More (Biased?) Results

Here are the results from the CBCL 6-18.  All of the pre-post differences were statistically significant at p<0.005:

	Girls Pre	Girls Post	Boys Pre	Boys Post	All Pre	All Post
	(n=20)	(n=20)	(n=13)	(n=13)	(n=33)	(n=33)
Internal	50.8	43.4	55.3	43.3	52.5	43.3
External	57	46.5	63.3	55.4	59.5	50
TOTAL	53.7	42.9	58.5	49.8	55.5	45.6

As one can imagine, numerous confounds and potential biases influenced these outcomes.

La Revedere! Arrivederci!

Yes, I am ecstatic to come home to family and friends.  Yes, I am relieved to speak English consistently again.  Yes, I am glad to participate in activities such as cooking, going to church, and grocery shopping.  However, there are many things I will miss after my 16-week stay in Câmpina.
1.) Gorgeous weather and beautiful scenery.
2.) Receiving countless hugs and kisses daily.
3.) Paying $0.40 for a loaf of whole-wheat bread.
4.) Fresh fruit and vegetables straight from the garden...every day.
5.) Homemade ice cream, jam, and honey.
6.) Meeting various people from Italy and attempting to speak their language.
7.) Passing people "walking" their cows, goats, and horses.

and the things I will not miss...
1.) Listening to unnecessary castigations, especially first thing in the morning and last thing at night.
2.) Wondering which pieces of clothes will not return from the laundry.
3.) The dogs: chasing me on my runs and barking incessantly at night.
4.) The slow pace and uncertain nature of tasks being accomplished.
5.) Hearing the phrases "Te rog frumos" and "Hie repede" repeatedly.
6.) Not being able to fully express myself verbally-- to both the children and the caregivers.
7.) Smoking.  Everywhere.

Every End has a New Beginning

It's been quite a journey here at Casa Sperantei.  Even still it seems like a couple weeks ago that the children dragged me around asking, "What is this?" (one of the few English phrases they knew), and giggling at each word I pronounced in English.  Or they growled in frustration because I couldn't understand them.  Clearly I have come a long way in the communication department. 

For the final week Iulia and I took two groups of children to nearby playgrounds to clean-up the garbage that litters them.  Another group of the smaller children cleaned-up around Casa Speranței.  While this was a good activity for them, I know just one volunteering experience will not serve to increase their social interests and empathy development.  However, it's definitely a step in the right direction (not to mention later in the week Iulia heard one of the little ones tell the others not to throw trash on the ground).  Unfortunately my dream of taking some of the children to a clinic with children with disabilities to distribute their cards and teach games/songs was not realized due to failed connections.  Iulia assures me that she will continue to look for opportunities for the children to visit children who are sick or disabled.

On Thursday groups from our anger management sessions presented what they have learned to all the other children.  We were impressed with their ideas for the presentations, and just as impressed with the actual performances.  Two pairs put on puppets shows that conveyed the importance of speaking nicely to each other, as well as strategies to use when you get angry and want to say something mean.  I'm not sure how much the other children gleaned from the shows, but I know those presenting will have to "own" their behaviors a bit more now.  Iulia expressed her dedication in continuing these sessions with the children and getting even more children involved.

Knowing that this marked my last week here the children all begged to come play one last time.  Each day I was met by myriad children who inquired, "Chi lo prendi?!" ("Who are you taking?!") or "Posso venire con te?" ("Can I come with you?").  While I had anticipated this it still was difficult to not grant each child this opportunity.  Amidst wrapping everything up here I wasn't able to meet with as many children as I hoped.  Nevertheless I still spent some time on the computer with a handful of children and played with another handful one-on-one.  It will be a difficult adjustment for them to not have this individual time any more, but I know it helped a lot of them develop their socio-behavioral skills, competence, and self-regulation.

Overall it's been an undulating, challenging, rewarding learning experience.  I'm forever indebted to Iulia for her wonderful support, knowledge, translation skills, and dedication.  Without her (and Sister Marisa) none of this would have been possible.  It's also comforting to know someone like Iulia will remain at Casa Speranței to continue to make progress with both the caregivers and children.  I look forward to my future contacts with her to get an update on the happenings here.

Outcomes?

We met with the caregivers on Monday to review the principles they learned, complete various surveys, distribute therapy items and toys, and discuss follow-through components. 

Here's a first glance at the process and outcome evaluations I tracked:
1. Meeting attendance:
      Caregivers:  80.1%
      Sisters:  13.9%
2. Caregiver Knowledge Survey:  (Bear in mind this survey was created by myself, and some of the questions were not explicitly covered in the lesson plans...or were lost in translation.)
<><><><><>   <><><><><><>   <><><><><><>  <> <><><><><> 

	Pre (% correct)	Post (% correct)
Health Outcomes	43	37
Development	70	87
Behavioral Issues	53	67
Sensory Concerns	40	64
TOTAL	52	64

***Red sections were the primary focus of the weekly lessons

3. CBCL results pending until the caregivers complete them at the beginning of October. 

4. Feedback from the caregivers:
*Strategies learned and currently use regularly: (Number of caregivers who gave the response)
     >Time-out and rules regarding time-out (2)
     >Break every 20 min. during homework time (3)
     >Encouragement and praise when the children behave (2)
     >Have the children repeat the instructions (3)
     >Ask the children if they understand the instructions (2)
     >Giving the children a verbal time notification (e.g. 10 min. left)
     >Using "please" and "thank you" when speaking with the children
     >Saying the instructions one time
*Strategies learned and want to use more often:
     >Encouragement and praise when the children behave (3)
     >Have the children repeat the instructions
     >Time-out and rules regarding time-out
     >Giving the children a verbal time notification (e.g. 10 min. left)
     >Reading the rules together with the children
     >Not paying as much attention to mistakes or using criticism
     >Giving the children more freedom to express themselves
*Stategies learned and probably won't use:
     >Saying the instructions one time (2)
     >Enforcing the rules when the children disobey (3) [Yikes!]
     >Relaxation techniques, such as progressive muscle relaxation
[It's nice to hear they have utilized or want to utilize many of the strategies we discussed, and that many of them gave similar responses.  Now increasing the consistency will be key...]

