Why youth mental health awareness is a lot more than information workshops: cascade approach paper

No community mental health awareness is easy. There are always a few pre-requisites of engagement, key messages and delivery approaches to get those messages through. But the majority of models do not go beyond the paprticipant group, thus are not sustainable.

Hence, the Train-of-Trainer (cascade) framework adopted in this project in disadvantaged Karachi communities, of which awareness was only ther first step. It is harder, as one has to work at multiple levels in training and supporting trainers to work with communities, but it is so much more rewarding.

Why? Because trainers come from the same communities, therefore hold unique expertise and credibility. Because they utilize their position to co-produce new knolwedge and mobilize communities that would find external professionals more distanced. Because community participants (in this case youth and parents) can model themseleves on the trainers and feel empowered to cascade this new knowledge within their family (including extended unit), peer group, school and neighbourhood. All these components will ultimately improve help-seeking and lead to better psychosocial integration of existing services. The link of the new paper:

https://doi.org/10.1016/j.mhp.2024.200339

New WACIT paper on youth mental health awareness in Pakistan: Parallel trainer and community participant growth

This was (usually should be) the first step of integrating mental health to existing psychosocial support in disadvantaged communities of Karachi. It was also the first test for our interprofessional group of trainers, only a few weeks after completing the first of four training modules. Although they were well prepared, using the same template to design the four events with youth and parents, they were spontaneous, innoative and creative in finding their own ways of engaging communities and putting key messages across.

From stakeholders’ feedback, it was interesting to note that trainers had to go through their own growth, in challenging previous beliefs about stigma; finding the right balance between concepts of mental health, culture and religion; addressing gender issues; and building their confidence to facilitate the events. Considering the short period, they went through the motions rather impressively quickly, but the findings also demonstrate the importance of paying attention to the training process (e.g. in contrast with a manulized only approach) and putting supports in place.

The link to the full article:

https://doi.org/10.1016/j.mhp.2024.200339

The complexity of a Train-of-Trainer programme for refugee children, but it was all worth it

It was probably daunting and implausible for all of us, but step-by-step we completed it! Involving professionals from different backgrounds, experience and organizations in one trainer group, while they were cascade training to their own staff, was a great challenge. On reflection, and looking at the evaluation findings, several factors had to be put into place – this was never going to be the case of a prescriptive manualised programme. If anything, the manual was informed by the trainers and the learning process.

Gelling together before adapting to the different needs of their staff group, relating to psychologists-caregivers-cooks among others in a single interprofessional training crack, allowing for their own growth, stamping the programme with their creativity and ideas, dealing with the emotional impact and burnout of everyday management of trauma, all in the face of organizational challenges, shifts and duties, were the key factors.

Ultimately, this was a case of combining experiential learning at individual and systemic level. To find out what actually happened:

https://doi.org/10.1177/13591045241242324

New WACIT paper: National approach to child mental health capacity for unaccompanied minors

We experimented with the Train-of-Trainer (cascade) approach in different countries, usually in disadvantaged areas and through community-based organizations. This was a different challenge in enhancing capacity for all shelters (around 70 at the time) for unaccompanied refugee children across Greece, which were provided by approximately 20 NGOs.

The key innovation was that trainers intercepted their own training by upskilling their staff group every two months. It was the breadth of the reach that mattered: we reached cooks, domestics, drivers and administrators; the core but often neglected group of caregivers; and the more anticipated social workers, educationalists and psychologists. Crucially, training was joint (interprofessional) and contextualized.

A description of the process and what various stakeholders made of it:
https://doi.org/10.1177/13591045241242324

Mums carrying multiple emotional weights in Ukraine

It was a very polite but most unusual apology that some people might be a bit late for the training: “the air raid sirens were on”. Yet, most were there (“we are used to it, can’t stop”) and the rest came rather promptly. The topic was supporting parents, and it was impossible to escape the thought that almost all professionals were mothers exposed to war themselves for over two years.

Nevertheless, they were resolved in helping other parents and children. When we discussed creating emotional space for children (for example, emotional meaning behind behavioural tasks), it obviously came up that most mothers in the country have to compensate for fathers being absent by joining the military, thus carry all resulting anxieties and uncertainty about the future. On top of those, teachers and our psychologists, among others, have to carry another heavy emotional layer of absorbing other parents’ burden.

