AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #476 - The essential package: fostering positive caregiver-child interaction in the context of HIV and AIDS
Authors: Presenting Author: Ms Kendra Blackett-Dibinga - Save The Children
Additional Authors: Mrs Kendra Blackett-Dibinga, Ms. Nicole Richardson, Ms. Ann Digirolamo,
Aim: The aim of the Essential Package is to develop a framework for action for program managers working in high HIV prevalence areas to address the needs of the very young child. Key to this framework is a better understanding of how best to foster positive caregiver-child interaction especially when caregivers are under severe stress brought upon by poverty and high disease burden.
Method / Issue: In 2009, Save the Children (SC) in collaboration with CARE received funding from the Hilton Foundation to develop standards for early childhood development (ECD) in the context of HIV and AIDS. An extensive literature review formed the basis of this initiative by highlighting the unique needs of children who are both infected and affected by HIV and AIDS in early childhood. This review provides scientific justification for interventions for children and caregivers including the basis for the development of a framework for action. This framework is complemented by a volunteer visual guide to help HBC providers to support child specific needs during visits; a program manager guide on integrating ECD in OVC programming; and M&E tools to capture changes in outcomes at child, caregiver and caregiving environment levels. Given the high burden of HIV in Africa, SC is validating the essential package in Mozambique, CARE in Zambia, and Firelight Foundation in Malawi. The process has engaged key stakeholders working in both ECD and HIV fields to provide critical technical input into the design of the materials which make up the Essential Package.
Results / Comments: In Mozambique, SC is working in two rural communities, Incaia and Chipenhe, targeting 130 households and approximately 280 children between the ages of 0 to 8. Volunteers have been trained to deliver key messages and track changes while also providing feedback on the use of the tools. This qualitative exercise is being complemented by a quantitative one, helping program managers to best understand how to address issues of social isolation which limits caregivers’ access to particular services and social networks through which they can meet their needs. Further understanding is also being sought on how best to support positive caregiver-child interaction in early childhood amidst stress. A care plan is being used to track caregiver and child needs and is developed with the targeted families. Initial data indicate that the majority of target households are being headed by grandmother. Issues of child abuse, caregiver mental health and access to services must be addressed in order to make positive and long-lasting changes at the child level. The 6-month pilot is nearing an end at which time, SC will capture more data on the ability to affect change at the level of the caregiver, child and caregiving environment levels to understand the potential impact of the package on desired child outcomes
Discussion: There is recognition that OVC programs must attend to the needs of all vulnerable children using an age and developmentally appropriate approach. However, addressing the needs of the different types of caregivers is also vital within an HIV and AIDS context in order to strengthen families to be the frontline providers for the children under their care. For instance, the findings thus far from the validation indicate that many children are being cared for by the elderly, the majority of caregivers are suffering from an acute or chronic illness, and most feel down, depressed and hopeless which can all greatly affect the caregiving environment and lead to a lack of responsive caregiving. Additionally, the findings show that the tools used by paraprofessionals at the point of service delivery need to be tailored in such a way that they are user-friendly for low literacy levels but are also able to capture the needed information in order to asses, refer and follow up within a timely manner.
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