Community-based mental health counseling for children orphaned by AIDS in China

Abstract

There is an urgent need to develop scalable approaches to community-based mental health services for children in rural China and other developing countries involving task shifting from clinicians to trained community workers. Evidence is needed about the effectiveness of interventions for children affected by AIDS in rural areas. This article describes an intervention study aimed at developing, implementing, and evaluating a community-based counseling program for the AIDS orphans of Fuyang, Anhui Province, an area of central China where a tainted blood donation scheme infected countless farmers and left many children orphaned by AIDS. In China these children live in rural settings with no access to mental health services. The authors trained a group of community-based counselors to provide group counseling sessions focusing on self-awareness and communication and to provide a basic therapeutic approach for depression and anxiety. The authors conducted a baseline and two follow-up surveys of 39 children who met the clinical diagnostic criteria for anxiety and depression. There was a statistically significant improvement for the children on anxiety, but there was no statistically significant improvement on depression, with greatest gains immediately following the intervention. We demonstrated the feasibility of task shifting for mental health services in this setting.

Keywords:

• HIV/AIDS
• China
• mental health
• task shifting
• AIDS orphans

Acknowledgements

The authors gratefully acknowledge the assistance of the psychiatric nurses from Huilongguan Hospital in Beijing, Zhang Xiaoli (who tragically passed away before the study was completed), Meng Mei and Wang Yaxin, who conducted the mental health assessments in Fuyang, developed the curriculum, and trained the Fuyang community-based counselors, Elizabeth Shea, clinical psychologist, who participated in the preliminary study, and Marlys Bueber who assisted in developing the curriculum and training materials. The authors thank the staff of AOS for facilitating the study, the principals of the schools in Fuyang for allowing us to conduct the studies at the schools, and the families and children who participated in the baseline study, the counseling intervention and the follow-up surveys. The authors are grateful to Johnson and Johnson, the ZeShan Foundation and to the Aaron Diamond AIDS Research Center for providing funding to different phases of the study.

Notes

1. Positive attitude toward persons with AIDS and children; accepting and nonjudgmental, interactive and engaging; empathetic, open, warm interactions with children, children can trust them and feel safe with them; can adapt to nonauthoritarian or nondirective approach in group work, not telling children how to think or act; can adhere to the training principles and methods that will be taught to them; not the teachers of the AOS students.