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Barriers to childcare in Children's Homes in Ghana: Caregivers' solutions
Accepted Manuscript Barriers to childcare in Children's Homes in Ghana: Caregivers' solutions
Alhassan Abdullah, Ebenezer Cudjoe, Esmeranda Manful PII: DOI: Reference:
S0190-7409(18)30008-2 doi:10.1016/j.childyouth.2018.03.045 CYSR 3761
To appear in:
Children and Youth Services Review
Received date: Revised date: Accepted date:
3 January 2018 23 March 2018 24 March 2018
Please cite this article as: Alhassan Abdullah, Ebenezer Cudjoe, Esmeranda Manful , Barriers to childcare in Children's Homes in Ghana: Caregivers' solutions. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Cysr(2018), doi:10.1016/j.childyouth.2018.03.045
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ACCEPTED MANUSCRIPT Barriers to childcare in Children’s Homes in Ghana: Caregivers’ solutions
1. Given name (Alhassan)
Family name (Abdullah)1
Department of Sociology and Social Work
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Kwame Nkrumah University of Science and Technology, Kumasi-Ghana Private Mail Bag,
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University Post Office.
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Email: [email protected]/ [email protected]
2. Given name (Ebenezer)
Family name (Cudjoe)
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Department of Social Studies
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University of Stavanger, N-4036 Stavanger, Norway
Family name (Manful)
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3. Given name (Esmeranda)
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Email: [email protected]
Department of Sociology and Social Work
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Kwame Nkrumah University of Science and Technology, Kumasi-Ghana Private Mail Bag, University Post Office.
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Email: [email protected]
1
Corresponding author
ACCEPTED MANUSCRIPT ABSTRACT The care of children in need of alternative care is a matter of concern to government, nongovernmental organisations and international communities. Understanding the barriers to childcare and knowing the measures to overcome them are important in ensuring the safety and wellbeing of children in alternative care. Few studies exist on caregivers’ suggestions of solutions to overcome barriers to childcare in Children’s Homes in Ghana. Drawing on in-depth semi-
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structured interviews with 37 caregivers in two Children’s Homes in Ghana, this study sought to
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explore caregivers’ suggestions of solutions to barriers in childcare. This study adopted a
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phenomenological approach, reporting findings in participants’ own words. The study findings revealed ensuring gender balance, the need for staff and interdisciplinary teams, and financially motivating caregivers as measures to overcome barriers in childcare. Professionals working with
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children in alternative care and policymakers should pay attention to these solutions to ensure the safety and wellbeing of children in care.
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Keywords: children in alternative care, caregivers, Children’s Home, childcare, Ghana
ACCEPTED MANUSCRIPT 1. Introduction The care of children in need of alternative care is a matter of concern to government, nongovernmental organisations and international communities. UNICEF (2015) estimates that there are over 150 million children in the world without parental care with 52 million in sub-Saharan Africa. Bettmann, Mortensen and Akuoko (2015) state that there are about 1.1 million of such children in Ghana representing 4.7% of the total population and 10.4% of the children and
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adolescent population. Children without parental care in Ghana are usually absorbed by extended
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family members and other close relatives (Frimpong-Manso, 2014; Kuyini, Alhassan, Tollerud,
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Weld, & Haruna, 2009). The traditional Ghanaian community is actively engaged in the care of such children because of the popular cultural adage that says, “it takes a village to raise a child” (Nukunya, 2016), which is strongly valued in Ghana. Again, this practice is valued in most parts
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of sub-Saharan Africa because of the need to maintain family connections and culture (Maundeni & Malinga-Musamba, 2013).
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However, with modernisation, support from kin and kith that characterised the traditional Ghanaian society is waning (Manful & Badu-Nyarko, 2011; Nukunya, 2016). This has brought an
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increased interest in the provision of alternative care arrangements for children in need of alternative care by placing them in institutions. Private individuals, religious organisations and
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nongovernmental organisations (local and foreign) are providing alternative care arrangements for such children by establishing residential institutions, known popularly as Children’s Homes,
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where hired “parents” take care of children. In Ghana, Children’s Homes represent an important fabric of society for the care and protection of children in need of alternative care (DSW, 2008).
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The general public has negative perceptions about the quality of care in Children’s Homes due to recent investigations revealing such Homes as sources of abuse (Anas, 2015). The Ghanaian government made efforts to phase out Children’s Homes with the introduction of the Child Reform
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Initiatives (DSW, 2008). Yet, Children’s Homes continue to grow steadily due to the increasing number of children in need of alternative care (UNICEF, 2015). With support from UNICEF, the Department of Social Welfare (DSW) and Ministry of Gender, Children and Social Protection (MoGCSP) developed standards to ensure that children in alternative care are provided with quality care in these institutions (DSW, 2008). However, it appears that these standards are not being fully adhered to or monitored by caregivers and the DSW as the institutions are deteriorating (Darkwah, Daniel, & Asumeng, 2016). While research has examined the impacts of institutional care on children and the challenges faced by caregivers in the provision of care (James et al.,
ACCEPTED MANUSCRIPT 2017; Sen, Kendrick, Milligan, & Hawthorn, 2008; Souverein, Van der Helm, & Stams, 2013), little has been done to study caregivers’ suggestions of solutions to overcome these barriers. Existing research indicates that most children placed in institutions have negative experiences (Attar-Schwartz, 2011; Fernandez, 2009; Fernandez, Delfabbro, Ramia, & Kovacs, 2017). For many countries, institutional care appears to be a last resort because of the challenges faced by most children and young people in care (Sen et al., 2008; Sherr, Roberts, & Gandhi, 2017) as
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separation of children from their primary caregivers can cause psychological trauma for children
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(Malet et al., 2010). Separation threatens children’s ability to maintain connections and healthy
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relationships with others (Bettmann et al., 2015). Bettmann et al. (2015) observed that the effect of this separation is more so for older children who become aware that the caregivers are not their biological parents. This problem compounds if the caregiver is unable to provide adequate care
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for the child. Thus, it is important for caregivers to receive appropriate training to be able to meet the needs of such children (Castillo, Sarver, Bettmann, Mortensen, & Akuoko, 2012). However,
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some children have indicated that they would have been worse off if not moved from their biological parents and placed in institutions (Dunn, Culhane, & Taussig, 2010). Some children
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prefer to be in institutional care because they will not be abused again by their parents and they have their voices heard by the caregivers (Bessell, 2011; Dunn et al., 2010). This means that not
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all children in alternative care have negative experiences but there is overwhelming evidence that most children placed in care are unhappy (Timmerman & Schreuder, 2014; Uliando & Mellor,
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2012).
Considering the fact that most children and young people in care have negative experiences and
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their institutions can also serve as threats to their positive growth and development (BederianGardner et al., 2018; Khoo, Mancinas, & Skoog, 2015; Sekol, 2013), little has been done to explore caregivers’ suggestions of solutions to ensure the wellbeing and safety of children in
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alternative care. A study by Moore, McArthur, Death, Tilbury and Roche (2017) in Australia revealed that caregivers’ inconsistency in the provision of care could negatively affect the wellbeing of children. Caregivers are unable to make sufficient time to establish relationships with children because they are constantly moved to different units. This has negative consequences for how the child feels towards building subsequent relationships with caregivers as the child knows such relationship may not last (Castillo et al., 2012). Two Ghanaian studies, Bettmann et al. (2015) and Castillo et al. (2012), identified some challenges faced by caregivers in their care of children in Children’s Homes. Castillo et al. (2012) revealed that most caregivers do not receive formal training while others receive training that is
ACCEPTED MANUSCRIPT not consistent. This affects the quality of care provided to the children as, with insufficient training, the caregivers may not be able to adequately respond to the needs of each child (Bettmann et al., 2015). McLeod (2010) suggests that to be able to respond to their needs, caregivers should consider children in care as friends and as equals. Some caregivers have suggested the need for training in childcare, how to meet children at different stages and how to respond to their emotional needs (Castillo et al., 2012) as some ways to ensure the safety and wellbeing of children in
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alternative care. Not much is known about caregivers’ suggestions of ways to overcome barriers
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to childcare in Children’s Homes. This study explores the understanding of barriers faced by caregivers and identify their recommended solutions. This study integrates barriers in childcare
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as they relate to solutions. Solutions to barriers provided by caregivers draw attention to measures that can be put in place to ensure the safety and wellbeing of children in care.
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1.1. Research questions
The main objective of this study was to understand what solutions could be provided by caregivers
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to address barriers they face to childcare in Children’s Homes. These specific research questions were explored:
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1. What do caregivers perceive to be barriers to childcare for children in Children’s Homes?
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2. What are caregivers’ suggestions of ways to overcome these barriers?
2.1. Study design
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2. Methodology
Little is known about caregivers’ perception of solutions to barriers to childcare in Children’s
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Homes in Ghana, consequently, this study employed a qualitative approach. Qualitative research is useful to explore situations where little is known, and is useful in describing complex issues
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such as those involving caregivers’ perception of childcare for children in alternative care. This method was used in order to “understand the world as seen by the respondents” (Patton, 2014: 21). The qualitative research informed this study due to its exploratory nature. A phenomenological design was adopted to make sense of how people experience, describe, feel about, remember and judge a particular phenomenon (Padgett, 2008; Patton, 2014). The phenomenological design was used because the study aimed to understand caregivers’ subjective perceptions of solutions to the barriers in caregiving regarding the children in their care. Using this method, caregivers’ perceptions of childcare were explored and common themes in their responses were identified (Padgett, 2008; Patton, 2014).
ACCEPTED MANUSCRIPT 2.2. Study area Data for this study were collected from two Children’s Homes in the Ashanti region, Ghana: the Kumasi Children’s Home (KCH) in the Kumasi Metropolis and the SOS Children’s Village located in the Asokore Mampong Municipality. The KCH is a state care institution for homeless, abandoned, maltreated and orphan children lacking parental care. The institution was established in 1965 with the objective of providing adequate parental care for children in need of alternative
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care. Mainly, the institution liaises with the Department of Social Welfare in admitting children into
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the Home. The main source of funding for the running of KCH comes from the government.
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However, some philanthropists provide support to the organisation to compliment government’s effort. Recent investigations into some Children’s Homes in Ghana indicate that these funds are either inadequate or are being mismanaged by personnel at the Homes (Anas, 2015). This
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creates problems for children in care as their basic needs are not met. The KCH organises training programmes for the caregivers periodically. Thus, there are no fixed dates where in-service
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training is offered to caregivers. Further, special training is provided for the caregivers to provide care for children with mental health problems. Most of the children in care are at least three years
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of age and leave care when they become independent, placed in foster care or adopted. Care is provided for the children based on their age, sex and/ or whether they have special needs.
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Children are referred from the Department of Social Welfare after the social workers have carried out assessment, enquiries and obtained legal mandate needed to place children in substitute care institutions. This suggests that recruitment of children is not done at the Children’s Home but
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through referral from the Department. During the period of data collection, the KCH had about 122 children. Beside residential facilities, the Home has an educational establishment, a school
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which provides basic education for children in the Home. Staff at the KCH included 12 teachers, 19 caregivers, eight assistant caregivers and three administrators.
