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Perrigo JL, Molina AP, López O, Traube D, Palinkas LA. The deinstitutionalization of children and adolescents in El Salvador's child protection system. CHILD ABUSE & NEGLECT 2024; 147:106601. [PMID: 38113572 DOI: 10.1016/j.chiabu.2023.106601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/29/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND In 2010, El Salvador introduced legislation aimed at reforming the country's Child Protective System (CPS), with a focus on promoting deinstitutionalization. OBJECTIVE The study aim was to explore the impact of deinstitutionalization on the Salvadoran CPS. PARTICIPANTS AND SETTING The study was conducted in El Salvador, granting authors unique access to key informants with extensive experience in the country's CPS. Unlike the United States, which is divided into states, El Salvador is divided into departments, and CPS providers were recruited from all 14 departments. Focus groups were facilitated in the East, West, and Central zones to ensure representation from all regions. METHODS Qualitative semi-structured interviews (n = 26) were conducted in June/July of 2019, which were then followed by focus groups (n = 4) in August 2019. The analysis of the data employed a combination of deductive and inductive thematic coding methods. RESULTS CPS providers offered valuable insights, categorized into five main themes: (1) Strengths of El Salvador's CPS, (2) Deinstitutionalization policy encompassing socioenvironmental contextual factors, (3) Challenges in the deinstitutionalization process, including insufficient follow-up on deinstitutionalized children, (4) Recommendations from participants, highlighting the importance of enhancing stakeholder coordination/collaboration, and (5) The necessity for a paradigm shift, emphasizing the need to redefine the social contract on protecting children from child maltreatment. CONCLUSIONS The Salvadoran CPS requires substantial systemic changes. Encouragingly, key informants have demonstrated a commitment to reform not only the deinstitutionalization process but also the broader CPS system in El Salvador including case management and quality of care in institutional settings.
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Affiliation(s)
- Judith L Perrigo
- University of California, Los Angeles (UCLA), Luskin School of Public Affairs, Social Welfare Department, 3250 Public Affairs Building, Los Angeles, CA 90095-1656, USA.
| | | | - Omar López
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, 669 W 34(th) Street, Los Angeles, CA 90089, USA
| | - Dorian Traube
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, 669 W 34(th) Street, Los Angeles, CA 90089, USA
| | - Lawrence A Palinkas
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, 669 W 34(th) Street, Los Angeles, CA 90089, USA
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Novak-Pavlic M, Rosenbaum P, Di Rezze B. Changing Directions and Expanding Horizons: Moving towards More Inclusive Healthcare for Parents of Children with Developmental Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6983. [PMID: 37947541 PMCID: PMC10649410 DOI: 10.3390/ijerph20216983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Family-centred service (FCS) acknowledges the importance of family engagement in therapeutic processes and focuses on the needs of all family members. This way of thinking and practicing is becoming increasingly recognized as an optimal care delivery model for families of children with developmental disabilities (DDs). However, in most places, disability services are oftentimes 'child-centric', wherein family members are seen only as partners in therapy or care delivery, while their own needs are not addressed. This arises from the lack of awareness of complex and highly individual family needs by professionals with whom they interact, but also from a significant lack of service infrastructure oriented towards parent-specific needs in existing service delivery models. This concept paper highlights the known challenges associated with parenting a child with a DD and discusses the intersectionality of factors impacting parental health and well-being, with a goal of promoting more equitable, holistic, and inclusive healthcare for all family members of children with DDs.
