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PSYCHOSOCIAL SUPPORT FOR CHILDREN: A RAPID NEEDS ASSESSMENT IN NORTH-EAST NIGERIA October 2019 UNICEF Nigeria

PSYCHOSOCIAL SUPPORT FOR CHILDREN: A RAPID NEEDS ASSESSMENT IN NORTH-EAST NIGERIA November 2019

UNICEF Nigeria

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Acknowledgements This project was commissioned by UNICEF Nigeria with funding from the European Union Trust Fund/EUTF as a component of its two years project title. ‘From Risk to Resilience: providing reintegration assistance, case management, mental health and psychosocial support services to children in Borno, including those associated with Boko Haram”. Coded: T05-EUTF-SAh-NG-06-01. UNICEF will like to thank and

appreciate the European Union Trust Fund for this support. This report was prepared

by Aneeha Singh, Psychosocial Support consultant, and the project was overseen by Miatta Abdullai Clark, UNICEF Child Protection Specialist for Psychosocial Support, and Senathirajah Ravindran, UNICEF Child Protection Specialist. Fieldwork was supported by Aisha Lawan, Child Protection Specialist for Psychosocial Support. We are grateful for the guidance of Geoffrey Ijumba, Head of Field Office, Borno state, and Milen Kidane, Head of Section, Child Protection. We are also thankful to the Ministry of Women Affairs and Social Development in Borno State, as well as the Goal Prime Organisation of Nigeria, Grow Strong Foundation, Search for Common Ground and the Neem Foundation for their meaningful participation. We extend thanks to Deborah Magdalena at the International Organization for Migration for participating as co-chair of the Mental Health and Psychosocial Support Working Group in Borno state. We are also thankful to the International Rescue Committee for their participation. Most importantly, this assessment would not have been possible without the active participation of the girls and boys in conflict-affected regions of northeast Nigeria, their caregivers and the community members. We are grateful to these resilient children for teaching us that meaningful change is possible, even in the face of adversity. This publication was produced with the financial support of the European Union. Its contents are the sole responsibility of UNICEF and do not necessarily reflect the views of the European Union.

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Table of Contents

ACKNOWLEDGEMENTS ............................................................................................................................2

ABBREVIATIONS .................................................................................... ERROR! BOOKMARK NOT DEFINED.

EXECUTIVE SUMMARY ..............................................................................................................................5

DESK REVIEW ..............................................................................................................................................9

CONTEXT ........................................................................................................................................................... 9 UNICEF PSYCHOSOCIAL SUPPORT PROGRAMME FOR CHILDREN IN NORTHEAST NIGERIA .......................... 9

OBJECTIVES .............................................................................................................................................. 11

METHOD ...................................................................................................................................................... 11

APPROACH ....................................................................................................................................................... 11 DESK REVIEW ................................................................................................................................................... 11 FIELD ASSESSMENT ......................................................................................................................................... 12 SAMPLE ............................................................................................................................................................ 12 ANALYSIS ......................................................................................................................................................... 13 OPERATIONAL PLAN ......................................................................................................................................... 14

KEY FINDINGS FROM THE FIELD ASSESSMENT ............................................................................... 15

MANIFESTATIONS OF MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT PROBLEMS ............................................................. 15 PERCEPTIONS OF CAUSAL FACTORS .......................................................................................................................... 15 TYPES OF PSYCHOSOCIAL PROBLEMS ........................................................................................................................ 16 WAYS OF COPING AND SOURCES OF SUPPORT ............................................................................................................ 21 PERCEPTIONS ON VULNERABILITIES .......................................................................................................................... 23 MAIN BARRIERS TO ACCESSING PSYCHOSOCIAL SUPPORT ............................................................................................. 25 PREFERENCES FOR PSYCHOSOCIAL SUPPORT .............................................................................................................. 25 CHALLENGES OF SERVICE PROVIDERS ........................................................................................................................ 27

STRENGTHS AND OPPORTUNITIES ...................................................................................................... 30

CRITERION 1: RELEVANCE ...................................................................................................................................... 30 CRITERION 2: EFFICIENCY ....................................................................................................................................... 31 CRITERION 3: EFFECTIVENESS ................................................................................................................................. 31 CRITERION 4: IMPACT ........................................................................................................................................... 31 CRITERION 5: SUSTAINABILITY ................................................................................................................................ 32 CRITERION 6: COVERAGE ....................................................................................................................................... 32 CRITERION 7: COORDINATION ................................................................................................................................ 33 CRITERION 8: COHERENCE ..................................................................................................................................... 33 CRITERION 9: SAFETY AND PROTECTION ................................................................................................................... 33 RECOMMENDATION .............................................................................................................................................. 34

REFERENCES ............................................................................................................................................ 36

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Acronyms CFS Child Friendly Space

IDP Internally Displaced Person

MHPSS Mental Health and Psychosocial Support

PSS Psychosocial Support

UNICEF United Nations Children’s Fund

WHO World Health Organization

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Executive Summary Purpose: The overall purpose of this assessment was to consult with stakeholders and community-based service-users to better understand the psychosocial support needs of children affected by conflict in northeast Nigeria. This assessment will be used to inform the UNICEF Nigeria programming strategy for psychosocial support services. This foundational work in late 2019 will be used to review gaps and enhance programme design to ground psychosocial support programming for 2020-2021. Approach: This Mental Health and Psychosocial Support (MHPSS) needs assessment was guided by the World Health Organization & United Nations High Commissioner for Refugees (UNHCR) "Assessing Mental Health and Psychosocial Needs and Resources Toolkit".1 A desk review was followed by the development of a semi-structured interview tool with which to conduct 18 focus group discussions and five individual in-depth interviews: a total of 141 participants were involved in north-east Nigeria. Two of the six Local Government Areas in the region that UNICEF provides psychosocial support services to were selected for this assessment: MMC and Bama. A safe space was provided for each consultation, so that the assessment was participatory, inclusive and feasible and offered an opportunity for vulnerable children and their caregivers to express their situation. Participants included girls and boys, vulnerable youth, parents and caregivers, teachers, child protection workers, community leaders and key partner agencies in the psychosocial support sector. Consultations were adapted to group and individual formats. Learnings: Self-reported psychosocial distress amongst children was extremely pervasive. Culturally relevant manifestations of psychosocial problems amongst children were identified as ‘thinking too much’ and 'worrying all the time’, indicating high levels of anxiety. An overall sense of distrust was manifested in children's levels of suspiciousness and hyper-vigilance. Self-reported and teacher-reported anger, aggressiveness and irritability were common complaints. Children and protection workers shared concerns regarding sleep-related difficulties such as nightmares, disturbed sleep and sleeplessness; flashbacks of horror experiences; trouble concentrating; forgetfulness; withdrawal; isolation; somatic complaints (such as headaches); numbness; confusion; an inability to connect with what was happening around; poor self-care and hygiene; functional impairments; and moodiness. A thematic analysis identified three inter-related themes of psychosocial problems.

