Critical Reflections on the Usefulness of eConnect to a Sample of Child and Youth Care Workers in South Africa

ABSTRACT

In South Africa, most children in care have been removed from homes characterized by violence, abuse, poverty, and neglect, with many of these children often exposed to multiple traumatic events. Research points to a strong causal association between child trauma and attachment difficulties. Poor attachment increases children’s risk for a range of externalizing behaviors, with related negative consequences for the child in both the short and long term. Addressing attachment difficulties of children who have experienced disrupted care is therefore vital. This paper reflects critically on the usefulness of eConnect, a trauma informed and attachment-based programme in such cases. It reports the interview-facilitated insights of 11 child and youth care workers (CYCW) from a care facility in Johannesburg, South Africa, who completed the eConnect programme in 2021. The first interviews were conducted in the last eConnect session (2021); follow-up interviews were done in 2022. The resulting insights allow evaluation of the contextual fit of eConnect for CYCW in SA and understanding of which programme aspects had enduring uptake. They nudge continued sensitivity to situational and cultural dynamics to optimize programme efficacy and best enable care workers.

IMPLICATIONS FOR PRACTICE

• Implications for practice: Scrutinize roleplays and training materials to ensure cultural translatability, inclusivity, and relevance for diverse caregiver backgrounds.

• Explore ways to integrate trauma-informed programmes into existing family support initiatives within residential care settings.

• Recognize challenges associated with online programme delivery in under-resourced contexts, such as technical difficulties and power outages.

• Tailoring a programmes delivery mode to local conditions enhances practicality and ensures the programme’s usefulness in real-world contexts.

KEYWORDS:

• Attachment
• evidence-based intervention
• child and youth care workers
• residential care
• South Africa

Children in residential care have been exposed to neglect, poverty, and abuse and are likely to have experienced relational trauma. Research points to a strong causal association between child trauma and attachment difficulties (Galvin et al., 2019; Murphy et al., 2017). Poor attachment increases children’s risk for a range of externalizing behaviors, with related negative consequences for the child in both the short and long term. Addressing attachment difficulties of children who have experienced trauma is therefore vital. For children in residential care, better outcomes are possible when they are exposed to caregivers who are physically, psychologically, and emotionally available to connect with them (Bailey et al., 2019). However, many caregivers working in residential care have minimal training on the impact of trauma or attachment behaviors. The way they care for the child may be influenced by their own parenting experiences or how they were parented. Inappropriate, harsh, or ineffective parenting type practices may exacerbate trauma.

Evidence-based, trauma-informed care has been shown to improve the overall well-being of children in care and contribute to placement stability (Murphy et al., 2017). In line with this, we piloted eConnect, a trauma-informed attachment-based intervention, with child and youth care workers (CYCWs) at one residential care facility in South Africa in 2021. Like its parent programme Connect (Bao & Moretti, 2023), eConnect is a ten-week programme aimed at the parent and/or caregivers of adolescents. We engaged with CYCWs approximately a year after they were trained on eConnect to explore their views on the programme’s value, specifically assessing its usefulness and contextual fit.

Children Exposed to Risk

South Africa has progressive and comprehensive legislative and policy frameworks that guarantee children’s socio-economic rights and protection from abuse, exploitation, and neglect (Savahl et al., 2014, 2015). Despite these measures, persistent historical and structural challenges, including racial inequality, poverty, violence and poor access to resources, compromise the development of South Africa’s children.

In South Africa, approximately 30% of children live below the food poverty line in households unable to meet their nutritional needs (May et al., 2020). Further, a staggering 99% have been exposed to or experienced violence, with two-thirds reporting exposure to community violence and more than half reporting exposure to violence in the home (Richter et al., 2018). The cumulative impact of exposure to poverty, food insecurity, violence, and neglect is likely to lead to stress and trauma (Tomlinson et al., 2021).

Research has established that exposure to trauma impacts the child’s social, emotional, physical, and neurological development, increasing the risk for adverse outcomes, such as difficulty learning, mental health challenges, and risk-taking behaviors (Felitti et al., 1998; Siegel, 2007; van der Kolk, 2007). Exposure to trauma may be more prevalent for children living in residential care/out-of-home care (Fraser et al., 2014; Murphy et al., 2017). Children living in residential care are likely to have experienced relational trauma (Bailey et al., 2019). As a result, they may be hypervigilant and reactive and may find it challenging to develop relationships (Farragher & Yanosy, 2005). Forced removal from home, multiple placements, and inconsistent caregiving compound experiences of trauma (Murphy et al., 2017).

