Working with Adolescents to Strengthen Capacities and ...

March 2105

Working with Adolescents to Strengthen Capacities and Awareness:Using a Resilience based approach

Gracy AndrewCountry Director

CorStone India Foundation

Working with Adolescents to Strengthen Capacities and Awareness

KNOW VIOLENCE in CHILDRENRegional Expert Roundtable on

Prevention of Violence in Schools in South Asia Colombo,

25-27 April 2016

What will be covered

• About CorStone

• About Resilience

• Youth First – the evidence

• Youth First – the program

• Implication for violence prevention.

Vision

Our Hope

A World that Chooses

Love over Fear

Compassion over Indifference

and

Forgiveness over Blame

in the Face of Crisis

Who We Are

• Our Mission

To develop and implement resilience-based

interventions and research initiatives

to improve the health, education, and self-sufficiency

of marginalized adults and youth

around the world.

Focus• Our Commitment

• Innovation

• Continuous Improvement (Pilot, Assess, Adjust)

• Low cost

• Technical Transfer (TOT)

• Sustainability / Scalability

• Focus on Marginalized populations

• Dissemination

CorStone

• A US-based 501c3 nonprofit, founded in 1975.

• In India : Since 2009

• CorStone India Foundation – established in Oct 2015

Personal Resilience: The Power Inside.

Resilience: Thriving vs. Surviving

Types of responses to challenge or trauma:W

ellb

ein

g

challenge/ trauma

Time

Defeat

Surviving

Thriving

Bouncing back

Resilience: Essential Assets

Family, community and

culture

Education

Physical body

Emotions, thoughts

and behaviors

Emotional Resilience

• When emotional resilience is affected, outcomes in all other domains are improved

External Assets

Internal Assets

9

Is it innate?

• How do we give individuals the skills to not just bounce back, but to ‘change their life trajectories’ and thrive

• How do we make this a norm not an exception

• Most people in difficult circumstances…- are defeated or survive from day to day / Very few thrive.

• How can we teach our young people to ‘bouncing back better’ or ‘thrive’ when facing crisis. - - Not merely survival!

• Fortunately, research clearly demonstrates….Resilience is not merely innate - it is learned.

• It Can be cultivated thru training and programs.

optimism

self-belief

persistence

self-advocacyhumor

Self-efficacy

creativity

caring mentor strong relationships

YOUTH FIRST

13

Youth First and Girls First are evidence-based program that targets marginalized boys and girls, aged 12-16 in developing countries.It is an integrated resilience based health program that has and is being implemented in Bihar, Gujrat, Utharakhand , UP

Research confirms that CorStone’s resilience-based approach improves mental health, physical health, and education.

CorStone (US)

Local Partners

Master Trainers

Program Facilitators

Students/ Attendees

Local women and school teachers are trained as Program Facilitators. Community partnerships considered integral to success.

Train-the-Trainer Model

Program Facilitators Training, Bihar, India, 2013


culture

Education

Physical body

Emotions, thoughts and

behaviors

Youth First: Curriculum

15


• Character strengths

• Self-Esteem

• Goal Setting and

Planning

• Identifying and

regulating emotions

• Somatic awareness

• Benefit finding

• Gratitude…etc.

Social Resilience

• Listening skills, collaboration,

trust

• Assertiveness

• Self-Advocacy

• Problem Solving

• Conflict Resolution…etc.

Physical Resilience

• Health knowledge

• The health system

• Nutrition and

anemia

• Hygiene

• Water and

sanitation

• Reproductive &

Sexual Health

• Health attitudes

• Gender equality

• Promoting rights

…etc.