1. Growing up with armed groups: In the past two years, about 752 children who receive psychosocial support from UNICEF and partners in north-east Nigeria have experienced abduction and/or forced conscription. They have spent crucial childhood

“There was no happiness. I was always thinking about how to get out, constantly

worried and stressed.” - a 12-year-old girl, speaking of her

abduction experience

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periods of their lives living in stressful conditions in small, hot, overcrowded, enclosed space with no freedom to go outside. Further, there was stigma associated with reintegration of the children who were associated with non-state armed groups. (Challenges around civilian child combatants are discussed in the report.)

2. The continuation of stressors: Psychosocial problems experienced by

children and adolescents were identified in the Internal Displaced Person (IDP) camps, as well as conflict-affected host communities. A trend is provided below.

Children were separated from their family and, estimated 50%, had witnessed the murder of their parents, relatives or neighbours. Children had parents who were in prison due to an alleged association with non-state armed groups, as perpetrators of violence. Every interview, all children, adolescents, youth and social workers reported that stigma of those who had been abducted was widespread and pervasive. The stigma was particularly harsh for adolescent girls who had had a child as a result of sexual abuse during captivity. There was reported prevalence of sexual violence at the IDP camps, less so in the host communities. However, it's important to note that reporting mechanisms across IDP camps and host communities was inadequate. Children were not encouraged to attend school by caregivers, as adults prefer that children contribute to the household income from a young age, as well as for children to marry, sometimes as young as 12 years old. Child marriage was

perceived as a kind of protection from abduction by armed groups, and a practice culturally accepted and continuing amongst the camp-based and host communities, for both boys and girls.

An overall lack of community support was reported. Stakeholders reported deteriorating family relationships and parent’s inability to provide effective psychosocial care.

“It is unsafe near the gate, toilets and shower areas, under the stadium construction area where there are many small rooms… I was threatened with a knife by a man… I do not feel safe." -A young girl at an IDP camp in Maiduguri

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3. The experience of repeated displacement: Almost 75% of the 500,000 plus members of the IDP community affected by the protracted conflict in Borno State have experienced multiple displacements: from a home village to an IDP camp, returning years later to an IDP camp in the Local Government Area; sometimes a family moves into to the host community or to other urban areas. As discussed in Theme 1, there was also the experience of abduction.

There is an urgent need to strengthen coping mechanisms in these environments where children and caregivers’ traditional ways of problem management have been depleted. Age, gender and location-based vulnerabilities were identified. Avoidance-focussed coping, such as by distraction through play, running away or not going out, were prominent and often maladaptive during adolescence. For example, adolescents reported higher levels of stress due to their ability to be analytical. Girls were identified to be at greater risk for child marriage, and for not being permitted to attend school. However, both social practices were common experiences for boys as well. Barriers to accessing psychosocial support:

• Cultural perceptions of women and girls’ roles: girls are not allowed to go outside of the house to access child-friendly spaces or attend school;

• Stigma associated with children and youth formerly associated with non-state armed groups;

• A negative worldview developed in the aftermath of extremely distressing experiences, worsened due to the absence of community and family support;

• Information gaps regarding types of services available, target populations, locations and process of support-seeking;

• A perception of the child-friendly space (CFS) as a place for young children only, and of activities such as singing, playing, dancing and clapping as inappropriate for adolescents.

Preferences for content, delivery, provider characteristics and modality of interventions were explored. It was determined that sports, drawing and meditation were considered useful and interesting. Boys and girls also identified emotional recognition tasks and activities associated with understanding their own strengths and weaknesses as useful: this underlines a key strength of structured psychosocial support programming delivered by UNICEF in collaboration with NGOs. An 'approachable provider' was described as someone who is young and an active listener who treats children without judgement. Preferences for both group and individual services were identified: group work advantages being a time for interaction, teamwork and peer support; and individual psychosocial support was described as a time for discussion on ‘difficult feelings and thoughts. Children’s preferences must be considered in the standardisation of programming, in consultation with service providers. Strengths and opportunities: UNICEF Nigeria provide programming for important psychosocial support to children affected by conflict who have experienced, and continue to experience, high levels of stress over prolonged periods. Based on nine criteria,1 the assessment determined that the programme was relevant, provided coverage to a large part of the population, was well coordinated, and focused well on

1 The nine criteria can be found on page 30 of this report.

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the durability of psychosocial support and child protection services. Opportunities for improvement in efficiency, impact and coherence were identified, including: employing standardised, global, evidence-based interventions to provide structured psychosocial interventions to children and adolescents; integration with other sectors; implementation of a learning agenda based on programme monitoring and evaluation; and strength-based capacity building of community members through regular coaching and mentoring.

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Desk review

Context

The protracted conflict in north-east Nigeria continues to devastate the lives of civilians, resulting in a humanitarian crisis affecting 7.7 million women, men and children who are all in acute need of help and protection. Since the start of the conflict in 2009, more than 20,000 people have been killed, more than 4,000 people abducted and 1.7 million remain displaced, most of them in Borno State.

Those caught up in the conflict have experienced brutal violence, lost family, friends and homes, lived with acute and sustained levels of stress in poor conditions, seen their communities torn apart and had little or no access to life-saving services such as health and education. An estimated 2.7 million children and adolescents (1.5 million girls and 1.2 million boys) need cross-sector protection services, including psychosocial support services.

In September 2019, a publicly disseminated MHPSS needs assessments from the region was published. The survey indicated an immense burden of psychological stress: 60 per cent of respondents reported at least one mental health difficulty, and 75 per cent reported functional impairment associated with unmet psychological needs.2 Self-reported factors contributing to distress amongst the displaced populations of Maiduguri, the capital of Borno state, included: food shortage; poor physical health; displacement and not having a place to live; separation from or loss of family members; and a lack survival basics such as clothing.3 Children and schools are systematically targeted by non-state armed groups fundamentally opposed to western education. Known threats and risks to the well-being of girls and boys include family separation, explosive remnants of war, gender-based violence including child marriage and conflict-related sexual violence, recruitment and use of children in armed conflict, abduction of children and other grave child rights violations. The post-traumatic stress rate amongst children is high.4 This has led to prevalent psychological distress amongst children and caregivers. To ensure that children are equipped to cope with and manage distress from the conflict, displacement and resulting crisis, attention to age, gender and culturally appropriate community based MHPSS is urgently required.

UNICEF Psychosocial Support Programme for Children in Northeast Nigeria Mental Health and Psychosocial Support (MHPSS) is positioned within the UNICEF Nigeria Child Protection Programme and focusses on tiers 1 and 2 of the MHPSS intervention pyramid: 1. advocate to mainstream psychosocial support; and 2. strengthen social support. The programme is guided by the Inter-Agency Standing Committee Guidelines on Mental Health and Psychosocial Support using a community-based approach.

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The main channels to provide psychosocial support, adopted by UNICEF Nigeria in Borno state, is through child-friendly spaces (CFS), Safe Spaces (SS) and Adolescent Kit activities. This compliment mobilising family and community support; a systematic referral process; and integration of MHPSS into other sectors. Activities work to reconnect children with family members, foster positive social interactions, restore a sense of normalcy in the aftermath of conflict, build resilience and restore a sense of control over their own lives. And finally, to identify, refer and provide interventions for children with severe psychological difficulties.

