Category: Caregiving Situations and Living Environments

Neuropsychological benefits of cognitive training in Ugandan HIV children

Written by matthew on . Posted in Caregiving Situations and Living Environments, Training and Therapy. Leave a Comment

Study Title: Neuropsychological benefits of cognitive training in Ugandan HIV children

Context: Over 110,000 HIV Ugandan children are at risk for neurocognitive disorders due to the progressive encephalopathy of CNS HIV infection. Even if clinically stable, these children can have motor, attention, memory, visual-spatial processing, and other executive function impairment.

Study Aims: Study Aim 1: To compare the neuropsychological benefit of 24 training sessions of Captain’s Log CCRT to the active and passive control groups over a 8-week period, and at 3-month follow-up. Study Aim 2: To compare the psychiatric benefit of 24 training sessions of Captain’s Log CCRT to the active and passive control groups over an 8-week period, and at 3-month follow-up. Study Aim 3: To evaluate how HIV subtype, ART treatment status, and the corresponding clinical stability of the child modifies CCRT neuropsychological performance gains and psychiatric symptom reduction.

Methods: One-hundred and fifty school-age children with HIV in Kayunga District, Uganda, will serve as our participants. Fifty of these children will be randomly selected to receive 24 training sessions of a computerized cognitive rehabilitation therapy (CCRT) program called Captain’s Log, marketed mostly for American children with attention or learning problems. A locked version of Captain’s Log which does not direct the child’s training in a progressive manner will be administered to a second “active control” group; while a third group will be a passive control group not receiving any computer training intervention.  Outcome Assessments: The Kaufman Assessment Battery for Children, 2nd ed. (KABC-2), Tests of Variables of Attention (TOVA) visual and auditory tests, CogState computerized neuropsychological screening test, Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), and Achenbach Child Behavior Checklist (CBCL) will be administered before and after the 8-week training period and at 3-month follow-up. We have previously used all these assessments with Ugandan children with HIV to effectively evaluate neuropsychological and psychiatric problems. Captain’s Log has an internal evaluator feature which will help us monitor the specific training tasks to which the children best respond. Based on our prior research with Kayunga children with HIV, we anticipate that about 40% of our sample will be on ART at study enrollment, and about 20% will be Subtype D while 60% will be subtype A. We also observed that children with HIV Subtype A are at greater risk for neurocognitive deficits. Analyses: We will compare neuropsychological and psychiatric gains over the 8-week training period and at 3-mo follow-up for our three study groups, anticipating that they will be significantly greater for the CCRT intervention children (Study Aims 1 & 2). These neuropsychological gains will be associated with improved school performance over the long-term. Intervention children on ART will have greater gains than those not on ART, and HIV subtype D children will have lower viral loads and higher lymphocyte activation levels, resulting in greater gains from CCRT (Study Aim 3). Conclusion: CCRT will prove effective and sustainable in potentiating the neurocognitive benefit of ART in HIV children. It will prove viable for assessing and treating children in resource-poor settings.

Public Health Relevance: Beyond the direct neurodevelopmental impact of pediatric HIV infection, the public health burden of HIV disease for tens of millions of HIV children and orphans globally is monumental when considering how it further compromises quality of home environment and educational opportunity for children already impoverished. If computerized cognitive training proves practical and effective for enhancing neuropsychological function and psychiatric well-being in HIV children, then this would support the second of the UN Millennium Development Goals, which is to ensure that all children have the best opportunity to complete primary schooling. Computerized cognitive training and assessment might also allow for cost/effective interventions in resource poor settings in low-income countries, where special education or medical rehabilitative care by trained professionals are not available.

