***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!
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