Programme: MHPSS is within the Child Protection Programme, UNICEF Nigeria

Focus: Tier 1 and tier 2 of the MHPSS intervention pyramid: advocate to mainstream psychosocial support; and strengthen social support.

Guided by:

• Inter-Agency Standing Committee Guidelines on Mental Health and Psychosocial Support

• UNICEF Core Commitment for Children in Emergencies

Channels:

• Child Friendly Spaces

• Safe Spaces for women and girls

• The Adolescent Kit programme

• Psychosocial support training for school staff

• In school psychosocial support

Programme focus:

• Mobilise family and community support for children and caregivers to reinforce resilience and promote positive coping mechanisms

• Develop a systematic referral system

• Integrate with other sectors

Activity goals:

• Reconnect children with family members

• Foster positive social interactions

• Restore a sense of normalcy in the aftermath of conflict

• Build resilience and restore a sense of control over their own lives

• Identify, refer and provide interventions to children with severe psychological difficulties

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Objectives The objectives of the MHPSS Rapid Needs Assessment are:

Method

Approach The World Health Organization and UNHCR Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Humanitarian Settings guided the design of the rapid assessment. The qualitative consultations, which are the backbone of the assessment, assured a safe space for children and stakeholders (caregivers, teachers, community leaders, child protection staff and NGO and United Nations staff) so participation in the assessment was conducted in an inclusive, acceptable and feasible way. Vulnerable children and communities were able to articulate their concerns in a safe environment.

Desk review The first phase of the assessment consisted of a rapid desk review in line with global recommendations for rapid assessments.5 UNICEF child protection MHPSS conducted a simple web search using free and publicly available resources for MHPSS such as Google Search, Google Scholar, MHPSS.net, Relief web, and mhinnovation.net, using words and phrases to describe: (a) our thematic focus “mental

health”, “psychosocial support”, “well-being”, “distress”, “psychosocial interventions”; (b) our geographic focus, “Nigeria”, “north-east Nigeria” and “Borno”; and (c) the population of interest for the purpose of this assessment, “children”, “conflict-affected communities”, “camp-based populations” and “host community”. The desk review focussed on the mental health and psychosocial support needs of and services for children, adolescents and their caregivers in communities affected by armed conflict in north-east Nigeria. In addition, we conducted internal, expert consultations to collect relevant grey literature, focussed on the rapid changes since 2009 in the region with the eruption of violence between Boko Haram, a militant Islamist group, and Nigerian security forces. The desk review research is described in the previous section to contextualise the report and referenced throughout.

Identify MHPSS needs of children and their caregivers;Identify needs

Assess the extent of support for and awareness of MHPSS services, and access to and appropriateness of the services;

Understand support

available

Explore community perceptions of MHPSS concerns of children, adolescents and caregivers.

Explore perceptions

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Field assessment The second phase was the field assessment, conducted from late October to early November 2019. The assessment lead consultant developed a contextualised semi-structured interview tool (Supplementary Material A) which was reviewed by the Child Protection Psychosocial Support programme leadership. The interview guide was reviewed weekly over the duration of the assessment through iterative, multi-disciplinary team discussions to highlight gaps in information. The tool was flexible to record spontaneously elicited information and tapped upon interviewers’ knowledge of the subject area and contextual gaps in information. All interviews were conducted by the assessment lead in collaboration with the UNICEF Nigeria Borno team for psychosocial support for children. The UNICEF team also provided translation support from English to Hausa, Kanuri and Shuai, as applicable. It was emphasised that translations be contextually and culturally appropriate, and not literal. To the extent possible, the co-interviewer was the same gender as the participant.

Sample UNICEF provides community-based psychosocial support services to children displaced by conflict in six Local Government Areas in north-east Nigeria: MMC, Jere, Bama, Biu, Dikwa and Monguno. UNICEF also provides services in two Local Government Areas to children from host communities: Galtimari and DCC Shuwari in MMC and Jere respectively. Consultations were conducted at IDP camps, transit centres and in the host community in Maiduguri and Bama. Each consultation was conducted from one to over two hours, and the assessment consisted of 18 focus group discussions and five individual in-depth interviews with a total of 141 participants. A maximum-diversity sample of internally displaced persons and affected host community members in north-east Nigeria, between the ages of seven and 56 years old, was recruited with the support of the UNICEF Child Protection team. Participants came from 16 different tribal backgrounds and identified as Muslim or Christian.

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Participants included girls and boys, caregivers, teachers, social workers, community volunteers, community leaders, partner agency providers and MHPSS Working Group members.

Analysis Detailed handwritten notes were taken during all consultations. These were cleaned up and shared for team reflection. A thematic framework was developed for an in-depth analysis.

Write-up

Thematic framework development

In-depth review of data

Team reflection

Notes cleaned up and summarised

Detailed notes taken during consultation

In-depth, participatory, qualitative enquiry

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Operational plan This rapid need assessment of psychosocial support needs of children in Borno state took place over six weeks from mid-October to late-November. The work plan is described below.

Timeframe Activity

Week 1 Tool development and desk review

Weeks 2-4 Field assessment with all stakeholders and team discussion

Week 5 In-depth analysis and development of thematic framework

Week 6 Report write-up

Step 1: The tool (available in Supplementary Material A) was a semi-structured interview guide that could be readily adapted to group and individual formats and for use with various stakeholders. Section heads helped to focus the guide, and probes were provided for each line of enquiry. A rapid desk review of information, gathered from sources on the internet and from internal UNICEF experts, was reviewed to understand programme structure, programme activities and evidence on gaps. Step 2: The field assessment took place in Maiduguri and Bama. This included interviews with girls and boys of different ages, parents and caregivers, teachers, community leaders, religious leaders and partner service providers as well as key members of the MHPSS Working Group. The goals were two-fold: to gather information from all stakeholders and to obtain buy-in from all involved. Step 3: A qualitative thematic framework analysis was conducted with all primary data gathered during the assessment. Psychosocial support needs of children, ways of coping and caregivers’ perceptions were documented. This report also includes feasible recommendations for programme enhancement

Focus group discussion of Adolescent boys and their care giver at the Teacher’s Village Camp, Borno State

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Key findings from the field assessment

Manifestations of mental health and psychosocial support problems For an assessment to be meaningful, it is essential that culturally appropriate ways of expressing poor psychosocial status be explored so that mainstream, western conceptualisations are not imposed. A snapshot of how these were described by the community is presented below.

Perceptions of causal factors Perceptions regarding causal factors were explored. There was consensus across participants that psychosocial distress was largely attributed to the conflict, displacement and related experiences of abduction, forced conscription to armed groups and witnessing the killing of family members. In addition, sexual violence and the overall context of poverty were highlighted as major contributory factors. Some young people attributed severe emotional distress to being possessed by demons. Girls were thought be at greater risk of being affected by supernatural causal factors.

Conflict, displacement,

abduction, forced conscription,

witnessing difficult circumstances

Sexual violence Poverty Supernatural

causes

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Types of psychosocial problems A thematic framework of problems is presented below.

