Haitian Children’s Disaster Trauma – Comprehensive Study Notes

Context and Rationale

  • 2010 Haiti earthquake occurred in an already fragile sociopolitical context (rape, gangs, corrupt police, political rivalries, limited public sector capacity, health inequity).

  • Children face continuous trauma—ongoing, realistic threats (poverty, violence, natural disasters, disease outbreaks).

  • Existing mental–health response: short-term crisis teams (Red Cross, Médecins Sans Frontières) but no systematic assessment for long-term interventions.

  • APA (2017) & Nicolas et al. (2012) call for culturally informed tools that respect communalism, spirituality, social roles, and African‐Caribbean history.

House-Tree-Person (HTP) Test and Its Cultural Adaptation

  • Classic projective drawing test (Buck, 1948/1981) – children draw a house, a tree, and a person.

  • Interpretation assumptions:
    • House → home/family relations
    • Tree → environmental & interpersonal relations
    • Person → self-concept, personality, social attitudes.

  • Limitations of standard HTP: sparse quantitative validation, culture-bound scoring, mixed reliability results.

  • Adaptation steps for Haiti (Roysircar et al., 2017):
    • Integrated Afrocentric criteria (Asante, 2007) – focus on personhood, communal location, African spirituality, linguistic fairness (Créole).
    • Added Haitian contextual symbols: tents, decorative doors, open windows, tropical fruits, palm fronds, banana leaves, communal activities, bright clothing.
    • Two overarching indices scored dichotomously (present = 1 / absent = 0):
    – Resilience (11 indicators) – e.g., lush foliage, dominant tree, clothing, open arms.
    – Vulnerability (15 indicators) – e.g., bare tree, missing body parts, sad look, exposed genitals.
    • Objective scoring manual in Appendix (see 26 items).

  • Prior pilot (2012): κ<em>Res=.91\kappa<em>{Res}= .91, κ</em>Vul=.80\kappa</em>{Vul}= .80, α<em>Res=.87\alpha<em>{Res}= .87, α</em>Vul=.77\alpha</em>{Vul}= .77.

Study Objectives and Research Questions

  1. Quantify rater error and demographic influences on HTP scores (Generalizability Theory).

  2. Uncover latent dimensions of the adapted HTP (Exploratory Factor Analysis, EFA).

  3. Examine internal consistency of all measures.

  4. Test convergent, divergent, discriminant validity among HTP factors, self-esteem, PTSD symptoms, self-concept.

  5. Determine if pictorial factors reflect the Haitian diunital worldview of suffering ↔ endurance.

Methodology

Participants (N = 88)

  • Sex: 45 girls, 43 boys.

  • Age groups: 3-5 yr (9), 6-8 yr (30), 9-11 yr (35), 12-14 yr (14); xˉage=9\bar x_{age}=9 yr.

  • Settings:
    • Blanchard (34) – mixed housing, tent cities.
    • Damien (12) – former pig farm, now relocation village.
    • Canaan (26) – barren hillside camp, limited resources.
    • The Providence orphanage (16).

Measures

  • HTP Drawing Test – 26 scored items → summed Resilience and Vulnerability.

  • Hare Area-Specific Self-Esteem Scale (HSS) – 20 items (peer & family); 1:31{:}3 Likert.

  • Child Report of Post-Traumatic Symptoms (CROPS) – 25 items; PTSD spectrum last 7 days.

  • Child Self-Concept Scale (SCS) – 21 adjective items; positive attributes.

Translation & Administration

  • Forward & back translation to Créole by two Haitian-American teachers; verified by local lay helpers and medical staff.

  • Group HTP administration (15 min/drawing) with crayons; no post-drawing inquiry (translators not clinicians).

  • Individual oral surveys read by trained translators; 30 min per child.

  • Cultural etiquette: children arrived well-dressed; refreshments & games during waiting periods.

Rater Training & Scoring

  • 4 expert raters (White US) from 2012 pilot + 6 novice raters (African-, Caribbean-, and Euro-American).

  • 6-hour scoring workshop; drawings rated in fixed order (House → Tree → Person).

  • Dichotomous scoring; multiple occurrences counted once per item.

Data Handling & Analyses

  • Listwise deletion: final n = 75 (85%) for correlational work; all 88 used for HTP reliability.

  • Standardization: all scale totals → z=(x−μ)/σz = (x-\mu)/\sigma.

  • Reliability: Cronbach α\alpha for each scale.

  • Generalizability analysis: facets = rater (10), HTP (2), child; sub-analyses by sex, age, site.

  • EFA: Principal Axis Factoring; Bartlett \chi^2(325)=1275.6, p<.001; KMO =.77.
    • Parallel Analysis, Scree, VSS, Optimal Coordinate → 3-factor solution.
    • Varimax rotation; factor loading cutoff ∣.30∣|.30|.

  • Correlations: Pearson rr among latent factors and interview scales.

Results

Descriptive & Reliability

  • Mean standardized scale scores:
    • HSS zˉ=0\bar z = 0, SD =1=1 (raw M=35.30,SD=5.55M=35.30, SD=5.55).
    • HTP zˉ=0\bar z = 0, SD =1=1 (raw M=4.78,SD=1.15M=4.78, SD=1.15).