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Affiliation(s)
- Monika Novak-Pavlic
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada;
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - Briano Di Rezze
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada;
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada;
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Yeh MJ. Saving unwanted children: a proposal for a National Rearing Institute. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:435-452. [PMID: 37131116 DOI: 10.1007/s11017-023-09621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/04/2023]
Abstract
Unwanted children are carried, born, and reluctantly raised each year; they are prone to abortion, abandonment, neglect, and abuse. Meanwhile, many developed societies are suffering from depopulation. To address these two issues concurrently, I propose that governments should grant pregnant women and mothers an irreversible and unconditional one-time chance to relinquish all their legal rights and obligations associated with each of their children under a specific age to a National Rearing Institute that adopts the children and rears them to the age when they can fully exercise their rights as adult citizens. I call this set of policy arrangements "Project New Republicans." This project aims to (1) protect and support the best interests of unwanted children, (2) maximize the health outcomes of the mothers who gave birth to these children and help the mothers to achieve self-realization, and (3) preserve an influx to the population from procreation against depopulation. The project is primarily grounded on both the utilitarian and intra- / inter-generational accounts of justice. It also ameliorates the oppression and domination of women by unjust social structures in alignment with the human rights-based approach.
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Affiliation(s)
- Ming-Jui Yeh
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, 17 Xuzhou Road, Taipei, 100, Taiwan.
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Sousa M, Peixoto MM, Cruz O, Cruz S. The Relationship Between Temperament Characteristics and Emotion Regulation Abilities in Institutionalized and Noninstitutionalized Children. PSYCHOLOGICAL STUDIES 2023; 68:1-13. [PMID: 37361514 PMCID: PMC10185962 DOI: 10.1007/s12646-023-00735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/20/2023] [Indexed: 06/28/2023] Open
Abstract
This study examined the role of institutionalization and temperament dimensions on emotion regulation and negative lability in school-aged (6-10 years) children. Participants were 46 institutionalized (22 boys; 24 girls) and 48 noninstitutionalized children (23 boys; 25 girls), matched in age and sex. Emotion regulation and negative lability were assessed with the Emotion Regulation Checklist (ERC). The School-Age Temperament Inventory (SATI) was used to measure temperament dimensions. No significant between-group differences emerged in temperament dimensions, emotion regulation and negative lability. After controlling for institutionalization status, results indicated that (a) approach/withdrawal (sociability) and persistence positively predicted emotion regulation, (b) negative reactivity positively predicted negative lability, and (c) persistence negatively predicted negative lability. Institutionalization did not predict emotion regulation or negative lability. The protective role that specific temperament characteristics, such as persistence and approach/withdrawal (sociability), may have for at risk populations (e.g., institutionalized) and typically developing (e.g., noninstitutionalized) children is highlighted.
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Affiliation(s)
- Mariana Sousa
- The Psychology for Positive Development Research Center, Lusíada University - Porto, Porto, Portugal
| | - Maria Manuela Peixoto
- Center for Psychology at University of Porto, Faculty of Psychology and Sciences of Education of the University of Porto, Porto, Portugal
| | - Orlanda Cruz
- Center for Psychology at University of Porto, Faculty of Psychology and Sciences of Education of the University of Porto, Porto, Portugal
| | - Sara Cruz
- The Psychology for Positive Development Research Center, Lusíada University - Porto, Porto, Portugal
- Department of Psychology, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK
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Ismayilova L, Claypool E, Heidorn E. Trauma of separation: the social and emotional impact of institutionalization on children in a post-soviet country. BMC Public Health 2023; 23:366. [PMID: 36803447 PMCID: PMC9942302 DOI: 10.1186/s12889-023-15275-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND In the former Soviet Union (fSU) region, which has the highest rate of institutional care worldwide, 'social orphans' -indigent children who have one or both parents living-are placed in publicly run residential institutions to receive education, food, and shelter. Few studies have focused on understanding the emotional effects of separation and life in an institutional environment on children who grow up with their families. METHODS Semi-structured qualitative interviews (N = 47) were conducted with 8- to 16-year-old children with a history of institutional care placement and their parents in Azerbaijan. Semi-structured qualitative interviews were conducted with 8- to 16-year-old children (n = 21) involved in the institutional care system in Azerbaijan and their caregivers (n = 26). Trained interviewers collected narratives about children's experiences prior to being separated from their families while living in an institution, as well as the impact of institutional placement on their emotional well-being. We applied thematic analysis with inductive coding. RESULTS Most of the children entered institutions around the school entry age. Prior to entering institutions, children had already experienced disruptions within their family environments and multiple traumatic events, including witnessing domestic violence, parental divorce, and parental substance abuse. Once institutionalized, these children may have had their mental health further impaired by a sense of abandonment, a strictly regimented life, and insufficiencies of freedom, privacy, developmentally stimulating experiences, and, at times, safety. CONCLUSION This study illustrates the emotional and behavioral consequences of institutional placement and the need to address accumulated chronic and complex traumatic experiences that occurred before and during institutional placement, which may affect emotion regulation and the familial and social relationships of children who lived in institutions in a post-Soviet country. The study identified mental health issues that could be addressed during the deinstitutionalization and family reintegration process to improve emotional well-being and restore family relationships.