Innovate

Pilot

Validate

Disseminate

Scale-up Trials

Model for Growth

Stakeholder Advocacy

2009Delhi - 100 girls

2011 Surat - 1,000 girls

2013-14Bihar / Uttar

Pradesh / Surat -5,500 girls

2015-18

9

Bihar – 70,000+ girls/boys

Girls First - India: Randomized controlled trial (RCT)

• 3,400 adolescent girls in 76 schools

• 70 community women trained as program facilitators

• Profile: 12-16 years old in rural poverty in Bihar, India

• 15-20 girls per group

• Meet 1-2 times per week for 1 hour

• 6-8 month program

• 2 Program Facilitators per group

3 intervention arms and 1 control arm:• Resilience Curriculum only (RC)

• Health Curriculum only (HC)

• Resilience + Health (RC + HC)

• School-as-usual control (SC; no intervention)

Assessment Framework

18

Impact area Key Outcomes Assessment tools (Examples)

Mental/ emotional wellbeing

• Resilience• Self-efficacy• Psychological wellbeing

• Connor-Davidson Resilience Scale-10• General Self-Efficacy Scale• KIDSCREEN Psychological Wellbeing subscale• Patient Health Questionnaire-9; GAD-7

Physical wellbeing

• Health knowledge• Health-related behaviors• Health/gender attitudes

• Survey instrument developed in part from:• General self-report of health• Indian Adolescent Health Questionnaire• KIDSCREEN Physical Wellbeing subscale

Social wellbeing

• Social skills• Social relationships (peers; family)

• Relevant Child and Youth Resilience Measure subscales• KIDSCREEN Social Wellbeing subscale

Academic wellbeing

• School engagement• Perceived safety at school

• School records; survey instrument• Child and Youth Resilience Measure Education Subscale

Girls First – Bihar: Study Design

Arm 1 (RC+HC)

Arm 2 (RC)

Arm 3 (HC)

Arm 4 (Control)

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Resilience Curriculum

Resilience Curriculum

Health Curriculum

Health Curriculum

Month 0 5 11 16

Baseline Time 2 Time 3 Time 4

School as Usual

School as Usual

School as Usual

School as Usual

Measurements

RC=Resilience Curriculum; HC=Health Curriculum

Mixed Methods Assessments and Analysis

Assessments at 4 time points: Baseline, midline, endline and 4-month follow-up

Quantitative

Internationally-validated and rigorously-piloted scales

Difference in Difference OLS regression estimation (DiD)

Qualitative

Semi-structured interviews and focus groups

Thematic analysis

Assessment method

Analysis method

Girls First Profile: Full Sample by the Numbers99.0%

50.4%

79.3%

57.9% 57.3%

31.1%

42.6% 43.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Unmarried Motherliterate

Father literate Toilet at home TV at home Vehicle athome

Ever worriedabout not

having enoughfood

Ever worriedabout losing

home

Baseline Measures

Household Wealth Economic VulnerabilityFamily Characteristics

What it measures• Coping skills• Self-confidence• Self-concept• Adaptability/ Flexibility• Courage• Benefit-finding• Focus• Determination

Connor-Davidson Resilience Scale (CD-RISC)

0%

5%

10%

15%

20%

25%

30%

35%

40%

ER+AH AH ER SC

Pre to post test changes

***

***

Note: Asterisks denote significant differences vs. control (SC), through DiD OLS regression analyses including demographic covariates. *** p < 0.001, ** p < 0.01, * p < 0.05

22


Girls who received RC (through RC+HC or RC) significantly improved their resilience vs. controls. Girls in HC did not significantly improve vs. controls.

RC+HC HC RC SC

Schwarzer’s General Self-efficacy Scale

-8%

-6%

-4%

-2%

0%

2%

4%

6%

8%

10%

ER+AH AH ER SC


***

***

**


23

Self-Efficacy

What it measures• Self-efficacy’ or belief in ability to

succeed and have an impact on one’s own life trajectory

Greater scores indicate greater self-efficacy

RC has a protective and promotive effect: Self-efficacy increased for girls who received RC, while it decreased for girls who didn’t receive RC.

RC+HC HC RC SC

Clean water item; 6 clean water behaviors


0%

20%

40%

60%

80%

100%

120%

ER+AH AH ER SC


***

**

24

Clean Water Behaviors

Adding RC improves water behaviors: RC+HC achieved significantly better clean water behavior than HC from the same amount of direct instruction on keeping water clean.

What it measures• Girls are asked how they keep their

water clean at home, including:• Filtering• Boiling• Chlorinating• Taking water directly from well (etc.)

