A Descriptive Study to Assess the Selected Psychosocial Problems Among Street Children in Foster Homes at Tumkur, Karnataka, India

Background: Street life is always challenge for survival not only for adults but very difficult for children. They live within the city but are unable to take advantage of the comforts of urban life. Nurses have a major role in addressing this issue. This study focused primarily on access to health and education in street children from different age groups in Thumkur District, Karnataka, India. Methods: A survey was conducted on 326 children (aged 4-17 yrs) residing in home-based foster care between Aug 2004 to Jan 2006 in Tumkur, Karnataka, India. Statistics: Percentage was calculated to know the difference. Results: Majority of the samples were from rural area with 68 (68%) participants and remaining 32 (32%) were from urban area. 30 (30%) were Hindus, 60 (60%) were Christians, 10 (10%) were Muslim and from other religious caste. Among 100 street children, 12 (12%) were in the age group of 6 and 8 years, 14 (14%) were in the age group of 7 and 12 years, whereas, 17 (17%) were in the age group of 9 years, 22 (22%) were in the age group of 10 years and 10 (10%) were in the age group of 11 years. Based on the family system of 100 street children, 60 (60%) were from nuclear families, 32 (32%) were from joint families and 8 (8%) were from extended families. Majority of the samples were rarely absent to school with 15 (15%) participants, 12(12%) were often absent to school, 8 (8%) were absent very often to school and remaining 65 (65%) were regular to school. The other parameters considered were no. of children in the family, birth order of the child, preschool learning, marks percentage, problems with isolation. Conclusion: As nurses have a major role in addressing this issue, there should be trained in planning and implementing all the basic need a street child needs and work in association with government and NGO’s.


Introduction
The enormous problems faced by the street children in the last several years were stated by different scholars in different times and topic of diverse philosophy. Street children faces tremendous problems which has been seen in last few years which has been observed by research scholars at different times and also with diverse philosophy related to particular topic [1,2].
The problems of street children show a wide dispersion in terms of psychological, physical and sexual abuses and unfortunately, they were not included in society programme [3].
Children living in certain pockets of the society termed as social epi-centres undergo various traumas in life such as poverty, abuse, discrimination, stigma and isolation that affect their psychosocial development [4]. The higher stress experienced by the children interferes with their day-to-day life and results in various behavioural problems that are mostly antisocial in nature, which is reported more among boys [4].
Poverty is known directly or indirectly to force children toward streets. A multitude of causes, such as alcoholism, family violence, non-fulfillment of basic needs, hunger, and familial issues, in pushing the children "on the streets" and sometimes "of the street" [5].
The type of work or occupation is an important factor to analyze the mental health of an individual. The results highlight the children those who were engaged in begging and rag picking are more prone to psychosocial problems. The existing literature argues that working children are at high risk of physical, emotional and sexual abuse at work place [6].
Street children belonging to Latin American and Asian countries and more specifically the African country is more affected than any other part of the world, although this issue is a global one with more percentage seen in developing countries [7]. Migration shows a major role in the context of street children especially in Asia [1,8]. Literature review reveled that social intervention has a positive role in addressing the problems of street children along with NGO's [9]. Supportive housing offers a timely, but underused opportunity to address the significant psychosocial needs of formerly homeless children through prevention and treatment [10]. Strategies including effective Psychological support, parent redirection to their responsibility and the fight against family/domestic violence would be helpful in facing the problem of street children. More effort to satisfy the children's basic needs as well as the effective support for their studies may be possible solutions to successfully address the persisting phenomenon of street children. It also would be good to provide parents with training on effective children upbringing in the areas such as the effectiveness of parental affection and in terms of guidance for children [11].
As children living on street live without responsible adult's supervision and face many problems they are more likely to face psychosocial distress. The situation and needs of the children living on street not adequately understood. Therefore, it is necessary to understand symptoms of distress among children living on street. Keeping these facts in mind, the following study was undertaken.

Research design
Descriptive research design was adopted for the present study.

Dependent variable
Psychosocial problems faced by the street children in foster homes.

Demographic variable
Age, religion, domicile, family system, number of children in the family, birth order of the child, preschool learning, school absenteeism and percentage in last exam.

