Guatemalan family-style orphanages: A grounded theory examination of caregiver perspectives

Abstract

This study is an exploratory qualitative examination of two separate non-profit family-style orphanages in Guatemala. The researchers used a grounded theory approach to study semi-structured interviews of caregivers (N = 20). Caregivers mainly consisted of ‘tias’ who lived with the children and teachers who taught the children at the schools associated with the orphanage. The following categories emerged from the data: sense of belonging, hope for the future, and the importance of structure (e.g. organization and schedule). There was also an emphasis on religion in both the sense of belonging and hope for the future categories. This study adds to the emerging research regarding family-style orphanage care and focuses on caregiver perspectives.

Keywords

Caregivers Guatemala grounded theory orphanage care

Introduction

Worldwide, there has been considerable research demonstrating that children who experience profound institutional deprivation are at a greater risk of a host of developmental problems, including indiscriminate friendliness (Groark et al., 2011), lower cognitive functioning (Rutter et al., 2004), and increased internalizing and externalizing problems (Gunnar et al., 2007). These findings have led scholars and child welfare advocates to question whether institutions can be improved (McCall, 2013) when family care alternatives are not feasible (e.g. reunification with biological family, foster care, adoptive families, or kinship care). In this study, we explore the experiences and insights of caregivers (tias and teachers) in two family-style orphanages in Guatemala.

In an effort to address the problems with institutional care, research has focused on caregiver–child interactions. A study of three government-run orphanages for young children in Central America found that caregivers displayed little empathy, guidance, or support to children, and similarly, children displayed substantial detachment from caregivers (Groark et al., 2011). The researchers hypothesized that the lack of warm and sensitive interactions between caregivers and children may contribute to the high rates of indiscriminate friendliness, aggressive behavior, and developmental delays. McCall et al. (2010) developed an intervention study at a Latin American orphanage that explicitly addressed improvements in caregiver–child interactions. They found noticeable improvements in both caregiver–child interactions and developmental outcomes for the children.

Building upon this research on the importance of caregiver–child interactions, some institutions have changed the structure of the orphanage to promote more family-like or family-style institutional care (see the review by McCall and Groark, 2015). This shift is supported by attachment theory (Ainsworth et al., 1978; Bowlby, 1969; Schore and Schore, 2008) as institutionalized children with insecure attachments are more likely to demonstrate developmental delays (Stams et al., 2002). Furthermore, the importance of attachment for children goes beyond early childhood (Kerns, 2008), and children within residential institutions may stay beyond their first four years of life. In comparison with larger, state-funded orphanage care settings, family-style orphanages aim to provide stable and consistent caregivers and teachers and develop ‘little families’ (separate smaller units) within the larger institution, thus providing children with greater opportunities to develop caregiver attachments.

Family-style orphanages, which have children from birth to late adolescence, are associated with better social and academic outcomes (Pittracher et al., 2004) and increased support for the emotional needs of the child (Niemetz, 2011). Results from a specific intervention to improve caregiver–child interactions in orphanages in Russia, with children between birth and the age of four, showed improvements in social-emotional relationships and reductions in atypical behaviors and disorganized attachment behaviors (The St. Petersburg–USA Orphanage Research Team, 2008). Results from a similar intervention in Central America showed improvements in the physical and cognitive development of children with severe disabilities (Groark et al., 2013).

Guatemala

Guatemala provides a unique setting for exploring the functioning of family-style orphanages. During a 36-year genocidal civil war that ended in 1996, over 200,000 people were killed and numerous human rights violations occurred (Bunkers et al., 2009; Gibbons et al., 2009). Since then, a combination of high birth rates, malnutrition, poverty, and rural migration to urban centers for jobs has led to child safety issues and a large number of relinquished children needing care (Lindstrom, 2003; Marini and Gragnolati, 2003). In 2008, there were approximately 6,000 children living in residential care, and half of these institutions lacked adequate staff to care for the children (Perez, 2008). This weak social welfare infrastructure within Guatemala has led to an increase in children in the adoption system (Rotabi et al., 2008). The Guatemalan government has made attempts to attenuate the large numbers of street children and high rates of malnutrition. However, such efforts have been ineffective due to the limited expenditure of the Guatemalan gross domestic product (GDP) (less than 5%) in areas such as healthcare (Center for Economic and Social Rights, 2008).