Children in Care in South Africa

For children exposed to significant adversity, relational support is recognized as a significant enabler of resilience (Ungar, 2004; van Breda, 2017). Such support would typically be accessed from within the child’s immediate environment, that is, the family. For some children, however, the family cannot fulfill this role and may be directly responsible for children’s exposure to traumatic events. In circumstances where the family is unable, unwilling, or unfit to meet the child’s needs, alternate care options are necessary.

In South Africa, The Children’s Act 38 of 2005 sets out the minimum required to ensure children’s well-being, prevent abuse or neglect, and provide alternative care options for the care of children at risk. In terms of this Act [38 of 2005], children in need of care and protection are children that have been exploited, abused, neglected, abandoned or orphaned and have no means of support, children with difficult, uncontrollable behaviors, street living children, children with substance abuse addictions without means of support, children at risk, or who are exposed to or who live in circumstances which may seriously harm the child’s physical, mental or social well-being. The Children’s Act makes provision for children in these circumstances described above to be removed from the home and placed in kinship care, foster care, temporary safe care, or child and youth care centers (CYCCs).

Admission to CYCCs is often considered as a last resort. Information on the number of children living in care and the reasons for placement and duration is not easily accessible. Information obtained from a parliamentary hearing in 2021 suggests that there are approximately 16 313 children in care and currently 449 registered CYCCs; of these, 2 522 are registered as temporary safe care placements, 15 552 are residential care placements, and 912 are secure care placements (Parliamentary Monitoring Group, 2022). CYCCs are typically staffed by child and youth care workers (CYCWs). The majority of CYCWs hold a Further Education Training Certificate in Child and Youth Care Work (FETC: CYCW), which is equivalent to a National Qualification Level 4 or Grade 12 certification (National Association for Child Care workers, n.d.). CYCWs in South Africa, as in other parts of the world, are often marginally trained, work long hours with low pay and often have little access to information regarding how trauma impacts children. In their evaluation of trauma-informed interventions with caregivers in South Africa, Mathews et al. (2016) found that CYCWs’ services were hindered by a limited understanding of the impact of trauma on child development, as well as how to support traumatized children. The caregivers also faced challenges related to their own experiences of trauma, coupled with a lack of supervision and guidance. Consequently, they are likely to become involved in challenging situations with children in their care and may unintentionally reenact traumatic experiences (Farragher & Yanosy, 2005).

Amongst the many critiques leveled against residential care facilities is the perceived lack of individual attention given to children and limited opportunities for attachment to adults, the lack of understanding of children’s traumatic history and inability of care workers to adequately respond to these (Murphy et al., 2017). However, others like Islam and Fulcher (2022) and Whetten et al (2014) assert that there is insufficient evidence to suggest that all children in residential care are worse off than children in home, kin or foster care. Based on his research on institutional care in Bangladesh, Islam (2016) further suggests that some institutions may provide opportunities for children to develop multiple attachments, which may be beneficial in learning social skills and developing resilience.

The importance of a supportive adult for children exposed to adversity has also been emphasized in resilience research. Resilience researchers (Luthar et al., 2015; Masten & Barnes, 2018; Ungar, 2004) have consistently pointed out that one of the best ways to capacitate child and adolescent resilience is to capacitate their caregivers. Resilience studies in South Africa suggest that while the presence of a warm caregiver is an essential promotive and protective resource for youth exposed to adversity and living in stressed, poorly resourced communities, warm caregiving is not necessarily accessed from biological parents only and may include both kin, and/or non-relatives (Theron et al., 2022). The function of the parent and the residential care worker may, therefore, be similar, and trauma-informed, attachment-based parenting intervention programmes may also benefit care workers. Upskilling CYCWs is thus a priority. Approaches incorporating trauma-informed attachment theory may help care workers understand the experiences of children in care and equip them to respond sensitively and empathically (Pasalich et al., 2022). Mathews et al. (2016) assert that to better support children exposed to trauma, and in care, it is necessary to minimize children’s continuous exposure to risk or harm, as it is detrimental to the psychological well-being of traumatized children and undermines therapeutic support. This may be done through implementing contextually relevant, effective programmes, improving the capacity of those who work with children to identify and respond appropriately to continuous, complex and intergenerational trauma, and greater investment in effective family strengthening and parenting programmes.

Interventions aimed at parents and family systems are increasingly common in South Africa. The recognition that integrated, multi-level interventions are needed to ensure better child well-being outcomes has resulted in efforts to expand the loci of focus to include parents, families, and communities. The Sihleng’imisi family strengthening programme has shown promising resulting in various resource-poor communities, as has the Parenting for Long Life interventions (Lachman et al., 2022; Ross et al., 2020). Studies of parenting-type or attachment interventions aimed at foster parents of other caregivers (e.g., CYCWs) in South Africa are, however, limited. Studies conducted elsewhere have however shown that an attachment intervention that an attachment intervention – the Connect Programme – holds promise for foster parents and the adolescents they are caring for (Moretti et al., 2020).

