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PSYCHOSOCIAL INTERNAL TRAINING AND ORIENTATION 25 –26 November, 2004. UNICEF Indonesia. DAY 1 - SESSION 1. WHAT IS PSYCHOSOCIAL WELLBEING?. Why is psychosocial help important?. What are the main needs of children?
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PSYCHOSOCIAL INTERNAL TRAINING AND ORIENTATION25 –26 November, 2004 UNICEF Indonesia
DAY 1 - SESSION 1 WHAT IS PSYCHOSOCIAL WELLBEING?
Why is psychosocial help important? What are the main needs of children? We frequently focus attention primarily on physical needs and don’t pay enough attention to children’s needs for safety, affiliation, affection, acceptance and social interaction usually called psychosocial needs. This is especially true in emergency situations – we think about health, clean water, housing etc. and psychosocial help has traditionally been given less priority
Psychosocial help What words come to mind when we talk about psychosocial development or help? Psychosocial help can be of three main kinds: • Helping the child to build their ability to cope, heal and develop psychosocially • Strengthen the ability of caregivers such as teachers, parents, older siblings, community leaders to provide more appropriate social support for children • Professional or paraprofessional help for children who are experiencing particular difficulties
What is psychosocial development? Psychosocial development is defined as: “changes in cognition, emotion, spirituality and social relations mediated by socialisation processes”. In other words it includes children’s psychological and social development. Psychological development includes changes in: qCognition/Thinking - the mind of the child. It includes the way the children think, remember, learn, use language, what they believe, how they observe their world (see, hear, touch, etc.), their ability to become creative and logical, their ability to understand others. qAffect/Emotion - the emotion of the child. It includes motivations and emotions such as love, anger and frustration. Emotional development includes what emotions the children feel, how they react emotionally towards different situations, how they understand their own emotions and the emotions of others, and how they express or deal with their own emotions. qSpirituality – how the child makes sense of the world around them, what religious, moral or spiritual beliefs and understandings they have
What is psychosocial development? Social developmentis the development of social behavior of the child, including ability to interact with others,cooperate, communicate, and find their role in the family and community, who is the important person in their life (families, friends, etc.). It also refers to what groups they feel attached to or actually participate in e.g. religious groups, ethnic groups, sporting or family groups
What is Psychosocial Well-being? What words do you associate with ‘well-being’? Can you find other similar words? Well-being is difficult to define. . . It refers to sense of wholeness, of living life to the full, overcoming challenges, resiliency etc. Wellness and distress/illness are opposite ends of a continuum
Aim of Psychosocial Help What is the aim of psychosocial help? • To promote psychosocial well-being for children. Psychosocial Well-being can be thought of as a number of interconnected competencies. Can you think of psychosocial competencies of children? E.g. to form strong attachments to caregiver, to be responsible
Psychosocial Competencies What are basic psychosocial skills or competencies? (1) Feel loved and cared for by caregivers - Child feels safe and cared for by supportive and responsible adults (usually parents). (2) Meaningful friendships and social skills - Child can make friends, get along with their teachers and other people in their community. (3) Trust in others- Child believes that they can rely on others in their community to help and listen to them. They feel that others will not hurt them or their community. (4) Sense of Belonging - Child feels part of a community and feels that that community addresses and meets their needs.
Psychosocial Competencies (5) Self-esteem - Child feels valued by others and has confidence in themselves. (6) Empowerment – Child has the ability to participate in decisions affecting their life and to form independent opinions and express themself. (7) Ability to access to opportunities – Child knows how to find or create opportunities to help them (8) Hopefulness or optimism about the future – Child feels confident that the world offers at least some positive things for them. They are able to see both good and bad things in their life.
Psychosocial Competencies (9)Responsibility – Child understands the effects of their own behaviour, shows that they care about the effect their actions have on others, and can learn from their mistakes. (10) Empathy – Child is able to understand and empathize with the needs, rights and feelings of others. (11) Creativity – Child is able to be creative and to imagine different possibilities. (12) Adaptability – Child and caretakers are able to adjust to their social situation, and to make the best of changes. • Do you think these competencies are relevant for children in Indonesia? Which are given priority? Are there any that should be given more priority?
