PSYCHOSOCIAL INTERVENTIONS EVALUATION OF UNICEF …

Transcript PSYCHOSOCIAL INTERVENTIONS EVALUATION OF UNICEF …

PSYCHOSOCIAL INTERNAL TRAINING AND ORIENTATION 25 –26 November, 2004

UNICEF Indonesia

DAY 1 - SESSION 1

WHAT IS PSYCHOSOCIAL WELLBEING?

Why is psychosocial help important?

What are the main needs of children?

We frequently focus attention primarily on physical needs and don ’ t pay enough attention to children ’ s needs for safety, affiliation, affection, acceptance and social interaction usually called

psychosocial needs

. This is especially true in emergency situations – we think about health, clean water, housing etc. and psychosocial help has traditionally been given less priority

Psychosocial help

What words come to mind when we talk about psychosocial development or help?

Psychosocial help can be of three main kinds:  Helping the child to build their ability to cope, heal and develop psychosocially  Strengthen the ability of caregivers such as teachers, parents, older siblings, community leaders to provide more appropriate social support for children  Professional or paraprofessional help for children who are experiencing particular difficulties

What is psychosocial development?

Psychosocial development

emotion, spirituality and social relations mediated by socialisation processes”.

is defined as: “changes in cognition, In other words it includes children’s

psychological

and

social

development.

Psychological development includes changes in

: q

Cognition/Thinking

- t he mind of the child. It includes the way the children think, remember, learn, use language, what they believe, how they observe their world (see, hear, touch, etc.), their ability to become creative and logical, their ability to understand others.

Affect/Emotion

- t he emotion of the child. It includes motivations and emotions such as love, anger and frustration. Emotional development includes what emotions the children feel, how they react emotionally towards different situations, how they understand their own emotions and the emotions of others, and how they express or deal with their own emotions.

Spirituality –

how the child makes sense of the world around them, what religious, moral or spiritual beliefs and understandings they have

What is psychosocial development?

Social development

is the development of social behavior of the child, including ability to interact with others, cooperate, communicate, and find their role in the family and community, who is the important person in their life (families, friends, etc.). It also refers to what groups they feel attached to or actually participate in e.g. religious groups, ethnic groups, sporting or family groups

What is Psychosocial Well-being?

What words do you associate with ‘well being’? Can you find other similar words?

Well-being is difficult to define. . . It refers to sense of wholeness, of living life to the full, overcoming challenges, resiliency etc.

Wellness and distress/illness are opposite ends of a continuum

Aim of Psychosocial Help

What is the aim of psychosocial help?  To promote psychosocial well-being for children.

Psychosocial Well-being can be thought of as a number of interconnected competencies.

Can you think of psychosocial competencies of children? E.g. to form strong attachments to caregiver, to be responsible

Psychosocial Competencies

What are basic psychosocial skills or competencies?

(1) Feel loved and cared for by caregivers -

safe and cared for by supportive and responsible adults (usually parents). Child feels

(2) Meaningful friendships and social skills -

make friends, get along with their teachers and other people in their community. Child can

(3) Trust in others-

community.

Child believes that they can rely on others in their community to help and listen to them. They feel that others will not hurt them or their

(4) Sense of Belonging -

and feels that that community addresses and meets their needs.

Child feels part of a community

Psychosocial Competencies

(5) Self-esteem

- Child feels valued by others and has confidence in themselves.

(6) Empowerment

– Child has the ability to participate in decisions affecting their life and to form independent opinions and express themself.

(7) Ability to access to opportunities

– Child knows how to find or create opportunities to help them

(8) Hopefulness or optimism about the future

– Child feels confident that the world offers at least some positive things for them. They are able to see both good and bad things in their life.

Psychosocial Competencies

(9)Responsibility

– Child understands the effects of their own behaviour, shows that they care about the effect their actions have on others, and can learn from their mistakes.

(10) Empathy

– Child is able to understand and empathize with the needs, rights and feelings of others.

(11) Creativity

– Child is able to be creative and to imagine different possibilities.

(12) Adaptability

– Child and caretakers are able to adjust to their social situation, and to make the best of changes.  Do you think these competencies are relevant for children in Indonesia? Which are given priority? Are there any that should be given more priority?

SESSION TWO

PSYCHOSOCIAL PROGRAMMING

Can you give examples of psychosocial programming?

Psychosocial Programming.

adverse influence.” “Psychosocial programming consists of structured activities designed to advance children's psychological and social development and to strengthen protective factors that limit the effects of What does this mean??

Psychosocial Programming

3 Levels of Psychosocial Programming



Promotion –

activities done by paraprofessionals, for all conflict affected children 

Prevention or Healing –

activities done by counselors, for children having adjustment problems 

Treatment –

psychiatry and clinical psychological services for mentally ill children

UNICEF usually focuses on Promotion and Prevention but can do Treatment if necessary.

Levels of Psychosocial Programming

Treatment

Psychiatrists and Clinical Psychologists

Prevention

by Counselors

Promotion

by Community Members

Types of Psychosocial Programming

Healing Treatment Promotion

What is psychosocial programming?

