The Red Pencil in Kenya, Kibera: Kenya – Kibera Colours Mission

KENYA-KIBERA COLOURS STEP 1 REPORT AUGUST TO SEPTEMBER 2020

IN PARTNERSHIP WITH

WITH THE GENEROUS SUPPORT OF

Copyright Š 2020 by The Red Pencil (Singapore)  All rights reserved.

No part of this publication may be reproduced or utilised in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

CONTENTS Context

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Executive Summary

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1: Background - Kibera

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2: Our Local Partners

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3: The Red Pencil's Mission in Kibera

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4: Mission Objectives

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5: Methodology

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6: Evaluation of Mission Outcomes

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7: Case Studies: Stories of Change

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8: Challenges Faced and Lessons Learned

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9: Way Forward

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10: Conclusion The Red Pencil (International) - December 2020

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CONTEXT WHERE

ART THERAPY TEAM

Kibera, Nairobi, Kenya

Clinical Supervisor: Gretchen Miller Lead Art Therapists: Sarah Vollmann and Kim Bryan Programme Supervisor: Dr Penelope Orr Edinboro University Art Therapy Graduate Interns: Angela Bossut and Sara-Jane Asman

WHEN Step 1: 31 Aug - 17 Sep 2020

TYPE OF MISSION Online Train-the-Trainer in Self-Care and Mental Health Awareness

BENEFICIARIES 22 key workers (teachers, youth mentors, social workers, counsellors, etc) completed the Online Train-the-Trainer Programme Working with 500 children and young people in Kibera

IN PARTNERSHIP WITH

The Turning Point Trust, Uweza Foundation and Edinboro University

WITH THE SUPPORT OF The Red Pencil (International) expresses its heartfelt gratitude to Faber-Castell for their generous support to this mission.

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Photo credit: Mufadhal Musa

EXECUTIVE SUMMARY The Red Pencil is a pioneering humanitarian organisation whose expertise is to bring the benefits of creative arts therapy to vulnerable children and families who have faced traumatic events such as natural disasters, conflict zones, displacement and migration, human trafficking, violence, abuse or life-threatening injuries and illnesses. The creative process of arts therapy allows a person of any age or culture to express the unspeakable, experience release and relief, find new resources, gain self-confidence and feel empowered to move towards a more hopeful and happier life.

The Red Pencil (International), based in Geneva, Switzerland, was privileged to be able to implement a creative arts therapy mission in the Kibera slum in Nairobi, Kenya, in September 2020. We are grateful to Faber-Castell for sponsoring this pilot mission as part of their Children of the World collaboration with us and standing with us throughout this challenging year.

We also wish to thank the staff from our local partner organisations, The Turning Point Trust and Uweza Foundation, who gave us fantastic support on the ground in Kibera to enable us to launch our first online mission when it became evident that the field mission originally planned for March 2020 could not take place due to the global Coronavirus pandemic closing down school activities across the world from the spring of 2020.

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We owe an enormous debt of thanks to one of our Red Pencil Ambassadors, Dr Penelope Orr, Director of the Edinboro University Art Therapy Program in Pennsylvania, USA, who helped us to pivot our missions online in 2020 by developing a new online training course to enable our art therapists to be trained for online missions, a new Monitoring and Evaluation Framework based on mobile technology, and a new online Train-the-Trainer programme to equip the staff in Kibera with skills and knowledge in Self-Care and Mental Health Awareness. This was further developed by a fantastic team of volunteer art therapists, Sarah and Kim, who worked with Clinical Supervisor, Gretchen Miller, and a team of interns from Edinboro University to support the development of this pilot mission.

From the staff in Kibera, the feedback was overwhelmingly positive. This opportunity to boost their mental health resilience at this critical time of Covid-19 anxiety, care for their own emotional regulation through art therapy techniques, and learn how to bring these new self-care skills and trauma-informed care to the children they serve in their community was warmly welcomed by all the participants. They had previously been isolated at their homes for many months due to strict Covid-19 lockdowns and curfews in Kenya.

Their joy in using the art materials and learning new ways of expressing their emotions through art was truly heartwarming for the art therapists to observe, and strong bonds of support were forged during the mission. This has laid a solid foundation for a subsequent Step 2, which we hope will take place when the children return to their school and group activities in 2021.

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Photo credit: Mufadhal Musa

1. BACKGROUND - KIBERA Rapid urbanisation and population explosion in the Sub-Saharan region of Africa have led to the development of many slums in the capital city Nairobi, the largest city in Kenya. The community of Kibera is one of the most prominent and is considered the largest urban slum in Africa. Located at a distance of 6 km from the city centre, it is home to over 500,000 people[1]. Poor living conditions, extreme poverty, lack of basic infrastructures such as roads, access to clean water and sanitation facilities, as well as health concerns such as sexually transmitted infections and HIV/AIDS characterise daily living in Kibera.

People live in densely-packed shacks or rudimentary housing with an average floor space of 12ft x 12ft (3.6 x 3.6 m). A single shack may house up to 8 people. UN– Habitat, which is implementing the “The Kibera Integrated Water, Sanitation, and Waste Management” project, estimates the population density in Kibera to be over 2000 people per hectare[2].

Chr. Michelsen Institute (CMI) an independent, non-profit research institution and a major international centre in policy-oriented and applied development research, published a report in 2015 titled “The Situation of Youth and Children in Kibera” (Onyango & Tostensen, 2015). According to this report, "Youth and children constitute a large proportion of Kenya’s population with those between 15 and 24 years [accounting] for 7.9 million, of whom 2.6 million live in urban areas (32.3%). Of this latter group, some 900,000 (34.4%) lived in poverty in urban areas in 2009. The majority of youth in this group live in slum communities, Kibera included[3]".