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The SOS Children’s Village in Kumasi was established in 2009, as a substitute care Home for orphaned and maltreated children. The institution has five branches spread over the country. The institution admits children through a community outreach programme conducted by staff to identify orphans and children whose parents find difficulty in providing their basic needs. Between July to September 2017, the institution was home to 111 children and a total of 30 staff, comprising 10 teachers, three administrators, 13 caregivers and four assistant caregivers working in the educational and residential facilities. Interviews with caregivers at the Home revealed that majority of the organisation’s funding comes from international donors, most of these donors work with the SOS Children’s Village. Other sources of funding are from private individuals and philanthropists
ACCEPTED MANUSCRIPT through fund raising activities organised by the Home. Also, caregivers at the SOS Children’s Village receive training in childcare once every year. This is to ensure that the caregivers have the required knowledge and skills to provide care for institutionalised children. All children in care at the Home are at least three years of age. Children in care at the home are assigned to caregivers based on their problem-behaviour. For example, caregivers with special skills and training or with much experience are assigned to care for children with behavioural problems like
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aggression and delinquency. Both Children’s Homes operate under the supervision of the
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Department of Social Welfare (DSW, 2008).
2.3. Recruitment
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On July 2017, the lead author visited the Children’s Homes and provided information about the study to the caregivers and administrators. This was to ensure that workers at the Children’s
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Homes were aware of the researchers’ intent to collect data for the study from their institution. During this period, there were 19 caregivers, eight assistant caregivers and three administrators at the KCH while there were 13 caregivers, four assistant caregivers and three administrators at
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the SOS Children’s Village. Thus, in total, there were 44 caregivers and six administrators from
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the two institutions. The lead author contacted all caregivers and administrators to seek their interest to participate in the study. The lead author provided phone numbers to the caregivers and administrators to establish contact if interested to participate in the study. Thirty-one (31)
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caregivers and all six administrators contacted the researchers and scheduled appropriate times for the interview. In this study, administrators were recruited as caregivers because they worked
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in the same institution with the caregivers and provided care for the children when needed. Thus, the study collected data from 37 caregivers.
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2.4. Study participants
The study included 37 research participants comprising caregivers, assistant caregivers and administrators of the two Children’s Homes.
Caregivers were individuals who worked as
“mothers” and “fathers” at the institution because they engaged in the day-to-day upbringing of the children in their care. Assistant caregivers are caregivers in the institution who perform shortterm caregiving roles in the absence of the primary caregivers. Assistant caregivers are mostly called “aunties”. Because the study aimed at investigating solutions to barriers associated with caregiving in the institutions, selection of caregivers and assistant caregivers who are directly involved with caregiving helped provide adequate information needed to achieve the objectives
ACCEPTED MANUSCRIPT of the study. Administrators were also included in this study because they experience the idea of caregiving for children in the institutional context. Further, the administrators can provide their perception of barriers to childcare from a managerial point of view. The table also shows that there were more women (35) than men (2) in the two care institutions, suggesting the gendered
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nature of childcare in institutional Homes in Ghana.
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Table 1 Participant demographics
Category
Sex
Male
35
30-35
3
41-45
3
46-50
11
51-55
15
Bachelor Degree
1
Diploma
2
Senior High School levers
30
Junior High Schools levers
4
Caregivers
25
Assistant caregivers
6
Administrators
6
1-5
14
6-10
6
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Work role
Length of work
2
Female
36-40
Education
Number
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Age
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Item
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Source: Field data, 2017
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2.5. Ethical considerations Permission was obtained from the Department of Social Welfare before data collection began. Informed consent was sought from all participants indicating their voluntary participation in the study. The participants were assured that they will maintain anonymous throughout the study and
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they could refuse to participate at any point during the interview without consequences. In cases
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where participants mentioned the names of people or places that could be linked to them, pseudonyms were used.
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2.6. Procedure for data collection
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Data collection begun with researchers establishing rapport and continued contacts with a Head from each Children’s Home serving as gatekeepers. Establishing contacts with the gatekeepers was important for this study as it helped the researchers to introduce themselves and the study
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to potential participants (Given, 2008). The Heads of the Children’s Homes enabled the researchers to access the caregivers by introducing the researchers to the caregivers at their
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institution.
All research participants were involved in an in-depth semi-structured interview of approximately
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50 minutes. Interviews were conducted from July through September 2017 with the aid of a semistructured interview guide. The use of semi-structured interviews provided flexibility and allowed
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the researchers to probe into new insights that emerged from the interviews. This allowed for multiple, divergent and even contradictory information on the topic that deepened and enriched
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the understanding of the research (Marvasti, 2004). Following participants’ consent, all interviews were audio recorded. Questions on the interview guide focused on the study’s research questions.
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Specifically, caregivers were asked to share their experiences of barriers they faced in caring for children in their care. They were also asked to suggest some ways to overcome these barriers. Interviews with the caregivers were conducted in Twi (local) while interviews with the administrators were conducted in the English language. The use of the local language allowed caregivers to explore their perceptions in-depth and added to the quality of the research. All interviews were conducted at offices within the Children’s Homes, the choice of research participants. 2.7. Data analysis
ACCEPTED MANUSCRIPT The audio recorded interviews were transcribed ad verbatim. All researchers checked the transcribed data with the audio for correctness and accuracy. The thematic analysis was used to identify themes for this study (Braun & Clarke, 2006). In line with thematic analysis, the transcribed data were read and re-read by researchers to immerse self into data. Initial codes emerged following researchers’ familiarity with the data. The researchers developed the codes by reading through the transcripts more than twice and taking notes along the way (Padgett, 2008). Open
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coding was done where the researchers engaged in a line-by-line reading of the data to organise
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quotes that reflected the research questions (Charmaz, 2014). Codes such as “special needs”, “emotional challenges”, “financial motivation” and “gender balance” emerged from the data. The
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codes were organised into potential themes and further refined to ensure they answered the research questions. Some themes reflected similar ideas, thus, they were merged into each other.
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Considering the exploratory nature of this research, codes containing less prevalent responses were not discarded but were revisited and some included for the study. The interview data were
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managed with the NVivo 11 qualitative software.
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3. Findings
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Major themes that emerged from the interview data have been presented in this section. The themes have been presented in accordance with the main research question: to explore caregivers’ suggestions of measures to overcome barriers to childcare in Children’s Homes.
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Some barriers to childcare identified by the caregivers have been included to the findings as they relate to the caregivers’ suggested solutions. One of the barriers (children with special needs)
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have been presented in a separate section without solutions suggested.
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3.1. Solutions to barriers in childcare 3.1.1. Ensuring gender balance in childcare Commenting on ways to overcome barriers to childcare in institutional homes in Ghana, participants identified the lack of gender parity among caregivers as a challenge which can be solved by ensuring gender balance among caregivers. According to the caregivers, the lack of gender parity, specifically the absence of a father figure in the Homes affect caregivers’ ability to instil discipline in the Homes. Some female caregivers who commented on this indicated that, traditionally, men are expected to ensure discipline in the family environment. Therefore, as a
ACCEPTED MANUSCRIPT semblance of the traditional family setting, the Home requires men who will provide care, assistance and ensure discipline among children in the Home: “…. you know that traditionally men are expected to ensure discipline in family, same as here. So sometimes we find it difficult to discipline the children as mothers when they go wrong, it is expected that we instil discipline in them which will be better done with the assistance of a male caregiver” (Assistant mother, Kumasi Children’s Home, 3 years in
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service)
The perception of the female caregivers regarding the need for a father figure was expanded by
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some participants who believed that the presence of male caregivers will ensure child-caregiver attachment. According to them, male caregivers will develop close attachments to female children
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whereas the female caregivers will also develop attachment to the male children. Therefore, the absence of a father figure affects the emotional development and attachment relationships for
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female children:
“Boys develop close relationship with their mothers and girls too develop same relationship with their fathers, therefore the absence of a father in the home affect the
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relationship building between we the mothers and the female children. Since they would
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find it difficult to share their issues with us. Even sometimes, the babies, when they are crying we do everything possible to calm them down, yet they will continue to cry but when luckily a man pops up here and carry her along within a moment she will be quiet. This
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tells us that we really need male caregivers”. (Mother, Kumasi Children’s Home, 11 years
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in service)
The few male caregivers in the study revealed that they face some social ridicule from the public
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due to their job as caregivers at the Home. “Some of our colleagues who know of our job as workers here laugh at us even though am not directly involved in caregiving, but the mere fact that am working in the children’s home makes them tag me with that mentality. So, it will be difficult to get a male to be directly involved in caregiving. Unless the person is passionate and very enthusiastic like the one we have here” (Administrator, SOS Children’s Village, 5 years in service) The only male caregiver identified in the study attributed the limited number of male caregivers in the Homes to the gendered nature of childcare: “The challenge is that the term caregiver is more skewed towards females which deters many men from involving themselves in.” (Father, SOS
ACCEPTED MANUSCRIPT Children’s Village, 4 years in service). His opinion suggests that the caregiving occupation is gendered and this consequently leads to few male enrolments. It appears the Ghanaian family practice considers women as the primary caregivers and this concept is transferred to the Children’s Home. Responding to the challenge of the absence of a father figure in the care Homes, the research participants suggested that childcare institutions should consider recruiting male caregivers to
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ensure gender balance in caregiving. Through the in-depth interviews, caregivers, mostly
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females, revealed that recruiting male caregivers will help the institutions achieve their general
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status as a substitute Home for children in need of alternative care. A research participant asserted to this:
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“I think management should also consider bringing in male caregivers, when we have males here the whole place will be like a traditional family with mother, father and children”
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(Mother, Kumasi Children’s Home, 3 years in service) Another research participant illuminated on this:
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“They should try and bring in men, if we have men here they will be performing the traditional role of a father with us performing our roles as mothers and the children will be
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better cared for” (Assistant mother, Kumasi Children’s Home, 4 years in Service” The perspectives shared by the participants suggest that caregivers in institutional Homes in
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Ghana perceive the Homes as substitute for traditional family homes. Therefore, its structure and culture ought to resemble a traditional family home: “You know the institution is like a normal
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home that’s why they call us mothers because we perform the mothers’ role so we need fathers to perform the fatherly role” (Assistant mother, SOS Children’s Village, 4 years in service). Thus,
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there is a need to introduce father figures to ensure a balance in caregiving. 3.1.2 Need for staff and interdisciplinary team In order to ensure better outcomes for children in care institutions, research participants suggested increasing the staffing of care institutions to overcome one of the main challenges facing childcare institutions: inconsistencies in care. According to the caregivers, inconsistency in caregiving came up due to the consistent changes in caregivers’ assigned roles and responsibilities, which obstructed their ability to carefully monitor children’s developmental and emotional needs: “Day in day out we are assigned to different groups of children which makes it difficult to keep an eye on each child” (Mother, SOS Children’s Village, 4 years in service).
