Patricia Paul-Carson, MSW, was the former manager of Intercountry Adoption Services for the Canadian government and consulted with UNICEF and the Cambodian government on developing an intercountry adoption system. She is responsible for communications for Child Haven International Children’s Home in India.
Position: Professor of Clinical and Health Psychology at University College London.
Background: Her research domain includes population health and infection, immunology, and inflammation.
Education: PhD at the University of Warwick (1989), Bachelor of Arts (with Honors) at the University of Warwick (1978)
Contact Information:
| l.sherr@ucl.ac.uk |
OVC Wellbeing Content:
Child transitions from residential facilities to other communities: predictors of child wellbeing
Title: Evaluation of the orphans reunification project in Eritrea
Authors: E Morah, S Mebrathu, K Sebhatu
Date: 1998
Abstract:
The evidence clearly shows that the status of assisted orphans compares favorably with that of non-orphans, thus indicating that the psychosocial integration between the host families and the orphans has been successful. Although orphan boys were indicated to be slightly better off, the gender differences were not dramatic. Substantial evidence also suggests that the project has built capacities of the relevant government ministry on a number of key areas’ research skills and appreciation of the importance of solid operational research before social interventions, participatory planning, monitoring and management tools, community mobilization and advocacy for child protection. Finally, the reunification project is found to be significantly more cost-effective, psychosocially acceptable and sustainable than the alternative strategy of keeping the children in orphanages.
Title: Family reunification
Author: Fred Wulczyn
Date: 2004
Abstract: Reunifying children placed in foster care with their birth parents is a primary goal of the child welfare system. Yet, relatively little is known about the reunification process. This article analyzes new data on trends in family reunification and discovers: Although most children still exit foster care through family reunification, exit patterns have changed over the last 8 years. Currently, reunification takes longer to happen, whereas adoptions happen earlier. A child’s age and race are associated with the likelihood that he or she will be reunified. Infants and adolescents are less likely to be reunified than children in other age groups, and African-American children are less likely to be reunified than children of other racial/ethnic backgrounds. Although many children who are reunified exit the system within a relatively short period of time, reunifications often do not succeed. Nearly 30% of children who were reunified in 1990 reentered foster care within 10 years. The principle of family reunification is deeply rooted in American law and tradition, and reunification is likely to continue as the most common way children exit foster care. Thus, greater efforts should be made to ensure that reunifications are safe and lasting. The article closes with a discussion of changes in policy and practice that hold promise for improving the safety and stability of reunified families, such as instituting better measures of state performance, and continuing to provide monitoring and supports for families after a child is returned home.
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Orphan reunification, or the process by which orphaned and abandoned children are returned to their extended family for care, has long been a policy intervention favored by researchers opposed to the institutionalization of children. Though the reunification process often takes longer than adoption, many researchers and policy-makers favor the process because they believe it leads to better outcomes.
But a recent narrative of one family’s repeated attempts to adopt an Ethiopian infant in need, and the regional government’s attempts to force reunification on the unwilling—and incapable—father, sheds light on another side of orphan reunification programs. The article, published last month in the Huffington Post, follows the life of an Ethiopian infant whose birth resulted in the death of her mother, a father without the means to support the child on his own, an American family wishing to adopt the child and a regional government that favored reunification over relinquishment. Though the story is not over for anyone involved, it highlights a rarely-seen side of reunification programs.
Many research projects support the claim that reunification supports the overall well-being of the child. For instance, one study conducted in Eritrea, Ethiopia discovered a wide-scale reunification project in the area was “significantly more cost-effective, psychosocially acceptable and sustainable than the alternative strategy of keeping the children in orphanages.”
Other studies have highlighted the flaws of reunification programs. For instance, some orphans are more likely to be successfully reunified than others; infants and adolescents are less likely to successful complete the process than children of other ages, and African-American children are less likely to be reunified than are children of other racial and ethnic backgrounds. Moreover, the study discovered that many reunifications eventually fail—in 1990, almost 30 percent of children who were reunified reentered foster care within 10 years. Yet, according to this study, the reunification system can be salvaged—as long as states and countries institute a series of reforms, including increased monitoring and evaluation.
But the account described in the Huffington Post raises questions regarding the feasibility of working with state and country officials to improve global reunification programs. In this tragic case, regional government officials appeared to have forced the father to care for his biological daughter in exchange for meager financial support, despite his hesitations about safely raising his infant. Later, after trying to convince his deceased wife’s mother to care of the child, the regional Women Children and Youth Affairs Bureau allegedly forced the man to take back his daughter–or risk going to jail. As the article explains:
[box] “…With an obviously failing-to-thrive child, the father expressed a desire to return his daughter to an orphanage. However, he would only do so if he could be sure he would not be sent to jail; he would rather keep her and watch her die than be sent to jail. He felt he was given no other option but to raise his daughter, and could not understand how he had been given the right to relinquish her in the first place.
