Dimensions of Zoë-Life's Capacity Assessment Tool
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Age / Developmental Level is based on the child's self-report, and documentation (ID or other). If there is any doubt as to whether the child is 12 years or older, a judgement is made based on the child's:
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behaviour and responses during the assessment process;
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growth and physical development (although children may show stunting due to malnutrition or HIV infection through MTCT);
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mental and cognitive development;
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emotional and social maturity.
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Behaviour and Mental State is assessed on the extent to which the child: engages with the interviewer (even if hesitant initially, or needing encouragement throughout); speaks reasonably fluently (in own language); speech is not slurred or very rapid and difficult to follow; does not appear drowsy; is not excessively restless (can remain seated for five or more minutes at a time); pays attention to what is being said, does not appear distracted (occasional lapses acceptable); is able to respond to most questions (not just single word responses); offers responses that are not long, rambling, incoherent or irrelevant to the question or topic; can give his/her own name, where s/he is today (e.g. NGO name, clinic, hospital), whether it is morning or afternoon, and name the area/suburb/town/city where s/he lives.
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Responsiveness is gauged on the extent to which responses are appropriate, rather than whether they are correct: to introductory greetings (e.g. greets, takes seat) and to identifying questions (e.g. gives name, age); can give account of self (e.g. living situation, schooling, friends, out-of-school activities); gives appropriate reason for coming to the service or wanting to test (e.g. to find out status, may have been infected); attempts some sort of explanation in response to the question: "What do you know about HIV?"
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Knowledge is determined on the extent to which the child has or can acquire, and then convey, facts and implications related to HIV and testing. This may be shown either through his/her initial response, or if the child's response is incorrect or insufficient when the question is repeated in more detail.
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Reasoning is measured on the extent to which the child can make logical deductions; can indicate understanding of confidentiality and raise any concerns; can respond to a request to consider possible events (e.g. if s/he tests positive, then what? Or if s/he tests negative ...); has or can construct a plan of what to do and where to access support in the event of a positive result.
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Voluntariness is discerned by verifying that the child is testing voluntarily and not as a result of pressure from anyone, e.g. partner, peers, parents, other family members, caregivers, teachers, health workers). Note is taken if someone else had suggested testing, but the child does not indicate this or identify anyone (e.g. in response a question about how they came for testing).
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Support / Safety is reckoned on the extent to which the child: has access to resources for support, or may be at risk (especially if s/he tests HIV-positive); can identify or is open to help in accessing resources (caregiver, peer, teacher, community worker, health worker) that could provide support if s/he tested positive (or in any event); does not identify any immediate source of marked risk or threat to his/her safety if s/he tests.
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Emotional State is assessed to ensure that the child's emotions are not so intense or overwhelming that s/he cannot maintain or regain sufficient control to be able to engage in the interview, for example: agitation (shaking, very distracted, not able to sit still); distress (crying); withdrawal (does not respond to questions or needs a lot of prompting, no eye-contact); may express suicidal ideas but when probed, has no firm or comprehensive plans.
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