ACCEPTED MANUSCRIPT This implies that caregivers in Children’s Homes in Ghana are not assigned specific groups of children to monitor and work with. Additionally, some caregivers opined that the challenge of maintaining close attention to children’s emotional and developmental needs would not have been a problem if caregiver-child ratio was managed properly. According to them, the number of children assigned to caregivers at a point in time makes it difficult to keep an eye on every single child:
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“Even though the shift in caregiving affect the attachment relationship and makes it difficult
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for us to monitor children’s psychological and developmental challenges, it would have
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been minimised if we have a small number of children in our care. That would have helped to keep an eye on the progress of individual child regardless of the change in caregivers. Here is the case one caregiver may be assigned to about 30 children at a time, how can
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you monitor them individually? (Assistant mother, Kumasi Children’s Home, 6 years in service)
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In response to the challenge of inconsistencies in care, the caregivers suggested the need for more staff as a possible remedy. Majority of the caregivers alluded to this opinion by indicating
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that increasing the number of personnel at the Home will help release burden on the caregivers and ensure that each worker performs her or his responsibility with great efficiency:
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“I believe that if they employ others in addition to us majority of these problems will be reduced. If they employ a lot that means we will have less work to do and with the little we
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are assigned to do we will do it best to ensure maximum outcome” (Assistant mother,
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Kumasi Children’s Home, 4 years in service) Some caregivers highlighted the need to introduce personnel with specialised knowledge to care for children with special needs. A participant echoed this concern by adding that the Home should
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target recruiting people with diverse or specialised knowledge and skills needed to care for the children. According to her, recruiting more caregivers with the right knowledge and skills will help improve caregiving in the Home: “I think staffing is one of the main challenge we report to the management during meetings, and it is not just about staffing anyhow but recruiting people with the right knowledge to improve caregiving in the institution. You realise that we don’t have people who have vast knowledge in caregiving, majority of our caregivers were recruited based on their experience as mothers in our traditional homes” (Administrator, Kumasi Children’s Home, 5 years in Service)
ACCEPTED MANUSCRIPT Adding to the view on the need for caregivers with specialised knowledge, an administrator at the SOS Children’s Village shared his experience on how they have been managing issues that required the need for a specialist: “For us to improve our work here we need staff who have specialised knowledge. Sometimes we hire the service of a psychologist from a hospital when one of our caregivers detect a psychological problem in some of the children. This cost us a lot and
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is one of the reasons why we have suggested to management to get us a psychologist.
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Not just social workers and psychologist we also need counsellors among others to ensure
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that we improve our work” (Administrator, SOS Children’s Village, 7 years in service) In fact, the perception shared by both caregivers and administrators of the Homes clearly shows
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that caregiving in institutional Homes can be improved with the right interdisciplinary team. Also, it appears that some caregivers were not passionate about the caregiving role due to lack of
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specialised knowledge in caregiving, even though they are mothers to children of their own. 3.1.3 Financial motivation and government support
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Most research participants opined that in order to improve caregiving at the Homes, caregivers need to be financially motivated to help them stay focused on their work. According to the
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participants, motivating caregivers will help curtail the challenge of low financial motivation identified in most Children’s Homes in Ghana, “My concern is about the money aspect, if they pay
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us well, we will also focus and give our maximum best” (Assistant mother, Kumasi Children’s Home, 4 years in service). A caregiver emphasised on their multiple roles performed, which did
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not reflect their earnings, as a major challenge in caregiving at the Homes. According to the caregivers, the low financial motivation attached to their job sometimes impelled them to engage
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in other part-time jobs to make enough money for themselves and their family: “Hmmmm, the salary too is a problem. The salary is not enough to take care of us and our family. You know we also have children to take care of. So sometimes we are forced to engage in other part-time jobs before coming to work, which affects our work here. But we have no option, since the money we make here is not enough”. (Assistant mother, Kumasi Children’s Home, 6 years in service) Evidence provided by the participants suggest that caregivers in institutional Homes receive meagre salaries despite the difficult nature of their work. However, it must be noted that this particular theme was shared by few workers and it was specific to workers at the Kumasi
ACCEPTED MANUSCRIPT Children’s Home. Considering the fact that Kumasi Children’s Home is state-owned, it could be argued that private-owned Children’s Homes pay better salaries to caregivers than state-owned Children’s Homes. However, some caregivers argued that the salary they received was enough to take care of their family and themselves. This view was shared by the few administrators interviewed for the study. “Well, for me, financial motivation is not a challenge, because I am able to survive on the little I
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make here” (Administrator, Kumasi Children’s Home, 4 years in service). It appears that the
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perspectives of the administrators regarding the issue of financial motivation shows disparities in
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salary structure at care institutions in Ghana.
Commenting on the solution to the challenge of low financial motivation, a caregiver shared her
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opinion:
“… Seriously, we would be glad if our salary is increased to help us focus and care for the
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children. We have the zeal to care for them but the motivation is too small, this sometimes causes distraction in our work, because instead of us to watch the children and care for them we are also thinking of what to eat in the evening with our children.” (Assistant
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mother, Kumasi Children’s Home, 3 years in service)
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Another research participant indicated that even though they are aware of the moral reward God will give them for taking care of children lacking parental care, they also need money to take care
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of themselves and their family:
“For me, I think money is the issue, because if they pay us well we won’t even think of
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engaging in part-time jobs. We would stay focused and care for the children. After all they are our children so if we take good care of them God will reward us. But we also need the
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money to cater for our own children and family”. (Mother, SOS Children’s Village, 6 years in service)
Whereas the parents were calling for financial motivation, administrators of the institutions were also yearning for support from government and other benevolent individuals: “We call on the government and benevolent individuals to come and help us. We really need a lot to make the institution a world class substitute home for children without parental care” (Administrator, Kumasi Children’s Home, 4 years in service). Another administrator added by acknowledging supports received from corporate bodies and philanthropic individuals:
ACCEPTED MANUSCRIPT “I would say that the public has done well in supporting us both in kind and in cash but we would need more to augment various aspects of the agency, so as to ensure that children here have the best care”. (Administrator, SOS Children’s Village, 7 years in service).
3.2 Children with special needs
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The caregivers indicated that caring for children with special needs was a challenge to them. The
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term “children with special needs” is used to refer to children in care with emotional and
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developmental problems (Sullivan, Farnsworth, & Susman-Stillman, 2018). Most children in care encounter emotional problems due to experience of separation from their immediate caregivers. Developmental problems occur for the children in care due to low quality of care received and the
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poor nutrition. The caregivers argued that the challenges in care were more apparent among children with special needs: “you know caring for children is difficult but here it’s worse due to the
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special issues some of them have” (Mother, Kumasi Children’s Home, 11 years in service). The caregivers had a common understanding of what is considered special needs. A caregiver
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expressed her opinion on the meaning of special needs: “one of the main challenge we encounter in caring for the children is that, some of them
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have special issues, not mental problems, No. But some of them experience sudden developmental and emotional problems which we find it difficult to handle” (Mother,
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Kumasi Children’s Home, 13 years in service) It appeared that children’s emotional and developmental challenges served as barriers to
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caregiving at the Home: “Some of them have developmental challenges and we find it difficult to understand them, since we also don’t have the required skills to handle them (Mother, SOS
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Children’s Village, 8 years in service) Another caregiver added to this by lamenting on how their skills are insufficient to properly handle issues of children’s special needs and how this adversely affect their work with children: “… hmmm the hard truth is that, majority of us are not trained in this profession, but as tradition requires, mothers are seen as good caregivers. Therefore, some of us approached this job with that mentality only to experience that caring for children at this home is a different issue requiring technical knowledge and skills set totally different from our traditional caregiving roles” (Mother, Kumasi Children’s Home, 4 years in service).
ACCEPTED MANUSCRIPT Emphasising on the dichotomy of the traditional ways of caregiving and caregiving at the Children’s Homes, a participant shared her experience “even though I am a mother myself I never knew children are difficult like this if I have not been here” (Assistant mother, SOS Children’s Village, 2 years in service). The experiences shared by the caregivers reveal that childcare institutions in Ghana are not properly staffed with personnel who have the required training and skills needed to care for the
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special needs of children in care. It appears that caregiving in Children’s Homes require a different
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approach than in a traditional family environment. Though, the interview data did not reveal ways
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in which this challenge can be addressed, its identification provides insight into the diverse challenges facing caregivers in Children’s Homes. And could suggest that training is needed to
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address the issue of caring for children with special needs. 4. Discussion and implications
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This study explored caregivers’ suggestions of solutions to barriers to childcare in Children’s Homes in Ghana. It has been established that studies in Ghana have identified some barriers faced by caregivers in providing care for children in need of alternative care (Bettmann et al.,
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2015; Castillo et al., 2012). However, not much is known about caregivers’ suggestions of
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measures to overcome the barriers. Thus, this study addresses a significant gap in the research literature by exploring ways to address barriers in care to ensure the safety and wellbeing of
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children.
Caregivers in this study indicated that the Children’s Home should be a semblance of the traditional family environment where there is a mother and father. This was because there were
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very few men working as caregivers in the Children’s Homes. The caregivers argued that the absence of fathers resulted in the lack of discipline and control in the Homes. This is common to
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most traditional Ghanaian families where the presence of the father is usually seen as a symbol of authority (Nukunya, 2016) which ensures that children listen to and obey their parents. Thus, more males should be employed as caregivers in the Homes. This would ensure that the children have both mother and father figures to turn to when in need as mothers and fathers often have different but complementary roles to perform in childcare (Newland & Coyl, 2010). Caregivers perceived that some female children were unable to relate well with them because they needed fathers to confide in. Data from the study shows that only three caregivers had tertiary education and caregivers receive training only once in a year. Thus, it could mean that the caregivers have not received adequate training and education needed to relate well with the children. Existing
ACCEPTED MANUSCRIPT research shows that mothers provide love and security to children and this is expected to ensure positive caregiver-child relationship (Newland & Coyl, 2010; Paquette & Bigras, 2010). However, the study findings suggest that the female caregivers could not provide this form of care or the care was insufficient for the female children. Consequently, the caregivers recommended that more males should be employed as caregivers to ensure balance in caregiving for children. Further, the caregivers suggested that bringing in more staff to engage in caregiving could help
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reduce their workload and ensure parity with the caregiver-child ratio. The study findings suggest
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that the caregivers were not happy with the fact that they had to work on shifts as this negatively
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affected their care for the children. These inconsistencies in care does not give them the opportunity to pay attention to children’s emotional and physical needs (Castillo et al., 2012). Moore et al. (2017) also found that most caregivers are unable to build sustained relationships
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with children in care because the caregivers are constantly moved to other units. Increasing staff size at the Children’s Homes could ensure that caregiving is consistent and workers are not
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constantly moved to different units at all times (Moore et al., 2017). The result of this will be the provision of stable, long-lasting care for the children. Moreover, introducing more staff to the
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Children’s Homes could ensure the caregivers have sufficient time to develop continued interactions with the children which could lead to better outcomes for each child (Rabley, Preyde,
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& Gharabaghi, 2014). With regards to increasing staff at the Homes, caregivers suggested that attention should be paid to introducing individuals with specialised knowledge about the needs of the children. The aim of this is to able to have caregivers who will be able to address the concerns
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of children with special needs.
