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LEARNER MANUAL Psychosocial support skills development programme for community caregivers
Name of learner
Date
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Acknowledgements This Learner Manual has been developed for the Thogomelo Psychosocial Support Skills Development Programme for Community Caregivers. In collaboration with South Africa’s Department of Social Development, the US Agency for International Development is supporting the implementation of the project by a consortium consisting of Programme for Appropriate Technology in Health (PATH), Health and Development Africa (HDA) and the International HIV and AIDS Alliance (IHAA). The Thogomelo Project aims to provide training and capacity development to community caregivers on psychosocial care and support and responses to child protection violations – as identified by community-based organisations. The training will be conducted nationally over the project’s five-year lifespan from 1 October 2008 to 30 September 2013. Thereafter, the curriculum will be handed over to the Department of Social Development. A curriculum on Child Protection works alongside this Skills Development Programme, and is targeted at supervisors and managers working in home- and community-based organisations. This Learner Manual guides learners through the training and should be used alongside the Thogomelo Community Caregiver Toolkit (a set of resources for community use). The Thogomelo team wishes to thank the Department of Social Development for providing invaluable technical support during the development of this skills programme. It has also played a pivotal role in consultation with the Provincial Departments of Social Development to enable a field review of the learner materials and curriculum in three provinces (Gauteng, Mpumalanga and Limpopo) and subsequent implementation of the training in all nine provinces. The Learner Manual was also made possible through the technical support and consultancy of the following individuals and organisations: • Berenice Meintjies • Rose Smart • Patricia Oosthuizen
• Sonja Giese • Lulu Venter • Soul City
• ChildLine • Child Welfare • Naledi Hospice
• N ICDAM • RAPCAN • REPSSI
A special thank you goes to the writers who helped develop the learner materials: • Craig Higson-Smith (Modules 5 and 8) • Bev Killian (Modules 3 and 4) • Ncazelo Mlilo-Ncube (Modules 1 and 2) • Moefeeda Salie-Kagee (Modules 6 and 7) • Nirvana Pillay (all Modules) • The core Thogomelo Team from HDA, Naomi Hill and Margaret Roper; Rita Muyambo from IHAA; and Siyabulela Zondi from the Foundation for Professional Development, PEPFAR Fellowship Program Finally, we wish to thank all the training service providers responsible for implementation of the training.
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Contents
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v How to use this Learner Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi What you will be able to do at the end of the programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Learner Manual modules Module 1: Being a community caregiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Module 2: My psychosocial wellbeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Module 3: Dealing with stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Module 4: Dealing with death, grief, bereavement and frightening experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Module 5: Creating a caring community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Module 6: Protecting our children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Module 7: Responding to vulnerable children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Module 8: Caring for the community caregiver in the organisation and community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229 Module 9: Palliative care for children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .266
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Abbreviations AIDS ART CBO CCG CJB CP CPA CPO DoH DSD FBO HCBC HIV NGO OVC PSS SAPS UNCRC UNICEF VCT US
Acquired Immune Deficiency Syndrome Anti-retroviral Treatment Community-Based Organisation Community Caregiver Child Justice Bill Child Protection Criminal Procedures Act Child Protection Organisation Department of Health Department of Social Development Faith-Based Organisation Home- and Community-Based Care Human Immunodeficiency Virus Non-Governmental Organisation Orphans and Children made Vulnerable from HIV and AIDS Psychosocial Support South African Police Service United Nations Convention on the Rights of the Child United Nations Children Fund Voluntary Counselling and Testing Unit Standard
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Introduction Community caregivers are the backbone of community care for children and people with HIV and AIDS, but the enormous responsibility of care and support needed by children, families and communities takes a serious toll on caregivers’ physical and psychosocial wellbeing. Community caregivers work in a context of poverty, deprivation and disease which is stressful and impacts on them physically, psychologically, emotionally, socially, spiritually and even economically. Caregiving is emotionally and psychologically draining by its very nature, making caregivers highly susceptible to stress, burnout and compassion fatigue. Despite the psychosocial impact of caregiving, organisations working with community caregivers, and caregivers themselves, often fail to recognise the full impact that caregiving has on their lives. Community caregivers seem to focus the majority of their attention on the children and families they provide services to, but often struggle to pay attention to their own needs. Because they have spent several hours being exposed to the pain and difficulties experienced by children and families under their care, they too become affected by it. Some of their challenges arise from their own lives and personal circumstances in which they live. Another source of difficulty for some community caregivers lies in the difficult working conditions and the difficult circumstances in which care and support services are offered. At present, there is an extremely high turn-over of community caregivers who work in very poor circumstances, with little support and training, and for which there is no career path. An initial step to remedy this, is to provide community caregivers with support and insight into the impact of community caregiving. The focus of the Thogomelo Psychosocial Support Skills Development Programme for Community Caregivers is to build the capacity (knowledge, skills and practice) of community caregivers to effectively work by learning to take better care of themselves.
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How to use this Learner Manual This Learner Manual is for you: • to use during the 10-day training programme • to use after the training programme • to help you take care of yourself • to share what you have learnt in your family, community and organisation This skills development programme is an accredited training programme. You will be able to get the credits towards a qualification if you complete the assignments in the Learner Workbook and in the Learner Practical Workbooks (these form your Portfolio of Evidence), and do the Summative Assessment. You will have to be assessed before you can get the accreditation. This Learner Manual provides the information and directions to help you complete your Learner Workbook. Your facilitator will guide you through each module in the classroom. Each learner will also receive a Thogomelo Community Caregiver Toolkit that has important additional information, resources, tools and things to help you to take care of yourself and to help you through this 10-day programme. In each module there are activities with group or individual activity icons that look like this: There are difficult words that have been underlined and explained at the bottom of each page. You may want to write next to some of them, what the word is in your own language.
“
ACtIvIty 1.2
ACtIvIty 1.3
Small group activity Individ
What community needs am I responding to? me to be a community ca What motivates
Aim: to explore the range of needs that as a community caregivermotivation respond toto Aim:you to understand your personal
We haveordiscussed thatyou there many different fac Spend a few minutes thinking about 3 children adults that haveareworked with in the become community caregivers. Each one of you ma past few months. similarities context circumstances and the options that were or were no 1. Givethethem different names to protect ways things, people or situationtheir or identities (confidentiality). Write their new n discussion you had in the classroom should have ra situations are the same or circumstances down. like each other for caring for others: 2. Next to their names write down what their needs or problems are. • The desire to care for and to help others and to b 3. Now think about how their individual problem (mirrors) the bigger problems in who arereflects suffering. community or in South Africa. • The desire to help in the control of a disease tha communities.
The focus of this 10-day training programme is on building theand investing in the future – some p • Self-interest for others, they will also be helped in the future s problems. knowledge, skills and psychosocial wellbeing of community • Hope for paid employment with a particular orga caregivers. This training will help community caregivers to • Some people are attracted by what is offered by example access to income-generating schemes, be better equipped to support the children, families and stipends. • A high value placed on children, or feeling respon communities with whom you work.
”
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What you will be able to do at the end of the programme you will be able to: Apply knowledge of self in order to make a personal decision US 120308 Specific outcomes: • Demonstrate knowledge and understanding of self as a unique individual. • Demonstrate an understanding of self in relation to different environments. • Use a variety of strategies to deal with life situations. • Make an informed life decision based on self-knowledge. Identify causes of stress in own life and indicate techniques to manage it US 244564 Specific outcomes: • Describe stress and its effects on daily life. • Identify causes of stress in own life. • Identify reactions to stress in own life. • Indicate techniques to help manage stress in own life. Demonstrate an understanding of factors that contribute towards healthy living US 14659 Specific outcomes: • Explain basic principles of personal hygiene. • Demonstrate understandings of healthy nutritious eating habits. • Demonstrate understanding of the consequences of abusing drugs and medicine. • Demonstrate understanding of sport and/or recreational activities for a healthy lifestyle.
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What you will be able to do at the end of the programme
Assist with palliative care US 119565 Specific outcomes: • Demonstrate fundamental knowledge of the concept of palliative care. • Assist in the management of total pain. • Demonstrate a fundamental understanding of grief, loss and bereavement. Investigate ways of contributing towards community development US 244584 Specific outcomes: • Explain community development and the importance of individual participation in developing a community. • Conduct a situational analysis in a specific community (in relation to psychosocial support). • Reflect on own expertise to inform a personal contribution plan. • Design a plan for personal involvement in a specific community project. Demonstrate an understanding of violence and victimisation affecting children and youth US 117883 Specific outcomes: • Understand the social context of violence affecting youth and children. • Identify and refer victims of child abuse and neglect. • Understand youth at risk. • Understand youth in conflict with the law.
you will also be able to: • Demonstrate an understanding of the concept of community caregiving in South Africa. • Demonstrate an understanding of psychosocial wellbeing within various contexts. • Demonstrate an understanding of self in relation to psychosocial wellbeing. • Identify formal and informal psychosocial support services (range: psychologist, social worker, counsellor, vs. traditional leader, informal peer community groups etc). • Describe how to manage reactions arising from a traumatic event. • Explain the process to be followed in referring an individual for debriefing or psychosocial wellbeing.
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Module 1
Being a community caregiver Understanding community caregiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 What is community caregiving?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Who provides care in our communities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 The history of caregiving in South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Organisations in the community providing care and support . . . . . . . . . . . . . . . 10
My motivation to become a community caregiver . . . . . . . . . . . . . . . . 11 The factors that underlie my motivation to be a community caregiver . . . . . . 12 Why are community caregivers mostly women?
............................
16
My roles and responsibilities as a community caregiver . . . . . . . 19 What are my roles and responsibilities as a community caregiver? . . . . . . . . . . 19 Being a quality caregiver – providing the best service I can!
................
21
What are the rights of community caregivers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 What do I understand about confidentiality in community caregiving? . . . . . 25
Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . . . 28
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Module 1
Being a community caregiver
Why is this module important? This is the first module in a programme to assist community caregivers in taking better care of themselves in their personal and work lives. It is a response to the reality faced by many community caregivers in South Africa who are at the centre of providing care and support to vulnerable children and families in a time of HIV and AIDS, poverty, crime and unemployment. Many community caregivers work under difficult and stressful conditions. This module: • explores caregiving in the South African context • explores what motivates people to become involved in community caregiving It is also important that we look at the roles, responsibilities and rights of community caregivers. We have all had situations where we have had to keep confidential information. We have also had situations where we were not sure how to respond. Some of the issues that will be covered in this module are: • How did we handle such situations? • Were we able to realise our boundaries and know when information was confidential?
vulnerable
context
confidential
boundaries
at risk; easily harmed or hurt
background; environment
private; secret
limits; limitations
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What is community caregiving? According to the South African Norms and Standards for Home and Community Based Care (HCBC) (November, 2007), community caregiving is the “provision of comprehensive health and social services by primary and community caregivers in the home and community in order to promote, restore and maintain a person’s level of comfort, social functioning and health”.
Being a community caregiver
In this section, we will explore caregiving and the reasons that people become caregivers. • We will have an opportunity to look at our own experiences as community caregivers. • We will also identify the benefits and contributions that this work has made to our lives and the lives of our beneficiaries. • We will also explore benefits that the communities we work with may have gained from our work as community caregivers. • Finally we will look at the structures in our communities within which community caregivers work and provide support.
Module 1
Understanding community caregiving
Community caregiving aims to provide continuous care and support services for people who are vulnerable to HIV and AIDS and other burdens of the disease. The South African government is trying through the Home Community Based Care Programme (HCBC) to make sure that vulnerable communities have access to various services, which address their basic needs. The basic needs are: • food • shelter • education
• health care • care and protection from abuse and malnutrition
HCBC programmes allow the individual, family and community to have access to services nearest to their home1. Community caregivers operate under the supervision of HCBC organisations.
1 National norms and standards for Home and Community Based Care and Support Programmes, Department of Social Development, November 2007
contributions
beneficiaries
continuous care
help; positive effects
the people who receive our care
care that carries on for a long time; constant care
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• A community caregiver is a person who gives of his or her time, ideas, ideals, resources, knowledge and skills to help vulnerable individuals within the community. • Community caregivers provide many different services to the people they help, both children and adults. They usually provide services in their own community where they see the needs of community members every day. • The community caregiver is the first line of support between the community and other services. • They play a vital role in empowering community members to make informed choices about their health and wellbeing.2 • A community caregiver is not the same as a primary caregiver.
Module 1
Being a community caregiver
Who provides care in our communities?
Primary caregivers A primary caregiver is a person who has the parental responsibility or right to care for a child or any other person who is in need of care and support. This includes a person who is living with a disability, is aged or sick. The primary caregiver includes the child’s parents, grandparents, guardians, other adults, brothers or sisters.
Community caregivers Community caregivers offer their support to primary caregivers and their families to make sure they have access to different resources, services and information. They complement the primary caregiver by strengthening their knowledge and skills so that they are better able to care for the beneficiaries.
2 National norms and minimum standards for Home Community Based Care (HCBC) and support programme, Department of Social Development, November 2007.
ideals
resources
first line of support
empowering
parental
morals; standards; ethics
things that help achieve something; they can be people, money or equipment
the first person people meet before they go to other services
giving power to
being a parent or acting like one
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Being a community caregiver
ACtIvIty 1.1
Large group activity
Who is a community caregiver? Aim: to understand the qualities required of a community caregiver In the whole group, look at the picture of Gugu on the poster. Discuss the questions below and write your group responses up on the cards. Then stick them on the poster next to Gugu. You will use this and refer to it during the rest of the day. 1. In the group, brainstorm all the words that come to mind when you think of a “community caregiver�. 2. What do community caregivers like Gugu do?
ACtIvIty 1.2
Module 1
3. What qualities are you likely to find in a community caregiver like Gugu?
Small group activity
What community needs am I responding to? Aim: to explore the range of needs that you as a community caregiver respond to Spend a few minutes thinking about 3 children or adults who you have worked with in the past few months. 1. Give them different names to protect their identities (confidentiality). Write their new names down. 2. Next to their names write down what their needs or problems are. 3. Now think about how their individual problem reflects (mirrors) the bigger problems in the community or in South Africa.
guardians
complement
brainstorm
confidentiality
caretakers and protectors
work together; help
think and talk about
privacy
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Being a community caregiver Module 1
Discussion Once you have completed the exercise, share some of the examples with the group. You will find that there are many similarities between your beneficiaries, and the stories of other community caregivers and their beneficiaries. This is because many communities in South Africa have the same difficulties. We are all part of a bigger problem caused by: • HIV and AIDS • poverty • lack of employment prospects • crime • poor living conditions There are many other problems experienced by South African communities, and your discussion should have raised some of these. This means that the context in which you work is very complicated.
similarities
context
prospects
the ways things, people or situations are the same or like each other
situation or circumstances
opportunities; chances of success
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• By then 60% of hospital beds were taken up by people with HIV-related conditions. • Families could not cope with taking care of ill people, especially as most households did not have extra resources because of poverty. • There was also stigma directed at people with HIV and AIDS. This resulted in people avoiding each other and not being willing to support each other. Therefore many people became neglected and needed care and help. What did these departments do? The needs of people in communities was a big concern for the Department of Health and the Department of Social Development. So they looked at ways of taking services to people where help was most needed.
Being a community caregiver
In 1999, the Department of Health and the Department of Social Development saw that HIV and AIDS had a huge impact on individuals, families and communities everywhere. They noticed that clinics, hospitals and other health services could not keep up with the number of people who were already ill, wanting to be tested for HIV, and who needed care.
Module 1
the history of caregiving in South Africa
• It was decided to train and mobilise individuals and groups to take services to individuals and families in need of care and support. • The people who were involved would fall under the Home and Community Based Care (HCBC) Programme. They would work closely with each other in a group system and with social services and health services. • They made arrangements to supervise formal service providers (for example clinics). They also supervised referral to the clinics, hospitals and other health services. • With the Home and Community Based Care Programme, people could get services at their homes and communities. This meant there was more care available for vulnerable children and ill people. • As time went by, community caregivers became more skilled. They were able to assist people more and more. They also were able to identify different needs of children and people in households. At this point community caregivers have the knowledge and skills to provide support to people with different needs. Adapted from Department of Social Development
It is because of the demand for services for vulnerable children and families that we have Home and Community Based Care (HCBC) programmes.
stigma
neglected
mobilise
shame; disgrace; embarrassment
when people are not cared for
organise people and bring them together to achieve something
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Being a community caregiver Module 1
Organisations in the community providing care and support Community caregivers work within certain structures in communities such as: • Faith-based organisations (FBOs) • Non-governmental organisations (NGOs) • Community-based organisations (CBOs) • Support groups These organisations and groups recognise that the community is vulnerable and needs support. However, they may have different target groups that they assist. They may also offer support through different programmes such as: • HIV and AIDS and other chronic awareness campaigns • caring for vulnerable children programmes • income-generating projects
Formal and informal structures Some of these organisations exist through formal and informal structures: • Formal structures are those that are registered, for example NGOs. Such organisations are registered with the Department of Social Development as nonprofit organisations. They have formal management structures like a director and managers. • Informal structures are normally those that are not registered, for example a local church group or a neighbourhood group of people living with HIV who support each other. These may not have proper management in place but may have a chairperson and a secretary. Most organisations work closely with a government department, clinic or hospital. These structures provide guidance and support for community caregivers. We all come from different organisations, some formal and some informal. The differences in the organisations we come from do not make our work any more or less important. We are all contributing to the bigger South African vision of community care. We are all passionate about the work that we do.
target groups
formal
informal
contributing
groups that people work with mainly, such as children, the elderly or people living with HIV
official
unofficial; casual
adding
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• The growth and spread of community-based caregiving in South Africa. • The huge burden placed on government as a result of HIV and AIDS. This is being carried out by the Department of Social Development and Department of Health through the Home Community Based Care and Support Programme.
Module 1
We are all contributing to the bigger South African vision of community care.
Being a community caregiver
Government-driven processes to formalise community caregiving structures have resulted from:
My motivation to become a community caregiver Some community caregivers feel drawn to caregiving by something inside them. For some, it is a choice they make. For others, the circumstances in their community leave them with no other choice. Your wish to help other people is brought on by thoughts and feelings that you are aware of – and some which you are not aware. This section helps you to think about why you are a community caregiver and what factors make you choose to help others. We all have different motivations for becoming community caregivers. Motivation is the drive that pushes people to take a particular action. Things that motivate people usually have a lot to do with their beliefs, values and attitudes, as well as their options and choices.
vision
burden
feel drawn to
circumstances
factors
picture; dream
problem; responsibility
are attracted to
situation; conditions
reasons
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Being a community caregiver Module 1
the factors that underlie my motivation to be a community caregiver Beliefs, values and attitudes Things that motivate us to become community caregivers are our beliefs, values and attitudes. They affect our relationships with our beneficiaries, our families, our communities and our work environment. They are also linked to our psychosocial wellbeing. • A belief is the conviction or the principles that you have. For example, you may have the belief that people are good. This belief may affect the work that you do and may motivate you to help others. This may have influenced your choice to be a community caregiver. • A personal value system is a set of principles or ideals that drive or guide your behaviour. Your personal value system gives you structure and purpose by helping you work out what is meaningful and important to you. It helps you express who you are and what you stand for. Your values make your character. They impact on every aspect of your life: - your personal and work behaviour - your interactions with family, friends and co-workers - your decision-making processes - the direction you take in life This is why it is so important to know what you value and what is important to you. For example, you may value community service. This may have motivated you to become a caregiver. • Attitude is your approach or outlook on certain issues. Our attitude relates to our feelings, our beliefs and our values. If we feel positive and good about something, we will have a positive attitude. For example, if our attitude to our work is positive, then we are likely to believe that our work is important and valuable. Other people will also be able to see that we have a positive attitude to our work.
Our beliefs, values and attitudes affect the choices we make in life, including the decisions we make every day.
impact have an influence or effect on
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Life is about choices we make and how they affect us. • Sometimes we have options or choices but sometimes we do not. We have reasons why we are doing the work we do. • Some of us made the choice to be in this work, but some of us did not have a choice. • Whatever our circumstances are, the work that we do affects our lives. We interact on a daily basis with all kinds of people including our family, friends, beneficiaries and work colleagues. These may be people from different religious, gender, age and cultural backgrounds. Our beneficiaries and friends may be male or female, able-bodied or people with disabilities, homosexual or heterosexual, young or old.
Being a community caregiver
We are also influenced in our decision to become community caregivers by our options, choices and consequences.
Module 1
Options, choices and consequences
The way in which we relate and react to different people is guided by our beliefs, values and attitudes, and the choices we make.
Our relationship with our beneficiaries is also guided by what we believe to be our roles and responsibilities as community caregivers. As individuals we make choices on a daily basis, some are difficult choices while some choices may be easier. For example, when we are overworked and tired, we may have to make a difficult choice not to increase the number of families we support. This is very difficult when you know that a family needs help. Making choices is difficult because choices have consequences.
able-bodied
disabilities
homosexual
heterosexual
strong and healthy
conditions where you cannot use a body part (physical) or brain (mental) properly
attracted to the same sex
attracted to the opposite sex
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Being a community caregiver Module 1
Your choice – your consequences Your work as a community caregiver involved a choice that you made at some point in your life. It may have consequences that you don’t expect for your overall health and wellbeing, as well as for your family and loved ones.
ACtIvIty 1.3
Individual activity in Learner Workbook
What motivates me to be a community caregiver? Aim: to understand your personal motivation to become a community caregiver We have discussed that there are many different factors that motivate people to become community caregivers. Each one of you made the decision based on your life circumstances and the options that were or were not available to you. The facilitated discussion you had in the classroom should have raised most of the following reasons for caring for others: • The desire to care for and to help others and to be compassionate towards those who are suffering. • The desire to help in the control of a disease that has caused a lot of suffering in communities. • Self-interest and investing in the future – some people hope that by doing good for others, they will also be helped in the future should they be faced with similar problems. • Hope for paid employment with a particular organisation. • Some people are attracted by what is offered by community programmes, for example access to income-generating schemes, food handouts, incentives or stipends. • A high value placed on children, or feeling responsible for children.
compassionate
incentives
stipends
kind and caring
bonuses or other benefits
payments of money
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Think about your decision to become a community caregiver by answering the following questions in your Learner Workbook. 1. What motivated you to become a community caregiver (why did you become a community caregiver)? 2. What are your personal values (principles or ideals) that affected your decision to become a community caregiver? 3. What are your personal beliefs (conviction or principles) that affected your decision to become a community caregiver? 4. What are your personal attitudes (approach or outlook) that affected your decision to become a community caregiver?
Being a community caregiver
• Personal experience of HIV and AIDS.
Module 1
• Ubuntu – the ability to do something about another’s problems. “You are a person through others, and the wellbeing of an individual is only possible through a community”.
5. Did you have a choice in becoming a community caregiver? If you did, why did you choose community caregiving instead of the other options you had? 6. What are your roles and responsibilities in: a. Your home? b. Your work? c. Your community life (such as at church or a stokvel)? 7. How has being a community caregiver affected (influenced or changed) your life? This could be a positive or negative effect.
Whatever our choices and circumstances are, the work that we do affects our lives.
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Being a community caregiver Module 1
Why are community caregivers mostly women? We may have strong beliefs, values about the role of men and women in society. These beliefs and values will determine our attitude to men and women. These beliefs have contributed to the fact that the majority of community caregivers are women. There are many gender beliefs that exist: • This means that we think of men and women as having expected roles and responsibilities. • We create stereotypes about people when we do this. To stereotype means to label people. An example of a typical stereotype is that women should take care of their homes and families, whereas men should earn money and take care of the safety of families and communities. • Each one of us has specific ways in which we think about men and women. It is important for us to know why and how we stereotype men and women, and to challenge our stereotypes. • Our attitude may be a result of the values and beliefs that have been passed on to us from elders in our community or our family and friends.
We need to constantly challenge our values and beliefs so that we avoid stereotyping people, because we may have the wrong idea of them.
stereotypes
to challenge
labels we give to people or groups we put them into
to question or examine
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“Only women are community caregivers” Aim: to understand how our values and beliefs affect our attitudes toward men and women Look at the gender statements below. (These have also been put up on the wall). Decide if you agree with them or not. 1. Men don’t know how to deal with children. 2. Women should look after the sick, elderly and people living with a disability. 3. Men do real work, like mining, farming and policing. 4. Only women can be caregivers. 5. Men are not affected by other people’s pain and suffering. In your small groups, discuss the statements. Then explain to the entire group why your small group believes each statement to be true or not. There is usually disagreement between different groups – listen to the other points of view calmly and try to understand them. Remember that we need to be tolerant of views that are different from our own.
Being a community caregiver
Group activity
Module 1
ACtIvIty 1.4
Discussion All the statements above are not true. They are stereotypes of men and women. While they may be true of some men and women, they are not true for all men and women. There are many men in our families and communities that are caring and compassionate. More men are becoming involved in community caregiving these days. Women also do work like farming, mining and policing. There are women and men that are not affected by other people’s pain and suffering. There are also women and men that are affected by other people’s pain and suffering. We cannot make generalisations about people based on their gender. Each one of us is unique and is driven by our own values and beliefs.
tolerant
generalisations
accepting of other people’s beliefs or ways of living
statements that seem to be true in most situations but sometimes are not true
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Being a community caregiver Module 1
Many gender beliefs have been created over the years and have passed on from generation to generation. Culture is often used to justify the use of gender beliefs and stereotypes. Individuals choose to “label� or stereotype people because of their gender. We need to think carefully before we judge people in a way that may harm or hurt them. Here are some ideas for you to think about on how we can encourage men to participate in caregiving and become community caregivers. 1. Challenge the stereotype that men are emotionally not suited to offer psychosocial care to children. 2. Raise awareness of the need for male community caregivers in the community, and in providing for the care and protection of children. 3. Encourage male community caregivers to promote male caregiving in the family, home, church, organisations and community. 4. Discuss with women and men the important role men can play in promoting safer sexual practices and preventing HIV. 5. Highlight the important role that male community caregivers can play in being a father or a positive male figure to children. This can help build positive values to encourage boys to become responsible men in the future.
It is important to encourage men to participate in caregiving and to become community caregivers.
culture
roles
responsibilities
boundaries
a group of people’s ideas, beliefs and way of life
jobs; responsibilities
everyday tasks
barriers; walls
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We now understand what community caregiving is and how we relate to and work within our communities. As community caregivers we have a number of roles and responsibilities. We need to be clear about these roles, so that we are able to work in a clearly defined way. We also need to know what is not our role and responsibility, so that we are able to create boundaries between ourselves and our beneficiaries. This is often very difficult to do. When we do not keep a healthy distance from our beneficiaries, we cannot help them effectively. When we allow our roles and responsibilities as community caregivers to spread into other aspects of our lives, problems arise:
Module 1
• Our work interferes with our family.
Being a community caregiver
My roles and responsibilities as a community caregiver
• It interferes with our leisure time. • This affects our wellbeing.
What are my roles and responsibilities as a community caregiver? Refer to the poster of Gugu that you worked with earlier in the day. You looked at what community caregivers do. These are the things that make up the roles and responsibilities of community caregivers. In general, the roles and responsibilities of a community caregiver may include: • Caring for the sick and providing treatment support • Identifying vulnerable children and families early so that appropriate services or referrals can take place • Identifying children early who are neglected, abused or exploited • Addressing the needs of child-headed households • Providing psychosocial support and care • Providing assistance such as food parcels
effectively
vulnerable
exploited
psychosocial support
well; properly
at risk; easily harmed or hurt
treated badly; taken advantage of
help with the feelings and emotions
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Being a community caregiver Module 1
• Linking families with programmes that help reduce poverty (for example incomegenerating programmes, food gardens and skills-building projects) • Making sure that there is alternative care for vulnerable children and that they are referred when necessary to other facilities • Helping with access to government services such as social grants, legal documents, health services and access to education • Counselling and support for the bereaved • Assisting with wills, memory boxes, pictures etc
ACtIvIty 1.5
Group activity
Roles and responsibilities of the community caregiver Aim: to understand the challenges associated with some of the roles and responsibilities of community caregivers The facilitator has each of the roles and responsibilities that are listed above written onto individual cards. Think about whether there are more roles and responsibilities that you would like to add. The facilitator will then add these to the cards. Place all these cards in a box. Learners should volunteer to take a card from the box, and place them on the flipchart under the headings “Less challenging” and “More challenging”. Brainstorm in the group: • What are the difficulties of the particular role or responsibility that you have identified as “More challenging”? • What can be done to overcome that challenge?
bereaved
overcome
people whose family member or friend has died
beat; end problems
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Both of these are important as they set the goals for community caregivers to work towards so that they can provide a quality service. Quality means the “standard of excellence” being set for community caregivers. The Department of Social Development has developed the Norms and Standards for Home Community Based Care (there is a copy of this in your Thogomelo Toolkit). Code of Conduct These norms and standards are sometimes called a “Code of Conduct” in organisations. Your organisation may have a “Code of Conduct” with rules and standards. • Codes of conduct create standards so that all those working for an organisation offer the same level and quality of services. • It is the organisation’s way of making sure that their staff are working responsibly and following a set of rules and principles. • Codes of conduct are also helpful for employees because they guide the roles and responsibilities of employees. • They assist us to understand the ethics of our work.
Being a community caregiver
In addition to roles and responsibilities, community caregivers also have norms and standards. • Norms are the rules that people live and work by. • Standards are the minimum level of service or effort needed to be able to do a “good” or “excellent” job.
Module 1
Being a quality community caregiver – providing the best service I can!
According to the HCBC Policy Framework developed by the Department of Social Development in 2008, the following guidelines were developed for a Code of Conduct for community caregivers.3
3 National Home Community Based Care Policy framework, Draft, 2008
quality
ethics
good and professional
morals and beliefs
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Being a community caregiver Module 1
A community caregiver: • is expected to maintain a professional working relationship at all times with the beneficiary • should give quality service as outlined in the norms and standards for the HCBC programme • should request and accept guidance and support from the mentor or supervisor • should follow agreed upon procedures in addressing challenges • should treat beneficiaries with respect at all times • should respect the beneficiary’s right to privacy and confidentiality
Ethics These are the principles and values that guide our behaviour. • Ethics are about how to behave properly and correctly. • They form the basis of the way we treat people in ways that show respect for them. • Understanding ethics helps us to know the difference between right and wrong and what will be acceptable in our work. • Ethics help us to have a ready understanding of how to react in certain situations. • Codes of conduct are often used to tell people about the ethical principles that should guide their work.
Understanding ethics helps us to know the difference between right and wrong.
mentor
principles
legal
moral
a person who gives advice and acts as a teacher and guide
beliefs and values
given or allowed by the law
having to do with rights and what people deserve
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We are all entitled to our human rights without discrimination. These rights: • are all connected • are dependent on each other • cannot be separated Very few countries have laws to protect the rights of a community caregiver. However, plans exist to make such laws in South Africa. Until these laws are in place, and where there is no legislation and policy governing community caregiver working conditions, many organisations have realised that community caregivers do have certain rights. These organisations accept and protect the rights of community caregivers.
the HCBC Policy Framework has put together a set of “rights” of community caregivers
Being a community caregiver
A right is a legal or moral entitlement or permission. Human rights are rights that apply to all human beings, whatever our nationality, place of residence, gender, national or ethnic origin, colour, religion, language, or any other status.
Module 1
What are the rights of community caregivers?
• Community caregivers should be protected against discrimination (directly or indirectly) on the basis of gender, ethnic origin, marital status, living with a disability, religion, sexuality or age during recruitment and deployment. • They should work in a safe and friendly environment. • They should be treated with respect as a human being and as a person with important knowledge and skills. • Community caregivers should be recognised as a worker in line with the Public Works Special Programme. • They should also be supported and provided with opportunities to deal with their experiences and emotions. • Community caregivers should receive ongoing training and have the opportunity to develop to higher levels if they would like to. • They should be acknowledged for their contribution. By following these rights, the organisation protects the psychosocial wellbeing of its community caregivers. Beneficiaries also have rights.
entitlement
ethnic origin
recruitment
deployment
rights; things people deserve and should have
coming from a group of people who have the same traditions and culture
hiring; employment
when people are working
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Being a community caregiver Module 1
Rights of beneficiaries All people have rights. This includes vulnerable people, such as the sick, those needing special care and support, or children that have been abused. They all have the right to: • Dignity and respect – we must treat others as we would like to be treated ourselves. • Information – your beneficiaries need to be given information about what you can and cannot do for them. This is important so that both you and the beneficiary are aware of the “boundaries” of your work. They should not expect more than you are able to give. • Choice – the right to decide if they would like you to visit them or not. This includes the right to whether they would like you to be involved with their children or not. Beneficiaries have the right to decide what information about them is shared. • Privacy and confidentiality – people hate to be the subject of gossip. It is very important that you never gossip about your beneficiaries. Trust in the relationship between you and your beneficiary is based on privacy and confidentiality. • Continuity of care – it is not good for one person to be passed from one community caregiver to another. Once a person has developed trust in you, they have a right to expect that you will continue to offer care. If you are no longer able to do so, you need to explain to them why. • Opinion – everyone is allowed their own opinion. As a community caregiver you should not persuade people that your opinion is right. You can provide them with information that may challenge their opinions. In the end, however, they are always allowed to have their own opinions and make their own choices.
gossip
challenge
when you talk about another person when they are not there
question; examine
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Confidentiality This can be difficult and there are times when you will have questions around privacy. In general, when beneficiaries tell you something, they need to know that you will not speak to others about it. This is of course unless the beneficiary has given you their permission. However, when the safety of your beneficiary is in danger, you have a responsibility to speak to your supervisor for advice. For example: • if your beneficiary is suicidal • if there has been sexual abuse of a child, where you have a legal responsibility to report the case to the police
Being a community caregiver
In our work there are always difficult situations. We may be aware that matters between the beneficiary and community caregiver should be confidential. But there are times when this becomes complicated. We need to have clear lines that will assist us to understand the ethics around our work. We also need to understand what is and isn’t our role or responsibility.
Module 1
What do I understand about confidentiality in community caregiving?
Always speak to someone senior if you are not sure what to do.
As community caregivers you have to be aware of your beneficiaries’ rights and the need for you to follow your code of conduct.
complicated
suicidal
difficult; problematic; complex
when a person wants to kill him- or herself
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Being a community caregiver Module 1
ACtIvIty 1.6
Group role play
Community caregivers in difficult situations – making the right choice! Aim: to understand the roles, responsibilities and ethics of a community caregiver in relation to beneficiaries’ rights. Divide into 3 groups, and each group take one of the case studies that have been provided. Read the situations in your group, and create a role play of the case study described. As you watch the role plays: • Look at what the roles and responsibility of the community caregiver are. • Look at what is not the role or responsibility of the community caregiver. • Look at what the beneficiary’s rights are, and what would be acceptable interventions of the community caregiver.
CASE STUDY 1
NOMA, a community caregiver, visits the Mthembu household where there is a young girl living with a disability. She has taught Mrs Mthembu how to take care of the girl and has advised her to take her out for a walk once a day. The girl is in a wheelchair and is hardly ever taken out for walks or for fresh air. When Noma realised this and confronts her, Mrs Mthembu gets very angry and tells Noma that she must do it herself if it worries her so much. What should Noma do?
interventions
confronts
situations where you become involved in an issue
when a person speaks to another person about something uncomfortable
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MRS tHOMAS, a community caregiver, is offered money and gifts by a family to help them over the weekends to care for the elderly grandfather in the home. As a result, she spends most of her time with this household. Mrs Thomas is already receiving a stipend from the clinic she supports with home-based care.
Module 1
What should Mrs thomas do?
Being a community caregiver
CASE STUDY 2
CASE STUDY 3
MR MOgADI is a community caregiver. He is helping a family access a social grant, as there is no one employed in the family. While he is on a visit with the family, the wife confides in him that she is worried that her husband is unfaithful and is sleeping with other women. A few weeks later, Mr Mogadi sees the husband who is very drunk and holding onto another woman. What should Mr Mogadi do?
confides tells someone about their feelings or secrets
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• Community caregivers may have different motivations for becoming involved in caregiving. Some of these are about beliefs and values, but some of these may be because of other circumstances. Being involved in community caregiving can be stressful and difficult and has consequences for you, your family and your community. • As community caregivers you should know and understand your rights, roles and responsibilities. It is important that you understand and recognise your own boundaries.
Always remember that we should take care of ourselves too.
Module 1
Being a community caregiver
Module summary: main learning points
Module reflection: what does this mean for me? 1. What have I found useful about the things that we have spoken about in this module? 2. What have I found difficult about the things that we have spoken about in this module? 3. What will I do differently in my work using what I have learnt in this module? 4. What do I need to know more about?
motivations reasons
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Module 2
My psychosocial wellbeing Understanding psychosocial wellbeing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 What is psychosocial wellbeing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 What are the different factors (contexts) that shape our lives?
..............
32
What does this mean for me? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
My psychosocial needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Wheel of Psychosocial Wellbeing
...........................................
36
Understanding myself better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 What is self-awareness? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Why is self-awareness important?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Knowing yourself better: the Tree of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . . . 46
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Module 2
My psychosocial wellbeing
Why is this module important? In Module 1 we explored community caregiving in the South African context, and the roles and responsibilities of community caregivers. We will now move on to look at psychosocial wellbeing. The purpose of this module is to help you understand more about yourself and your psychosocial wellbeing. It allows you to explore your needs in different areas of your life. It will help you to become more aware of yourself and your needs, and to find ways to get support. The activities in this module will help you: • to look at yourself in a new way • to look at things that make you feel happy and content • to look at things that make you feel sad and sometimes helpless This is important because you need to understand the things that prevent you from feeling whole and well balanced. You need to be able to work as a community caregiver and provide support to others. You also need to live a fulfilled and happy life with family and friends. If you understand yourself better, you will be able to get a better balance between your work and personal life. This module lays the foundation of the training on psychosocial support. It will provide a foundation for the following modules.
wellbeing
feeling whole
well balanced
to feel well and happy
you are content with yourself
a sensible or reasonable attitude to life
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• You reach those people who are worst affected and provide them with different forms of health and social care. • You understand the suffering that many individuals, families and communities are experiencing because of the HIV and AIDS pandemic and other diseases. • You are able to help people to access different services. These will help their basic needs, such as for food, education and health care, or will protect them from malnutrition.
