IIHD Research Fellow, Rebecca Horn writes about support for children in Sierra Leone affected by ebola

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Supporting teachers to support children affected by ebola: An account of Psychosocial Support Training for teachers in Sierra Leone

Rebecca Horn, January 2015

Introduction

I first came across EducAid Sierra Leone in 2007 when I was working for the Special Court for Sierra Leone – it was the one spark of positivity in what seemed to be a country struggling to emerge from years of war.  Since then, I’ve been back to Sierra Leone several times, a few of these on a voluntary basis to conduct trainings for EducAid staff and students (e.g. on research methods), and to help them develop a monitoring and evaluation strategy.

EducAid has gone from strength to strength in the time I’ve known it, and continues to inspire me with the professionalism, compassion and strength of the students and staff.  It has responded to the ebola crisis with typical resilience, immediately becoming involved in community awareness activities, creating podcasts and other resources to enable the students who were not in school (due to the State of Emergency which includes school closure until further notice) to continue to learn, and continuing to support those boys and girls who didn’t go home for the holidays but lived in the schools.

EducAid has several schools, two in Port Loko, a district which has been particularly badly hit by ebola.  It wasn’t long before community leaders started contacting EducAid staff to ask whether they could take in some children who had lost their parents to ebola, and their extended families could not afford to take care of them.  As a result, EducAid opened an Observation, Interim Care Centre (OICC) in one of its schools, where children would be monitored and cared for until they were confirmed to be free of ebola (after 21 days).  In a different school, they opened an Interim Care Centre (ICC), for children who had already gone through a quarantine period, just to be sure that the children were ebola-free before they joined the main school.  The EducAid management wanted to be sure that the teachers had the skills to (a) support the children who had lost parents and other relatives to ebola, and (b) help the new arrivals to integrate into the main school after their quarantine period successfully, without experiencing the discrimination or rejection commonly reported by those affected by ebola.  I agreed to come and spend two weeks with a group of teachers from all the EducAid schools exploring these issues and helping them to develop some skills and plans of action, which the teachers would then share with their colleagues.  This blog is an account of my two weeks with EducAid in Port Loko, Sierra Leone.

The training will take place over eight days, with five days on input and five ‘practice days’, where the participants have an opportunity to use the skills they have practiced in the classroom and to reflect and get feedback on them.  The aims of the training are:

  • To enable participants to strengthen the psychosocial wellbeing of children in the ICC.
  • To enable participants to help the children integrate into the main school from the ICC (focusing on the wellbeing of both the new arrivals and the existing school community)
  • To enable participants to take care of their own psychosocial wellbeing, so they can support others

The training focuses on both knowledge and skills, and will include an element of planning how to put what has been learned into practice, and share with others.

We have twelve participants, two from each of the EducAid schools. Four of the participants are female staff; a significant proportion in a country where women struggle to obtain the education, confidence and positive attitude necessary to enable them to teach and mentor others.

Monday 19th Jan 2015

We began today with the foundations – in the morning, a workshop on understanding psychosocial wellbeing.  The aim of this was to help the twelve participants understand how the wellbeing of the children they work with consists of various inter-related ‘domains’, including physical wellbeing, material wellbeing, social wellbeing, cultural wellbeing, emotional wellbeing, spiritual wellbeing and thinking and learning (mental wellbeing).   We explored participants’ ideas about what children need for good ‘wellbeing’, and what EducAid already does to strengthen the different aspects of children’s wellbeing.

EducAid differs from most schools in Sierra Leone in the emphasis it puts on ‘giving back’ to the community and the country.  The fees for attending the school are not financial, but are ‘excellent effort, excellent attendance and excellent behaviour’, and these core values are reinforced by staff and older students.  The school environment, therefore, has a very holistic view of ‘achievement’ and ‘success’, and this is reflected in participants’ understanding of what constitutes wellbeing.  Many of the twelve participants are former EducAid students, who have now joined the staff, and their level of maturity and integrity is striking.  I have done the ‘wellbeing exercise’ in many different contexts, but this is the first place where people have said that key aspects of wellbeing are honesty, integrity, concern for others, and so on.