Principal Investigator: Michael J. Boivin (Michigan State University)

[button link=”http://projectreporter.nih.gov/project_info_description.cfm?aid=8056556&icde=11423324″ color=”green” newwindow=”yes”] View Online[/button]

Enhancing Ugandan HIV-Affected child development with caregiver training

Written by matthew on . Posted in Caregiving Situations and Living Environments, Emotional Wellbeing, Training and Therapy. Leave a Comment

Study Title: Enhancing Ugandan HIV-Affected child development with caregiver training

Context: Children up to the age of 5 years affected by HIV are the most vulnerable subgroup of HIV populations globally, especially in low-resource areas. This is because of the strategic, volatile, and vulnerable nature of this highly sensitive period of child development. Mediational intervention for sensitizing caregivers (MISC) has a structured training program to enable caregivers to improve their children’s cognitive and social development during everyday casual interactions in the home.In our preliminary NIMH R34 findings, Ugandan HIV children of caregivers receiving MISC training biweekly for a year showed significantly greater gains on the Mullen Early Learning Scales Composite of g fluid intelligence, when compared to children whose caregivers received a standard health/nutrition education intervention (treatment as usual or TAU). The MISC caregivers were also significantly less depressed, and their child mortality that year was significantly lower.

Study Aims:  Study Aim 1 will evaluate if MISC significantly enhances child outcomes when compared to controls for both HIV-positive and orphan children when assessed from baseline to 6, 12, and 18 months. Study Aim 2 will evaluate if MISC significantly enhances caregiver EWB and daily functioning outcomes. To better understand the mechanisms of MISC-enhanced child development, a Secondary Aim is to evaluate the mediating effect of improved caregiver EWB outcomes on corresponding child development gains, and the modifying effects of caregiver HIV illness and functioning on child outcomes.

Methods: One hundred Ugandan HIV-positive preschool and 200 HIV orphan caregiver/child dyads will be enlisted from Kayunga and Pallisa Districts. These dyads will be randomly assigned by village clusters to either biweekly MISC or health/nutrition education TAU intervention for one year. Child Outcomes are the child development gains on the Mullen, the Early Childhood Vigilance Test (ECVT) of attention, and the Color- Object Association Test (COAT) of memory, the Behavior Rating Inventory of Executive Functioning – Preschool (BRIEF-P), and the caregiver administered version of the Achenbach CBCL. Caregiver Outcomes include an array of emotional wellbeing (EWB) and daily functioning measures validated during the initial qualitative study phase.

Implications: The Overall Impact comes from establishing the feasibility, acceptability, and effectiveness of MISC for HIV orphans and vulnerable children (OVC) and their caregivers in low resource settings; the sustainability of MISC in low resource settings since it is not dependent on published materials or outside resources; the complementary dual impact of significant psychotherapeutic benefit for the caregiver, especially mothers struggling with HIV disease. MISC will also reduce HIV child mortality because in our initial R34 findings, MISC heightened maternal bonding, sensitivity to serious illness, and the prompter seeking of medical care. It also can improve treatment adherence. Finally, our evidence-based MISC caregiver training interventions can be readily implemented globally as a sustainable way to augment OVC cognitive, psychosocial, and medical wellbeing.

Public Health Relevance: Early childhood (up to age 5 yrs) is a period of dramatic change in the cognitive, emotional, social, and behavioral domains; children continuously progress by observing and interacting with the world around them. In the face of economic instability and nutritional, medical and educational deprivation, HIV-affected very young children are the most vulnerable HIV subgroup globally because their families are often the most vulnerable, with little margin for sustaining a favorable developmental milieu for the child. Through strategic caregiver interventions during this sensitive period of child neurodevelopment, our study findings have the potential for positively re-directing the developmental trajectories of tens of millions of HIV-affected children globally.