Despite efforts by the government to improve child outcomes, the number of relinquished children remains high and the country is forced to find alternative care for the children. A joint project by UNICEF et al. (2002) estimated that 345,000 of all children in Guatemala would be ‘single orphans’ (loss of one parent) and 13,000 would be ‘double orphans’ (loss of both parents) by 2010. In 2008, Perez estimated that within 133 children’s shelters operating in Guatemala, 33 percent of the children (1,848) were considered permanent shelter residents, with the vast majority (92%) not available for adoption. Furthermore, many children’s shelters were operated outside of the guidelines mandated by the Integral Child and Adolescent Protection (PINA) Law, for example by failing to have specialized personnel for the children (Perez, 2008). UNICEF (2013) estimates that there are currently approximately 5,800 children living in children’s homes with almost no access to either their families or alternative forms of care.

From 2005 to 2008, families from the United States adopted approximately 4,000 infants per year from Guatemala (US State Department, 2014). Due to concerns of human rights abuses, particularly noncompliance with the Hague Adoption Convention guidelines to prevent child trafficking, the Consejo Nacional de Adopciones (CNA) was instituted in Guatemala to oversee adoptions. The US State Department continues to encourage more safeguards from the CNA and there has been a drastic decrease in international adoptions to the United States from Guatemala. In 2012, there were only seven international adoptions from Guatemala into the United States, and in 2013, the number increased slightly to 23 adoptions (US State Department, 2014).

To address the growing number of relinquished children, researchers and private organizations within Guatemala have examined alternative care situations and interventions, including family group conferencing (Rotabi et al., 2012) and family-style orphanages. The family-style approach to orphanage care complements the broader cultural worldview of family and community in Latin America. In 1972, Carlos and Sellers highlighted the continued importance of the extended family (parentesco) and fictive kinship (compadrazgo) in the Latin American family structure, despite speculations that these relationships were weakened by modernization. More than 30 years later, Kuznesof (2005) continued to argue that globalization has not weakened family ties in Latin America and that kinship is the ‘central mode of social interaction and individual adaptation to factors of modern life that might otherwise lead to alienation’ (p. 860). This flexibility and strength of the Latin American family is present even in the high number of street children and ‘orphans’ living in institutions (Kuznesof, 2005). The concept of fictive kinship, already embedded within Latin American culture, contributes to the culture of family-style orphanage care.

Description of the study

Given the unique situation of Guatemala, both historically and culturally, this study focused on caregiver perspectives in two non-profit, family-style orphanage settings in two major cities in Guatemala. We used a grounded theory approach to study semi-structured interviews of caregivers. Although the majority of these children have living biological parents, the children have been relinquished to the care of the orphanage. These orphanages are unique in their emphasis on ‘family units’ (comprising the caregiver and other children in a smaller unit) and the addition of an elementary school as part of the institution.

Methods

Participants

A total of 20 caregivers from two different family-style orphanages participated in this study. Caregivers included house parents called ‘tias’ (n = 9), teachers (n = 7), orphanage directors (n = 2), a psychologist (n = 1), and a sponsor (n = 1). Every participant had at least six months’ experience at the particular home, and the majority of participants had experience in other family-style orphanages prior to employment. There were 16 females and 4 males interviewed; their ages ranged from 28 to 67 years. In all, 18 of the participants were Guatemalan (ethnically and nationally) and two were White Americans living in Guatemala. Both White American participants had lived in Guatemala for over five years and both spoke fluent Spanish. Each caregiver was assigned a ‘casa’ with approximately 10–14 children living in each unit.

Although both institutions were privately funded family-style orphanage care facilities in Guatemala, there were some differences in the structure of the school. In the first children’s home there was a total of 140 children (both boys and girls), and in the second, there were 40 children (all girls). The youngest child at both homes was five years old; the oldest in the first children’s home was 18 years old, while the oldest in the second home was 12 years old.

Researcher-as-instrument

The coding team included three undergraduate research assistants and the first author (O.M.K.), who is an adopted Korean American. The undergraduate research assistants were composed of an Argentinean American familiar with the culture of Central America, a White American, and an adopted Korean American. This was O.M.K.’s fourth visit to Guatemala and she was familiar with Guatemalan culture. In accordance with grounded theory, the coding team discussed personal biases regarding this research topic. Biases included (a) associations of Guatemala with poverty and a high crime rate, (b) knowledge of institutional care and its impact on child development, (c) personal experiences with international adoption, and (d) assumptions regarding the definition of family.

