Good Practice Guide: Family-Centred HIV Programming for Children

"This guide is designed to support children and their families who are affected by HIV in different ways. The starting point is our belief that children have the right to be treated with dignity and respect and that children can be an active part of the solution."

This Good Practice guide is designed to help HIV programmers implement family-centred HIV programming for children. As with each guide in the Alliance good practice series, this one is accompanied by a set of programming standards. This guide to using a family-centred approach to HIV programming for children has been produced collaboratively by the Alliance and Save the Children UK (United Kingdom).

"A definition of the family-centred approach that is widely used in the area of HIV is: 'A comprehensive coordinated care approach that addresses the needs of both adults and children in a family and attempts to meet their health and social care needs, either directly or indirectly, through strategic partnerships and/or linkages and referrals with other service providers.'

The above definition highlights two principles that are important in family-centred programming and policy development:

1. Social care and health needs are both addressed, including developmental, cognitive and emotional needs. A family-centred approach helps families to care for children within the family. It provides services in a way that is 'family friendly' and recognises the relationships between family members.
2. The holistic needs of the family are met by a number of different groups, so referral and coordination between groups and agencies is needed."

The guide examines six areas of intervention for children and their families: health, economic strengthening, food and nutrition, education and early childhood development (ECD), care and protection, and emotional and psychological support. In each sector, the guide offers ideas about how to implement programmes in a more family-centred way and illustrates these with case studies of programmes that have started using family-centred approaches.

Within the area of education and ECD, it is recognised that children withdraw from school due to financial pressures and in in order to be caregivers. "Family-centred education needs to take into account these pressures."

The document asks ECD programmes to consider the following:

• "targeting early childhood development programmes to all family members who have a caring role, not just mothers
• assessing which family members spend most time with infants
• recognising that relationships with a child are different based on factors such as biological connection, age and family position
• teaching family members, such as fathers, grandparents or siblings, about the key factors and stages in the development of a child and how to provide the best care for the child
• designing parent education initiatives that improve the skills and capacity of parents to care for and communicate with their children, and assisting with referrals to other services or to access entitlements
• recognising that parent education approaches may be especially important for parents experiencing difficulties themselves - for example, mental health issues, drug use and gender-based violence - and for carers taking on children who are not their own. Parenting support is also crucial for individuals who have had poor or dysfunctional care in their own childhood."

The standards recommended by this guide are the following: Good practice standard 6 - "Our organisation promotes a family-centred approach, reaching children within and through their families and communities" and Good practice standard 7 - "Our organisation promotes and/or provides integrated family-centred services in health, education and social welfare in order to address the needs and rights of children."

Contents of the guide include the following:

• Introduction

What is this guide for?
Who is this guide for?
Making it work in practice
Language matters

1. What is a family-centred approach?
   • Definition of a family-centred approach
   • Why should we apply a family-centred approach to our work with children affected by HIV? 
   • What is the evidence that a family-centred approach can work in practice?
   • Critiques of a family-centred approach
2. What do we need to know about families? 
   • Definitions of family 
   • Common ‘shapes’ of families 
   • What characteristics of families are relevant to designing programmes? 
   • Contexts in which families live 
   • Who are the people and what are the places that support families?
3. How do we design a family-centred programme? 
   • Principles in planning and design  
4. Family-centred programmes in practice 
   • Health 
   • Economic strengthening 
   • Food and nutrition 
   • Education and early childhood development 
   • Care and protection 46
   • Emotional and psychological support 
5. How do we make a family-centred approach work in our organisations? 
   • How do we adapt our programmes to a family-centred approach?
6. How do we add quality to our programmes? 
   • What are the cross-cutting principles of family-centred care? 
   • How do we target services and make sure they reach those who need them?
7. Summary

• Appendix 1: Standards
• Appendix 2: Glossary
• Appendix 3: Stages of development