The Connect Programme

Connect is an evidence-based, trauma-informed, attachment-based parenting intervention. The programme is a structured 10-week (1.5 hours weekly) manualized programme aimed at supporting parents and caregivers of adolescents to connect with teens (Moretti et al., 2020). The programme draws on existing evidence on adolescent development and mental health, attachment styles and parenting programmes (Moretti et al., 2012, 2015; Ozturk et al., 2019).

Two trained facilitators deliver the programme to a small group of parents/caregivers. During the weekly sessions, an attachment principle (e.g., “All behaviour has meaning” or “Conflict is part of attachment;” Moretti et al., 2020) is shared. The principles allow parents and caregivers to understand better the attachment issues that may be linked to difficult interactions with their child/ren. The programme includes role-plays, experiential exercises and reflections; through these techniques, parents and caregivers are guided to develop the skill of engaging mindfully, respectfully and empathetically with their adolescents. At the same time, these techniques support parents to regulate their own emotions and reactions (Moretti et al., 2015; Pasalich et al., 2021).

The efficacy of Connect is supported by a number of randomized clinical trials, wait-list, and nonrandomized implementation trials. It has been implemented in several countries and with diverse populations, including refugee populations (Osman et al., 2017). An adapted version was successfully implemented with parents of gender-diverse youth (Dangaltcheva et al., 2021). Amongst others, findings from these studies showed that participation in Connect improved caregiver ability to self-regulate and enhanced parent-child relationships (Moretti et al., 2012; Ranahan et al., 2021), resulting in significant reductions in adolescent depression and behavioral problems (Moretti & Obsuth, 2009), and decreased adolescent attachment insecurity and caregiver strain (Högström et al., 2017). An adapted version of the programme, implemented with foster parents in Canada, showed small to medium positive effects on caregiver well-being and youth behavior (Moretti et al., 2020). Similarly, implementation with kinship caregivers in Australia reduced caregiver strain and youth mental health challenges (Pasalich et al., 2021).

“In response to the COVID-19 pandemic, Connect was adapted for online use, giving rise to eConnect. Emerging evidence suggests that the online eConnect is similarly efficacious (Bao & Moretti, 2023). The contextual fit and perceived usefulness of both Connect and eConnect has yet to be established in a Global South/South African setting, including residential care settings.

The Current Study

The aim of this study was to explore CYCW’s experience of the eConnect programme in a residential care setting in South Africa. In particular, it considers CYCW’s views on the programme’s value (e.g., usefulness; limited usefulness) and contextual fit approximately one year after they had participated in the eConnect programme. Participating CYCWs’ immediate appraisal (July 2021) was highly favorable, but this could have been an artifact of the recency of the participation or their appreciation for support during COVID-related lockdown and associated limited opportunities to interact with others (Marshall et al., 2021). Understanding care workers’ personal experience of the programme’s value/lack thereof and contextual congruence over time is important to future iterations in South Africa and similar sub-Saharan contexts.

Methodology

To better understand CYCWs’ longer-term experience of the programme’s value/lack thereof and contextual congruence, we conducted a phenomenological study approximately one year after implementing the eConnect programme. As we are skeptical of concepts such as universal truth, we worked from an interpretivist stance (Green & Thorogood, 2004). To this end, we dialogued with CYCWs to make meaning of eConnect in the context of a residential child and youth care center (CYCC) in South Africa. Ethical approval for the study was obtained from the University of Pretoria, South Africa as well as from Simon Fraser University, Canada.

Study Context

The CYCC is based in an urban area east of Johannesburg, South Africa and was founded in 1992 in response to the substantial population of youth who were living on the street. The CYCC is a registered nonprofit organization (NPO) and has served as a home to over 5000 children since its establishment (Haffejee & Levine, 2020). As a NPO it receives partial funding from the state. In 2021, the CYCC provided care to 154 children. The age of children ranged from 4 to 20 years old, with a mean age of 14.4 years. The average length of stay for children at the CYCC in 2021 was 50.3 months. Reasons for placement in care included parental neglect and domestic violence (35%), poverty (20%), abuse (20%), uncontrollable behavior (18%), and living on the streets (8%). Of those in care in 2021, 36% were double orphans, 8% were maternal orphans, 30% paternal orphans, and 26% had both parents who were still alive.

