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Caregiver Characteristics and Perceptions, Quality of Interactions with Children, and Children's Development in Family-Like Or CAREGIVER CHARACTERISTICS AND PERCEPTIONS, QUALITY OF INTERACTIONS WITH CHILDREN, AND CHILDREN’S DEVELOPMENT IN FAMILY-LIKE ORPHAN CARE IN SOUTH AFRICA by Hilary A. Warner Bachelor of Arts, Messiah College, 2009 Master of Science, University of Pittsburgh, 2014 Submitted to the Graduate Faculty of the School of Education in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2017 UNIVERSITY OF PITTSBURGH SCHOOL OF EDUCATION This dissertation was presented by Hilary A. Warner It was defended on June 5, 2017 and approved by Shannon Wanless, PhD, Associate Professor, Psychology in Education Maureen Porter, PhD, Associate Professor, Administrative and Policy Studies Dissertation Advisors: Christina Groark, PhD, Associate Professor, Psychology in Education Robert B. McCall, PhD, Professor, Psychology ii CAREGIVER CHARACTERISTICS AND PERCEPTIONS, QUALITY OF INTERACTIONS WITH CHILDREN, AND CHILDREN’S DEVELOPMENT IN FAMILY-LIKE ORPHAN CARE IN SOUTH AFRICA Hilary A. Warner, PhD University of Pittsburgh, 2017 This mixed-methods study included a total of 49 children (birth to 5 years) and 28 caregivers from two family-like institutional care settings in KwaZulu-Natal, South Africa. The purpose of the study was to assess the associations between caregivers’ age, education, experience, depression, and social support and the quality of interactions they have with the young children in their care, and to test the associations between caregiver-child interaction quality and child attachment and growth outcomes. Results indicated that caregivers’ perceived social support from friends was positively associated with caregiver-child interaction quality. In addition, among HIV+ children, interaction quality was positively associated with children’s height z-scores, and regardless of children’s HIV status, interaction quality was positively associated with children’s weight z-scores. No other significant associations were found. The qualitative portion of the study included an in-depth exploration of caregivers’ perceptions of their role, their reports of challenges they experience, and the resources they desire. Caregivers’ discourse about what their role entailed included each of the six parental role beliefs that comprise Mowder’s (2005) Parent Development Theory. This study contributes to the institutional orphan care field by addressing the shortage of iii research on care and development in existing family-like care settings, and includes recommendations for future research, policy, and practice. iv TABLE OF CONTENTS PREFACE ................................................................................................................................. XVI 1.0 INTRODUCTION........................................................................................................... 17 2.0 REVIEW OF THE LITERATURE .............................................................................. 20 2.1 ORPHAN AND VULNERABLE CHILDREN CARE ................................... 20 2.1.1 Characteristics of institutional care .......................................................... 21 2.1.1.1 Group size and child-adult ratio ........................................................ 21 2.1.1.2 Transitions ........................................................................................... 22 2.1.1.3 Caregiver-child interactions............................................................... 22 2.1.2 Child development in institutional care .................................................... 23 2.1.3 Current policies and models of care .......................................................... 23 2.1.4 OVC care and development in South Africa ............................................ 24 2.1.5 Remaining questions ................................................................................... 26 2.2 PHYSICAL GROWTH ..................................................................................... 27 2.2.1 Physical growth in institutional care ......................................................... 27 2.2.2 HIV and growth .......................................................................................... 28 2.3 ATTACHMENT ................................................................................................ 29 2.3.1 Defining attachment.................................................................................... 30 2.3.2 Importance of attachment .......................................................................... 32 v 2.3.3 Attachment and culture .............................................................................. 33 2.3.4 Attachment in institutional care ................................................................ 34 2.4 QUALITY OF CAREGIVER-CHILD INTERACTIONS ............................ 35 2.4.1 Mother-child ................................................................................................ 36 2.4.2 Child care ..................................................................................................... 37 2.4.3 Institutional care ......................................................................................... 38 2.4.4 Predictors of interaction quality ................................................................ 38 2.4.4.1 Theoretical models .............................................................................. 39 2.4.4.2 Caregiver.............................................................................................. 40 2.4.4.3 Context ................................................................................................. 45 2.5 CULTURE .......................................................................................................... 47 2.6 PRESENT STUDY ............................................................................................ 49 2.6.1 Research questions and hypotheses ........................................................... 49 2.6.1.1 Quantitative ......................................................................................... 50 2.6.1.2 Qualitative............................................................................................ 51 3.0 METHOD ........................................................................................................................ 52 3.1 SAMPLE ............................................................................................................. 52 3.1.1 Institution A ................................................................................................. 56 3.1.1.1 Residents .............................................................................................. 56 3.1.1.2 Structure and caregiver schedules..................................................... 56 3.1.2 Institution B ................................................................................................. 57 3.1.2.1 Residents .............................................................................................. 57 3.1.2.2 Structure and caregiver schedules..................................................... 57 vi 3.2 MEASURES ....................................................................................................... 58 3.2.1 Material translation .................................................................................... 58 3.2.2 Site records .................................................................................................. 58 3.2.3 Demographics .............................................................................................. 59 3.2.4 Caregiver role .............................................................................................. 60 3.2.5 Depression .................................................................................................... 60 3.2.6 Social support .............................................................................................. 61 3.2.7 Caregiver-child interaction quality ........................................................... 62 3.2.8 Attachment security .................................................................................... 63 3.2.9 Physical growth ........................................................................................... 66 3.2.9.1 Height ................................................................................................... 66 3.2.9.2 Weight .................................................................................................. 66 3.2.9.3 Head circumference ............................................................................ 66 3.2.10 Qualitative interviews ................................................................................. 67 3.3 PROCEDURE .................................................................................................... 67 3.3.1 Training and reliability .............................................................................. 67 3.3.2 Data collection ............................................................................................. 68 3.3.2.1 Observational data .............................................................................. 68 3.3.2.2 Physical growth data ........................................................................... 69 3.3.2.3 Survey data .......................................................................................... 69 3.3.2.4 Local cultural assessment ................................................................... 70 4.0 QUANTITATIVE ANALYSIS,
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