1. Growing up with armed groups UNICEF Nigeria works with vulnerable children who have experienced abduction and/or forced conscription by non-state armed groups. The children reported having spent crucial periods of their childhood in captivity, in small, hot, enclosed, overcrowded spaces, leading to extreme distress endured over a long duration of time. Children expressed elevated levels of anxiety, with constant worry about how to escape captivity. They shared that they had had nothing to look forward to except their release, and uncertainty if they had a future created a sense of hopelessness. Girls and boys both commonly spoke of withdrawal and isolation.

Children in the current group of participants reported having been in captivity for nine to 12 months. However, it is general knowledge that many spend longer. Age

of forced recruitment varied. The youngest participant, at seven years old, had spent nearly a year in captivity, and the oldest was a vulnerable youth of 22 years in this sample recently released. Each child participant reported having witnessed an extremely difficult experience, such as murder of their parents or sexual violence. Vulnerable children include those who were affiliated with the Civilian Joint Taskforce and involved in combat and witnessed violence. The assessment revealed that the stigma, which is significantly high for children raised in association with armed groups, is not a barrier to reintegration for children formerly associated with the Civilian Joint Taskforce. However, challenges associated with feeling disconnected from those who had a ‘normal’ childhood remain, as do experiences of separation from family and caregivers. Flashbacks of violence were prominent amongst both groups of children interviewed and all children who had been associated with armed groups expressed high levels of distress and anxiety. Service providers described how children who had experience with armed groups were easily angered and aggressive, primarily externalised through verbal aggression by girls and physical aggression by boys.

“We were initially in the bush, then in Bama, then taken to barracks where I was locked up. There was no happiness. I was always thinking about how to get out, constantly worried and stressed.” -A 12-year old girl who had experienced abduction

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2. The continuation of stressors after release

2.1 Separation from family and loss of caregivers Child participants experienced the death of their loved ones. Experiences of displacement often meant that young people were separated from their caregivers. Children at the transit centre shared that they wanted to be reunified with their families immediately. Some children’s parents were in detention due to their affiliation to non-state armed groups. One concern identified was that experience in the transit centre could be stressful as it involved a further separation from family. Children did not have information about their parents’ whereabouts, even in circumstances when parents had been traced, and this contributed to the sense of loss. Children indicated that they had no role models for guidance, and there was an overall feeling of a lack of community support. Children reported feeling alone, unprotected and vulnerable and said they would join armed groups to survive.

“My father was killed; my mother is in a camp with my siblings. Our parents are our caregivers. Without them, we’re left unprotected and alone. Anything can happen to you in such a situation. You will join anything to survive. I am an example of this. We moved from one settlement to another, but Boko Haram followed us. I was beaten badly." (shows scars) -An adolescent boy at the transit centre

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2.2 Stigma and isolation A common sign of distress was withdrawal from social activities and isolation of those who had previously been associated with armed groups. Parents did not allow their

children to play with the girls who had experienced sexual violence. Additionally, there were very few girls at the transit centre and opportunities for positive interactions between girls and boys were nearly absent. Children also highlighted concerns associated with bullying, and parents were reluctant to send their child to the CFS if they had experienced bullying or peer pressure from older children to use drugs. Stigma was associated with children who had been abducted or forcefully conscripted by armed groups. A few girls, when rescued from the barracks where they had been forcefully kept and abused, were pregnant or were nursing babies; reintegration was particularly challenging for these children.

2.3 Prevalence of sexual violence Sexual violence was prevalent at the camps and was reported by every girl interviewed for the assessment. Sexual exploitation by volunteers during food and non-food item distribution was frequently reported during the assessment. Almost every girl shared that she had been followed by a stranger at the camp more than once. When probed for unsafe spaces, the

girls shared that toilet and shower areas were unsafe as there was only a thin metal sheet dividing the male and female showers, with the clothes hung at the same place. Girls also complained of holes in the metal sheet through which they had been watched. Places with no light were reportedly unsafe and girls felt unsafe going to fetch water. (Opportunities to integrate with other sectors are discussed in

Recommendations-page 30). Construction areas, such as at Stadium camp in Maiduguri town, were also described as unsafe, and girls reported that reception areas for new arrivals were unprotected and there were nooks and corners with spaces in which girls were raped.

“Girls don’t go to the kitchen; the matron collects their food. For girls, it is difficult to open up.” - A social worker at the transit Centre

“There are drug users near the gate, toilets and shower areas, under the stadium construction area where there are many small rooms. In zone A, I was threatened with a knife by a man. Even though I am safe at home, I do not feel safe. Inside our shelters may be fine, but we are at risk walking to the toilet, when going to collect water. There is only a thin metal sheet between the men’s and women’s shower areas. Our clothes are hung on the same sheet”. -A young girl at an IDP camp in Maiduguri

“We want to be accepted… we have changed and started over. It was a different experience there. We want to be treated like normal children.” -A teenage boy in Maiduguri

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Overall, girls did not feel safe or protected in the camps. Sexual exploitation and abuse-reporting mechanisms were indicated to be inadequate. Children did not feel comfortable reporting incidents of sexual violence to parents. When reported to religious community leaders, the reports were dismissed. The stigma associated with surviving sexual violence meant that girls who reported were disowned by family and shunned by the community.

2.4 Challenges with attending school Caregivers reported a significant preference for children to work instead of attending school. In a culture that prioritises obedience to elders, children had almost no alternative but to adhere. Girls from a very young age, some as young as 9yrs were expected to take responsibility for household

chores such as cleaning, cooking and caring for younger siblings. Boys had more time to play before they were sent out for work. Girls too were expected to work outside of the house. Typical income generation activities for children were cap making, tailoring and street hawking. Girls and boys were exposed to protection issues when engaged in child labour. Further, children felt like they had nothing to do, and that being idle (without work and school) they were more likely to adopt negative ways of coping, using harmful, addictive substances. Child marriage was perceived to secure protection from sexual violence and from abduction by armed groups (further discussed in sub-section 2.6 ‘child marriage’). Once children were married, they were not sent to school. Further, girls were at greater risk to not attend school due to cultural perspectives on gender roles. All girls interviewed reported that they were not allowed to attend school by their caregivers. Parents saw little value in school, as formal education did not always lead to a better job. Children felt that as their parents had not received a western education, they preferred their children did not receive formal education. For boys, religious school was the preferred option. In many Local Government Areas outside of Maiduguri, for example in Bama, secondary schools were far and therefore inaccessible. This was a barrier to school enrolment as well as parental permission to attend, as it was understood to be of no use.

“The underlying problem is that our parents have not had western education in schools, so they don’t see the use. They would rather girls start working.” -An adolescent girl at an IDP camp in Maiduguri

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2.5 Loss of dignity and child labour An agricultural community was left with limited or no access to land in the aftermath of conflict. Food distribution was inadequate, and food insecurity has led to a loss of self-reliance, with an almost exclusive dependence on humanitarian aid. Parents and children both reported that the capacity to parent and to provide care deteriorated due to the conflict and consequent displacement. Parents reported having no option but to send children to work, and children reported that they have no option but to do as told, even when engaging in exploitative work. Further, a loss of self-esteem due to dependence on external support was reported by caregivers and children.

