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Participatory Problem-Solving for Youth Suicide Prevention

Facilitated by Sara Krosch, MA sarakrosch@gmail.com

at the FSM National Youth Summit Yap State - June 21, 2006


Key Terms Community: A group of people living in the same area and/or with common interests. Stakeholder: any individual, community, group or organization with an interest in the outcome of a project. Stakeholders are influenced positively or negatively by a project and/or they can influence activities in a positive or negative way. Participation/Participatory: When everyone who has interests or a stake in activities or a process has a voice, either in person or by representation, and contributes. Facilitation: The process of making something easier or less difficult. Facilitator: Helps participants to interact with each other, gain new information, share their knowledge and build upon their experience. A neutral person who leads the problem-solving and action planning process. Risk Factor: traits, beliefs, and behaviors of individuals, families, and communities that make youth more vulnerable to suicide. Circumstances and experiences that increase the likelihood of risky behaviors. Protective Factor: traits, beliefs, and behaviors that "protect" from suicide by reducing the effects of risk factors. Circumstances and experiences that promote healthy behaviors and positive development. Targets of Change: People who directly experience the problem or are at risk. Also, people who contribute to the problem through their actions or lack of actions. Agents of Change: People who control or can influence risk and protective factors affecting the problem. People with time, resources, desire and the respect of the Target groups. Community Asset: anyone or anything that can be used to improve the quality of life in the community--people, groups, buildings or places, institutions, businesses, programs, activities, resources etc. Strategy: What you will do to reach the goal. Tactic: The steps you will take to reach the goal. CAP: Community Action Plan CAPIT: Community Action Plan Implementation Team


Facilitation Teams What is Facilitation?

“I cannot teach you. I can only create an environment where you can learn.” Facilitation is the process of making something easier or less difficult. A Facilitator helps people interact with each other, gain new information, share their knowledge to solve their problems. The Facilitator is basically a neutral person (with no decision-making authority) who leads the problem solving and action planning process. The Facilitation Team “A single blade of grass won’t sweep the yard.” A team is a group organized to work together towards a common goal. Ideally, each State will form one or more Facilitation Teams made up of: 1 adult leader 1 youth leader 1 or more FSM Suicide Prevention Coalition members, and 1-2 community leaders/representatives

Roles of the Facilitation Team The Leader: • contacts community and serves as the primary link with community leaders • coordinates the logistics (location, time, materials etc.) of the field work • oversees team members work • ensures that activities stay on schedule. • oversees report writing, editing and distribution after community workshops and activities have taken place • should have experience working with youth and communities and some facilitation/training experience

The Recorder: • observes and records the Stakeholder Workshop and subsequent activities • transcribes both written notes and hand-drawn maps and diagrams that community members create • records who attends the workshop, key comments that are made and observations of group dynamics. • should be observant, a good listener and be able to summarize and present information clearly • completes Reporting Sheets for each session

The Facilitator:

Community Link persons:

• leads the workshop activities with Stakeholders • ensures that all Stakeholders understand the process and directions for each activity • encourages the fullest participation of all Stakeholders and keeps groups on task • must have good interpersonal skills, a good sense of humor, and be flexible and patient • be comfortable and confident with the process, leading activities and answering questions • completes Reporting Sheet for each session

• identified by Facilitation Team when planning the Stakeholder Workshop

• serve as liaisons between the community and the team leader

• help with logistical arrangements and can also help lead workshop activities

• should be respected, influential people who are willing to learn from their fellow community members and be able to attend the entire workshop to model behaviors

Team members may switch roles as needed. However, the Leader should be a permanent point of contact.