PROMOTION Indirect psychosocial promotion activities include:

 Promoting family reunification  Promoting family self-sufficiency (economic projects)  Ensuring adequate emergency shelter (appropriate housing)  Ensuring continuous schooling  Ensuring appropriate health and sanitation services

All members of the community

have responsibility to ensure there is a suitable environment for psychosocial development. These activities help to establish a project.

suitable environment

to protect and promote psychosocial healing and well-being. Usually these programmes are conducted by other organisations or under separate Psychosocial programmes should

coordinate

with programmes that address these needs. They should

advocate

for ensuring these basic needs are met, and that such programmes are implemented in a way that supports psychosocial development and healing.

What is psychosocial programming?

Structured psychosocial promotion activities include

: • Recreational and expressional activities for children • Child to child or mentoring programmes • Parents/community meetings to address their own and their children’s psychosocial well-being • Psychosocial information material for parents and teachers • Training and support of psychosocial para-professionals, including teachers, youth volunteers, health workers • Supporting community structures and cultural activities/traditions These kinds of activities can be conducted by

suitably trained members of the community.

Psychosocial programmes should focus first on these kinds of activities. This should be the base of the psychosocial programming pyramid

What is psychosocial programming?

PREVENTION Psychosocial prevention activities include:

 Group, including art and play, counseling for children  Individual and/or family counseling    Support groups for care-givers Community healing rituals Advocacy to decision makers to improve the environmental situation Can be conducted by

school counselors, community or social workers trained in counseling or psychologists

. This is for people who can not be helped by the activities conducted by community members – that is who are having difficulty to adapt

TREATMENT

 Psychiatic treatment, including therapy and medication   Clinical psychology including behavioural, relaxation and cognitive therapy For people with mental illness e.g. clinical depression, PTSD, drug abuse Is any level more important than the other? If yes, why? If not, why not?

Psychosocial Programming In regular or on-going emergencies, psychosocial programming is usually

mainstreamed

into



Health (including HIV/AIDS)



Education



Child Protection

Can you think of examples of psychosocial projects in each of these three areas?

Psychosocial Programming in Health

 Training health professionals to identify, provide basic psychosocial assistance and refer psychosocial problems  Training health professionals in better parenting  Mental health projects  Counseling/support groups for HIV/AIDS patients  Play groups for children affected by HIV/AIDS  Life skills education for children/youth affected by HIV/AIDS

Psychosocial Programming in Education

 Training teachers in basic psychosocial help  Supporting school counselors to conduct counseling for students and/or parents  Life skills for children and youth  Non-formal education e.g. peer-to-peer activities, recreational or cultural activities, summer camps  Training of community members to provide non formal psychosocial help e.g. youth, community leaders  Supporting ECD caretakers to conduct structured play groups with children

Psychosocial Programming in Child Protection

 Psychosocial projects for children affected by armed conflict e.g. establishment of safe play spaces  Rehabilitation projects for child soldiers or children in conflict with the law  Social and psychological support for separated children e.g. drop-in house, family reunification  Counseling and peer support for victims of sexual or physical abuse  Training social or religious workers in psychosocial help

SESSION THREE

PSYCHOSOCIAL PROGRAMMING AND UNICEF’S MANDATE

UNICEF’s Mandate

Do you think psychosocial programming is part of UNICEF’s mandate? If yes, why and in what situations? If not, why not?

 According to article 39 of the CRC, States parties must take all appropriate measures to promote the physical and psychological recovery and social reintegration of a child victims of: neglect, exploitation or abuse; torture or any form of cruel, inhumane or degrading treatment or punishment; armed conflict.

 UNICEF considers psychosocial programming as a core component of its response to emergency situations (see Core Commitments for Children)  In non-emergency situations, psychosocial programming is implemented according to needs and priorities of the Country Office

UNICEF Psychosocial Principles

 What do you think are some of the principles that should govern psychosocial programming for UNICEF?

 In small groups, discuss 2 of the following principles. Are they appropriate? How would you implement these in a psychosocial project?

 Are there any principles you think should be added to the following list?

UNICEF Psychosocial Programming Principles

Conduct field-based Assessment

Should focus on two main issues:  existing and potential psychosocial stress factors in the community; and  existing and potential community-based mechanisms for promoting psychosocial well-being and recovery

Utilise community-led process:

 Members of the affected community should be active partners in psychosocial programmes.  Participation of the community has therapeutic benefits, helping to re establish meaning and direction in people's lives, gain control over their situation, and raising self-esteem.  Psychosocial programmes can make matters worse if they reinforce a sense of powerlessness by treating those affected as helpless victims.  Youth can be a valuable resource, to be trained to help their peers or younger children

PRINCIPLE UNICEF Psychosocial Programming Principles

Focus on healing:

 Programmes should aim to support healing processes, including reintegrating the child into a stable and nurturing family environment, strengthening child's existing care system, re-establishing daily routines, and providing the child opportunities for expression and skills for overcoming adversity.

