Notes from the Field
Today our founder Karen Spencer sent the following message to all of Whole Child’s partners, supporters, and other friends to recognize a pretty wonderful milestone:
To all our friends and supporters,
I founded Whole Child International on this day 15 years ago with the goal of bringing love and connection to vulnerable children everywhere. As I look back on all these years, I think of the children whose lives Whole Child has impacted and also about the many people who have made it all possible.
Speaking on behalf of our whole team, we are forever in the debt of so many people. I am thinking especially of our champions within development banks and those within government ministries, of our fellow foreign aid partners, and of so many champions in foundations who have worked to bring funds and support to us over the years. And last but not least, we are truly indebted to those many individuals who have chosen to provide us with the funds and other support we’ve needed, often digging deep into their own pockets so that Whole Child could carry on, grow, and aspire to reach more children in more countries around the world.
To all of you who have made our work possible over these last 15 years, thank you.
What better way to spend our 15th anniversary than with our growing team!
Again, thank you for your support, and for celebrating this milestone with us!
Last week, Whole Child’s program and evaluation teams and our partners at Duke University rolled up our sleeves for a five-day working session on WCI-QCUALS, our tool for measuring quality of care in limited-resource childcare centers. The team spent the week pulling apart the elements of the tool and analyzing each of them for user-friendliness. User-friendless is especially important for something designed to be used by highly burdened staff and supervisors of early childcare and development and residential childcare centers in some of the world’s most resource-deprived places.
Since our founding nearly 15 years ago, Whole Child has believed passionately that one of the key obstacles to the improvement of quality of childcare is how to measure it. We are concerned that as interest in improving quality of care continues to grow, the focus in investment will remain on buildings and materials — when science tells us the most important factor for children’s emotional well-being is the quality of the relationships in their lives. From the beginning, this factor proved difficult to measure, but we were faced with another crucial challenge as well: the predominance of tools designed for care centers in developed nations to measure centers in under-developed countries.
(Factors that might “fail” a center in the United States, such as a dirt floor or unreliable electricity, are far less important in a neighborhood where these things are commonplace. It is important to focus on things like the caregiver’s ability to connect with a child while changing her diaper — which is of primary importance no matter where you are.)
In 2012, we started working with the Center for Health Policy and Inequalities Research (CHPIR) at Duke University’s Global Health Institute, which shared our passion for measurement and the importance of relationship in children’s long-term well-being. We worked together to fine-tune the tool and turn it into a smartphone/tablet app. Together, in 2014, we piloted use of the tool on a nationwide scale, measuring 213 centers in the “National Evaluation of Quality of Childcare in El Salvador” as part of our project partially funded by the Inter-American Development Bank, “Improving the Quality of Care in Early Childhood.”
Last week’s arrival in San Salvador marked the beginning of the second phase of our development of the tool, which we look forward to using as a key measurement tool in our USAID project. It is designed for use in a variety of settings, including early child care and development (ECCD) centers, residential care centers, centers for previously trafficked children, and many more. When completed, there will be multiple versions, including one that centers can use for self-assessment, and one for governments to monitor centers they operate and supervise. Crucially, we have always intended to make the tool free to use, as the cost of measurement tools is very often a prohibitive factor in situations where they are most important.
We were deeply grateful to have our faithful friends at Duke working alongside our own team — led by CHPIR Director Kate Whetten, Research Associate Hy Huynh, and Research Analyst Andrew Weinhold. The team brings invaluable experience assessing quality of care through their numerous NIH-funded studies.
Pictured: (Top) Whole Child and Duke staff working together on QCUALS. (Bottom) Longtime collaborators Kate Whetten and Karen Spencer, respectively Director, Center for Health Policy and Inequalities Research, Duke University; Whole Child Founder & CEO.
Last month, the Whole Child International El Salvador program staff met with around 200 members of the country’s 14 Departmental Shared Care Networks, or RAC for its acronym in Spanish, to begin the process of collaboration on our USAID Project’s various elements. The RAC is coordinated by the Salvadoran Institute for the Comprehensive Care for Children and Adolescents (ISNA), one of our key government partners.
Our team led a series of presentations and workshops illustrating how the Project will work, sharing all three components of the project and how the members of the RAC are integrated into these actions. Our presentation met with enthusiasm among these partners, many of whom worked with us from the beginning to develop the program.
The delegations identified significant areas where our project reinforces other national-level work of another key partner, the National Council for Children and Adolescents (CONNA), the government institution guarantor of child protection through the development and oversight of child policy and regulations, in particular on matters of positive parenting with pregnant adolescents and adolescent mothers.