My psychosocial wellbeing
In the overall struggle to cope with HIV and AIDS, community caregivers are our country’s most valuable resource. They help to strengthen families affected by the problems of HIV and AIDS and other diseases. This is because:
Module 2
Understanding psychosocial wellbeing
• Your help enables many people in your community to cope. You know from your own experience how difficult life would be for many community members if you were to stop offering your care.
Your work as a community caregiver is very important. Caregiving takes time and energy You spend a lot of time and energy caring for children and families. This is a very difficult job and can place a lot of stress on you and your family. It is important that as you do this very valuable work, you fully understand yourself and how your work affects your life. This knowledge and understanding will help you to: • Create a healthy balance between your work and personal life. This will help you to enjoy your work and your life without being exhausted. • Look after yourself so that you can help the people you care for in your work. • Judge how much work and support you can manage to provide for others without harming yourself, your family and your loved ones. We all have our limits. If we are taking on too much, we will not be able to help anyone else properly. We need to learn to look after ourselves!
resource
pandemic
something that helps achieve something; it can be people, money or equipment
a disease that affects almost everyone in a large area
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My psychosocial wellbeing Module 2
What is psychosocial wellbeing? Looking after ourselves and good health is more than just being physically well. For a person to enjoy a healthy life it is not just the body that needs to be well. Physical, emotional and spiritual health are all just as important in contributing to general health and wellbeing.
What does psychosocial mean? “Psychosocial” refers to the dynamic relationship that exists between our psychological world and the social world around us. The word “psychosocial” comes from two words: psycho and social. • Psycho refers to our thoughts (mental and spiritual), feelings, emotions, beliefs, attitudes and values. These things cannot be seen or heard by anyone – they exist “inside” each one of us. It is different from our physical characteristics like our hair colour, or the colour of our eyes. Just like our physical characteristics make us unique, our psycho characteristics also make us unique. • Social refers to our relationships with our family, community, workplace and friends. It is the context or environment in which we live. The psycho (internal) part and social (external) part interact and influence each other all the time. A person therefore has both “psycho” and “social” needs. So we can say that each person has psychosocial needs. If these needs are not met or provided for, it will affect the psychosocial health of that person.
What are the different factors (contexts) that shape our lives? Social, cultural and economic factors all affect our lives and our wellbeing.
Social factors These include things like our age, gender, race and educational status. • These factors affect the relationships we have. We relate to those around us differently depending on these social factors. For example, we relate differently to men and women, to older and younger people and children, and to people of different races or educational status.
dynamic
context
active, exciting
situation or circumstances
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• This affects where we live, what we eat, and where our children go to school. • The economy of the country we live in also affects our personal economic life. For example, if there is a decline in the economy, there may be a loss of jobs. We may then become unemployed, which will have a negative effect on the lives of our families.
Cultural factors These include things like the way we dress, the food we eat, and the customs and rituals we choose to celebrate. • This is determined by our roots, our heritage and our traditions. For example, death is dealt with differently by different cultures. Some cultures may mark the passing of a loved one by celebrating their life. Others may mark the passing of a loved one by a painful period of grief and mourning.
My psychosocial wellbeing
These include things like our income, the kind of jobs we have, and the general state of the country’s economy.
Module 2
Economic factors
• Our cultural practices are passed on from generation to generation. They are often adapted and changed to deal with changing ideas and circumstances. We are influenced by a mixture of helpful and harmful cultural messages. An important part of our awareness is to understand where the messages are coming from. • We should be able to assess the positive and negative effects of certain cultural practices. For example, certain cultures may encourage a widow (a deceased man’s wife) to marry the brother. We need to change cultural practices that compromise our rights. • Ubuntu is an example of a helpful cultural practice because it promotes the idea of a sharing and caring community.
Our psychosocial wellbeing is affected by all of these different factors.
economic
economy
decline
rituals
compromise
relating to money
the system by which a country’s trade, industry and money are organised
to become less or worse
formal ceremonies
threaten
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My psychosocial wellbeing Module 2
ACtIvIty 2.1
Individual activity
My social, economic and cultural life Aim: Learners become aware of factors that influence their wellbeing. In the space below draw a simple picture of yourself. In your body map, draw and write about what you are feeling. Make sure you cover each body part below. Mind/head:
What do I fill my mind with? Is it positive or negative?
Ears:
What do I listen to and what messages do I hear from others about me?
Eyes:
Who do I see assisting me in happy and sad times?
Mouth:
What do I contribute to the lives of those in my family and in my community?
Heart:
Who is dearest to me? What relationships are dearest to me?
Shoulders:
What load am I carrying?
Hands:
Who holds and helps me?
Legs:
Who are those people and resources that help me to get where I need to be?
Feet:
Who carries and supports me?
Muscles:
Who and what give me strength?
contribute give; add
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Share the words or thoughts, in your own language, that you used to describe how you feel. Explain to your partner why you have chosen those words.
My psychosocial wellbeing
What does this mean for me?
Module 2
Reflection on your body map After you have drawn your body map and thought about the questions above, turn to the person next to you and talk about your drawing. Explain what is on your body map.
It is important to know that as a community caregiver, we are surrounded by things that we sometimes have control over. However, sometimes we may have little or no control over these things.
If we understand the things that affect our psychosocial wellbeing, this will provide us with greater insight into: • the things that make us feel well and supported • the things that make us feel sad and helpless Our work involves caring for others so that they enjoy greater physical and psychosocial wellbeing. We also need to pay attention to our own psychosocial needs to maintain our own psychosocial wellbeing. It is normal for people to have ups and downs – to feel happy sometimes and to feel sad at other times. We need to learn to be able to deal with the things that compromise our psychosocial wellbeing.
It is important that we are able to acknowledge and express our real feelings.
insight
acknowledge
a chance to understand or learn more about something
to accept that something is real or true
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My psychosocial wellbeing
My psychosocial needs
Module 2
Remember that needs are things that are necessary in our lives for us to feel physically and emotionally well. They are different to things we may want. For example, we may all “want” a beautiful house, but we all “need” shelter that is warm and safe and protects us from bad weather.
In this section we will explore our own psychosocial wellbeing. This means we will explore our individual needs, as well as the environment in which we live and function. As we go through life, each of us has different needs. Our needs are both “psycho” and “social”. If these needs are not met, this affects our ability to cope and function in the world. Our psychosocial wellbeing will be affected. • Some needs are more important than others, and may impact on our ability to function. • For example, our physical need for food, warmth and shelter is a critical need. • It is very difficult to feel happy and positive if these needs are not met.
Wheel of Psychosocial Wellbeing1 The “Wheel of Psychosocial Wellbeing” opposite shows us what our different needs are. The wheel has different spokes that indicate the different needs we each have. These include emotional, social, spiritual, physical, economic and mental needs. These different needs occur in relation to our families, our communities and our work.
1 REPSSI. 2007. Psychosocial care and support for Young Children and Infants in the time of HIV and AIDS.
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Wheel of Psychosocial Wellbeing
M CO
NIty U M
ORgANISAt ION
FA M
IO At
N
ILy FAM
FAMILy
tION NISA A Rg
O
NI S
Spiritual needs May be met by connecting with ourselves through religion, poetry, music, meditation or quiet reflection.
COMMUNIty
Social needs To be part of a family or community. It includes places and relationships that allow us to relax, have fun, and meet and talk to people.
ORg A
Mental needs Learning and challenging ourselves through our work, studies or by reading. Emotional needs To be loved and cared for by others.
ILy
Physical needs Economic needs Food, clothes, shelter. Employment and a sustainable livelihood.
Cultural needs Practising our culture and maintaining our traditions.
Module 2
Our needs as individual community caregivers in our world of family, community and work
My psychosocial wellbeing
thogomelo Project
CO
MM U N I ty
thogomelo Psychosocial Support Skills Development Programme for Community Caregivers. Strengthening South Africa’s capacity to care for its community caregivers and protect vulnerable children.
sustainable
meditation
reflection
challenging
able to continue for a long time
quiet thought that helps you relax
careful thought about something
testing your skills and abilities
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My psychosocial wellbeing Module 2
We all have different needs From the poster on the previous page, we see that we all have different needs. Our needs are equally important, but sometimes one need depends on the other for it to happen. We also prioritise our needs. • We all need to have people who support us, and make us feel happy and whole. But in our daily lives sometimes we have to deal with people and situations that make us feel sad, unhappy or stressed. • Our needs and relationships are important for healthy human development and wellbeing. If any of our needs or relationships are neglected, the wheel will not function well. It will be incomplete. If a wheel loses a spoke it cannot go round, and if it is damaged it will not be a balanced wheel. • When your emotional and social needs are not met, you will not experience psychosocial wellbeing. The role of the family, community and workplace is very important. The most sustainable emotional and social support is met within families, trusted friends or the community.
ACtIvIty 2.2
Individual activity
What makes us feel whole? Aim: Learners become aware of their own needs Look at the “Wheel of Psychosocial Wellbeing”, and answer the questions below on your own. Remember your body map as you do this activity. Think about the different needs illustrated in the wheel, and how they relate to you. After you have thought about your answers, share your responses with the group. 1. What do I need to feel healthy and happy? Why do I need these things? 2. Who are the people in my life that make me feel happy and supported? Why? 3. Who are the people in my life that make me feel sad or stressed? Why? 4. What are the things that I need but don’t have that make me feel sad or stressed?
prioritise
neglected
sustainable
decide in which order to do things
ignored; not taken care of
able to continue for a long time
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We have looked at: • our needs – these are the things that are necessary to keep us physically and emotionally well • the different relationships that we have with people that make us feel supported • the different relationships that may contribute to causing stress and unhappiness in our lives • the idea that when we are happy and well, we experience psychosocial wellbeing It is normal for us to feel positive and negative emotions. It is when we are sad, unhappy or anxious for a long time that we start to feel unwell. This is the time when we need to get help to restore our psychosocial wellbeing.
My psychosocial wellbeing
In this section we have explored many things about ourselves.
Module 2
Discussion
Understanding myself better We have explored our psychosocial needs and what makes us feel whole. This section builds further on our knowledge and understanding of ourselves. In order to be able to work with others, you need to know and understand: • yourself • your emotions • your strengths and weaknesses Self-understanding is based on honesty and openness in the way you look at yourself. This is not always easy, but it is an important journey to take if you want to work with other people, while also taking care of yourself.
restore to cause a positive situation to exist again
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My psychosocial wellbeing
What is self-awareness?
Module 2
• It is therefore difficult to talk about the “self” without thinking about the people and the relationships that have influenced us to become the people that we are today. But it is also important that we are able to identify ourselves as individuals who are worthwhile and important. We need to know that we exist separately from others.
Self-awareness is about being aware of ourselves so that we are able to: • understand our feelings and know where they are coming from • know and understand our behaviour in relation to others
We know there are many things that have an impact on who we are as individuals. • These include the people who are important to us, like our family, friends and colleagues. • Our culture, religion and belief systems are also important in contributing to who we are as individuals.
Why is self-awareness important? Self awareness is the key to relationships. The more we know ourselves, the better we can deal with the world and the challenges that we face in life. Being self-aware allows us to be able to do the following things: • To keep trying to know more about ourselves and to discover more of who we are, for example, our values, hopes, dreams, beliefs, strengths, weaknesses, special connections or relationships.
We are allowed to have our own beliefs, feelings, thoughts and behaviour.
contributing to
influenced
challenges
helping to make something happen
what has had an effect on us or has changed us
difficulties; problems
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• To be stronger to face life and its challenges because we have a rich sense of who we are and where we are going in our lives. • To take time to reflect when we are in conflict with others, or when we are in relationships that make us feel unhappy or sad. We need to understand what the other person may be feeling. But we also need to see what we have done to affect the situation. • To be able to take responsibility for our actions – bad and good. And to know when it was not our responsibility. • To be able to say what we feel and think and need when talking to others. • To be prepared to face even the most difficult or painful parts of our lives and to learn from them.
My psychosocial wellbeing
• To have a good sense of the history, values and beliefs that shaped our lives and will shape our future. We remain connected to what is important in our lives. This can help us to remain strong even when times are hard.
Module 2
• To appreciate the people and relationships that have influenced us.
• To always look at our lives so that we can find ways to improve.
Self-awareness may guide your response in difficult situations. It helps your psychosocial wellbeing. Understanding myself better: the tree of Life2 Each of us is unique and special. It may seem that many of us have similar life situations, but when we think deeply about our lives, we will see that each of us is different. We have grown up with many different influences and situations that have shaped the type of person we are today. You can compare your life to that of a tree. See the “Tree of Life” poster on the next page.
2 This Tree of Life methodology with Narrative Therapy ideas was developed by Ncazelo Ncube (REPSSI) and David Denborough (Dulwich Centre Institute of Community Practice). Copyright 1997.
appreciate
rich sense
to reflect
unique
influences
understand the true nature of a situation
strong idea or understanding
to think hard about something
special; only one of us
people or things that have an effect on you
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My tree of Life Aim: to understand yourself better in different ways. to build knowledge and awareness of self in relation to life experiences. A tree is a useful tool to look at different parts of our lives. The different parts of the tree can be used to represent different aspects of our lives. Read the description of the “Tree of Life” below, paying special attention to the questions that will help to make the description relevant to your life.
SOIL The soil is about your country and culture. It is about the environment in which you grew up and where you are at the moment. Think about your country and your environment where you grew up. • Where did you grow up? • How did it affect you as a child? How has it influenced who you are? • How did your cultural and religious background influence who you are?
• Where do you live now, and who do you live with? • What is your favourite thing to do when you’re at home?
My psychosocial wellbeing
Individual activity in Learner Workbook and small group discussion
Module 2
ACtIvIty 2.3
ROOtS The roots are for your family and friends. They are part of your own personal history, your ancestors and family line. • Who are the important people in your life that have influenced you? (They could be living or may have passed on.) • How have they shaped your life?
• What important values have been passed down in your family? • How have you kept these alive in your own life?
tRUNk The trunk is for the different experiences you have had in your life. Each of us has had positive experiences and painful experiences in our past. On the left hand side of the trunk:
On the right hand side of the trunk:
• Which of your experiences have had a major impact on your life? • Who are you with? • Describe what you are doing. • Why have these experiences been important for you?
• What skills, abilities, and talents are you proud of? • Where do these come from? • How were they passed on to you? • What did they want you to do with these skills? (continued on following page)
relevant
environment
influenced
experiences
important to what is being discussed
the place in which we live and work
affected the way you think or behave
knowledge or skills gained
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My psychosocial wellbeing Module 2
BRANCHES The branches are for other parts of your life, such as your work, school or education, friends, colleagues, church, spiritual aspects, hobbies, sports, etc. Our lives usually have many different branches. What direction is your life taking? • What are the different branches in your life? • Where is your branch leading you to? • What are your dreams?
• What has influenced your direction? • What does this say about what you want for your life?
LEAvES Trees draw their life strength from their leaves. These are important people that have contributed in shaping your life. • What makes these people important to you? • How have they touched you?
• What have they contributed in your life? • What have you contributed to their lives?
FRUIt The fruit is for the gifts that you have received, or that you want and hope to achieve in your life. The fruit also shows us your achievements: it could be passing school, or having good relationships with people. They are the things you are proud of, such as helping a child to go to school. • What gifts have you received? (life-giving gifts, knowledge) • Who has given these to you? • Why did they give them to you?
• What hopes do you think they had when they gave them to you? • What are your achievements?
BUDS These are for your dreams and wishes. In your Tree of Life, the buds are for the chances you have in your life for growth, healing and progress. • What are your dreams and hopes for your life?
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Draw your Tree of Life on the large sheet of paper provided for you. Use different colours to make your tree as descriptive and creative as you would like it to be. Think about the different parts of the tree, and what these represent in your life. You can write on different parts of your tree if you would like to. Once you have drawn your Tree of Life, answer the following statements in your Learner’s Workbook. These statements relate to your unique and special qualities as a person and as a commmunity caregiver. These should be clearer to you after having worked on your Tree of Life. 1. My most important beliefs about community caregiving are…
My psychosocial wellbeing
ACtIvIty 2.3 (continued)
3. My personal values affect my caregiving in the following ways… 4. My special abilities are… 5. My particular interest in community caregiving is…
Module 2
2. My most important personal values are…
6. What I like about community caregiving is… 7. What I dislike about community caregiving is… 8. My strengths as a community caregiver are… 9. Areas in which I can improve and grow as a caregiver are… Reflection on your tree of Life Once you have finished your tree, spend a few minutes thinking about the following questions. Then work in groups of 4–5. Share your thoughts with other members of the group if you feel comfortable doing so. 1. How do you feel after having drawn your Tree of Life? 2. Share with others what your unique qualities are and why you think they are unique. 3. Share a life experience that has had a positive impact on your self-esteem. Explain how it has influenced your life? 4. Share your hopes and wishes for the future.
beliefs
values
comfortable
influenced
opinions; principles
principles or ideals that guide our beliefs
at peace with doing something
affected
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My psychosocial wellbeing Module 2
Module summary: main learning points The aim of this section was to explore who we are as individuals and to develop a greater sense of self-awareness. • Who we are, and how we have come to be the individuals that we are, has a big impact on our psychosocial wellbeing. • We also explored the Wheel of psychosocial needs and what this means for us as caregivers. • The Tree of Life was used as a tool to analyse the different things in our lives that have impacted on who we are today. • We have looked at our heritage, our culture, our beliefs and values, and our strengths and weaknesses. • We have also looked at the important factors and life experiences that have shaped who we are today.
Module reflection: what does this mean for me? 1. What have I found useful about the things we have spoken about in this module? 2. What have I found difficult about the things we have spoken about in this module? 3. What will I do differently in my work using what I have learnt in this module? 4. What do I need to know more about?
to analyse to study or examine something in detail
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Module 3
Dealing with stress Understanding stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 What is stress? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Our thoughts and beliefs about our ability to cope with stress . . . . . . . . . . . . . . 56 Stress reactions
.............................................................
58
What happens when our stress levels are too high? . . . . . . . . . . . . . 63 Compassion fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Burnout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Caring for myself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 How can I deal with high-level stress? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 My self-care strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Effective communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Problem-solving and decision-making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Time management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 .....................................................
84
..........................................................
87
Asking for support Healthy living
Goal-setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Developing a Self-Care Plan
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . 104
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Module 3
Dealing with stress
Why is this module important? By now you will have an understanding of your psychosocial wellbeing and your role as a community caregiver. This module builds on the self-awareness work covered in Module 2. The focus now changes to understanding the impact of caregiving on you and your loved ones. We will discuss some of the extremely difficult situations that you come across sometimes. Each day you provide care and support to people living in poverty and coping with the effects of a terminal illness. • You may be going through similar and difficult situations in your own life and carrying many emotional burdens and responsibilities. • Perhaps you have challenges in your working conditions such as long hours, staff shortages and low pay. • Although caregiving can bring you a lot of satisfaction, it is at times a stressful and difficult job. • Its effects can be quite disabling, and even crippling for you unless you pay attention to the way the work is affecting you. By learning to deal with the impact of caregiving, you will be able to enjoy psychosocial wellbeing. The focus in Module 3 is on caring for yourself and exploring the ways in which you manage your stress. Caregiving is only effective if it is done when the person giving has the resources to give. Without personal resources, caregivers are likely to become overwhelmed and overburdened. When a caregiver reaches this point, everybody in the giving and receiving relationship suffers.
terminal illness
disabling
crippling
overwhelmed
a sickness that has no cure and that a person will die of
when something happens that makes you unable to do things, like your job, well
when something happens that stops you from doing things
emotional; cannot handle a situation; too much to do
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This is a “doing” module in which you are encouraged to “do self-care” as opposed to simply “talking or discussing” it. Taking care of yourself means doing a lot of things in your life. • It includes being able to feel that you are in control of your life and being able to make informed life decisions. • It means knowing how to deal with life challenges and knowing when to ask for help. • You might need to explore personal life goals in your family and work life. • You may also need to look at how you manage problems and resolve conflict. • You will need to learn how to manage your time so that you do not feel stressed and overwhelmed. • Managing the way you care for others will help you take better care of yourself.
Dealing with stress
It is therefore important that your personal resources as a caregiver are “topped up” regularly. You need to realise that there are limits to the amount of caring that you, or anybody else, can do. It is important that community caregivers realise that because they are the “tool” in the work that they do, they have to keep their tool working well. Just as a mechanic cleans and oils his tools regularly, so caregivers need to look after themselves. If a mechanic does not oil his tools, they rust and do not work properly, and so it is the same with caregivers.
Module 3
Personal resources
Through understanding the emotional burden you carry as a caregiver and listening to your own needs for support, you will be better able to support others. You will also then remain motivated in your work. If, as community caregivers, we make caring for ourselves a priority, we can help make community caregiving a sustainable resource in our communities.
Through the life of Gugu, we will describe the causes of stress in the day-to-day experience of a community caregiver. We will explore its effect on daily living and what happens when we experience too much stress.
overburdened
motivated
priority
sustainable resource
when you feel like you have too many problems to deal with or too much work to do
encouraged; liking work and wanting to do a good job
something important
something that helps achieve something that will last for a long time
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Dealing with stress Module 3
Understanding stress What is stress? From the work we do, we all realise that the community caregiver role is extremely stressful. In your daily work, you are exposed to repeated stress without any relief. It is difficult for anyone to keep up this challenging and draining role for a long period of time. The work of a community caregiver requires strength and an ability to care. This is difficult even for the most resilient and compassionate person. StRESS • Stress occurs when someone feels overwhelmed by the demands they face. • Stress is a part of everyday life for everyone and cannot be avoided. • Stress is also unique to each individual. • Something that is stressful for one person may not be stressful for another. • Each of us expresses stress in our own individual way.
Stress may be both positive and negative Positive stress This motivates you to do something you are nervous about. Say, for example, you are a shy person who does not like to speak in front of others. When you are asked to give feedback after a small group discussion in this training, you decide to try even though you are scared you will not manage. You then might surprise yourself by how well you cope. This is an example of positive stress that leaves you feeling good and proud of yourself.
Negative stress This happens when you are put under pressure. Even though you try your best to succeed, you end up feeling unhappy, stressed, anxious or depressed. An example of negative stress is going for many job interviews without being successful. This can make you feel bad about yourself and unsure of your abilities. Another example is when you simply have too many important things to do at the same time.
resilient
compassionate
quick to recover from bad experiences
kind and caring
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• Traumatic events: The above events are painful, but they are not traumatic. Traumatic experiences are sudden and shocking. They involve danger, and feelings of fear, helplessness and horror. The following events would be considered traumatic by most people: physical abuse, rape, attack, armed robbery and floods.
Dealing with stress
• Stressful life events: These are things that happen in our lifetime which cause us much distress. It could be the death of a loved one, losing a job or being involved in a taxi accident. These events feel as if they change our lives in a big way.
Module 3
There are three things that cause negative stress: • Daily hassles: These are difficulties that irritate us, but that we can do very little about. We just have to put up with the hassles, for example the sound of a dog barking while we are trying to fall asleep, or somebody arriving late for a meeting.
Stress in daily life Your experience as a community caregiver is different from day to day. As you start each day, you do not know how the day will work out: • You don’t know what will be good about the day. • There may be challenges and crises that you will have to face. • Sometimes you have good days and sometimes you have bad days. Other days are a mixture of good and bad.
traumatic when something is very frightening, shocking and upsetting
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Dealing with stress Module 3
ACtIvIty 3.1
Large group discussion
gugu: good day, bad day Aim: to become aware of the sources of stress in daily life Read the two case studies that follow: “A good day” and “A bad day”. The purpose of these case studies is for you to identify with another community caregiver (Gugu) who has good and bad days in her caregiving work.
gugu – a community caregiver Gugu lives in a rural community in South Africa. She is 36 years old and has four children. Her husband went to find work in the city and she has not seen or heard from him for a long time. She decided to become a community caregiver after her mother died last year. As you read the case studies, please think about yourself and the similarities you share with Gugu and how you are different from her.
CASE STUDY 1
A good day for gugu One day, Gugu set out on her daily tasks as a community caregiver. Gugu is a person who is very kind and worries about everything and everyone, and can also get cross and lose her temper. She first went to the home of a family in which there had been many difficulties. As she walked up to the home, she was happy to see that the two young boys were looking after the vegetable garden – she remembered the first time that she had spoken to the family about growing their own vegetables and how these boys had seemed so uninterested. She could see that the pumpkins and spinach were growing well. The boys were so happy to see her. Instead of being hungry, this family could now put a little bit on the table every night. Gugu sat down to talk to the sick parents who were also happy to see her even though the mother was very ill. They smiled at her and thanked her for coming. Gugu felt good inside and wanted to do even more to help this family. She looked around and realised that the entire home, even the people, now looked fresh and clean. The parents had begun to talk to the children about their illness and had made great progress in living
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After the meeting, she visited the school playground and saw that the children she had been caring for seemed happier. Even little Lindiwe seemed a little less depressed – Lindiwe’s mother had died six weeks ago and Gugu felt so worried about how Lindiwe would manage as she had been so close to her mother. And yes, she also saw Sandile talking with the other boys. Sandile was a blind albino child, who always used to stay at home, but she had managed to get him to mix with the other children in the community. Oh, it was so good to see Sandile out with other boys.
Dealing with stress
Then Gugu went on to a community meeting. On her way she could see people walking to get their pensions. So many people greeted her, that she felt proud that she was well known and liked. At the community caregiver meeting, she and the other caregivers spoke about many things that had been worrying them, and she enjoyed seeing her friends. She was also happy to be given blankets that she could take to her poorest families. “Thank you”, she said, “now I do not need to lie awake at night worrying about the people suffering from the cold”.
Module 3
positively. The daughter of the home was sitting at the side of the room reading. “You will go far my child”, said Gugu, “I can see you want to do well at school”.
Gugu spoke happily to various children. She felt so good about how the children were coping. Then she saw Pretty looking at her, so she went over to speak to shy Pretty who cared so well for her younger brothers and sister. Gugu asked Pretty about her father’s drinking and the fighting that went on in the family. Pretty answered, “Yes things are hard but I am trying. Mama will soon be home at the end of the month – she will bring food and other things we need”. Gugu went home and as she walked towards her house, she wondered how her own children were doing. As she approached home, everything looked quiet, so she was a little worried. But she did not need to worry. There were her four children doing their homework and playing with their toys. Her son asked her if she wanted some tea, and after some good-hearted joking about who should make the tea, Gugu was brought a nice hot cup. Gugu felt happy – she could see that she had made a difference to so many people and she was happy to have had such a good day. “Thank you, dear Lord”, she said. And that night Gugu slept well. She had no nightmares and her back did not ache at all.
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Dealing with stress Module 3
CASE STUDY 2
A bad day for gugu Gugu woke up the next morning feeling bright and happy, ready to face another day and hoping that she would again have such a good day. It started badly when her son did not want to get up and get dressed for school. Once again, he was moaning about not liking school. “What can I do to help my own child?”, thought Gugu. Then Gugu’s daughter started asking for tuckshop money and Gugu felt bad because she had no money to give her daughter. “Oh dear, not a good start to this day,” thought Gugu. “Well it can only get better now,” she said to herself. Off she went to visit her first family. It was a long, hot and dusty road, so by the time she reached their house her throat was dry. She could not drink water there, because they didn’t have a tap and she thought of the people who had to carry the water up the hill from the river. As she walked up to the house, she could hear a lot of shouting. There was a big fight going on – she remembered the last time this mother and father were fighting. She immediately worried about the safety of the two-year-old boy. She was also worried about herself. What if the father threw something at her again? She stopped to think, but then she heard the little boy crying, so she walked a little quicker with a heavy heart. Knock, knock. The man opened the door and, on seeing her, he shouted at her to mind her own business and go away. She felt frightened of him and thought she should go and get someone to help her. Then she saw the mother crying, lying on the floor, with her arms over her face, and her little boy trying to climb into her arms. It was hard, but she went inside and took the mother and boy away to a neighbour where she thought they would be safe. As she walked down the hill again, she looked back and could have cried! She saw the man dragging his wife back to the house and he was shouting at her to clean the yard and make him his meal. “Oh, dear, that was a waste of time,” she thought, “and I am so worried because I do not know what to do!”
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“This is such a bad day, that I am going to go home early,” Gugu said to herself. She could feel a headache coming on. She was happy to see her friend in the distance. When she got to her friend, the friend was cross with her and at first did not feel like talking to her. The friend said, “You are always being too busy with others to have time for your friends”. Gugu felt bad and did not know what to do. She wanted to talk about what a bad day she was having but her friend needed to talk. So Gugu listened and did not speak about her own problems.
Dealing with stress
She went to stop the fight, but then saw Pretty crying. Gugu went to speak with Pretty. She was sad because her little brother was sick and she was worried that he too was HIV positive. Gugu also felt worried and she did not know what to say to Pretty. So she told Pretty to go and play, and stop worrying. She knew this would not help Pretty, but she did not know what else to say to her. She saw the fear and sadness in Pretty’s eyes as she walked on.
Module 3
Off she went to see the children at the school. She did not like what she saw. The boys were wrestling again and usually someone ending up crying when they did that. She felt heartbroken when she saw it was Sandile who was getting hurt. She wanted him to mix with the other boys and now her actions had led to him being hurt – and he was blind so how could he stand up to the rough boys?
When Gugu got home, she was exhausted. No-one brought her tea today; they were cross, arguing and not wanting to help her. Gugu lost her temper with her son when he refused to fetch firewood. He turned around and shouted at her, “Mama, you are never at home to help the family”. Then he stormed out of the house to go and play soccer. Gugu wished she had not lost her temper. When at last she got into bed, Gugu found that she could not fall asleep – her back ached and she worried about the fighting going on in the family she had visited that day. She was also worried about her son, and Pretty, and then she worried about Sandile. “I feel useless today. How am I ever going to help anyone, ever again?”
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Dealing with stress Module 3
Think about the case studies that you have just read, and answer the following questions in your groups. You will then write your own answers in your Learner Workbook. 1. What is stress? 2. What does Gugu find stressful about her work? 3. What do you find stressful about your daily work? 4. What does Gugu enjoy about her work? 5. What do you enjoy about your work? 6. How does the stress in Gugu’s work affect how she behaves? 7. How does the stress in your work affect how you behave? There are no right or wrong answers to these questions. Just think about what they mean for your own life experience.
As we have already started seeing, community caregivers are constantly faced by challenges that they often have no control over. Trying to carry out your many responsibilities to the families, community and work, can be very stressful and overwhelming. These are the things that threaten your psychosocial wellbeing. However, each one of you is unique with your own beliefs, values and attitudes. You all have your own weaknesses and strengths. Who you are affects how you react in different situations.
Our thoughts and beliefs about our ability to cope with stress One of the important things that affects our stress levels is the way in which we think about our own ability to cope. We have learnt that in spite of the stress we feel, it helps when we trust our ability to cope. We sometimes surprise ourselves by discovering that we can do something that we had thought we could not. This is what we describe as positive stress.
beliefs
values
attitudes
strong feelings that something is real and true
principles or ideals that guide our beliefs
someone’s opinions and feelings about something
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Dealing with stress
Perhaps, before you became a community caregiver, you did not think much about the child living with a mental disability who lives up the hill. You may have been aware that he hardly ever goes out, but you just felt sorry for him and did nothing about improving his situation. • Once you became a community caregiver, you may have felt more pressure to think about what you could do to help him after you saw him looking out of his doorway one day. • If you had not worked with a child living with a mental disabilty before, the thought of what you could do might have made you scared, anxious or helpless. • You may have decided to put aside your fears and anxieties. Instead you could focus on your knowledge, experience, strengths and abilities that you could use to reach out to this young boy. • In doing this, you may have discovered that he is a very pleasant, loving child, who loves to talk and longs to play with the other children.
Module 3
think of your work as a community caregiver
By thinking differently about your own ability, you were able to overcome your stress and take positive action. This also gave you a chance to learn something new about children living with mental disabilities. This could have changed your own thinking (or prejudice) and the thoughts of others about them. We need to realise that we cause some of our own stress by the negative ways we think about ourselves.
think about your attitude towards yourself Some of us may need to reconsider our own thinking and attitude about ourselves. We may have one or more of the following unhelpful attitudes about ourselves that actually cause us to feel stressed: • We may have many uncertainties or worries: we may worry about things that do not concern us or about which we can do nothing. • We may have a pessimistic attitude, in other words, always looking for the bad and expecting the worst.
pressure
focus
prejudice
pessimistic
feeling worried about a difficult problem
concentrate; pay attention to
not liking a particular person or group of people for no good reason
someone who expects the worst from a situation
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Dealing with stress Module 3
• We may be full of self-criticism and hold unrealistic expectations. • We may be so busy trying to do things perfectly that we put too much pressure on ourselves in an imperfect world with lots of demands. • We may have a very low self-esteem, in other words a belief that maybe we are not good enough and that others are better than us. • We may carry so much anger or tiredness inside us that we forget to feel happy or relieved about getting something done. • We may lack assertiveness, which means we do not know how to say “no” when someone asks us to do something. So we try to do too much and are not able to ask for help from others.
Stress reactions The other important aspect of stress is the way in which we react or respond to stress. At times our reaction happens without us even knowing, as our body responds without our thinking about it. You may be so focussed on getting on with your work and life that you hardly notice you have become stressed, and that this has affected the way you are living. It is important that we spend some time talking about the ways in which we react to stress, so that you can identify your own stress reactions. When we feel the demands placed on us go beyond what we can cope with, our stress reactions begin.
Many things happen to us mentally, physically and emotionally when we feel negative stress.
self-criticism
unrealistic expectations
low self-esteem
lack assertiveness
when a person is hard on themself and thinks they are doing something badly
when people expect something to be better than it could possibly be
the feeling that you are unimportant and not valuable
not confident; unsure about expressing your opinions
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When we talk about the cognitive, we refer to the mind and our thinking. Does stress affect our thinking? Yes it does! We find that when we are negatively stressed, we start to lose concentration, we do not focus, and we do not make good decisions. Other cognitive signs are: • Memory problems
• Racing and fearful thoughts
• Not making decisions
• Constant worrying
• Trouble thinking clearly
• Not being objective
• Poor judgment
• Not being able to concentrate
• Seeing only the negative
Dealing with stress
1. Cognitive signs
Module 3
Here are four of the different signs of stress:
2. Emotional signs When we are stressed, we may find ourselves feeling very emotional. We find ourselves crying for no reason, we get angry easily, we feel very anxious most of the time and we might just shout at someone for no reason. Other emotional signs may be: • Moodiness • Restlessness • A short-temper and impatience • Not being able to relax and feeling tense • Feeling overwhelmed or heavy • Feeling lonely • Depresion or general unhappiness
concentration
objective
giving your attention to something; focusing on something
basing your thoughts on facts instead of feelings
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Dealing with stress Module 3
3. Behavioural signs Stress also affects behaviour. Our day-to-day actions change for the worse if we are experiencing negative stress. We find ourselves behaving in different ways than usual. At a behavioural level we may find that we: • Eat more or eat less • Sleep too much or too little • Keep away from other people • Put off doing things and neglect responsibilities • Use alcohol, cigarettes or drugs to relax • Develop nervous habits (such as nail biting, pacing) • Grind our teeth or clench our jaws • Overdo some activities (such as cleaning, exercising, shopping) • Overreact to unexpected problems • Start fights with others
4. Physical signs Our bodies also react in different ways when we are stressed. Physically we may find that we begin to suffer with: • Headaches • Chest pains • Backaches • Rapid heartbeat • Muscle tension and stiffness • Weight gain or loss • Diarrhoea or constipation • Skin breakouts (pimples) • Nausea • Loss of sex drive • Dizziness • Too little or too much sleep • Frequent colds and illnesses as our immune systems do not work so well It is also important to realise that too much stress can also worsen some medical conditions, such as chronic pain, migraines, ulcers, heartburn, high blood pressure, heart disease, diabetes, asthma, pre-menstrual tension, auto-immune diseases such as HIV and AIDS, irritable bowel syndrome, skin problems and so on.
migraines very bad headaches
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How do we experience stress? Aim: to understand the physical, emotional and mental indicators (signs) of stress A. Get into small groups and discuss the following statements. You will then write your own answers in your Learner Workbook. 1. As you read in the Gugu case study, stress can be both positive and negative…. (give examples) 2. I have experienced positive stress … (give examples) 3. I have experienced negative stress … (give examples) 4. Gugu’s behaviour caused a situation at home to become stressful when she ….
Dealing with stress
Small group and individual Learner Workbook activity
Module 3
ACtIvIty 3.2
5. The situation becomes stressful with relationships with other people (for example my family, friends and colleagues) when I …. Being aware of your stress levels is very important so that you are able to recognise if you are not coping. Then you can decide how and when to get psychosocial support. B. In your Learner Workbook, complete the following activity on your own. See yourself as the person drawn below. In the body of the person, write down the effects that stress has on your body. To the left of the person, write down how stress affects your emotions. To the right of the person, write down how stress affects your behaviour. Stress and my body (physical) Stress and my emotions (feelings):
Stress and my behaviour (actions):
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Dealing with stress Module 3
Main learning points in this section • Community caregiving carries with it a huge emotional and psychological burden. • Community caregiving can be very rewarding, but it can also be very stressful and overwhelming. • As a community caregiver, you often put the needs of others above your own needs. You forget to top up your own supply of energy, until there is nothing more to give. • You need support to help you deal with difficult life and work experiences. • As a community caregiver, you need to be aware of the life and work experiences that cause you stress. Then you can take the right steps to look after yourself. • You often feel powerless when you are unable to help others solve their problems. • Community caregiving sometimes means dealing with problems that you do not know how to solve. It is especially important at these times to clearly understand your roles and responsibilities. • It is also important to recognise boundaries at these times. Remember to refer difficult cases to others who may be better able to offer you support.
