Learning to Work with Orphans and Vulnerable Children

1
Learning to Work with Orphans and Vulnerable
Children

• A Project of the Social Work HIV/AIDS Partnership
  for Orphans Vulnerable Children in Tanzania
• Day 4
• Assessment of Needs and Strengths

2
Social Work Process for Working with Most
Vulnerable Children and their Families

• Identifying Vulnerable Children and their
  Families
• Engaging Vulnerable Children and Families
• Assessing the Strengths and Needs of Vulnerable
  Children and their Families
• 4. Developing a Plan of Services for Vulnerable
  Children and their Families

3
Social Work Process for Working with Orphans and
Vulnerable Children Affected by HIV

• 5. Implementing the Plan of Services
• Identifying and Referral to Other Resources
• Providing direct services problem solving,
  support and coordination
• Empowering and supporting caregivers
• Addressing HIV related prevention and care
  concerns
• Evaluating Progress, Revising Service Plan and
  Following Up Through Ongoing Case Management,
  Family Support And Advocacy

4
Objectives

• At the end of this day, Para Social Workers will
  be able to
• Define assessment in the context of working with
  vulnerable children and their families
• Present the purposes and process of assessment
• Explain the importance of the strengths approach
  to child and family assessment
• Describe the characteristics of effective
  assessments
• Use the Child Status Index Form to assess needs
  vulnerable children and families
• Record the essential elements of assessment

5
Assessment

• The Concept of Holistic Assessment, Needs and
  Strengths

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Who has conducted an Assessment?

• Discussion
• What is an assessment?

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Definition of Assessment

• The process of
• gathering
• analyzing and
• synthesizing
• information about a child and/or family
  situation
• In order to
• understand the situation
• identify which needs are most important
• develop a plan to assist the family
  (interventions)
• deliver services.

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Phases of Assessment

• Plan the Assessment
• What information do you need?
• Where can you obtain needed information?
• What is the best method for obtaining the
  information?
• Gather information
• Interview child, family members, others
• Records school, health, others
• Observations appearance, behaviors, environment

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Phases of Assessment, Contd

• Analyze information
• What are the major needs to be addressed?
• What are the strengths and resources to build
  upon in addressing the needs?
• Using information toward making a plan
• What are the priorities for services?
• Recommendations How should we proceed?

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Process of Assessment

• Assessment starts at beginning of involvement
  with child and family after we obtain agreement
  to work together
• Assessment continues throughout our work with the
  child and family
• New needs emerge
• Situation improves
• Other changes
• Determine progress
• Determine when services need to change or end

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Characteristics of Successful Assessment

• Assessment is best conducted in partnership with
  the child and family
• They have the most information about their
  situation. Their lives are most affected by
  decisions
• The child and family make the decisions about
  their lives
• They must implement any changes

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Characteristics of Successful Assessment

• Assessment is most effective when conducted from
  a strengths perspective
• Concentration on problems or needs alone can lead
  to frustration and HOPELESSNESS
• EVERYONE has strengths - qualities, abilities,
  resources - that can form the basis for change
  and growth
• Focusing on strengths provides a basis for
  problem solving and HOPE

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Basic Assumptions of the Strengths Approach

• All persons possess strengths that can be used to
  improve the quality of life.
• Recognize and express the strengths in the
  situation, even if the child or family member
  does not see them.
• Allow the child or family member to define the
  next steps as positively as they can.

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Basic Assumptions of the Strengths Approach

• Discovering strengths requires a process of
  cooperative exploration between Para Social
  Worker and the child and/or family
• Focusing on strengths helps the Para Social
  Worker be non- judgmental
• Acknowledging the strength(s), resilience and
  resourcefulness required to survive in difficult
  circumstances

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Characteristics of Successful Assessment

• Assessment is most helpful using an ecological
  perspective, focusing on the person and their
  environment
• Individuals influence and are influenced by
  their environments
• Social environments may include
• household
• extended family
• peer group/friends
• school, neighborhood and faith communities
• resources provided by civil society agencies
  (government, non governmental organizations, etc)
• Factors that contribute to individual needs AND
  solutions may be found within the larger
  systems in which the child lives.

