Abstract
Background
Contextually relevant interventions are needed to support the well-being of at-risk adolescents in Sub-Saharan Africa. In particular, the large number of children who have been orphaned, such as by HIV/AIDS, are in need of interventions to foster their resilience.
Objective
The goal of this study was to investigate the efficacy of the Balekane EARTH program, a 2-week wilderness-based therapeutic intervention in Botswana for children who have been orphaned.
Method
A quasi-experimental pretest–posttest design was used. At program entry and again at completion, participants (n = 650) aged 11–17 from communities across Botswana completed a questionnaire containing contextualised versions of the Child and Youth Resilience Measure (CYRM-28), the Inventory of Complicated Grief, the Future Aspirations/Peer Leader scale, the Conduct Problems subscale of the Strengths and Difficulties Questionnaire, and questions pertaining to school engagement.
Results
Following participant in the camps, there were improvements in reported resilience. Female participants also reported improvements in problems related to grief and future aspirations. The half of the participants who scored most poorly on measures of resilience, problems with grief, and future aspirations (those most at-risk) were found to report the biggest gains on these measures following the intervention.
Conclusions
These preliminary findings indicate the promise of programs such as Balekane EARTH that address the trauma experiences of children in sub-Saharan Africa who have been orphaned, though further research is needed to identify appropriate target thresholds and to investigate the longer-term impact of the program.
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References
AIDS and Sexually Transmitted Disease Unit. (1998). The rapid assessment on the situation of orphans in Botswana. Gaborone: Ministry of Health.
Atwine, B., Cantor-Graae, E., & Bajunirwe, F. (2005). Psychological distress among AIDS orphans in rural Uganda. Social Science and Medicine, 61(3), 555–564. https://doi.org/10.1016/j.socscimed.2004.12.018.
Betancourt, T. S., Meyers-Ohki, S. E., Charrow, A., & Hansen, N. (2013). Annual Research Review: Mental health and resilience in HIV/AIDS-affected children—A review of the literature and recommendations for future research. Journal of Child Psychology and Psychiatry and Allied Disciplines, 54(4), 423–444. https://doi.org/10.1111/j.1469-7610.2012.02613.x.
Bonanno, G. A., & Mancini, A. D. (2012). Beyond resilience and PTSD: Mapping the heterogeneity of responses to potential trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), 74–83. https://doi.org/10.1037/a0017829.
Boyden, J., & Mann, G. (2005). Children’s risk, resilience, and coping in extreme situations. In M. Ungar (Ed.), Handbook for working with children and youth: Pathways to resilience across cultures and contexts (pp. 3–26). Thousand Oaks: SAGE Publications, Inc. https://doi.org/10.4135/9781412976312.
Calear, A. L., & Christensen, H. (2010). Systematic review of school-based prevention and early intervention programs for depression. Journal of Adolescence, 33(3), 429–438. https://doi.org/10.1016/j.adolescence.2009.07.004.
Campbell, C., Andersen, L., Mutsikiwa, A., Madanhire, C., Skovdal, M., Nyamukapa, C., et al. (2015). Re-thinking children’s agency in extreme hardship: Zimbabwean children’s draw-and-write about their HIV-affected peers. Health & Place, 31, 54–64. https://doi.org/10.1016/j.healthplace.2014.09.008.
Cluver, L., & Orkin, M. (2009). Cumulative risk and AIDS-orphanhood: Interactions of stigma, bullying and poverty on child mental health in South Africa. Social Science and Medicine, 69(8), 1186–1193. https://doi.org/10.1016/j.socscimed.2009.07.033.
Corp, I. B. M. (2012). IBM SPSS statistics for windows (version 21). Armonk, NY: IBM Corp.
Dahlberg, L. L., Toal, S. B., Swahn, M. H., & Behrens, C. B. (2005). Measuring violence-related attitudes, behaviors, and influences among youths: A compendium of assessment tools. Atlanta, GA: Centers for Disease Control and Prevention.
