A One-Way Street?
Report on Phase I of the Street Children Project
Part 6 of 9
This report is reprinted in nine parts with permission of the World Health Organization, Programme on Substance Abuse, 1993. The document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated in part or in whole, but not for sale nor for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the
responsibility of those authors.
WORLD HEALTH ORGANIZATION
PROGRAMME ON SUBSTANCE ABUSE
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WORLD HEALTH ORGANIZATION
ESTABLISHMENT OF AN EFFECTIVE MODEL WHICH MAY BE USED TO ASSESS THE NEEDS OF STREET CHILDREN IN RELATION TO DRUG USE AND TO STRUCTURE AN EFFECTIVE RESPONSE
Participating centres were unanimous in endorsing the model (The Modified Social Stress Model) and the methodology that flows from it.
"It is desirable that every institution in the world adopt the methodology designed by PSA..." Mexico)
"We conclude that the experience has been a very valuable one (we devoted a great deal of time and effort to it) and that this pilot phase has proven that the project methodology, including community development principles and the project instruments including the modified social stress model and the use of focus groups are feasible and appropriate ways for addressing the issues of street children and drug use." (Honduras)
"The project model and methodology, when presented to the officers and staff of the implementing agencies, created a lot of enthusiasm and excitement. Everybody agreed that the conceptual framework and the instruments for data gathering and interventions were very comprehensive". (The Philippines)
"This project could have an important future to play in advocating for the street children and youth health rights and allocation of health services for the children and adolescents in Rio de Janeiro, and indirectly with repercussions for Brazil." (Brazil)
"The project as a whole is a well balanced and well structured model that is applicable in a country like Egypt." (Egypt)
As can be seen from above, a wealth of information emerged which was useful in informing intervention strategies. Overall, the model appears to be quite a satisfactory way to record data, allowing its easy use in the preparation of planned interventions.
There was a suggestion that a variable "locus of control" be added. However, it is felt that this may be already subsumed under coping strategies/skills, as without a degree of internality of control and belief in self-efficacy people may feel in a powerless position to change their lives. An internal locus of control and self-efficacy usually come from positively rewarding consequences from actions. That is, from employing coping strategies or skills, with or without a belief that they will work, and finding that they do.
Although focus groups were considered to be an effective method for the collection of information, it was recommended that other rapid assessment strategies could be used to complement and validate these groups.
ESTABLISHMENT OF A STRONG AND INFLUENTIAL NETWORK OF INDIVIDUALS AND AGENCIES WHO WORK WITH OR COME INTO CONTACT WITH STREET CHILDREN
--The Community Advisory Committees--
Community Advisory Committees formed part of the activities required to meet this objective. In some cities, the participating organizations already had broad-based management or advisory committees. Often these were expanded with the implementation of the project, and the identification of key and/or willing individuals who wished to participate. In other cities, committees were formed by the amalgamation of representatives from a number of different organizations.
Representatives on the committees formed included: psychologists, academics, psychiatrists, teachers, social workers, local community leaders, local religious leaders, representatives of state or national agencies (for example, welfare, juvenile/criminal justice, drug strategy), local youth development officers, businessmen (local and more broadly based), police, politicians, local community nurses and physicians, and representatives of local NGOs.
In one case there were some difficulties, partly resolved, where potential committees members requested an incentive payment via a "sitting allowance".
Most reports indicated that better cooperation was achieved, via the meetings of the Community Advisory Committees, and that even social interaction increased. A comment from The Philippines: "Interestingly, the Advisory Committees had served thus far as inter-agency bodies that had been coordinating the services provided by the various agencies in the community work with street children. The meetings of the Advisory Committees have become a venue for social interaction among different persons involved with street children resulting in better cooperation among the different agencies...".
In one case (Brazil), despite concerted efforts on the part of the principal investigators, little cooperation could be achieved in the short term. Consequently, the institutions to which the principal investigators belonged formed the functions of an advisory committee. Brazil, was hopeful that formal or informal meetings could be held in the near future.
Of some concern was the role of street children or ex-street children on the Community Advisory Committees. It was not clear from the reports whether this empowerment process had been considered and found inappropriate, unworkable or not. If it was overlooked, it needs to form part of any review of local methodologies and plans.
It may be that a two-pronged system could evolve. One group, containing primarily service providers and street children representation, could provide on-going up-to-date information on local changes in the population of street children, drug availability, and other difficulties and obstacles in their lives. The other group could contain higher-level officials, who may have a better capacity to advocate, access resources and make overall decisions in relation to plans. A two-tier Community Advisory Committee has been developed in Bombay and Cairo/Alexandria, and may provide models for this.
