met dignitaries and leaders from around the world, and was honored to share a moment with the Queen.


Investment in Early Education is Essential for Peace

January 16th marked the 26th anniversary of the Chapultepec Peace Accords, which ended a 12-year civil war in El Salvador. Though the Peace Accords are unique to El Salvador, the scope and implications of the agreement to create lasting peace start with investing in our children’s future.

Nearly 26 years after the signing of the peace accords, El Salvador is one of many countries that still faces profound challenges related to violence and child development. Studies have shown that programs that aim to teach youth how to develop the life skills needed to succeed in the labor market keep children off the streets and, as a result, makes them less susceptible to the influence of gangs. Our intervention in child care facilities strives to combat this ongoing issue by providing vulnerable children with the internal resources needed to become educated, productive members of society.

Whole Child’s support of the Salvadoran government’s limited-resource early education (ECE) centers is just one of our major investments in children’s future, but there is still considerable work to be done. Studies show that high-quality ECE is not only important for children’s healthy development, but it has significant economic and social payoffs. Together, by investing in early childhood education, we can build a more peaceful and prosperous future.


Whole Child & Shift Design: A Dynamic Nonprofit Duo

A primary goal of Whole Child’s new five-year strategy is to replicate our relationship-centered care model in new care settings and new countries. To help do this, we have partnered with a UK-based group called Shift Design. Shift is an award-winning not-for-profit social design agency that supports the creation and improvement of products and services that have positive social impact. For the past several months our El Salvador team has been working with a team from Shift to develop tools and a framework to scale-up our approach to care-giving, from impacting policy on a governmental scale to working directly with caregivers.

The support from Shift is one of our initiatives to grow carefully and systematically as an organization. As we expand, Shift will offer its guidance on how we can support our global partners even more effectively. We relish taking this deep dive into the details of our program processes and working with this award-winning charity to continue to improve the quality of care for vulnerable children.

Pictured: Whole Child and Shift staff explore the context of Whole Child’s training materials.


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