2.6 Child marriage

The typical age of marriage in interviews was 13 to 14 years old for girls, and 16 to 17 years for boys. Girls were reportedly at higher risk of child marriage and had little choice-making capacity. Often, adolescent girls were married to middle-aged men as one of multiple wives. Children reported feeling extremely helpless. Most of the

children had some knowledge of adverse effects on sexual and reproductive health related to childbearing at an adolescent age. Children also had insight into the adverse effects on the baby. However, it was reported that not being married put one at higher risk of being abducted by armed groups.

2.7 Deteriorating interpersonal and family relationships It was observed that interpersonal relationships were poor and reportedly getting worse. Communication was strained, and children were not involved in family decision-making processes. With death of family members during the conflict, new families were formed. A girl shared that after losing her father, her mother had remarried and that she felt uncomfortable and excluded at home. Cultural

“The volunteers and workers take advantage of girls, seeking sexual favors in exchange for food. If you refuse, they twist it around against your family. And because our parents don’t work, we are dependent on aid.” -A teenage girl at an IDP camp in Maiduguri

“Parents don’t listen (about child marriage). If we report it to our grandfathers, it’s still the same… Sometimes girls run away.” -An adolescent girl living in an IDP camp in an urban area

“My mother remarried and has another husband and a new baby. If the baby is crying, she asks me to comfort him. But then she insults me if the baby continues to cry. She says, ‘it is because you are not related by blood, you do not have the same father’. I have run away from home before.” -An adolescent girl describing poor family relationships

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boundaries between stepparents and stepsiblings remained blurred and children found it difficult to make sense of changing family environments. Children also reported an overall absence of community support. Girls said that they received no support from parents or community leaders in reporting incidents of sexual violence. A girl shared with us that when she sought community support to report an incident of assault, it was initially dismissed by community heads; when pushed, she was told that if she chose to pursue it, the community would not back her up and that she would not be offered any protection. Children also reported that they did not receive psychosocial support from community elders when reintegrating back into social life.

3. The experience of repeated displacement

To further challenges described in themes 1 and 2, many children in north-east Nigeria have lived through the stressful experience of displacement multiple times. Displacement was initially from their home village to an IDP camp, sometimes having to move from one camp to another. In some instances, they move back to their home Local Government Area, often to the IDP camp then the host community. Many children, almost 75% of the children in this sample experienced abduction or forced recruitment by armed groups, another experience of forced displacement. It is important to note that when these children arrived at the transit centre, while the overall protection situation improved, they found the experience difficult due to the uncertainty of how long they would stay. Social workers shared that for about three months children had access to support at the centre, but much of this was lost when they transitioned back to the community.

Ways of coping and sources of support Psychosocial theories commonly describe three broad ways of coping: problem focussed, appraisal focussed, and emotion focussed.6 They can be both adaptive and maladaptive and can be used simultaneously. Problem-focussed ways of problem management attend to the root causes of the difficulty: some boys reported that they cope with stress by thinking about what would help Nigeria as a country and how the conflict would end its problems. While problem-focussed coping strategies can be adaptive when the situation is controllable, in this case it was not as children had little control over the political instability in the region. Appraisal-focussed strategies were prominent, but primarily avoidance-focussed such as distraction and running away. Emotion-focussed strategies, such as talking with others, were not typically employed. This highlights an opportunity to strengthen positive ways of coping. When asked about where they seek psychosocial support, children identified school and the CFS as primary sources. Strategies included playing, learning, interacting, gaining numeracy and literacy skills and ways of living peacefully. Children highlighted that at the CFS they had somebody to talk to. They shared that the CFS offered an opportunity to learn positive, more adaptive ways of coping instead of using

22

drugs or violence. This indicates that psychosocial support services address children’s well-being.

Through the enquiries, children were asked about personal strategies they developed to deal with a psychosocial difficulty described in the section above. Overall, children’s ability to cope was depleted by the protracted nature of the conflict and ongoing challenges in places of asylum. With sexual violence as a main threat, girls described not going out, avoiding danger zones, not being in proximity of men, and asking their mother to escort them to the toilet as main strategies for self-protection. Girls and boys both said they prayed to God to help them when feeling distressed. As discussed, trying to forget, and seeking distraction through recreational activities and running away, were prominent themes in dealing with psychosocial problems.

Girls and boys, when probed, elaborated on the kind of support they received from other sources. Peer support was comprised of acceptance: for example, by saying to your peers, ‘This is life’. Peer support for girls involved directing those who had experienced sexual violence to medical support. Family support was almost entirely limited to livelihood opportunities, highlighting an opportunity to strengthen parenting skills for psychosocial care.

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Perceptions on vulnerabilities

1. Age Children described that the ability to cope falls with age, as both adolescent girls and boys ‘think too much’ and ‘cannot forget through play’ as younger children do. Children indicated that the ability to be analytical increases with age and that this was not helpful in coping with problems. However, it was also suggested that adolescents were less likely to be misled by adults. This was important as a few children, boys and girls, had indicated that they felt they were deceived and as a result tricked into joining armed groups. Children indicated that the ability to cope with school improves with age as ‘adolescents require less repetition’, even when this was the first school experience that children had. Older boys felt they were better able to prevent violence toward women in their household; and information obtained by UNICEF and partner services was useful towards this. It was highlighted by children and caregivers that younger children needed more parental support than adolescents, who were ‘like adults.

2. Gender

A majority (90%) of participants reported that, overall, girls were at higher risk of protection threats than boys. A group of teenage girls informed that girls were at higher risk of abduction by armed groups, as they were ‘more useful as they like pretty things. However, boys felt that they were at higher risk of being forcefully conscripted and therefore at greater risk of being taken away by armed groups. Boys shared that they experienced peer pressure to join armed groups if others in their community had been recruited; girls ‘had to join if their husbands joined’. Children also shared being pressured by parents and community elders into joining the Civilian Joint Taskforce as ‘protectors of the community’. Girls were at higher risk of sexual violence at the camps. It was shared that the risk rose manifold at the camps compared to the village, as everybody lived in a shared, enclosed space at the camp. While both boys and girls were discouraged from attending school, boys had opportunities to play outside of the home and were encouraged to attend religious school that offered opportunities for interaction with peers. Both boys and girls were at risk of child marriage, with the age of marriage for boys being slightly higher than that for girls.

Ability to cope reduces with age as children ‘think too much’ and ‘cannot forget with play’

Older children less likely to be ‘misled’ by armed groups

Ability to cope with school increases with age as need less repetition

Older boys feel they are better able to prevent violence towards women in their homes

The ability to be analytical increases with age and this is not helpful

Younger children are more in need of support from mothers

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3. Location Every stakeholder reported that children in urban areas live with greater risk as they had to support themselves without any aid and often in the absence of caregiver support. Hawking was the most common source of income in urban areas such as Maiduguri town, and risks associated with this were assessed to be higher compared to rural Local Government Areas. Further, children in strongholds of non-state armed groups were at higher risk of forced recruitment for combat.

