Carlson’s NIMH Grant Project Aims to Prevent Violence Against Children in Ugandan Schools

“What we want to do is work with school administration to also change the practices and policies of the school so they can also have a role in making school a healthier, safer environment.”

Dr. Catherine Carlson

Nurturing & Learning

Carlson leads NIMH project in Ugandan schools Researchers, non-profits addressing mental health, violence against students

By David Miller

Defining mental health can vary depending on geography, culture, socioeconomic status and access to health care, even in the United States, where research, education and awareness campaigns have made growing mental health resources and services a priority.

But in low-income countries, mental health services often are only available through private medicine and are typically unaffordable. As a result, the public is often undereducated on what mental health is and what it looks like day to day. This void can create physical and emotional hurdles for children through their adolescent years, when half of all mental health conditions are diagnosed, according to the World Health Organization.

The National Institute of Mental Health has increased its interest and funding of global mental health research in recent years, including a Uganda-based project led by University of Alabama School of Social Work researcher, Dr. Catherine Carlson, who is in the second year of a project to integrate mental health education and promotion materials into existing curriculum that addresses school culture and climate to prevent corporal punishment.

Carlson is partnered with Raising Voices, a Ugandan non-profit organization that created and has operated a successful school-culture program in more than 1,000 schools in the country, to add mental health teaching and training materials to the “Good School Toolkit.” For instance, Carlson and her collaborators have developed a cartoon booklet that children and teachers in primary schools can read, engage with and use in points of discussion about mental health.

“In Uganda, if you say mental health, most people don’t really know what you’re talking about,” Carlson said. “They’ll think about brain disorders or epilepsy, or simply that someone is ‘mad.’ So we’re trying to bring the message that everyone has mental health, and like physical health, we go through different phases. And, sometimes, you need help. We’re trying to destigmatize it and educate people and create a conversation that currently doesn’t exist.”

Carlson is one of the first researchers to receive a NIMH Career Development(K01) Award for global mental health. She has more than 10 years of various research and programming experience in Uganda, working primarily with Raising Voices to address issues of family violence through prevention.

EARLY PHASES Carlson began the four-year project with an exploratory, qualitative research phase to understand how mental health is stigmatized in the country and how to communicate it in a positive, relatable way. This phase also revealed more nuanced characteristics about how teachers perceive and respond to student conduct issues, prompting the need to distinguish misbehaving from signs of deeper, underlying issues.

Researchers also discovered that school practices and policies affect children’s mental health; For example: a “traumatizing” experience some children were experiencing during a common policy of school administrators announcing the names of children who had not paid school fees – a requirement for children to attend both public and private schools – during assemblies.

“What we want to do is work with school administration to also change the practices and policies of the school so they can also have a role in making school a healthier, safer environment,” she said.

The qualitative phase was vital in helping Carlson and her collaborators determine materials for the Good School Toolkit, with an emphasis on reframing language related to mental health, educating teachers on warning signs and providing a blueprint for how to respond. To serve the children that may have needs that extend beyond what teachers and school administrators can address, Carlson said she is partnering with another agency to deliver therapy to kids in schools.

THE NEXT PHASES The strength of Carlson’s ties to Raising Voices and Raising Voices’ relationships with teachers and administrators have laid the groundwork for an 18-month pilot program in eight schools – four control schools and four treatment schools. If successful, they’ll incorporate the new Toolkit materials into the four control schools, and more, potentially.

“Raising Voices has been working with schools for a long time and has established relationships with

the Ministry of Education, which, the last I’d heard, is intending to make the existing Toolkit part of required education policy, countrywide,” Carlson said. “[Potentially implementing mental health materials country-wide] will take some important planning around scale up and process of laying out, but it’s an exciting possibility.”

Ultimately, the materials that will be added to the Toolkit will be “flexible and dynamic,” important attributes in implementing the program in real-world schools. Carlson said Ugandan teachers can have more than 50 students in a class, so they had to prove the relevancy of the program and collaborate on the materials for teachers to “feel ownership” and buy-in completely. This intentional approach, along with partnering with a well-established local agency like Raising Voices, also helps avoid the negative perception of “western influence,” a hurdle Carlson has faced in previous work with other international non-profits.