Here's a first glaces at the lessons learned during my time here:
1. You can't help everyone, but you can positively change something.
2. Modeling and immediate feedback matters.
3. Love is a powerful therapy tool.
4. Advocacy never escapes the mind of a devoted therapist.
5. More occupational therapists need to be involved in orphanages.
6. Community practice requires flexibility without compromising goals.
7. Age makes a difference; so does effective communication.

Taking Things in Strides

Surprise!  Another volunteer group showed up Saturday night-- and we thought no more would be coming...how silly of us.  However, because the children have not participated in our group sessions for two weeks due to Iulia's vacation I decided to nix them for this week.  My outlook in working alongside the group started out positive but slowly began to fade as the week progressed.  While I was still able to conduct the anger management sessions with Iulia and the computer lessons with the little kiddos, my one-on-one/two-on-one time with the children suffered greatly.  Not to mention we were forced to push back the final "review" meeting for the caregivers to Monday (which means poorer attendance because two of them will be on vacation next week before the school year begins).  With so many children returning from Italy this past week and already trying to reintegrate I'm not convinced having this volunteer group was the best for them (i.e. being shuffled from activity to activity after enjoying the freedoms of being in a small family setting).  Plus, a couple noticeably regressed from the progress we had made with them after returning from their trip to Italy, which is obviously frustrating (probably due to the difficulty of the transition).  I cannot stress enough the importance of consistency for these children! 

On Tuesday I conducted my last lesson plan with the caregivers-- it's hard to believe!  We talked about different ways we regulate our senses without being aware of it, and how some of these might be useful to teach children who struggle to do this independently (or use less appropriate strategies).  Then I gave them therapy tools and ideas for sensory regulation before the children do homework or quiet activities.  Many are similar to those I gave related to behaviors (which makes remembering them easier), but some of the new ones can definitely benefit the children.  While I think they appreciated learning these sensory techniques, I also believe they are glad to be done with the meetings.  However, I will be recommending that they continue to meet on a weekly basis (with Iulia) to discuss with each other specific strategies/techniques that work with specific children, ask/answer any questions that arose, and gain more information related to topics of interest.  These meetings will be more informal but also very beneficial; and they might help them integrate the strategies more and increase consistency of responding to the children.  On Monday we have our "wrap-up"/"review" meeting where I will give outcome/feedback surveys, tie-up a lot of loose ends, and address any pressing concerns.

For the anger management sessions this week Iulia and I first reviewed the strategies discussed from two weeks ago and inquired whether the children had used them.  "I forgot" or "I didn't need to" were common excuses from the children, while others cited specific examples of when they utilized them.  Through the week I reminded several of them to use the techniques in various situations which I believe was useful for them recognizing when they might need to calm themselves down.  I also observed a couple use some of the strategies without them being aware that they did it.  The more practice (and more comfortable) the children get in using the strategies will obviously benefit them more.  After this review we had them play the "Good Decisions Game"-- a game I created where each scenario has two choices to make.  Once the child made a choice he/she moved to the corresponding response where the scenario continued.  At the end of a series of choices the child found out how his/her day turned out based on all the decisions made.  Finally we had them watch a powerful YouTube video on the consequences of bullying, which I believe positively affected each of them in some way.  Many of them noted at the conclusion of the video that they didn't want to be the bully, they wanted to be the person who helped the child being bullied.  Sometimes I think children (and adults) aren't aware of what they look like when they perform certain actions; this was a good way of illustrating how their anger can impact others.

A huge success for the week came yesterday when Iulia and I installed the educational games on the children's computer.  It finally has a sound driver (thanks to Iulia's technological skills) to run the programs and for the children to listen to music.  Iulia hopes to make a weekly schedule for using the computer; I suggested creating a check-out system for the CDs.  The older girls played a couple of the games last night and listened to some of the music I put on the computer; this morning they excitedly told me how much fun the games are and how much they enjoy the songs.  They are eager to play the other games that require a CD.  Thank you to those who donated money-- with which I bought several of the computer games-- and to those who donated educational computer games.  Know that you brought smiles to many children!

Look! I did it!

In our ever-progressing world of technology the ability to use a computer consistutes an important occupation for both children and adults.  Within orphanages, even well-equipped ones such as Casa Speranței, these opportunities may be considerably limited.  Fortunately Iulia pursued the provision of a computer for the children to use; and while one computer for forty children is not ideal, it is better than nothing.  Some of the older children learn the basics of computer usage in school, but most of their peers already have exposure to a computer on a regular basis long before these classes begin. 

This week I pulled out several of the younger children individually to provide 30-minute computer lessons.  During these lessons I taught them the basics of using a mouse (which, they quickly discovered, takes considerable coordination) and typing through the use of the "Paint" program.  It was fun to see their reaction when they pressed on a key for several seconds instead of only one time.  Or the magic behind the space bar and backspace keys.  Or when they clicked the wrong thing and a message popped up.  All of them were so proud of themselves after writing their names using the keyboard.  Several turned and smiled, saying "Look!  I did it!  I wrote my name!"  Others stated, "Mama mia!" or "Che bella (how pretty)!" when they used various painting tools or changed colors.  I will continue with these lessons the next two weeks in order to progress their skills even further.  The educational games I purchased (thanks to donations) have also been installed on the computers, but Iulia and I still need to find a sound card and a few other applications in order for them to run properly.  With any success these tasks will be completed before I leave so I can be more assured that the children can access the games.

