A community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho (Early Morning Star): a cluster-randomised, controlled trial.

BACKGROUND: When caregivers live in remote settings characterised by extreme poverty, poor access to health services, and high rates of HIV/AIDS, their caregiving ability and children's development might be compromised. We aimed to test the effectiveness of a community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho. METHODS: We implemented a matched cluster-randomised, controlled trial in the Mokhotlong district in northeastern Lesotho with 34 community clusters randomly assigned to intervention or wait-list control groups within a pair. Eligible clusters were villages with non-governmental organisation partner presence and an active preschool. Participants were caregiver-child dyads, where the child was 12-60 months old at baseline. The intervention consisted of eight group sessions delivered at informal preschools to all children in each village. Mobile health events were hosted for all intervention (n=17) and control (n=17) clusters, offering HIV testing and other health services to all community members. Primary outcomes were caregiver-reported child HIV testing, child language development, and child attention. Assessments were done at baseline, immediately post-intervention (3 months post-baseline), and 12 months post-intervention. We assessed child language by means of one caregiver-report measure (MacArthur-Bates Communicative Development Inventory [CDI]) and used two observational assessments of receptive language (the Mullen Scales of Early Learning receptive language subscale, and the Peabody Picture Vocabulary Test 4th edn). Child attention was assessed by means of the Early Childhood Vigilance Task. Assessors were masked to group assignment. Analysis was by intention to treat. This trial was registered with ISRCTN.com, ISRCTN16654287 and is completed. FINDINGS: Between Aug 8, 2015, and Dec 10, 2017, 1040 children (531 intervention; 509 control) and their caregivers were enrolled in 34 clusters (17 intervention; 17 control). Compared with controls, the intervention group reported significantly higher child HIV testing at the 12-month follow-up (relative risk [RR] 1·46, 95% CI 1·29 to 1·65, p<0·0001), but not immediately post-intervention. The intervention group showed significantly higher child receptive language on the caregiver report (CDI) at immediate (effect size 3·79, 95% CI 0·78 to 6·79, p=0·028) but not at 12-month follow-up (effect size 2·96, 95% CI -0·10 to 5·98, p=0·056). There were no significant group differences for the direct assessments of receptive language. Child expressive language and child attention did not differ significantly between groups. INTERPRETATION: Integrated child health and parenting interventions, delivered by trained and supervised lay health workers, can improve both child HIV testing and child development. FUNDING: United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR).

"It is in the Nature of Men": The Normalization of Non-Consensual Sex and Intimate Partner Violence Against Women with Acquired Physical Disabilities in South Africa.

This study employed a cross-sectional, qualitative individual interview methodology to explore South African women with physical disabilities' experiences of intimate partner and sexual violence, inclusive of non-consensual and coerced sexual intercourse. For the participants, disability was a factor that intersected with gender norms to create vulnerability to abuse, and that patriarchal ideologies constructing how women should perform their gendered roles in marriage or sexual partnerships, as well as disability stigma, exacerbated this vulnerability. It is important to develop understandings of the different risk factors for violence - at the individual level and in the context of dyadic relationships - to develop programming to better support women.

Self-identified intervention priorities amongst women with road accident-acquired physical disabilities in South Africa.

Background: Acquiring a physical disability in adulthood necessitates a range of adjustments, with past research suggesting that some challenges encountered are unique to women. Moreover, several factors may complicate adjustment to an altered embodiment and difficulties in functioning after an accident, including insufficient rehabilitation and support services and problematic societal attitudes towards disability. In addition, women with disabilities are often excluded from health and social policy and programme development, an oversight that can result in support gaps. Objectives: This article presents the self-identified priority interventions of women with road accident-acquired physical disabilities in South Africa. Methods: We conducted interviews with 18 women with road accident-acquired physical disabilities. The participants were recruited via snowball sampling. Interviews were conducted by experienced interviewers, who were home language speakers of the participants' preferred language of communication. The interview recordings were transcribed, translated, and coded by trained, independent researchers. Results: Study participants identified three key areas of intervention requiring consideration in supportive intervention planning: the acute post-injury environment and healthcare infrastructure, transitional services and social inclusion interventions. These were identified as overlooked areas in which they required support to successfully adapt to limitations in functioning. Conclusion: To develop inclusive, accessible, and practical policy and programming for people with disabilities, exercises like those outlined in this research - eliciting intervention ideas from lived experience - should be conducted as they highlight actionable priorities for programming.

