How a person thinks and feels, and how s/he is a part of groups of other people combine to make up his or her psychosocial experience. Former Restavek’s can have serious and complex psychosocial problems. In a perfect world, rehabilitation programs would include mental health professionals who could help children through counseling.
Counseling includes:
- listening to a child express his or her experiences and emotions,
- accepting all that s/he feels, without judging or criticizing,
- showing care and understanding, and
- helping the child toward more self-confidence and a sense of self (knowing oneself as a person).
But often mental health professionals are not available to do counseling. People who are not professionals can help mostly by active listening:
- allowing a child to speak and express feelings in his or her own way
- listening with complete attention
- showing that you understand, by body language and small sounds, and
- not giving opinions or advising.
Staff members also need to know some ways to assess newcomers (to form an idea of their psychosocial condition through observing and listening to them with attention). Assessing children permits staff members to plan the care that each one needs. This may include a need for professional mental health help. Needs differ from one child to another. The age and gender of the children, the form of Restavec and how long it went on, their relations with the Patron family, their experience of violence, how they got out of slavery and many other things will affect their needs for psychosocial care.
IMMEDIATE CARE
Newcomers are beginning a long process of learning to feel safe. It is most important in the first days to
- give a warm welcome
- establish safety
- let the newcomer know what to expect
- provide food and water, health care, and rest
- keep children together with others from similar situations
Slavery that was longer, lonelier, and more severe usually has worse psychosocial effects on the victims.
Sexually exploited children need mental health professionals
Children coming out of prostitution are a minority among the total number of children in slavery. But they need special consideration. They have deep psychological and social problems that the rehabilitation program must deal with carefully. There are very risky areas in dealing with these children that are not as common in children removed from other situations of slavery.
Should organizations without professional mental health training and experience attempt their rehabilitation? They should not, because the behavior problems and the trauma, as well as stigmatization and sometimes violence upon reintegration, are often too severe. Helping appropriately requires specialized counseling and social work skills. For example, inviting children who were sexually exploited to express emotions is a definite no-no for anyone who is not a fully trained professional. It is easy to get the emotions out. But after they are out, it may take far more skill, understanding and experience to help the client deal with those expressed emotions. At the same time, these human resources don’t drop off the trees to us. Few organizations have such highly trained professional staff. Active listening and showing care and understanding are not counseling. They can surely be done by anyone. We must give care as best we can, without fear.
Assess newcomers
When newcomers arrive, staff begins to assess their condition and needs. This is especially important with children. The staff may do an intake interview (quiet talk with a new child about his or her experiences, problems, needs and wishes). Explain why you are gathering information, and do not hurry or put pressure on the child. Children often cannot give the information needed for their record.
Do not urge anyone to talk more than they want to. Allow time for trust to develop.
Remembering pain, fear and shame may become terrible, and retraumatize the newcomer. If any interview becomes too difficult for the child, offer to wait until another time.
Suggestions for interviewing a child
Children will react in different ways. Try more than one way to gain their trust, and see what makes them comfortable (feeling warmly accepted, at ease, not having anxiety).
In order to get the fullest answers, make a child as comfortable as possible before inviting him or her to speak. Use a gentle, calm, soft voice. Sit down with your head at the level of the child’s head, not above it. Do not hurry or urge the child to talk. Try doing something that does not need any words from the child. You could show a picture book, or show how something works. Or you could explain a little about other children and their experience in the home. Take time. Some children have a lot of fear and shame. These emotions keep them quiet, and they may not speak in the first chat. You may need to wait until another time, even for weeks, before a child is ready to speak freely. Usually asking a series of questions does not help people to express themselves. When the child is comfortable and feels safe, s/he may tell you a lot without your having to ask many questions. Use active listening to show that you are paying attention and understanding what you hear. If you must ask questions, give the child a way of understanding why you are asking them. For example, you can say:
“Sometimes children who come to the home tell me how they feel.
Putting their feelings in words helps them to feel better.
That’s why I am asking you about yourself.”
Invite the child to talk by explaining some of the things that other children have told
you. (Do not name those children.) Say that you wonder if the same sort of things
are also true for the child you are talking with.
“Last week a boy told me he is afraid at night.
He has bad dreams about what happened to him.
I wonder if sometimes it is like that for you….”
If the child asks questions, answer them honestly. After the interview, write down as many notes as possible. These should go into the child’s confidential record. It is helpful to read the notes before the next interview or quiet talk with a child.
Psychosocial conditions to look for in newcomers
The psychological condition of a child could include
- levels of fear, anxiety, sadness, anger, shame, and other emotions
- whether s/he is agitated (not able to be quiet, moving all the time, shaking, reacting very
- suddenly, very anxious)
- whether s/he is very inhibited (very silent, closed in, not able to express any feelings)
- problems with paying attention
- problems with bad memories being always present, often in dreams
- speaking that is disorganized (not making sense, out of order, mixed up)
Social situations will also show how the child relates to (connects with) other people.