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Affiliation(s)
- Leyla Ismayilova
- The University of Chicago, Crown Family School of Social Work, Policy, and Practice, Chicago, IL, USA.
| | - Emily Claypool
- grid.170205.10000 0004 1936 7822The University of Chicago, Crown Family School of Social Work, Policy, and Practice, Chicago, IL USA
| | - Emma Heidorn
- grid.170205.10000 0004 1936 7822The University of Chicago, Crown Family School of Social Work, Policy, and Practice, Chicago, IL USA
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Prommin S, Siritaratiwat W, Bennett S, Mato L, Keeratisiroj O, Kamruecha W. Effects of Play in an Upright Position on Intra-Individual Variability of Gross Motor and Language Development in Institutionalized Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11804. [PMID: 36142086 PMCID: PMC9517534 DOI: 10.3390/ijerph191811804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
(1) Objective: To investigate the effects of play in an upright position on intra-individual variability and to examine the relationship between the variability of gross motor and language development in institutionalized infants aged six to ten months. (2) Methods: Thirty infants were conveniently enrolled in either the experimental or control groups. The Alberta Infant Motor Scale (AIMS) and the Communication and Symbolic Behavior Scales Developmental Profile (CSBS-DP) Infant/Toddler Checklist were tested pre and post each monthly intervention for three months. Sixteen infants in the experimental group received an additional program of 45 min play in an upright position three times a week for a 3-month period. (3) Results: There were significant between-group differences in intra-individual variability of the AIMS percentiles (p-value = 0.042). In addition, there was a significant difference in the intra-individual variability of the language percentile between groups (p-value = 0.009). The intra-individual variability of gross motor development was significantly correlated (rs = 0.541; p = 0.03) with language development. (4) Conclusions: Play in an upright position could be applied to improve intra-individual variability in gross motor and language development percentiles in institutionalized infants.
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Affiliation(s)
- Sunanta Prommin
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Muang, Khon Kaen 40002, Thailand
| | - Wantana Siritaratiwat
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Muang, Khon Kaen 40002, Thailand
| | - Surussawadi Bennett
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Muang, Khon Kaen 40002, Thailand
| | - Lugkana Mato
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Muang, Khon Kaen 40002, Thailand
| | | | - Worawan Kamruecha
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Muang, Khon Kaen 40002, Thailand
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Hecker T, Mkinga G, Kirika A, Nkuba M, Preston J, Hermenau K. Preventing maltreatment in institutional care: A cluster-randomized controlled trial in East Africa. Prev Med Rep 2022; 24:101593. [PMID: 34976652 PMCID: PMC8683896 DOI: 10.1016/j.pmedr.2021.101593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
Interaction Competencies with Children prevents maltreatment in institutional care. Feasibility of intervention despite low resources and heterogeneity of institutions. Participation in intervention significantly reduced maltreatment of orphans. Positive attitudes towards violence declined through intervention participation. Participation in intervention significantly increased childcare knowledge.
