The forms of problems that the children experience are usually a result of the HIV/AIDS pandemic, extreme poverty combined with other psychosocial risk factors, child abuse (especially sexual abuse of children) and violence. Effectiveness of the SP based on the focus group discussions 216 Figure 9.5: Degree of involvement by SP participants in PSS activities 224 Figure 11:1: Sample distribution according to vulnerability status and gender.
DISCUSSION AND CONCLUSIONS Chapter 12: Discussion of Results
Defining Key Terms
- Children and Childhood
- Rationale for the focus on vulnerable children
- Rationale for the focus on strengthening the community to support vulnerable children
Moreover, the construct of childhood is undergoing rapid redefinition in the context of the HIV/AIDS pandemic. The psychosocial impact of the HIV/AIDS pandemic on the psychosocial functioning of children is addressed in Chapter 3.
The demography of a modern day plague
However, the sheer scale of the HIV/AIDS pandemic and the number of children affected appears to be unprecedented in history (Hunter & Williamson, 2000; Sherr, 1995). In sub-Saharan Africa, the number of orphans is increasing dramatically in both real and relative terms.
Epidemiological factors impacting on the psychosocial well-being of children
- The changing face of society
- Transmission of HIV
- Course of HIV/AIDS
The number of households in sub-Saharan Africa that currently have orphaned children in their care (usually in informal care) is already a significant proportion of the total. The rate of child sexual abuse is likely to increase as a result of some of the myths that have developed about HIV treatment.
General issues impacting on the well being of children
- HIV/AIDS and poverty
- Stigma, secrecy and social isolation
However, in the face of the current pandemic, they need support to prevent the negative impact of HIV/AIDS on children (Foster, 2001). HrV infection is associated with a great deal of stigma due to the widespread belief that HTV only affects bad and immoral people (Clacherty & Associates, 2001; Mailman, 2002; Smart, 2000) who are seen as shamefully different (Fox et. al. , 2002).
The emotional impact of HIV infection
The psychosocial impact of HIV/AIDS begins when the parent or primary caregiver becomes infected with HIV and continues long after the death of the parent(s). The emotional impact of HIV infection that begins when the parents realize they may be HIV+ and suffer from a stigmatizing terminal illness.
Illness, home-based care and witnessing physical debilitation
Wild, 2001 ).The awareness that one may be HIV+ is often associated with the beginning of a long period of instability during periods of hospitalization and illness of the parent. The death of a parent from an AIDS-related illness is particularly difficult because of the stigma and real-life consequences for the children (Lin, Rotheram-Borus & Stein, 2001; Reyland, McMahon & Higgins-D'Alessandro, 2002) .
Changes consequent to the death of a parent
- The decision-making process
- Sibling dispersal
- Inheritance praxis
- Impact of multiple losses
The sheer scale of the pandemic, particularly in northern South Africa, has changed traditional strategies for deciding who should take over the custodial care of orphaned children (Cook, . 1998; SCOPE & Family Health International, 2001). Unfortunately, in certain situations where the parent has provided financial security for the children, this can leave them vulnerable to being perceived as financial assets by relatives eager to take over the care of the children simply because they bring in money and other resources. (Gilborn & Nyonyintono, 2000; SCOPE & Family Health International, 2001).
Impact of alternate care placements
- Foster care
- Institutional care
The latter is more likely to be a formal/legal arrangement in which the custodial parent receives a grant to meet the child's financial needs. Wherever possible, children in Europe are placed in foster care or adoption 'in the best interests of the child' (Goldstein, Freud & Solnit, 1973).
Child-headed households
- Abandoned and street children
The children may thus decide to try to cope on their own without the support of the extended family. Alternatively, they may choose to live on the streets most of the time and return home at regular intervals.
The HIV+ child and children's understanding of illness and death
In the Western world, MTCT has been almost eliminated (UNAIDS, 2001) by the use of highly active antiretroviral therapy (HAART). Little is known about how children suffering from a deadly disease in the midst of a pandemic cope with or understand the disease.
