Presented by Tracie Rogers Social Work Unit Department of Behavioural Sciences UWI, St. Augustine

1. The role of the Social Worker in ARV Rollout Based on Social Work Practicum Experience at Sinikithemba Clinic, Mc Cord’s Hospital Durban, South Africa Presented by Tracie Rogers Social Work Unit Department of Behavioural Sciences UWI, St. Augustine

2. Social Work Practicum • Social Work Unit Behavioural Sciences/ Faculty of Social Sciences – University of the West Indies, St. Augustine School of Social Work & Psychology, University of Kwazulu Natal, Durban, South African • Placement at Sinikithemba Clinic, McCord Hospital • ARV Roll out at Sinikithemba Adult Paediatric

3. Overview of Presentation Role of the Social Worker in Pediatric ARV Treatment and Management Role of the Social Worker in Adult ARV Treatment and Management Group & Community Work The Potential of the Social Worker

4. The Social Worker in Pediatric ARV Treatment and Management Three Areas of Focus: • Psychosocial Assessments • Intervention • Evaluation

5. Psychosocial Assessments The Social Worker in Pediatric ARV Treatment and Management 1. Assessing the Child 2. Assessing the Family System 3. Assessing the Support Structures

6. Personality & Adjustment to Living with HIV/AIDS Level of Disclosure Child’s Functioning & Developmental Stage Education/ School Based Needs/ Peer Relations CD4 Count %/ Medical issues & concerns The present family structure Regularity of the Care giver Family’s capacity for supporting adherence to ARV regimen Stability of the Family Level of Disclosure among family members Norms, Values, Beliefs, Socio-cultural Dynamics Religion/ Spirituality Financial Stability/ Welfare needs Making a Psychosocial Assessment: 1. The Child2.The Family

7. Making a Psychosocial Assessment: 3. Assessing the Support Structures • The Extended Family Support System • The Environmental/ Community Support System • Institutional Support • Placement in a Children’s Home

8. Initial Interview Goals: • Make psychosocial assessment • Identify and create initial care plan to target presenting problems • Evaluate ARV readiness Protocol for child under age 14 – caregiver(s) is/are primary client(s); child is integrated where if developmentally mature enough to contribute to the interview; limited confidentiality for children Protocol for children above age 14 – adolescent is primary client; caregiver(s) is/are integrated into the interview process; adolescents are interviewed individually as well as with caregiver(s) Family/caregiver’s support structure or support system of the residential facility in cases where children are institutionalized are assessed specifically in terms of their capacity to provide for a child living with HIV

9. Disclosure Planning & Acceptance of Status Is the Child aware of his/her status? What is the caregiver’s attitudes towards disclosure Assessment of the safety of disclosure for the child Assessment of disclosure risks and benefits explained to the caregiver(s) Where the child is under the age of 14 and the social worker’s assessment differs from the caregiver’s, the social worker clarify concerns and provide continuous support and information to the caregiver(s) in the interest of the child’s safety and wellbeing Where the child is over age 14, the social worker advises caregiver of the legal ramifications for persons who are sexually active and HIV positive Caregiver(s) encouraged to disclose to children and the social worker should work with them to disclose in a systematic and psychologically safe way

10. The Social Worker in Pediatric ARV Treatment and Management Three Areas of Focus: • Psychosocial Assessments • Intervention • Evaluation

11. Intervention • Formulating an Intervention Plan • Connection individual, family & community resources • Intervention in the Family System • Accessing social welfare • Family Testing & Counselling • Addressing stigma and discrimination • Direct Intervention with the Child • Counseling in specific issues identified e.g. coping, social skills • Making referrals

12. The Social Worker in Pediatric ARV Treatment and Management Three Areas of Focus: • Psychosocial Assessments • Intervention • Evaluation

13. Evaluation • Case Evaluation • Is the SW providing relevant, reliable and valid service • Is the SW meeting needs of clientele • Is the SW providing ethical service • Continuous Case Management • Adherence monitoring • Welfare needs • Advocacy

14. The Social Worker in Adult ARV Treatment and Management • VCT as the Gateway to Care and Treatment • Referrals to Social Work • Social Workers & Counsellors • The Social Work Intake Interview • The Social Worker as Enabler, Advocate, Resource Moblizer Our primary concern is linking clients to comprehensive, holistic support services • Intervention & Evaluation: • Linking people to programmes

15. Group & Community Workat The Sinikithemba Clinic • Teenage Support Group • Playgroup • Grannies Support Group • Adult Support Group • Income Generation Projects • Youth Projects

16. The Potential of the Social Worker • The Professional Capacity of the Social Worker in HIV/AIDS Care and Treatment • Counsellor • Negotiator • Advocate • Activist and Coordinator • Administrator • Educator • Researcher & Programme Developer

17. Thank you for your attention