Think about the work experiences that cause you stress. Find ways to look after yourself.
rewarding
boundaries
satisfying; pleasing
limitations; barriers
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Dealing with stress
We are now going to describe what can happen when someone has too much stress in their life. Imagine that you are walking along a dusty road with a basket on your head. This basket is filled with the emotional load you carry from your own life and the lives of the people you work with. At times you can carry the basket as it is not too heavy. At other times the basket is too full and becomes too heavy to carry. When this happens and you do not receive the support that you need to lighten the load or someone who can help you carry it, you may over time develop the following: 1. Compassion fatigue 2. Secondary traumatic stress 3. Burnout 4. Depression 5. Anxiety
Module 3
What happens when our stress levels are too high?
When feelings like this overwhelm people, there’s maybe a tendency to try to numb the feelings by using drugs or alcohol. (this is described on pages 93–94). We will explain what each of these terms mean.
1. Compassion fatigue Compassion fatigue occurs in people who become mentally and emotionally worn out from being kind-hearted and caring to others. They are not doing enough to balance out the emotional weight of their work. To be compassionate, we need to be kind-hearted, considerate, empathetic and concerned about others. “Compassion satisfaction is about the pleasure you get from being able to do your work well. For example, you may feel like it is pleasure to help others through your work”.1
1 B Hudnall Stamm, Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales-III. 1995-2002. www.isu.edu/-bhstamm.
empathetic understanding how another person feels
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Dealing with stress Module 3
The opposite of this can happen. We often need to hide our own emotional reactions. For example, we stop ourselves from crying, getting angry or feeling depressed about the way things are for others and about what has happened to our fellow human beings. This can be rewarding as we see how our beneficiaries benefit from having a compassionate and caring listener, but can also be extremely emotionally draining. Sometimes we continue to hold our own emotional reactions in over a long period of time, without giving ourselves space to express them. Then the signs of compassion fatigue can show. In fact, when caregivers focus on others without practising self-care, compassion fatigue may show. It is the natural result of stress from caring for and helping traumatised or suffering people.
Signs and symptoms of compassion fatigue • Blaming others and finding fault with them • Not showing your emotions, to the point that you are no longer even sure how you feel • Keeping yourself away from others, especially those with whom you used to enjoy a good relationship • Abusing substances (including headache pills, anti-spasmodics, drugs and alcohol) to cover up your feelings • Overspending, overeating, gambling and sexual addictions • Poor self-care (for example poor hygiene, poor appearance) • Physical problems that go on a long time, such as gastro-intestinal problems and colds • Feeling sad or no longer enjoying activities that you used to find fun • Difficulty concentrating, feeling mentally and physically tired • Always feeling busy, but not able to focus on the here-and-now
The signs of compassion fatigue are normal ways to show stress. They result from the caregiving work you perform on a regular basis.
anti-spasmodics
gastro-intestinal
medicines that help spasms or cramps
happening in the stomach and intestines
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Compassion fatigue is also sometimes called secondary traumatic stress. Community caregivers can develop this because we hear, see and know a lot about other people’s difficult experiences. “It is about your work-related, secondary exposure to extremely stressful events. For example, you may hear stories about the traumatic things that happen to other people.”2
Dealing with stress
Secondary traumatic stress
Module 3
As the effects of compassion fatigue can cause pain and suffering, it is best to try to prevent them. You can do this by practising reliable and effective self-care. We will explore this later in this module from page 75.
Secondary traumatic stress can develop when you have had the following experiences: • You are unable to cope psychologically after you have been told about someone else’s difficult and frightening experiences for a long period of time. • You regularly see a lot of suffering. • When you know in detail about a difficult or frightening event experienced by another, this may lead you to experience difficult feelings that are hard to deal with. • Sometimes it feels as if the other person’s difficult feelings rub off onto you. Not all people who work with the suffering of others will develop compassion fatigue or secondary traumatic stress.
It is important to understand the signs of secondary traumatic stress and prevent it through self-care. 2 B Hudnall Stamm, Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales-III. 1995-2002. www.isu.edu/-bhstamm.
secondary exposure when you receive news and get stressed about someone else’s bad experiences
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Dealing with stress
2. Burnout
Module 3
Burnout is like a breaking point. When this has happened, it is almost impossible to cope with the environment in which you live and work. It is a psychological experience involving feelings, attitudes, motives and expectations resulting in an energy crisis.
Burnout is a more extreme form of distress emerging from helping others over a long period of time. It is usually experienced as a state of physical, mental and emotional exhaustion caused by long-term involvement in emotionally demanding situations. It is usually associated with feelings of hopelessness and difficulties in doing your work effectively.
Your emotional resources have been used up and the demand for caring is far greater than your ability to continue to care. The signs of burnout are usually more mental than physical, but do involve some physical aspects.
Signs and symptoms of burnout can include feelings of: • Powerlessness
• Feeling trapped
• Emotional and physical exhaustion
• Feelings of failure
• Detachment
• Despair
• Isolation
• Distrust and doubt in yourself or others
• Irritability
• Boredom
• Disappointment and lack of interest
• Feelings of helplessness and hopelessness
• Negative attitudes towards yourself, work, people and life itself
• Suicidal thoughts or intentions
• Frustration
extreme
motives
energy crisis
exhaustion
detachment
strong; intense
reasons
where you cannot manage to do anything without effort
being very very tired
not feeling connected or involved
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Of course, feeling down from time to time is a normal part of life. However, depression is when the following happens: • When sadness takes hold of you and will not go away, it may be depression. • Depression could be when you feel unable to function because of your low mood. • If you have severe depression, you have little or no interest in life. • You may even have trouble getting out of bed in the mornings.
Dealing with stress
Depression is an ongoing feeling of being down and unable to cope with life.
Module 3
3. Depression
Depression is treated with medication, support and help from others. However, learning how to understand depression – including its signs, symptoms and causes – is the first step to getting over the problem.
Depression can be treated with medication, support and help from others.
frustration
despair
feeling annoyed because you are not getting what you want
to feel the situation is so bad that nothing can change it
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Dealing with stress
Myths about depression
Module 3
Depressed men are especially likely to hate themselves for feeling down. They are more likely to think of themselves as weak, emotional and hopeless. This means that many men do not get the help that they need and deserve. They may even try to “sort themselves out” by: • committing suicide • trying to blot out their pain through the use of alcohol and drugs • getting very angry and aggressive • doing reckless or dangerous things
• In many cultures across the world, the thinking is that depression only affects women. • Unfortunately, many people also think of depression as a sign of weakness and uncontrolled emotions. • Sometimes we think that a person with depression should overcome their illness by just “pulling themselves together”. • Often people think that men should be strong and pull themselves together to overcome depression.
Signs and symptoms of depression Important – depression is a clinical condition that can only be diagnosed by a mental health professional. • Feelings of helplessness and hopelessness: Loss of interest in daily activities. This is likely to also affect your interest in and enjoyment of sex. • Appetite or weight changes: Big weight loss or weight gain. • Sleep changes: This may take the form of you wanting to sleep all the time, or an inability to sleep. It may also mean that you begin to wake in the early hours of the morning, several hours ahead of your usual waking time. • Feeling agitated or sluggish. • Loss of energy: Feeling tired and physically drained. • Experiencing strong emotions: Guilt, feelings of worthlessness and self-hate. Often you criticise yourself harshly because you think you are at fault or making mistakes. • Concentration problems: trouble focusing, making decisions or remembering things.
You can get more information from the Soul City booklet “Depression: you can beat it”. This booklet is in your toolkit.
myths
uncontrolled
blot out
reckless
agitated
beliefs that people have that are not true
when people have no control over something
hide; cover
careless; risky
restless; nervous; tense
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Depression and anxiety are almost the same, but there is a difference. In the earlier section on stress on page 50, we discussed how stress is not always a bad thing as it can help us to stay alert and focused. It can also motivate us to take action to solve problems. However, when we experience constant or severe worry or fear in situations where most people would not feel threatened, help from a mental health professional is needed.
Dealing with stress
Anxiety is a general feeling of fear and worry that affects our daily lives. Although we all feel worried, afraid or anxious at times, when the worries and fears prevent us from getting on with life, then we have a problem.
Module 3
4. Anxiety
Signs and symptoms of anxiety Important – anxiety is a clinical condition that can only be diagnosed by a mental health professional. • Feelings of apprehension or fear • Trouble concentrating • Feeling tense and jumpy • Expecting the worst • Irritability • Restlessness • Watching for signs of danger and seeing danger in everything • Feeling like your mind has gone empty • Intense fear of things that are not really a threat, such as insects
sluggish
worthlessness
trouble focusing
alert
apprehension
slow; having no energy
not being important or special
not able to pay attention
awake and aware
fear and anxiety
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Dealing with stress
ACtIvIty 3.3
Small group and individual Learner Workbook activity
the possible effects of a high stress load Aim: to understand the signs and indications of stress, depression, anxiety, burnout and compassion fatigue
Module 3
We are now going to explore some of the signs and indications that you may experience when your emotional load is too heavy, you feel overwhelmed or unable to cope. Read the following case studies and then answer the questions in your Learner Workbook.
CASE STUDY 1
PHINDI Phindi is a hard working community caregiver who has served the community for years. She helps TB patients and their families in her community. She works closely with the Department of Health and Department of Social Development. The community values the wonderful work that Phindi does in the community. But Phindi has not reported for work for weeks. As a result she has not visited her TB patients to DOT them. This began when Phindi saw her son being killed in the taxi violence in the area. She now fears leaving the house and using public transport to go and do her work or to go to any other place. Whenever she is in a crowd, whether in the shopping centre or attending a community meeting, she starts sweating and feels tense and panicky. She thinks or feels that something bad will happen to her. So to avoid these feelings, she prefers to just stay at home. She has not been out for two months now. She has also started drinking.
DOt Directly Observed Therapy to make sure medication is taken
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Sarah is a community caregiver who loves her work. She is, however, saddened by the situation in the community. There are many things that worry Sarah about her work. Her beneficiaries do not have food, and she feels helpless because she also can’t help them. Some of her beneficiaries and people she knows die on a daily basis because of HIV and AIDS-related illnesses.
Dealing with stress
Each time Sarah hears about death, it reminds her of her only daughter who died a year ago and left three children in her care. Sarah blames herself for not doing enough to save her. This is the reason why she does community caregiving. She felt she had to help educate other girls about HIV and AIDS.
Module 3
CASE STUDY 2
SARAH
Sarah does not see her friends as much as she used to. She lacks the energy to wake up in the morning and says that she would rather spend her day in bed. She sometimes wishes that she was dead to escape the sadness that she feels. But then who would look after the three children? Some days she cries herself to sleep. CASE STUDY 3
CONNIE In their support group at work, Connie mentioned that she is tired of caregiving and finds nothing fulfiling about it anymore. For her, every day is just a bad day and she is always feeling tired when she has to do her work. She feels that she just can’t go on, she has seen and done it all. As Connie was sharing her story, some of the other community caregivers in the group mentioned that because of the sad stories that they have heard and seen in their work, they feel “dead” inside. It is sad for them to listen to and see the painful experiences that their beneficiaries and families go through. They hear about death, illness and child abuse daily. Sometimes their beneficiaries go hungry and they cannot help them. They can no longer feel the pain of their beneficiaries and cannot empathise with them anymore. They cannot listen to any more life situations. They are feeling emotionally and mentally tired of helping.
empathise to understand how another person feels
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Dealing with stress Module 3
Answer these questions in your Learner Workbook: What signs and symptoms 1. What signs and symptoms of too much stress can you find in each of the women in the case studies? Give at least two examples. 2. What type of stress and emotional overload (such as compassion fatigue, burnout, depression or anxiety) do you think each of the community caregivers in these case studies is experiencing? 3. Why is each individual in the case studies experiencing this type of stress and emotional overload? 4. What needs are not being met for each community caregiver? Think back to Module 2 and the Wheel of Psychosocial Support.
5. Now match the signs to the correct word in the column on the right Being stressed because children are not Depression doing homework Ongoing feelings of being down and Everyday stress unable to cope A breaking point and feelings of being Anxiety that can become a disorder unable to cope Fear that is out of the normal Compassion fatigue Being emotionally drained because of Burnout doing work that demands compassion REMEMBER Some signs and symptoms may occur in all the different ways we experience stress (burnout, depression, anxiety and compassion fatigue).
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• Community caregiving is especially difficult when you feel powerless and unable to help. • When people expect too much of you as a community caregiver, you become stressed and emotionally burdened. • These factors together mean that as a community caregiver you carry a burden of care that leads to a range of emotional reactions. • This can result in you feeling stressed, traumatised, anxious, depressed, burnt out or feeling as though you are experiencing compassion fatigue. • When you feel like this, it is important that you seek help.
Dealing with stress
• The emotional load due to community caregiving can sometimes be overwhelming and a burden for you.
Module 3
Main learning points in this section
• You may choose to talk to someone that you trust about the way you are feeling. • If you feel that you have many of the signs of one or more of the above conditions, you can also seek help from a social worker or psychologist.
traumatised very shocked and upset
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Dealing with stress Module 3
Caring for myself How can I deal with high-level stress? Community caregiving can be rewarding but also emotionally exhausting and difficult. Community caregivers who are committed to, and passionate about, their work might take on more work and become more involved in the lives of those they are caring for than other people would. These are of course positive qualities. But they can use up the caregiver’s own emotional and mental resources if these are not being topped up regularly. Caring for ourselves as caregivers should be part of our work in caring for others. Some of our beliefs about culture, religion, the roles of women and men, and about caregiving often: • are not helpful • need to be challenged • are not sustainable • need to be changed We cannot give what we have not got. Therefore, effective and sustainable caregiving begins with self-care.
If we do not take good care of ourselves, we will have nothing left to give to others. Self-care is one of the most neglected parts of community caregiving. More often than not self-care is ignored. Often community caregivers are extremely passionate about their work and feel that when they look after themselves, they are being selfish. There are also so many people relying on the caregiver’s “giving” that there may not be time for taking good care of yourself. There are therefore many more people requiring care than people who are able to give it. This means that those who are able to provide support and care, like you, can become overwhelmed and overburdened because they feel as though they are fighting a neverending battle.
topped up
not sustainable
challenged
neglected
refilled; freshened
will not last into the future
questioned; examined
ignored; not cared for
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When we are in difficult situations, we normally ask ourselves: “What can I do?� This question refers to things we can do to help us cope better with challenges that we face. There are many strategies we can apply, and we will explore those when we do the exercises in this section. First we need to know what strategies to apply in different situations. This is the same as dealing with difficult beneficiaries. We need to understand the challenge and then decide on what strategy to use.
Dealing with stress
In order for us to maintain our psychosocial wellbeing and deal with stress, we need strategies that fit our situation. We need to look at ways of dealing with the situation and then move on. This is part of taking care of ourselves. By looking after ourselves, we will find the energy to continue assisting our beneficiaries. It is not always easy but we need to try to balance our work so that we do not get burnt out.
Module 3
My self-care strategy
In this section we will explore the following strategies and skills that you can develop to help you cope with stress: 1. Effective communication
4. Asking for support
2. Problem-solving and decision-making
5. Healthy living
3. Time management
7. Developing a Self-Care Plan
6. Goal-setting
1. EFFECtIvE COMMUNICAtION Effective communication is one strategy to solve issues and challenges. With good communication skills, we can be assertive and negotiate effectively. Without effective communication skills, we are likely to cause confusion and possibly conflict in our lives. This can be painful and stressful. Effective communication is one of the most important skills for community caregivers because we spend so much time interacting with others. In order to understand the problems experienced by beneficiaries, we need to be able to talk to and listen to them in such a way that we fully understand each other. Problems arise when we do not understand each other clearly.
strategies
effective
negotiate
plans; approaches
successful; useful
to reach an agreement by discussing things
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Being able to express ourselves and to hear one another are essential tools that everyone can improve. To communicate effectively remember the following: • You need to be attentive and to concentrate on what is being said and communicated. • You need to be non-judgemental and to respect the other person’s views. • Everybody, whether they are caregivers or beneficiaries, like to have their own independent ideas and opinions about their lives. • Everybody will want to be treated with respect and dignity. Being aware of this can make your communication an effective tool in solving issues and challenges in your personal and work life.
Some tips to remember about effective communication • We all communicate both verbally and non-verbally. Sometimes what is said nonverbally through facial expressions is as important as (or more important) than the words you use. • Active listening involves listening with your ears, eyes, heart and mind. • Asking questions in a gentle, non-threatening way will make is easier for people to answer openly and honestly • Use simple language that both you and the other person can easily understand. • Try to show your feelings – communication is successful when the person feels understood and that you know how they feel. • Reflecting or summarising what your beneficiary has said gives them feedback that you have understood what they have said. • Silence is important – sometimes it is better to be with someone in silence rather than always trying to find something to say.
attentive
non-judgemental
verbally
non-verbally
to pay attention; to listen
not criticising other people’s views or saying that they are wrong
using words
using ways other than verbal to communicate, eg body language
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• Listening with your ears – to hear the words and tone of what a person says • Listening with your eyes – to notice the non-verbal communication • Listening with your mind – to think about what they are saying in relation to what you already know about them and their life • Listening with your heart – to feel how they are feeling
To be an active listener you need to be attentive • You need to concentrate on what is being said and what is being communicated. • You need to be non-judgemental – try not to pre-judge what you think your beneficiary is going to say or should be saying. • It is useful to reflect back what you have heard. Then you can check that you have actually understood what they meant you to hear. By summarising the message in this way, your beneficiary can then add in extra pieces of information that you may have forgotten or misunderstood.
Dealing with stress
Effective communication involves active listening. This means:
Module 3
the first and most important step in communication is listening to the other person.
Listening with your eyes When you listen with your eyes, you can read the non-verbal communication in relation to the person’s cultural and family positions. You can look at: • their facial expressions • their posture • any gestures that they make Non-verbal communication In working with beneficiaries, we can also use our own non-verbal communication to make the person feel at ease and comfortable. • You can match their posture – if they are standing you can stand, if they are sitting you can sit. • It is important to sit with an open and listening posture, slightly leaning forward to show your interest in them. • By noticing their facial expressions, you will pick up their feelings, as these are often reflected in expressions of the face. • Body language reveals a lot about how you interpret and send messages. So be aware of when you send signals that might cause the beneficiary to think that you are angry, tired, not interested or bored.
non-threatening
reflecting
posture
gestures
calm; not angry
mirroring
the way people stand or sit, and their attitude
movements that express a person’s attitude
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ACtIvIty 3.4
Group and Learner Workbook activity
Effective listening Aim: to know how to communicate effectively The facilitator will lead an activity in the classroom on talking and listening. He or she will ask you to tell a short story to a partner. After the activity, you will discuss the following questions in the whole group. You will then write your own answers to the questions in your Learner Workbook. 1. How did you feel while you were telling your story? Give at least one feeling word. 2. Did you feel that your partner was really listening? What did they do well? How could they improve their listening skills? 3. How did you feel when you were listening? Give at least one feeling word. 4. Do you think you listened well? What could you have done better? 5. Why is it important for you as a community caregiver to develop effective listening skills?
2. PROBLEM-SOLvINg AND DECISION-MAkINg Effective problem-solving can be a strategy to solve issues and challenges. Decisionmaking is similar to problem solving. Good decision-making is necessary for living life productively – some decisions are small and others are huge and could be life changing. In our work as community caregivers we are faced with many problems and decisions. These are not only our own problems, but problems that other people face. The community may also see us as a person who solves problems. This can be overwhelming as we may not know the answers to other people’s problems and we may not be able to solve their problems. Even though we may not be able to “fix” problems, it is useful for us to know a bit about problem-solving, so that we can help people to solve their own problems more effectively. We can also apply these techniques in our own lives. Good problem-solving and decision-making requires following a SEVEN STEP process (see next page).
productively
overwhelming
achieving good results
when a situation is difficult to handle
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• It is important that, before we try to solve a problem, we understand the actual root or the cause of a problem. • If we know why there is a problem, it will be easier for us to go about solving it. P2 STE
Clearly identify the problem and the obstacles that the problem presents • As community caregivers, we might get caught up in many problems, instead of tackling the problem itself. • We cannot possibly solve all of the problems in our community, so we need to focus on what we can solve. • Understanding what we have control over and what we don’t have control over is a crucial step in being able to solve problems effectively.
Dealing with stress
Understand why there is a problem
Module 3
P1 STE
P3 STE
Have all the relevant information to be able to deal with a problem • During Step 2, we may find that we and the people we are trying to assist only have half of the information needed to deal with the problem. • One of the most important steps in being able to resolve a difficulty is getting the correct and full information.
P4 STE
think carefully about the information that you have. Do not make quick decisions • Once you have all the information, spend some time thinking about it carefully. This is called analysing the problem. • You will need to think about the causes, what happens, and how the problem develops. • When you think about the problem, you may find that you don’t have enough information and will need to go back to Step 3 before you continue analysing it.
P5 STE
Brainstorm and decide on possible options and solutions • The next step is for you, and maybe all of the people involved, to think about all the possible solutions to the problem. • This is called brainstorming – when you just come up with a list of ideas, and do not as yet decide which will or won’t work. • You begin by writing down all of the ideas about how to solve the problem. • It is useful at this stage to try to get lots of ideas about possible solutions.
obstacles difficulties that stop a solution from being reached
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P6 STE
you should now be ready to act – with a good plan in place • If all of the previous steps have been followed fully, the next step is easy. • First you need to have considered all possibilities, spoken to all those concerned, and got all of the necessary information. • Then it should be easy to solve the problem or to find the best way of dealing with it.
P7 STE
Feedback • Once you have acted, evaluate whether it was the best decision. • Ask yourself if you achieved what you needed to. • If you did not achieve what you needed to, go back to see what you could have done differently.
In brief, solving problems requires that you think through the problem carefully and talk to all of those involved. You then think about all of the options and take actions that are most reasonable and that most would agree with. Some points to think about when making decisions: • Certainly there are no guarantees that a decision will be correct and so you must be prepared to take risks. If you make a mistake, view it as an opportunity to learn about what didn’t work and why. Many times decisions can be changed if you change your mind. • If you’ve done everything you can to make a good decision and still can’t make up your mind, do not delay making an important decision for fear that you don’t know enough or will make the wrong choice. • Sometimes people become so afraid of making a wrong decision that they panic and lose sight of what they’re trying to achieve. When that happens it prevents them from making a good decision. • Do the best with what you have to work with. If all else fails, go with your gut feeling. Quite often it may be all you have to go by.
evaluate
no guarantees
gut feeling
examine
no promises; it is not certain
when you know something is right, even though you cannot give reasons for it
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get ready to act (with your well thought-out strategy)
5 Brainstorm and decide on possible options and solutions
Understand why the problem exists
give feedback
StEPS to effective problem-solving and decisionmaking 4
2 Be able to clearly identify the problem
3 Have all the relevant information
Dealing with stress
6
1
7
Module 3
Diagram of the 7 decision-making and problemsolving steps:
Carefully analyse the information that you have
tips on problem-solving and helping beneficiaries to make decisions: • When supporting people and helping them solve their problems, recognise your limitations and your boundaries. • Do not accept responsibility to solve other people’s problems. You can help them understand their problem and find possible solutions, but you cannot solve them. • You cannot make other people’s problems go away. You can only help them and support them through a problem. • When you are not in a position to help them, then it is best that you refer them to someone or somewhere that can. (Refer to Module 5, on page 146, where we will explore community networking and referral in greater detail.) • It is important for us to understand that as community caregivers we can be most effective in our work if we give people the skills to be able to help themselves and solve their own problems.
limitations as far as you can go with something
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ACtIvIty 3.5
Group activity
Solving a problem and making informed decisions Aim: to know how to solve a problem effectively Once again look at the Case Study of Gugu in the beginning of this module on pages 54–55. Gugu has a problem when wanting to assist Pretty. She feels powerless, and unable to help. She also feels overwhelmed and sad. Instead of helping Pretty deal with her problem, she chooses to avoid it. Now look at the problem-solving steps on the previous page. As you go through the steps, think about what Gugu could have done at each step. Discuss in the group and write these up step-by-step on a flipchart.
3. tIME MANAgEMENt Effective time management can be applied as a strategy to solve issues and challenges in your personal life. As a community caregiver you need to be able to make every minute count so that you have more time to do the things that you want to do. There are a number of techniques that you can use to make time work to your advantage. A simple diary can assist you in managing your time. Refer to the Thogomelo “My Guide to Psychosocial Wellbeing” that is in your community caregiving toolkit. Use your time wisely This seems rather obvious, doesn’t it? However, most of us waste a lot of time. Many of us have got used to the waiting and time wasting. • Whether it is ten minutes or an hour, it is useful to decide not to waste time and to be sure that you use your time carefully. • You have to be serious about not doing the things that put you off. • You need to reorganise your time so that you can use it carefully and wisely. Carry a notebook or a diary It is useful to have a little notebook or diary in which you can plan your day. • Make a “to do” list so that you can tick off the things as you do them. In this way you will also not forget about some of the things that you want to do or have to do. • You will probably be surprised to see just how much you do on a daily basis. (Thogomelo “My Guide to Psychosocial Wellbeing”)
techniques ways of doing things
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Keep a calendar Keep a calendar in which you can write all the important events that will take place in the future. • A calendar will help to decrease stress as you won’t have to remember everything. • Plan out projects, guessing the number of hours things will take. • It also means that you have a time-line with dates attached for getting everything done on time.
Dealing with stress
Break all large jobs into smaller jobs that are easier to achieve • If you do this, you will be able to manage them in shorter periods of time. • Every little thing you can do gets you closer to finishing a job. For example, spring-cleaning your house is a very big job, but if you do just one cupboard or room at a time, you will be able to manage to get the whole job done.
Module 3
Learn to say “no” This is generally a hard one for many of us… really hard. • As community caregivers, we often take on too many tasks and try to do too much. • You might say, “I want to do everything! I want to help everyone!” However, you need to realise that unless you set limits and say “no” to some things, you will not be able to help anyone at all. You may not even be able to help yourself in the future. • Saying “no” gets easier the more often you do it.
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ACtIvIty 3.6
Group discussion
Managing your time Aim: to assist in managing your time effectively In the group, discuss some ideas about how you can manage your time better. Write these up on a flipchart. Now look at the points on the previous spread on how to manage your time better. Discuss each point: a) How do you manage your time? b) Where can you improve in your time management? Share tips that you may have with the rest of the group. Remember to use the Thogomelo Psychosocial Support Diary.
4. ASkINg FOR SUPPORt When we have a lot of stress and challenges, we often feel that we can manage difficult situations on our own. If we are to improve our wellbeing, we should be able to recognise that sometimes we have to rely on the support of other people. This involves understanding what support systems are available to you in your community. There are many places where we find emotional and social support. Some of these types of support are informal, such as talking to your friend or neighbour, or visiting your mother to talk about your problems. Most of the time this is enough to help us to cope with our challenges. But sometimes we have to look for more formal support when traditional methods of support do not work. This could be going to a community or health facility to see a counsellor, doctor or nurse.
traditional based on old customs and beliefs
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Pyramid of Psychosocial Support
4 3
Dealing with stress
Counselling services
2 1
Specialised mental health services
Module 3
The Support Pyramid3 The pyramid below looks at the different levels of psychosocial support available. • It ranges from the informal networks of support, such as family and friends, to the more formal levels of support, such as trained psychologists and psychiatrists. • If the bottom of the pyramid is working well, it creates less of a demand for specialised services by social workers, psychologists and other mental health experts. The most sustainable emotional and social support is provided at this level by people closest to you.
Organisational/workplace support
Everyday family and community support
Level 1: Everyday family and community support • The base of the pyramid is the widest and strongest level. • It represents the everyday care and support provided by family members, friends, neighbours, community members and work colleagues. • This level can affect and benefit the majority of people as the focus is on day-to-day supportive and caring relationships.
3 REPSSI. 2008. Psychosocial Care and Support Mainstreaming Guidelines
psychologists
psychiatrists
people who study how your minds work and how this affects your behaviour
doctors who treat people with mental illnesses
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Level 2: Organisational and workplace support • This level shows workplaces that offer support services for their employees. • There are employee wellness programmes aimed at addressing employees’ personal and workplace problems. This can be done through the appointment of a professional or specialist in the workplace or through referral to the right services.
Level 3: Counselling services • This level shows us the counselling and support services provided by social workers, priests/ clergy, nurses and lay counsellors. This also includes guidance and counselling from teachers in schools. • These people can help other people who are struggling to cope with day-to-day family, community and economic challenges.
Level 4: Specialised mental health services • The top of the pyramid is what we call the “formal level” of support. • It is when specialised people look after others with mental health problems. These could be psychosocial specialists, psychiatrists, psychologists and highly specialised traditional healers. The problems could include depression, eating disorders, anxiety or traumatic stress. • It is at the top of the pyramid because it can only benefit small numbers of people.
lay counsellors
traumatic stress
counsellors who do not have formal or professional training
anxiety caused from a very shocking, upsetting event
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Exploring formal and informal psychosocial support services Aim: to know where to go to for social and emotional support in your community In groups answer the following questions. Then write your answers in your Learner Workbook. 1. What are some of your daily activities that make you feel supported and cared for? 2. What specific activities happen in your culture that make people feel supported? 3. What words in your language do you use to offer emotional or social support to others? 4. Where do you go or what do you do for emotional and social support? 5. What role do you play as a community caregiver in providing emotional and social support to children, families and others in your community? Describe what you do.
Dealing with stress
Small group and individual Learner Workbook activity
Module 3
ACtIvIty 3.7
6. What do you do when you are unable to offer emotional and social support to the families or children you work with? 7. Go back to the case studies of Phindi, Sarah and Connie (Activity 3.3 on pages 70–71). Discuss where you think they need to go for social and emotional support in their community.
5. HEALtHy LIvINg When we experience a lot of stress, we may eat badly, take medication, or abuse drugs or alcohol to make ourselves feel better. In this section we will explore healthy living and the steps to take to make sure that you are healthy. The information will also come in handy when you are dealing with beneficiaries. It has been proven over and over again that balancing body, mind and soul is essential for psychosocial wellbeing.
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Module 3
te
u t o c o mp
le
yo
le
For
yo
te
1 For
Dealing with stress
In the following diagram, you can see the basic elements for healthy living:
u t o c o mp
6 Having fun and laughing
Basic elements for healthy living
5 Complying with instructions for prescribed medication
Healthy diet and nutritious food
2 Exercise and physical activity
3 4
Restful sleep and relaxation
Avoiding drugs and alcohol
We will explore the following parts of healthy living as they can all affect your stress levels positively or negatively. They also contribute to your psychosocial wellbeing: 1. Maintaining a healthy and clean lifestyle 2. Maintaining healthy eating habits 3. Exploring the dangers of habit-forming medication 4. Exploring the value of sport and recreational activities
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The human body is complicated, with different organs that have specialised functions. These systems have important functions that include: • Our digestive system uses energy from food and breaks it down into usable fuel. • Our respiratory system and lungs provide oxygen and get rid of excess heat. • The urinary system removes dissolved waste products from our bodies. • The skin provides a shield against dangerous substances and organisms such as bacteria and parasites. It also gets rid of excess heat. • Our immune system also provides protection against bacteria and parasites that gain entrance into our body. • The male and female reproductive systems join together for fertilisation and reproduction. • The nervous system allows us to cope with changes in the environment. • Our endocrine system helps us to react to the environment or danger. • Our brain and nervous system manage and coordinate all the functions in our body.
Module 3
1. Maintaining a healthy and clean lifestyle
In our community caregiving work, it is important to make sure that we: • keep ourselves clean and maintain simple hygiene to protect our body organs • keep ourselves physically safe • keep ourselves safe from possible infections and disease Feeling safe allows you to deal with your beneficiaries professionally. It will help you to assist in the best way you can. We all need to protect ourselves from HIV and AIDS, TB, hepatitis, cholera and other diseases. This is where the universal precautions become important in our day-to-day activities.
bacteria
parasites
reproduction
endocrine system
universal precautions
very small organisms, sometimes causing disease
small organisms that live on or inside you and feed on you
having babies
the glands in your body that produce hormones
the accepted way to keep clean and hygienic so that disease does not spread
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Universal precautions Poor hygiene is the opposite of all the healthy lifestyle habits discussed on page 88. It would be irresponsible for us not to take care of our bodies in a manner that helps us to avoid disease. Use these simple universal precautions to protect yourself, your family and others so that you can have clean and healthy lifestyle habits: • Wash your hands: This is a very important part of your day-to-day routine. You need to wash your hands with soap and hot water: - after going to the bathroom - before breastfeeding - before and after preparing and eating food - after taking off your latex gloves - after handling blood or other body fluids Washing your hands probably should take at least 20 seconds. Remember to wash between your fingers and under your nails. If your skin is dry and sensitive, use handcream to prevent your hands from becoming rough and sore. • Cover cuts: If you have a cut or an open wound like a graze or a scrape, you need to cover it with a plaster or bandage as soon as possible. • Wear gloves: If you are handling blood or any other body fluid, you need to wear latex gloves. This will protect you and the person you are helping. Always have gloves available. Remember to only wear a pair of gloves once and then dispose of them safely in a plastic bag. • Do not share personal items: These include toothbrushes, razors and nail files. However, this also means any item that has come into contact with any body fluid or sores. By doing this, you are protecting yourself and other people around you. • Discard rubbish safely: When you are dealing with rubbish that might contain infected materials, you need to be careful. It is best to throw it away in a separate plastic bag that you can tie up. • Clean up after yourself: If there are any spills of blood or any other body fluid, you need to clean it up. Remember to wear your latex gloves and use a paper towel to clean up the mess. You can make an easy and cheap cleaning-up solution: 1 part household bleach and 9 parts water. • teach others: You need to tell other people and especially children about these “universal precautions”. It will keep them safe and keep the people around them safe too.
irresponsible
latex
careless; foolish
a type of rubber
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You need to get food from all of these groups every day. Getting different types of food is especially important for children. This are even more important for children who are sick, are HIV positive, have AIDS or who are malnourished. Remember that children and adults who are living with HIV and AIDS are more likely to get sick. So it is very important that they get the right food to keep them healthy. If you do not have the money to buy these foods, try to grow some of them. • Vegetable gardens are useful community projects in which everyone can be involved and benefit. It is pleasant to work together with others on one goal. • You could grow your own fruit and vegetables like spinach, tomatoes and cabbage. • You can also grow mealies and potatoes to get your carbohydrates.
Dealing with stress
Food is what keeps us alive and gives us energy. Food is a very important part of our lives and so you need to know what food is all about. There are five basic food groups: proteins, dairy, carbohydrates, fruit and vegetables, and fats.
Module 3
2. Maintaining healthy eating habits
malnourished do not have enough food to eat
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Proteins
Dairy
Carbohydrates
Fruit and Vegetables
Fats
Meat, chicken, fish, nuts, eggs and beans
Maas, milk, cheese, buttermilk and yoghurt
Bread, maize, rice, samp, porridge, potatoes, cereal, mealies and oats
Carrots, spinach, bananas, tomatoes, lettuce and oranges
Butter, margarine, cooking oil and sweets
These foods help to keep you strong and will help children grow up healthy. They are called body-building foods.
These foods give you calcium to keep your teeth, muscles and bones strong and are very important for growing children.
These give you energy and can help underweight people to gain weight. Never eat too much of these foods and remember to include other foods with them. They are called energygiving foods.
These foods give you vitamins and minerals which help your body to stay strong, healthy and prevent sickness. They are called protective foods.
These are also important in your diet because they give you energy – but never eat too much of them. They are called energygiving foods.
Basic elements of a healthy diet Bread, other cereals and potatoes
Fruit and vegetables
Milk and dairy products
Meat, fish and alternatives Foods containing either fat and/or sugar
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3. Exploring the dangers of habit-forming medication
Dealing with stress
You can also get more information in the Soul City booklet High blood pressure: Healthy living is good for everyone. This booklet is in your Thogomelo Community Caregiver toolkit.
Module 3
Creating my balanced meal We need to make sure that we have these basic food groups in our everyday diets. If we want to be healthy, we have to have a balanced diet. The other parts of healthy living are: • staying away from habit-forming medication • exercise • managing your stress
Medicines play a valuable role in our lives and in the lives of people living with HIV and AIDS. Situations where medication and alcohol have a negative effect Sometimes in life when things get very stressful, we feel like we just can’t cope anymore. This feeling may make us want to drink alcohol or take medicines or drugs. • Although alcohol and drugs might make us feel a bit better for a little while, they may cause more stress and pain to ourselves and those around us. • Alcohol may make us aggressive and even depressed. • It is also very addictive, and so we can easily end up spending a lot of money buying alcohol. • We could end up with problems and conditions that affect our health. For more information on the effects of alcohol, refer to the Soul City booklet Alcohol and you. This booklet is in your Thogomelo Community Caregiver toolkit.
aggressive
addictive
angry and violent
you cannot stop taking or drinking something
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Drugs • Illegal drugs are also very addictive and they are very expensive. • When we abuse drugs, we also don’t really know what we are doing. The drugs and alcohol may make us think that what we are doing is okay, but most of the time it isn’t. • There are many different types of drugs and you need to find out about them so that you can avoid them. We are not just talking about illegal drugs, but also prescription, over-the-counter drugs and medicine that we can get from the clinic.
Module 3
Don’t drink too much tea, coffee or energy drinks • These are very high in caffeine and can also be addictive. • Although the occasional cup of coffee, or glass of fizzy cooldrink is fine, do not drink them too often. Caffeine makes you feel like you have energy and keeps you awake – but too much is bad for you because it can make you feel tired and depressed. Situations where medication has a positive effect When you see a doctor or nurse at the clinic, they may prescribe medicine or tablets for you to take. • It is very important that you take this medicine exactly as prescribed and for as long as the doctor tells you to. • All medicines are very carefully researched and tested before people can use them. When medicines are tested, they work out exactly how much of the medicine is needed. More than or less than the prescribed amount can do damage to your body or not work at all. • Always read the instructions of your medicine carefully and only take them as you are supposed to. • If the medicine is something like painkillers, then only take them when you are having physical pain. • Remember that some of these medicines can be just as bad as the illegal drugs if you do not use them correctly. If you are unsure of how to use a medicine, ask someone at the clinic or pharmacy to help you. • With some medicine you will be told that you should take it after a meal. Sometimes they just say “with food”. If you take the medicine without food in your stomach, you may find that the medicine is not digested properly and sometimes it can give you a sore stomach. This can also lead to ulcers or sores.
prescription
caffeine
researched
digested
a form from the doctor telling the pharmacist which drugs to supply
a substance that makes you feel awake
studied carefully; closely examined
food is absorbed into the body
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4. Exploring the value of sport and recreational activities Doing exercise will keep you fit and happy. When we move our bodies around, our brains send messages that tell us to feel happy. When you exercise, you are getting rid of any bad feelings and you are keeping yourself healthy. As long as you are moving your body quickly and with lots of energy, you will get more energy and feel better about your life.
