SECTION II Literature Review
53. Descriptions of the protective processes
5.6. Translating theory into practice
(2000) was considered to be especially useful in this regard. Working with AIDS orphans in Tanzania, Madorin developed a structured group therapy programme that systematically enabled children to deal with their experiences of risk and to enhancing the development of resilience (ibid.).
Mad8rin's programme was adapted for the South African context, with the aim of further developing the resilience enhancing variables and including a greater focus on cultural rootedness (Killian, 2002). The resilience promoting strategies that are incorporated in this community based intervention programme are listed Table 5.3, where the reader will note the marked similarity with the protective processes that tabulated in Table 5.1.
A significant conclusion from the International Resilience Research Project was that resilient individuals are helped to become resilient. Although, Grotberg (1995) defined resilience as the universal capacity that allows a person, group, or community to prevent, minimize or overcome the damaging effects of adversity, it is important that partnerships be formed to facilitate this process.
People can be helped to draw on their inner resources and strengths within a structure of guidance, direction and support (Grotberg, 1999; Masten, 2002).
The concept of psychosocial support (PSS) became the central mechanism through which the impact of community-based initiatives could usefully translate the theoretical literature on resilience with grass-root practice. While children's educational and physical needs are more obvious, there has been a tendency to neglect their psychological, social, and spiritual needs. The study of risk and resilience has thrown into sharp focus the need to address these psychosocial needs. The theoretical literature enables systematic building of resilience in children and communities. The dire predictions associated with the risk literature indicate that there will be several generations of children who will loose out on the basic socialisation processes that are integral to the functioning of a civil society. On the other hand, the resilience literature offers several meaningful ways in which effective interventions can meet the needs of children, families and communities rendered vulnerable through the HIV/AIDS pandemic.This intervention programme aimed to target several aspects of microsystemic interactions in order to build and enhance resilience and minimise the impact of the risks to which children were being exposed. Having developed the programme, it was important to shift the focus away from adversity, illness (HIV/AIDS) and risk to resilience and coping, and to look at what works and what does not work (Ungar, 2003).
SECTION III
The intervention programme and context of evaluation
In this section of the dissertation, the programme development is described, and the two programmes that were the specific focus of this research are outlined (with a more detailed overview in Appendices D and E). The reader will note that in accordance with contextually based theories of child development, it was essential to integrate microsystemic and macrosystemic strategies into this holistic intervention programme (Chapter 6). This however makes the reporting of the procedure complex, and so the chapter on programme development is followed by an outline of the overall intervention/research programme (Chapter 7).
By beginning with a presentation of the broader research methodology, it is hoped that the reader will be able to track the process of grounding the research within the partnering communities. The basic research ethic was one of participatory action research, as this was considered to be the optimal method through which communities could be strengthened to offer psychosocial support to their vulnerable children. It was thus imperative that community members viewed themselves as co-participants and co- researchers in the process. They were regularly consulted and gave advice. Their information was valued as being contextually rich and relevant in terms of offering support to their vulnerable children.
The reader will see that the process, described in Chapter 7, continually wrestled with the tensions created in real world research contexts, in which the rigours of research could not be compromised by the need to empower and enrich the participants in the research. This was difficult and time-consuming, but ultimately increased the effectiveness of the two programmes - the Sensitisation Programme (SP) and the Structured Group Therapy Programme (SGTP) - that are essentially the focus of this research.
The evaluations of these two programmes are described in Sections 4 and 5 respectively of this dissertation.
Chapter 6
Programme Development
"It is impossible to overemphasize or exaggerate the scope and complexity of challenges faced by children affected by HIV/AIDS and by the families, communities and governments responsible for them" (Atwood, 1997, p.l)
Over the last few years many programmes have developed in response to the dire needs of children who have frequently been perceived to be the helpless victims of the HIV/AIDS pandemic (Germann, 2002). Care and support in crisis situations usually begins by trying to meet basic physical needs, in much the same manner as the Red Cross has assisted in disaster areas for many decades. War nurseries, refugee camps, and children's homes are also reflective of this form of intervention. In many of these circumstances, children's psychosocial needs have been neglected (Burr & Montgomery, 2003). For example, in many parts of the world institutional care has repeatedly been shown to be less than satisfactory due to its disregard of children's psychosocial needs (Burr & Montgomery, 2003; Dunn et al., 2003). Institutional care has the added disadvantage of not being economically viable (UNICEF, 1999). While crisis and reactive programming usually addresses children's basic physical and educational needs, there is little focus on their emotional, social and spiritual needs. Meeting children's physical and educational needs is a resource-intensive activity, that is usually accompanied by the assumption that their psychosocial needs are automatically met through the compassionate care of those who are in daily contact with the children. This assumption is seldom valid.
Recognising the need to promote effective interventions with children affected by HIV/AIDS, various international aid organisations developed a strategic framework to guide appropriate programming (Hunter & Williamson, 2002). This strategic framework is the co-ordinated plan offered by the major international stakeholders (including UNA1DS, UNICEF and USA1D) and is consistent with other intervention objectives that have been suggested (Family Health International, 2001). It also complements the United Nations General Assembly Declaration of Commitment (UNGASS, 2001) in which policy developers from the United Nations, governments and NGO's undertook to develop national policies and strategies that build the ability of all key-stakeholders to support children infected with and affected by HIV/AIDS. Implementation by 2005 was agreed upon.
Some African countries are making progress towards the achievement of these goals (Germann &
Stally, 2003).
