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Rachel Whetten , MPH Center for Health Policy and Inequalities Research Duke University

More than the Loss of a Parent: A Multi-Country Study of Potentially Traumatic Events Among Orphaned and Abandoned Children. Rachel Whetten , MPH Center for Health Policy and Inequalities Research Duke University Wednesday, April 6 th 2011. Background. 143 million orphans worldwide

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Rachel Whetten , MPH Center for Health Policy and Inequalities Research Duke University

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  1. More than the Loss of a Parent: A Multi-Country Study of Potentially Traumatic Events Among Orphaned and Abandoned Children Rachel Whetten, MPH Center for Health Policy and Inequalities Research Duke University Wednesday, April 6th 2011

  2. Background • 143 million orphans worldwide • Millions more abandoned • Trauma in the context of losing a parent

  3. Trauma and Orphanhood • Recent studies hypothesize orphans at higher risk for additional trauma following parental death • ‘Potential events’ not quantified • Behavioral outcomes not measured (truancy, anger issues, difficulty getting along with others ) • Childhood trauma associated with anxiety, depression–associated with high risk activity in adulthood • Trust issues

  4. Positive Outcome for Orphans - POFO • Life events, placement, cultural setting on children’s 1. behavioral/emotional 2. learning/development 3. health • Positive Outcomes for Orphans (POFO) sampled 1,480 OAC ages 6-12 living in family settings in 309 randomly selected clusters in 5 countries (6 sites): India (Hyderabad, Nagaland), Cambodia, Ethiopia, Kenya, Tanzania

  5. POFO – Sampling cont. definitions • Family dwelling or ‘community’ selection: single or double orphan or child abandoned by both parents living in a family situation –not an institution or on the streets • Five children from each sampling ‘cluster’; chosen from available list or house-to-house census • Caregiver Selection: Children’s self-identified primary caregiver (n=1480) • 301 non-orphans • www.pofo.org for more details on sampling

  6. POFO –Methods • Interviewers trained – Dec 2005 • Baseline data collected between May 2006 and April 2007 • Informed Consent by all caregivers • Assent by all children • Ethical approval by Duke University IRB and local and national IRB’s at each site

  7. POFO – Trauma Measures • Life Events Checklist (PTSD): Child and caregiver reporting • Anxiety: PTSD Checklist – Specific (PCL-S) • Strengths and Difficulties – used to assess emotional and behavioral difficulty and pro-social behavior • World Bank Child Needs Assessment ToolKit-Demographic variables • DHS

  8. Trauma Measures • Six Concept Groups: -physical or sexual abuse - witnessing family violence - being forced to leave home - war, riots or killings -disasters or accidents • Parental death and abandonment separate

  9. Table 2 Characteristics of Orphaned And Abandoned Children Ages 9-15 And Their Primary Caregivers Note.(N=1,258) aWeighted to ensure equal representative of all ages, both genders and all six study sites

  10. Child Characteristics • 53% male • One-third experienced death of mother, 75% death of father • 7 years average since death of parent • 63% living with biological parent, 21% with grandparent, 13% with aunt/uncles • Age primary caregiver – 42.5 (avg)

  11. Results • 98% experienced at least one additional potentially traumatic event beyond death/abandonment of parent • More than half (55%) experienced 4 or more events • 1/3 reported events in past year • Abandoned children experienced most physical/sexual abuse (84%) • Double orphans most likely to witness family violence (59%)

  12. Results - continued • Children not cared for by biological parent were more likely to report more events • Experiencing past trauma predicted that trauma in the future eg: sexual abuse at baseline strongly predicted reporting again at follow-up • Four event categories associated with higher levels of anxiety and emotional difficulties • Sensitivity analysis show strongest associations between event categories and symtomatology at the African sites.

  13. Conclusions • First study to look at potentially traumatic events longitudinally in large random group of OAC in less wealthy nations. • Trauma beyond parental death or abandonment • Being a single or double orphan results in greater negative impacts of additional events • Children are willing to report and discuss these events!

  14. Limitations • Risk of under-reporting/reporting bias • Threat to validity – 222 lost to follow-up = 8 months older, symptoms of anxiety & more likely to be abandoned • Lack of data on total # of events within categories • Kenya reporting reflects the 2008 election violence. • Need longitudinal data

  15. Conclusions – Moving forward • Boys are as much at risk as girls are • Social Service/mental health care systems need strengthening as much as those that provide basic food/shelter, etc. • Coping skills – life skills, like DBT • These kids are the future

  16. Nagaland District, IN Hyderabad, IN Battambang District, KH Addis Ababa, ET Bungoma District, KE Kilimanjaro Region, TZ

  17. http://pofostudy.org

  18. For more information about POFO, please see the study website at http://pofostudy.org

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