As you may have guessed, my time with the children has continued, primarily now with pairs, to further assist their social skill development.  I have been happily surprised with many of their interactions together-- both within the therapy room and outside when playing.  Arguments and scuttles still occur, but it seems they are less frequent and not as major.  Excitedly I witnessed a few of the children who attend the anger management sessions use strategies we taught.  And they definitely love being recognized and praised for these positive changes.

A major development here is the addition of six new members to the Casa Speranței household.  All from the same family, the four brothers and two sisters range in age from two to eight years (I think).  The eldest is currently being taught how to write and read by one of the older girls here.  It has been fun to see some of the other children assist with the little ones-- a good source of responsibility and self-confidence indeed.  Not to mention this decreases the burden on the already overextended caregivers.  And I believe three more children will be coming in the near future (I do not know their ages).  Even more reason for the caregivers to keep utilizing the strategies we discussed!

A Romanian Wedding

Last Saturday I had the privilege of attending the wedding of Iulia and Madalin.  The ceremony took place at a Catholic church in Câmpina that seemed to have many of the components of a Catholic wedding in the United States.  Both the ceremony and reception were small and informal, but had many traditional components.

The Newlyweds!

 Unlike American wedding receptions (where you usually eat then dance), Romanian receptions feature an array of entrees served for the duration of the celebration.  In a sense you eat your way through the night.  This was the approximate schedule: 6:00pm- snack foods; 7:30pm- appetizer; 9:00pm- course 1; 12:00am- course 2; 1:00am- dessert.  You can see the fare below (pardon the quality of the last two pictures).  I felt guilty only eating about 1/2 of all the food served, but it just kept on coming.  And to think they opted not to have one of the entrees!  In traditional Romania fashion, meat (fresh and not processed!) composed the majority of each dish (I was told jokingly they are still making up for the 5 years during the communist reign when meat was almost inaccessible).  Overall a delicious eating experience.

Appetizer- Cheeses, Vegetables, Salami, Ham, and Meatballs

 

Course 1- Cabbage, Polenta, Rice and Beef Rolls


In between the courses of food we danced and enjoyed each others' company, much like any American wedding.  I learned a couple Romanian dances thanks to the welcoming nature of the attendees.  And not even a Romanian wedding is complete without dancing to the "bunny hop" (although called something different).

 

Course 2- Potatoes, Pork chop, Sausage link




 

Dessert- Cake, Brownie, Wafer cookies

Representatives from five different nations attended the wedding and reception: Hungary, France, Germany, United States, and, of course, Romania.  As usual the common language spoken between everyone was English-- an obviously refreshing advantage for me.  Even still I spent a lot of time sitting and listening, just trying to figure out what people were talking about.  My Romanian proved very rusty after speaking primarily Italian the last 6 weeks.  Luckily dancing requires no words!

By the time Iulia finally threw her bouquet of flowers (around 2:30am) only two unmarried females remained; unfortunately I did not catch it.  I'll leave that matter in the hands of God.  Nevertheless I couldn't have asked for a better (cultural) experience and was grateful for the opportunity to attend such a wonderful occasion.  A much-needed social and psychological boost for sure!

Quotes of the Week

Thought I would share some of the great things the children said this week:

"How many ice creams did you have to eat to get all of those?"  (referring to all the popcicle sticks we used to make picture frames)

"Why don't you know everything in Italian?"  (which prompted me to write the poem from earlier this week)

"What does this say?"..."It says, 'You are a child of God'."..."Me!?"  (a six-year old asking about a sign I made and posted in the therapy room)

"First we need to clean up."..."With what? A broom?"  (a child's response after finishing our game of Trouble)

As a side note, it was exciting to meet a couple from Italy who had read my blog before coming this past week.  Plus they spoke English, which is always a nice surprise.  It's also encouraging to see couples from Italy again and hear them comment on the progression of my Italian.  I will miss having people come in and out these next couple of weeks-- makes for lonely mealtimes.

Still Chugging Along

Early this week Iulia and I spent most of our days in the anger management sessions with selected children.  Some of them came with examples of when they used the things we had previously taught, which is encouraging even if they only employed them a couple times.  I have also observed a few of them using (or trying to use) what they learned.  This week we provided them with more strategies to regulate their anger/frustration, such as squeezing their hands/feet together, putting something in their mouth, stomping the ground (instead of someone else!), and closing their eyes or turning the other direction.  After practicing them each one identified their favorite; many liked the first three options.  Next we played a game with colored candies that required them to give the number of responses as they had candies of that color (i.e. 3 red candies= 3 responses).  The prompts asked what they could do when they get angry/frustrated, what they can say when they don't like what someone did, and what nice things they can say to someone else.  For each correct response they won that piece of candy.  With two weeks until our next session we told them to practice everything they have learned, rely on each other, and report back what strategies they practiced.  I'll be on the lookout as well and providing guidance to make the better decision when needed.

With the help of the caregivers I was still able to conduct a few group activities with the children this week.  One day the older children made picture frames out of popcicle sticks.  First they had to choose four different children and write a nice adjective that describes him/her.  Then they exchanged the popcicle sticks, which served as the border of the picture frame.  Next came the task of decorating; which, of course included taking turns, sharing, and asking politely to use various materials.  Throughout the week I have been taking pictures of them playing nicely with each other and will develop the pictures to put in the frames.