Preventing HIV infection in children and youth
Clearly, the HIV/AIDS pandemic challenges the implementation of these principles, bringing the protection and promotion of human rights into sharp focus. Children have human rights in relation to the HIV/AIDS pandemic in three ways: (i) as HIV-infected children; (ii) in their vulnerability to infection; and (iii) as children affected by the HIV/AIDS status of a family or community member. A human rights framework for children infected, affected or vulnerable to HIV/AIDS must be developed as a standard for the protection of the rights of all vulnerable children.
A research and action agenda
The Convention on the Rights of the Child (CRC), which has been ratified by almost all countries (the United States and Somalia being the only two exceptions), has four general principles: (i) non-discrimination. ii) the best interests of the child; (iii) survival, life and development; and (iv) participation (UNICEF, 1989). The inherent vulnerability of children, the enormity of the epidemic, the cascading impact on household and community economies, and the psychosocial consequences of these variables require a human rights perspective in developing and implementing appropriate responses. A realistic definition of the impact of HIV/AIDS on children would include the holistic needs of children.
Literature Review
The developmental trajectory
Most risk studies have adopted the convention of a somewhat simplified division of psychopathologies into two superordinate constructs in the classification of developmental psychopathology: externalizing and internalizing disorders (Fleming, Mullen & Bammer, 1997; Kazdin, 2000; Killian & Brakarsh, 2004; Masten, 1997; Smith & Carlson , 1997). Internalizing disorders are poorly recognized by caregivers, educators and even children themselves. Therefore, internalizing disorders are thought to be underrepresented in large-scale research where the instruments used to measure distress have been in the form of checklists (Luthar & Cicchetti, 2000).
Relevance of stress to psychosocial models of adaptation
The cognitive appraisal of the interaction of the stimulus determines the response, causing variations in it. These external sources of stress are considered particularly persistent in the children's lives within the current research context. Although some events, such as the death of a parent, may be considered inherently stressful, the child's assessment of the situation is critical.
Models of risk and vulnerability
Risk factors are defined as any influence that increases the statistical probability of the occurrence, maintenance or worsening of a problem condition (Coie, Watt, West, Hawkins, Asarnow, Markman, Ramey, Fraser, 1997; Luthar & Cicchetti, 2002; Rutter, 1999; Shure & Long, 1993). While the presence of two risk factors can result in a fourfold increase in the likelihood of an adverse outcome, the presence of four or more factors can result in a tenfold increase (Luthar & Cicchetti, 2000; Rutter, 1979; Sameroff). , Seifer & Bartko, 1997). To confirm these estimates, Jenkins and Keating (1999), using a cross-sectional methodology with children aged six and ten, found that children who were not exposed to any risk factors showed approximately a 10% rate of problem behavior compared to children , who were not exposed to any risk factors. a fivefold higher rate (50%) in children who were exposed to four or more risk factors.
Risk factors relevant for children in high prevalence HIV/AIDs communities
- Poverty
- Lack of secure attachment to a primary care-giver
- Exposure to political violence and discrimination
- Children's understanding of illness and death
- Child abuse
Logically, emotional and experiential factors would be crucial in the child's understanding of these concepts, as well as in determining the level of sophistication of the child's view of illness and death. For example, Piaget's theory of cognitive development has been used as a basis for understanding the developmental sequence of children's understanding of illness and death (Killian & Perrott, 1994). The consequences of child sexual abuse (CSA) on the social and psychological functioning of the child victim can be extreme.
Summary and critique of the risk and stress related literature
Levett (1989) states that individual circumstances must be taken into consideration to understand the degree of impact on the child. One must be aware of the criticisms that have been made of the risk literature. Equating risk, deficiency and problems can have serious consequences, such that all children exposed to certain risks (orphans, poor children or abused children) are considered 'problems'.
Issues of definition and function
1999; Sameroff & Seifer, 1987, in Rolf et al., 1990), indicating once again that a systemic perspective on the social ecology of childhood is required. In adults, the three critical components of resilience appear to be a firm acceptance of reality; a deep belief, often supported by strongly held [religious] beliefs, that life is meaningful; and an uncanny ability to improvise (Coutu, 2002, p. 48). iv) Certain protective processes are linked to cognitive, emotional or social maturity, as they only come into play when the child matures (Elder, 1995;.