[1] https://mirror.unhabitat.org/content.asp?cid=3220&catid=206&typeid=13 [2] https://mirror.unhabitat.org/content.asp?cid=3220&catid=206&typeid=13 [3] Onyango, P. and Tostensen, A. (2015). The Situation of Youth and Children in Kibera. CMI Report. https://www.cmi.no/publications/file/5527-the-situation-ofyouth-and-children-in-kibera.pdf

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Photo credit: Mufadhal Musa

The report also describes the challenges facing the young people in Kibera: "Crime and violence are reported to be ‘normal’ occurrences in slum communities in Kenya and children and youth are exposed and vulnerable to these acts. According to some studies, youths are both victims and perpetrators of crime. Access to proper housing and education also poses a challenge to children and youth living in slum communities. With small rooms of 12 x 12 ft, congestion forces youth to leave their families to live on the streets with groups of other youth and children. In these groups taking drugs and alcohol is commonplace, which, in turn, leads them into criminal activities, as well as early exposure to and engagement in sexual activity....

In summary, youth in slum dwellings in Nairobi and Kibera face numerous challenges as they transit from adolescence into adulthood. They find themselves in a rather hostile slum environment characterized by unemployment, poor housing, large family sizes, violence, crime, drug and alcohol abuse, poor education facilities, and a lack of recreational activities. This situation subjects adolescents in the slums in Nairobi to early sexual activities three years earlier and twice more likely to have multiple partners who live in non-slum parts of Nairobi[4]".

[4] Onyango, P. and Tostensen, A. (2015). The Situation of Youth and Children in Kibera. CMI Report. https://www.cmi.no/publications/file/5527-the-situation-ofyouth-and-children-in-kibera.pdf

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2. OUR LOCAL PARTNERS Given the many difficulties faced by children in Kibera, The Red Pencil (International) was invited to organise an art therapy mission to support two Kenyan registered NGOs – The Turning Point Trust and Uweza Foundation, who work directly with around 500 children and youth in Kibera.

The Turning Point Trust operates as a UK charity and a Kenyan registered NGO. Their vision is to empower vulnerable children and families living in the Kibera slum to achieve their full potential and to demonstrate a Christian heart for the poor through programmes that relieve poverty, transform lives and restore hope amongst the most vulnerable families and children in Nairobi’s informal settlements. In precoronavirus times, they normally run several programmes to support the local community, including:

Children attending a class pre-COVID-19

Schools have been closed since March 2020 due to COVID-19

A School Transition Programme preparing 30–50 out-of-school or street children to start or return to formal education every year.

Fountain of Hope Primary School, providing free quality education to children who graduate from the School Transition Programme.

Secondary and Further Education Support enabling young people who are performing well academically to attend secondary school and go on to college courses where funds are available. Those who are less academic are supported in vocational training such as carpentry, mechanics, tailoring and fashion design or catering.

Laini Saba Community Library providing a quiet well-resourced space for children to read, research and do homework. Local volunteers run homework clubs and reading clubs for primary-school aged children. They also run events such as spelling competitions and debates to further promote literacy and reading in the community.

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In normal times, they also run annual parenting courses and art workshops from the Community Library, where they were starting to bring in aspects of trauma counselling training. They hope that learning more about self-care and art therapy tools will support them in feeding this learning into their parenting courses when these can resume, as well as supporting their ongoing work with the children when they are able to return to group activities. The workshops are normally open to children from the Laini Saba area of Kibera to attend and serve as an important trust builder with local families.

The Turning Point Trust often works in partnership with another Kenyan NGO, The Uweza Foundation, which is a US-based charity providing opportunities for children and young people in Kibera. Founded in 2008, they normally work with around 300 Kenyan children and youth each year, offering a range of programmes to help them pursue a path to a better future through the discovery and development of their talents and abilities. This includes sponsoring education and assisting them to earn incomes that utilise their own inherent strengths. Their staff live in Kibera and know the community well. They work out of the Uweza Community Center, which opened in 2011.

We would like to extend our heartfelt gratitude to our partners, especially Emily and Moses Obiti from The Turning Point Trust and Jennifer Sapitro, Maxwell Anduvate and Cedrick Joseph from Uweza Foundation, for helping us plan and implement the logistics of this mission despite the limited access to IT and facilities and the many additional challenges faced during this global pandemic. Organising an online mission in a location such as Kibera was only possible due to their resourcefulness and ingenuity in overcoming the challenges on the ground. It has been a huge privilege to partner with their teams and we would be delighted to organise another Step 2 in 2021, if coronavirus conditions and further funding allow a continuation of this mission.

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3. THE RED PENCIL'S MISSION IN KIBERA The Red Pencil’s mission to Kibera was originally being planned as an exploratory field trip on the ground, but this had to be postponed in March 2020 due to COVID19 travel restrictions and global lockdowns. Since the beginning of this year, all NGOs have faced the mammoth task of pivoting their missions online to adjust to the prevailing threat of COVID-19. Many of our projects had to be delayed or cancelled due to a lack of access to the internet, electricity, or groups of beneficiaries. International flights and travel across countries have generally become very difficult or impossible in more fragile settings and many schools and group activities across the globe have had to close for months.

For some countries, it has proved impossible to obtain sufficient internet access or digital technology to continue with our intended projects. Thankfully, Nairobi is blessed with a relatively stable internet connection. Our local partners also had access to several laptops and an IT technician, thanks to the IT classes offered by the school. The Turning Point staff have done their best to support the community in Kibera by continuing to offer meals or food vouchers for the children, setting up handwashing stations and educating them on the importance of regularly washing hands and wearing masks, in an attempt to mitigate the risks of COVID-19 spreading in the densely populated shacks.

The Uweza staff have engaged in distributing food and essential supplies to the people of Kibera who are suffering from even greater losses of employment and education opportunities in recent months, due to the lockdown and curfew restrictions.

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The effects of lockdown on the children and young people in the absence of their normal group activities and friendships at Turning Point and Uweza have been profound. Given the new challenges, it was important to develop a new kind of programme that would enable The Red Pencil (International) to continue supporting frontline staff and their beneficiaries in fragile and humanitarian settings. The need for mental health support was clearly increasing but the operational difficulty of accessing groups of beneficiaries on the ground meant that only a new online programme could meet the need.

With these difficulties in mind, a new online Train-the-Trainer in Self-Care and Mental Health Awareness was developed and piloted as a first mission step. The programme was designed to help support the frontline workers in Kibera and to equip them with art therapy skills and techniques to improve the self-care and emotional regulation of the children. This will help them settle back into education when the schools and group activities are permitted to re-open, hopefully in January 2021.

