During their first years of life, children develop brain architecture and establish a foundation for life-long health and learning. Malnutrition interrupts this process, and children who experience adversity are at the highest risks of malnutrition. This blog will explore how social service workers are working to prevent malnutrition in vulnerable children; and how capacity building and stronger systems can lead to better development outcomes for all children.
Nutrition, disability, and the right to family care
Vulnerable children, including those with disabilities and those without family care, face some of the highest risks of malnutrition. Children with disabilities are three times as likely to be malnourished; and SPOON’s work has shown rates of malnutrition as high as 91% in residential care facilities. Around 80% of children with disabilities have feeding difficulties, and specialized feeding support is limited in most low- and middle-income countries.
In residential care facilities, staff typically do not receive training on nutrition best practices, and children often miss out on nutrition and nurturing care at critical developmental windows. Globally, the social welfare community is working to develop childcare systems that fulfill every child’s right to family life. A strong foundation of nutrition helps to prepare children for community life and contributes to the success of care reform efforts.
While malnutrition is a significant challenge, it is preventable. SPOON equips social service workers and caregivers to prevent and respond to malnutrition in these highly vulnerable children by linking children and caregivers with the individualized support they need.
Embedding nutrition in the social service system in Vietnam
In Vietnam, child malnutrition is high nationally, with vulnerable children particularly at risk. SPOON, International Social Service, and the government of Vietnam are working together to support social service workers to respond to the nutrition and feeding needs of children with disabilities living in institutions and those living outside of, or returning to, family care.
In Vietnam, SPOON has equipped a team of Master Trainers from the Ministry of Labour, Invalids and Social Affairs with knowledge, skills, and tools in growth monitoring, anemia prevention, and improved feeding practices for children with disabilities. These Master Trainers are training children’s caregivers to improve nutrition and feeding practices by using SPOON’s app, Count Me In, to track children’s growth, detect anemia, and assess feeding practices. Data from Count Me In helps caregivers implement individualized care plans for each child, and improve nutrition and feeding practices across community or residential care sites. Their work is reducing rates of malnutrition and improving children’s health, development, and chances for a successful return to family care.
This program also aims to prepare children with disabilities as they to transition to community settings into family care through supporting the government in building a reintegration pilot. The long-term goal is to equip the social service workforce with knowledge and skills to include the unique feeding and nutrition needs in the case management of children during the reintegration process, and to support families to care for children with disabilities.
Scaling social service workers’ impact in nutrition
With strong training and tools, social service workers can support caregivers and link them with services to prevent malnutrition in vulnerable children. SPOON has seen significant improvements in nutrition outcomes with this approach, with stunting halved across our programs. To make this a reality at scale, social service champions need to ensure that appropriate training and support are in place and that children who need specialized care and treatment are linked with the health system. Nutrition must be included in policies and programs that seek to improve children’s development. With supportive policies, consistent capacity development, and strong systems, social service workers can ensure that all children meet their potential.
By Carolyn Moore and Tammy Teske, SPOON. SPOON is a global nonprofit empowering caregivers to nourish children who are highly vulnerable to malnutrition. Learn more about our work at www.spoonfoundation.org.
by Heather Modlin, PhD, Provincial Director, Key Assets Newfoundland and Labrador, Canada
Self-care is a hot topic these days, particularly for those of us in a helping profession. We know that working closely with people who are struggling makes us vulnerable to struggling ourselves. As we interface with the pain of others we are susceptible to experiencing vicarious trauma, compassion fatigue and burnout. Add to this the long hours, isolation and shortage of resources with which many in the social service workforce are familiar and the risks multiply. It is important to acknowledge the toll that working in this sector can have on practitioners and openly discuss ways in which the risks can be mediated.
I am not a fan of the traditional self-care rhetoric. While there is nothing wrong with taking care of ourselves, I am concerned that sometimes the discourse on self-care crosses over into self-indulgence. Self-care is really about monitoring and knowing ourselves, taking responsibility for ourselves and making sure that we are the best we can be in every functional domain. Self-care is about continuous growth and development.
The most useful self-care framework I have come across, from the Child Welfare League of Canada, that focuses on helping people recognize what gives them energy and what depletes their energy across various functional domains. Download in pdf format.
The premise of this framework is that we can’t – nor do we need to – stop doing the things that deplete our energy. We just need to ensure that as we use up energy, we concurrently create energy. We also need to recognize that this must be individualized – generalized self-care platitudes can be harmful when we assume that they apply to everyone in the same way. Let me provide an example.
