Agincourt Child Health and Resilience Project Mercy Hlungwani
University of the Witwatersrand. SA Mina Fazel Oxford University.
UK Slide 2 Outline of the Presentation Background, Area Context
Pilot study Planned Intervention Current Status and Future
Acknowledgements Slide 3 Agincourt Health & Demographic
Surveillance System (DSS) Involves continuous demographic
monitoring of a geographically- defined population, with timely
production of data on all vital events (births, deaths and
migrations) Additional information may be collected on: verbal
autopsies, morbidity and disability, pregnancies & partner
relationships, economic and social activity, lifestyle etc Baseline
census 1992; annual update rounds births, deaths, in- and
out-migrations births, deaths, in- and out-migrations 2003 study
population: 21 villages with ~70,250 people in ~11,650 households
Slide 4 Agincourt study site Rural but densely settled ~30%
Mozambican Education to primary, most secondary, few 3 o High
unemployment High labor migration Arid, no subsistence farming Poor
water and sanitation Health center, five clinics, 3 district
hospitals 25-60 kms away Slide 5 Border region of Southern Africa
Slide 6 Agincourt Study Site Slide 7 Agincourt Villages Slide 8
Research framework Health, population and social transitions
Measuring and monitoring Measuring and monitoring Investigating
Investigating Responding Responding Slide 9 Program focus Societies
in transition Impact on vulnerable groups Measures to
offset/overcome these impacts promoting resilience in transitioning
societies Slide 10 Resilience Resilience is defined as: The human
capacity to face, overcome and be strengthened by or even
transformed by the adversities of life be strengthened by or even
transformed by the adversities of life (Grotberg, 2005) Slide 11
Aim of project To develop and evaluate a sustainable school-based
intervention to deliver to primary school children that decreases
emotional and behavioural problems, encourages resilience and
improves the school environment. Slide 12 Specific objectives To
deliver a primary prevention programme for all school children with
special attention to the most vulnerable groups To develop an
evidence-based intervention that will be replicable and sustainable
To promote healing from trauma as measured by increased awareness
of the impact of trauma on mental health by teachers and children
and a reduction of symptoms in the children at the schools To
promote prosocial skills by helping children build coping skills
and improve emotional intelligence To measure short and long-term
outcomes in the children and schools/communities To develop a
curriculum suitable for integration into the ongoing school context
through teacher participation and curriculum development To develop
a culturally appropriate intervention that builds on inherent
community strengths Slide 13 Hypotheses A school based programme
using teachers as the key mediators can have a positive impact on
the emotions and behaviour of children, improve their resilience
and social skills and also improve the school climate and general
school performance An intervention at both the individual and
school level will have greatest effect Continuation with this
intervention will have positive impacts on the life skills of the
children, on the school and the community in general Slide 14
context A rural setting Children exposed to chronic and ongoing
adversities; in particular children whose lives are affected by the
escalating HIV/AIDS pandemic. (living with chronic illness, dying,
bereavement, orphans, economic deprivation, multilevel
vulnerabilities caused by the pandemic, prime age adults, needs of
children easily overlooked) Agincourt DSS site has unique
opportunities for accessing data from the past, present and future
also provides a population context to the school data International
partnership to build on the combined expertise on the best
understanding in terms of mental and public health Slide 15
Diverse, Experienced Partnership Agincourt Primary Schools
Education District and Circuit Offices Linc Office Wits School of
Public Health Oxford University Child Psychiatry Harvard School of
Public Health Slide 16 Strong Theoretical Foundation Innate
strength and resiliency of youth Social learning Theory Emotional
Intelligence Theories Understanding the role trauma, grief and loss
play in the choices children make and in social and cognitive
development Slide 17 Link between Violence Exposure and Chronic
PTSD with: Substance Abuse Reckless Behavior High-risk Sexual
Behavior Gang Participation Disturbances in Academic Functioning
Kilpatrick, Saunders & Resick, 1998 Slide 18 Pilot Study Needs
identified by teachers and district office Two Schools Primary and
High School Number of Children Strenghts and Difficulties
Questionnaire -Teacher Completed questionnaire -Teacher Completed
questionnaire -Psychological functioning of children -validated
Slide 19 What is the SDQ? Behavioural screening questionnaire about
3-16 year olds. Behavioural screening questionnaire about 3-16 year
olds. Exists in several versions to meet the needs of researchers,
clinicians and educationalists Exists in several versions to meet
the needs of researchers, clinicians and educationalists Each
version includes between one and three of the following components:
A) 25 items on psychological attributes B) An impact supplement C)
Follow-up questions Slide 20 25 items on psychological attributes
All versions of the SDQ ask about 25 attributes, some positive and
others negative. These 25 items are divided between 5 scales: 1)
emotional symptoms (5 items) 2) conduct problems (5 items) 3)
hyperactivity/inattention (5 items) 4) peer relationship problems
(5 items) 5) prosocial behaviour (5 items) 5) prosocial behaviour
(5 items) Added together to generate a total difficulties score
(based on 20 items) Slide 21 Slide 22 Slide 23 Planned Intervention
Intervention will be a primary intervention Focus on both education
and mental health Focus on both education and mental health Focus
on the whole primary school climate/ethos Develop a generic
framework that can be replicated in different contexts and allow
flexibility to ensure that existing community and individual assets
and cultural strategies can be incorporated Develop a conceptual
framework/theoretical model incorporating the range of theoretical
perspectives on how to promote childrens resilience in context of
ongoing life stressors on a background of various levels of
cumulative disadvantage Capturing a critical time in development
and transition of a society Capturing a critical time in
development and transition of a society Incorporate relevant
stakeholders Slide 24 Intervention Plan Components In-class
Curriculum Parent Involvement Staff Training School Based Counselor
Community Service Infrastructure/School Climate Assessment
Monitoring and evaluation Slide 25 Outcome Measures School measures
Individual measures Teacher measures Community measures Slide 26
Current Status and Future International team established Community
networks established Planned meetings and workshops Intervention
schools and control schools Funding Slide 27 Acknowledgements Prof
Steve Tollman: member of research and trouble shooting team,
supporting proposal development, enable the project within
Agincourt, Wits and SA Dr Kathy Kahn: involved in supporting
intervention development, strategy, access and relevant
developments within Agincourt. Assist on working out the budget.
Finding synergies with the child development project that is also
in its development phase. Mark Collinson: leader of DSS on the
ground, including managing the DSS team to facilitating and
conducting data processing, data requests and secondary data
analysis. Prof Deborah Prothrow-Stith: member of research and
trouble shooting team, support intervention development and finding
funding opportunities, facilitate proposal development, supporting
Mercy and Rhian in career development Prof Alan Stein: member of
research and trouble-shooting team, facilitate proposal development
and finding funding opportunities Rhian Evans: contact person on
Agincourt site, helping collecting some local information,
facilitate contacts with schools and key education people, link
role and member of the research team, inform to the communities and
link back to communities