The challenges posed by the enormity of the HIV/AIDS pandemic dictate that comprehensive, cost- effective approaches based on coordinated partnerships in which community mobilisation occurs (Family Health International, 2001). To this end, the purpose of both the strategic framework and the UNGASS declaration is to enhance the global, national and local responses by providing guidance and a common point of reference for those working with vulnerable children, families and communities affected by HIV/AIDS (Hunter & Williamson, 2002; UNICEF, 1999; USAID & the Synergy Project of TVT Associates, 2001). The five strategies, contained in the strategic framework, reflect the evolving and dynamic principles that should guide effective intervention strategies for children12 (Hunter & Williamson, 2002; USAID, 2004):
Strategy 1: Strengthen and support the capacity of families to protect and care for their children.
This strategy acknowledges the critical role of the family. The objective is to empower families to provide care, support and protection to vulnerable children through economic strengthening and psychosocial support.
Strategy 2: Mobilise and strengthen community-based responses by enabling communities to organise themselves to identify the most vulnerable children and to channel local and external resources to the most needy. Community mobilisation has become a key activity in many effective intervention programmes (Aggleton & Warwick, 2003; Hunter &
Williamson, 2002; Levine & Foster, 1998; Mann, 2002).
Strategy 3: Strengthen the capacity of children and young people to meet their own needs, to fulfill their right to participation, to integrally involve them in the solution, and to ensure that they remain in education for as long as possible. This strategy is in line with the CRC (UNICEF,
1989) and sees children as part of the solution.
Strategy 4: Ensure that governments develop appropriate policies to include programmatic frameworks and essential services for the most vulnerable children. The UNGASS Declaration of Commitment (2001) services this strategic initiative.
Strategy 5: Raise awareness within societies to create facilitative and compassionate environments that generate shared responsibility and decrease stigma and discrimination.This overarching aim is consistent with the other five strategies and would usually be implemented through social and health service provision, community mobilisation, media programmes and microsystemic interactions.
12The underlining principles that inform these strategies are presented in Appendix A.
Using Bronfenbrenner's (1986b) theory of the social ecology of child development, the inter- relationship between the five basic strategies can be diagrammatically (see Figure 6.1). The axiomatic principles underlying systemic theories13 explain the dynamic, inter-active and multi- directional zones of influence between these strategies/systems. Strategy 4 can be conceptualised as being focussed primarily at the macro/exosystemic levels, whilst strategies 1, 2, and 3 operate principally within microsystems. Strategy S needs synergistic programming across all of the systemic levels. Child-sensitive policies and essential services at global, national and local level, together with increased awareness, compassion, understanding and commitment at all systemic levels, would meaningfully reduce the adversities and risks experienced by vulnerable children. This would mediate risk variables and build individual and group resilience.
Figure 6.1: Conceptualising the strategic framework within a systemic perspective
Strategy 1 | Strategy 3 |
Strategy
2 |
* - »
Strategy 4 and
Environmental resources and risks
*
•
Interpersonal resources and risks Intrapsychic resources or risks
Microsystemic interactions
^ Exosystemic interactions
5 1 ^ ^ ^ > M e s o s y s t e m i c a n d M a c r o s y stem ic interac tions
Operationalising the strategies requires the mobilising and strengthening of local initiatives (Hunter
& Williamson, 2002). There is a need to design culturally and epidemiologically specific responses by adapting interventions for local conditions at both national and community levels (UNA1DS Best Practice Collection, 1997). While some programmes have been identified as "best practice models"
The systems approach is based on the premises that (i) development is based on a complex network of multidirectional interactions between all systems in a society, (ii) individuals are active participants in their own socialisation; and (iii) all systems are dynamic adaptive structures that simultaneously influence each other in a circular and reciprocal fashion in an endeavour to find equilibrium.
(USA1D, 2001), the grassroots circumstances are complex and cut across all levels of community functioning. Imported models are only likely to be effective if they include local stakeholders who endorse and support the intervention (Duffy & Wong, 2000). Interventions that draw on and incorporate local wisdom and experience have the greatest probability of being both effective and sustainable (Cook, 1998). There needs to be a sense of ownership among the stakeholders who live and work within the affected communities (Duffy & Wong, 2000; Meintjes, 2003).
Of course, there is no need to reinvent the wheel each time an intervention is planned. Valuable lessons have been learnt from earlier responses that attempted to limit the destructive impact of HIV/AIDS since the beginning of pandemic in the mid 1980's (Family Health International, 2001).
One such lesson is that synergistic programming is a means through which various policies and intervention programmes can work together harmoniously in a co-ordinated and collaborative manner to meet the needs of the whole child across all systemic levels. Synergistic programming aims to create a facilitative environment in a mutually reinforcing manner so that comprehensive integrated care is offered to vulnerable children, their families and communities. In applying the strategic initiatives identified by the international consortium (Hunter & Williamson, 2002), one can discern various operating principles (see Appendix A) that inform effective interventions. These principles encourage synergistic programming by specifying that the various components of integrated intervention strategies need to be co-ordinated and collaborative (UN1CEF, 2001).
Increased participation, transparency and accountability at all levels is necessary to integrate these principles into programmatic interventions (USAID Office of Sustainable Development, 2002).
There is no doubt that the strengthening of cross-sectoral linkages increases the impact of intervention programmes and generates greater sustainability.
In terms of the strategic framework, there are two strata of ecological concern: (i) macro/exosystemic commitment that generates and implements policies to enhance general well-being; and (ii) microsystemic participation and assistance to mobilise and strengthen supportive interactions between children, families, communities and service providers.