4. Other significant vulnerabilities identified by stakeholders

Unaccompanied children and those in care of foster parents were described to be at high risk of child labour and exploitation. This was largely rationalised by the community by explaining that there was widespread poverty. Children with disabilities were not systematically included in programming and access-related challenges need further attention. Out-of-school children are at higher risk of developing psychosocial problems as they have little opportunity for support, learning or interaction. About children who had experienced combat, those recruited by non-state armed groups were often at increased risk when reintegrating due to the stigma associated with their history.

Girls more vulnerable to being abducted by

non-sate armed groups

Girls more at risk of sexual violence

Boys may be sent to religious learning

centres even if they are not sent to school

Boys less at risk of child marriage

compared to girls, however important to

address

Young boys pressured to support

families

Boys at risk of being forcefully conscripted

as combatants

Peer pressure to join armed groups

experienced by boys

Women forced to join armed groups if husbands join

Boys do not have the same restrictions on movement as girls

Children in urban areas at higher risk as need to support

themselves

Risks assessed to be higher while

hawking in urban locations

Children in strongholds of non-state armed group

at higher risk

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Main barriers to accessing psychosocial support The main barriers to accessing psychosocial support were described as:

• Culturally defined gender roles, such that girls were not allowed out of the house and had little opportunity to play as they were engaged in household chores. This limited their ability to access formal and informal sources of psychosocial support.

• Children who had experienced challenges associated with reintegration, particularly regarding the stigma of being associated with non-state armed groups, were more hesitant to seek psychosocial support due to an absence of overall community support during the period after their return. Service providers also reported that children who had had negative experiences during reintegration often developed a negative worldview and this was a barrier to support-seeking.

• Information gaps on how and where to seek psychosocial support, what kind of problems to seek support for, and from whom to seek support. Meaningful inclusion of caregivers in providing psychosocial care to children requires structured implementation.

• Perception of the CFS as a ‘place to clap, sing and dance’ discouraged caregivers form permitting adolescents to attend sessions, as they were perceived to be inappropriate activities for adolescents.

• Younger children who had been bullied by older adolescents at the CFS were less interested in attending sessions.

Preferences for psychosocial support All participants were asked: what kind of psychosocial support programme content they found useful and interesting; preferences for characteristics of providers and what made them approachable; delivery formats and frequency of interventions. Community preferences are described below and must be factored into strengthening programmes, to increase acceptability and uptake.

1. Content Children and service providers reported that children enjoyed drawing and artwork, however it was noted that there was a need for better structure to the sessions. Children and adolescents enjoyed physical activity, with football and yoga being favourites. Adolescents also enjoyed meditation, which highlights an opportunity to mainstream evidence-based mindfulness-based approaches. A significant preference for learning vocational activities was highlighted by children, adolescents, caregivers and service providers. Suggested activities were soap making, cap knitting, tailoring and sending mobile music. There was consensus across all stakeholders that integrated programming must address social, emotional, cognitive and economic factors. Adolescent boys highlighted benefiting from learning about emotions, which helped them identify others’ expressions when reintegrating back into the community. Girls and boys also liked activities that helped them understand themselves better, such as strengths, weaknesses and exercises to identify

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aspirations. Twenty five percent of boys at the transit centre shared that they had found it useful to learn about gender-based violence and felt empowered to prevent it in their homes. In an environment where children felt they had limited support and guidance, girls and boys sought psychosocial advice on the difference between right and wrong. In a state of protracted conflict, children highlighted that they wanted to better understand how to improve community relationships and live harmoniously with their neighbours, who may be from a different ethnic background. Service providers reported that what was expected from them was great and often not aligned with their purpose (to deliver psychosocial support). For example, many children and caregivers expected food and money in exchange for attending CFS activities. One service provider shared that in one Local Government Area location, they expected the CFS providers to support rebuilding a burned-down house of the child attending CFS services. 2. Provider Children described the ideal facilitator as someone who: accepted them as ‘normal’ children; treated them like a brother or sister; they did not have to hide anything from; they could trust, respected them and listened to them; had time and was willing to spend it with young people. Children felt it was important to be encouraging and playful. They preferred a facilitator who would support them in interacting with peers, while teachers and parents indicated love and sympathy as priority needs of children affected by adversity. Knowing the language was determined to be very important. The assessment identified the need to ensure that programme staff in Local Government Areas were from diverse linguistic backgrounds. For example, in Bama, providers revealed that Shuwa speakers were not typically attending the CFS, as activities were carried out in Kanuri or Hausa. While many children did not indicate a preference for male or female facilitators, typically gender-matched facilitators were employed as this was culturally more appropriate. However, enhancing healthy cross-gender discussion may also need consideration. All children preferred young, active and agile facilitators who were engaging and a role models for young people. 3. Modality At the time of the assessment, all services provided were in group format. All stakeholders that participated in this assessment appreciated that group formats provided an opportunity for peer interaction, teamwork, sharing and overall peer learning. However, a need for individual sessions was also identified. Individual sessions were preferred by adolescent girls; this may be because girls were not encouraged to speak up and struggle to discuss difficult topics and experiences in front of others. Adolescent boys who had been involved in combat in any form preferred individual sessions as well. Individual sessions were an opportunity to discuss ‘low feelings’, while group sessions were opportunities to collaborate and build skills. Individual sessions may also be more likely to provide an opportunity for personalised feedback and tailoring of approaches to each child. While cost-

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effectiveness of group sessions is acknowledged, an effective, stepped care model must be structured to integrate modes of intervention delivery. (This is further discussed in the section on Recommendations). 4. Dosage It is important to consider duration of the intervention, frequency of sessions and the interval length between contact. There was significant variation across these, in addition to variation in content employed by partner organisations. This revealed the opportunity to standardise intervention delivery and dosage across partner agencies. Global guidance suggests brief structured interventions, between eight to 12 sessions, of 30 to 60 minutes per contact occurring regularly (e.g. weekly). At the time of the assessment, some interventions were up to 26 sessions, which may have a negative impact on scalability, cost-effectiveness, coverage and reach. Recovery and reintegration sessions held over a full day, once annually, may be less beneficial than more regular support.

Challenges of service providers

1. Delivery In a multi-lingual community, there were challenges in delivering integrated programming to children from diverse language groups such as Hausa, Kanuri, Shuwa. While efforts were made by partner organisations to recruit across the major language groups, this was a challenge in Local Government Areas. As a result, coverage across the population was affected. For example, in Bama, Shuwa speakers were unable to meaningfully attend. Providing psychosocial support to children younger than seven years old was highlighted as challenging, as was working with teenagers. Services providers also highlighted that they need more support in managing aggressive behaviours in group settings. It was also highlighted by facilitators that children often found it difficult to absorb and retain materials shared during PSS and life-skills sessions. It is, however, important to note that forgetfulness is in fact a complaint associated with experiencing traumatic events; thus, there may be opportunities for further staff sensitisation on the various manifestations of distress in children.

Regarding format of delivery, there were some concerns working with groups of variable sizes. It was noted that smaller groups were more relevant when working with children previously associated with armed groups, however this was not always possible due to high demand. It was also shared that adolescents and young people affected by distress typically preferred individual sessions, but that space was not available for this. All service providers said that they struggled with building trust with children involved in the conflict, but trust was facilitated by private conversations in confidential space, which was limited.