Daigneault, I., Dion, J., Hébert, M., McDuff, P., & Collin-Vézina, D. (2013). Psychometric properties of the Child and Youth Resilience Measure (CYRM-28) among samples of French Canadian youth. Child Abuse and Neglect, 37(2), 160–171. https://doi.org/10.1016/j.chiabu.2012.06.004.
Daniel, M., Malinga Apila, H., Bj Rgo, R., & Therese Lie, G. (2007). Breaching cultural silence: Enhancing resilience among Ugandan orphans. African Journal of AIDS Research: AJAR, 6(2), 109–120. https://doi.org/10.2989/16085900709490405.
Department of Social Services. (2006). Rapid assessment for non governmental organisations giving services to children. Gaborone: Department of Social Services.
Des Jarlais, D., Lyles, C., Crepaz, N., & TREND Group. (2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. American Journal of Public Health, 94(3), 361–366.
Dray, J., Bowman, J., Campbell, E., Freund, M., Wolfenden, L., Hodder, R. K., et al. (2017). Systematic review of universal resilience-focused interventions targeting child and adolescent mental health in the school setting. Journal of the American Academy of Child and Adolescent Psychiatry, 56(10), 813–824. https://doi.org/10.1016/j.jaac.2017.07.780.
Evans, R. M. (2005). Social networks, migration, and care in Tanzania: Caregivers’ and children’s resilience to coping with HIV/AIDS. Journal of Children and Poverty, 11(2), 111–129.
Fahie, D. (2014). Doing sensitive research sensitively: Ethical and methodological issues in researching workplace bullying. International Journal of Qualitative Methods, 19–36. https://doi.org/10.1177/160940691401300108.
Heath, M., Donald, D. R., Theron, L., & Lyon, R. C. (2014). AIDS in South Africa: Therapeutic interventions to strengthen resilience among orphans and vulnerable children. Social Psychology International, 35(3), 309–337.
Hooyman, N. R., & Kramer, B. J. (2008). Living through loss: Interventions across the life span. New York: Columbia University Press.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.
Kassis, W., Artz, S., & Moldenhauer, S. (2013). Laying down the family burden: A cross-cultural analysis of resilience in the midst of family violence. Child & Youth Services, 34(1), 37–63. https://doi.org/10.1080/0145935X.2013.766067.
Kidman, R., Petrow, S. E., & Heymann, S. J. (2007). Africa’s orphan crisis: Two community-based models of care. AIDS Care, 19(3), 326–329. https://doi.org/10.1080/09540120600608396.
King, E., De Silva, M., Stein, A., & Patel, V. (2009). Interventions for improving the psychosocial well-being of children affected by HIV and AIDS. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD006733.pub2.
Li, H., Liebenberg, L., & Ungar, M. (2015). Understanding service provision and utilization for vulnerable youth: Evidence from multiple informants. Children and Youth Services Review, 56, 18–25. https://doi.org/10.1016/j.childyouth.2015.06.012.
Liebenberg, L., Ungar, M., & van de Vijver, F. (2012). Validation of the Child and Youth Resilience Measure-28 (CYRM-28) among Canadian youth. Research on Social Work Practice, 22(2), 219–226. https://doi.org/10.1177/1049731511428619.
Luthar, S. S., & Zigler, E. (1991). Vulnerability and competence: A review of research on resilience in childhood. The American Journal of Orthopsychiatry, 61(1), 6–22.
Maciejewski, P. K., Zhang, B., Block, S. D., & Prigerson, H. G. (2007). An empirical examination of the stage theory of grief. JAMA, 297(7), 716–723. https://doi.org/10.1001/jama.297.7.716.
Masten, A. S. (2001). Ordinary magic. Resilience processes in development. The American Psychologist, 56(3), 227–238.
Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85(1), 6–20. https://doi.org/10.1111/cdev.12205.
