PSYCHOSOCIAL SUPPORT FOR CHILDREN IN EMERGENCIES

We are not crazy! What we feel is not abnormal– the situation is crazy and abnormal!” -- a rural child in Bosnia Herzgovina (Source: “The Tiger is our Guest,” CARE, 2005)

SESSION 1: Objectives of the Workshop To share and map experience on PSS in Emergency and Humanitarian Response in the Horn of Africa To increase understanding of psychosocial support in emergencies, including objectives, strategies and activities To identify next steps for further development of PSS in Emergency Response in the Horn of Africa

Programme Presentations can include: Coordination issues Psychosocial Assessments Objectives of programmes and indicators Main activities What sectors are programmes implemented in (child protection, health, education etc.) Psychosocial evaluation Strengths and challenges of your programme Session 2: Country Presentations and Mapping

Session 3: Psychosocial Wellbeing and Support Psychosocial wellbeing Psychosocial support What do these terms mean? What is the difference between them? Why do we use the term psychosocial?

Psychosocial wellbeing Psychosocial wellbeing is the sense of wellbeing that exists at the individual, family and community level. Psychosocial support is a composite term used to describe any type of local or outside support that aims to protect or promote psychosocial well-being Psychosocial programming is often used to describe psychosocial support that is externally supported There are a number of models for wellbeing.

3 Domains of Psychosocial Well-Being (Psychosocial Working Group model) Individual Capacity Societal Culture and Values Family and Community

Social-ecological model of psychosocial wellbeing Wellbeing exists at the following levels: Individual Family Community/Society And at each level can include the following: Social wellbeing Emotional wellbeing Skills and knowledge

Example of psychosocial wellbeing Individual level: Ability to form and maintain positive relationships with caregivers, peers and positive role models Sense of security, trust, self-confidence and hope for the future Life skills/empowerment Family: Ability to protect, care and support children and other family members Ability to address and reduce the stresses of poverty, violence

Psychosocial wellbeing Community/society level Community mobilization to address psychosocial concerns, including awareness of how to address them Community cohesion, social support and tolerance

What do we mean by “psychosocial?” The dynamic relationship between psychological and social effects of experiences, each continually influencing the other PSYCHOLOGY Mind Thoughts Emotions Feelings Behaviors SOCIAL WORLD Environment Culture Traditions Relationships Roles and tasks

Psychosocial Programming: Strategies and Activities Exercise: 1.In small groups you will draw a pyramid divided into four (4) sections. Imagine the pyramid represents a population affected by an emergency 2.You will receive four (4) strips of paper indicating levels of psychosocial support 3.Place the paper on the appropriate levels of the pyramid

Specialised services Focused, non-specialised supports Basic services and security Community and family supports

(continued) What kind of psychosocial activities should be conducted at each level Who should benefit from the activities at each level Who should conduct activities at each level?

Level 1: Addressing Basic Services and Security Advocate for the protection of children from violence, abuse and exploitation Advocate for re-establishing education Promote family unity and family-based care for separated children Promoting family self-reliance Advocate for delivery of humanitarian assistance in a manner that promotes well-being Facilitate community involvement in decision-making and assistance Disseminate essential information to affected populations

Level 2: Community and Family Supports Support play, art and sporting activities Provide structured groups activities for expression and the development of life skills and coping mechanisms Support children and youth friendly spaces/environments Promote meaningful opportunities to participate in rebuilding society

Level 2 (cont’d) Strengthening the family: –Provide culturally appropriate guidance on how parents and family members can help children –Support parents and families to cope with their own difficulties –Support and facilitate the establishment of parent groups/committees –Carry out regular family visits for caregivers in need of extra support –Support family access to basic services

Level 2 (cont’d) Strengthening community supports: –Helping caregivers and educators to better cope –Help key people to support children –Teacher training on psychosocial care and support –Training for health personnel –Psychosocial support for adult caregivers –Strengthen child-to-child or youth support –Resumption of cultural activities –Strengthening social networks

Level 3: Focused Supports For children who are: –struggling to cope within their existing care network –Not progressing in terms of their development –Unable to function as well as their peers –In need of activities that address their psychosocial needs more directly

Level 3 (cont’d) Focused psychosocial support activities require trained and experienced staff Activities may include: –Case management –Psychological first aid –Support groups –Structured play activities –Psychosocial hotlines

Level 4: Specialized Services Traditional specialized healing (e.g. cleansing and purification rituals) Counseling (individual, family or group) Psychotherapy Drug or alcohol treatment Custodial mental health care Training of local mental health workers

Psychosocial Programming Form 4 small groups, each of which will discuss one of the levels. Each groups should consider: What programming do the members of the group currently do at this level? How could they improve the programming at this level?

