Authors: Ssewamala FM, Sperber E, Blake CA, Ilic VP.
Abstract: Youth of color are disproportionately likely to grow-up in poor, disadvantaged neighborhoods characterized by high levels of psychosocial stressors and inadequate supportive resources. Poverty and racial minority status correlate with an increased risk of high-school dropout, teen pregnancy, substance abuse, and sexually transmitted infections (STIs). Given these trends, child welfare researchers are developing various interventions to increase the protective resources and social opportunities available to youth of color. This article reports results of a preliminary, qualitative study that investigated the feasibility and acceptability of an economic empowerment intervention in the South Bronx and East Harlem, New York. Using focus groups and brief questionnaires with youth and their parents/guardians (N=24 dyads), we explored attitudes toward youth educational savings accounts, financial planning classes, and mentorship for inner-city youth. Findings indicate a strong interest in an economic empowerment intervention among adolescents and their caregivers in these communities. These findings have implications for the design of larger-scale research programs that aim to improve inner-city youth’s socio-economic wellbeing using economic empowerment models.
[button link=”http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22581997/”] Read More[/button]
Author: Ssewamala FM, Neilands TB, Waldfogel J, Ismayilova L.
By adversely affecting family functioning and stability, poverty constitutes an important risk factor for children’s poor mental health functioning. This study examines the impact of a comprehensive microfinance intervention, designed to reduce the risk of poverty, on depression among AIDS-orphaned youth.
Children from 15 comparable primary schools in Rakai District of Uganda, one of those hardest hit by HIV/AIDS in the country, were randomly assigned to control (n = 148) or treatment (n = 138) conditions. Children in the treatment condition received a comprehensive microfinance intervention comprising matched savings accounts, financial management workshops, and mentorship. This was in addition to traditional services provided for all school-going orphaned adolescents (counseling and school supplies). Data were collected at wave 1 (baseline), wave 2 (10 months after intervention), and wave 3 (20 months after intervention). We used multilevel growth models to examine the trajectory of depression in treatment and control conditions, measured using Children’s Depression Inventory (Kovacs).
Children in the treatment group exhibited a significant decrease in depression, whereas their control group counterparts showed no change in depression.
The findings indicate that over and above traditional psychosocial approaches used to address mental health functioning among orphaned children in sub-Saharan Africa, incorporating poverty alleviation-focused approaches, such as this comprehensive microfinance intervention, has the potential to improve psychosocial functioning of these children.
[button link=”http://linkinghub.elsevier.com/retrieve/pii/S1054-139X(11)00283-7″]Read More[/button]
Authors: Boothby N, Wessells M, Williamson J, Huebner G, Canter K, Rolland EG, Kutlesic V, Bader F, Diaw L, Levine M, Malley A, Michels K, Patel S, Rasa T, Ssewamala F, Walker V.
Children outside of family care face increased risk of threats to their well-being, have lower educational achievement, and experience adverse developmental outcomes. While it is generally accepted that early response and intervention is critical to reducing the risk of harm for children who have been separated from their families, it is not always clear what the most effective early response strategies are for assessing and addressing their immediate needs. The purpose of this review was to identify evidence-based early response strategies and interventions for improving the outcomes of children outside of family care, including children of and on the street, institutionalized children, trafficked children, children affected by conflict and disaster, and who are exploited for their labor.
A multi-phased, systematic evidence review was conducted on peer-reviewed and gray literature, which yielded a total of 101 documents that met the inclusion criteria and were reviewed.
Overall there is a weak evidence base regarding assessment and early response interventions for children living outside of family care. Few studies included careful outcome measures or comparison groups. Although few proven interventions emerged, the review identified several promising early interventions and approaches. In emergency settings, family tracing and reunification is a highly effective response in regard to separated children, whereas placing children in institutional care is problematic, with the possible exception of time-limited placements of formerly recruited children in interim care centers. Livelihood supports are promising in regard to preventing and responding to children living outside family care. Other promising interventions include psychosocial support, including the use of traditional cleansing rituals as appropriate, educational supports such as Child Friendly Spaces, the maintenance of family connectedness for children of or on the streets, the use of community-based approaches that aid social integration, and approaches that enable meaningful child participation. A recurrent theme was that to be effective, all assessments and interventions must fit the context.
A strong need exists for strengthening the evidence base regarding the effectiveness of early assessments and responses to children living outside family care and for using the evidence to guide operational policy and practice. Recommendations regarding policy, practices, and research emerged from the review process.
