Working with Adolescents to Strengthen Capacities and ...
Transcript of Working with Adolescents to Strengthen Capacities and ...
March 2105
Working with Adolescents to Strengthen Capacities and Awareness:Using a Resilience based approach
Gracy AndrewCountry Director
CorStone India Foundation
Working with Adolescents to Strengthen Capacities and Awareness
KNOW VIOLENCE in CHILDRENRegional Expert Roundtable on
Prevention of Violence in Schools in South Asia Colombo,
25-27 April 2016
What will be covered
• About CorStone
• About Resilience
• Youth First – the evidence
• Youth First – the program
• Implication for violence prevention.
Vision
Our Hope
A World that Chooses
Love over Fear
Compassion over Indifference
and
Forgiveness over Blame
in the Face of Crisis
Who We Are
• Our Mission
To develop and implement resilience-based
interventions and research initiatives
to improve the health, education, and self-sufficiency
of marginalized adults and youth
around the world.
Focus• Our Commitment
• Innovation
• Continuous Improvement (Pilot, Assess, Adjust)
• Low cost
• Technical Transfer (TOT)
• Sustainability / Scalability
• Focus on Marginalized populations
• Dissemination
CorStone
• A US-based 501c3 nonprofit, founded in 1975.
• In India : Since 2009
• CorStone India Foundation – established in Oct 2015
Personal Resilience: The Power Inside.
Resilience: Thriving vs. Surviving
Types of responses to challenge or trauma:W
ellb
ein
g
challenge/ trauma
Time
Defeat
Surviving
Thriving
Bouncing back
Resilience: Essential Assets
Family, community and
culture
Education
Physical body
Emotions, thoughts
and behaviors
Emotional Resilience
• When emotional resilience is affected, outcomes in all other domains are improved
External Assets
Internal Assets
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Is it innate?
• How do we give individuals the skills to not just bounce back, but to ‘change their life trajectories’ and thrive
• How do we make this a norm not an exception
• Most people in difficult circumstances…- are defeated or survive from day to day / Very few thrive.
• How can we teach our young people to ‘bouncing back better’ or ‘thrive’ when facing crisis. - - Not merely survival!
• Fortunately, research clearly demonstrates….Resilience is not merely innate - it is learned.
• It Can be cultivated thru training and programs.
optimism
self-belief
persistence
self-advocacyhumor
Self-efficacy
creativity
caring mentor strong relationships
YOUTH FIRST
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Youth First and Girls First are evidence-based program that targets marginalized boys and girls, aged 12-16 in developing countries.It is an integrated resilience based health program that has and is being implemented in Bihar, Gujrat, Utharakhand , UP
Research confirms that CorStone’s resilience-based approach improves mental health, physical health, and education.
CorStone (US)
Local Partners
Master Trainers
Program Facilitators
Students/ Attendees
Local women and school teachers are trained as Program Facilitators. Community partnerships considered integral to success.
Train-the-Trainer Model
Program Facilitators Training, Bihar, India, 2013
Family, community and
culture
Education
Physical body
Emotions, thoughts and
behaviors
Youth First: Curriculum
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Emotional Resilience
• Character strengths
• Self-Esteem
• Goal Setting and
Planning
• Identifying and
regulating emotions
• Somatic awareness
• Benefit finding
• Gratitude…etc.
Social Resilience
• Listening skills, collaboration,
trust
• Assertiveness
• Self-Advocacy
• Problem Solving
• Conflict Resolution…etc.
Physical Resilience
• Health knowledge
• The health system
• Nutrition and
anemia
• Hygiene
• Water and
sanitation
• Reproductive &
Sexual Health
• Health attitudes
• Gender equality
• Promoting rights
…etc.
