Group Home Settings for Orphans and Effect on Life Trajectories Around the World
There are an estimated 150,000,000 children who have been orphaned and millions more who are in need of care away from their biological parents. Yet, group home care options for orphaned children are being shut down with the assumption that such places are unable to provide loving, stable, enriching environments. A goal of global policy makers is that all children live “within a strong, loving, supportive family”[i] and it is assumed that such a setting cannot occur in a group home. In the meantime, numbers of street children are rising daily. Before we make negative generalized conclusions about a care structure and spend large amounts of money funding programs to close those options down, let’s try to gather some evidence about what has worked and not worked in residential facilities (e.g. group homes, residential institutions, etc.) compared to living with families. Let’s talk to people who were orphaned and needed a place to live about their experiences in different care settings before we start closing down all the group care options for the next generation.
As policies are being rapidly put in place in low and middle income countries (LMICs) it is critically important to use evidence that is based on solid research to understand what the best care for each child can look like when resources are limited. We need to examine how we define and create strong, caring, supportive environments for those whose biological parents and family members are either not an option, or are unable to provide that setting. We will survey adults aged 20-29 whose parents both died before age 10. We will interview all of the adults from this group who spent at least 2 years in a “residential facility” and for each of those people, we will interview another adult from the group who was raised in a family We will ask about their lifetime experiences, the setting in which they were raised and their feelings about it and find out how they are doing today. In this way we will be able to compare childhood experiences and current life outcomes of adult orphans who lived in residential care in relation to those who were in families.
We need to raise $75,000 to start this study in one country. An additional $25,000 is needed for each additional country. We propose to start the study in Cambodia, then Ethiopia and Kenya. With sufficient funding, we can add other countries.
Four in ten hepatitis C patients who drank alcohol refrained from it as part of a Duke pilot program that integrates alcohol and hepatitis C treatments. Led by DGHI researcher Rae Jean Proeschold-Bell and Duke physician Andrew Muir, the dual model of care may be a viable option for steering these patients away from alcohol, who may otherwise develop serious health complications that lead to liver failure or death.
The Duke study, featured in the April issue of Digestive Diseases and Sciences, involved hepatitis C patients from the Duke Liver Clinic who received both alcohol treatment and medical care over a six-month period. Of the 53 alcohol-drinking patients in the study, 44 percent had stopped drinking alcohol by the end of the six months. Patients who did not become abstinent by six months still reported a 30 percent drop in alcohol consumption, spending on alcohol and urges to drink.
“We were able to show that integrated hepatitis C-alcohol care is feasible,” said Proeschold-Bell, a DGHI faculty member at the Center for Health Policy and Inequalities Research. “More than that, the study shows that such integrated care results in alcohol reductions that benefit patient health.”
Researchers say the intervention worked in part because it focused on liver health, rather than simply reducing alcohol use. It involved weekly group therapy and bi-weekly individual sessions customized to each patient that address alcohol use, nutrition, stress and family support. Because knowledge alone does not change behavior, the addictions specialist taught patients practical ways to improve other aspects of their lives based on their individual circumstances. Study participants were also evaluated for mental illness and had access to a psychiatrist for care, if needed.
The research team also found ways to increase communication and collaboration between the patient’s hepatologist and addictions specialist, a critical part of the study.
“We didn’t know the extent to which we could get busy medical providers and addictions specialists to collaborate. We had to find ways to fit the collaboration into the clinic flow,” said Proeschold-Bell. “In some instances, we had the addictions specialist use a laptop outside the patient exam rooms so medical providers could easily access her and her knowledge about the patient’s alcohol use and behavior changes.”
To date, studies have shown that adults with hepatitis C are three times more likely to have at least one alcoholic drink a day and almost eight times more likely to have at least three drinks a day, compared to adults without hepatitis C. The combination of alcohol use and hepatitis C speeds the time to liver failure and increases rates of liver fibrosis and cancer.
As strong proponents of clinic-based alcohol treatment, Proeschold-Bell and Muir hope to pursue a larger study that recruits patients from the Duke Liver Clinic, the UNC Liver Clinic and the Durham Veterans Affairs Medical Center.
“Alcohol treatment needs to occur in a trusted and known setting,” said Muir. “This study shows that patients will attend alcohol treatment offered in the liver clinic setting and try to change their behaviors in the context of their lives beyond alcohol use.”
More information on this CHPIR project on the HEP ART page
“We are hoping this intervention will make a meaningful change in the state-level rates of testing and people engaged in appropriate HIV care,” said Lynne Messer, assistant professor of global health at CHPIR and Duke’s principle investigator for the initiative. “The state-wide data structure that we will be building over the next four years will allow those who care for HIV-positive clients to know if their people are appropriately engaged in care or have somehow been lost.”