In the afternoon we had a more practical session, focusing on developing and practising basic listening skills, including active listening and helpful responding.  We practised listening and trying to hear and reflect what someone was really saying to us.  These skills are generally useful, but tomorrow we’ll move on to thinking about how we can adapt them to help children to talk about their feelings and experiences.

Sierra Leone revised blog (2)

Tuesday 20th Jan 2015

Today we began the training with a review of what participants found interesting and difficult from yesterday’s sessions.  Several people were struggling with the idea that passing judgement on what somebody says, or giving advice, or asking a lot of questions were not helpful ways to really understand how a person is thinking and feeling.  These are common ways of responding, particularly adults to children, and the idea of adopting a more neutral approach to try to understand a situation from another person’s perspective – to empathise – was challenging for some.

Our main focus of the morning was an orientation to Psychological First Aid (PFA).  PFA is an approach developed and endorsed by a wide range of organisations working in humanitarian settings, led by WHO, World Vision International and War Trauma Foundation. It is for use in crisis situations, to provide humane, supportive and practical help to people in the immediate aftermath of a distressing event.  In Sierra Leone it is being used by health care staff and psychosocial staff, as well as others working directly with individuals and communities affected by ebola.  EducAid teaching staff are less likely to be in daily contact with individuals in the immediate aftermath of a crisis event, but it does happen and it is good for staff to know how to respond.  For example, if a child gets news that a parent has died, or some other very distressing information, PFA may be appropriate.

A situation in which PFA would have been useful occurred today, and in fact the teacher involved did use many of the skills instinctively.  A 12-year old girl had arrived in the ICC from her village last week and seemed to settle in well, but today was very distressed and said she was not sleeping well because ‘devils’ were talking to her, telling her she wasn’t safe in the ICC and should return to her village.  The member of staff who taught this girl noticed she was not herself in the morning (the first principle of PFA is ‘Look’, or observe), and talked to her to find out what was concerning her (the second principle – ‘Listen’).  He tried to address her concerns by taking her to somewhere in the compound where she felt safe, and bringing her clothes and other personal items in a plastic bag, as she requested.  He discovered that the girl had come to EducAid with a female cousin, who she was close to, and he brought the cousin to sit with the girl, chat with her and comfort her.  The teacher called the EducAid country director (Miriam) to ask for advice, (the third principle – ‘Link’), and was given the phone number for the uncle of the distressed girl, who lived in the village she had come from.  The teacher called the uncle to explain the situation, and gave the phone to the girl, who talked to her uncle and seemed happier afterwards.  After some time, she made the decision to return to the ICC and at the time of writing she is happy and relaxed.

In the afternoon’s training session, we returned to the basic listening skills we had covered yesterday, and thought about how they might need to be adapted for use with children.  Through role-plays, demonstrations and discussions of cases, we explored how to listen and talk to a child in a way that can help us to understand her or his thoughts, feelings and experiences.  The participants recognised the importance of this, and were able to give examples of times from their own childhoods when they had been listened to, and felt valued and safe, and it had given them confidence and a sense of belonging.  However, when we discussed how we might respond if a child said they felt guilty about the death of a parent, all participants said that the most appropriate response would be to tell the child they were wrong to think this, that death comes to everyone and they should just accept it.  There is a big difference between accepting in principle that a certain approach is a ‘good idea’, and applying it in practice.  Participants were very familiar with the concept of empathy, and could describe it well, and explain why it is important – but listening to children in a supportive, non-judgemental way goes against traditional ways of interacting with children in Sierra Leone.

Participants are currently struggling to see how and why they would use this style of listening to a child in their context, although they can see that the skills we are learning are useful in other contexts. As teachers, they feel that they should be more directive in giving guidance and advice, and are finding it hard to identify the times when it might be helpful to take a different approach in their interactions with children.  Tomorrow, we are having a ‘practice day’ where all 12 participants will practice their listening skills with some of the children in the Maronka school compound.  They will be working independently, and will talk to at least one child each, using the listening and responding skills we have been focusing on over the last two days.  They will not be talking to children who are known to have particular problems, and they will not focus on negative experiences, but more positive issues, such as a happy time in the child’s life or the things they like about being here in Maronka.  The aim is for the participants to see for themselves how effective a non-judgemental, accepting approach to listening can be in understanding a child’s perspective.

