Learning to Work with Most Vulnerable Children and their Families

1. Learning to Work with Most Vulnerable Children and their Families A Project of the Social Work HIV/AIDS Partnership for Orphans and Vulnerable Children in Tanzania Day 6 Support and Behavior Change for Vulnerable Children and their Families

2. Social Work Process for Working with Orphans and Vulnerable Children Affected by HIV Identifying Vulnerable Children and their Families 2. Engaging Vulnerable Children and Families 3. Assessing their Strengths and Needs 4. Developing a Plan of Services for Vulnerable Children and their Families

3. Social Work Process for Working with Orphans and Vulnerable Children Affected by HIV 5. Implementing the Plan of Services • Identifying and Referral to Other Resources • Providing direct services: problem solving, support and coordination • Empowering and supporting caregivers • Addressing HIV related prevention and care concerns • Evaluating Progress, Revising Service Plan and Following Up Through Ongoing Case Management, Family Support And Advocacy

4. Objectives At the end of this day, Para Social Workers will be able to: • Explain the basis of behavior change and the stages of change model • Explain the concept of risk reduction and how to support risk reduction decisions • Demonstrate skills in family-based problem solving and risk reduction for vulnerable children, families and caregivers • Explain the process of grief and loss in the context of vulnerable children and families

5. Planning for Behavior Change Para Social Worker as a Change Agent Supporting Vulnerable Children and their Families

6. Planned Behavior Change Planned behavior change has three aspects: • Adapting: some change based on the environment • Altering:a complete change based on internal motivation • Modifying: partially changing the degree of the target behavior for a variety of circumstances

7. Planned Change • People change in response to their situation (environment) to satisfy needs and their goals • Active, dynamic process where people interact with their environment as an ecosystem in which each shape the other • People may change their environments to fit their physical and psychological needs

8. Change is Affected By…. • Developmental growth, maturity • Changes in situation • Family loss, • Loss of income • External forces affecting established patterns of behavior • Change in family responsibilities • Individual decision to change a behavior they see as harmful and/or unacceptable • Example: Unprotected sexual behavior may lead to health problems • Example: Traditional practice (e.g. female genital cutting) has become known in the community as unsafe

9. Change is Affected By…. • Other factors (within the person or the situation) • Peer pressure • Increased knowledge of the effects of harmful behavior • Family or community pressure (either positive or negative) • Symptoms of illness and/or physical distress • Positive or negative social pressure from all levels of society • Policy-related pressure

10. Risk Reduction • Risk reduction is a model of behavior change that can be helpful in understanding how behaviors change and how para social workers can be helpful in that process. It focus on modifying the risk instead of modifying the action/behavior • Risk Reduction strategies reduce harm while giving the client the space, time and positive feedback required for permanent behavior change • Risk Reduction may provide useful ways to change over time by reducing negative behaviors or increasing positive ones.

11. What are some examples of risk reduction behavior s (negative or positive) Brainstorm

12. What are some examples of risk reduction behaviors (negative or positive)? • Reducing the number of sexual partners • Increasing condom usage • Decreasing the amount of substance consumed

13. Role of the Para Social Worker in Planned Behavior Change • Planned change is an approach to problem solving based on • Problem assessment • Knowledge of the individual’s readiness for change • Change focused intervention • Para Social Worker functions as a change agent with the child/family and jointly plans with them for change • Planned change has a specific purpose and increases the likelihood of predictable outcomes as a result of the change efforts (Hefferman, et al., 1988:10)

14. Risk Reduction and Behavior Change • Risk reduction or harm reduction approaches assume that: • Behavior change is a process that occurs over time rather than a single event • Risk Reduction involves many factors, including psychosocial relationships as well as other social and environmental factors • Risk reduction strategies must be broken into small enough steps for the person to do successfully

15. Stages of Change

16. Circle of Change • The model “circle of change” describes the stages of change each person goes through on the journey to changing behavior. • This “stage of change” model was developed by Prochaska and Diclementi (1982) who differentiated six stages in the change process.

