1. Learning to Work with Orphans and Vulnerable Children A Project of the Social Work HIV/AIDS Partnership for Orphans Vulnerable Children in Tanzania Day 4 – Assessment of Needs and Strengths

2. Social Work Process for Working with Most Vulnerable Children and their Families 1.Identifying Vulnerable Children and their Families 2.Engaging Vulnerable Children and Families 3.Assessing the Strengths and Needs of Vulnerable Children and their Families 4.Developing a Plan of Services for Vulnerable Children and their Families

3. Social Work Process for Working with Orphans and Vulnerable Children Affected by HIV 5. Implementing the Plan of Services Identifying and Referral to Other Resources Providing direct services: problem solving, support and coordination Empowering and supporting caregivers Addressing HIV related prevention and care concerns 6.Evaluating Progress, Revising Service Plan and Following Up Through Ongoing Case Management, Family Support And Advocacy

4. Objectives At the end of this day, Para Social Workers will be able to: Define assessment in the context of working with vulnerable children and their families Present the purposes and process of assessment Explain the importance of the strengths approach to child and family assessment Describe the characteristics of effective assessments Use the Child Status Index Form to assess needs vulnerable children and families Record the essential elements of assessment

5. Assessment The Concept of Holistic Assessment, Needs and Strengths

6. Who has conducted an Assessment? Discussion What is an assessment?

7. Definition of Assessment The process of gathering analyzing and synthesizing information about a child and/or family situation In order to understand the situation identify which needs are most important develop a plan to assist the family (interventions) deliver services.

8. Phases of Assessment I.Plan the Assessment What information do you need? Where can you obtain needed information? What is the best method for obtaining the information? II.Gather information Interview child, family members, others Records – school, health, others Observations – appearance, behaviors, environment

9. Phases of Assessment, Cont’d III.Analyze information: What are the major needs to be addressed? What are the strengths and resources to build upon in addressing the needs? IV.Using information toward making a plan: What are the priorities for services? Recommendations: How should we proceed?

10. Process of Assessment Assessment starts at beginning of involvement with child and family after we obtain agreement to work together Assessment continues throughout our work with the child and family New needs emerge Situation improves Other changes Determine progress Determine when services need to change or end

11. Characteristics of Successful Assessment Assessment is best conducted in partnership with the child and family They have the most information about their situation. Their lives are most affected by decisions The child and family make the decisions about their lives They must implement any changes

12. Characteristics of Successful Assessment Assessment is most effective when conducted from a strengths perspective Concentration on problems or needs alone can lead to frustration and HOPELESSNESS EVERYONE has strengths - qualities, abilities, resources - that can form the basis for change and growth Focusing on strengths provides a basis for problem solving and HOPE

13. Basic Assumptions of the Strengths Approach All persons possess strengths that can be used to improve the quality of life. Recognize and express the strengths in the situation, even if the child or family member does not see them. Allow the child or family member to define the next steps as positively as they can.

14. Basic Assumptions of the Strengths Approach Discovering strengths requires a process of cooperative exploration between Para Social Worker and the child and/or family Focusing on strengths helps the Para Social Worker be non- judgmental Acknowledging the strength(s), resilience and resourcefulness required to survive in difficult circumstances

15. Characteristics of Successful Assessment Assessment is most helpful using an ecological perspective, focusing on the person and their environment Individuals influence – and are influenced by their environments Social environments may include: household extended family peer group/friends school, neighborhood and faith communities resources provided by civil society agencies (government, non governmental organizations, etc) Factors that contribute to individual needs AND solutions may be found within the larger “systems” in which the child lives.