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The caregivers highlighted that their salaries should be increased in order to ensure that they get focused on their caregiving responsibilities, without spending most times on part-time jobs. The study findings suggest that caregivers received too little income for the work they had to do in
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caring for the children. Consequently, they had to engage in part-time jobs to sufficiently care for themselves and their families. The study by Castillo et al. (2012) revealed that Children’s Homes in Ghana lack adequate funding which makes it difficult to meet the basic needs of the children. However, this study suggest that private-owned Children’s Homes may not have issues about financially motivating caregivers. Especially for caregivers in state-owned Children’s Homes, an increase in their salaries is more likely to result in a positive relationship with the children. Thus, the DSW, through the MoGCSP, should ensure that caregivers in state-owned Children’s Homes are financially motivated. The administrators of the Children’s Homes have also called for financial support from the government and philanthropists (Castillo et al., 2012). Attention should be paid
ACCEPTED MANUSCRIPT to these suggestions made by the caregivers to ensure that children in need of alternative care feel safe and secure in Children’s Homes. Finally, the study findings indicate that there was a challenge in providing care for children with special needs. Findings from the study suggest that the children had emotional and behavioural challenges (Holden et al., 2010) that made them difficult to control and care for. It appears that the institutions did not provide an enabling environment for the positive growth and development
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of the children. Thus, a “home” environment should be created for the children to ensure that they
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are able to have positive relationships with their caregivers. This will further ensure that the special
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needs of the children are met. Further, appropriate training should be offered to the caregivers to be able to meet the children’s emotional and developmental challenges (Castillo et al., 2012).
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5. Limitations
There are limitations to applying this study outside of the study context. The use of the
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phenomenological approach could mean that this study is highly contextual, thus, caution should be exercised when applying the study findings to other contexts. Further, the use of a limited sample size and a focus on two institutions could make statistical generalisation difficult. Still, the
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study findings can apply to institutions that are similar to the ones used in this study.
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6. Conclusion
Solutions to barriers in childcare are needed to ensure the safety and wellbeing of children in
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Children’s Homes. Several studies in Ghana have addressed caregivers’ perception of barriers to childcare in Children’s Homes. The study findings revealed ensuring gender balance, the need
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for staff and interdisciplinary teams, and financially motivating caregivers as the recommended solutions to ensure better outcomes for children in need of alternative care. Although caregivers
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may face some difficulties in providing care for children in alternative care, solutions exist to overcome these barriers to ensure positive outcomes for children in care. Thus, professionals working with children in alternative care and policymakers should pay attention to these solutions to ensure the safety and wellbeing of children in care. Declarations of interest none The authors(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article
ACCEPTED MANUSCRIPT References Attar-Schwartz, S. (2011). Maltreatment by Staff in Residential Care Facilities: The Adolescents’ Perspectives. Social Service Review, 85(4), 635–664. https://doi.org/10.1086/664009 Bederian-Gardner, D., Hobbs, S. D., Ogle, C. M., Goodman, G. S., Cordón, I. M., Bakanosky,
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S., … Chong, J. Y. (2018). Instability in the lives of foster and nonfoster youth: Mental
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health impediments and attachment insecurities. Children and Youth Services Review,
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84(Supplement C), 159–167. https://doi.org/10.1016/j.childyouth.2017.10.019 Bessell, S. (2011). Participation in decision-making in out-of-home care in Australia: What do
US
young people say? Children and Youth Services Review, 33(4), 496–501. https://doi.org/10.1016/j.childyouth.2010.05.006
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Bettmann, J. E., Mortensen, J. M., & Akuoko, K. O. (2015). Orphanage caregivers’ perceptions of children’s emotional needs. Children and Youth Services Review, 49(Supplement C),
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71–79. https://doi.org/10.1016/j.childyouth.2015.01.003
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Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
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Castillo, J. T., Sarver, C. M., Bettmann, J. E., Mortensen, J., & Akuoko, K. (2012). Orphanage
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caregivers’ perceptions: The impact of organizational factors on the provision of services to orphans in the Ashanti Region of Ghana. Journal of Children and Poverty, 18(2), 141–
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160. https://doi.org/10.1080/10796126.2012.710484 Charmaz, K. (2014). Constructing Grounded Theory (2 edition). London ; Thousand Oaks, Calif: SAGE Publications Ltd. Darkwah, E., Daniel, M., & Asumeng, M. (2016). Caregiver perceptions of children in their care and motivations for the care work in children’s homes in Ghana: Children of God or children of white men? Children and Youth Services Review, 66(Supplement C), 161– 169. https://doi.org/10.1016/j.childyouth.2016.05.007
ACCEPTED MANUSCRIPT Department of Social Welfare (DSW) (2008). Regulations for care and protection of children without appropriate parental care in Ghana. Accra: Ministry of Manpower, Youth and Employment Dunn, D. M., Culhane, S. E., & Taussig, H. N. (2010). Children’s appraisals of their experiences in out-of-home care. Children and Youth Services Review, 32(10), 1324–1330.
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https://doi.org/10.1016/j.childyouth.2010.05.001
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Fernandez, E. (2009). Children’s wellbeing in care: Evidence from a longitudinal study of
https://doi.org/10.1016/j.childyouth.2009.07.010
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outcomes. Children and Youth Services Review, 31(10), 1092–1100.
US
Fernandez, E., Delfabbro, P., Ramia, I., & Kovacs, S. (2017). Children returning from care: The
AN
challenging circumstances of parents in poverty. Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2017.06.008
M
Frimpong-Manso, K. (2014). From walls to homes: Child care reform and deinstitutionalisation in Ghana. International Journal of Social Welfare, 23(4), 402–409.
ED
https://doi.org/10.1111/ijsw.12073
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Given, L. M. (Ed.). (2008). The SAGE Encyclopedia of Qualitative Research Methods (1 edition). Los Angeles, Calif: SAGE Publications, Inc.
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Holden, M. J., Izzo, C., Nunno, M., Smith, E. G., Endres, T., Holden, J. C., & Kuhn, F. (2010). Children and residential experiences: A comprehensive strategy for implementing a
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research-informed program model for residential care. Child Welfare, 89(2), 131–149. James, S. L., Roby, J. L., Powell, L. J., Teuscher, B. A., Hamstead, K. L., & Shafer, K. (2017). Does family reunification from residential care facilities serve children’s best interest? A propensity-score matching approach in Ghana. Children and Youth Services Review, 83(Supplement C), 232–241. https://doi.org/10.1016/j.childyouth.2017.10.032
ACCEPTED MANUSCRIPT Khoo, E., Mancinas, S., & Skoog, V. (2015). We are not orphans. Children’s experience of everyday life in institutional care in Mexico. Children and Youth Services Review, 59(Supplement C), 1–9. https://doi.org/10.1016/j.childyouth.2015.09.003 Kuyini, A. B., Alhassan, A. R., Tollerud, I., Weld, H., & Haruna, I. (2009). Traditional kinship foster care in northern Ghana: the experiences and views of children, carers and adults
IP
T
in Tamale. Child & Family Social Work, 14(4), 440–449. https://doi.org/10.1111/j.1365-
CR
2206.2009.00616.x
Malet, M. F., Mcsherry, D., Larkin, E., Kelly, G., Robinson, C., & Schubotz, D. (2010). Young
US
children returning home from care: the birth parents’ perspective. Child & Family Social Work, 15(1), 77–86. https://doi.org/10.1111/j.1365-2206.2009.00645.x
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Manful, S. E., & Badu-Nyarko, S. K. (2011). Where are the HIV/AIDS orphans? Exploring characteristics of vulnerable children in public residential care in Ghana? Journal of
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Global Social Work Practice, 4(1), 1–8.
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Marvasti, A. (2004). Qualitative Research in Sociology (1 edition). London ; Thousand Oaks, Calif: SAGE Publications Ltd.
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Maundeni, T., & Malinga-Musamba, T. (2013). The role of informal caregivers in the well-being
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of orphans in Botswana: a literature review. Child & Family Social Work, 18(2), 107–116. https://doi.org/10.1111/j.1365-2206.2011.00820.x
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McLeod, A. (2010). ‘A Friend and an Equal’: Do Young People in Care Seek the Impossible from their Social Workers? The British Journal of Social Work, 40(3), 772–788. https://doi.org/10.1093/bjsw/bcn143 Moore, T., McArthur, M., Death, J., Tilbury, C., & Roche, S. (2017). Young people’s views on safety and preventing abuse and harm in residential care: “It’s got to be better than home.” Children and Youth Services Review, 81(Supplement C), 212–219. https://doi.org/10.1016/j.childyouth.2017.08.010
ACCEPTED MANUSCRIPT Newland, L. A., & Coyl, D. D. (2010). Fathers’ role as attachment figures: an interview with Sir Richard Bowlby. Early Child Development and Care, 180(1–2), 25–32. https://doi.org/10.1080/03004430903414679 Padgett, D. K. (2008). Qualitative Methods in Social Work Research (2nd edition). Los Angeles, Calif: SAGE Publications, Inc.
IP
T
Paquette, D., & Bigras, M. (2010). The risky situation: a procedure for assessing the father–child
https://doi.org/10.1080/03004430903414687
CR
activation relationship. Early Child Development and Care, 180(1–2), 33–50.
US
Patton, M. Q. (2014). Qualitative Research & Evaluation Methods: Integrating Theory and Practice (4 edition). Thousand Oaks, California: SAGE Publications, Inc.
AN
Rabley, S., Preyde, M., & Gharabaghi, K. (2014). A survey of adolescents’ perceptions of their relationships with nonparental caregivers in group home settings: An attachment
M
perspective. Children and Youth Services Review, 40(Supplement C), 61–70.
ED
https://doi.org/10.1016/j.childyouth.2014.02.012 Sekol, I. (2013). Peer violence in adolescent residential care: A qualitative examination of
PT
contextual and peer factors. Children and Youth Services Review, 35(12), 1901–1912.
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https://doi.org/10.1016/j.childyouth.2013.09.006 Sen, R., Kendrick, A., Milligan, I., & Hawthorn, M. (2008). Lessons learnt? Abuse in residential
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child care in Scotland. Child & Family Social Work, 13(4), 411–422. https://doi.org/10.1111/j.1365-2206.2008.00566.x Sherr, L., Roberts, K. J., & Gandhi, N. (2017). Child violence experiences in institutionalised/orphanage care. Psychology, Health & Medicine, 22(sup1), 31–57. https://doi.org/10.1080/13548506.2016.1271951 Souverein, F. A., Van der Helm, G. H. P., & Stams, G. J. J. M. (2013). ‘Nothing works’ in secure residential youth care? Children and Youth Services Review, 35(12), 1941–1945. https://doi.org/10.1016/j.childyouth.2013.09.010
ACCEPTED MANUSCRIPT Sullivan, A. L., Farnsworth, E. M., & Susman-Stillman, A. (2018). Patterns and predictors of childcare subsidies for children with and without special needs. Children and Youth Services Review, 88, 218–228. https://doi.org/10.1016/j.childyouth.2018.03.002 Timmerman, M. C., & Schreuder, P. R. (2014). Sexual abuse of children and youth in residential care: An international review. Aggression and Violent Behavior, 19(6), 715–720.
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https://doi.org/10.1016/j.avb.2014.09.001
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Uliando, A., & Mellor, D. (2012). Maltreatment of children in out-of-home care: A review of associated factors and outcomes. Children and Youth Services Review, 34(12), 2280–
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2286. https://doi.org/10.1016/j.childyouth.2012.08.003
ACCEPTED MANUSCRIPT Highlights
Caregivers’ perception of barriers to childcare and their recommended solutions were explored
Ensuring gender balance among caregivers, the need for staff and interdisciplinary teams, and financially motivating caregivers were found as some ways to overcome barriers to childcare in Children’s Homes Caring for children with special needs was a challenge to most caregivers.
