THE PSYCHOSOCIAL EFFECT OF INSTITUTIONALIZATION OF ORPHANS AND VULNERABLE CHILDREN IN OYO STATE

CHAPTER TWO

REVIEW OF LITERATURE

2.1 INTRODUCTION

Our focus in this chapter is to critically examine relevant literature that would assist in explaining the research problem and furthermore recognize the efforts of scholars who had previously contributed immensely to similar research.

2.3 CONCEPTUAL REVIEW

CONCEPT OF ORPHAN AND VULNERABLE CHILDREN

UNAIDS defines an orphan as a child under the age of 15 who has lost either their mother (maternal orphan) or both parents (double orphan) to AIDS. Many researchers and intervention groups raise the age limit to 18, while some appear to adopt the UNAIDS standard. It is also becoming more widely acknowledged that a child would be classified as an orphan if his or her father died. The UNAIDS definition has been chastised for its lack of breadth and sensitivity to the reality of many children. Critically, scholars agree that raising the age range covered by the definition to 18 has policy implications because it increases the number of children whose lives are affected. However, the circumstances make this admission necessary.

Layers of vulnerability are handled inside the orphan grouping as one technique for giving descriptive insight into the context of the OVC. There appear to be some implicit classification systems for orphans, such as the nature of their caregivers, such as extended families, foster parents, community caregivers, child-headed households, and those in institutional care, the level of additional assistance required, and the distinction between maternal, paternal, and double orphans. Vulnerability, according to Evans (2013), is far more difficult to characterize. The difficulty grows when it is noted that this definition must guide work with children in a variety of situations throughout the world while avoiding being seen as stigmatizing. Children who live in households where one or more people are ill, dying, or deceased; children who live in households that receive orphans; children whose caregivers are too ill to care for them; and children living with very old and frail caregivers are some of the identifiers listed by World Vision (2006).

A Kenyan consultative conference characterized children as vulnerable if they lived in households with a chronically sick parent or caregiver, as well as in terms of access to important resources such as food, shelter, education, psycho-social and emotional support, and love. These categories are concerned with HIV-related issues. According to Nguefack, Ourtching, Gregory, and Priso (2014), there are a lot of things to look at that are more general about the child's environment, like poverty, access to housing, education, and other basic services, handicap, drought effect, stigma, and political repression. All of these things could make a child more likely to get sick.

2.3.2 ORPHAN AND VULNERABLE CHILDREN IN NIGERIA

According to the Nigeria Country Report (2004), an orphan is a kid under the age of 18 whose mother (maternal orphan), father (paternal orphan), or both parents (double orphan) are deceased. A kid is considered vulnerable when he or she is at a higher risk of experiencing poor consequences than the typical youngster in a defined society. Malnutrition, increased morbidity and mortality, poor school attendance and completion rate, and increased risk of abuse and psychological effects are all negative outcomes. According to Nigeria's National Plan of Action on Orphans and Vulnerable Children (2007), the categories of children who may be vulnerable are not complete, but for working purposes, a child is defined as a male or girl under the age of 18. An orphan is a kid (under the age of 18) who has lost one or both parents, regardless of the cause of death. People who have lost both parents are referred to as "double orphans," whereas the meaning of vulnerability differs from society to civilization and is community-specific.

Nevertheless, the Federal Ministry of Social Development (2007) provides some key indicators determining children’s vulnerability including children that are:

• From poverty stricken homes;
• With inadequate access to educational, health and other social support;
• Live in a household with terminally ill parents or care-giver(s);
• Neglected children and Abandoned children.