This meeting was an important initial dialogue that will ensure we have the access we need across the system of care, and engage all the stakeholders we need to get the job done.
Outreach Visits to Private Residential Care Centers
The project presentation meetings laid the groundwork for a series of visits to private residential care centers now informed about the project and its scope. Certain components of our project in particular meet ongoing needs the residential centers have identified, such as monitoring of children reunited into families and other forms of support, and these shared goals have encouraged these private centers to become active partners in the project.
These information sharing visits are a crucial opportunity for our team to get to know more closely the challenges of the centers and benefit from the experience and perspectives of the personnel on the front lines.
We’re moving forward on multiple fronts in our project in El Salvador. One goal we have been able to realize is the seconding of two staff members from ISNA, the Salvadoran government’s Institute for the Comprehensive Development of Children and Adolescents. These two members, Lorena Santos and Hazzel Romero, will spend two years in our office in San Salvador, where our staff of 19 can learn from them and vice-versa.
Lorena and Hazzel are technical specialists in child protection and limited-resource childcare, respectively. They will be accompanying the technical teams of early childhood care centers and protection centers in the processes of training and strengthening their skills and abilities (mentoring) related to guaranteeing quality care practices in different environments. They are also playing an important role in mapping out the child protection system in the research phase of the project.
Our project is specifically about creating capacity in the Salvadoran government to implement best practices and policies in childcare, across its system of care from residential centers to childcare centers to foster and other alternative care. So, there’s nothing more effective than working as closely as possible with the permanent staff who will be guiding and implementing these practices and policies long after Whole Child has completed its work and gone to other countries of need.
Hazzel & Lorena meet with CEO & Founder Karen Spencer, January 2019
This is the fifth of a five-post blog series. Part 1 introduced our USAID-funded “Protection and Quality of Care for Children Project” and Part 2, Part 3, and Part 4 described its three principal components. This post will serve to put it all into a wider context.
While the Protection and Quality of Care for Children Project was not timed or designed to respond directly to the ongoing migration crisis that became BREAKING NEWS in mid-2018 with the separations of children from their parents, the project’s focus on child protection, quality caregiving, and early childhood development does help ameliorate root causes of the crisis — violence and poverty — and it helps respond to consequences of the crisis — child separation and family dislocation.
For example, as described in the previous posts, the project will use an evidence-based approach to prevent children from becoming victims of violence — or perpetrators of it — by strengthening:
- the child protection and social service workforce;
- case management, so more children are placed in safer care settings;
- the system for monitoring children’s well-being;
- the care system’s capacity to respond to reported cases of violence, abuse, and neglect; and
- the capacity of caregivers and parents to practice positive parenting and relationship-centered care that builds children’s socio-emotional health and resilience.
The project will generate policy and technical recommendations based on concrete experiences of children and youth within El Salvador’s child protection system and incorporating proven best practices in other countries and institutional settings.
This system and capacity strengthening will also help the government continue and improve its efforts to reunify, and support migrant children and youth returning to El Salvador due to deportation or the dangers and difficulties of migration.
The project will also help prevent family breakdown by expanding access to quality early childhood education and daycare that enables vulnerable families, including women-headed households, to earn income and break the cycle of poverty that drives irregular migration.
For the next five years, we’ll be talking about this program in these pages. We hope you’ll keep reading as we conduct this program, assess its impact, and hopefully demonstrate the potential of these ideas for making a real, lasting, and meaningful impact on the lives of some of the world’s most vulnerable children — benefits that reach across Salvadoran society and indeed help ensure a more peaceful and secure American continent for us all.
This is the fourth of a five-post blog series introducing our USAID-funded “Protection and Quality of Care for Children Project” and its three principal components, and putting it all into a wider context. (Jump back to Part 1, Part 2, or Part 3.)
The Project’s third component focuses on supporting the ongoing transition from residential to family care for vulnerable children in El Salvador.
The number of children in residential care decreased from 6,000 in 2009 to an estimated 1,500 in 2017. In 2017, for instance, 250 institutionalized children were reintegrated with families. Much good work has been done to date on the care transition, but challenges remain. To help the government address these challenges and achieve a lasting re-orientation of the residential care sector toward family and community-based care, our Project will:
- promote and develop the desire for change within the residential care sector.
- support the development of the legal and policy reform necessary to permit residential care institutions to take on social casework such as family reunification, reintegration, and preservation; and coordinate with judges, local child rights boards and social service staff in the transition process.
- demonstrate how existing residential care professionals can be re-trained and re-deployed to do case management, supervision, training in parenting, and family support;
- pilot foster and kinship care approaches modeled on prior work done by NGOs and others;
- strengthen the system to monitor the well-being and safety of children placed in family-based care.