16. Levels of Assessment When thinking about the needs of the child we need to look at the people with whom the child has important connections Starting with those most closely related to the child We then move out into the extended family and friends Then we look at the larger community including organizations

17. Phase I: Planning the Assessment Prepare— Be sure to have the materials you need (forms, pen, etc.) Introduce yourself to local leadership, obtain agreement from leadership and the parents or guardian Identify the child Arranging the visit with the child and family Usually in the child’s home situation May be in other community settings

18. Starting the Visit Greet, introduce yourself Keep conversation informal and as natural as possible Verify if the child is the person who you intended to see Explain the purpose of the visit – to find out how the family and children are doing Explain to the caregiver why knowing “How the child and the family are doing” is important to find a way to help them Obtain agreement to do assessment Show sincere and genuine interest in the family and child

19. Phase II: Gathering Information

20. Child Family Extended Family Community Eco Framework Friends Areas of Information to explore A.Information about the child B.Information about the family C.Information about extended family and friends D.Information about community Child Level

21. Phase II: Information about the Child What information and issues do we consider when we assess the child’s needs and strengths? Brainstorm

22. Areas for assessment 1. Shelter 2. Psychosocial 3. Education and Vocational Training 4 Health 5. Food and Nutrition 6. Economic Strengthening 7. Protection

23. 1. Shelter How can we determine if the child has a stable shelter that is adequate, dry, and safe? Brainstorm

24. 1.Shelter Possible Observations What is the housing made of? Is this house or institution adequate? Does the house appear safe? Does the house protect from rain or cold? Is the house in need of repairs? Child Questions (depends on age) Family Member Questions Where do you live? Do you have a place to eat and sleep regularly? Where do you sleep? Do you ever stay somewhere else? Where does the child live? Does the child have a place to eat and sleep regularly? Where does he/she sleep? Does he/she ever stay somewhere else or spend the night outside

25. 2. Psychosocial: Emotions How do we assess if the child is happy and content with a generally positive mood and hopeful outlook? Brainstorm

26. 2. Psychosocial: Emotions Possible Observations: Does the child seem happy and active? Do you observe signs of sadness, anxiousness or being withdrawn? Child Questions (depends on age)Family Member Questions Do you feel happy or sad most of the time? Do you think you have a good life? Do you have trouble controlling your emotions? Are you angry much of the time? Do you feel your life is worth living? Is this child happy or sad most of the time? How can you tell if he/she is happy or unhappy? Do you worry about this child’s sadness or grief? Do you worry he/she might hurt himself/herself?

27. 2. Psychosocial: Social Behavior Possible Observations: How does the child interact with the family? How does the child interact with you as a Para Social Worker? Child Questions (depends on age)Family Member Questions Do you get along well with adults? How often do you get punished if you do something wrong? Do you like playing with other children? Do you have friends? Tell me about your friends What is his/her behavior toward adults? Does this child need to be punished often? How does the child play with other children? Tell me about the child’s close friends.

28. 3. Education and Vocational Skills Training How can we assess how child is progressing in acquiring knowledge and life skills at home, school, job training, or an age-appropriate activity? Brainstorm

29. 3a. Education & Skills Training: Knowledge and Life Skills 3a. Child is progressing well in acquiring knowledge and life skills at home, school, job training, or an age-appropriate Possible Observations If in school, observe the response when asked about class performance ranking. If the child is five years old or younger, observe the child’s developmental progress (i.e., in language, movement, learning), and compare this to what you expect for children that age (i.e., talking, walking by year two). Sample Child Questions (depends on age) Sample Family Member Questions Are you doing new things that you are learning from? What skills are you learning or would like to learn? (ask adolescent) Do you do chores at home? Can you describe? Is this child learning new things, as you would expect others his/ her age (younger child)? What do the teachers report about how the child is doing in school? How does the child do with chores at home? Is the child advancing to the next grade as expected?

30. 3b. Education & Training: School or Age Related Activity 3b. Child is enrolled and attends school or age-appropriate play, learning activity, or job. Possible Observations If possible, observe the child’s school uniform or supplies and their usage. For infants or preschoolers observe if he/she is involved in any play or learning activity with any family member(s). Sample Child Questions (depends on age) Sample Family Member Questions Are you in school now? In which class or grade are you? Tell me about your school or training. How often do you miss school? Do you have a job, and if so how often do you go to work? Is the child in (has he/she completed) primary school? Tell me about the child’s school or training. Who pays school fees and buys uniforms and school materials? (If enrolled) does this child attend school regularly? How often must the child miss school for any other reason? Does he/she go to work regularly?