2.3.3 TYPES OF ORPHANAGE

There are two types of orphanages in Nigeria. Government-run orphanages are the most prevalent type of institution, followed by privately managed orphanages owned by individuals and/or faith-based organizations. Regardless of the kind, the applicable processes for acquiring or maintaining custody of any child must be followed. Furthermore, private orphanages are usually run by non-governmental organizations, but like government orphanages, they may be granted a license for child placement if their aims include child adoption and foster care. This, however, is done under the supervision of the State Ministry. As a result, children who are to be adopted may be in the care of either a private or a government orphanage. Nonetheless, these non-governmental institutions are not permitted to adopt any child without the consent of the state ministry where adoption procedures are handled. This is because the ministry is normally in charge of all processes, including any necessary investigations. In addition, orphanages house various types of children, depending on their care type or status. There are children who have been placed only for care and safety by their destitute parents or relatives. This group of children makes up a portion of the unadoptable children in Nigeria (CRA, 2003). Another component is children, for whom efforts are currently being made to reunite them.

INSTITUTIONALIZATION

An orphanage is an institution that houses children whose parents are deceased or whose whereabouts are unknown. It is a public institution created to provide care and protection for children without parents. Simply put, an orphanage is a residential institution devoted to the care of large numbers of children. The first orphanages, called "orphanotrophia", were founded by the Catholic Church in the 1st century amid various alternative means of orphan support. The Jewish law, for instance, prescribed care for the widow and the orphan, and the Athenian law supported all orphans of those killed in military service until the age of eighteen. Plato (Laws, 927), as cited in The Catholic Encyclopedia, Volume XI, says: “Orphans should be placed under the care of public guardians. Men should have a fear of the loneliness of orphans and of the souls of their departed parents. A man should love the unfortunate orphan of whom he is guardian as if he were his own child. He should be as careful and as diligent in the management of the orphan's property as of his own or even more careful still.” The care of orphans was referred to bishops and, during the Middle Ages, to monasteries. Many orphanages practiced some form of "binding-out" in which children, as soon as they were old enough, were given as apprentices to households. This would ensure their support and their learning an occupation.

Institutional (orphanage) care is mostly outside the normal human beings type of care giving in which the primary caregiver usually the mother is always there to attend to the needs of the child. In institutions (orphanage) the caregivers are employs paid by organizations or individuals to take care of the children, they rotate shifts and take care of large number of children. These rotating of shifts usually results in continuous instability of care giving for the children and also makes care giving in institutions (orphanage) to lack quality and quantity which is enough to hinder appropriate social and Emotional development. Most orphanages in some parts of Nigeria are substandard due to lack of caregiver child warmth, responsive social-Emotional interactions and the opportunity to experience relationship with few, caregivers. (Perry, 2001).

Importance of support facilities for institutionalized orphans

The importance of support for orphans can not be underestimated. Orphans, by virtue of their circumstances, face a myriad of vulnerabilities and in most cases, when there is no adequate support; they find it very difficult to cope with these risks or the stress that arises from the inability to cope. This in turn brings about far reaching negative consequences for the orphans. Research has established that social support and active coping effectively help to mediate stress. Additionally, face-to-face support groups are positively correlated with desirable outcomes, resulting indirectly from adaptive coping skills and responses (Sullivan, 2003). Orphans, including institutionalized orphans should enjoy care and support in these core areas: psychosocial support, education/vocational training, food and nutrition, legal and protection, shelter and care, health care (GHARP, 2007).