--Service Providers Focus groups--
The Service Provider Focus Groups provided another level of networking. Where conducted, the Service Providers Focus Groups contained a mixture of participants from relevant agencies, an existing network, the management committees of the participating organizations, or the Community Advisory Committee itself became a focus group for the purposes of the exercise.
Rio de Janeiro: there were meetings of staff from Republica das Criancas Fundacao Sao Martinho and, Casa da Alcolhida da Tijuca.
Toronto and Montreal: members of a number of relevant agencies met once.
Cairo and Alexandria: two groups were held with the Caritas Youth volunteers, and were more like debriefing sessions than focus groups.
Tegucigalpa: members of a number of relevant agencies met 5 times. Agencies represented included: Casa Alianza Honduras, the National Family Welfare Association, Project Alternatives, the Female Police Division, Juvenile Court, IHADFA (Instituto Hondurerlo Para La Prevencion Del Alcoholismo, Drogadiccion Y Farmacodependencia), and the Honduran Red Cross.
Bombay: two groups met a number of times; one of which included a local liquor retailer, a drug dealer, and a distributor of the scrap collected by some of the children.
Mexico City: staff of Centros Toxicologicos Venustiano Carranza y Xochimilco, Programa Para los Ninos de la Calle, and Consejo T utelar de Menores Infractores were reported to have been involved.
Manila: Maryville Centre was the only organization to have been able to set up service providers groups at this stage. Two groups met twice: volunteer parents who acted as leaders in their barangays; and members of the Community Advisory Committee.
Lusaka: the staff of the participating agencies provided information. Difficulties similar to those in setting up the Community Advisory Committees appear to have a negative impact on broadening participation in Lusaka. The Community Advisory Committee established as part of Commonwealth Youth Programme Project addressed a range of focus group issues.
As mentioned above, in addition to providing information, the Service Providers Focus Groups assisted in cooperation, sharing of information, increasing trust and social interaction. They were found to be useful by the organizations and their staff, and the level of participation of street children, although variable in a few cases, was high and enthusiastic.
It may be necessary, where service provider groups have not been held, to increase efforts to develop such groups or something similar. It would not be a satisfactory situation for the participating organizations to become marginalized and isolated, to miss out on valuable information that other organizations may have, and to not participate in an effective network of cooperating organizations.
Following the completion of this phase of the project and the preparation of centre reports, PSA provided grants to each centre (apart from Canada) to conduct dissemination workshops. The purpose of the workshop was to bring together a range of governmental and nongovernmental agencies and individuals who work with street children in order to discuss the project and its implementation in the respective participating centres.
All centres which received funding executed at least one workshop with some centres planning further workshops in different regions and targeting different groups. Significantly, the workshops provided fora for disseminating information on the project and establishing networks of people and organizations working in the area. The centres provided written reports on the workshop to PSA.
Most workshops addressed a wide range of issues associated with street children and did not focus just on the Street Children Project. The workshops were well attended by various governmental officials who had responsibilities in policy development and service planning; intergovernmental NGOs including Caritas, Street Kids International and Red Cross; local NGOs; religious and community leaders; law enforcement officials, community health and welfare workers, including street educators; representatives of the media; academics and researchers; and street children themselves.
As a result of the workshops, some centres produced reports which were widely distributed. The centre in Honduras indicated that it is seeking funds to edit and print the workshop document so that it may be widely disseminated as a training resource.
Other recommendations which came from the workshop included:
IMPROVED ADVOCACY FOR THE POPULATION OF STREET CHILDREN WHO USE DRUGS
Participating organizations claimed that increased advocacy had occurred, and that they were pleased with this. Likewise, the methodology which uses street children as "experts" in the focus groups is empowering. It appears from the centre reports that the process has begun to involve a wider group of individuals as members of the Community Advisory Committees and that senior governmental staff, in many cases, have indicated a strong willingness to participate or be supportive.
Throughout the planning and implementation of the project, most participating organizations have made contact with senior and influential governmental and nongovernmental officers. The prestige of WHO has given the project a high profile both internationally and within participating countries.
In some countries the project received considerable media attention, ensuring an increase in community awareness of the issue.
DEVELOPMENT OF LOCAL STRATEGIC PLANS TO ADDRESS THE PROBLEMS OF STREET CHILDREN
In some cases participating organizations had existing plans, into which they incorporated new, or increased attention to, the use of drugs by street children. In other cases, plans were developed around the Modified Social Stress Model, with interventions linked. In yet other cases no plans appeared to have been developed, over and above on-going agency planning, for a variety of reasons. As described in section 5.3.2 above, recommendations with regard to strategic planning were made during dissemination workshops.