Focus on Stress and Adaption, not Traumatisation

 Exposure to sudden, life-threatening – traumatic – events is an important source of stress but is only one of many stressors  Other sources of stress, such as family tension, poverty, inappropriate housing, education, or health systems, dislocation etc., are equally important  Programmes should deal with all sources of stress, and traumatic events as one source of stress, rather than focusing on traumatic events

Focus on Resilience, not Vulnerability

 Most people in conflict situations will find a way to cope and often become stronger  Programmes should acknowledge the difficulties people face, and let people express their feelings, help them recognise the ways they do overcome difficult circumstances , and to learn from other people in their community about how to cope better.

UNICEF Psychosocial Programming Principles

Understand and respect local traditions and practices:

 Programmes should utilise local views of child development and local beliefs about children, and understand local culture and practices.  This includes the rites and rituals related to becoming an adult as well as those associated with death, burial and mourning.

Avoid institutional approaches:

 Institutionalizing children and identifying them as traumatized can impose an inadvertent stigma and contribute to their isolation and withdrawal, and it is too expensive  The most effective and sustainable approach for promoting psychosocial well-being and recovery is to mobilize the child's existing care system.  When groups of vulnerable children, such as child soldiers, are targeted for special attention, it should be done with the full cooperation of the community so as to ensure their long-term reintegration

SESSION FOUR

DIFFICULT SITUATIONS AFFECTING CHILDREN, THEIR RESPONSES AND COPING MECHANISMS

Difficult Situations Affecting Children

 What are some difficult situations that might lead to psychosocial problems for children?

Difficult Situations Affecting Children

     General problems  Separated from parents and families    Witness act of violence or abuse Become the victim of violence or abuse Death or loss of parents and close families (e.g. due to HIV/AIDS) Live in poverty Drop-out of school Work in exploitative situation e.g. sexual exploitation Victim of trafficing Tension and violence within families, schools and communities  Serious illness e.g. HIV/AIDS

Difficult Experiences for Children Conflict specific difficult experiences



Live in fearful, threatening environment



Live as a refugee or return to their village



Participate directly in violence and conflict e.g. child soldiers



School and other activities of children are interrupted

Children’s Reactions to Difficult Situations

What are some of children’s reactions to difficult situations?



Physical reactions,

such as strong heart beat, tensed muscle, panted breath, pain without cause such as headache, dizzy, painful muscle, tiredness, lack of energy or psychosomatic problems 

Changes in Thinking

such as only thinking about the problem, getting confused or changing mind easily, difficulty in concentrating, changes in beliefs, flashbacks, unable to trust others 

Changes in Emotions,

feeling angry, sad or hopeless. Not feeling anything (becoming numb), erratic mood changes or lack of empathy for others

Children’s Reactions to Difficult Situations



Behavioral changes,

such as nervous, aggressive, argumentative, dangerous activities such as drugs, ‘ strange behaviour ’ (e.g. hording things), withdrawal from activities and others, increasing dependency on the support and suggestions of others, problems with sleep (difficulty in sleeping, nightmare, oversleep), regression to earlier developmental stage, being ‘ too good ’ Changes can range from: Depressive to Aggressive Note: We often overlook the problems of depressive children as they tend to become more quiet

Trauma and Stress

What is the difference between trauma and stress? Why is it important to distinguish between trauma and stress?

Stress is when a person feels they are unable or have difficulty to meet the demands placed on them e.g. a poor mother to provide food for her children Traumatic events are sudden, unexpected experiences that are or are perceived to be life threatening and out of the range of ordinary experience e.g. rape or villages being burnt

Resilience and Coping

Why do some children overcome difficult situations and others have much difficulty? What determines whether children are able to overcome difficult situations?

 “ Resilience is the human capacity to face, overcome and be strengthened by or even transformed by the adversities of life. . . With resilience children triumph over difficulties, without it the difficulties triumph ”

Resilience

What determines resilience? What determines whether a child copes and heals or not?

Resilience is determined by two main factors:



Characteristics/abilities of the child



Environmental factors e.g. families who model good coping behaviour

Resilience

    Characteristics/abilities of the Child  A person people can like and love    Glad to do nice things for others and show my concern Respectful of myself and others Willing to be responsible for what I do Are sure things will be all right Talk to others about things that frighten or bother me Find ways to solve problems I face Control myself when I feel like doing something dangerous  Find someone to help me when I have problems

Resilience

Environmental factors  Consistent and secure relationships with caretakers  Caregivers who the child can trust and who loves them no matter what  People who set limits for the child to stop them getting into danger  People who encourage the child to learn how to do things themselves and who help them when they are in trouble  Parents who are models of coping and appropriate behaviour

SESSION FIVE

KEY PSYCHOSOCIAL SUPPORT TECHNIQUES AND APPROACHES

Psychosocial Support Techniques

Demonstrate a Technique…  What did you learn from this experience?  How could you use what you learnt for helping children?

Psychosocial Techniques

Two main types of psychosocial help:  Action that is done as part of regular interaction with children e.g. teachers behaviour in class towards students  Structured activities such as counseling groups, play or artistic activities Think of someone you know who is a good psychosocial helper for children. .. What are the qualities and behaviours of that person?

