Lessons Learned from the First Workshop of the Adapted

LESSONS LEARNED FROM THE FIRST WORKSHOP OF THE ADAPTED

CARE FOR CHILD DEVELOPMENT TRAINING PACKAGE FOR LATIN AMERICA (SPANISH VERSION)

Background

In November 2012, UNICEF and WHO (at the regional and country levels) jointly organized a meeting in Panama City of inter-sectorial experts in early childhood development (ECD) from across Latin America and the Caribbean. In addition to experiencing first-hand the trainer of trainer workshop, the experts were called upon to review and make suggestions to adapt the package for use in the LAC region. Spanish-speakers validated the Spanish translation of the package.
Exactly one year later after the experts’revisions had been completed, UNICEF and WHO/PAHO held the first national workshop using the regionally adapted Spanish version of the training materials (Atención al Desarrollo del Niño – LAC) in Santiago de Veraguas, Panama over a 3.5 day period from November 12 to November 15, 2013. While maintaining the strong emphasis of the original Care for Child Development (C4CD) package on the health sector, the LAC adaptation marked a move to a broader approach.
Thus, the LAC adaptation does not refer to “clinical practice” as this sounds as though it is limited to the health sector but rather to practices in multiple “settings,” which included in a public educare/ centre, a facility for children at-risk for developmental delays and/orwith disabilities, in addition to a hospital maternity ward and a public health centre. Invitees to the 2013 workshop included representatives from all these sectors as well as a technical university that is the main professional training institute for professionals working in ECD in Panama.
The LAC adaptations in Spanish and English have also included more detailed information on specific topics. Examples include:

the rights and involvement of fathers
additional play and communication activities
an expanded section on the specific context of the family (Checklist) and available local resources to assist families (Counseling Card)
early interventions for children at risk, including children with disabilities and those subject to violence
ways to strengthen the environments where young children spend most of their time, especially in the home through support to their families

As with the original C4CD, care was taken to stress that the regionally adapted training package, ADN-LAC, is intended to be integrated into existing health, ECD and early intervention programmes and services for young children and their caregivers as well as professional development and training programmes. However, implementation using an inter-institutional approach (as opposed to just focusing on just the health sector) is a more complex task. This is discussed in further detail below in the sections on Validation and Next Steps.

Part 2: More Detailed Considerations

A)Organization of the National Workshop

More time might be devoted to ensure theinitial preparation of appropriate spaces and conditions for families and workshop participants to interact. For example, complications arose when staff at the practice locations were not 100% clear on the training process (in spite of previous in-person explanations) or where space constraints meant that the caregiver had to hold onto the child (e.g., on a bench in a waiting room). To some extent, organizers mitigated the lack of space by providing workshop participants with grass mats which could be placed on the floor to allow more relaxed contact with the child and caregiver.
Similarly, it is critical to prepare the workshopfacilitators as thoroughly as possible, particularly for the practice sessions. Although there were facilitators circulating in each practice location, it was not possible to have a trained observer overseeing every session with participating caregiversor to ensure a full video record. Some participants expressed a desire for more continuous observation of their efforts in order to be assured of their readiness to act as a trainer in the future.
Building on the lessons learned from the 2012 meeting of regional experts in Panama, more time was scheduled in the agenda of the 2013 workshop to discuss implementation. However, as the workshop was inter-sectorial and included personnel from different operational levels, even more time could have been scheduled to work through the concrete details. A further scheduling issue arose because the main session on implementation was held at end of the workshop. This was doneon the basis that, by the close of the event, all the participants would be familiar with the tool and possess a greater understanding of how their counterparts work with young children and their familiesand, thus, be able to identify possible synergies among them. However, not all participants were able to stay to the end of Day 4. As this session on implementation is key to the use of the C4CD materials as part of on-going/ existing systems, perhaps the timing and durationof this part of the workshop should be reconsidered.
Although not discussed in detail, further modifications are required in the Facilitator’s Guide to clarify specific workshop activities (e.g. role plays).