SESSION TWO PSYCHOSOCIAL PROGRAMMING
PSYCHOSOCIAL PROGRAMMING Can you give examples of psychosocial programming? Psychosocial Programming. “Psychosocial programming consists of structured activities designed to advance children's psychological and social development and to strengthen protective factors that limit the effects of adverse influence.” What does this mean??
Psychosocial Programming 3 Levels of Psychosocial Programming • Promotion – activities done by paraprofessionals, for all conflict affected children • Prevention or Healing – activities done by counselors, for children having adjustment problems • Treatment – psychiatry and clinical psychological services for mentally ill children UNICEF usually focuses on Promotion and Prevention but can do Treatment if necessary.
Types of Psychosocial Programming Healing Treatment Promotion
What is psychosocial programming? PROMOTION Indirect psychosocial promotion activities include: • Promoting family reunification • Promoting family self-sufficiency (economic projects) • Ensuring adequate emergency shelter (appropriate housing) • Ensuring continuous schooling • Ensuring appropriate health and sanitation services All members of the community have responsibility to ensure there is a suitable environment for psychosocial development. These activities help to establish a suitable environment to protect and promote psychosocial healing and well-being. Usually these programmes are conducted by other organisations or under separate project. Psychosocial programmes should coordinate with programmes that address these needs. They should advocate for ensuring these basic needs are met, and that such programmes are implemented in a way that supports psychosocial development and healing.
What is psychosocial programming? Structured psychosocial promotion activities include: • Recreational and expressional activities for children • Child to child or mentoring programmes • Parents/community meetings to address their own and their children’s psychosocial well-being • Psychosocial information material for parents and teachers • Training and support of psychosocial para-professionals, including teachers, youth volunteers, health workers • Supporting community structures and cultural activities/traditions These kinds of activities can be conducted by suitably trained members of the community. Psychosocial programmes should focus first on these kinds of activities. This should be the base of the psychosocial programming pyramid
What is psychosocial programming? PREVENTION Psychosocial prevention activities include: • Group, including art and play, counseling for children • Individual and/or family counseling • Support groups for care-givers • Community healing rituals • Advocacy to decision makers to improve the environmental situation Can be conducted by school counselors, community or social workers trained in counseling or psychologists. This is for people who can not be helped by the activities conducted by community members – that is who are having difficulty to adapt TREATMENT • Psychiatic treatment, including therapy and medication • Clinical psychology including behavioural, relaxation and cognitive therapy • For people with mental illness e.g. clinical depression, PTSD, drug abuse Is any level more important than the other? If yes, why? If not, why not?
Psychosocial Programming In regular or on-going emergencies, psychosocial programming is usually mainstreamed into • Health (including HIV/AIDS) • Education • Child Protection Can you think of examples of psychosocial projects in each of these three areas?
Psychosocial Programming in Health • Training health professionals to identify, provide basic psychosocial assistance and refer psychosocial problems • Training health professionals in better parenting • Mental health projects • Counseling/support groups for HIV/AIDS patients • Play groups for children affected by HIV/AIDS • Life skills education for children/youth affected by HIV/AIDS
Psychosocial Programming in Education • Training teachers in basic psychosocial help • Supporting school counselors to conduct counseling for students and/or parents • Life skills for children and youth • Non-formal education e.g. peer-to-peer activities, recreational or cultural activities, summer camps • Training of community members to provide non-formal psychosocial help e.g. youth, community leaders • Supporting ECD caretakers to conduct structured play groups with children
Psychosocial Programming in Child Protection • Psychosocial projects for children affected by armed conflict e.g. establishment of safe play spaces • Rehabilitation projects for child soldiers or children in conflict with the law • Social and psychological support for separated children e.g. drop-in house, family reunification • Counseling and peer support for victims of sexual or physical abuse • Training social or religious workers in psychosocial help
SESSION THREE PSYCHOSOCIAL PROGRAMMING AND UNICEF’S MANDATE
UNICEF’s Mandate Do you think psychosocial programming is part of UNICEF’s mandate? If yes, why and in what situations? If not, why not? • According to article 39 of the CRC, States parties must take all appropriate measures to promote the physical and psychological recovery and social reintegration of a child victims of: neglect, exploitation or abuse; torture or any form of cruel, inhumane or degrading treatment or punishment; armed conflict. • UNICEF considers psychosocial programming as a core component of its response to emergency situations (see Core Commitments for Children) • In non-emergency situations, psychosocial programming is implemented according to needs and priorities of the Country Office
UNICEF Psychosocial Principles • What do you think are some of the principles that should govern psychosocial programming for UNICEF? • In small groups, discuss 2 of the following principles. Are they appropriate? How would you implement these in a psychosocial project? • Are there any principles you think should be added to the following list?
