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Evaluation report

2001 OPT: Evaluation of Psycho-social Interventions Supported by UNICEF in West Bank and Gaza October 2000 - October 2001



Author: Melville, A.

Executive summary

Background

UNICEF psychosocial programming aims to meet children's key needs in the current crisis. The crisis-related programmes focus on strengthening the resilience of populations through promotion of appropriate coping mechanisms and strengthening protective factors for 'at risk' groups. The aim is to help children and their care takers to more effectively deal with and overcome the problems they face in their lives.

It covers a range of various activities that can be regrouped as follows: 1) Raising awareness among the community on how to overcome adversity; 2) Training volunteers to provide support, mentoring and recreational/expressional activities for children; 3) Training people in professions to conduct psychosocial activities with children; 4) Supporting direct interventions that promote children's psychological and social well-being, and help to overcome the problems they are facing; and 5) Contributing to the development of a Palestinian psychosocial policy, within the framework of a Code of Conduct for psychosocial interventions. UNICEF provided a very limited support to interventions covering the treatment and rehabilitation of psychological and social, as such interventions are deemed to require technical expertise and financial resources beyond the capacity of the organization. Such support covered the training of, and direct intervention projects by, professionals.

Purpose / Objective

The present report is an internal evaluation of the most significant psychosocial interventions supported by the UNICEF office in West Bank and Gaza during one year since the beginning of the Al Aqsa Intifada at the end of September 2000. It reflects the diversity of interventions supported by UNICEF.

Strengths and limitations in UNICEF-supported projects have been evaluated along the following criteria:
- Timing of the projects
- Scope of the projects along with the strategies of promotion, prevention, early detection and treatment, and rehabilitation
- Access to intended beneficiaries
- Design and implementation of training activities
- Design and implementation of direct interventions

Methodology

Short three- to five-page evaluations given on each project supported by UNICEF. The projects are divided into three areas: training of, and support for, volunteers to conduct psychosocial activities; training of, and support for, professionals to conduct psychosocial activities; and direct psychosocial interventions. For each project, the aims and objectives are listed, followed by Strengths, Weaknesses, and Recommendations. In the Annex is a complete copy of the Palestinian Code of Conduct for Psychosocial Interventions.

No analysis is given of how the author made these judgements. We do not know if surveys or interviews were used, how many, who participated, etc.

Key Findings and Conclusions

Timing:
At the beginning of the current crisis, UNICEF was able to very quickly develop a wide range of interventions to address the psychological and social problems of children and their families. Due largely to effective contingency planning, UNICEF had sponsored 8 psychosocial projects within the first 6 weeks of the Intifada. However, there were a number of important delays that negatively impacted on the programming, seriously disrupting the continuity of the projects and volunteers, and the availability of these services. In addition, parents' brochure should have been completed much earlier and should have been given priority over the teachers' brochure. Finally, training kindergarten teachers and social workers in the Injured Care Department earlier in the crisis would have been more efficient.

Scope and effectiveness of the projects:
The majority of UNICEF's programming effectively served to help children and their families overcome their psychological and social problems, help prevent acute psychological and social distress and, to some degree, detect quickly such distress. The maintenance and intensification of regular programming in the areas of health, education, youth participation and children's protection helped maintain a routine and sense of normalcy in children's lives during the crisis. It contributed to promote psychological and social well-being during the crisis. These two foci were overall an appropriate use of UNICEF's technical and financial resources.

Access to intended beneficiaries:
At the beginning of the crisis, UNICEF programming reached out to all children and families, on the assumption that all children were being affected by the situation. With time, areas exposed to violence became better known as patterns of military confrontation developed. While UNICEF projects have been successful at targeting children in areas exposed to violence, they have been less effective at targeting vulnerable children living in areas less commonly under attack. This is something that should be addressed in UNICEF 2002 psychosocial programming.

Design and implementation of training activities:
UNICEF's focus on conducting training activities for youth and volunteers, and supporting them to conduct activities with children was a good way to both give them opportunities for participation and provide them with guidance as to how to help children deal with the crisis. However, training activities faced several problems relating to lack of relevance for the intended target group, poor training skills limiting participants' active participation in their learning, poorly developed training materials, and insufficient follow-up of trainees. Training activities were often too theoretical and did not include sufficient practical activities. Trainers limited trainee's participation. Those training activities that were practical and helped the participants to plan their activities, such as the MOSA training or the Canaan training for children workers, usually produced the most effective interventions with children and families. Volunteers have sometimes been trained in areas they could not be competent to intervene in, such as individual counselling.

