Title: A Brief Assessment of Learning for Orphaned and Abandoned Children in Low and Middle Income Countries
Authors: Karen O’Donnell, Robert Murphy, Jan Ostermann, Max Masnick, Rachel A. Whetten, Elisabeth Madden, Nathan M. Thielman, Kathryn Whetten and The Positive Outcomes for Orphans (POFO) Research Team
Abstract: Assessment of children’s learning and performance in low and middle income countries has been critiqued as lacking a gold standard, an appropriate norm reference group, and demonstrated applicability of assessment tasks to the context. This study was designed to examine the performance of three nonverbal and one adapted verbal measure of children’s problem solving, memory, motivation, and attention across five culturally diverse sites. The goal was to evaluate the tests as indicators of individual differences affected by life events and care circumstances for vulnerable children. We conclude that the measures can be successfully employed with fidelity in non-standard settings in LMICs, and are associated with child age and educational experience across the settings. The tests can be useful in evaluating variability in vulnerable child outcomes.
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Title: Orphanhood and Completion of Compulsory School Education Among Young People in South Africa: Findings From a National Representative Survey
Authors: Don Operario, Lucie Cluver, Helen Rees, Catherine MacPhail, Audrey Pettifor
Date: Feb. 21, 2008
Abstract: We examined the association of orphanhood and completion of compulsory school education among young people in South Africa. In South Africa, school attendance is compulsory through grade 9, which should be completed before age 16. However, family and social factors such as orphanhood and poverty can hinder educational attainment. Participants were 10,452 16–24-year-olds who completed a South African national representative household survey. Overall, 23% had not completed compulsory school levels. In univariate analyses, school completion was lower among those who had experienced orphanhood during school-age years, males, and those who reported household poverty. In multivariate analyses controlling for household poverty, females who had experienced maternal or paternal orphanhood were less likely to have completed school; orphanhood was not independently associated with males’ school completion. Findings highlight the need for evidence-informed policies to address the education and social welfare needs of orphans and vulnerable youth, particularly females, in South Africa.
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Study Title: School support as structural HIV prevention for adolescent orphans in Western Kenya
Context: The HIV/AIDS pandemic has led to illness and early death for millions of adults, and this, in turn, has left many millions of orphans in sub-Saharan Africa. In Kenya, alone, there are more than 2.4 million orphans who are at great risk for school dropout, early sexual debut, and HIV infection. Approaching the fourth decade of the AIDS epidemic, many in the field have called for a paradigm shift in HIV prevention, to address structural, as well as individual-level, factors.
Study Aims: This study examines the impact of school support as a structural intervention, tested among adolescent Luo orphans in Nyanza Province, Kenya. The Luos have the highest HIV prevalence and largest orphan prevalence of all ethnic groups in the country. The study uses a rigorous randomized controlled trial design to test whether school support can retain adolescent orphans in school through the transition to high school, delay sexual debut, and reduce the likelihood of HIV and herpes simplex virus type 2 (HSV-2) infections. Specific aims for the proposed study are: 1) To experimentally test whether providing comprehensive school support to Luo orphaned boys and girls will reduce school dropout, reduce sexual risk behaviors, and prevent HIV/HSV-2 infection; 2) To conduct a process evaluation of the implementation of the program; and 3) To conduct comparative cost effectiveness analyses, specifying the intervention’s cost and return on investment as evidenced by cost per unit improvement in the primary outcomes of school enrollment, delay of sexual debut and prevention of risk behaviors and HIV/HSV-2 infection, as well as by gains in health- related quality of life.
Methods: The design randomizes 24 primary schools to intervention or control condition. All youth in grades 7 and 8 who have lost one or both parents, regardless of cause of death, will be invited to participate; the total number of participants to be recruited into the study is approximately 840 students, 420 in each condition. Youth in intervention schools will receive five years of school support, including tuition, fees, uniforms, and a school-based adult “helper.” Data will comprise annual ACASI surveys, school data (attendance, grades), and HIV/HSV-2 bio-specimens. Analyses will test posited mediators and gender moderation in causal pathways and program effects. Cost effectiveness analyses will add much needed policy-relevant information.
Public Health Relevance: Although millions of children have been orphaned as a result of the AIDS pandemic, few studies have considered the particular vulnerability of young orphaned adolescents for school dropout, risky sexual behaviors, and HIV infection. The Luo people of Nyanza Province have the highest proportion of orphans, highest HIV prevalence, and earliest sexual debut among all ethnic groups in Kenya. This structural intervention trial uses a strong conceptual framework and rigorous experimental design to test whether school support can keep adolescent Luo orphans in school, reduce sexual risk behaviors, and prevent HIV /HSV-2 infection. Process evaluation and cost effectiveness analyses add further relevance for policy development.
Principal Investigator: Hyunsan Cho (Pacific Institute for Research and Evaluation)
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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)
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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.
