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Addressing Psycho-social Distress and Trauma
Many of the OVC groups covered in this toolkit have been victim to some form of psychosocial distress or trauma. These include children who have watched their parents die from illness or conflict; children living in the street who have fled an abusive situation at home or are subject to abuse from their peers in the street; and children formerly associated with armed groups who have been the victims of abuse and may, themselves, have committed atrocities.
Common symptoms of children under psychological distress include sleep-related problems – nightmares, bed-wetting, insomnia and irregular sleep patterns. Fear is also a common symptom – fear of darkness, fear of sleeping alone, fear of leaving the house, and fear of strangers. Other problems include anxiety, irritability, inability to concentrate, regression to developmentally earlier stages of behavior, withdrawal from friends and family, rebellion, aggression, and psychosomatic symptoms, such as headaches and skin diseases. Children become pessimistic about the future and feel as if they have no control over their lives.
Post Traumatic Stress Disorder (PTSD) occurs when a past trauma has not healed. The symptoms of PTSD are (Abudabbeh, Nuha):
- Intrusions or flashbacks, intense emotions, nightmares, and reenactments. These intrusions often leave a person feeling a sense of great loss, anger, helplessness, or betrayal.
- Compulsive Re-Exposure to Trauma. Victims of trauma are more likely to be re-victimized. Self-destructiveness is a common reaction of children who have been abused.
- Avoiding and Numbing of Emotions. Avoidance of the memory of the traumatic event can be done by staying away from reminders, consuming drugs or alcohol, and detachment from everyday activities.
- Inability to Control Emotions. People with PTSD can react with intense emotions, such as anger, fear, or panic, when they see something that reminds them of the source of their trauma. They often over react by threatening others or by seeing the world as an unsafe place. Children often regress under these circumstances.
- Attention and Distractibility. People with PTSD have difficulty sorting out relevant from irrelevant information.
- Alterations in Defense Mechanisms and Changes in Personal Identity. Trauma is usually accompanied by feelings of shame and inadequacy, but since these feelings are too painful to live with, the person with PTSD often denies them, which opens the door to further abuse.
Research has shown a strong connection between poverty and stress. Poverty is caused not only by the debilitating conditions created by stress, depression, and chronic disease but also by the reduced productivity of people as a result of these conditions. Therefore, it is critical that psycho-social distress and trauma be detected and treated.
In some of its work with children under distress, UNICEF supports strategies that help children feel secure, express themselves, understand their situation and develop constructive ways to deal with and overcome the adversities they face. Adolescents need a meaningful, non-violent way to participate in and support their community. UNICEF’s psycho-social programming is built around four strategies:
- Promotion of psychological and social well being;
- Prevention of acute psychological and social distress;
- Early detection of psychological and social distress; and
- Treatment and rehabilitation of acute psychological and social distress.
Psychosocial Interventions should promote the following key competencies and outcomes among children and their caretakers:
- Secure attachment with caretakers;
- Meaningful peer attachments and social competence;
- Trust in others;
- Sense of belonging;
- Self-esteem;
- Empowerment;
- Ability to access to opportunities for cognitive, emotional, and spiritual development and economic security;
- Hopefulness or optimism about the future;
- Sense of responsibility for own actions;
- Empathy with the needs, rights and feelings of others;
- Creativity; and
- Adaptability.
Here are some examples of activities that can be implemented to support children in distress:
To raise parents and children’s awareness on how to overcome adversity :
- Develop and broadcast educational radio announcements to enable parents and care givers to provide simple psychological support to their children. Some of these messages may need to be tailored to grandparents.
- Develop and distribute copies of a parents’ brochure and teachers’ brochures. This intervention could be effective in African countries with high literacy rates.
- Assist the Ministry of Social Affairs to produce dramatic performances involving children to educate them on their rights and problem-solving.
To prepare volunteers to provide support, mentoring and recreational/expressional activities for children :
- Training of youth psychosocial volunteers who provide mentoring, and recreational and awareness-raising activities for children and their parents.
- Training of volunteers to provide first hand psycho-social support and crisis intervention for children.
To train professionals to conduct psychosocial activities with children :
- Training for school counselors;
- Training of social workers on psychosocial support and supplying them with educational and therapeutical materials for their activities with children and families.
- Training of pre-school teachers and teachers in psychosocial interventions.
To benefit children in need of special protection :
- Recreational, expressional and education activities for children living near a zone of conflict or who are living in an AIDS-affected household;
- Individual and group psychological and social counseling for injured children.
- Counseling support to children in distress through face-to-face, play, family counseling, play and awareness-raising seminars.
- Support training course for professionals in psychology.