Procedure

The interviews were conducted during the months of July–August 2008 in two separate family-style orphanages, one in Guatemala City, and one in San Lucas. Both orphanages were comparably sized and followed a similar model of small ‘casas’ in which ‘tias’ provided care to a small group of elementary-aged children. As O.M.K. had only a basic command of Spanish, the interviews were translated from Spanish to English by a professional translator and then transcribed by O.M.K. Given issues around trust, particularly in the aftermath of a fairly recent civil war, the interviews were not audio- or video-recorded. All participants were informed of the study by O.M.K. and participants indicated understanding that this study was voluntary. The study participants did not receive compensation, although O.M.K. did volunteer at the school reading English to the students. The length of interviews ranged from 60 to 90 minutes.

Interview protocol

The semi-structured interviews were focused around four main categories, comprising general questions around home and schools (including daily routines, relationships, challenges, rewards, and counseling), risk and protective factors, social support, and indigenous/non-indigenous relationships. These topics were developed based on previous literature (Aronowitz, 2005; Carlos and Sellers, 1972; Mills et al., 1988; Smyke et al., 2002; The St. Petersburg–USA Orphanage Research Team, 2005, 2008). Consistent with grounded theory (Charmaz, 2006), O.M.K. added questions about emergent categories during the latter interviews. These questions were added after the 11th interview and focused on (a) participants’ feelings and opinions around international adoption in Guatemala and (b) recommendations for government-funded social welfare for children.

Data analysis

Interview transcriptions were analyzed by a coding team consisting of O.M.K., two undergraduate research assistants, and a third undergraduate research assistant who served as an external auditor. In the initial open coding phase, each member of the team independently coded and analyzed the interviews. The coding team attempted to stay ‘close’ to the data by using the participants’ own words to describe the codes. The team met weekly to discuss the codes, emerging statements, biases, and any discrepancies between coding. There were 142 codes identified during this phase. The auditor was present at all the coding meetings, noted any discrepancies in the codes, and facilitated discussion among the authors about such discrepancies.

During the axial coding phase, the research team placed the codes into higher-order categories. During this stage, members of the coding team independently merged codes based on parallels between the interviews and met weekly to discuss these axial codes. When there were no longer new codes emerging, the team moved to the selective coding phase and the remaining interviews were coded using three distinct codes. In this stage, axial codes were merged and synthesized. Members of the coding team examined the data to identify connections and understand the relationship among the different codes. In this final phase, the coding team met to discuss the different categories emerging from the data, and shifted focus to the development of a theory regarding family-style orphanage care.

Quality and rigor of this study were maintained by a number of checks. Out of an initial 146 total codes, 12 were debated among the coding team and auditor. During weekly meetings, the coding team resolved any discrepancies in coding following the guidelines from grounded theory. The coding team analyzed the results of the teachers, tias, and staff and did not find qualitative differences among the types of caregivers. The team also analyzed the results between the two family-style orphanages and did not find qualitative differences between the two groups. To help facilitate the coding process, the research team used QSR International’s NVivo software to organize the interviews, record coding and coding procedures, and aid in reliability checks. Qualitative data software such as NVivo allows researchers to organize the emergent categories (and their exemplars) more efficiently without replacing the researchers’ role in analysis (Hutchinson et al., 2010).

Results and discussion

There were three major categories that emerged from the interviews, including sense of belonging, hope for the future, and importance of structure.

Sense of belonging

Instilling a sense of belonging, either in a particular ‘casa’ or as a member of the orphanage, was an important category mentioned by the majority of the participants. Many of the individuals who were interviewed brought up the importance of the family or friend-like relationships provided by the caregivers, teachers, and other staff members of the orphanages, which may reflect the collectivist values and fictive kinship present in Guatemalan culture. The tias were most often portrayed as taking on a mother or sister role to the children. For example, one caregiver explained the role of a tia as ‘like a mother; sometimes she sees things in them and needs to tell them to behave and to do better’. Other tias stated that they see their role as ‘more like a friend’ who ‘talks about their [the children’s] life in all aspects’.

Teachers also expressed a close, family-like bond with the children as either a parent or friend. The relationship was described as ‘very close’ as the children are ‘fond of teachers because parents are away or they don’t have parents’. Another teacher described the relationship between teachers and students as simultaneously part teacher and part friend. In all cases, teachers and tias saw the relationship between children and staff as a positive influence on the children and as an important aspect in helping the children feel accepted at the homes. They believed that the staff–child relationship positively impacted the children’s adjustment to living in the orphanage and ultimately impacted their emotional development. From the perspective of the caregivers, these close relationships serve as protective factors for the children.