Score is computed by adding whether she performs behaviors proven to keep water clean (filtering, boiling, chlorinating)RC+HC HC RC SC


25

School Engagement

Girls who received RC (through RC+HC or RC) significantly improved their school engagement vs. controls, to a greater extent than girls in HC.

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

RC+HC HC RC SC


*

****

What it measures• Feeling of safety at school• Sense of belonging at

school• Belief in importance of

education

School engagement items

Gender Attitudes Scale (adapted from GEMS)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

ER+AH AH ER SC


***

**


26

Gender Attitudes

Adding RC improves gender attitudes: RC+HC had a significantly greater effect despite the same amount of direct instruction about gender differences and women’s rights.

What it measures• Girls rate agreement on statements

like: • “It is equally important for girls and

boys to attend school.”• “It is ideal for a woman to have her first

child before age 18.” • “There are times when a woman

deserves to be beaten.”

Higher scores indicate greater equality in attitudes

RC+HC HC RC SC

Qualitative Study: Illuminates the “How” of Girls First’s impact

• 37 semi-structured interviews and 13 focus groups over the course of the program.

• Content analysis yielded main theme of gender discrimination.

27

Problems faced by girls (from Qualitative data):

Gender Discrimination

Difference in access to and

quality of healthcare

Early Marriage

Unsafe environment-violence, eve

teasing

Partial treatment at

home

Girls Built 4 Key Skills to Help Them Thrive

• Self-realization of their feelings and the validity of those feelings

• Courage to act up on feelings and opinions

• Long-term perspective and outlook

• Set goals and define road map to achieve these goals

Skills used to benefit the community as a whole

29

Early Marriage: Attitudes• Girls in all intervention arms were adamant that they will not

get married until age 18 or after

• However, those in arms that received resilience training emphasized why this is important to them

• They stressed their goals and determination to achieving them

• Steps they will take to achieve their goals

• They thought specifically about how they will talk to their parents or others involved in any early marriage proposal

30

31

Girls thought specifically about how they will oppose early marriage—using the character strengths they learned about in the program.

Interviewer: If you are presented with a marriage proposal then how will you handle it? What qualities can you use to share your point of view with others?

Girl: Courage, perseverance, and affection. These are very beneficial qualities. It is obvious that if I don’t speak affectionatelythen my mother won’t like it. If I don’t present my point of view courageously and simply agree to what others are saying then I will become weak. If I don’t show perseverancetowards my goal then I will lose sight of it.

32

“I told [my cousin who wanted to leave school to marry after Standard XI] her that we should not lose focus. We should first achieve our goals and get a job…. I explained this to her and she was able to understand…. She is studying properly now. She keeps on saying thanks to me.

I didn't know all this before but I learned it in Girls First…. We girls have changed.”

Girls combined the knowledge they had gained in HC with the confidence and assertiveness they had gained in RC, to help others.

Safety issues: ‘Eve-teasing’ (harassment)

• Almost every girl had a story about eve-teasing or a safety concern with a boy

• Girls who had gone through any intervention arm were clear that this is against their rights

• But girls who received the RESILIENCE program drew on their strengths to oppose it –and used group support to solve the problem

33

Gains confidence…problem solves…

“If he can threaten me just because he is a boy, then I am a girl, I can seek help from the people around me because molesting a girl is a legal offense. I can get help for this and I will reply him in the same manner”

Girls learn to communicate to parents:

• “. If a boy stares at her, touches her, and tells her something, then she should definitely tell it to her parents…… Earlier I used to be very scared about whether I should tell my mother or not. Then I thought that having self confidence is very much necessary. If I will tell her, she will not scold me because she will scold me only when she will see my fault. When I will not be at fault, then why would she scold me? if we don't tell her things on time, then she might think wrong about me”

36

“I learned in Girls First that we should not suppress our feelings and if we share our problems with someone else it will not increase them. This is why I shared my problem with the group and I got a lot of help and courage too….

When I was sharing in the group I realized that problems become easier when they are shared…. I can seek help from the people around me because molesting a girl is a legal offense. I can get help for this.”

Girls realized that their feeling and opinions mattered. With that realization came the courage to act.

