The symposium was chaired by Katie Schenk, responsible for research among children affected by AIDS for the Horizons program. She opened the meeting by clarifying the meaning of psychosocial care and support, and citing examples of psychosocial support strategies employed in diverse circumstances. These included the creation of memory books by families affected by AIDS in Uganda as a way for parents to pass on important memories to children and to discuss their future. And the use of psychodrama activities by an Israeli volunteer in a camp for Sri Lankan children displaced by the Tsunami, using techniques originally developed for use among children affected by the Israeli-Palestinian conflict. Schenk set the stage by briefly identifying some of the similarities and differences between different types of crises faced by children in the different settings (see opening remarks).

David Hughes, senior HIV/AIDS advisor at Plan USA, presented examples of Plan’s psychosocial support (PSS) activities for orphans and vulnerable children (OVC) affected by AIDS in Uganda and Haiti. He described Plan’s strategies, based on “The Circle of Hope,” a child-centered, community-focused, integrated approach. Hughes described how Plan Uganda was working to integrate PSS for families into the context of a program for the prevention of mother-to-child transmission of HIV/AIDS. Psychosocial interventions include the introduction of succession planning, whereby parents are encouraged to discuss the appointment of caregivers for their children, and setting up child centers that provide a space for children to participate in counseling, peer-led support groups, and other therapeutic and recreational activities. Plan is also working in Haiti, where “delegate mothers” make home visits to families affected by HIV/AIDS in impoverished neighborhoods, to provide counseling and emotional support. Hughes concluded by identifying some of the successes of and challenges to Plan’s PSS programming. He cited the popularity of home visits, the importance of on-the-job learning, and the need for culturally relevant activities to support children dealing with trauma as Plan’s successes; challenges include a need for further documentation of program impact, over-reliance on volunteers at field level, and the requirements of scaling up (see PowerPoint presentation).

Laelia Gilborn, independent consultant currently working with Save the Children and Christian Children’s Fund, presented data from research conducted among children affected by AIDS in Zimbabwe while she was with the Horizons program. She described an exploratory study to investigate the effects of PSS programs in Bulawayo and Matabeleland provinces, where service providers CRS/STRIVE and the Salvation Army were conducting activities to support children affected by AIDS. The activities studies included ongoing psychosocial support programs within faith-based and community programs, and a ten-day residential camp (Masiye Camp). Gilborn presented findings that indicated that most survey respondents (and especially females) had experienced multiple traumas, including the death or illness of a loved one, experiences of enacted stigma, the loss of land or possessions, being forced to leave school; and daily stressors including poverty and health problems. Levels of psychosocial distress among the respondents were high, especially guilt, worry, sadness, and a feeling of being overwhelmed, which were associated with traumas, stressors, and social isolation. Many respondents reported feeling an absence of support from the adults in their lives. However, despite these adverse circumstances, Gilborn reported finding evidence of well-being and resilience among these children. She presented data showing that the PSS programs studied were associated with greater self-confidence, especially among males, yet also with higher prevalence of psychosocial distress manifestations; hypothesizing that in helping youth to become more articulate and “emotionally literate,” they had become more open about the distress they were experiencing. Gilborn concluded by recognizing that the ongoing traumas and stresses faced by these children present a formidable challenge for any PSS program, and that further research is needed to explore the relative roles of different types of programs, including ongoing community interventions using existing support structures one-off intensive interventions situated outside the community (see PowerPoint presentation).

Solène Edouard-Binkley, Representative for Policy and Programs at the Christian Children’s Fund (CCF), began by noting the variations in intensity of psychosocial distress among children, and emphasizing the importance of responding to children’s different experiences in an appropriate manner. She suggested that in a situation of severe trauma such as the Tsunami, approximately 10 percent of children would be severely affected to the extent that they would require psychological assistance in order to be able to function normally; and a further 20 percent of children would remain relatively functional but still at risk (e.g., separated children, children with disabilities) and would require community support interventions. The remaining 70 percent of children affected by the Tsunami in a more general way would experience shock but remain relatively resilient, and would benefit from interventions including life skills and training. Edouard-Binkley suggested that in the presence of ongoing post-traumatic stress, and especially if left unsupported without appropriate interventions, children will move between these different groups as their stress and trauma levels change. She presented some examples of CCF’s work among communities affected by the Tsunami in India, including an intervention to establish child-centered spaces. She reported that CCF staff who had also worked with communities affected by armed conflict observed that children facing the loss of a parent due to a natural disaster found the coping and healing process easier than children facing the loss of a parent due to violence, perhaps as they can attribute the cause of death to a supernatural force rather than a human being. Edouard-Binkley questioned the structure of institutions governing relief responses, under which child protection needs and mental health services are typically administered separately. She concluded by emphasizing the importance of responding according to each child’s situation, and that not every child needs psychotherapy (see presentation summary).

Questions to the speakers examined a variety of aspects of their work, including whether it was appropriate to apply Western concepts of psychosocial distress and post-traumatic stress disorder in very different cultural settings. Speakers cited examples of developing culturally relevant models to measure and respond to community PSS needs without directly imposing a Western framework. Another key discussion point was the importance of addressing and responding to gender roles and expectations among children and caregivers for any services and training provided.

Schenk offered some concluding thoughts to summarize the discussion, recognizing that although the terminology of providing psychosocial support to orphans and vulnerable children may be new jargon, it behooves us to recognize that it is certainly an old approach. Researchers and service providers working in the diverse contexts including HIV/AIDS, natural disasters, and armed conflict would benefit from sharing the lessons each has learned from PSS programs. Schenk observed the common themes cited by each of the three speakers, including the importance of holistic, culturally-grounded, community-based programs and the need for the participation of local people as key players. Because researchers and service providers in these diverse settings are all struggling with common issues, including the difficulties of measuring psychosocial well-being and the need for further documentation of PSS program impact, she urged participants to continue the dialogue and share tools and lessons learned.