31. 4. Health How can we assess whether the child is physically healthy? How can we obtain needed information about existing health problems? Brainstorm

32. 4a. Physical Health 4a. -Child is physically healthy Possible Observations Does the child appear to be active and generally healthy? Does the child say that he or she is feeling ok? Has he/she felt ok in the last week? Is there any sign of illness, accidents or health problems? Sample Child Questions (depends on age) Sample Family Member Questions Do you have any health problems we may be able to help you with? Do you miss school or work due to illness? Tell me about this child’s health. Tell me about the last sickness the child had. Does he/she miss school or work because of illness?

33. 4b. Health Care Services 4b. – Health Care Services-- Child can access health care services, including medical treatment when ill and preventive care. Possible Observations Look at the child’s immunization card Is a bed net available? Sample Child Questions (depends on age) Sample Family Member Questions What happens when you become sick? Have you been ill recently? When that happened did you go to the health center? Do you take medicine? If so how do you get it? What happens when this child falls ill? When he/she needs medicine, how do you get it? (For under 5) Has the child been immunized to prevent illness? (For adolescents) Has anyone talked to the child about risks for HIV/AIDS and how to protect against these risks?

34. 5. Food and Nutrition How can we assess if child has sufficient food to eat at all times? How can we assess if the child is growing well compared to others of his/her age in the community? Brainstorm

35. 5. Food and Nutrition 5a. Child has sufficient food to eat at all times. Possible Observations: Look around the home including the storage facilities like granary, garden, and farm animals. Does the kitchen look like it was used to prepare food recently? Sample Child Questions (depends on age) Sample Family Member Questions Do you have enough food to eat? Who prepares food for you? Tell me what you do at times when there is not enough food. What does the family/child eat? Tell me about what the child/what you ate yesterday. How does this household/institution get the food? Tell me about times when there is not enough food.

36. 5b. Nutrition and Growth 5b. Child is growing well compared to others of his/her age in the community. Possible Observations: Compare how well the child seems to have grown compared to other local children the same age. Sample Child Questions (depends on age) Sample Family Member Questions How do you think you are doing compared to others your age in terms of growing taller and stronger? How is the child growing? Does he/she seem to be growing like other children the same age? Are you worried about this child’s growth? Weight? Height?

37. 6. Economic Support How can we assess if the family has a reliable and adequate source of income? Brainstorm

38. 6. Economic Support 6a. Family has a reliable and adequate source of income. Possible observations: Does home have material, food, clothing for child and other family members? Is there evidence that small amounts of funds are available for necessary things or emergencies? Sample Child Questions (depends on age) Sample Family Member Questions Do those who take care of you have money to pay for food and clothing? Do you have money you need for your school or other expenses? Do you have a job to help you get money you need? (for adolescents) How do you support your family? How well does your income meet your family’s needs? How steady is your income? Are there times during the year when it increases or decreases? How would you pay for a doctor visit for the child if needed?

39. 7. Protection How can assess if the child is safe from any abuse, neglect, or exploitation? How can we determine if the child has access to legal protection services as needed? Brainstorm

40. 7. Protection and Exploitation 7A. Child is safe from any abuse, neglect, or exploitation. Possible Observations: Does the child have any marks or bruises that suggest abuse? Does the child seem like an abused child, very withdrawn or scared? Sample Child Questions (depends on age) Family Member Questions Do you feel safe in your home and school? Can you tell me about a time when someone hurt you? Do you work for anyone outside the household. If you do not feel safe who can help you? Does anyone hurt this child? Do you think the child feels safe? Does the child work for anyone outside the household? Does anyone else who knows the child think he/she is being hurt by someone else? Or sexually abused?

41. 7. Legal Protection 7b. Child has access to legal protection services as needed. Possible Observations When possible, observe the child’s fear of losing his/her family properties. Does the caregiver have any concerns or hesitations when asked about the child’s legal protection services? Sample Child Questions (depends on age) Sample Family Member Questions Have you ever seen your birth certificate or registration? Have you ever felt that any of your rights were not respected? Have you ever experienced someone taking things that belong to you without your permission? Has anyone forced you to work against your will? Is there an adult who can take care of you if your needs are not being met? Does this child have birth registration or certificate? Does the family have a will? Has he/she been refused any services because of legal status? Do you know of any legal problems for this child, such as land grabbing? Does this child have an adult who stands up for the child legally?