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Authors: Karimli L, Ssewamala FM, Ismayilova L
To understand the role of extended family in responding to problems of AID-orphaned children and adolescents in Uganda, the study examines who are the primary caregivers of AIDS-orphaned children and adolescents, what are the types of caregiving provided to orphans and whether the quality of caregiving varies by the primary caregiver’s gender and type.
The study uses bivariate analyses and mixed effects models utilizing baseline data from a cluster randomized experimental design including 283 orphaned adolescents in Uganda.
The analysis revealed a generally dominating role of female caregivers for both single and double orphans. In the absence of biological parents – as in the case of double orphans – grandparents’ role as caregivers prevail. On average, the study participants indicated receiving the high level of perceived caregiver support: the average score of 3.56 out of 4 (95% CI=3.5, 3.65). Results of mixed effect models (adjusting for school effects) revealed significant differences in perceived caregiver support by caregiver’s gender. Compared to their male counterparts, female participants with whom the child/adolescent lives (B=0.22, 95% CI=0.11, 0.34) and women who are currently taking care of a child/adolescent (B=0.15, 95% CI=0.05, 0.26) provide greater caregiver support as perceived and reported by a child/adolescent. Similarly, female financiers – compared to male source of financial support – provide greater caregiver support as perceived and reported by a child/adolescent (B=0.16, 95% CI=0.04, 0.3).
Our findings demonstrate that extended families are still holding up as an important source of care and support for AIDS orphaned children and adolescents in Uganda. The findings support the argument about importance of matrilineal and grandparental care for AIDS orphans.
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Authors: Campbell C, Skovdal M, Mupambireyi Z, Madanhire C, Nyamukapa C, Gregson S.
Abstract: Given relatively high levels of adherence to HIV treatment in Africa, we explore factors facilitating children’s adherence, despite poverty, social disruption and limited health infrastructure. Using interviews with 25 nurses and 40 guardians in Zimbabwe, we develop our conceptualisation of an ‘adherence competent community’, showing how members of five networks (children, guardians, community members, health workers and NGOs) have taken advantage of the gradual public normalisation of HIV/AIDS and improved drug and service availability to construct new norms of solidarity with HIV and AIDS sufferers, recognition of HIV-infected children’s social worth, an ethic of care/assistance and a supporting atmosphere of enablement/empowerment.
[button link=”http://linkinghub.elsevier.com/retrieve/pii/S1353-8292(11)00124-9″]Read More[/button]
Authors: Skovdal, Morten
Abstract: This article reviews the expanding body of literature that examines the mental health of HIV-affected children in sub-Saharan Africa. Focusing on primary research across disciplines and methodologies, the review examines the use of universalistic assumptions about childhood adversity and mental health in driving forward this body of research. Of the 31 articles identified for this review, 23 had a focus on the psychological distress experienced by HIV-affected children, while only 8 explored social psychological pathways to improved mental health, resilience and coping. The article argues that this preoccupation with pathology reflects global assemblages of definitions, understandings and practices that constitute the global mental health framework. While such a focus is useful for policy interventions and the mobilisation of resources to support children living in HIV-affected communities, it overshadows more culturally relevant and strengths-based conceptualisations of how mental health is understood and can be achieved in different parts of Africa. Furthermore, a continued focus on the psychological distress experienced by HIV-affected children runs the risk of medicalising their social experiences, which in turn may transform the social landscape in which children give meaning to loss and difficult experiences. The article concludes that mental health professionals and researchers need to take heed of the biopolitical implications of their work, and argues for more community-oriented and resilience-enhancing research that brings forward the voices of local people to inform interventions tackling the psychosocial challenges inevitably experienced by many children in sub-Saharan Africa.
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Authors: Nyberg BJ, Yates DD, Lovich R, Coulibaly-Traore D, Sherr L, Thurman TR, Sampson A, Howard B.
Abstract: President’s Emergency Plan for AIDS Relief (PEPFAR’s) response to the millions of children impacted by HIV/AIDS was to designate 10% of its budget to securing their futures, making it the leading supporter of programs reaching orphan and vulnerable children (OVC) programs globally. This article describes the evolution of PEPFAR’s OVC response based on programmatic lessons learned and an evergrowing understanding of the impacts of HIV/AIDS. In launching this international emergency effort and transitioning it toward sustainable local systems, PEPFAR helped establish both the technical content and the central importance of care and support for OVC as a necessary complement to biomedical efforts to end the HIV/AIDS epidemic. Critical services are reaching millions of HIV-affected children and families through vast networks of community-based responders and strengthened national systems of care. But rapid program scale-up has at times resulted in inconsistent responses, failure to match resources to properly assessed needs, and a dearth of rigorous program evaluations. Key investments should continue to be directed toward more sustainable and effective responses. These include greater attention to children’s most significant developmental stages, a focus on building the resilience of families and communities, a proper balance of government and civil society investments, and more rigorous evaluation and research to ensure evidence-based programming. Even as HIV prevalence declines and medical treatment improves and expands, the impacts of HIV/AIDS on children, families, communities, economies, and societies will continue to accumulate for generations. Protecting the full potential of children-and thus of societies-requires sustained and strategic global investments aligned with experience and science.
