Effect of social skills training program on self- esteem and aggression among children in residential institutions in Port Said City

Background: There is now an abundance of global evidence demonstrating serious developmental and psychological problems associated with placement in residential care which refl ected in the form of poor self-esteem, aggressive behavior, academic failure and later on, personality disorder. Aim: The study aimed to evaluate the effect of social skill training program on self-esteem and aggression among children in residential institutions in Port-Said City. Subjects and Methods: A quasi-experimental research design was used. The present study was carried out at all governmental residential institutions in Port Said city namely, Al-Nessaieya le Tahseen AlSeha, Dar Alkaserat, Kafalit Al-Yateem, and Apnaa Ramses. The subject of the study compromised 57 children, 36 were males and 21 were females. Three tools were utilized to collect data in this study which are Socio-demographic data questionnaire, Self-esteem inventory scale, and Aggressive behavior scale for children. Results: The study revealed that almost half of the studied children had low self-esteem and the mean scores of verbal aggression among the studied children were slightly higher than mean scores of physical aggression Also, there was a positive effect of the social skills training program in enhancing self-esteem levels and slightly decreasing physical aggression but there was no effect found regarding verbal aggression. Conclusion: The study concluded that there was a signifi cant effect of social skill training program on enhancing self-esteem and slightly decreasing physical aggression, while it had no effect on verbal aggression. Recommendations: broad-based psychosocial intervention programs for resident children and rehabilitation programs are mainly recommended to enhance self-esteem and minimize aggressive behavior among children. Research Article Effect of social skills training program on selfesteem and aggression among children in residential institutions in Port Said City Soma Ibrahim Ali1, Sorayia Ramadan Abdel-Fatah2, Amal Sobhy Mahmoud3* and Sonia Mohamed ElSayad4 1M.Sc, Psychiatric Nursing and Mental Health Department, Faculty of Nursing, Port Said University, Egypt 2Professor, Psychiatric Nursing and Mental Health Department, Faculty of Nursing, Ain-Shams University, Egypt 3Assistant Professor Psychiatric Nursing and Mental Health Department, Faculty of Nursing, Port Said University, Egypt 4Lecturer, Psychiatric Nursing and Mental Health Department, Faculty of Nursing, Port Said University, Egypt Received: 08 October, 2018 Accepted: 31 October, 2018 Published: 01 November, 2018 *Corresponding authors: Amal Sobhy Mahmoud, Assistant Professor, Psychiatric Nursing and Mental Health Department, Faculty of Nursing, Port Said University, Egypt, Email:


Introduction
In the human life cycle, the childhood phase is considered the most important phase for every human being. Giving children the best start in life means ensuring them good health, proper nutrition, and early learning. The well-being of children depends on the ability of families to function effectively. From an environmental perspective, it means safe water, basic sanitation, and protection from violence, abuse, exploitation and discrimination [1]. continues to be viewed as a 'placement of last resort' for diffi cult to serve children who have experienced multiple foster placement 'failures' and for whom no alternative placement can be found [5]. Children in residential care have been described as engaging in anxiety, depression, suicide, loneliness, high levels of violence and aggression, as well as low self-esteem [6,7].
According to self-esteem is a psychological construct which refers to how the self (body and mind) is viewed and valued, that is basically how one feels about himself, how he judges himself in terms of skills, talents, abilities and attributes and how much he values and respects himself. Individuals with low self-esteem are prone to depression because they lack suffi cient coping resources, whereas those with high selfesteem are able to cope effectively and consequently avoid spiraling downward into depression [8].
On the other hand, aggressive acts are intentional behaviors that may cause psychological or physical harm to others. Aggressive behaviors can be physical, verbal, relational, or sexual. Physical aggression is the intentional use of physical force with the potential to cause disability, injury, or harm [9,10], defi ne verbal aggression as the intentional use of words with the potential to cause psychological or emotional distress. Children, who are irritable and aggressive, evaluate themselves negatively, they communicate rarely, and they often need social skills training. Studies have been done in the fi eld of the training effect of social skills on some personality characteristic and the results of these studies showed that social skills training signifi cantly increase social growth, selfesteem, personal adequacy, adjustment as well as reduced inappropriate behaviors such aggression and violence (Pasha & Gorjian, 2010) [11].
Defi ned social skills training as a set of psychotherapeutic technique based on social learning theory that has been developed to teach social skills to individuals. It teaches people how they can better communicate and express feeling, thoughts and needs to others. Social skills training programs encourages human interaction and is expected to improve the individual's skills of assertiveness and communication skills. It is also allow the individual to achieve three goals: a) Develop positive interpersonal relationships, b) Enhancing ability to cope with expectations of various social situations, c) Execute effective communication in social situations [12].
The principal of social skills training is the use of conversation and role-playing in different ways. Social skills training techniques may be incorporated into individuals, groups and family treatment modalities where there may add measurable benefi ts [13]. The psychiatric nurses could implement psycho-education programs to increase social skills, create a social support network and sources for children and their families in houses, schools, and the society, as well as participate in studies about this issue [14]. The only drawback to this type of group is that it works best when the group is closed-ended; that is, once the group has been formed, no one is allowed to join until the group has reached its preestablished closure. Members are allowed to propose topics for discussion and the leader serves as a teacher much of the time and facilitates discussion of the proposed topic, also members may from time to time be presenters and serve as discussion leaders. Sometimes, psycho-education groups evolve into traditional therapy discussion groups [15].
The role of nurses working with institutionalized children and adolescents in meeting health and psychosocial needs of this population is regarded as critical. A multidisciplinary and multi-sectorial approach is required to identify the complexity of problems that these children and adolescents experience and to bring their abilities to the optimal level to care for themselves. It has been stated that the cooperation of the members of the justice system, social services, and education and health services is important. In this context, psychiatry nurse specialists working in institutions such as forensic psychiatry services, prisons, schools, and so forth should be encouraged to use such training programs [16].