Two participating organizations (in Bombay and Manila) prepared their plans under the components of the Modified Social Stress Model.
It was reported that two participating organizations in Manila included street children in their strategic planning meetings.
ESTABLISHMENT OF A MECHANISM FOR CONSULTATION WITH STREET CHILDREN
--Selection and training of interviewers/facilitators/street educators--
This formed the beginning of the process of consultation, and helped select target groups of children after suggestions from the participating organizations.
Most street educators and facilitators were selected from within existing organizations due to their: proven ability to engage street children and engender trust; skill in group work and dealing with sensitive issues which may arise; knowledge of local culture, communities and resources; and previous work with street children. Most were psychologists, social workers, teachers, and in some cases students of these professions or persons who had undertaken other training courses offered by the participating organization(s). In one case, volunteer youth participated, providing programmes in juvenile/criminal justice institutions, with few difficulties. The difficulties encountered, in this case, related to the use of a female volunteer with Muslim youth, and due to lack of trust and high levels of suspicion by some staff of the institutions. In Bombay, ex-street children were utilized to help identify and engage street children.
The overall difficulties encountered will be reviewed below "under street children focus groups". Reports indicated that the street educators and facilitators went about their tasks with dedication and enthusiasm, enjoyed the process, learned a great deal of new information, and learned how to utilize a conceptual model to aid this.
Where regarded as necessary, training sessions for street educators and facilitators were run. The content of these sessions varied from centre to centre. The range of topics chosen included: drugs and their use, epidemiology and aetiology of drug use, drug dependency, detoxification, adolescent development, psychology of street children, HIV/AIDS, behavioural patterns, sexual problems, health, emotional problems, interview and group work skills, and a briefing on the street children project.
Sessions contained information input and skills acquisition. In many cases the training was regarded as a continuous process, and plans were made to provide for this. This was seen to be particularly important in relation to the emergence of new information, or where emotional issues arose and street educators felt unskilled in dealing with these.
It is again unclear from most responses as to whether ex-street children were involved as facilitators or interviewers, or merely used to locate children due to their work as outreach workers or street educators. This issue also needs to be addressed in Phase II of the project.
--The Street Children Focus Groups--
Each participating organization conducted a number of street children focus groups. The populations of the various groups reflected what was easily available, the normal group-work and activities of some organizations, and moving out and/or snowballing to new populations not previously engaged with services. In some cases camps were held, in others children were interviewed in groups in parks or on the streets. At other times, children were interviewed individually where a group was seen as too threatening or dangerous to safety, or likely to reveal unusable and unreliable information. Food and/or a recreational or enjoyable activity were often provided to engage the children for the lengthy process of the focus groups.
Various questions were deleted from the lists in the Menu in some cases, as certain topics were viewed as inappropriate or culturally insensitive to ask in those cases. One centre (Brazil) developed a useful mechanism for recording information from a number of children in a group setting. This format set out each question on a new page, with boxes in a semi-circle to represent individual group participants. As children spoke, their data were recorded in the box allocated to them for that particular question/issue. In Egypt some of the topics were turned into multiple choice questions.
In Rio 14 groups were conducted, with a total of 106 young people (reduced to 98 for analyses), aged 18, of whom 49% lived on the streets, 43% lived at home, and 8% in institutions. Interviews were conducted in the streets (Saes Pena Square), at various agencies and institutions (TEAR, Associacao Methodista de Acao Social - AMAS, and Fundacao Sao Martinho), and in the Favela do Lixao.
In Toronto there were two groups: a group of young people in regular contact with a service dealing mainly with out of home gay and lesbian youth, and youth from the "Ambassadors Program", a peer education and counselling programme for "street kids". In Montreal one group was conducted with a cross section of young people out of home.
In Cairo and Alexandria 194 street children were interviewed - 138 in Cairo and 50 in Alexandria from one open juvenile detention centre in Alexandria, three open/semi open juvenile detention centres (Giza, Ein Shams and Misr ElKadima) and one closed centre (Marg-Cairo) in Cairo. There were 6 children from St. George Orphanage in Alexandria who were interviewed. Ages ranged from 9 to 23 years, with a mean of 14 years. About 30% still lived with their families and 65% were working regularly. Group processes and individual interviews were used as appropriate. There were 23 groups conducted in Cairo and 7 in Alexandria, which met about 5 times each.
In Tegucigalpa there were five groups: 1) abandoned male children living in the streets and using substances (aged 12-22) which met 11 times, with an average of 6 participants; 2) abandoned male children living in the streets and not using drugs (aged 8-15) which met 11 times, with an average of 9 participants; 3) institutionalized male children who had a history of problematic drug use (Casa Alianza Honduras - closed centre) (aged 12-17) which met 14 times, with an average of 8 participants; 4) market vending male and female children who are in school and not using drugs (aged 8-11) which met 28 times, with an average of 8-11 participants; 5) market vending male children who are not in school and not using drugs (aged 8-9) which met 12 times, with an average of 8-11 participants.