Profile of the beneficiaries For Step 1, 22 staff from The Turning Point Trust and Uweza Foundation were trained. They included teachers, social workers, youth workers, football coaches, counsellors, mentors and educational support staff, working with 500+ children and adolescents in Kibera and their families. Most of the staff are Kenyan and are all educated to secondary school level, some also have diplomas and mentoring training. The Management Teams of both organisations are mostly educated to degree level in sociology/community development fields. The beneficiaries attended the sessions either from their homes or from the main office of the organisations.

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The Art Therapy Team The programme was developed by Dr Penelope Orr, a Red Pencil Ambassador and Director of Edinboro University Art Therapy Program, who is an expert in Online Art Therapy and its monitoring and evaluation. We would like to acknowledge the tremendous work Dr Orr has accomplished on behalf of The Red Pencil to assist us in moving our work online in response to the global pandemic this year.

The Lead Art Therapists were Sarah Vollmann from the USA and Kim Bryan from Trinidad and Tobago, both Masters trained and experienced ATR Board Registered Art Therapists. They were assisted by Sara-Jane Asman, based in Johannesburg in South Africa, and Angela Bossut, based in the US, both final year graduate interns at the Edinboro University Art Therapy Program.

The Clinical Supervisor for this project was Gretchen Miller, a Board Director of AATA (The American Art Therapy Association). Logistical support was provided by Heather Woodward, International Operations Manager for The Red Pencil (International) in Geneva. The Red Pencil is grateful to have worked with this team of committed professionals from different time zones, some of whom were logging in at 3am in the morning to facilitate this mission in a reasonable time zone for Kenya. Their dedication to extending creative arts therapy to communities such as Kibera and their commitment to pioneering with The Red Pencil to deliver this first online humanitarian mission under difficult circumstances was exemplary.

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4. MISSION OBJECTIVES In view of the additional stresses on the staff in Kibera, who were being supported on half of their salaries during the protracted lockdown in Kenya, the two local partners requested self-care training to support the mental health of their teachers, mentors and support staff, as well as the well-being and emotional regulation of the children in their care. They also requested that we start the Trainthe-Trainer (TTT) programme in August/September 2020, before the schools and group activities were due to resume after the lockdown, while the staff had more time available.

The overall objectives of the Kibera mission Step 1: (1) To provide an online Self-Care module and Visual Journal training for teachers and support staff, to strengthen their mental health resilience and coping skills in response to the difficulties being experienced in Kibera and additional COVID-19 concerns.

(2) To provide a bespoke Train-the-Trainer (TTT) module online to equip teachers and support staff with knowledge of mental health and trauma care through the use of art therapy tools and techniques which can be used to support the children during COVID-19 lockdowns and when they return to the primary school and other activities.

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5. METHODOLOGY The TTT programme was planned to adapt to the new online setting and to equip The Turning Point Trust and Uweza staff to use art therapy tools and techniques in their work with children and adolescents in Kibera. It focused on equipping them with mental health awareness, art therapy experientials, and useful techniques for assessing trauma and intellectual disabilities and strategies for improving emotional regulation.

These skills will be needed more than ever when the children return to the school and club activities after a long period of absence from formal schooling and groups. Schools are due to restart in January 2021, as this is the normal start of the academic year in Kenya, but this will be subject to the COVID-19 rates and approval from the Kenyan government.

The interns helped to host this first online mission for RPI using an online Zoom business platform and a programme of art therapy sessions developed with the support of Dr Penelope Orr. A schedule of the sessions was shared with the partners and this ensured that the beneficiaries and the art therapists were logged in at the designated time. The programme of activities was scheduled for 4 hours a day, 4 days a week, over a 3 week period from 31st August to 17th September:

Daily Schedule

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Monitoring and Evaluation A Survey Monkey questionnaire was designed to gather individual feedback at the start and end of the Step 1 Train-the-Trainer (TTT). The surveys (pre and post) were distributed via the local partners on the social media communication app “WhatsApp”, in a closed and encrypted messaging group, direct to the participants’ phones. This methodology was selected because WhatsApp is the preferred and most reliable method of keeping in touch in Kibera.

Using personal mobiles for this mission also helped prevent the risk of crosscontamination through collecting and passing around paperwork. Qualitative data was collected through the reports of the art therapists, recorded interviews and case study material or “Stories of Change”. Numerical data was analysed using cross tabs and descriptive statistics, while written data was analysed using indexing and axial coding for themes.

The videos and photographs used in the report were taken by three Kenyan photographers, Mufadhal Musa, Maxwell, and Cedrick. We are grateful to our local partners for assisting with the local photography, especially to Cedrick and Maxwell who attended the sessions nearly every day over the 3 weeks of the mission. They are the first graduates from Uweza’s Photography Academy, a vocational course run by a professional photographer at the Uweza premises in Kibera, so it was great to see their skills being put to good use to record this mission.

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6. EVALUATION OF MISSION OUTCOMES The TTT programme was attended by 22 participants, 16 working with The Turning Point Trust and 6 with the Uweza Foundation. 82% of the participants attended more than 75% of the sessions, indicating that they found the programme relevant and engaging. Reasons for absence related mainly to childcare or health issues and were followed up well by our partner contacts to ensure that the participants were working safely through the more challenging material around grief and loss.

The Red Pencil (International) worked with Dr Penny Orr during 2020 to develop a new Monitoring and Evaluation Framework for online missions, using the following Key Performance Indicators (KPIs), which we intend to track across all our missions in the future: KPI 1: Increase community knowledge of art therapy and mental health KPI 2 : Increase emotional and social well-being through art therapy interventions We also monitored stakeholder feedback through team videocalls, interviews and case study material to track satisfaction with our art therapy programmes, reflect on the lessons learned from each mission and take forward this learning to the next mission.

