This article details an early intervention program in orphanages in St. Petersburg, Russian Federation. The program is based upon the analysis of the orphanage system and statistical data on children, personnel, and their interaction. The results of observations conducted before the intervention showed crucial deficits of the caregiving staff with respect to their stability and consistency, as well as responsiveness and emotional availability. Instead, the caregivers focus attention on medical care, education, and daily routine caretaking. This article outlines the guiding principles for the institution-wide early intervention program, with the aim for each child having an early experience of ongoing interaction with his/her own close and emotionally available adults. The outlined program guiding principles were supported by a St. Petersburg, Russian Federation-Pittsburgh, USA joint project with two main interventions: training of caregivers and structural changes in the orphanage to promote family-like conditions for children. An overview of the training intervention is described in a parallel article (Groark, Muhamedrahimov, Nikiforova, Palmov, & McCall, in press). The structural changes intervention was aimed at improving stability and consistency of caregivers and creating a more family-like environment that would support relationship building. Specifically, it consisted of smaller group sizes, integration by age and disability status, primary caregivers who were present every day, Family Hour, pullout groups, and team-like staff organization. Observations and early data analysis show the effective implementation of the structural changes intervention, an increase in the consistency and stability of caregivers, and changes in children and caregivers.