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Gender segregated groups were generally preferred; and this community perception should be factored in for optimal delivery. The benefits of age- and gender-transformative dialogue require consideration against potential limitations due to community perception. In general, while acknowledging resource constraints, adopting models of ongoing, sustained support (as opposed to more intensive workshops currently offered) is likely to be beneficial. Providers shared that the coordination between psychosocial support services and case management protocols was not always clear. Also, a need remains to build the capacity to identify those who require further support, through channels such as the CFS. On the same note, the referral protocols between teachers and CFS facilitators requires strengthening. 2. Sustainability Mental health and psychosocial support (MHPSS) services are limited in the community, which was identified as the main barrier to sustainable programming. There was an absence of quality high-level care (tiers 3 and 4-IASC MHPSS pyramid) in the community, and participants shared that even when opportunities to refer were possible, such as in Maiduguri, the quality of services was limited, and service providers had little confidence in the benefit of these services. The World Health Organisation was identified as the focal agency for medical care for MHPSS. However, this information was not clear for all MHPSS partners, which calls for strengthening coordination and identifying focal agencies at each level of the Interagency Standing Committee (IASC) MHPSS pyramid. Partners also shared the need to form active child protection committees and youth groups. Finally, better reporting mechanisms, such as for incidents of sexual violence, was a key priority. As mentioned, better coordination and referral management between teachers and facilitators would be of benefit. Teachers also need support to manage vicarious psychosocial distress. The use of incentives to promote psychosocial support services may challenge sustainability. While not frequently employed, it was debated whether incentives may be useful in engaging with caregivers. Careful evaluation of durability of such measures must be conducted before implementation. Overall, managing expectations of the community was highlighted as a stressor for providers. It was indicated that there was often a mismatch between children and caregivers' psychosocial support needs, as well a mismatch between community expectations and programme offering. Those who lead the programme across agencies expressed concern with internal as well as community-provider capacity. Developing programme strategies to build staff capacity is priority for programme sustainability and relevance. Delivery of sessions on socio-emotional skills to caregivers was highlighted as priority need for support. Support was also needed for staff self-care. All partner providers also struggled with concerns of child labour and how to meaningfully address the issue with families.

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Finally, there were challenges associated with material procurement and availability of supplies at the CFS, such as tents, games, sports equipment and life-skills training kits. Challenges around the set-up of the CFS were also discussed. For example, it was highlighted that ensuring physical safety from injury in open plan CFSs was challenging. A preference for closed structures was indicated. An assessment on the feasibility of this need will be based on programme budgets.

Group of Children at the Stadium IDP camp in Miaduruguri, Borno State

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Strengths and opportunities Integrating child protection and psychosocial programming for children and adolescents in northeast Nigeria has made serious strides, with UNICEF leading the effort. The psychosocial support programme was reviewed using an inter-agency framework with nine criteria developed by UNICEF and partners in 2011: 1. relevance, 2. efficiency, 3. effectiveness, 4. impact, 5. sustainability, 6. coverage, 7. coordination, 8. coherence, and 9. safety and protection. The main programme strengths are briefly described below, along with feasible programmatic opportunities.

Criterion 1: Relevance Strengths: The UNICEF psychosocial support programme was assessed as highly relevant to the population. This was a major strength of the programme: the key provider of psychosocial support services to young people and lead of CFS facilities. The desk review and field assessment revealed a pervasive rate of psychosocial difficulties and that UNICEF was addressing this gap. UNICEF and partner team members were aware of children's and caregivers’ need for psychosocial support; organisations have been engaged to meet the need. There was consensus among participants across priority areas for psychosocial support programming. Finally, community members were engaged in the delivery of the psychosocial support programme, which established crucial community links. Opportunities: As no previous need’s assessment was available, it was difficult to assess if there had been a change in needs, or in programme strategies to meet those needs. It is recommended that UNICEF Nigeria gather periodic feedback from community members, including children and caregivers, to be incorporated into the learning agenda.

0

20,000

40,000

60,000

80,000

100,000

120,000

Q1 Q2 Q3

85,603 87,055

108,782

Beneficiries reached with Community Based PSS Activities 2019

Series1

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Criterion 2: Efficiency Strengths: Programming reaches many children and community members. The team expressed strong cost efficiency, with the engagement of community-based staff for psychosocial support programming and national NGOs. Psychosocial support services were coordinated by the MHPSS Working Group, led by the International Organization for Migration, which met monthly and collaborated efficiently. Decisions regarding provision of care are made internally by partner agencies, which allows for timely action. Opportunities: It is recommended that the structure and organisation of MHPSS services be reviewed to strengthen sources of support at each level of the IASC MHPSS pyramid.7 The current focus of UNICEF and partners is on level 2: enhance social support. It is also recommended that referral protocols be standardised, and information be disseminated regarding all available sources of internal and external referral through a 5Ws mapping. Also, effective community-based strategies, for example coaching community workers, should be jointly conceptualised across agencies for standardised, scalable implementation.

Criterion 3: Effectiveness Strengths: Satisfaction with CFS-related services was assessed to be high. Children, the main beneficiaries of the psychosocial support programme, reported receiving support and guidance from the programme. Adolescents reported that they found life-skills sessions useful. Opportunities: It was assessed that improving effectiveness of psychosocial support programming would optimise benefit. While satisfaction is high, it is recommended that interventions be better structured and include (but not limited to) play. While numbers reached are high, there is little information available on change over time in social and emotional well-being of children and ability to cope with distress.

Criterion 4: Impact Strengths: The central goal of the project was to improve psychosocial well-being of children in a sustained manner and provide a safe space,

“I am grateful and happy for the CFS activities. It gives us time to learn new

things and play with each other. Before I use to think a lot about my family and the war but now I don’t

think much because I have hope that we will go back home and life will be

good again.”

12 year-old girl in Teacher’s Village IDP camp

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such as the CFS. Based on community feedback, the UNICEF Nigeria programme was assessed to be meaningful in achieving this. The many channels of support and ongoing care available through the programme (detailed on page 9) ensure that the impact of the programme is across the age-range of young people and include those not attending the CFS. Opportunities: UNICEF's programme has a positive impact, but it is essential to have information on enduring changes in lives of children and caregivers, quality of services, fidelity of interventions and so on. Impact can be difficult to assess in humanitarian contexts and at the time of the assessment, there were significant limitations to this.

Criterion 5: Sustainability Strengths: Due to the protracted state of the conflict, issues of sustainability are key in programming decisions. New capacities were being built within the community to support psychosocial support programming for children and there was high involvement of community members. The team was aware of the need to develop durable solutions. Trainings were taking place for a diverse group of community members, including community leaders and teachers. Finally, UNICEF has strong ties with government stakeholders and a collaborative relationship for effective service delivery. Opportunities: For services to be truly sustainable, it is important that community members be provided adequate training. It is recommended that regular psychosocial-support training activities are incorporated into the UNICEF Nigeria psychosocial support agenda. It is recommended that indicators reflect trainings and be followed up by regular (e.g., weekly or bi-weekly) technical supervision, support, mentoring and coaching sessions. Capacity building should be carried out for all levels of staff, organisation leads, programme leads, facilitation leads and community support workers. Further, durable solutions require advocacy to government providers including the Ministry of Women Affairs, specialised psychiatric centres as well as primary healthcare facilities with non-specialist input on mental healthcare.

