CCIH, 25 May 2009 Measuring Child Wellbeing: A self report measure from a child perspective Adele Clark Catholic Relief Services

CCIH, 25 May 2009 OVC Wellbeing Tool Why this matters Tool Development Current Status How to Use Feedback from Children Next Steps Hands-on

CCIH, 25 May 2009 Why this matters Child participation Ensuring children have a voice in monitoring their wellbeing Empowering children

CCIH, 25 May 2009 Background HIV Global Technical Team Meeting November 2006 Need for a comprehensive measure of OVC wellbeing Goal: create an instrument which can be used internationally to monitor holistic OVC programming from a child’s perspective that is valid, reliable and practical to administer. Tool Development: Background

CCIH, 25 May 2009 Guiding Principles Capture wellbeing from the child’s perspective A valid and reliable measure of wellbeing Age-appropriate Applicable to multiple settings Ease of use Repeated measure

CCIH, 25 May 2009 Literature Review Expert Statements Judging Draft tool created Piloting: five countries Analysis Tool Development: Methodology

CCIH, 25 May 2009 The Tool Self-Report Measure Originally 48 Questions Likert Scale Used for Children Aged Domains of Wellbeing –Nutrition and food security –Shelter and environment –Protection –Family –Health – Spirituality – Mental health – Education – Economic – Community cohesion

CCIH, 25 May 2009 Tool Development: Results 890 OVC Compared OWT: –Larger evaluation –Children’s Hope Scale 1Snyder et al (1997). The Development and Validation of the Children’s Hope Scale. Journal of Pediatric Psychiatry 22(3),

CCIH, 25 May 2009 Current Status OWT now finalized –Reduced number of items in the tool from 48 to 36 items End Result: A valid, practical SELF REPORT tool to measure OVC wellbeing now exists.

CCIH, 25 May 2009 Current Status The OWT has been used in Ethiopia, Haiti, India, Kenya, Malawi, Rwanda, Tanzania, Vietnam, and Zambia. Translations are available on the OWT website.

CCIH, 25 May 2009 Who should use the OWT? OVC program staff Communities

CCIH, 25 May 2009 How the OWT information should be used To monitor OVC programs at an aggregate level to identify patterns of change in OVC wellbeing within projects. –Weaker domains should be explored –Strengths identified NOT an in-depth assessment tool at the individual level! –However, rapid scoring can highlight need for follow-up and more in-depth assessment with children who report significant problems.

CCIH, 25 May 2009 How to Use the Tool Informed Consent Translation Administration Scoring

CCIH, 25 May 2009 Informed Consent REQUIRED!!! Must consult the child for consent. Need to train field staff on what this means: consultants, enumerators, etc.

CCIH, 25 May 2009 Translation Need accurate translation –Abstract concepts –Literal translation will not work! Translate, then back translate Field test Modify

CCIH, 25 May 2009 Administration Appropriate training for enumerators –Practice sessions for them –They must understand all the items’ original intent! –Need to know how to respond –PLUS all the basics (nonverbal responses, etc.) Takes minutes oral Self administration still under study

CCIH, 25 May 2009 Scoring Enter into database (syntax available) Option: field scoring Caution: Risk of over-interpretation. General: –Desirable scores: >25 (rare, especially at baseline) –Average scores around 23 at baseline –Over time, expect this to increase –Special attention needed < 22, especially as project progresses (look at individual domain scores and changes over time) –<15 should be followed up immediately (error in response or an immediate problem?)

CCIH, 25 May 2009 Strengths and Challenges Strengths: –Child’s perspective –Holistic –Universal tool –Age appropriate –Rapid –Low cost Challenges: –Universal tool –Translation accuracy –Eliciting information from children on sensitive subjects

CCIH, 25 May 2009 Feedback from the Children Initial feedback was critical in the adaptation of the tool (e.g. questions eliminated based on their feedback) Currently=Enthusiastic Have said they are pleased to be able to give their opinion on matters relating to them No reported problems understanding the questions on the OWT

CCIH, 25 May 2009 Next Steps Roll out in other countries Continue data analysis to determine predictive value of OWT Develop a similar tool for younger age groups Comparison study of self report data to other reports (work with Child Status Index) Mobile technology

CCIH, 25 May 2009 Take Home Points Important to consult OVC when assessing their wellbeingImportant to consult OVC when assessing their wellbeing Participatory assessment and feedbackParticipatory assessment and feedback Learning from what the children sayLearning from what the children say

CCIH, 25 May 2009 Thank you Contact: Adele Clark Catholic Relief Services Tool developed by a team of staff, led by Shannon Senefeld, Susan Strasser, and James Campbell. Please note that the photographs in this publication are used for illustrative purposes only; they do not imply any particular health status (such as HIV or AIDS) on the part of the person who appears in the photograph.