Current Environment:

The Early Institutionalization Intervention Impact Project


Approximately 250,000 children in the Latin American and Caribbean (LAC) region live in orphanages, with countless more in unregistered institutions. In Brazil, the population of institutionalized children is around 40,000 and rising rapidly. Despite decades of research from other countries charting the severe harm orphanages cause to children’s physical, social, cognitive, and emotional development, policy makers in LAC continue to fund institutions. In Brazil, 95 percent of children in out-of-home care live in institutions.

Where we started

The Bucharest Early Intervention Project, led by the same team of researchers, clearly demonstrated that family care conferred advantages over institutional care. Indeed, the sooner children were placed in adequate caregiving environments the more likely they were to recover from the effects of deprivation and the fuller their recoveries were likely to be. In 2017, the team, supported by funds from the Lumos Foundation and GHR Foundation, began trips to São Paulo, Brazil, to determine the feasibility of a similar study. Over the past three years, the researchers have built strong working relationships with the local collaborators including the Child and Youth Courts, local leaders in foster care programs, and a research partner, Instituto PENSI.

Our impact

The project is in the preparation phase. The objective of the project is to document and compare the impact of institutional care on early childhood development to that of high-quality foster care. The study will include a two-armed intervention, in which 100 children under 24 months of age who have been abandoned by their parents or removed from their homes due to maltreatment are placed, at random, in either enhanced institutional care or high-quality foster care. Children will participate in an initial screening assessment, after which caregivers (institutional caregivers or foster parents) will participate in a caregiving training with the child. Children and caregivers will then participate in up to follow-up assessments at 12 months, 24 months, and 36 months.

Moving forward

Over the next year, the study team in Brazil will complete training and begin data collection for the first phase of the study, a historical control group of children currently living in institutional care. Subsequently, we will begin foster parent recruitment and training of caregiving interveners.


Charles Nelson, PhD

Improving Surgery Systems in Brazil

The Program in Global Surgery and Social Change (PGSSC) has several projects in Brazil, focusing on surgical system strengthening through database and field research and nascent policy initiatives. Led by Dr. Nivaldo Alonso, the Chief of Craniofacial Surgery at Hospital das Clinicas in Sao Paulo, Brazil, the PGSSC team collaborates directly with two states to perform national-level data collection. In-country collaborators include Universidade Estadual do Amazonas (State University of Amazonas) and Universidade de Sao Paulo (University of Sao Paolo), as well as the Burn Society of Brazil. We fully expect this project will continue to flourish under the strengthening relationships with local organizations.