To assess the psychological health of orphans and other children made vulnerable by HIV/AIDS. Childrens emotional, cognitive and social development is learned through interaction with their environment and the people (especially the caregivers) in their lives. Through appropriate care and stimulation, children learn: flexibility and adaptability in emotional response, appropriate social interactions, expectations for behaviour, mastery and capability, a stable and positive sense of self, and skills for daily living. Measuring the impact of psychosocial support arrangements can be accomplished through direct measures of emotional health and functioning. These measures also reflect childrens resilience and coping capacity. Psychosocial health and functioning of children and adolescents is reflected in a variety of wellbeing domains:
1. Emotional (mood including depression, grief, stress and worry; self-perception and selfesteem; cognitive aspects such as hopefulness and future orientation).
2. Functioning (reflects the capacity of the child or adolescent appropriate to their developmental stage and age; for younger children, this can mean achievement of appropriate developmental milestones, for older children and adolescents, it can be reflected in school performance and the activities of daily living).
3. Behaviour (internalizing and externalizing behaviours, including risk behaviours).
4. Social connectedness and capacity.
Good psychological health is evidenced by the concept of resilience, which is an overarching theme to the domains listed above. Individual resilience can be thought of as the development of emotional and practical intelligence, which includes:
1. emotional strength
2. social connectedness with peers and adults, including the ability to access necessary social support
3. the ability to solve problems in ways that affect the childs well-being, survival and meeting day-to-day needs.
The environment around the child also fosters resilience through the availability of social supports (adults, positive peer groups, caregivers), and structural supports that offer care and protection (access to education, health services).
The components of psychological health used in the survey are: (i) stress and worry, (ii) mood, (iii) future orientation, (iv) self-esteem/self-worth, (v) self-perception of physical health, (vi) functioning/capability, (vii) internalizing behaviour, (viii) externalizing behaviour, (ix) social connection and capacity.
(1) Psychological health of orphaned and vulnerable children. Numerator 1: The number of OVC with an adequate score (at least 20 points out of maximum 32 points). Denominator 1: All OVC interviewed.
(2) Psychological health of other children. Numerator 2: The number of non-OVC with an adequate score (at least 20 points out of maximum 32 points). Denominator 2: All non-OVC interviewed.
Orphan psychological health ratio: The ratio of (1) level of psychological health of orphaned and vulnerable
children to (2) level of psychological health of other children.
Adolescents will indicate their level of agreement to a series of statements related to different components of psychological health. The instructions ask the respondents to indicate how they have been feeling over the past two weeks. Questions are worded both positively and negatively, and the coding of response scales for analysis must be adjusted accordingly. Prior to administration of the survey, it is essential for assessors to ensure that the wording of questions is valid in the local language and sociocultural context. Many terms for emotional well-being and distress do not translate well between different languges and cultures, and so a validation procedure must be undertaken before the questionnaire is widely administered. Steps to validate the questions include:
1. Translation into the local language, and separate back-translation.
2. Focus groups with youths in the age range to ascertain local descriptors for emotional distress and well-being, and to review the survey for relevance to the local language and culture, relevance to adolescent concerns and priorities, and ease of use of the response scale.
3. Focus groups with local service providers (psychologists, child-oriented care workers, parents and other caregivers) to ensure linguistic and cultural relevance.
Adaptations to the survey to best fit the local language and culture may be necessary. As much as possible, however, the response scale and general domains of the questionnaire should remain intact to allow cross-country comparisons of results. Pictorial prompts of the response scale can also be used to ease use for adolescent respondents:
Strongly agree 1
Strongly disagree 4
Instructions to respondents. The following is a list of questions about how you may have been feeling over the past two weeks. For each question, please answer by stating the number that most reflects how much you agree or disagree with the statement (show response scale):
1. I feel stressed and worried (i)
2. I enjoy doing things (ii)
3. I feel like crying (ii)
4. I cant shake off sad feelings (ii)
5. I feel life isnt worth living anymore (iii)
6. I have hope for my future (iii)
7. I feel good about myself (iv)
8. My health is good (v)
9. I feel tired these days (v)
10. I feel people dislike me (iv)
11. I feel confident (iv)
12. I feel able to solve problems in my life (vi)
13. I am able to make decisions in my life (vi)
14. I dont want to be around friends and family like usual (vii)
15. I get into more trouble than usual (viii)
16. I get so angry these days, I get into fights (viii)
17. I get along well with other people (ix) 18. I am able to make friends (ix)
(The numbers in parentheses refer to the components of psychological health referred to above.)
Geographic location: N/A
Pregnancy status: N/A
Time period: N/A
Type of orphan: N/A
Vulnerability status: N/A
Although intended to be useful across cultures, pre-testing and validation are essential to ensure that the items are cross-culturally appropriate. xpressions of emotional distress vary according to language, expectations for proper behaviour of children and adolescents, and social mores and gender. Many standardized surveys assess the psychological status of children and adolescents. However, they are limited in international application by cross-cultural variances in emotional distress symptoms and language, and sociocultural expectations for proper behaviour and emotional expression. In addition, depending on their age and developmental stage, children may express emotional distress through their behaviour or psychosomatic symptoms. Given the need for rapid, simple assessment tools, the survey questions developed for this indicator have focused on general concepts, in the hope of achieving greater cultural relevancy and ease of linguistic translation.
It is important to note that the indicator suggested above for psychological health is a general measure of emotional well-being. It cannot be used for clinical diagnosis of psychiatric conditions (i.e., major depression, anxiety disorders, post-traumatic stress disorder, psychosis). To assess the overall level of psychosocial problems, the data should also be presented for all children combined. In addition, research has shown that girls tend to respond with more internalizing symptoms, whereas boys tend to externalize. Indicators should be disaggregated by gender. If a tabulation of this indicator shows a correlation of psychological health with age, then further analysis of OVC status by psychological health should be done, controlling for age..