The following day the younger children made butterflies which will be given to the older adults they visit with one of the sisters.  Using a popcicle stick as the body the children wrote a nice message (primarily "have a good day").  Next they traced their hands and cut them out for the wings (yay fine motor skill development!).  Finally they decorated the wings with stickers, markers, colored shapes, and string.  Many of them need encouragement to slow down and take their time; several need one-on-one attention for honing their cutting skills (which I've been trying to do a bit in my play time with them).  As with the older children I was definitely pleased with the way they shared, waited their turn, and used their manners when asking for materials. 

Because the majority of the children have spent several session with me one-on-one I have started to ask the children if they want to play together with someone.  Many, but not all, opt for this choice.  It's a great way for them to employ the skills they have learned individually and facilitate their interaction with one another.  Plus they enjoy teach each other the games they have learned and exploring new activities together.  The most difficult task is having them work together on projects (e.g. building a house, making an object with Play-doh) rather than doing these things in parallel.  With three weeks to go I think some positive changes in this area can still be made.

At the meeting this week with the caregivers I attempted to tackle the difficult subject of sensory regulation.  Before starting I composed a mini-Sensory Profile survey for them to take (on themselves).  This allowed them to get an idea of what the topic entailed, and get them thinking about various children who might respond strongly to the items.  Then we talked about each sense, I introduced the proprioceptive and vestibular senses, and we discussed the consequences of too much or too little stimulation.  Next week we'll delve into strategies to address sensory integration issues, specifically those concerning a few of the children here (although most of the behavioral issues are truly behavior related and not sensory related).  It's a tough topic to grasp, but they seemed engaged in learning something they never heard about before.

All in all a successful week sprinkled with positive changes during my daily observations (mostly from the children).  After two fairly frustrating weeks it was refreshing to have one that was more upbeat.  As more and more children begin returning from Italy I'm eager to see how they will integrate back into Casa Sperantei, and how both groups will teach each other the positive behaviors they gained this summer. 

Translation

De ce nu
mi capisci quando
I talk
cu tine?
Noi potremmo parlare
o limbă
that we all
capite.  La lingua
de iubirii.

Duck...Duck...Goose!

Here's a glimpse into one of our group sessions where the children are playing 'Duck, Duck, Goose' for the second time.  They love this game and played for nearly 20 minutes!  (The first time definitely wasn't as successful, and unfortunately not all of our groups are this well behaved.)  This simple game is such a great tool for teaching numerous skills such as waiting a turn, playing by the rules, being gentle, and listening.  Hopefully this will brighten your day!

Same Ol' Ups and Downs

My apologies for not posting last week.  The internet was down all weekend and I got behind on many things, this blog included. 

The past two weeks have been a roller coaster ride of progress and frustration-- no surprises there.  With only four weeks left here I'm beginning to realize how many things on my "to-do" list have not been accomplished and how many other things are only starting to take shape.  And to add to that imminence Iulia will be out for the next two weeks due to her upcoming wedding.  While I cannot blame her for taking this time off it definitely puts a damper on implementing several activities with the children and impedes with our consistency.  Luckily we will still meet with the pairs doing the anger management sessions on Monday and Tuesday and we'll have the caregiver meeting on Tuesday.

For the children's activities the past weeks we did the following:
1.) "Sleeping Bear"-- One child sits on a chair blindfolded with a whistle underneath.  The other children take turns trying to creep up on the 'bear' to steal the whisle and blow it three times.  If the child is caught by the bear another child takes a turn.  If the child is successful he/she becomes the new bear.  It's a great game for listening, taking turns, and patience.  After awhile I had two children go at the same time to elicit teamwork skills.  The kids LOVED this simple game and continually ask to play it again.  Success!
2.) Chalk Buddies-- One child lays on the ground while the other child traces him/her with sidewalk chalk.  They switch places so their 'chalk buddies' are next to each other.  Then they write something nice in a word bubble to the other person, and/or have the buddies sharing a toy, etc.  Finally a face and clothes can be added.  This activity forced them to work cooperatively together, use nice words to each other, and think about the principles of sharing (not to mention they had to share the sidewalk chalk).  All the children giggled when they were being traced and very much enjoy using chalk.
3.) Kids as Leaders-- We selected two children who went to a camp in Italy to teach a game/song/craft to the other children.  Towards the end of the session we switched and gave the children who stayed here a chance to teach a game/song they learned.  Needless to say some groups were facilitated much better than others.  It was encouraging to see some positive leadership skills from both the children who stayed here and those who went to Italy.  When reflecting on this experience, the children were able to see how frustrating some of their behaviors can be.  It also showed me how far we still have to go.

Iulia and I continue to make progress in meeting with pairs of children for anger management.  Aside from simply bringing attention to their feelings and reactions we have seen some minor positive changes in their responses to frustrating situations (i.e. not hitting/kicking/swearing/yelling).  [Unfortunately this is even more difficult when the child can hear a sister in the next room yelling at children who are doing homework.]  We've used social stories and puppets to retell a situation where the child became angry or frustrated and had a negative response.  Then they must retell the story with an alternative positive response (e.g. playing together, walking away, ignoring, telling an adult).  Now we need to be present in their daily play to facilitate the transfer of this concept to real life (as well as teach the caregivers how to do this).  Another activity we've done is teach them emotional regulation strategies such as taking 5 deep breaths, squeezing fingers and toes, putting something in the mouth, closing eyes/turning away, and thinking of something funny.  The first three seem to be the preferred methods for the children-- we'll see if they actually implement them! 

The past two meetings for the caregivers/sisters only the caregivers have attended.  Last Friday I talked about common psychological issues that tend to arise in orphanages: ADHD, depression, and anxiety.  In the beginning I had them do an activity that simulated what it might be like for children who have ADHD.  Some of these concepts have been taught previously because of Iulia's background as a psychologist, but it's always good to reinforce them.  Afterwards I gave them strategies to use with children who struggle with symptoms of ADHD, especially during homework time.  These include setting clear expectations, using a timer, taking a 5 min. break every 20 min., removing distractions from the room, breaking the task into smaller parts, and using a therapy ball as a seat.  They all seemed eager to try these methods because many of the children struggle with sitting still and completing a task. 

