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«Caregiver Perspectives on Psychosocial Support Programming for Orphans and Vulnerable Children in South Africa: A Non-Governmental Organization Case ...»

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University of Ottawa: School of International Development and Global Studies

Caregiver Perspectives on Psychosocial Support Programming for

Orphans and Vulnerable Children in South Africa:

A Non-Governmental Organization Case Study

Cherie Martin

Thesis Supervisor: Dr. Lauchlan Munro

© Cherie Martin, Ottawa, Canada, 2015

Table of Contents


1.1 Overview

1.2 Terminology

1.3 South African Context

1.4 Political and Economic History

1.5 HIV/AIDS in South Africa

1.6 Orphaned and Vulnerable Children (OVC)

1.7 Crime, Violence and Child Abuse

1.8 Fetal Alcohol Syndrome

1.9 Tuberculosis (TB)


2.1 Outcomes for Psychosocial Development and Mental Health for OVCs................. 16

2.2 Psychosocial Programs and Interventions for OVCs

2.3 South African Policy Frameworks for HIV/AIDS OVCs

2.4 Challenges and Considerations for Policy

2.4.1 Foster care policy

2.4.2 Foster care vs. institutionalized group homes

2.4.3 Caregiver burnout

2.4.3 Gender

2.4.4 Political challenges

2.4.5 Human-Rights based policy

2.5 Gaps in the Literature and Contributions


3.1 Theory

3.1.1 Child development theory

3.1.2 Theoretical framework

3.2 Methodology

3.2.1 Research design: a qualitative case study

3.2.2 Organization recruitment

3.2.3 Research ethics protocol

3.2.4 Changes in research design and complications

3.2.5 Participant observation (the crèche)

3.2.6 Participant recruitment

3.2.7 Individual interviews

3.2.8 Debriefing procedures

3.2.9 Data Capturing, analysis and reporting

3.3 Background Information

3.3.1 HomefromHome strategy

3.3.2 Structure of the foster homes

3.3.3 Nature of vulnerability and orphanhood

3.3.4 Regions

3.4 Limitations



4.1 Research Questions

4.2 Foster Mothers

4.2.1 Challenges in providing psychosocial support

4.2.2 Best forms and sources of psychosocial support

4.2.3 Awareness for policy makers

4.2.4 The role of psychosocial support

4.2.5 Caregiver suggestions

4.2.6 Role of the church & local community

4.2.7 Challenges related to children’s biological families

4.2.8 The future of the children

4.2.9 Gendered Issues

4.3 HomeFromHome Personnel (Social workers and administrator)

4.3.1 Challenges in providing psychosocial support

4.3.2 Best forms and sources of psychosocial support

4.3.3 Awareness for policy makers

4.3.4 The effects of trauma and children’s emotional and behavioural problems.......... 86 4.3.5 The role of formal psychosocial support

4.3.6 Challenges related to children’s biological families

4.3.7 The importance of community integration

4.3.8 Failing systems


5.1 Challenges in Delivering Psychosocial Support

5.2 Best forms and Sources of Psychosocial Support

5.3 Suggestions and Concerns for Policy Makers

5.4 Identified Themes

5.4.1 The role of psychosocial support

5.4.2 Child development theory

5.4.3 Different forms of alternative child care & determinants of vulnerability.......... 107 5.4.4 Role of the community and the church

4.4.5 Gap between policy and implementation

5.4.6 Gender issues

5.4.7 The aging-out process

5.4.8 Biological families


APPENDIX 1 - Different Forms of Alternative Child Care

APPENDIX 2 - Interview Questions for Foster Mothers

APPENDIX 3 - Interview Questions for Social Workers

APPENDIX 4 - Interview Questions for the Administrator

APPENDIX 5 - Map of the HomeFromHome Communities

APPENDIX 6 - Initial Findings Report



In 2011 there were an estimated 3.9 million orphaned children in South Africa, many of them orphaned by HIV/AIDS. These children are at high risk for developing psychosocial and mental health problems. The National Strategy for the care of orphans and other vulnerable children (OVCs) recognizes the importance of psychosocial support but there are few specific guidelines on best practice and little research on the effectiveness of psychosocial support programs. There is even less research capturing the perspectives of front-line staff and caregivers. This master’s thesis project conducted a case study of an NGO that provides foster care for OVCs in the Western Cape of South Africa.

Semi-structured interviews were carried out with 14 foster mothers, four social workers and one administrator of the HomeFromHome organization. Interviews explored the experiences, opinions and concerns of participants regarding psychosocial support and the respondents’ views on the (1) main challenges they face in providing psychosocial support (2) what they see as the most effective forms of support and (3) their recommendations for policy changes.

Responses highlighted the psychosocial challenges faced by OVCs, those caring for children, and program staff. The research findings support the existing literature, which promotes psychosocial support as essential for orphaned, and vulnerable children. This case study found that HomeFromHome social workers, foster mothers and administration want increased levels of psychosocial support for both children and caregivers. Respondents identified foster mothers and a primary loving caregiver as the most significant form and source of psychosocial support for the children.

An analysis of the participant responses identified several areas that warrant further investigation for future policy and program development. These include: the different forms of alternative childcare, the role of the community and the church, the gap between policy and implementation, gendered issues, the aging out process, and issues concerning biological families.

