To see Ana* today, poised and pretty at 15, it is almost impossible to imagine her as a starving baby, jostling along the rutted roads of her Georgian village in a handmade wheelbarrow full of junk.

Ana’s father had little choice. His wife had abandoned the family, leaving him sole caregiver for four children, including baby Ana. He struggled with mental illness, making him irascible and explosive—and hard to employ. So he took the baby with him on the rare occasions when he found odd jobs.

The sight of the infant—dirty, ragged and so malnourished she could not hold up her head—prompted neighbors to call authorities.

“Nobody knows what he was feeding her, maybe just bread,” says Nino, who runs the small group home where Ana lives today. The emaciated baby was in such bad shape that the staff at the state-run orphanage took her in, although the rules normally barred children less than 3 years old.

Until recently, Ana was warehoused with 250 other children, including her older siblings, in an institution where she got little individual attention. By the time she emerged 13 years later, she had developed serious health and emotional problems.

“When she moved here in early 2012, she was very reserved,” says Nino. “She would not speak or show any emotion. She sat with her head and eyes downcast, she would not make eye contact or talk. She could not smile at all. If you approached her, she would draw back. She had no interest in how she looked or what clothes she wore.”

Her physical health wasn’t much better. She had chronic ear infections, impaired vision and a bad case of psoriasis. She sometimes flailed her arms and legs, and she rocked back and forth constantly—a behavior often seen in children starved for affection from an early age.

Across Georgia, 45 small group homes have been opened, housing approximately 400 children in groups of eight to 10 children each. Ten children ranging in age from 13 to 17 live in Ana’s house. Each home is staffed by trained caregivers who act as parents, making sure the children are clean and well-fed, helping with homework and assigning chores—and providing a stability that has often been missing.

Ana’s primary caregiver at the group home began to bond with Ana as they focused on her physical problems. “We spent a lot of time together when we were going to doctors,” the caregiver says. “The first time she showed emotion was when she got rid of the psoriasis. She was really happy.” Step by step, she says, Ana began to come out of her shell.

The small group homes are one of the ways USAID is supporting Government of Georgia reform of the country’s childcare system. Georgia inherited a Soviet-style system of large institutions that provided care and support for vulnerable and abandoned children. The children in these large institutions suffered from lack of adequate care; a horrible, overcrowded living environment; and rampant abuse and violence.

Since 2005, Georgia has shut down 36 of the nation’s 41 large childcare institutions. The number of children in state care has dropped from more than 4,000 to 150.

Childcare reform in Georgia has been supported intensively by USAID, through UNICEF, and the European Union since 2005. USAID has contributed $10 million over the past three years, from 2011-2013. The reform involves a consortium of NGOs, professional associations and networks including Save the Children, EveryChild, First Step Georgia, Children of Georgia, the Georgian Association of Social Workers, the Anti-Violence Network of Georgia, SOS Kinderdorf Children’s Village and the Public Health and Medicine Development Fund of Georgia.

Experts agree that it is far better for a child to grow up in a family or a family-like atmosphere rather than in a large institution. Children raised in institutions lag behind others in many ways, from performance in school to emotional and mental health.

Children in Georgia wind up in state care for a number of reasons. An estimated 80 percent of them have relatives, but many can’t afford to care for the children or the families have fallen apart due to poverty or other problems. The state first tries to reintegrate children with their biological families, if possible. The second option is to place children in foster care. If neither of those options works out, the small group homes are the third option.

Ana’s group home is a comfortable two-story building renovated with support from USAID. It has a large, modern kitchen; well-furnished common areas downstairs; a porch with a fine view of the Greater Caucasus Mountains; and airy bedrooms upstairs shared by two or three children.

Nino, who worked for 37 years at an institution before being hired to run the group home, says the difference is immeasurable. “We are grateful to USAID for buying this house so these children can live in such conditions,” she says.

Children and staff are doing their best to make those conditions even better. Under Nino’s leadership, they are systematically transforming the barren and rocky lot around the house into a beautiful patchwork of flower and vegetable gardens.

“At first the kids weren’t very interested in helping, but I just started cleaning, and one by one they started to help,” says Nino. “Eventually all 10 got involved, and now they are very interested.”

The garden is a fitting metaphor for the staffers’ work with the children. As Ana chatters happily about her plans to learn dressmaking and fashion design, her body rocks gently back and forth—a ghostly reminder of the terrible isolation of her early years.

But Nino and Ana’s caregiver have a plan for that too—they’re hoping to get a sewing machine donated for Ana, to focus her attention on mastering new physical skills that, incidentally, will help her support herself when she reaches 18 and has to leave the group home.

Ana says she is happy living in the group home, and appreciates the help she gets from the staff. In the institution, she says, “There were at least 30 of us in one group. They could not pay so much attention to anyone.”

At the group home, she says her caregiver “helps me to learn, and if I want or need something, or if I have a private or personal problem, there is just one caregiver for three of us. She has a lot more time for us.”

Staffers say she is developing other interests as well, from reading history and adventure stories to learning to cook. When she arrived, they say, the only thing she seemed to enjoy was sitting on a sofa and watching TV. Now, Ana says, she is looking forward to studying hotel management in addition to dressmaking: “I like design and painting as well, and I am happy I have plenty of time to learn more.”

Ana says she would tell other children in difficult situations to give the small group home experience a chance. “Kids will easily adjust to this kind of home. They will find warmth here. And they will like it here.”

* All names have been changed or omitted to protect identities.