Several years ago I was teaching a group of child and youth care students in their last semester of a two year diploma program. These bright and committed students, who until this semester had been showing up for class enthusiastic and eager to participate in the learning process, were now dragging themselves through the door, looking tired and demoralized, muttering under their breath about how burnt out they were. I was concerned about them and also curious about how they had gotten to this place, and I decided to spend a day exploring self-care. We did the exercise above. One of the students was a single parent. In addition to attending school full-time and raising her three children, she had worked a part-time job in the retail sector. Bowing to pressure from her family and friends that she was going to “burn herself out” she quit her job. When she completed her self-care table, she identified that the things that depleted her energy were her children and school. Being at work, in a job she loved, gave her energy. In a misguided effort to prevent herself from becoming stressed out, this student gave up the part of her life that was keeping her energized. Even worse, some of the activities she had engaged in with her children, that gave her energy, were no longer affordable since she had lost the income from her job. After doing this exercise, the student went back to work and her symptoms of “burn out” immediately disappeared.
This example is not representative of all situations, and it does not reflect scenarios in which employees are negatively impacted by the stress of the job. This example is also not intended to imply that burn out is not a real thing – it is. Sometimes, however, when we think we are burnt out we may be just tired. We may need to get our energy back up. To do this, we need to know ourselves and we need to recognize what we have the capacity to control. We may not be able to control our work hours, our organizational environment, the challenges of the work itself, or even what consumes our time outside of work, but we can control our mindset. This is where self-care starts.
As we wrap up Social Service Workforce Week with this focus on the importance of self-care for the social service workforce, some suggested further reading:
- The Alliance brought social service researchers and practitioners together to review existing evidence on social service workforce strengthening through the Building Evidence Interest Group. They produced a report, which includes a section on staff care, one of the more heavily researched methods related to workforce support. Read the report here.
- The Guidelines to Strengthen the Social Service Workforce for Child Protection also include a section on supporting the workforce and focusing on staff care.
- For guidance for organizations wishing to institutionalize staff care, particularly in emergency or humanitarian aid settings, a key resource is Essential Principles of Staff Care: Practices to Strengthen Resilience in International Humanitarian and Development Organizations
- The Essential Principles for Self-care website links to many other related resources on the topic.
by Nino Shatberashvili, PhD, MSW, Deputy Head, Office of Resource Officers of the Educational Institutions, Ministry of Education, Science, Culture and Sports, Georgia
Standing at the vanguard of social work development in the educational setting, I feel excited, responsible, motivated and curious.
Social work is still a relatively a new profession in Georgia, in comparison to other countries, where it has been already developed for a century, and in comparison to other supportive professions in my own country. I myself grew with this profession, when I entered it in 1999, and have supported it by helping to found the Georgian Association of Social Workers. The maturity of a profession relates to the length of its development, the historical moment it was introduced, the tradition on which it was developed, the sphere from which it introduced itself in the society. All of these mold its image.
A newly adopted law on social work legitimizes, though does not limit to, four core directions of the profession: child welfare, justice, health and educational social worker. It also emphasizes the role of a social worker at the municipal level. So far only central level statutory social workers exist, and they are limited with their responses to referrals and unable to provide outreach services.
Currently I am a deputy head of the Office of Resource Officers of the Educational Institutions under the Ministry of Education, Science, Culture and Sports of Georgia, curating psycho-social services. The center hires 55 specialists: social workers, psychologists and child psychiatrists to be based in 10 locations across the country. We are serving children from ages 6 to young teens who exhibit emotional, behavioral or destructive behavior. Sometimes neither school nor society or the family is aware of their needs. Or there are situations when the case doesn’t yet meet the criteria to be reported to the police, Social Service Agency or our Psych-Social Center. Sometimes, there is reluctance to report the case for number or reasons. It is quite difficult to maintain a golden standard - not to rush to report cases for which you feel resourceful or have already taken concrete steps and are seeing results and vice versa. But we have to move to this direction.
School is a quite complex social organism. As school definitely is the place to teach children how to behave and support their personal growth and development, it also is not an institution for the treatment of behavioral problems. Though the need has to be addressed. Any kind of problem, be it discrimination, violence, oppression flourishes in silence and wilts only when and if discussed. Therefore, supportive professionals have a huge role in school setting.
