Assessing emotional wellbeing in a refugee camp [Read-Only]€¦ · Sunday’: Assessing emotional...

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When every day is a When every day is a Sunday Sunday : Assessing : Assessing emotional wellbeing in a emotional wellbeing in a refugee camp refugee camp Rebecca Horn Rebecca Horn Institute of International Health & Development Institute of International Health & Development Queen Margaret University Queen Margaret University

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  • ‘‘When every day is a When every day is a SundaySunday’’: Assessing : Assessing

    emotional wellbeing in a emotional wellbeing in a refugee camprefugee camp

    Rebecca HornRebecca HornInstitute of International Health & DevelopmentInstitute of International Health & Development

    Queen Margaret UniversityQueen Margaret University

  • Conflict and displacement are known to Conflict and displacement are known to impact on psychosocial wellbeingimpact on psychosocial wellbeing

    There are now many interventions There are now many interventions which aim to improve the psychosocial which aim to improve the psychosocial wellbeing of those affected by conflictwellbeing of those affected by conflict

  • Model of psychosocial wellbeingModel of psychosocial wellbeing

    Economic resources

    Environmental resources

    Physical resources

    Individual factors Social factors

    Culture and values

  • Recent years have seen Recent years have seen the development of the development of guidance regarding guidance regarding effective mental health and effective mental health and psychosocial interventions, psychosocial interventions, especially the IASC especially the IASC Guidelines on Mental Guidelines on Mental Health and Psychosocial Health and Psychosocial Support in Emergencies.Support in Emergencies.

    But progress has been But progress has been hindered by a failure, until hindered by a failure, until recently, to systematically recently, to systematically evaluate these evaluate these programmes.programmes.

  • Why has evaluation not happened?Why has evaluation not happened?Difficulties in finding appropriate measures of Difficulties in finding appropriate measures of psychosocial wellbeingpsychosocial wellbeingLack of methods for crossLack of methods for cross--cultural adaptation cultural adaptation and validation of assessment instrumentsand validation of assessment instrumentsEticEtic measures often used inappropriatelymeasures often used inappropriatelyCreation of new, locally appropriate Creation of new, locally appropriate measures hindered by lack of knowledge, measures hindered by lack of knowledge, skills and resources in the fieldskills and resources in the fieldSome exceptions: Jon Hubbard (Centre for Some exceptions: Jon Hubbard (Centre for Victims of Torture) and Paul Bolton (Boston Victims of Torture) and Paul Bolton (Boston University)University)

  • KakumaKakuma Refugee CampRefugee Camp

    Insert pictureInsert picture

  • Jesuit Refugee Service Jesuit Refugee Service –– Community Community Counselling ProgrammeCounselling Programme

    Refugees trained in Refugees trained in basic counselling skillsbasic counselling skills40 employed to provide 40 employed to provide emotional support emotional support within their own within their own communitiescommunitiesAddress wellbeing Address wellbeing broadly: listening, broadly: listening, talking, helping to talking, helping to access services etc.access services etc.Train other community Train other community members in basic members in basic counselling skillscounselling skills

  • Why assess emotional Why assess emotional wellbeing in wellbeing in KakumaKakuma??

    To assist JRS counsellors to assess new clients To assist JRS counsellors to assess new clients in a systematic wayin a systematic wayTo monitor progress of clientsTo monitor progress of clientsTo assist with supervisionTo assist with supervisionTo assist with management of the Community To assist with management of the Community Counselling Programme (e.g. identify training Counselling Programme (e.g. identify training needs)needs)To assist with evaluation of the Community To assist with evaluation of the Community Counselling ProgrammeCounselling Programme

  • Development of instrumentDevelopment of instrument

    Based on methodology used by Paul Based on methodology used by Paul BoltonBoltonFreelistingFreelisting (n=84)(n=84)

    Emotional problems affecting people in your Emotional problems affecting people in your communitycommunityThe main tasks a man/ woman is expected to The main tasks a man/ woman is expected to do for self/ family/ communitydo for self/ family/ community•• Pile sort: essential; desirable; optionalPile sort: essential; desirable; optional

    Pilot study (n=201)Pilot study (n=201)

  • KakumaKakuma Emotional Wellbeing Emotional Wellbeing Interview (KEWI)Interview (KEWI)

    Introduction & information about Introduction & information about respondentrespondentEmotions sectionEmotions sectionFunction section (gender specific)Function section (gender specific)

  • Emotions sectionEmotions section

    20 items (e.g. 20 items (e.g. I am easily annoyed or I am easily annoyed or irritated).irritated).Response format:Response format:

    I am going to read you a list of problems that people can have. For each one I am going to ask you how much you have experienced each one IN THE LAST WEEK, including today.

