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June 2005
Providing Psychosocial Support
to AIDS-affected Children
Operations research informs programs in Zimbabwe and Rwanda
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Children participate in an outdoor activity as part of their 10-day residential program at Salvation Army Masiye Camp in Zimbabwe. Photo credit: REPSSI |
In Matopos National Park, Zimbabwe, the sun sets gracefully, casting shadows over massive granite rock formations as white rhinos lumber toward their water holes. Not far away, the calls of children can be heard as they finish their afternoon activities and prepare for dinner. The voices of camp counselors rise above those of the children, directing them toward their next pursuit.
But the activities and adventures that these children are experiencing during their ten days together at Salvation Army Masiye Camp serve a greater purpose than fun and games. The youth have been chosen by their communities to participate in this residential, faith-based program in Matabeleland Province because their lives have been profoundly affected by HIV/AIDS.
At the same time, 30 miles away in downtown Bulawayo, other children are engaged in an energetic soccer game while their peers work on art projects in a room nearby. These children too are participating in structured programs, called Kids’ Clubs, designed to help the ever-growing population of orphans and vulnerable children in the country.
Masiye Camp and the Kids’ Clubs are examples of a growing number of programs in Africa and elsewhere that focus on the psychological and social needs of AIDS-affected children. Given the traumatic effects of grief, loss, and other hardships faced by these children, there is increasing recognition of the importance of programs to help them strengthen their social and emotional support systems. This issue of Horizons Report describes findings from operations research in Zimbabwe and Rwanda (full text) that examines the psychosocial well-being of orphans and vulnerable children and ways to increase their ability to adapt and cope in the face of adversity.
In these studies, a person’s psychosocial well- being refers to his/her emotional and mental state (psycho-) and his/her network of human relationships and connections (-social). Good psychosocial well-being is when one’s mental/emotional state and social relationships are predominantly positive and healthy. Lack of psychosocial well-being or psychosocial distress is when these are mostly negative or unhealthy.
The Zimbabwe Study
Youth affected by AIDS typically face a wide range of stressful events and circumstances, including the loss of caregivers, the burden of adult-like responsibilities, and social isolation. Yet little is known about whether programs such as Masiye Camp and the Kids’ Clubs, which aim to improve psychosocial well-being directly through counseling, spiritual support, group recreation, and peer-to-peer support, do indeed help the youth they target.
Participation in psychosocial support programs is associated with greater self confidence, especially among males. |
In response, researchers from the Regional Psychosocial Support Initiative (REPSSI), the STRIVE Program of Catholic Relief Services, and the Horizons Program collaborated on an exploratory study in southern Zimbabwe. The study sought to develop a better understanding of psychosocial well-being among vulnerable youth and how to measure it, and explore the effects of participation in psychosocial support programs.
The Zimbabwe study began in June 2003 with formative research, which included in-depth interviews and focus groups. Informants included youth and adults working with youth, such as teachers, NGO staff, pastors, and counselors. Researchers then used the qualitative findings and select items from standardized surveys to draft a questionnaire to learn more about the psychosocial well-being and psychosocial distress of vulnerable youth. The survey tool was refined based on pre-testing and on feedback from local youth and international experts.
Local interviewers administered the questionnaire to a sample of vulnerable youth, aged 14 to 20. The study focused on this age group because of the presence of programs for them in the study area and because they face unique responsibilities and challenges, including caring for younger children and sick adults. The sample included youth who had and had not participated in community psychosocial programs, such as Masiye Camp and the Kids’ Clubs.
Life Circumstances
A total of 1,258 youth were interviewed, 604 males and 654 females. All were deemed vulnerable by their communities because they had been affected by HIV/AIDS and/or other factors such as severe poverty. The average age of respondents was 15.9 years. The vast majority were enrolled in school, but two-thirds had not completed the expected level of schooling for their age. Only about a third of respondents had both parents living; the rest were orphans, mostly paternal orphans (father deceased) or double orphans (both parents deceased).
The study yielded mixed results with respect to social support for youth and their feeling of social connectedness. Peer relationships are an important source of social support and coping, as over 90 percent of youth said that they enjoy time spent with friends. However, while 88 percent of youth reported seeking help from an adult in times of difficulty, only about half feel “very well” supported by adults in their lives. Orphans in particular reported not having any adults to talk to about problems, and 22 percent of those living with guardians have been made to feel unwelcome. Overall, orphans scored lower on the social support measures than did non-orphans.
The researchers developed a trauma index to measure the level of potentially traumatizing events experienced by each respondent. Among the entire study sample, most respondents had experienced multiple traumas. These included the death of loved ones, illness in the family, stigma and discrimination, loss of land or possessions, and rejection in times of need. Females had significantly higher trauma scores than males.
Distress and Resilience
Youth reported high levels of psychosocial distress. For example, 76 percent felt guilty, 70 percent felt worried or stressed, 63 percent felt sad, and 61 percent felt overwhelmed by problems some or most of the time in the last month. Headaches, nightmares, trouble concentrating, and fatigue were commonly reported signs of emotional distress. Females were significantly more likely to report signs of psychosocial distress. As expected, the researchers found that high exposure to trauma was associated with high levels of psychosocial distress, such as anxiety and depression.