This past Tuesday I discussed adolescent development and changes the caregivers should anticipate in the next couple years.  I want them to start thinking about this now so they can start to develop ideas and strategies to address these issues.  Many new daily occupations arise in adolescence and somebody needs to be there a.) to teach them these occupations, and b.) to listen/talk to them about their feelings and questions.  It's also important that they designate a male figure that the boys can approach with questions.  I'm hoping that one of the maintenance workers will be willing to take on this role (we're going to ask him first then let the boys know he can be a resource for them).  Most importantly I stressed the need for the caregivers to guide the adolescents through decision-making and not simply berate their actions.  This challenge takes more time and patience but has much greater outcomes in the end. 

Ugh.  It's been a long week and I am glad to see the weekend.  I'm trying to focus on the positive improvements I've been seeing, but it's so difficult when the negatives are so evident.  With four weeks left there is still plenty of time for change.  Not to mention plenty of time to share love and enouragement.  The ride's not over yet!   

Love Them Like Jesus

Last week Iulia and I identified several children whom we thought would benefit from a behavioral management program that focuses on controlling emotions.  Based on the foundational ideas of the "Alert Program", we are meeting with these children in pairs to help them recognize their emotions, provide them with alternative strategies to dealing with their emotions, and implement those strategies during the day.  This first week we had them talk about situations that induce different emotions and what they feel inside during those times.  For the younger ones we did a couple role play scenarios that elicited happiness and anger.  Then they drew faces of different emotions of their choice-- a very difficult task for all of them.  Using a mirror with the younger ones definitely helped them see their facial features.  Finally we had them throw a ball at the wall in a manner that corresponded with each of the emotions they drew.  Overall the sessions were successful but it is evident Iulia and I have a long way to go with these children.  They struggle not only with identifying their emotions, but also with simply talking about their emotions. 

For our group activity this week I had the children make cards that they will (hopefully) deliver to children with disabilities or in the hospital.  Some of the children found it difficult to think of something to say to these children or what they would want on a card if it was given to them.  In order for them to make the cards they had to transport the supplies from one end of the room to the other by playing "Over-Under" as a team.  They definitely made some interesting creations with all the materials, but I know they enjoyed the process (plus they did a great job sharing the supplies and using their manners).  Some of them wanted to keep their cards at the end and we had to re-explain the purpose of the project.  Clearly empathy is not something many of the children have developed.  Later in the week some of the children played "duck-duck-goose" and went on a team scavenger hunt; again, to teach playing cooperatively and working as a team.  Mixing the ages of the children worked extremely well this week and we will continue with this pattern for next week.  Maybe in a couple weeks they'll be ready to play fairly and nicely with children their own age.
 
Each day I still meet with a couple children one-on-one.  It's fun to see their excitement to play games such as "Trouble", "Memory Match", and "Connect Four" because they rarely get to sit down and have this interaction with someone.  These games are also a great medium for teaching not to cheat, taking turns, being a humble winner, and expanding their attention span.  I have also been challenging the children to use their imagination and create new designs when they build, color, or mold.  My Italian has also been improving the more I interact with the children-- an added bonus for sure.  The computer usage has been put on-hold as I await a computer with sound that can run the various educational games I brought.

Only three caregivers came to the meeting on Friday because of various reasons.  I conducted the lesson with them and will do the same lesson with the others on Monday.  We switched gears this week to talking about stress management and the importance of taking care of themselves as well as the children.  I found it alarming to hear some of the responses when I asked about their stress at Casa Sperantei: crying, difficulty sleeping, constantly feeling tired, vomitting, and headaches to name a few.  Some techniques I provided for them (which we did together) included purse-lipped breathing, progressive muscle relaxation, imagery, brief escape/pause from the situation, and smiling/laughter.  I also suggested writing on a sheet of paper things that induce stress within their control and those out of their control, and also the major stressful behaviors of the children versus the minor irritating behaviors.  This way they can evaluate their situations more clearly and realize that some things are not worth stressing over.  Integrating these simple techniques into their daily routine will truly impact their health, emotional state, and relationships with others.  But they actually have to use them in order for this to happen. 

Scheduling continues to be a headache here, and it's easy to see why the children don't receive consisent attention.  The volunteers this week and next week work with groups in several communities and bring a few of the children to these groups each day.  I cannot complain about this because I think this integration is extremely important and helpful for the children here.  However, Iulia and I don't know when/if they will go and when they will return each day, which makes our job more like a guessing game.  And with the group of children returning from Italy this weekend we will have even more of a challenge managing the groups.  But we are doing our best to give the children some sort of consistency, persistently pursuing the conduction of our various groups.

Through all of this I find myself reminded that the one thing the children truly need is to feel loved.  That Iulia and I can toil day and night to change their behaviors, but none of that will matter if they do not know the love of Jesus.  I must constantly recite Corinthians 13 in my head to remember what God's love looks like and how I can reflect this love.  This is the greatest gift I can give and the most lasting impact I can make.

