Tag: emotional well being

Pathways to health and well-being: social networks of orphans and abandoned youth

Written by matthew on . Posted in Emotional Wellbeing. Leave a Comment

Study Title: Pathways to health and well-being: social networks of orphans and abandoned youth 

Context: Globally, 153 million children are estimated to have been orphaned as defined by the death of one or both parents due to diseases such as malaria, tuberculosis, maternal mortality, unintentional injuries, natural disasters and armed conflict: AIDS accounts for 16.6 million of these children. Little is known, however, about the social networks that have been informally established that may assist orphaned and abandoned children (OAC) as they transition from structured family care or residential facility settings to their adult lives.

Study aims: The primary goal of this study is to determine key factors that may put youth at a disadvantage as they transition from structured care settings into their adult lives and those that support positive transitions. To accomplish this, researchers will study existing education and employment support networks as well as sexual communities. Researchers will then be able to determine how certain characteristics of these networks are associated with OAC health outcomes, including poor education, ability to generate income, and HIV risk-taking behaviors. Based on prior OAC-related research, this study expects to find that OAC networks are small and lack variability, leading to reduced access to education, fewer positive employment opportunities, and increased sexual-risk behavior. Findings will be used to construct potential interventions to promote OAC health and well-being.

Methods: This study will use a “network analysis approach” to identify major characteristics of OAC social and sexual networks. Researchers will then examine the association between network factors and OAC outcomes in two steps: examining the relationships between social network characteristics and education and income-generation outcomes, and between sexual network characteristics and HIV-risk outcomes. Researchers expect to learn which social and sexual network features are associated with poor outcomes, such as educational accomplishment, obtaining employment, and high sexual risk behavior. Such risk behaviors include an early age of sexual debut, a high number of sexual partners, and certain characteristics of the sexual partners themselves. This research will provide the basis for designing interventions to prevent disenfranchisement as OAC enter their adult lives. With this research, we will be able to learn how to effectively design community networks for OAC to prevent poor health and lifestyle outcomes.

Policy Implications:

  • To determine if OAC network features account for success in educational, income generation, and sexual risk-taking behaviors
  • To provide the basis for social network and sexual network interventions to reduce damage done to OAC to prevent disenfranchisement as OAC become adults.

Principal Investigator: Lynne Messer (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), Jim Moody (Duke University), Vanroth Vann (Homeland, Cambodia), Augustine Wasonga (ACE Africa, Kenya), Kathryn Whetten (Duke University), Rachel Whetten (Duke University)

Contact: duke.ovcstudies@gmail.com

Randomized Controlled Trial of Ways to Improve OVC HIV Prevention and Well-Being (Zambia CBT)

Written by matthew on . Posted in Emotional Wellbeing. 1 Comment

Study Title: Randomized Controlled Trial of Ways to Improve OVC HIV Prevention and Well-Being (Zambia CBT)

Context: With millions of youth orphaned by AIDS in sub-Saharan Africa undergoing high levels of stress-related problems—such as interpersonal and problem-solving skills deficits, unhealthy thoughts, and maladaptive behaviors—addressing trauma and stress is a pressing need. Addressing these stressors is especially important in preventing the spread of HIV by reducing stress-induced risky sexual behaviors among orphaned and vulnerable children. Other studies have shown that cognitive behavior therapy interventions, when adapted for local environments, have been effective in addressing such stress-related problems.

Study Aims: This study will focus on comparing the effectiveness of psychosocial counseling (PC) and trauma-focused cognitive behavioral therapy (TF-CBT). The study will primarily compare the effectiveness of psychosocial counseling and trauma-focused cognitive behavioral therapy in addressing the stress-related problems among orphaned and vulnerable children (OVC). In addition, the study will examine the effectiveness of these two major types of treatment in reducing sexual risk behaviors while accounting for factors that mediate and moderate HIV risk behaviors. Finally, this study will compare the cost-effectiveness of the two treatment methods.

Methods: This study, which is being conducted in Zambia, utilizes a randomized controlled trial of psychosocial counseling and trauma-focused cognitive behavioral therapy, which has been utilized in other previous and ongoing studies. The major outcomes that this study will analyze include HIV risk behaviors, emotional and behavioral health, social support, overall well-being and mental health development of OVC. Researchers will recruit adolescents aged 13-17 who report risky sexual behavior, including recent sex without a condom. Adolescent participants and their caregivers will be assessed utilizing a computerized interviewing program that will enhance privacy and honesty of responses.

Policy Implications:

  • This study will provide necessary scientific evidence on the feasibility, effectiveness, and cost effectiveness of interventions for OVC affected by HIV/AIDS.
  • Results from this study will help inform efficient program design, policy, and effectiveness of interventions for preventing HIV among OVC living in low-resource settings.

M-Principal Investigators: Laura Murray (Johns Hopkins University) and Paul Bolton (Harvard University)

Investigators: Judith Cohen (University of Pittsburg), Shannon Dorsey (University of Washington), Kathryn Whetten (Duke University),

Contact Information: duke.ovcstudies@gmail.com

 

Improving Outcomes for Orphaned Youth: Implementation of Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Grief

Written by matthew on . Posted in Emotional Wellbeing. 1 Comment

Study Title: Improving Outcomes for Orphaned Youth: Implementation of Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Grief

Context: Approximately 50 million orphaned and abandoned adolescents currently live in sub-Saharan Africa. Previous studies have indicated that many of these children and adolescents, who often have mental health problems associated with parental loss, have high rates of other traumatic experiences and ongoing trauma exposure. Because the gap in mental health care is large in sub-Saharan Africa, with few individuals in need of treatment receiving even minimal support, more information regarding how to best implement effective interventions, like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for orphaned and abandoned children (OAC) is needed. Cognitive behavioral therapy approaches have been shown to be effective in low- and middle-income countries with adults and in wealthier nations with children and adolescents. More research on the effectiveness of CBT approaches effect resource-poor settings is needed. It is also critical to identify what level of provider and supervisor support is needed for maximum effectiveness and local feasibility. 