17. Circle of Change • This model is not presented to suggest that change is simple or easy, but rather to emphasize that change is complex and involves a process. • Para Social Workers can assess where a person is in the change process and choose interventions appropriate to that stage. • This helps Para Social Workers “begin where the person is”

18. The Stages of Change • No changeplanned (Pre-contemplation) • Thinkingabout change (Contemplation) • Decidingto change (Decision) • Changingbehavior (Action) • Continuingthe change (Maintenance) • Relapsereturning to the harmful behavior (Relapse)

19. Circle of Change No Change Relapse Continuing Thinking Deciding Changing

20. No Change Stage Person has no desire to change, or is not aware of the problem or is ignoring it, or is in denial • Role of the Para Social Worker • Provide information and feedback to raise awareness of the problem and the possibility of change • Information should not be judgmental • Involve family, social and community forces to help introduce the idea of behavior change • Provide assurances that positive support for change will occur

21. Thinking Stage Thinking about change, feeling somewhat Concerned about the behavior, but not having yet made commitment to change • May be a lengthy process requiring the person to move from accepting the problem, to accepting some responsibility, to feeling a need to do something about the problem • Considers change, but also may be threatened by it and thus may reject it • Role of the Para Social Worker • Help the person tip the balance in favor of change • Help the person see the benefits of changing and the consequences of not changing

22. Deciding Stage • Deciding to do something about the problem. Making a decision to make a change but has not yet put the decision into practice • Role of the Para Social Worker • Help the person find a change strategy that is: • Timely • Realistic • Achievable • Acceptable • Feasible • Appropriate • Effective

23. Changing Stage Taking action to make the change • Role of the Para Social Worker • Provide continuous, ongoing support • Advocate with family and community to avoid blame and to support change • Help accomplish the steps for change

24. Continuing Stage Continuing or maintaining the new behavior Role of the Para Social Worker • Help person continue to engage in the new behavior • Provide tools such as reminders, calendars, rewards to sustain positive change • Identify possibility of returning to old behavior (relapse) • Help person identify and use strategies to prevent relapse • Help the person to acknowledge the success of behavior change maintenance

25. Relapse Stage Goes back to the original behavior • Can lead a renewed decision to further work on the problem • Relapse can result in going back to the old behavior which will put the person back at the beginning of the circle of change

26. Relapse Stage The role of the Para Social Worker Assure the child/family that change is still possible and that relapse is not uncommon Assure the child/family member that our support will continue even if behavior changes Avoid blame, judgment and other negative responses Assure the child/family that positive change can endure Identify the conditions that led to relapse Help the child/family to understand how to change those conditions to sustain positive behavior

27. The Role of Para Social Workers: Problem Solving for Behavior Change and Risk Reduction

28. Helping Families to Solve Problems To help families solve problems, Para Social Workers always working as: • Helpers • Links to services in the community (Discussed in Day 5) • Family and community advocates

29. Who are the Community Resources Who Can Help Solve Problems? • Para Social Work Supervisors • Medical doctors, Nurses, Teachers • Experienced Counselors in the Community • Religious Leaders • Skilled situational counselors • Experienced school counselors • Experienced mental health or addiction specialists • Social Welfare Officers

30. Para Social Worker as an Agent for Problem Solving • Help the family get basic needs (food, clothing, shelter) • Help the caregiver or child to accept support for problem solving • Help other family members to support problem solving activities • Plan for linkage services between the child and family and the referral source if necessary (discussed in Day 5) • Coordinate with other providers so that the linkage can be efficient, effective and timely

31. The Role of a Para Social Worker: Problem Solving for Change Focuses on the process of change, which requires: • Developing and maintaining rapport with the child/family within the context of change • Identifying and exploring how to effect change • Identifying and exploring the willingness to change and barriers to change • Exploring the support required for long term behavior change • Selecting an option/solution and making a plan for behavior change

32. Overview: The Problem Solving Model • Building the Relationship 2. Exploring the Problem 3. Understanding the Problem 4. Planning for Action and Evaluating Results

33. The Problem Solving Model Building the relationship and communicating, requires nonjudgmental communication skills Tone of voice Attending behavior Questioning Paraphrasing Reflecting feelings Summarizing Non-judgmental

34. The Problem Solving Model • Exploring the Problem. Make the problem specific • What is the problem? • When did it start? • How much of a problem is it?

