Browsing by Author "de Vries, Petrus"

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    Child and adolescent mental health services in the Western Cape of South Africa: policy evaluation, situational analysis, stakeholder perspectives, and implications for health policy implementation
    (2021) Mokitimi, Stella; de Vries, Petrus; Schneider, Marguerite
    In spite of the need for child and adolescent mental health (CAMH) services across the globe, very little has been done to develop and strengthen CAMH in low- and middle-income countries (LMIC). South Africa is an example of an LMIC where CAMH services have been very limited as a result of various potential factors, including the legacy of apartheid, stigma associated with mental health, and lack of priority of CAMH. In this thesis, we set out to generate an evidence-base about CAMH services in one South African province to inform service strengthening across the full healthcare system through policy development and implementation. We proposed that a comprehensive understanding of specific services requires a multilevel exploration of ‘hardware' (structural) and ‘software' (social) elements in the health systems that support these services. We started by reviewing the CAMH policy landscape with an analysis of the current state of policy development and implementation at national and provincial levels in all nine provinces of South Africa. Using the Walt and Gilson policy analysis triangle (1994), we examined the content, context, processes and actors involved in mental health or CAMH-specific policies. We then evaluated the hardware and software elements of CAMHS in the Western Cape Province by performing a situational analysis using the WHO-AIMS version 2.2 of 2005 (Brief version) adapted for the South African context and to CAMHS. We proceeded to seek the perspectives of stakeholders within the province – firstly a SWOT analysis with senior stakeholders, and secondly, qualitative analysis of the perspectives of grassroots service providers, and of parents/caregivers and adolescent service users. We collected information from these stakeholder groups through a stakeholder engagement workshop, focus group discussions and semi-structured individual interviews. Using the World Health Organization (WHO) (2007) and Gilson (2012) health systems frameworks, we reviewed both the hardware and the software elements of CAMH services and concluded with a synthesis of findings to provide a set of recommendations for policy development and service strengthening based on the evidence generated. In terms of service delivery, findings showed that child and adolescent mental health services (CAMHS) in the Western Cape were provided at all levels of care (primary, secondary and tertiary) and, at least at inpatient and outpatient level, based on catchment/geographical service areas. However, CAMHS were still limited and were provided under very resource-constrained conditions by inadequately trained service providers. In terms of the health workforce, CAMHS were provided by a range of professionals including child & adolescent psychiatrists, general psychiatrists, medical officers, clinical psychologists, social workers, mental health nurses, occupational therapists, and speech and language therapists. However, multidisciplinary expertise and psychosocial interventions were only available in specialist CAMHS at tertiary level of care. In addition, the specialist services were all based in the City of Cape Town, with no direct access to specialist CAMHS at secondary levels of care or in any of the rural districts of the province. Health information systems were not fit-for-purposes to generate disaggregated data on under-18-yearolds, thus made it extremely difficult to provide a comprehensive view of CAMHS in the province. In terms of access to essential medicines, basic classes of psychiatric medications were available at all levels of care, but not consistently so. An exploration of financing showed that no ring-fenced or disaggregated budgets were available for CAMHS, thus making it impossible to comment on the appropriateness of funding for the mental health needs of children and adolescents. In terms of leadership and governance, a national CAMH policy existed, but no implementation plans had been developed since the publication of the CAMH policy in 2003. Our findings highlighted a lack of dedicated CAMH leadership and governance in the province. We argued that the absence of a clear CAMH leadership structure also explained why provincial plans and strategies had not been developed and implemented over the last two decades. A very consistent finding from our data was a need for a dedicated provincial lead for CAMH. We concluded the thesis with hardware and software recommendations for policy implementation, service development, training and research.