Principal Investigator: Michael J. Boivin (Michigan State University)

[button link=”http://projectreporter.nih.gov/project_info_description.cfm?aid=8208859&icde=11423324″ color=”green” newwindow=”yes”] View Online[/button]

Cognitive and psychosocial benefit of caregiver training for Ugandan HIV children

Written by matthew on . Posted in Caregiving Situations and Living Environments, Training and Therapy. Leave a Comment

Study Title: Cognitive and Psychosocial Benefit of caregiver training for Ugandan HIV children

Context: 110,000 Ugandan HIV children and 1 million non-infected AIDS orphans will have poor or inconsistent caregiving because one or both parents are ill or dead from AIDS (UNAIDS 2006). Consequently, the cognitive and social development of these children may be stunted in early childhood, and eventually they will perform more poorly in school. Mediational intervention for sensitizing caregivers (MISC) has a structured curriculum and training program to teach HIV mothers/caregivers the skills for enhancing their child’s cognitive and social development in the home each day. This is done by teaching mothers/caregivers how to focus a child’s attention, excite a child’s interest, expand her cognitive awareness, encourage her sense of competence, and regulate behavior during play, feeding, bathing and working.

Study Aims: To adapt MISC to the Ugandan context and demonstrate its effectiveness for enhancing the cognitive and social development of HIV children and orphans, we will use a four-part protocol for evaluating parent training programs: context evaluation, input evaluation, process evaluation, and product evaluation (CIPP Model of Evaluation). Study Aim 1 is the context evaluation of MISC through the use of focus groups of local community leaders, teachers, and caregivers, partnering with us to adapt MISC to the Ugandan context. Study Aim 2 involves the input evaluation of appropriateness and acceptability of MISC training for the caregivers and household through interviews and training compliance. Study Aim 3 is the process evaluation of the fidelity of intervention though home observation and evaluation of HOME quality, and videotape evaluation of caregiving interactions between mother/caregiver and child, as well as changes in the caregivers own attitudes and approach throughout the year-long training period. Study Aim 4 evaluates the product or benefit of the MISC training; in terms of the child’s gains on the Mullen Scales of Early Learning, the Early Childhood Vigilance Test (ECVT) of attention, the Color-Object Association Test (COAT) for memory, and the Child Behavior Checklist (CBCL) for psychosocial adjustment.

Methods: Mothers/caregivers of half of 120 HIV-infected and 120 non-infected preschool AIDS orphans in Kayunga District, Uganda, will be assigned to monthly home-based MISC training for one year. The remaining children and caregivers will continue to receive the regular monthly home health care visits. MISC for both the HIV infected and non-infected orphans will lead to greater gains on the Mullen learning, ECVT attention, and COAT memory scores compared to non- intervention children. These gains will be mediated by improved scores on monthly videotaped caregiving samples evaluated for MISC features, HOME scale quality of home environment, and child/caregiver quality interactions (CCQI) scores from home-based observations. These gains will be moderated by clinical stability of the HIV children.

Implications: Establishing the feasibility and effectiveness of MISC caregiving training will provide a strategic and sustainable means of cognitive enhancement for millions of HIV-affected children in resource-poor settings. Beyond the direct neurodevelopmental impact of pediatric HIV infection, the public health burden of HIV disease for tens of millions of HIV orphans globally is monumental when considering how it further compromises quality of home environment and caregiving for children already impoverished. In the African context, home-based caregiver training interventions to enhance the developmental milieu of HIV-affected children may be the single most developmentally strategic, culturally relevant, and resource sustainable means of buffering them from this impact of HIV disease. More broadly, caregiver training interventions may also enhance the cognitive ability and psychosocial adjustment of all children at risk from poverty and other public health challenges to the second of the UN Millennium Development Goals, which is to ensure that all children are able to complete primary schooling.

Principal Investigator: Michael Joseph Boivin (Michigan State University)

[button link=”http://projectreporter.nih.gov/project_info_description.cfm?aid=7792212&icde=11423324″ color=”green” newwindow=”yes”] View Online[/button]

Well-being of South African children: household, community and policy influences

Written by matthew on . Posted in Caregiving Situations and Living Environments. Leave a Comment

Study Title: Cognitive and psychosocial benefit of caregiver training for Ugandan HIV children

Context: A decade after the end of apartheid, the well-being of South African children is still in a precarious state. Nearly 70% of the nation’s Black African children live in households with incomes less than $2000 per year. The HIV/AIDS prevalence rate for pregnant women attending public antenatal services is over 30%. And, by 2010, 19% of South African children will have experienced the death of one or both parents, half due to AIDS.

