Tuesday, October 20, 2009

Psycho-Social Programming for Children in Crisis

In 2004, Save the Children produced a handbook on psycho-social programming for children (Children in Crisis: Good Practices in Evaluating Psycho-social Programming, by Joan Duncan and Laura Arntson). You can download this handbook under the DME Documents section to the right. Those country offices doing, or considering psycho-social programming, should read this handbook if you have not already. It provides a good overview of psycho-social programming, from theory, definitions, issues, types of interventions, and measuring program/project outputs and outcomes. And, there is a very helpful chapter that discusses the differences between outcome and impact measurement.

Some short summaries from the handbook are:
What does psycho-social refer to? “The term “psychosocial” implies a very close relationship between psychological and social factors. When applied to child development, the term underlines the close, ongoing connections between a child’s feelings, thoughts, perceptions and understanding, and the development of that child as a social being in interaction with his or her social environment.”

What are the levels of severity children face in crisis? 1) Severely Affected Group- these are children in which their psychological and social functioning abilities may be severely compromised. While generally a small percentage of the overall population, this group requires intensive psychological attention because they are unable to manage on their own. Children forced to view and/or commit violent acts, such as child soldiers, are likely to fall into this group. More time-intensive, individualized approaches are likely to be the most appropriate responses, where social and cultural resources permit. This group is in need of one-on-one attention in order to address the more severe traumatic and/or depression disorders, for example. 2) At-Risk Group- A second segment of the community consists of those who have experienced severe losses and disruption, are significantly distressed, and may be experiencing despair and hopelessness, but whose social and psychological capacity to function has not yet been overwhelmed. Children in this category may be suffering from acute stress disorder (the most extreme, or exaggerated normal reaction to violence and trauma). They may have lost family members in the violence, they may have witnessed deaths, or they may be victims of violence. This group is at particular risk for psychological and social deterioration if their psychological, social, cognitive, and development needs are not addressed through timely community and social support mechanisms. 3) Generally Affected Group- The third and broadest segment of the population consists of individuals who may not have been directly affected by crisis events and whose families may be largely intact. Children in this group may be suffering from physical and mental exhaustion, for example, but are not experiencing the level of distress felt by those in the severely affected or at-risk groups. Community-based interventions that include not only normalization activities but also theme- and body-based activities can preserve and augment positive coping strategies among this population in a shorter time-frame and contribute effectively and more immediately to children’s and youths’ social, cognitive, and emotional development.

What are psycho-social programs/projects? Child-focused psychosocial projects are those that promote the psychological and social well-being and development of children. The orientation here is that child development is promoted most effectively in the context of the family, community, and culture. At its most fundamental level, psychosocial programming consists of activities designed to advance children's psychological and social development, to strengthen protective and preventive factors that can limit the negative consequences of complex emergencies, and to promote peace-building processes and reduce tensions between groups.

What are the primary issues psycho-social program attempt to address?
+ Secure attachments with caregivers - Child feels safe and cared for by supportive adult caregivers.
+ Meaningful peer relations or social competence - Child has the capacity to create and maintain relationships with peers and adults. Feels he/she is able to effectively navigate his or her social world.
+ Sense of Belonging - Child is socially connected to a community and feels he/she is part of a larger social whole. Child adopts the values, norms and traditions of his/her community.
+ Sense of self-worth and value, self-esteem, well-being - Child thinks of him/herself as worthy and capable of achieving desired goals. Child has a sense of empowerment and a sense of being valued. Child participates in larger community and feels in harmony with norms of his/her society. Child has the capacity and/or possibility to participate in decisions affecting his/her own life and to form independent opinions.
+ Trust in others – Child has a belief that he/she can rely on others for nurturance, help, and advice. Child feels that he/she will not be hurt by others.
+ Access to opportunities – Child has a sense of being in a supportive environment. Child has access to opportunities for cognitive, emotional, and spiritual development and economic security.
+ Physical and economic security – Child’s physical health, livelihood/economic security and environment are supportive and do not pose threats to the child’s emotional or physical wellbeing.
+ Hopefulness or optimism about the future – Childs feels confident that the world offers positive outcomes and a hopeful future.

Should psycho-social programs/projects be similar to each other? Some elements of psychosocial development are specific to a particular culture, meaning that there is not a “one size fits all” approach to psychosocial programming. A key challenge facing project designers is how cultural factors minimize or increase risk, and promote or impede resiliency. However, child development theory and research does point to a set of concepts that are useful building blocks for psychosocial projects regardless of where they are established. These include understanding what makes children resilient and the role that protective factors play throughout development. Identifying the ways these concepts are expressed within a particular culture should guide psychosocial project development and implementation. Through the study of children who have grown up under difficult circumstances, we have learned that some have certain characteristics and social supports that have enabled them to overcome adversity. Similarly, features of the social world have been identified that buffer the consequences of negative experiences on children. These features are often referred to as protective factors.

What are the content areas for interventions? Since children and adults experience and react to complex emergencies in unique ways, the types of projects designed to address their needs will also differ. Projects range and include those that are curative, preventive, and those that promote psychosocial well-being. Curative projects address the diagnosed psychological effects of complex emergencies on children and families, such as treatment of trauma. Preventive projects seek to prevent further psychosocial deterioration and may focus on a particular group or social environment. Lastly, projects may seek to promote healthy psychosocial development through, for example, opportunities to engage in educational, social, and spiritual activities that support the development of children.

What are the basic intervention approaches? There are different approaches to psychosocial programming, depending on the population being targeted and the project to be implemented. It is possible to identify three major groupings:
1. Psychological: Some projects focus more on psychological factors than on social factors. For example, some projects may provide individual counseling to children who have had traumatic experiences or provide training to key community members to identify, refer, or counsel children. These projects will most likely target children and caregivers who have been most severely impacted by crisis events and require a higher level of individualized attention than community-based interventions can provide.
2. Predominately Psychosocial: Some psychosocial projects are predominately or exclusively psychosocial in focus. The project is self-contained and not integrated into other projects with different foci health, food security, shelter) that may co-exist and are co-located. Examples include stand-alone recreation projects, art therapy, or various community-based interventions that promote positive cognitive, emotional, and educational development and functioning. Staff working in these psychosocial projects may have only minimal contact with staff working on other projects. Predominately psychosocial projects are likely to target their activities toward generally affected and at-risk populations, and provide screening and referral (to individualized mental health services or counseling programs) for those more severely affected by conflict or violence.
3. Integrated/Holistic: In some cases psychosocial interventions are integrated into a holistic and total response to the needs of a community. In this case, the “psychosocial” elements may not be as visible. For example, income generation or vocational training projects are not typically thought to be psychosocial. Yet, addressing the economic livelihood of families is fundamental to psychosocial health both in terms of reducing the daily stress of how a family will feed itself, and in terms of providing a pathway to stability and hope for the future. Similarily, such an intervention may have an educational component that supports cognitive development and at the same time fosters good peer relationships and social skills. An income generation project or vocational training project may be a conduit for improved self-esteem and self-worth and the establishment of peer friendships. The position here is that projects that are based on such a holistic approach are to be preferred since they maximize a mutually reinforcing effect when responding to different aspects of child development simultaneously. These projects are most likely to focus on those in the at-risk or generally affected group.
It is useful to organize projects into six broad areas that encompass the diverse social and psychological needs of children during and after a crisis: The Primacy of Family, Education, Engaging Activities, Economic Security, Community Connections, and Reconciliation and Restoration of Justice.

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