Sample
The sample size of the present study consists of 100 street children residing in selected study settings.

Research hypotheses
H1: There will be a significant association between selected demographic variables and the rating scores for the selected psychosocial problems.

Sampling technique
In the present study purposive sampling technique was adopted to select the sample.

Selection and development of the tool
After an extensive review of literature, discussion with the experts and the investigator's personal experience a Structured 3-Point Rating Scale on Psychosocial problems was developed. Structured questionnaire which consist of 2 parts.
Part-I: It consist of 9 items related to demographic data which includes age, religion, domicile, family system, number of children in the family, birth order of the child, preschool learning, school absenteeism and percentage in last exam.

Part-II:
It is again divided into 2 sections which are related to the psychosocial problems. Severe: 50% and below.

Results and Discussion
India is in second place among country in the world not only in terms population but also in terms of large child population especially the street children are increasing day by day. In our study, we found that among 100 street children, 12 (12%) were in the age group of 6 to 8 years, 14 (14%) were in the age group of 7 to 12 years, whereas, 17 (17%) were in the age group of 9 years, 22 (22%) were in the age group of 10 years and 10 (10%) were in the age group of 11 years ( Table 1). This age group has given the result that majority of the children belong to age group 10 years. In case of religion wise category, about 30 (30%) were Hindus, 60 (60%) were Christians, 10 (10%) were Muslim and from other religious caste showing the vulnerability of the children towards on particular community which needs to be addressed very seriously. Majority of the samples were from rural area with 68 (68%) participants and remaining 32 (32%) were from urban area which indicates the seriousness of the importance to be given to rural area more vigorously ( Table 1). Based on the family system of 100 street children, 60 (60%) were from nuclear families, 32 (32%) were from joint families and 8 (8%) were from extended families ( Table 1). This result shows the trends in change of family type due to lack of unity in family. Regarding number of children in the family, 5 (5%) of them were single child, 15 (15%) of them were having one sibling, 32 (32%) were 3 as children in their family and 48 (48%) were more than 4 children in their family ( Table 1). This result had shown that lesser the number, more is the importance to child than increase in number of children which results in lack of specific care to particular child. Regarding birth order of the child, 76 (76%) of them were first child, 24 (24%) of them were second child and none of them were third or the fourth child ( Table 1).   This result has given the impression of the current status of the child in this particular district and which may differ compared to different district in our state and different district belonging to different states of the India. Regarding preschool learning, 8 (8%) of them had went to nursery, 28 (28%) of them had went to Anganwadi, 5 (5%) had went to day care and 59 (59%) had attended none ( Table 2).
Majority of the samples were rarely absent to school with 15 (15%) participants, 12 (12%) were often absent to school, 8 (8%) were absent very often to school and remaining 65 (65%) were regular to school ( Table 3).
This data tells us the current education system importance in terms of street children in this selected district. Majority of the samples 56 (56%) were having more than 75%, in their last exam 32 (32%) were having 60-75%, 8 (8%) were having less than 60% and remaining 4 (4%) were having less than 35% ( Table 4). This data suggest that majority of children are quite intelligent but lack support from family members which may be due to poverty or any other family disputes.