Staff at the CYCC include social workers, administrators, cleaning and cooking staff and CYCWs. At the time of the intervention, 30 CYCWs were employed. These CYCWs worked on rotational shifts, with 16 CYCWs per shift during the day. This number is slightly under the government recommended staff:child ratio.

Like the rest of South Africa, the CYCC is subject to almost daily power cuts. Because of energy constraints, the national public power utility rations electricity using a system of “loadshedding” during which power to whole communities is cut off for a period of two to three hours. Depending on the severity of the energy constraint on a given day, power can be cut for up to six hours. In 2021, South African communities experienced more than 1100 hours of loadshedding (Steyn, 2021). Internet access and reliable internet connectivity are not the rule in South Africa (Mlaba, 2021). While South Africans living in more privileged neighborhoods or working in organizations that provide internet access/technology are familiar with virtual platforms and have fairly reliable access, others have little/no experience or access. Loadshedding further complicates internet access.

Participants

The CYCC was conveniently chosen by the first author (SH) as an implementation site for eConnect. SH has a long-standing working relationship with the CYCC and has provided psychological support services to youth at this CYCC for the past eight years. Information pertaining to the study was communicated to the director and managers at the CYCC. These individuals played a key role in identifying CYCWs for inclusion in the study. Selection criteria were based on the CYCWs’ job responsibilities at the CYCC, specifically their involvement in providing counseling, conducting educational workshops for youth, families, and community members, and their close work with children in care as care workers. Additionally, CYCWs within the organization who expressed an interest in participating were also considered for inclusion. Ultimately, a total of fifteen CYCWs actively participated in the eConnect training sessions in 2021 and subsequently applied their training with other staff members at the CYCC later in the same year. The training and the implementation of eConnect were virtual.

While all 15 CYCWs who participated in eConnect in 2021 were invited to participate in our follow-up phenomenological study, only 11 were available to do so. Of the eleven participants, three had professional degrees, one had a diploma, and the remaining staff had the basic qualification in childcare certification (FETC mentioned above). Eight participants self-identified as women and three as men. As summarized in Table 1, their experience of working in a CYCC ranged from 2 to 30 years. The majority spoke isiZulu or Sesotho and English.

Table 1. Participant demographics.

Name	Gender	Profession of participating CYCWs	Length of time in service in organization
Participant 1	Female	Life coach (diploma)	28 years
Participant 2	Female	Teacher	30 years
Participant 3	Male	Intern psychologist (psychology degree)	6 years
Participant 4	Male	Social worker	2 years
Participant 5	Female	Child and youth care worker	13 years
Participant 6	Female	Child and youth care worker	28 years
Participant 7	Male	Child and youth care worker	2years
Participant 8	Female	Child and youth care Worker	2 years
Participant 9	Female	Child and youth care worker	25 years
Participant 10	Female	Child and youth care worker	14 years
Participant 11	Female	Child and youth care worker	13 years

Data Generation and Documentation

Following participant consent, a trained research assistant (who was completing her internship as an educational psychologist and who could converse with the CYCWs in Sesotho, isiZulu and English) generated the data. To do so, she engaged each group of participants (see Table 1) in a focus group discussion. She prefaced these discussions with an invitation to participants to create a drawing or collage and then explain these in writing. These arts-based methods constituted a non-threatening approach that allowed time for participants to reflect and respond to a specific prompt (Backett-Milburn & McKie, 1999). In this way, participants were given an opportunity to recall and reflect on their experiences of eConnect.

The prompt used was “What is your greatest takeaway from the eConnect programme.” Thereafter, she engaged the groups in a semi-structured conversation that revolved around the following foci: aspects of eConnect that resonated most, and that resonated least, usefulness of programme for context, and aspects that worked and that needs to be changed. The conversations were recorded, translated (as necessary), and transcribed by a professional service. The research assistant verified the transcripts. She also scanned the drawings and collages and uploaded them to a password-protected google drive folder.

Analysis

Two authors (SH and LT) reviewed and analyzed the data independently and collaboratively, using inductive, reflexive thematic analysis (Braun & Clark, 2006, 2019). This approach to data analysis is reflexive, recursive and rigorous (Braun & Clarke, 2019), and entails deep immersion in data, the generation of initial codes, and later themes, reviewing the themes before finally defining and naming the themes. The generation of codes and themes is seen as a subjective and reflexive process influenced by the researchers. In this study, we used our positioning (experienced researchers and practitioners in the South African context) to interpret the data. Two questions guided this analysis:

1. How useful, or not, was the eConnect programme to South African CYCWs working in a residential care facility?

2. From the perspective of CYCWs, how well did eConnect programme fit the South African context?

Findings

As detailed next, there was general consensus regarding the programme’s usefulness, with care workers agreeing that the training was helpful to their caregiving work. They repeatedly noted that eConnect “helped a lot.” There was, however, more variance regarding the contextual fit of the programme.