Back in the Saddle Again

It felt great to be back working with the children again!  While I would love to work with two groups each day, I'm thankful for the time I have with them amidst their busy schedules.  These next several weeks (starting this past week) will focus on teamwork and the importance of cooperating.  To facilitate this idea I designed partner relay races that consisted of "wheelbarrows", "leap frog", and tossing a ball; some of the children also participated in "over-under".  At the end the children who behaved appropriately played games with the parachute.  Of the four groups, the youngest seem to have the most difficulty with behaviors; not to mention a cascade effect happens when one begins to misbehave.  In response Iulia and I have made three rules the children must follow: 1.) We keep our hands and feet to ourselves, 2.) We use nice words, and 3.) We play the entire game.  Right now it feels like we spend more time addressing poor behaviors than actually participating in playing games.  Unfortunately this difficult aspect of the job must be done if something is going to change in the children.  As imaginable the language barrier makes the task even more difficult because I cannot properly attend to a misbehaving child or conduct the group unless Iulia assists me.  This leaves the other children who are behaving left in-limbo, seemingly punished as well.  We continue to press the issue of caregivers attending the groups to help with this aspect; sometimes they come, sometimes they don't.  However, I have observed that the children respond remarkably well to positive feedback-- much better than trying to attend to poor behaviors.  For example, when several children are sitting quietly in the circle and a few others are goofing off, I begin to praise those "sitting nicely and listening" by name and the others almost immediately fix their behaviors to receive this attention.  Definitely a recommended strategy to utilize!   

In order to better facilitate the groups for this upcoming week we decided to mix the ages of the children; this way the older ones can help the younger ones.  Obviously playing fairly with children your own age is important, but we must first establish some foundational concepts.  With this arrangement we hope the older children will feel a sense of responsibility to act as a role model and helper towards the younger ones; and we hope the younger ones will observe positive behaviors displayed by the older children.  We cannot predict how these groups will turn out, especially with so many ill-behaved children across ages, but it is worth a try.

During the beginning of the group sessions I had the children assist me in reviewing the rules (for mealtime and bedtime) we created together.  For the older children I had them take turns reading the rule and then acting out what that rule looks like.  Select rules were discussed more in depth because of their importance (e.g. "We listen to the caregivers and sisters"-- you must listen all the time (not just when you want) and the first time).  The little ones had the rules read to them, they pointed to the corresponding pictures, and then they acted them out.  One day mid-week Iulia and I reviewed the rules for the table before lunchtime and hung them in the dining room.  Each week we will return to the dining room at lunch to review the rules as more children begin to return from Italy.  On Friday we hung the rules for bedtime in their respective places.  We encouraged the caregivers to review the rules repeatedly the first couple weeks to serve as a reminder for the children. 

Aside from our group time I played one-on-one with about 15 children; some for the first time, some for the second time.  Graciously the volunteers showed flexibility in allowing me to do this, recognizing its importance to the child.  Each time I come looking for a specific child several others latch onto me and beg to come play.  I must explain that all the children take a turn before they come again.  They love this time of respite, freedom, and special attention.  I enjoy teaching the children new games and challenging them to think creatively; not to mention addressing some concerns.  A couple children wanted to play on the computer, so I allowed them this privilege the last 15 min. of our time together.  They struggled with maneuvering the mouse and clicking the appropriate buttons because of their limited exposure to using a computer.  It will be fun to teach them these skills so important in our technological world.

As a continuation from last week, the meeting with the caregivers and sisters (or sister, rather) focused on behavioral strategies.  First I had them play a "game" where they had to match scenarios with the corresponding appropriate response based on concepts we discussed thus far.  After successfully completing this task they went around and read one of the pairs and we talked about whether they have tried the strategy, their success in using it, or barriers to them not using it.  From their responses it seems many of them have integrated several strategies into their routines (some of which I have observed) and reported success with them most of the time.  Undoubtedly some use the strategies more than others and all of them could use the strategies more consistently, but I cannot overlook their willingness to at least try-- after all there is always something to complain about.  Hopefully the children recognize the difference in their behaviors as well. 

Some of the concepts I introduced during the lesson were giving choices, following through on punishment warnings, and giving time-outs.  While some children receive threats for their ill-behavior (e.g. not going to the pool) the caregivers rarely hold the children accountable.  In this way the children know they can behave poorly without actually receiving any negative consequences (besides being yelled at, which isn't much of a deterrent to most).  The caregivers say they feel bad for singling out the child, which is understandable-- yet I emphasized that if the behavior is going to stop they must face this difficult challenge.  Time-outs are a fairly new concept here as well that I think can benefit the children who display large issues such as hitting or kicking others violently.  Again, I highlighted that consistency and persistency must be used with time-outs for them to be effective.  Two videos on YouTube from "Supernanny" served as useful tools to demonstrate the important steps associated with time-outs.  I'm interested to hear their feedback on using this technique next week. 

I can say that I am pleased with the progress being made with the caregivers yet there is much more to be made.  On a daily basis I find it easy to become annoyed or perturbed with small behaviors from the caregivers, but I need to keep in mind that addressing the biggest concerns must come first.  The same can be said of the children.  Giddy-up!

Occupational Deprivation

For those of you unfamiliar with occupational therapy jargon, the term "occupational deprivation" refers to persons separated from performing their daily activities due to various circumstances out of that person's control.  After nine weeks at Casa Sperantei I find myself longing to participate in several mundane occupations.  Some of those I yearn for include:
1.) Cooking!  Besides occassionally making oatmeal on the stove I haven't cooked at all-- something I enjoy passionately and miss tremendously.  (P.S. when I respond that I am making oats the usual remark is "we feed that to animals", lol!)
2.) Grocery shopping.  Usually I buy whole-wheat bread for the week and that's it.  Yes, I actually enjoy strolling up and down the aisles to purchase delicious food to cook.
3.) Doing laundry.  So far two pairs of Nike shorts and one shirt have gone missing.  Needless to say I would miss this task even if nothing had been lost.  Minus ironing  =)  .
4.) Church!  While I find time to spend in prayer and the Word each day I truly miss the fellowship, worship, and singing that accompanies being connected with brothers and sisters in Christ. 
5.) Socializing.  Iulia and Madalin provide some fulfillment of this occupation, but I cannot deny that I am looking forward to social events with friends and family when I return-- even if that just means sitting in a room talking or playing a board game.

