The removal of institutions or group homes will not lead to better child well-being and could even worsen outcomes for some orphaned and separated children, according to new findings from a three-year study across five low- and middle-income countries. Children in institutions are as healthy and, in some ways, healthier than those in family-based care, according to the study, which was led by Kathryn Whetten, a Duke professor of public policy and director of the Center for Health Policy and Inequalities Research (CHPIR).In the largest and most geographically and culturally diverse study of its kind, Duke researchers found there is great variation in how much children’s well-being improves over time. The type of residential setting, either institution- or family-dwelling, was a poor predictor of change. The study found that stronger predictors of child well-being were country, neighborhood or community, and differences in psychosocial characteristics such as age, gender, baseline emotional and nutritional status, and life course events. Researchers also found that children in group homes were more likely to have their basic needs met.The Positive Outcomes for Orphans (POFO) study based at the Duke Global Health Institute is following more than 1,300 orphaned and separated children living in institutions and another 1,400 children in family-based care. This sub-study includes three years of data from caregivers and children aged 6-15 across study sites in Cambodia, Ethiopia, India, Kenya and Tanzania. Researchers examined many aspects of child well-being, including physical health, emotional difficulties, growth, learning ability and memory.With more than 2 million children living in institutions worldwide, this research challenges views held by children’s rights organizations that institution-based caregiving results in universal negative effects on the development and well-being of children.“Our findings put less significance on the residential setting as a means to account for either positive or negative child well-being over time, " Whetten said. "This underscores the need to continue working to tease out the blend of caregiving characteristics that lead to the best child outcomes within each setting.” “We believe returning children from institutions to biological families may not result in the best outcomes, at least without significant intervention for the biological family, including supervision and follow-up,” Whetten said. Ultimately, Whetten believes the evidence suggests a need to “focus on improving the quality of caregiving in family settings and group homes, the well-being of caregivers and improving communities.”The study, which appears Aug. 29 in Plos One, was funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (5R01HD046345).Other CHPIR researchers involved in the study include Jan Ostermann, Brian Pence, Rachel Whetten, Lynne Messer, Sumedha Ariely, Karen O’Donnell, Augustine Wasonga, Vanroth Vann, Dafrosa Itemba, Misganaw Eticha, Ira Madan and Nathan Thielman. The study was supported by funding from the National Institute of Child Health and Development.CITATION: “Three-year change in the wellbeing of orphaned and separated children in institutional and family-based care settings in five low- and middle-income countries.” Whetten K, et al and The Positive Outcomes for Orphans (POFO) Research Team. PLOS ONE, Aug. 29, 2014.