What are some structured psychosocial techniques or activities that you know or have heard about?

Basic Advice in Helping Children

As part of caregivers regular interaction with children there are some basic actions they can do to help children:  Listen to the child. Don quickly ’ t lecture them or give advice too  Observe the child ’ s reaction and try to identify the cause. Don ’ t assume you know what ’ s really bothering them.

 Provide children with support. Reassure them you care about them and their reaction is normal  Help children learn to cope with their problems. Help them to think for themselves about the different possibilities for how they can react and which is the best.  Help children return to normal activities slowly.

Basic Advice in Helping Children

   Encourage children when they make improvements Maintain minimum standards of behaviour without using physical punishment Don’t call children names who are having difficulties e.g. naughty, stupid  Encourage older children to discuss moral issues such as ethical behaviour in the community  Provide opportunities for children to play and express themselves and participate in their family and community Conduct role-play of giving basic psychosocial support.

Structured Psychosocial Techniques

      These techniques can be used by caretakers with children of different ages:  Sand Box     Clay Puppets and dolls Traditional folklores and fantasy Using black/white board Games (if possible cooperative ones) Painting or drawing Writing and story-telling Drama and singing Group discussions and/or projects Relaxation techniques

Structured Psychosocial Techniques

These techniques can be  Open - that is, children address any subject they want or  Theme – that is the children are asked to address a theme or issue and then the teacher provides follow-up questions What are the advantages and disadvantages of these two approaches? When would each be appropriate?

For details of how to implement these techniques see UNICEF/PPPG Tetulius Psychosocial Manual

SESSION SIX

UNICEF’S PSYCHOSOCIAL WORK IN INDONESIA AND FUTURE DIRECTION

Review of Projects Conducted To Date and Ongoing

Psychosocial Help Project for West Timor and Conflict Affected Areas (1999-2000)

Support teachers, counselors and play facilitators to provide basic psychosocial assistance to children in conflict zones. It involves using play, art etc. as a way to help children overcome their difficult situations.

EMDR (2000-2001)

Training professionals and paraprofessionals in the use of EMDR. The project aimed to treat the effects of trauma.

 

Psychosocial Support for Victims of the Bali Bomb (2003)

Cooperation with IMC to provide training for teachers/NGO workers and for the creation of support groups.

Cooperation with local NGO YKIP to develop Wayang performance to address the psychosocial impact of the bombing on Balinese children.

 

Review of Projects Conducted To Date and Ongoing

Psychosocial Activities in Aceh (2003-2004 Ongoing)

A psychosocial participatory planning process in cooperation with WHO Provided technical expertise to the Ministry of Education/University Mohammadiyah Malang TOT to prepare trainers to train 900 teachers.

Integration of psychosocial help in the Mohammedeyah child participation project in 2003 and the child protection project in 2004/2005 Training of governmental counterparts (education, health, social welfare) in 2005 if $ available



Community-Based Psychosocial Project in Maluku (2003-4 Ongoing)

A community-based psychosocial project in cooperation with Dept.

Education to train 250 community members and 30 counselors to provide psychosocial interventions in 8 districts. Will continue in 2005.

Review of Projects Conducted To Date and Ongoing

Development of Psychosocial Curriculum for PPPT Tetulius (2003 2004 Complete)

Development and testing of a psychosocial curriculum for elementary school children.

Psychosocial/peace education curriculum for the Malukus (2003 2004 Ongoing)

A joint psychosocial/peacebuilding curriculum was completed for Maluku and the process begun in North Maluku

   

As part of regular programme (Ongoing):

Taman Posiadu (Health)?

Life Skills Education (Education) Voluntary Testing and Counseling for HIV/AIDS (HIV/AIDS) Psychosocial components in training for teachers in prevention of child abuse and training for doctors on child abuse (Child Protection)

Questions on UNICEF psychosocial programming

What are the main lessons learnt from these projects?

Are there any need to make any changes for the plans for psychosocial projects for next year? Are there are projects/activities that are missing that should be added?

Is there a need to adjust any of the ongoing projects? If yes, how?

For next Country Programme how do you see psychosocial projects included, if at all?

DAY 2 – SESSION SEVEN

DESIGN AND IMPLEMENTATION OF PSYCHOSOCIAL PROJECTS

DESIGN PRINCIPLES

What are some of the key principles when designing a psychosocial project?

Focus on healing:

 Programmes should aim to support healing processes.  Key elements of healing include reintegrating the child into a stable and nurturing family environment, activating and enabling the child's existing care system, re establishing age-appropriate daily routines, including schooling, and providing the child opportunities for expression and skills for overcoming adversity.