Facilitator Reporting Sheet Facilitator(s) _____________________________________________________________________________________ Recorder(s) _____________________________________________________________________________________ Group name and location: ______________________________________________________________________ Name of Activity:

Date and Place Conducted:

__________________________________________________

_____________________________________________________

__________________________________________________

_____________________________________________________

Materials used: _______________________________________________________________________________________________________________ Process: ____________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ Key Findings: _____________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Reflections: What went well? ______________________________________________________

What needs improvement? ___________________________________________________

______________________________________________________

___________________________________________________

______________________________________________________

___________________________________________________


Recorder Reporting Sheet (Attach all related chart papers)

Recorder(s) __________________________________________________________________________________________ Facilitator(s) _________________________________________________________________________________________ Group name and location: __________________________________________________________________________ Name of Activity: _________________________________________________

Date and Place Conducted: _____________________________________________

_________________________________________________

_____________________________________________

Stakeholder Characteristics:

Numbers

Approx Ages

Level of Participation

men

High Medium Low

women

High Medium Low

boys

High Medium Low

girls

High Medium Low

General Observations of Groups:

Key Comments: _________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ Key Findings: ___________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ Reflections: What went well? _______________________________________________________

What needs improvement? ________________________________________________________


Risk & Protective Factor Recording Sheet

Risk Factors

Protective Factors

traits, beliefs & behaviors of individuals, families, & communities that make youth more vulnerable to suicide.

traits, beliefs & behaviors that "protect" from suicide by reducing the effects of risk factors.

The opposite of a Risk Factor is a Protective Factor.

They are circumstances & experiences that increase the likelihood of risky behaviors.

They are circumstances & experiences that promote healthy behaviors & positive development.

List of Risk Factors

List of Protective Factors

RISK

RISK RISK RISK PROTECT

GOALS: We want to eliminate, lessen or buffer youth from risk factors. We want to create, increase or improve protective factors to make youth more resilient to life’s challenges.

PROTECT PROTECT PROTECT


Where are Risk & Protective Factors Found?

SOCIETY/CULTURE

COMMUNITY PEERS

SCHOOL

FAMILY

INDIVIDUAL


A “Culture of Silence” We expect Stakeholders to feel uncomfortable discussing the problem of youth suicide. Why? A Culture of Silence around the issue has been growing for decades. As facilitators of a participatory process it is critical that they are able to get Stakeholders talking about the problem. Use one or more of the following activities to start a discussion. Activity 1: Draw pictures similar to the ones fond on the next page. Ask participants to describe what they see in the pictures. Discuss what is good about each picture and what in each picture keeps people silent. Debrief the pictures with the following information:

What is a Culture of Silence? Many societies tend to be authoritarian. People are expected to accept without question the decisions of those who are in power. They are to obey humbly and not challenge those decisions. This creates a culture of silence. Silence can also come from shame or embarrassment. We are afraid of what others will think about us. People become afraid to speak about issues and problems that affect them for fear that others may judge them as being wrong or bad. A culture that promotes silence discourages people from solving their problems or from taking responsibility for their actions. They feel hopeless and helpless to change their situation. To end the silence around the problem of youth suicide we will try to give ordinary people the chance to express their feelings and ideas and create opportunities to change the current trend. To do this, we must agree that silence will not make the problem go away and we must be confident that we can start to solve the problem if we discuss it and plan to change it.

Activity 2: Ask the participants the following questions. Record answers chart paper: • • • • •

Why do you or others stay silent about youth suicide? Who benefits by maintaining a culture of silence/by staying silent? Have groups or individuals always been silent about the problem of youth suicide? If they have spoken about the problem in the past, what was the reaction? Why do you think this was the reaction?

See no evil, hear no evil, speak no evil…change no evil?


A “Culture of Silence” Discussion Pictures


Icebreaker: Hopes & Fears One worry, fear or negative thought about involving the community in youth suicide prevention I am afraid… I fear... I am worried… I don’t want...

One hope, positive feeling, good expectation about involving the community in youth suicide prevention I hope… I am hopeful that… I would like to see… I want… I am excited...

Discuss the group’s fears and hopes. Stress that participants must be willing to overcome their fears to realize their hopes. Review the objectives of the workshop and how they relate to the participants’ hopes and fears. Revisit this list at the end of the workshop to see if feelings have changed.


