PSYCHOSOCIAL SUPPORT FOR CHILDREN IN EMERGENCIES

We are not crazy!We are not crazy!

What we feel is not abnormal– What we feel is not abnormal– the situation is crazy and the situation is crazy and

abnormal!”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 issuesPsychosocial AssessmentsObjectives of programmes and indicatorsMain activitiesWhat sectors are programmes implemented in (child protection, health, education etc.)Psychosocial evaluationStrengths 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/empowermentFamily: • 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

Specialisedservices

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. Coordinate2. Undertake an assessment3. Plan activities based on assessment4. Address basic services and security issues

that impact on psychosocial well-being5. Mobilize family and community support6. Develop structured psychosocial programs

(if needed)7. Refer to appropriate mental health services8. 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: SpecificMeasurableAppropriateRealisticTime-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?

THANK YOU