Focus on Stress and Adaption, not Traumatisation

 Exposure to sudden, life-threatening deal with – traumatic – events is an important source of stress but is only one of the many stressors that people in conflict situations have to  Other sources of stress, such as family tension, poverty, inappropriate housing, education, or health systems, dislocation etc., are equally important  Programmes are more effective if they deal with all sources of stress, and traumatic events are one source of stress, rather than focusing on traumatic events Develop

assessment

approach, if possible from beginning of project. Assessment should be field based and involve children where possible

Design Principles

Understanding and respect for local traditions and practices:

 Psychosocial programmes should need to understand the basic principles of child development and local beliefs about children, they should also understand local culture and practices.  This includes the rites and rituals related to becoming an adult as well as those associated with death, burial and mourning.

Focus on Resilience, not Vulnerability

 Most people in conflict situations will find a way to cope and often become stronger  Programmes should acknowledge the difficulties people face, and let people express their feelings  However, after this stage, they should help people recognise the ways they do cope with and overcome difficult circumstances, and to learn from other people in their community about how to cope better. Provide

on-going support

(financial, human resources) to local people to the degree possible to implement psychosocial training

Design Principles

Avoidance of medical model or institutional approaches:

 Should not use ‘medical’ model where the

active

expert is seen as having the knowledge to cure the sick,

passive

patient  Institutionalizing children and identifying them as traumatized can impose an inadvertent stigma and contribute to their isolation and withdrawal, and it is too expensive  The most effective and sustainable approach for promoting psychosocial well-being and recovery is to mobilize the child's existing care system.  When groups of vulnerable children, such as child soldiers, are targeted for special attention, it should be done with the full cooperation of the community so as to ensure their long-term reintegration  a.

Where possible, psychosocial projects should have

multiple level design:

Promotion activities, to help parents, teachers, youth volunteers and children themselves better support children, should be combined with Prevention activities, by counselors and other psychosocial specialists, to help children who need more specialised assistance. Advocacy for and referral to treatment by psychological or psychiatric professionals

Design Principles

In small groups, discuss 2 or 3 of these design principles:  How important do you think this principle is?

 How would you make sure that this principle was included in a psychosocial project?

 Are there any other design principles you think are especially important?

Each group will explain this design principles to the other group and their answers to this question

EXAMPLE DESIGN – CRISIS BALI BOMB

Promotion/Community Activities

 Production of Balinese puppet performance with psychosocial messages  TV and radio programmes to discuss psychosocial issues   Production of psychosocial posters and brochures Psychosocial training for teachers, NGO workers

Healing

 Support groups for children, adolescents and widows

Treatment

 Individual therapy and psychiatric treatment (not supported by UNICEF)

EXAMPLE DESIGN – ONGOING CONFLICT JENIN (Palestine)

Establishing coordinating group of helpers

for support groups for helpers planning meetings a.

Immediate community activities

: Promotion/Community a.

Open days for children Healing Home visits Support groups (children, adults) Debriefing Individual counseling Treatment a.

Psychological/psychiatric clinic (Ministry of Health)

EXAMPLE DESIGN – ONGOING CONFLICT JENIN (Palestine)

Mid-term (1-12 months) activities Promotion/Community  Open days  Summer camps   Adolescent participation activities Play ground Healing  Home visits  Community meetings      Support groups for helpers (counselors, health workers, etc) Support groups for children and adults Individual counseling 12 month training and supervision programme for counselors Clearing house and phone hotline Treatment  Clinical psychological and psychiatric clinics (MSF/Ministry of Health)

EXAMPLE DESIGN – POST CRISIS MALUKU

Establishing organising committee and designing project Assessment Training of trainers (TOT) Training of community members (youth, religious leaders, women) Training for counselors in counseling

  

     

EXAMPLE DESIGN – POST CRISIS MALUKU

Activities by community members

after training) (decided by community members Recreational and expressional activities, such as festivals, games, competition, artistic performances by youth/parent volunteers.

Play groups for children under 12 Adolescent peer to peer on life skills and participation Youth/adolescents mentoring younger children Discussion groups between children and their parents Small grants to community for child activities

Activities by ‘helpers/counselors’

Develop/adapt psychosocial information material for parents and children, including brochures and posters Support groups for children, adolescents and parents Advocacy seminar with decision makers

Evaluation and planning

Design Psychosocial Project

Assignment: Group 1 – Crisis (start of a conflict or natural disaster) Group 2 – Post crisis Group 3 – Abused children Questions:  Objective? Beneficiaries?

 How to identify partners?

  What will be the design process?

Develop example design (design framework)

DESIGN FRAMEWORK

Aim of activity Activity Conducted by whom? Beneficiaries (location and number) Number of activities Approx.

Dates Support needed (supervision, supplies, $) Support from who?

SESSION EIGHT

ASSESSMENT AND EVALUATION

ASSESSMENTS AND EVALUATIONS

Example Evaluations/Assessments 1.

Assessment of needs e.g. North Maluku assessment for psychosocial/peace education curriculum External Evaluation e.g. Psychosocial Evaluation of UNICEF 3.

Internal e.g. Evaluation of impact of psychosocial project in Maluku or Iran Mental Health Evaluation

Principles of Assessments

Assessments determine needs for programming. Principles of good assessments include:  Are linked to rapid provision of assistance  Collect information on how local people understand their situation, cope and want to move forward (field based)   Analyse local capacities as well as needs Are ongoing and produce increasingly deeper understanding  Map how psychosocial needs and capacities vary according to gender, age, group affiliation. Map is most vulnerable, who is excluded etc.