UNICEF Psychosocial Programming Principles Conduct field-based Assessment Should focus on two main issues: • existing and potential psychosocial stress factors in the community; and • existing and potential community-based mechanisms for promoting psychosocial well-being and recovery Utilise community-led process: • Members of the affected community should be active partners in psychosocial programmes. • Participation of the community has therapeutic benefits, helping to re-establish meaning and direction in people's lives, gain control over their situation, and raising self-esteem. • Psychosocial programmes can make matters worse if they reinforce a sense of powerlessness by treating those affected as helpless victims. • Youth can be a valuable resource, to be trained to help their peers or younger children
PRINCIPLE UNICEF Psychosocial Programming Principles Focus on healing: • Programmes should aim to support healing processes, including reintegrating the child into a stable and nurturing family environment, strengthening child's existing care system, re-establishing daily routines, and providing the child opportunities for expression and skills for overcoming adversity. Focus on Stress and Adaption, not Traumatisation • Exposure to sudden, life-threatening – traumatic – events is an important source of stress but is only one of many stressors • Other sources of stress, such as family tension, poverty, inappropriate housing, education, or health systems, dislocation etc., are equally important • Programmes should deal with all sources of stress, and traumatic events as one source of stress, rather than focusing on traumatic events Focus on Resilience, not Vulnerability • Most people in conflict situations will find a way to cope and often become stronger • Programmes should acknowledge the difficulties people face, and let people express their feelings, help them recognise the ways they do overcome difficult circumstances, and to learn from other people in their community about how to cope better.
UNICEF Psychosocial Programming Principles Understand and respect local traditions and practices: • Programmes should utilise local views of child development and local beliefs about children, and understand local culture and practices. • This includes the rites and rituals related to becoming an adult as well as those associated with death, burial and mourning. Avoid institutional approaches: • Institutionalizing children and identifying them as traumatized can impose an inadvertent stigma and contribute to their isolation and withdrawal, and it is too expensive • The most effective and sustainable approach for promoting psychosocial well-being and recovery is to mobilize the child's existing care system. • When groups of vulnerable children, such as child soldiers, are targeted for special attention, it should be done with the full cooperation of the community so as to ensure their long-term reintegration
SESSION FOUR DIFFICULT SITUATIONS AFFECTING CHILDREN, THEIR RESPONSES AND COPING MECHANISMS
Difficult Situations Affecting Children • What are some difficult situations that might lead to psychosocial problems for children?