Models of resilience
A third model of resilience focuses on the principle that certain children, families, and communities have protective capacities or processes that enable them to better cope with the trials and tribulations of life. An integrative systemic model of resilience and risk, consistent with Bronfenbrenner's (1986a) systems theory (see Chapter 4), and consistent with the categorization of protective processes presented in Table 5.1, is conceptualized (see Figure 5.1) as being a model that incorporates the principles of systems theory, as well as those related to the concepts of risk and resilience. This model of resilience incorporates the different types of processes (resilience is not a discrete quality) that have been internationally recognized as integral to understanding and utilizing the concept of resilience.
Descriptions of the protective processes
- Intrapsychic strengths
- Genetic and temperamental internal strengths
- Intrapsychic strengths and assets
- Interpersonal assets and skills
- Accessing social support
- Adaptive coping in childhood
- External supports and resources
- Resilient families
- Effective Schools
- Community and cultural resilience
- Measuring resilience
- Mechanisms through which resilience can be developed
- Translating theory into practice
- Macro/exosystemic components of intervention
- PSS starting with community entry
- PSS through the process of community mobilisation
- Sensitisation Programme [SP]
- PSS through structured group psychotherapy with vulnerable children
Nevertheless, some of the action-focused coping strategies appear to be associated with greater resilience (Grotberg, 1995, Lazarus, 1991; Richter et al., 1994). Relatively few of the participants in the pilot program changed their pattern of microsystemic interaction with children. The SP (Killian et al., 2002) therefore became an integral part of the process by which this community-based intervention could meet the psychosocial needs of children.
Much of the theoretical consolidation in the field of group psychotherapy is based on the seminal work of Yalom (1985). The daily routine consisted of 7 sections: i) initiation ritual; (ii) an introduction to the topic of the day; (iii) the first unit of work; (iv) break &.
Methodology
- The research ethic
- Rationale for this research programme
- The research questions
- The first unit of analysis: Evaluation of the community-based variables
- Second unit of analysis: Vulnerable children
- An overview of the programme: matching research typology with intervention
- Issues of translation and concept interpretation
- Ethical considerations
- Describing the context
- Community profiles
The main focus of this research program is the summative evaluation of SP and SGTP. Although the researcher hoped that one of the results of community entry and mobilization. of the total number) of the SP participants (a citation sample of approximately 20 people from each community) completed the Community Profile Questionnaire (CPQ)1.
1 lAfcBWbLi
Socio-economic context
At the other end of the spectrum, 3.4% of respondents had a total monthly household income of more than R4000:0() (these were mainly traditional leaders and professionals - social workers and educators - who followed SP). In conditions of such abject poverty, one can understand why catering became a key feature of the program for both adult participants in SP and children during SGTP. There was variation across geographic regions in terms of respondents who received grants and the type of grants they received (See Table 7.7).
SP participants' perceptions of problem areas
- Summation
It seems that the main defining characteristic of the nine partner communities is the extreme poverty in which they live and survive. In this section, the methodology, results and discussion on the evaluation of the Awareness Program are presented. In developing the outreach program it was recognized that all the partner communities had faced different difficulties, including extreme poverty (Richter, 1994) and a history of political discrimination and violence (Dawes & Donald, 1994; Higson-Smith & Killian , 1999).
The research questions in relation to the partnering communities
The aim of SP was therefore to create greater awareness, understanding, compassion and care at the micro-systemic levels within the partner communities. The formative evaluation addressed strategies for improving SP and responding more effectively to the needs of participants. Thematic analysis of SP with (i) post-workshop questionnaires and (ii) focus group discussions to assess the effectiveness of SP.
Action research
- The exploration of community conceptualisations of key concepts
- Health, illness, death, community and orphanhood
- Vulnerable children
- Analysing the community inputs
On the last day of SP, participants were asked to prepare action plans for community initiatives to offer PSS. On the first day of the SP, the concepts of health, illness, death, community and orphans were discussed. On the second day of SP, community members were asked to discuss the concepts of risk.