Innovate
Pilot
Validate
Disseminate
Scale-up Trials
Model for Growth
Stakeholder Advocacy
2009Delhi - 100 girls
2011 Surat - 1,000 girls
2013-14Bihar / Uttar
Pradesh / Surat -5,500 girls
2015-18
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Bihar – 70,000+ girls/boys
Girls First - India: Randomized controlled trial (RCT)
• 3,400 adolescent girls in 76 schools
• 70 community women trained as program facilitators
• Profile: 12-16 years old in rural poverty in Bihar, India
• 15-20 girls per group
• Meet 1-2 times per week for 1 hour
• 6-8 month program
• 2 Program Facilitators per group
3 intervention arms and 1 control arm:• Resilience Curriculum only (RC)
• Health Curriculum only (HC)
• Resilience + Health (RC + HC)
• School-as-usual control (SC; no intervention)
Assessment Framework
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Impact area Key Outcomes Assessment tools (Examples)
Mental/ emotional wellbeing
• Resilience• Self-efficacy• Psychological wellbeing
• Connor-Davidson Resilience Scale-10• General Self-Efficacy Scale• KIDSCREEN Psychological Wellbeing subscale• Patient Health Questionnaire-9; GAD-7
Physical wellbeing
• Health knowledge• Health-related behaviors• Health/gender attitudes
• Survey instrument developed in part from:• General self-report of health• Indian Adolescent Health Questionnaire• KIDSCREEN Physical Wellbeing subscale
Social wellbeing
• Social skills• Social relationships (peers; family)
• Relevant Child and Youth Resilience Measure subscales• KIDSCREEN Social Wellbeing subscale
Academic wellbeing
• School engagement• Perceived safety at school
• School records; survey instrument• Child and Youth Resilience Measure Education Subscale
Girls First – Bihar: Study Design
Arm 1 (RC+HC)
Arm 2 (RC)
Arm 3 (HC)
Arm 4 (Control)
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Resilience Curriculum
Resilience Curriculum
Health Curriculum
Health Curriculum
Month 0 5 11 16
Baseline Time 2 Time 3 Time 4
School as Usual
School as Usual
School as Usual
School as Usual
Measurements
RC=Resilience Curriculum; HC=Health Curriculum
Mixed Methods Assessments and Analysis
Assessments at 4 time points: Baseline, midline, endline and 4-month follow-up
Quantitative
Internationally-validated and rigorously-piloted scales
Difference in Difference OLS regression estimation (DiD)
Qualitative
Semi-structured interviews and focus groups
Thematic analysis
Assessment method
Analysis method
Girls First Profile: Full Sample by the Numbers99.0%
50.4%
79.3%
57.9% 57.3%
31.1%
42.6% 43.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Unmarried Motherliterate
Father literate Toilet at home TV at home Vehicle athome
Ever worriedabout not
having enoughfood
Ever worriedabout losing
home
Baseline Measures
Household Wealth Economic VulnerabilityFamily Characteristics
What it measures• Coping skills• Self-confidence• Self-concept• Adaptability/ Flexibility• Courage• Benefit-finding• Focus• Determination
Connor-Davidson Resilience Scale (CD-RISC)
0%
5%
10%
15%
20%
25%
30%
35%
40%
ER+AH AH ER SC
Pre to post test changes
***
***
Note: Asterisks denote significant differences vs. control (SC), through DiD OLS regression analyses including demographic covariates. *** p < 0.001, ** p < 0.01, * p < 0.05
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Emotional Resilience
Girls who received RC (through RC+HC or RC) significantly improved their resilience vs. controls. Girls in HC did not significantly improve vs. controls.
RC+HC HC RC SC
Schwarzer’s General Self-efficacy Scale
-8%
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
ER+AH AH ER SC
Pre to post test changes
***
***
**
Note: Asterisks denote significant differences vs. control (SC), through DiD OLS regression analyses including demographic covariates. *** p < 0.001, ** p < 0.01, * p < 0.05
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Self-Efficacy
What it measures• Self-efficacy’ or belief in ability to
succeed and have an impact on one’s own life trajectory
Greater scores indicate greater self-efficacy
RC has a protective and promotive effect: Self-efficacy increased for girls who received RC, while it decreased for girls who didn’t receive RC.
RC+HC HC RC SC
Clean water item; 6 clean water behaviors
Note: Asterisks denote significant differences vs. control (SC), through DiD OLS regression analyses including demographic covariates. *** p < 0.001, ** p < 0.01, * p < 0.05
0%
20%
40%
60%
80%
100%
120%
ER+AH AH ER SC
Pre to post test changes
***
**
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Clean Water Behaviors
Adding RC improves water behaviors: RC+HC achieved significantly better clean water behavior than HC from the same amount of direct instruction on keeping water clean.
What it measures• Girls are asked how they keep their
water clean at home, including:• Filtering• Boiling• Chlorinating• Taking water directly from well (etc.)
Score is computed by adding whether she performs behaviors proven to keep water clean (filtering, boiling, chlorinating)RC+HC HC RC SC
Note: Asterisks denote significant differences vs. control (SC), through DiD OLS regression analyses including demographic covariates. *** p < 0.001, ** p < 0.01, * p < 0.05
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School Engagement
Girls who received RC (through RC+HC or RC) significantly improved their school engagement vs. controls, to a greater extent than girls in HC.