It appears that this father and daughter are victims of an ill-planned reunification program. No permanent or viable solution was given to the father that would empower him to raise her. In the end, he didn’t keep his daughter because he wanted to or was capable of doing so; he had been threatened.
….It is now mid-April 2012, and the father has given up. Because he has been so bullied by local government, he is no longer able to trust the helpers who assured him that his country’s constitution provides fathers in his situation with basic rights. Though Ethiopian family law clearly states that it is legal for him to relinquish his daughter, the father still does not believe this.”[/box]
The purpose of this post is not to look down on all reunification programs and favor reunification of children housed in orphanages; instead, it is meant to highlight the complexities of the situations many orphans, their families, and families wishing to adopt must confront. Moreover, it shows the potential dangers associated with adopting a one-sided policy program regarding orphans and adoption services. Reunification may be a good option for some orphaned and abandoned children, but, as this case shows, it is not necessarily appropriate for all. Thus, countries are placing themselves in potentially dangerous situations when adopting a clear-cut “yes-or-no” stance to certain programs.
Please respond to this article in our discussion forum.
Title: More than the loss of a parent: Potentially traumatic events among orphaned and abandoned children
Authors: Kathryn Whetten, Jan Ostermann, Rachel Whetten, Karen O’Donnell, Nathan Thielman, and The Positive Outcomes for Orphans Research Team
Date: March 25, 2011
Abstract: This study examines rates of potentially traumatic events and associated anxiety and emotional/behavioral difficulties among 1,258 orphaned and abandoned children in 5 low- and middle-income countries. The study quantifies the types of events the children experienced and demonstrates that anxiety and emotional/behavioral difficulties increase with additional exposure. As policies for orphaned and abandoned children are being implemented, this study helps policy makers and care providers recognize that (a) children and caregivers are willing to report experiences of potentially traumatic events, (b) those who report such events are at higher risk for experiencing additional events, (c) resulting symptomatology indicates a need for appropriate mental health services, and (d) boys are as vulnerable as girls, indicating an equal need for protection.
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Title: Child work and labour among orphaned and abandoned children in five low and middle income countries
Authors: Rachel Whetten, Lynne Messer, Jan Ostermann, Kathryn Whetten, Brian Pence, Megan Buckner, Nathan Thielman, Karen O’Donnell, and The Positive Outcomes for Orphans (POFO) Research Team
Date: Jan. 13, 2011
Abstract:
The care and protection of the estimated 143,000,000 orphaned and abandoned children (OAC) worldwide is of great importance to global policy makers and child service providers in low and middle income countries (LMICs), yet little is known about rates of child labour among OAC, what child and caregiver characteristics predict child engagement in work and labour, or when such work infers with schooling. This study examines rates and correlates of child labour among OAC and associations of child labour with schooling in a cohort of OAC in 5 LMICs.
The Positive Outcomes for Orphans (POFO) study employed a two-stage random sampling survey methodology to identify 1480 single and double orphans and children abandoned by both parents ages 6-12 living in family settings in five LMICs: Cambodia, Ethiopia, India, Kenya, and Tanzania. Regression models examined child and caregiver associations with: any work versus no work; and with working <21, 21-27, and 28+ hours during the past week, and child labour (UNICEF definition).
The majority of OAC (60.7%) engaged in work during the past week, and of those who worked, 17.8% (10.5% of the total sample) worked 28 or more hours. More than one-fifth (21.9%; 13% of the total sample) met UNICEF’s child labour definition. Female OAC and those in good health had increased odds of working. OAC living in rural areas, lower household wealth and caregivers not earning an income were associated with increased child labour. Child labour, but not working fewer than 28 hours per week, was associated with decreased school attendance.
One in seven OAC in this study were reported to be engaged in child labour. Policy makers and social service providers need to pay close attention to the demands being placed on female OAC, particularly in rural areas and poor households with limited income sources. Programs to promote OAC school attendance may need to focus on the needs of families as well as the OAC.
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Title: Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries
Authors: Lynne Messer, Brian Pence, Kathryn Whetten, Rachel Whetten, Nathan Thielman, Karen O’Donnell, Jan Ostermann
Date: 2010
Abstract:
In the face of the HIV/AIDS epidemic that has contributed to the dramatic increase in orphans and abandoned children (OAC) worldwide, caregiver attitudes about HIV, and HIV-related stigma, are two attributes that may affect caregiving. Little research has considered the relationship between caregiver attributes and caregiver-reported HIV-related stigma. In light of the paucity of this literature, this paper will describe HIV-related stigma among caregivers of OAC in five less wealthy nations.
