Let’s start by highlighting two numbers. The first is 2,971, the most recent yearly total of international adoptions to the US.1 The second is 6,000,000, the estimated number of children living in orphanages worldwide.2 While some of these children are reunited with their families, some are adopted in their own countries and a handful are placed in other Western nations, the figures above tell us that the chances of any of these children waiting to find a permanent home is vanishingly small. At the Adoption Medicine Clinic (AMC), we focus a great deal of attention on helping families successfully parent their adopted children. However, we recognize that we have an equally important role advocating for the well-being of the countless children left behind. We do this in two ways, direct education and through partnerships with organizations that share our belief that every child deserves a family.


Thirty-five years ago, institutional care was the accepted standard throughout the world. UNICEF even stated that living in an orphanage was preferable to international adoption. However, within orphanages, a ratio of one caregiver for 5 to 10 infants can never provide the critical individual nurture that permits normal physical and emotional development during early life. In orphanages, children rapidly fall behind in motor, speech and cognitive development. These delays are Prompt, clearly measurable within months; Pervasive, affecting all areas of development, and often Permanent, unless placed in a family where children are able to recover much of what was lost.

In hundreds of presentations over the past three decades, AMC staff members have disseminated information on the adverse effects of institutional care to thousands of decision makers such as national governments, NGO’s and religious organizations. We are gratified that information from scientific studies, many initiated at the University of Minnesota, has started to turn the tide of opinion towards the benefits of family-based care.

Advocacy Partnerships

While progress is being made, developing better care options and closing orphanages is complex, expensive and lengthy. How do we help the millions of children in care today? This is where advocacy partnerships are so important. Over the past twenty years, I have had the opportunity to serve on the boards of four NGO’s that are offering hope to children currently institutionalized and are working to eliminate orphanage care worldwide. Combining our technical knowledge with their passion and fundraising skills has been an effective means of furthering our mutual goals. Your support of the Dana Johnson Society is directly helping to achieve our goal that every child has a family.

One Sky

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OneSky started by creating Infant Nurture Centers and Preschools for orphaned children in China. The core of the OneSky approach is to train caregivers to use responsive care which promotes growth in physical, social/emotional, cognitive and language development in these vulnerable and underserved children. In 2010, after successfully implementing programs in over 50 orphanages, China’s Ministry of Civil Affairs invited OneSky to train every child welfare worker in the country on how to effectively support the OneSky-inspired programs.Today, variations on the programs are practiced in the majority of state-run orphanages in all 31 provinces. Responding to an increasing number of children with disabilities in state-run orphanages, OneSky developed “Loving Families”, which provides permanent foster families for children whose special needs likely preclude their adoption. OneSky programs focused on early nurture have now expanded to Vietnam, Hong Kong and Mongolia.  Visit onesky.org for more information about this organization. 


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Children with disabilities and children without family care are particularly vulnerable to malnutrition, but good feeding and nutrition practices can change this.SPOON empowers caregivers, creates tools, and strengthens systems to bring critical nutrition and feeding practices to children without family care and children with disabilities. Prior to Spoon, no organization focused on either the nutritional needs of orphans or the challenges of feeding disabled children within an institutional care setting. Collaborating with a variety of international organizations, including UNICEF, Spoon not only trains orphanage caregivers but also parents of children with disabilities. In many cases knowledge and simple equipment can prevent a child with special feeding needs from being institutionalized. Visit spoonfoundation.org for more information about this organization.


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National Council for Adoption is the leading expert on adoption issues, providing resources, education and advocacy for all people and organizations connected to adoption so that every child can thrive in a nurturing, permanent family. The mission is to meet the diverse needs of children, birth parents, adopted individuals, adoptive families, and all those touched by adoption through global advocacy, education, research, legislative action, and collaboration. With funding from the US Department of Health and Human Services’ Children’s Bureau, a team of agencies including NCFA is now creating and testing the National Training and Development Curriculum (NTDC). This evidence-based interactive classroom and online curriculum provides essential knowledge and tools to those interested in fostering or adopting as well as ongoing support for families after placement. Visit adoptioncouncil.org for further information about this organization.


BEB Logo

Both Ends Believing recognizes that one of the barriers inhibiting the transition of children from institutional to family care is the inability of government social workers to access child data in a timely fashion. In response to this need, Both Ends Believing partnering with Tyler Technologies developed Children First Software (CFS). CFS begins with the Profile Module, whereby a child is registered via the creation of a comprehensive electronic record. Profile is the foundation for Planning, Placement and Monitoring Modules, which support a social worker in their decision process to choose the best permanency option for a child. CFS has been embraced at the federal government level in 5 countries – Honduras, Uganda, Dominican Republic, Haiti and Benin with over 12,000 children registered using CFS. In the Dominican Republic, 100% of institutionalized children are registered and on the path to a family via reunification or adoption. In all our client countries, over 500 children have been reunified and over 100 adopted. Visit bothendbelieving.org for further information about this organization.


  1. U.S. Department of State-Bureau of Consular Affairs (2021) Adoption Statistics. https://travel.state.gov/content/travel/en/Intercountry-Adoption/adopt_ref/adoption-statistics-esri.html

  2. van IJzendoorn MH, Bakermans-Kranenburg MJ, Duschinsky R, Fox NA, Goldman PS, Gunnar MR, Johnson DE, Nelson CA, Reijman S, Skinner GCM, Zeanah CH, Sonuga-Barke EJS. Institutionalisation and deinstitutionalisation of children 1: a systematic and integrative review of evidence regarding effects on development. Lancet Psychiatry. 2020 Aug;7(8):703-720. doi: 10.1016/S2215-0366(19)30399-2. Epub 2020 Jun 23. PMID: 32589867.


When Dr. Dana Johnson co-founded the Adoption Medicine Clinic almost all of the advocacy work being done was in Eastern Europe. Today, advocacy work continues in many African countries. Dr. Johnson is pictured here on a trip to Ndola, Zambia, where he helped collect growth data on more than 300 orphaned children to help advise on how to best care for this population or children in the future.


Despite the best intentions of orphanage employees, most are understaffed, underpaid and undertrained. We have the ability to send specialists--like occupational therapist Megan Bresnahan--abroad to train staff to help orphaned children reach their potential and increase their quality of life. Here, Megan demonstrates exercises to help exercise the muscles of this child in an Ethiopian care center who has cerebral palsy.

Clinical Services

In addition to her annual work testifying to the welfare ministry in South Korea about the benefits of adoption, Judy Eckerle also travels frequently to provide medical care and consultation to low-resource orphanages, such as the one this boy lives in in coastal China.