Defining the Problem Youth suicide is a multi-faceted problem. Participants will share their knowledge and experiences to form a group definition of the problem of youth suicide. The group can decide on a single problem statement as a guide for community action plan goals.

1) Individual

Finish one statement: I know___________________ or I see____________________ or I have experienced_________ or

Think of: Who? What? Where? When? Why? How?

I have learned_____________

Think of:

2) Pairs

Frequency

Share your statement with a partner and discuss. Add to your statement if necessary.

How often does the problem occur?

Duration How long has it been a problem?

Scope & Range Who/what is affected by the problem? How many are affected?

Severity In what ways does the problem disrupt personal, family & community life?

Perception Does the community prioritize this problem?

3) Small group

Create a single statement about the problem all small group members can agree on. The statement should not try include all aspects of the problem.

Statement Starters: We know_________________ or We see__________________ or We have experienced_______ or

4) present to large group

We have learned___________


ROOT CAUSES Tool 1: Force Field Analysis (mixed or focus groups)

1. Draw the Force Field diagram on chart paper with the Problem Statement in the left-hand box and the Vision Statement in the right-hand box.

Helping Forces NOW Problem Statement

FUTURE Shared Vision

Hindering Forces

the left box shows the current situation “Where We are Now” the right box shows the improved situation in the future “Where We Want to Be” the arrow in the middle is the path to the future the arrows pointing up represent forces that will help us get from “now” to the “future” the arrows pointing down represent the obstacles preventing us from reaching our goals 2. Next, identify the positive, helping forces (resources and actions that exist or that will be needed) to get us to our shared vision. Identify the negative, hindering forces (constraining factors and sources of resistance) that may challenge us. Helping Force: resources or actions that exist or are needed for positive progress Hindering Force: constraining factors and sources of resistance

Think of all of the forces that help and hinder at the individual, family, community and societal levels. What are cultural, religious, economic, and social forces that impact the problem and our efforts to solve it? 3.

When you group cannot think of any more forces to add to the diagram, reflect on the completed poster. Ask yourselves: What are the dominant helping/hindering forces? Did new forces emerge that you had not thought of? How easy will it be to improve the current situation? How long is it likely to take before real improvements are seen?

4. Which of these forces are risk factors? Which are protective factors? Hindering Forces - may be resistant to change - may cause our efforts to fail - are risk factors

Helping Forces + may enable change + may help our efforts succeed + are protective factors/assets


ROOT CAUSES Tool 2: “But, why?” Technique (mixed or focus groups)

Here is an example beginning with an observation of a problem: The little girl has an infected cut on her foot. But, why ? Because she stepped on a thorn But, why? Because she has no shoes But, why? Because her family cannot afford to buy any But, why? Because her parents are unemployed. But, why? Because her father lost his job and her mother is uneducated But, why? But why? Because the business he worked for closed...

Because she got married and pregnant young...

Observation: ______________________________________________________________ But, why?

What risk and protective factors did this activity reveal? (As in the example above, adult unemployment, under-education and society’s poor economy were risk factors for young children having health problems. Adult employment, education and a prosperous economy would be possible protective factors for child health.) Risk Factors: Protective Factors:


EXPLORING ALTERNATIVES Tool 3: Playback Theater Role Plays (mixed or focus groups)

1. Choose a scene to act out or develop your own scene.

Short Case Studies for Performance & Discussion ∗ A 17-year old boy who had often complained that his family did not love him injured his younger brother in a fight and was severely scolded by his parents for this behavior. Not long after this he got drunk and hanged himself outside his house.

∗ A young man was ordered by his father to work in the family garden although he stated he had other plans that day. After the family had left to attend a community celebration, he dug up the garden and then hanged himself.

∗ An 18-year old committed suicide shortly before his graduation when his parents denied his request for money. ∗ One young man in his early 20s took his life when his family refused to allow his marriage to a girl with whom he had been living for almost two years and with whom he had a child.