I see social work in educational settings as assisting children, teachers, parents to not only cope with difficulties and stress that comes with change, but to support them to exercise their resiliency.
We are planning for social workers to work with school officers, teachers, administration and parents not to neglect the problems, cases of violence, bullying, as it will fuel over representation of exclusion, stress etc. School absenteeism is often attributable to feelings of being excluded or not fitting into the school network. Social workers have to promote children’s social success in par with academic success. They have to identify, assess and intervene.
Recently, I was impressed when referred by my dear colleague Mark Doel to Rachel Bramble’s work on school social work methods. She emphasizes that children are assessed on everything but not happiness, and this is true for the majority of countries. But this is a component of welfare and well-being. How can they be socially effective, successful? This is quite challenging.
Another challenge is to find its role among other professionals and decide when to act as a stand alone professional and when to step in multidisciplinary setting, as there is no clear-cut standpoint on when a monodisciplinary solution is not enough and a multidisciplinary approach may be more effective. They need to be confident on how to address these issues not only individually but at the school level too. We must conduct strengths-based interventions to empower students to become the kind of person they want to become.
Social workers in hospitals settings help support psychosocial wellbeing for patients and staff. Within the hospital, a medical social worker is an important member of the multidisciplinary team of health professionals, which can include medical doctors, nurses, clinical psychologists, laboratory sciences, medico-legal services, occupational therapists, recreational therapists, etc. By addressing the interrelationships of physical, emotional and social factors that are present in the diagnosis and treatment of diseases of patients in the hospital, medical social workers play a major role in a patient’s care. They are also key to effective discharge planning for patients by ensuring an adequate and conducive environment after leaving the hospital. Their support is especially critical when working with patients with mental health issues.
Family support groups as a means toward improved mental health outcomes
One specific aspect of care that medical social workers coordinate at the University College Hospital in the city of Ibadan is family support groups for patients with mental illness. As the first family support for patients with mental illness in Nigeria, the groups have been in existence since 2014 through generous donations from individuals and medical doctors at the hospital. The purpose of the group is to promote mental health among the patients and their family members, educate on mental health issues with the general public, reduce the rate of relapse, and serve as advocates for the rights of persons with mental illness in the country. The medical social workers also help to navigate the diversity of culture, traditions and beliefs surrounding stigmatisation for mental health illness and mental health services.
The family support group currently has a total of 671 members, largely comprised of previously admitted patients from different regions, communities and states in Nigeria. Medical social workers facilitate the weekly group meetings, giving lectures on specific topics and conducting modules on mental health issues. Oftentimes, individual therapy sessions are organised to address specific health and well-being concerns. The social worker often provides relapse prevention services by linking individuals with existing mental health facilities in his/her community or providing medication subsidies. The support group also participates annually in World Mental Health Day on October 10 with a phone-in programme, road walks and distribution of educational information to the general public in the city of Ibadan. The advocacy efforts have created great momentum in Ibadan and other parts of Nigeria, resulting in several other hospitals in other regions replicating the programme through the technical support of medical social workers from the University College Hospital.
About Medical Social Work
In Nigeria, Medical Social Services started at the University College Hospital, Ibadan, in 1957, with only five Nigerian medical social workers providing psychosocial services in collaboration with an Irish trained social worker. Today, that number has grown to more than 2,500 medical social workers practicing in all 36 states plus the federal capital territory in Nigeria. They all hold both Bachelor’s and Master’s degrees in social work and are registered members of the Association of the Medical Social Workers of Nigeria (AMSWON). Their work includes:
- To collaborate with other professionals to evaluate patients’ medical or physical condition and to assess clinical needs
- They advocate for clients or patients to resolve crisis.
- They refer patients or family to community resources to assist in recovery from mental or physical illness and to provide access to services such as financial assistance, legal, housing, job placement or education.
- They investigate child abuses or neglect cases and take authorized protective action when necessary.
- They counsel patients in individual and group sessions to help them overcome dependencies, recover from illness and adjust to life.
- They plan discharge from care facility to home or other care facility.
- They monitor, evaluate and record patient’s progress according to measurable goals described in treatment and care plan.
- Identify environmental impediment to patient progress through interviews and review of patient records
- Organise support groups or counsel family members to assist them in understanding, dealing with and supporting the patient.