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Based on our KPI’s, the following expected outcomes were formulated and monitored: Expected Outcome 1: By the end of this Train-the-Trainer participants will increase their mental health knowledge 1.1 1.2

1.3

Understand neurological effects of trauma and neglect on child development Demonstrate the capacity to identify, accept, and regulate personal emotions that have a blocking effect (acute stress, fear, depression, feelings of helplessness‌) Identify typical grief and loss behaviours in children

Expected Outcome 2: By the end of this Train-the-Trainer participants will improve their self-care 2.1 2.2 2.3

Identify at least 3 healthy coping strategies for reducing stress and/or anxiety Demonstrate at least 2 healthy methods for working through grief and loss Increase mood due to art therapy interventions

Expected Outcome 3: By the end of this Train-the-Trainer participants will develop strategies for working with the children using art therapy 3.1 3.2 3.3

Identify at least 3 arts therapy interventions they could use with the children to help them regulate their emotions Identify at least 2 measures they can use with the children to determine if they are ready to learn Identify at least 3 arts therapy interventions that they could use with the children to help them process their grief and loss

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Based on data collected through the pre and post surveys, the art measures, the art therapists’ report and observations, and the “stories of change” case study material, we are pleased to present the following findings from Dr Orr’s analysis and our collective evaluation of the results.

KPI 1: Increase community knowledge of art therapy and mental health Expected Outcome 1: By the end of this Train-the-Trainer participants will increase their mental health knowledge 1.1 Understand the neurological effect of trauma and neglect on child development This involved a group Q & A discussion based upon daily trauma training.

Participants were also placed into smaller groups to brainstorm questions to bring back to the larger group. Many important questions were raised. This training was effective and appreciated by the participants because they were able to address any questions they had about the effects of trauma and relate their own experiences of working with children and families in Kibera. Some participants were triggered by this content due to traumatic experiences in their own lives. This was anticipated and addressed with individual online support provided by the art therapists, as well as follow-ups from our partner contacts on the ground.

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From her analysis of the pre- and post-survey results, Dr. Orr concluded that: Participants perceived a 30.917 point increase in understanding of art therapy on a scale of 0-100 from before the TTT to the end of the mission. This demonstrates a 60.325% increase in their knowledge of Art Therapy (Fig. 1).

Fig. 1: How would you rate your understanding of art therapy at this time?

Pre Post 0%

25%

50%

75%

100%

Participants perceived a 25.85 point increase in understanding of Trauma and its effects on children on a scale of 0-100 from before the TTT to the end of the mission. This demonstrates a 49.78% increase of knowledge on Trauma and its effects in children (Fig. 2).

Fig. 2: How would you rate your understanding of trauma and its effects on children?

Pre Post 0%

20%

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60%

80%

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1.2 Demonstrate the capacity to identify, accept and regulate emotions which have a blocking effect (e.g. acute stress, fear, depression, feelings of helplessness‌) Emotions held in the body were explored both in an art therapy directive and in discussion. Self-care options were explored, with ideas for soothing, such as the soothing stones which they all enjoyed creating. Participants were very engaged in this activity and were able to discuss difficult emotions held in their bodies through these activities. Some participants were very triggered by this activity and needed assistance from the art therapists.

1.3 Identify typical grief and loss behaviours in children This learning outcome was addressed through discussion and the art therapy directive of creating an image about their experience of working with a child who has experienced some type of loss. The group discussed losses due to death and other types of grief and loss. Traumatic losses were brought up throughout the TTT by participants, as ongoing and current events happened frequently in their communities. Many questions were asked about how to work with children and loss, which demonstrated the need for this information and suitable art interventions for working with bereaved children.

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KPI 2: Increase emotional and social well-being through art therapy interventions Expected outcome 2: By the end of this Train-the-Trainer participants will improve their self-care 2.1 Identify 3 healthy coping strategies for reducing stress and/or anxiety Throughout the TTT, the art therapists focused on self-care. They did the self-care wheel twice to learn how to use this tool for themselves and with the children and families they work with. The Visual Journaling technique was explained and participants were encouraged to continue this activity at home and after the mission for ongoing self-care through reflection and self-expression. Participants were able to identify many new self-care tools to use by the end of the TTT and were very engaged with this topic.

The following results from the pre- and post-TTT survey also show a significant decrease in stress levels and increased levels of confidence and resilience: 0.73 increase on the statement “I trust in my ability to do things”, increased on a scale of 1-5 from before the TTT to the end of the mission (Fig. 3). This demonstrates an 18.81% increase in feelings of self-efficacy.

Fig. 3: I trust my ability to do things Pre Post 0

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0.71 increase on the statement “I feel relaxed”, increased on a scale of 1-5 from before the TTT to the end of the mission. This demonstrates an 18.73% decrease in stress levels (Fig. 4, next page).

Fig. 4: I feel relaxed Pre Post 0

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2.2 Demonstrate at least 2 healthy methods for working through grief and loss Ways to support ourselves and those who are grieving were also reviewed, with an emphasis on the fact that each person’s experience of grief will be different. Selfcare and how to use the Visual Journal technique for processing grief was explained in relation to understanding the repercussions of loss. There was a general understanding of this topic among the group, but many questions were raised about specific responses to grief and loss. A lack of local referral facilities for further mental health support was flagged up on several occasions, but this is indeed the sad reality for many developing countries or fragile settings, where governments lack the necessary finance, training and support structures to provide for the mental health needs and child protection demand of their population.

2.3 Demonstrate increase in mood due to the workshop interventions The sharing of art pieces created an increased sense of community and social cohesion in the group and noticeably heightened their mood. With the integration of music, participants were also able to explore movement and dance, which opened up the group and brought some playfulness and joyfulness to the online meetings. Icebreakers were also included to put the participants at ease and encourage full participation by each group member. The participants responded well to these activities and became more connected to the art therapists and across their various groups.

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Mood and their desire to participate increased as the sessions progressed, as can be seen by the following results from the pre- and post- TTT surveys: 0.59 increase on the statement “I feel proud of myself”, increased on a scale of 1-5 from before the TTT to the end of the mission (Fig. 5). This demonstrates a 14.46% increase in positive self-concept.

Fig. 5: I feel proud of myself Pre Post 0

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0.59 increase on the statement “I feel comfortable about myself”, increased on a scale of 1-5 from before the TTT to the end of the mission (Fig. 6). This demonstrates a 14.75% increase in positive self-concept.