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Levels of Assessment

• When thinking about the needs of the child we
  need to look at the people with whom the child
  has important connections
• Starting with those most closely related to the
  child
• We then move out into the extended family and
  friends
• Then we look at the larger community including
  organizations

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Phase I Planning the Assessment

• Prepare
• Be sure to have the materials you need (forms,
  pen, etc.)
• Introduce yourself to local leadership, obtain
  agreement from leadership and the parents or
  guardian
• Identify the child
• Arranging the visit with the child and family
• Usually in the childs home situation
• May be in other community settings

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Starting the Visit

• Greet, introduce yourself
• Keep conversation informal and as natural as
  possible
• Verify if the child is the person who you
  intended to see
• Explain the purpose of the visit to find out
  how the family and children are doing
• Explain to the caregiver why knowing How the
  child and the family are doing is important to
  find a way to help them
• Obtain agreement to do assessment
• Show sincere and genuine interest in the family
  and child

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Phase II Gathering Information
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Eco Framework
Extended Family
Family
Community
Child
Friends

• Areas of Information to explore
• Information about the child
• Information about the family
• Information about extended family and friends
• Information about community

Child Level
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Phase II Information about the Child

• What information and issues do we consider when
  we assess the childs needs and strengths?
• Brainstorm

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Areas for assessment

• 1. Shelter
• 2. Psychosocial
• 3. Education and Vocational Training
• 4 Health
• 5. Food and Nutrition
• 6. Economic Strengthening
• 7. Protection

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1. Shelter

• How can we determine if the child has a stable
  shelter that is adequate, dry, and safe?
• Brainstorm

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1.Shelter

• Possible Observations
• What is the housing made of?
• Is this house or institution adequate?
• Does the house appear safe?
• Does the house protect from rain or cold?
• Is the house in need of repairs?

Child Questions (depends on age) Family Member Questions
Where do you live? Do you have a place to eat and sleep regularly? Where do you sleep? Do you ever stay somewhere else? Where does the child live? Does the child have a place to eat and sleep regularly? Where does he/she sleep? Does he/she ever stay somewhere else or spend the night outside
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2. Psychosocial Emotions

• How do we assess if the child is happy and
  content with a generally positive mood and
  hopeful outlook?
• Brainstorm

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2. Psychosocial Emotions

• Possible Observations
• Does the child seem happy and active?
• Do you observe signs of sadness, anxiousness or
  being withdrawn?

Child Questions (depends on age) Family Member Questions
Do you feel happy or sad most of the time? Do you think you have a good life? Do you have trouble controlling your emotions? Are you angry much of the time? Do you feel your life is worth living? Is this child happy or sad most of the time? How can you tell if he/she is happy or unhappy? Do you worry about this childs sadness or grief? Do you worry he/she might hurt himself/herself?
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2. Psychosocial Social Behavior

• Possible Observations
• How does the child interact with the family?
• How does the child interact with you as a Para
  Social Worker?

Child Questions (depends on age) Family Member Questions
Do you get along well with adults? How often do you get punished if you do something wrong? Do you like playing with other children? Do you have friends? Tell me about your friends What is his/her behavior toward adults? Does this child need to be punished often? How does the child play with other children? Tell me about the childs close friends.
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3. Education and Vocational Skills Training

• How can we assess how child is progressing in
  acquiring knowledge and life skills at home,
  school, job training, or an age-appropriate
  activity?
• Brainstorm

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3a. Education Skills Training Knowledge and
Life Skills

• 3a. Child is progressing well in acquiring
  knowledge and life skills at home, school, job
  training, or an age-appropriate
• Possible Observations
• If in school, observe the response when asked
  about class performance ranking.
• If the child is five years old or younger,
  observe the childs developmental progress (i.e.,
  in language, movement, learning), and compare
  this to what you expect for children that age
  (i.e., talking, walking by year two).

Sample Child Questions (depends on age) Sample Family Member Questions
Are you doing new things that you are learning from? What skills are you learning or would like to learn? (ask adolescent) Do you do chores at home? Can you describe? Is this child learning new things, as you would expect others his/ her age (younger child)? What do the teachers report about how the child is doing in school? How does the child do with chores at home? Is the child advancing to the next grade as expected?
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3b. Education Training School or Age Related
Activity

• 3b. Child is enrolled and attends school or
  age-appropriate play, learning activity, or job.
• Possible Observations
• If possible, observe the childs school uniform
  or supplies and their usage.
• For infants or preschoolers observe if he/she is
  involved in any play or learning activity with
  any family member(s).