While I'm sure there are others I can think of if I ponder long enough, these come to mind immediately.  Despite not performing these activities I find myself continually blessed at Casa Sperantei and God daily provides everything I need.  Life is good because He is good.

As a side note:  During my evening stroll one night this week I heard "Cotton-eyed Joe" coming from one of the houses.  The next night I heard "Blowin' in the Wind".  Neither of which I expected to hear while in Romania, but the former much more than the latter.  You just never know...

Halfway to Where?

***Heavy Sigh*** No groups with the children this week because the Italian volunteers have field trips planned almost everyday, and activities the rest of the time.

With all the down time this week, on Thursday I went with Madalin (a psychologist) to the outpatient mental health clinic where he and Catalin (an "occupational therapist") work.  Work days are much less structured and more laid back than similar settings in the US.  Clients (called "beneficiaries") show up around 10am, coming and going freely until 4pm; they generally number between 7-10.  On a given day Madalin conducts one group session and sees a couple clients for one-on-one counseling.  Catalin works with clients on various crafts and games.  While the theory behind this clinic is a transitional stage until the clients reintegrate into the community, the reality is a day center for socialization.  As I mentioned in a previous post, the societal stigma surrounding persons with mental illness prevents employment opportunities and community support.  However, I think basic skills like cooking, paying bills, shopping, etc. could easily be taught at this center by the occupational therapist.  "Field trips" into the community could be beneficial not only for the clients but also for addressing the stigma behind mental health disorders.  Gaining funding for teaching such skills posits another barrier, as the EU funders are more apt to provide money for art and craft projects. 

Surprisingly many of the clients spoke some English, and were curious to ask me questions about my interests and various aspects of America (we sat around conversing for almost two hours).  Two clients even taught me how to play a new game ("Remii", sp?) with very few words uttered.  I caught on fairly well and only needed minimal guidance from Catalin when he joined us later on-- kudos to the clients!  Later in the day Madalin conducted a group session on stress management, providing various relaxation techniques for the clients.  And finally I was able to observe and interact with clients working alongside Catalin who were making cards.    

Friday marked our weekly meeting with the caregivers and sisters.  Small victories keep me going as two of the sisters surprisingly attended the meeting; one of whom never came before.  At the beginning I presented the finished posters of the rules and showed a video of the positive behaviors seen during our groups several weeks ago.  I want to show the caregivers and sisters that the children are working hard to act positively, and that they can behave well when certain techniques are used and standards are set.  Next we talked about the cycle of behavior as it relates to receiving attention.  In other words, the desire for attention leads to a display of negative behavior which leads to an immediate response to address the behavior which leads to the increased display of negative behaviors for more attention.  Breaking this cycle through both prevention and intervention necessitates consideration.  Many of the prevention skills, such as praise and encouragement, good instruction-giving, and rule setting have already been discussed.  This week we talked about ignoring behaviors like unnecessary whining, interrupting, goofing off, and dramatic acts (and then explaining to the child later why he/she was being ignored).  After introducing the idea of reinforcement, I asked them for their ideas on what reinforcements can be given to the children when they behave well, and then gave some of my own.  My confidence in them actually utilizing these reinforcement strategies remains fairly low-- they might need help initiating this process.  I also pointed out that small things like using manners, asking without demanding, and sharing are stepping stones to addressing larger issues.  Now that the program is halfway complete the caregivers shared (briefly) their feelings about the strategies and our meetings, noting that they can already see some changes in the children, but with other children they find themselves resorting back to their old methods (mainly out of frustration).  Comments such as this cause me to feel more eager to conduct groups with the children, as both parties must work together to make changes.

Groups of volunteers will be in and out of Casa Sperantei until August 10.  By the time September rolls around almost all of the children will have spent some time away-- most of them for several weeks.  This makes me think the pre-post CBCL will more accurately measure the effectiveness of the children travelling to families rather than their participation in our group sessions.  However, the groups Iulia and I implement may be an important component of transferring their learned skills as they integrate back into Casa Sperantei, producing longer-term (positive?) effects.  In either case useful information can be gleaned from the surveys. 

One of the sisters has agreed to speak with the groups to tell them that we need at least an hour each day to conduct groups with the children.  [This compromise definitely is not ideal, as we will only see the children once a week instead of twice a week.  And while an hour of time doesn't seem like much, having concepts reinforced every three days varies dramatically from every seven days.  But with my frustration mounting, I will take what I can get.]  The volunteers are encouraged and welcomed to join, and I have asked Iulia to come to more of the activities the volunteers conduct so we can carryover our strategies in different settings.  This continuity will be beneficial not only for the children but also for the caregivers-- more exposure to the techniques and strategies may aid in their implementation of some of them.  This time can theoretically be used for my individual sessions with the children as well (many of them begged me for this time together the past week).  I also suggested speaking with the volunteers to highlight our objectives for addressing behaviors with the children and providing them with simple strategies to elicit positive interactions.  Because we already have written suggestions we give to the Italian "adoptive" families, Iulia posited that we edit these a bit and give them to the volunteers upon their arrival.  Hopefully these changes go over well and we can successfully work together with the volunteers!

Out and About

Accompanying the children on field trips to various places in Romania is one of the few benefits of the influx of volunteers here.  On Tuesday we ventured to the gorgeous town of Sinaia (30km away in the mountains) to visit the Castel Peleș. Because of its popularity, we had to wait in line for several groups, some of whom came out of nowhere and entered before us.  As one group made their way through the masses one of the Italian volunteers murmered, "They're American, they have the money."  I turned and smiled at her because the statement probably rang true.  At the same time the children all began excitedly telling me "they're American" and pointing as they passed by.  They are all very proud when people from the US visit their country. 