Fig. 6: I feel comfortable about myself

Pre Post 0

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0.61 increase on the statement “I enjoy interacting with others”, increased on a scale of 1-5 from before the TTT to the end of the mission (Fig. 7). This demonstrates a 14.62% increase in positive feelings from the group process.

Fig. 7: I enjoy interacting with others

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0.45 increase on the statement “I am confident in expressing my emotions/thoughts”, increased on a scale of 1-5 from before the TTT to the end of the mission (Fig. 8). This demonstrates an 11.59% increase in confidence in expressing emotions and thoughts.

Fig. 8: I am confident in expressing my emotions/thoughts

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0.5 increase on the statement “I find it easy to share my dreams and hopes with family/friends” increased on a scale of 1-5 from before the TTT to the end of the mission (Fig. 9).

This demonstrates a 13.05% increase in sharing/communication with friends and family.

Fig. 9: I find it easy to share my dreams and hopes with family/friends Pre Post 0

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3.1 Identify at least 3 art therapy interventions they could use with children to help them regulate their emotions This was reviewed daily with the participants. Art therapy interventions such as the "feelings cards", "painted stones", and the "hand of connection" were introduced.

These directives were welcomed and observed to be effective. The participants identified for themselves some of the activities which they felt would be most useful for them in their work with the children. They raised many questions on this topic which were discussed and answered during the sessions.

3.2. Identify at least 2 measures they can use with the children to determine if they are ready to learn.

Participants’ work with the children was reviewed through discussion. Emotional regulation and co-regulation were explored as topics, with suggested art interventions to assist children to feel understood and to be able to regulate their emotions. Many questions were asked on this topic. The participants had various different roles and responsibilities, including teachers, youth mentors, football coaches, social workers and counsellors, so their specific needs and questions were different. To accommodate the different needs, the art therapists placed the participants into relevant sub-groups to enable the teams to raise questions and find answers pertaining specifically to their areas of work.

Photo credit: Mufadhal Musa

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3.3 Identify at least 3 art therapy interventions that they could use with the children to process grief, loss, and trauma.

Examples of suitable art interventions included the “feelings cards”, used to check in with individuals at the start and end of a session; “self-care wheels”, which encourage individuals to map out visually what can bring strength and support to them, where strengths and resources can be found, areas to improve and work on; “soothing stones” to aid with grounding and calming anxiety; drawing/creating “a safe space” to nurture or restore a new sense of safety, which is the first step for healing from trauma to begin. The “hand of connection” was also a directive that was used for grounding and creating a sense of support and social cohesion.

Participants were responsive to all of these art activities. As they experienced these art activities themselves, it made it much easier for them to imagine using them with the children. The art therapists discussed ways to adapt them for different age groups among their respective beneficiaries.

In her analysis of the pre- and post-survey information, Dr Orr concluded that the expected outcomes of this first online mission had been successfully accomplished: Most individuals came into this TTT with a vague sense of what art therapy was and how to use it with the children for trauma. This was shown by the high number of general art answers to the open-ended question like “drawing” and non-art making answers such as “courage” in the pre-survey. Participants made a 950% increase in their knowledge of art therapy interventions to use for trauma interventions, as shown by the increase in specific art therapy interventions listed in the post survey. The number of art interventions listed by participants in the pre-survey at the beginning of the TTT was found to have doubled per person by the end of the mission.

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Table 1: What art therapy intervention do you think you could do to help your children regulate their emotions?

A similar trend was seen in the topic of grief and loss. Participants made a 50% increase in their knowledge of art therapy interventions to be used to help children with grief and loss, as shown by the increase in specific art therapy interventions listed in the post-survey. As with the knowledge of trauma, the number of art interventions listed by participants doubled per person by the end of the TTT. Table 2: What art therapy interventions could you use to help your children process their grief and loss?

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Individuals in the TTT programme increased their positive self-care strategies by 50%, which is shown in the ratio of positive strategies per person. In this data, we can also see that negative coping mechanism were reduced and positive coping mechanisms had increased for participants. The most common positive strategies were talking to friends and listening to music. 4 art strategies were added in the post-survey, whereas none were stated by participants in the pre-survey.

Table 3: What are some coping strategies that you use to work through grief and loss or trauma?

Note: Negative strategies mentioned in the pre-survey included: crying, keeping to myself, focusing on work, and sleeping as much as possible. In the post-survey, only positive strategies were mentioned.

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As part of our stakeholder analysis, TTT participants were also asked, “How satisfied were you with The Red Pencil’s Train-the-Trainer?” This elicited a 91.78% satisfaction on a scale of 1-100. Participants enjoyed learning how to create art therapy ideas with their children the most (72.22%), with art therapy for their own personal wellness coming second at 55.56%.

Fig. 10: What did you like best about the TTT?

Learning about mental health issues Learning about art therapy Creating art therapy for my personal wellness Creating art therapy ideas to use with the children 0%

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50%

75%

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7. CASE STUDIES: STORIES OF CHANGE The following “Stories of Change” are drawn from the art therapists’ reports, case study material, artwork photographs and video interviews. They provide a qualitative overview of how the mission was experienced by the participants and the art therapists. They also highlight the positive benefits and sustainable change that can be gained through the transference of art therapy knowledge, tools and techniques during a Train-the-Trainer mission:

Story of change (1): Caring for Self and Others Veronica (pseudonym) is a counselling psychologist working in Kibera since 2017. She has always had an interest in art therapy and tries to include art into her interventions with children. She has explored further training in art therapy but there are no programmes in Kenya that would support her further development in this area.

From the outset, Veronica was comfortable using and exploring art materials, understanding directives and processing artwork. She engaged with dedication during the sessions and came across as being very self-aware and thoughtful. She had a dip in her participation and energy mid training when she became so overwhelmed and tired. She revealed that while she works hard to help others, she is often overextended and that she has trouble asking for help for herself.

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Veronica was able to reflect on this and remained engaged with the training utilizing the artwork and her relationships with the art therapists for support.

After reviewing self-care in the training, she was able to take new steps for herself that were unfamiliar - asking a friend for help and validation, and cutting back her overwhelming work schedule to carve out time for rest and for her learning process. She was pleased and relieved about being able to do this. She found it very helpful and empowering.