Some of these problems were due to lack of knowledge/experience on behalf of UNICEF staff and/or the partners as to the most effective training approach. Others were due to insufficient attention to the content of the training or to monitoring of the training by UNICEF staff. Through ongoing monitoring and evaluation, these problems were recognised and attempts were made to rectify them, including greater attention to the training agendas. As a result, the content of the training activities did markedly improve, but the training style remained largely discussion-based. For most projects, training materials remained mediocre.

Design and implementation of direct interventions:
The interventions generally provided opportunities for children and their families to express themselves, and provided parents with appropriate guidance on how to deal with their problems. Among examples of successful interventions are those that enabled children and their families not only to discuss their problems and fears, but also to learn ways to deal with problems in their lives more effectively. Many stated that they felt less frustrated and depressed after participating in these projects. Almost all of the volunteers felt these projects helped them contribute to their community in this time of crisis, and provided them with a sense of purpose.

Also important were projects that helped return the children to their normal routines by giving them the opportunity to think over their lives and project themselves in the future (Muntada and Canaan), or providing them with basic services such as education for injured children (IPCFA-Gaza) or children living in areas under closures and curfews. Organising theatre performances and other entertaining activities have also proved to be a popular intervention in restoring normalcy in the lives of the Palestinian children.

However, particularly at the early stages of the crisis, a number of interventions have significantly deviated from the theory governing psycho-social interventions, as follows:
- by lecturing participants and providing them with ready-made solutions to their problems, some interventions served to undermine the resilience, confidence and coping mechanisms of the beneficiaries.
- by applying a medical model to the situation, some interventions contributed to the dis-empowerment of the beneficiaries. Associated with this, there was a tendency to exaggerate and associate mental illness, including trauma, to a large proportion of the population. Many psychosocial workers failed to understand the difference between abnormal reactions to crisis - that is, trauma, which a very small percentage of the population will exhibit; and normal reactions to crisis - that is, distress, which the majority of a population could experience.
- by giving priority to individual approaches, such as involving children without their families, many interventions often limited their effectiveness and, at times, undermined the child's existing support mechanisms.

In many projects, it was seen as sufficient to help the children express their problems and fears. Children would be given the opportunity to draw, write, or act what they wanted - which usually involved expressions of their fears about the situation or experiences of violence - and provided with very little debriefing or guidance. Rarely were the children encouraged to think about what they could do to deal with their problems. In extreme but disturbingly frequent cases, children were simply encouraged to act out scenes of violence in groups as a way of 'releasing' their fear, out of a mere lack of awareness of the negative impact representations of violence can have on children. Equally, a lack of awareness of the unhealthy nature of an obsession-like repeated representation of violence by children, and how to help children overcome it, was observed.

Cooperation with other organizations was also very important in effectively reaching the beneficiaries. The most successful projects were those where the implementing partner was able to effectively work with other organizations. It was particularly effective when organizations such as MOSA or DCI partnered with local community organizations. The UNICEF partner brought the technical expertise, materials and additional human resources to conduct the activities, and the community organization provided the location, some materials (at times), and conducted the coordination with the community. Even better was when the staff of the community organization observed or assisted with the initial activities, and then conducted follow-up activities themselves with the guidance of the UNICEF partner.

Recommendations

The counselling content of sessions needs to be improved to include a clear purpose, and should take the beneficiaries through a clear healing or problem-solving process. This process, at the minimum, should contain the following steps:

a. Identification of the problem to be addressed
b. Helping the children to express their feelings about the problem
c. Working with the children to identify better ways to deal with the problem

For sessions with adults, the psychosocial worker must draw the problems and their solutions from the participants themselves. The psychosocial worker can guide the participants, add additional information not stated by the participants and summarise what has been said.

There is a great need to be clear about the guidance that is given to children and their care takers on how to deal with specific problems they are facing. Key problems that have been addressed throughout UNICEF psychosocial programming, which could be included in future programming include how to help children deal with the following issues: sleeping problems; fear; lack of concentration; rebellion and rejection of authority; risk-taking behaviour, including participation in clashes; martyrdom; hopelessness and lack of belief in the future; depression; regression; keeping safe; hyperactivity; aggression; boredom; low self-esteem; generational conflict; gender relations; and educational problems.

Training should be spread over a period so as to ensure that participants have the opportunity to practice what they learnt in the training, and then receive additional guidance from the trainers. Training style should be participatory, and largely skills practice (60%). Role-playing, small group discussions, worksheets and homework/journals should be used more often.

Training materials should contain both theoretical material relevant to the topics, as well as activity sheets (to describe how to conduct particular activities). Better training materials are also needed. Distribute package of 'best of' training materials to UNICEF key past and present partners in psychosocial programming.



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Report information

Date:
2001

Region:
MENA

Country:
Occupied Palestinian Territory

Type:
Evaluation

Theme:
Health - Mental Health

Partners:

PIDB:

Follow Up:

Language:
English

Sequence Number:
2001/800

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