About the Author
Oluwagbemiga Oyinlola provides clinical social services, research and training in his capacity as a registered Senior Medical Social Worker at University College Hospital in Ibadan, Nigeria. He popularised the use of community-based mobile courts for the prevention of domestic violence in the rural areas of Ekiti State. He was also involved in the development of the Ekiti State Gender-Based Violence Prohibition Bill of 2011. He holds a bachelor’s degree in Social Work and Community Development and a master’s degree in Social Work. He was a 2018 commonwealth fellow at the University of Southampton, UK. He is currently the steering chair of Social Work Technology in Africa, an NGO with more than 300 members from eight African countries. He is also currently the Assistant General Secretary of the Association of Medical Social Workers of Nigeria.
by Carolyn Housman, CEO of Children and Families Across Borders (CFAB)
Children are on the move all over the world. The social service workforce can play a key role in meeting child protection, emotional needs, child rights, and family supports. In doing so, the workforce can support achieving the best outcome for children moving across borders.
Spotlight on Children and Families Across Borders (CFAB), the UK branch of International Social Service (ISS)
CFAB supports children on the move between other countries and the UK, where they are seeking to settle with extended family members. Our international social work team offers free advice and ensures all options for a child’s long-term care are thoroughly assessed, that their views are listened to, and that they get the right long-term support.
In 2019, CFAB launched a new, free support service specifically for unaccompanied asylum-seeking minors joining family in the UK. This is in response to evidence of high rates of family breakdown within two years of reunification, due the traumatic journeys these unaccompanied children have taken and the lack of support available to family carers. The project provides advice, practical and emotional guidance, and assistance for families in this situation, supporting them to remain together where this is beneficial, understand their rights, and achieve their full potential.
CFAB is currently running a campaign to ensure more statutory support is provided to children being placed with family members overseas. For more information, click here.
Children on the Move and Immigration in the United Kingdom
Children on the move is a generic term that encompasses children who have been trafficked, who migrate, who are displaced by conflict and natural disasters, and who live and work on the streets.
With an estimated 50 million children on the move worldwide, migration is seen as a key challenge within the European Union (EU). Of particular concern is the increase in the number of child refugees in the last 10 years. In some cases, EU countries have seen more than a 200% increase in irregular borders crossings and more than a 1000% increase in asylum applications. In Britain, concern over immigration in general played a major role in the vote to leave the European Union. In August 2019, the UK said it would no longer accept asylum-seeking children with family in the UK due to the UK’s exit from the EU.
The UK’s current immigration policy makes it difficult for people to access services, including healthcare, education, housing, work, bank accounts, or benefits. Prejudice against migrant or refugee families, as well as a lack of knowledge around entitlement to services, can mean that families are not seeking or getting statutory support when they may need it. It is also likely to disproportionality affect BAME (Black, Asian, and minority ethnic) families.
CFAB’s offers support based on the needs of the child or young person. This includes:
- the development of an individual support plan,
- referrals into relevant local services,
- advice and signposting regarding financial support & other entitlements in the UK
- support in navigating emotional and practical issues arising from changing family dynamics,
- support for carers with parenting skills, respite care, peer support groups and family group conferencing.
What social service professionals and paraprofessionals can do
Children on the Move is not a European topic. Children are on the move all around the world. Below are some top tips for any social service professional to ensure child protection is at the centre of practice and to achieve the best outcome for children moving across borders. These are based on the recommendations of the Initiative for Child Rights in the Global Compacts.
- The best interest of the child should be the primary consideration in all actions and decisions. This should include the participation of qualified guardians and advisors for unaccompanied or separated refugee and migrant children.
- Promote and facilitate the social inclusion of refugee and migrant children, in particular concerning their access to legal identity, nationality, education, health care, justice and language training.
- Child protection services should be made available for all at-risk refugee and migrant children, including those who are unaccompanied and separated, from the time of their arrival.
- Support family unity or reunification, when this is in the child’s best interests. Cross-border coordination between national child protection services is needed to provide a continuum of protection.
- Migrant children should access a range of services, including those related to health and education, adequate accommodation, social protection and psychosocial needs.
- Ensure children are not held in immigration detention and promote the right of children to remain with their families and/or guardians in non-custodial, community-based contexts while their immigration status is being resolved.
- If they are of an appropriate age or ability, children should participate in any decisions affecting them. Sustainable solutions should include residence and integration, and any returns must be both assisted and voluntary.
CFAB also recommends practitioners read the International Social Service practical guide, Children on the Move: from protection to a quality sustainable solution.