• Psychosocial support – refers to interventions that support orphaned children to cope with the emotional and social aspects and impacts of orphanhood. As a result of being orphaned, children might experience traumatic events such as stigma and discrimination, isolation and loneliness, violence and exploitation, lack of adult support and guidance. Psychosocial support is important for orphaned children because it helps them overcome the challenges posed by their circumstances and it builds in them coping mechanisms as well as trust and hope in their future. Psychosocial interventions also help orphaned children build self-esteem. Orphaned children should be provided with age-appropriate support that recognizes that children often respond differently to trauma and loss.
• Education/Vocational Training – refers to activities that support orphaned children’s intellectual development across the age span from preschool to secondary level. There should be consistent school attendance for school age children, caregiver skills in early childhood education for preschoolers should be built, and increasing access to vocational training for older children should be provided. Education is important because every child has a basic human right to learn how to read and write and to be provided with quality education. Education is a basic right for every child to guarantee a responsible livelihood in society. Furthermore, education is the key to development, which can be used to effectively combat poverty – it reduces abject poverty and hardship. Education and vocational training is important to build a strong foundation and hope for the future of disadvantaged children (Child Survival Aid Ghana, 2012). Access to basic education is meant to allow orphaned children to live a healthier and more productive life. An educated child would have wider choices and opportunities in the future to improve his/her socio-economic status; and to be in position to take on new social responsibilities in the community (NELA, 2008).
• Vocational training: In addition, vocational training is most important for the rehabilitation process of children at risk, in this case, orphans. If children are empowered economically, they can survive with grace and dignity. Without education, empowerment is harder for children to achieve.
• Food & Nutritional Support – refers to the provision of food and nutritional support. Orphaned children need access to adequate and appropriate foods to meet their bodies’ nutritional needs. Food and nutritional support is important because insufficient diet will make orphaned children malnourished and malnourishment can lead to poor health and low resistance to disease. It could also lead to lack of energy and concentration in school, work, or play (NELA, 2008).
• Shelter & Care – refers to activities that support orphaned children to live in a safe physical environment and to grow up within the confines of a family and a community. Institutional care should only be considered as a last resort due to concerns about the effects of residential care on children’s development. Activities aimed at ensuring children have a guardian in place should they lose their current parent or guardian(s) as well as efforts to place institutionalized children in permanent families (through reintegration, fostering or adoption) should be implemented. In addition the area of shelter and care includes basic material support for physical needs such as bedding and clothing that are not covered under other areas such as food and health care. Shelter and care is important for orphaned children to meet their developmental needs, to equip them with knowledge and skills required for independent life in the community, to help them retain sense of belonging and identity, and to help them benefit from the continuous support of network within that community (NELA, 2008).
• Protection & legal support – refers to all efforts to protect orphaned children from neglect, abuse, exploitation and trafficking as well as protection of their legal rights such as civil registration, guardianship and inheritance. This area also includes activities to prevent and confront stigma and discrimination faced by orphaned children. The importance of protection and legal support affords orphaned children access to Protection from maltreatment by those responsible for their care; protection from economic exploitation and work that is hazardous, that interferes with their education or harm their health and physical, mental, spiritual, moral and social development; protection from sexual exploitation and abuse; protection from being sold or trafficked; protection from being subjected to torture or degrading treatment. If they become a victim of armed conflict, torture, neglect, maltreatment or exploitation, protection and legal support helps them to receive appropriate treatment for their physical and psychological recovery and reintegration into society (NELA, 2008).
• Health Care – refers to efforts to ensure orphaned children have access to age-appropriate preventive and curative health care offered through public services. Healthcare is one of the main social services essential for the wellbeing of orphaned children. It includes preventive care which involves actions aimed at preventing or avoiding illness, promotive and curative care which is centered on actions that are taken once a person falls ill or is injured to reduce or completely remove pain. Health care is important for orphaned children because it puts them in a state of physical and mental wellbeing that provides an opportunity for them to achieve their greatest potential.

PSYCHO-SOCIAL NEED OF ORPHAN AND VULNERABLE CHILDREN

Every child’s ability to learn and grow is dependent on how the environment responds to some of his/her basic needs. Every child needs to feel physically and emotionally protected, respected, and valued; therefore, persons in the environment where a child finds himself/herself must create a healthy environment within which the child’s dignity is protected and he/she feels stimulated enough to explore and develop his/her full potential. Children are more vulnerable to changes in their physical, emotional and social environments because of their rapid physical and mental health growth. The health and well-being of children depends on the safety and quality of their physical/natural environments, built environments and social environments – at home, school and in the community. Children also need to be in environments which protect them from violence, abuse, exploitation, injuries and neglect. Every child has their own rate and pattern of development and although research has identified what can be referred to as norms of development, babies and young children need to be allowed the time and the support necessary for their own personal development. From the onset, growth and development must involve opportunities to play, interact, explore, create, learn and solve problem. Additionally, children need in their environments, adults that are flexible and responsive, who can adapt to their immediate interests and needs and who are interested and attentive caregivers; good relationships that encourage them to participate actively; and opportunities for them to communicate their feelings and their thoughts. Thus, a stimulating physical space and the assistance of trained childcare professionals are factors that can help provide a positive environment for children to grow and develop (Olarte, 2012). During early childhood, children undergo rapid growth that is highly influenced by their environment. The more stimulating the early environment, the more a child develops and learns (Olarte, 2012).