Steps in Conducting Psychosocial Evaluations (assessing project impact)

Design

  

What are the main issues to consider in designing PSE?

  First task is the design of the

evaluation framework

This framework should include key questions as well as the source of data for each question   Should outline number and sampling of respondents Should clarify whether it is qualitative (FGD and/or interview) and/or quantitative. Best is combination If use FGD sampling cells should be >25 If use questionnaires sampling cells should be >50 For questionnaire for beneficiaries should do either pre-post test comparison or control and test group cf.

Design Framework

ISSUE GENERAL QUESTIONS 1. Background 2. Design

a) Who were the beneficiaries?

General Context Psychosocial Needs of Children Other Programmes Overview of Psychosocial Programmes

b) Were the objectives of the two projects relevant to needs of beneficiaries?        Who were the beneficiaries? How was the decision made to focus on particular beneficiaries? Where the beneficiaries clearly defined? Was the age, geographical region and level of distress of the chosen beneficiaries appropriate? What were the priority needs of the beneficiaries? Did the programme address these needs? What level (primary, secondary or tertiary) of assistance did this project provide to the beneficiaries and was this appropriate to their needs?

CFSI SPECIFIC QUESTIONS EMDR SPECIFIC QUESTIONS METHODOLOGY

UNICEF documents Reports/Assessments by other organizations Monthly reports Meetings with other organizations CSFI evaluation Programme proposals   Is EMDR an effective treatment methodology? Is EMDR appropriate for use on children? Interviews with beneficiaries and parents Interviews with trainees Interviews with UNICEF staff Literature review

Steps in Conducting Psychosocial Evaluations

Data collection and analysis methods can include:

What are the main data collection and analysis methods?

   Desk study of relevant documents Interviews with the project staff FGD, interviews or questionnaires for the trainees   Focus groups, interviews or questionnaires with beneficiaries Where possible, FGD should be analysed using response matrix (i.e. categorisation of responses)   Trainee questionnaires can be analysed by hand compilation (categorisation of responses) Beneficiary questionnaires need to be analysed using statistical programme (e.g. SPSS)

Steps in Conducting Psychosocial Evaluations

Psychosocial Evaluation tools can include:  Protocol for Interview or FGD with trainees   Questionnaire for Trainees Protocol for Interview/FGD with beneficiaries   Questionnaires for beneficiaries Note: For young children (<5) can use analysis of drawings 3.

Report writing, presentation and review What are the main considerations in writing the report?

 If possible, draft report should be prepared and presented to wider group (e.g. partners)  Their comments should be incorporated into final version

PSYCHSOCIAL EVALUATIONS

Each group should design an evaluation of their project.

Group 1 – Crisis (start of a conflict or natural disaster) Group 2 – Post crisis Group 3 – Abused children

UNICEF Project Evaluation

Project 1 - Psychosocial Help Training Project Support teachers, counselors and play facilitators to provide basic psychosocial assistance to children in conflict zones. It involves using play, art etc. as a way to help children overcome their difficult situations.

Project 2 – Eye Movement Desensitisation Reprocessing Training professionals and paraprofessionals in the use of EMDR. The project aimed to treat the effects of trauma.

Project 1 - Psychosocial Help Training Project Summary

• • • • •

Project Activities 1.

Phase I in West Timor in response to the East Timorese refugees

Teachers adjusted their teaching style to allow more time for

expression fun and

Counselors and youth conducted Information materials such as Counselors conducted

play groups and sports posters

were produced.

support groups and community meetings

adolescents and parents. for Counselors and youth also

organised the community

activities (recreational, educational) for children to conduct • •



PHASE II for conflict areas throughout Indonesia

Advanced training in Psychosocial Help in Jakarta for 30 counselors from throughout the conflict areas, LPAs in Central Java and Northern Sumatra and teachers in East Java

Recreational and expressional activities Vocational training and skills building

(concentration, relaxation)

No. Beneficiaries: Total -

children Approximately 35,000, of which 30,000 were

Cost/beneficiary:

Approximately $7/beneficiary

Eye Movement Desensitisation and Reprocessing (EMDR) Summary Project Activities:

 Assessment  Level 1 EMDR training in both Maluku and Aceh (5 days with 29 and 28 participants respectively)  Level 2 training in Jakarta, Maluku and Aceh  1 Week supervision of trainees

Number of beneficiaries: Total

Estimated 781, of which an estimated 560 are children

Cost/beneficiary:

Approximately $400/beneficiary

Project #1 – Psychosocial Help

IMPACT ON BENEFICARIES

Psychosocial activities helped children to be happier, less fearful, more animated, develop friendships and other social skills, reduced anxiety and depression Helped to ‘animate’ the refugee camps and get people involved in making their communities more child friendly

IMPACT ON TRAINEES

• • • • Key changes in trainees included: Greater self-confidence and motivation to work with children in armed conflict Perception of children as active learners Recognition of the importance of self-knowledge and expression Increased skills to help children express/play

Project #1 – Psychosocial Help

CONCLUSION

 Easily implementable, practical project that has proven psychosocial benefits for children   Cost efficient project Generally consistent with UNICEF policies and guidelines   Should be continued and strengthened Minor adjustments are needed, integrating lessons learnt and best practices from this evaluation

Project #2 - EMDR

ACTIVITIES

 Used very little and inconsistently  Why used so little?