∗ A nine-year old boy who had been watching television at a neighbor's house hanged himself for fear that he would be beaten for returning home so late.

∗ A 15 year old girl asked to use her sister’s video camera but the sister refused. The girl killed herself with an overdose of medicine.

∗ A 24-year old male took his own life after he was refused credit in the family store.

2. Plan out your scene: Where does it happen? Who are the characters? What is the action/what happens? How will you give the audience the impression that the character commits suicide? Give a short introduction of your scene and then act it out. Make sure the audience can see and hear you and tell them to watch the play closely. Remember to speak loudly and do not turn your back to the audience. 3. After you are finished, ask the audience to tell you what they saw. Then ask the audience to provide missing information: What do you think was happening before the scene started—1 day, 1 week, 1 month earlier— that may have led to the young person taking their life? Ask them to explain their answers. 4. Re-play the scene with the additional information given by the audience. But this time the audience is allowed to stop the action at any time they want to change what is happening. They do this simply by yelling, “Stop,” or by raising their hand. The actors must then freeze and the audience member(s) must tell them what to do differently so as to have a more positive outcome. When the audience member(s) say, “Go,” the play resumes. The play can be stopped as many times as the audience feels changes need to be made. 7. After the performance, ask the audience: What changes were made to the first act? What impact did those changes have? Did the changes have positive or negative results? Were the changes realistic? Do people act that way? What caused the youth to commit suicide in the first play? Did they change their behavior in the second play? Why? Ask the actors if there was anything difficult about playing their roles? What risk and protective factors were revealed?


EXPLORING ALTERNATIVES Tool 4: Reasons to Live Discussion (mixed or focus groups)

1. Imagine you are thinking of committing suicide. Take a few minutes to think of as many reasons as you can why you would/should not commit suicide and go on living individually. 2. Individuals share their answers with the small group which records a list of Reasons to Live. 3. Small groups come together into the large group and share their lists of Reasons to Live. The Recorder works with the participants to put the responses into categories* such as religious/spiritual beliefs or commitment/love of family. Record your categories in clusters or a list. 1) Individual Reasons to Live

2) Small Groups Reasons to Live

3) Category Clusters category

reason

reason

category

category reason

reason

reason

reason

reason

reason


COMMUNITY ASSETS Tool 5: Community Maps (focus groups by age and/or gender)

1. Draw a map of your “world”: including the most important people, places and things in your community. Maps are not meant to include everything, rather they should represent the assets the group values most. Think about a typical day or week and all the people they interact with and the places they go during that time. What roads/paths do you travel? What places do you go to? (school, church, stores, work, health clinics, markets, homes, community places, cultural/sacred places, family lands) Which people do you interact with most? What activities do you do and where do you do them? 2. Share small group maps with the large group. Discuss the following questions: What “adult” places can/do youth contribute to? What “youth” places can/do adults contribute to? What are the most valuable locations to the community as a whole? What activities take place at these locations? What labeled populations can be found at these locations? ( local artists/craftspeople, college students, musicians, traditional/religious/youth leaders, etc.) Where can risk factors be found? (i.e. alcohol drinking on the causeway) Where can protective factors be found? (i.e. youth group meets at church)

EXAMPLE


COMMUNITY ASSETS Tool 6: Community Clocks (focus groups by age and/or gender)

1. Draw either a column of boxes representing the hours of the day or a timeline (see examples below), from the time you wake up to the time you go to sleep. The group first decides what time they usually wake up. Answers may vary but the group should come to a consensus of what time to begin the clock. 2. Groups should show all the activities they do on a typical day and how long each activity takes to complete. If activities are done at the same time (cooking and childcare), they should be shown in the same box. Use words or pictures to describe activities. 3. Small groups share their clocks with the large group. Compare clocks by asking: How is time used differently? Who has the heaviest work load and who has more time for leisure and rest? How much time is spent in activities with peers, family, community members? What free time and activities do/can ToC and AoC share? Would clocks be different on different days or during different months? What “adult” activities can/do youth contribute to? What “youth” activities can/do adults contribute to? What are the most common activities of the groups? Where do these activities take place? Do activities utilize community assets? Time

