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This introductory chapter explores how working families shaped institutional child care, emphasizing the historical agency of parents and the children themselves in that process. Throughout this study, the term “child care” is used to mean assistance with the daily labor of caring for children; and specifically in the case of orphanages, parents' tactic of placing their children temporarily in institutions with the intention of retrieving them after a relatively short time. Working parents and their children continually cooperated with orphanage managers, who also had to bargain with progressive reformers, staff members, and the broader community over the future of their organizations. The book argues that the development of institutional child care was premised upon and rife with gender, race, and class inequities—these persistent ideologies had consequences for the evolution of social welfare and modern child care.

This study employs biocultural perspectives to explore resource availability, and experiences of enrichment for neglected, abused, abandoned, and orphaned children living in institutional care settings in Jamaica. Long-form interview data were collected and coded from 124 children living in children’s homes, and from 119 children living in familial homes. Residents of children’s homes had fewer friends, and were less likely to share their feelings with peers or adults. They also had limited opportunities for outdoor play. This study highlights the psychosocial and environmental challenges facing these children, and underscores the need for consistent financial support and early mental health interventions.

This concluding chapter demonstrates how James Caldwell's experience highlights the way in which orphanages served as “community institutions,” serving the needs of the local people who used them. But institutional child care was contested terrain. Both the United Presbyterian Orphan's Home (UPOH) and the HCC illustrate how many different stakeholders negotiated the development of child care institutions, each with sometimes competing agendas and expectations. Similarly, the managers displayed motives of social control, wishing to not only assist poor children, but to reform poor families themselves. These managing women were the most powerful stakeholders in the orphanages, but they were never alone; their control of the institutions was mediated by constant interaction with working-class families, reformers, staff, and the broader community.

In this chapter, the authors address infant and toddler flourishing in the context of child care using a well-being perspective, arguing that infant and toddler well-being necessitates health and wellness throughout caring systems that include and surround them. They present a model of well-being informed by Noddings’s (2003) theories of natural and ethical care, and Bronfenbrenner’s (1977) bioecological-relational systems, and that considers current conceptualizations of quality in child care that inform recommended practices with infants and toddlers. The authors urge advocates, researchers, policymakers, and practitioners to care about and with families and professionals who provide primary, relational care for infants and toddlers.