Mediational Intervention for Sensitizing Caregivers to Improve Mental Health Outcomes in Orphaned and Vulnerable Children

Objective: There is an urgent need to equip community-based careworkers with the skills to
address the mental health needs of orphans and vulnerable children (OVC) as an essential response
to shortages in human resources for mental health in Sub-Saharan Africa. We conducted a quasiexperimental
feasibility trial in South Africa to adapt and evaluate an established year-long semistructured,
manualized video-feedback caregiver intervention (the Mediational Intervention for
Sensitizing Caregivers; MISC) for community-based organizations (CBOs).
Methods: Following a year-long iterative cross-cultural adaptation of MISC, we recruited 88 OVC
(ages 7–11; 45.5% girls) and their CBO careworkers (N = 18; 94.4% female). Two CBOs (45 children; 9
CBO careworkers) received 12 months of MISC, and two CBOs (43 children; 9 CBO careworkers)
received treatment as usual. Child mental health and quality of caregiving were assessed at
6 months into the intervention and at completion through multi-informant questionnaires and
video-recordings of careworker-child interactions. Qualitative interviews were conducted to evaluate
feasibility and acceptability.
Results: MISC-CBO was acceptable and feasible in terms of attendance and post-intervention
interviews. MISC improved child mental health, as well as the quality of careworker caregiving in
terms of interactive effects for affective and cognitive (Expanding) components of MISC, and main
effects for the cognitive components of Rewarding and Provision of meaning. MISC components
did not mediate the effects of the intervention.
Conclusions: The current study shows that laypersons with no tertiary education and virtually no prior
training who undergo MISC training can improve caregiving quality and the mental health of OVCs.