These activities will be informed by the assessment of the government’s de-institutionalization program that we will conduct under the first component of the project.
That’s the “Protection and Quality of Care for Children Project” in a nutshell! Please stay tuned for Part 5 of this series, which will explain the connection between the project and the humanitarian crisis on the U.S.-Mexico border. (Jump to Part 4 — “The Connection between Our Project and the Border Crisis.”)
This is the third of a five-post blog series introducing our USAID-funded “Protection and Quality of Care for Children Project” exploring its three principal components, and putting it all into a wider context. (Jump back to Part 1 here and Part 2 here.)
The second component of the project focuses on building the capacity of ISNA, the Salvadoran government’s ministry of child services, and its training school to plan, deliver, and sustain a comprehensive national training and mentoring program which will help improve the quality of care and developmental outcomes among El Salvador’s most vulnerable children.
Training and mentoring focus on the range of people involved in planning and delivering quality care: the caregivers themselves, their mentor-supervisors, technical leaders, academics, policymakers, members of the judiciary involved in child welfare and protection, and, of course, parents.
Training content focuses on key topics related to best policy and practice in child development, childcare, and child protection including the neuroscience of early child development and the buffering effect of nurturing care relationships that create resilience to the toxic stress of an environment of extreme violence. The mentoring component involves one-on-one follow-up on the results of our assessments of residential care centers and support for early childhood caregivers in the early childhood care and development (ECCD) centers. It is a key step towards improvement of care after the initial assessments are carried out in Part 1.
Five best practices for quality childcare in limited-resource settings are at the core of all training and mentoring:
- Responsive relationship-centered caregiving.
- Continuous primary care.
- Small groups.
- Freedom of movement; and
- Individuality and identity.
Prior work by Whole Child and partners in El Salvador demonstrated that a key challenge to improving care quality is to effectively improve communication between supervisors and caregivers. Therefore, training of supervisors and directors will include a substantial focus on best practice in mentoring — developing capacity to support behavior change in respectful and productive ways which helps ensure best care practices are maintained.
The training program will not only increase the use of best caregiving practices, but it will strengthen the critical mass of practitioners and policymakers equipped to champion national care reform more broadly by, for example, strengthening the social service workforce, carefully moving children from institutional care to family-based care, and strengthening systems to monitor their care in families — which will be the subject of our next blog post.
The next post will explore the third component of this project, “Family-Based Care Practices” — a series of interventions that will help residential care centers expand their social services and train care center staff to provide desperately needed case management in a country that has far too few social workers to respond to its citizens’ child protection needs. (Jump to Part 4 — “Family-Based Care Practices.”)
Whole Child International invited Dr. Ricardo Santamaria, a graduate of our first university certificate course on childcare management, to teach the class on basic health concepts in childcare for our second course on best childcare practices at the University of Central America.
As the Metropolitan District Director of the El Salvador Ministry of Health, Dr. Santamaria perfectly represents the key objective of our training programs — to equip and prepare major stakeholders in developing countries to convey a comprehensive set of best practices in childcare and protection to a much wider population.
The graduates of the second course will now go on to implement what they learned in childcare centers and orphanages across the nation and will support caregivers in their efforts to provide more stable, nurturing high-quality caregiving relationships for more than 10,000 of the country’s most vulnerable children.
This past week, Whole Child’s Program Director Meghan López addressed Zero to Three’s 30th-annual National Training Institute, “Reaching a Milestone: Connecting Science, Policy and Practice.”
In her talk, “Quality Care in Limited-Resource Settings: Focus on People, Not Places,” Meghan shared Whole Child’s strategy of dedicating resources with a rigorous emphasis on the caregiver-child relationship, which has proven to be an effective and cost-effective approach to quality care. The presentation gave an overview of how we have made best practices accessible and applicable to all settings and all staff and highlighted that it is not where care is received, but how it is provided. Meghan also led participants through an activity of washing each other’s hands, demonstrating how important interactions are during daily care routines. The Seattle event’s program brought together experts from child welfare, parent education, and pediatrics to explore the latest strategies for caring for infants and toddlers.
As our work in El Salvador gains national attention, La Mejor FM‘s national radio show “Habla Conmigo” (“Talk with Me”) invited Program Director Meghan López on the air to provide parents and caregivers guidance for helping children develop positive self-esteem.
Meghan explained to listeners that for children to feel secure they need to feel loved for who they are, not for what they can do. She offered positive reorientation as a substitute for such counter-productive means as yelling, hitting, or insults.