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    Perceived parenting style and suicidal/Non-suicidal self-Injury in students at the University of Cape Town
    (2021) Chundu, Mwanja; de Vries, Petrus; Davids, Eugene
    Background: Low- and middle-income countries like South Africa carry the greatest suicide burden, with local general population suicide attempt rates of 2.9–22.7%, in comparison to 0.7–9% in international literature. Non-suicidal self-injury (NSSI) commonly co-occurs with suicidal behaviours and estimates range from 5.5% internationally to 19.4% in South Africa. As a subgroup of the general population, university students are at higher risk both of suicidal behaviours and NSSI (S/NSSI). Risk factors for S/NSSI include parenting style; however, very little is known about the relationship between parenting styles and S/NSSI in university students in the South African context. Objectives: In this dissertation we set out to perform a literature review relating to explanatory models and risk factors associated with S/NSSI and then proceeded to collect novel data from students at the University of Cape Town. This research study aimed to describe the rates of S/NSSI behaviours and to explore the relationship between the Baumrind parenting style typography and S/NSSI in university students. The study hypothesised that authoritative parenting would negatively correlate with S/NSSI. No a priori hypotheses were made about the other parenting styles investigated. Methods: In chapter 1, we performed a literature review of peer-reviewed publications on Pubmed, Psychinfo via EBSCOHost and MEDLINE via EBSCOHost identified through search terms that were relevant to the focus of the study. In chapter 2 novel data were collected. Students from all faculties at the University of Cape Town were invited to complete an anonymous, online electronic survey. Data collection included a socio-demographic questionnaire, Parenting Styles and Dimensions Questionnaire and Self-Harming Behaviours Questionnaire. Descriptive statistics quantified parenting styles, suicidal behaviours and NSSI. Spearman's correlation coefficients examined the association between parenting style and S/NSSI. Results: Literature review provided a topline review of explanatory models and risk factors associated with S/NSSI and identified relevant literature about parenting styles using the Baumrind typology. In the electronic survey of university students, the rate of suicidal attempts was 6.3% and of NSSI was 22.7%. Suicide threats, suicidal thoughts, and thoughts of dying were reported by 5.9%, 35.7% and 50.7% respectively. No significant differences were seen between male and female students. We observed no significant association between authoritative parenting and suicidal behaviours, but authoritative mothers and fathers were significantly associated with a history of NSSI. Both permissive mothers and fathers were associated with suicide attempts, threats, and thoughts, whereas only permissive mothers were associated with NSSI. Conclusion: This study replicated previously reported high rates of S/NSSI in South African university students in comparison to general population and international data. Contrary to our hypothesis, authoritative parenting style was positively correlated with NSSI, but not with suicidal behaviours. Further studies are warranted to examine parenting style, and permissive parenting, in particular, in relation to S/NSSI
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    Reaching the hard to reach: longitudinal investigation of adolescents' attendance at an after-school sexual and reproductive health programme in Western Cape, South Africa
    (BioMed Central Ltd, 2015) Mathews, Catherine; Eggers, Sander; de Vries, Petrus; Mason-Jones, Amanda; Townsend, Loraine; Aaro, Leif; De Vries, Hein
    BACKGROUND: Adolescents need access to effective sexual and reproductive health (SRH) interventions, but face barriers accessing them through traditional health systems. School-based approaches might provide accessible, complementary strategies. We investigated whether a 21-session after-school SRH education programme and school health service attracted adolescents most at risk for adverse SRH outcomes and explored motivators for and barriers to attendance. METHODS: Grade 8 adolescents (average age 13years) from 20 schools in the intervention arm of an HIV prevention cluster randomised controlled trial in the Western Cape Province of South Africa, were invited to participate in an after-school SRH program and to attend school health services. Using a longitudinal design, we surveyed participants at baseline, measured their attendance at weekly after-school sessions for 6months and surveyed them post-intervention. We examined factors associated with attendance using bivariate and multiple logistic and Poisson regression analyses, and through thematic analysis of qualitative data. RESULTS: The intervention was fully implemented in 18 schools with 1576 trial participants. The mean attendance of the 21-session SRH programme was 8.8 sessions (S.D. 7.5) among girls and 6.9 (S.D. 7.2) among boys. School health services were visited by 17.3% (14.9% of boys and 18.7% of girls). Adolescents who had their sexual debut before baseline had a lower rate of session attendance compared with those who had not (6.3 vs 8.5, p<.001). Those who had been victims of sexual violence or intimate partner violence (IPV), and who had perpetrated IPV also had lower rates of attendance. Participants were motivated by a wish to receive new knowledge, life coaching and positive attitudes towards the intervention. The unavailability of safe transport and domestic responsibilities were the most common barriers to attendance. Only two participants cited negative attitudes about the intervention as the reason they did not attend. CONCLUSIONS: Reducing structural barriers to attendance, after-school interventions are likely to reach adolescents with proven-effective SRH interventions. However, special attention is required to reach vulnerable adolescents, through offering different delivery modalities, improving the school climate, and providing support for adolescents with mental health problems and neurodevelopmental academic problems.TRIAL REGISTRATION:Current Controlled Trials ISRCTN56270821; Registered 13 February 2013.
