A Multilevel Intervention Helps Children Struggling with Extreme Adversity

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A Multilevel Intervention Helps Children Struggling with Extreme Adversity    

Jim Windell

           How do you best help children cope with extreme adversity – such as poverty or exposure to violence?

           That has been a question guiding the research of scientists for some time.

            Xiaoming Li, of the University of South Carolina, and his research associates have suggested that a multilevel resilience-based intervention designed to help children may be the answer.

           In previous research, Li and his colleagues proposed the ChildCARE intervention, which is based on a resilience framework proposed by Li and other in 2015. ChildCARE is a conceptual framework illustrating the dynamic resilience process in shaping positive adaptation of children who experience parental HIV and associated risk factors, such as poverty, stigma and violence). ChildCARE is an intervention resulting from the interplay of multiple factors within and across three ecological systems: child internal assets (e.g., coping), family resources (e.g., parenting), and community resources (e.g., social cohesion).

           Previous studies found that these resilience-related factors at the child, family, and community levels, together, play a critical role in influencing positive outcomes, including better mental health, among children affected by parental HIV. Accordingly, the ChildCARE intervention consists of intervention components at three levels: child, caregiver, and community. The child-level component was designed to enhance multiple intrapersonal skills, such as coping, emotional regulation, and positive multilevel resilience-based intervention designed to promote children’s coping skills, positive parenting and community integration for HIV-affected families.

           Drawing on other studies, Yanping Jiang, a researcher at the Rutgers Institute of Health, has reported on the latest study that may confirm what has been found in past research. Building on previous studies of children in China whose parents are living with HIV or have died from AIDS-related complications, Jiang analyzed the efficacy of resilience-based interventions on mental and behavioral health in children. She found that simultaneously focusing on kids, caregivers and community members produces better outcomes than interventions that focus on children in isolation. The stud was recently published in the Journal of Child and Family Studies.

           According to Jiang, who is lead author and an instructor in the Department of Family Medicine and Community Health at the Rutgers Robert Wood Johnson Medical School, “The children and their families we studied experienced multiple levels of adversity, from the stigma of having HIV-positive parents to growing up in orphanages. We wanted to see if multilevel-resilience interventions that focused on the children as well as those close to them could improve emotional wellbeing.”

           In the 1990s, an outbreak of HIV infection in China’s Henan province was traced to unhygienic commercial blood and plasma collection practices. Working with Xiaoming Li and Sayward Harrison, both from the University of South Carolina, Jiang hypothesized that programs aimed at increasing mental and behavioral health in affected children would be more effective if they included initiatives to address family cohesion and reduce community stigma. Thus, they created ChildCARE, which stands for Child-Caregiver-Advocacy Resilience, and, as indicated, is a multilevel resilience-based intervention.

           To examine the efficacy of ChildCARE, Jiang and Li studied 790 children in Henan whose parents were living with HIV or passed away due to AIDS-related illnesses. These children were randomly assigned to a control group or one of three intervention groups –  Group 1 received a child intervention component, Group 2 received both child and caregiver intervention components, and Group 3 received child, caregiver and community intervention components. The researchers implemented the interventions and then conducted follow-up surveys every six months for 36 months.

           They found that a combination of interventions targeting children, families and communities was more effective at reducing children’s symptoms of depression and anxiety than targeting children only. The benefits, however, were relatively short-lived. After 18 months, the ChildCARE program wasn’t associated with meaningful changes in mental health outcomes.

           While this study confirms that multilevel programs such as ChildCARE can strengthen mental and behavioral health of children affected by extreme adversity, Jiang says that they must come up with ways to sustain the effects of interventions over time.

           To read the original article, find it with this reference:

Jiang, Y., Li, X., Harrison, S.E. et al. (2022). Effects of a Multilevel Resilience-Based Intervention on Mental Health for Children Affected by Parental HIV: A Cluster Randomized Controlled TrialJournal of Child and Family Studies, 31, 1094–1105. https://doi.org/10.1007/s10826-022-02236-x


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