Adequate training and education are required to increase the carers’ caregiving capacities.
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Alhassan Abdullah, Ebenezer Cudjoe, Esmeranda Manful PII: DOI: Reference:
S0190-7409(18)30008-2 doi:10.1016/j.childyouth.2018.03.045 CYSR 3761
To appear in:
Children and Youth Services Review
Received date: Revised date: Accepted date:
3 January 2018 23 March 2018 24 March 2018
Please cite this article as: Alhassan Abdullah, Ebenezer Cudjoe, Esmeranda Manful , Barriers to childcare in Children's Homes in Ghana: Caregivers' solutions. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Cysr(2018), doi:10.1016/j.childyouth.2018.03.045
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ACCEPTED MANUSCRIPT Barriers to childcare in Children’s Homes in Ghana: Caregivers’ solutions
1. Given name (Alhassan)
Family name (Abdullah)1
Department of Sociology and Social Work
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Kwame Nkrumah University of Science and Technology, Kumasi-Ghana Private Mail Bag,
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University Post Office.
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Email: [email protected]/ [email protected]
2. Given name (Ebenezer)
Family name (Cudjoe)
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Department of Social Studies
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University of Stavanger, N-4036 Stavanger, Norway
Family name (Manful)
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3. Given name (Esmeranda)
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Email: [email protected]
Department of Sociology and Social Work
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Kwame Nkrumah University of Science and Technology, Kumasi-Ghana Private Mail Bag, University Post Office.
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Email: [email protected]
1
Corresponding author
ACCEPTED MANUSCRIPT ABSTRACT The care of children in need of alternative care is a matter of concern to government, nongovernmental organisations and international communities. Understanding the barriers to childcare and knowing the measures to overcome them are important in ensuring the safety and wellbeing of children in alternative care. Few studies exist on caregivers’ suggestions of solutions to overcome barriers to childcare in Children’s Homes in Ghana. Drawing on in-depth semi-
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structured interviews with 37 caregivers in two Children’s Homes in Ghana, this study sought to
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explore caregivers’ suggestions of solutions to barriers in childcare. This study adopted a
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phenomenological approach, reporting findings in participants’ own words. The study findings revealed ensuring gender balance, the need for staff and interdisciplinary teams, and financially motivating caregivers as measures to overcome barriers in childcare. Professionals working with
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children in alternative care and policymakers should pay attention to these solutions to ensure the safety and wellbeing of children in care.
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Keywords: children in alternative care, caregivers, Children’s Home, childcare, Ghana
ACCEPTED MANUSCRIPT 1. Introduction The care of children in need of alternative care is a matter of concern to government, nongovernmental organisations and international communities. UNICEF (2015) estimates that there are over 150 million children in the world without parental care with 52 million in sub-Saharan Africa. Bettmann, Mortensen and Akuoko (2015) state that there are about 1.1 million of such children in Ghana representing 4.7% of the total population and 10.4% of the children and
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adolescent population. Children without parental care in Ghana are usually absorbed by extended
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family members and other close relatives (Frimpong-Manso, 2014; Kuyini, Alhassan, Tollerud,
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Weld, & Haruna, 2009). The traditional Ghanaian community is actively engaged in the care of such children because of the popular cultural adage that says, “it takes a village to raise a child” (Nukunya, 2016), which is strongly valued in Ghana. Again, this practice is valued in most parts
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of sub-Saharan Africa because of the need to maintain family connections and culture (Maundeni & Malinga-Musamba, 2013).
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However, with modernisation, support from kin and kith that characterised the traditional Ghanaian society is waning (Manful & Badu-Nyarko, 2011; Nukunya, 2016). This has brought an
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increased interest in the provision of alternative care arrangements for children in need of alternative care by placing them in institutions. Private individuals, religious organisations and
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nongovernmental organisations (local and foreign) are providing alternative care arrangements for such children by establishing residential institutions, known popularly as Children’s Homes,
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where hired “parents” take care of children. In Ghana, Children’s Homes represent an important fabric of society for the care and protection of children in need of alternative care (DSW, 2008).
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The general public has negative perceptions about the quality of care in Children’s Homes due to recent investigations revealing such Homes as sources of abuse (Anas, 2015). The Ghanaian government made efforts to phase out Children’s Homes with the introduction of the Child Reform
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Initiatives (DSW, 2008). Yet, Children’s Homes continue to grow steadily due to the increasing number of children in need of alternative care (UNICEF, 2015). With support from UNICEF, the Department of Social Welfare (DSW) and Ministry of Gender, Children and Social Protection (MoGCSP) developed standards to ensure that children in alternative care are provided with quality care in these institutions (DSW, 2008). However, it appears that these standards are not being fully adhered to or monitored by caregivers and the DSW as the institutions are deteriorating (Darkwah, Daniel, & Asumeng, 2016). While research has examined the impacts of institutional care on children and the challenges faced by caregivers in the provision of care (James et al.,
ACCEPTED MANUSCRIPT 2017; Sen, Kendrick, Milligan, & Hawthorn, 2008; Souverein, Van der Helm, & Stams, 2013), little has been done to study caregivers’ suggestions of solutions to overcome these barriers. Existing research indicates that most children placed in institutions have negative experiences (Attar-Schwartz, 2011; Fernandez, 2009; Fernandez, Delfabbro, Ramia, & Kovacs, 2017). For many countries, institutional care appears to be a last resort because of the challenges faced by most children and young people in care (Sen et al., 2008; Sherr, Roberts, & Gandhi, 2017) as
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separation of children from their primary caregivers can cause psychological trauma for children
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(Malet et al., 2010). Separation threatens children’s ability to maintain connections and healthy
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relationships with others (Bettmann et al., 2015). Bettmann et al. (2015) observed that the effect of this separation is more so for older children who become aware that the caregivers are not their biological parents. This problem compounds if the caregiver is unable to provide adequate care
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for the child. Thus, it is important for caregivers to receive appropriate training to be able to meet the needs of such children (Castillo, Sarver, Bettmann, Mortensen, & Akuoko, 2012). However,
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some children have indicated that they would have been worse off if not moved from their biological parents and placed in institutions (Dunn, Culhane, & Taussig, 2010). Some children
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prefer to be in institutional care because they will not be abused again by their parents and they have their voices heard by the caregivers (Bessell, 2011; Dunn et al., 2010). This means that not
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all children in alternative care have negative experiences but there is overwhelming evidence that most children placed in care are unhappy (Timmerman & Schreuder, 2014; Uliando & Mellor,
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2012).
Considering the fact that most children and young people in care have negative experiences and
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their institutions can also serve as threats to their positive growth and development (BederianGardner et al., 2018; Khoo, Mancinas, & Skoog, 2015; Sekol, 2013), little has been done to explore caregivers’ suggestions of solutions to ensure the wellbeing and safety of children in
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alternative care. A study by Moore, McArthur, Death, Tilbury and Roche (2017) in Australia revealed that caregivers’ inconsistency in the provision of care could negatively affect the wellbeing of children. Caregivers are unable to make sufficient time to establish relationships with children because they are constantly moved to different units. This has negative consequences for how the child feels towards building subsequent relationships with caregivers as the child knows such relationship may not last (Castillo et al., 2012). Two Ghanaian studies, Bettmann et al. (2015) and Castillo et al. (2012), identified some challenges faced by caregivers in their care of children in Children’s Homes. Castillo et al. (2012) revealed that most caregivers do not receive formal training while others receive training that is
ACCEPTED MANUSCRIPT not consistent. This affects the quality of care provided to the children as, with insufficient training, the caregivers may not be able to adequately respond to the needs of each child (Bettmann et al., 2015). McLeod (2010) suggests that to be able to respond to their needs, caregivers should consider children in care as friends and as equals. Some caregivers have suggested the need for training in childcare, how to meet children at different stages and how to respond to their emotional needs (Castillo et al., 2012) as some ways to ensure the safety and wellbeing of children in
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alternative care. Not much is known about caregivers’ suggestions of ways to overcome barriers
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to childcare in Children’s Homes. This study explores the understanding of barriers faced by caregivers and identify their recommended solutions. This study integrates barriers in childcare
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as they relate to solutions. Solutions to barriers provided by caregivers draw attention to measures that can be put in place to ensure the safety and wellbeing of children in care.
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1.1. Research questions
The main objective of this study was to understand what solutions could be provided by caregivers
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to address barriers they face to childcare in Children’s Homes. These specific research questions were explored:
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1. What do caregivers perceive to be barriers to childcare for children in Children’s Homes?
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2. What are caregivers’ suggestions of ways to overcome these barriers?
2.1. Study design
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2. Methodology
Little is known about caregivers’ perception of solutions to barriers to childcare in Children’s
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Homes in Ghana, consequently, this study employed a qualitative approach. Qualitative research is useful to explore situations where little is known, and is useful in describing complex issues
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such as those involving caregivers’ perception of childcare for children in alternative care. This method was used in order to “understand the world as seen by the respondents” (Patton, 2014: 21). The qualitative research informed this study due to its exploratory nature. A phenomenological design was adopted to make sense of how people experience, describe, feel about, remember and judge a particular phenomenon (Padgett, 2008; Patton, 2014). The phenomenological design was used because the study aimed to understand caregivers’ subjective perceptions of solutions to the barriers in caregiving regarding the children in their care. Using this method, caregivers’ perceptions of childcare were explored and common themes in their responses were identified (Padgett, 2008; Patton, 2014).
ACCEPTED MANUSCRIPT 2.2. Study area Data for this study were collected from two Children’s Homes in the Ashanti region, Ghana: the Kumasi Children’s Home (KCH) in the Kumasi Metropolis and the SOS Children’s Village located in the Asokore Mampong Municipality. The KCH is a state care institution for homeless, abandoned, maltreated and orphan children lacking parental care. The institution was established in 1965 with the objective of providing adequate parental care for children in need of alternative
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care. Mainly, the institution liaises with the Department of Social Welfare in admitting children into
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the Home. The main source of funding for the running of KCH comes from the government.
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However, some philanthropists provide support to the organisation to compliment government’s effort. Recent investigations into some Children’s Homes in Ghana indicate that these funds are either inadequate or are being mismanaged by personnel at the Homes (Anas, 2015). This
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creates problems for children in care as their basic needs are not met. The KCH organises training programmes for the caregivers periodically. Thus, there are no fixed dates where in-service
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training is offered to caregivers. Further, special training is provided for the caregivers to provide care for children with mental health problems. Most of the children in care are at least three years
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of age and leave care when they become independent, placed in foster care or adopted. Care is provided for the children based on their age, sex and/ or whether they have special needs.
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Children are referred from the Department of Social Welfare after the social workers have carried out assessment, enquiries and obtained legal mandate needed to place children in substitute care institutions. This suggests that recruitment of children is not done at the Children’s Home but
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through referral from the Department. During the period of data collection, the KCH had about 122 children. Beside residential facilities, the Home has an educational establishment, a school
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which provides basic education for children in the Home. Staff at the KCH included 12 teachers, 19 caregivers, eight assistant caregivers and three administrators.