Baseline data were collected between May 2006 through February 2008. The sample included 1,480 community-based and 192 institution-based caregivers. Characteristics of the community-based and institution-based caregivers are described using means and standard deviations for continuous variables or counts and percentages for categorical variables. We fit logistic regression models, both for the full sample and separately for community-based and institution-based caregivers, to explore predictors of acceptance of HIV.
Approximately 80% of both community-based and institution-based caregivers were female; and 84% of institution-based caregivers, compared to 66% of community-based caregivers, said that they would be willing to care for a relative with HIV. Similar proportions were reported when caregivers were asked if they were willing to let their child play with an HIV-infected child. In a multivariable model predicting willingness to care for an HIV-infected relative, adjusted for site fixed effects, being an institution-based caregiver was associated with greater willingness (less stigma) than community-based caregivers. Decreased willingness was reported by older respondents, while willingness increased with greater formal education. In the adjusted models predicting willingness to allow one’s child to play with an HIV-infected child, female gender and older age was associated with less willingness. However, willingness was positively associated with years of formal education.
The caregiver-child relationship is central to a child’s development. OAC already face stigma as a result of their orphaned or abandoned status; the addition of HIV-related stigma represents a double burden for these children. Further research on the prevalence of HIV-related acceptance and stigma among caregivers and implications of such stigma for child development will be critical as the policy community responds to the global HIV/AIDS orphan crisis.
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Title: A Comparison of the Wellbeing of Orphans and Abandoned Children Ages 6–12 in Institutional and Community-Based Care Settings in 5 Less Wealthy Nations
Authors: Kathryn Whetten, Jan Ostermann, Rachel Whetten, Brian Pence, Karen O’Donnell, Lynne Messer, Nathan Thielman, The Positive Outcomes for Orphans (POFO) Research Team
Date: 2009
Abstract:
Leaders are struggling to care for the estimated 143,000,000 orphans and millions more abandoned children worldwide. Global policy makers are advocating that institution-living orphans and abandoned children (OAC) be moved as quickly as possible to a residential family setting and that institutional care be used as a last resort. This analysis tests the hypothesis that institutional care for OAC aged 6–12 is associated with worse health and wellbeing than community residential care using conservative two-tail tests.
The Positive Outcomes for Orphans (POFO) study employed two-stage random sampling survey methodology in 6 sites across 5 countries to identify 1,357 institution-living and 1,480 community-living OAC ages 6–12, 658 of whom were double-orphans or abandoned by both biological parents. Survey analytic techniques were used to compare cognitive functioning, emotion, behavior, physical health, and growth. Linear mixed-effects models were used to estimate the proportion of variability in child outcomes attributable to the study site, care setting, and child levels and institutional versus community care settings. Conservative analyses limited the community living children to double-orphans or abandoned children.
Health, emotional and cognitive functioning, and physical growth were no worse for institution-living than community-living OAC, and generally better than for community-living OAC cared for by persons other than a biological parent. Differences between study sites explained 2–23% of the total variability in child outcomes, while differences between care settings within sites explained 8–21%. Differences among children within care settings explained 64–87%. After adjusting for sites, age, and gender, institution vs. community-living explained only 0.3–7% of the variability in child outcomes.
This study does not support the hypothesis that institutional care is systematically associated with poorer wellbeing than community care for OAC aged 6–12 in those countries facing the greatest OAC burden. Much greater variability among children within care settings was observed than among care settings type. Methodologically rigorous studies must be conducted in those countries facing the new OAC epidemic in order to understand which characteristics of care promote child wellbeing. Such characteristics may transcend the structural definitions of institutions or family homes.
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Title: A conceptual framework for the targeting and evaluation of UNICEF-supported pro-equity programmes
Authors: Jan Ostermann, Volker Grzimek, Kathryn Whetten, Donald H. Taylor, Thomas C. Ricketts
Date: October 6, 2011
Objective:
The objective of this paper is to describe a conceptual framework for the selection of target districts for equity-focused interventions, to outline methodological approaches for the implementation of the selection process, and to describe options for the evaluation of the intervention’s effects on outcomes and equity.
In a hypothetical scenario, a UNICEF country programme is assumed to support a country’s government to deliver one or more interventions for up to 5 years in several of the country’s districts, subject to budget constraints. Child wellbeing with respect to the intervention(s) is measured by a single outcome indicator. The goal is to demonstrate improvements in the outcome indicator and reductions in inequity in the distribution of the outcome indicator within intervention districts and between intervention and non-intervention districts.
The objectives of this paper and an associated workshop are to outline methodological options to: 1) Identify the intervention districts;
2) Estimate the impact of a successfully implemented country programme on the outcomes gap between children in intervention districts and between intervention and non-intervention districts;
3) Simulate the effects of varying district selection strategies and budget constraints on programme performance;
4) Clarify which data are required to utilize the model and assess the programme’s impact with and without the availability of control/comparison data from non-intervention districts
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