Experiences in the first few years of life have been proven to have a significant impact on shaping a child’s future health, well-being, personality, and behaviour (Olarte, 2012). Developing an early emotional connection to a caregiver is also critical for an infant’s well-being. The absence of attachment to a consistent caregiver – such as occurs in a poorly run orphanage – can have significant negative effects on brain development and cognitive functioning (World Health Organization, 2009). In other words, a supportive environment is essential to the positive development of a child. Findings from a study conducted by researchers at the University of British Columbia (2010) showed that children who report having more support in their community are also more likely to have high self-esteem, optimism, overall health, happiness and less sadness. It then means that to make any environment fit for the holistic development of a child, the necessary support facilities must be put in place. Orphans, like other children, need a stimulating environment with adequate support facilities to foster the growth and development of their full potential. Institutions/orphanages that are responsible for the care of orphans are therefore expected to factor these support facilities into the environment provided for the orphaned children. All across the globe, several institutions/orphanages have been established to absorb the ever increasing number of orphans. Not all orphans are institutionalized; some roam the streets, some live in child-headed homes, some are sheltered by relatives or significant others, but a significant number of orphans live in institutions/ orphanages. Although living in institutions/orphanages is preferable to living with abusive or neglectful relatives, institutions/orphanages may however not be able to adequately provide children with the support, and nurturing that comes from living in a caring, loving, knowledgeable family environment.

There is reason to be concerned about the psychological well- being of orphans. This is because of their developmental status as adolescence which involves a lot of emotional changes. The value of improving students' ability to adopt and to get along with people is often overlooked by educators (Tutter, 2009). Learning skills of students rely on their ability to adapt and cope with people. In other works, being confident, mastering of the environment, ability to personally grow and positively relate with others and solving problems is the key factor to a good psychological well-being, especially for the orphans because of the circumstances of life surrounding them. Huppert (2009), opine that psychological well-being is about lives going well. It is the mixture of feeling good and operating efficiently. A person with a high psychological well-being level is healthy, competent, wellsupported, satisfied with personal professional land life. Sustainable well-being does not allow people to feel good all the time; feeling painful emotions (e.g., deceit, loss, grief) is a normal part of life, and it is important for longterm well-being to be able to manage such negative or painful emotions. However, when extreme or very long lasting psychological well-being is compromised and interferes with a person’s ability to function in his or her daily life. According to Geeta (2014), it was Ryff that developed a new model of Psychological well-being that the researcher used in this work which include the following:

• Self-acceptance: positive self-evaluation and past-life assessment 
• Personal growth: A sense of continued development and growth as an individual 
• Purpose in Life: The conviction that one's life is important and purposeful 
• Positive relations with others: The possession of quality relations with others 
• Environmental Mastery: The capacity to effectively manage one’s life and surrounding world 
• Autonomy: self-determination feeling According to Ryff and Singer (2008), together, these six dimensions constitute the eudaimonic concept of psychological well-being in an integrative framework, operationalized by the psychological well-being scale (PWBS).

In developing of a positive self-identity a family environment is crucial (Guest,cited in Magampa 2014). Consequently, a parent's loss can contribute to children with lack of concentration at school. This may lead to poor academic performance of the affected children. According to Elegbeleye (2014), healthy development depends on healthy and inclusive environments that offers young people opportunities for young to create positive and meaningful connections with their schools, families and communities. Orphaning is always an ideal environment and can cause problems with mental health, such as depression. This is because, without the support o parents orphans strive to integrate previous roles of being young and carefree, to address the emotional demand for loss. This can aggravate the grieving process by organizing and addressing the possibility of a future without parents, or abandonment by those in whose care they are placed, or an intense fear of pain and termination (Boeree 2006), which in effect jeopardizes their state of psychological well-being.

