Evaluation of the Child Status Index
Children affected
by HIV/AIDS have many needs. The U.S. President’s Emergency Plan for AIDS
Relief (PEPFAR), an initiative with the largest financial commitment to the
global HIV/AIDS response, has made assistance to orphans and vulnerable
children (OVC) a major priority. OVC are children aged 0-17 years who are
either orphaned, or made vulnerable
because of HIV/AIDS.1 By 2008, PEPFAR had supported care for more
than four million OVC, providing over $300 million for OVC activities in 2008
alone.2 In 2006, PEPFAR
supported the development of a tool to measure the vulnerabilities and needs of
OVC, and outcomes of OVC services. The Child Status Index (CSI) was developed
by U.S.-based researchers with input from partners and potential future tool users
in sub-Saharan Africa.3 It was made
available publicly in 2008.4
|
Final Report 2010
Sabin, L., Brooks B., Tsoka M., Miller C., Sabin L. (2011). “Measuring vulnerability among orphans and vulnerable children in rural Malawi: validation study of the Child Status Index tool.” In review.
Abstract: Objectives:
To validate the Child Status Index (CSI) as an instrument
that can meaningfully measure the vulnerabilities of orphaned and vulnerable
children (OVC), including those infected and affected by HIV/AIDS.
Methods: Two instruments comprised of previously
validated tools and indicators commonly considered best practice were
administered to 102 children aged 5-10 years and 100 children aged 11-17 years in
Mchinji, Malawi. Respondents were randomly
sampled from a roster of children recently scored with the CSI tool. For each
of the CSI’s twelve sub-domains, we assessed construct validity using Spearman
Rank correlation coefficients. We also calculated cross tabulations to explain
the resulting correlation coefficients. Analyses were conducted separately for
the two age groups.
Results:
No
relationships exceeded the standard for high construct validity (≥0.7). Only 2
were moderate (0.3-0.7), both for the younger age group: food security (0.4)
and wellness (0.36). All other relationships were weak or negative. In most
sub-categories, a substantial proportion of children indicated distress that
was not evident from CSI scores. In the abuse and exploitation sub-domain, all children
were rated as “good” or “fair” by the CSI, but among surveyed children aged
11-17, 20% or more reported being beaten, kicked, locked out of the house,
threatened with abandonment, cursed, and made to feel ashamed.
Conclusions:
In
this rural Malawi
population, we were not able to validate the CSI as a tool for assessing the vulnerabilities
of OVC. We recommend caution in interpreting CSI scores, revisions to the tool,
and further validation research.
|
The CSI is
comprised of 6 domains that address: 1) Food/nutrition; 2) Shelter and care; 3)
Protection; 4) Health; 5) Psychosocial situation; 6) Education and skills
training (Table 1).4 Every domain,
in turn, has two specific factors that community workers identified as key
areas of concern during the development phase. The factors were designed to help
community workers identify urgent situations for a child.3 A field
guide recommends the use of several sample questions to consider for each
factor. For example, Domain 1, ‘Food and Nutrition,’ encompasses factors ‘food
security’ and ‘nutrition and growth.’ The questions for the former include: “Tell
me about times when there is no food;” and “Does this child complain of
hunger?”5 For each factor,
the guide recommends that assessors provide a score that indicates the child’s
situation: good, fair, bad, or very bad.3, 5
Throughout
several African countries, various agencies, including community based
organizations (CBOs), have been using the CSI. While the extent of CSI utilization
is unclear, a 2009 survey distributed to OVC organizations elicited responses
from 18 organizations operating in 9 countries.6 Of these,
most were non-governmental organizations (NGOs).
The
primary motivation for developing the CSI was to establish a tool for
widespread use. Thus, it is critical to evaluate the tool’s ability to generate
valid information regarding child vulnerability. This study is an independent
assessment of the construct validity of the CSI.
|
|