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
RC+HC HC RC SC
Pre to post test changes
*
****
What it measures• Feeling of safety at school• Sense of belonging at
school• Belief in importance of
education
School engagement items
Gender Attitudes Scale (adapted from GEMS)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
ER+AH AH ER SC
Pre to post test changes
***
**
Note: Asterisks denote significant differences vs. control (SC), through DiD OLS regression analyses including demographic covariates. *** p < 0.001, ** p < 0.01, * p < 0.05
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Gender Attitudes
Adding RC improves gender attitudes: RC+HC had a significantly greater effect despite the same amount of direct instruction about gender differences and women’s rights.
What it measures• Girls rate agreement on statements
like: • “It is equally important for girls and
boys to attend school.”• “It is ideal for a woman to have her first
child before age 18.” • “There are times when a woman
deserves to be beaten.”
Higher scores indicate greater equality in attitudes
RC+HC HC RC SC
Qualitative Study: Illuminates the “How” of Girls First’s impact
• 37 semi-structured interviews and 13 focus groups over the course of the program.
• Content analysis yielded main theme of gender discrimination.
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Problems faced by girls (from Qualitative data):
Gender Discrimination
Difference in access to and
quality of healthcare
Early Marriage
Unsafe environment-violence, eve
teasing
Partial treatment at
home
Girls Built 4 Key Skills to Help Them Thrive
• Self-realization of their feelings and the validity of those feelings
• Courage to act up on feelings and opinions
• Long-term perspective and outlook
• Set goals and define road map to achieve these goals
Skills used to benefit the community as a whole
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Early Marriage: Attitudes• Girls in all intervention arms were adamant that they will not
get married until age 18 or after
• However, those in arms that received resilience training emphasized why this is important to them
• They stressed their goals and determination to achieving them
• Steps they will take to achieve their goals
• They thought specifically about how they will talk to their parents or others involved in any early marriage proposal
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Girls thought specifically about how they will oppose early marriage—using the character strengths they learned about in the program.
Interviewer: If you are presented with a marriage proposal then how will you handle it? What qualities can you use to share your point of view with others?
Girl: Courage, perseverance, and affection. These are very beneficial qualities. It is obvious that if I don’t speak affectionatelythen my mother won’t like it. If I don’t present my point of view courageously and simply agree to what others are saying then I will become weak. If I don’t show perseverancetowards my goal then I will lose sight of it.
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“I told [my cousin who wanted to leave school to marry after Standard XI] her that we should not lose focus. We should first achieve our goals and get a job…. I explained this to her and she was able to understand…. She is studying properly now. She keeps on saying thanks to me.
I didn't know all this before but I learned it in Girls First…. We girls have changed.”
Girls combined the knowledge they had gained in HC with the confidence and assertiveness they had gained in RC, to help others.
Safety issues: ‘Eve-teasing’ (harassment)
• Almost every girl had a story about eve-teasing or a safety concern with a boy
• Girls who had gone through any intervention arm were clear that this is against their rights
• But girls who received the RESILIENCE program drew on their strengths to oppose it –and used group support to solve the problem
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Gains confidence…problem solves…
“If he can threaten me just because he is a boy, then I am a girl, I can seek help from the people around me because molesting a girl is a legal offense. I can get help for this and I will reply him in the same manner”
Girls learn to communicate to parents:
• “. If a boy stares at her, touches her, and tells her something, then she should definitely tell it to her parents…… Earlier I used to be very scared about whether I should tell my mother or not. Then I thought that having self confidence is very much necessary. If I will tell her, she will not scold me because she will scold me only when she will see my fault. When I will not be at fault, then why would she scold me? if we don't tell her things on time, then she might think wrong about me”
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“I learned in Girls First that we should not suppress our feelings and if we share our problems with someone else it will not increase them. This is why I shared my problem with the group and I got a lot of help and courage too….
When I was sharing in the group I realized that problems become easier when they are shared…. I can seek help from the people around me because molesting a girl is a legal offense. I can get help for this.”
Girls realized that their feeling and opinions mattered. With that realization came the courage to act.
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Many girls continue to meet in groups even after the program has ended. They continue to grow stronger and healthier.