Mayaba, N. N., & Wood, L. (2015). The value of using folktales as an intervention tool to enhance resilience for children orphaned and rendered vulnerable by HIV and AIDS. Education as Change, 19(1), 10–35. https://doi.org/10.1080/16823206.2015.1024143.
Ministry of Local Government. (2012). Botswana non governmental organisations’ forum: Strategising for psychosocial support. Gaborone: Ministry of Local Government.
Ministry of Local Government. (2014). Interventions for orphans and vulnerable children: Non governmental organisations’ contribution. Gaborone: Ministry of Local Government.
Murray, L. K., Skavenski, S., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J. A., et al. (2015). Effectiveness of trauma-focused cognitive behavioral therapy among trauma-affected children in Lusaka, Zambia: A randomized clinical trial. JAMA Pediatrics, 169(8), 761–769. https://doi.org/10.1001/jamapediatrics.2015.0580.
Nyamukapa, C. A., Gregson, S., Wambe, M., Mushore, P., Lopman, B., Mupambireyi, Z., et al. (2010). Causes and consequences of psychological distress among orphans in eastern Zimbabwe. AIDS Care, 22(8), 988–996. https://doi.org/10.1080/09540121003615061.
Osterweis, M., Solomon, F., & Green, M. (1984). Bereavement during childhood and adolescence. In Bereavement: Reactions, consequences, and care. Washington, DC: National Academies Press (US). Retrieved June 29, 2018 from https://www.ncbi.nlm.nih.gov/books/NBK217849/.
Pallant, J. F. (2007). SPSS survival manual: A step by step guide to data analysis using SPSS for windows (3rd ed.). Maidenhead: Open University Press.
Phaladze, N. A., Ngwenya, B. N., & Gabaitiri, L. (2018). Orphans’ perspectives on grief and loss in Botswana. AIDS Care, 30(4), 506–510. https://doi.org/10.1080/09540121.2017.1382677.
Pienaar, A., Swanepoel, Z., van Rensburg, H., & Heunis, C. (2011). A qualitative exploration of resilience in pre-adolescent AIDS orphans living in a residential care facility. SAHARA J: Journal of Social Aspects of HIV/AIDS Research Alliance, 8(3), 128–137. https://doi.org/10.1080/17290376.2011.9724995.
Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., et al. (1995). Inventory of complicated grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research, 59(1–2), 65–79.
Resilience Research Centre. (2016). The child and youth resilience measure (CYRM). Youth version. User’s manual. Halifax, NS: Resilience Research Centre.
Rosenberg, A., Hartwig, K., & Merson, M. (2008). Government-NGO collaboration and sustainability of orphans and vulnerable children projects in southern Africa. Evaluation and Program Planning, 31(1), 51–60. https://doi.org/10.1016/j.evalprogplan.2007.08.005.
Rutter, M. (1987). Psychosocial resilience and protective mechanisms. The American Journal of Orthopsychiatry, 57(3), 316–331. https://doi.org/10.1111/j.1939-0025.1987.tb03541.x.
Schenk, K. D. (2009). Community interventions providing care and support to orphans and vulnerable children: A review of evaluation evidence. AIDS Care, 21(7), 918–942. https://doi.org/10.1080/09540120802537831.
Sherr, L., Cluver, L. D., Betancourt, T. S., Kellerman, S. E., Richter, L. M., & Desmond, C. (2014). Evidence of impact: Health, psychological and social effects of adult HIV on children. AIDS (London, England), 28(Suppl 3), S251–S259. https://doi.org/10.1097/QAD.0000000000000327.
Skovdal, M., & Daniel, M. (2012). Resilience through participation and coping-enabling social environments: The case of HIV-affected children in sub-Saharan Africa. African Journal of AIDS Research: AJAR, 11(3), 153–164. https://doi.org/10.2989/16085906.2012.734975.