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The SOS Children’s Village in Kumasi was established in 2009, as a substitute care Home for orphaned and maltreated children. The institution has five branches spread over the country. The institution admits children through a community outreach programme conducted by staff to identify orphans and children whose parents find difficulty in providing their basic needs. Between July to September 2017, the institution was home to 111 children and a total of 30 staff, comprising 10 teachers, three administrators, 13 caregivers and four assistant caregivers working in the educational and residential facilities. Interviews with caregivers at the Home revealed that majority of the organisation’s funding comes from international donors, most of these donors work with the SOS Children’s Village. Other sources of funding are from private individuals and philanthropists
ACCEPTED MANUSCRIPT through fund raising activities organised by the Home. Also, caregivers at the SOS Children’s Village receive training in childcare once every year. This is to ensure that the caregivers have the required knowledge and skills to provide care for institutionalised children. All children in care at the Home are at least three years of age. Children in care at the home are assigned to caregivers based on their problem-behaviour. For example, caregivers with special skills and training or with much experience are assigned to care for children with behavioural problems like
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aggression and delinquency. Both Children’s Homes operate under the supervision of the
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Department of Social Welfare (DSW, 2008).
2.3. Recruitment
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On July 2017, the lead author visited the Children’s Homes and provided information about the study to the caregivers and administrators. This was to ensure that workers at the Children’s
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Homes were aware of the researchers’ intent to collect data for the study from their institution. During this period, there were 19 caregivers, eight assistant caregivers and three administrators at the KCH while there were 13 caregivers, four assistant caregivers and three administrators at
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the SOS Children’s Village. Thus, in total, there were 44 caregivers and six administrators from
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the two institutions. The lead author contacted all caregivers and administrators to seek their interest to participate in the study. The lead author provided phone numbers to the caregivers and administrators to establish contact if interested to participate in the study. Thirty-one (31)
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caregivers and all six administrators contacted the researchers and scheduled appropriate times for the interview. In this study, administrators were recruited as caregivers because they worked
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in the same institution with the caregivers and provided care for the children when needed. Thus, the study collected data from 37 caregivers.
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2.4. Study participants
The study included 37 research participants comprising caregivers, assistant caregivers and administrators of the two Children’s Homes.
Caregivers were individuals who worked as
“mothers” and “fathers” at the institution because they engaged in the day-to-day upbringing of the children in their care. Assistant caregivers are caregivers in the institution who perform shortterm caregiving roles in the absence of the primary caregivers. Assistant caregivers are mostly called “aunties”. Because the study aimed at investigating solutions to barriers associated with caregiving in the institutions, selection of caregivers and assistant caregivers who are directly involved with caregiving helped provide adequate information needed to achieve the objectives
ACCEPTED MANUSCRIPT of the study. Administrators were also included in this study because they experience the idea of caregiving for children in the institutional context. Further, the administrators can provide their perception of barriers to childcare from a managerial point of view. The table also shows that there were more women (35) than men (2) in the two care institutions, suggesting the gendered
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nature of childcare in institutional Homes in Ghana.
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Table 1 Participant demographics
Category
Sex
Male
35
30-35
3
41-45
3
46-50
11
51-55
15
Bachelor Degree
1
Diploma
2
Senior High School levers
30
Junior High Schools levers
4
Caregivers
25
Assistant caregivers
6
Administrators
6
1-5
14
6-10
6
M ED PT CE AC
Work role
Length of work
2
Female
36-40
Education
Number
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Age
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Item
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Source: Field data, 2017
5
ACCEPTED MANUSCRIPT 11-15
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2.5. Ethical considerations Permission was obtained from the Department of Social Welfare before data collection began. Informed consent was sought from all participants indicating their voluntary participation in the study. The participants were assured that they will maintain anonymous throughout the study and
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they could refuse to participate at any point during the interview without consequences. In cases
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where participants mentioned the names of people or places that could be linked to them, pseudonyms were used.
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2.6. Procedure for data collection
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Data collection begun with researchers establishing rapport and continued contacts with a Head from each Children’s Home serving as gatekeepers. Establishing contacts with the gatekeepers was important for this study as it helped the researchers to introduce themselves and the study
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to potential participants (Given, 2008). The Heads of the Children’s Homes enabled the researchers to access the caregivers by introducing the researchers to the caregivers at their
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institution.
All research participants were involved in an in-depth semi-structured interview of approximately
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50 minutes. Interviews were conducted from July through September 2017 with the aid of a semistructured interview guide. The use of semi-structured interviews provided flexibility and allowed
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the researchers to probe into new insights that emerged from the interviews. This allowed for multiple, divergent and even contradictory information on the topic that deepened and enriched
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the understanding of the research (Marvasti, 2004). Following participants’ consent, all interviews were audio recorded. Questions on the interview guide focused on the study’s research questions.
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Specifically, caregivers were asked to share their experiences of barriers they faced in caring for children in their care. They were also asked to suggest some ways to overcome these barriers. Interviews with the caregivers were conducted in Twi (local) while interviews with the administrators were conducted in the English language. The use of the local language allowed caregivers to explore their perceptions in-depth and added to the quality of the research. All interviews were conducted at offices within the Children’s Homes, the choice of research participants. 2.7. Data analysis
ACCEPTED MANUSCRIPT The audio recorded interviews were transcribed ad verbatim. All researchers checked the transcribed data with the audio for correctness and accuracy. The thematic analysis was used to identify themes for this study (Braun & Clarke, 2006). In line with thematic analysis, the transcribed data were read and re-read by researchers to immerse self into data. Initial codes emerged following researchers’ familiarity with the data. The researchers developed the codes by reading through the transcripts more than twice and taking notes along the way (Padgett, 2008). Open
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coding was done where the researchers engaged in a line-by-line reading of the data to organise
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quotes that reflected the research questions (Charmaz, 2014). Codes such as “special needs”, “emotional challenges”, “financial motivation” and “gender balance” emerged from the data. The
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codes were organised into potential themes and further refined to ensure they answered the research questions. Some themes reflected similar ideas, thus, they were merged into each other.
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Considering the exploratory nature of this research, codes containing less prevalent responses were not discarded but were revisited and some included for the study. The interview data were
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managed with the NVivo 11 qualitative software.
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3. Findings
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Major themes that emerged from the interview data have been presented in this section. The themes have been presented in accordance with the main research question: to explore caregivers’ suggestions of measures to overcome barriers to childcare in Children’s Homes.
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Some barriers to childcare identified by the caregivers have been included to the findings as they relate to the caregivers’ suggested solutions. One of the barriers (children with special needs)
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have been presented in a separate section without solutions suggested.
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3.1. Solutions to barriers in childcare 3.1.1. Ensuring gender balance in childcare Commenting on ways to overcome barriers to childcare in institutional homes in Ghana, participants identified the lack of gender parity among caregivers as a challenge which can be solved by ensuring gender balance among caregivers. According to the caregivers, the lack of gender parity, specifically the absence of a father figure in the Homes affect caregivers’ ability to instil discipline in the Homes. Some female caregivers who commented on this indicated that, traditionally, men are expected to ensure discipline in the family environment. Therefore, as a
ACCEPTED MANUSCRIPT semblance of the traditional family setting, the Home requires men who will provide care, assistance and ensure discipline among children in the Home: “…. you know that traditionally men are expected to ensure discipline in family, same as here. So sometimes we find it difficult to discipline the children as mothers when they go wrong, it is expected that we instil discipline in them which will be better done with the assistance of a male caregiver” (Assistant mother, Kumasi Children’s Home, 3 years in
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service)
The perception of the female caregivers regarding the need for a father figure was expanded by
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some participants who believed that the presence of male caregivers will ensure child-caregiver attachment. According to them, male caregivers will develop close attachments to female children
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whereas the female caregivers will also develop attachment to the male children. Therefore, the absence of a father figure affects the emotional development and attachment relationships for
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female children:
“Boys develop close relationship with their mothers and girls too develop same relationship with their fathers, therefore the absence of a father in the home affect the
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relationship building between we the mothers and the female children. Since they would
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find it difficult to share their issues with us. Even sometimes, the babies, when they are crying we do everything possible to calm them down, yet they will continue to cry but when luckily a man pops up here and carry her along within a moment she will be quiet. This
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tells us that we really need male caregivers”. (Mother, Kumasi Children’s Home, 11 years
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in service)
The few male caregivers in the study revealed that they face some social ridicule from the public
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due to their job as caregivers at the Home. “Some of our colleagues who know of our job as workers here laugh at us even though am not directly involved in caregiving, but the mere fact that am working in the children’s home makes them tag me with that mentality. So, it will be difficult to get a male to be directly involved in caregiving. Unless the person is passionate and very enthusiastic like the one we have here” (Administrator, SOS Children’s Village, 5 years in service) The only male caregiver identified in the study attributed the limited number of male caregivers in the Homes to the gendered nature of childcare: “The challenge is that the term caregiver is more skewed towards females which deters many men from involving themselves in.” (Father, SOS
ACCEPTED MANUSCRIPT Children’s Village, 4 years in service). His opinion suggests that the caregiving occupation is gendered and this consequently leads to few male enrolments. It appears the Ghanaian family practice considers women as the primary caregivers and this concept is transferred to the Children’s Home. Responding to the challenge of the absence of a father figure in the care Homes, the research participants suggested that childcare institutions should consider recruiting male caregivers to
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ensure gender balance in caregiving. Through the in-depth interviews, caregivers, mostly
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females, revealed that recruiting male caregivers will help the institutions achieve their general
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status as a substitute Home for children in need of alternative care. A research participant asserted to this:
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“I think management should also consider bringing in male caregivers, when we have males here the whole place will be like a traditional family with mother, father and children”
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(Mother, Kumasi Children’s Home, 3 years in service) Another research participant illuminated on this:
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“They should try and bring in men, if we have men here they will be performing the traditional role of a father with us performing our roles as mothers and the children will be
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better cared for” (Assistant mother, Kumasi Children’s Home, 4 years in Service” The perspectives shared by the participants suggest that caregivers in institutional Homes in
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Ghana perceive the Homes as substitute for traditional family homes. Therefore, its structure and culture ought to resemble a traditional family home: “You know the institution is like a normal
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home that’s why they call us mothers because we perform the mothers’ role so we need fathers to perform the fatherly role” (Assistant mother, SOS Children’s Village, 4 years in service). Thus,
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there is a need to introduce father figures to ensure a balance in caregiving. 3.1.2 Need for staff and interdisciplinary team In order to ensure better outcomes for children in care institutions, research participants suggested increasing the staffing of care institutions to overcome one of the main challenges facing childcare institutions: inconsistencies in care. According to the caregivers, inconsistency in caregiving came up due to the consistent changes in caregivers’ assigned roles and responsibilities, which obstructed their ability to carefully monitor children’s developmental and emotional needs: “Day in day out we are assigned to different groups of children which makes it difficult to keep an eye on each child” (Mother, SOS Children’s Village, 4 years in service).