Sample Child Questions (depends on age) Sample Family Member Questions
Are you in school now? In which class or grade are you? Tell me about your school or training. How often do you miss school? Do you have a job, and if so how often do you go to work? Is the child in (has he/she completed) primary school? Tell me about the childs school or training. Who pays school fees and buys uniforms and school materials? (If enrolled) does this child attend school regularly? How often must the child miss school for any other reason? Does he/she go to work regularly?
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4. Health

• How can we assess whether the child is physically
  healthy?
• How can we obtain needed information about
  existing health problems?
• Brainstorm

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4a. Physical Health

• 4a. -Child is physically healthy
• Possible Observations
• Does the child appear to be active and generally
  healthy?
• Does the child say that he or she is feeling ok?
  Has he/she felt ok in the last week?
• Is there any sign of illness, accidents or health
  problems?

Sample Child Questions (depends on age) Sample Family Member Questions
Do you have any health problems we may be able to help you with? Do you miss school or work due to illness? Tell me about this childs health. Tell me about the last sickness the child had. Does he/she miss school or work because of illness?
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4b. Health Care Services

• 4b. Health Care Services-- Child can access
  health care services, including medical treatment
  when ill and preventive care.
• Possible Observations
• Look at the childs immunization card
• Is a bed net available?

Sample Child Questions (depends on age) Sample Family Member Questions
What happens when you become sick? Have you been ill recently? When that happened did you go to the health center? Do you take medicine? If so how do you get it? What happens when this child falls ill? When he/she needs medicine, how do you get it? (For under 5) Has the child been immunized to prevent illness? (For adolescents) Has anyone talked to the child about risks for HIV/AIDS and how to protect against these risks?
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5. Food and Nutrition

• How can we assess if child has sufficient food
  to eat at all times?
• How can we assess if the child is growing well
  compared to others of his/her age in the
  community?
• Brainstorm

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5. Food and Nutrition

• 5a. Child has sufficient food to eat at all
  times.
• Possible Observations
• Look around the home including the storage
  facilities like granary, garden, and farm
  animals.
• Does the kitchen look like it was used to prepare
  food recently?

Sample Child Questions (depends on age) Sample Family Member Questions
Do you have enough food to eat? Who prepares food for you? Tell me what you do at times when there is not enough food. What does the family/child eat? Tell me about what the child/what you ate yesterday. How does this household/institution get the food? Tell me about times when there is not enough food.
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5b. Nutrition and Growth

• 5b. Child is growing well compared to others of
  his/her age in the community.
• Possible Observations
• Compare how well the child seems to have grown
  compared to other local children the same age.

Sample Child Questions (depends on age) Sample Family Member Questions
How do you think you are doing compared to others your age in terms of growing taller and stronger? How is the child growing? Does he/she seem to be growing like other children the same age? Are you worried about this childs growth? Weight? Height?
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6. Economic Support

• How can we assess if the family has a reliable
  and adequate source of income?
• Brainstorm

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6. Economic Support

• 6a. Family has a reliable and adequate source of
  income.
• Possible observations
• Does home have material, food, clothing for child
  and other family members?
• Is there evidence that small amounts of funds are
  available for necessary things or emergencies?

Sample Child Questions (depends on age) Sample Family Member Questions
Do those who take care of you have money to pay for food and clothing? Do you have money you need for your school or other expenses? Do you have a job to help you get money you need? (for adolescents) How do you support your family? How well does your income meet your familys needs? How steady is your income? Are there times during the year when it increases or decreases? How would you pay for a doctor visit for the child if needed?
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7. Protection

• How can assess if the child is safe from any
  abuse, neglect, or exploitation?
• How can we determine if the child has access to
  legal protection services as needed?
• Brainstorm

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7. Protection and Exploitation

• 7A. Child is safe from any abuse, neglect, or
  exploitation.
• Possible Observations
• Does the child have any marks or bruises that
  suggest abuse?
• Does the child seem like an abused child, very
  withdrawn or scared?

Sample Child Questions (depends on age) Family Member Questions
Do you feel safe in your home and school? Can you tell me about a time when someone hurt you? Do you work for anyone outside the household. If you do not feel safe who can help you? Does anyone hurt this child? Do you think the child feels safe? Does the child work for anyone outside the household? Does anyone else who knows the child think he/she is being hurt by someone else? Or sexually abused?
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7. Legal Protection

• 7b. Child has access to legal protection services
  as needed.
• Possible Observations
• When possible, observe the childs fear of losing
  his/her family properties.
• Does the caregiver have any concerns or
  hesitations when asked about the childs legal
  protection services?