Veronica had a deep interest in art therapy before the training began and was hungry for information. She said that through the training she had been able to deepen her understanding of art therapy and self-care, and had learned how art therapy could be used to self-soothe and self-regulate. She explained that she now understood that art therapy could be used not solely for interpretation but also its process, product, and relationship-building capacities. She learned about how art therapy may be used for emotional regulation with children who experience trauma. She was excited to bring this new knowledge to her work as a therapist.

Using art for “Self-Care� became a major theme in Veronica’s artwork and discussions. She was focused on how to care for oneself both personally and in her work as a healing professional. The experiential activities seemed to be the most meaningful for her, as well as her individual relationship with the art therapists, who supported her during the ups and downs she faced during the TTT. She learned how to set boundaries with friends and clients, which is a key lesson for a therapist to learn in order to keep resilient when caring for so many others in a community such as Kibera.

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Veronica utilised the art interventions well for her personal growth and started to use them in her professional life with her client groups. She was highly creative throughout the training and very comfortable with supplies.

She made compelling art pieces which she enjoyed sharing, and she was able to explore her process and the meaning of her pieces.

She found Visual Journaling to be a useful and effective tool to self-regulate and document all that she was doing. This helped her put in new elements to care for herself better. She would start activities and add to them at home later, reflecting further and developing on the themes and thoughts addressed in the sessions. She gained a better awareness of self through the "feelings cards" directive and used these cards well to check in with the group and the art therapists. Veronica shared that she had already started using the "feeling cards" with her young clients. She found that this was an effective tool, as the children were able to express themselves and communicate more freely with her.

She was looking forward to using directives such as the “self-care wheel”, the “mandala”, and the “self-soothing stone.” She will use these concepts of selfcare not only for herself but also for those she works with in Kibera. Her expanded knowledge around trauma was very significant to her growth as a person and as a counsellor. She talked about this through the “path of life” art directive - exploring her own experiences of trauma, ways to be resilient and hopeful moving forward - and ways to use art supplies with those who are traumatized to promote self-regulation. It was encouraging to see how this new understanding and growth in her personal journey could be used to help others in Kibera.

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Story of change (2): Searching for Hope Eliza (pseudonym) is a social worker in Kibera. She works with children to support their return to school or their first school admission. She wanted to learn more about mental health and what causes mental illness and different strategies for self-care through the TTT programme. Her key focus was to deepen her knowledge of trauma and different activities that can be used to work with children to learn more about them and their feelings. She previously only used verbal interventions with children, so she was excited to learn about art therapy and begin using art in her work with children.

Though she was looking to gain more knowledge for professional reasons, the sessions affected her personally as well.

She reported feeling emotionally overwhelmed, which she was able to identify, express and address through making art, supported by the art therapists.

She really engaged with the sessions and seemed to think reflectively about all the activities and how they could specifically be utilized with her client group. She was very keen to understand trauma and its impact, and reflected on each activity and how it could be presented in a way that it could be utilized with children of different ages.

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She was also very interested in the concept of resilience and made art as she explored this topic. She made an art piece about getting a lemon, but using it to make lemonade, on the theme of “when life gives you lemons, make lemonade”. She said that the training had helped her to see how to make the best of what they have in Kibera and that having a positive mind-set was essential to help build resilience.

In the middle of the workshop she heard some family news that made her very anxious. She was fearful about the poor health of a family member, which was especially stressful as she had lost another close family member just 3 months earlier. She was able to use art to express some of her feelings during that time and also to self-soothe.

Eliza used all her art supplies with great passion and enthusiasm, creating large art pieces. She loved doing the mandala in particular. She gained a lot of knowledge from the TTT, saying that it was “so informative and helpful” and that she definitely planned to use the modality of art in her future work with children. She spoke of art as a way not only to express feelings but as a way to assess how well things were going, in an ongoing manner. She also loved the "feelings cards" and planned to use that idea with the children in her care.

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Eliza was able to internalize her own experience of art making and make plans of how best to use art with the children in her care. She also demonstrated new knowledge about trauma and self-care. She recognized that art materials can be an easier and more fruitful modality for children who struggle with educational challenges. She also loved the directive of creating a safe space and understood the ways that the art supplies, coupled with the relationship, could foster safety and exploration.

Eliza on her feelings at the end of the Train-the-Trainer programme:

Personally, I really loved this. I’ve grabbed something from it and I’ll take it and run with it wherever I go. And I’ll make sure I utilise it in the best way possible.

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Story of change (3): An Unexpected Discovery of the Value of Art Timothy (pseudonym) is an art manager at Uweza Foundation where he conducts classes with children to teach them how to draw. He has been working there since 2016. He believed that by engaging with the programme he would gain better knowledge on how to teach people art and that it was geared towards artists. He had never engaged with anything like this before, so he went on an interesting journey of discovery about art therapy during the TTT sessions and how it can be used to support the children he works with at Uweza.

Timothy was inquisitive and curious. His previous idea about art was as a “product� that should be appealing, so that it could be sold. He initially thought that the training would help him to become a better artist. He quickly gained an understanding of what art therapy truly is and how it could be utilized in his work with the children and young people of Kibera. He learned that art is not only for retail but that it can be utilized to help people express themselves, and that art expressions may be interpreted and understood in many ways.

As an artist, Timothy was very competent with art materials and he always seemed eager to engage with the directives given. Throughout the workshop he became more communicative with the group and would ask more questions. He was playful and interactive. Art therapy was a new concept for him that opened up ideas of ways to express himself and work with children.

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He seemed to struggle a bit with working with older children - particularly how to engage adolescents and work with their behaviour. He indicated that he tried to avoid working with adolescents because they are more challenging. During the TTT, he gained more knowledge through the workshop about how he could work with them and seemed more confident about approaching work with adolescents in the future.

He gained a better understanding of how art therapy could access feelings, bring a sense of connection, and provide a means for an individual to express those feelings to others. A popular directive was “the hand of connection�, and discussion around the importance of our relationships. Participants were asked to trace their hand and to draw/ write on it about their connections, and also to decorate it. This directive was very well received and participants enjoyed being very creative and expressive. They also were able to reflect on how easily this directive could be translated into a meaningful activity for the children in their care.