- relating to others very slowly, or perhaps not at all
- being full of fear and anxiety with other people
- using force, angry words or bullying
- seeking too much touch in ways that are not appropriate
If they do not agree with someone, they may not know any way to respond except by violence. If fighting helped children to survive in slavery, they may also expect to fight in a our home.
Understand the experiences that make some children difficult, acting out their anger
and fear. You may need to set limits on any behavior or expression of feelings that
is not good for the newcomer or for the other children.
Case management planning
As soon as possible, hold a meeting of the staff who are important for this child. In this meeting
discuss what staff members have learned by paying attention, observing, and listening to the child
decide which of a child’s psychosocial problems are most important
exchange ideas, and develop a plan for the child’s care in the coming weeks
write it down with the names of the staff members who are responsible for each part of the plan
For example:
Therese (the child) has stomach pains. She also suffers from a lot of shame and anxiety, and is very agitated. But she is not fighting, trying to run away, or threatening to harm herself.
Mary, the teacher, will take her to a doctor this week to have the stomach pains assessed and treated. Mary will stay with her all through that experience.
Jedidah, the house mother, will find calming activities for Therese to try. She will ask Mariam, one of the more settled children, to stay near her for a few days.
Savitri, an older child, will find time to sit with Therese every day in these next two weeks and talk quietly with her, using active listening.
Everyone will pay attention to Therese for two weeks and consider how she is doing. Then we will decide whether we need to get help for her from a mental health professional.
THE FOLLOWING WEEKS AND MONTHS
Continue active listening
Provide quiet times for actively listening to each child. Find a space that is private, but not completely away from everyone.
A center in Togo uses a small open building for private counseling. Grass mats hang around the sides, but the child can see out.
Other people can see that someone is talking inside there. But they cannot watch and cannot hear what is being said. (Hyde, “Physical and Mental Health”)
All staff members can learn to do active listening.
If you want children to talk freely, avoid asking questions that can be answered with yes, no, or just one word. Use open questions (questions that encourage a person to talk freely and give him/her more control over what s/he talks about). Usually open questions are not questions about facts and do not have correct answers. They are like gentle invitations to speak, such as:
- How was it for you when you were there?
- What happened after that?
- Why do you think that happened?
- I’d like you to tell me more, if you want to.
- How do you feel about being with us here?
Accept whatever the child says. If you think it is wrong, do not say so. Avoid giving advice or criticisms. The basic (very necessary) aim is to listen to the child.
Feeling listened to and understood is basic in any process of healing.
But if the child says things that are wrong about himself or others, you can gently give correct information.
For example:
Child: They all hate me, because I’m different. They don’t talk to me.
Staff member: Yesterday I saw Yolanda and Jyoti ask you to play a game with them.
And did I hear Salmah say something good to you today about the new food?
If a child starts to cry, remember that s/he has a lifetime of pain inside. Being able to express emotions may be part of the healing process. A child does not need to feel shame about crying. The active listener lets the child cry, and quietly stays with him or her.
Active listening is to help the child, not to seek facts. But child stories will come out, little by little in their own words. Later, make a note of any new facts and evidence about what they experienced in their confidential records.
Overall psychosocial aims
Create a healing environment for child.
- Most children need to develop
- trust in other people
- self-confidence
- a sense of self
- a feeling that they have personal power and control
Many children also need help in
- learning how to relate to other people
- understanding their own feelings and problems
Some children will understand their difficult feelings better when they can name them. They think more clearly when they can use words such as anger, sadness, anxiety, being agitated, not relating to other people, being afraid, or going out of control. Talking and being listened to may be helpful, but it also brings up painful memories. If you need to end a meeting but the child is still full of strong feelings, take a few minutes. Help the child to put away the pain of the past for now, and come back into the present time. Very simple methods of calming emotions can be tried, like breathing deeply, or counting from ten to one.
When people are deeply traumatized, be careful not to go too far into feelings that the child is not ready and able to deal with. For girls traumatized by sexual exploitation, staff without professional training should not try to give counseling.
Be careful not to retraumatize any child.
Trauma
Trauma is a psychological condition coming from terrible experiences that people see as a threat to their lives. Most Restavek children experienced violence, were threatened with violence, and saw violence against others. Other common causes of trauma are severe hunger, serious abuse as a child, sexual abuse such as rape, serious injuries, being abducted (suddenly and secretly taken away with violence).
Not all people who go through terrible experiences show signs of trauma. But many do, especially after repeated and long-term traumatic experiences. Among our children, signs of trauma will appear in their feelings, behavior and mental and physical health. They are listed here in groups, but any of these can appear at any time, and many of them can appear together.