CFAB is the UK member of the International Social Service (ISS) – a network of social workers, lawyers and other child protection professionals and partners in over 120 countries.
Formed 90 years ago and headquartered in Geneva, ISS is the only international network focussed on inter-country social work.
The ISS network gives us unrivalled access to expert, on-the-ground support which allows us to assess whether a child’s return to their home country is realistic and in their best interests. This is more appropriate and cost-effective than sending social workers from the UK to make family assessments overseas. For more information, visit: www.cfab.org.uk
by International Social Service-USA
Of the close to 260 million migrants around the world, an estimated 50 million are children who have left home as a result of poverty, war and other life-threatening circumstances .[i],[ii] In the United States, there is increased attention over the past few years, to the hundreds of thousands of Central American migrants seeking safety at the US-Mexico border, including tens of thousands of unaccompanied minors.[iii] The conversation about the future for these children has largely been taking place in the context of legal aid, with millions of dollars invested in the legal defense of unaccompanied and separated children. Meanwhile, there has been little attention to or investment in, their social service needs. While many children seek relief through the backlogged US asylum system, few petitions are granted. The vast majority remain in the US with limited access to services and vulnerable to deportation. However, others seek voluntary return to a home country. It is for these children in particular that a robust global social service workforce is crucial to ensuring long term safety.
Children on the Move include migrant, refugee, trafficked or other asylum-seeking children who leave home with family or on their own to seek a better life. Most are fleeing danger, including natural disasters, war, armed conflict or other violence.[iv] Children on the move present unique challenges to the coordination of social services as they cross state and international borders and engage with multiple judicial and protection systems that often lack coordination. It is at the nexus of legal, judicial and protection systems that social service workforce has a vital role to play, particularly social service case management.
Social workers and case managers identify, engage, and coordinate services for children. This includes legal aid groups, psychosocial resources, medical and educational systems and other supports that help children return to, and remain safe, in their communities. When working with children on the move, the missing piece is cross-border case management that includes pre-departure planning, the development of a repatriation and reintegration service plan, and on-going case management upon return.
International Social Service-USA (ISS-USA), is the US branch of an international network of social service providers present in 130 countries. ISS-USA has been providing cross border case management and permanency planning services for migrating children and families for more than 90 years. The extensive knowledge gained by International Social Service (ISS) network partners working with migrating children and families over the years has allowed the network to author/co-author several key guidelines to best practices, most recently, Children on the Move: From Protection Towards a Quality Sustainable Solution, A Practical Guide. In addition to presenting policy and advocacy recommendations, the Guidelines provide action steps for social service professionals, regardless of their country context, to work with children on the move and ensure long term solutions in the best interest of the child.
ISS-USA’s current Family Reunification and Reintegration program in Guatemala is an example of how the Guidelines can be put into practice. ISS-USA case managers coordinate with US-based providers working with unaccompanied and separated children, as well as with the ISS partner social workers in Guatemala. The local Guatemalan social worker conducts assessments and resource mapping, working with the family prior to the child’s return to develop a service plan and engage local resources to stabilize the child’s reintegration. Once the child arrives in Guatemala, the social worker accompanies the family for six months, helping them access a variety of services including housing and nutritional support, medical and mental health services, educational and vocational programs and other social service supports based on the family’s needs and wishes.
Preparing for the possibility of a child’s return to his or her country of origin is not equivalent to advocating for a child’s forced removal or aiding in enforcement policies. Rather, engaging a network of social service professionals across borders and disciplines ensures that decisions made for each individual child are factually-informed, abide by international law, and are based in internationally-recognized best practices in child protection.
To learn more about best practices related to Children on the Move, check out ISS-USA’s October conference Beyond Separation: Protecting Cross Border Families).
by Colleen Fitzgerald, MSW, Case Management Specialist, International Rescue Committee and Co-Chair of the Child Protection Case Management Task Force
All over the world there are Child Protection caseworkers and social workers accompanying vulnerable children through some of the most harrowing experiences of their lives: Abuse. Family separation. Exploitation. Engagement with armed forces. Trafficking. Displacement. Child marriage.
It is the task of social workers and caseworkers to support and protect children in these situations, to build trust in order to understand what they have experienced, help them find safety and navigate a way forward toward healthy development. On a daily basis, workers engage with children and families in order to provide direct support and connect them to life-saving services. In such environments, clear solutions and decisions regarding children’s best interests are often complex and unclear.