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Title: The educational and psychological experiences of children orphaned by AIDS in Western Kenya
Author: Grace Jepkemboi
Abstract: The purpose of this study was to describe the perceptions of teachers and caregivers concerning the psychological and educational experiences of children orphaned by AIDS in Western Kenya. On the basis of qualitative inquiry, the design of the study focused on phenomenology inquiry. Audio-taped interviews were used as the primary source to gather data for this study. The questions that guided the study were “What are the psychological characteristics of children orphaned by AIDS in Kenya?” “What are the educational experiences of children orphaned by AIDS?” and “What strategies do the teachers and caregivers at the orphanages use to help the children orphaned by AIDS cope with the loss of the parent(s)?”
There were 20 participants, 12 teachers and 8 caregivers, in seven orphanages who volunteered to participate in the study. Findings of the study revealed that the children orphaned by AIDS went through a continuum of experiences. At one end of the continuum are the experiences that arise as the children see their parents develop signs of HIV/AIDS, become terminally ill, and eventually die. Children were most affected psychologically and educationally in their first year in the orphanages. Some of the emotions they expressed were feeling sad, rejected and unwanted, lonely, strange, in need of acceptance, gloomy, dull, cold, worried, desperate, afraid, hopeless, angry, annoyed, upset, feeling stigmatized, in panic, disturbed, frustrated, confused, tensed, angry, reserved, desperate, violent, stigmatized, emotional, and in grief.
At the other end of the continuum are the emotions, personalities, and attitudes of the orphaned children toward the end of the first year and in the second year, which included being happy, hopeful, trusting, confident, respectful, outgoing, cooperative, warm, complacent, and courageous. The techniques that teachers and caregivers used to help children cope with grief after the loss of the parent(s) are also described. The results of the study could provide information for early childhood educators, psychologists, administrators at orphanages, and policy makers, as they consider the psychological and educational needs of the children orphaned by AIDS.
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Title: The impact of parental death on school outcomes: longitudinal evidence from South Africa
Author: Anne Case and Cally Ardington
Abstract: We analyze longitudinal data from a demographic surveillance area (DSA) in KwaZulu-Natal to examine the impact of parental death on children’s outcomes. The results show significant differences in the impact of mothers’ and fathers’ deaths. The loss of a child’s mother is a strong predictor of poor schooling outcomes. Maternal orphans are significantly less likely to be enrolled in school and have completed significantly fewer years of schooling, conditional on age, than children whose mothers are alive. Less money is spent on maternal orphans’ educations, on average, conditional on enrollment. Moreover, children whose mothers have died appear to be at an educational disadvantage when compared with non-orphaned children with whom they live. We use the timing of mothers’ deaths relative to children’s educational shortfalls to argue that mothers’ deaths have a causal effect on children’s educations. The loss of a child’s father is a significant correlate of poor household socioeconomic status. However, the death of a father between waves of the survey has no significant effect on subsequent asset ownership. Evidence from the South African 2001 Census suggests that the estimated effects of maternal deaths on children’s outcomes in the Africa Centre DSA reflect the reality for orphans throughout South Africa.
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Title: Orphanhood and the Long-Run Impact on Children
Author(s): Kathleen Beegle, Joachim De Weerdt, Stefan Dercon
Abstract: This paper presents unique evidence that orphanhood matters in the long-run for health and education outcomes, in a region of Northwestern Tanzania, an area deeply affected by HIV-AIDS in Africa. We use a sample of non-orphans surveyed in 1991-94, who were traced and reinterviewed in 2004. A large proportion, 23 percent, lost one or more parents before the age of 15 in this period, allowing us to identify the impact of orphanhood shocks. Since a substantial proportion reaches adulthood by 2004, we can also assess permanent health and education impacts of orphanhood. In the analysis, we can control for a wide range of child and adult characteristics before orphanhood, as well as community fixed effects. We find that maternal death causes a permanent height deficit of about 2 cm (or 22 percent of one standard deviation) and a persistent impact on years of education of almost 1 year (or 25 percent of one standard deviation). We also find that paternal orphanhood has an impact on educational outcomes, but only for particular groups. We show evidence that living arrangements and whether the child was in school at the time of losing a parent strongly influence the impact of maternal and paternal death. We also illustrate the problems of inference on the impact of orphanhood if only children who remained in their baseline communities by 2004 had been reinterviewed.
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Title: Academic Achievement of Students in Foster Care: Impeded or Improved?
Author(s): Larry Evans
Abstract: Foster care’s impact on academic development was investigated for 392 students reentering foster care. Psychoeducational evaluation was performed at initial and return placements. Average achievement increased .22 points between placements. Students reentering care did not show differences in achievement or IQ compared to control students with a single placement. Although average achievement showed a small increase between placements, some students showed large changes. Declining achievement was directly related to above-average initial achievement ( p < .001), and indirectly related to not being in special education ( p < .001) and nonminority race ( p < .02). Results provide evidence that overall academic development appears neither enhanced nor hindered by foster care placement, but specific groups may be at risk for poor gains.
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Title: Orphans and schooling in Africa: A longitudinal analysis
Author: David Evans and Edward Miguel
Abstract: AIDS deaths could have a major impact on economic development by affecting the human capital accumulation of the next generation. We 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, in a novel finding, for those with low baseline academic performance.
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