“It Has Helped a lot” – Usefulness of eConnect programme

In general, the eConnect training was well-received by participating CYCWs. Across all three groups, participants provided positive feedback on the programme’s usefulness, commenting on the valuable lessons learnt and how these lessons positively impacted their caregiving. In fact, participants thought the eConnect programme was helpful enough that all care-workers should be exposed to it:

I’m able to distinguish from a care-worker who has attended eConnect and the one who has not … The approach is not the same … so I for one … I believe this [the eConnect programme] should be one of the models for all care-workers. (Participant 8)

In specific, participants appreciated the principles and skills that were part and parcel of eConnect. Each is detailed next.

Learning Principles of Attachment

Participants valued how the eConnect principles formed a meaningful whole. Participant 10 explained this as, “With all the principles that we did, I think one leads to the other.” Participant 2 said, “You know, there is just that link between one to the other one and this one. They just connect. All of them.” Likewise, in explaining a drawing that he made to show what stood out for him in the eConnect training (see Figure 1), Participant 7 drew attention to the interconnectedness of the eConnect principles:

Okay, my greatest take away was the conflict principle (Principle #3) … it taught people to understand one’s needs and feelings. So, from this drawing here she has a broken heart. Person X fights against Person Y and then after some time they get a better understanding of one another. Then it helped them to grow in the relationship. Now, there is a heart here [referring to drawing]. So, with this heart here it represents growth in the relationship. Due to what? To conflict, they now understand one another. Then when it comes to empathy, er I try tried to draw some shoes with different colours [referring to drawing] where putting oneself in … another person’s shoes. Then with that it balances the relationship, and it helps you understand the needs of other people. Then with that it helps you to grow in the relationship as well. Then you see there’s this heart with a smile [referring to drawing], erm, I tried to draw a sad smile but then [chuckles] it comes back to understanding and they get more attached. The bond now becomes solid.

Figure 1. Interconnectedness of eConnect Principles

Despite the appreciation for how the principles formed a helpful whole, it was interesting that 9 of the 11 participants (i.e., almost all) specifically referred to the value of learning that all behavior had meaning (Principle #1). For instance, when asked what stood out most for her about the usefulness of eConnect, Participant 2 answered: “So, I think the first principle: all behaviour has meaning. When I heard that, I was like wow!.” Similarly, Participant 8 said:

It has assisted me to learn more about what the behavior of the child is saying to me. And, it is such a, uhm, rewarding feeling to understand your child. It’s really rewarding to know what the child is saying to you without saying it.

Understanding that all behavior has meaning had a ripple effect on how the participants interacted with the children in their care. As also shown in Figure 2, it typically encouraged participants to be more patient and empathic. For example, Participant 6 shared how her behavior changed. Where previously she didn’t allow for discussion, or an explanation, now she sought to understand the behavior, before reacting.

Figure 2. All behaviour has meaning

I used to – when I heard that maybe there’s an incident about one child – when I heard about that, I would call that child and [snaps finger repeatedly] and give them, give them and give them [referring to use harsh words or a reprimand]. But lately, I just call them just to find out, “Why did you do that?”

Another care worker also spoke to learning the value of trying to understand the child’s actions. She said:

Behavior is a way that I can understand a child. That when a child behaves like this, I should ask myself what causes that, what the child wants. So, as an adult I need to sit down with a child and try to understand … not expect the child will just come and tell me that, “ABC” … because sometimes we tend to say, “You’re naughty, you’re naughty!” not knowing that there is something that bothers the child. (Participant 9)

The participants were keen to share their learning that all behavior has meaning with colleagues who had not been part of the eConnect training and with parents in the communities that they came from and/or did outreach work in. For instance, Participant 4 said:

For me … that awareness not to take anything for granted, especially the first principle that all behaviour has meaning. So, we use that a lot … we give a lot of psychosocial support to the parents in the communities who have conflict with their children. So, at least we are able to draw from that [first principle] and just give them those tools to say, “No, look at this” … it brought a lot of awareness and we’re taking that to the communities.

In the section below, participants expand on the practical skills they developed and the additional tools they now had at their disposal.