Difficult Situations Affecting Children General problems • Separated from parents and families • Witness act of violence or abuse • Become the victim of violence or abuse • Death or loss of parents and close families (e.g. due to HIV/AIDS) • Live in poverty • Drop-out of school • Work in exploitative situation e.g. sexual exploitation • Victim of trafficing • Tension and violence within families, schools and communities • Serious illness e.g. HIV/AIDS
Difficult Experiences for Children Conflict specific difficult experiences • Live in fearful, threatening environment • Live as a refugee or return to their village • Participate directly in violence and conflict e.g. child soldiers • School and other activities of children are interrupted
Children’s Reactions to Difficult Situations What are some of children’s reactions to difficult situations? • Physical reactions, such as strong heart beat, tensed muscle, panted breath, pain without cause such as headache, dizzy, painful muscle, tiredness, lack of energy or psychosomatic problems • Changes in Thinking such as only thinking about the problem, getting confused or changing mind easily, difficulty in concentrating, changes in beliefs, flashbacks, unable to trust others • Changes in Emotions, feeling angry, sad or hopeless. Not feeling anything (becoming numb), erratic mood changes or lack of empathy for others
Children’s Reactions to Difficult Situations • Behavioral changes, such as nervous, aggressive, argumentative, dangerous activities such as drugs, ‘strange behaviour’ (e.g. hording things), withdrawal from activities and others, increasing dependency on the support and suggestions of others, problems with sleep (difficulty in sleeping, nightmare, oversleep), regression to earlier developmental stage, being ‘too good’ Changes can range from: Depressive to Aggressive Note: We often overlook the problems of depressive children as they tend to become more quiet
Trauma and Stress What is the difference between trauma and stress? Why is it important to distinguish between trauma and stress? Stress is when a person feels they are unable or have difficulty to meet the demands placed on them e.g. a poor mother to provide food for her children Traumatic events are sudden, unexpected experiences that are or are perceived to be life-threatening and out of the range of ordinary experience e.g. rape or villages being burnt
Resilience and Coping Why do some children overcome difficult situations and others have much difficulty? What determines whether children are able to overcome difficult situations? • “Resilience is the human capacity to face, overcome and be strengthened by or even transformed by the adversities of life. . . With resilience children triumph over difficulties, without it the difficulties triumph”
Resilience What determines resilience? What determines whether a child copes and heals or not? Resilience is determined by two main factors: • Characteristics/abilities of the child • Environmental factors e.g. families who model good coping behaviour
Resilience Characteristics/abilities of the Child • A person people can like and love • Glad to do nice things for others and show my concern • Respectful of myself and others • Willing to be responsible for what I do • Are sure things will be all right • Talk to others about things that frighten or bother me • Find ways to solve problems I face • Control myself when I feel like doing something dangerous • Find someone to help me when I have problems
Resilience Environmental factors • Consistent and secure relationships with caretakers • Caregivers who the child can trust and who loves them no matter what • People who set limits for the child to stop them getting into danger • People who encourage the child to learn how to do things themselves and who help them when they are in trouble • Parents who are models of coping and appropriate behaviour
SESSION FIVE KEY PSYCHOSOCIAL SUPPORT TECHNIQUES AND APPROACHES
Psychosocial Support Techniques Demonstrate a Technique… • What did you learn from this experience? • How could you use what you learnt for helping children?
Psychosocial Techniques Two main types of psychosocial help: • Action that is done as part of regular interaction with children e.g. teachers behaviour in class towards students • Structured activities such as counseling groups, play or artistic activities Think of someone you know who is a good psychosocial helper for children. .. What are the qualities and behaviours of that person? What are some structured psychosocial techniques or activities that you know or have heard about?
Basic Advice in Helping Children As part of caregivers regular interaction with children there are some basic actions they can do to help children: • Listen to the child. Don’t lecture them or give advice too quickly • Observe the child’s reaction and try to identify the cause. Don’t assume you know what’s really bothering them. • Provide children with support. Reassure them you care about them and their reaction is normal • Help children learn to cope with their problems. Help them to think for themselves about the different possibilities for how they can react and which is the best. • Help children return to normal activities slowly.
Basic Advice in Helping Children • Encourage children when they make improvements • Maintain minimum standards of behaviour without using physical punishment • Don’t call children names who are having difficulties e.g. naughty, stupid • Encourage older children to discuss moral issues such as ethical behaviour in the community • Provide opportunities for children to play and express themselves and participate in their family and community Conduct role-play of giving basic psychosocial support.
Structured Psychosocial Techniques These techniques can be used by caretakers with children of different ages: • Sand Box • Clay • Puppets and dolls • Traditional folklores and fantasy • Using black/white board • Games (if possible cooperative ones) • Painting or drawing • Writing and story-telling • Drama and singing • Group discussions and/or projects • Relaxation techniques
Structured Psychosocial Techniques These techniques can be • Open - that is, children address any subject they want or • Theme – that is the children are asked to address a theme or issue and then the teacher provides follow-up questions What are the advantages and disadvantages of these two approaches? When would each be appropriate? For details of how to implement these techniques see UNICEF/PPPG Tetulius Psychosocial Manual
SESSION SIX UNICEF’S PSYCHOSOCIAL WORK IN INDONESIA AND FUTURE DIRECTION