Wednesday 21st Jan 2015

Most were quite anxious at the start of the practice day, and seemed reluctant to begin the task.  I felt quite anxious myself, to be honest.  What if the usual active listening and responding skills didn’t work in Sierra Leone for some reason?  What if the participants gave up on them or decided they were no use to them?  An hour or so later, as I saw one participant walking up towards the football field chatting with a small boy who walked alongside him, I felt more relaxed.  I watched a female participant wandering around the wooded area below the school with a female student, and another participant playing with a child whilst talking to her.  The participants had been told not to probe students’ problems or painful stories, since they were just practising their skills, but to explore more positive feelings, like the things that make the child happy, or some good times they have had, or the things they enjoy doing.

We all met later in the afternoon, and the participants shared their experiences.  Some had found the exercise challenging, and most were struggling to move away from asking questions towards reflecting the content of what the child said and/ or their feelings, and using such statements to demonstrate understanding and encourage the child to share more about their thoughts and feelings.  However, there were some great stories of participants using their skills well.  One described how the child he was talking to seemed distracted, and he discovered that she had lost her slippers (flip-flops) that morning, so he helped her to search for them and once they had been found she was more able to talk to him.  Addressing basic needs first!  Another participant had dealt extremely well with a girl who became distressed and started crying. The opportunity to practice the skills had been very beneficial, both in terms of developing skills and confidence.

Thursday 22nd Jan 2015

The main work of the day was introducing the participants to some simple ways of using activities to help children talk about their thoughts, feelings and experiences.  We practiced using drawings, small toy animals, story books, pictures and the process of creating stories with children, and using listening and responding skills to reflect on the drawing/ picture/ animals/ story and help the child to engage with it and relate it to their own thoughts and feelings.  The participants had already noticed the previous day that children found it much easier to talk when they were doing something (walking, playing), so were open to these approaches.  In addition, they saw how it is easier when using stories, toys or pictures for children to talk about distressing events or feelings, since they can project their feelings onto another character.  The helper can use the fictional character or events to help children to recognise their own strengths, to normalise their experiences, or to recognise the consequences of their behaviour, amongst other things.

Sierra Leone revised blog (3)

At the end of the day, the head teacher asked for some time to discuss an issue that had emerged and he wanted to share with his colleagues on the training.  He had found some girls saying that they wanted to leave the school and return to their villages, and planning to behave badly so that they were sent away.  It then emerged that some of the children in the ICC were also saying they wanted to go home.  The whole group of trainees discussed how to approach this issue, and decided that they should each talk to one of the concerned children individually after the close of the day’s training session.  They should spend some time trying to understand the child’s thoughts and feelings about being away from home, and the reasons they wanted to return.  It may be that some of the issues could be addressed fairly simply (e.g. those related to basic needs, such as lack of clothing).  For those children whose needs could not be addressed simply, the participants decided that they would try to help the child consider their options, and what the advantages and disadvantages would be of each.  It may be that through this process, some children decided that although it was hard to be away from home, the advantages of the education and other opportunities offered by EducAid outweighed these difficulties, and they would stay.  For those who still wanted to leave, the trainees would try to encourage them by using themselves as examples of people who had been through the EducAid system and now had good lives and were able to serve others.  The children who still wanted to go home would be referred to Miriam for a decision to be made about the best way forward.

I was very encouraged by this exchange.  It showed that the trainees (including the head teacher) really valued the skills they had learned, and saw opportunities to use them.  They felt that they had something to offer, and were very realistic in their discussion about what they would be able to achieve through listening to the concerned children.  They recognised the advantages of trying to understand the children’s thoughts and feelings before taking any other step, and that there were benefits to supporting the child to think through their options and the consequences of each, rather than simply advising them immediately.  They also recognised that there may be some cases which need to be referred to a higher authority within the organisation (Miriam).