Developing Practical Connection Skills

Participant 1, who has been working in a care facility for over 25 years, remarked that due to its comprehensive guidelines, clearly delineated steps, and practical activities, eConnect stood out for her. In particular, she valued that it provided enabling skills or tools:

This is probably the most relevant training that I’ve ever had in all the years of being at X and all the trainings we’ve had. You may be in certain trainings, it sounds good … the training stops where it should start. They always tell you all the things, they unpack everything which actually we kind of know and then they leave you hanging. Whereas this one took you to the next step and said okay now how- what does this look like. The whole pace for me was really wonderful because it made it real. It gave me real life things to say, how could we do it. … . Didn’t have a Hollywood moment, it didn’t have a teen saying, “I love you, you’re the best mom!” Instead, like, “I still don’t wanna talk to you.” But [with the skills they gave us] we have made that little space … better. And that for me is so real you know … in other trainings … they didn’t give you the tools.

Many participants highlighted that learning to pause and contemplate their reactions and understanding the reasons behind their responses was valuable. This practice proved beneficial as it effectively diffused conflicts and promoted more empathetic and empowering interactions with the children in care. In this regard, participants shared:

Sometimes, you feel like you need to scream at the child. But … before you do that you think of the ways of talking to a child and then you fix yourself … you talk nicely knowing that inside you are boiling. (Participant 6)

So, I think the reflecting part for me just stood out. It has even made the way you communicate with the children to be better, the way you do things to be better, you always wanna do better because you can understand really what the child feels at that time. (Participant 11)

Because you are not reflecting and, yoh yoh yoh yoh [exclamations], you see what this child had done … you feel like going through the roof and you discipline right there without reflecting. Then, things might just fall apart right there because you would be using emotions instead of being intentional … So, when you realize that, yoh [exclamation], my emotions are up there, take a step back and reflect … that’s helping me to help the child, yes. (Participant 10)

Just taking the time to step back and reflect before I react … realizing how my feelings and thoughts affect how I react and may cause more discord. And, just giving myself the platform to step back and not have a solution straight away. For me that was the biggest takeaway from this training. (Participant 2)

Some participants were especially grateful that eConnect taught them to reflect on what they had been like as children and to use the resulting insights to be less judgmental. To that end, Participant 9 reflected:

That’s how eConnect works and at the end of the day it helps because we tend to forget that we were once younger … it takes you back again that you need to know that you were once the same … maybe this child you think is naughty is better than you. Maybe you were worse.

For some participants, the skill of reflecting was not necessarily a new one. For them, eConnect was helpful because it reminded them of the importance of reflecting and becoming more intentional about it. For instance, Participant 5 said, “some of these things, we do them every day, but without being aware … [so] it’s an eye opener.” Likewise, Participant 11 said: “I don’t think that we were not doing them, we were doing them but I can say … now there’s a structure.”

The knowledge and practical skill gained by participants was supported in their wish to have the programme extended to others within their networks and to the wider community.

Sharing the Benefits

Recognizing the value of eConnect, participants expressed a desire for broader accessibility to the training. Specifically, they recommended extending it to other staff within their CYCC, child and youth care workers in government institutions, and parents in the community. For instance, Participant 6 said:

I wanted to say this, I think we are very much fortunate. Us to attend this training and then after I attended neh [colloquil for yes], I thought about the parents of the children that we’re working with, that if they can get er training like this and that will prevent some of the children coming to shelters and stuff like that.

Similarly, Participant 4 raised the need for working in communities, where parents are challenged in their relationships with their teenagers, saying, “if it [eConnect] can reach a wider audience, it can definitely make a difference.” Speaking of the need to extend to other childcare organizations, Participant 10 added: “especially the government centers, if the eConnect can be taken there and the childcare workers there be trained more.”

Limited Contextual Fit

While the participants were unanimous in their appreciation of the usefulness of eConnect, some questioned alignment with traditional African ways of parenting. Others raised concerns regarding the online delivery mode in a context with inconsistent access to power.

Limited Alignment with African Values

There was some discussion among participants about the traditional African valuing of interdependence. Interdependent ways-of-being conceptualise an individual as a part of a greater whole; young people are socialised to interact respectfully with that greater whole and to accept that they have a duty to the collective (Ratele, 2021). To that end, Participant 5 reminded the group about “Ubuntu. How to live with people: you can never be an island and you are never alone.” In this regard, participants reflected that understanding teen meltdowns and stepping back before responding angrily might not necessarily be understood, or sanctioned, by traditional African parenting norms. The traditional expectation would be for parenting that prompted adolescent compliance.