She concluded with practical tips for guiding children. Her advice included setting limits without using the word “no,” allowing consequences to happen naturally, and assuring open communication. Her interview is available online (part 1) (part 2), and is part of La Mejor FM’s series called “Supporting Positive Attitudes for Children Ages Seven to Twelve.” El Salvador’s National Council for Children and Adolescents sponsors the radio program to promote healthy caregiving practices.
Parents and childcare providers are often inundated with new techniques to motivate infants to sit, crawl, and walk more quickly. But as part of our university certificate course in El Salvador, we asked “What’s the rush?”
Last week we devoted a class to freedom of movement — the practice of allowing babies and children to develop at their own pace with the opportunity to move their bodies as they are able to do independently, without being pushed to the next stage of movement or placed in positions they have not learned on their own. Katharina Becker, Founder of Casa Emmi Pikler in Ecuador, taught the class, and guided participants to reflect about benefits for children, such as strengthening developing muscles naturally and increasing confidence and autonomy.
Many very common practices, such as leaving babies in infant seats, swings, or strollers, actually restrict them and their freedom to explore their bodies and new-found abilities. In group care, such restraints are often used for extended periods of time, significantly limiting opportunities to develop, communicate, and learn — potentially causing delays in development. Instead of a child being in a bouncy seat, imagine them on the floor — free to play, to follow their own interests, and above all to move. Freedom of movement helps children in every developmental domain.
The government officials and program directors in our course at the University of Central America appreciated exploring this practice as a way to help babies and children play, explore and, develop – inspiring them and helping give them the tools to to put this into practice nationwide in all of the childcare centers and orphanages across El Salvador.
Whole Child International is delighted to introduce you to the new staff members who have joined our team in El Salvador this year. Please visit our
Staff page and learn more about their valuable contributions to our team:
- Vilma Gaitan, Operations and Procurement Supervisor
- Dina Cáceres, Research Coordinator
- Pedro Amaya, Logistics Coordinator
- Alejandra Acevedo, Technical Coordinator
- Magdalena Rodas, Accountant
- Marina Del Carmen Sanabria, Research Assistant
One of our veteran staff members, Tamara Bayres Mosher, has taken on a new role as Technical Supervisor. Together with our Program Director, Meghan López, and our Academic Supervisor, Gabriela Serrano, our team is well prepared to carry out an unprecedented national evaluation, provide five levels of training, and take on our ambitious effort to help improve the quality of childcare across El Salvador. We are honored to have each of them on our team.
In El Salvador we are scaling up our national evaluation to reach the second group of government childcare centers and orphanages. We began with an initial trial set of centers known as “Group F” in May, which gave us the opportunity to fine-tune our research protocols, test our evaluation model, and validate the electronic version of our evaluation tool, WCI-QCUALS.
The research model for Phase 2 is vast – in addition to using WCI-QCUALS, which assesses 10 areas key to assuring quality care, we are using a series of other tools, including the Battelle Development Index and the Child Measurement Survey to assess all aspects of child development, detect disabilities, and measure the well-being of the caregivers. Our research now also includes a home-based survey to look at the well-being of the families of children in participating childcare centers; assess for domestic violence, abuse, or other issues; and gain an understanding of beliefs about childcare, while also collecting valuable demographic information. To support our expanded research efforts, our partners at Duke University, Andrew Weinhold and Morgan Barlow, traveled to San Salvador help supervise data collection and reporting. We will ultimately evaluate a total of 210 government childcare centers and orphanages nationwide in a longitudinal study which will collect data and guide our program for four full years.
El Salvador University Course at UCA: Leading Pediatric Neurologist Illuminates the Importance of the First Five Years
Our university course continues at El Salvador’s University of Central America. This week, the Salvadoran officials, childcare directors, and childcare supervisors attending the course heard from Dr. Antonio Rizzoli, a leading pediatric neurologist from Mexico. With his clear passion for helping governments, communities, and caregivers understand and support healthy brain development, he described in detail how crucial the first five years of a child’s life are — a time in which the brain structure is formed and greatly impacts the rest of the child’s life. In his opinion, the greatest challenge is being able to plan effective ways to support children from the very beginning, especially the first two years when 85% of the brain develops.
Dr. Rizzoli passionately advocated for assuring that technology doesn’t invade our need for human interactions, described the urgency and responsibility we all have in supporting child development, and spoke to the need for children to receive the best care possible as early as possible. He highlighted the consequences of not supporting healthy attachment and meeting children’s emotional needs during the first five years, and outlined major social problems later in life that affect not only the individual, but also the entire society.
