The development and evaluation of a community-based programme offering psychosocial support to vulnerable children affected by HIV/AIDS, poverty and violence.

Abstract

This research programme endeavours to develop, implement and evaluate an effective method of offering psychosocial support to vulnerable children. Vulnerability is defined by trained community members as including children who are experiencing especially difficult lives. The forms of difficulties experienced by the children has usually been a consequence of the HIV/AIDS pandemic, extreme poverty combined with other psychosocial risk factors, child abuse (especially child sexual abuse) and violence. This community based programme incorporates four phases of intervention, only two of which were the focus of summative evaluation. However, due to the integrated nature of the programme it was necessary to implement and document the various phases of the intervention programme: (i) community selection and mobilisation; (ii) the 5-day Sensitisation Programme (SP) sensitises adult community volunteers to the psychosocial needs of vulnerable children; (iii) the 15-session Structured Group Therapy Programme (SGTP) enables children to work through past adversities and to build resilience within small groups of peers in a programme where community volunteers served as apprentice facilitators under the supervision, guidance and ethical responsibility of qualified psychologists; (iv) community based initiatives to offer on-going of PSS activities to vulnerable children in each of the partnering communities. Nine partnering communities were selected, three township, periurban and rural communities. This programme was not effective in the informal settlements as it was not possible for these communities to place children as a priority. A qualitative summative evaluation of the SP took place using post workshop evaluation questionnaires, focus group discussions conducted by an independent researcher and an audit of the community based initiatives that developed as a result of participation in the SP. The SGTP was summatively evaluated using a 4-way Factorial design with one within-subject and three between-subject conditions: to investigate the age of the subjects, the geographic regions and gender variables. The 741 children formed five experimental and control conditions to conduct various combinations of the above-mentioned phases programmes and to adequately control for the many confounding variables. Pre- and post intervention assessments were conducted by trained community research assistants. The dependent variable measures were the Culture Free Self Esteem Inventory (Battle, 1992), the Trauma Symptom Checklist for Children (Biere & Elliot, 1997), the Reynolds Depression Scale for Children (Reynolds, 1989), the Social Support Scale (Beale Spencer, Cole, Jones, and Phillips Swanson, 1997) and the Connor's Parent Questionnaire Connors, 1998). Multivariate analysis evaluated the effectiveness of the various experimental and control conditions. The results indicate that the SGTP, run in combination with the SP, is an effective intervention strategy in that it alleviates symptoms of self-reported depression and other psychosocial manifestations of distress as well as decreased the number and severity of symptoms reported by primary caregivers, and leads to increased access to perceived social support. The SP and the SGTP conducted independently of each other have limited benefits and as such can be considered to be partially effective. The children who had formed part of the non-vulnerable control group felt left out of the programme and report an increase in symptomatology and decreased access to social support. While this community-based programme can be considered to be an effective method of therapeutic intervention and of offering psychosocial support to vulnerable children, further research is needed to consider the cost-effectiveness, the sustainability and ways in which those children who do not participate can still can benefit.