Trainees did not have necessary basic counseling skills Individual nature of EMDR not culturally appropriate and time consuming Perceived as ‘strange’ by beneficiaries (and some trainees) Difficult for Indonesians to articulate feelings, to self-reflect Often difficult for survivors of traumatic events to concentrate Difficult to access beneficiaries due to security situation Dangers associated with raising traumatic events and not effectively processing them

EMDR, IMPACT cont.

IMPACT ON BENEFICARIES

 Trainees reported that EMDR with other psychosocial interventions is better than those interventions alone  Since EMDR is usually conducted with other therapies it is difficult to determine what causes the positive outcomes and there are questions about how is positive outcome measured e.g. wanting to please therapist, self-report, placebo effect etc.

 Questionnaire comparing psychosocial status of children who had EMDR to those who did not shows no difference

IMPACT ON TRAINEES

 Mixed  Paraprofessionals were very happy to have at least one technique to deal with traumatised children/adults  Other participants were frustrated because EMDR was so difficult to implement

EMDR CONCLUSION   

Conclusion:

 Difficult to implement, inappropriate for the Indonesian context  Unclear if it is more effective than other therapies (in Indonesia and in general) Inconsistent with UNICEF policies and guidelines Cost inefficient project Should not be continued

UNICEF Psychosocial Evaluation Lessons Learnt

DESIGN

 Psychosocial programming is important aspect of emergency programming but often has to overcome adult focus on material needs  Programme decisions and priorities must derive from a situation analysis on the ground  Children should have an active role in designing and implementing programmes  Where possible, projects should have multilevel design including both promotion and prevention activities  Psychosocial activities should be integrated with other programmes which support psychosocial healing, such as family reintegration and educational programmes.   Incorporate clear evaluation protocol from beginning of project Support activity implementation and follow-up trainings for all projects  Should take care to ensure that approaches are culturally appropriate and ‘workable’ before implementation

UNICEF Psychosocial Evaluation Lessons Learnt

IMPLEMENTATION

 Implement activities by youth volunteers and teachers first and after implement activities by counselors  Training topics should have a balance between knowledge/attitude change and skills building. Need to include specific art/play group counseling techniques for children.

  Need longer than 5 days to train counselors Training should be elicitive, participatory, flexible and culturally sensitive  Should carefully select trainees

SESSION NINE AND TEN

SPECIFIC ISSUES FOR UNICEF INDONESIA

Children Affected by Armed Conflict

Group 1 – What are the psychosocial reactions of children affected by armed conflict?

Group 2 – What are the reactions of children aged 0-5, 6-12 and 13-18?

Group 3 – What are strategies to provide psychosocial help to children affected by armed conflict?

Children Affected by Armed Conflict

Reactions of Children Affected by Armed Conflict

include:  Depression/withdrawal  Fear (clinging, hypervigilance)  Aggression  Grief  Sleeping problems  Dangerous/antisocial behaviour  School problems (concentration)  Psychosomatic problems

Children Affected by Armed Conflict

Children of 2-5 years old

:  May become very fearful especially towards any things that remind them of this event.

 Do not easily understand death so may think of it like separation and expect the person to return.

 Do not want to be separated from their parents and may be afraid or cry if they are  May revert to earlier stages of development, such as sucking their thumb or bedwetting.

 May have nightmares and have difficulty falling or staying asleep.

Children Affected by Armed Conflict

Children of 6-11 years old

:  May withdraw, or be very fearful  Have difficulties to concentrate  May easily get angry, lose control of their emotions, be aggressive and destructive.

 Do not want to go to school  May start complaining physical illnesses without any medical causes  May engage in play with violent or repetitive themes

Children Affected by Armed Conflict

Children 12-18 years

:  May feel hopeless and withdraw  Can appear more adult than they really are  May engage in risky or self-destructive behaviours (such as alcohol or smoking)  May experience physical problems with no clear medical reasons.  They often need to share their feelings with adults or their peers through talking

Children Affected by Armed Conflict

    

Key Strategies to help CAAC:

 Promote reestablishment of stable family life;   Reestablish sense of normalcy in child’s life; Promote opportunities for expression of feelings; Protect children from further harm; Mobilise the child's existing care system; Train relief personnel on dealing with psychosocial issues; Help to lessen the psychological impact of emergencies; Enable children to be active agents in rebuilding communities and a positive future.

Child Abuse

Group 1 – What are the effects of child abuse on the children?

Group 2 – What are the reasons for abuse?

Group 3 – How can we deal with child abuse?

Child Abuse

Abused children are children who are physically, emotionally or sexually abused by parents, other family members, teachers, community members, strangers or even other children.