All this, just one week after Women’s Day and a few days from (in some countries) Mother’s Day… #

(an uncomofortable) Conversation with Israa from Gaza

She was not angry, which made it much harder. She got in touch “I just want to share my stories” (and happy to use her name). She told me about completing her nursing studies and briefly working at a children’s hosptal department (I was scared to ask “does it still exist?”). She was generous and asked me about my early work there (I was scared to ask “does the university still exist?”). She also offered to read our first paper with my late friend Abdel Aziz:
https://www.researchgate.net/profile/Abdel-Aziz/publication/227768171_Post-traumatic_Stress_Reactions_in_Children_of_War/links/5a5745fba6fdcc30f86df6f9/Post-traumatic-Stress-Reactions-in-Children-of-War.pdf

[This was the beginning of many projects on how war conflict affected children (I was scared to ask “do the children from those studies still exist?”). At the time, there was limited evidence and approaches on directly capturing children’s distress. So, I guessed it must have helped. It has been cited by many international reports, especially on refugee children, so it must have helped. But has it actually helped the children of Gaza? Definitely not. If anything, I feel ashamed rather than proud that this work may have colluded with their suffering.]

Going back to Israa (verbatim from our conversation):
“The situation here inside the tent is very difficult. I don’t know what will happen to my future”…(shame)
“Talking is very easy, but the reality is difficult. Maybe I will be with the dead in the morning. No one knows his fate in Gaza”…(shame)
“Stop the war for us, this is our only hope”…(shame)

Why is intergenerational resilience is growing in influence? New paper from Pakistan

It is interesting trying to understand the evolution of the concept of resilience in recent years: from individual trait, to systemic inter-connectedness along the child’s socioecology (individual, family and community); and more recently by encompassing historical and intergenerational responses to trauma in a cultural context, in a shared trauma and resilience framework. The model sounds complex, but the applications and findings were pretty simple.

As in an earlier paper in five countries during the pandemic, in this paper sharing resilience stories across three generations enabled young people to form new narratives and coping strategies – but also for parents and grandparents to draw new coping and understanding of young generations.

This process was, of course, anything but easy! It had to be mastered over a period of time, by young people themselves who facilitated as peer educators. The link to the paper:
https://doi.org/10.1093/heapro/daae010

New WACIT paper: Engaging family advisers to inform design of mental health promotion programme

The outcome was not a surprise, but we had to work at multiple levels for eveyone else to experience and engage in the process. Sajida, Zeenat and the ICAN team went to two disadvantaged areas of Karachi and invited eventually 11 family units of three generations (grandmothers, mothers, young people) to act as advisers. The concept did not mean anything at the beginning, as they had probably never been asked before, but they used it more and more as the project went on. They had to be valued before accepting the role.

At the same time, 14 young peer educators took on the responsibility of driving the project. In phase 1, reported in this paper, they utilised training and workshops with the family advisers to design the mental health promotion programme. This part of the journey was the most innovative in seeing peer educators’ interactions with families, and how the two groups floursihed in parallel and together.

The first family consultation workshop was probably the most important, as everyone was tentative and there were several pre-conceptions to work through – “grandmothers might not engage, families might feel intimidated, not likely to share, coming from conservative communities”, and so on. All potentially true of course, but none happened. Every step was anticipated, peer educators made families feel comfortable, and the rest was fun – grandmothers, in particular, loved it!

There were two more, not insubstantive steps, in peer educators repeating the consultation workshops in the families’ communities, then passing by them the final questions about the design of the programme – here is the link to the paper:

https://doi.org/10.1093/heapro/daae010

New paper on positive psychological resources for refugees – with more than a hint of gender inequalities

Murat and Izaddin’s work reflects a fundamendal shift in approaching vulnerable populations (be it for policy, interventions, services or research). It also shows the increasing influence of resilience and positive psychology, which are no longer viewed as ‘either or’ with addressing risk factors and mental health problems. Concepts such as flourishing, hope and life satisfaction maybe tough, but far from absent in challenging life circumstances. They can also be instilled or strengthened through interventions, and not just for individuals but for systems too.

One worrying finding though, despite the lack of depth of the data to understand potential underpinning reasons, is that female refugees had either less access or benefit from such positive psychological resources, wherever these might be coming from (own or host communities, or other support systems).

A preliminary link to the paper:

https://doi.org/10.1080/15332640.2022.2078918

What is child mental health integration and why?

There are both child- and resource-related reasons for incorporating child mental health provision to existing psychosocial support, especially in contexts of disadvantage such as the South African communities participating in this project: children often have multiple social care, health and educational needs that are unlikely to be addressed by one single agency or intervention; and there are not enough resources or access to mental health services. This is the principle, but how did we go about it?

Our childcare practitioners (or trainers) followed a multi-domain framework (protection, family support, resilience through school and community, upskilling professionals and community volunteers, enhancing service access). Within each domain, they identified what psychosocial support was available, agreed priorities with community providers, co-produced and implemented realistic and achievable service plans.

Essentially, they added an ‘M’ to what they were already doing, but it took a lot of training, motivation and skill (dancing too) to see it through.

Here is how youth, parents, professionals and managers experienced this model:

https://doi.org/10.1016/j.childyouth.2024.107482