“That’s part of being relevant and sustainable to schools, where you provide this toolkit of different materials to the teachers and students that are leading it, and they can pick out what they think would be relevant for their school,” Carlson said. “We don’t have a lot of real manualized interventions where it’s like, ‘we meet for 12 weeks and do this prescribed session.’”

Carlson said she travels to Uganda at least twice a year and has Skype calls with teachers and Raising Voices personnel almost each day. The arrangement allows for her to provide research and content expertise, and for the partners onsite to be “experts in context and what works.” Carlson is also aided by Social Work doctoral student Violet Nkwanzi, a native of Uganda, who received a research award from the UA Center for CommunityBased Partnerships to work with Carlson.

“To have a Ugandan student, who has the cultural knowledge and linguistic ability, has been a huge advantage for the project,” Carlson said. “And it’s a great learning experience for her in terms of learning about the research.”

A FAR-REACHING NETWORK UA SOCIAL WORK STUDENTS TO BEGIN ‘CROSS CULTURAL COMMUNICATION’ WITH GHANAIAN STUDENTS

By David Miller

International social work experiences, whether realtime or virtual, provide foundational pay-offs for one’s social work career, even for those that don’t aspire to work outside the United States.

Added perspective is the most significant benefit, and it’s gained and applied in a variety of ways. For instance, differences across cultures can affect how social workers conceptualize or address problems. And for American students, international social work can help them recognize their own assumptions that are only apparent when someone from a different country or culture asks questions of them, says Dr. Debra Nelson-Gardell, associate professor and coordinator of international initiatives.

“There’s no social worker that leaves a social work program that’s ever going to work with anyone who is exactly like them,” Nelson-Gardell says. “International social work is an opportunity to work on cross-cultural communication and appreciation. People around the world have worthwhile things to say. There’s an opportunity to also learn something that can be useful in the U.S.”

These learning opportunities, if one does a study-abroad experience, are expensive - typically between $5,000 and $10,000 per semester - and greatly limit the potential number of students who can participate, says Nelson-Gardell, who has overseen the School’s collaborative work with universities in Hong Kong and Mainland China.

But, in lieu of complete immersion, NelsonGardell is hopeful to replicate an important component of international social work – organic conversation – through an innovative project funded by the Council for Social Work Education Katherine A. Kendall Institute for International Social Work Education. “Promoting Global Citizenship in Ghana and USA through WhatsApp/ Flipgrid” is tentatively scheduled to begin work with students in spring 2020, implementing a threeyear partnership that will see UA MSW and BSW field students communicate regularly with their counterparts at the University of Ghana. The students will use two popular social media apps – WhatsApp and Flipgrid – to overcome resource limitations and “spread some of the goodness of international knowledge,” Nelson-Gardell said.

Nelson-Gardell has used several social networks, including WhatsApp, in her own international work. She said the conversations on WhatsApp are more informal and with freer exchanges. The platform also provides a level of immediacy not achievable in more formal formats, like email or online learning systems.

The pilot will begin with an online MSW policy class at UA (26 students) and 10 master’s students at the University of Ghana. In summer 2020, up to 20 BSW and master’s level students at UG will be trained to use both WhatsApp and video networking app Flipgrid. Then, by Fall 2020, the program will be implemented with 52 MSW students in two online social welfare policy courses, 25 BSW field students at UA and 20 Ghanaian students. The program will increase UA student participation in both 2021 and 2022, with a projection of more than 150 students.

UA adjunct professor, Beth Okantey, who will teach the pilot course, will work with a Ghanaian social work education colleague to coordinate student participation at UG. She’ll have an assignment for the project built into the class she’s teaching for UA.

“UA students will be working on assignments using WhatsApp groups with at least one Ghanaian partner student,” Nelson-Gardell said. “The conversations, we hope, will at least contribute at a small level to increase an awareness of how social work is done in other places, and the opinions of others who aren’t U.S. citizens.

“Even for those people that don’t want to work internationally, this kind of project has the potential to benefit all social work students because of our need to be able to communicate and engage crossculturally.”