His insights were highly motivating, especially for our participants who are responsible for early childhood education and child protection on a national level, and whose decisions affect the lives of thousands of children each year.
Together with the University of Central America, our team is now launching the second phase of our training program in El Salvador. The second phase is a university certificate course designed to provide the “how-to” for elevating and monitoring the quality of care provided to thousands of the country’s most vulnerable children. The course, “Best Childcare Practices: Developing the Whole Child in Limited-Resource Settings,” emphasizes practical techniques for implementing quality childcare.
This course is aimed at supporting authorities and field staff from the Salvadoran government’s Institute for Children and Adolescents (ISNA). These are the key officials who design, implement, and oversee national early-childhood programming and supervise 210 childcare centers and orphanages. Together they are responsible for day-to-day care during one of the most vulnerable stages of children’s lives. Their programs will help determine whether this generation of Salvadorans will have the opportunity to develop to its full potential, or not.
Our 65 course participants play a vital role in developing, managing, and implementing childcare center policies that affect thousands of children’s lives each day. From how children acquire language skills to their emotional well-being, the care their centers provide directly impacts every aspect of child development. Look for more posts on how the graduates of the first-phase university course, as “Agents of Change,” will support the participants in our second training program.
Government Officials Complete El Salvador’s First-Ever University Certificate Course in Childcare Management
Whole Child is especially proud to announce that after five months of learning about best childcare practices and sharing their experiences and perspectives, 72 government officials from 10 different institutions graduated from the first university certificate course in childcare management in El Salvador, which we provided through the University of Central America.
It’s important to recognize the commitment of the El Salvadoran government which facilitated high-level officials from 10 different institutions to spend one day a week for five months offsite, attending this unprecedented university course. We also thank the Inter-American Development Bank (IDB), the Korean Poverty Reduction Fund, and the Technical Secretariat of the Presidency of El Salvador for making the course possible.
Participants received their diplomas in the presence of Korean Ambassador to El Salvador Mr. Kim Byong-seop; Ms. María Deni Sánchez of the IDB; Ms. Elda Tobar, Director of El Salvador’s Institute for Integral Development for Children and Adolescents (ISNA); and other representatives of the government of El Salvador.
“Good coaching creates new ideas for addressing problems and enhances creativity—it inspires the mind and encourages the heart” –
As an organization focused on training and organizational change on multiple levels, one of Whole Child’s most important tools is professional coaching. This unique focus is an empowering means for helping all program recipients, from policy-makers to direct caregivers, learn how to improve childcare and meet vulnerable children’s social and emotional needs — by proactively supporting problem solving at all levels as a first step in effective collaboration.
In El Salvador, as part of our university course for government officials who are key decision-makers in early childhood, Whole Child’s board member and coaching expert John Schuster taught this week’s course, sharing a range of techniques in both coaching and interpersonal communication.
Throughout the course, while also updating knowledge on early childhood development, we strive to help bridge the gap between current ingrained practices that cause harm and delay children’s development with the practices that support children’s physical, cognitive, linguistic and social emotional development. By helping government officials gain coaching skills we are helping them be catalysts of change to improve childcare policies, practices, and programs and we assure that decision-makers have effective tools to empower their staff to make radical changes.
Just as the current training program is empowering government-level decision-makers, the next level of training will serve to empower childcare center and orphanage directors to promote changes among caregivers. This approach is key for Whole Child as we strive to maximize impact and keep costs down ensuring that the greatest impact gets to our beneficiaries. To accomplish this, John shared these inspiring words of Robert F. Kennedy:
“Few will have the greatness to bend history itself; but each of us can work to change a small portion of events. […] It is from numberless diverse acts of courage and belief that human history is shaped.”
How can policymakers and early-childhood programs measure childcare effectively given the budget, time, and data constraints that most governments and childcare facilities face? It is a tricky challenge for most countries. This week Whole Child International is joined by our partner and colleague, Dr. Kate Whetten, in El Salvador to share her insights on how to implement practical and cost-effective evaluation methodologies in our university certificate program on childcare management. As this program’s participants continue to develop skills to be agents of change for quality childcare, they have had the opportunity to explore firsthand how the quality of childcare can be measured and quantified for ongoing improvements and maintaining positive changes. In addition, the national early childhood and child protection officials in attendance took full advantage of her policy experience in less wealthy countries, asking a range of critical questions. One participant reflected with the group saying “What should the result of this course be? To influence the national policies in early childhood, which is a priority for the government. However we have many institutions represented here and seeing results in national policies will be proof of what we have learned and done.”