42. Child Family Extended Family Community Eco Framework Friends Areas of Information to explore A.Information about the child B.Information about the family C.Information about extended family and friends D.Information about community Child Level

43. Phase II: Family/Household Information Needed 1.Who is involved with the child? Children who are referred Name, age/birth date, location (include contact information) Parents, siblings, other family members. Names, age/birth date, location of (include contact information) Who lives in the household where the child currently resides? Name, age/birth date, relationship to child (list all household members, include contact information) Who informed you about the child(ren) or referred them for help? Name, relationship to the child, and contact information of person Other people involved with the child. Name, relationship to the child, role and contact information.

44. Family/Household Information needed (con’t) 3. Why is the child/family in need of help? ( What is the presenting problem/issue or reason child/family referred?) From the perspective of the person referring the child/family for services? From the child(ren)’s perspective? From the parent(s)’ perspective? If the child’s caregiver is someone other than the parent, from the caregiver’s perspective? From the perspective of other persons involved with the child(ren)?

45. Child Family Extended Family Community Eco Framework Friends Family Level

46. Phase II: Information Needed about Friends and Families (con’t) What are the needs and resources/sources of support available to assist in addressing the problem? Individual strengths and coping strategies of family members? (Identify needs, strengths and coping strategies of each family member: child(ren), parent(s), other family members) Extended family? Friends?

47. Child Family Extended Family Community Eco Framework Friends Extended Family and Friends

48. Phase II: Community Information Needed for Assessment (con’t) Connections to faith community? Non-Governmental Social Service Agencies? Governmental Agencies? Other sources of support/resources? What are the resources/sources of support available to assist in addressing the problem?

49. Child Family Extended Family Community Eco Framework Friends Friends and Community

50. Other Information: Background to the Problem Health needs? Mental health needs? Educational needs? Substance abuse? Financial needs? Recent transitions/changes? Previous losses/separations? Child physical abuse? Child sexual abuse? Spousal abuse? Other stressors/needs? When and how did the problem/issue begin? How has the problem/issue evolved/developed over time? What other stressors/needs affect the problem/issue? ( Identify needs/issues affecting each family member: child(ren), parent(s), and other family members)

51. What efforts have been made to resolve the problem/issue? What strategies have been used to solve/address the problem? What resources services have been provided? What have been the results of each effort to resolve problem? What successes were achieved? What challenges/barriers were encountered ?

52. Phase III: Analyze Information How do we put together the information we have gathered to determine what issues need attention and what resources may address those needs?

53. Analyzing Assessment Information What are the identified needs? How problematic are these needs? What are the strengths? What are other things (underlying conditions) going on with the family?

54. The Child Status Index A tool to Analyze assessment information Record what we’ve found Begin to think about how these lead to a plan to address the issues

55. The Child Status Index as our Assessment Tool Developed and tested in Ethiopia & Tanzania Child oriented tool Identifies key areas of need based on child’s situation Used to gather information about (assess) a child’s needs Can be used over time to measure changes in child’s status or needs

56. What is the CSI An assessment tool used by Para Social Workers to determine: The information on his/her home situation The immediate needs of the child The resources (food, housing, clothing) needed to help the child immediately The services and service providers required to help the child (educational support, health care) now and in the future

57. Areas for assessment (CSI Dimensions) 1. Shelter 2. Psychosocial 3. Education and Skills Training 4 Health 5. Food and Nutrition 6. Economic Strengthening 7. Protection

58. The CSI Form

61. How to Rate the CSI Score each domain or area on a scale from 1 to 4, with 4 being the best score 4 Good There are no concerns and no apparent risks for this factor. 3 Fair The situation is generally acceptable. There are some concerns in this area on the part of the caregiver or visitor. Things could be a bit better. 2 Bad The situation is a problem for the child or family. 1 Very Bad The situation is very bad and creates an emergency for the child and/or family.