Dealing with stress Module 3
• If you are prescribed an antibiotic, it is very important that you take all the tablets in the correct way. If you stop before the course is finished, then your body can become resistant to the antibiotic and it will not work in the future. • It is especially important that you take medicine for TB, HIV and AIDS exactly as you have been told by the nurse or doctor at the clinic. Some people now have a form of TB that is especially drug resistant and it is very difficult for them to get better. This form of TB has developed as a result of many people not finishing their course of TB medicine.
Doing exercise does not need to be something hard and boring. • It can be something simple and fun like walking or gardening. • You could even do dancing and other types of exercise with your friends. • Useful kinds of exercising include walking, riding a bicycle, dancing, running and even gardening. • Try to start exercising by doing short and simple exercises. • Then, as you get fitter, increase the amount of time you exercise for each day – try to make it a little bit tougher each time. • But do not overdo it – if you think you and your body cannot do any more, then stop. • Always remember to stretch before and after doing exercise. Stretching helps to prevent you from getting sore muscles and will also be relaxing.
Everyone needs to do some kind of exercise regularly, even if it is only for half-an-hour each day.
antibiotic medicine that cures illnesses when they are caused by bacteria
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Doing exercise will keep you fit, happy and relaxed After a long day of work, we all need to relax and get a good night’s sleep in order to face the next day. Since we live stressful lives, the easiest way to do this is through relaxation. When we are relaxed, we are able to get to sleep easily and we sleep better. So we wake up feeling refreshed and ready to face the new day. Having a good night’s sleep will give you more energy. It also puts you in a better mood. We all relax in different ways: • reading before we go to bed • chatting with friends and family • doing relaxation exercises Always remember that people are different and have different weaknesses and strengths. If you are better at dancing than your friend, just remember that your friend may be better than you at cooking! Each person will also be able to do different amounts of exercise. So try to work out what is best for you, what fits into your daily times and what you enjoy doing.
ACtIvIty 3.8
Individual homework Learner Workbook activity
Healthy living Aim: to understand and live healthily as a way of taking care of yourself Complete the questions that follow in your Learner Workbook: 1. What is your average food intake over the course of any normal day? (List all the food you typically eat for breakfast, lunch and supper – don’t forget the snacks inbetween!) 2. Do I follow a balanced diet? (Explain your answer by using the basic elements of a healthy diet diagram – see page 92) 3. How can you plan your meals so they are balanced? 4. What traditional food do you eat and which food groups do they fit into? 5. What you are doing now to live a healthy life. 6. What can you do to improve your health (living a clean and healthy lifestyle, having healthy eating habits, promoting the value of sport and recreation, taking medication according to prescriptions, not drinking too much etc)?
relaxation a situation that makes it possible for you to rest and enjoy yourself
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9. On your own, study the following table and answer the questions in your Learner Workbook. Try to describe what you are doing under each section. This will be part of your Self-Care Plan.
How do I get to where I want to be? What am I doing now? What should I do? Managing my stress
How do I do it?
Dealing with stress
8. How do you think improving your health will increase your psychosocial wellbeing?
Module 3
7. What can you do in your caregiving to improve the health of children and families you care for (a clean lifestyle, healthy eating habits, sharing the dangers of habit forming medication and promoting the value of sport and recreation)?
Eating habits
When taking medication
When I feel ill
When I exercise
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Part of having a positive attitude is to also have personal goals. Gugu was asked by a friend what her goals were and this is what she had to say:
“
I often think about the type of person I want to be known as and then I try and work towards being that type of person. For example, I want to be known as a kind, compassionate person who is well-organised and helpful. It is also important to me that I am known as a spiritual person who lives my faith and does not just go to church on Sundays.
Module 3
Dealing with stress
6. gOAL-SEttINg
So my own personal goals include these wishes to be kind, compassionate, well-organised, helpful and spiritual. It is also very important to me that my children know how much I love them. Therefore, another big goal of mine is to be a good mother. These wishes and goals of mine then guide me on a daily basis to be the best person I can be. Having these goals in mind, I try to do the best I can and become known as the type of person that I wish to be.
”
Personal goals One of your personal goals may be to stop being a particular type of person. • You may have been an irritable person and you decided you wanted to have a more positive attitude to life. So your goal then was to stop being irritable or getting upset easily. • You may want to stop always helping others and neglecting yourself. • Perhaps you allow others to order you around without thinking about your feelings, and you want this to change. • You might find yourself in a difficult or abusive relationship that you want to change. • You may have put yourself at risk by relying on medication to help you cope. You decide to find ways to change this.
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We will now try to develop goals for our Self-Care Plan. From the beginning of this course, our aim was to improve our psychosocial wellbeing. Therefore we would like to make a plan on how we can achieve this. The plan is a life-time decision to always take care of ourselves.
ACtIvIty 3.9
Individual Learner Workbook activity
Dealing with stress
We all have different goals, so use this next exercise to think about the type of person you want to be. Goals will normally be achieved if there are times allocated to them and they are very clear.
Module 3
We all neglect ourselves in different ways. Do you ever find yourself wishing that you would stop doing something or being a particular type of person?
Setting my goals Aim: to set your goals as a community caregiver Think back to where you looked at what you need to improve in order to meet all your needs. Also look at what you identified as the support you may need to meet these needs. Think about your own personal goals. These goals are about the type of person that you want to be every day. By coming up with these goals, you are also making decisions on who you would like to be. Use this to guide you in the development of some personal goals you would like to set for yourself. For example: • Gugu from our “Good day, bad day” case study may decide that one of her goals is to be a better mother. • This will fulfil some of Gugu’s emotional and spiritual needs. • Gugu needs to think about what goals she can set for herself to feel like a better mother. • She may also decide that she needs to exercise more so that her back does not hurt so much after a long day of walking. This will help fulfil her need for better physical health.
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Dealing with stress Module 3
Complete the table in the Learner’s Workbook by doing the following: 1. Write down four of your personal goals 2. Now think about what you can do to achieve each of your personal goals. Write the ways in which you can achieve your goals. 3. Also indicate by when you think you could have achieved your goals. 4. Remember to think about what resources you need to achieve those goals, and write them down. 5. Now promise yourself, and one of your friends that is here with you today, that you will do everything that you can to achieve these personal goals. Then sign the achievement pledge at the bottom of your goal plan. 6. Over the next few days, find pictures in magazines and newspapers that show you what your goals are. Cut them out and keep them in this manual to help you to achieve your goals.
Developing a Self-Care Plan We have made lots of decisions in our lives. One of the decisions you made was to become a community caregiver. Making an informed life decision can be as stressful as dealing with a difficult beneficiary. Making a decision includes: • setting up personal goals • deciding on the strategy to achieve those goals • drawing up a plan on how to achieve the goals This is the purpose of this section. We are now moving towards developing a SelfCare Plan. We will begin by deciding on some of our personal goals, moving on to working out ways to manage our time better, and ending up with developing a Self-Care Plan. The Self-Care Plan will also include homework so that you can really begin the road to taking better care of yourself.
Building self-care strategies over time Every day It is good to have something that you look forward to every day. Maybe at the end of the day you do one of these things: • You put your feet up and watch television. • You may have a nice cup of tea. • You may sit in the yard of your house or on the street and talk with your friends.
resources things that help achieve something; they can be people, money or equipment
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A short period ahead It is also useful to have something to feel excited about that will happen soon, within a short period of time. You can look forward to something that you can do, or not do, over weekends, on Sundays or in the holiday time. • You may look forward to church on Sunday, or to singing a particular hymn with the choir. • It may be that you look forward to seeing your married child and her husband next week. • For some it may be going shopping, or taking a walk along the river.
Dealing with stress
Every day in the morning, you can decide what you can do today that will be fun and relaxing. It does not have to be anything special, but it has to be something that you know you will enjoy just for yourself.
Module 3
• You could have a relaxing wash and sleep. • You may play and colour-in with your children.
It is good to change these things all the time, so you always have something nice and exciting to think about. In a few months It is also useful to have something that you are working towards, or that you will enjoy in a few months, or at the end of the year or at sometime in the future. • You may be looking forward to going with your family on holiday. • It could be fixing your chairs. • Maybe buying a new dress or shoes. • Or even learning how to make a basket out of grass and beads. If you build your Self-Care Plan using these time guidelines, it will mean that you will have something to look forward to every day, within a short time, and into the future. Keeping excitement alive in your life can do a lot to reduce your stress and make you feel better about yourself. It also sends a message that goes to your brain that you deserve to have a good time and that you can plan for these exciting things.
Keep excitement alive in your life!
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Dealing with stress Module 3
My Self-Care Plan Now that you have a sense of what your goals are, and you have tips on how to manage your time better, you can start developing a Self-Care Plan. Spend a few minutes on your own thinking about all the activities you have completed in this module. Then think about the things you have learnt in Modules 1 and 2. You have learnt a lot about your work and your life, and about the people and things that create stress and unhappiness in your life. We are now going to start looking at how you can build self-care into your life, so that you do not feel burnt out and overwhelmed. Think of things that are small and that you can do, and that in time you will be able to build into your day and life.
ACtIvIty 3.10
Homework in Learner Workbook
My Self-Care Plan Aim: to develop a Self-Care Plan Complete the Self-Care Plan in the Learner Workbook. Use this to guide you in the development of some personal goals you would like to set for yourself. For example: 1. Take this exercise home with you, and reflect on your plan each day over the next three weeks. 2. Go to your Thogomelo Community Caregiver toolkit and read more about self-care. You will use your Self-Care Plan over the next few weeks to really make yourself do something for yourself every day. It is only when you practise something that you start seeing improvement and reward. This is the same for self-care.
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Discussion Some reminders about looking after yourself: • Be kind to yourself. • Build your awareness with education. • Accept where you are on your life journey at all times. • Understand that those close to you may not always be there for you when you need them most. • Talk to supervisors and mentors openly and honestly about your feelings and experiences. • Clarify your personal boundaries. • Discover what forms of self-care work for you and which do not.
Module summary: main learning points • We need a well-balanced diet to keep us healthy. This means that we need to eat foods from the different food groups, and we need to drink plenty of water. • Exercise will help us to keep fit. • Sometimes in life when things get very stressful, we feel like we just can’t cope anymore. This feeling may make us want to drink alcohol or take medicines or drugs. These may make us think that what we are doing is okay, but much of the time it isn’t. • A positive attitude is very important to being successful and happy. Thinking and acting with a positive attitude can do more than anything else towards making us healthy and content. If we have support from friends and family and if we have strong faith, it is less likely that we will become too stressed. • In order for you to be good at your job and decrease your stress levels, you need to have social support. This means having people you can talk to about your problems. Being able to relax and have fun with others, such as your friends, your family, your neighbours and your community is helpful. It is good to have people on whom we can rely and who we trust, even if it is only a few people. This is important because when we speak about our problems and have fun with others, we feel better and feel valued. We cannot just keep it all to ourselves. Speaking to others can help us feel relieved.
mentors people who give advice and act as teachers and guides
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• As a community caregiver, there are a number of things that you need to look after: physical, emotional, social, mental, spiritual, economic and cultural needs. • Skills that help you to take care of yourself include: effective communication, problem-solving, time management and decision-making. • Remember to ask for emotional and social support. Make the time to talk to your friends or family when you need to. • The support pyramid on page 85 shows the different levels of support that are available, and that are available in your community. • A Self-Care Plan helps you to set goals, manage your time and take better care of yourself. • It is important to maintain a healthy lifestyle, and you can do this through many different areas of your life including: - following the universal precautions - eating healthily - avoiding drug and alcohol abuse - being involved in sport and recreational activities - doing exercise regularly
Module reflection: what does this mean for me? 1. What have I found useful about the things we have spoken about in this module? 2. What have I found difficult about the things we have spoken about in this module? 3. What will I do differently in my work using what I have learnt in this module? 4. What do I still need to know?
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Module 4
Dealing with death, grief, bereavement and frightening experiences Understanding grief, loss, bereavement and frightening experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 What is death? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Cultural and religious factors associated with death . . . . . . . . . . . . . . . . . . . . . . . 107 The emotional reactions to death: grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Coping with death and grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113 How to cope with death and grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 How to help children deal with death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Understanding difficult and frightening experiences . . . . . . . . . . 122 Frightening and traumatic experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Adaptive (normal) traumatic responses
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
More serious traumatic responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Coping with frightening experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 How can you help someone after a frightening experience? . . . . . . . . . . . . . . . . 126
Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . .133 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . 134
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Module 4
Dealing with death, grief, bereavement and frightening experiences
Why is this module important? One of the most difficult challenges for community caregivers is helping people cope with death. Death is nearly always difficult as it leads to many different feelings and can leave the caregiver feeling: • helpless • unsure about how to help • very aware of their own life circumstances Coping with death is a particularly difficult situation, so this section will focus on finding ways to assist us in coping with death, loss and grief. We will begin by talking about death, grief and bereavement. We will then discuss some of the cultural and family ways of dealing with these situations.
grief
bereavement
sadness
when a loved one passes away
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Death is difficult to understand even though it is a natural part of life – where there is life, there is death. All things eventually die.
Death is especially difficult to deal with at the moment. This is because so many young people are dying without having had the opportunity to live their lives and to raise their own children. We all come to understand as we grow up that when someone we love dies: • The soul leaves the body as the body is now too tired, damaged or sick to go on. The soul goes somewhere else. Where the soul goes depends on your beliefs, religion and or culture. • Everyone will die sometime, death is universal, but we do not know when it will come. Not knowing this can be frightening. We may think that someone is so ill that they cannot go on. But then they may recover and seem to be doing better, only to die unexpectedly at another time. It is hard to accept that death comes in its own time and at an unknown time. • We all remember people differently and our own memories of the deceased are important.
Dealing with death
What is death?
Module 4
Understanding death, grief and bereavement
If children, or adults, do not know these things about death, they can develop many fears and worries about the person who has died. To help prevent worries, we need to explain the facts about death to them.
Cultural and religious factors associated with death Each family, religion and culture has its own way of explaining death and performing rituals (like funerals and cleansing ceremonies) to help people cope with death. It is important that we as community caregivers understand and respect the different ways in which people cope with death. The easiest way of finding out about these different ceremonies is to ask people. A discussion on the different understandings will be facilitated in the classroom. Remember that each person, family or culture is allowed their own beliefs. It is important that we respect this as we share our views.
soul
universal
deceased
ceremonies
the spiritual part of a person that some people believe lives on after their body dies
worldwide; it happens everywhere
dead person
traditions, actions and words that are used during events like weddings or funerals
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Dealing with death Module 4
the emotional reactions to death: grief When someone we love has died, we experience all kinds of difficult, and at times surprising, emotions. These may be shock, anger, sadness and guilt. These feelings are grief reactions.
While these feelings can be frightening and overwhelming, they are normal reactions to loss. Accepting them as part of the grieving process and allowing ourselves to feel what we feel is necessary for healing. There is no right or wrong way to grieve – but there are healthy ways to cope with the pain. Grief that is expressed can often be very healing. It can eventually strengthen you and make your life richer.1
grief is a natural response to loss Grief is the emotional suffering you feel when something or someone you love is taken away. However, any loss can cause grief: • miscarriage • the end of a relationship or marriage • loss of health • a loved one being diagnosed with a serious illness • death of a pet • loss of a dream or goal • loss of a job or money • loss of safety after a traumatic event
The bigger the loss, the greater the grief.
1 Coping with Grief and Loss. 2008. www.hns.org/Portals/1/Myths. 3 May 2009.
guilt
miscarriage
when you feel like something is your fault; feeling ashamed and sorry
when a baby dies before it is born
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The grieving process takes time and healing happens gradually. It cannot be forced or hurried – and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process takes many years. Whatever your grief experience, it is important to be patient with yourself and allow the process to unfold naturally.
Dealing with death
Grieving is a personal experience. How you grieve depends on many factors: • your personality and coping style • your culture • your life experience • your faith • the nature of the loss
Module 4
Everyone grieves differently
there are many feelings connected with grief Loss affects people differently and people will feel many different emotions after the death of a loved one. In fact, nearly any feeling after a death is considered to be normal: • feeling like you’re going crazy • feeling like you’re in a bad dream • questioning your religious beliefs Generally people from all different backgrounds have a similar set of stages following the loss of a loved one. The duration and stages differ for each person and there are usually cultural differences in groups in the way grief is expressed.
unfold work out; happen
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Dealing with death Module 4
Elisabeth Kübler-Ross (1981), a psychiatrist, developed a model that identifies the following stages of grief: P1 STE
Denial This first stage is shock and disbelief. The person may even deny that their loved one has died and refuse to accept the news. This may be described as a period when the person feels numb.
P2 STE
Anger Denial is usually followed by anger. It may happen that the person is angry with the one who has died, with God, with others around them, and with themselves. They may blame others or themselves for what has happened.
P3 STE
Bargaining It is common for the bereaved person to bargain – usually with God. They may say things like “If I agree not to... then the person will be brought back again.” Or they may say “If only I had... then I would now be better able to accept the loss”.
P4 STE
Depression Of course where there is bereavement there is much sadness, and the person may go through a very depressed period. This may include a loss of hope or feelings of no future without their loved one.
P5 STE
Acceptance Usually when the person has grieved enough, he or she starts to accept the death, and accepts life without the other person.
P6 STE
Move to hope Eventually the person may start feeling hopeful again. At this stage she or he may start believing in relationships and life again.
numb
bargain
when you don’t feel anything
to try to convince someone to change a situation
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Sometimes you may still be feeling sad after a long time, or your grief is getting worse. This may be a sign that your grief has become complicated or has developed into depression. The sadness of losing someone you love never goes away completely, but it should not remain a major part of your daily life. If the pain of the loss is so severe that it keeps you from carrying on with your life, you may be suffering from a condition known as complicated grief. You may have trouble accepting the death long after it has occurred. You may be thinking so much about the person who died that it affects your other relationships.
Dealing with death
However, as time passes, these emotions should become less intense as you accept the loss and start to move forward.
Module 4
It is normal to feel sad, numb or angry following a loss
The signs of complicated grief are: • Intense longing for the deceased • Thoughts or images of your loved one all the time • Denial of the death, or a continued sense of disbelief • Imagining that your loved one is alive – such as talking to them and searching for them in familiar places • Avoiding things that remind you of your loved one • Extreme anger or bitterness over the loss • Feeling that life is empty or meaningless
Complicated grief is like being stuck in an intense state of mourning.
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Some people may develop depression because of the death of a loved one. The difference between grief and depression is that even when you are in the middle of deep mourning, there will be moments when the grief is less intense and there is space for other emotions to come out (look back to Module 3 on page 67). If depression that remains long after a death is left untreated, these conditions can lead to serious problems. This is when it is important to refer a beneficiary for professional support, for example to a clinic or a mental professional (look back at the Pyramid in Module 3 on page 84).
Module 4
Dealing with death
Depression
ACtIvIty 4.1
Individual Learner Workbook activity
Exploring death, bereavement and grief Aim: to understand the meaning of death in different cultural and religious contexts and the emotional reaction to death Answer the following questions in your Learner Workbook: 1. In my culture or religion when someone dies we have the following: a. beliefs around death… b. rituals and ceremonies that take place before, during and after the death… c. roles that people play… 2. People have different beliefs about death. Give one example of a different culture or religion from yours. What do they believe? What are the main ceremonies when someone dies? 3. What are the six emotional stages of grief a person (adult or child) normally goes through after the death of a loved one? Explain each stage with an example. 4. Why is it important for a community caregiver to understand different cultural beliefs and responses to death?
rituals traditional actions and words that are used during events like weddings or funerals
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The most important thing to do when you have experienced the death of a person you care about is to get support from others. • It is helpful to talk about your feelings even if you are someone who is usually not comfortable talking about your feelings. • Sharing your loss makes the burden of grief easier to carry. • Wherever the support comes from, accept it and do not grieve alone. • Being with others, talking about your feelings, and getting support from others are all ways to help you to heal.
Dealing with death
As community caregivers it is important that we are aware of death and the process that people normally follow when they have lost a loved one. We also need to be aware of how people cope so that we can provide them with support. We also need to know when their grief has become complicated so that we can refer them for support.
Module 4
Coping with death and grief
Now is the time when you need to rely on others, even if you are the type of person who is strong and independent.
How to cope with death and grief What to do in times of death and grief • At the time of death, loved ones need to draw close. Do not avoid your loved ones – rather accept their help. Often people want to help but do not know how, so tell them what you need – whether it is a shoulder to cry on or help with funeral arrangements. • Face your feelings rather than trying to cover them up. You can try to suppress your grief, but you cannot avoid it forever. In order to heal, you have to acknowledge the pain. Unresolved grief may lead to depression, anxiety, substance abuse and health problems. • It can help to express your feelings by writing a letter saying the things you never had the chance to say or by putting together a memory activity, such as a box, picture, quilt or other item. If you make a memory box, put all the special things that remind you of the deceased person into this special box where you can keep them safe. Then you can look at them when you need comfort and a sense of closeness.
acknowledge to admit that something exists
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Dealing with death Module 4
• Take good care of your physical and emotional wellbeing by making sure that you eat properly, get enough sleep, exercise, avoid alcohol and drugs, and spend time relaxing so that you can get over your loss. • Do not let anyone tell you how to feel. Your grief is your own, and no one can tell you when it is time to move on or get over it. Let yourself feel whatever you feel without being embarrassed or feeling judged. It is okay to be angry, to yell at the heavens, to cry or not to cry. It is also okay to laugh, to find moments of joy, and to let go when you are ready.
What to say to someone in times of bereavement • Don’t try to bully a person out of the denial stage – usually people move on to the next stage when they are ready to deal with what has happened. Don’t tell them they will feel better soon, or will find someone to take the deceased person’s place soon. The process cannot be rushed. Avoid anything that shows disrespect for the deceased. • Don’t try to cheer a person up when they are in the depressed stage. Crying and grieving are healthy and necessary. Provide a safe place where they can show their emotion, and even encourage as much sadness as possible. Even if you feel embarrassed when a beneficiary starts crying, try to keep quiet, or say something like “Take your time” or “I can understand your sadness”. • Encourage the person to talk about the one who has died. He or she may like to show you photographs and tell stories about the person. It is fine to ask respectful questions about the one who has died. Don’t encourage the idea that we should not speak about the person for fear of upsetting the grieving person. But be respectful of cultural traditions. • Usually the early stages of bereavement involve idealising the dead person (remembering him or her as perfect and good). Do not tell them they are wrong to do this – once the person feels ready, he or she will also remember the irritating parts about the deceased. Then the person may be able to combine these feelings to remember their loved one’s good and bad parts. • Warn the person that he or she may feel very sad again on anniversaries of the death (such as the deceased’s birthday or anniversary of the death) or special occasions (Christmas, graduation ceremonies, etc). Emphasise that this is normal. Encourage the person to plan for these times, for example by lighting a candle, visiting the grave, or being with family on that day.
embarrassed
judged
respectful
idealising
worried about what other people think of you
when you feel that other people think badly of you
showing respect; being polite
believing someone was perfect or was better than they were
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• If a person has survived a trauma in which someone close to them died, try to separate the trauma process from the bereavement process. Deal with the trauma part first – we talk about this in the next section of this module. Then talk more about the loss. Sometimes a person will change the conversation to talk more about the deceased, as a way to avoid the subject. This can confuse the feelings of trauma and loss.
Module 4
• Usually families and friends do not realise how long it takes to grieve. They may expect the person to get back to normal sooner than they are ready to. Remind the person that there is no rush to “move on” too quickly or to “get over it”. Tell them they need to take special care of themselves. You may explain some of these things to family and friends, who often feel very helpless, not knowing what to say or do.
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How to emotionally support someone who is grieving It is not always easy to talk to someone who is grieving, especially when it brings up our own feelings of loss. It is helpful to remember the following: • Create the right environment - Remember how to be a good listener: don’t be judgemental, be open and honest, have an open posture, be empathetic, and try to feel and understand what your beneficiary is experiencing. Help them to express their feelings. - Make sure you have time and energy to listen so that the person feels that they can trust you. - Try to avoid distractions, for example talking to a bereaved person in a busy place with people moving around. • Active listening helps them tell their story - Help the person to give words to their sorrow and other feelings. It is important to listen, and give verbal and non-verbal hints for them to continue. Show that you understand and are listening. - Repeat in your own words (reflect) your understanding of what the beneficiary is saying. Having your feelings understood, accepted and carefully put into words can be a very positive experience for the bereaved. • Acknowledge their feelings - Help to identify and express feelings. - Recognise and normalise their feelings of anger, guilt, sadness and fear. Explain the process of grieving. - Some people, especially children, can hide their feelings through somatisation or in their changed behaviour, anger or feelings of guilt.
Remember to create the right environment, listen actively and acknowledge the grieving person’s feelings.
empathetic
distractions
somatisation
reassure
understanding how another person feels
things that make it difficult to concentrate
the experience of physical pain such as tummy aches in place of mental distress
take away their worries
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• Talk about their fears and anxieties and reassure them that they are not to blame - People have many fears and fantasies about death (particularly that they caused it). They need to feel safe enough to share these worries and to be reassured that they did not cause the death. - Children need to be reassured that surviving caregivers are not going to die. • Provide and facilitate opportunities to say goodbye - This can be done symbolically or with the person who has died. Funerals are often enough to help someone say goodbye to a loved one. People often need a personal opportunity to find closure. - Encourage people to complete all their rituals and ceremonies at the correct time, even if they are short of money. - A traditional healer or any informed person can be consulted for advice. - It is a good idea for people to make a memory box or book, or a wall of photographs in their house.
What to say when you need to tell people that a person they care about has died One of the most difficult things to do for people in the helping profession is having to tell someone that a person they care about has died or is going to die. We feel their loss, and often their reactions stay with us long after the event. Some ideas on how to handle this difficult situation are: • Try to find a private room or place for the person or family. Let them be seated, but don’t fuss or delay. Try to get to the point as quickly and compassionately as possible. This is because people often know what the news is going to be. The worst part is waiting to hear it for definite. • If possible, try to give them the news with another colleague. It helps to support one another. • Try to tell the family in a calm and gentle manner. You may say something like: “I am very sorry that you have to hear this bad news. I know this is going to be very difficult to hear. Last night your....... died at about 2 am.” If the death was totally unexpected, give a brief explanation for the cause of death, like: “He was shot dead” or “She was killed in a car accident”. • Wait as calmly as possible while they try to take in what has happened.
fantasies
symbolically
compassionately
untrue beliefs or imaginings
not actually; pretending you are still able to talk to the person
kindly
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• Be aware of the stages of bereavement, as the family may cycle quickly through them, or express a lot of emotion in one of the stages. • If the family strongly denies that this is possible, for example saying, “But that’s impossible, I saw her only yesterday”, don’t rush into arguing. Stay calm and empathetic. For example, say, “I know this is very hard to hear”. Don’t offer to show the body or offer evidence unless asked. Be as gentle as possible with their denial of the loss. • If the family members become very angry, try to stay calm. Do not take this personally, even if it is directed at you. They are suffering, and need to show their anger about their loss. Try to stay empathetic, like by saying, “I am really sorry for your loss” or “I know this is really hard to hear”. • If the family ask questions about the death, try to offer reassuring observations if there are any to offer. For example, if the person looked very peaceful, or if you held the person’s hand. • Try not to burden one family member (like the father) with too much responsibility. For example, it is tempting to tell the “stronger” person, and then have them tell the others or identify the body. If possible, tell the relevant people together, and ask them who should be involved in further action. • Remember that everyone copes differently. Some people like to be official, busy and businesslike. Others like to sit quietly alone for a while. Others cry loudly. Try to respect these differences, and follow what the individuals find useful. • If children are getting the news, try to have a supportive and calm adult there. Never think that children should be kept out of things because they are too young to understand.
How to help children to deal with death When helping a child to deal with death remember that many of us have grown up with the belief that we should try to protect children from death by not talking to them about it. However, children go through similar stages of grieving when someone they love has died. It is important to include children in grieving rituals.
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ACtIvIty 4.2
Dealing with death
Here are some ideas for helping children who have lost a loved one: • Encourage children to talk about the person who has died. • Encourage them to ask questions about the person who has died, even long after the death. • Allow children to be a part of grieving rituals. • Give them a chance to find their own ways of expressing their grief. Some older children may have specific ideas about grieving rituals. This may include writing a letter or poem to the deceased. Children may be invited to say a special prayer at the funeral or to bring flowers or a picture to the grave. • Be honest about what has happened to the person. • Explain that their lives are going to change and keep them informed of decisions that affect them. • Where possible, give children some choices about what is going to happen. • Help the child to keep some special things of the person in a safe place, or to do a memory box. This helps the child keep the memories and links them with their past and their identity.
Module 4
Children should be given a chance to talk about the loss.
Small group activity and individual Learner Workbook
How can gugu help the bereaved and care for herself? Aim: to be able to deal with bereavement. to be aware of the support that could be provided during bereavement. As community caregivers, we normally feel that we have to assist every time someone is in need of care and support. • Sometimes these feelings stress us, especially when we feel that we cannot do much to meet their needs. • Sometimes we feel we can do something about it. There is no right or wrong way of dealing with these feelings. We have to accept that we can only do so much and that we have only done our best. Read the paragraph on the following page from Gugu’s journal. She used to write a daily journal of her thoughts. This is a story about what she was thinking when one of her beneficiary’s sons died.
memory box a collection of items to remind the person of the loved one
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“
Today was a very long day for me. I felt so tired but there was nothing I could do. I still needed to prepare for the funeral of one of my beneficiaries. I loved Mathembu. He was a good boy. Anyway, I am not sure how I should console his mother. She is in real pain. Mathembu’s sister also needs consolling. I think there will be lots of people at the funeral and Mathembu’s mother will not have enough food for everyone. I am just wondering who I should ask to assist. Perhaps I should go to church and ask the pastor if they can help. But Mathembu’s mother belonged to Rugoga Support Group. They should be able to help. I know this is going to be hard for Mathembu’s family but I am also feeling tired. I know I should be looking after myself as well, but how can I do that when I am needed by my family, friends and community?
”
Now discuss the following questions in your small group: 1. What help would Mathembu’s mother need? 2. What help would Mathembu’s family need? 3. How can Gugu assist Mathembu’s mother emotionally? 4. Can Gugu assist the family financially? Please give a reason for your answer. 5. How could you assist children emotionally in times of death and bereavement? Now answer these questions in your Learner Workbook: 6. How do you feel when you support bereaved beneficiaries, especially children who are grieving? 7. How can you take care of your own mental, emotional and physical health as a community caregiver during times of death and bereavement of a beneficiary? 8. Where would you be able to go for help and support to maintain your own psychosocial wellbeing during these times? (Look back to the Pyramid of Psychosocial Support on page 85). 9. What support would you have given Gugu as a community caregiver on how to deal with the death of Mathembu? 10. What services are available in your organisation and community that could assist a beneficiary to meet their needs (emotional, spiritual and financial) in times of death, dying and bereavement?
consolling make someone who is unhappy feel better
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• Children, in particular, find it difficult to cope with death. This is more so when the adults around them do not talk to them about how they are feeling, and do not listen to how they are feeling. • There are different ways that our cultures deal with death. Some of the traditions that surround burials, cremation and death help us cope with the passing of a loved one. • It is important to include children in these rituals and traditions, so that they feel they are part of it all. Then they can go through the grieving and mourning process.
Dealing with death
• One of the main challenges experienced by families and communities affected by HIV and AIDS is that death is all around us. These days people die younger than is normal, and children are often left without parents.
Module 4
Main learning points in this section
• As community caregivers it helps for us to know what to do and say to our beneficiaries and children, when someone has died or is grieving. This knowledge and these skills will help to relieve our stress. It is also important for us to take care of ourselves when we are supporting our beneficiaries during these times. This will help us to build our psychosocial wellbeing. • There are also other situations that can cause trauma to people, such as a shack fire, taxi violence, a car accident, domestic violence, having one’s life threatened, or being raped.
cremation the burning of a body
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Understanding difficult and frightening experiences We are now going to explore other experiences that are difficult and frightening for community caregivers and their beneficiaries to deal with. We will start by thinking about the many different things we experience during the course of life. All of these experiences affect our lives. It is as if we collect them and carry them with us in a bag on our heads or our backs. Even the experiences we had as a child are carried with us. The picture below shows a few examples of different experiences that life gives us. The woman is carrying a bag on her head, and in the bag are these experiences:2
Motor vehicle accidents
Poverty
Verbal abuse
Unemployment
Neglect
Divorce
Being humiliated
Loss of loved ones
Floods
Loss of one’s home
Rape
Illness
Being neglected by your parents
Disability Physical abuse
Armed robbery
Domestic violence
Loss of possessions
Attack
2 TRAUMA Handbook, Sinani Programme for Survivors of Violence.
humiliated
neglected
being made to feel ashamed
not being looked after
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While some of the experiences described above are painful, not all of them are traumatic. Sometimes in life we go through very frightening experiences. We can even go through times when we fear for our lives. We may even have the thought “I am going to die here”. During these times it is as if time stands still and everything becomes very sharp and clear. It is as if the memory of what has happened is forever on our minds. The memory of what happened is often very strong and may disturb us for some time afterwards.
Dealing with death
Frightening and traumatic experiences3
Module 4
The picture opposite shows you that: • Some of these experiences are easy to cope with. • Other experiences are very difficult to cope with. • Some experiences may even be so difficult that they affect us very strongly afterwards.
Such frightening experiences are worse if we felt very out of control or if we felt helpless. It is the person’s experience of an event that leads us to call some events traumatic.
What is trauma? Experiences are usually called traumatic when the person: • feels that their life is threatened • sees someone else’s life being threatened • feels strong fear, helplessness or horror
Here are some other examples of frightening experiences that many people would find difficult to cope with and could be called traumatic: • Armed robbery or assault • Sexual assault or rape • Hijacking (having a car stolen violently) • Car accidents • Being in situations of serious floods, earthquakes or fire
3 Sinani Handbook for Trauma Support Workers: Restoring Dignity. Sinani KwaZulu-Natal Programme for Survivors of Violence.
traumatic
disturb
assault
when something is very frightening, shocking and upsetting
make us worried; affect our peace of mind
violent attack
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What support is needed? • Most people usually recover with some support in about 4–6 weeks. • Some people get better by having counselling. • Some people need more special trauma counselling. • A few need treatment in hospital.
More serious traumatic responses Some people who have been through a lot of bad experiences in life may need special help in order to recover. A person may take longer to recover if: • Other bad things have happened to that person before. • The frightening situation went on for a long time. • The person who caused the fear was known (such as in domestic violence). • Someone hurt the person or caused fear on purpose. • The person was already carrying a lot of stress in their life. • The person’s family was not there to help them afterwards. What support is needed? If any of these things have happened on top of the frightening experience or during it, a person is likely to take a lot longer to recover. They should be referred to a professional like a psychologist for special care.
Post-traumatic stress disorder This is a term developed by psychologists for a severe trauma reaction. It should only be used by a professional person because the word “disorder” suggests the person has a type of illness. If someone responds to a trauma with the reactions discussed above, it does not mean that they are ill or going mad. Refer back to the Pyramid of Psychosocial Support on page 85.
psychologist people who study how your mind works and how this affects your behaviour
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Someone is only suffering from post-traumatic stress as described on the previous page if the following is happening: • They have many different reactions, including avoidance, re-experiencing and increased anxiety. • Their reaction is bad enough to interfere with their normal living. • Their reactions are present for a long time after the trauma (at least one month, or longer).
Coping with frightening experiences As community caregivers we are often called on to help people who have been through difficult experiences. It is a privilege to be able to support people during difficult times in their lives. But it can also be quite stressful if you feel that you do not have enough skills to be able to help people. This section aims to help you as a caregiver to: • build your knowledge and skills to be able to support people who have been through very difficult experiences • know what you can do to assist people • know when the case is more serious and needs referral to another specialist in trauma work
How can you help someone after a frightening experience? There is a lot that you can do as a community caregiver to help someone after a frightening experience. You can never take away the memory of what happened, but there is a lot you can do to help the person to cope with that memory and to recover well. The five ideas that follow are based on a model for trauma debriefing developed at Wits University in South Africa.4
4 Eagle and Freidman. University of the Witwatersrand. Johannesburg: South Africa
avoidance
privilege
not wanting to talk or think about the event
an honour and pleasure; a benefit
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One of the most useful things that you can do for someone who has been through a frightening experience is to re-connect them with their family and friends. This is very important immediately after the event. • You can help to phone family and friends to come and be with the person after a bad experience. • You can also talk to the family and friends of the person and explain to them how important it is to be kind to the person after the event. • You can encourage them to be patient with the person. • You can explain to them that the recovery can take a long time. • You can also show kindness and patience to the person. • You can spend time building a good relationship with that person so that he or she trusts you and learns to trust other people again. • Do not tell their story to other people, or the person may feel that they cannot trust you again.
Dealing with death
Social support is the care and help we get from our family and friends. This is worth more than professional support. Kind words from the important people in our lives can do a lot to help us if we have been through a frightening experience.
Module 4
1. Social support
Here are some helpful things that you or the person’s family can say to someone who has been through a frightening experience: • I am so sorry that this happened to you. • I will be thinking about you over the weeks ahead. • Please let me know if you can think of any way that I can help you.