    To decide how much each problem bothers you, think of yourself as a jerry can. The more water there is in the jerry can, the more the problem bothers you:

    Not at all (0) A little (1) Quite a bit (2) Extremely (3)

  • Function sectionFunction section

    10 male tasks and 10 female tasks (e.g. Keeping 10 male tasks and 10 female tasks (e.g. Keeping yourself clean and tidy)yourself clean and tidy)Response format: amount of difficulty compared Response format: amount of difficulty compared to man/ woman of same age in same communityto man/ woman of same age in same community

    11 22 33 44 55No difficulty A little No difficulty A little Moderate A lot Moderate A lot Often cannot doOften cannot do

  • Validity and Reliability TestingValidity and Reliability TestingIdentification of communitiesIdentification of communities

    Ethiopian; Ethiopian; AcholiAcholi; Great Lakes; Great LakesTranslationTranslation

    Research teamResearch team

    ParticipantsParticipantsAssessing criterion validity without a Assessing criterion validity without a ‘‘gold standardgold standard’’

  • ParticipantsParticipants

    203 interviews conducted203 interviews conducted

    110 (54.2%) male; 93 (45.8%) female110 (54.2%) male; 93 (45.8%) female

    65 (32%) Ethiopian; 61 (30%) 65 (32%) Ethiopian; 61 (30%) AcholiAcholi; 77 (38%) ; 77 (38%) Great LakesGreat Lakes

    Ages 16Ages 16--64 (Mean=33.9; SD=9.3)64 (Mean=33.9; SD=9.3)

    Lived in Lived in KakumaKakuma 11--18 years (Mean 9.4; SD=5.0)18 years (Mean 9.4; SD=5.0)

    90 identified as having emotional problems; 90 90 identified as having emotional problems; 90 identified as not having; 23 unknown.identified as not having; 23 unknown.

  • Validity and Reliability ResultsValidity and Reliability ResultsInternal consistencyInternal consistency

    Emotions scale: Emotions scale: CronbachCronbach’’ss alpha = .93alpha = .93Function scale (male): Function scale (male): CronbachCronbach’’ss alpha = .87alpha = .87Function scale (female): Function scale (female): CronbachCronbach’’ss alpha = .80alpha = .80

    TestTest--retest reliabilityretest reliability (23 interviews, 2(23 interviews, 2--13 days later)13 days later)Emotions scale: r =.85Emotions scale: r =.85Function scale: r =.84Function scale: r =.84

    Construct validity:Construct validity: single factor accounted for 45% of single factor accounted for 45% of variance, all items loaded above .3variance, all items loaded above .3

    Criterion validity:Criterion validity: scores of 90 scores of 90 ‘‘with problemswith problems’’participants were significantly higher than 90 participants were significantly higher than 90 ‘‘without without problemsproblems’’ participants, on both emotions and function participants, on both emotions and function scalesscales

  • But But ……

    High proportion of missing data for function High proportion of missing data for function scale, especially male versionscale, especially male version

    Motivations for participationMotivations for participationMost willing Most willing –– nobody declined but some warynobody declined but some warySome Some ‘‘passively declinedpassively declined’’Some participated because they understood what Some participated because they understood what research is, and its purposeresearch is, and its purposeSome participated out of respect for the interviewerSome participated out of respect for the interviewerSome participated because they believed they would Some participated because they believed they would benefit somehowbenefit somehow

  • They have seen these things They have seen these things happening many times. They come happening many times. They come and do assessment of the house, they and do assessment of the house, they come and do assessment of the come and do assessment of the children, they come, and then another children, they come, and then another time you will get some construction time you will get some construction material. And they are always material. And they are always ‘‘why not why not I be interviewed? Why didnI be interviewed? Why didn’’t they come t they come and talk to me?and talk to me?’’ Because they have to Because they have to get, if they are not asked, interviewed get, if they are not asked, interviewed about something, about their family, about something, about their family, children and everything, they will not children and everything, they will not get mosquito net. Or something. You get mosquito net. Or something. You know? This has happened many many know? This has happened many many many times for the last 15 years. many times for the last 15 years. People come always and see things, People come always and see things, and then go back and bring something. and then go back and bring something. I can just see from their face that they I can just see from their face that they feel like, you know, they tend to explain feel like, you know, they tend to explain their problem further. And then as time their problem further. And then as time goes by, they forget it. Because this goes by, they forget it. Because this also happens. They have come and also happens. They have come and interviewed me, and they did nothing. interviewed me, and they did nothing. This also happens in This also happens in KakumaKakuma..

  • Other factors affecting responsesOther factors affecting responses

    Refugee situationRefugee situation‘‘I think a lot about my current problemsI think a lot about my current problems’’‘‘ I think a lot about the future and whether things will I think a lot about the future and whether things will ever improveever improve’’

    Increased insecurityIncreased insecurity‘‘I feel afraidI feel afraid’’[Difficulty] [Difficulty] ‘‘Protecting self and familyProtecting self and family’’

    Culture and shameCulture and shameSocially desirable responses, especially amongst Socially desirable responses, especially amongst Ethiopians and Ethiopians and AcholisAcholis..

  • Other thoughts Other thoughts ……

    Appropriateness of systematically measuring Appropriateness of systematically measuring psychosocial wellbeingpsychosocial wellbeing

    Focus on emotional aspect of wellbeingFocus on emotional aspect of wellbeingDifficulty in focusing on emotional/ psychological Difficulty in focusing on emotional/ psychological causes of difficulties performing taskscauses of difficulties performing tasks

    Reliance on shared understandings & Reliance on shared understandings & challenges of translationchallenges of translation

    Challenge of comparing self to othersChallenge of comparing self to others

  • ConclusionsConclusions

    The KEWI emotions scale could make a The KEWI emotions scale could make a useful contribution to the JRS useful contribution to the JRS Community Counselling programme.Community Counselling programme.

    The disadvantages of the function scale The disadvantages of the function scale outweigh its advantages.outweigh its advantages.

    Next step: to find a way of combining Next step: to find a way of combining KEWI with broader assessment of KEWI with broader assessment of wellbeing, including resources as well wellbeing, including resources as well as challenges.as challenges.