35. The Problem Solving Model • Understanding the Problem • Label the feelings – sad, happy, angry • Notice nonverbal messages/feelings and reflect them back • Acknowledge and affirm conflicting or ambivalent feelings • Tie the feelings to the facts or to the problem

36. The Problem Solving Model • Planning for Action and Evaluating the Results What are possible activities? Brainstorm

37. The Problem Solving Model Planning for Action and Evaluating the Results Plan together with the child or caregiver Explore past attempts to solve the problem Explore how to solve the problem now Share your ideas about possible solutions Follow up on the plan of action

38. The Problem Solving Model of Counseling Select an option/solution and make a plan • Help the child or family member choose a realistic solution • Which solution might work best? Why • Which strategy is feasible for the child or family? • How and when would the person be able to solve the problem (specific action plan)?

39. Para Social Worker’s Role: Following up on the Plan • Help to establish a family and community support network to support the problem solving plan of action • Decide who will do what, when, and where • Make referrals as appropriate • Follow-up to see if the plan was followed

40. Life of a Child III: Grief and Loss

41. Overview: Grief and Loss in Children • All children experience grief and loss when separated from their parent(s) whether by illness, death, or abandonment. • Like other aspects of human development, grief and loss depends on gender and developmental stage among other factors.

42. Overview: Grief and Loss in Children Feelings about grief and loss may cause many behaviors that indicate grief and loss, for instance: Anger Sadness Hyperactivity Becoming withdrawn These feelings are appropriate but may produce behavior s that are harmful to the child, others, or property

43. The Grief Process • Feelings about grief and loss may cause many behaviors that indicate grief and loss, for instance: • Anger • Sadness • Hyperactivity • Becoming withdrawn

44. Grief Process • Grief, like behavior change, is a process that may assume a circular form. People experiencing grief and loss may revert to prior stages depending upon other circumstances. An unrelated event or trauma may evoke a renewed grief reaction for the earlier loss. • What do you think are stages in the process of grieving? Brainstorm

45. Stages of Grieving • Shock/Denial • Anger • Bargaining • Sadness and Depression • Acceptance Note: • Everyone may grieve differently. • May not go through stages in order and may move back and forth between the stages.

46. Developmental Grieving • We may grieve even after we believe we have achieved acceptance • Children revisit losses at each stage of development • Children may seem to forget the loss for a while, then suddenly become very sad or angry • Sometimes children seem to have reached acceptance but have simply “bottled up” their feelings. These strong feelings may erupt at a later time • Multiple losses trigger strong, but unresolved emotions from previous losses

47. Effects of Developmental Grieving • Children who are separated from their parents due to illness, death, or other cause will be grieving • The pain of separation and loss is a type of trauma • Children can become stuck at one level, or even go back to an earlier level of development

48. Impact of Developmental Grieving • Children who are separated from parents may appear angry, depressed, or hostile • When we see a child who angry this may reflect their experiencing loss and pain (“Whenever you see anger, look for the pain” • Other children may appear charming and carefree. This is a way of hiding the pain of loss

49. Events and Contexts that Trigger Grieving • Anniversaries • Birthdays • Weddings • Holidays • Special songs, foods, etc. • Places associated with the loss • People who have the same name or look like the missed person

50. Factors that Affect Ability to Grieve Nature of the loss Health and self-esteem Age at time of each loss Children who don’t understand the concept of death may not be able to grieve appropriately and may then experience delayed grief Degree of attachment to lost person The intrinsic vulnerability of the person experiencing the loss