Hope and Hard Data: the Bucharest Early Intervention Project
- Ellen Jopling
- 3 hours ago
- 5 min read
In 1989, the reign of Romania’s Communist leader came to a sudden, brutal end when Nicolae Ceauşescu was executed by firing squad on live television. In the revolution that followed, international observers rushed into a nation long sealed off from view – only to discover nearly 170,000 abandoned children being raised in warehouse-like orphanages.
In response, at the request of the Secretary of State for Child Protection in Romania and in collaboration with the Romanian Ministry of Health, a group of US researchers launched the Bucharest Early Intervention Project (BEIP). For those unfamiliar, the BEIP is the only long-term randomized study that placed children being raised in state-run institutions either into high-quality foster care or to care-as-usual, to determine whether family-based care could repair the socioemotional harm caused when children’s earliest years were spent in institutions rather than families. It is a landmark study that has fundamentally shaped what we know about the impacts of early adversity.
As a researcher interested in the ways in which early adversity (e.g., abuse and neglect) “gets under the skin”, I had a clear goal for my postdoctoral training: to work on the Bucharest Early Intervention Project (BEIP).
The research I have completed over the course of my postdoctoral fellowship has focused on how early institutional care (and subsequent placement into high-quality foster care) impacts wellbeing during adolescence and early adulthood in the context of the BEIP.
The BEIP Study
The BEIP began during a time when Romania had essentially no foster care system and relied on large, state-run institutions (warehouse-like orphanages) to raise children. Under dictator Nicolae Ceauşescu, harsh pronatalist policies (i.e., encouraging an increased birthrate) coupled with widespread poverty resulted in many families abandoning children they could not afford to raise to these institutions. This practice was supported by the regime’s widespread belief that the state could raise children more effectively than their families. Even after Ceauşescu’s deposition in 1989, widespread poverty and institutionalization continued, and Romania was struggling to restructure child protection while managing enormous numbers of institutionalized and newly abandoned children.
The aim of the BEIP was to improve the welfare of Romanian children by establishing foster care that was affordable, culturally sensitive, and replicable in other settings. In tandem, this project offered an unprecedented opportunity to examine the effects of institutionalisation on the brain and behavioural development of young children and to determine whether these effects could be remediated through intervention - both of which would have enormous implications for children worldwide.
It is not an exaggeration that the BEIP offers the strongest existing evidence that the early social environment strongly impacts development and can be substantially improved through high-quality foster care early in life.
The BEIP has followed 136 abandoned infants and toddlers. Half of the children were randomly assigned to foster care while the other half were assigned to care as usual. A matched comparison sample of children raised in their birth families were also followed, to contextualise developmental outcomes.
Over more than two decades of follow-up, the BEIP has provided the strongest causal evidence to date that severe early psychosocial deprivation profoundly shapes development, and that early, stable, family-based care can substantially alter those trajectories.
Children who remained in institutions showed lower IQ, more emotional and behavioural difficulties, and atypical attachment patterns. However, children placed into high-quality foster care - especially before the age of two - demonstrated striking improvements across cognitive, emotional, and social domains.
My research on the BEIP has been both hard and hopeful.
The hard
The arms of early adversity reach deep within one’s biology and across the lifespan.
I have shown that growing up in an institution can have long-lasting effects on children’s development. It can alter functioning of the cardiac and metabolic systems; accelerate biological aging; and can influence how well someone copes and functions during early adulthood. Across this work, one thing has emerged as crystal clear: stability matters. Disruptions in care – being moved from one placement to another – can affect the timing of puberty and can further speed up the ‘ticking’ of the biological aging clock across childhood and adolescence.
However, the importance of stability cuts both ways, and herein lies the hope.
The hope
While both early institutionalisation and disruptions carry risks, stability of the caregiving environment is protective.
While young people with a history of institutional care showed poorer functioning during early adulthood (e.g., less engagement in education and skilled employment), those who experienced stable foster care placements during childhood showed greater educational engagement and higher-skilled employment than those with disrupted placements.
The lesson across two decades of data is remarkably consistent: stability matters. Early, nurturing, and consistent caregiving does not simply improve behaviour – it shapes physiology, developmental timing, and adult functioning.
The Implications
BEIP’s findings make clear that early, stable, family-based care is not only preferable but is biologically and developmentally necessary for healthy maturation across childhood and into emerging adulthood.
Findings also highlight that child welfare systems must prioritize placement stability – not just removal from unsafe environments – if they truly wish to support children’s long-term physical health, mental health, and capacity to meaningfully participate in adult roles.
Even more broadly, the BEIP demonstrates that policies and interventions implemented during the earliest years of life can shape trajectories across the lifespan, altering both risk and resilience.
The relevance of BEIP in 2026
Living in the United States during my postdoctoral training has further driven home the broader implications of BEIP findings, beyond the post-communist Romanian context.
In the US, 80% of all cases reported to child protection services involve neglect – and estimates suggest that 85 to 95% of children in foster care experience at least one placement disruption while in care. While the ‘zero tolerance’ policy (which aimed to prosecute all adults crossing the US-Mexico without inspection) was officially ended in 2021, families continue to be separated at the border under other practices and policies.
Currently in 2026, parents are being detained and deported by the United States Immigration and Customs Enforcement (ICE) while children remain in the United States; many previously separated families have yet to be reunified; and reports continue to emerge detailing where detention effectively separates families and exposes children to unacceptably adverse conditions.
The science is clear: separating children from primary caregivers and subjecting them to unstable care environments carries measurable biological and developmental consequences,
which underscores the importance of evidence-informed policies aimed at minimizing child-caregiver separations.
Looking Forward
As I prepare to move beyond my postdoc to become an Assistant Professor at Dalhousie University in Canada, I am committed to continuing this work at the intersection of biology, development, and policy, with the aim of generating the kind of hard data that makes it impossible to ignore children’s need for stable, nurturing care.
Following the outstanding examples of my formidable mentors on the BEIP, Drs. Charles Nelson, Nathan Fox, Natalie Slopen, and Charles Zeanah, I am dedicated to spending my career ensuring that what we now know from the BEIP—that adverse early experiences literally get under the skin—translates into systems that protect, rather than undermine, children’s lifelong health and potential.