Physical abuse

is anything that results in non accidental physical injury or harm to the child.

Emotional abuse

is unreasonable non-physical punishment or neglect such as cursing or withholding emotional support

Sexual abuse

is when adults or older person use children for sexual purposes

Child Abuse

Effects of Child Abuse

 Many of the same problems as children living in conflict situations (aggression, withdrawal, inability to concentrate etc.)     Undermining of self-esteem and confidence of child. Overly fearful and anxious. Undermines sense of control and autonomy Guilt – child may be blamed or believe they ‘deserve’ it May become submissive or aggressive (even both, submissive to aggressor, aggressive to others)  If sexual abuse, child may develop sexually related problems

Child Abuse



Identification with the aggressor.

When child is abused by trusted person they try to maintain the trust by overidentifying with the person. They drive own feelings of aggression/anger towards person underground and often become aggressive towards other, insensitive to own or others hurt 

Strained family relations.

Children are often not believed if they claim abuse and often blamed. Tensions in the family often occur regarding honor of the family, who is responsible, and what to do about it.

Child Abuse

Approaches to Child Abuse

 Previously: vulnerability. Children as passive, vulnerable and incapable of self-repair and healing. Weak, defenseless and scared by abuse.

 Recently: resilience. Children as resourceful, strong and independent of spirit. Able to recovery from, grow and transcend abuse. See opportunity in the face of adversity.

Child Abuse

Reasons for Abuse

 Cultural reasons e.g. necessary for ‘education’ of children, ‘respect’ elders, ‘honor’ of family or ‘ownership’ of child    History of abuse in the family Child with ‘difficult’ temperament Adults with negative or unreasonably high expectations of children  Stress including poverty

Child Abuse

Reasons for child sexual abuse:

 The avenger – to harm child or someone who loves child   The taker discarded – children as commodities to be used and The controller – bargain for sexual favours, and they want to control the child    The conqueror – lure the child by giving them something they want, ‘seducing’ them The playmate – a friend of the child The soulmate – who projects themselves onto the child

Child Abuse

Dealing with Child Abuse

 Increase awareness of long-term effects of child abuse  Educate adults in non-abusive parenting and discipline techniques  Try to understand reason for abuse and address this underlying cause  Disciplinary/legal proceedings for serious child abuse References: Bustista, Roldan, and Garces-Bascal. Working with Abused Children through the Lenses of Resilience and Contextualisation (2001) and Surviving the Odds: Finding Hope in Abused Children’s Life Stories (2000)

Sexual and gender-based violence and exploitation

Including rape, child and/or forced prostitution, sexual humiliation and mutilitation, sex trafficking and domestic violence against women While these types of SGBV vary considerably in their psychosocial impact there are some themes or considerations in providing psychosocial help to victims

SGBV

Psychosocial Reactions

 Survivors cope differently with SGBV  Circumstances and reasons for becoming victim will affect how victim deals with the situation e.g. if they knowingly become involved, was it a single incident or multiple, committed by stranger or someone they trust  Common reactions include: fear, helplessness and humiliation/shame, loss of trust, low self-esteem/worth  Reactions can include: aggressivity, anger, hatred, depression/withdrawal, grief, anxiety, phobia, PTSD, or ‘numbing’, sense of injustice and loss of beliefs

SGBV

Psychosocial Reactions cont.

 Female survivor often feels clean and unworthy (cultural notions of chastity) and may feel guilty  Male survivors may feel similar and sense of manhood may also be undermined  Extreme reactions can include self-harm, suicide or if pregnant self-abortion or infanticide  Key social issues: stigmatisation and other difficulties to reintegrate into community, relationship issues including marriage prospects, sexual relations etc, economic self-sufficiency,

SGBV

Principles

: What are the principles for providing help to SGBV victims?

 Informed consent (especially re any obligations on the counselor to disclose any information received)    Respect confidentiality Respect views of the victim Prevent further harm (safe space, family intervention, community action, camp protection mechanisms)   Promote healing Avoid retraumatisation e.g. non-mental health professionals should not ask detailed questions about traumatic events  Psychosocial help should be part of package of medical, legal, educational/vocational and psychosocial help.  Psychosocial help should be clearly separated from legal processes but appropriately linked

SGBV

Types of psychosocial help What types of psychosocial help can be provided?

 Counseling (individual/group)  Life skills including vocational and interpersonal skills  Social support from families/friends  Ensuring medical, legal and other support personnel are trained to deal with survivor in sensitive and supportive manner   Cleansing or other community rituals Participation in women’s groups or community or human rights activities e.g. employment generation project, organising anti-violence campaign etc.

SGBV

Psychosocial help for survivors of SGBV needs to based on thorough understanding of common psychosocial reactions to this particular type of experience. For example, ECPAT notes that children who go into residential care after sexual exploitation or abuse go through the following stages: 1. Honeymoon 2. Adjustment (with most behavioural problems) 3. Settling 4. Moving on

SGBV Resources:



The psychosocial rehabilitation of children who have been commercially sexually exploited: A training guide. ECPAT, 2001.

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