SECTION II Literature Review
53. Descriptions of the protective processes
6.1. Macro/exosystemic components of intervention
6.2.3. Sensitisation Programme [SP]
Several child-focussed sensitisation and capacity building programmes have been developed in response to the distress experienced by volunteers who offer HBC (Germann & Stally, 2003). For example, community-based children's programmes, conducted by NGO's such as TREE, LETCEE, s man i - the KwaZulu Natal programme for Survivors of Violence, Sinosizo Home Based Care Organisation, and The Valley Trust (all effective NGO's that operate in the KwaZulu Natal province
of South Africa) train community workers to work more effectively with children in distress. The community workers (employed or volunteer) who visit families engage at the coalface and directly witness the unfolding tragedy and the profound difficulties experienced by children affected by H1V/A1DS. They report feeling distressed and powerless, yet eager to learn ways to support the children (Schoeman et al., 2000).
The programme that is being evaluated in this dissertation was originally developed to meet the needs expressed by volunteers and staff working for the Sinosizo Home Based Care Organisation in Durban, South Africa. Working under the auspices of the Catholic Church, they had successfully rallied dedicated volunteers whom they had effectively trained in HBC. At their regular supervision, training and support meetings, the volunteers expressed concern for children who were witnessing the severe debilitation of parent figures and experiencing multiple family deaths. The Director of Sinosizo approached the Child and Family Centre at the University of Natal, Pietermaritzburg Campus, with the request that a training programme be developed to address these concerns. The first draft of the current sensitisation programme (Schoeman et al., 1999) was piloted, revised and again piloted using the staff and volunteers from the Sinosizo Home Based Care Organisation. The programme was well-received with the overall response being extremely positive (Killian et al., 2000). However, various difficulties with the original edition needed to be ironed out. The second draft (Killian et al., 2002) seemed to have effectively resolved some of the earlier difficulties, and although it remains a fluid and dynamic document, it was believed that a formal summative evaluation needed to be undertaken.
The major difficulty that had emerged from the piloting of the first edition was that whilst community members seemed to understand the need to develop warm and supportive relationships with vulnerable children, they tended to revert to their more familiar authoritarian approach and either instructed or ignored (although feeling highly compassionate) children when they returned to the field after the programme. Relatively few of the participants in the pilot programme changed their pattern of microsystemic interaction with children. These rigid patterns of interacting with children had been so habituated that it was difficult for many of the participants to change, to show their love and compassion, to be playful, and to actively listen without reverting to advice-giving, questioning, or giving of instructions. Community members expressed fears that if they were not firm with children, then the children would become difficult and disrespectful. In addition, for many the value of expressing feelings, and telling the story of one's life, was considered to be foreign and
potentially risky.
In order to overcome these difficulties, an apprenticeship model of capacity building with selected community volunteers was adopted(See Appendix D). It was assumed that if volunteers and professionals joined forces, they could learn from each other: (i) apprentice-facilitators would observe, participate and acquire the skills necessary to both work therapeutically with children and to conduct the structured group therapy programme (SGTP), thereby becoming more child-centred, less authoritarian and more therapeutic in their interactions with children; (ii) the psychologists would be able to work with apprentice-facilitators to gain important information about the customs and traditions within the community and culture; (iii) the children would benefit by having members of their own community who had insight into their difficulties and who could form a social support network for them, when the psychologists were not available. It had originally been thought that the apprentice-facilitators would also be able to translate. However, in most circumstances it became necessary to separate out these roles, in order to free the apprentice-facilitators to be more spontaneous with the children. The SP (Killian et al., 2002) therefore became an integral part of the process through which this community-based intervention could meet the psychosocial needs of children. After entering and mobilising a community, 25 to 30 volunteers were identified by community members to participate in the SP. The specific aims and objectives of the SP are set out in Table 6.1. This 5-day programme covered the topics in Table 6.2, using a participatory methodology, based on the principles of adult education. Formative assessments took place at the end of each day and three forms of summative assessments were undertaken.
A brief overview of the SP will now be presented. Each day began with a prayer or hymn that was led by a volunteer community member. An energising ice-breaker prepared the group members for the day's proceedings. Energisers and new games were used extensively throughout the programme and were particularly well-received by the participants. The first day's work schedule began with a brief introduction or go-around to reinforce the important contribution that each individual had on the overall success of the programme. The purpose was to convey a sense that the group consisted of a number of individuals each of whom was significant in terms of the overall functioning of the SP group and within the community as a whole. For many individuals, it was an unfamiliar experience to have to speak in front of a group and much support was offered to encourage people to speak-up in front of the group to report on how they were feeling or what they had done, thought
or worried about on the previous evening.
Table 6.1 Aims and objectives of the sensitisation programme:
— = • •-
Empowerment
Knowledge
Skills
Participants as Individuals
• Self confidence
• Faith in own capacity to help and one's own knowledge base
• Motivation to apply experience for own benefit as individual and family member
• Willingness to ask for help and support when needed
• Awareness that one learn's from own experiences
• Holistic understanding of vulnerable children's needs - physical, social, educational, emotional and spiritual
• Understand the impact of risk
• Identify indicators to distress
• Ways of building resilience and adaptive coping
• PSS is critically important and does not cost much in financial terms
• Impact of this work on self and need for self care
• Resilience building techniques
• Memory boxes are for everyone
• How to communicate with children
• Basic counselling skills - active listening & reflecting feelings
• How to talk to children about death
• Bereavement counselling
• Helping starts at home and with self
Participants as Community
• Confidence to participate in community decision making
• Willingness to advocate for vulnerable children
• Ability to speak about HIV/AIDS
• De-stigmatise HIV/AIDS and work against discrimination
• Holistic understanding of the community through the community profiles
• Understanding of how some communities become vulnerable
• It takes a village to raise a child
• PSS applies to individuals, families and communities
• Active advocacy for vulnerable children
• Agricultural and income generating projects
• Importance of feeling part of a community
• Ability to critically reflect on cultural norms and customs and their
implications for children.
• Organising and implementing activities and support for vulnerable children
• Importance of record keeping and group work
• Acquiring social services
Similar programmes have been written in many African countries, with marked similarities in content, although invariably the emphasis differs in each circumstances (Cook, 1998; Madori n. 2000;
PACT, 2002; SANTSEP, 1999; SCOPE & Family Health International, 2001). As far as is known, few formal evaluations have been conducted on them. Rather, most have successfully met their purpose and are regarded by the participants and recipients as useful. REPSSI has embarked on a process of collating a synthesised training programme that will draw these resources together and share the significant learnings across the various organisations that offer PSS to children in the sub- Saharan African region (Germann & Stally, 2003). The researcher is involved in this process and this
research programme will inform some aspects of REPSSI's work.