An increasing number of orphans in low- and middle-income countries are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. To prevent maltreatment, we tested the effectiveness and feasibility of the intervention Interaction Competencies with Children – for Caregivers (ICC-C). In a two-arm cluster-randomized controlled trial, 203 caregivers (65.5% female, Mage = 36.63 years, SDage = 12.26) and 356 children (46.1% female, Mage = 9.43 years, SDage = 1.93) from 24 orphanages in Dar es salaam (Tanzania) participated from August to October 2018 (Baseline) and March to April 2019 (Follow-Up). Orphanages were assigned to the intervention or waitlist-group. Caregivers in the intervention group received the ICC-C intervention to prevent maltreatment through focusing on non-violent caregiving strategies. The primary outcome was the change in self-reported maltreatment by caregivers (Conflict Tactics Scale). Trial registration: ClinicalTrials.gov, NCT03594617, 20 July 2018. Participation in the intervention resulted in a significant reduction in reported maltreatment (f2 = 0.153), a decrease of positive attitudes toward violent discipline (f2 = 0.248), and an increased level of childcare knowledge (f2 = 0.220) in the caregiver sample, each indicating a moderate effect. Caregivers’ training participation did not predict reduced maltreatment reported by children. Aspects of feasibility, including motivation to participate, acceptability, and integration of the new strategies were evaluated positively. The study promises initial effectiveness and feasibility of efforts to improve the situation of children in institutional care settings in resource-poor countries by offering training to care providers.
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Affiliation(s)
- Tobias Hecker
- Department of Psychology, Bielefeld University, 33501 Bielefeld, Germany.,vivo international, 78340 Konstanz, Germany
| | - Getrude Mkinga
- Department of Psychology, Bielefeld University, 33501 Bielefeld, Germany.,vivo international, 78340 Konstanz, Germany
| | - Anette Kirika
- Department of Psychology, Bielefeld University, 33501 Bielefeld, Germany
| | - Mabula Nkuba
- vivo international, 78340 Konstanz, Germany.,Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, 2329 Dar es Salaam, Tanzania
| | - Justin Preston
- vivo international, 78340 Konstanz, Germany.,Department of Psychology, University of Massachusetts, Boston, USA
| | - Katharin Hermenau
- vivo international, 78340 Konstanz, Germany.,Department of Psychology, University of Konstanz, 78457 Konstanz, Germany
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Psychological Distress Symptoms and Resilience Assets in Adolescents in Residential Care. CHILDREN-BASEL 2021; 8:children8080700. [PMID: 34438591 PMCID: PMC8391887 DOI: 10.3390/children8080700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022]
Abstract
Most studies with institutionalised children and adolescents focus on evaluating the impact of negative life events on emotional development. However, few have investigated the relationship between resilience assets and the teenagers’ psychopathological problems. The purpose of the present study was to investigate differences in psychological distress symptoms and in resilience assets in institutionalised and non-institutionalised adolescents. A total of 266 adolescents aged between 12 and 19 years old took part in the study (60.5% female): 125 lived in residential care and 144 resided with their families. Results found a significant and inverse relation between psychopathology and the perception of individual resilience assets, specifically with self-efficacy and self-awareness in the community sample, and with empathy in the institutionalised sample. Overall, and regardless of the age group, adolescents in residential care tend to perceive themselves as significantly less resilient in perceived self-efficacy and empathy, and they report fewer goals and aspirations for the future. The importance of promoting mental health and resilience assets in adolescents, particularly in those in residential care, is discussed. This can be achieved through early interventions that may prevent emotional suffering and deviant life paths, with transgenerational repercussions.
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Dialogic Feminist Gatherings: Impact of the Preventive Socialization of Gender-Based Violence on Adolescent Girls in Out-of-Home Care. SOCIAL SCIENCES 2020. [DOI: 10.3390/socsci9080138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gender-based violence is a social scourge with an increasing incidence at younger ages. Many studies have focused on finding effective solutions for overcoming this problem; however, few studies have analyzed the contribution of interactive learning environments to gender-based violence prevention. This article attempts to fill this gap by showing the impact of Dialogic Feminist Gatherings on the preventive socialization against gender-based violence toward adolescent girls (aged 15–18) who are in out-of-home care and living in shelters—part of the institutional protection system—for different reasons that are primarily associated with violence and a lack of family protection. This qualitative study was conducted using the communicative methodology involving fifteen daily life stories that analyze the dialogues and reflections produced among the girls during Dialogic Feminist Gatherings. The results show the acquisition of competencies in aspects such as attraction, election, and equality in sexual-affective relationships. These dimensions, when developed through Dialogic Feminist Gatherings, are consistent with the scientific literature that characterized them as protective factors against gender-based violence. This study concludes by contrasting participants’ daily life reality with scientific evidence, which makes possible new methods of the preventive socialization against gender-based violence for adolescent girls in out-of-home care.