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Over the three weeks, Timothy took on the role of the group leader for the Uweza group, and became an integral part of building the relationship with The Turning Point team.

He began to think more about the integration of play and music as tools for working with children and for making meaning.

He gained a lot of knowledge to give him new strategies for working with children and adolescents and how to integrate various activities to help them access their feelings. By the end of the TTT sessions, he said that he now understood how to put feelings onto a canvas or on paper and how to approach children in different ways. He also felt more equipped to work with children who have particularly difficult situations.

In common with the other participants, he faces the challenge of sometimes not having as many resources of support as he would like to offer to children in need. The workshop helped to build his skills in assisting children through art, by providing avenues for expression, understanding, and relationship building.

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Story of change (4): Overcoming Anxiety through Sharing Art Vincent (pseudonym) is a soccer coach who works with children and adolescents in Kibera. He has been coaching since 2004. Art therapy was a new concept for him, but he quickly understood that art can help someone understand your feelings in a new way. He was initially reserved, but he did share his art pieces with the group from the beginning of the training. He soon informed the group that he was quite worried about an ill family member and this worry stayed very active throughout the training.

He used art for self-expression throughout the TTT, realizing that his art pieces helped others to understand his feelings. He was very preoccupied throughout the training about the severe illness of his family member. He was in touch with the art therapists for individual support, used his art pieces for expression, and confided a little bit to the larger group about his struggles.

He was very engaged and creative in his art-making, and really embraced the possibilities for exploration, self-soothing and expression. He became increasingly confident during the TTT sessions and built trust with the leaders as the group progressed. The support gained in this training was helpful for him personally during this very difficult time.

He began to explore more about working with children and what kind of activities he could use with them when coaching. He also shared more details about the children in his care, in particular a family that had lost their home to a fire, a common occurrence in Kibera. He began to understand more about the effects of trauma in discussing how this family was impacted by this incident. He brought good questions to the group.

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During the TTT, Vincent realized that art could allow him to understand more about a child’s experiences of the past and their outer world. The sick family member remained an everpresent challenge, but Vincent built a strong rapport with group leaders and the art therapists to increase his support. He also used the art therapy sessions for maximum self-care benefit. He liked the “soothing stone” and used aspects of the other selfcare concepts to consider his strengths and coping strategies.

He became a little less reserved as his trust in the group increased. He consistently shared his pieces and felt that the WhatsApp group allowed him to see the feelings of other people… he said that this WhatsApp thread became a safe place to collectively share and be validated by each other.

He began to appreciate the true value of sharing with others and expressing his concerns with others. He also understood how that relates to his work with children and how valuable it would be to provide them with a safe space to do this themselves. He was able to think of ways that he could integrate this type of work with the children in his care, to give them a space for expression and to allow him to understand more about them.

He also said that soccer is like art, and that he needs to be creative and modify activities in a way that works best for the children. He used his time in the training well… to learn, to share about his own experiences and current struggle, to increase self-care, and to explore the impact of stress, trauma and loss.

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By the end of the TTT, Vincent articulated the need to modify plans and approaches based on the needs of each child and their situation. He spoke of his plans and ideas of how to use this new self-care knowledge with the children he coaches, as he considered the creative possibilities within soccer itself, as well as ways to build in art making with the children in his care. He expressed his gratitude for the support received with this artwork on the last day of the training:

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8. CHALLENGES FACED AND LESSONS LEARNED Some participants were facing serious stressors in their lives, which they were updating the art therapists about regularly. More consideration may be needed for the circumstances of members, and ideally, more support available on-site would be beneficial. Since this is not easy under the present circumstances, a second online step is strongly recommended to help create an ongoing support and referral system among the team through smaller group sizes and the direct participation of an experienced clinical supervisor over a longer period of time.

This learning was used in the next Red Pencil mission in Lebanon to good effect.

Some of the art interventions had to be adapted to respond to the group’s needs, to make the subject less personal and more about their role as a helper. Due to some of the grief responses observed by the art therapists, they felt the need to be protective and to work safely within the limits of this short online mission. Grief is a large and complex topic to cover and more difficult to handle online, as it inevitably brings up strong emotions and may trigger painful memories for the participants, so this topic would be worth exploring further in a longer mission.

Many of the participants asked about what to do regarding a lack of support services for children who were facing very difficult circumstances. The art therapists did their best to give them coping strategies for handling these cases.

Unfortunately, this was not an area that we could easily help them progress with during an online mission, as it requires connections on the ground with sustained follow-through from suitably qualified personnel. This in turn requires better provision of training programmes and government or UN support for child protection and mental health services.

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As a small international NGO, we do not have the resources to answer all these needs, but we intend to continue working with The Turning Point Trust and Uweza Foundation to help strengthen mental health training and support structures for the staff and children in 2021, ideally with another mission in the field, if this becomes feasible whenever the global pandemic permits.

The lack of training and resources for mental health and child protection services is a much neglected, systemic problem in many countries such as Kenya, where funding is completely inadequate for these essential services to be properly staffed. Art therapy training and other types of mental health training are difficult to find in Kenya and this is a huge area that needs financial support and professional expertise from international organisations such as our own. The Red Pencil is passionate about trying to improve the provision of art therapy services in developing countries and in addition to running these vital Train-the-Trainer missions, we also offer scholarships to allow candidates from developing countries to pursue Masters level training in Creative Arts Therapy.

On the technical side, 4 participants at the Uweza premises had access via one laptop and a projector and two members joined from home on their laptops/phones. All seemed to access the training most of the time, but frequent drops in connectivity did cause some frustration for the participants. Fortunately, they had the back-up of the WhatsApp group which enabled them to reconnect via a different channel. Uweza spent about 3,000 KSH ($30 USD) more than usual on data bundles for their office wifi over the course of the 3 weeks.

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The Turning Point team suffered a power outage at the school premises on the first day, so the whole team had to relocate to their office premises, which were a little cramped for the 16 members of their group. Apart from this initial issue, the technical set-up worked relatively well for them, however, with more laptops at the school, a projector, and a school IT technician available if needed. Some members also joined in from home computers.

