Palestine

USAID-Save the Children (STC)-ITC –Palestine

GOAL AND OBJECTIVES

The USAID goal of the Community Psychosocial Support Program (CPSP) is sound psychosocial development for Palestinian children and youth growing up in adverse circumstances, thus enhancing their capacity for moral reasoning and action and supporting them to become productive, satisfied and involved citizens of the future.

1: Increased comprehensive out-reach of psychosocial support efforts in Palestine, particularly in marginalized areas and including enhanced opportunities for participation and self-development of children and youth.

2: Increased technical capacity of Palestinian psychosocial support providers.

3: Increased availability and access to psychosocial support resource materials within an appropriately researched behavior change communication campaign.

4: Increased collection and dissemination of quantitative and qualitative management information on the psychosocial status of Palestinian children, youth, families and communities.

Assessment of Psychosocial Interventions

Impact of Second Initifada on Palestine Youth, Psychosocial Infrastructure, Finance and Parenting: After a rigorous assessment by USAID, STC and ITC in affiliation with the Secretariat of the National Plan of Action for Palestinian Children it was established that the organizational response of mental health providers has been primarily reactive in nature, meaning formal and non-formal providers of psychosocial health care have responded on a short-term level to emergency situations.  An in-depth study of the resources available in this sector conducted by the Secretariat of the National Plan of Action for Palestinian Children emphasized that there is no national, long-term coordinated plan of action for dealing with the current psychosocial needs.  They state: “A review of existing governmental policy relating to mental health issues and concerns in the Palestinian society indicates that this area has received little attention and no prioritization (p. 191)”, although the study goes on to say that the Ministries of Health, Education and Social Affairs all consider the issue to be a priority.

In the interest of brevity we next present the IMAPCT of the 5 year ITC program in Palestine during the second intifada. The infrastructure development and development assistance programming for the CPSP program is detailed below the impact statement. The full USAID report is attached for detailed reference.

IMPACT

The USAID report (see attached document for full report) presents the findings of an extensive impact assessment that was undertaken to measure the impact of the Classroom-Based Intervention (CBI c ) Program implemented in the West Bank and Gaza. The CBI program, designed and developed by ITC (formerly the Boston Center for Trauma Psychology), is a psychosocial integration and recovery program for children, adolescents and their adult caregivers who are exposed to psychological trauma.

Through highly structured expressive-behavioral group activities, CBI is designed to (1) reduce potentially harmful traumatic stress reactions, such as fear and depressed moods, and (2) to increase children’s ability to solve problems, maintain pro-social attitudes, and sustain self-esteem as well as hope for the future. The CBI program was introduced in the West Bank and Gaza in 2003 by Save the Children USA (SC USA) as a core component of their Community Psychosocial Support Program (CPSP), funded by the USAID Mission to the West Bank and Gaza (USAID/WBG). The program was introduced in response to the reported increase in stress and trauma amongst Palestinian children and youth following the escalation of the conflict situation in Spring 2002. Feelings of danger or insecurity, as well as pessimism regarding the future, were found to be wide-spread amongst children and youth. Teachers reported a decrease in academic performance and parents reported overwhelmingly that one or more of their children exhibited traumatic stress symptoms such as bedwetting, increased aggressiveness or withdrawal.

The CBI program, though not the only psychosocial support program available, gained community-wide acceptance quickly. It was endorsed by the Ministry of Education at the outset of the academic year beginning in September 2003. A few months later the United Nations Relief and Works Agency for Palestinian refugees (UNRWA) also introduced it in its schools. Community organizations and summer camps provided yet another venue.

In little over a year after the CBI launch, over 1,400 school counselors and other social workers were trained in CBI techniques and over 100,000 children completed the full 15-session program in the first two years. This has made CBI in the West Bank and Gaza the largest scale psychosocial support program known to date in development assistance. By 2007 over 528,000 youth (1/6 of the entire Palestinian youth population) had completed the 15-session program.