To improve clarity, please change this sentence to: Relatedly, some participants indicated that the role plays did not consistently align with the interdependent cultural values and traditional expectations of children’s behavior. Further, they believed that in many traditional communities, children and teenagers would not be given spaces to express their feelings and speaking out would be seen as disrespectful. In the light of this, some of the roleplays were difficult for some of the participants to identify with and learn from. This was especially true for older, more traditional male care workers who participated in eConnect. For instance, Participant 2 said:

That’s [roleplay] exactly what teenagers would say and do and how they would react. And I think, ‘Culturally, it’s not okay for a teen to be behaving like this.’ … culturally it would be, ‘Oh you’ve got no control over your house and over your children when they behaved this badly.’ So, you would be shamed for a child that’s just being a teen.

While Participant 1 also reflected on her discomfort at some of the roleplays, she noted that it enabled her to think about the range of ways in which young people may express their needs,

I think it was hard for me too, to have a child that outspoken, especially session after session, it felt tiring being the parent. Yes, the staff were saying culturally it would not be allowed. But in the second session when we looked at their attachment needs as teens it brought all of us a bit closer to [the] range of emotions that teens go through.‘All behaviour has meaning’ is a gem, I use it all the time to get beyond being judgmental with teens.

Some participants remarked on the fact that eConnect was developed by international researchers and not South Africans. The implication was that local researchers might have been disinclined to script roleplays that were culturally dissonant. A suggestion was made that South African researchers, with an understanding of the context and the unique problems facing South Africa, as well as what is culturally valued, are needed to develop solutions. To this end, Participant 9 suggested: “Like if, let’s say, she’s a researcher living in that community, she knows exactly. She can have a better idea that actually where did we go wrong, or those people, where did they go wrong.”

Still, there was some appreciation for how the perceived misalignment with the South African context and culture may be potentially enabling of care workers. This related to the way in which the programme challenged the ways in which participants had been socialized to view children. During eConnect, it dawned on them that these traditional views were perhaps obstructive to connecting with the teenagers they were caring for. More importantly, perhaps, it gave them the courage to consider questioning these views. As Participant 2 said, “You know, I think it allowed us to challenge our own stories of what children or teens should be doing and how they should be behaving.”

The Challenges of a Virtual Platform

Not surprisingly, participants appeared to be divided regarding the virtual training platform on which they were engaged. For many, issues of competence with digital platforms, erratic connectivity, and unfamiliarity with virtual learning platforms emerged as key challenges. For example, Participant 9 noted that concentrating while online was sometimes challenging, saying “You are there, but not fully.” This same participant also alluded to the fatigue related to having so many activities taking place online, saying “Yah [yes], because Zoom was just too much.”

In particular, disrupted connectivity and electricity meant that roleplays were hard to follow. For instance, Participant 1 said, “The internet connection, it wasn’t right. So, we had those typical issues which puts you a little off … breaks up and when you are on a roleplay, suddenly the internet goes.” As the impact of the power cut extended over a wide geographical area encompassing all participants’ locations, whenever there was a power outage the training sessions came to a halt and was later resumed.

Discussion

The trauma informed Connect attachment programme directed at caregivers has proven to be effective across a range of settings, with diverse populations, including foster and kinship carers (Moretti at al., 2020; Pasalich et al., 2021). Although it has been successfully implemented with Somali immigrants in Sweden, it has not been used in an African/Sub Saharan context. In this study, we share findings based on the first ever pilot of the online Connect programme, eConnect, in South Africa. We were particularly interested in CYCW’s perceptions of the usefulness and contextual fit of the programme over time. To that end, one year after they had participated in the programme, we conducted focus group discussions with 11 eConnect participants working in a residential care facility.

Consistent with findings from a study with kinship carers who rated the Connect programme positively and reported high levels of satisfaction (Pasalich et al., 2021), participants in this study also viewed the programme favorably, reporting that the training they received – specifically the principles and skills learnt – allowed them to have greater insight into the behaviors of children in care. As in the Pasalich et al. (2022) study where a reduction in caregiver strain and aggression was noted, CYCWs in our study also reported that the training they received enabled them to be less reactive when dealing with children and allowed them to explore alternate ways of engaging. New ways of engaging included greater empathy, a willingness to listen to the child, and the ability to step back and reflect on the event, the child’s behavior and their own behavior. As Ranahan et al. (2021) note, this process of effective emotional regulation and stepping back results in a reduction in feelings of caregiver insecurity in the relationship. “As all change occurs in the context of a relationship, shifts in the parents” story opens the door to transforming the youth’s story as well’ (Ranahan et al., 2021, p. 129).