–  –  –

1.1 Overview Maltreatment and trauma experienced at a young age have been linked to a range of future mental health problems and psychological disorders including anxiety, depression, and post-traumatic stress disorder (PTSD) (Hermenau et al., 2011; T. Lee, Foster, Makufa, & Hinton, 2002). Psychological disorders and mental illness have both direct and indirect negative consequences for individuals, family members, employers and even society as a whole.

Numerous studies have shown that psychological disorders can diminish educational attainment, individual productivity and skills development, thereby reducing human capital (Alonso et al., 2011; Hermenau et al., 2011; World Economic Forum, 2011). This loss of human capital and need for increased social services further strains government resources and can impede national development efforts (UNAIDS, 2010b). In South Africa the current and future implications of widespread child vulnerability and increased risk for mental illness are extreme. In 2011 there were an estimated 3.9 million orphaned children in South Africa, as well as an unknown number of children made vulnerable by other detrimental circumstances such as childhood trauma, abuse, poverty and disease. These conditions indicate that millions of South African children are at a high risk for developing psychosocial and mental health problems. For South Africa, the scale of the problem makes this a potential compounding tragedy for children, families, communities, and national development (Frith, 2014).

Numerous non-governmental organizations, development agencies and government departments have recognized the need to support and protect the millions of orphaned and vulnerable children (OVCs) in South Africa. Many policies and frameworks have also been developed that acknowledge the need to provide support to promote healthy psychosocial development of OVCs. However, an analysis of these policies, which was conducted for this study, indicates that there are few specific guidelines for practice and implementation.

Furthermore, while there is considerable literature documenting the psychosocial problems and needs of OVCs, there has been little research to date that examines specific interventions that promote their psychosocial health, and few that identify the specific characteristics of effective OVC care programs. Specifically, the existing literature lacks experiences and opinions from front-line workers who provide care to OVCs (Cluver and Gardner, 2007). There is a clear need for a better understanding of the role of psychosocial support for OVCs and identifying the best methods to alleviate future psychosocial problems. The current study aims to contribute to this knowledge base for policy makers and program providers through the perspectives of caregivers and front-line staff working directly with OVCs.

This research focused on the following central research question: What can the experiences, opinions and concerns of OVC caregivers and program staff tell us about psychosocial support and the role of psychosocial support programs for OVCs in South Africa?

More specifically, the research sought to identify: 1) the problems OVC caregivers and program staff encounter in delivering psychosocial support; 2) what the caregivers and program staff believe are the characteristics of the best forms and sources of psychosocial support and 3) what program staff and caregivers want policy makers to be aware of or be incorporated into future policy developments regarding orphaned and vulnerable children.

This qualitative case study used open-ended interviews and participant observation of a South African NGO, called HomeFromHome. The HomeFromHome (HFH) organization partners with various community organizations to develop and support foster homes within several communities across the Cape Town region of the Western Cape of South Africa. The organization provides care for OVCs by placing children in supported foster homes, with a foster mother, an assigned social worker and general caregiving support. For this study, 14 social workers, four social workers, and one administrator from HFH were interviewed to obtain their perspectives on the role of psychosocial support for orphaned and vulnerable children.

The responses from foster mothers, social workers and program staff provided insight into their frontline experiences and their perspectives on how to best support vulnerable children and the challenges they face in doing this. The experiences of, and issues raised by, these frontline staff are consistent with the existing research that emphasizes the critical importance of meeting the psychosocial needs of vulnerable children in addition to their basic physical needs such as food and shelter. Taking into account the current economic, political and social context of South Africa, and the current policies and frameworks, a number of common themes were identified from the participant responses. These themes are then discussed as areas that warrant further investigation in order to identify ways of improving the psychosocial support for OVCs in South Africa.

This thesis is structured into six chapters. Chapter one has first laid out a brief introduction to the research project with an overview of the study design and purpose, and will next provide an overview of the South African context with relevant background information.

This contextual information includes: the key terminology, the history of South Africa; the HIV/AIDS epidemic; orphaned and vulnerable children; crime, violence and child abuse; fetal alcohol syndrome; and tuberculosis. Chapter two then provides a literature review of the relevant research related to psychosocial support for OVCs including the outcomes for psychosocial development and mental health of OVCs, the existing psychosocial programs and interventions, the South African policy frameworks for OVCs, the challenges and considerations for policy development, and the identified gaps in the literature. Chapter three describes the theory and methods of the research project, including the theoretical framework, and the study design. The methodology section also presents the detailed background information on the HomeFromHome organization, how this organization was selected, the changes in research design, the participant observation, and a detailed overview of the procedures taken for recruiting participants, conducting interviews, debriefing and data analysis. Chapter Four discusses the research findings by presenting direct quotes from participant’s responses as well as a brief identification of common themes. Chapter five then provides a discussion of these findings in relation to the central research questions, followed by a discussion of the identified themes, specifically focusing on the areas that warrant further investigation based on the research findings. Finally Chapter 6 provides a summary and conclusion of the study.

1.2 Terminology

Two key terms used throughout this thesis research project are ‘OVC’ and ‘psychosocial’. While the term OVC is frequently used to refer to orphans and vulnerable children who are affected by HIV/AIDS, the term OVC was coined by researchers and development practitioners to represent all children at elevated risk, whether due to HIV or other causes (Cheney, 2012; Schenk, Michaelis, Nelson Sapiano, Brown, & Weiss, 2010). Previous terminology such as “AIDS orphans” implied that a child was either HIV-positive or that both parents had died from AIDS. The term OVC aims to broaden this definition to represent children orphaned or made vulnerable by various circumstances, including but not limited to HIV/AIDS.

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