Sample Child Questions (depends on age) Sample Family Member Questions
Have you ever seen your birth certificate or registration? Have you ever felt that any of your rights were not respected? Have you ever experienced someone taking things that belong to you without your permission? Has anyone forced you to work against your will? Is there an adult who can take care of you if your needs are not being met? Does this child have birth registration or certificate? Does the family have a will? Has he/she been refused any services because of legal status? Do you know of any legal problems for this child, such as land grabbing? Does this child have an adult who stands up for the child legally?
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Eco Framework
Extended Family
Family
Community
Child
Friends

• Areas of Information to explore
• Information about the child
• Information about the family
• Information about extended family and friends
• Information about community

Child Level
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Phase II Family/Household Information Needed

• Who is involved with the child?
• Children who are referred Name, age/birth date,
  location (include contact information)
• Parents, siblings, other family members. Names,
  age/birth date, location of (include contact
  information)
• Who lives in the household where the child
  currently resides? Name, age/birth date,
  relationship to child (list all household
  members, include contact information)
• Who informed you about the child(ren) or referred
  them for help? Name, relationship to the child,
  and contact information of person
• Other people involved with the child. Name,
  relationship to the child, role and contact
  information.

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Family/Household Information needed (cont)

• 3. Why is the child/family in need of help?
• (What is the presenting problem/issue or reason
  child/family referred?)
• From the perspective of the person referring the
  child/family for services?
• From the child(ren)s perspective?
• From the parent(s) perspective?
• If the childs caregiver is someone other than
  the parent, from the caregivers perspective?
• From the perspective of other persons involved
  with the child(ren)?

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Eco Framework
Extended Family
Family
Community
Child
Friends
Family Level
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Phase II Information Needed about Friends and
Families (cont)

• What are the needs and resources/sources of
  support available to assist in addressing the
  problem?
• Individual strengths and coping strategies of
  family members? (Identify needs, strengths and
  coping strategies of each family member
  child(ren), parent(s), other family members)
• Extended family?
• Friends?

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Eco Framework
Extended Family
Family
Community
Child
Friends
Extended Family and Friends
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Phase II Community Information Needed for
Assessment (cont)
What are the resources/sources of support
available to assist in addressing the problem?

• Connections to faith community?
• Non-Governmental Social Service Agencies?
• Governmental Agencies?
• Other sources of support/resources?

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Eco Framework
Extended Family
Family
Community
Child
Friends
Friends and Community
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Other Information Background to the Problem

• When and how did the problem/issue begin?
• How has the problem/issue evolved/developed
  over time?
• What other stressors/needs affect the
  problem/issue? (Identify needs/issues affecting
  each family member
• child(ren), parent(s), and other family members)

• Health needs?
• Mental health needs?
• Educational needs?
• Substance abuse?
• Financial needs?
• Recent transitions/changes?

• Previous losses/separations?
• Child physical abuse?
• Child sexual abuse?
• Spousal abuse?
• Other stressors/needs?

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What efforts have been made to resolve the
problem/issue?

• What strategies have been used to solve/address
  the problem?
• What resources services have been provided?
• What have been the results of each effort to
  resolve problem?
• What successes were achieved?
• What challenges/barriers were encountered?

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Phase III Analyze Information

• How do we put together the information we have
  gathered to determine what issues need attention
  and what resources may address those needs?

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Analyzing Assessment Information

• What are the identified needs?
• How problematic are these needs?
• What are the strengths?
• What are other things (underlying conditions)
  going on with the family?

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The Child Status Index

• A tool to
• Analyze assessment information
• Record what weve found
• Begin to think about how these lead to a plan to
  address the issues

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The Child Status Index as our Assessment Tool

• Developed and tested in Ethiopia Tanzania
• Child oriented tool
• Identifies key areas of need based on childs
  situation
• Used to gather information about (assess) a
  childs needs
• Can be used over time to measure changes in
  childs status or needs

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What is the CSI

• An assessment tool used by Para Social Workers to
  determine
• The information on his/her home situation
• The immediate needs of the child
• The resources (food, housing, clothing) needed to
  help the child immediately
• The services and service providers required to
  help the child (educational support, health care)
  now and in the future

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Areas for assessment(CSI Dimensions)

• 1. Shelter
• 2. Psychosocial
• 3. Education and Skills Training
• 4 Health
• 5. Food and Nutrition
• 6. Economic Strengthening
• 7. Protection

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The CSI Form
59
(No Transcript)
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(No Transcript)
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How to Rate the CSI

• Score each domain or area on a scale from 1 to 4,
  with 4 being the best score

4 Good There are no concerns and no apparent risks for this factor.
3 Fair The situation is generally acceptable. There are some concerns in this area on the part of the caregiver or visitor. Things could be a bit better.
2 Bad The situation is a problem for the child or family.
1 Very Bad The situation is very bad and creates an emergency for the child and/or family.
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Example CSI Score Food and Nutrition as an
Example (See handout for all domains)

• Good and Fair

• Bad and Very Bad

• GOOD 4
• Child is well grown
• with good height,
• weight, and energy
• level for his/her age.
• FAIR 3
• Child seems to be
• growing well but is
• less active compared to
• others of same age in
• community.