THE PSYCHOSOCIAL EFFECT OF INSTITUTIONALIZATION OF ORPHANS AND VULNERABLE CHILDREN

There is an increasing body of evidence that orphanages, especially large orphanages, are the worst possible care option for children (Wikipedia, 2012). In large institutions, all children particularly babies may not receive enough eye contact, physical contact, and stimulation to promote proper physical, social or cognitive development (Wikipedia, 2012). In the worst cases, orphanages can be dangerous and unregulated places where children are subject to abuse and neglect (Wikipedia, 2012). In a study by Bilson & Cox (2005), findings showed that conditions in many institutions were poor. In many state institutions there was poor sanitation, inadequate sleeping arrangements, and children were not provided with a nutritious diet. The emotional needs of children were rarely met and some fundamental rights were violated. Findings of international research undertaken over a period of almost 20 years, shows that for many children institutional care has had a serious and negative impact on their social and educational development, well-being, and human rights (Green, 2000; Sample, 2006; UNICEF, 2003). The effects of institutionalization for young children are not simply psycho-social and educational. Recent research in Romanian orphanages into the brain development of children aged less than 4 years shows structural changes that may explain the cognitive, socio-emotional, and behavioral difficulties that are observed in many children from such institutional backgrounds (Eluvathingal et al., 2006). Further evidence shows that care in family-type settings (the child’s natural or extended family, foster care or adoption), is immeasurably better than life in even a well organized institution for almost all children. The individual, one-to-one love and attention that only parents (whether birth, foster or adoptive) can give, is extremely powerful and cannot be replaced by institutional care in promoting the development of children. Furthermore, there is a huge body of evidence from a wide range of countries, that institutional care is very much more expensive than family-based alternatives. An assessment of the evidence indicates that on average, institutional care is twice as expensive as the most costly alternative: community residential/small group homes; three to five times as expensive as foster care (depending on whether it is provided professionally or voluntarily); and around eight times more expensive than providing social services-type support to vulnerable families (Carter, 2005). The condition of living in most of orphanages is at the minimum level due to the fact that many of the orphanages often depend on charity donations, which may not effectively cater for the huge cost of maintaining the orphanages. Asides this, the number of children in some orphanages greatly surpasses the number of caretakers, which makes it near impossible to be able to give adequate attention and care to any one child per time.

In some orphanages (Institutions), most of the children are unable to form attachment with anyone in the institutions because of lack of nurture and quality of actual relationship. This attachment create bonds which are connections between one person and another characterized by certain qualities of a special bond in material - infant or infant caregiver relationship. It is anen during emotional relationship with a specific person which brings safety comfort, soothing and pleasure to individual. (Mobulagi, 2017). These characteristics are best seen in maternal-child relationship and most of the time absent in institutionalized (orphanage) children who most of the time has poor attachment with the primary caregivers which makes them develops fear and insecure attachment in the presence of visitors. They become isolated and don't socialize with other children outside the institution (orphanage) because they are emotionally touched and therefore feel neglected and rejected. They grew up with the trauma that they were abandoned and rejected by their parent that is why they are institutionalized. The act of holding, singing rocking, kissing and other behaviours necessary in caring for infants and children are not there because of large number of children with few caregivers. Thus, all infants cannot defend their selves but rely on a caregiving adult for survival. Mothers' presence in the life of an infant is very important because she smells, cuddle, rock, and gaze at her infant and in turn the infant will respond by smiling and this also brings pleasure and satisfaction to the mother. Without adequate responsive and nurturing care giving, the infant will lack the entire necessary requirement for normal attachment which is mostly the case of institutionalized (orphanage) children.

