The Oak Life Journal
May | Jun 2023
Orphanages: How to Start Your Own Quality Assessment
By Aarin Talbot
7 minute read
Oak Life is proud to introduce its newest regular contributor, Aarin Talbot, to its team of writers. Research writer for The Journal and a clinical research professional by trade, Aarin hopes to empower alternative care workers by introducing a literary perspective to major issues. When she is not working on research projects, she enjoys spending time with her family and friends in Indiana, United States.
The general outlook on alternative care homes for children has changed dramatically over the past decade. So much so, in fact, that certain organizations have even been founded for the sole purpose of defunding and demoralizing this form of care in the public eye. And yet, should a person try to find the justification behind their outspoken disapproval, they are soon met with a disappointing lack of qualified research or data to support it.
Such a lack of sufficient data is a double-edged sword, however. While it may not provide a reason to disregard alternative care homes, it also leaves orphanage directors without the right tools to vocalize their value. This begs the question, then, what can be done? How can orphanage directors and supporters join the conversation?
An answer comes from the 2017 research study conducted by the Hammill Institute on Disabilities. This study set out to establish factors that could be used to assess the quality of youth homes. Using several different volunteers for comparison, they determined that homes which adhered to the prevention of poor staffing, treatment, safety, and settings were more likely to have positive outcomes for their children than those that failed to do so.
As a result, a new door has opened for directors to assess the quality of their own youth homes, thus contributing to the overall positive outcomes of alternative care. The purpose of this article therefore is to provide a defined list of the four factors mentioned above. Although this list is by no means exhaustive, it may serve as a good starting place for assessing the quality of current practices.
• Ensure that only qualified personnel are hired as caregivers
Screen potential staff by using background checks, contacting their references, ensuring any certifications are valid (i.e. not expired, relevant to the role), and that their experience is appropriate.
Note: Students applying from Oak Life School of Orphan Care will already have the hands-on training and relevant experience needed for caregiver roles. If you are an orphanage director looking to hire new staff and would like to know more about Oak Life students and graduates, click here.
• Ensure that staff receive significant training and regular re-training
Regardless of prior experience, each incoming caregiver should receive the same amount of training. Keep a training log on each new caregiver with a checklist of protocols and policies to cover. Document the amount of time they are trained in hours, with a minimum of 40 hours of on-the-clock training. Also ensure that regular re-training occurs so that the standard of care is maintained.
• Set a criterion for continuity in all caregivers
Each caregiver needs to adhere to protocols, schedules, and rules. (i.e. children are in bed at the same hour every night regardless of who is in charge; the same level of discipline or reward is used regardless of who is in charge, etc.)
• Practice safe staff-to-youth ratios
Limited to 6–8 children for every 1 caregiver.
• Establish a recognizable and evidence-based model of care
For example, Teaching Family model, stop-gap, RE-ed, TBRI, etc.
• Maintain routines and schedules
This includes treatment regimens ordered by doctors/psychologists as well as routines outlined in the desired model of care and routines for daily living.
• Ensure that treatment is predictable and understandable by each child
Before any treatment or medical procedure is performed, educate the child in a language that’s aligned with their developmental level about what they can expect (i.e. if they will be visiting new places, meeting new people, what the treatment or medical procedure will be accomplishing, what the process look like, whether or not they will feel pain from a medical procedure, etc.).
• Create treatment plans that aid in child development, rather than those with a sole focus on fixing immediate issues
Start planning for a child’s exit of the care home upon their admission. Increase the depth of education based upon their developmental level to provide real-world skills, including social, personal, educational, occupational, and home-related skills.
• Help children develop healthy relationships outside of the alternative care home
When interacting with doctors, psychologists, strangers, etc. help the children feel safe, heard, and understood to better improve their outlook on outside relationships. Some ways to do this is by modeling good social skills, keeping the child involved in the conversation rather than simply talking about them to other adults, speaking in a language that’s understandable according to their developmental level, etc.
• Perform regular assessments on child development with caregivers
Maintain documents that allow caregivers to give their input on child progress and current areas that may need more attention. Observations on child behavior, development, social skills, response to treatment, etc. allow for more individualized care of each child. Note: To maintain child privacy, keep all documents on child progress out of the view of anyone who is not a current caregiver of that child, nor discuss information on assessments with anyone that is not relevant to that child’s care.
• Have measures in place for child protection
Teach caregivers basic first-aid and CPR/Heimlich; teach children protocols for severe weather (earthquakes, hurricanes, etc.);
• Ensure discipline is used fairly and not more than necessary
Positive outcomes are linked to how discipline is performed. The use of restraints or harsh punishment negatively affects a child’s development and ability to enter society. However, fair correction with a positive focus was more likely to help children learn and develop properly.
• Create an environment where children are allowed to discuss their fears or concerns with a trusted caregiver
Make it known that children are allowed, without consequence, to admit when they feel scared or perceive danger in some way. Address the concern directly and as soon as possible.
• Provide children with a questionnaire that allows them to give their own assessment of the home’s safety
According to the research study cited in this article, an important person to bring into the discussion of safety is the child himself / herself. A way to do this is by creating a short questionnaire that addresses potential abuse, continuity of care, and fairness. Using suggestions from the Teaching Family Quality Assessment protocol, children in the Hammill Institute study were asked to rate each question either “not true,” “sometimes true,” or “certainly true” to see if staff was fair, if staff cared about them, if staff helped them learn things, and if the rules were adhered to regardless of who was in charge.
Note: Create an environment where children will feel safe to answer honestly (i.e. no repercussions for answers, staff in question are not influencing the child’s decisions in the questionnaire, etc.)
• Maintain a clean environment
Teach children to keep play areas and bedrooms tidy; regularly clean showers, toilets, and sinks; keep eating areas clean after every meal; teach children how to throw away trash; regularly disinfect surfaces to decrease infection; regularly clean children’s bedding; provide new toothbrushes, razors, sanitary products when needed; etc.
• Maintain a safe environment
Fix building issues like leaks or damage; keep dangerous chemicals and cleaning supplies in locked cabinets or out of reach; keep a cover on pools when not in use and set designated times where children are allowed to be at the pool with qualified supervision (i.e. a caregiver who recognizes the signs of drowning and is capable of performing CPR if necessary); if children are in bunkbeds, ensure the top bunk has rails to prevent falling; keep children a safe distance from fires used for cooking or heat and remove access to matches; etc.
• Provide access to age-appropriate items
Have books, games and toys that are relevant to each grade or developmental level.
Have books, games and toys that are relevant to each grade or developmental level.
In conclusion, taking the time to regularly assess where current youth home practices align with the highest standard of care grants orphanage directors, caregivers, and supporters a voice in the conversation. More importantly, it increases the positive outcomes in the children being cared, and furthers their success upon entering society.
Farmer, E., Murray, M., Ballentine, K., et. al (2017) “Would We Know It If We Saw It? Assessing Quality of Care in Group Homes for Youth,” Hammill Institute on Disabilities, 25(1), p. 28-36