Girl: Before the training many girls would not talk to me but studying [in Girls First] together many of the girls started talking to me…. Earlier even I would not talk to them.… [Now I] talk to everyone…even the small kids…. They all teach me something and I too teach them…. What I do not know, they do, and what they do not know, I do….
Interviewer: So were you doing this before the [Girls First] training?
Girl: No….Interviewer: But the training has stopped. Do you still…discuss in groups?Girl: Yes.
With boys
CorStone - Girls First Bihar - Not for Distribution
Pilot with 250 boys to study feasibility
• Positive impact on gender –attitudes
• Favorite topics: Managing emotions, Forgiveness and setting goals
• Quote from a Boy:
• Before: “My cousin brother abused me. So I slapped him hard for using abusive words and language”
• After: “now I will try to understand the matter. I will try to discuss the matter first.”
Innovate
Pilot
Validate
Disseminate
Scale-up Trials
Building the Evidence Base: Where we are now
2009Delhi - 100 girls
2011 Surat - 1,000 girls
2013-14Bihar / Uttar
Pradesh / Surat -5,500 girls
2015-17
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Bihar – 50,000+ girls/boys
Feasibility
Effectiveness
Scalability
The intervention!What's the magic bullet??
IMPLEMENTATION STRATEGY
A PEER-SUPPORT MODEL
• 15-20 students per group
• Meet 1-2 times per week for 1 hour
• 6-8 month program
• 2 Program Facilitators/teachers per group
• Facilitative/ activity driven
• Intense group activities
• Take home experiments
• Sharing
CorStone - Girls First Bihar - Not for Distribution
Building the Resilience Toolkit: Evidence-based Practice
1. Positive Psychology: strength-based vs. deficit-based approach
• Building on ‘what is right’ not ‘what is wrong’• ‘No one ever told us we had strengths’
2. Social-Emotional Learning (SEL)• Emotional awareness; positive interpersonal communications
3. Attitudinal Healing• Values-based approach to cultivating inner health• Emphasis on universal values and assets
• Love, Empathy, Forgiveness, Kindness, Gratitude…
4. Restorative Practices• Group-based problem-solving, conflict resolution
Building up the skills from the Inside...
Internal assets:
• Self esteem
• Benefit finding
• Management of feelings
Interpersonal assets :
Empathetic listening
Communication
Restorative practices
• Group problem solving
• Restorative justice / resolving conflicts
Family, community and culture
Educatio
n
Physical body
Emotions, thoughts
and behaviors
Girls First: Curriculum
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Emotional Resilience
• Character strengths
• Self-Esteem
• Goal Setting and
Planning
• Identifying and
regulating emotions
• Somatic awareness
• Benefit finding
• Gratitude…etc.
Social Resilience
• Listening skills,
collaboration, trust
• Assertiveness
• Self-Advocacy
• Problem Solving
• Conflict Resolution…etc.
Physical Resilience
• Health knowledge
• The health
system
• Nutrition and
anemia
• Hygiene
• Water and
sanitation
• Reproductive &
Sexual Health
• Health attitudes
• Gender equality
• Promoting
rights
…etc.
Activities in groups
CorStone - Girls First Bihar - Not for Distribution
Opening circle
CorStone - Girls First Bihar - Not for Distribution
What's my character strength?
CorStone - Girls First Bihar - Not for Distribution
Work on their goals
CorStone - Girls First Bihar - Not for Distribution
Listening skills
CorStone - Girls First Bihar - Not for Distribution
Family, community and
culture
Education
Physical body
Emotions, thoughts and
behaviors
Implication to prevention of violence in schools
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Emotional Resilience
• Character strengths
• Self-Esteem
• Goal Setting and
Planning
• Identifying and
regulating emotions
• Somatic awareness
• Benefit finding
• Gratitude
• Forgiveness
Social Resilience
• Listening skills, collaboration,
trust
• Assertiveness
RESTORATIVE PRACTICES:
• Problem Solving
• Conflict Resolution/ restorative
justice – to manage bullying
Physical Resilience
• Health knowledge
• The health system
• Nutrition and
anemia
• Hygiene
• Water and
sanitation
• Reproductive &
Sexual Health
• Health attitudes
• Gender equality
• Promoting rights
…etc.
“No oneever toldus we had strengths.”
-- Girls FirstParticipantBihar, India
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Youth First builds resilience and self-confidence in marginalized adolescents, empowering them to achieve their potential despite difficult circumstances.
For more information:
Gracy AndrewCountry DirectorCorStone India Foundation+91 [email protected]
www.corstone.org