As always, it is an honor to work with Kate who is part of one of the more groundbreaking studies in our field, Positive Outcome for Orphans, which provided new insights on optimal and feasible care settings for orphans and abandoned children. As Director of the Center for Health Policy & Inequalities Research (CHPIR) of Duke University‘s Global Health Institute she also leads research on a number of cutting-edge public-health policy challenges. Her knowledge and experience have deeply informed the groundbreaking national study that we are currently implementing with the government of El Salvador and Duke University on the quality of childcare, and they should be a continual inspiration for our program participants and the evaluating team she is helping supervise.
How are vulnerable children cared for? This is one of the questions Whole Child is exploring in El Salvador as part of our national study on the current quality of childcare. To help us address this question and learn more about the cultural aspects of childcare, we hired a team of four local ethnographers to do a qualitative analysis. Marta, Grazzia, Jacqueline, and Yessenia, all with backgrounds in anthropology, are gathering information to better understand the social and cultural aspects of care in the communities where we are working. By observing the care routines (bathing, feeding, changing, etc.) and interviewing caregivers, they are discovering how both caregivers and children feel about the care being provided. They will also study the relationships between the childcare centers and orphanages and their local communities. The University of Pittsburgh’s Tomas Matza is leading the team for this activity and is overseeing their fieldwork. Their study will shed light on the values and practices surrounding childcare by asking questions such as “What do children need from adults to support their full development?” In the first phase of their work, from May through July, the team will study eight centers. We will keep you posted on their progress!
The qualitative information they gather will complement quantitative data collected and insights learned from a series of evaluation tools. One of the tools we will use is WCI-QCUALS, which is the tool Whole Child International developed to assess the following 10 domains in low resource settings: Administration; Environment; Group Size; Continuity of Care; Primary Care Giving; Freedom of Movement; Interactions between Caregiver and Children; Attachment to Caregivers; Nutrition, Safety and Hygiene; and Security. The national study will be the first of its kind in Latin America and will help guide future childcare programming and policies in El Salvador for years to come.
One of our most inspiring activities outside of orphanages and childcare centers is working with government officials to improve national policies and programs. Our program includes a university certificate course tailored for the government to explore evidence-based best practices for management from the perspective of their needs and roles in childcare and protection. During the course we learn from the government stakeholders’ experiences and provide them with guidance on how to keep the child’s best interests and their development at the heart of all decisions and policies made. Considering the complexities of legal systems, family dynamics, and ingrained practices, it’s not a simple task. It is, however, vital for children’s mental health and emotional stability.
As part of our nationwide project in El Salvador and outreach efforts in Ecuador, more than 75 government officials from both countries are participating in our current university certificate course, which is in its fourth month. We have seen judges for the first time in their career reflect about how to consider a child’s attachment to his caregiver in the decisions made regarding his care. The key child-development concept of attachment had never before been part of their vocabulary. Likewise, a Ministry of Health representative for the metropolitan region of San Salvador, Dr. Ricardo Santamarí, noted that learning about “neuroscience, attachment, and child-centered administrative practices not only stimulated my mind, but touched my heart.”
We have seen the participants’ criteria for decision-making and program design evolve and change throughout the course. The difference is knowledge — of child development, harm reduction, and a right’s-based approach, among other essential topics that they walk away with for the rest of their careers. Our government partners are key to our program’s success as they make life-changing decisions and manage programs that affect thousands of children’s lives.
Whole Child International was invited to share information on measuring the quality of childcare with U.S. and Russian experts who work with vulnerable children in a webinar funded by the U.S. Embassy to Russia as part of the US-Russia Peer-to-Peer Dialogue Program. Stellit, the Russian NGO that hosted the event, provided a space for exchanging information around best practices in childcare and measuring the well-being of children who are orphaned and/or separated from their parents. It gave us the opportunity to share how our tool, WCI-QCUALS (Whole Child International Quality Childcare Universal Assessment for Limited-Resource settings) measures care settings, and how we use its results to improve quality of care.
Our Program Director Meghan Lopez presented via web conference from El Salvador, explaining our integral approach for assessing quality in limited-resource settings, including orphanages. Officials in Moscow and St. Petersburg listened with simultaneous translation. Dr. Karen O’Donnell from our partner Duke University’s Center for Health Policy and Inequalities Research, presented about measurement with small children. Dr. Laura Murray from Johns Hopkins’ Bloomberg School of Public Health spoke about the need to use short, clear measurements. They were joined by Russian speakers who shared their experience working with orphans and vulnerable children and appreciated Whole Child’s experience using measurements to improve care. We look forward to a continued collaboration with these Russian and U.S. colleagues, and are pleased to find new ways to leverage the investment in our work by helping other organizations improve care and measure their progress.