As stated in the introduction, research indicates that a nurturing, warm, and responsive caregiver–child relationship is associated with more positive developmental outcomes for children (McCall et al., 2010; Niemetz, 2011). Although there is some evidence that children may prefer that caregivers do not attempt to act as their family (Anglin, 2004), the understanding of fictive kinship already present in the culture may ease the acceptance of family-like relationships. An intervention in a Nepalese orphanage demonstrated improved health and development outcomes for children after providing support to caregivers’ while changing the caregivers’ titles to encourage a greater sense of dignity (‘maid’ to ‘mother’; Wright et al., 2014). This change in title impacted the way in which the caregiver viewed herself and her interactions with the children. Similarly, tias and teachers in this study described their relationship as ‘more than’ an official role or job, and ‘more like’ either a friend or a mother. The structure of living in ‘little houses’ with one tia who cleans and cooks for the children in the home encourages this mother-like relationship.

Hope for the future

In many cases, the education provided by the family-style orphanage was viewed as an opportunity for better future employment and further education. This educational system was seen as superior to the public schools as the children were in school longer and had access to computers. These orphanages differ from the majority of child institutions in Guatemala, where only 42 percent shelters have basic internal education installations (Perez, 2008). One tia said the advantage of education is that ‘they can go to the university’ even though their parents ‘only went through sixth grade’. Directors and teachers often mentioned the high quality of the education provided by the orphanage. One director stated that they had a ‘great academic program because [they] have been able to develop a plan that combines educational background from the US, Israel, and Guatemala’. The caregivers emphasized the role of education in providing a better future for these children and their families.

Educational aspirations, persistence, and belief in a bright and compelling future are believed to be protective factors for at-risk youth (Aronowitz, 2005). In addition, being in an environment that has high expectations of the child also proves to be beneficial by promoting a strong work ethic and academic self-efficacy (Lee, 2012; Mills et al., 1988). Both of the orphanages in this study have high-quality education as a main focus and encourage the children to aspire to higher levels of education by offering financial support. Teachers continually reinforced that these students were in a unique situation due to their access to a higher quality of schooling than public school, and that despite the family or living situation, the children were ‘lucky’ to have these opportunities.

A category that indicated both a sense of belonging and hope in the future was religion. Although the interviewer did not ask questions regarding religion or the spiritual development of the children, the respondents often talked about the importance of religion for the development of the children. The family-style orphanages did not have a religious affiliation, although the caregivers encouraged the children to pray and attend church. The directors also felt that religion, either Christianity or an indigenous religion, was important for the development of the children. For example, when a caregiver (tia) was questioned about the goal or mission of the orphanage, she answered that the home’s mission is ‘to help the girls know God and become professionals in the future’. A director of one of the orphanages responded that the mission is ‘to produce Christian women who can impact the communities in the country for Christ’.

The prevalence of references to religion and God in the interviews is indicative of the value of religion in Guatemalan culture and specifically indicates that religion can play a significant role in orphanage care, particularly in countries that value religion. The tias and teachers viewed fostering a relationship with God as a crucial part of the care provided at the orphanages and believed that religion helped the children. This belief suggests that religion could be used to improve orphanage care by providing the children with a source of hope or a means of coping. Additionally, religion may be viewed as a means of support and motivation for the caregivers to continue their task of caring for the children (Pargament et al., 2005). Future research should examine how religion impacts child outcomes, particularly as the category of religion emerged unsolicited in the majority of interviews. Although research has found that religion serves as a protective buffer (Pargament, 1997), little is known about its specific use as a coping method in at-risk children.

Importance of structure

Another important category discussed in the interviews surrounded the unique structure of the family-style orphanages. All the staff contributed to the reinforcement of the structure. Structure refers to the explicit rules, policies, and overall organization of the homes and school. This includes consistent scheduling, rewards and punishments, weekend activities, and general reinforcement of boundaries. One tia mentioned the daily schedule:

[They] wake up at 5:00 in the morning, clean up, eat breakfast and do the cleaning and come to prayer. Then they go to school until 1pm. Then lunch from the kitchen at the house where everyone eats together, chat a little at the table, clean, and then [they go] back to school. After [they] work on homework, watch TV for one hour, prepare and eat dinner, have a time of prayer at night, clean up and sleep at around nine pm.

Teachers also talked about the ‘passports’ that children could fill up with stickers for good behavior, for example ‘if they are following rules and being on time or help others’, and if they fill up their passport they get prizes.

