This study represents a quasi-experimental test of the role of early social–emotional experience and adult–child relationships in the development of typically developing children and those with disabilities birth–4 years of age living in orphanages in St. Petersburg, Russian Federation. Caregivers performed routine duties in a perfunctory, business-like manner with minimal interaction with children, and children had 9–12 caregivers per week and as many as 60–100 different caregivers over the first 2 years of life. Orphanages were non-randomly assigned to one of two intervention or a no-intervention condition. Training staff members to engage in warm, sensitive, responsive, and developmentally appropriate interactions during routine care giving duties and altering the structure of care (e.g., higher caregiver-child ratios, stability of caregivers) were associated with substantial improvements in the development of children. Although training alone was less effective than training combined with structure changes, training alone was more effective than no intervention. These findings provide a rationale for making similar improvements in other institutions and perhaps in foster care and non-residential care environments as well and for balancing skill building with social–emotional-relationship training in early childhood personnel preparation curricula.