While the work itself is deeply meaningful and essential, it is also relentless in hurdles and stress. There are often complicated family dynamics, dangerous environments and significant legal and bureaucratic obstacles. In addition, witnessing the suffering of children and their families on a constant basis can lead to vicarious trauma and burnout.
With the complexity of the work and the high demands on workers, governments, NGOs and community-based organizations should not expect them to do it alone. Recognizing this reality, the Case Management Task Force of the Alliance for Child Protection in Humanitarian Action has prioritized the well-being of caseworkers and social workers by developing an Inter-agency Case Management Supervision and Coaching Package. Here’s what we’ve learned:
Supervision is critical.
What we know is that consistent, structured supervision is essential in order to provide social workers and caseworkers the necessary support to consider children’s best interests and cope with the daily stressors of the work. Evidence from practice and research has taught us that workers who are supported through consistent supervision can improve the lives of children and families. Supervision can ensure that children who have experienced violence, exploitation, abuse or neglect receive the appropriate services and are protected from further harm by providing adequate support to workers.
Best practices from the Task Force have been adopted across various organizations, sectors, and countries.
We are thrilled to see that this resource and advocacy has reached Child Protection organizations, workers and supervisors across the world, in both development and humanitarian settings including Myanmar, Nigeria, Bangladesh, Iraq, Syria, Burundi, Tanzania, Turkey, Niger, Kenya, Burkina Faso and counting.
Investing in Supervision and Coaching yields improved performance from workers and better outcomes for children and families.
Through an external review of the Supervision and Coaching package, it was found that the Supervision and Coaching training initiative has increased the capacity of caseworkers to provide quality case management. Supervisors have reported improvement among caseworkers in their communication, interactions and support to children and their families. In Nigeria, it was mentioned that there has been a shift in confidence of workers, as they now feel equipped to seek guidance and support from supervisors. Some informants mentioned that they have seen higher responsiveness and improved support to high risk cases as a result of consistent supervision for caseworkers.
Supervision requires first and foremost an investment from the start, as well as adequate staffing structures, building trust within a team and resources. Child protection workers need time to reflect, space to learn and support to process their experiences in order to sustain themselves in this critical work. When our organizations make investments in developing, guiding and supporting workers, we see improved outcomes across the board – for case management teams, staff retention and most importantly for the children and families we serve.
Want to learn more about the Supervision and Coaching Package? Visit the launch page to access the resource in English, French, Arabic and Spanish. There are also videos and testimonies from several countries.
The Case Management Task Force worked closely with the Alliance Case Management Interest Group in the development of resources contained in the Case Management Compendium for the social service workforce, which also incorporated materials on supervision. Noting the importance of collaboration across humanitarian and development actors working on issues related to child protection, the recently released 4Children Case Management Package also built on this work.
Strengthening Social Service Delivery through Workforce Development in the Middle East and North Africa RegionSubmitted by Nicole Brown on Sun, 09/29/2019 - 2:00pm
- There are many countries within the region that have made great progress in planning, developing and supporting their social service workforce, through establishing policies, codes of ethics, minimum standards, licensing, registration, and training and degree programs. Learnings from these countries can be applied to support countries still in the early stages of workforce development.
- Low ratios of social service workers to child population reduce access to and quality of care. The number of workers per 100,000 children ranges within the eight countries from 19 to 140. The global target ratio is 2000 workers for every 100,000 children.
- Lack of available data on this workforce negatively affects allocations of proper human and financial resources, resulting in decreased quality and availability of services.
- With up to 173 different job titles for social service workers reported, comparing data across countries can be challenging; however, this also highlights progress and importance of cultural and contextual application of titles between English, French and Arabic.
By Wanda Jaskiewicz, HRH 2030 Director
Originally appeared on the HRH2030 website, reposted with permission
The numbers are staggering. One billion children under age 18 experience some form of physical, sexual, and/or emotional abuse. With more than two billion children in the world, that means one child in every two is exposed to harmful situations that negatively affect them now and long into their future.
There is no question the problem is complex and must be tackled from many sides. Of interest to HRH2030, of course, are the workforce implications; in particular, the health workforce and the social service workforce. Imagine how much more powerful of a force they would be if they intersected more regularly. And not only for direct intervention with children suffering some form of abuse or neglect but also for their family members, whose health and well-being are essential to prevent and mitigate abuse situations and provide children with the nurturing environment they need to grow.