Secondary trauma among trauma researchers: Lessons from the field.

OBJECTIVE: There is a substantial body of research that indicates that professionals treating traumatized clients or patients may suffer from burnout, compassion fatigue, vicarious trauma, or secondary traumatic stress and that those who are most empathic are most vulnerable. However, there is limited research on the effects of participant trauma on trauma researchers. This is the focus of the current study. METHOD: Drawing on case illustrations from a large trauma-related study, we demonstrate the effects of participant trauma on trauma interviewers. RESULTS: The experiences of fieldworkers in this study often mirror the syndromes found among "flooded" therapists, suggesting that it is the listening, and not so much the purpose for which one is listening, that can result in trauma-by-proxy. CONCLUSION: Recommendations: Ethics applications should include a provision for the proper care for trauma researchers, who may, without support, develop symptoms of secondary traumatic stress. Training and regular supervision should become a mandatory part of trauma research practice, and if trauma levels are high, the principal researcher may need to invite a trauma counselor to do debriefing. In contexts where trauma levels are as high as in South Africa, fieldworkers are entitled to debriefing by an appropriately trained professional. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Producing boundary-breaking texts on disability issues: the personal politics of collaboration.

PURPOSE: This article explores the reflection on a process of inter-collaborative team work to produce a photographic book on caregivers' experiences of parenting their disabled children. The team of authors consisted of members with diverse backgrounds, including media studies, social science and photography. The purpose of this article was to explore and gain a deeper understanding of the process of boundary breaking, one which is important if we are to develop new knowledges and new ways of thinking about disability. METHOD: In-depth interviews were conducted with all contributors to the book. RESULTS: Themes emerging from the interviews include the existence of different worlds, crossing boundaries, questions about expertise, conflicting hopes and expectations, and the ethics of anonymity. CONCLUSION: An account of the anxieties, the frustrations and rewarding aspects of the collaboration is provided. We conclude that "us" and "them" categorization permeates our thinking. It characterizes some of the most simplistic thinking in the world of disability--able-bodied vs. disabled. In reality, there are no such categories, we all reside along a highly differentiated continuum of changing states of impairment and health. If we open ourselves up to this reality, we can meet one another and draw on one another's knowledge and experience.

Youth violence risk assessment: gaps in local knowledge and directions for future research.

There is a lack of research on violence risk assessment in South Africa, particularly on the assessment of risk for violence in children and adolescents. This is problematic, because of the strong association between conducting sound assessments and the appropriate referral of youths to intervention programmes. Considering the very high levels of violence in our country, the effective treatment of violent youths is imperative. International literature on violence risk assessment indicates that although a number of instruments designed to assess youth violence risk exist, many primarily focus on identifying psychopathic tendencies in young people, which has stimulated much debate amongst scholars. In addition to paying careful attention to the content of youth violence risk instruments, their administration should be monitored, to ensure that assessment practice is up to standard. Future research efforts in South Africa should be dedicated towards testing the applicability of instruments developed internationally in local settings, and towards the development and testing of local instruments.

Youth violence: A review of risk factors, causal pathways and effective intervention.

This paper presents a review of theoretical and empirical research on risk factors for: 1) the development of violent and other antisocial behaviour; 2) international interventions targeting antisocial, including violent youths; and 3) outcome evaluations and meta-analyses of interventions targeting antisocial, including violent youths. Taken together, the international literature indicates that interventions which effectively reduce violent and other antisocial behaviours are informed by a number of generic principles which should guide the development and implementation of South African violence-prevention programmes. Common characteristics of interventions which effectively reduce youth violence are presented, with the aim of informing the design and delivery of local interventions. In light of the alarmingly high levels of violence in South Africa, there is an urgent need to develop intensive, multi-modal, evidence-based, structured, cognitive-behavioural programmes for violent adolescents and young adults. Furthermore, it is imperative that efforts are directed at developing a reliable local evidence base of 'what works' for young offenders generally, and violent young offenders specifically.