Activity

6:30

Wake up, shower, get dressed

7:00

Wake siblings, help them get dressed

7:30

Eat breakfast

7:45

Walk to school

8:30 - 12:00

classes

12:00 - 12:30

Lunch

12:30 - 2:30

classes

2:30 - 4:30

Youth group/sports

4:30 - 5:15

Walk home

5:15 - 6:30

Hang out with friends

6:30 - 7:00

Eat

7:00 - 9:30

Homework, hang out with friends, watch videos


Prioritizing Risk & Protective Factors

Factors for Youth Suicide Risk (-) & Protective (+)

Degree of Importance 1= slightly important 2= moderately important 3= very important

Degree of Changeability

+

1 = unable to change/directly affect 2 = partially changeable/able to affect 3 = highly changeable/can directly affect

= Final Value

()

+

=

()

+

=

()

+

=

()

+

=

()

+

=

()

+

=

()

+

=

()

+

=

()

+

=


Signatures

(+)

(+)

(-)

(-)

Risk/Protective Factors Goal Statements

Problem Statement

Agents of Change (AoC)

Targets of Change (ToC)

Target Groups people, places, resources, programs, institutions, partners to assist

Community Assets How will AoC support or create protective factors for ToC?

How will AoC decrease or buffer ToC from risk factors?

Strategies & Tactics

Vision Statement

human & material

Resources Needed Plan Start Stop Evaluate

When

Quantitative & Qualitative

Indicators of Success

Community Action Plan


ACTION PLAN Strategies & Tactics Strategy: What you will do to reach the goal. Tactic: The steps you will take to reach the goal. Goal: Joe would like to get married. Strategy: Joe wants Joyce to fall in love with him. Tactics: buy her flowers, write her a song, take her for a romantic night cruise, etc.

1. For each goal statement, first decide on a strategy—what will you do to try to reach this goal? Types of Strategies: provide information or support growth teach new skills or provide training create a new service or program enhance an existing service or program or modify access and barriers monitor and give feedback Brainstorm possible strategies by asking yourselves: What can the identified AoC do with the ToC to reach this goal? What Community Assets do the AoC and ToC have in common? How can the identified Community Assets be utilized to reach this goal? What has been done in the past to try to reach this goal? Was the effort successful? Why or why not? What needs to be done to reach the goal (information, skills, service, program)? Keep strategies simple and practical by following this formula: Targets of Change Agents of Change

+

Community Asset

+

Type of Strategy________________

2. Small groups record possible strategies. Evaluate each by discussing the following Is the strategy appropriate and appealing for the target group? Does the strategy make the best possible use of available resources and community assets? Is it practical and simple? Are there any negative effects from employing this strategy? Can one strategy meet more than one goal area? 3. Decide on one strategy per goal statement. 4. Next, break the strategy down into steps or tactics. For example, If your strategy is to get more males ages 1824 involved in sports and to gain skills in overcoming obstacles by pairing up with adult mentors what do you need to do first, next, after that, finally‌


ACTION PLAN Targets & Agents of Change Targets of Change: People who directly experience the problem or are at risk. Also, people who contribute to the problem through their actions or lack of actions. Agents of Change: People who control or can influence risk and protective factors affecting the problem. People with time, resources, desire and the respect of the Target groups.

Targets of Change Who directly experiences and/or is most affected by this factor? Who indirectly experiences this factor and has the potential to become more involved?

Agents of Change Who directly creates or contributes to this protective factor? Who influences the people and conditions that contribute to this factor?

Who causes this risk factor? Who’s actions or lack of actions support this risk factor? Who has experienced this risk factor and is still suffering from it?

Who has experienced this risk factor and overcome it? Who has the power, resources, time and desire to change this factor? Who is working positively with the target group already?