Session 4: Impacts of an Emergency on Psychosocial Well-Being The individual capacity of a person Physical Emotional Behavioral Cognitive Status Family and community functioning Displacement Extra burdens on families Community supports eroded or destroyed Societal Culture and Values Sense of violation Beliefs and values undermined, changed Loss of identity

Potential Positive Outcomes of an Emergency on Psychosocial Well-Being Greater awareness of rights Children and communities can become more active in supporting themselves Greater access to information Change in gender roles Opportunities for social change

Characteristics of an Emergency that Affect Psychosocial Well-Being Scope of secondary effects of the emergency Duration of the emergency Degree of impact on daily living situation

Are all children in an emergency likely to be affected in the same way?

Children’s reactions will vary according to: Their experience in the emergency Individual characteristics Past experiences The level of support they receive The situation of their family, community Their beliefs and values

Role of Culture on a Child’s Reaction to an Emergency Impact on parenting Who looks after children How they are cared for Impact on status, traditional roles and ethnicity Discrimination Changes in traditional gender roles Language barriers with movement Faith and value systems Expressions of grief and loss Acceptance of support for emotional difficulties Healing processes

Role of Gender on a Child’s Reaction to an Emergency Men, women, boys and girls are affected differently because of their different roles and the power relations in society What might be the different experiences of girls and boys in emergency situations?

Common Psychosocial Reactions in Children Physical reactions Changes in thinking e.g. beliefs and values Changes in emotions Changes in behavior e.g. more passive or aggressive Changes in social relations

Nearly all children will show some changes in emotions. behavior, thoughts and social relations in the short term These reactions are normal, and with access to basic services, support and security the majority of children will regain normal functioning. Mild or moderate mental health problems will increase slightly after an emergency A very small percentage of persons will have severe mental illness

Session 5: Strategies to Strengthen and Protect Children’s Psychosocial Wellbeing Children’s outcomes are determined by the balance of risk factors and protective factors. Risk and protective factors exist at individual, family and community level.

RESILIENCE... A person’s ability to overcome difficulties and adapt to change Determined by the following protective factors: Individual characteristics of a child (e.g.) Ability to problem solve and express oneself Hope for the future Self-respect Ability to access resources Family and Community factors Secure attachment with parents or caregivers Caregivers who model positive coping skills Established routine and structure in daily life Safety and security

Strategies to strengthen psychosocial wellbeing How can we reduce risk factors and strengthen protective factors? Strengthen children’s life skills Enhance routine and structure in children’s lives Provide opportunities for children to participate in and contribute to their communities and a more positive future Strengthen ability of child’s support network to protect and care for the child Provide support for caregivers (families, teachers etc) Strengthen basic services and security (through advocacy, coordination etc)

Session 11: Psychosocial Planning 1.Coordinate 2.Undertake an assessment 3.Plan activities based on assessment 4.Address basic services and security issues that impact on psychosocial well-being 5.Mobilize family and community support 6.Develop structured psychosocial programs (if needed) 7.Refer to appropriate mental health services 8.Monitor and evaluate

Basic Principles of Psychosocial Care and Support in Emergency Settings Human Rights and Equity Participation Do No Harm Build on available resources and capacities Integrated Support Systems Multi-Layered Supports (Source: IASC Guidelines)

We should not focus on trauma Traumatic experiences are only one aspect of difficult situations e.g. social and economic stressors often identified as more difficult Most importantly: a stress reaction only becomes a disorder if it impairs daily functioning or involves intense suffering “PTSD” is a clinical syndrome that can only be diagnosed and treated by a qualified psychologist or psychiatrist. There are specific symptoms that must have a certain duration Should avoid single disorder programming

Overuse of this word can be: Inaccurate (only an extremely small percentage of the population will have PTSD) Stigmatizing Counterproductive to healing Encouraging a passive victim identity Deflecting attention away from the broader social context

Session 12: Psychosocial Objectives and Activities

Session 13: Indicators, Monitoring and Evaluation Why monitor and evaluate? “The primary purpose of an evaluation is to identify the strengths and weaknesses of an intervention (sic) to improve that intervention and ultimately others like it” For psychosocial projects: To build evidence base for what works To minimise harm or risk of doing harm

Principles of Monitoring and Evaluation Culturally grounded and participatory (working with communities to determine local understanding of wellbeing and distress, ensuring tools are culturally appropriate/validated) Informed consent and feedback Confidentiality Sensitivity to consequences (sensitive interviewing, appropriate follow-up etc.)

Indicators Output (process) - what was done e.g. how many trainings Outcome (immediate results) - immediate effects of activities on beneficaries e.g decreased levels of fear Impact (lasting results) – mid or long-term change in status or behaviour as a result of our project e.g. greater levels of participation in school

Indicators Indicators should be: Specific Measurable Appropriate Realistic Time-bound e.g. Reduce children’s feelings of isolation through strengthening attachments with friends SMART: reduce feelings of isolation by increasing the number and quality of peer friendships and attachment to supportive adults

Indicators Qualitative Children’s understanding and ability to make sense of their experience Quantitative Percentage of children involved in activities in their community Responses on checklist

Monitoring and Evaluation Key methodological considerations: Causality versus changes Ethical comparison groups Participatory methods Who do you collect information from? Sampling including sample size and random sampling Ethical comparison groups Triangulation Use of combined quantitative/qualitative What tools will you use?

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