Thamuku, M., & Daniel, M. (2012). The use of rites of passage in strengthening the psychosocial wellbeing of orphaned children in Botswana. African Journal of AIDS Research, 11(3), 215–224. https://doi.org/10.2989/16085906.2012.734980.
Thamuku, M., & Daniel, M. (2013). Exploring responses to transformative group therapy for orphaned children in the context of mass orphaning in Botswana. Death Studies, 37(5), 413–447. https://doi.org/10.1080/07481187.2012.654594.
Theron, L. C. (2010). A critical review of studies of South African youth resilience, 1990–2008. South African Journal of Science, 106(7&8), 1–8.
Tomita, T., & Kitamura, T. (2002). Clinical and research measures of grief: A reconsideration. Comprehensive Psychiatry, 43(2), 95–102.
Ungar, M. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. The American Journal of Orthopsychiatry, 81(1), 1–17. https://doi.org/10.1111/j.1939-0025.2010.01067.x.
Ungar, M. (2012). Social ecologies and their contribution to resilience. In The social ecology of resilience: A handbook of theory and practice (pp. 13–31). New York: Springer. https://doi.org/10.1007/978-1-4614-0586-3_2.
Ungar, M. (2013). Resilience, trauma, context, and culture. Trauma, Violence, & Abuse, 14(3), 255–266. https://doi.org/10.1177/1524838013487805.
Ungar, M. (2018). The differential impact of social services on young people’s resilience. Child Abuse and Neglect, 78, 4–12. https://doi.org/10.1016/j.chiabu.2017.09.024.
Ungar, M., Brown, M., Liebenberg, L., Othman, R., Kwong, W. M., Armstrong, M., et al. (2007). Unique pathways to resilience across cultures. Adolescence, 42(166), 287–310.
Ungar, M., & Liebenberg, L. (2011). Assessing resilience across cultures using mixed methods: Construction of the child and youth resilience measure. Journal of Mixed Methods Research, 5(2), 126–149. https://doi.org/10.1177/1558689811400607.
UNICEF. (2013). Children and AIDS: Sixth stocktaking report.pdf. New York: UNICEF. Retrieved June 29, 2018 from https://www.unicef.org/publications/files/Children_and_AIDS_Sixth_Stocktaking_Report-Summary.pdf.
UNICEF. (2015). The state of the world’s children: Reimagine the future: Innovation for every child. New York: UNICEF.
UNICEF. (2017a). Children and AIDS: Statistical update. Retrieved 13 June 2018, from https://data.unicef.org/resources/children-aids-statistical-update/.
UNICEF. (2017b). Orphans. Retrieved 13 June 2018, from https://www.unicef.org/media/media_45279.html.
Werner, E. E. (2013). What can we learn about resilience from large-scale longitudinal studies? In S. Goldstein & R. B. Brooks (Eds.), Handbook of resilience in children (pp. 91–105). Boston, MA: Springer. https://doi.org/10.1007/0-306-48572-9_7.
Yendork, J. S., & Somhlaba, N. Z. (2015). Do social support, self-efficacy and resilience influence the experience of stress in Ghanaian orphans? An exploratory study. Child Care in Practice, 21(2), 140–159. https://doi.org/10.1080/13575279.2014.985286.
Zahradnik, M., Stewart, S. H., O’Connor, R. M., Stevens, D., Ungar, M., & Wekerle, C. (2010). Resilience moderates the relationship between exposure to violence and posttraumatic reexperiencing in Mi’kmaq youth. International Journal of Mental Health and Addiction, 8(2), 408–420. https://doi.org/10.1007/s11469-009-9228-y.
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This study was funded by the Government of Botswana Department of Social Protection.
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Katisi, M., Jefferies, P., Dikolobe, O. et al. Fostering Resilience in Children Who have been Orphaned: Preliminary Results from the Botswana Balekane EARTH Program. Child Youth Care Forum 48, 585–601 (2019). https://doi.org/10.1007/s10566-019-09497-6
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DOI: https://doi.org/10.1007/s10566-019-09497-6