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Julian MM, McCall RB, Groark CJ, Muhamedrahimov RJ, Palmov OI, Nikiforova NV. Development of children adopted to the United States following a social-emotional intervention in St. Petersburg (Russian Federation) institutions. APPLIED DEVELOPMENTAL SCIENCE 2019; 23:273-293. [PMID: 31488944 DOI: 10.1080/10888691.2017.1420480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study is a post-adoption follow-up of a social-emotional intervention in St. Petersburg, Russian Federation Baby Homes (BHs). Children previously resided in BHs and received Care as Usual (CAU, N=220), Training Only (TO, N=94), or Training plus Structural Changes (T+SC, N=45). This study examined intervention effects 0-6.5 years post-adoption to the USA, at age 9 months to 7 years old. Adoptive parents completed questionnaires on their child's social and behavioral development. Intervention graduates had better attachment security, less indiscriminate friendliness, and fewer behavior problems than CAU graduates. Children who had longer exposure to intervention conditions had better attachment security, but poorer executive function, externalizing and internalizing problems, and competence. Thus, although post-institutionalized children were generally functioning in the normal range in early childhood and effect sizes were small, a social-emotional intervention in institutions is associated with modest benefits to attachment and behavior problems and apparent decrements to executive function.
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Early Caregiver–Child Interaction and Children’s Development: Lessons from the St. Petersburg-USA Orphanage Intervention Research Project. Clin Child Fam Psychol Rev 2018; 22:208-224. [DOI: 10.1007/s10567-018-0270-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Nakatomi T, Ichikawa S, Wakabayashi H, Takemura YC. Children and adolescents in institutional care versus traditional families: a quality of life comparison in Japan. Health Qual Life Outcomes 2018; 16:151. [PMID: 30055631 PMCID: PMC6064077 DOI: 10.1186/s12955-018-0980-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/18/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A good quality of life (QOL) is important for the physical and mental well-being of all children. However, young people who live in an institutional setting may face different challenges than those who are raised in a traditional family. While a few quantitative studies of institutionalized children's QOL have been conducted, no research has investigated the QOL of young people living in Children's Homes (CHs) in Japan. This research compared the QOL of children and adolescents in Japan who live in CHs with that of children and adolescents living in traditional families. METHODS A cross-sectional study was conducted in July 2016 with 204 students (grades three through nine), 47 of whom lived in a CH, and 157 of whom lived in a traditional family. Ages ranged from 8 to 15 years (CH: 55.8% Female, 44.2% Male; Traditional: 54.1% Female, 45.9% Male). Participants answered the kid-Kinder Lebensqualität Fragebogen (Translated from German: Children's quality of life questionnaire; KINDL®) Japanese Version, which covers six subscales of QOL; they filled in the questionnaires at home. Analysis of variance was used to compare QOL between the two samples. RESULTS The total QOL score for all students (combined elementary school students and junior high school students) from CHs was statistically significantly lower than that for students from traditional families. Scores for the subscales, emotional well-being and family, were also significantly lower for CH young people than for those in traditional families. While elementary pupils in CHs reported lower QOL than those in traditional families, no significant differences in QOL were seen between junior high school students from CHs and their peers from traditional families. CONCLUSIONS The findings presented support previous research showing that the QOL of elementary school students living in CHs is significantly lower than that of their peers in traditional families. However, this difference was not observed among junior high school students. This contrast suggests that QOL changes with age. Future research is needed to evaluate the determinants of QOL among all generations and family contexts.
