Advertisement

Fostering Resilience in Children Who have been Orphaned: Preliminary Results from the Botswana Balekane EARTH Program

  • Masego Katisi
  • Philip JefferiesEmail author
  • Olebogeng Dikolobe
  • Onkarabile Moeti
  • Joshua Brisson
  • Michael Ungar
Original Paper

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.

Keywords

Resilience Orphans HIV/AIDS Botswana Youth studies 

Notes

Funding

This study was funded by the Government of Botswana Department of Social Protection.

Compliance with Ethical Standards

Conflict of interest

The authors of this paper declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants involved in the study.

Ethical Approval

All procedures involving human participants were approved by Botswana’s Ministry of Local Government and were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. AIDS and Sexually Transmitted Disease Unit. (1998). The rapid assessment on the situation of orphans in Botswana. Gaborone: Ministry of Health.Google Scholar
  2. 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.PubMedGoogle Scholar
  3. 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.Google Scholar
  4. 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.Google Scholar
  5. 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.Google Scholar
  6. 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.PubMedGoogle Scholar
  7. 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.Google Scholar
  8. 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.PubMedGoogle Scholar
  9. Corp, I. B. M. (2012). IBM SPSS statistics for windows (version 21). Armonk, NY: IBM Corp.Google Scholar
  10. 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.Google Scholar
  11. 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.PubMedGoogle Scholar
  12. 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.PubMedGoogle Scholar
  13. Department of Social Services. (2006). Rapid assessment for non governmental organisations giving services to children. Gaborone: Department of Social Services.Google Scholar
  14. 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.Google Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.Google Scholar
  17. 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.
  18. 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.Google Scholar
  19. Hooyman, N. R., & Kramer, B. J. (2008). Living through loss: Interventions across the life span. New York: Columbia University Press.Google Scholar
  20. 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.PubMedGoogle Scholar
  21. 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.Google Scholar
  22. 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.PubMedGoogle Scholar
  23. 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.PubMedGoogle Scholar
  24. 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.Google Scholar
  25. 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.Google Scholar
  26. 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.PubMedPubMedCentralGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. Masten, A. S. (2001). Ordinary magic. Resilience processes in development. The American Psychologist, 56(3), 227–238.PubMedGoogle Scholar
  29. 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.PubMedGoogle Scholar
  30. 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.Google Scholar
  31. Ministry of Local Government. (2012). Botswana non governmental organisations’ forum: Strategising for psychosocial support. Gaborone: Ministry of Local Government.Google Scholar
  32. Ministry of Local Government. (2014). Interventions for orphans and vulnerable children: Non governmental organisations’ contribution. Gaborone: Ministry of Local Government.Google Scholar
  33. 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.PubMedGoogle Scholar
  34. 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.PubMedPubMedCentralGoogle Scholar
  35. 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/.
  36. 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.Google Scholar
  37. 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.PubMedGoogle Scholar
  38. 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.Google Scholar
  39. 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.PubMedGoogle Scholar
  40. Resilience Research Centre. (2016). The child and youth resilience measure (CYRM). Youth version. User’s manual. Halifax, NS: Resilience Research Centre.Google Scholar
  41. 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.PubMedGoogle Scholar
  42. 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.PubMedGoogle Scholar
  43. 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.PubMedGoogle Scholar
  44. 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.Google Scholar
  45. 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.PubMedGoogle Scholar
  46. 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.PubMedGoogle Scholar
  47. 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.PubMedGoogle Scholar
  48. 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.Google Scholar
  49. Tomita, T., & Kitamura, T. (2002). Clinical and research measures of grief: A reconsideration. Comprehensive Psychiatry, 43(2), 95–102.PubMedGoogle Scholar
  50. 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.PubMedGoogle Scholar
  51. 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.
  52. Ungar, M. (2013). Resilience, trauma, context, and culture. Trauma, Violence, & Abuse, 14(3), 255–266.  https://doi.org/10.1177/1524838013487805.Google Scholar
  53. 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.PubMedGoogle Scholar
  54. 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.PubMedGoogle Scholar
  55. 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.Google Scholar
  56. 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.
  57. UNICEF. (2015). The state of the world’s children: Reimagine the future: Innovation for every child. New York: UNICEF.Google Scholar
  58. UNICEF. (2017a). Children and AIDS: Statistical update. Retrieved 13 June 2018, from https://data.unicef.org/resources/children-aids-statistical-update/.
  59. UNICEF. (2017b). Orphans. Retrieved 13 June 2018, from https://www.unicef.org/media/media_45279.html.
  60. 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.Google Scholar
  61. 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.Google Scholar
  62. 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.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Western Norway University of Applied SciencesBergenNorway
  2. 2.Resilience Research Centre, Dalhousie UniversityHalifaxCanada
  3. 3.Ark and Mark TrustGaboroneBotswana

Personalised recommendations