Individual art materials were purchased locally in Nairobi from Faber-Castell suppliers, to ensure that there was no need for cross-contamination via the use of shared art materials. The choice of art materials needs to be carefully monitored to avoid cross-contamination risks while the global pandemic continues.

A field mission was not feasible operationally in 2020 due to lack of flights, additional border controls, unpredictable lockdowns, and the impossibility of obtaining travel insurance or adequate health cover in the midst of a global pandemic. Fortunately, online missions present very few operational risks, but they do require a good connection to work efficiently. This is identified as a Critical Success Factor for an online mission. The proximity to Nairobi allowed for a relatively stable connection in Kibera. The WhatsApp thread also provided a useful back-up when needed.

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9. WAY FORWARD The art therapists were struck by the pressing need for further support for the group members, in particular for them to be able to access psychosocial support on-site in Kibera if this can be facilitated locally. Clearly, this may be difficult to resource in Kibera, where provision of mental health support is currently very limited due to the lack of qualified personnel in Kenya. It is recommended that The Turning Point Trust and Uweza Foundation aim to connect with a local referral system to access further psychosocial support and ongoing training if this is feasible in the coming year.

In order to further assist our partner organisations, we are also proposing to continue with a Step 2 online mission in Q1 - Q2 of 2021, since 140 children are due to return to The Fountain of Hope school in January 2021. A limited number of facilities, including the local library, re-opened in October 2020, albeit with reduced numbers permissible at present due to COVID-19 precautions.

The overall mission structure is provisionally planned as follows: Step 1: September 2020 – 3-week online Train-the-Trainer in Self Care and Mental Health Awareness - started 31st August 2020 and completed on 17th September 2020.

Step 2: Q1 - Q2 2021 – an online follow-up phase is proposed, aiming to provide a weekly support group for the staff as they implement the new art therapy tools and techniques when the children return to school and group activities. This would include online work with the children, supported by our local partner staff in Kibera.

Step 3: Q3 2021 (or whenever possible, COVID-19 permitting) – a field art therapy mission in Kibera, with 2-4 art therapists and a videographer, to provide in-situ art therapy sessions for children and parents and further training for local partner staff.

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10. CONCLUSION Based on the pre- and post-surveys, the Stories of Change, and the qualitative data from the video feedback, it can be concluded that the goals and expected outcomes of Step 1 have been fully met to the satisfaction of all stakeholders.

Participants were highly engaged throughout the training and were able to explore art therapy directives for themselves. As they shared about their experiences of the art therapy experientials, they demonstrated an understanding of the importance of both the process and the product, and an appreciation of the possibilities for expression and exploration.

By the end of this Step 1 mission, there was a marked increase in knowledge about art therapy, mental health, trauma, grief and loss and coping strategies for improved self-care through art interventions. Through visual journaling and other self-care strategies, the staff of The Turning Point Trust and Uweza Foundation were able to continue caring for their own emotional well-being as frontline workers. They were also equipped with new skills and art interventions to help build resilience and aid recovery from trauma for many children and families in Kibera over the coming years.

The partners and the art therapists also expressed their satisfaction with the way the mission was planned and implemented, despite the challenges of working online instead of on the ground, as we have previously done in pre-COVID-19 times. The art therapists wrote the following in their Step 1 report:

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Despite facilitating the group remotely, we were able to build community and connection to the participants. People on the ground were highly helpful with this, i.e., moving around with the camera, and asking participants to introduce themselves and to participate.

The WhatsApp group was also instrumental in keeping the connection.

Members could let us know if they were running late or disconnected due to technology issues, and we put all art prompts on the thread.

The thread became another place of group sharing as participants photographed and shared their art pieces.

The group always demonstrated a willingness and an openness to learn. They were keen for more information, always asking interesting questions that were relevant to them. This continued throughout our time with them. People who did not have any awareness of what art therapy was at the beginning seemed to gain an understanding of it, and to learn how they could use it for self-expression, as well as in their work with the children. Many people who were not used to sharing stepped out of their comfort zones to share with the group.

One of the biggest changes was the growing connection and the communication and relationships built between Turning Point and Uweza. At the group’s conclusion, members asked us to keep the WhatsApp group active as they did not want to relinquish the connections.

There seemed to be an increase in understanding about trauma as well, and how to work with trauma in their respective areas. Their bond to the art therapists was also noted as they made the request to learn a bit more about us, a request that seemed to be culturally fitting and significant. As a result, both art therapists decided to create a piece of response art to the group experience and to share it, which was well received and seemed like an important validation of the group’s bond and work together. Laughter and playfulness helped carry this group throughout our time together, fostering connection and community.

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It was the first online art therapy Train-the-Trainer programme for all stakeholders involved, so plenty of lessons have been learned for future online Red Pencil missions. We would like to extend our sincere thanks to The Red Pencil Art Therapy Team – Sarah Vollmann, Kim Bryan, Angela Bossut, and Sara-Jane Asman for their dedication, resourcefulness and pioneering spirit in delivering this programme successfully. We also thank Dr Penelope Orr and Gretchen Miller for their kind advisory support and clinical supervision of this new online programme.

We were privileged to work with our local partner contacts, Emily and Moses Obiti from The Turning Point Trust, and Jennifer Sapiro from Uweza Foundation, who gave excellent logistical support for the project on the ground at their respective premises in Kibera. We would also like to thank the photographers, Cedrick Joseph, Maxwell Anduvate and Mufadhal Musa who contributed all the photos and video material for this mission. A selection of these photos and video clips can be accessed via bit.ly/kenyamediaannex.

Finally, we would also like to give our heartfelt thanks to FaberCastell for their kind sponsorship of this first online mission, especially for their understanding and flexibility to allow the project to go ahead online when the global pandemic caused so much disruption to all our operations on the ground in 2020. We are so pleased to continue our longstanding partnership with FaberCastell and extend our sincere thanks for the trust placed in us as we participate together in the “Children of the World” collaboration.

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We would like to thank Faber-Castell for their generous support in helping us bring art therapy to those in need, especially in this time of pandemic.

The Red Pencil (International) Avenue Blanc 53 CH 1202Â Geneva Switzerland welcome@redpencil.org

www.redpencil.org

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