However, for the most part, we in the global health community tend to talk about these two groups separately and take a siloed view of them, when we could all learn—and children and families could be better served—from an integrated, more inclusive approach. Personally, when talking about the health workforce, I prefer to use the fuller, more inclusive term of “health and social services workforce.” It’s well documented that the social determinants of health affect health risks and outcomes. The advocacy role that the social service workforce plays for its clients in its own domain is often lacking within health systems—because health workers must focus on other things. Too often, however, healthcare is impeded when patients can’t focus on getting well because they are worried about how their illness is causing housing issues, employment issues, or childcare issues or makes parenting more difficult. It’s the social service workforce—social workers, case managers, child protection agents, youth care officers, and others— that facilitate access to services in these areas.
In some countries, this kind of integration is better established or is trying to get there. In Colombia, the current government launched a cross-institutional social and health framework, called Ni Uno Mas, or Not One More, with the goal of providing better services in order to reduce the high child mortality rates associated with all types of violence. This initiative is led by the first lady, the Ministry of Health, and the Colombian Family Welfare Institute (ICBF); the latter is an HRH2030 partner in our Colombia activity. Ni Uno Mas also involves participation from the private sector (Fundación Éxito and Niñez Ya), the public sector (local and regional governments), international organizations such as USAID and UNICEF, and most importantly, local communities. This framework strives to improve the coordination between institutional stakeholders, clearly defining the roles of all those who are involved, qualifying the services with better tools in parenting and family care, improving social and health sector capacities with training in technical skills, and ensuring a link with vulnerable rural communities and indigenous populations.
I was fortunate to visit Colombia in May, where I met with leaders and providers of child welfare services from both the health and social service sectors. HRH2030 is supporting the cross-institutional social and health framework and is working with ICBF, the Ministry of Health, and the National Learning Service (SENA) to develop training for social workers, psychologists, lawyers, nutritionists, and health personnel in order to ensure better adherence to childcare protocols and better case management practices with children and families. In addition, we are supporting the process to improve the coordination between stakeholders with a clear referral process, as well as to establish better communication processes with the communities to ensure their direct involvement in the referral process.
Colombia is not alone in taking a more integrated approach to the health and social service workforces. Evidence from South Africa has shown that the child protection component contributes to supporting HIV prevention goals. The Global Social Service Workforce Alliance continues to document the role that the social service workforce plays in contributing to the fight against HIV and AIDS. Earlier this year, UNICEF published Guidelines to Strengthen the Social Service Workforce for Child Protection, which recognized the undue burden that violence against children places on the social service workforce and how it undermines investments in health.
As we’ve seen in the human resources for health domain, calls for more integrated and inclusive approaches can have results. After years of advocacy for scaling up and better integration of community health workers into health systems, for example, the WHO issued guidelines last year on optimizing community health worker programs into health systems, and soon thereafter, members at the World Health Assembly adopted the CHW resolution to invest in these types of programs.
We talk a lot about interprofessional care within health systems, and when we do, we are mostly thinking about integrating physicians, nurses, pharmacists, and nutritionists and the like. Wouldn’t it be great if we could more naturally and more frequently think about social workers when we think about health workers, too? Doing so will let us join forces for the benefit of children and families and help ensure quality health for all.
 Hill, Susan, et al. “Global prevalence of past-year violence against children: A systematic review of minimum estimates,” Pediatrics 137(3): 1-13. 2016.
HRH2030 Project Director Wanda Jaskiewicz has more than 20 years of experience in international health and development with a focus on human resources for health, HIV/AIDS, family planning, reproductive health, and maternal and child health.She has worked in more than 25 countries providing strategic leadership to advocate for global and national initiatives to strengthen the health workforce.
HRH2030 Communications Director Elizabeth Walsh contributed to this blog.
Photo:. Credit: HRH2030, 2019.
blog by Dr. Mark Kavenagh, Head of Research and Policy, ECPAT International
Sophie was only 13 when she was taken from her home and exploited at the hands of a relative. Barred from attending school and forced to perform household chores, she was left destitute precisely when she needed support and care the most.
Human trafficking for the purposes of forced labour or sexual exploitation is the third largest crime industry in the world, behind drugs and arms trafficking. Almost one third of human trafficking victims in the world are estimated to be children.