Friday 23rd Jan 2015

The trainees arrived to today’s session with very good feedback from their discussions with the children who were saying they wanted to go home.  They had been to talk to them to find out their concerns, and, as expected, some of the issues were practical, such as not liking some of the food they were given.  As well as individual conversations, some of the trainees tried some group activities to address the issues.  One of the trainees asked the children to help him with a role play.  He pretended to be very sad, and said he wanted to go home because he missed his parents and wasn’t happy in the ICC because he wasn’t allowed to move freely.  One of the children came to talk to him, and explained all the reasons he should stay – that he was only in the ICC for 21 days, after this he could move freely, and education would benefit him in the future, and so on.  By the end of the discussion, the children felt listened to and had identified for themselves some of the benefits of staying at EducAid.

Today was another practice day, with each trainee using one of the approaches we had introduced the day before – drawing, story-telling, using miniature animals, using pictures or story books – with at least one child, and writing a report describing their experiences, focusing on what had worked well and what they had found challenging, as well as how they might use these approaches when they returned to their workplaces.  Only one was brave enough to try using the miniature animals with a child, but it worked surprisingly easily.  Several used drawings, some used pictures (creating their own pictures because it was difficult to find relevant ones), some tried creating stories with children in order to explore issues affecting them, and one or two tried using a story book.  All found the exercise challenging in some ways, but effective in terms of encouraging children to talk about their thoughts, feelings and experiences.  These new approaches are slowly slowly starting to come more naturally, and to be seen as valuable.

Saturday 24th Jan 2015

Today we started looking at a new issue – the challenges likely to be faced when the schools re-open when the ebola crisis is over.  There will be three groups of students to consider: the new arrivals (through the ICC, OICC or directly from their villages) who are not familiar with the EducAid system and ethos, which differs greatly from other schools in Sierra Leone; the returning students who have been out of education since last August; and those who have been in EducAid all through the crisis, because they had no family to go to in the August holidays, when the state of emergency was declared.  The trainees are from six different EducAid schools, so in their pairs they considered their concerns for each of these groups, thinking about all aspects of wellbeing.

Sierra Leone revised blog (4)

We discussed the issue of stigma, and – surprisingly – this hasn’t been found to be an issue in the two EducAid schools which already accept children from the ICC and OICC.  The staff talk to students in the relevant schools before students join them from the isolation centres, to explain that the children are confirmed to be free of ebola, but have had some difficult experiences in their lives and need kindness and support.  They continue to monitor the situation once the new children have arrived, and up to now have not seen any examples of discrimination or exclusion.

Structured recreational activities, or ‘activities with a purpose’ can be used to strengthen many aspects of wellbeing.  They can be used to teach life skills such as problem solving, decision making, good communication, interpersonal relationship skills, cooperation, coping with stress and coping with emotions, as well as values such as respect, fairness, inclusion, respect for diversity, responsibility and acceptance.  I introduced this concept to the trainees, and shared various resources with them on a memory stick.  I also demonstrated an ’activity with a purpose’, designed to encourage participants to think about how it feels to be excluded from activities, and what they can do to make sure this does happen to children in their schools, as much as possible.

The trainees then spent the rest of the day working in groups to identify an activity that they want to try with a group of children, and planning for it.  Planning is such a crucial part of this process, it involves thinking about the needs of the target group of students, considering the goals one wishes to reach, how one can reach them, with which activities and how to evaluate the result intended.  By the end of the day all three groups had planned a different activity, with clear objectives, a structured activity, and a follow-up discussion designed to help the children focus on the relevant issues.  Tomorrow they will all be trying out their planned activities with groups of children in the school we’re based in.

