The Whole Child Vision

Whole Child International’s mission is to elevate the quality of care for children worldwide. We specialize in relationship-centered care for children – responsive, consistent care that engenders stable attachments and trusting bonds between children and their primary caregivers. We provide training and mentoring and conduct research that supports partners to implement policies and practices that improve quality of care and outcomes for children. 


As part of NBC’s Dateline: On Assignment feature, Cynthia McFadden and Whole Child founder Karen Spencer discuss four ways Whole Child International helps improve the lives of children who live in orphanages.

The Problem

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 social-emotional needs are often not met, resulting in developmental delays and long-term negative 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.

A Knowledge Vacuum

Caregivers who work in childcare centers for vulnerable children tend to work in a knowledge vacuum caused by their marginalization in the bottom professional echelon. Thus insulated from scientific developments, and coupled with intense need in the population they serve, caregivers and their administrators adhere to outdated “factory-line” methods for providing care which emphasize efficiency and cleanliness. The results are predictably bleak.

A Need for Our Work across Care Settings

These problems are not limited to orphanages — even children in childcare who live with parents who work long hours have been seen to exhibit disorders stemming from a lack of nurturing, stable caregiving relationships.  Whole Child believes that whether a child lives in a family environment or remains in an institution, they must receive care that meets their basic emotional needs, and we also know that regardless of the setting of care, the societal costs of withholding quality care while in the current situation vastly outweigh the costs of our program.

Astonishingly, these problems are relatively easy to correct through the simple methods at right. Whole Child International is one of the only organizations in the world committed to solving these problems regardless of care settings — helping children in multiple forms of limited-resource group care for as long as the children are there.

Case Study: Reinforcing Childcare Principles Through Day-to-Day Routines

In this video, a caregiver from the Managua area describes how Whole Child’s program incorporated the principles above into hands-on training and practical support within the childcare setting.

The Solution

Our program 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.

Our rigorously evaluated program focuses our work on five basic and essential childcare principles.

Five Essential Childcare Principles

  1. Responsive caregiving: Caregivers shift the priority from speed, efficiency, and institutional cleanliness to meeting the developmental and emotional needs of each child under their care. Interaction, communication, and paying special attention to the child’s cues are prioritized.
  2. Continuous primary care: Each child must be able to form an attachment to an adult caregiver, and maintaining this relationship is made a top administrative priority. Primary caregivers are given a special place in the child’s life. On the child’s birthday, when she needs medical attention, or any other key activity normally led by a parent, the primary caregiver takes the lead. Unfortunately, in many cases centers divide up these responsibilities to nurses, social workers, and administrators, wasting a valuable opportunity to build on the core relationship whose strength and quality is central to the child’s well-being.
  3. Small groups: Without increasing existing numbers of caregivers, we reduce group size to best develop and sustain relationships between the children and their caregivers, peers, and environment. Being in a group of 20 children with two caregivers feels entirely different to a child than being in a group of ten with one caregiver. Again, at no extra expense, we can dramatically change the child’s day-to-day experience. and impact the quality of primary caregiving relationships.
  4. Freedom of movement: Caregivers learn to prepare a safe environment that children are encouraged to explore, ending the dominant practice whereby centers and caregivers restrict children’s mobility to maintain order and simplify housekeeping.
  5. Individuality and identity: Children are recognized as individuals and their development of identity is supported through simple, cost-effective changes such as spaces for personal effects and individual birthday parties. Even low-cost options such as a sewn fabric sack tied to the end of a bed where children can store personal belongings can make a big difference to a child’s sense of identity.

The absence of these principles is in large part responsible for the poor outcomes typical for children raised in limited-resource care settings, whether residential or day care. Even with limited resources and within existing facilities, they can be meaningfully implemented by working closely with childcare workers and administrators, connecting care centers’ basic resources, and ensuring the long-term sustainability of these activities. By implementing these principles, Whole Child is working to realize its vision of helping ensure that every child has the chance to become a whole person.