Criterion 6: Coverage (Also see Annex 1) Strengths: UNICEF programming covers a wide geographical area and reaches a diverse ethnic, religious background. Programming reached girls and boys of all ages and included vulnerable youth, such as those affected by forced recruitment. Engagement strategies were assessed to be culture-appropriate and acceptable to adults and children. Opportunities: Access limitations remain, particularly for girls, and require further advocacy. It is also recommended that specific vulnerabilities receive tailored attention: such as safe space services in some Local Government Areas for children who have experienced sexual violence, and children with disabilities and special needs.

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Criterion 7: Coordination Strengths: Cross-agency coordination between NGOs, international NGOs and United Nations agencies is efficient in the region, coordinated by the International Organization for Migration and WHO in collaboration with the Ministry of Women Affairs. UNICEF also successfully coordinated with partner agencies to deliver psychosocial support trainings and functioned as co-lead. Opportunities: The opportunity to strengthen programming internally with cross-sector coordination, primary education, should be explored. There is a need to mainstream psychosocial support in the Water, Sanitation and Hygiene programme to improve the protection environment for girls at the camp. It would be effective to consider ways to integrate income-generation training for older adolescents and caregivers in programming. It's essential to strengthen coordination between agencies delivering psychosocial support programming to standardise interventions, and to coach and mentor providers.

Criterion 8: Coherence Strengths: The psychosocial support focal points across all agencies were aware of and well-informed about activities taking place in the community and open to improving coherence and messaging of the programme. Opportunities: For the community and camp-based, non-specialist staff to understand the programme, guidelines must be developed based on best practices, such as how MHPSS awareness and sensitisation activities should be conducted and adoption of manualised psychosocial support interventions. At the time of the assessment, community members including caregivers, children and community-based staff needed more support to understand the purpose, process and benefit of a structured psychosocial support programme.

Criterion 9: Safety and protection Strengths: UNICEF Nigeria has a central role in providing protection, health, livelihoods and other essential services to conflict-affected children and caregivers. Multi-sector programming led by UNICEF offers opportunities to mainstream MHPSS within the child protection sector. Opportunities: While the psychosocial support programme sits within the Child Protection sector, there are benefits in having close coordination with schools. Risks associated with pharmacological treatments by non-specialists need to be prioritised and addressed in safety plans.

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Recommendations:

1. Develop an action plan, including standardised interventions, referral protocols and a capacity-building plan for community-based staff, grounded in evidence-informed approaches and contextualised before roll-out. The plan should integrate psychosocial support into other UNICEF programmes, sectors and with partners.

2. To strengthen programme response, better monitoring and evaluation

mechanisms must be implemented that include information such as: on the

kinds of interventions provided; screening tools; change in score on

standardized measures programming period; and number of sessions.

Recorded and analyse data quarterly. Cultural and contextual adaptations to

standard interventions should be documented. Users’ input should be

gathered, and satisfaction assessed systematically. To ensure sustainability,

users and providers must understand the benefit in programming: monitoring

and evaluation to measure effectiveness and impact must be implemented.

Regular technical support and implementing agencies' supervision, with

proper reporting and follow-up, is essential.

3. Review and streamline identification of community volunteers, who should

have a minimum level of education (high school graduate and trainable).

UNICEF and relevant ministries should develop criteria and a procedure for

selecting community volunteers, to minimize risk and enhance quality of the

community-based psychosocial support services provided.

4. MHPSS should include tailored responses, such as to children with physical and/or development disabilities, out-of-school children, adolescent mothers and children affected by child marriage. While safe spaces are provided to these young people, there is a need to tailor MHPSS approaches to their care.

5. External coordination with partners is working well, but mainstreaming

psychosocial support within UNICEF programmes is recommended, such as working with UNICEF Water, Sanitation and Hygiene programme to improve the protection environment for girls at the camp.

6. Also, integrate income-generation training for older adolescents and caregivers in programming. It is also essential to strengthen coordination between agencies delivering psychosocial support programming to standardize interventions, and to coach and mentor providers.

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7. Information dissemination should be done in a user-friendly manner so that it is of interest to caregivers and coherently communicated to all involved. Review messaging around MHPSS to avoid language that might stigmatize.

8. Ensure safety and protection for all: non-specialist psychosocial support staff

should be supervised in a structured and regular manner. Also, confidentiality should be honoured: private space was often unavailable at the CFS. Staff should be trained in the ‘do no harm’ approach, to ensure conversations with a child or caregivers are in their best interest.

9. Finally, long term planning must prioritise multi-sectoral system strengthening and advocacy for mainstreaming MHPSS within health and protection services offered by the Government of Nigeria. All action plans should include timelines for review of progress.

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References

1 World Health Organization & United Nations High Commissioner for Refugees (2012). Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Humanitarian Settings. Geneva: WHO.

2 Kaiser, B. N., Ticao, C., Boglosa, J., Minto, J., Chikwiramadara, C., Tucker, M., & Kohrt, B. A. (2019). Mental health and psychosocial support needs among people displaced by Boko Haram in Nigeria. Global public health, 1-14. 3 Onyencho, V. C., Kwajaffa, P. S., Abdu, W. I., Ali, M. A., Placidus, O., Mohammed, J. S., & Abba, W. M. Assessment of Psychosocial Needs among Internally Displaced Persons (IDPS) In Maiduguri Based On the Humanitarian Emergency Settings Perceived Needs Scale (HESPER). 4 Bakar, Z. A., & Rabiu, D. K. (2018). The development of post traumatic stress disorder among secondary school students in borno state Nigeria: a systematic review. International Journal of Engineering & Technology, 7(4.9), 32-38. 5 World Health Organization & United Nations High Commissioner for Refugees. Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Humanitarian Settings. Geneva: WHO, 2012.

6 Folkman, S., & Lazarus, R. S. (1988). Coping as a mediator of emotion. Journal of personality and social psychology, 54(3), 466. 7 Inter-Agency Standing Committee (IASC) (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva: IASC.

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Annex 1: Child Friendly Spaces and Local Government Areas supported by EUTF

Local Government Area per Child Friendly Space (CFS& SS)

Name of Local Government Area # of CFS

BAMA 8

BAYO 13

BIU 10

Damboa 7

Dikwa 6

Gwoza 1

HAWUL 20

Jere 7

KWAYA KUSAR 11

MAFA 2

MMC 8

MONGUNO 5

Grand Total 98

Types of CFS

Type of CFS # of CFS & SS

Mobile 6

Open space 56

Permanent 3

school 3

Semi Perm 29

Temporary 1

Grand Total 98

# of CFS in Host Communities and IDP camps Whether is IDP camp/Host comm # of CFS

Community Centre 5

Host Community 64

IDP CAMP 29

Grand Total 98

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