Research surrounding the importance of structure for young children has been well-documented in child development. Although the majority of literature surrounding structured routines has involved families, the smaller ‘families’ within orphanages provide similar structure. These activities within the family maintain a shared sense of communication, commitment, and continuity (Fiese et al., 2002) and are positively related to a number of developmental outcomes, including language formation (Blum-Kulka and Snow, 2002) and academic skill development (Rosenkoetter and Barton, 2002). Both teachers and tias emphasized the importance of structure and order in the daily activities of the children in their care.

Conclusion

There is little research on the quality and nature of care in family-like orphanages in low-resource countries. Due to this gap in the literature, this study is an exploratory, grounded theory approach to examining two family-style orphanages in Guatemala. With the understanding that orphanage care can and should be improved, researchers conducted interviews with caregivers regarding the day-to-day activities at the orphanages. Although much of the previous research on childcare institutions highlights the harmful effects of the environment, this study focuses on protective aspects that are uniquely provided by family-style care. Consistent with the small body of research on family-style orphanage care (e.g. Niemetz, 2011), the findings suggest that the family-style structure of the homes can provide children with better quality relationships, greater resources, and opportunities for the future.

Within the broader historical and social context of Guatemala, the results of this study emphasized the need for cost-effective, structural-level changes in the institutional care of children in low-resource countries. Considering the statistics cited in the introduction related to the number of children in need of care, coupled with the current situation regarding international adoption, there is a clear need for practical interventions targeted at the improvement of orphanage care. The theory that emerged from the interviews focused on the importance of the family-style structure to foster a sense of belonging and hope for the future. Building on research that aimed to improve the quality of caregiver–child relationships (Groark et al., 2013; Wright et al., 2014), the shift to family-style care is a viable option in order to improve orphanage care on a structural level. Interviews indicated that caregivers perceived children as finding a sense of belonging in the ‘casa’ and/or school, and the structure of the family-style orphanage (as well as the school) helped children work toward a future that valued religion and education.

There were several limitations with this study, including the language barrier between the interviewer and the participants, the use of a translator, and the different cultural contexts of the researchers and participants. Some cultural nuances and meanings may have been lost during the translation from English to Spanish or Spanish to English. These nuances may be impossible to directly translate from one language to another and this may have influenced the coding process as we analyzed the content of the interviews (Temple and Young, 2004). The nuances that may have been ‘lost in translation’ include differences of assumptions between researchers and participants regarding ideas around family and residential care.

Another limitation was the possibility that caregivers may not have felt comfortable discussing more negative aspects of the orphanages. The caregivers emphasized the unique contributions of the institutions, and the content of the interviews focused on more positive and protective factors. Given the history of Guatemala, particularly concerns regarding privacy in the aftermath of a 36-year civil war, participants may have been reticent to discuss issues that might have been construed as criticism. At the same time, focusing on aspects that are working, as opposed to focusing on the negative aspects of orphanage care, provided a valuable frame for this study.

It is imperative that policy workers and researchers continue to examine alternative care placements and interventions in institutional orphanage care. Follow-up studies should focus on the way in which the themes in this study (i.e. sense of belonging, hope for the future, and importance of structure) impact the children’s development longitudinally. Future research should also expand interviews to include children’s perspectives, particularly around the structure of family-style care and which specific aspects were most helpful and appreciated. Although this study has focused on the caregivers’ perspectives, the authors of this study recognize the importance of the children in the orphanages speaking about and documenting their own experiences.

Footnotes

Funding

This research was supported by the Diversity of Views and Experience Fellowship, awarded to Oh Myo Kim by the University of Minnesota.

Author biographies

Oh Myo Kim, M.Div., PhD is Assistant Professor of the Practice in the Counseling, Developmental, and Educational Psychology Department at Boston College. Dr. Kim’s research focuses on child welfare, including institutional care and adoption. Her research also examines the intersection of culture and identity with international, transracial adopted adults.

Kevin C Hynes, M.A., is a doctoral student in Human Development and Family Studies at the University of Connecticut, specializing in Marriage and Family Therapy. His primary research focus is on the process of therapy and minority client engagement. In addition, his research focuses on developing therapy processes for adult transracial, transnational adoptees.

Richard M Lee, PhD is Professor of Psychology at the University of Minnesota, Twin Cities. He studies the racial, ethnic, and migration experiences of racial/ethnic minority, immigrant, adopted, and refugee populations and its relationship to family, development and mental health.

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