From the start, the feedback received by SC USA and USAID/WBG was very encouraging. Children stated time and time again that CBI helped them feel better, happier, and more confident. Families reported that they found their children more optimistic and more cooperative at home. Teachers reported that students were more focused after CBI, more ready to learn, and less aggressive overall. However, it was decided early on that anecdotal information did not suffice and that an evidence-based study was required to measure impact and to ensure continued proper service provision to the Palestinian youth. A randomized and controlled impact study was thus undertaken on an unprecedented scale in academic literature, involving 664 children and 11 different assessment instruments. Analysis focused not only on assessing the impact of the CBI program on young Palestinian children (6-11 years) and adolescents (12-16 years), but also examined gender differences in CBI impact for both age groups.

PROGRAM PARTNERSHIPS AND COORDINATION

The CPSP promoted and supported a comprehensive national program for community psychosocial support and incorporated the various levels of coordination and partnership outlined below.

1. National level program policy coordination

Save the Children (STC-ITC) and its core CPSP in-country program partner, the Secretariat for the National Program of Action for Palestinian Children (NPA), worked with the United Nations Relief and Works Agency (UNRWA) to catalyze the formation of a national psychosocial coordination body that will include those three organizations as well as the key concerned Ministries of the Palestinian Authority (Health, Education, Social Affairs, and Youth and Sports).  The purpose of this body is to consider national psychosocial policy and to ensure program complementarity and coordination of the organizations chiefly concerned with psychosocial support activities in Palestine.  It is proposed that this body will meet on a quarterly basis.

A second level of national coordination occurred between the two major psychosocial support programs: the CPSP, implemented by STC-ITC and the NPA and targeting the Palestinian population living outside of refugee camps, and a similar program implemented by UNRWA, which is currently targeting the residents of refugee camps in the West Bank (with possible future expansion of the program to the camps in Gaza).  This coordination was more operational in nature with the purpose of ensuring the complementarity and consistency of the psychosocial support mechanisms and messages of the two programs.  These groups met every four to six weeks, depending on need, to review major coordination issues and share relevant information.  Ongoing coordination on implementation took place between STC-ITC, the NPA and UNRWA’s designated manager for the implementation of their program, the Foundation for Health and Social Development.

2. Core CPSP partnership between STC-ITC and the NPA

Through the CPSP, STC-ITC  provided direct support to the NPA, which currently coordinates national efforts to ensure the welfare and rights of Palestinian children.  The project specifically supported the NPA’s ongoing coordination of the psychosocial activities of the various organizations involved in this endeavor.

Within this partnership, the NPA did:

• Continue its coordination of the larger group of concerned agencies, including the development of joint technical approaches and training materials (incorporating within that the related curricula developed by UNRWA);
• Work with STC-ITC on the development and implementation of the CPSP training and technical assistance component;
• Work in coordination with the Palestine Central Bureau of Statistics (PCBS) on the development and implementation of a psychosocial management information system; and
• Work in cooperation with STC-ITC on the qualitative research and documentation component and the development of the behavior change communication campaign.

In addition to supporting the above, STC-ITC did:

• Provide psychosocial technical advice and support throughout the project;
• Manage a series of subgrants to national implementing partners;
• Coordinate the development of the BCC campaign; and
• Be responsible for overall project implementation and management.

3. Coordination with national implementing partners

Over 20 NGOs, GOs and multi-lateral agencies have participated in recent psychosocial planning meetings coordinated by the NPA with support from STC-ITC.  Within the CPSP, STC-ITC and the NPA continued to involve this group in the development of joint technical approaches and training and resource materials for psychosocial programming.  In addition, an estimated nine organizations received subgrants to implement CPSP activities in marginalized locations not currently receiving effective psychosocial support.  A CPSP Partnership Coordination Committee was established with representation from STC-ITC, the NPA and the project subgrantees, to ensure effective cooperation on project implementation.

INTERVENTIONS/TECHNICAL APPROACH

4. Target beneficiaries/locations

The ultimate focus of the CPSP is to ensure effective outreach of sound psychosocial support for children and youth throughout Palestine.  As noted above, this was undertaken in coordination with UNRWA, which worked with the residents of the refugee camps, while the CPSP targeted the non-camp population in its direct implementation.  The CPSP will further prioritise its directly supported outreach activities to those non-camp locations without current access to comprehensive psychosocial programs or locations with a great degree of need.

The Priority areas were:

Northern West Bank

The municipalities and villages in the Jenin, Tulkarem, Qalqilya and Salfit Districts.

Central West Bank

Jericho and its surrounding villages along with the villages around Ramallah, Jerusalem and Bethlehem that have difficulties accessing existing services or have a high level of need.

Southern West Bank

The municipalities of Halhoul, Hebron, Dura, Al Dahariya, Al Sammu’a, Yatta, S’air and the villages surrounding them.

Gaza

All locations outside of refugee camps (and within camps if UNRWA’s project is not extended to Gaza).

2. National coordination and program guidance (addressing all project IRs)

The wide-ranging CPSP target locations noted above were reached with appropriate psychosocial interventions through a coordinated, consistent and comprehensive effort undertaken by multiple agencies and spearheaded by the CPSP core partners: STC-ITC and the NPA.  The NPA continued its leadership role in the coordination of the larger group of concerned agencies, including NGOs, GOs and multilateral organizations.  Within this, the NPA coordinated the development of joint technical approaches and training materials that all cooperating agencies utilized.  These materials were built upon and include the related curricula developed by UNRWA.

In addition to these coordination efforts, STC-ITC and the NPA provided program guidance at the national level through the sharing of data and analysis on the psychosocial status of Palestinian children, youth and communities.  This information was generated through a quantitative management information system complemented by qualitative research by STC-ITC as discussed further below.  This information was also central to the development of a national behavior change communication program in support of children’s sound psychosocial development.

3. Community outreach of effective psychosocial interventions supported by technical and financial assistance to implementing partner organizations (addressing IRs 1 and 2)

In support of enhanced outreach of psychosocial interventions to the CPSP target locations, STC-ITC and the NPA  completed the following activities:

1. Provided targeted training and technical assistance to interested cooperating agencies to ensure the appropriateness, quality and consistency of their psychosocial program efforts.  This training was based on assessed needs and drew as appropriate from the UNRWA curricula, the joint training materials developed through the CPSP and other materials as required.
2. Promoted through the coordination efforts of the NPA the equitable geographic distribution of the ongoing psychosocial interventions of the cooperating organizations.  The organizations were encouraged to target the most marginalized areas of need within their current programs if at all possible.
3. Conducted a subgrant competition to support the implementation of psychosocial interventions in marginalized communities.  The competition was based on clear selection criteria including both technical and organizational capacity to undertake the STC-ITC scope of work.  A technical committee composed of representatives from key institutions, likely to include the NPA, recognized mental health organizations and the Ministries of Health, Education, Social Affairs and Youth and Sports, was utilized to review the proposals and rate and recommend to STC-ITC based on the established criteria.
4. Managed the subgrant process, including pre-qualification of subgrantees, enhancement of subgrantee financial systems to ensure compliance with all applicable regulations, establishment of necessary fund transfer and management procedures, and regular monitoring of compliance through thorough reviews of monthly financial reports.
5. Monitored subgrantee programs quality and provided related on-site technical support as required.  This was undertaken as a coordinated team effort between STC-ITC and NPA technical staff.
6. Facilitated linkages for the subgrantees and other cooperating organizations with programs providing other opportunities for institutional capacity building.  These would include the recently funded USAID Civil Society project and other relevant activities funded by the USAID Democracy and Governance Office.
4. Management information and child protection documentation (addressing all project IRs)

The CPSP contributed to a more in-depth and comprehensive national understanding of the psychosocial status of Palestinian children and youth, all of whom are being raised in families that are now in their second or third generation of life under occupation and, for many, as refugees.  This was undertaken through quantitative data collection and analysis combined with complementary qualitative research.

The quantitative data was handled within the framework of a management information system that linked all cooperating organizations with a common set of indicators, means of data collection and monitoring timeframe.  The MIS contained two components creating access to appropriate and adequate data for monitoring on two levels: the national status of children’s psychosocial well-being in regards to the impact of current events and the project level indicating changes in relation to the enhanced provision of related services.

The Palestinian Central Bureau of Statistics (PCBS) developed the national level system with technical input from the NPA and STC-ITC.  The survey was conducted at least twice during the term of the CPSP, which allowed the results to be compared within the context of current event changes and the project interventions.  Through this, the CPSP partners encouraged the PCBS to adopt the survey as a regular component of their national statistics portfolio.

On the project level, STC-ITC, the NPA and the implementing partners agreed on a monitoring system that incorporated the same set of indicators as used on the national level.  The implementing partners collected data throughout the process of project implementation and forwarded this on to the NPA.  The project MIS was housed at and managed by the NPA where implementing partner data was compiled into a comprehensive analytical framework.  The NPA produced and circulated regular reports from the project data.

As noted previously, the quantitative data of the MIS is complemented with qualitative research that further explore the psychosocial status of Palestinian children and youth and also served to inform the behavior change communication component of the CPSP.  ITC and Dr. Vivian Khamis complete a randomized controlled trial of the CBI for 5-12 year olds and 13-16 year olds in throughout Palestine.

5. Behavior Change Communication (addressing IRs 1, 2 and 3)

The BCC component is an integral part of the CPSP, building upon the insights provided by the MIS/research component and incorporating activities that can be promoted through the programs of the implementing partners.  The CPSP contracted international expertise to support the design and development of the BCC component and built upon the extensive awareness promotion experience within the STC West Bank/Gaza programs and the NPA.

Due to project financial constraints and the critical need for psychosocial outreach to communities, initial BCC efforts were developed for targeting at that level.  Therefore, although the project did not have sufficient funding to undertake a serious national BCC campaign, such as the production and airing of a TV drama series, it was  able to develop and pilot various activities, for example through child-to-child programs and local development theatre groups, which provided critical insights for a more extensive endeavor in the future.

The CPSP BCC component sought to develop linkages with the similar efforts of the upcoming USAID Improved Village and Community Health Services Project.  Specifically, it encouraged the IVCHS to incorporate psychosocial issues within the projects efforts to promote behavior and normative changes for a more supportive environment for child health.  Within this linkage, the CPSP took into account the important insights already provided by the USAID-contracted “Assessment of Behavior Change Communication Capacity in the West Bank and Gaza” by Fox and Tifft.

6. Direct piloting of program innovations (addressing all project IRs)

To provide flexibility and efficiency for the CPSP to pilot innovative psychosocial interventions, STC-ITC hired three CPSP field coordinators to work within the program framework of its ongoing USAID-funded Community Services projects.  These projects already incorporate strong components for early childhood development, primary education and youth activities, which will be expanded to incorporate psychosocial responses.  This STC-ITC involvement in direct implementation facilitated the piloting of program innovations and the development of training designs and methods appropriate for a variety of implementing partner organizations from the local community through to government Ministries.  The STC-ITC efforts promoted integrated approaches to the psychosocial response by linking these activities with its ongoing work in child rights, early childhood development and non-formal education.

Evaluation

The CPSP, through its combined efforts in program development, training, technical assistance and financial support, did in fact promote and support the healthy psychosocial development of Palestinian children and youth.  Specific indicators for assessing this within the Palestinian context were defined by the project MIS and ITC and Dr. Vivian Khamis.  Given the many external variables that affect children’s development, however, it was a unique challenge to measure the ultimate project impact.  Further, the magnitude of project achievement was greatly affected by the degree of externally imposed adversity confronting Palestinian families and communities which ITC and Dr. Khamis accounted for in the USAID funded randomized controlled trial.

Incremental benefits from the project interventions were extremely beneficial in confronting the difficult contextual circumstances.  These included:

• Increased coverage and effectiveness of psychosocial support activities;
• Increased technical skills of psychosocial support providers;
• Increased organizational capacity of psychosocial support organizations;
• Increased linkages, information sharing and program consistency of psychosocial support organizations;
• Enhanced understanding of the psychosocial status and issues in the Palestinian context and methods of addressing them;
• The foundations for a behavior change communication campaign that promoted individual behavior and normative change on a national level.
• Profound positive impact on the school and camp “climate or culture” in education domains
• Profound positive impact on the public health approach in Palestine

SUSTAINABILITY

The CPSP is had sustained impact in terms of changed behaviors at the family and psychosocial support provider levels and in the institutional technical capacity of the partner organizations, including the NPA, government ministries and NGOs, for continuing psychosocial program interventions and adaptation of public health policy dissemination.  In addition, through the national coordinating body, the project impact has been sustained with respect to influences on national mental health policies and approaches to non-aggressive methods within education and family settings. CBI continues to be conducted today throughout Palestine.