B: Validation of the Spanish Version of the Regionally Adapted Training Package for LAC

The wide range of participants from different sectors and operational levels provided a rich training and validation environment for reviewing the ADN-LAC adaptation. In general, participants reacted favourably to the approach and the specific materials. They were very interested and appeared keen to continue to work together to implement it as part of existing services in Panama.
While a more indepth validation exercise will need to take place in Panama among the participating institutions involving different organizational levels and different geographic sites, initial participant feedback included several suggestions for making the tools to be used with the caregivers more visually appealing and physically easier to use. For example, several participants suggested more drawings, diagrams, and colours. Others thought it would be helpful to use larger fonts and spaces on the Checklist and a larger poster of the suggested play and communication activities that could be affixed to the wall where the counselling session was to be held. In addition, facilitators/organizers considered that it would have been useful to have been able to show brief video clips of what was expected of the interactions planned for each practice session before they occurred. Instructions were discussed verbally, but some participants remained confused as to their roles, for instance, at times:

both members of the pair were interacting with the family at the same time
all the toys were taken out at once, overwhelming some children and making follow-up with families difficult (thinking ahead to real-life implementation)
the tendency among time-conscious workshop participants to jump into play activities (often not child-led) and/or recommendations without prior observation of the interaction between child and caregiver, diminishing the message about the importance of caregiver-child communication
the tendency, particularly among health professionals, to frame the practice sessions as “evaluations” of the child rather than strength-based coaching to fortify the skills already possessed by young child’s caregivers

They also thought that visual adaptations could make the materials more relevant to the specific country implementing it. The training package could also be visually adapted for use with specific populations, such as indigenous peoples (e.g., to include drawings that reflect traditional dress, etc.).This led to a discussion about the potential use of locally produced videos during national ADN-LAC workshops, whichwould require obtaining thewritten consent of the participating families.
Participants agreed with the expanded scope of the package (e.g., to cover subjects such as children with disabilities, family violence, strengthening all learning environments, especially the home setting). However, they thought more information could be provided on discipline issues (e.g., the use of corporal punishment or emotionally abusive discipline practices) and raised questions about the appropriate vocabulary to be used to describe negative practices. For example, some participants thought the Spanish translation“regañar” for “scold” on the Checklist should be changed to “grita y/o castiga fisicamente” (yell at or physically punish), at least for Panama.
In addition to the toys suggested in the Facilitator’s Guide, the participants also thought the following items could be useful:

a magazine or small children’s book
crayons
a more complicated puzzle since participants routinely came across slightly older children (e.g., 4 or 5 years) in their practice sessions
another easy-to-clean and safe object that young babies could put in their mouths (apart from the soft balls)

Participants suggested simplifying the fold-out Counselling Card (e.g., having the recommended activities on a separate and larger poster) and going through both it and the Checklist at the start to have an overview of these tools before starting the practices.
Other suggested improvements to the materials, included:

re-wording the translation of the questions on the Checklist (e.g., múestrame cómo responde usted a las reacciones, gestos y estados de ánimo de su hijo / show me how you respond to the reactions, gestures and moods of your child),
ensuring the Checklist is coordinated with the norms required of the Integrated Management of Childhood Illness before its use in the health sector, and
preparing support materials to guide the integration of the C4CD/ADN model into existing health, education and ECD services, but as part of the overarching national system - this critical information is missing from the package

One positive practice that arose spontaneous in some of the practice sessions was for the workshop participant to ask the caregiver for feedback at the end (e.g., was this useful?), which was both a respectful way to conclude and a valuable quality assurance mechanism. This approach could be expanded to include the older children who were often present during the practices with the caregiver (e.g., older siblings).

C: Next Steps

Some of the next steps flowing from initial feedback from the 2013 workshop are:

Panama (country level)

Form an inter-sectorial working group to guide implementation in Panama. The first step will be to use information gathered in the workshop to establish a concrete action plan for 2014.
Undertake an inter-sectorial validation process for the revised package, taking into account the suggestions received from the 2013 workshop, including translating/ adapting the content of the package for use with indigenous populations.
Establish a trainer of trainers programme and accredit a core group of national facilitators.
Analyze in much more detail how the approach will be implemented. This will include a mapping of existing programmes and services aimed at young children and their caregivers as well as the associated existing tools, instruments and norms.
Identify further areas of joint UNICEF-WHOP/PAHO cooperation for the future and to follow up.

Regional Level

Prepare for the next training/validation workshop, including making changes to the materials based on the lessons learned from the 2013 workshop in Panama.
Engage with regional partner, WHO/PAHO, with respect to identifying funding and personnel requirements to continue inter-agency support for C4CD/ADN in Latin America and the Caribbean.

PREPARED BY: Janet Lennox, Consultant, UNICEF LACRO

DATE: 20 November 2013