ACCEPTED MANUSCRIPT This implies that caregivers in Children’s Homes in Ghana are not assigned specific groups of children to monitor and work with. Additionally, some caregivers opined that the challenge of maintaining close attention to children’s emotional and developmental needs would not have been a problem if caregiver-child ratio was managed properly. According to them, the number of children assigned to caregivers at a point in time makes it difficult to keep an eye on every single child:
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“Even though the shift in caregiving affect the attachment relationship and makes it difficult
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for us to monitor children’s psychological and developmental challenges, it would have
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been minimised if we have a small number of children in our care. That would have helped to keep an eye on the progress of individual child regardless of the change in caregivers. Here is the case one caregiver may be assigned to about 30 children at a time, how can
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you monitor them individually? (Assistant mother, Kumasi Children’s Home, 6 years in service)
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In response to the challenge of inconsistencies in care, the caregivers suggested the need for more staff as a possible remedy. Majority of the caregivers alluded to this opinion by indicating
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that increasing the number of personnel at the Home will help release burden on the caregivers and ensure that each worker performs her or his responsibility with great efficiency:
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“I believe that if they employ others in addition to us majority of these problems will be reduced. If they employ a lot that means we will have less work to do and with the little we
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are assigned to do we will do it best to ensure maximum outcome” (Assistant mother,
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Kumasi Children’s Home, 4 years in service) Some caregivers highlighted the need to introduce personnel with specialised knowledge to care for children with special needs. A participant echoed this concern by adding that the Home should
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target recruiting people with diverse or specialised knowledge and skills needed to care for the children. According to her, recruiting more caregivers with the right knowledge and skills will help improve caregiving in the Home: “I think staffing is one of the main challenge we report to the management during meetings, and it is not just about staffing anyhow but recruiting people with the right knowledge to improve caregiving in the institution. You realise that we don’t have people who have vast knowledge in caregiving, majority of our caregivers were recruited based on their experience as mothers in our traditional homes” (Administrator, Kumasi Children’s Home, 5 years in Service)
ACCEPTED MANUSCRIPT Adding to the view on the need for caregivers with specialised knowledge, an administrator at the SOS Children’s Village shared his experience on how they have been managing issues that required the need for a specialist: “For us to improve our work here we need staff who have specialised knowledge. Sometimes we hire the service of a psychologist from a hospital when one of our caregivers detect a psychological problem in some of the children. This cost us a lot and
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is one of the reasons why we have suggested to management to get us a psychologist.
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Not just social workers and psychologist we also need counsellors among others to ensure
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that we improve our work” (Administrator, SOS Children’s Village, 7 years in service) In fact, the perception shared by both caregivers and administrators of the Homes clearly shows
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that caregiving in institutional Homes can be improved with the right interdisciplinary team. Also, it appears that some caregivers were not passionate about the caregiving role due to lack of
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specialised knowledge in caregiving, even though they are mothers to children of their own. 3.1.3 Financial motivation and government support
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Most research participants opined that in order to improve caregiving at the Homes, caregivers need to be financially motivated to help them stay focused on their work. According to the
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participants, motivating caregivers will help curtail the challenge of low financial motivation identified in most Children’s Homes in Ghana, “My concern is about the money aspect, if they pay
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us well, we will also focus and give our maximum best” (Assistant mother, Kumasi Children’s Home, 4 years in service). A caregiver emphasised on their multiple roles performed, which did
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not reflect their earnings, as a major challenge in caregiving at the Homes. According to the caregivers, the low financial motivation attached to their job sometimes impelled them to engage
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in other part-time jobs to make enough money for themselves and their family: “Hmmmm, the salary too is a problem. The salary is not enough to take care of us and our family. You know we also have children to take care of. So sometimes we are forced to engage in other part-time jobs before coming to work, which affects our work here. But we have no option, since the money we make here is not enough”. (Assistant mother, Kumasi Children’s Home, 6 years in service) Evidence provided by the participants suggest that caregivers in institutional Homes receive meagre salaries despite the difficult nature of their work. However, it must be noted that this particular theme was shared by few workers and it was specific to workers at the Kumasi
ACCEPTED MANUSCRIPT Children’s Home. Considering the fact that Kumasi Children’s Home is state-owned, it could be argued that private-owned Children’s Homes pay better salaries to caregivers than state-owned Children’s Homes. However, some caregivers argued that the salary they received was enough to take care of their family and themselves. This view was shared by the few administrators interviewed for the study. “Well, for me, financial motivation is not a challenge, because I am able to survive on the little I
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make here” (Administrator, Kumasi Children’s Home, 4 years in service). It appears that the
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perspectives of the administrators regarding the issue of financial motivation shows disparities in
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salary structure at care institutions in Ghana.
Commenting on the solution to the challenge of low financial motivation, a caregiver shared her
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opinion:
“… Seriously, we would be glad if our salary is increased to help us focus and care for the
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children. We have the zeal to care for them but the motivation is too small, this sometimes causes distraction in our work, because instead of us to watch the children and care for them we are also thinking of what to eat in the evening with our children.” (Assistant
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mother, Kumasi Children’s Home, 3 years in service)
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Another research participant indicated that even though they are aware of the moral reward God will give them for taking care of children lacking parental care, they also need money to take care
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of themselves and their family:
“For me, I think money is the issue, because if they pay us well we won’t even think of
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engaging in part-time jobs. We would stay focused and care for the children. After all they are our children so if we take good care of them God will reward us. But we also need the
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money to cater for our own children and family”. (Mother, SOS Children’s Village, 6 years in service)
Whereas the parents were calling for financial motivation, administrators of the institutions were also yearning for support from government and other benevolent individuals: “We call on the government and benevolent individuals to come and help us. We really need a lot to make the institution a world class substitute home for children without parental care” (Administrator, Kumasi Children’s Home, 4 years in service). Another administrator added by acknowledging supports received from corporate bodies and philanthropic individuals:
ACCEPTED MANUSCRIPT “I would say that the public has done well in supporting us both in kind and in cash but we would need more to augment various aspects of the agency, so as to ensure that children here have the best care”. (Administrator, SOS Children’s Village, 7 years in service).
3.2 Children with special needs
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The caregivers indicated that caring for children with special needs was a challenge to them. The
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term “children with special needs” is used to refer to children in care with emotional and
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developmental problems (Sullivan, Farnsworth, & Susman-Stillman, 2018). Most children in care encounter emotional problems due to experience of separation from their immediate caregivers. Developmental problems occur for the children in care due to low quality of care received and the
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poor nutrition. The caregivers argued that the challenges in care were more apparent among children with special needs: “you know caring for children is difficult but here it’s worse due to the
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special issues some of them have” (Mother, Kumasi Children’s Home, 11 years in service). The caregivers had a common understanding of what is considered special needs. A caregiver
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expressed her opinion on the meaning of special needs: “one of the main challenge we encounter in caring for the children is that, some of them
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have special issues, not mental problems, No. But some of them experience sudden developmental and emotional problems which we find it difficult to handle” (Mother,
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Kumasi Children’s Home, 13 years in service) It appeared that children’s emotional and developmental challenges served as barriers to
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caregiving at the Home: “Some of them have developmental challenges and we find it difficult to understand them, since we also don’t have the required skills to handle them (Mother, SOS
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Children’s Village, 8 years in service) Another caregiver added to this by lamenting on how their skills are insufficient to properly handle issues of children’s special needs and how this adversely affect their work with children: “… hmmm the hard truth is that, majority of us are not trained in this profession, but as tradition requires, mothers are seen as good caregivers. Therefore, some of us approached this job with that mentality only to experience that caring for children at this home is a different issue requiring technical knowledge and skills set totally different from our traditional caregiving roles” (Mother, Kumasi Children’s Home, 4 years in service).
ACCEPTED MANUSCRIPT Emphasising on the dichotomy of the traditional ways of caregiving and caregiving at the Children’s Homes, a participant shared her experience “even though I am a mother myself I never knew children are difficult like this if I have not been here” (Assistant mother, SOS Children’s Village, 2 years in service). The experiences shared by the caregivers reveal that childcare institutions in Ghana are not properly staffed with personnel who have the required training and skills needed to care for the
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special needs of children in care. It appears that caregiving in Children’s Homes require a different
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approach than in a traditional family environment. Though, the interview data did not reveal ways
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in which this challenge can be addressed, its identification provides insight into the diverse challenges facing caregivers in Children’s Homes. And could suggest that training is needed to
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address the issue of caring for children with special needs. 4. Discussion and implications
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This study explored caregivers’ suggestions of solutions to barriers to childcare in Children’s Homes in Ghana. It has been established that studies in Ghana have identified some barriers faced by caregivers in providing care for children in need of alternative care (Bettmann et al.,
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2015; Castillo et al., 2012). However, not much is known about caregivers’ suggestions of
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measures to overcome the barriers. Thus, this study addresses a significant gap in the research literature by exploring ways to address barriers in care to ensure the safety and wellbeing of
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children.
Caregivers in this study indicated that the Children’s Home should be a semblance of the traditional family environment where there is a mother and father. This was because there were
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very few men working as caregivers in the Children’s Homes. The caregivers argued that the absence of fathers resulted in the lack of discipline and control in the Homes. This is common to
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most traditional Ghanaian families where the presence of the father is usually seen as a symbol of authority (Nukunya, 2016) which ensures that children listen to and obey their parents. Thus, more males should be employed as caregivers in the Homes. This would ensure that the children have both mother and father figures to turn to when in need as mothers and fathers often have different but complementary roles to perform in childcare (Newland & Coyl, 2010). Caregivers perceived that some female children were unable to relate well with them because they needed fathers to confide in. Data from the study shows that only three caregivers had tertiary education and caregivers receive training only once in a year. Thus, it could mean that the caregivers have not received adequate training and education needed to relate well with the children. Existing
ACCEPTED MANUSCRIPT research shows that mothers provide love and security to children and this is expected to ensure positive caregiver-child relationship (Newland & Coyl, 2010; Paquette & Bigras, 2010). However, the study findings suggest that the female caregivers could not provide this form of care or the care was insufficient for the female children. Consequently, the caregivers recommended that more males should be employed as caregivers to ensure balance in caregiving for children. Further, the caregivers suggested that bringing in more staff to engage in caregiving could help
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reduce their workload and ensure parity with the caregiver-child ratio. The study findings suggest
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that the caregivers were not happy with the fact that they had to work on shifts as this negatively
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affected their care for the children. These inconsistencies in care does not give them the opportunity to pay attention to children’s emotional and physical needs (Castillo et al., 2012). Moore et al. (2017) also found that most caregivers are unable to build sustained relationships
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with children in care because the caregivers are constantly moved to other units. Increasing staff size at the Children’s Homes could ensure that caregiving is consistent and workers are not
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constantly moved to different units at all times (Moore et al., 2017). The result of this will be the provision of stable, long-lasting care for the children. Moreover, introducing more staff to the
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Children’s Homes could ensure the caregivers have sufficient time to develop continued interactions with the children which could lead to better outcomes for each child (Rabley, Preyde,
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& Gharabaghi, 2014). With regards to increasing staff at the Homes, caregivers suggested that attention should be paid to introducing individuals with specialised knowledge about the needs of the children. The aim of this is to able to have caregivers who will be able to address the concerns
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of children with special needs.
