Tag: care options

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: 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: 

Background

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.

Methodology

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.

Principal Findings

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.

Conclusion

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.

[button link=”http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0008169″ color=”green” newwindow=”yes”] View Online[/button]

Title: Posttraumatic stress in AIDS-orphaned children exposed to high levels of trauma: the protective role of perceived social support

Authors: Lucie Cluver, Dylan S Fincham, Soroya Seedat

Date: 2009

Abstract: Poor urban children in South Africa are exposed to multiple community traumas, but AIDS-orphaned children are at particular risk for posttraumatic stress. This study examined the hypothesis that social support may moderate the relationship between trauma exposure and posttraumatic stress for this group. Four hundred twenty-five AIDS-orphaned children were interviewed using standardized measures of psychopathology. Compared to participants with low perceived social support, those with high perceived social support demonstrated significantly lower levels of PTSD symptoms after both low and high levels of trauma exposure. This suggests that strong perception of social support from carers, school staff, and friends may lessen deleterious effects of exposure to trauma, and could be a focus of intervention efforts to improve psychological outcomes for AIDS-orphaned children.

[button link=”http://www.mendeley.com/research/posttraumatic-stress-in-aidsorphaned-children-exposed-to-high-levels-of-trauma-the-protective-role-of-perceived-social-support/” color=”green” newwindow=”yes”] View Online[/button]

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: [email protected]

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