After almost an hour of waiting we finally went inside the castle-- definitely a gorgeous piece of architecture and craftsmanship.  While I only understood random bits and pieces of what the guide said, most of the castle contains original furniture and decor from the 1600-1700s and has required little restoration.  Most of the children enjoyed seeing parts of the castel but could have easily zipped through in a third of the time the 45-minute tour lasted.  Nevertheless I was impressed by their behavior inside.  After the castle we had a picnic lunch near the forest, and then went to a nearby playground to let the children run around. 

 



The group at Castel Peleș

Another fun thing I did with the volunteers was walk to the supermarket with the children, as mundane as that sounds to many of us.  For some of the children this marked the first time they saw the inside.  Even for those who had been before the chance to go again was a rare adventure.  With almost a one-to-one ratio of adults to children, we took each child through the aisles to look at everything the store sold.  The children enjoyed pointing out each type of food and stating whether or not they liked it.  Many of them passed up and down the aisles several times, intrigued by the vastness of the store (even though it contains only 9 aisles).  After spending quite awhile in the store each child picked out an ice cream to experience going through the check-out line.  When sitting outside to eat their ice cream many children asked questions about the beggars and gypsies standing around the doors.  Unfortunately my feeble responses were inadequate to explain their circumstances.  Exposure to these situations definitely helps the children see the social circumstances that surround us, and will be useful as Iulia and I try to teach them empathy.  Again, I was impressed by the children's behavior inside the store, as well as during the long trek to and from.  The fact that almost half of the children are now in Italy or various homes in Romania makes trips like this much easier (albeit this doesn't help with the consistency of participating in the activities Iulia and I are implementing.)

This marks the half-way point of my journey here.  While I continually experience frustrations, barriers, and set-backs, I am eager to see what the next 8 weeks bring.  At the same time I am eager to return home to see family and friends, as well as indulge in conversations in English.  I can truly say this has been a great learning experience thus far that will provide necessary knowledge in pursuing similar work in my future.  Plus I'll have learned a new language (and pieces of another one)!  Thank you to those praying for me and supporting me-- God has been working in me and through me each day.  Perseverence, diligence, tenacity, and patience represent the key characteristics as I move forward.  And so, I keep pressing onward.

Flying Solo

With Iulia on vacation this week I was left to my own demises.  Obviously this meant that the children did not participate in their small group activities and no caregiver meeting took place; this further delays the progress we hope to see, but is part of the nature of life.  While I think the children appreciated the break from organized activities, they still continually queried when we will resume playing together.

The "therapy" room

I took advantage of the free time (both mine and the children's) by inviting 4 children each day to come play with me individually for 45 minutes.  This first time together I simply observed their behaviors and emotions.  Most of the children relished this escape from the world (a few declined, preferring to ride a bicycle or rollerblade).  Even having made a schedule of times with their corresponding names the children seemed not to grasp the notion of taking turns and wanted to come with me each day.  Because I will only be able to meet with each child individually 4 or 5 times I'm not fully convinced of the impact this time will have on their behaviors when transferred to a large group.  However, I am glad that I can provide them with a temporary gift of solitary time, one I know they definitely cherish. [On a side note, one of the sisters (the head cook whom I have developed great rapport with) approached me to congratulate me after my individual session with one of the children.  She said another sister commented on how much better adjusted the girl was during the remainder of the day.]

During our time together many of the children were initially overwhelmed with making a choice to play a game/complete an activity.  Most seemed very disorganized in their selection and did not stick with an activity for longer than 10 minutes.  Several were eager to learn how to play new games ("Trouble", "Memory Match", "Go Fish") and truly enjoyed the one-on-one attention in a quiet place.  The majority didn't say much during the session; I'm not sure whether this was out of choice or because they know my communication skills are limited.  But my newly acquired Italian skills came in very handy, and I am making much more progress in comprehending and speaking this language-- it's definitely an answered prayer.  It was also very clear from the sessions that the children vie for attention by displaying immature or inappropriate behaviors.  They also continually looked to me for approval and wanted to see my reactions to certain actions.  Subsequent sessions I will utilize therapeutic strategies to address the concerns I found while still allowing them their independence in choosing activities.  I am also happy to report that one of the sisters asked to see my therapy notes at the conclusion of my time here so she can present them to the teachers and volunteers in Italy in order to track the "evolution" of the children.  At least I know she values my clinical judgement and my work with the children (even if she isn't willing to change her behaviors).

Another major task for the week was creating large posters of the rules developed by the caregivers and children last week.  Several of the children helped by coloring pictures, cutting various items, and gluing things onto the posterboards.  They (and I too, admittedly) were very proud of the final products.  This upcoming week Iulia and I will review these rules with the children, make sure they understand what each rule means, and then post them in their respective places to be seen on a daily basis.  We'll see how well they follow through with complying to the rules and how well the caregivers do with helping them comply.



Rules for bedtime





Rules for mealtime



Yesterday a second group of Italian volunteers arrived with several days worth of activities planned for the children (they leave on Wednesday, I believe).  My diligence in studying Italian has definitely paid off, allowing me to communicate with the volunteers on an elementary level.  I can also participate more in their activities and continue to utilize my strategies with the children.  On the other hand, their arrival puts another cramp in the schedule of activities and individual time I created.  This also means the reintegration of several children who have been in Italy for the past two weeks, as well as several other children leaving for Italy.  While I understand the value of being flexible, I must also bear in mind that I only have 9 weeks left with the children.  So many unexpected barriers!  It will definitely be interesting to see what September brings regarding measurable results, especially with such inconsistency.