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Affiliation(s)
- Takahiro Nakatomi
- Department of Family Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Shuhei Ichikawa
- Department of Family Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Hideki Wakabayashi
- Department of Family Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Yousuke C. Takemura
- Department of Family Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
- Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8510 Japan
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McCall RB, Muhamedrahimov RJ, Groark CJ, Palmov OI, Nikiforova NV, Salaway JL, Julian MM. The Development of Children Placed into Different Types of Russian Families Following an Institutional Intervention. ACTA ACUST UNITED AC 2016; 5:255-270. [PMID: 28042513 DOI: 10.1037/ipp0000060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined whether interventions in Russian Baby Homes promoting warm, sensitive, and responsive caregiver-child interactions and relationships would be associated with advantages in those children's behavior years after they transitioned to family care. Children (N = 135) who had resided for at least 3 months (M = 13.8 months) in one of three intervention institutions were subsequently placed in Russian families (relatives or non-relatives) for at least 1 year (M = 33.5 months). When children were 1.5-10.8 years of age, parents provided ratings of attachment, indiscriminate friendliness, executive functioning, social-emotional development, and behavior problems. Despite very substantial differences in the developmental status of children at departure from the three institutions, there were fewer than expected significant differences between children from the three institutions at follow-up or as a function of being placed with relatives or non-relatives. Specifically, children reared in the most improved institution displayed less indiscriminate friendliness, were less aggressive/defiant, and had less externalizing behavior. Children from all three institutions who were placed into families at older ages tended to be rated more poorly on some measures. These results suggest that previously institutionalized children adjust well to family life, but improved institutional caregiving can have some persistent benefits over several years in children transitioned to families.
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The development of postinstitutionalized versus parent-reared Russian children as a function of age at placement and family type. Dev Psychopathol 2016; 28:251-64. [PMID: 26753952 DOI: 10.1017/s0954579415000425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A total of 149 children, who spent an average of 13.8 months in Russian institutions, were transferred to Russian families of relatives and nonrelatives at an average age of 24.7 months. After residing in these families for at least 1 year (average = 43.2 months), parents reported on their attachment, indiscriminately friendly behavior, social-emotional competencies, problem behaviors, and effortful control when they were 1.5-10.7 years of age. They were compared to a sample of 83 Russian parents of noninstitutionalized children, whom they had reared from birth. Generally, institutionalized children were rated similarly to parent-reared children on most measures, consistent with substantial catch-up growth typically displayed by children after transitioning to families. However, institutionalized children were rated more poorly than parent-reared children on certain competencies in early childhood and some attentional skills. There were relatively few systematic differences associated with age at family placement or whether the families were relatives or nonrelatives. Russian parent-reared children were rated as having more problem behaviors than the US standardization sample, which raises cautions about using standards cross-culturally.
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Burkholder AR, Koss KJ, Hostinar CE, Johnson AE, Gunnar MR. Early Life Stress: Effects on the Regulation of Anxiety Expression in Children and Adolescents. SOCIAL DEVELOPMENT 2015; 25:777-793. [PMID: 28584408 DOI: 10.1111/sode.12170] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined children's (N = 79; 9-10 years) and adolescents' (N = 82; 15-16 years) ability to regulate their emotion expressions of anxiety as they completed a modified version of the Trier Social Stress Test for Children (TSST-C). Approximately half in each age group were internationally adopted from institutional care (N = 79) and half were non-adopted, age-matched peers (N = 82). Institutional care was viewed as a form of early life stress. Coders who were reliable and blind to group status watched videos of the session to assess anxiety expressions using the Child and Adolescent Stress and Emotion Scale developed for this study. Children exhibited more expressions of anxiety than adolescents, and youth adopted from institutions showed more expressions of anxiety than their non-adopted counterparts. The role of early life stress on observed anxiety expressions remained significant after controlling for differences in age, physiological stress responses measured through salivary cortisol reactivity, and self-reports of stress during the TSST-C. This suggests possible deficits in the regulation of expressive behavior for youth with early life stress histories, which cannot be explained by experiencing the task as more stressful.