Essential training topics should include: psychological and social well-being; sources of stress/crisis and reactions to stress/crisis; crisis intervention, including problem-solving or healing process; common social and/or psychological problems and suggested guidelines; activities for intervention, which could include drama, drawing, writing, singing, dancing, discussions, play, role-playing or theatre; and group facilitation skills.
Training of trainers should be spread over a period so as to ensure that participants practice what they learn. The training style should be participatory and include role playing, small group discussions, worksheets, journals, etc. Training materials should be both theoretical and practical, ideally including materials that trainees can use with the children or adults they work with.
While not all of the interventions described above are appropriate in the African context, many can be adapted for use with children in Africa, particularly for those affected by HIV/AIDS and conflict.
Save the Children Alliance (Richter, Linda, Julie Manegold & Raishnee Pather) has developed some useful guidelines for working with children affected by armed conflict and displacement. These guidelines are consistent with UNICEF’s approach described above and applicable to children living with HIV/AIDS and other stressful circumstances.
- Apply a long-term perspective that incorporates psychosocial well-being of children.
- Adopt a community-based approach that encourages self-help and builds on local culture, realities and perceptions of child development.
- Promote normal family and everyday life so as to reinforce a child’s natural resilience.
- Focus on primary care and prevention of further harm in the healing of children’s psychological wounds.
- Provide support as well as training for personnel who care for children.
- Ensure clarity on ethical issues in order to protect children.
- Advocate children’s rights.
Psychosocial support – Masiye Camp, Zimbabwe
The Salvation Army developed the Masiye Camp Initiative in 1994 with the aim of addressing the lack of psychosocial support in programs that were working with OVC. The primary objectives of Masiye Camp were to put in place support interventions for children affected by HIV/AIDS that are both cost-effective and high-impact.
Masiye offers the following services:
OVC Camps – This is the primary activity of the Masiye Project. There are two types of camps – the first provides life skills training to children (one program focuses on 6-11 year olds and another on 12 – 16 year olds) and the second provides youth parenting skills primarily for children who are heading households. By the end of 2002, Masiye had trained 4,200 AIDS affected children in 10-day camps. These young people were then organized into Kids Clubs, which served as points of follow-up and support for children who had passed through the training camps. Evaluations showed that the camps had contributed significantly to strengthening the children’s ability to cope and that youth who worked with orphans were more likely to change their own behavior with regards to AIDS. Young people who had passed through the psychosocial support training were then used as assistant group leaders in subsequent OVC Camps.
The Strive Project – This project is implemented in partnership with Hope for a Child in Christ (HOCIC), an organization encompassing over 20 faith-based bodies, which has helped the Masiye Project do outreach at the community level and have access to a large group of volunteers. The Strive Project seeks to provide support to approximately 8,000 children affected by AIDS in eight locations; to increase safety nets for these children and strengthen HOCIC’s capabilities in its area of operation. Strive’s activities range from training teachers and child care workers in counseling to setting up an emergency fund to cover affected children’s physical and practical needs.
Youth Drop In Center – This project provides counseling, information, talks, recreational activities, and entrepreneurship advice to AIDS-affected youth.
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Memory Boxes: The Sinomlando Project, Pietermaritzburg, S.Africa
Memory boxes are designed to help the millions of families affected by HIV/AIDS in Africa to cope with disease, death and grief, and to plan the children’s future. Created in 2000, the Memory Box Program is an initiative of the Sinomlando Project, an outreach program of the School of Theology at the University of Natal. The overall objective of the Memory Box Program is to enhance resilience in vulnerable children and orphans affected by HIV/AIDS. The memories of the families are kept in a ‘memory box’ which contains the story of the deceased parents as well as various objectives pertaining to their history. To achieve this objective the Program conducts two types of intervention: family visits and children’s groups. In the first case, the program’s ‘memory facilitators’ encourage the sick parents or the caregivers to tell the history of the family in the presence of their children as a way of facilitating the bereavement process for the children. The methodology of oral history is used for collecting the family’s memories. Transcripts of conversations in Zulu are edited and compiled in a booklet that accompanies an audiotape of all the voices. These materials are presented to the interviewed family and placed in a ‘memory box’ created by the children with the help of memory facilitators.
To complement the work done with the families, the memory facilitators organize children’s groups with the assistance of their partner organizations. Ten to 12 children of similar ages, usually orphans, attend 12 sessions, each of two hours, after school. Basic therapy techniques are used. The Memory Box Program draws inspiration from the Humuliza Project, an AIDS orphans support program in Tanzania. Special emphasis is laid on life stories, family trees and bereavement narratives. During the sessions, the children create memory boxes, which they fill with various artifacts.
Since 2002, the Program has trained various NGOs, FBOs, and CBOs in the methodology as a means of extending the reach of the organization.
More on memory projects: See Memorybooks in Tanzania and Zimbabwe. |
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