  • Internal consistency:
    • α<em>HTP Res=.85\alpha<em>{HTP\ Res}= .85 • α</em>HTP Vul=.75\alpha</em>{HTP\ Vul}= .75
    • α<em>HSS=.69\alpha<em>{HSS}= .69 • α</em>CROPS=.69\alpha</em>{CROPS}= .69
    • αSCS=.92\alpha_{SCS}= .92.

Generalizability Findings (n = 34 subsample)

  • Rater facet explained (<1\%) of variance – novice ≃ expert.

  • HTP facet (Resilience + Vulnerability) largest variance component (≈12%12\% overall).

  • Minor demographic effects:
    • Boys vs. girls – small variance difference.
    • Younger (5-9) children – more unexplained variance (drawing skill developmental).
    • Orphanage & older group (10-14) – higher HTP variance (richer drawings).

  • Conclusion: scoring system stable across raters and subgroups.

Exploratory Factor Analysis (n = 85, 22 items retained)

Factor

Eigenvalue

Var.%

Items (examples)

α\alpha

1 Resilience–Vulnerability Integrated

λ1=7.76\lambda_1 =7.76

29.9%29.9\%

lush foliage, dominant tree, accessible house; (negatively weighted) bare tree, missing body parts

.82

2 House Feeling Safe

λ2=2.68\lambda_2 =2.68

10.3%10.3\%

nurturing house, many windows, environmental detail

.86

3 Person Feeling Unloved

λ3=2.43\lambda_3 =2.43

9.4%9.4\%

no mouth, no arms/feet, non-human, small figure

.79

Total variance explained =49.5%=49.5\%.

Correlations (N = 75–88)

  • Factor relationships:
    • r<em>F1,F2=+.45</em><strong><em>r<em>{F1,F2}=+.45^{</em><strong><em>} • r</em>F1,F3=−.63</strong>r</em>{F1,F3}= -.63^{</strong>}
    • rF2,F3=−.42∗∗r_{F2,F3}= -.42^{**}

  • Convergent validity: HSS ↔ SCS r=.70∗∗r=.70^{**}.

  • Divergent trends:
    • F1 (integration) ↔ CROPS r=−.24<em>r=-.24^{<em>} (more balance → fewer PTSD symptoms). • SCS ↔ CROPS r=−.24</em>r=-.24^{</em>} (better self-concept → fewer symptoms).

  • Discriminant: HSS low correlations with all three pictorial factors.

Discussion & Implications

  • Diunital worldview: Haitian spirituality (Vodou & Christianity) frames life as a balance of opposites; Factor 1 embodies simultaneous resilience and vulnerability.

  • Home as sanctuary: despite societal chaos, children draw secure, detailed houses (Factor 2) – mirrors communal reliance and spiritual protection.

  • Personal alienation: Person-Feeling-Unloved (Factor 3) captures self-alienation from cumulative traumas (poverty, orphanhood, displacement).

  • Comparisons: similar damaged‐self indicators in South African, Israeli, Chinese, Sri Lankan disaster studies, but Haitian drawings uniquely integrate positive & negative symbols.

  • Clinical utility: 3-factor, 22-item HTP offers rapid, low-literacy screening for resilience / risk; high inter-rater reliability and cultural sensitivity.

  • Program development: findings inform resilience-building curricula (arts, music, faith practices) and trauma-focused counseling at NGO clinics.

Limitations & Future Directions

  • Non-probability sample, modest N; replication with larger, rural cohorts needed.

  • Cross-sectional; longitudinal follow-up could map trajectories (Infurna & Luthar, 2017).

  • Potential translation nuance losses; future work with professional Créole linguists.

  • Absence of diagnostic interviews; integrate structured PTSD interviews for criterion validity.

  • Expand CBPR involvement – community feedback loops, shared data ownership.

Ethical, Philosophical & Practical Notes

  • Informed consent/assent in Créole; thumb-print option for illiterate guardians.

  • Translators trained in confidentiality, non-stigmatizing language, and avoidance of personal anecdotes.

  • Proverbs teaching stoicism (e.g., “Le ou pa jwenn manman ou, tete grann” – "When you lack a mother, nurse from your grandmother") frame children’s resilience narratives.

  • NGOs must avoid "orphanage tourism" stereotypes; prioritize empowerment over pity.

Key Numerical Reminders

  • Reliability thresholds: acceptable α≥.70\alpha \ge .70.

  • Generalizability: variance due to HTP ≈ 12%12\%; rater variance < 1%1\%.

  • Factor eigenvalues: \lambda1 > 7, λ</em>2≈2.7\lambda</em>2 \approx 2.7, λ3≈2.4\lambda_3 \approx 2.4.

  • Significant correlations: |r|>.30 (moderate), |r|>.50 (large).

  • Listwise deletion retained 85%85\% usable cases.

Study Take-Aways for Exam

  • Know the 3 latent factors and their cultural meanings.

  • HTP scoring: dichotomous, 26 items; be able to list key resilience vs. vulnerability indicators.

  • Validity evidence: internal consistency, inter-rater reliability, generalizability, EFA, correlational patterns.

  • Cultural adaptation principles: Afrocentric lens, communalism, spirituality, local language, CBPR.

  • Critical reflection: importance of balancing quantitative rigor with respect for indigenous worldviews and social justice.