This field study describes changes in caregiving and young children's physical and behavioral/cognitive development as a consequence of a pilot intervention using typical staff in 2 Central American orphanages for children with severe and multiple disabilities. The intervention trained staff in sensitive, responsive, child-directed, caregiver-child interactions; provided on-the-ward coaching; and changed staff employment practices to promote greater stability of caregivers in children's lives. In addition, trainers of caregivers received 5 hours of instruction on positioning, handling, and other aspects of working with children with severe disabilities. Caregivers improved their appropriate positioning and handling of children and sensitive and responsive caregiving, and children improved in physical and behavioral/cognitive development. This pilot study shows that typical orphanage staff can improve the development of infants and young children with severe disabilities by increasing their sensitive, responsive caregiving with minimal specialized professional services.