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The caregivers highlighted that their salaries should be increased in order to ensure that they get focused on their caregiving responsibilities, without spending most times on part-time jobs. The study findings suggest that caregivers received too little income for the work they had to do in
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caring for the children. Consequently, they had to engage in part-time jobs to sufficiently care for themselves and their families. The study by Castillo et al. (2012) revealed that Children’s Homes in Ghana lack adequate funding which makes it difficult to meet the basic needs of the children. However, this study suggest that private-owned Children’s Homes may not have issues about financially motivating caregivers. Especially for caregivers in state-owned Children’s Homes, an increase in their salaries is more likely to result in a positive relationship with the children. Thus, the DSW, through the MoGCSP, should ensure that caregivers in state-owned Children’s Homes are financially motivated. The administrators of the Children’s Homes have also called for financial support from the government and philanthropists (Castillo et al., 2012). Attention should be paid
ACCEPTED MANUSCRIPT to these suggestions made by the caregivers to ensure that children in need of alternative care feel safe and secure in Children’s Homes. Finally, the study findings indicate that there was a challenge in providing care for children with special needs. Findings from the study suggest that the children had emotional and behavioural challenges (Holden et al., 2010) that made them difficult to control and care for. It appears that the institutions did not provide an enabling environment for the positive growth and development
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of the children. Thus, a “home” environment should be created for the children to ensure that they
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are able to have positive relationships with their caregivers. This will further ensure that the special
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needs of the children are met. Further, appropriate training should be offered to the caregivers to be able to meet the children’s emotional and developmental challenges (Castillo et al., 2012).
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5. Limitations
There are limitations to applying this study outside of the study context. The use of the
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phenomenological approach could mean that this study is highly contextual, thus, caution should be exercised when applying the study findings to other contexts. Further, the use of a limited sample size and a focus on two institutions could make statistical generalisation difficult. Still, the
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study findings can apply to institutions that are similar to the ones used in this study.
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6. Conclusion
Solutions to barriers in childcare are needed to ensure the safety and wellbeing of children in
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Children’s Homes. Several studies in Ghana have addressed caregivers’ perception of barriers to childcare in Children’s Homes. The study findings revealed ensuring gender balance, the need
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for staff and interdisciplinary teams, and financially motivating caregivers as the recommended solutions to ensure better outcomes for children in need of alternative care. Although caregivers
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may face some difficulties in providing care for children in alternative care, solutions exist to overcome these barriers to ensure positive outcomes for children in care. Thus, professionals working with children in alternative care and policymakers should pay attention to these solutions to ensure the safety and wellbeing of children in care. Declarations of interest none The authors(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article
ACCEPTED MANUSCRIPT References Attar-Schwartz, S. (2011). Maltreatment by Staff in Residential Care Facilities: The Adolescents’ Perspectives. Social Service Review, 85(4), 635–664. https://doi.org/10.1086/664009 Bederian-Gardner, D., Hobbs, S. D., Ogle, C. M., Goodman, G. S., Cordón, I. M., Bakanosky,
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S., … Chong, J. Y. (2018). Instability in the lives of foster and nonfoster youth: Mental
IP
health impediments and attachment insecurities. Children and Youth Services Review,
CR
84(Supplement C), 159–167. https://doi.org/10.1016/j.childyouth.2017.10.019 Bessell, S. (2011). Participation in decision-making in out-of-home care in Australia: What do
US
young people say? Children and Youth Services Review, 33(4), 496–501. https://doi.org/10.1016/j.childyouth.2010.05.006
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Bettmann, J. E., Mortensen, J. M., & Akuoko, K. O. (2015). Orphanage caregivers’ perceptions of children’s emotional needs. Children and Youth Services Review, 49(Supplement C),
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71–79. https://doi.org/10.1016/j.childyouth.2015.01.003
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Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
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Castillo, J. T., Sarver, C. M., Bettmann, J. E., Mortensen, J., & Akuoko, K. (2012). Orphanage
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caregivers’ perceptions: The impact of organizational factors on the provision of services to orphans in the Ashanti Region of Ghana. Journal of Children and Poverty, 18(2), 141–
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160. https://doi.org/10.1080/10796126.2012.710484 Charmaz, K. (2014). Constructing Grounded Theory (2 edition). London ; Thousand Oaks, Calif: SAGE Publications Ltd. Darkwah, E., Daniel, M., & Asumeng, M. (2016). Caregiver perceptions of children in their care and motivations for the care work in children’s homes in Ghana: Children of God or children of white men? Children and Youth Services Review, 66(Supplement C), 161– 169. https://doi.org/10.1016/j.childyouth.2016.05.007
ACCEPTED MANUSCRIPT Department of Social Welfare (DSW) (2008). Regulations for care and protection of children without appropriate parental care in Ghana. Accra: Ministry of Manpower, Youth and Employment Dunn, D. M., Culhane, S. E., & Taussig, H. N. (2010). Children’s appraisals of their experiences in out-of-home care. Children and Youth Services Review, 32(10), 1324–1330.
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https://doi.org/10.1016/j.childyouth.2010.05.001
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Fernandez, E. (2009). Children’s wellbeing in care: Evidence from a longitudinal study of
https://doi.org/10.1016/j.childyouth.2009.07.010
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outcomes. Children and Youth Services Review, 31(10), 1092–1100.
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Fernandez, E., Delfabbro, P., Ramia, I., & Kovacs, S. (2017). Children returning from care: The
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challenging circumstances of parents in poverty. Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2017.06.008
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Frimpong-Manso, K. (2014). From walls to homes: Child care reform and deinstitutionalisation in Ghana. International Journal of Social Welfare, 23(4), 402–409.
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https://doi.org/10.1111/ijsw.12073
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Given, L. M. (Ed.). (2008). The SAGE Encyclopedia of Qualitative Research Methods (1 edition). Los Angeles, Calif: SAGE Publications, Inc.
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Holden, M. J., Izzo, C., Nunno, M., Smith, E. G., Endres, T., Holden, J. C., & Kuhn, F. (2010). Children and residential experiences: A comprehensive strategy for implementing a
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research-informed program model for residential care. Child Welfare, 89(2), 131–149. James, S. L., Roby, J. L., Powell, L. J., Teuscher, B. A., Hamstead, K. L., & Shafer, K. (2017). Does family reunification from residential care facilities serve children’s best interest? A propensity-score matching approach in Ghana. Children and Youth Services Review, 83(Supplement C), 232–241. https://doi.org/10.1016/j.childyouth.2017.10.032
ACCEPTED MANUSCRIPT Khoo, E., Mancinas, S., & Skoog, V. (2015). We are not orphans. Children’s experience of everyday life in institutional care in Mexico. Children and Youth Services Review, 59(Supplement C), 1–9. https://doi.org/10.1016/j.childyouth.2015.09.003 Kuyini, A. B., Alhassan, A. R., Tollerud, I., Weld, H., & Haruna, I. (2009). Traditional kinship foster care in northern Ghana: the experiences and views of children, carers and adults
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in Tamale. Child & Family Social Work, 14(4), 440–449. https://doi.org/10.1111/j.1365-
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Malet, M. F., Mcsherry, D., Larkin, E., Kelly, G., Robinson, C., & Schubotz, D. (2010). Young
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children returning home from care: the birth parents’ perspective. Child & Family Social Work, 15(1), 77–86. https://doi.org/10.1111/j.1365-2206.2009.00645.x
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Manful, S. E., & Badu-Nyarko, S. K. (2011). Where are the HIV/AIDS orphans? Exploring characteristics of vulnerable children in public residential care in Ghana? Journal of
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Global Social Work Practice, 4(1), 1–8.
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Marvasti, A. (2004). Qualitative Research in Sociology (1 edition). London ; Thousand Oaks, Calif: SAGE Publications Ltd.
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Maundeni, T., & Malinga-Musamba, T. (2013). The role of informal caregivers in the well-being
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of orphans in Botswana: a literature review. Child & Family Social Work, 18(2), 107–116. https://doi.org/10.1111/j.1365-2206.2011.00820.x
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McLeod, A. (2010). ‘A Friend and an Equal’: Do Young People in Care Seek the Impossible from their Social Workers? The British Journal of Social Work, 40(3), 772–788. https://doi.org/10.1093/bjsw/bcn143 Moore, T., McArthur, M., Death, J., Tilbury, C., & Roche, S. (2017). Young people’s views on safety and preventing abuse and harm in residential care: “It’s got to be better than home.” Children and Youth Services Review, 81(Supplement C), 212–219. https://doi.org/10.1016/j.childyouth.2017.08.010
ACCEPTED MANUSCRIPT Newland, L. A., & Coyl, D. D. (2010). Fathers’ role as attachment figures: an interview with Sir Richard Bowlby. Early Child Development and Care, 180(1–2), 25–32. https://doi.org/10.1080/03004430903414679 Padgett, D. K. (2008). Qualitative Methods in Social Work Research (2nd edition). Los Angeles, Calif: SAGE Publications, Inc.
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Paquette, D., & Bigras, M. (2010). The risky situation: a procedure for assessing the father–child
https://doi.org/10.1080/03004430903414687
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activation relationship. Early Child Development and Care, 180(1–2), 33–50.
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Patton, M. Q. (2014). Qualitative Research & Evaluation Methods: Integrating Theory and Practice (4 edition). Thousand Oaks, California: SAGE Publications, Inc.
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Rabley, S., Preyde, M., & Gharabaghi, K. (2014). A survey of adolescents’ perceptions of their relationships with nonparental caregivers in group home settings: An attachment
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perspective. Children and Youth Services Review, 40(Supplement C), 61–70.
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https://doi.org/10.1016/j.childyouth.2014.02.012 Sekol, I. (2013). Peer violence in adolescent residential care: A qualitative examination of
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contextual and peer factors. Children and Youth Services Review, 35(12), 1901–1912.
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https://doi.org/10.1016/j.childyouth.2013.09.006 Sen, R., Kendrick, A., Milligan, I., & Hawthorn, M. (2008). Lessons learnt? Abuse in residential
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child care in Scotland. Child & Family Social Work, 13(4), 411–422. https://doi.org/10.1111/j.1365-2206.2008.00566.x Sherr, L., Roberts, K. J., & Gandhi, N. (2017). Child violence experiences in institutionalised/orphanage care. Psychology, Health & Medicine, 22(sup1), 31–57. https://doi.org/10.1080/13548506.2016.1271951 Souverein, F. A., Van der Helm, G. H. P., & Stams, G. J. J. M. (2013). ‘Nothing works’ in secure residential youth care? Children and Youth Services Review, 35(12), 1941–1945. https://doi.org/10.1016/j.childyouth.2013.09.010
ACCEPTED MANUSCRIPT Sullivan, A. L., Farnsworth, E. M., & Susman-Stillman, A. (2018). Patterns and predictors of childcare subsidies for children with and without special needs. Children and Youth Services Review, 88, 218–228. https://doi.org/10.1016/j.childyouth.2018.03.002 Timmerman, M. C., & Schreuder, P. R. (2014). Sexual abuse of children and youth in residential care: An international review. Aggression and Violent Behavior, 19(6), 715–720.
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https://doi.org/10.1016/j.avb.2014.09.001
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Uliando, A., & Mellor, D. (2012). Maltreatment of children in out-of-home care: A review of associated factors and outcomes. Children and Youth Services Review, 34(12), 2280–
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2286. https://doi.org/10.1016/j.childyouth.2012.08.003
ACCEPTED MANUSCRIPT Highlights
Caregivers’ perception of barriers to childcare and their recommended solutions were explored
Ensuring gender balance among caregivers, the need for staff and interdisciplinary teams, and financially motivating caregivers were found as some ways to overcome barriers to childcare in Children’s Homes Caring for children with special needs was a challenge to most caregivers.
Adequate training and education are required to increase the carers’ caregiving capacities.
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