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2. Consistency Consistency means things staying the same. It is helpful for people who have been through frightening experiences to keep to the normal routine of their lives. This means keeping to their same everyday patterns of doing things – both at work and home. Many people want to make big changes after a frightening experience – they may want to move house or change jobs. But try to advise them to keep things the same as usual, at least for six months after the experience. This is difficult for some people to hear, because they may be very frightened. So don’t push this too hard – rather offer some gentle advice. Here are some helpful things that you can say to someone who has been through a frightening experience. These things will encourage them to stay consistent in their usual life patterns:
• I know you want to change your life because of what happened. But we know that people actually recover better if things stay the same for some time after such an experience. • I am sure that this is not what you want to hear, but it may be better if you don’t make any big changes to your life for the next few months. • This is probably one of the most difficult things for you to do, but it may be better for you to go back to work (or school) as soon as possible. • Maybe you should wait a few weeks until you are able to think more clearly before making such a big decision.
routine the everyday way of doing things; keeping to a daily schedule
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Normalising is very helpful because many people feel like they are going mad after a traumatic experience. They may feel ashamed about their responses.
Dealing with death
Another very helpful thing that you can do is to explain to people how they may be affected by a traumatic experience. This is about normalising their responses to the trauma.
Module 4
3. Normalising
Hearing that other people go through similar responses and that these are normal is very helpful. Here are some helpful things that you can say to someone who has been through a frightening experience to normalise their response:
• Don’t be surprised if for some time afterwards you are affected by nightmares, thinking about it all the time, feeling angry and afraid about what happened. This is normal and most people go through such reactions. • These reactions are our body and mind’s way of working through what happened. We are in fact more worried if people do not show any of these reactions because it means they are in denial. They may be more affected later on by what happened, so it is better if you have these strong reactions early on. • During a very frightening experience our bodies give out a lot of adrenalin. This adrenalin makes us very strong. It also makes us see and hear better. This is why the memory of the trauma becomes so sharp. But adrenalin takes about a month to clear out of our bodies. So that is why we keep being affected by the memories of what happened. It is also why people become more irritable and angry.
normalising
adrenalin
making normal
a chemical that gives you more energy and makes your heart beat fast
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4. Listening to the story about what happened People who have been through frightening experiences may find it helpful to talk about what has happened to them.5 Here are some helpful tips for you as a community caregiver: • Try to make times for you to be with the person alone doing something that they enjoy. It could be playing sport, going for a walk, going out for a drink or meal together. Use this time to ask the person how he or she is doing. • Remember not to push the person to talk – rather try to make a safe space where the person is able to talk. • You may even say to the person, “If you would like to talk about what happened, I would be very willing to listen”. • If the person does talk about what happened, try to stay calm and quiet. You may listen quietly and make some comments like, “It sounds like that was a very difficult time for you”. Then try to focus on what the person has done well in order to cope with what has happened. Thank the person for opening up. Encourage more talking when he or she thinks of other things to say. • Let the person talk about even the very bad parts of what happened. • Let the person ask questions about what happened. Try to give them time to discuss these questions without offering judgements. Talking about frightening experiences is very difficult. It is like going back and living through that bad day again. But people who have talked about their experiences say that is helps because:
• It offers relief to offload the story and details about what happened. • It makes you feel less alone. • It stops the thoughts from going round and round in your head because you can organise them better. • It helps you to understand what happened – so that the memory is less confusing and mixed up. • These are important ways of helping to deal with the memory of what happened so that it does not continue to disturb your life.
5 Adapted from REPSSI’s guide on Mainstreaming Psychosocial Support into the Education Sector
judgements
offload
criticisism; saying they are wrong
to talk a lot about something to get it off your mind
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Be careful not to do this in a way that stops them from talking about the bad parts of what happened. Here are some helpful things that you can say about how the person coped well with what happened:
Dealing with death
If the person does talk to you about what happened, first give them time to talk about how bad that situation was. Then try to focus on what the person did well in order to cope with that situation.
Module 4
5. Focus on coping
• The fact that you are alive today means that you did something right to survive that situation. • At some level you must have known what to do to come out of that situation alive. • I wonder how you were strong enough to cope with that situation? • What did you do to help yourself through that situation?
REMEMBER If the person is taking a long time to recover from what happened, or if you are worried that he or she is not coping well with life afterwards, it is a good idea to refer the person to a professional for extra help.
focus concentrate; pay attention to
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Small group activity
A person affected by a very frightening experience Aim: to understand the effects of a frightening or traumatic experience on a person Read the case study of Mandla below and then answer the questions in your group:
Module 4
Dealing with death
ACtIvIty 4.3
CASE STUDY
MANDLA is a male community caregiver. He works in a project with children made vulnerable by HIV and AIDS. Each day Mandla and his colleagues identify children in their community who need help. They link these children with government services. Mandla received a phone call from Thandi’s neighbours to say that Thandi was struggling to take care of her siblings following the death of their parents. They had called Mandla to help Thandi and her siblings to get birth certificates so that they could get government grants. When Mandla was leaving Thandi’s home it was dark and very cold. He was in a rush to get home. He saw three men running towards him. He became a bit anxious and started walking even faster. The three men started to run towards him. Mandla just knew that he was in danger. His heart started racing. One man took out a gun and pointed at Mandla. The first thought that came into his mind was that he was going to die. They hit him, took his money and left him to die. He was found by the police and taken to hospital. Mandla was badly affected by what happened. He thinks about it every day and even when he is trying to work. At home he is always irritable and angry. He feels ashamed of himself and is afraid to talk about it to anyone. He thinks that people will think that he is not “man enough” or that he is a coward.
not “man enough”
coward
not doing what is expected of you as a man
someone who is not brave
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3. How was Mandla affected emotionally after the frightening experience? 4. How was Mandla affected mentally or cognitively after the frightening experience? 5. What was Mandla’s behaviour like after the frightening experience? 6. What are your feelings about Mandla’s situation? 7. Have you come across frightening incidents in your caregiving? How have they made you feel? 8. How do you cope with hearing about traumatic events like Mandla’s? 9. What ideas do you have on how you can help someone after a traumatic experience?
Dealing with death
2. How was Mandla affected physically by the frightening experience?
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1. How did Mandla feel during the time of the trauma?
10. As community caregivers, how can we help each other in dealing with traumatic experiences?
Module summary: main learning points • As community caregivers, we need to take care of ourselves so that we have the resources to give care to our beneficiaries. • Coping with death and loss is a reality in our lives. We need to acknowledge our own needs and the needs of others. We also need to talk to people about death, dying and bereavement. • As community caregivers, we often help people who have been through difficult, frightening or traumatic experiences. • It is important to know people’s reactions to death, bereavement and trauma, and to develop our skills in supporting ourselves and others during these times. These skills contribute to our psychosocial wellbeing.
cognitively having to do with the intellect and reasoning
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Module reflection: what does this mean for me? 1. What have I found useful about the things we have spoken about in this module? 2. What have I found difficult about the things we have spoken about in this module? 3. What will I do differently in my work using what I have learnt in this module? 4. What do I still need to know? 5. How do we take care of ourselves during these times? 6. After exploring this module on caring for others, what do you need to add to your Self-Care Plan?
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Module 5
Creating a caring community Understanding community development . . . . . . . . . . . . . . . . . . . . . . . . . . .137 What is community development and community wellbeing? . . . . . . . . . . . . . . 138 How does community caregiving contribute to community development? . 140 What are the challenges in building a strong community? . . . . . . . . . . . . . . . . . 140 What contributes to successful community development and wellbeing? . . . 141
Promoting community wellbeing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142 How do I contribute to creating a caring community? . . . . . . . . . . . . . . . . . . . . . 142
Our organisational contribution to community development and wellbeing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144 How do community organisations contribute to community development and wellbeing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 How can I develop a community support network? . . . . . . . . . . . . . . . . . . . . . . . . 146
Developing a community map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149 Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . 152
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Module 5
Creating a caring community
Why is this module important? Perhaps the most important part of psychosocial wellbeing is feeling cared for by the people around us. We know this is true for our beneficiaries who face many difficult problems in their day-to-day lives. Unfortunately, when we become exhausted and stressed, the following things happen: • We often forget to show how much we care for others. • We also forget to take care of ourselves. • We no longer have time and energy for other people. • We sometimes let the difficulties of our lives and work break down the healthy support networks in our organisations and communities.
If we want to stay healthy and be successful in our work, we must get involved in building and maintaining stronger community networks to support us and the people around us.
beneficiaries
community networks
the people who receive our care
groups in society that communicate with one another
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We must remember that we can develop psychosocial wellbeing but if it is not supported in our families, communities and organisations, it will be difficult to maintain. At the same time, we need to realise that our families, communities and organisations are not able to support us in everything. This module covers the following: • understanding how communities develop • helping our communities develop • finding out how community caregiving contributes to community development and community wellbeing • exploring the advantages of strong community support
Creating a caring community
Community networks
It will be important for us to look at how we use our organisational and community networks for individual and community psychosocial support and wellbeing. We will have an opportunity to practise and develop these skills in our own organisations and communities. Therefore most of the work that we will cover in this module will be very practical.
Module 5
• discussing tools for building community networks
Understanding community development Community development is a very broad idea that includes many different projects and programmes. • At one level, community development involves the creation of physical infrastructures and resources that are necessary for communities to live in safe and healthy physical conditions. These include things like access to: - clean water - safe and hygienic sanitation - housing - schools - clinics - roads
community wellbeing how healthy and happy a community is
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• At another level, community development involves the strengthening of networks and links between people and organisations to support each other and create a caring community. This level of community development creates and supports greater levels of social cohesion. This creates stronger and more effective communities. Important roleplayers include: • Community organisations and faith-based organisations that bring together people to talk about different issues (such as HIV and AIDS, community safety or child health). These offer support to individuals and families. • Leaders and individuals in the community like traditional leaders, priests, health workers, counsellors and community caregivers who offer care and support to others and contribute to the overall wellbeing of the community. Communities respond to different issues in different ways: • Sometimes we may feel that we are not doing enough. • However, even our small contribution is important and helps with the bigger response that is led by government. We will look at examples of excellent community caregiving work and show how community support networks are so important for success.
What is community development and community wellbeing? Community development and the promotion of community wellbeing is a way of working together. By doing this it supports local people at a community level to find answers to the social and health-related needs that are in the community.
As community caregivers, we help the local community with social and health-related challenges. We also support them in finding solutions.
social cohesion
effective
roleplayers
strengthening the networks and relationships between individuals and organisations
working well to produce the result that was intended
people or groups who have a part to play
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Community development refers to the process of developing active and sustainable communities based on: • good relationships • common goals • shared respect Community development expresses equality, accountability, opportunity, choice, participation, ubuntu, fairness and continuous learning. It is something that must be planned. It cannot be sustainable without careful management and agreement of the communities involved. Individual members need to believe that the advantages of community development are much greater than the disadvantages. Many changes happen in community life all the time, but when we want things to get better, it is important that we think carefully about the best ways to build a better community.
Creating a caring community
This is the planned improvement of community wellbeing through members of the community doing things together.
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Community development
Encouraging psychosocial wellbeing and improving access to psychosocial support is part of community development. It is essential if we are to improve community wellbeing.
Community wellbeing Local solutions to local problems often work best, especially where the community takes responsibility for carrying out the plans that they agree on. Community development programmes that involve local people in decision-making improve the community wellbeing. Research and practice has shown that participation and ownership by the local community is critical in making sure that community development is successful. Community wellbeing is a very broad idea but includes many different parts: • good local leadership • good schools • a strong local economy • good relationships between people • good living conditions • a strong spiritual life in the community • a clean environment • opportunities for recreation and sport • good health services • a rich traditional and cultural life • good social services Can you think of any others?
accountability
sustainable
responsibility
managed so that it will last into the future
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Creating a caring community Module 5
How does community caregiving contribute to community development? As we can see, community caregivers are an important part of community development. We support community development and the wellbeing of the community because: • We help people create good living conditions and clean environments. • We are an important part of the community’s health and social services. • We help build better relationships between people. • We are able to identify and mobilise community resources. • We encourage and support involvement in social and cultural activities. • We strengthen networks of support and assistance. • We promote psychosocial wellbeing and resilience. Sometimes community development is very difficult. It is not easy to start and keep up, especially when we talk about psychosocial support.
What are the challenges in building a strong community? • Community members do not see the impact of their involvement in community development. This can cause them to feel discouraged. • There may be a lack of motivation by individuals to be involved in community development. This can happen when individuals can’t see how they can gain from this. They may also have other more important things to do. • Poor community morale reduces the energy needed to make community development work. • There may be a lack of skills and resources to carry out the work that is needed, for example, educators or builders are not available. • Leaders may not be committed to community development. • There could be little support or influence from government partners or poor government management and services. • There may be a lack of knowledge in handling community relationships, including anger and conflict. • Communities sometimes do not know or understand their role and responsibility in the development process.
mobilise
resources
resilience
organise people and bring them together to achieve something
things that help achieve something; they can be people, money or equipment
the ability to be strong again after an illness or a problem
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What contributes to successful community development and wellbeing? • Clear and realistic roles and responsibilities of local members in the community • Adequate and appropriate resources • The ability to be creative and search for other choices when there are no resources • Good relationships between community members involved in the project • Democratic leadership with good principles • The right sort of management support from our organisations and partners • Identifying the importance of other organisations in the same field • Identifying how we can work together, for example, networking and referral (we will discuss this further in this module on page 146)
motivation
morale
marginalised
adequate
leadership
feeling inspired, encouraged and eager to do something
spirit; feeling of confidence
not included; pushed to the side
enough; satisfactory
the people in charge
Creating a caring community
• There are less people involved. Therefore, there are less skilled people or people who bring specific gifts, knowledge, energy, equipment or strengths. • People can feel marginalised and therefore will continue with negative behaviours. These can impact on the development of the community. For example, throwing litter on the ground, or TB patients not taking care of themselves so the disease can spread to others.
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When individuals do not participate, community development becomes more difficult because:
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Creating a caring community Module 5
ACtivity 5.1
Individual activity in Learner Workbook
A window on my community Aim: to explore your understanding of community development and the dynamics (relationships and structures) of your community Write the answers for these questions in your Learner Workbook. 1. Using your own words, describe what “community development” and “community wellbeing” mean for you. 2. How does community development contribute to wellbeing in your community? Give examples. 3. Think about a community project or programme that you know about that has worked successfully. What made the project successful? Give at least two responses. 4. Think about a community project or programme that did not benefit the community or did not work well. Why did the project or programme not work well? Give at least two responses. 5. Who in your community and which community projects play the most important role in creating a caring and supportive community? Please explain your answer.
Promoting community wellbeing In this section, we create the space for you as community caregivers to explore the benefits of your involvement in community development. Community development cannot happen without the participation and support of organisations in the community. Individual involvement and participation is equally important. Your involvement in community caregiving is especially important.
How do i contribute to creating a caring community? We have looked carefully at ourselves, who we are, and how we should take care of ourselves in Modules 3 and 4. We have explored how taking better care of ourselves improves our ability to better take care of others. We now need to look at how we can meaningfully contribute to the community if we take care of ourselves.
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ACtivity 5.2
Individual activity in Learner Workbook
A window on my participation in community development and wellbeing Aim: to explore your own participation in community development and community wellbeing Answer these questions for yourself in your Learner Workbook.
Creating a caring community
• In community projects, there are often tasks or activities that need extra resources or skills if they are to work well in our communities. • It is important to recognise some of the limitations of our work and our projects and to know when and who to ask for help and support. • It is important that we refer our problems to other individuals or organisations that may be able to complete the task more easily. They may also have the necessary skills for the task or activity.
Module 5
We are already involved in community projects
1. How does my community caregiving work promote community development and wellbeing? 2. What other activities, structures or organisations do I participate in that contribute to community development and wellbeing? 3. What would the consequences for my community be if I was not involved in caregiving and other organisational activities? 4. How has my psychosocial wellbeing and self-growth improved from being involved in community wellbeing?
consequences results; effects
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Our organisational contribution to community development and wellbeing Organisations that are based in a community have a big role to play in community development and community wellbeing. • Their role is to provide services to meet the needs or challenges that a community faces. These may be to provide water and sanitation, or respond to the needs of people living with HIV and AIDS. • Community-based organisations are powerful when they are able to link and connect local community resources, strengths or assets to common development goals. This is part of building community networks.
How do community organisations contribute to community development and wellbeing? They are able to contribute towards community development by:1 • Building connections, links and relationships (in other words networks) between community resources. By doing this, organisations strengthen their ability to develop and support communities. For example, home- and community-based care organisations build relationships with clinics and other services and resources that help support and care for people living with or affected by HIV and AIDS. By doing this they strengthen their role in the community. They also help with the overall wellbeing of the community. • Building and strengthening the community by investing in the resources and assets that are already there. These could be: - developing people - building relationships and networks - strengthening the relationship between government services and people - getting crèches established for children - building community ownership of infrastructure such as water pumps • Strengthening current and future community-based projects and activities that contribute towards community development. This could be: - helping to make schools safer - getting a library built - increasing access to books in the community - starting a drama club for children 1 Asset-Based Community Development Institute. 2005. A Community Building Workbook.
infrastructure the systems that help a community operate: sewerage, telephones, water supplies, etc
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• Physical – such as land, buildings, transport, parks, playgrounds, electricity, water, sanitation. • Economic – such as businesses, spaza shops, things people produce (like wood or maize), entrepreneur skills, savings of individuals and groups (stokvels). • People – such as retired teachers, pastors, traditional leaders, medical staff, health workers, community caregivers. • Organisations – such as sports clubs, church groups, social clubs, CBOs, NGOs. • Government services – such as clinics, fire and ambulance services, schools, courts, police stations, prisons. There are many factors that affect the wellbeing of our community. For example, crime can negatively affect our community wellbeing. This is because it may result in people being afraid of each other, or afraid of walking at night. This will impact on the building of social support networks. Sustainable and effective organisations always look out for ways to build partnerships and relationships. These can be with individuals and organisations that help to create supportive and caring communities.
Creating a caring community
These could be the following:
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Community assets
Organisations can contribute to the wellbeing of a community.
entrepreneur being clever with business planning and working with money
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Creating a caring community
How can i develop a community support network?
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It takes effort to build and maintain strong and effective community networks. When we stop paying attention to community networks, we find that they quickly die. If this is happening, community development work becomes very slow and tiring, and it is easy to lose morale and faith in the work we do.
Community development and community wellbeing happens when there is co-operation by members of the community. This means that people need to get involved and work together. You are a member of your community. As we explored on the previous pages, the work that you do contributes a lot to all other community development initiatives in your community. We are able to achieve much more if we work together with others who are also involved in community development. A social support network is a group of people and organisations that support each other and work together to create a caring community.
ACtivity 5.3 Organisational group and individual Learner Workbook activity
Our social support network map Aim: to explore your relationships within a community and to understand the importance of the different relationships. A social support network map is a diagram that shows relationships that are important: • to a person, such as a community caregiver • to an organisation, such as your CBO, FBO or NGO The social network map you will draw in your organisation is to show the relationships you have as an organisation with people: • who provide services in your community • who contribute to community wellbeing (such as the clinic sister, the traditional healer, the police station commander, the head of the local school, the local government official and others)
initiatives ideas; business plans
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2. Agree whose relationship you will map – for example select a “typical” community caregiver or select one of you from your organisational group. Draw this person in the middle of the page. 3. Draw other people around this person. These other people are people who they have important relationships with in the community and who contribute to community wellbeing. 4. Use lines and arrows to show the type of relationship this person has with each of the other people you have drawn. Decide as a group how you want to show the different relationships by using thick or thin lines, dotted lines or curvy lines. Develop a key to show these different lines. 5. Now think of people who are not shown on the map that you think it is important to have a relationship with as they play a role in community wellbeing. Draw these people on your map and use a line to show the relationship. Discuss in your group how you can build the relationship with these people.
Creating a caring community
1. Work with colleagues from your organisation.
Module 5
How to draw a social support network map:
6. Each organisation will be asked to discuss what the map shows when you present it back to the training group. Use the following questions to guide your discussion on what your map shows: a. Who makes up our social development network in our community? b. How do each of these people contribute to or harm our community wellbeing? c. Which of these relationships do we need to improve or strengthen? How can we do this? d. What else can we do to improve wellness in our community? e. What other psychosocial support services would we like in our community for ourselves and children, and why do we need them? This could be informal, formal or professional – refer back to the Pyramid of Psychosocial Support on page 85.
After drawing and presenting your organisational social support network map, draw your own social support network map with you at the centre in your Learner Workbook.
key a list of signs, symbols and meanings for a map, drawing or plan
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Here is an example of a social support network map that was done to show the important relationships for a family affected by HIV. 2 one-year-old daughter
husband local government official
doctor
best friend
mother/father/ sister
distant friend
health visitor
headteacher of school
great-uncle
KEy business relationships
loving relationships
friendships
lack of relationship
helping relationships
2 International HIV AIDS Alliance. May 2006. Tools Together Now! 100 Participatory tools to mobilise communities for HIV/AIDS.
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Why is community mapping useful? It is useful to: • Identify which places and people are important in the community and why. • Explore people’s concerns about their communities and what they would like to change. • Identify services and resources available in a community, and gaps in services. • Highlight different views from different groups. For example, a group of children might draw different things on a map of the same area compared to a group of community caregivers.
the purpose of this community map is to discover the assets in your community
Creating a caring community
“A community map is a map showing important places in a community – for example, churches or temples, markets, health services, schools, bars, places where people meet, places where people socialise, and so on.”3
Module 5
Developing a community map
• They can help you as a community caregiver to respond to the challenges you face. • They can also build psychosocial support for you and your community. Remember assets can be physical, economic, people or individuals, organisational or government services. • Once you have discovered them and mapped them, then you are able to find out how they are connected to the work you do, to community development, and to the wellbeing of your community. • Assets can also help us to mobilise resources to address certain needs or challenges our communities face, such as working with vulnerable children or building community networks to respond to trauma or bereavement. • The map can also help us identify where the gaps are, and encourage us to think about how we can develop projects to address these gaps. You will develop a community map when you go back to your organisation between the two training blocks.
3 International HIV AIDS Alliance. 2006. Tools Together Now! 100 participatory tools to mobilise communities for HIV/AIDS.
assets resources; benefits
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Organisational group practical in Learner Pratical Workbook 1
Developing a community map Aim: to develop a community map to show community resources, support networks and organisations that contribute to the wellbeing of your community, with a special focus on community caregivers and children This is an example of a community map:4
Module 5
Creating a caring community
ACtivity 5.4
Have fun developing your own community map.
4 International HIV AIDS Alliance. May 2006. Tools Together Now! 100 Participatory tools to mobilise communities for HIV/AIDS.
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2. Plan a time when you will be able to work on the map and discuss how you are going to do the map in the time between the two training blocks. 3. Take a sheet of paper for you to draw your map on during the training break. 4. When you are together, first discuss what type of places to show on the map. Think about what the important places are for each member of your group. Draw your organisation at the centre of the map. Remember that you are looking for the assets that are in your community that will help to build psychosocial wellbeing among all in the community. these assets will strengthen the community’s capacity to support children. 5. Draw your map. 6. Present this map to your organisation to share what you have found. Point out and discuss with your organisation:
Creating a caring community
1. Get into your organisational groups. You will be doing one map for your organisation and you will need to involve as many people as possible from your organisation in drawing the map.
Module 5
How to do the community map:
a. What resources your community has b. What the map tells you about the needs of the community members (think back to the Wheel of Psychosocial Wellbeing on page 37) c. How your organisation contributes to community development and community wellbeing d. What resources are available in the community that contribute to the psychosocial wellbeing of individuals in the community (these could be families, women, the elderly, people living with a disability, children, the ill, people in business, caregivers and other groups that you identify in your community) e. The gaps that you have found, particularly in relation to creating access to psychosocial support Record your answers to Question 6 in your Learner Practical Workbook 1. you will present your community map and the findings from the discussion with your organisation to the group on the first day of the next training block!
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Creating a caring community Module 5
Module summary: main learning points • Healthy community caregivers have strong psychosocial support networks, and they use them. • Different people give us different kinds of support. • There are healthy support networks in our organisations and in our communities that contribute to our psychosocial support and the wellbeing of our communities. • We need to get involved as individuals and organisations in building and maintaining strong community support networks. • Community development helps to build community wellbeing. • Community caregiving contributes to community development and community wellbeing. • Community development is not always easy, but it is worth the effort!
Module reflection: what does this mean for me? 1. What have I found useful about the things that we have spoken about in this module? 2. What have I found difficult about the things that we have spoken about in this module? 3. What will I do differently in my work using what I have learnt in this module? 4. What do I need to know more about?
CONGRATULATIONS! You have come to the end of the first training block. During the break between the two training blocks, remember to do the assignments. We look forward to seeing you at the next training block.
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Module 6
Protecting our children Why do we focus on child protection? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155 The principle of “the best interests of the child” . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
What do we mean by “children at risk”? . . . . . . . . . . . . . . . . . . . . . . . . . . 156 What environments affect children?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Understanding factors that put children at risk
............................
158
Vulnerable groups of children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 A child in the River of Life
................................................
160
How does violence affect children? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 What is violence? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 The effects of violence on children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 The cycle of violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Identify signs and symptoms of child abuse, neglect and exploitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 The Children’s Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Understanding child protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 What is child protection? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Understanding prevention and early intervention programmes for vulnerable children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Community caregivers supporting child protection . . . . . . . . . . . . . . . . . . . . . . . . 184
Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . 188
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Module 6
Protecting our children
Why is this module important? We know that the responsibility of community caregivers to protect and care for vulnerable children is significant. It is therefore important that this Thogomelo programme on psychosocial support is able to provide you with an understanding of child protection. It also needs to provide you with the skills and tools necessary to support vulnerable children. This module explores the following: • It explains what we mean by “child protection” and “children at risk” or vulnerable children. • It helps you to understand how violence affects children. • The signs and symptoms for children who are abused, neglected or exploited are given to help guide you in responding to children’s needs. • The module will also help you to understand how violence affects you as a community caregiver.
In Module 7, we will explore how you can respond to vulnerable children, particularly children who have been abused, neglected or exploited. Children in conflict with the law will also be discussed. As this is a psychosocial wellbeing programme, we will also explore how you can look after yourself and get support in dealing with the stress and difficult feelings that you may experience when working with children who have been abused.
vulnerable
significant
at risk
exploited
at risk; easily harmed or hurt
huge; major; important
in danger; vulnerable
treated badly; taken advantage of
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Section 28 of our Constitution calls for the protection of children from “maltreatment, neglect, abuse or degradation”.
the principle of the “best interests of the child” This call for child protection was taken forward in the Children’s Act of 2005. The main principle of this Act is that all actions taken with a child and all factors concerning the care, protection and wellbeing of the child must be in “the best interests of the child”.
Protecting our children
In 1994, South Africa signed the United Nations Convention on the Rights of the Child (UNCRC). It committed itself to provide for the human rights of children. This was taken forward in the Bill of Rights in the Constitution of the Republic of South Africa (Act 108 of 1996).
Module 6
Why do we focus on child protection?
The principle of the best interests of a child tries to reach the following “standards”:1 • The child is brought up in a stable family environment and, where this is not possible, in an environment as close as possible to a caring family environment. • There is a good relationship and attitude between the child and the parent or caregiver. • The parent or caregiver has the capacity to care for the child’s needs such as their emotional, physical and intellectual needs. • Any changes to the child’s environment (or context) must have the least negative effects on the child. • The child is able to keep his or her personal relationships and direct contact with the parent or caregiver on a regular basis or is to remain in the care of the family. • The child’s physical and emotional security, and their intellectual, emotional, social and cultural development is met. • The needs of the child living with a disability or chronic illness are met. • The need to protect the child from any physical or psychological harm caused by abuse, neglect, exploitation or degradation, or expose to violence or other harmful behaviour. This also means that the child must be protected from being exposed to domestic violence and harmful behaviour towards another person, for example from a husband beating his wife. • That any action or decision taken must avoid or minimise further legal action or harm to the child.
1 Republic of South Africa. Children’s Act. 2005
maltreatment
degradation
capacity
psychological
violent, cruel behaviour
taking someone’s pride away; treating people with no respect
ability
having to do with feelings and emotions
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Protecting our children Module 6
There has been lots of progress made in dealing with the problem of child abuse, neglect and exploitation, and in trying to protect our children. But there are still significant challenges that children face. Our response in South Africa requires a partnership between government and community-based organisations, and between all people who work with children. This includes building the skills of community caregivers to work together with other services in their communities. We know that community caregivers have an important role in the wellbeing of children, and in being able to respond to the challenges that children face.
What do we mean by “children at risk”? This section explores what we mean by “children at risk” in South Africa. • Children refers to all people who are under the age of 18 years. • Risk refers to factors that may or may not be obvious that create possible danger for children, or increases the vulnerability of children. • Vulnerable refers to children that are unprotected from possible danger or harm, or who are unable to protect themselves. “Children at risk” are children who are exposed to risk factors that could put them in danger or harm them, and where they are unable to protect themselves. We often talk of “vulnerable children” instead of “children at risk”.
A vulnerable child or a “child at risk” is therefore understood as:2 A child whose survival, care, protection or development may be compromised due to a particular condition, situation or circumstance and which prevents the fulfilment of his or her rights.
2 Policy Framework for orphans and other children made vulnerable by HIV and AIDS in South Africa. DSD. July 2005.
challenges
compromised
fulfilment
tests; difficulties
threatened; weakened
a feeling of happiness and satisfaction
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The protection of children must be looked at in every context of our lives. Some of the contexts that may affect a child include: The political context • This means when we vote or talk with councillors we need to make sure that they have the needs and interests of children at heart. • For example, when they decide about access to clean water, housing or safe playgrounds.
Protecting our children
If we understand what it is in our environment (contexts) that creates risk or danger for children, this places us in a better position to act or respond to those dangers.
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What environments affect children?
The economic context • This means when we make sure that children in child-headed households access grants. • This also means they are provided with the security of inheriting and staying in their homes when their parents die or leave them. The social context • This means where we encourage adults and families in the community to take the responsibility of raising children in line with the principles of ubuntu – “your child is my child” and “it takes a village to raise a child”. • This context includes families, communities, organisations, schools, faith-based settings and individual relationships.
inheriting to get property from someone after they have died
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Understanding factors that put children at risk There are many factors beyond your control as a community caregiver, that may affect the wellbeing of children. Some of these factors create opportunities for risk or increase the vulnerability of children.
Risk factors3 Risk factors may include the following: • Social factors such as lack of supervision, exposure to violence (in particular domestic violence), substance misuse or lack of education. How individuals and communities see children (their attitudes) can influence how children are treated in that community or family. • Economic factors such as no consistent income, no safe or secure housing, lack of access to services because they can’t afford transport. Also, spending money on luxuries (like a television) and not on basic needs (like food) can harm the wellbeing of the child. • Political and historical factors such as political violence, racism or the lack of school resources because of past historical factors can put children at risk of danger. • Gender roles, for example, traditional practices of viewing women and girls as being inferior (lower in status) and having inferior roles in communities often make them vulnerable to abuse. Girls and women can also develop patterns of abusive behaviour, such as hitting their partner, siblings or children. Substance misuse can also develop because of the gender roles they were brought up with. Other gender stereotypes include: - viewing girls as sex objects - the belief that girls and women cannot say “no” to sex with their partner - the belief that boys must not cry or show sadness or fear - the belief that boys must fight back Boys are vulnerable because they are less likely to disclose abuse because of these stereotypes; and the fear that they will be labelled as gay or weak. • Some cultural, traditional or customary practices, despite promoting positive values, could cause harm or even death to children in some communities. For example, women preparing and educating girls about marital relationships, reproduction and sexual intercourse is a positive value. However, promoting boys to be sexually active could be a negative cultural value.
3 Department of Social Development. 2004. National Policy Framework and Strategic Plan for the prevention and management of child abuse, neglect and exploitation. Pretoria: South Africa.
substance misuse an abuse of alcohol or drugs
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• Children living in poverty can sometimes become victims of abuse as they try to make a living. Children living in poverty often find themselves abused or having to resort to prostitution for shelter, clothes, food or money. Once this happens, it becomes difficult to return the child to a “normal life”. They are then often unable to access services that could protect them from the abuse. • The family is meant to be the first line of protection for children, but the family can also increase the risk or vulnerability of the child. Some of the factors that can increase the risk to children are: - loss of parents through death or abandonment - parents moving about a lot - lack of adult supervision - poor adult role-modelling Many children grow up in a family where the parent or caregiver is “here today, gone tomorrow”. Unfortunately, child abuse often occurs within the family and many children experience their first abuse in the home. • Parents or caregivers who misuse substances (such as abusing alcohol or drugs) often neglect children in their care. • Children exposed to domestic violence suffer emotional trauma. This may result in difficult behaviour at home or at school, for example: - screaming - not obeying rules, such as not wanting to eat when asked - becoming very demanding on the non-abusive parent or caregiver as they want attention all the time from a caring adult - becoming over-protective and maybe accepting responsibility for things she or he didn’t do and saying things like, “Daddy, it’s my fault that the food burnt”. • The incidence of child trafficking is on the rise in South Africa and children can be found in conditions of slavery – where they can be both physically and sexually abused. Children in domestic work or working children can also be exploited and are usually denied their rights to education, health and safety. The context of your caregiving affects you and your psychosocial wellbeing (refer back to Module 2 on page 29). The context of children’s lives also affects them. Violence, gender norms, HIV and AIDS, family relationships, and poverty all affect the child in some way.
prostitution
supervision
child trafficking
exploited
being paid to have sex with someone; sex workers
taking care of; watching over
selling and buying children; the children are usually hurt and abused
treated badly; taken advantage of
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vulnerable groups of children There are some groups of children that are more vulnerable than others, for example: • Children who are infected or affected by HIV and AIDS are usually more vulnerable because they may be physically and emotionally neglected; people may avoid them because of the stigma of HIV and AIDS; they may be malnourished; or they may be abandoned by their parents, family or friends. • Children living with a disability are vulnerable and have an increased risk of abuse because they may need personal care; they often cannot avoid the abuse; and they may not be able to communicate easily. They may also be neglected because they are dependent on others to do things for them. • Refugee and undocumented children are often marginalised from communities and are highly vulnerable to abuse. Many children are often victims of xenophobia, or are forced into prostitution to earn money. • Children who are not registered (do not have a birth certificate) are often excluded from benefiting from services that they are entitled to if they are in need, such as grants. • Children in conflict with the law – these are children who have committed a crime (an offence) or who are alleged to have committed a crime. Their vulnerability to harm, danger and victimisation can be increased when they are held in custody (such as a police cell or a prison). Children exposed to these factors in their own contexts (environment) are considered to be “at risk” or more vulnerable to being abused, neglected or exploited. They may also be more at risk of turning to crime and violence, or not reaching their full potential.
A child in the River of Life4 Violence amongst children and youth is a reflection (mirror) of the interconnectedness of the social, political and economic context on the one hand, and on the other hand the qualities (the skills, characteristics and strengths) of the young person. The model of a child in the River of Life is used to help understand how these factors influence a child.
4 Secretariat for Safety and Security. 1999. Joint Framework Document: Towards an intervention strategy to address youth violence in schools. Pretoria: South Africa.
malnourished
marginalised
xenophobia
prostitution
not enough food or the right type of food
not included; pushed to the side; separated
fear of and hatred for people from other countries
when people, usually females, get paid for sex
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Protecting our children Module 6
Protective factors There are various currents that can push a child down either of these streams towards the destinations. Risk factors can be seen as strong currents that push a child towards the concerning behaviour. Currents can push the child towards reaching their own potential – these are the protective factors that can help a child grow and develop. There are many risk factors that children are exposed to, and that they are becoming increasingly vulnerable to in the context of HIV and AIDS. However, each child has his or her own strengths, characteristics or ways of coping. We call these coping mechanisms or resilience. These may help protect the child from harm, danger or from being abused. There are many factors that help children carry on and cope in times of stress and difficulty.
the child in the River of Life is not powerless Children have their own qualities and strengths, and they can develop tools to help them steer along the stream towards reaching their potential. These tools are the resilience factors such as: • succeeding at school • having feelings of being loved and cared for • having good communication and problem-solving skills • having self-esteem • feeling that you can cope with your challenges This model of a child in the River of Life has important lessons for how community caregivers can minimise the risk factors. It can also teach you how to respond when a child’s protection is violated. • The development of a child’s life path relies on the balance between the child’s character and their tools, and what the world has to offer that child. • Children who have more risk factors will have stronger currents towards the concerning behaviour stream. They need powerful tools to steer them away from this current. • Children who have fewer risk factors and have more protective factors are more likely to steer towards their full potential. But the other stream is still open to them. • Children who have been abused, neglected or exploited may need more tools and stronger support to help them steer through their River of Life.
coping mechanisms
resilience
self-esteem
violated
the ways people deal with difficult situations
being quick to recover from bad experiences
feeling you are as important as other people
abused; broken
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Protecting our children Module 6
ACtIvIty 6.1
Group activity and individual Learner Workbook
A child in the River of Life Aim: to understand factors that put children at risk Read the two case studies and do the following exercise. CASE STUDY 1
POPPy is 12 years old and lives with her mother and father, brothers and sisters. Her father works in another city, and only comes home every few months. Her mother works part-time doing different jobs in town. Sometimes the family can only eat once a day. When Poppy’s parents are both working, she has to cook and clean and look after her younger sister and brother. Her older brother sometimes sits on the street corner with his friends and does not do any of the chores around the house. “It’s girls work,” he says. Poppy is good at school, and dreams of becoming a doctor. She has spoken to her father about this dream, but he laughed at her and said that it was more important for his sons to get an education. But Poppy still holds onto her dream, and knows that somehow she will make her dream come true.
CASE STUDY 2
tHABO is 14 years old. His mother passed away from HIV two years ago. He moved from the city to live with his uncle in a rural area six months ago. Thabo found it very difficult to live in the rural area after city life – he had to walk to a school that did not have electricity, he had to make new friends, and he had to look after the cattle. At his school in the city, his best subject was computers. On the way to school, the bigger boys started calling him bad names, because he would not smoke dagga with them. Thabo’s uncle thought that he was hanging around with these big boys, and kept shouting at him. One day his uncle came home drunk and started beating him because he had not brought the cattle in.
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1. Describe the background of Poppy and Thabo. 2. What is preventing them from realising their dreams? 3. What are the factors that put each of these children at risk from realising their potential? 4. Do either of these children show signs of resilience? Explain. 5. Think of children you have come across in your community caregiving (not Poppy and Thabo). Give examples of children at risk that you know and the risk factors that have affected them. Remember not to use their real names as we need to keep their identity confidential. 6. Using your experience, answer these questions for two of the children at risk that you have identified above.
