MODULE ONE: The Social Context of Children in Especially Difficult Circumstances (CEDC) CONTENTS OF THIS MODULE: PAGE Session Plans .......................................................................... 2 Session One: Problems and Possible Actions ............... 2 Session Two: The ESCAP Project on Sexual Abuse and Sexual Exploitation of Children and Youth in the Greater Mekong Subregion (GMS): Research and Intervention Phases ..................................................... 5 Background Document on The Social Context of Children in Especially Difficult Circumstances (CEDC): Problems and Possible Actions ..................................................................... 7 Background Document on The Mekong Project on Sexual Abuse and Sexual Exploitation of Children and Youth: Research and Intervention Phases ................................................................ 30 Annex I: Interview Guides and instructions for filling in the Interview Guides .................................. 67 Physical Health and Psychosocial Well-being Inventory ....................................... 84 PowerPoint Presentations ..................................................... 87 Reference List .......................................................................... 113 I – 1 ESCAP HRD COURSE ON PSYCHOSOCIAL AND MEDICAL SERVICES FOR SEXUALLY ABUSED AND SEXUALLY EXPLOITED CHILDREN AND YOUTH SESSION ONE: Problems and Possible Actions Timing: 3 hours Session learning objectives: • To define children in especially difficult circumstances (CEDC) and selected categories of CEDC; • To identify, understand and analyse the situation of different categories of CEDC focusing on the immediate and root causes of their situation; • To describe the process of moving to especially difficult circum- stances and identify risk and protective factors at each stage; • To identify and analyse the risks that selected categories of CEDC encounter in their situation and the implications to their physical and psychosocial health and development; and • To describe the objectives of primary, secondary and tertiary programmes and strategies. Session contents: • Definition of the terms CEDC (or children in need of special protection), other categories of especially difficult circumstances and health; • Description and analysis of the life situation/social context of CEDC at different stages and factors that affect their physical and psycho- social health and well-being; • Discussion of the children’s care-seeking behaviour and availability of, and access to, health and social services; and • Description of the levels of intervention and principles for effective interventions. I – 2 MODULE ONE: THE SOCIAL CONTEXT OF CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES (CEDC) List of key terms: • CEDC • CNSP • Primary prevention • Secondary prevention • Tertiary prevention • Rehabilitation • Reintegration Key questions to be asked: 1. Who are CEDC? 2. What are the causal factors? 3. What are the intervening factors at each stage? 4. What are the health problems and how do the children cope with them? 5. What are the different levels of intervention and what are their objectives? 6. What programmes/strategies are appropriate at different levels? Method of presentation: The facilitator will present the content and invite the participants to contribute information on their country contexts at different stages of the lecture. Participants should be encouraged to discuss and share examples based on their country contexts and experiences with the children they work with. Workshop aids and equipment required: • PowerPoint presentation equipment/real object projector (not essential); • Overhead projector; • Transparencies and pens; • Flip chart paper and markers. References: Resource materials provided in the participants’ folder. I – 3 ESCAP HRD COURSE ON PSYCHOSOCIAL AND MEDICAL SERVICES FOR SEXUALLY ABUSED AND SEXUALLY EXPLOITED CHILDREN AND YOUTH Materials for all sessions in this Module written by: Ms Wanjku Kaime-Atterhög, CEDC Expert, BA; MA; MPHM Section for International Maternal and Child Health Entrance 11, S-75185, Uppsala University, Sweden E-mail: [email protected] Note: This Module does not cover training on the Convention on the Rights of Child, as many good training guides exist already in this area. See the References section for a partial listing of available materials. I – 4 MODULE ONE: THE SOCIAL CONTEXT OF CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES (CEDC) SESSION TWO: The ESCAP Project on Sexual Abuse and Sexual Exploitation of Children and Youth in the Greater Mekong Subregion (GMS): Research and Intervention Phases Timing: 4.5 hours Session learning objectives: • To identify needs assessment issues and concerns; • To understand and be able to apply concepts of needs assess- ment; and • To describe problems encountered in primary, secondary and tertiary prevention programmes and possible solutions. Session contents: • Part 1: Needs assessment: how to identify the needs of CEDC and their families and how to use research approaches that view children as subjects; and • Part 2: Interventions: the principles for effective interventions at the different levels that can be carried out at the street/work, centre and community levels. List of key terms: • Needs assessment • Action research I – 5 ESCAP HRD COURSE ON PSYCHOSOCIAL AND MEDICAL SERVICES FOR SEXUALLY ABUSED AND SEXUALLY EXPLOITED CHILDREN AND YOUTH Key questions to be asked: 1. What is happening to this community/family/child? 2. What are the characteristics of a good preventive and remedial programme? 3. How would you design a preventive and remedial programme for children in your care? Method of presentation: Concepts and principles of needs assessment effective interventions will be presented (first part). Participants will share their experiences and problems they have encountered in conducting needs assessment and developing interventions and brainstorm the solutions with input from the facilitator. Participants will also work in country groups to identify needs (second part) and develop minimum actions (third part) for selected groups of CEDC. Workshop aids and equipment required: • PowerPoint presentation equipment/real object projector (not essential); • Overhead projector; • Transparencies and pens; • Flip chart paper and markers. References: Resource materials provided in the participants’ folder. ESCAP subregional and national research reports (see Reference list). I – 6 MODULE ONE: THE SOCIAL CONTEXT OF CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES (CEDC) Background Document on The Social Context of Children in Especially Difficult Circumstances (CEDC): Problems and Possible Actions 1. INTRODUCTION Children are in especially difficult circumstances when their basic needs for food, shelter, education, medical care, or protection and security are not met.1 Such children are at great risk of suffering malnutrition, disease and possibly death. Unless their own situation changes, their condition of gross disadvantage will extend to their own children who may suffer even greater misery and suffering. Disruptive social change is the principal cause of the growing numbers of children in difficult circumstances in developing countries and Eastern European countries. Rapid urbanization associated with socio-economic, cultural and political transformation has resulted in numerous negative changes, disrupting the family and its traditional support system and weakening community organizations. Many parents looking for non- existent jobs in the city end up poorer, with their children condemned to living in overcrowded slums and squalid environments. Likewise, children seeking work in cities of neighbouring or far away countries to support themselves and their families are exposed to abuse and exploitation by their employers and the majority remain poor. They are made to work hard and for long hours and generally lack access to educational and health care services. They are susceptible to malnutri- tion and disease and their lifespan is short. The problem of CEDC is not confined to cities. In rural areas of many developing countries there are children who are victims of abject poverty, frequent drought and famine. These children remain largely 1 These groups of children are usually referred to as “children in especially difficult circumstances” (CEDC), “children in need of special protection” (CNSP), “children in distress”, “children in crisis”, “children in exceptionally difficult conditions”, and so on. In this paper, CEDC is used since it is the most widely-used term internationally. These children are, for shorter or longer periods in their lives, exposed to intense, multiple risks to their physical and mental health. A common characteristic of CEDC is that they lack proper adult care and protection, and that they lead their lives outside society. I – 7 ESCAP HRD COURSE ON PSYCHOSOCIAL AND MEDICAL SERVICES FOR SEXUALLY ABUSED AND SEXUALLY EXPLOITED CHILDREN AND YOUTH invisible and need to be further studied and addressed. They include children of landless squatters and unemployed parents (especially poor single female heads of households) as well as children of nomadic parents in drought-stricken areas and those of ethnic minority groups. Their condition and environment prevents them from realizing normal growth and achieving their full potential. They too are perpetually vulnerable to malnutrition, disease and death. Besides the categories identified above, other groups