62. Example: CSI Score – Food and Nutrition as an Example (See handout for all domains) Good and Fair GOOD = 4 Child is well grown with good height, weight, and energy level for his/her age. FAIR = 3 Child seems to be growing well but is less active compared to others of same age in community. Bad and Very Bad BAD = 2 Child has lower weight, looks shorter, and/or is less energetic compared to others of same age in community. VERY BAD = 1 Child has very low weight (wasted) or is too short (stunted) for his/ her age (malnourished).

63. Important Events The CSI Record Form includes a section for describing any important events that have happened in the child’s life Check any events that have happened since the last CSI assessment (or during the past year for children who have not previously been rated).

64. Identifying Needs and Resources: Family Caregiver What are the main issues or needs from the parent or other caregiver’s perspective? What are the strengths of the parents, other caregivers or other family members? Are their particular issues of other family members that need to be addressed (parent is ill, HIV positive, sexual or physical abuse, etc.)?

65. Identifying Needs and Resources: Extended Family and Friends Who is providing help to the family from extended family or friends? Who helps in emergency situations or when additional money or other resources are needed? Who provides support to the parent or other caregiver? Is this family caring for other extended family members and how does that affect the child?

66. Identifying Needs and Resources: Community What services are available in the community? Are there community programs already helping this family? If there are no resources available, for example for medical care, how can health needs be met elsewhere?

67. Services or Resources Another section on the CSI Record Form is used to record all services and resources being received by the child, household, or institution at the time of the assessment. Ask the primary adult in the child’s life, usually a parent or guardian, about these services and mark the form accordingly.

68. Phase IV: Using information toward making a plan What are the priorities for services? Recommendations: How should we proceed?

69. Phase IV: Using information toward making a plan What are the most important needs that need to be addressed? (List on the form) What are the resources that are used or should be considered? (List on the form) What are your recommendations for where to begin as we develop a service plan? Your recommendations form the basis for developing a plan of services with the child and family. (Service Planning will be covered in Day 5)

70. Important things to consider Maintain the family’s confidentiality (personal details) Complete the CSI form immediately following the visit, before you leave the home This is the family’s information. Summarize what you have found with the family to be sure you obtained correct information and that all agree on next steps.

71. Guidelines for Follow-up ScoreGuidelines for scoring Guidelines for follow up 4Good.No follow up needed. General knowledge about resources can be shared, if appropriate. 3Fair.This is an area that the visitor will want to be aware of in future visits to make sure the situation has not gotten worse. This is not seen as an urgent matter, but if the community worker has information that might help the child or family, it should be provided to them. 2Bad.It is recommended that the worker consider what the child and family needs are and if there are available resources or services to help. The worker can make the referral directly or discuss with the agency or the village leader to get help for the family, if possible. 1Very Bad.When the worker discovers an emergency for the family, the worker must respond accordingly. Home visitors should address the situation or refer the family/child to the appropriate resources. When there are bad circumstances and the worker does not know what the best response is, then the worker should make a plan with the agency director or village or community leader, as appropriate. The step(s) taken should be documented on the CSI record sheet.

72. Using the CSI Remember the Video– Dancing for Mwakaila Think about how we would assess this family using the CSI We will consider what we can do to identify the needs and strengths Ask the child or family member Observe in the home or community Divide into 7 groups– each to take one of the CSI areas

73. Using the CSI Each group to rate Mwakaila and his family on their specific area of need and strengths (CSI area) We will discuss what we learned in a brief report back. Please include any issues or questions that came up

74. Skills Building Workshop Completing the Assessment Get into the four small groups Using your case as an example from one group member’s experience, role play a Para Social Worker interviewing a family in order to assess a child’s needs. Complete the assessment based on your assessment Record your findings on the Assessment Form (CSI) Discuss with the group what we learn

75. Reference Nyangara, O’Donnell, Murphy & Nyberg (2009). Child Status Index A Tool for Assessing the Well-Being of Orphans and Vulnerable Children — Field Users’ Guide. The Measurement Group.