Study Aims: In response to this crisis, the overarching objective of the proposed project is to conduct a short-term, longitudinal, multi-level study of 6000 7- to 10-year-olds and their parents/parent surrogates in 60 urban and rural South African communities in KwaZulu-Natal. We posit three specific aims. AIM 1. Examine the associations between a) a set of major household risk factors and a set of adverse childhood experiences; and between b) the occurrence and nature of adverse childhood experiences and child psychosocial, health and educational outcomes. AIM 2. Explore the degree to which selected factors at multiple levels moderate the influence of major household risk factors on adverse childhood experiences, and adverse childhood experiences on key child outcomes. AIM 3. Test the effects of a major social policy innovation Conditional Cash Transfers on household and childhood risk factors (directly) and children’s well-being (indirectly). This project is a collaboration of researchers at New York University in the U.S. and the Human Sciences Research Council in South Africa in cooperation with the South African government and the World Bank. PUBLIC HEALTH RELEVANCE The results of this study have two main implications for public health. First, one set of results will indicate whether Conditional Cash Transfers can improve the health, education and well-being of poor South African children in high HIV/AIDS prevalence communities. Second, another set of results can inform the design of new public health and social policy strategies to support households in AIDS-affected communities.

Prinicipal Investigator: J. Lawrence Aber (New York University)

[button link=”http://projectreporter.nih.gov/project_info_description.cfm?aid=8053745&icde=11423324″ color=”green” newwindow=”yes”] View Online[/button]

Orphans and vulnerable children: Direct effects, spillover effects, and assistance

Written by matthew on . Posted in Caregiving Situations and Living Environments. Leave a Comment

This thesis examines the schooling impacts of parent death for orphans in Africa as well as for children in households that take in those orphans. The thesis also evaluates the impact of an intervention to facilitate education for vulnerable children in Africa. The thesis is divided into three chapters. In chapter one, I estimate the impact of parent death on primary school participation using an unusual five-year panel data set of over 20,000 Kenyan children. There is a substantial decrease in school participation following a parent death, and a smaller drop before the death (presumably due to pre-death morbidity). Estimated impacts are smaller in specifications without individual fixed effects, suggesting that estimates based on cross-sectional data are biased toward zero. Effects are largest for children whose mothers died, and those with low baseline academic performance. In chapter two, I first characterize households that provide care for orphans using a collection of 41 Demographic and Health Surveys from 26 African countries. I then estimate the impact of taking in orphans on outcomes for other household residents, including children’s health and education. One finding is that orphan care is concentrated in households with fewer other childcare responsibilities, especially elderly households. Using bias-corrected matching estimation, sibling differences within households, instrumental variables estimation, and a range of specifications, I find no evidence for significant effects of having an orphan join the household on other household members, contrary to popular views that orphans generate negative spillovers. In chapter three, I evaluate the impact of an educational intervention, in which a Kenyan non-governmental organization distributes school uniforms to children in poor communities. The NGO used a lottery to determine who would receive uniforms. Although compliance with the lottery was not perfect, I use winning the lottery as an instrumental variable to identify the impact of receiving a uniform. I find that giving a school uniform significantly increases school attendance (by 4.5% off a base of 83%), with a particularly marked effect for girls.

Citation: Evans, D. K. (2005). Orphans and vulnerable children: Direct effects, spillover effects, and assistance. United States — Massachusetts, Harvard University.

Attainment and Behaviour of Children in Care and at Home

Written by matthew on . Posted in Caregiving Situations and Living Environments. Leave a Comment

Reports on a longitudinal study about the educational progress and behavior of 49 children in long-term foster care and a comparison group of children receiving social work support while remaining with their birth families. Finds that the children in foster care showed lower academic achievement and more behavioral problems.

Citation: Colton, M. and A. Heath (1994). “Attainment and Behaviour of Children in Care and at Home.” Oxford Review of Education 20(3): 317-327.