• BAD 2
• Child has lower weight,
• looks shorter, and/or is
• less energetic compared
• to others of same age in
• community.
• VERY BAD 1
• Child has very low
• weight (wasted) or is too
• short (stunted) for his/
• her age (malnourished).

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Important Events

• The CSI Record Form includes a section for
  describing any important events that have
  happened in the childs life
• Check any events that have happened since the
  last CSI assessment (or during the past year for
  children who have not previously been rated).

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Identifying Needs and Resources Family Caregiver

• What are the main issues or needs from the parent
  or other caregivers perspective?
• What are the strengths of the parents, other
  caregivers or other family members?
• Are their particular issues of other family
  members that need to be addressed (parent is ill,
  HIV positive, sexual or physical abuse, etc.)?

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Identifying Needs and Resources Extended Family
and Friends

• Who is providing help to the family from extended
  family or friends?
• Who helps in emergency situations or when
  additional money or other resources are needed?
• Who provides support to the parent or other
  caregiver?
• Is this family caring for other extended family
  members and how does that affect the child?

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Identifying Needs and ResourcesCommunity

• What services are available in the community?
• Are there community programs already helping this
  family?
• If there are no resources available, for example
  for medical care, how can health needs be met
  elsewhere?

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Services or Resources

• Another section on the CSI Record Form is used to
  record all services and resources being received
  by the child, household, or institution at the
  time of the assessment.
• Ask the primary adult in the childs life,
  usually a parent or guardian, about these
  services and mark the form accordingly.

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Phase IV Using information toward making a plan

• What are the priorities for services?Recommendati
  ons How should we proceed?

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Phase IV Using information toward making a plan

• What are the most important needs that need to be
  addressed? (List on the form)
• What are the resources that are used or should be
  considered? (List on the form)
• What are your recommendations for where to begin
  as we develop a service plan?
• Your recommendations form the basis for
  developing a plan of services with the child and
  family. (Service Planning will be covered in Day
  5)

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Important things to consider

• Maintain the familys confidentiality (personal
  details)
• Complete the CSI form immediately following the
  visit, before you leave the home
• This is the familys information. Summarize what
  you have found with the family to be sure you
  obtained correct information and that all agree
  on next steps.

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Guidelines for Follow-up
Score Guidelines for scoring Guidelines for follow up
4 Good. No follow up needed. General knowledge about resources can be shared, if appropriate.
3 Fair. This is an area that the visitor will want to be aware of in future visits to make sure the situation has not gotten worse. This is not seen as an urgent matter, but if the community worker has information that might help the child or family, it should be provided to them.
2 Bad. It is recommended that the worker consider what the child and family needs are and if there are available resources or services to help. The worker can make the referral directly or discuss with the agency or the village leader to get help for the family, if possible.
1 Very Bad. When the worker discovers an emergency for the family, the worker must respond accordingly. Home visitors should address the situation or refer the family/child to the appropriate resources. When there are bad circumstances and the worker does not know what the best response is, then the worker should make a plan with the agency director or village or community leader, as appropriate. The step(s) taken should be documented on the CSI record sheet.
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Using the CSI

• Remember the Video Dancing for Mwakaila
• Think about how we would assess this family using
  the CSI
• We will consider what we can do to identify the
  needs and strengths
• Ask the child or family member
• Observe in the home or community
• Divide into 7 groups each to take one of the CSI
  areas

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Using the CSI

• Each group to rate Mwakaila and his family on
  their specific area of need and strengths (CSI
  area)
• We will discuss what we learned in a brief report
  back. Please include any issues or questions
  that came up

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Skills Building WorkshopCompleting the Assessment

• Get into the four small groups
• Using your case as an example from one group
  members experience, role play a Para Social
  Worker interviewing a family in order to assess a
  childs needs.
• Complete the assessment based on your assessment
• Record your findings on the Assessment Form (CSI)
• Discuss with the group what we learn

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Reference

• Nyangara, ODonnell, Murphy Nyberg (2009).
  Child Status Index A Tool for Assessing the
  Well-Being of Orphans and Vulnerable Children
  Field Users Guide. The Measurement Group.