Children in geographical areas with high prevalence HIV/AIDS are known to have significant unmet psychosocial needs, particularly related to grief and trauma from parent death.

Karen O’Donnell leading CBT training in Tanzania

Living with an ill and dying parent and, then, with the life changes that accompany parent death are often manifested as emotional difficulties, behavior problems, and poor health and educational outcomes. Data from earlier studies by our team and others demonstrate the high frequency of trauma-related symptoms and child traumatic grief among affected children.  Although service providers, including NGOs, CBOs, and FBOs, often offer psychosocial support services, there is a need for evidence-based intervention, particularly around grief and trauma, applicable to children in sub-Saharan Africa.

Interventions using cognitive behavioral therapy (CBT) approaches for children affected by trauma, chronic and multiple, and traumatic grief are shown to be effective in wealthier nations; there are only limited data on the use of CBT approaches in resource poor areas.  The models for traumatic grief have not been systematically adapted and tested in these areas of high need.

This project is designed to examine:

  • how an evidence-based CBT intervention for orphaned children can be adapted to an existing guardian/orphan support model being carried out in East Africa,
  • how the new grief and bereavement focused group model can be integrated into the existing community care infrastructure,
  • how children and caregivers can be recruited and retained, and
  • whether the intervention results include promising outcomes for the well being of children and their guardians.  This feasibility study is designed to result in preliminary data to be used for an R01 application to test the efficacy of the model.

CBT training

The first step for adapting the CBT model involves a community based participatory process for examining the need and applicability of specific CBT interventions for local children as well as how these intervention can be integrated into the current psychosocial support model for orphans and their guardians.  The step involves focus groups for service providers, guardians, children, and our existing community advisory board.  Then, a sequence of 8 treatment groups, including a minimum of 64 total single or double orphans aged 7-13 and their primary guardians are recruited for a series of four 12 week group treatment sessions.  The enrollees are recruited from villages in and around Moshi, Tanzania.  Children and their guardians are assessed pre-, post- and at follow-up on dimensions of emotional and behavioral well being.

The anticipated outcomes from this  project include:

1) an adaptation of existing Western based treatment models for grief and bereavement,

2) preliminary findings from the integrated model, and

3) promising data about feasibility and outcomes to use for an  R01 proposal testing the intervention in resource poor areas.