Far from being restricted to less developed countries, human trafficking sees no boundaries and affects various groups of people regardless of their gender, age, or ethnicity. All regions are affected, and all countries can be a destination, source and transit point for traffickers.
Commonly understood as “the recruitment, transportation, transfer, harbouring or receipt of a person by such means as threat or use of force or other forms of coercion, abduction, fraud or deception for the purpose of exploitation,” human trafficking, is not always well understood. Many social service providers may have encountered clients who have experienced forms of trafficking, though clients may not disclose this to practitioners, and in some cases, may not even self-identify as victims.
Although a large number of detected trafficking victims are women (almost 60 percent based on UNOCD estimates), we now understand that children and men are represented among victims in much higher numbers than previously thought. The latest figures also show that a growing number of cases take place at the domestic or regional level, with research showing that traffickers and their victims often “come from the same place, speak the same language or have the same ethnic background.”
Factors leading to trafficking are wide-ranging and complex and can include poverty; globalization; corruption; weak rule of law, and poor law enforcement. It is important to keep in mind however, that victims and survivors of human trafficking have diverse socio-economic backgrounds; varied levels of education; and may be documented or undocumented. Many are deceived or coerced, initially believing that they have been hired for a real job, or that they are going to get married, before finding themselves trapped and powerless.
Law enforcement bodies are key in dealing with the identification and protection of victims, but they are far from alone in fighting human trafficking and social services providers are a big part of the solution in support for victims and in moves to eradicate this pervasive crime. The ECPAT International Network, which includes 104 member organisations across 93 countries, plays an active role in the fight against the trafficking of children for sexual purposes: both on the frontline, by providing helplines and direct support to victims; and behind the scenes, by conducting research, advocacy and policy monitoring. A number of ECPAT members act to prevent children from being trafficked and sexually exploited, particularly through early or forced marriages, prostitution, by travellers and tourists and in online child sexual abuse material.
In many ways, the needs for social care of trafficking victims don’t differ substantially from those of other clients seeking care from helping professionals. A range of supports can be provided - from counselling to cope with traumatic experiences, through to supported reintegration back into communities – with attention to the push factors that may have put people at risk in the first place.
In serious cases, particularly involving children, specialist care and support is necessary. Some members, like ECPAT Foundation in the North of Thailand, employ specialist child protection staff with social work backgrounds to educate young people on the risks to consider when migrating for work, relevant laws to protect themselves, and how to access support when they need it. Others, like ECPAT USA, concentrate their efforts on leading public awareness campaigns such as the #doesyourhotelknow campaign, to alert the private sector and ordinary citizens of the role private businesses and particularly the travel and tourism industry can play in safeguarding children from exploitation. Many of our members engage with the private sector and encourage companies to implement a child protection code of conduct. Others are more involved with governments and development partners in drafting and supporting policies that protect children and criminalise offenders.
From producing research and leading support groups and shelters, to running campaigns and petitions at the regional and global level, ECPAT International’s work is varied and comprehensive. However, despite making headway in protecting children from trafficking and exploitation, ECPAT International cannot abolish the practise on its own and needs the help of other organisations and individuals to do so.
The international community has already committed to “take effective measures to eradicate forced labour, modern slavery and human trafficking” and to “end abuse, trafficking and all forms of violence and torture against children” by 2030 via the UN Sustainable Development Goals. To raise public awareness of trafficking, the international community will observe World Day Against Trafficking in Persons on July 30. Now is the time to act and put an end to this crime, collectively and permanently.
ECPAT International is a global network of organisations (104 member groups in 93 countries) dedicated to combating the sexual exploitation of children. The ECPAT International Secretariat is based in Bangkok, Thailand, and is the administrative and supporting unit of the network. The Secretariat coordinates and supports a range of network initiatives including research, programming and active campaigning along with the development of tools and provision of technical support to the global ECPAT network.
Dr. Mark Kavenagh, Head of Research and Policy, ECPAT International
Mark Kavenagh joined the ECPAT International Secretariat as Head of Research and Policy in early 2018 where he oversees a range of research projects that focus on ending the sexual exploitation of children. Mark began his career as a registered psychologist and worked in school settings with children and adolescents before moving into international development a decade ago. Since then, Mark has lived and worked in South East Asia and Eastern Europe in child protection programming and research roles. Most recently he worked for ChildFund Australia as their Child Protection Advisor. Mark holds a Doctorate of Educational Psychology from the University of Melbourne.