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    Towards integrated service delivery for children with autism spectrum disorder in the Western Cape Province of South Africa
    (2023) Pillay, Sarosha; de Vries, Petrus; Duncan Eve
    Background The prevalence of autism spectrum disorder (ASD) in South Africa is unknown and there is little information on the educational service needs of children with ASD in the country. There are no standardized procedures for identification, diagnosis and management of children with autism. The Western Cape is one of the better resourced provinces in the country in terms of ASD services, yet educational opportunities for these children are limited. The Western Cape was therefore used as a case study to understand the landscape of education systems for children with ASD in South Africa. Objectives The objectives of the study were a) to determine the number and profile of children with ASD both in and out of schools in the Western Cape, b) to examine stakeholder views, perspectives and proposed solutions to meet the educational needs of children with ASD and their families, and c) to generate suggestions to strengthen ASD systems and services. Methods An exploratory mixed-methods approach was used across two phases. In the first phase, quantitative provincial educational data were used to describe the profile of children with ASD in the formal public sector education system as well as those waiting for educational services. The second phase used qualitative focus groups and semistructured individual interviews to examine the perspectives and recommendations of caregivers, service providers and government stakeholders about ASD services. Results A systematic database search for children with ASD in the whole provincial educational system, combined with the provincial ‘waiting list' of those waiting for school placement found very low rates of ASD (
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    Towards Naturalistic Data Collection in South Africa: Feasibility of Home-based Smartphone Recordings of Caregiver-Child Interactions for Coding with the Joint Engagement Rating Inventory (JERI)
    (2024) Ndlovu, Minkateko; de Vries, Petrus; Franz Lauren
    Naturalistic developmental behavioural interventions (NDBI) represent an evidence-based group of early interventions for autism. The COVID-19 pandemic forced autism interventions globally to switch to telehealth that utilised smartphone technology. Even though the evidence base for NDBI in low-and middle-income countries (LMIC) is very limited, early research has suggested that the tele-delivery of NDBI could be feasible in LMIC contexts such as in South Africa. The Joint Engagement Rating Inventory (JERI) is a behavioural coding system that has shown utility in measuring intervention outcomes in low-resource South African environments under controlled ‘laboratory' conditions. To date, no studies in LMIC have examined the feasibility of using smartphone recordings made by families in their own ‘naturalistic' home environments as data sources for coding with the JERI. In this study, we sought to answer two specific questions – first, to assess whether the home-based recordings of interactions between caregivers and their young autistic children had the necessary technical elements to be coded with the JERI; second, whether the JERI could be coded with confidence and whether satisfactory inter-rater reliability could be achieved when coding smartphone-recorded caregiver-child interactions. Methods Young autistic children (between 18-72 months) and their caregivers (≥18 years) were recruited as part of a larger project. Caregivers were provided with instructions to record 6- minute interactions with their child using their own smartphones and play materials available at home, pre-and-post 12 non-specialists delivered NDBI caregiver coaching sessions. Data were rated by two research-reliable JERI raters to assess 1) technical feasibility, and 2) raters' confidence, coding difficulty and inter-rater reliability using 16 pre-selected items of the JERI. Quantitative descriptive analyses were performed. Results Data were available on 18 smartphone recordings representing 108 minutes of data. All recordings had acceptable audio and visual quality and captured adequate data to allow coding on the JERI. In terms of rater confidence, the rater indicated being “sure of ratings” and “somewhat sure of ratings” for a majority of JERI items in the majority of the smartphone data (15-18/18 recordings). The rater experiences no difficulties coding five JERI items in most (12-15/18) smartphone recordings but reported difficulties coding eleven JERI items in 1-6 smartphone recordings. The JERI inter-rater agreement (within one scale point) ranged between 71-100% for all JERI items. Eleven of the 16 JERI items had weighted kappa values of one and observer estimated accuracy values of >99% (within one scale point). Conclusion Results of this study suggested that smartphone recordings of interactions between caregivers and their young autistic children were technically suitable to code with the JERI. The majority of smartphone-recorded caregiver-child interactions could be coded with only some difficulty and with good inter-rater reliability on the JERI. These findings suggest that smartphones could be used as naturalistic data collection methods to measure and track the impact of NDBI in a South African environment. Keywords: autism, NDBI, JERI, smartphones, naturalistic data collection