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A new service for early development promotion in an emergency care setting


Background. Convergent evidence has demonstrated that infant's emotional and social development is grounded in the quality of social interactions with a preferred caregiver (Bolwby, 1969). It is through an individualized, consistent and warm infant-caregiver interaction that infants can construct coherent, predictable representations of themselves (Ainsworth, 2000), of others as available and supportive, and be confident in social interactions (Griffin & Bartholomew, 1994). However, institutionalized infants raised in overcrowded facilities and by multiple caregivers, have been reported to lack that one-to-one relationship with a primary caregiver, being this the major cause of harm identified in the context of residential care. A growing body of literature (e.g., Johnson et al., 2006) indicates that infants in institutional care will suffer impairment in their development if they are not moved to a family-based care.

Taking all of this into account, a new residential care unit was conceived focused on quality of infant-caregiver interactions. Moreover, this new service is an 'evidence-base' intervention with vulnerable and at-risk infants and tries to answer some challenges faced nowadays in Portuguese infants' emergency care practice and policy, as is the purpose of this conference.


Purpose. This paper reports the design and evaluation of a new service for abandoned and at-risk newborns waiting to be adopted.


Target population. The service was designed to match the needs of a specific group of 16 eligible for adoption children aged younger than 6 months defined as having an absence of emotional/affective bond and high rates of physical health problems and a need for individual stimulation at a social, emotional and cognitive level. This group includes abandoned newborns, babies without a family network or positive family relationships, or parents lacking parental competency.


Program goals. The main goal of the intervention is to design a new service f for abandoned and at-risk newborns waiting to be adopted, that differ from the current emergency unit in that it aims to promote facilitative conditions for children's global development through planned individualized interventions with a reduced number of caregivers and a normative socialization/integration, using the community resources, i.e. creation of a family-based care. In order to accomplish this goal, seven specific objectives were considered: 1. To provide daily and sustained care to the children and promote a living experience similar to the one provided by a family; 2. To place the residential unit in a residential neighbourhood and allow the child to interact with others in community spaces; 3. To promote individualized, stable and consistent relationships that facilitate the differentiating process between the self and others, in a way that insures quality interactions; 4. To insure an adequate interpretation and response to the signs of the child; 5. To respect the characteristics and the rhythm of the individual development of each child; 6. To allow the child freedom of movement and exploration in a living space that is safe and with diverse materials; 7. To integrate the child in daily activities that allow for the safe and spontaneous exploration of objects and domestic equipment.

This program also intends to decrease the time of stay within the institution (through residential unit) and avoid institutionalization (through foster care).


Theoretical Framework. The intervention model is theoretically integrated in a contextual/developmental perspective (Cicchetti, 1989), with a special emphasis on the individual and his/her socialization processes, using a focused approach on the child, on the interactions and relationships with the adult figures, as well as on the direct scenario in which the child is developing (micro system - Belsky, 1984, 1980).

Intervention will utilize an applied methodology through early stimulation focused on each child needs.


Intervention Program. The intervention program aims to reach strategic and outcome goals of the following specific dimensions:

-        Environmental Context, Motor and Physical Development - To promote the organization of the living space with characteristics of a familial environment (diversity of spaces, furniture and objects) that allow the child freedom of movement and exploration;

-        To allow the contact and exploration of community leisure facilities (public parks, swimming, commerce);

-        Social Development and Social Context - To promote the conditions that facilitate the global development of the child through interventions centered in individual, consistent and continuous interactions;

-        Cognitive and Language Development - To promote a synchronized and non-intrusive interaction that allows for experimentation in the environment.


To foster specific activities taking into account different dimensions of cognitive, development and individual needs.


Research design. The quasi-experimental research design is at an early stage of development and intends to assess three groups of 20 infants each, comparative and longitudinally, living in different early settings: new residential unit; existing emergency unit; and biological families.


Key findings. All the groups will be evaluated through well-validated instruments at the beginning, during and after a 2-year intervention, in the following areas: language, motor, and personal-social development; child-caregiver relationship quality. Significant differences are expected among the groups regarding infant's global development, with higher scores for the new programs vs. existing service.


Conclusions. This comparison of early developmental contexts is consistent with recent literature in emphasizing the need to change social policies regarding infant care, in order to improve current residential care units.


Key references

Ainsworth, M. D. S., Blechar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of strange situation. Hillsdale, NY:Laurence Erlbaum.

Belsky, J. (1984). The Determinants of Parenting: A Process Model. Child Development, 55, 83-96.

Johnson, R., Browne, K., & Hamilton-Giachritsis, C. (2006). Young Children in Institutional Care at Risk of Harm. Trauma, Violence and Abuse, 7(1), 34-60.


Contacts: Salomé Santos, Lisbon University - Faculty of Psychology and Educational Science; Research Centre for Social Research and Intervention (CIS-ISCTE), Faculdade de Psicologia e de Ciências da Educação. Alameda da Universidade. 1649-013 Lisboa. Portugal, Email: svs@fpce.ul.pt; maria.calheiros@iscte.pt; leonor.rodrigues@iscte.pt Phone: 00351 217943600.


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