Under her leadership as Director of the Loyola Marymount University Children’s Center (LMUCC), the center achieved accreditation for the second time from the National Association for the Education of Young Children (NAEYC), which fewer than 8% of U.S. childcare centers receive. LMUCC is truly a special place for children. Ani’s experience at the center and her research enabled her to help Whole Child International adapt our high-quality practices to orphanages and other limited-resource settings, and to publish our university course textbook and caregiver training materials. Her research and childcare center experience is now bringing innovative ideas to the university course participants in El Salvador, who found her insights on quality childcare pivotal. With the perspective and knowledge Ani brings to this conversation, they now have the tools to think differently about the role of the spaces and materials that adults prepare in childcare centers and the impact they have on children’s cognitive, physical, and social-emotional development.
As we reported late last year, Whole Child International has established an outreach office in Ecuador, in order to take full advantage of opportunities to establish our program to reach children in tremendous need for our work. This effort is bearing fruit, and we now have two strong local partnerships in place. Over the past month we have been working side-by-side with Fundación Esquel and Fundación Crisfe to develop programs to improve the quality of care that children receive in orphanages. It is an opportunity for Whole Child to grow and build on the results of our more than ten years of experience in Nicaragua and El Salvador, and work toward bringing our full program to Ecuador and benefit thousands of vulnerable children.Both Esquel and Crisfe are helping make this growth possible. Together they have more than 40 years of experience supporting human and social development and vulnerable groups in Ecuador. They have made a significant impact in the lives of Ecuadorians, bringing sustainable human development programs to more than a million people. Working with these two strong partners, we have the opportunity to share key government relationships and comprehensive operations and management infrastructures that will allow us to hit the ground running and begin working with orphanage personnel and government authorities as soon as possible.
Fundación Esquel has a rigorous and certified monitoring and evaluation program to complement the tools we have developed, such as the WCI-QCUALS measurement tool, to evaluate limited-resource childcare centers and systems of care. Their mission is to contribute to sustainable human development and improve the quality of life for Ecuadorians. Fundación Crisfe works to support vulnerable individuals and communities in their efforts to access education and improve their quality of life. Their deep knowledge and extensive experience working throughout Ecuador has helped open many windows of opportunity for us to bring our support to a new country of need. We look forward to collaborating with them for years to come.
As part of our project in El Salvador, Whole Child International has begun an unprecedented national study on the quality of childcare in the 210 government childcare centers and orphanages with which we are now working.
To get started, we and our partners at Duke University and the University of Central America have randomly divided these centers into six groups and have evaluated the first group, known now as “Group F.” Our observation of Group F is revealing profound insights not only about the day-to-day life in the centers, but also about their staff’s dedication and ongoing needs, and also about the challenges they face in running the center and managing community dynamics.
The evaluation model, which has been designed and endorsed by all our university partners, began in March 2015 with an informative meeting with caregivers and parents to explain the evaluation and request consent. Our evaluators then visited each center to apply a series of evaluation tools (WCI-QCUALS, the Early Childhood Environment Rating Scale (ECERS), and Battelle. We completed the evaluations in May and have sent the results to our Duke University colleagues to be analyzed prior to sharing with the Salvadoran government officials. In addition to learning about the quality of care in each center, we also learned more about the scope of each tool and how it evaluates quality comparatively.
For the first time, this experience has given us the opportunity to further validate the WCI-QCUALS, which is designed to evaluate limited-resource settings, as well as compare with ECERS, a tool frequently used in the United States. Having this comparison will help us continue to standardize WCI-QCUALS for its use by many kinds of organizations in similar settings around the world.
“If I miss the moment when the child is ready,
then they turn away and the relationship ceases to exist.”
That quotation is one of the moving insights shared by Anna Tardos and Agnes Szantos during the Advanced Pikler Training in San Francisco late last month, which three of our team members had the honor of attending. Meghan, Tamara, and Leah’s lives have been forever touched by this profound experience with Anna and Agnes – both of whom have spent their lives helping caregivers discover how to build a trusting relationship with young children. Our team was moved by their testimonies on how the Pikler Institute in Budapest, Hungary, has been able to provide stable, nurturing care for orphans and prepare caregivers. The Pikler Institute shows all of us who provide childcare in limited-resource settings that an institution is capable of providing quality care for children.
Since 1946 the Pikler Institute’s research and evidence has demonstrated that building relationships starts with being patient during caregiving, truly present during interactions, and interested in getting to know the children and their interests and abilities.