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Members of a Kids’ Club in Bulawayo pose after finishing a dance performance. Photo credit: Leslie Snider |
Despite adverse circumstances, many respondents showed signs of positive psychosocial well-being and resilience. More than three-fourths felt self-confident, hopeful about the future, and that they could do things to help themselves in the last month.
“These findings suggest that signs of positive and negative psychosocial well-being are not mutually exclusive,” said Linda Dube of REPSSI, one of the study’s principal investigators. “Although emotional distress is widespread, there is a considerable level of resilience in this vulnerable group of youth.”
Differences Between Groups
All youth in the study were in one of four study groups. The first group consisted of youth who participated in community-based psychosocial support programs, such as the Kids’ Clubs, which offer a variety of structured, specialized activities to foster support on an ongoing basis.
Youth who attended Masiye Camp’s residential, 10-day program, which aims to build self-esteem, trust, and skills in communication and conflict resolution, made up the second group.
The third group consisted of youth who attended Masiye Camp as campers and then became either a Masiye Camp counselor or a youth leader in a community psychosocial support program.
The fourth group, or comparison group, was made up of youth who had never participated in any formal psychosocial support program, but were identified as being vulnerable by community members consulted by the study investigators. (The youth in the comparison group received psychosocial support either from community programs or the Masiye Camp after the study.)
The researchers did not collect data on the youth before and after they participated in the interventions, nor were participants randomly assigned to study groups. Therefore, they cannot prove that the interventions are responsible for a particular outcome. However, using multiple regression analysis, the researchers examined differences in select psychosocial well-being variables (e.g., self-confidence) and psychosocial distress variables (e.g., sadness) between the intervention groups and the comparison group.
Efforts to sensitize community members to the need children have for someone to talk to are necessary. |
When comparing the intervention groups to the comparison group, all three interventions are associated with greater self-confidence, especially among males. For example, 96 percent of males in the counselor/leader group reported feelings of self-confidence compared to 77 percent of those in the comparison group, a statistically significant difference. Similarly, males in the community psychosocial program group were significantly more likely to report feeling self-confident in the last month than comparison group peers (85 vs. 77 percent).
“This is an interesting finding and reflects the aims of the interventions,” said Laelia Gilborn, formerly of Horizons/Population Council, a principal investigator. “But more rigorous research is needed to find out whether the programs attracted more self-confident youth or whether the programs are responsible for increasing self-confidence.”
The study also found positive trends for ability to cope and ability to help oneself, depending on the intervention, although these associations are not statistically significant. For example, a greater proportion of males and females in the Masiye Camp and the counselor/leader group felt that they could cope with difficulties in their lives compared to the comparison group.
Surprisingly, respondents in each of the three intervention groups reported more psychosocial distress than comparison group youth.
For example, a greater proportion of males and females in the counselor/leader group reported being sad and overwhelmed than youth in the comparison group. In addition, a greater proportion of females in the counselor/leader group reported crying, hopelessness about the future, and disinterest in life than females in the comparison group. Although none of these differences is statistically significant there is a pattern, whereby counselors/leaders, particularly females, may experience greater emotional distress.
This unexpected finding—a greater proportion of youth in the intervention groups exhibit signs of psychosocial distress—stimulated extensive discussion among the researchers and program implementers.
One possible explanation is that the programs help vulnerable youth become more articulate and open about their feelings of distress.
“Attending the Masiye Camp and becoming a leader may help youth become emotionally literate, which allows them to better express emotions,” said Leslie Snider of Tulane University, another study investigator. “If so, psychosocial support programs need to ensure that activities do not simply bring out emotions, but also help youth to cope with such feelings over time.”
The additional responsibilities taken on by the leaders/counselors, such as mentoring and counseling younger children, could also contribute to their comparatively higher levels of distress.
Program Implications
Youth in this study confront many traumatic experiences that likely lead to emotional distress. This context represents a serious challenge for psychosocial support programs. The research suggests ways to strengthen these programs to both promote psychosocial well-being and reduce emotional distress.
The findings show that many youth, particularly orphans, perceive that they do not receive adequate guidance and support from adults. An important role for psychosocial support programs would then be to link youth with trusted adults. Increased efforts to sensitize community members and caregivers to the needs children have for some-one to talk to about their feelings, relationships, and life decisions are necessary.
Programs also must better understand the grieving process in Zimbabwean youth, and, based on that understanding, help children cope with grief and distress over time, such as instituting or strengthening ongoing community-based follow-up. In addition, they also need to be sensitive to each child’s particular needs, such as those who require more skilled support in grief resolution.
More time and attention must be focused on responding to the gender-specific, psychosocial needs of females, as they appear to be particularly vulnerable. Girls-only activities may be useful.
A final report on this study will be published in mid-2005.
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© 2005 The Population Council, Inc.
See Also
For additional information please contact:
Horizons
Population Council
4301 Connecticut Ave. NW, Suite 280
Washington, DC
20008
Telephone: +1 202 237 9400
Facsimile: +1 202 237 8410
E-mail: horizons@popcouncil.org
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| Publications/Resources |
More Horizons publications on orphans and vulnerable children More Horizons publications on youth |
| June 2005 Horizons Report |
Providing Psychosocial Support to AIDS-affected Children Utilizing the Research On Their Own Ethical Issues in Program Design and Research PDF version (491 KB) |