In a political context of downsizing funding for social work within underfunded health systems in the Global South and increased pressure on lay counselors to carry out specialized care this project aims to analyze the intangible skills needed to do mental health work in conditions of trauma and violence and understand how the structure of the supervision program in which lay health workers are embedded contributes to the delivery of the intervention. The visit reports are unique snap-shots into the way responsive parenting models are translated in specific settings. The envisioned collaborative framework will contribute to capacity building and recognition of the unique skills of practitioners.
- 2023 - 2028
- Josien de Klerk
This ethnographic project aims to – collaboratively - unravel the practices of home-visiting and reporting in a (home-visiting) programmes aimed at promoting infant mental health in South Africa through written narrative reports (retrospective case note reviews) produced as part of the intervention.
During the past half-century insights into the developmental origins of disease (DOHAD), have led to a new global ‘imaginary’ where the critical window of opportunity for intervention to counter the adverse future life-course effects of environmental factors, such as nutritional deprivation, maternal stress and exposure to teratogens, is the ‘first 1000 days of life’ (between a child’s conception and a child’s second birthday (Mandy & Nyirenda, 2018; Pentecost, Michelle, 2016; Ross, Fiona, 2017). These insights have led to a growth of responsive parenting programs globally (Eshel, Neir et al., 2006). The Ububele Home Visiting Project is one such project. The programmes, carried out by trained lay counsellors, is directed at infants and their primary carers; mainly mothers living in the township of Alexandra, Johannesburg and stimulates maternal sensitivity and attachment in circumstances of chronic stress and violence (Frost et al., 2017). We propose to ethnographically study the practice of home-visiting, through the analysis of home visit reports written by lay counsellors. Ububele has used these reports mainly in an instrumentalist way, for documenting the intervention, training and supervision, yet the documents are also a unique source to understand how an intervention inspired by global models of ‘good parenting’ is translated and internalized by lay counselors in an underfunded health system. In 2017, Ububele and Leiden University College collaborated in a pilot analysis of a sub-set of home visit reports. This proposal emerges from this pilot. Through a politics of care lens, it sets out to systematically and collaboratively analyze the practice of home visiting as reported in the visit reports.
The project will address the following aims:
1) To conduct a geneology of notions of ‘good parenting’ in the home-visiting programme.
Ububele’s home-visiting programme is modelled onto another South African Infant Mental
Health model. The home visiting project is supervised by a counseling psychologist/parent-infant psychotherapist well versed in the cross-cultural applicability of attachment theory as mediated by lay counsellors and the reception of the intervention by mothers has been subject to substantial scholarly research from a developmental psychology perspective. How were supervisors trained, which theories on infant development shaped the intervention and how were these adapted to the specific setting of Alexandra. Within training materials and reporting formats notions of all these influences converge. What notions of ‘good parenting circulate in these documents? How have these notions shifted over time as the programme
matured? How are these notions mediated by home-visitors?
2) To trace how the responsive parenting intervention is implemented in practice as articulated
through the visit reports and the supervisor reports.
Home-visitors are central in the responsive parenting intervention. Home-visitors are selected carefully, they are over 30 and
mothers themselves, live in the same community, speak at least two local languages and are considered and assessed on their resilience and empathy. Home-visitors carry these qualities with them in the way they carry out the interventions and assess the situations of project-mothers and write about their work. This objective studies how home-visitors translate the training and visit guidelines into a suitable intervention in the particular context of a mother.
3) To study how evidence about the home visitors’ activities within the program circulates and is
assessed and appropriated by the different actors in the programme.
Home-visit reports are produced with an objective: they document the work of the home-visitor. This objective studies the
practice of report writing by home-visitors by tracing what evidence is produced and how this evidence circulates in other documents such as supervisions scripts.
The analysis will be conducted through virtual collaboration workshops with students from LUC, a South African University and Home-Visitors from Ububele, thereby integrating education and research.
To design these virtual collaborations the project is the focal point of a Virtual Collaboration Grant received from the Ministry of Education, Culture and Science (OCW). Through a Virtual collaboration, LUC students and students of the University of Stellenbosch will collaborate with home-visitors in collaboratively designing a product around one of the project's objectives. The precise type and form of the product is part of the design workshop process and might be different in each iteration of the virtual collaboration workshops.