In Bombay 65 children were interviewed: 23 boys living in the streets and mainly working as shoeshine boys and coolies along the Western Railway network, particularly Borivalli, Kurla, Chembur, Govandi and Mankurd Railway Stations, and 38 boys and 4 girls living in slum areas near the railway lines, such as Indira Nagar, Adarsh Nagar and Shivaji Nagar, mainly involved in rag and scrap trades. Individual interviews were conducted, as it was felt that this would be the most reliable means of obtaining information. Three on-going focus groups are being held.
In Mexico City 11,172 street children had been identified from previous research falling into 5 groups: Children who were selling goods, children who were providing services, children who were marginal service providers, children who were street performers and artists, and children involved in crime. 886 children had been interviewed in groups and 739 gave usable data; 72% were male (54% between 14-17 years), and 28% female (34% between 13 and 14 years), 1,020 lived in the streets and 10,152 worked in the streets.
In Manila groups were conducted by the participating NGOs: Maryville: 2 groups, each of which met 3 times: 10 males aged 9-11, and 8 males and 2 females aged 13-15. All except one member were at school and living with their families. At least 50% of waking time was spent on the streets. FCED: 2 groups, each of which met twice: 3 males and 2 females aged 8-12 all living with their families, but working on the streets, and 16 males aged 11-16 most of whom lived on the streets. The first group had 10 participants, but the second group had 16 as the original 10 brought peers. Masigla: 2 groups, each of which met twice: 2 males and 3 females, aged 12-15 most of whom lived on the streets, and 5 females and 6 males, aged 13-19 who were residents of a group home for street children.
In Lusaka Red Cross/SKI selected out specific children from their regular groups in Garden and Mtendere Compounds: one for 10 street boys from the SKI Drop-In-Centre in Garden Compound, aged 8 to 12, and one for 12 school boys and girls aged 7 to 14 from the Chitulmko Primary School Anti-Drug Youth Club in Mtendere Compound. CYP Africa Centre interviewed 31 children, all male except one; 16 from Matero Compound and 15 from Mtendere Compound, aged 16-24.
In all, over 550 street children participated in focus groups or were interviewed using the PSA format in the 10 cities. In addition, Mexico City contributed information from an extensive research project conducted earlier.
Most participating organizations found that to use the whole menu and list of questions was far too long for both the attention/concentration span of the street children. It was necessary to conduct a number of groups to cover all issues. It appeared that in some cases the sessions were conducted with fairly strict adherence to the question lists. Having greater familiarity with the process and question areas, it may be possible to have a more open, less structured and directive discussion where all topics are covered, but not in any rigid order. There was some difficulty in getting some children to return, and others needed to leave part way through to go to work. Only a few behavioural problems were evident, and these were mainly from the children who were drug users. Some children were actually inhaling solvents during some sessions.
Many of the reports commented on how much useful information came from the street children focus groups. In some cases, workers were confronted with new information that became very useful in developing strategies and interventions. For example, in Manila, the groups told the facilitators: that it was common for boys and girls to have sex after inhaling glue; that sex was used to obtain cannabis; that in non-tourist venues some had sex with adults in cinemas where pornographic movies were shown; that one form of substance use was to put wet carbon paper on their faces for 3 minutes and then inhale; that they mixed a local mint candy ("Stork") with "7-Up" and gained a cannabis like effect; and that they boiled toothpaste with cut up fibre matting and inhaled the fumes.
All reports indicated how involved the children became in the process, and how moved the facilitators were at times by the open disclosures of very painful and distressing information. At times, this required individual follow-up after the group. Many reports of focus groups noted how the behaviour of the participants changed over time. For example, hygiene, appearance and in group behaviour improved and more respect towards all participants was shown. Some street children even brought others in to become group members. This demonstrated a wide degree of acceptance by the children of the process; notwithstanding that the groups were long and sensitive material was being brought up and discussed.
There was fear of disclosure expressed in some settings, particularly in areas where children were known to have been killed and in some state institutions where it was alleged that drugs were available, and that staff were involved in their distribution and in physical and sexual assaults on inmates. In other cases high-status street children dominated discussions until facilitators were able to redress this. High-status children refer to those street children who are positioned high in the hierarchical structure of any particular group of street children, those who wield power and influence either through fear or respect. However, from the reports the information from the children was regarded as reliable and valid, but issues of staff and child safety require constant attention.