Protecting our children
Spend a few minutes thinking of Poppy and Thabo and their River of Life.
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In small groups, discuss the first 5 questions. After discussing them, go to your Learner Workbook and answer all 7 questions.
a. Which risk factors contribute towards increasing the vulnerability of the child? b. What are the consequences of these risk factors for the child? c. What factors in the lives of these two children could add to building their resilience (coping)? 7. Are the risk factors that you have chosen in Question 6 the same for girls and boys across all of South Africa?
Discussion • “Children at risk” refers to children whose survival, care, protection or development may be compromised. This is due to a particular condition, situation or circumstance and will prevent a child from having his or her rights. • The context of “children at risk” includes understanding the social, economic and political environment within which children live. • There are many factors that make children vulnerable and place them “at risk” in South Africa. These include: - high levels of poverty and unemployment - the impact of HIV and AIDS on children and families - high levels of crime and violence
confidential
consequences
compromised
private; secret
results
threatened; weakened
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• Some groups of children are more vulnerable than others, such as: - children with disabilities - those without birth certificates - refugee children - children who are infected or affected by HIV and AIDS
How does violence affect children? This section builds on our understanding of children at risk and vulnerable children, and the contexts within which they live. It will help us to understand “violence” and how it affects children.
What is violence? Violence is often thought of as only being physically hurtful – such as a physical injury against another person. But violence is more than only physical injury or harm. Violence is any action by a person or organisation or context that does not allow a person to realise their human rights.
Remember Section 28 of our Constitution calls for the protection of children from all forms of maltreatment, abuse, neglect and degradation. Protection is one of the rights of children, and violence takes this right away. In other words, because of violence: • they cannot realise this right • they cannot be protected and be safe • they then cannot reach their full potential as a child
maltreatment violent, cruel behaviour
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Violence is usually about a power struggle – where one person or party wants to dominate over another. There are also less obvious forms of violence. For example, a business may force its labourers to work in conditions that are dangerous and that may harm or injure the workers. The labourers feel that they cannot challenge the employer because they are afraid of losing their jobs. This form of violence takes away the employees’ (the workers’) right to work in a safe environment.
Protecting our children
• Violence can be any physical act, such as hitting, beating, biting or assault. • It can be verbal, such as swearing or name calling. • It can be emotional, such as not giving a child love and care, or threatening someone. • It can be armed conflict, such as in times of war. • It can be political, such as when two parties fight using weapons, or not giving food and shelter.
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violence takes many forms
A conflict is a disagreement or an argument between two people or parties. It may or may not turn into violence. For example, the conflict between two boys over a football (the disagreement) may be solved without violence (physical or verbal). But it could turn violent if the two boys don’t reach an agreement and they turn to physical fighting. Conflict is not always bad – it can be creative and help solve problems when people get together and are committed to finding a non-violent solution.
What happens when your rights are taken away? Because an individual cannot realise their rights, he or she may feel hopeless and helpless to change the situation. For example, you are walking down the street and someone comes up to you and takes out a knife and points it at you. The person demands that you hand over your money and cellphone! • This person is the perpetrator as he or she takes away your dignity. You are not able to control the situation. • This perpetrator is taking away (or violating) your rights of respect, safety and security. “Violence is anything that denies human integrity and leads to hopelessness and helplessness.” Martin Luther King Junior
perpetrator
integrity
a person who commits crimes or does other bad things
behaving with good morals so that others respect you
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the effects of violence on children Violence often has a physical effect on people – both adults and children. This could be a serious medical injury such as a knife or gun wound or a broken bone; or it could be bruising, bleeding or even a cigarette burn. Violence also has an emotional effect, for example, fear, sleeplessness, or post-traumatic stress (think back to Modules 3 and 4). Violence that results in the physical and emotional effects of stress, trauma and fear can affect the child’s emotional, physical, mental and social development. For example: • Emotional effects of violence include feelings of guilt and self blame; fear of being abandoned; low self-esteem; becoming withdrawn; anxiety (such as sleeplessness, nightmares, not eating); difficulty in talking or confiding in anyone; and showing negative emotions. • Physical effects of violence include slower development of a child; getting stressrelated physical ailments like headaches, ulcers or rashes; having hearing or speech problems; or showing regressive behaviour like bed-wetting. At the time of the violence the child (or adult) may “freeze”, “fly” or “fight”. • Mental effects of violence include affecting the ability of the child to speak, read and write (language skills); difficulty concentrating at school; depression; or doubting themselves. It can affect how they see things and in their own world. • Social effects of violence include difficulty in playing with friends; looking for attention; fighting at school or between siblings; and not going to school. • Behavioural effects of violence include bullying by girls (excluding someone from a friendship circle), bullying (physical or emotional); self-mutilation (for example cutting oneself); transactional sex; substance abuse; poor relationships; or living on the streets. Violence can also affect children in other ways. Read the box on the next page on how the United Nations Children’s Fund put forward how violence can affect children.
abandoned
confiding
regressive
self-mutilation
left alone by someone who should stay with you
telling someone about your feelings or secrets
when a child behaves like an even younger child
cutting or hurting yourself on purpose
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If we do not stop the little forms of violence, they tend to grow into bigger forms of violence. When we look at people who have committed violent offences against others, we often find that they had been exposed to violence from a very young age. Research shows that children who are for example exposed to domestic violence are more likely to be violent in their play and use violence as a way to deal with conflict. This is called a cycle of violence7. Sometimes we may not even realise that we are part of a cycle of violence – if a mother disciplines her child by hitting him or her, what message is she sending to her child? The message is that it is okay to use violence in relationships and that violence will solve a problem. It is much better to talk about it and try to reach a solution. In South Africa, corporal punishment is not allowed in our schools. It goes against the rights of children in our Constitution – the right to be protected from all forms of violence.
Protecting our children
the cycle of violence
Module 6
“Children subjected to violence, exploitation, abuse and neglect are at risk of death, poor physical and mental health, HIV and AIDS infection, educational problems, displacement, homelessness, vagrancy and poor parenting skills in later life”6
The cycle of violence can help us understand the cycle of abuse and how difficult it can be for a child or responsible adult to stop the cycle of violence. • The incident, as shown in the diagram on the following page, is any abusive act that an abuser carries out on a child. • This incident is a result of a tension building stage. • After the incident, there is a stage of making up. • After a while a stage of calm settles.
In cases of child abuse the abuse usually continues and at some point, the tension will build again.
6 UNICEF 7 Childline South Africa. Crisis Counselling Learning Manual
transactional sex
displacement
vagrancy
corporal punishment
in exchange for money, favours or resources
being forced out of your home or country
the crime of living on the streets and asking people for money
physical punishment by hitting
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tension Building • Abuser starts to get angry • Abuse may happen • Breakdown of communication • Victim feels the need to keep the abuser calm • Tension becomes too high • Victim feels he or she is ‘walking on eggshells’
Incident • Any type of abuse occurs
Cycle of violence Calm • Abuser acts like the abuse never happened • Physical abuse may not be taking place • Promises made during “make-up” may be met • Abuser may give gifts to victim • Victim hopes the abuse is over
Making-up • Abuser may apologise • Abuser may promise it won’t happen again • Abuser may blame the victim for causing the abuse • Abuser may deny abuse took place or say it was not as bad as victim claims
Skills that help Breaking cycles of violence is not always easy as it requires shifting the power of the relationship. Skills that help you to be aware of cycles of violence and to find ways to stop it include (refer to Module 4): • negotiation skills • conflict resolution skills • problem-solving skills • decision-making skills • communication skills Sometimes it is also necessary to get help from experienced people to break or stop cycles of violence. Approach a social worker or phone ChildLine on 08000 55 555.
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Breaking the cycle of violence Aim: to understand cycles of violence using examples Complete these questions in the Learner Workbook. 1. What do you understand by the cycle of violence? 2. How can the cycle of violence be broken? 3. How can you as a community caregiver make primary caregivers and other adults aware of the effects of violence on themselves and their children? 4. Think of an example of the cycle of violence that you have seen. a. If you were in that cycle of violence, what could you do to break it? b. What needs and rights were not being met in the situation you saw? Give at least one need and one right.
Protecting our children
Individual activity in Learner Workbook
Module 6
ACtIvIty 6.2
c. How did HIV and AIDS or violence affect the situation? Discussion • There are different types and contexts of violence in our communities, and this violence violates the needs and rights of children. • The cycle of violence affects a whole family and all the individuals involved. • Violence impacts on the physical, emotional, social and mental development and wellbeing of a child. • Cycles of violence can be broken.
What does this mean for me as a community caregiver? • How does this understanding of the cycles of violence affect my work as a caregiver? • How does this understanding of the cycles of violence affect me?
violates to do something that is against the law
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Protecting our children Module 6
Identify signs and symptoms of child abuse, neglect and exploitation As community caregivers who meet and talk to children all the time, it is important to know the signs and symptoms of child abuse, neglect and exploitation. Often, we can see that a child is not happy or in trouble, or they may tell us about some abuse or neglect, and we need to be able to respond to them. This is an important skill, because if we know what to do, we feel more empowered to be able to respond. This will then contribute to our own psychosocial wellbeing. In this section we build our knowledge about: • what the terms mean (the definitions) • the signs and symptoms of these terms by using examples • how we can recognise these signs and symptoms in the different stages of development of a child The activity provides case studies for you to practise your skills in identifying these signs and symptoms.
Signs and symptoms of child abuse at different child development stages This is a summary of the definitions, signs and symptoms of different forms of child abuse, neglect and exploitation.8 It is also important to know how children at different stages of their development react to these forms of abuse. • Signs mean something that you can immediately see. For example a bruise is a sign. • Symptoms refer to something that tells you something is wrong, such as an illness or problem. For example a symptom may be a child who regularly does not go to school. You don’t know what is wrong with the child, but their behaviour is telling you something is wrong.
8 These are the definitions from the Children’s Act (as amended)
exploitation unfair treatment; using the situation so that you can benefit
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Abuse is any form of harm or ill-treatment deliberately inflicted on a child, and includes the following forms: • Assaulting a child physically • Inflicting any form of harm or ill-treatment • Sexually abusing a child • Bullying by another child • Child labour or labour practices that exploit a child • Exposing or subjecting a child to behaviour that harms the child psychologically or emotionally
Protecting our children
The Children’s Act defines abuse as:
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the Children’s Act
GOLDEN RULE! When identifying signs and symptoms of abuse, it is important that you do not jump to conclusions. You must rather look at patterns of behaviour rather than a single example of behaviour – but remember not to ignore a single sign, it could be an early warning signal!
deliberately
jump to conclusions
on purpose
get the wrong idea about something because you do not know all the facts
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Physical abuse
Children’s Act Definition
Assaulting a child or inflicting any form of harm or ill-treatment
Easy Examples Definition
Any injury inflicted on a child on purpose
Module 6
Protecting our children
Type of Abuse
• Bullying • Hitting • Bites • Burns • Bruises • Pulling hair • Pinching • Excessive tickling • Cigarette burns • Scars • Force-feeding • Confinement (keeping a child in a room, a cupboard, a yard) • Too much or too little medication
Recognising abuse in different development stages of children 0 – 5 years old
6 – 12 years old
13 – 18 years old
• withdrawal or no interest • fear and anxiety • extreme or inappropriate reactions to pain • aggressive behaviour, head banging • overcompliance • hiding the marks • failure-tothrive (not growing)
• speech or learning difficulties • bed-wetting • negative attentionseeking • self-destructive or accidentprone (always getting hurt) • overcompliance
• eating disorders • drug, alcohol or substance abuse • inability to relate to peers or form friendships • running away • prostitution • aggressive behaviour • overcompliance
• excessive masturbation • inserting objects into body • difficulty sleeping, relaxing and/ or eating • regression (going backward in development such as thumb sucking, bed wetting etc) • sexualised play
• eating disorders • avoidance of sport or games • seeking out or avoiding adults • mentioning a “secret” in the family • sexual behaviour with other children • knowledgeable about specific sexual acts • sexual play • layered clothes to cover up the evidence
• obsessive behaviour • selfdestructive behaviour • isolation, fearfulness, extreme anxiety • promiscuity or prostitution • running away • eating disorders • depression • suicide
• Harmful restraint (such as tying up a disabled child) Sexual abuse
Sexually molesting or assaulting or allowing a child to be sexually assaulted or molested; Encouraging or forcing a child to be used for sexual exploitation; Using a child or deliberately exposing a child to sexual activities or pornography; Procuring or allowing or in any way participating in a child used for commercial sexual exploitation
When an adult, older person or person in a position of power interacts with a child in a sexual way to please the older person
• Having sex with a child • Deliberately having sex in front of a child • Exposing a child to pornography • Using a child for sexual and pornographic photos or activities • Touching a child to stimulate the child or the adult sexually • Seductive behaviour with children • Prostituting children • Flashing, masturbating and sexual hints directed at children
over-compliance
pornography
seductive
flashing
agreeing to everything
magazines, books or movies which are about sex
sexy
when a man shows his genitals in public to upset people
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A pattern of behaviour that harms a child’s emotional development or sense of self-worth
Examples
Recognising abuse in different development stages of children
• Criticism, threats or rejection • Ignoring, isolating, exploiting, corrupting or terrorising a child • Favouring one child over another • Not meeting a child’s need for affection or attention • Shouting or swearing at a child • Breaking down selfesteem • Manipulating children or making them take sides • Threatening violence or attempts to frighten the child • Lying to a child
0 – 5 years old
6 – 12 years old
13 – 18 years old
• withdrawal or not interested (apathetic) • crying and tantrums • failure-tothrive • speech and language delay • being needy or clinging • unable to form relationships, such as with friends
• fearfulness • yelling or screaming for no reason • hyperactive (over-active) or strange behaviour • over-anxiety to please • depression • unwilling to try new things • being needy or clingy • unable to form relationships, such as with friends
• eating disorders • drug, alcohol or substance abuse • impatience • unwillingness to discuss problems • suicide attempts • depression (in children this shows as anger or aggression) • unable to form relationships, such as with friends
masturbating
terrorising
manipulating
tantrums
to rub your sexual organs to get sexual pleasure
scaring; frightening
to get people to do things by tricking them or lying to them
when a person behaves angrily, crying and screaming
Protecting our children
Emotional abuse
Easy Definition
Module 6
Type of Abuse
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Deliberate neglect
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Protecting our children
Type of Abuse
Easy Definition
Not providing for a child’s physical and emotional needs
Examples
• Withholding love, affection or a loving touch • Withholding medical care • Keeping children from school • Preventing access to information • Withholding opportunities to play and socialise • Abandonment • Continuous failure to protect a child from exposure to danger, cold, starvation, substance abuse • Not carrying out important and basic care for the child • Unchanged nappy • Lack of sufficient sleep • Lack of mental stimulation • Lack of adult supervision (day or night) • Adult driving under the influence (such as alcohol or drugs) with a child in the vehicle (car, taxi, etc)
Recognising abuse in different development stages of children 0 – 5 years old
6 – 12 years old
13 – 18 years old
• withdrawn or apathetic • fearfulness • rocking • failure-tothrive • delayed speech and language development
• learned helplessness • fearfulness • keeping food or stealing • clinging or needy • pseudoindependent • regressive behaviour
• eating disorders • drug, alcohol or substance abuse • aggression • prostitution • stealing • suicide attempts
Physical signs: • being dirty • under or over weight • dirty or unkempt clothes • untended medical issues • absence from school • tired • nappy rash • pressure sores in a child living with a disability
Physical signs: • being dirty • under or over weight • dirty or unkempt clothes • untended medical issues • absence from school • tired • pressure sores in a child living with a disability
Physical signs: • being dirty • under or over weight • dirty or unkempt clothes • untended medical issues • absence from school • tired • pressure sores in a child living with a disability
unkempt
pseudo-independent
servitude
debt bondage
messy; scruffy
when young children think they can take care of themselves
when someone is controlled by someone else
having to stay under the control of someone because they owe them something
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Removal of body parts Child pornography Child trafficking Child sex tourism
Type of exploitation
Children’s Act Definition
Easy Definition
Examples
Child labour
Work by a child which is exploitative, hazardous or otherwise inappropriate for a person of that age; and places at risk the child’s wellbeing, education, physical or mental health, or spiritual, moral, emotional or social development
Work that is inappropriate for the child’s age and does harm to his or her developmental needs
• Exploiting child labour, such as children who are domestic workers
No person may employ a child under the age of 15 years or who is under the minimum school age
• Forced to take constant responsibility for younger siblings and/or household chores
Protecting our children
• • • •
Module 6
Child exploitation includes the following: • Slavery or servitude • Debt bondage • Forced marriage • Sexual exploitation • Forced labour, child labour or services
• Working on farms • Selling firewood • Being denied opportunities for schooling because they have to work
Child trafficking
The recruitment, sale, supply, transportation, transfer, harbouring or receipt of children, within or across borders of South Africa by any means (threat, force, abduction, deception, payment) or due to a position of vulnerability. This includes the illegal adoption of a child
• Selling children
Child Pornography
Any real or simulated image depicting a child under the age of 18 years where the child is engaged in sexual conduct, participates in or assists another person to participate in sexual conduct
• Images (pictures), sound recordings, written words of children being sexually abused that are is used by adults for sexual purposes
child trafficking
sex tourism
harbouring
abduction
selling and buying children; the children are usually hurt and abused
when people travel to a country to have sex with prostitutes or children
keeping
kidnapping; stealing children from their homes
• Supplying children for illegal purposes • Abduction • Illegal adoption of child
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Small group discussions and individual Learner Workbook
What happened to this child? Aim: to identify child abuse and neglect Read each case study and answer the following questions in your groups before answering the same questions in your Learner Workbook.
Module 6
Protecting our children
ACtIvIty 6.3
CASE STUDY 1
POPPy loves going to school every day. At school she has friends to talk to and she asks the teachers questions. She gets as many books as possible to read from the school library. It is very different at home: no one asks her how her day was, no one helps her with the chores, her mother shouts at her. Her brother can do no wrong – everyone speaks to him and encourages him to go to school – but all he does is sit on the street corner with his friends. Poppy stops eating and becomes very short tempered.
CASE STUDY 2
tHABO is very unhappy. His uncle shouts at him all the time, and hits him and tells him he is stupid. One day his uncle beats him so badly that he has to stay at home because he is bruised and can hardly move his arm. He thinks it might be broken. Gugu walks past him while he is sitting in the sun, and asks why he is not at school. Thabo tells Gugu that he’s fine and to leave him alone. He decides that he would prefer to be in the city where he can see his friends and where there is noise, taxis, soccer and everything is familiar to him.
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CASE STUDY 4
Protecting our children
DOREEN has spent her whole life at home, as she cannot walk on her own and has to use a wheelchair. She lives with her father in her grandmother’s house in a township. She does not go to school, has no friends as she seldom goes outside. Although the doctor has said she must exercise her muscles, nobody at home helps her do this. Some days she lies in bed waiting and waiting for someone to come to help her to get clean, or to give her food, or to just talk to her.
Module 6
CASE STUDY 3
SWEEtNESS used to be a happy child, always laughing and trying to help everyone. She used to love playing netball a few months ago, but now she has stopped playing and avoids staying after school. Sweetness also tries to avoid Gugu when she comes to visit the household. She only eats a little bit of food, and does not laugh or talk to her friends at school. She is more and more anxious every time Gugu sees her. Now she has said to Gugu that there is a family secret that she cannot tell anyone about.
1. Which signs and symptoms of abuse do you detect? Give at least two examples. 2. What type(s) of abuse is the child experiencing? 3. What is the definition of the form of abuse according to the Children’s Act? 4. What other signs and symptoms of abuse would you look out for? Give at least one example. 5. From your experience as a community caregiver, what signs and symptoms have you seen in the children you have met and worked with? Give at least two signs and symptoms.
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Protecting our children Module 6
Discussion There are different kinds of child abuse – the four main kinds you need to know are: • sexual abuse • physical abuse • emotional abuse • neglect that is done on purpose You also need to know what child exploitation is and how to identify it. This includes: • child labour • child pornography • child trafficking • children living and working on the streets All forms of abuse, neglect and exploitation have negative consequences for the abused child. • All result in different behavioural and emotional responses which may differ depending on the age of the child. • All may have long-term consequences for the abused child as an adult. This happens especially if the child does not get support to deal with the experiences. This should take place in a safe and supportive environment, such as in counselling.
Understanding child protection We have explored factors that put children at risk and we have also started looking briefly at the concept of resilience. We have discussed the cycle of violence and how it affects the child. We have also reflected on how all this affects us as community caregivers. This section explores what we mean by “child protection”. It gives you an opportunity to think about the children that you have met in your community caregiving, the risk factors they face and how we can protect them. At the beginning of this module we stated that South Africa has signed the United Nations Convention on the Rights of the Child. Article 19 in this convention calls for countries to protect their children.
resilience being quick to recover from bad experiences
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Article 19, UN Convention on the Rights of the Child
The United Nations Children’s Fund (UNICEF) defines “child protection” as follows: “Preventing and responding to violence, exploitation and abuse against children – including sexual exploitation, trafficking, child labour and harmful traditional practices, such as female genital mutilation/cutting and child marriage. Child Protection also targets children who are uniquely vulnerable to these abuses, such as when living without parental care, in conflict with the law, and in armed conflict.”
Protecting our children
“Children have a right to be protected from harm, and all adults have a responsibility to protect children from harm.”
Module 6
What is child protection?
The South African Children’s Act of 2005 looks more at “Children in need of care and protection” as a way of defining “child protection”.
genital mutilation when a child’s genitals are cut or removed
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Protecting our children
the Children’s Act says that “a child is in need of care and protection” when a child is in one or more of these situations:
Module 6
• The child lives or is exposed to a situation that may seriously harm his or her physical, mental or social wellbeing.
• The child has been abandoned or orphaned or is without a means of support. • The parent or caregiver cannot control the child’s behaviour. • The child lives or works on the street or begs for a living. • The child is addicted to alcohol, drugs or sniffing glue, and is without support to treat this dependency. • The child has been exploited or is exposed to a situation where he or she may be exploited.
• The child may be at risk if returned to the parent, guardian or caregiver if there is reason to believe the situation will seriously harm the child’s physical, mental or social wellbeing. • The child is physically or mentally neglected. • The child is being maltreated, abused, deliberately neglected or degraded by a parent or caregiver, a person who has parental responsibilities and rights, a family member, or by a person under whose control the child is. • The child is a victim of child labour.
Child-headed households A child in a child-headed household is included in the Children’s Act as a child in need of care and protection. The Act states that a social worker should find out whether the child is in need of care and support. If the social worker feels satisfied that the child can care for him/herself, the social worker will still need to, where necessary, take measures to support and help the child (for example to provide counselling, and assist in getting a social grant).
degraded embarrassed; shamed; treated as less than human
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Early intervention and prevention programmes are put in place to: • Preserve a child’s family structure • Develop the right parenting skills • Develop ways for parents and caregivers to safeguard the wellbeing and best interests of their children. This includes promoting: - positive parenting - non-violent forms of discipline - skills to help children with disabilities and chronic illnesses • Promote the right relationships within the family • Provide psychological, rehabilitative and therapeutic programmes for children • Prevent the neglect, exploitation, abuse or inadequate supervision of children • Prevent other failures in the family environment to meet children’s needs • Prevent problems happening again in the family environment that may harm children or negatively affect their development • Find early ways to help the child not become part of: - the child and youth care system (foster homes; places of safety) - the criminal justice system (court; prisons; sentences) • Avoid the removal of a child from the family environment
Protecting our children
These services are provided to families where there are children identified as being vulnerable to harm or at risk of harm. They may also be in need of removal into other care. By looking at these services and resources, we are responding to child abuse and neglect. We also have the opportunity to prevent or to intervene early in these situations. It is important to also look at the factors that place children at risk.
Module 6
Understanding prevention and early intervention programmes for vulnerable children
The Children’s Act states that early intervention programmes must involve and encourage families, parents, caregivers and children. They must all identify and look for solutions to their problems. Remember “problem-solving” on page 78 (Module 3). These skills can help people find solutions to their problems.
intervene
preserve
safeguard
rehabilitative
step in so that a bad situation will end
take care of
look after; watch over carefully
helping someone become well, physically and emotionally
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Protecting our children Module 6
Community caregivers supporting child protection How can community caregivers intervene early to prevent or reduce the risk factors that make children vulnerable?
As a community caregiver, you can strengthen a child’s coping skills in the following ways: • Help the child develop good communication skills and ways to express their needs and feelings. • Help them to develop good inter-personal relationships. • Help them to build their self-esteem and to find ways to feel good about themselves. • Help the child to find it easier to handle different people, conflicts and to avoid negative peer pressure. This can be done by encouraging them to play sport, join a chess or drama club, learn first aid, sing in a choir, join a debating team. • Encourage them to say “I can” rather than “I can’t”. • Help them to make decisions about what is “right” and what is “wrong” in difficult situations. • Help them to feel part of their community. • Encourage them to be involved in activities such as playing sport or being involved in cultural activities, join a youth group, or to take part in religious services. • Encourage children to grow their own vegetables or garden or start a chicken or egg-producing project. Then they can have food, proper nutrition and a sense of achievement. • Encourage them to attend school, do their homework, read and teach their younger sisters and brothers. • Encourage them to participate in schools, communities, cultural activities, churches and family life.
nutrition healthy eating
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• Be proud of who you are. • Try to always walk in pairs or groups, and don’t walk in isolated areas, or at night. • Talk to someone when you feel threatened or are threatened. • Know your rights and responsibilities. • Have an open relationship with your parents, guardian or caregiver. • Choose your friends wisely. • Don’t accept free rides in taxis or other forms of transport. • Don’t do things that you feel you are uncomfortable with. • Know that you have the right to say “no” to: abuse, alcohol and drugs, doing crime, being exploited, seeing pornography, being raped, sexual intercourse, being used for child labour.
Protecting our children
• Take control of your own body.
Module 6
you can share the following tips with children to help them be supported and protected:
• Talk to your doctor, teacher, caregiver or a relative if you need support or help.
you can help by working with the family or household As a community caregiver you can prevent children from becoming vulnerable, being put at risk, or being neglected or exploited in the following ways: • Encourage inheritance and guardianship planning. • Visit homes and encourage family members to talk to each other if appropriate. • Reduce children’s workload at home if the chores are not right for the age of the child. • Build knowledge and skills of people working with children on birth registration. • Raise awareness in the community about protecting children from harm. • Refer for social grants.
inheritance
guardianship
receiving money or property when someone dies
being legally responsible for someone
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Protecting our children Module 6
REMEMBER • Children are entitled to human rights • Child abuse should never be tolerated • Be a child-friendly adult • Believe children • Be committed to doing something about abuse • People who abuse children have committed a criminal act • Always act in the best interests of a child • Child protection starts at home and with your own family
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What is a safe child and how can I contribute to child protection? Aim: to provide a goal or vision of what you are working towards in your community 1. Draw a picture of a child that you would describe as safe or protected in your community. There is no right or wrong picture – the purpose of the drawing is for you to share what you think of when you think of a “safe child”. 2. Write a short paragraph or poem to explain your picture, or develop your picture as a poster. After drawing the picture, put it on the wall to make a gallery of drawings. 3. When everyone has completed their pictures, discuss the following questions in the group: a. Where do most people think that a child is safe? For example, in a house, school, community, taxi?
Protecting our children
Group discussion and individual activity
Module 6
ACtIvIty 6.4
b. What do the pictures tell us about how we see children’s psychosocial wellbeing? Can you see all the aspects of the Wheel of Psychosocial Wellbeing? c. Are there differences between drawings of girls and boys that show or tell us about our views about girls and boys? Yes or no? Give a reason for your answer. d. Are there any pictures that show any of the principles of the “best interests of the child”? Yes or no? Give a reason for your answer. 4. What are your ideas on how you as a community caregiver can take child protection forward in your daily activities?
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Protecting our children
Module summary: main learning points
Module 6
• There are resources in our communities that can help children at risk, to reduce their vulnerability or help them deal with the challenges they face.
• The responsibility of caring for vulnerable children or children at risk is often with community caregivers who come across children in their day-to-day caregiving activities. • The main principle that underlies all our work with children is based on the understanding of “the best interests of the child”. • Political, social and economic contexts affect children. • There are a number of factors that put children at risk of harm. • It is also important to build the resilience of children so that they can cope.
• Violence affects all aspects of someone’s life. • Cycles of violence can be broken. • Child protection is understood as preventing and responding to violence, exploitation and abuse against children.
Module reflection: what does this mean for me? 1. What child protection challenges affect you and your work? 2. How do you deal with the challenges on an individual level? 3. How do you deal with the challenges on an organisational level? 4. What have I found useful about the things that we have spoken about in this module? 5. What have I found difficult about the things that we have spoken about in this module? 6. What will I do differently in my work using what I have learnt in this module?
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Module 7
Responding to vulnerable children Seeing the need for care and support through the eyes of a child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 How does child protection affect me?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 What does this mean for me as a community caregiver? . . . . . . . . . . . . . . . . . . . 193
Responding to child abuse, neglect and exploitation within the law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Summary of main laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Summary of Child Protection Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Legal role and responsibilities of a community caregiver. . . . . . . . . . . . . . . . . . . 198 Consequences, boundaries and limits of reporting . . . . . . . . . . . . . . . . . . . . . . . . . 201 What happens after reporting a case? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 What does this mean for me as a community caregiver? . . . . . . . . . . . . . . . . . . . 204
talking with children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Guidelines for talking with children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 What does this mean for me as a community caregiver? . . . . . . . . . . . . . . . . . . . 209
Identifying services and referring children Who is responsible for services? Understanding referral systems
. . . . . . . . . . . . . . . . . . . . . . . 210
...........................................
210
............................................
213
Who can community caregivers refer children to?
.........................
215
What does this mean for me as a community caregiver? . . . . . . . . . . . . . . . . . . . 219
Children in conflict with the law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219 Summary of laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Understanding restorative justice
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Understanding diversion programmes and the role of service providers . . . . 224
Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . 228 189
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Module 7
Responding to vulnerable children
Why is this module important? Being a community caregiver puts us at the face of dealing with the harsh realities of our communities. Nothing places more stress on us as community caregivers than seeing a child being harmed or at risk of being harmed and we are helpless to change the situation. With the correct knowledge and tools we will not only be able to help children but also empower ourselves to best deal with the challenges of our task as community caregivers. This module will give community caregivers some of the tools to identify and refer children (in the correct way) who: • have been abused, neglected, exploited or at risk of abuse and neglect • are in need of care or protection The learning outcomes are limited to identification of the problem and then referral of the child. This module does not equip community caregivers to provide “counselling” to children or to investigate if abuse has taken place. The module will also give some insight into understanding children in conflict with the law. This also means understanding the laws affecting children, especially vulnerable children. The focus of the law is to know the legal obligations of community caregivers. A summary of the role of the main people in responding to child protection is also provided.
limited
obligations
restricted; to keep within strict limits
responsibilities and duties
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Seeing the need for care and support through the eyes of a child In Module 6, we spent time understanding the context in which children are “at risk” or “vulnerable” or “in need of care and protection”. We also looked at the effects of violence on them. This provides the context in which child abuse, neglect, exploitation, child labour and child trafficking occur. This gives us as community caregivers some clues as to how we need to approach the child and his or her environment so that we can: • prevent child abuse • respond to it • manage it
Responding to vulnerable children
We need to take care of ourselves so that we can respond to children. At the end of each section of this module we ask you to think about the following: • What does this mean for you? • How can you take care of yourself when you are taking care of children?
Module 7
Care of the community caregiver
When we see children experiencing pain, our immediate thought is to help and make it better by taking over. We often do this only thinking with our “adult brain”. But we need to understand the experience of abuse through the child’s eyes. It is only in this way that you can do meaningful work with children that does not make their experience worse for them.
We need to deeply understand the effects of abuse and the need for care and protection for the child.
child trafficking selling and buying children; the children are usually hurt and abused
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Responding to vulnerable children Module 7
How does child protection affect me? All community caregivers may feel some level of discomfort when responding to child protection challenges. These feelings of sadness or being upset are normal and a sign that you are a feeling, loving, caring person who feels the need to help children. When we no longer feel upset or feel no emotional response, we need to look at our ability to do this work. It may be that we have become numb to the trauma around us. Sometimes community caregivers feel so overwhelmed that they become disabled and are not able to function meaningfully. • This could be a sign of burnout (remember back to Module 3, page 66). • Or it could be that some of our own painful experiences that we have not been able to deal with properly are standing in the way of us responding to child abuse. This could be if we have experienced abuse ourselves. One of the most important lessons we can teach children in these circumstances is to reach out for help. If they see that you as a community caregiver and other people they look up to also ask for help from others, they may be able to do the same. Often we expect from children things that we as adults will not do. In the previous modules, we have explored our own psychosocial wellbeing and developed our skills to take care of ourselves. Take a few minutes to look at what you have in place or what you need to develop to maintain your wellbeing. These skills will help you to be able to respond to child protection issues, which we will explore further in the following sections.
Often the small things we do and say can make a big difference in the life of a child.
challenges
numb
overwhelmed
tests; difficulties
when you don’t feel anything
when you are emotional because you feel like you cannot handle a situation or that you have too much to do
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Lulu and friends – “Lulu takes charge” Aim: to see abuse through the eyes of the child Give yourself a few minutes after watching the DVD to think about what you have seen and heard. Acknowledge the feelings that the story has brought up in you. There will be a facilitated discussion to explore the following questions. 1. What did you learn from the story? 2. How did this story make you feel? 3. How do you usually respond or feel when you find a child that has been abused, neglected, or in need of care and support? 4. What difference do you think you can make to children? 5. What skills and support do you have in place that will help you to take care of yourself while you are helping children in need of care and support? 6. Do you have a story that you can share of a time when you were able to help overcome a child’s risk, vulnerability or violence challenges?
Responding to vulnerable children
DVD and group discussion
Module 7
ACtIvIty 7.1
What does this mean for me as a community caregiver? • How do my interactions with children affect their wellbeing? • What skills and strengths do I bring that can help support children in need of care and support? Discussion • It is important to recognise our own feelings of anger and fear. But we must make sure that we do not let these and other feelings prevent us making the right decision about what steps to take to help the child. • Children often feel helpless and powerless in the face of abuse. One of the ways we can help them recover is by allowing them to be part of decisions that affect them. • The feelings of children who are abused are ignored by the abuser. It is important for us as caregivers to give children an opportunity to express their feelings and to take them seriously. • You have skills and a care plan to take care of yourself when responding to children in need of care or support. • Often the small things we do and say can make a big difference in the life of a child.
burnout
to help overcome
ignored
when you have no energy left because you have been working too hard
to get the better of; to defeat
deliberately not noticed
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Responding to vulnerable children Module 7
Responding to child abuse, neglect and exploitation within the law When we as community caregivers respond to child abuse and neglect, we need to be aware of the laws, policies and strategies that guide us in our work with children.
Laws are the system of rules that connect a community. The policy is the umbrella plan of action adopted to put the law into practice for a particular department or across the relevant departments. Strategies are then developed to put into place the specific details of the law and policy over a specific period of time. the most important of these for community caregivers are: • The Children’s Act (No 38 of 2005) which focuses on all children’s issues. • The Domestic violence Act (116 of 1998) which focuses on violence against women and children. • The Sexual Offences Act (32 of 2007) which focuses on all sexual offences. • The Child Justice Bill (2007) which focuses on children in conflict with the law. We do not expect you to know all of these laws in detail. There are two important areas we need to focus on: • How the laws define certain actions and procedures • How the laws expect community caregivers and other service providers to respond to child abuse and neglect
REMEMBER Whenever you have any dealings with a child, the principle of “the best interests of the child” is very important! This is stated in our Constitution (Section 28) (remember back to Module 6, page 155).
Summary of main laws Information about these Acts follows: • The Children’s Act • The Sexual Offences Act • The Domestic Violence Act
umbrella plan
protection violations
intensive
alternative
a plan that covers all aspects
when rules and laws governing the protection of children are broken
a lot is needed
a different sort
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In this way, child care and protection services range from prevention through to more intensive interventions (such as legal services and alternative care for the safety of a child). Continuum of care provided to children:
Prevention
• • • •
Parenting skills Caregiving skills Children’s rights Early childhood education • Education and schools
Early intervention
• Income generation • Early intervention of child at risk or showing signs of abuse or neglect
Legal services (statutory)
• Placement of child in alternative care • Responding to child abuse and neglect in the law • Child justice system • Children’s court for adoption or placement
Reintegration and after care – healing of children and families
Responding to vulnerable children
The Children’s Act covers a broad range of issues in relation to services for children. • Firstly the Act makes conditions for support to families, to help them to care for and protect their children. • The Act recognises, however, that some children are not properly cared for. Many are at risk of protection violations, or have experienced such violations. • This Act therefore provides for assisting children in need of care and protection, as well as explaining the rights and responsibilities of parents. • The Act describes a number of possible interventions to help support families and children. The four stages that guide the interventions provide for continuous stages of care. These stages are shown below with examples.
