Study highlights long-term benefits of family-based care following institutional care

New research, published online today in the American Journal of Psychiatry, provides the most robust and comprehensive evidence to date that children exposed to early psychosocial deprivation benefit substantially from family-based care. Senior author Kathryn L. Humphreys, Ph.D., discussed this work today at a special briefing during the 2023 Annual Meeting of the American Psychiatric Association.

Results of research from the Bucharest Early Intervention Project, the first randomized controlled trial of foster care as an alternative to institutional (orphanage) care, found the positive effects of foster care persisted across nearly two decades of follow-up assessments. The researchers synthesized data from nearly 20 years of assessments to examine the impact on children's development of high-quality family-based care following exposure to institutional care in early life.

The Bucharest Early Intervention Project is a collaboration between researchers at Tulane University, University of Maryland, Boston Children's Hospital, Harvard University, Bucharest University, Vanderbilt University, and UNC-Chapel Hill. The study seeks to examine the impact of neglect and effective interventions, including high-quality foster care, that can have a positive impact on children's long-term outcomes.

"Our study highlights the importance of investing in family-based interventions for children exposed to early institutional care. These interventions can have a profound and lasting impact, helping to improve children's cognitive, emotional, and social development," Humphreys said.

"This is a very important study as it provides critical findings that demonstrate the ability of family-based interventions, such as high-quality foster care, to mitigate the substantial effects of early life deprivation and neglect on brain development, cognitive function, and the risk to develop psychopathology," said Ned H. Kalin, M.D., editor-in-chief of the American Journal of Psychiatry.

Lead author Lucy S. King, Ph.D., with Tulane University School of Medicine (LA), and colleagues analyzed more than 7,000 observations from infancy through adolescence for 136 children residing in institutions in Bucharest, Romania.

The children were aged 6-31 months when the study was initiated and were randomly assigned to either a newly created high-quality foster care intervention or care-as-usual (remaining in their institutional care placements). Because foster care was extremely limited when the study began, the researchers, in collaboration with Romanian officials, created a foster care network.

The children were assessed at ages 30, 42, and 54 months, and 8, 12, and 16-18 years. The study received ethics approval from the researchers' institutional review boards and from the local child protection agency and the children's legal guardians provided signed informed consent.

The study found the foster care intervention had positive effects on IQ, physical growth, symptoms of disorders of social relatedness (reactive attachment disorder and disinhibited social engagement disorder), and internalizing symptoms. The impact of the intervention was apparent by age 30 months and sustained through late adolescence.

While the benefits of family-based care were consistent across development, outcomes differed based on developmental domain, how early in life children were placed in family-based care, and whether this care was stable across childhood and adolescence.

Children who remained with their original foster families had better cognitive and physical outcomes and less severe mental health symptoms compared to children who experienced placement disruptions. The effect of having a stable family placement was largest in outcomes measured in adolescence.

The study provides "strong and conclusive causal evidence that children exposed to early deprivation benefit from high-quality family-based care, and, more broadly, that the nature of the early caregiving environment has an extensive and lasting impact on development," the authors conclude. "Our findings indicate that providing high quality and stable family-based care, which includes biological, foster, or adoptive families, is critical for children's well-being, and, in turn, the well-being of society."

Humphreys notes, "The results of our research have significant policy implications for global efforts to address the public health crisis of abandoned and orphaned children. Family-based interventions ensure that these children receive the care and support they need to thrive."