Mild problems with isolation 30
Moderate problems with isolation 32 Severe problems with isolation 38 Mild problems with fearfulness 6 Moderate problems with fearfulness 12 Severe problems with fearfulness 82 Mild problems with tendency to run away 62 Moderate problems with tendency to run away 20 Severe problems with tendency to run away 18 Mild problems with violence 02 Moderate problems with violence 78 Severe problems with violence 20 Mild problems with stage fear 25 Moderate problems with stage fear 67 Severe problems with stage fear 08 Mild problems with sportsmanship 58 Moderate problems with sportsmanship 36 Severe problems with sportsmanship 06 Mild problems with social isolation 68 Moderate problems with social isolation 25 Severe problems with social isolation 07 Mild problems with disobedience 72 Moderate problems with disobedience 26 Severe problems with disobedience 02 In terms of various problems, we found that, out of 100 street children: only 30 (30%) subjects had mild problems with isolation, 32 (32%) had moderate problems and 38 (38%) of the samples had severe problems. Only 6 (6%) subjects had mild problems with fearfulness, 12 (12%) had moderate problems and 82 (82%) of the samples had severe problems. Only 62 (62%) subjects had mild problems with tendency to run away, 20 (20%) had moderate problems and 18 (18%) of the samples had severe problems. Only 2 (2%) subjects had mild problems with violence, 78 (78%) had moderate problems and 20 (20%) of the samples had severe problems. Only 25 (25%) subjects had mild problems with stage fear, 67 (67%) had moderate problems and 8 (8%) of the samples had severe problems. Only 58 (58%) subjects had mild problems with sportsmanship, 36 (36%) had moderate problems and 6 (6%) of the samples had severe problems. Only 68 (68%) subjects had mild problems with social isolation, 25 (25%) had moderate problems and 7 (7%) of the samples had severe problems. Only 72 (72%) subjects had mild problems with disobedience, 26 (26%) had moderate problems and 2 (2%) of the samples had severe problems ( Table 5). This results clearly indicates the various problems faced by these children. All the other socio-demographic variables such as religion, family system, domicile, no. of children in the family, birth order of the child, preschool learning, school absenteeism and percentage in last exam had significant association and age had no significant with Psychosocial problems of street children in foster homes.
The findings of the study have been discussed with reference to the objectives and hypothesis. According to the hypothesis of the study the investigator found that there is a significant association between the knowledge scores with selected demographic variables. Hence, the alternate hypothesis is accepted.

Conclusion
Children who are vulnerable to street life include those who have been abandoned by their families or sent into cities because of family's intense poverty, often with hopes that a child will be able to earn money for the family and send it home. India has the dubious distinction of having the largest population of street children. Street children are formed from destitution, neglect, abuse and exploitation.
Based on the findings of the study the following conclusions are drawn: • Majority of the subjects, 22 (22%) were in the age group of 10 years. • Majority of the subjects, 60 (60%) were Christians. • Majority of the samples were from rural area with 68 (68%). • Majority of the subjects, 60 (60%) were from nuclear families. • Majority of the subjects, 48 (48%) were having more than 4 children in their family. • Majority of the subjects, 76 (76%) of them were first child in the family. • Majority of the subjects and 59 (59%) had attended none of the preschool learning. • Majority of the subjects, 65 (65%) were regular to school. • Majority of the subjects, 56 (56%) were having more than 75% in their last exam. • Majority of the subjects, 73 (73%) had severe psychosocial problems.
The overall mean score of psychosocial problem was 44.513 with SD of 1.10.
not have significant association with the selected psychosocial problems.

Implications
The findings of the study have implications in areas of nursing practice, nursing administration, nursing education and nursing research.

Nursing practice
The street children need to be educated. In school, school health nurses should educate the street children about its importance, so they can act as resource personal in early identification of psychosocial problems within early stage of livelihood and in taking a simple remedial measure for them. School Health Nurse can make use of the findings and educate street children who are having psychosocial problems in the school during school visits and school health program.

Nursing administration
The nursing administrator should take an initiative in creating health policymaking and developing protocols in providing education to the street children in the school, during their school visits and involve children who are having psychosocial problems in themselves in the promotion of good social and academic performance and also to reduce isolation.

Nursing research
Several research studies including the current study in the field of psychosocial problems serves as knowledge base to the beginner nurse researchers, who can further conduct research studies in the areas of avoidance of factors. The nurse researchers can discuss with adults in the society. Healthcare professionals can conduct future research on problems related to psychosocial problems.

Nursing education
In nursing school and colleges, students should be trained in planning and implementing health education programmers depending upon the need. In nursing school and college, the curriculum should include a detailed chapter, related to psychosocial problems.

Recommendations
In the light of the above findings and personal experience of the investigator the following recommendations are offered: • A comparative study can be conducted between school children and street children regarding psychosocial problems of preschoolers. • Similar study can be conducted using Interventions like SIM, STP and pamphlets.
• An Experimental study can be under taken with control group. • A comparative study can be conducted between children of working and non-working mothers. • Experts in the nursing profession may develop sufficient resources for the development of the psychosocial wellbeing by writing books or creating applications that are helpful for nursing. • An evaluative study can be conducted to test the effectiveness of the informational booklet.

Financial Disclosure
None declared.

Conflicts of Interest
None declared.