Module 7
the Children’s Act as amended1
• Therapeutic programmes • Monitoring of children by social workers • Restoring family relationships
1 This summary refers to the Children’s Act No. 38 of 2005 and the Children’s Amendment Act No. 41 of 2007 which is commonly referred to as the Children’s Act
continuum of care
reintegration
care that is provided to help all aspects continuously
settling in back home and being accepted by the family
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Responding to vulnerable children Module 7
the Sexual Offences Act The Criminal Law (Sexual Offences and Related Matters) Amendment Act (No 32 of 2007) we refer to as the Sexual Offences Act. • This Act reviewed and changed all parts of the laws and the implementation of the laws about sexual offences. • It also creates new categories of crimes. • It defines and categorises sexual offences. • It gives the ages at which a child may agree to sexual activity. • It gives procedures around the prosecution of offenders (abusers). • The laws mostly affect both children and adults, but some sections relate only to children. Key elements of the Act regarding child protection include the following: • It redefines ‘rape’ to include all forms of sexual penetration without consent. For the purposes of this definition, the gender of either person doesn’t matter; the way the child is penetrated doesn’t matter. It also says that sexual penetration with a child under the age of 12 years is rape, whether or not the child gave consent. • Indecent assault includes kissing, feeling breasts and rubbing the genitals of a person without consent. • The different crimes that commonly occur against children include a wider definition for: - sexual grooming - sexual exploitation - the use of children in pornography - the display of pornography to children • The age of consent to sexual activity is 16. This means that it is a crime for an adult to engage in sexual activity with a child under the age of 16 years, even if the child gives “consent”. • It is also a crime for consensual sexual penetration between children under the age of 16 and over the age of 12 years. In this case, both children will be charged. • The Act does not require that a case of rape must first be reported to the police before the victim can access post-exposure prophylaxis (PEP) against HIV infection. This supports the Department of Health guidelines which at the moment provide for PEP to be given to sexual offence victims without a charge having being laid with the police.
implementation
prosecution
consent
consensual
carrying out
taking offenders to court to decide if they are guilty or not
permission; agreeing
when both people agree
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The Domestic Violence Act (No 116 of 1998) aims to protect victims of domestic violence. This is defined as: • verbal abuse • physical abuse • intimidation and “controlling or • sexual abuse abusive behaviour” • emotional abuse
the Act outlines the duties of police officers in responding to instances of domestic violence. • A police officer called to an incident of domestic violence has to assist the person who lays the complaint. He or she is called the complainant. • This may include making arrangements for the complainant to find a suitable shelter and to get medical treatment. • The officer must also explain, and give the complainant a written notice containing information on, their right to criminally charge the person. The officer must also explain the services available to them.
Responding to vulnerable children
the Domestic violence Act
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• A person may apply for the compulsory HIV testing of the alleged sex offender. • Any person who has knowledge of a sexual offence against a child MUST report it to the police.
The Act also makes provision for protection orders. These prevent a known or alleged perpetrator of domestic violence from having contact with the child.
REMEMBER A child may approach the court directly for a protection order without adult help. An adult may also approach the court on behalf of the child.
Any person who has knowledge of a sexual offence against a child MUST report it to the police.
intimidation
alleged
frightening; threatening
accused; supposed
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Summary of the Child Protection Policy The key policy for child protection is the following: National Policy Framework and Strategic Plan for the Prevention and Management of Child Abuse, Neglect and Exploitation (2004) • This National Policy Framework and Strategic Plan was developed to assist the response to the problem of child abuse, neglect and exploitation in South Africa. • It aims to support government and civil society (such as CBOs, NGOs and FBOs) to work together to provide an integrated service. • It also aims to reduce the incidence of child abuse, neglect and exploitation in South Africa. • It is there to make sure there is good management of cases of abuse, neglect and exploitation. • It provides an overview of the situation of children in South Africa. • It explains the extent of child abuse and the associated risk factors that increase a child’s risk. These were discussed in Module 6 on pages 158–159. • It also outlines the roles and responsibilities of all services. • Finally, the policy also acknowledges that, although South Africa has come a long way to respond to child protection, there are still some areas that need strengthening.
Legal role and responsibilities of a community caregiver What is my role in responding to child abuse, neglect and exploitation within the law? According to the Children’s Act, as a community caregiver you have a moral obligation to report cases of child abuse, neglect or exploitation. You must do this if you have reasonable grounds to believe that the child: • has been abused • is living in circumstances that may harm his or her physical, mental or social wellbeing • is in need of care and protection • lives and works on the streets • has told you about the abuse, neglect or exploitation
exploitation
civil society
integrated
incidence
bad treatment; when people are taken advantage of
the organisations that work for people’s rights
where everything is included
the number of cases in a place or country
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This means the legal duty to report something. In other words, the following people have a legal obligation to report if they have reasonable grounds to believe a child is abused: • teachers • nurses and midwives • doctors and dentists • traditional healers • health practitioners • ministers of religion or religious leaders • social workers • traditional leaders • volunteers at a drop-in centre or child centre
Responding to vulnerable children
This is different to the “mandatory reporting” that professionals have to do.
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Reasonable grounds refer to having a sensible, believable, credible suspicion or cause for concern that the child is living in one or more of the situations described above.
The Sexual Offences Act places a legal obligation on any person who has knowledge of a sexual offence against a child to report this to the police.
extent
associated
credible suspicion
the degree to which something happens
connected in some way
when you have good reason to suspect something is wrong
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Who do you report the problem to? You must report the abuse, neglect or exploitation to one of the following:
• The Department of Social Development at the nearest local or provincial office or on 0800 60 10 11. • The South African Police Service either at a police station or on 10 111. • The Childline toll-free 24-hour telephone number on 08000 55 555. • A designated Child Protection Organisation (CPO) in your district, such as Child Welfare South Africa on 011 492 2888.
You will need to give the following information:2 • The child’s name, age and address or identifying particulars of the child • The child’s present location (where the child is staying) • The parent or guardian or caregiver’s name and address or identifying particulars • The nature of the injury or condition observed of the suspected abuse • The dates and types of incidents you are aware of • Details of the circumstances around the abuse • Any contact details of other people who could confirm the alleged abuse • Your contact details, in case the social worker has to follow-up any details with you If you suspect abuse but don’t have all this information, you should still report your concerns.
REMEMBER If a child is missing, report this to the police immediately or as soon as possible. It is not necessary to wait for 24 hours before reporting the missing child.
2 Department of Social Development, Children’s Directorate. 2009
designated selected; chosen
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You must be able to give reasons and support your report. You must also make your report “in good faith”. Then if the claim is wrong, you will not be liable for civic action (in other words for a legal claim to be made against you). The identity of the person who makes the report will be treated as confidential. The Children’s Act and the Domestic Violence Act provide for anonymous reporting of a case or a suspected case of child abuse.
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What are ethics? • Ethics are about how to behave appropriately and correctly. • Ethics are about treating people in ways that shows respect for them. • Understanding ethics helps you to tell the difference between right and wrong. It is about what will be acceptable in our work. • Ethics help us to react to a certain situation long before that situation happens.
Responding to vulnerable children
Consequences, boundaries and limits of reporting
the boundaries of how you respond to children include: • You must not assess (investigate or measure the range of) the abuse. • You must not remove the child (unless he or she is in immediate danger). • You can’t confront the parents or the suspected abuser. • You can’t discuss the case with anyone except the social worker or police or designated child protection official.
What is your role? It is your role to: • provide support to the child by listening • explain what the steps are for them to get help and support • keep in contact with the child • be honest with the child • provide emotional support where possible
in good faith
not be liable
anonymous
confront
being honest about what you say
people won’t be able to bring a court case against you
nameless; you don’t have to identify yourself
speak to someone about something uncomfortable
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After reporting a case to a social worker or the police, the following responses come into operation: • The Children’s Act • The regulations governing social workers • The police The legal procedures for responding to child abuse, neglect or exploitation are shown in the following diagram and then described. Follow the numbers on the diagram and in the text on the next page.
Responding to child abuse, neglect and exploitation
2 po rt
rt po
Re
Re
1 Incident or suspected abuse
2
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What happens after reporting a case?
3b
3a Police Referral
6 Children’s Court
Department of Social Development
5 Re p ort
3c Social worker Investigation
4 Child assistance
7 Confirmed abuse 8 Child Protection Register
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child pornography
in custody
perpetrators
books, movies or magazines which show children involved in sex or sexual activity
in jail
people who do something harmful
Responding to vulnerable children Module 7
The incident happens or is suspected. The child may or may not disclose to you. 2. If a community caregiver suspects or knows about the abuse or neglect, the community caregiver will report the situation to the social worker or the police. The social worker can be the district social worker or at a child protection organisation. 3. a) The police are not needed in all cases, only when a criminal offence has happened (such as rape, sexual abuse, child pornography, etc). b) The police must within 24 hours of the incident being reported, report the case to the Provincial Department of Social Development. c) Once the report comes to the social worker, they must do the first assessment of the report and investigate it. 4. After the social worker has investigated the report, he/she will assist the child. The abuser will only be removed if it’s in the best interests of the child. This can only be done by the social worker and the police. 5. So the social worker reports the suspected abuse to the police. 6. The child will also be referred to the Children’s Court for protection and for accessing the services needed. The child’s safety is important to the social worker and the police, and they have a responsibility to make sure the child is safe. The child does not have to be moved from the home. It is up to the social worker and the Children’s Court to decide what is best for the child. If the abuse is confirmed, then the social worker must make sure this is also reported to the police so that criminal proceedings can begin. The child will then be protected under the Children’s Act. A person who is suspected of a crime against a child is often not arrested immediately, as the police have to investigate the case. After the arrest, the alleged abuser will be kept in custody until he/she appears before the court. The alleged abuser may have the right to bail, which if the court gives them, means they will be out of custody until the trial. This does not mean that the person is innocent, but that the case is still being investigated and awaiting trial in the court. 7. If the investigations by the social worker confirm that the alleged abuser was guilty, this person’s name and details will be submitted to the National Child Protection Register. 8. The National Child Protection Register is a database of victims and perpetrators of abuse. 1.
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Once the case goes to Court, the child can be called to testify about what happened to him or her. This is done in a closed room where a social worker or trained person (called an intermediary) is with the child and he or she asks the questions for the court. The role of the community caregiver in these legal procedures stops after reporting the case, unless the social worker or police require you to be involved afterwards.
ACtIvIty 7.2
Small group discussion and Learner Workbook activity
How do I respond to the child in a specific case? Aim: to learn how to respond to cases After discussing these questions in your small group, go to your Learner Workbook to answer them. Read the case studies of Poppy, Thabo, Doreen and Sweetness (from Activity 6.3, pages 178–179) and answer the questions: 1. Do you have a moral or legal responsibility to respond to each of these cases? 2. How would you respond to each of these case studies to meet your responsibility? 3. What is your role in responding to the child in need of care and protection? 4. What are the possible challenges for the role players in the child protection system? 5. What ideas have you got on how these challenges can be overcome? Practical activity Find the names and contact details of registered child protection organisations in your district or province that you could report suspected cases to.
What does this mean for me as a community caregiver? • How do you feel about the situation in these case studies? • What type of cases have you come across in your community? How did you respond? • How would you deal with these cases now? • How can you look after yourself to respond effectively to these cases in your community?
to testify to give evidence in court
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In your daily caregiving, you meet many children and it is important to be able: • to talk with them about their lives, and the challenges or problems they face • to build their confidence in interacting with people • to develop their skills and talents Community caregivers can play an important role in the lives of children, and this is not something to be taken lightly, because how you interact with them will determine how well you are able to support them. Therefore the following skills in interviewing are important: • asking questions • helping children to express their feelings, especially to relieve their anxiety • recognising the strengths of the child • seeking clarification • exploring issues they bring up • listening to them carefully
Responding to vulnerable children
Community caregivers need to be able to talk to children and respond appropriately and ethically to children who disclose abuse. This section aims to develop your skills of responding to disclosure and non-disclosure with children within the ethical and legal boundaries. This is a critical skill that community caregivers need in order to talk to and respond effectively to children in their communities.
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talking with children3
3 Childline South Africa. 2009. Crises Counselling Learner Manual. RAPCAN, South Africa.
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the attitude of the community caregiver is important in these ways: • • • •
being empathetic respecting children not being judgemental accepting the child as he or she is
It is also very important as a caregiver not to give advice as they can be blamed for this advice if it doesn’t work out – rather find ways to encourage the child to discover their own solutions. Finally, it is very important for the community caregiver to be sure of the facts and to provide the correct information and guidance to the child. Then a trusting relationship can be built and sustained. However, children may not tell an adult or friend if they are being abused, because they: • Fear not being believed • Are being threatened by the offender • Want to protect the offender • Don’t know how to tell • Don’t know that the abuse is wrong • Fear being isolated or stigmatised • Fear being labelled (particularly as a homosexual) • Are embarrassed • Don’t know who to tell • Never find the right time or opportunity to tell someone • Don’t want to “tell tales” • Don’t have the words (“nice children don’t use words like that”)
empathetic
isolated
stigmatised
labelled
homosexual
understanding how another person feels
left alone
made to feel embarrassed or ashamed
called; named
attracted to the same sex
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• Believe the child. • Congratulate the child for their courage to disclose to you. • Tell the child that it was not his or her fault. • Explain confidentiality. Say that you need to tell a few adults so that as a team you can help. • Address the child’s concerns. Maybe share with them the understanding of “good and bad secrets”. • Acknowledge the child’s feelings.
How do I manage disclosure if a child tells me they are being abused? What to do when a child tells you they are being abused:
Responding to vulnerable children
The following are very important guidelines from Childline when you are managing disclosure:
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guidelines for talking with children
Remember this word: SOLvER. It stands for: S = Sit squarely facing the child. O = Open posture, be aware of your non-verbal body language. L = Lean forward towards the child and listen attentively. v = Voice not too loud or soft, use a friendly tone. E = Eye contact. R = Relax! Be aware of your own feelings.
tell tales
attentively
to tell stories about people to get them into trouble
kindly and calmly
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you will be helping the child if you: • Show that you really believe the child. • Go at the child’s pace (don’t rush the child, let the child tell his or her story without interrupting). • Praise the child for his or her courage in coming to talk to you. • Assist in providing for the safety of the child by referring to a social worker or the police – legally or morally you have to do this! • Always explain to the child what action needs to be taken or is being taken. • Always be honest with the child and do not promise things that you are not able to do. • Keep the abuse confidential by only talking to the social worker and police about it, or a designated child protection official (this may be someone in your organisation, or at Childline or through another NGO).
you will NOt be helping the child if you: • Get angry and emotional. • Make judgements, or blame the child, for example to say, “Why didn’t you run or call for help?” • Ask too many questions or pressure the child for details. • Examine the child by removing clothes or touching body parts. • Cover up the abuse or ignore what the child has told you or you have observed. • Withdraw from or abandon the child. • Make promises you can’t keep. • Discuss the abuse with others except the social worker or police. Remember to keep to the principle of “the best interests of the child” and therefore to keep the abuse confidential. • Confront the alleged abuser or try to remove him or her. • Remove the child – only a social worker (unless the child is in immediate danger), police officer or a designated child protection person can do this.
pressure
abandon
force or push
leave someone alone when you should stay with them
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ACtIvIty 7.3
Group role play
talking with children Aim: to practise skills in being able to talk to children when they disclose abuse to a community caregiver or if abuse is suspected It is important to know how to talk to children and how to respond to them if they disclose child abuse or neglect to you, or if you suspect they may be abused. There will be a facilitated role play in the classroom to give you an opportunity to practise your skills in talking and responding to children.
ACtIvIty 7.4
Responding to vulnerable children
These phrases are helpful when responding to a child: • “I believe what you are telling me.” • “I know it must be difficult to talk about this. Just take your time …” • “I’m glad you came to talk to me. It’s the right thing to do.” • “I am sorry to hear what has happened to you.” • “It’s not your fault.” • “In order to help you, I will have to speak to another person.” • “Whatever happens to the person who hurt you is not your fault.” • “Tell me everything that has happened to you.”
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What can I say to a child when they are disclosing abuse to me?
Paired discussion and individual Learner Workbook activity
talking with children Aim: to know the right and wrong responses when talking with children Look at the case studies in Module 6, pages 178–179 for Sweetness, Doreen, Thabo and Poppy. Write down in your Learner Workbook at least one way in which you would respond and one thing that you would say to each child.
What does this mean for me as a community caregiver? 1. What did I learn from the role play about how I respond to children? 2. What skills do I need to practise so that I can respond appropriately to children?
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Identifying services and referring children The purpose of this section is to explore what services are available to refer children to and who can support children who: • have been abused • are at risk • are in need of care and protection As community caregivers, it helps to have a supportive network and to share the responsibility for vulnerable children. You accept the need for specialist services and people, and are clear on what your roles and responsibilities are when: • you know what services are available • you are able to refer children in need of care and protection to them In this way, we are contributing to our own psychosocial wellbeing, to the child’s psychosocial wellbeing and to that of the community. The services that are available in a community can also support children throughout the continuum of care (remember back to Module 7, page 195).
Who is responsible for services? According to the Children’s Act, the government does not have to provide all of the services to children itself. But it must make sure that the services are provided and accessible to all vulnerable children. This means that there needs to be a good partnership between government and NGOs, CBOs or FBOs. The government must play the lead role and nonprofit organisations must be treated as equal partners. They must be paid the full cost by government for their services.
accessible when everyone can get the services they need
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1. Social workers at the Department of Social Development and Child Protection Organisations The social workers role is to: • Do a risk assessment through consultations. Compile a plan of action according to the needs and circumstances of the child and his or her family. • Do emergency removal if the wellbeing of the child is at risk. Arrange alternative care for children in need of protection as well as the recruitment, selection, training and support of safe-house parents, foster parents and adoptive parents. • Prepare the child and family for alternative care where applicable. Develop and make permanent plans for children in these situations. • Deliver or arrange ongoing counselling for the child, the family and the offender. • Design and implement preventive and developmental activities to prevent the child abuse. • Finalise children’s court enquiries. Provide the necessary support to the child and to his or her family. • Deliver probation services and diversion programmes to children in conflict with the law and their families. • Recruit, select, train, support and retain community caregivers. • Co-ordinate services and link all concerned with the necessary resources and support systems through effective case management.
perseverance
probation services
diversion programmes
to keep trying even when things get difficult
the services of a social worker who works with people who are in trouble with the law
programmes that help improve someone’s wellbeing
Responding to vulnerable children
Roles and responsibilities of central service providers
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REMEMBER • NGOs involved in child protection activities and services in terms of the Act must be registered as designated Child Protection Organisations. This means that quality services will be offered. • Although the law may say that certain systems must be in place for children, in reality the services may be far away from where you are. They also may not be available in your community. • Remember that at times the most powerful support we give others is through our perseverance and unconditional support. This support may just be by being present with someone without even sharing any words. • In identifying what you can do to mobilise resources, look for informal resources that strengthen your community and that the child and his or her family may get support from (remember back to the Pyramid of Psychosocial Support, page 85).
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2. The South Africa Police Service Their role is to: • Investigate the allegation of abuse. • Open a “docket”. • Make sure the child is safe and is not subjected to secondary trauma. • The police officer will interview the child to get a statement. He/she will take the age and other evidence into account during the interview. He/she will take the child for a medical examination if necessary.4 • The prosecutor and investigating police officer are responsible for opposing bail or requesting conditions if bail is granted. Talk to the police about options. • Find out whether a criminal offence has been committed. Collect evidence for prosecution and proceed with the charges. • Bring all reported cases of abuse or crimes against children to the attention of the Department of Social Development or a designated Child Protection Organisation. • Forward the case to the National Prosecution Agency (NPA) for a decision on whether to prosecute or not. Keep the victim informed of progress in the case.5 • Any adult can open a case on behalf of the child even if the child is not there. • The police may also order an abuser to leave the child’s home if this will make him/her safe. • Participate in inter-sectoral child protection teams, including joint investigations with designated social workers. 3. The National Prosecuting Authority and the Department of Justice and Constitutional Development Sexual Offences Court Their role is to: • Provide facilities at courts where child witnesses (especially in the case of abuse) can testify in a friendly and secure environment without the risk of being intimidated. This is to prevent and reduce secondary victimisation. This may include providing child-witness rooms which are fitted with one-way glass or closed circuit television next to the courtrooms. • Improve prosecution and conviction rates through the education of child victims, caregivers and other witnesses on processes and requirements for the trial in court. • Provide the complainants and others with skills to manage their stress. Encourage victims and witnesses to testify. 4 http://www.saps.gov.za/org_profiles/core_function_components/fcs/establish.htm 5 CHILDRENhttp://www.case.org.za
docket
opposing bail
designated
complainants
an official police file with a reference number
saying that a person should not be allowed out of jail for the period before their court case
selected; chosen; appointed
people who have asked the court to judge their cases
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The aim of a referral system is to set up a system or network in the community to link services between Home Community-Based Care and the needs of children. In this way there will be a continuum of care for them. A referral is the process of providing for the comprehensive needs of a child through access to a range of services. Referrals should also include reasonable follow-up efforts to: • Assist with contact between the service providers
Responding to vulnerable children
Understanding referral systems
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4 The District and Local offices of the Department of Health Their role is to: • Conduct a medical examination of a child who has been abused. A special crime kit must be used when a victim of a crime is being examined. • Collect medico-legal evidence for the successful prosecution of perpetrators in the criminal justice system. • Refer children to psychiatrists, psychologists or social workers as necessary. • Co-operate with other sectors involved in child protection.
• Check that the services are satisfactory6
6 Family Health International. January 2005. Establishing referral networks for comprehensive HIV care in low-resource settings.
psychiatrists
psychologists
comprehensive
doctors who treat people with mental illnesses
people who study how people’s minds work and how this affects their behaviour
full; complete
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Community caregivers and their organisations cannot always provide all the services that beneficiaries require, especially to children. Sometimes specialised services are needed for beneficiaries to meet their specific needs and to get the “highest level of quality of life”. • By having a referral system, community caregivers are then able to help the child or family access the care and support they need. • At the same time, community caregivers are helping to build the social support network of the community. • In this way they are contributing to the wellbeing of the whole community. This is because the responsibility of caregiving is then shared among all the services in communities. • In addition, all services in a community should work together to: - support each other with the workload and the responsibility of care - meet the needs of the beneficiary
Who do we need to refer? • • • •
Children in need of care and protection Families in need of care and support Children in need of support and early intervention services Community caregivers who need support in building their psychosocial wellbeing
What do I say to the child? • Explain to the child why you are referring them and the kind of help and support they can get. • Give the child a card with the following details: - the person and organisation - where the organisation is - how to access the organisation • Also give the child a referral letter that they can give to the person or organisation or contact the person directly - this needs to say why you are referring them - and for what sort of support • Follow up with the child to check whether they did access the service and whether they require further help.
specialised services that deal with special needs
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There are a number of community services or resources available to children at risk. We need to find ways to encourage children, families and households to access these projects, services or resources.
A number of government and community services and structures exist that can support children who are vulnerable or at risk. government services include: • clinics • schools • social workers • social grants
Responding to vulnerable children
Who can community caregivers refer children to?
Module 7
• Ask the service or person you have referred the child to for feedback so that you can check that the need of the child has been met. • Record the referral for monitoring and evaluation purposes and for future reference.
• the police youth desks • community police forums • places of safety Community projects include: • faith-based organisations • youth clubs • sporting groups • cultural groups • child care forums • food garden projects • CBOs and NGOs working with children, families or community development projects
evaluation checking afterwards to see how a process has gone
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Some of the services available for these children, or that you can refer children in need of care and protection to, include the following: • Schools to encourage learning. • Health officials such as clinic sisters, doctors and nurses for medical support, advice and care. • NGOs such as FAMSA, or for drug abuse counselling. • Registered diversion providers for children in conflict with the law or those that show criminal behaviour such as with NICRO or Khulisa Crime Prevention Initiative. • Social workers and psychologists for counselling and play therapy to restore emotional health and wellbeing. • Faith-based organisations or religious leaders for spiritual support. • Traditional healers and or health practitioners for spiritual, cultural and traditional health support. • A physiotherapist, speech therapist, remedial educator or occupational therapist to help with specific problems a child may have. • Youth groups, sports groups, cultural groups for social, cultural and community involvement. • Child Care Forums to identify orphaned and vulnerable children, to create awareness of needs and services and to build community capacity to respond. These are community-based structures that exist in some areas to bring together relevant stakeholders. • Specialised child justice courts and one-stop child justice centres for all cases involving children in conflict with the law, except when the child is charged with treason, murder or rape. The aim of these courts is to make sure that there is an appropriate environment for child offenders. The centres are designed to make the whole process quicker and simpler – from arrest to court appearances. • Designated child protection organisations (CPOs) that perform child protection services. • Child and youth care centres include children’s homes, places of safety, shelters, schools of industry, reform schools and secure care facilities. They may also offer: - residential care programmes - after-care services to children and young adults leaving residential care - programmes for the treatment of children with psychiatric conditions • Drop-in centres are facilities offering basic services and support aimed at
play therapy
physiotherapist
speech therapist
playing with dolls and pictures to help recover from the problem
someone who uses exercises to help people get over injuries
someone who helps people with speech problems
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meeting the emotional, physical and social development needs of vulnerable children. These basic services should include: - providing food - assistance with personal hygiene - laundry - school attendance support - guidance and counselling - educational programmes - community services - primary health care - outreach services - prevention and early intervention programmes • The Victim Empowerment Programme (VEP) was started to join programmes and policies for the support, protection and empowerment of victims of crime and violence. There is a special focus on women and children. The VEP is also responsible for the establishment of one-stop centres for women and children who are victims of abuse, especially domestic violence.
Can you identify any of these services on your community map?
remedial educator
occupational therapist
a teacher who gives extra lessons or who helps with learning difficulties
someone who gives people activities to improve their wellbeing
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ACtIvIty 7.5
Group and individual Learner Workbook activity
Referring children to services in my community Aim: to identify community resources for children in your community and develop a referral system Do the following exercise using the community map you did in the break between the two training blocks: 1. Identify and list the possible organisations, community interventions or resources that could help to address or reduce the problems or challenges children at risk face in your community. Give at least three organisations, community intervention or resource. 2. Indicate the locations of these interventions and organisations by drawing a star on your map. 3. Where would children go for help if: a. They needed a social grant? b. They were infected by HIV and needed treatment? c. They were living with a disability? d. Their mother was dying and they were going to be left alone? Read the case studies of Poppy, Thabo, Doreen and Sweetness on pages 178–179. Then go to your Learner Workbook to complete this activity. 4. What services can you identify in your community that you could refer the child to for support? Give at least two examples. 5. What is the role of the service provider you would refer each child to? During the practical work after this training, find out the name, contact details and referral or reporting process of a Child Protection Organisation or other service in your community that could support children. Write this in your Learner Practical Workbook 2.
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- experience child abuse, neglect and exploitation - are at risk or vulnerable - are in need of care and protection The purpose of this activity is to explore how you can be supportive to the children and families you work with on a daily basis. • Brainstorm with your colleagues and other community caregivers how you can build good relationships with people and services you have identified that can help you prevent and respond to child protection issues in your community.
Children in conflict with the law In South Africa, many children (under the age of 18 years) commit crimes or are accused of crimes.
Responding to vulnerable children
• Identify what you as community caregivers can do to mobilise resources and services for children who:
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What does this mean for me as a community caregiver?
The term “children and youth in conflict with the law” refers to children and youth under the age of 18 years who are: • alleged to have committed a criminal offence • arrested for a criminal offence When children, who are in conflict with the law, come into contact with the criminal justice system, they are at risk of potential harm and human rights violations. The criminal justice system is the legal process of our country. The following groups all work together: • police • prosecutors • magistrates • courts • social services • correctional services
prosecutors
correctional services
people who bring the case against the accused
prisons; correctional supervision; community sentencing
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It is therefore necessary to understand how government and services respond to these children. We also need to know what community caregivers who come into contact with these children can do: • to prevent them from committing crimes • to cope with the criminal justice system • to help reintegrate them back into families and communities Understanding this will also help us to take care of ourselves, by once again being able to explain this to children and refer them for the necessary help or support.
Children in South Africa In South Africa, the reason why children or youth become perpetrators of crime, violence or abuse is very complex. It is a combination of the individual psychological, social, political and economic contexts in which these children live. Identifying the risk factors early on in a child’s life helps us to address some of the underlying causes that push a child towards crime and violence. Criminologists know that people who end up doing serious crime often have the following things in common: • there were serious behavioural problems in childhood • they were often active in crime during their teenage years • their social and political contexts may also have influenced them Children in conflict with the law are seen as vulnerable children. This is because the same risk factors that lead to abuse and neglect can contribute to them committing crime (remember back to Module 6, pages 158–159). These children are therefore also children in need of care and support. The role of community caregivers is to find ways to include them in the same activities and interventions as vulnerable children.
Children in conflict with the law are seen as vulnerable children.
reintegrate
criminologists
join again with a family and community
people who study crime and criminals
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However, government realised that the criminal justice system should look at children and youth differently. They try: • to keep them separate from adult offenders • to find ways to address their needs • to change their lives and take them away from crime • to help them reintegrate back into their families and communities
Child Justice Act The Child Justice Act (CJC) of 2007 is the law dealing with children and youth in conflict with the law and their rights. It is based on the principles of the “best interests of the child”. It aims to make sure that all children in conflict with the law are treated fairly, consistently and appropriately. Some of the most important clauses in the Act are: • The minimum age at which a child is held responsible for a crime is at 10 years of age. Before that age the child cannot know the difference between right and wrong so clearly. This means that children under 10 years will not be prosecuted. • Arrested children must be assessed immediately after arrest. They must be taken to court within 48 hours to see if they can be released from custody to their guardian. The child may also be referred to a programme that will help him or her. The probation officer will see the child and write a report for the prosecutor. • The ideal situation is that no child under the age of 18 years should be kept in custody to: - prevent contact with adult offenders - protect them from the harm that can be caused in custody • There should be special child justice courts and one-stop child justice centres for all cases involving children, to ensure an appropriate environment for child offenders. There are already centres like this in some parts of the country. • The Act states that children cannot receive a life sentence.
not be prosecuted
assessed
probation officer
not taken to court to get punished
checked
social worker who works with people who are in trouble with the law
Responding to vulnerable children
Before the Child Justice Act, children and youth who were in conflict with the law were mostly treated in the same way as adults: • They were kept in the same prisons. • They were punished in the same way.
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Summary of laws
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Criminal Procedure Act 51 of 1977 (as amended) The Criminal Procedures Act is used in the criminal court to sentence people who are found guilty of a crime. It states what the sentence should be for particular crimes and in particular situations. The Act was amended to make sure that children and youth who come before the normal court can be referred to a Children’s Court where their needs can be meet.
Understanding restorative justice The criminal justice system is there to make sure that people (including children and youth) who commit crimes are dealt with appropriately. This means that they are punished and reformed. If children come into conflict with the law they are at risk in the following ways: • being labelled • dropping out of school • becoming victims of abuse during incarceration • committing more crimes Although children and young people must understand that what they did is wrong, it is not always necessary and in their best interests to be punished by a normal court in the criminal justice system.
the “old style” – punitive justice Punitive justice focuses more on establishing blame and guilt and imposes punishment that is painful and harmful. The punishment is directed by the courts. There is no room for forgiveness or for accountability by the individual for the harm caused.
restorative justice
incarceration
punitive justice
removing the causes of harm and mending what is broken
the time spent in prison
having to do with who is to blame for a crime and what their punishment is
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Restoration means “mending what is broken, healing the hurt and the removal of causes of harm”. This can be done by: • having procedures that are outside the normal criminal justice processes (going to court) • referring the child or young person to diversion programmes where he or she will have the opportunity “to mend what was broken” and to heal. Family group conferences and victim-offender mediation meetings are two examples of restorative justice procedures. This involves bringing together the child, the victim, their families or other people in their lives. The social worker normally leads the process and gives the child a chance to acknowledge and apologise for what was done. The victim can also give ideas of what the child can do to rebuild what has been broken. An example is a child helping in the shop from where he or she stole goods.
Responding to vulnerable children
This is another way of thinking about criminal justice. What does it do? • It creates the space for moral, social, economic and individual contexts to be restored or healed. • The focus is on problem-solving and creating dialogue. • It uses negotiation to deal with the conflict. • It provides the space for all individuals concerned to be involved in a process that leads to the balance being restored.7
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the “new style” – restorative justice
Everyone can heal through the process of restorative justice.
7 Religious Society of Friends (Quakers). 1994. Restorative Justice Action Pack. Repairing the Harm: Friends and restorative justice. QSRE Social Justice Committee.
diversion programmes
mediation
programmes that remove you from the problem and help your wellbeing
a process to try to end a disagreement between 2 people or groups
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Understanding diversion programmes and the role of service providers8 The Child Justice Act defines “diversion� as: Diversion of a matter involving a child away from the formal court procedures in a criminal matter by means of the procedures established in the Act.
Diversion programmes aim to help the child make amends for the crime, and to heal the child and the victim or community affected by the crime. Diversion programmes form part of restorative justice programmes. These programmes are there to replace normal court procedures (such as a trial) and punishment (such as a sentence in a correctional facility). The child could be ordered by the magistrate and court to participate in the diversion programmes. Then the child will not get a criminal record. The social worker (probation officer) or the court can refer children and youth to programmes that must be completed as agreed by the prosecutor. If the child does not complete the programme or the order, then he or she is likely to be referred back to the court for a trial.
8 Child Justice Act 2007
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Service providers that offer diversion programmes must be accredited with the Department of Social Development to provide these services. These could be NGOs, CBOs or FBOs. The following is required: • Service providers will work closely with the Probation Officer or officials from other departments to make sure that the requirements are met and that the child is referred back to court if he or she does not comply.
Responding to vulnerable children
Examples of diversion programmes include: • Youth development programmes where the child learns new skills and gains knowledge • Wilderness programmes that take children into the country and help the child discover who they are • Community service, such as working at the local library, where the child contributes to the same community that was harmed by the crime • School-based programmes to address learning difficulties or behaviour • Referral to counselling or therapy for treatment
Module 7
Diversion has many advantages for the child
• It is expected that children and youth who participate will give their full co-operation and will follow the requirements. • The improvement in the child’s behaviour will also be reported. • In many instances the child will also attend individual or group sessions with a social worker or other professional to look at specific problem areas to prevent further crime.
accredited officially confirmed as being good enough to provide a service
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Group discussion and Learner Workbook activity
Responding to children in conflict with the law Aim: to understand and apply your understanding of children in conflict with the law in your community Read the case study below and then answer the following questions. Go to your Learner Workbook to answer questions 1 to 5. Answer question 6 on your community map, and question 7 in the space provided on the opposite page. CASE STUDY
LESEBO Lesebo is 16 years old and his mother passed away a few weeks ago. He does not know where his father is. He is looking after his two younger sisters and they are all still living in his mother’s house in a small village. They are not registered for a social grant, and his grandmother who lives next door only gets a pension. Although Lesebo is still registered at the high school 4 kilometres away, he does not go to school every day.
Module 7
Responding to vulnerable children
ACtIvIty 7.6
Lesebo went to the local shop because he was very hungry. He watched the shop manager, Mr Suliman, emptying the till of money. It was a lot of money! Lesebo thought to himself, “If I take a few things worth maybe R100 it will make no difference to him. Besides that man has a big car and lots of stuff!” He took bread, biscuits, a chocolate, beer and a few small things he could put in his pockets. He had nearly made it out the door when he felt a hard whack on his back and shouts from Mr Suliman. Lesebo tried to run but he was trapped. He closed his eyes as he dropped the stuff and prepared himself for the worst.
trapped couldn’t get away
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2. If you were Mr Suliman, how would you react (your behaviour)? 3. What action would you (as a community caregiver) take against Lesebo? 4. What could happen to Lesebo if restorative justice is not used? 5. To which restorative justice procedures and programmes could Lesebo be referred? 6. What programmes and services are available in your community that you know about? Add these to your community map.
Module 7
7. What can you as a community caregiver do to respond to children in conflict with the law? How can you build restorative processes in your day-to-day activities?
Responding to vulnerable children
1. Which risk factors lead to Lesebo committing a crime?
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Module summary: main learning points • Community caregivers have moral and legal responsibilities to report abuse to the police, a child protection organisation or a provincial or district social worker. • It is important to know how to respond to children. • There are a number of services available to help and support children in need of care and protection. • There are a number of prevention and early intervention activities that community caregivers can include in their day-to-day work with children and families. • The Children’s Act, Domestic Violence Act and Sexual Offences Act are important legislation that guide the legal and social response to child abuse, neglect and exploitation in South Africa. • The National Policy Framework and Strategic Plan is for the prevention and management of child abuse, neglect and exploitation. It aims to guide the coordination of child abuse cases and to guide the strategy to reduce incidents of child abuse in South Africa. • If you have reasonable grounds to believe that a child has been abused, neglected or exploited, then you must report the case to the police, a social worker or a child protection organisation.
Module reflection: what does this mean for me? 1. What have I found useful about the things we have spoken about in this module? 2. What have I found difficult about the things we have spoken about in this module? 3. What will I do differently in my work using what I have learnt in this module? 4. What do I still need to know?
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Module 8
Caring for the community caregiver in the organisation and community Reminding ourselves – what is psychosocial wellbeing? . . . . . .231 Developing myself as a community caregiver . . . . . . . . . . . . . . . . . . . 233 Developing my skills to implement self-care
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Forgiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 Being assertive
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Negotiation skills
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Dealing with criticism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Acceptance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Making self-care an everyday part of your organisation . . . . . . 245 Why do we need a psychosocial programme in our organisation? . . . . . . . . . 245 Developing a psychosocial wellbeing programme in our organisation
.....
247
How can my organisation contribute to creating a caring environment in my community? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . 250
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Module 8
Caring for the caregiver in the organisation and community
Why is this module important? After a long journey and a great deal of hard work, we are coming to the end of this training course. At this point it is important for us to review our work in the previous modules and make sure that we really understand how it all fits together. In this module we will spend time: • looking back on all the previous modules • reminding ourselves of what we have learnt • reviewing our own psychosocial wellbeing • reviewing our personal Self-Care Plan • looking at possible ways to improve these by exploring our skills, such as being assertive, negotiating, dealing with criticism and accepting negative feedback • looking at how to include our new knowledge about community development and child protection • exploring ways of making psychosocial wellbeing an everyday part of the way we work, and a part of the way our organisations function When we have done this, we will be ready to return to our communities confident that we can do a good job as community caregivers and still stay healthy and happy.
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You have come a long way since we first looked at psychosocial wellbeing. It is now time to reflect on your understanding, and to re-write your definition based on what you have learnt and experienced since Module 2.
Module 8
Some of the things we explored were: • physical, mental and emotional health • friends, family and work relationships • self-awareness • social support
Caring for the community caregiver
Reminding ourselves – what is psychosocial wellbeing?
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ACtIvIty 8.1
Individual reflection
My understanding of psychosocial wellbeing Aim: to reflect on my learning and understanding of psychosocial wellbeing Think about the following questions and answer them for yourself: 1. Write down your own understanding of psychosocial wellbeing.