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Affiliation(s)
- Amanda R Burkholder
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park
| | - Kalsea J Koss
- Institute of Child Development, University of Minnesota, Twin Cities
| | | | | | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Twin Cities
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Gray CL, Pence BW, Ostermann J, Whetten RA, O'Donnell K, Thielman NM, Whetten K. Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2015; 3:395-404. [PMID: 26374801 PMCID: PMC4570014 DOI: 10.9745/ghsp-d-15-00093] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/10/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care settings. METHODS The Positive Outcomes for Orphans study used a 2-stage, cluster-randomized sampling design to identify 1,357 institution-dwelling and 1,480 family-dwelling orphaned and separated children in 5 low- and middle-income countries (LMICs) in sub-Saharan Africa and Asia. We used the Life Events Checklist developed by the National Center for Posttraumatic Stress Disorder to examine self-reported PTEs among 2,235 OSC ages 10-13 at baseline. We estimated prevalence and incidence during 36-months of follow-up and compared the risk of PTEs across care settings. Data collection began between May 2006 and February 2008, depending on the site. RESULTS Lifetime prevalence by age 13 of any PTE, excluding loss of a parent, was 91.0% (95% confidence interval (CI) = 85.6, 94.5) in institution-dwelling OSC and 92.4% (95% CI = 90.3, 94.0) in family-dwelling OSC; annual incidence of any PTE was lower in institution-dwelling (23.6% [95% CI = 19.4, 28.7]) than family-dwelling OSC (30.0% [95% CI = 28.1, 32.2]). More than half of children in institutions (50.3% [95% CI = 42.5, 58.0]) and in family-based care (54.0% [95% CI = 50.2, 57.7]) had experienced physical or sexual abuse by age 13. Annual incidence of physical or sexual abuse was lower in institution-dwelling (12.9% [95% CI = 9.6, 17.3]) than family-dwelling OSC (19.4% [95% CI = 17.7, 21.3]), indicating statistically lower risk in institution-dwelling OSC (risk difference = 6.5% [95% CI = 1.4, 11.7]). CONCLUSION Prevalence and incidence of PTEs were high among OSC, but contrary to common assumptions, OSC living in institutions did not report more PTEs or more abuse than OSC living with families. Current efforts to reduce the number of institution-dwelling OSC may not reduce incidence of PTEs in this vulnerable population. Protection of children from PTEs should be a primary consideration, regardless of the care setting.
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Affiliation(s)
- Christine L Gray
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA
| | - Brian W Pence
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA
| | - Jan Ostermann
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA
| | - Rachel A Whetten
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA
| | - Karen O'Donnell
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA Duke University, Center for Child and Family Health, Durham, NC, USA
| | - Nathan M Thielman
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA Duke University, Division of Infectious Diseases and International Health, Department of Medicine, Durham, NC, USA
| | - Kathryn Whetten
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA Duke University, Terry Sanford Institute of Public Policy, Durham, NC, USA
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Hermenau K, Kaltenbach E, Mkinga G, Hecker T. Improving care quality and preventing maltreatment in institutional care - a feasibility study with caregivers. Front Psychol 2015; 6:937. [PMID: 26236248 PMCID: PMC4501176 DOI: 10.3389/fpsyg.2015.00937] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/22/2015] [Indexed: 11/27/2022] Open
Abstract
Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and 3 months following the training workshop. The results showed high demand, good feasibility, high motivation, and acceptance of caregivers. They reported improvements in caregiver–child relationships, as well as in the children’s behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, 1 month before, and 3 months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach.
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Affiliation(s)
- Katharin Hermenau
- Department of Psychology, University of Konstanz, Konstanz Germany ; vivo international www.vivo.org Konstanz, Germany
| | - Elisa Kaltenbach
- Department of Psychology, University of Konstanz, Konstanz Germany
| | - Getrude Mkinga
- Department of Educational Psychology, University of Dar es Salaam Dar es Salaam, Tanzania
| | - Tobias Hecker
- Department of Psychology, University of Konstanz, Konstanz Germany ; vivo international www.vivo.org Konstanz, Germany ; Department of Psychology, University of Zurich Zurich, Switzerland
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