Signs of trauma to watch for in children
At first, children may
- be very anxious, worried about danger all the time
- have flashbacks (memories and feelings that keep coming back to someone, making them live through past terrible
- experiences and trauma again)
- be agitated, too active, very restless
- have frightening dreams and difficulty sleeping,
- show very sudden changes in emotions (loud, strong anger, or sudden crying)
- feel great shame
- feel that they have no value, believe that they are “nothing”
A little later, children may
- suffer panic attacks (sudden extreme fear), anxiety, phobias (severe fears of particular things such as going outside,
- or animals, or high places)
- experience mental emptiness
- show avoidant behavior (ways of acting that prevent a person from relating to others because s/he is protecting
- himself or herself)
- have no feeling of connection to the world
- seek dangerous situations
- completely forget the past and who they are, or forget many things
- not be able to connect with and relate to others
- fear death or fear they will have only a short life
Severe signs of trauma take longer to develop and are more and more complex.
- Severely traumatized children may
- almost never talk, not look at other people, or hide away in fear
- react to other people and situations with very little feeling or emotion
- be very tired all the time
- have health problems of the immune system, be sick very often
- experience pain that continues on and on
- have problems with their digestive system
- suffer from depression (silence, passive behavior, not being able to act, not being able to relate well to others, very deep sadness)
Red flags: signs that professional help is urgently needed
For children who show signs of severe or increasing problems, do all that is possible to
- find a mental health professional and get the child into their care. Professional help is urgent when a child
- seems to be getting worse in some way, such as continuing to lose weight, becoming more disorganized in speech,
- thinking or behavior, becoming more depressed, silent and passive, seeming almost to freeze
- talks about killing himself or herself
- is harming himself or herself
- has strong anger that s/he cannot control
- seems not to connect with real life, hears voices or sees things that are not there
- uses physical force and verbal abuse to hurt others
Delays are dangerous. Urgent professional care saves lives.
How a professional helps a traumatized person
Counseling children who are suffering from severe trauma is a special skill. Do whatever is possible to find a mental health professional who will work with the traumatized child. The professional will:
- make the child feel safe
- develop a connection of care and understanding
- help the child become able to trust
- decrease the child’s feeling of being passive and having no control
- work with a child’s anger and other strong emotions
- lead the child to understand himself or herself better
- help the child to develop self-confidence and a sense of self
- help the child to value himself or herself and have a sense of personal power
Group discussions
For older children who are not suffering from severe emotional problems, organize group meetings. In these meetings, children share their ideas and feelings. Half an hour to 45 minutes is usually plenty. A staff member leads the group, to make sure that it is helpful to the children. Good group discussions can build children’s’ self-confidence and their trust in others. The aim is to help children to feel better, so they can go forward with their lives.
Group counseling is not a class or teaching session. The children do most of the talking. A skilled leader asks only enough questions to keep the discussion active and going in a good direction.
The leader works hard. S/he
- starts the discussion
- keeps it from going too far away from the subject
- may make some rules, such as “No telling people what to do” or “No criticizing”
- gives everyone a chance to speak
- keeps everyone feeling safe and able to speak freely
- gives comments on how members of the group are relating to each other
In good group discussions, the children talk a lot and the leader talks much less.
Two advantages of group discussions are that they include more children and increase their social skills. Everyone in a group can be a helper as well as the receiver of help, which improves the way they value themselves.
Group sessions, reported by nearly all programs [in Cote d’Ivoire, Togo, Haiti and India] may be a more powerful form of therapy than individual counseling because the stories of others’ experiences serve to diminish the sense of isolation, reduce the stigma attached to low status and enslavement, and provide perspective. In the group, children are also encouraged to think of ways to prevent child abuse and enslavement, such as reporting suspected traffickers to the police. Children develop ties to one another through this process, which adds to their feeling of belonging, security and support. (Hyde, “Physical and Mental Health”)
Some groups plan the subjects they will talk about. The children may choose the subjects, or the leader may decide.
Other groups do not have a fixed subject for a meeting. Instead, everyone says
- what is on their mind
- how they are feeling
- what problems they are struggling with
Other group members may listen with attention and give support. They may also make suggestions, if the leader thinks such comments will be useful to that group.
Good effects of other groups
Other kinds of groups can provide a time and place for children to be together in good relationships, to learn new ideas and skills, and to know that they belong. Belonging to community groups may be especially important. Aims of such groups include education, service, and cultural or spiritual practices.
MOVING TOWARD REINTEGRATION
Learn what psychosocial care the child needs
- Through quiet talks and active listening, the leader learns
- what the child wants to have happen, now that s/he is safe
- what continued psychosocial problems the child needs help with
- what questions s/he has
- how much understanding s/he has of how the world works