2. Explain simply and shortly how the following tools can help you with your psychosocial wellbeing: Tool a. Wheel of Psychosocial Wellbeing
My explanation
b. Tree of Life c. Pyramid of Psychosocial Support d. Your Self-Care Plan
3. Where do you get psychosocial support in your daily activities and community?
4. How will the knowledge and skills from the Thogomelo training help you to care for your beneficiaries, especially children, in your community?
5. What has the Thogomelo Psychosocial Support Skills Development Programme meant for you, and how has it influenced your thinking about yourself and your life?
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Developing my skills to implement self-care First, it is important for us to pay attention to our thoughts and feelings. This is because it can be quite discouraging to find out that we have not succeeded in looking after ourselves as well as we had hoped. Here are some things that you might be feeling and thinking: Hopelessness
“I really wanted to change the way I care for myself but once again I failed. I will never get it right. I may as well just give up.”
Helplessness
“I really wanted to change the way I care for myself but something always gets in the way. Other people always want something from me and there is nothing I can do.”
Ashamed
“I’m sure everyone else in the class did better than me. I am embarrassed that I didn’t try harder to keep to my pledge.”
Angry
“I am really cross with myself that I didn’t do this. I have really let myself down here.”
Caring for the community caregiver
When we returned to the training after the break, we looked at our experience of our Self-Care Plans. Some of us were able to implement all or part of our Self-Care Plans. Many of us had challenges and difficulties with them. In this section, we will explore tools and skills that can be used to improve our self-care. This will help us to: • develop further as effective community caregivers • plan for our own wellbeing and development • stick to our plans and pledges • take better care of ourselves
Module 8
Developing myself as a community caregiver
Take a moment to think about your own feelings. Are you feeling any of these things? Are you feeling something different? For now just take note of your feelings. You will not be asked to share them, but it might be useful to talk about them with your partner, a friend or your peer support group.
beneficiaries
implement
discouraging
ashamed
people who get money and things when you die
put into action; carry out
feelings it is useless to try to do something
feeling guilty or embarrassed
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Caring for the community caregiver
There are five tools and skills that you can develop to help you with your self-care and wellbeing: 1. Forgiveness 2. Being assertive 3. Negotiation skills 4. Dealing with criticism 5. Acceptance
Module 8
It may sometimes happen that community caregivers feel that other people stand in their way, and prevent them from doing the things that need to be done. They could become very negative towards these people. When feeling negative about others and ourselves, it is impossible to enjoy psychosocial wellbeing.
1. FORGIVENESS Many community caregivers find it easier to take care of other people than to take care of themselves. Community caregivers often find it difficult to accept that they have limitations. If we allow our feelings of hopelessness, helplessness, shame or anger to take over, we may become too discouraged and give up wanting to help other people.
Self-care is about: • forgiving ourselves and others for our past shortcomings • letting go of our bad feelings • committing ourselves to doing better in future For effective self-care, it is important to recognise that life is a journey. Although we cannot change the past, we can always try to make the future better. Close your eyes and take several deep breaths. Then say to yourself: “I forgive myself for the things that I was not able to do. Those things do not matter anymore. The future matters, and I am committed to doing better from now on.” If there is someone else you would like to forgive, complete the same exercise for that person. Close your eyes and take several deep breaths. Then say to yourself: “I forgive……for……”
Forgiveness means forgiving ourselves and forgiving others. assertiveness
passive approach
self-centred
confidence about expressing your opinion
a way of doing things that is not assertive; being like a “lamb”
selfish; only thinking about yourself
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Non-assertive behaviour This means withdrawing from a situation. It is a passive approach to a situation. It can result in: • Denying your feelings or opinions • Allowing others to choose for you • Guilt, anger and frustration
Caring for the community caregiver
People may say things like: • “Oh, it’s nothing.” • “Oh, that’s all right. I didn’t want it anymore.” • “Why don’t you go ahead and do it? My ideas aren’t very good anyway.”
Module 8
2. BEING ASSERTIVE Many people find it difficult to express their feelings honestly and openly because they lack assertiveness. This can become a problem when building relationships, managing projects or communicating with friends, family members and coworkers. There are three typical types of behaviour: non-assertive, aggressive and assertive.
Aggressive behaviour This means over-reacting emotionally to a situation. Aggression can also take the form of a lie or a twisting of the facts. This is a self-centred approach to a situation resulting in: • “Put down’’ feelings on the receiver’s part • Not allowing others to choose for themselves, but choosing for them • Being unfriendly, defensive as the aggressor and hurt, humiliated as the receiver People may say things like: • “Are you crazy?” • “You make me sick!” • “You are selfish, lazy, etc….!” Other examples include sarcasm, name calling, threatening, blaming, insulting.
humiliated
sarcasm
embarrassed; shamed
saying the opposite of what you mean to make someone feel stupid
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Assertive behaviour Assertiveness is the ability to express your feelings, opinions, beliefs and needs. This is done directly, openly and honestly, while not violating the personal rights of others. Assertiveness does not in any way mean being aggressiveness. Aggressive behaviour is self-enhancing at the expense of others. It does not take other individuals’ rights into concern. Assertive behaviour is: • Correcting the situation when your rights are being violated. • Seeking respect and understanding for your feelings about a particular situation or circumstance. • Direct, upfront, (not defensive or manipulative) behaviour. Those using assertive behaviour confront problems, disagreements, or personal challenges head on. Their intent is very clear to others. • Using “I” statements rather than “you are”, when you tell others how you feel about a situation or their behaviour. • Finding a “win-win’’ solution in handling problems between two individuals. • Not giving in to pressure that is placed on you by another person or group (standing your ground). Assertive behaviour in a person is when they are sure of themselves, and can say what they think, feel and need. This is not being self-centred. It is about being active rather than passive in dealing with life’s situations. It can result in: • Being open and expressing your thoughts and feelings • Allowing others to choose for themselves • Everyone gets satisfaction from achieving a desired goal
violating
defensive
manipulative
passive
breaking; abusing
getting angry because you think someone has offended you
getting people to do things by tricking them or lying to them
letting things happen without trying to change them
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Body language that goes with assertive behaviour: • Eye contact and facial expression: Keep some eye contact, appear interested and alert, but not angry. • Posture: Stand or sit up straight, possibly leaning forward slightly. • Distance and contact: Stand or sit at a normal distance from the other person. • Gestures: Use relaxed hand movements, or nod your head. • Voice: Use non-emotional tones of voice (in other words don’t shout or raise your voice). Sound firm and serious, but not bossy. • Timing: Choose a time when both of you are relaxed A neutral site is best.
Caring for the community caregiver
• Express feelings about a situation without threatening others: - Identify the situation: Say things like, “When you criticise me …” - Identify how you feel about it: Say things like, “I feel angry because …” - Identify what you want: Say things like, “When you criticise me, I feel angry. I want you to know that, and to stop criticising everything that I do.”
Module 8
Strategies to be assertive include: • Make your desires and feelings known. Do not be side-tracked by others. Make a short, clear, assertive statement of your goal. Take into account what others are saying by continually repeating your goal, for example by saying, “Yes I understand (other’s response) but I still want (state your goal).”
Assertiveness is the ability to express your feelings, opinions, beliefs and needs.
continually
criticise
neutral site
all the time; again and again
say someone is doing something badly
a place that is not connected with anyone involved
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Caring for the community caregiver Module 8
3. NEGOTIATION SKILLS People solve disagreements in many ways Some deal with possible conflict by denying it or trying to avoid it altogether. Instead of confronting and solving problems, they may let their anger and resentment build up while they remain silent. This approach can result in constant personal stress, which can lead to illness or poor general health. If disagreements are not resolved, the possibility for more conflicts at some later time is increased. Problems do not get better or go away on their own very often. The goal of negotiation is: “everyone wins” Good negotiation is a two-way process that encourages both sides to actively participate in making decisions. It also provides a way for people to learn to understand each other better and to grow in their relationships. Negotiation helps to create a healthy balance between “giving” and “getting”. There are no “good guys”, “bad guys” or “winners” or “losers”. Negotiation is based on equality. No one has more power or control than another person. Each individual’s ideas, attitudes, values and objectives are recognised and respected. Solutions are agreed on by both people. Everyone becomes a “winner” through effective negotiation. How can everyone win? The key to good negotiation is clear communication. Communication involves three important skills: good understanding with good listening and good speaking. Negotiation is most effective when people are able to clearly identify and discuss their sources of disagreement and misunderstanding.
disagreements
resentment
negotiation
two-way process
fights; arguments
anger because you feel you have not been treated fairly
discussing things to reach an agreement
when both people or groups take part in discussions
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Caring for the community caregiver
Listening • Listening is the active process of concentrating all of one’s attention on the other person. • Encourage the other person to share thoughts and feelings. Give feedback on what has been heard. Keep eye contact. These are skills that show you are interested in understanding what he or she has to say. • It is always helpful to simply ask, “I understood you to mean….. Am I correct in this?” or “I hear you saying that you are…. Is that how you feel?” • Active listening assures the other person that he or she is heard, accepted and respected. The ability to listen actively supports open, ongoing negotiation.
Module 8
Speaking • Negotiation begins with a clear explanation of the problem as each person sees it. • Facts and feelings are presented in a rational manner from the individual’s perspective, using “I” statements. Communication between people will go more smoothly when statements such as “I become very upset when you…” are used rather than more aggressive statements such as “You make me mad when you…”. This blames the other person and puts him or her in a defensive position. • Shared issues rather than individual issues need to remain the focus of discussion throughout negotiation. • The negotiation process will be most effective when people take time to think through what they will say. When possible, plan ahead to meet at a time and place well-situated to everyone. A quiet, neutral spot where there are few distractions or interruptions is perfect for open discussion.
Understanding • Before two sides can look for solutions, a common understanding must be reached. • If two people do not understand each other’s problems and concerns, then the process of negotiation will either be broken off or will end with solutions that do not work. • It is good practice never to assume to understand the other person without first asking: - “Did I hear you correctly?” - “I have noticed that you appear….” - “I sense you are under strain. Do you want to talk about this?” - “I’d like to hear from you about how you are feeling.” These are all good examples of statements that encourage communication and better understanding between people.
equality
rational
defensive position
assume
when everyone is equal and everyone is important
sensible rather than emotional
when a person has to protect themselves from criticism
think something is true without proof
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Caring for the community caregiver Module 8
Guidelines for successful negotiation • Show respect to everyone involved in the negotiation. • Recognise and define the problem – each person begins with a clearly identified statement of what he or she wants and/or needs. From this process, a common ground for agreement between the individuals can be found. Problems are examined apart from the personalities involved. Blaming the other person is inappropriate and destroys the co-operative nature of negotiation. • Look for different solutions – mediators can provide unbiased help with the negotiation process. Brainstorming is one way to gather many creative ideas rapidly. This process allows everyone to openly make suggestions without fear of criticism. At this stage, every suggestion has value and is accepted. After all suggestions have been shared, they are reviewed to work out whether they might coincide or overlap with each other. Negotiation then becomes a matter of choosing a solution to which no one has an objection. Remember, personal goals should not become more important than shared goals. • Collaborate – working together doesn’t mean “giving up” or “giving in” to another person’s demands or goals. Two or more individuals can agree that disagreement exists. However, they can also agree to put aside their anger, frustration, resentment and egos in favour of working together for a solution to a common problem. All negotiated work is completed by consensus. A negotiated solution is reached when everyone has given up something to gain common benefits. • Be reliable – it is important to follow through with negotiated agreements.
The goal of negotiation is for everyone to win.
mediators
unbiased
brainstorming
collaborate
people who take part in a disagreement without taking anyone’s side
not taking anyone’s side
thinking and talking about something in a group
to work with someone to produce something
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Unfortunately, most of us view criticism as unnecessary feedback. Criticism feels like a knife being hurled at us, and we either duck or throw it back. We become defensive when we’re criticised, and we end up in “word wars” that only make us feel more hurt and angry. If we recognise that criticism can help us grow, we can analyse what’s being said to us. Then we can respond with our brain rather than our emotions. By doing this, we’ll have a better idea of who we are. Here are some guidelines to help • Recognise the value of constructive criticism. This can improve relationships and productivity. • Listen actively. Even though criticism may hurt, try to understand the criticism: - rephrase what the other is saying. - ask questions to increase your understanding. • Work hard to avoid becoming defensive. Resist any temptation to dismiss the criticism or to strike back. • Welcome criticism. Use it to improve yourself. • Look in yourself for positive changes to the behaviour that caused the criticism. • Insist on valid criticism that is timely and specific. • Communicate clearly how you feel and think about the criticism and receiving criticism. Use “I” messages.
Caring for the community caregiver
“Criticism is information that will help you grow”.1
Module 8
4. DEALING WITH CRITICISM Criticism comes from the Greek word kritikos which means “to judge for the sake of improvement”. So it’s really a positive thing.
Constructive criticism can improve relationships and productivity. 1 Hendrie Weisinger, Ph.D., psychologist and author of The Power of Positive Criticism (Amacom, 2000).
egos
consensus
productivity
valid
timely
the selfish parts of people; their opinions about their own importance
when everyone agrees
how well you work
real and suitable
when something comes at the right time
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Caring for the community caregiver Module 8
5. ACCEPTANCE Acceptance is necessary for coming to terms with that which we have no control over or cannot change. Life is not always fair. Things happen. Situations do not always work out the way we want them to. We need to be willing to see things as they are. How do we handle it? • We do not deny that unfortunate circumstances exist and that life doesn’t always go our way. We also do not fall apart in helplessness and give up. The first reaction to difficulty or trauma is often the desire to give up. Even denial seems to be a better option than having to face reality. • After we get over the first blow and shock to the system, we have to make a decision. Do we let the event put us out of action, or do we accept what we cannot change and make the best of the situation? • Acceptance doesn’t come easily. It might even be necessary to take time to think about and accept what has happened. Talking to compassionate friends or getting counselling is also helpful, but at some point we have to come to terms with a situation and accept it. • Most psychological suffering is caused by avoidance or escape from life’s challenges. We cannot avoid problems. We must face them, and by coming to terms with them, we prevent unnecessary suffering.
As soon as we accept a situation we cannot change, we free ourselves from it and it becomes easier to handle.
circumstances
acceptance
compassionate
situations
accepting and understanding that bad things sometimes happen
kind and caring
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What can I learn from other community caregivers about the skills they have developed? Aim: to understand the qualities and skills of a successful community caregiver who accepts criticism, is good at negotiation, is assertive and accepting, and to think about what I can learn from them. Think of a person who you think is a very good community caregiver. She or he might be a community caregiver in your organisation, or a nurse, social worker, teacher, community elder, a person related to a religious organisation, or a traditional healer. The person should be someone that you can learn from to help you grow as a community caregiver. In a small group share the following: 1. Who is the person? 2. What type of assertive behaviour does this person have towards other people? 3. How does this person handle criticism and accept negative feedback? 4. What type of negotiation skills does this person have?
Caring for the community caregiver
Small group discussion
Module 8
ACtIvIty 8.2
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Caring for the community caregiver Module 8
ACtIvIty 8.3
Individual reflection
Developing myself as a successful community caregiver Aim: to establish my personal psychosocial support network Answer the following questions in the spaces provided: 1. What are my goals as a community caregiver? Think about the goals you set in Module 3. Do you want to change them or do they still suit you?
2. Tick which of the following skills and tools you need to develop to help build your selfcare. a. Forgiveness
d. Dealing with criticism
b. Being assertive
e. Acceptance
c. Negotiation skills 3. How am I going to build the skills I need?
4. Who can support or mentor me to develop myself as a successful community caregiver?
5. Who can support or mentor me to respond to child protection issues?
6. Turn back to the local referral list that you developed during your practical field work between the two training blocks. The Thogomelo “My Guide to Psychosocial Wellbeing� is in your toolkit. Write down other names of the organisations, contact people and contact numbers that you might want to add to the list you have already developed. a. b. c.
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In this section we will: • explore why we need a psychosocial wellbeing plan in our organisation • give examples of what organisations can do • discuss how we can develop psychosocial wellbeing plans in our organisation In this section we define our “community” as our organisations and the community caregivers that are part of our organisations.
Why do we need a psychosocial programme in our organisation? Mainstreaming psychosocial support into the organisation is about making sure that the psychosocial needs of caregivers are catered for in all organisational activities.
Caring for the community caregiver
Sometimes it is difficult for us to remember to take care of ourselves. We often put the needs of our beneficiaries before our own needs. For this reason it is important that our organisations also remember to take care of us.
Module 8
Making self-care an everyday part of your organisation
Organisational activities These include: • Policies and procedures • Programme design and activities • Planning and budgeting • Capacity-building and human resource development • Monitoring and evaluation • Networking with government sectors and institutions • Service delivery, such as community caregiving
mentor
mainstreaming
capacity-building
monitoring
evaluation
a person who gives advice and acts as a teacher and guide
making sure it is accepted by most people
developing or strengthening skills and abilities
watching or observing
assessing and seeing how someone or a situation is doing
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Caring for the community caregiver Module 8
Mainstreaming psychosocial support This is important because: • It makes sure that staff and community caregivers are taken care of, valued and acknowledged in the organisation. • It makes sure that there is commitment to the personal and career development of community caregivers by providing for ongoing learning in the field. • It makes sure that the organisation opens opportunities for community caregivers to receive psychosocial training and support. It also facilitates the process of networking and referrals with other organisations. When the psychosocial needs of caregivers are met, they can care for themselves, their families and their beneficiaries. Mainstreaming psychosocial wellness in the organisation makes sure that the community caregivers receive support, and are nurtured and guided in their work.
Examples of psychosocial support programmes within organisations • Organisations can support community caregivers by developing, strengthening and maintaining systems and structures that assist with psychosocial wellness. • Some of the systems and structures include the process of mentoring and supervision. Mentoring and supervision provides support and guidance and also assists with finding a career. • Capacity-building is another system that can help with the psychosocial wellness of caregivers. It involves training, ongoing learning, coaching and mentoring from professionals in the field such as co-ordinators, social workers, psychologists and trained counsellors. • To mainstream psychosocial wellbeing, organisations can establish and maintain systems for referrals and networking with other organisations that provide support for community caregivers. • Organisations can also provide space for group debriefing and personal counselling as stated in the DSD Norms and Standards. The debriefing sessions should be facilitated by professionals. Debriefing and counselling sessions allow caregivers space to receive care and offload their own burdens that they carry every day. • The organisation can also give caregivers time to develop their own support groups where they come together and share experiences. Support groups offer a safe place to seek and give advice, and to share practical information with others.
mentoring
psychologists
debriefing
when an experienced person teaches and helps someone less experienced
people who study how people’s minds work and how this affects their behaviour
to offload burdens and receive care from a health professional
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• • •
• • •
Allowing community caregivers time off when needed Having information days for learning and sharing knowledge and experience Prayer meetings before work Family days, such as getting together for a picnic, to play soccer, to visit a place of interest, or to celebrate the organisation’s successes Celebrating community caregivers’ birthdays Starting a choir in the organisation with community caregivers Community caregivers doing fun activities as a team such as playing netball, developing a drama for the community, painting a wall at a crèche, or having a picnic on a Friday afternoon Growing vegetable gardens or starting sewing clubs Regular staff meetings to share experiences, concerns and successes Recognising community caregivers’ work by giving them awards or days off
Developing a psychosocial wellbeing programme in our organisation You have an opportunity now to meet with other community caregivers in your organisation to discuss the ways that you would like your organisation to take care of you. This should include psychosocial wellbeing in your day-to-day and monthly activities (mainstreaming). How can our organisation take care of us?
Caring for the community caregiver
• • • •
Module 8
Some of the practical day-to-day activities that organisations can implement
We need to find ways in which we can all work together.
Then we can look after our wellbeing as well as the people in our community.
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In doing this try to remember the following: • The responsibility for your wellbeing must be shared between you and your organisation. Think about what you will do, and what you would like your organisation to do for you. • The need for care of community caregivers must be balanced against the need to work hard and to do a good job for the people in your community who depend upon your services. • Sometimes little things can make a big difference. We have been looking at how we can contribute to community development on an individual and organisational level. It does not help if we keep this information to ourselves. We need to share it within our organisations so that we can contribute to the greater good of community development. The next section explores this.
How can my organisation contribute to creating a caring environment in my community? We will develop a plan of action which will look at how we can create a better environment, in terms of psychosocial support, for ourselves and our beneficiaries. In Module 3, we developed a Self-Care Plan that we are starting to implement. Remember that taking care of yourself: • improves your wellbeing • provides you with a positive mind when you are dealing with your beneficiaries We will also explore how to plan, manage and implement activities that you can do that contribute to community wellbeing as part of community development. As a result of this, the community caregiver will: • actively engage us as individual community members in identifying our own needs • encourage self-reliance through the mobilisation of community resources and networks • provide a forum for us to gain self-confidence in planning for our future These are important and critical to any community-based psychosocial intervention.
self-reliance
mobilisation
able to take care of yourself; not needing other people to look after you
organising people and bringing them together to achieve something
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Developing a psychosocial wellbeing programme in your organisation Aim: to make self-care an everyday part of your organisations’ work; and to develop a community mapping (situational analysis) for strengthening psychosocial wellbeing in your community. The Practical Leaner Workbook 2 will guide you through the process of developing a psychosocial wellbeing programme in your organisation: 1. Meet with fellow community caregivers from your organisation and share ideas for how your organisation can put psychosocial support and wellbeing into the daily, weekly and monthly activities. Write down at least five ideas in your Workbook that you will be able to discuss with your managers when you return to your community. 2. Select one of the ideas to develop further into a project that you can all contribute to that will build community caregiver psychosocial wellbeing in your organisation. The purpose of this is to support the community caregivers in your organisation and community. 3. Develop an action plan for this project in your organisation. Use the action plan in your Learner Practical Workbook 2. Remember to include in your plan how you as an individual can contribute to the specific caregiving project you are developing.
Caring for the community caregiver
Organisation activity and Learner Practical Workbook activity
Module 8
ACtIvIty 8.4
4. Think about how you can approach supervisors and managers about mainstreaming care in the organisation. Write down a few steps you can take when you are back in your organisation. Include as one of the steps a meeting with the management and other important people in your organisation to present your plan. Then they can support and be involved in this plan.
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Caring for the community caregiver Module 8
Module summary: main learning points • There are many skills that help in your personal development as a community caregiver. • These skills include forgiving ourselves, being assertive, negotiation skills, acceptance and dealing with criticism. • Community caregivers can build on their strengths and interests, develop plans to overcome their personal limitations, and develop their skills. • There are a number of different ways that community caregivers can build their psychosocial wellbeing in their daily activities, their organisations and in their communities.
Module reflection: what does this mean for me? 1. What have I found useful about the things that we have spoken about in this module? 2. What have I found difficult about the things that we have spoken about in this module? 3. What will I do differently in my work using what I have learnt in this module? 4. What do I need to know more about?
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Module 9
Palliative care for children Understanding palliative care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Understanding community home-based palliative care . . . . . . . 253 What is community home-based care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
the principles of palliative care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 A team approach to community home-based palliative care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255 Practical application of palliative care for community caregivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255 Emotional care and support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Spiritual care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Social care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Cultural care
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Behavioural care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Managing children in pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258 What is acute and chronic pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Management and treatment of pain
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
What can influence pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Caring for yourself while supporting a child who is terminally ill or in pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 Module summary: main learning points . . . . . . . . . . . . . . . . . . . . . . . . . . . 264 Module reflection: what does this mean for me? . . . . . . . . . . . . . . . 264 251
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Module 9
Palliative care for children1
Why is this module important? As a community caregiver, it is often difficult to watch or respond to children who are in pain or who are terminally ill. This module gives information on understanding and responding to children who are terminally ill, or who are in pain from an injury or a disease.
Understanding palliative care Palliative care for children is a special area of care. It is similar to adult palliative care. The World Health Organization says that palliative care supports children and their families: • It includes the child’s body, mind and spirit. It also gives support to the family. • It begins when the illness is diagnosed and continues whether or not a child receives treatment for the disease. • Health care providers evaluate and try to remove a child’s physical, psychological and social distress. • Care requires a broad multidisciplinary approach. This includes the family and available community resources. Care can be successfully given even if there are few resources. • It can be offered in tertiary care facilities (such as a hospital or hospice), in community health centres, and even in children’s homes. 1 NALEDI HOSPICE. September 2005. A guide for health care personnel in Pediatric Palliative Care. Free State: South Africa. NALEDI HOSPICE and the Department of Health. National Guidelines: Palliative Care for Adults South Africa.
terminally ill
evaluate
multidisciplinary
tertiary care
very ill; you will not live for long
think carefully about something; examine
involving several different approaches
special services given in some hospitals for people with complicated problems
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What is community home-based care? It is a health service. The care can be given by formal and informal caregivers in the home to promote, restore and maintain a person’s maximum level of comfort, function and health. This includes care towards a dignified death. Home-care services include the following: • Prevention interventions
• Rehabilitation
• Health promotion
• Psychosocial support
• Therapeutic intervention
• Palliative care
Palliative care for children
Understanding community home-based palliative care
Module 9
The goal of palliative care for children is to: • Maintain the quality of life of the child. • Keep the child as comfortable as possible. • Provide emotional support to the dying child and the grieving family.
Community home-based care helps the patient to get help nearest to home. It achieves the following: • encourages everyone to be involved • responds to the needs of people • encourages traditional community life • creates responsibilities Home-based care has the advantage over hospital care because it allows the care team to assess the child and caregiver’s social and economic situation. It also helps break down or prevent the sense of isolation experienced by many people with terminal diseases. A community home-based palliative care approach tries to satisfy three basic needs of the child and family: • Psychosocial and spiritual support • Physical support • Material support, for example food and clothes
dignified
therapeutic
isolation
calm and painfree
treating with medicines
feeling or being far away from everyone
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Palliative care for children
the principles of palliative care
Module 9
Right to information and privacy This means that the child, primary caregivers and family have the right to be informed about the disease, treatment, outcomes, appropriate resources and choices. It is the responsibility of the community caregiver to provide this information in an honest way. They must respect the child, primary caregiver and family’s right to confidentiality. Confidentiality is important to keep the privacy of the patient or beneficiary (remember back to Module 1, page 24).
Palliative care is centred on the following principles: Care is comprehensive This means that care is directed towards meeting the physical, psychosocial, social and spiritual needs of the child, caregiver and family. This is given with sensitivity to their personal, cultural and religious values, beliefs and practices. Care is patient oriented This means that the child, primary caregiver or family control the decisions around the care. Any sort of care should preserve and promote the self-sufficiency of the child, caregiver and family.
Right to choice This means that the child, primary caregiver and the family have the right to be heard, to be told facts, to share decisions with the service provider and other primary caregivers. The caregiver or family’s choices about the child’s care need to be respected. Interdisciplinary team This means that there should be a mixed team with different forms of training that all provide care. They all have a common goal of improving the quality of life for the child. The ‘”community” of carers includes the family, friends, neighbours, community groups, community caregivers and health and mental health professionals who provide the physical, psychosocial and spiritual support. Quality of care This means that care is delivered within the framework of the national palliative care guidelines.
self-sufficiency
interdisciplinary
to be able to look after yourself
a mixed team with different subjects of study
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• Understand the grief process as family members may go through different emotions, such as denial, bargaining, anger, depression and acceptance (remember back to Module 4). • Observe and respect the child’s cultural rituals and customs regarding death and dying (remember back to Module 4). • Understand the importance of support systems for the family, such as: - not having to deal with the loss by themselves - having access to people who can offer emotional support during the course of their grief - having reliable people who will be able to assist in some of the day-to-day jobs • Be part of the team approach to community home-based palliative care • Take care of themselves when they look after terminally ill children
Palliative care for children
• Support the child and his or her family and primary caregivers.
Module 9
What can community caregivers do?
A team approach to community home-based palliative care Home-based care needs a team approach to provide the patients with all the support they need. Team members can include: • A medical practitioner or professional nurse from the nearest hospital, clinic or non-governmental organisation to outline and monitor the child’s care plan. • A social worker or trained counsellor who can help the family to talk about and cope with issues such as their grief and stress and their material and financial concerns. They can then refer them to the right community resources. • Friends and neighbours who can help the family with simple tasks. This may be just someone to talk to, or perhaps just to spend time with them. • Community members who may be able to provide support such as meals, or doing small tasks for the family.
monitor check
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Palliative care for children Module 9
• A religious or spiritual leader who will meet the spiritual needs of the child, primary caregiver and family and be able to provide special prayers and ceremonies important to the patient and family. • Community caregivers can help identify community needs, for example, financial needs. They can also lobby for services and resources, advise formal systems, and negotiate with other sectors around preventive, curative, therapeutic and palliative care.
Practical application of palliative care for community caregivers 1. Emotional care and support • Beneficaries and their families or primary caregivers should be emotionally supported in an empathetic way on an ongoing basis. • Beneficaries and their families or primary caregivers should be educated about their condition and their treatment. They should be involved in the decisionmaking process. • Counselling should form an important part of the process. • Always tell the truth, but do this in an empathetic way. • A person-centred approach should be applied. This means you should listen to the beneficaries’ concerns, fears and feelings in an empathetic way. • Pay attention to the beneficary and talk about common emotions such as fear, denial, guilt, anger, sadness, bargaining and depression. • Be there for the child and his or her family. • Refer beneficaries to psychologists, psychiatrists, counsellors, traditional healers, if necessary. • Training should be given to help with coping skills for children, their families and caregivers. • Encourage the beneficary and family to talk about the diagnosis and death.
lobby
negotiate
empathetic
to try to influence politicians or people in authority
to reach an agreement by discussing things
understanding how another person feels
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The following opportunities should be available to the beneficaries together with community caregivers and family members: • Prayers • Singing • Scripture-reading • Sacrament
Palliative care for children
For those nearing the end of life, there is often an increased need for: • Affirmation and acceptance • Forgiveness and reconciliation • The discovery of meaning and direction • A spiritual relationship, for example with God • Involvement of spiritual leaders in the care and support of the beneficary
Module 9
2. Spiritual care
3. Social care • The value of community caregivers, social workers or mental care workers in the multidisciplinary team is important. • Food, income and a home are important in providing for the wellbeing of the child. • Assistance with all of the basic necessities of life as well as access to grants, when necessary, is essential. • Good relationships within the family and society should be maintained and assisted.
4. Cultural care This includes: • Respect and sensitivity for the family’s cultural norms and values. • Removing the language and cultural barriers that may be there between the community caregiver and the child.
affirmation
reconciliation
support or approval
friendly relationship with someone you used to argue with
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Palliative care for children Module 9
5. Behavioural care This needs to be arranged according to the beneficary’s wants and belief systems. There must be co-operation between the behavioural and medical teams. This should be a form of extra care and should not be given instead of other forms. Examples include: • Counselling • Psychotherapy • Meditation • Touch massage • Being comforted and held • Distraction, such as art and music, playing with toys, games • Traditional healing
Managing children in pain Pain is one of the most feared symptoms of a disease or injury. It is a difficult experience as psychological and behavioural factors interact with physical illness or injury. These result in the child responding in a mixed way.
What is pain? The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Pain is about how our body interprets a particular sensation.
Pain is what the patient says it is, and it exists when the patient says it does.2
2 Margo McCaffery, 1968
meditation
distraction
quiet thought that helps you to relax
things that help you to forget about your problems
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Chronic pain This is an ongoing condition. For example, back and neck pain, headaches, nerve pain, bones and muscle pain, and pain related to a disease or ongoing illness. There are different levels or types of chronic pain. These include the following: • Physical pain: stinging, stabbing, burning, throbbing, gnawing, spasmodic or nauseating pain • Emotional pain: sorrow, anger, depression, guilt, shame and fear • Relational pain: combination of physical and emotional pain The treatments for acute and chronic pain are usually quite different. In some cases, pain can be stopped or helped by one single procedure or a series of procedures. Sometimes, chronic pain is part of a widespread disease process, and the specific cause may be difficult to explain. Once the specific factor that causes pain is identified, then it can be treated so that the condition no longer occurs. In some beneficaries, the specific factor causing the pain, such as cancer, cannot be changed. But we may be able to reduce the pain or help the beneficary to better cope with the pain through a combination of medical, psychological and rehabilitation techniques.
Palliative care for children
Acute pain This only lasts a short time. It is usually the result of an injury, surgery or illness. This type of pain includes physical injuries such as a broken leg or a deep cut, postoperative pain and post-trauma pain.
Module 9
What is acute and chronic pain?3
3 http://paincenter.stanford.edu/patient_care/pain.html
gnawing
spasmodic
rehabilitation
continuous pain
happening for short periods and not often
to help someone who has been very ill to return to a useful life
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Palliative care for children Module 9
Management and treatment of pain The objectives of managing pain are: • To recognise and relieve pain as quickly as possible • To relieve fears associated with pain • To provide support and encouragement for primary and community caregivers of beneficaries who are in pain • To maintain the greatest possible quality of life and the ability to die with dignity • To empower beneficiaries to take control of their own pain • To transfer the necessary skills needed in the treatment of pain as early as possible • To use the right medication, right dose, at the right time and right route as prescribed by the medical practitioner • To follow a multidisciplinary approach – it is important that the most qualified person prescribes medication and does the medical procedures • To encourage the participation of the child and family or primary caregiver • To transfer the responsibility for care from the community caregiver to the primary caregiver for treating pain in children • To refer the child to specialised services, if necessary • To make sure that children who have difficulties in communicating their pain get extra care and thought – for example, those unable to hear, a very young child or the elderly
the treatment of a child in pain Community caregivers should: • Relieve the distress in the child • Treat easily manageable complications, such as nausea, sorrow or muscle cramps • Talk with the primary caregivers on what they can do and how they can support the child • Discuss the child’s needs and responses with the health care providers so that they are sympathetic to each child’s needs • Refer the child and family to resources in the community • Refer the child for medical treatment
disfiguration
insight
prognosis
imagined
spoilt appearance; damaged
a chance to understand or learn more about something
doctor’s opinion of how a disease will progress
what you think about something
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Fear of pain, disfiguration, dying, loss or fear of loss of control, independence, dignity, feeling helpless, hopeless Disease
No insight about prognosis
Rapidly progressive
Loss of self-esteem
Unrelieved pain Uncontrolled symptoms
Loss or fear of loss of job, special position, family role, loved one or spouse
Disfiguration, disabilities or physical dependence
Feeling isolated (actual or imagined) and isolation from friends or restorative play
Long illness
Fears for family, anxious personality, being neurotic
Trauma leading to psychological exhaustion
Palliative care for children
Patient
Module 9
What can influence pain?
treatment team Poor communication, unhelpful, disinterested, lack of information and education, lack of continuity of care
Social Pre-existing family problems
Exclusion of patient, family and caregivers in decision-making
Failure of social support or resources
A culturally insensitive manner
Financial hardship treatment
Spiritual or religious concerns not discussed
Delays in diagnosis Failed treatments Bureaucratic red-tape Myths about pain-control methods or medication
restorative
bureaucratic
helping a child to return to a happier and safer state
involving a lot of complicated rules
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Caring for someone who is terminally ill can be emotionally and physically exhausting. All those providing care, family members, friends and caregivers, both professional and lay, need access to some form of support. This is to prevent “burn-out”. It can be through regular support groups or by one-on-one counselling sessions. Think back to what you have learnt in this Thogomelo Psychosocial Support Skills Development Programme for Community Caregivers. Think about this question: How can you put into practice what you have learnt about taking care of yourself when you are working with terminally ill or children in pain?
Module 9
Palliative care for children
Caring for yourself while supporting a child who is terminally ill or in pain
ACtIvIty 9.1
Learner Practical Workbook 2
Palliative care for children Aim: to demonstrate knowledge of palliative care and assisting in the total management of pain. Complete the activities in Section 4 of the Practical Workbook 2 on page 41.
ACtIvIty 9.2
Group and individual role play for assessment
How do I respond to a child in a specific situation? Aim: to demonstrate the practical application of palliative care to provide the best quality of life for the child in a particular situation; and to identify the needs of a child in pain and how to treat the child in relation to the specific situation and available resources. Read the case studies in the Practical Workbook 2 on pages 43–44. In each of the case studies is a child, a community caregiver and a parent or guardian. You will do a role play to show (demonstrate) how you as a community caregiver will respond to the child and the guardian. You will be given time to practise in a group of 3 taking turns to be the child, community caregiver and guardian.
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1. Identifying the needs of a child in pain 2. Showing how you as a community caregiver can alleviate pain in a child 3. Referring the child and guardian to the appropriate palliative care team in the community Important points to bring into your role play: • Make sure the room is clean. • Open windows and make sure there is good lighting. • Make the guardian and child comfortable.
Palliative care for children
The purpose of this role play is to demonstrate the practical application of palliative care by:
Module 9
You will then be assessed on how you as a community caregiver provide quality care to the child. At the end of the role play there will be time to reflect and share on what you have learnt from this activity.
• Offer spiritual support. • Observe the cultural norms. • Ensure confidentiality. • Ask questions that are relevant. • Offer moral support. • Refer the family to the right palliative care team.
cultural norms the standards of culture that are expected in a particular society
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Palliative care for children Module 9
Module summary: main learning points • Palliative care for children is about supporting children who are terminally ill or in pain from an injury or disease. • Community home-based care helps the child to get help nearest to their home. • The principles of palliative care are important to know. • A team approach to community home-based palliative care brings together different types of care to improve the quality of care to the child. • The practical application of palliative care includes providing emotional care and support, spiritual care, social care, cultural care and behavioural care. • Pain is about how our body interprets a particular sensation. • Acute pain lasts a short time; chronic pain is an ongoing condition. • Community caregivers need to know who to assist in treating a child in pain.
Module reflection: what does this mean for me? 1. What have I found useful about the things we have spoken about in this module? 2. What have I found difficult in the things that we have spoken about in this module? 3. What will I do differently in my work using what I have learnt in this module? 4. What do I need to know more about?
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CONgRAtULAtIONS! You have come to the end of the Thogomelo training!
Palliative care for children Module 9
At last we have come to the end of this part of our journey together. It is now time to wish each other well for the journey ahead. During this time we have come to know each other well and hopefully have made some friends. Now you will have a chance to express good wishes to each community caregiver in your class during the farewell session.
We wish you all the best in your community caregiving.
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Notes
NOtES
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