At the memorable training sessions, Anna and Agnes shared personal stories about how children have thrived as a result of being allowed to play and move freely, take as much time as they need during daily routines, and trust their caretakers, among other key elements of Pikler childcare practice. They shared the only interview questions that the Pikler Institute uses to hire caregivers: “Do you enjoy playing?” and “Did you have a happy childhood?” Abiding by these simple questions has consistently produced caregivers who find joy in providing the high-quality childcare that institutionalized children need.
Twenty members of the Whole Child team have attended Pikler training sessions, deeply informing our practices and principles. The most recent training event came at an important time in our El Salvador project, as we and the Salvadoran government work together to evaluate the current state of childcare across the country, and engage our university course participants in creating the systemic changes that will be necessary to improve the overall quality of care across El Salvador’s childcare centers and orphanages.
Pikler/Lóczy Fund USA hosted the training and invited our founder and CEO, Karen Spencer, to speak as a guest of honor. Karen shared stories and insights about our program development and our current work in El Salvador, and spoke of how she became inspired by the Pikler Institute’s work when her daughter was three months old — and how this led her to found Whole Child International.
Three years after the end of our funded program with the Inter-American Development Bank to improve the quality of care in orphanages in Nicaragua (please see one-page overview of results and more about our research and evaluation), our Program Director Meghan Lopez and Program Coordinator Tamara Bayres had an unforgettable follow-up visit with two of the orphanage directors this week. They report back that the impact of our training and technical assistance is vibrantly illustrated and confirmed in the quality of care being provided in each care center.
A few striking examples of the sustained high-quality childcare we observed include:
- One of the most striking aspects they witnessed was the continued efforts caregivers are making to prepare and update documentation journals for each child. Documentation journals are one of the most challenging changes to sustain given the time, thoughtfulness, and effort it takes to maintain them, yet they are an important means for observing and documenting children’s development while providing them a sense of belonging and a reference to affirm their sense of personal identity for the rest of their lives. When Tamara and Meghan arrived at each orphanage, they were delighted to find all the journals were up to date. The books include important information on each child’s milestones (such as first words and steps), personal letters from caregivers, and memories from special moments (such as birthdays).
- It was equally gratifying to see all of our caregiver training materials being used to train new staff and provide ongoing technical assistance to more seasoned staff.
- Perhaps the most rewarding finding of all is that each child continues to be assigned a primary caregiver upon arrival in a care center, and receives personalized care from that caregiver throughout their time in the center. This is critical to the children’s sense of security and one of Whole Child’s primary evidence-based practices for quality care.
- Beyond continued quality caregiving, the infrastructure improvements and materials we provided continue supporting the children and caregivers alike in an important way. They continue to enjoy freedom of movement, and are allowed to climb and explore without being restricted to cribs, small playpens, or other forms of confinement for long hours. They enjoy building castles in the sandboxes as well having quiet time in the soft indoor areas when they need time to relax.
The children are thriving and the caregivers feel supported and valued. Ultimately these children should emerge from this care emotionally ready for the next step in their lives, whether it be a family environment or into the world as stable young adults.
It was a moving visit for Meghan and Tamara, and it is an inspiration for all of us getting our program under way in El Salvador. Seeing the benefits that our work continues to have on the lives of the children years after our project ended validates our approach and shows the potential we have to continue making lasting changes in the lives of orphans and vulnerable children around the world.
In March, Whole Child’s partners from Duke University’s Center for Health Policy & Inequalities Research (CHPIR) traveled great distances into rural El Salvador, four-wheeling through remote areas to visit childcare centers to help us oversee the first national study on the quality of childcare in Latin America. Karen O’Donnell and Amy Hobbie traveled through crowded streets during the peace demonstrations to meet with and supervise our local evaluators who are working in the childcare centers to collect data on children’s development, the quality of childcare being provided, and the well-being of the caregivers.
CHPIR’s Positive Outcomes for Orphans, an important longitudinal research precedent in five low- and middle-income countries, provides the group with invaluable perspectives on how to apply research protocols and data quality standards. Aside from research guidance, CHPIR also gave us a hand with assuring that our evaluator team is consistently using evaluation tools (Battelle Development Index, WCI-QCUALS, and ECERS). (Please see our Research page for examples of what we are measuring at this point on our program.)
Even more exciting for Whole Child International, they helped fine-tune our brand-new electronic version of WCI-QCUALS, the tool we developed to assess the quality of childcare in limited-resource childcare settings. Furthermore they helped us design our research and implementation in such a way to measure the individual impact of each activity under our program. As a result we hope to soon have new evidence-based insight into what are the most cost-effective activities for improving the quality of childcare, which will help us maximize our impact as we take our program to scale around the world.
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