[button link=”http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1525-4135&volume=60&issue=&spage=S127″] Read More[/button]
Authors: Robertson L, Mushati P, Eaton JW, Sherr L, Makoni JC, Skovdal M, Crea T, Mavise G, Dumba L, Schumacher C, Munyati S, Nyamukapa C, Gregson S.
Abstract: Census data, collected in July 2009, from 27,672 children were used to compare the effectiveness, coverage and efficacy of three household-based methods for targeting cash transfers to vulnerable children in eastern Zimbabwe: targeting the poorest households using a wealth index; targeting HIV-affected households using socio-demographic information (households caring for orphans, chronically-ill or disabled members; child-headed households); and targeting labour-constrained households using dependency ratios. All three methods failed to identify large numbers of children with poor social and educational outcomes. The wealth index approach was the most efficient at reaching children with poor outcomes whilst socio-demographic targeting reached more vulnerable children but was less efficient.
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Authors: Temcheff CE, Serbin LA, Martin-Storey A, Stack DM, Hastings P, Ledingham J, Schwartzman AE.
Literature suggests that early patterns of aggressive behaviour in both girls and boys are predictive of a variety of health risks in adulthood. However, longitudinal examination of the predictive links between childhood aggression, negative physical health outcomes in adulthood and overall use of health care has not been done. We looked at use of health care and a variety of physical health outcomes in adulthood to extend the current body of knowledge regarding the long-term negative sequelae of childhood aggression.
Participants of the Concordia Longitudinal Risk Project were eligible for the current study if they had received medical care in the province of Quebec between 1992 and 2006, and if we were able to retrieve their medical and education records. Our primary outcome was use of the health care system, as determined using records from the Régie de l’assurance maladie du Québec and the Ministère de la santé et des services sociaux. Our controlled variables were socioeconomic status of the neighbourhood in which participants lived in 1986 and level of education. We used hierarchical multiple regression to explore the association between childhood behaviour and physical health in adulthood.
During the 15-year period studied, childhood agression corresponded to an increase in medical visits (8.1% per 1 standard deviation increase in agression), and injuries (10.7%) or lifestyle-related illnesses (44.2%), visits to specialists (6.2%) and visits to emergency departments (12.4%). We saw a positive relation between social withdrawal during childhood and government-funded visits to dentists. Peer-rated likeability during childhood showed negative relations with use of health care (overall), medical visits due to injuries and government-funded visits to dentists.
Childhood aggression is a health risk that should be considered when designing interventions to improve public health and diminish the costs of medical services, particularly when considering interventions targeting children and families.
[button link=”http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22083681/”]Read More[/button]
Authors: Stack DM, Serbin LA, Girouard N, Enns LN, Bentley VM, Ledingham JE, Schwartzman AE
Abstract: The present research examined how family psychosocial risk may be associated with emotional availability (EA) across age and time in two longitudinal, intergenerational studies with high-risk, disadvantaged mother-child dyads. Study 1 examined dyads during preschool and middle childhood. Study 2 examined a different sample of dyads, tested intensively at five time points (6, 12, and 18 months; preschool; and school age). Across studies, maternal childhood histories of aggression and social withdrawal predicted negative EA (higher levels of maternal hostility) during mother-child interactions at preschool age. In Study 1, mothers with higher levels of social withdrawal during childhood had preschoolers who were less appropriately responsive to and involving of their mothers during interactions. In Study 2, higher levels of observed appropriate maternal structuring predicted child responsiveness while observed maternal sensitivity (and structuring) predicted observed child involvement. More maternal social support and better home environment combined with lower stress predicted better mother-child relationship quality. Findings contribute to the burgeoning literature on EA by focusing on a high-risk community sample across time and generations. Results are interpreted in light of the developmental psychopathology framework, and have implications for a broader understanding of how EA is related to parental history and personal characteristics, as well as ongoing family and environmental context.
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