37

Many girls continue to meet in groups even after the program has ended. They continue to grow stronger and healthier.

Girl: Before the training many girls would not talk to me but studying [in Girls First] together many of the girls started talking to me…. Earlier even I would not talk to them.… [Now I] talk to everyone…even the small kids…. They all teach me something and I too teach them…. What I do not know, they do, and what they do not know, I do….

Interviewer: So were you doing this before the [Girls First] training?

Girl: No….Interviewer: But the training has stopped. Do you still…discuss in groups?Girl: Yes.

With boys

CorStone - Girls First Bihar - Not for Distribution

Pilot with 250 boys to study feasibility

• Positive impact on gender –attitudes

• Favorite topics: Managing emotions, Forgiveness and setting goals

• Quote from a Boy:

• Before: “My cousin brother abused me. So I slapped him hard for using abusive words and language”

• After: “now I will try to understand the matter. I will try to discuss the matter first.”

Innovate

Pilot

Validate

Disseminate

Scale-up Trials

Building the Evidence Base: Where we are now

2009Delhi - 100 girls

2011 Surat - 1,000 girls

2013-14Bihar / Uttar

Pradesh / Surat -5,500 girls

2015-17

9

Bihar – 50,000+ girls/boys

Feasibility

Effectiveness

Scalability

The intervention!What's the magic bullet??

IMPLEMENTATION STRATEGY

A PEER-SUPPORT MODEL

• 15-20 students per group

• Meet 1-2 times per week for 1 hour

• 6-8 month program

• 2 Program Facilitators/teachers per group

• Facilitative/ activity driven

• Intense group activities

• Take home experiments

• Sharing


Building the Resilience Toolkit: Evidence-based Practice

1. Positive Psychology: strength-based vs. deficit-based approach

• Building on ‘what is right’ not ‘what is wrong’• ‘No one ever told us we had strengths’

2. Social-Emotional Learning (SEL)• Emotional awareness; positive interpersonal communications

3. Attitudinal Healing• Values-based approach to cultivating inner health• Emphasis on universal values and assets

• Love, Empathy, Forgiveness, Kindness, Gratitude…

4. Restorative Practices• Group-based problem-solving, conflict resolution

Building up the skills from the Inside...

Internal assets:

• Self esteem

• Benefit finding

• Management of feelings

Interpersonal assets :

Empathetic listening

Communication

Restorative practices

• Group problem solving

• Restorative justice / resolving conflicts

Family, community and culture

Educatio

n

Physical body

Emotions, thoughts

and behaviors

Girls First: Curriculum

45



• Self-Esteem


Planning

• Identifying and

regulating emotions


• Benefit finding

• Gratitude…etc.

Social Resilience

• Listening skills,

collaboration, trust

• Assertiveness

• Self-Advocacy

• Problem Solving

• Conflict Resolution…etc.

Physical Resilience


• The health

system

• Nutrition and

anemia

• Hygiene

• Water and

sanitation

• Reproductive &

Sexual Health


• Gender equality

• Promoting

rights

…etc.

Activities in groups


Opening circle


What's my character strength?


Work on their goals


Listening skills



culture

Education

Physical body

Emotions, thoughts and

behaviors

Implication to prevention of violence in schools

51



• Self-Esteem


Planning

• Identifying and

regulating emotions


• Benefit finding

• Gratitude

• Forgiveness

Social Resilience

• Listening skills, collaboration,

trust

• Assertiveness

RESTORATIVE PRACTICES:

• Problem Solving

• Conflict Resolution/ restorative

justice – to manage bullying

Physical Resilience


• The health system

• Nutrition and

anemia

• Hygiene

• Water and

sanitation

• Reproductive &

Sexual Health


• Gender equality

• Promoting rights

…etc.

“No oneever toldus we had strengths.”

-- Girls FirstParticipantBihar, India

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Youth First builds resilience and self-confidence in marginalized adolescents, empowering them to achieve their potential despite difficult circumstances.

For more information:

Gracy AndrewCountry DirectorCorStone India Foundation+91 [email protected]

www.corstone.org

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