Children need a solid social - Emotional development at an early stage in order to form good attachment with the mother, caregiver or any adult member they may come in contact with in the process of development. Most children, in orphanages tend to show fear, anxiety and sadness towards strangers because of heightened emotion as a result of absence of mother child relationship at an earlier stage of life. Most of the children in Nigerian orphanages are illegitimate children abandoned by their mothers because they, cannot take care of them and the father have in most cases denied the pregnancy, while others are either born by mothers in the asylum or those in shows that Children in institution (orphanage) tend to have low IQ and are unfriendly than those adopted and restored back to the irnatural mothers. This is so because of the environment they live. In most orphanages, the children are many that the staff-child ratio is not enough to cater for the children's need in terms of social - Emotional development. A child that is socially and emotionally unstable may be angry, sad, and afraid, will not be able to form good relationship with peers outside the orphanage unlike the child that is socially and emotionally stable in the mix of family members and level ones. Children in orphanages have poor attitude towards strangers and their only friends are those in the orphanage because they believe they have a common characteristic “abandoned” by their parents, as such, they grow up with that trauma in their minds.

2.2 THEORETICAL FRAMEWORK

GROUNDED THEORY APPROACH

This study used the Grounded theory approach developed by (Strauss & Corbin, 1990). Taking a grounded theory approach allows a researcher to understand the context in which a phenomenon thrives (Dougherty, 2017). Grounded theory approach deals with generating explanations of a phenomenon of interest from a systematic analysis of raw data (Glaser & Strauss, 2017). In other words, it is a theoretical exposition that is grounded in the data systematically collected and analyzed. This theoretical approach provides explanations into the processes that lead to the protracted stay of children in institutional care which are supposed to be transitional. Adopting this approach, therefore, unearthed the major encumbrances to timely placement as cutting across irregularities within different stages of a child’s contact with the institutional homes. Within these stages, major concepts and constructs inductively emerged that further provide detailed explanations of these encumbrances. For instance, at the entry stage, issues relating to the absence of legal time frame on how long a parent could formally abandon a child in the home before their parents’ rights are terminated, and such a child is placed was found. Within the institutional care, social and health care neglect was noted as reasons for placement process disruption and dissolution, where children were returned to their former orphan homes. At the exit stage, issues with discriminatory placement strategy and poor legal attitude to inter-country placement provide explanations for the prolonged stay of children in orphanage.

2.3 EMPIRICAL STUDIES

Many studies have shown that orphans suffer from psychosocial issues that are greater than their non-orphan peers who are not orphans (Afework, 2013). Orphans had a much stronger perception of friends in social support than non-orphans, while non-orphans had a much stronger perception of supporting the family than orphans. According to Yendork and Somhlaba (2015), high levels of self-efficacy and resilience were registered by orphans and non-orphans. Nabunya (2014), when investigating the role of caregiver support in improving academic performance of AIDS-orphans it was found that perceived caregiver support in form of warmth and acceptance was significantly linked to improvements in school grades and reduced school dropout. The Perceived family cohesion was significantly associated with attendance at school and household was associated with grades at school. However, as cited in Afework (2013), Subbarao, Maltimore, and Plangemann found that orphaned children were discriminated against solely on the basis of their orphan status. Because of discrimination arising from their non-orphaned peers or from their immediate surroundings, orphaned children that differ from other children and may result in negative self-identity (self-concept) and low selfesteem. According to Weidner (2013), the role of parents in developing a child's self-esteem is very significant in early childhood. A child raised in a family has a highly developed emotional disposition towards him / herself. In most situations, this psychological attitude is optimistic. Losing a loved one or loved ones has been shown to have psychological effects on an individual. When a parent or both parents die, it is difficult for an orphaned child to try to cope with his or her life and the loss he or she encounters as a result of their unfortunate circumstances, including problems such as poor education, neglect, and abuse, this leads, among others, to poor quality of life.

In another research conducted by (Abalaka, 2016) on the effects of Early social-Emotional and relationship experience on the development of young orphanage children, he reported that one attribute of the orphanage environment such as very limited caregiver-child social-Emotional interactions and lack of opportunity to develop caregiver-child relationships, can be responsible for delays in most major domains of development in institutionalized children.