The debate about institutional care versus foster homes is of high importance in order to ensure that the great number of orphaned and abandoned children in need receive the best form of care possible. It is essential for the physical and mental health of children to have a good quality of life. Therefore, research on this subject is crucial, yet it can be challenging due to ethical reasons. Institutions and foster care both consist of risks and benefits of caregiving environments that are worth considering. The Bucharest Early Intervention Project is the first and only randomized control trial of foster care as an alternative to institutional care for young children. American investigators along with Romanian health and child protection professionals came together to thoroughly examine the phenomenon. Research from all over the world has also contributed to this debate.
In the article “Ethical Considerations in International Research Collaboration: The Bucharest Early Intervention Project,” Dr. Vukov and colleagues discuss the ethical issues raised by the BEIP. The researchers focused on what would likely be more harmful for participants: participating or not participating in the project. The study consisted of 136 children who had been living in institutions for at least half of their lives, and 72 of them were randomly selected to be placed in foster care. The purpose was to compare children raised at home with children raised in institutions and children removed from those institutions and placed in foster care. Children were videotaped in various settings in order to assess numerous crucial developmental characteristics. One of the ethical concerns mentioned in this article addresses what occurs to the participants placed in foster care after the study ends, however, the investigators ensured that no child would have to return to an institution after being placed in foster care by negotiating agreements with local government authorities. When assessing the risk to benefit ratio, Vukov and colleagues stated though previous research on the subject has been limited due to selection bias, studies have shown more favorable development for children in foster care. Moreover, the authors mention one of the most important aspects of the BEIP: the use of randomization. Randomization was crucial in order to avoid selection bias and determine whether any developmental gains were causally related to foster care, however, half of the institutionalized children were left to remain in institutions during the study. After careful consideration of other study designs, the investigators concluded that randomization was the most efficient option as long as no interference took place. The BEIP assured that both groups would benefit from the experiment in various ways. For the institutionalized group, a careful medical examination was provided by an expert, referral was provided as needed for identified problems, there was a reduction in the population of institutionalized children in all of the orphanages for young children without a reduction in staff, and more careful inspection of each child's legal situation. For the foster care group, foster parents were recruited, trained, and monitored by project personnel for the safety of the children, along with monthly expenses covered for each child and a secured plan for their adoption or return to their families of origin. After careful analysis, the authors concluded that the benefits of the BEIP far outweighed any possible risks. This article provides careful examination of the ethical considerations in the Bucharest Early Intervention Project and provides a thoughtful discussion from their own perspectives that support those of the investigators.
The detailed analysis of the Bucharest Early Intervention Project which Dr. Vukov and colleagues have contributed can be paired with findings from children in institutional care versus traditional families to provide additional support for the BEIP. In the article “Children and Adolescents in Institutional Care versus Traditional Families: A Quality of Life Comparison in Japan,” Nakotami and colleagues conducted a cross-sectional study comparing the quality of life of children and adolescents who live in institutions with that of children and adolescents who live with traditional families. The researchers highlighted the importance of this subject due to the recommendation from the United Nations to provide social care for children in need in family-like settings, along with the decision of various countries to move from institutional care to foster care. A children’s quality of life questionnaire was utilized as their measure, which consisted of physical and mental health, human relationships, family, education, safety, freedom, and the environment. Their results showed that total quality of life, emotional well-being, and family scores in institutionalized children were significantly lower than those living with traditional families for children in elementary school. Though they did not find a significant difference for high school adolescents, the researchers suggest that there is a possibility that adolescents in institutional care have been under more stress than their peers ever since their elementary school years because of their living environment. This research is important because it opens the door for future research on the subject of quality of life as we age. In addition, the findings from the elementary school population support the many benefits that can come from foster care.
In conclusion, these research articles provide clear evidence in support of foster care. Proper care is crucial to meet children’s developmental needs, which institutions might not be able to provide as well as foster care would. Therefore, research for alternatives to institutional care is important. Dr. Vukov and colleagues along with Nakotami and colleagues have contributed thoughtful insights into this debate that can be applied to make a change in the lives of orphaned, abandoned, and maltreated children.
Citations:
Nakatomi, T., Ichikawa, S., Wakabayashi, H., & Takemura, Y. C. (2018). Children and adolescents in institutional care versus traditional families: A quality of life comparison in Japan. Health and Quality of Life Outcomes,16(1). doi:10.1186/s12955-018-0980-1
Zeanah, C. H., Koga, S. F., Simion, B., Stanescu, A., Tabacaru, C. L., Fox, N. A., & Nelson, C. A. (2006). Ethical considerations in international research collaboration: The Bucharest early intervention project. Infant Mental Health Journal, 27(6), 559-576. doi:10.1002/imhj.20107
No comments:
Post a Comment