The Potential for Successful Family Foster Care: Conceptualizing Competency Domains for Foster Parents

Written by matthew on . Posted in Caregiving Situations and Living Environments. Leave a Comment

Title: The Potential for Successful Family Foster Care: Conceptualizing Competency Domains for Foster Parents

The potential to foster successfully starts with developing and supporting competency in 12 domains: (1) providing a safe and secure environment; (2) providing a nurturing environment; (3) promoting educational attainment and success; (4) meeting physical and mental healthcare needs; (5) promoting social and emotional development; (6) supporting diversity and children’s cultural needs; (7) supporting permanency planning; (8) managing ambiguity and loss for the foster child and family; (9) growing as a foster parent; (10) managing the demands of fostering on personal and familial well-being; (11) supporting relationships between children and their families; and (12) working as a team member. This article describes each domain and reviews relevant research to help guide the assessment of practicing and future foster parents.

[button link=”http://www.mendeley.com/research/potential-successful-family-foster-care-conceptualizing-competency-domains-foster-parents/” color=”green” newwindow=”yes”] View Online[/button]

Residential Group Care as a Socializing Environment: Toward a Broader Perspective

Written by matthew on . Posted in Caregiving Situations and Living Environments. Leave a Comment

Residential group care has often been viewed as antithetical to healthy normalizing developmental processes for troubled or “at-risk” children and youth, yet it appears in other settings to be the method of choice for leadership preparation for the elite. This chapter examines group care generically and attempts to bring implications from programs in the latter category to bear on those in the former.

Citation: Arieli, M., J. Beker, et al. (2001). “Residential Group Care as a Socializing Environment: Toward a Broader Perspective.” Child & Youth Care Forum 30(6): 403-414.

Positive Outcomes for Orphans (POFO)

Written by matthew on . Posted in Caregiving Situations and Living Environments. Leave a Comment

Study Title: Positive Outcomes for Orphans (POFO): Longitudinal study of orphaned and abandoned children (OAC) from ages 6-12 to ages 15-21 living in 6 diverse settings 

Context: International policymakers are struggling to find solutions for the estimated 153 million children worldwide who have had at least one parent die, largely due to high mortality rates from conditions such as malaria, tuberculosis, HIV/AIDS and pregnancy complications. Millions more do not know the whereabouts of their parents. In light of the large presence of orphaned and abandoned children, especially in low- and middle-income countries continued research is needed that allows policy makers and providers to understand and develop locally feasible and appropriate ways to care for the children.

Study Aims: Positive Outcomes for Orphans (POFO) is longitudinal study conducted in five countries over a period of 9-10 years thanks to 2 consecutive National Institutes of Child Health and Development (NICHD) funded studies. OAC were ages 6-12 at baseline and will be ages 15-21 at the conclusion of the study. This unique population-based study is the only one of its kind that follows orphaned and abandoned children (OAC) for up to 9 years in culturally and structurally diverse settings allowing for a glimpse into what current care options are and the effects of that care and other life events over time on: health, cognition, emotion, educational attainment, labor force participation (including forced labor), sexual risk taking, marital patterns and community engagement. 

Methods: OAC ages 6-12 and living in family settings were recruited from six diverse study areas in five countries: Addis Ababa (Ethiopia), Bungoma District (Kenya), Kilimanjaro Region  (Tanzania), Battambang District (Cambodia), and Hyderabad and Nagaland  (India) (N=1480). The sampling strategy involved the selection of 50 sampling areas (‘‘clusters’’) at each site and five OAC from each cluster. From comprehensive lists of residential facilities in study area, 83 facilities were randomly selected for including in the study with 1,357 OAC then randomly selected from lists of children of the appropriate age from each facility. Baseline assessments were collected for children and caregivers being in May 2006: enrollment continued for 22 months. OAC were defined as children who had at least one parent die or who were abandoned by both parents. In households with multiple eligible children, one child was selected as the child whose first name started with the earliest letter in the alphabet. Interviews with children’s self-identified primary caregivers were conducted in their respective native language in the child’s residence. Six-month follow-up assessments were conducted in 5 of the 6 study sites and 12-months follow-up assessments in all sites. Interview windows for follow-up assessments were open from one month prior to two months after the scheduled follow-up date.