Research suggests that implementing culturally and contextually relevant intervention programmes ensures greater acceptability and overall effectiveness (Castro et al., 2010). In particular, CYCWs encountered challenges related to the cultural accessibility of roleplays. Some participants, particularly those with more traditional and conservative views, found it difficult to connect with the behaviors portrayed by the children in the roleplays. Expressing dissent and challenging adult authority, as depicted in the roleplays, is deemed unacceptable in traditional African culture, where high regard for elders is deeply ingrained. This finding resonates with findings from Lachman et al.’s (2016) study that emphasized the necessity of developing and implementing culturally appropriate parenting interventions. Lachman and colleagues (2016) found that participating parents emphasized the need for programmes to include aspects of intlonipho (respect) and social responsibility.

Ensuring that programmes are culturally suitable and respectful of community values is crucial. Equally important however, when working from a trauma-informed approach, is recognizing the necessity of understanding the needs of the child, even when those needs are expressed through behavior that may initially appear inappropriate. Training programmes should therefore address generational or cultural misalignment in ways that are respectful yet promote effective communication and greater connection. Recognizing the evolving needs of young people, trauma informed training programmes play a crucial role in challenging and educating CYCWs, and parents, about the diverse and complex aspects of youth experiences.

In implementing any programme, it is also essential that we remain cognizant of structural and socio-economic conditions that impact on institutions, caregivers and children. As such it would be prudent to explore ways in which to integrate the programme into existing family support initiatives in South Africa. Likewise, Kumpfer et al. (2008) note that adaptations to evidence-based programmes should be a considered process. Lachman et al. (2016) concur noting that programmes may be tailored to a specific population, but still grounded in theory-driven behavioral change techniques that preserve the underlying function of evidence-based parenting programmes. Connect is designed to be flexible to cultural and contextual modifications that increase the fit and relevance of programme content, while retaining the programme’s central focus on promoting caregiver’s regulation of their own emotions and increasing their sensitivity and responsibility to the child. In their adaptation of Connect, Osman et al.’s (2017) Ladnaan parenting intervention with Somali immigrants living in Sweden, included culturally tailored societal information, and culturally relevant metaphors, images and stories, which they combined with the evidence-based and tested Connect programme. In Canada, the programme has also been re-envisioned by Indigenous Elders, knowledge holders and parents who created Reclaiming Connections (McComb et al., 2018) to capture traditional practices and beliefs of interconnectedness with others, the land and ancestors, that guide wise parenting practices. Any adaption we consider would draw on these lessons.

The online delivery of the programme elicited a mixed response; while the convenience of an online platform was appreciated, the technical difficulties caused by interruptions in power, and lack of familiarity with the Zoom platform caused some frustrations. It should be noted that in 2021, the country saw close to a 40% increase in power outages as compared to 2020, with a total of 1 169 hours without electricity (Council for Scientific and Industrial Research [CSIR], 2021). This undoubtedly impacted negatively on the implementation of the programme, as well as the experience of it. Notwithstanding this, an online platform has the potential to reach more families, and for some may be more convenient (Bao & Moretti, 2023). In South Africa, this would need to be weighed against digital literacy, access as well as connectivity issues. Given South Africa’s continuing challenges with power outages and the limited access to digital technology for a large percentage of the population, implementation of the Connect, in person programme should be considered and assessed to determine usefulness and uptake. One response to the CYCWs’ calls for the attachment programme to be made widely available, is to explore hybrid options.

Our study, which was the first to explore the usefulness of eConnect in an African context, provides useful insights for next steps. Still, it is important to recognize that our study was exploratory and, relatedly, limited to a small sample of CYCWs. A mixed method study, with a larger and more diverse sample, may provide greater insights into the usefulness of the programme. In this follow-up study, it would be useful to expand the current focus on caregivers’ impressions to include those of the adolescents they care for. This would significantly enhance our understanding of the effectiveness of the programme in a South African context.

Conclusion

In resource-constrained, inequitable contexts like South Africa, adolescents will continue to be exposed to experiences that challenge their capacity to connect with adult caregivers. In the absence of strong bonds with enabling adult caregivers, adolescent resilience cannot flourish. Consequently, it is imperative to support caregivers – including CYCWs – to form meaningful attachments with the young people that they care for. To that end, refinement of the eConnect programme, with particular attention to its contextual fit, is an important next step.

Authorship Contribution

Sadiyya Haffejee: Conceptualization, methodology, data gathering, data analysis, write-up

Linda Theron: Conceptualization, methodology, data analysis, write-up

Marlene Moretti: Funding acquisition, conceptualization, write-up.

Acknowledgments

We are grateful to the NGO who participated in this pilot intervention and the staff that gave of their time and resources. This research was funded by the Canadian Institutes of Health Research (CIHR).

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Canadian Institutes of Health Research.