ACTION PLAN Resources, Timeframe & Indicators of Success Resources Human Resources Needed

Material Resources Needed

(knowledge, skills, abilities)

(buildings, transportation, printed materials, food, equipment, etc.)

Timeframe How long will you need to plan & prepare? When will you start? When will you evaluate? When do you hope to finish?

Indicators of Success Quantitative Indicators Specific Measurable Achievable Relevant (to the goal) Timeframed Example: By June 2007, at least 20 males ages 1824 will have joined the basketball league and completed peer leader training with their adult mentors.

Quantitative Indicator:

Qualitative Indicators Based on observations, interviews Record how behaviors, thoughts and feelings have changed Capture people’s judgments/ perceptions of the strategy Relevant (to the goal) Example: We want to build the confidence of participants and we went their families and communities to be proud of them.

Qualitative Indicator:


Stakeholder Workshop Planning Sheet

1) Facilitation Team Members: Team Leader _____________________________________________________________________________________________ Facilitator(s) _____________________________________________________________________________________________ Recorder(s) _______________________________________________________________________________________________ 2) How will you identify your Stakeholders? What group(s) would be interested in this process? ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ 3) Brainstorm possible Community Link people. Who has access to or already works with youth, their families and communities? Who are respected, influential, organized and responsible leaders interested in working with you? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 4) What might be good locations to hold the Workshop? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 5) When is a good time (month, time of the day) to hold the Workshop? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 6) How will you advertise the workshop and encourage attendance? Who will do this? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 7) What activities would you like to do with Stakeholders? _____ Force Field analysis _____ “But, why?” technique _____ Community Mapping _____ Playback Theater/role play _____ “Reasons to Live” discussion _____ Risk/Protective Factor Identification _____ Target Groups Identification _____ Community Clocks _____ Action Planning 8) What problems or obstacles do you think you will encounter when planning and hosting the Stakeholder Workshop? How will you overcome them? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________


Brainstorming

Brainstorming is a tool used to draw on the group's collective, creative energy. It permits uninhibited participation by each person and often results in surprising ideas and new solutions to old problems. Brainstorming can be done in large or small groups, in pairs or individually. A good brainstorming session should last until the group “exhausts” or has no more ideas coming to them—about 5-15 minutes plus time for discussion. A Recorder writes down ideas generated by the large group, or individuals, pairs or small groups can brainstorm and record ideas first and then share them with the large group. This allows for more comfort and usually leads to more ideas.

Process 1. Display the question or problem so that everyone can read it. Decide if you will work as individuals, pairs, small groups or the entire large group. 2. Instruct the Stakeholders to take the next 5-10 minutes to come up with as many ideas as possible to answer the question or to solve the problem. Present the Brainstorming Guidelines. Brainstorming Guidelines The emphasis is on quantity. Try to generate as many ideas as quickly as you can Any idea is allowed, there are no dumb or impossible ideas at this stage Try to piggy-back: if someone's idea reminds you of another say it, even if it sounds similar No criticism is allowed – ideas will be evaluated later 3. Designate one or two people to be the Recorders so that contributions can be written down as they appear. The visual display of ideas often sparks others. 4. Call time when the announced time is almost up, or when you feel the group has exhausted their ideas. 5. Tell the group to take 3-5 minutes to review their list of ideas and identify the three solutions/ideas they feel are most useful. Groups can decide if criteria for evaluation will be used (i.e. “We have limited time and funds so we cannot choose expensive activities that take a lot of our time.”), or if discussion, debate and voting will be used to narrow the list. 6. Reconvene and have small groups report their top ideas/solutions. Record the answers. Small groups should support their answers if questioned. 7. Finally, have the whole group (including yourself as facilitator) decide which ideas are most useful.


Working with Small Groups

Mixed Groups

Share a common characteristic (age, gender, experience)

Any age, gender, status, occupation, etc. May not have things in common

Individual Brainstorming

Pairs

Focus Groups

Small Group

Have at least one thing in common

Large Group


Training of Trainers Workshop Handouts: A New Path- Community-based Youth Suicide Prevention