Working defi nition
Social skills: The social skills which were included in the current study are self-care, how to communicate (speakinglistening) attitude toward self, control of anger, respecting and advising others.

Aim of Study:
The study aimed to evaluate the effect of social skill training program on self-esteem and aggression among children in residential institutions in Port-Said City.
Research Question: Which type of aggression is most prevalent in residential institutions?
What is the effect of social skill training program on self-esteem and aggression among children in residential institutions in Port-Said City?

Technical design
Research design: A quasi-experimental research design was used in the current study. Sampling: The study sample was a convenient sample of children (boys and girls) who was attended the selected residential institutions at the time of collecting data.

Scoring system of tool II (SEI):
One point is given for each positive item answered ''like me'' and each negative item answered ''unlike me''. The total raw score was multiplied by two to arrive at a total self-score which was ranged from (0:116). The scores of each group of the study were arranged in ascending order and divided into four quartiles, the fi rst one was low self-esteem, the second and the third were moderate self-esteem and high self-esteem was the fourth quartile (Booth, 1992). a) Low self-esteem is equal to or less than 62. b) Moderate self-esteem is equal to or greater than 64. c) High self-esteem is equal to or greater than 80.

Administrative design
Before starting any step in the study, an offi cial letter was and permission to conduct the study in the institutions, after explaining the aim of the study.

Ethical Considerations:
The researcher explained the aim of the study to the director of each institution to take their permission to carry out the study. Before starting the interview, a verbal consent was taken from the children and after a short introduction about the aim of the study in order to gain children's cooperation. The researcher also informed them about their rights to refuse. They were ensured that any information obtained will be confi dential and used only for the purpose of the study. In addition, they were told that there was no right or wrong answers; it is a just honest expression of their feelings and behaviors.

Statistical design
Data entry and statistical analysis were done using SPSS       increased to be 29.8% immediately after implementation of the program b slightly decreased during follow up period (28.7%).

Results
Finally, there was a highly statistical signifi cant difference found among the three phases of program (throughout pre, post and follow up) in relation to self-esteem levels (P< 0.01). Table 5  lead to a very positive social self-image. According to [22], it may be the case that possession of social skills leads to a form of 'social' self-effi cacy-a belief in one's ability to master diverse social situations. Thus, it is expected that there should    According to [23], the explanation of the relation of social skills and self-esteem to say teaching social skills to children improves the beliefs, attitudes, and motivations of their, their interests, tasks, and which expression changed. Also, their judgment about feelings, relationships and expectations of the family has changed and the level of their intelligence, to the school, classmates, teachers and school to create positive change. Similar to the foregoing current study results [2], who studied the effect of social skills training program on selfesteem and social skills among adolescents and found that there was the highly statistically signifi cant difference between pre and post intervention on the self-esteem of adolescents.
However, a study carried out by [24], contradicted this study, who studied the effects of social skills training on self-esteem and aggression among male adolescents, he found that there were no statistically signifi cant differences between pre and post intervention on the self-esteem of adolescents.
Aggression is a very much part of the lives of the children›s institutions, and it seems to be part of a boarder picture of problems associated with risk for and experience of children›s institutions as stated by Khamis, (2013). The present study revealed that mean scores of verbal aggression among the studied children were slightly higher than mean scores of physical aggression. This may be due the rules of institutions which refuse physical aggression and punishing these behaviors. In disagreement with this [25,26], who studied physical and verbal aggression among adolescent school students prevalence in Egypt, found that physical aggression was more prevalent than verbal aggression.
According to the results of the current study, the social by [24], contradicted this result as he found that there were a signifi cant differences between the experimental and control groups in verbal aggression after social skills training but there isn't signifi cant differences between the experimental and control groups in physical aggression.
In the light of above discussion, it could be said that social skills training can specifi cally address the needs of children growing up in environments that lack opportunities to develop these skills. Health promotion and prevention programs focusing only on transferal of information are less effective than programs incorporating skills development.

Conclusion
Based on the fi ndings of the current study, it is concluded that, almost half of the studied children had low self-esteem and the mean scores of verbal aggression among the studied children were slightly higher than mean scores of physical aggression Also, there was a signifi cant positive effect of social skill training program on enhancing self-esteem and physical aggression among the studied children, while it had no effect on verbal aggression.

Recommendations
There is a need for broad-based psychosocial intervention programs in dealing with resident children and adolescents, and active treatment programs along with long-term support and rehabilitation programs.
Further work on large scale epidemiological studies concerning the psychological problems among institutionalized children especially depression, aggression, and child abuse.
Empowerment programs are necessary to enhance children's social, decision making skills and attachment to their institutions, especially males.
Designing guiding program to foster mothers at institutions to ensure that, they have the nurturing practice and knowledge of cognitive, emotional, physical, moral and psychological development of children.