Policy Implications:

  • The study seeks to determine which environmental characteristics (e.g. home, community, culture, social networks, etc.) promote positive and negative outcomes for OAC as they transition through to young adulthood. With this knowledge, more appropriate local, national and international policies can be created for this age group and appropriate care options can be more actively supported.
  • The study will seek to examine how personal factors, including life events, (e.g. number of potentially traumatic events experienced, emotional health, and cognitive development) affect orphans and identify potential interventions that could improve outcomes for the adult lives of orphans.

Principal Investigator: Kathryn Whetten (Duke University)

Investigators: Bernard Agala (Duke University), Cyrilla Amanya (ACE Africa, Kenya), Misganaw Eticha (SVO Ethiopia), Amy Hobbie (Duke University), Dafrosa Itemba (TAWREF, Tanzania), Rachel Manongi (KCMC, Tanzania), Lynne Messer (Duke University), (KCMC, Tanzania), Karen O’Donnell (Duke University), Jan Ostermann (Duke University), Brian Pence (Duke University), Nathan Thielman (Duke University), Vanroth Vann (Homeland, Cambodia), Augustine Wasonga (ACE Africa, Kenya), Rachel Whetten (Duke University)

Contact Information: duke.ovcstudies@gmail.com

Explaining the Expansion of Institutions in Battambang Province

Written by matthew on . Posted in Caregiving Situations and Living Environments. Leave a Comment

Study Title: Explaining the Expansion of Institutions in Battambang Province

Context: According to a 2009 UNICEF statistic, there are an estimated 630,000 orphans in Cambodia, 12,000 of whom currently reside in orphanages. Although some institutions provide services specific to the needs of certain populations of vulnerable children (victims of sexual trafficking, children living with HIV, street children, and children with disabilities), a 2011 UNICEF report revealed that a majority of the 12,000 children in Cambodia’s orphanages have one living parent; 28% of children in orphanages have lost both parents. Furthermore, the number of children in care has more than doubled in five years. In Cambodia’s northwest province of Battambang, the number of orphanages has more than quadrupled from 11 to 45 over the last decade.

Study Aims: This study aims to better understand the reasons for institutional expansion in Battambang Province. Through a series of qualitative interviews with orphanage directors and caregivers, the study will help us to understand the reasons underlying the expansion in the number of orphanages in the region.

Methods: A stratified random sample of 15 orphanages in Battambang was contacted for participation in this study.  Orphanages were stratified based on four criteria: size, length of presence in the province, foreign/locally-run institutions, and religious affiliation. A series of 45-minute interviews are being conducted with the directors of selected institutions to better understand the reasons that they opened the institution, why children are sent to live in orphanages as well as to learn more about the services provided by these institutions. A small sample of 7-10 parents/caregivers in the Ek Phnom District will also be interviewed to gain more direct information about the reasons why Battambang Province families send their children to institutions.  Questions regarding the socio-economic background of the family, the reasons for sending children to institutions and the perception of need in the local community will be asked of each participant.  The participating individuals will be the parents/caregivers of scholarship students at the Khmer Center for Development (an afternoon-English program in Ek Phnom District, Battambang Province) whose child/children is/are currently placed in institutional care.

Policy Implications:

  • The study will provide relevant information regarding why orphanages are being opened at such a quick pace in the Battambang region. This knowledge could lead to similar studies in other areas.

Principal Investigator: Leila Dal Santo (Duke University)

Investigators: Vanroth Vann (Homeland, Cambodia), Kathryn Whetten (Duke University)

Contact Information: duke.ovcstudies@gmail.com

 

FOLLOW US FOR OVC UPDATES: