Indicators for Psychosocial Programs

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					Indicators for Psychosocial
    Leslie Snider, MD, MPH
    Tulane University SPH&TM
 M&E of Psychosocial Programs
• New field with few models
• Work includes global, national and
  program-level indicator development
• Two illustrative studies (Horizons):
  – Zimbabwe: impact of psychosocial programs
    on well-being of adolescents
  – Rwanda: impact of adult mentorship program
    on CHH, younger siblings and mentors
      What is “Psychosocial?”
• Achieve a better understanding of what
  psychosocial programs intend to do: clear
  objectives help to demystify the concept
• Not a separate sector: interwoven with all
  other programs/services that promote
  children’s healthy development, and shore
  up their resilience in face of adversity
• “Good enough mothering”
• Psychosocial programs intend to provide
  culturally-appropriate care, support, nurturance
  and guidance for children and adolescents at
  different stages of their development
• Help to coordinate services to meet the array of
  children’s well-being needs, in a sensitive and
  caring way
• Time spent with a child in a caring relationship,
  availability of adult or mentor to the child
              Types of Indicators
• Emotional health of child is expressed in various
   –   Physical health
   –   Behavior
   –   Self-perception and self-esteem
   –   Functioning
• Proxy indicators include general health and
  nutritional status (is child fed, clothed, clean?),
  living conditions, school attendance and
  performance (matriculation)
  Emotional, Social, Behavioral
• Cross-culturally determined
• Include: mood (self-perception), self-
  esteem, confidence, behavior (including risk
  behavior), functioning according to age and
  developmental stage, cognitive aspects
  (cognitive capacity and future outlook,
  hopefulness), and spirituality
        Well-Being Domains
• Social connectedness
• Psychological health, including self-
  perception (mood and esteem), cognitive
  and behavioral aspects
• General health and well-being
• Functioning in relevant roles
Some Challenges to Psychosocial
    Indicator Development
• Cross-cultural contexts: the experience,
  expression and recognition of emotional
  distress is rooted in culture
• Establishing indicators for children and
  adolescents at different ages and
  developmental stages
• Gender considerations
  Use of Standardized Measures
• Standardized psychological scales may be useful,
  but require adaptation and validation (Paul
  Bolton’s work)
   – Zim study: physical symptoms had other meaning
• Instruments found to be useful in other contexts:
• Even if using standardized scales, qualitative
  methods essential to get at the priorities and terms
  in children and youth’s own words
         Take Home Messages
• Psychosocial programs provide care, support,
  nurturance and guidance to children and
  adolescents through supportive relationships.
  They also coordinate the array of services to meet
  well-being needs of children. Like a “mother.”
• Useful indicators include proxy measures (general
  health, nutrition, etc.) and emotional, social and
  behavioral measures
• Qualitative methods are most useful in
  determining local terms for emotional distress and
  priorities for psychosocial health and interventions