Study Aims: This research will examine the effectiveness of TF-CBT for treating unresolved grief and traumatic stress for OAC and adolescents in two East African countries, Tanzania and Kenya. The randomized trial will examine the effectiveness of TF-CBT compared to receipt of services as usual in these countries. The study involves collaboration with local organizations in Tanzania and Kenya, in which nine local counselors in each country will be trained by both a US-based TF-CBT expert and Tanzanian lay counselors who gained TF-CBT expertise in a previous feasibility study of TF-CBT for OAC, to deliver group-based TF-CBT for childhood traumatic grief to children ages 7-13. This study will evaluate the effectiveness of TF-CBT compared to existing services as usual orphan supports. The study will also examine the impact of implementation factors (e.g., intervention fidelity, lay counselor-supervisor relationship, child/guardian attendance) to study how enhanced local involvement and responsibility (i.e., Tanzanian lay counselor involvement in co-training and supervision) impacts outcomes.

Methods: This study build on previous work demonstrating that TF-CBT is a feasible and acceptable approach for OAC and adolescents by including a control group to properly examine the effectiveness of the TF-CBT approach. The 18 counselors who are trained in TF-CBT will deliver the treatment in 20 groups in each country, 10 rural and 10 urban, resulting in a total of 320 children and adolescents receiving the treatment (40 groups). TF-CBT and mental health experts will oversee the training of the lay counselors and the treatment given to the groups.

Policy Implications:

  • The study will examine the effectiveness of TF-CBT treatment for OAC and adolescents, as compared to receipt of services as usual in two East African Countries.
  • Incorporating experienced lay counselors in providing training and supervision in TF-CBT will inform future efforts to build local expertise and sustainability. This work will inform not only TF-CBT for CTG efforts but also efforts for scale up of other mental health interventions.
  • Generate important recommendations for OAC treatment and training approaches that are effective in low- and middle-resource settings.

M-Principal Investigators: Shannon Dorsey (University of Washington) and Kathryn Whetten (Duke University)

Investigators: Dafrosa Itemba (TAWREF), Kevin King (University of Washington), Rachel Manongi (KCMC), Karen O’Donnell (Duke University), Augustine Wasonga (ACE Africa)

Contact Information: duke.ovcstudies@gmail.com

Child transitions from residential facilities to other communities: Predictors of Child Wellbeing

Written by matthew on . Posted in Caregiving Situations and Living Environments. 1 Comment

Study Title:  Child transitions from residential facilities to other communities: predictors of child wellbeing 

Context: Globally, one hundred and fifty three million children are estimated to have been orphaned as defined by the death of one or both parents due to diseases such as malaria, tuberculosis, and cancers, maternal mortality, unintentional injuries, natural disasters and armed conflict: AIDS accounts for 16.6 million of these children. We can anticipate that numbers of orphaned children will increase with factors such as economic declines, decreased agricultural output due to environmental changes and increased natural disasters. In Ethiopia, an estimated 650,000 children have lost one or both parents to AIDS. The majority of orphaned children and children whose biological parents have left them are cared for by the remaining parent, other family members, or non-relatives in family settings: a small proportion live in residential facilities

Study Aims: The primary goal of this pilot study is to understand the emotional and physical well-being of children transitioning out of residential care to better inform good policy and practice on the protection of children. The intent is to understand factors associated with positive and negative transition outcomes. Care transitions occur for a variety of reasons, such as family placement, aging out (reaching the maximum age allowed in residential facilities), child self-initiated departures, community or family initiated retrievals, residential facility initiated expulsions, and residential facility closures.  This study attempts to assess children’s mental and physical well-being while still living in residential care and then follow them out of residential facility care into other living environments.

Methods: This initial study is designed to determine the feasibility of finding, following and maintaining communication with children as they leave residential facilities, to examine the different living environments they transition into, and to examine if there are trends or associations in how well transitions are made. In particular, pre-transition child characteristics (e.g., age of entry into residential care, years in residential care, age at placement in a community setting), facility characteristics, transition planning characteristics, community placement characteristics, and child wellbeing outcomes will be analyzed and compared to data from matched controls in community-family settings.  Short-term descriptive information such as documenting the range of living environments children transition into is vital.  However, short-term outcomes may not reflect longer-term physical or emotional trends.  If the pilot study methodology proves successful, i.e., children are able to be followed over time and useful measurements obtained, a longer, multi-country longitudinal study will be proposed.

Policy Implications:

  • To examine the positive and negative physical and mental health trajectories of children and young adults transitioning out of residential facility care for a variety of reasons, including residential facility closures, aging out and self-other initiated departures.
    • To determine how different types of residential facility-to-community transition experiences (e.g., types of preparation, planning process, availability of resources) affect children and families’ mental and physical wellbeing.
    • To better understand associations between characteristics of the residential facilities and post-residential facility care, and child emotional, physical and social well-being before and after re-location.
    • If the pilot study methodology proves successful and children are able to be followed over time, researchers may propose a larger multi-country study.

Principal Investigator: Sumi Ariely (Duke University)

Investigators: Misganaw Eticha (Stand for the Vulnerable Organization, Ethiopia), Charles Nelson (Harvard University), Jan Ostermann (Duke University), Lorraine Sherr (University College London),  Kathryn Whetten (Duke University), Rachel Whetten (Duke University)

Project Coordinator: Andrew Goodall

Contact Information: duke.ovcstudies@gmail.com

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