Monday 26th Jan 2015

This morning three teams of trainees ran three separate ’activities with a purpose’ with groups of children.  I was able to overhear one of the groups, which struggled to explain the instructions for the activity to a group of small children, all around six years old.  When I came back later, I saw the team repeating the activity, much more successfully, with a group of 10-12 year old children.  Up on the football field, a second team were standing in a circle with a group of children, singing and dancing and getting to know each other before the activity began.  The third team was doing something similar with a group of older children (aged 12-15) in the ICC.

Sierra Leone revised blog (5)

In the afternoon, all three teams reported back.  Most had chosen activities designed to focus on strengthening social relationships through developing respect, cooperation and inclusion.  All groups experienced challenges during the activities, and we discussed how they could overcome these in future.  For example, giving clear instructions for the activities was difficult but two groups found that giving a short demonstration or role play helped to clarify.  It was clear that at least two people were needed to run these activities well.  In one group, a boy could not participate because he only spoke his local language (Temne), not Krio or English.  His place in the activity was taken by one of the facilitators, but we discussed how this boy could still have been given a role (e.g. signalling when the time came for the children to change places by clapping loudly) and the importance of ensuring that he was included in some way.

Sierra Leone revised blog (6)

We’re now coming to the end of the training, and are starting to think about how the participants can put what they have learned into practice in their schools.  A clear action plan should be developed for each school by the end of tomorrow.  We started working on this today by assessing the current situation in each school.  This involved reviewing the ’domains of wellbeing’ we introduced on the first day, and considering the ways in which the schools strengthen each ’domain of wellbeing’ and the challenges experienced in relation to each.  By the end of the day, we had some idea of where each school is at the moment in terms of the wellbeing of the school population, and some of the challenges anticipated in maintaining and continuing to strengthen wellbeing once the schools re-open and new and returning students join the school population.  The next step will be to build on this by identifying some ways the new skills and knowledge acquired through this training can be applied to mitigate some of the challenges, and strengthen children’s wellbeing.

Tuesday 27th Jan 2015.

But first – self care.  The EducAid staff work in circumstances that are sometimes difficult, with children from a wide variety of backgrounds, and they themselves have lived through a war and now the ebola crisis.  They will soon be working with new students and returning students who have experienced various challenges in their lives, including having lost parents and relatives to ebola.  The staff need to ensure that they take care of their own wellbeing if they are to be able to give these children the support they need.  So the first session of the day focused on understanding and managing our own stress.

Following that, the hard work began.  Yesterday, we carried out a rough assessment of the areas of psychosocial wellbeing that could be strengthened in EducAid schools.  The next step was to review these and identify those that we thought could be addressed, in whole or in part, using the skills learned during the training.  We also considered the eleven indicators of change that EducAid staff and students identified as part of their monitoring and evaluation strategy a couple of years ago, since psychosocial approaches could help to strengthen these aspects of students’ wellbeing (e.g. increased confidence).  The two staff from each school then went through this list of potential issues to be addressed and considered which applied to their school, then identified five priority issues to be addressed using the psychosocial approaches they had learned.  For example, in one secondary school, the five priority issues identified were: reducing bullying/ teasing; reducing sexual harassment amongst students; supporting students who are distressed or grieving; supporting those who feel sad at being separated from parents; and increasing students’ concern for others.

Each school team then considered which of the approaches they had learned during the training might help them to address their priority issues.  They then developed a plan of which other teachers (and in some cases students) they would train in these approaches, and how they would ensure that the skills, techniques and approaches were implemented following the training.  This included a system of teachers supporting each other to use the approaches, and monitoring how they were being used.  At the end of this planning process, each school team had an action plan that was relevant to their specific needs and which they felt confident about implementing.

That deserves a certificate!

Generally I’m quite reluctant to give certificates at the end of a training programme, especially without some form of assessment.  However, in this case I was happy to do so.  All the participants had really worked hard to learn the skills and approaches in the classroom, and to practice using them with children in the school where the training was being conducted.  They had all submitted reports reflecting on their practice sessions, and had demonstrated an understanding of the issues.  So, certificates it was, and there was great rejoicing.  In this case, completing the training really felt like a huge achievement for all of us, and was something worth celebrating.

Sierra Leone revised blog (1)

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