Innovation summary

Haitian traditional values emphasize parental authority (especially paternal) particularly corporal punishment which is considered a normal way to educate children.

In the broader context of the mental health services gap in Haiti, this innovation addresses family violence alongside mental health of children e.g. children developmental, affective and behavioral disorders.

The goals of the innovation are to:

  1. Increase awareness of mental health issues within the Grand Goâve area population
  2. Develop new educational strategies with parents
  3. Support parental parenting skills and improve their self-esteem
  4. Improve children’s capacity to cope with adversity

The project implemented a network of community mental health services, carried out by a team of community workers which were trained and supervised (locally and remotely via Skype), to deliver workshops, radio broadcasts, individual and family assessments, and more.

Impact summary

  • 1142 adults and 2917 children reached through intervention activities, after two years (apart from radio listeners)
  • $250,000 CAD funded over two years

“ I used to strongly hit my child, but since I attended the workshops, if he’s crying, I hold and cuddle him.” and “Before, I thought that someone who had mental health problems was crazy, but [the trained caregivers] taught me that a lot of things could cause mental health problems e.g. unemployment, homelessness, problems with husband or children…”

 

- Young mothers, New Family program focus group, GROSAME

This innovation is funded by Grand Challenges Canada

Innovation details

Inspired by the service organization Pyramid for an Optimal Mix of Services for Mental Health (WHO, 2009)1, we consolidated the services initially offered by the “natural caregivers” (active members of their community, with diverse backgrounds, e.g. nurse, farmer, driver, minister, etc.) in Grand Goâve, Haiti by creating a non-profit organization to develop a team of non-specialist mental health persons consisting of nine natural caregivers and eight primary school teachers.

The project’s educational and intervention activities focus on five components:

Developing a non-specialist mental health team

Training and supervision of the non-specialist mental health team is regularly offered from Canada through Skype and locally through one-week mission trips 3-4 times a year, by the project team (8 mental health professionals from Montreal and 2 Haitian psychologists)

With appropriate training and supervision in mental health psychosocial interventions, natural caregivers became first level providers with general knowledge on mental health issues, providing support and referrals to the people of Grand Goâve.

Increase in Mental Health Literacy

Educational radio shows are a powerful mass medium to inform a large number of citizens, thereby saving time, energy, money and resources in an effective way.

This project has produced tailor-made messages for the Haitian population that are broadcasted twice a week. Each program lasts one hour and discusses one key topic such as child development and parental/family problems potentially leading to violence among other family related topics. These themes were proposed to the local community workers in relation to our principal objectives. We progressively adapted the program planning to the needs and suggestions of the population (questions or comments addressed to presenters by phone or SMS).

The aim of these messages is to educate, inform and mobilize the audience collectively as well as individually. For the collective population specifically, the aim is to build and adopt non-violent relationships and behaviors with children.

Another strategy the project is using to reach and inform different sectors of the population is through conferences on specific mental health issues which are organized every so often.

In both cases, natural caregivers benefit from the transfer of knowledge through the guidance of the Montreal based mental health professionals.

Zippy’s Friends2 

Zippy’s Friends is a mental health promotion programme for school children, which is delivered by trained classroom teachers. This programme (1 hour/week, for 14 weeks) was created in London, in 1996, to help young children – 6 and 7-year-olds – to develop coping and social skills. Children also learn to identify and talk about their feelings and to explore ways to find solutions when confronted with difficult situations such as conflict, rejection or grief.

Home care visits with first time mothers

Home care visits by natural caregivers are designed to help first time mothers to engage in healthy practices with their infants. The visits provide support and knowledge on early development and affective needs, in order for the mothers to become proud and successful parents. Natural caregivers are trained on topics such as mother-child attachment and different aspects of child development through a bio-psycho-social perspective.

Parenting skill workshops

Parenting skill workshops consist of a four weekly session curriculum based on themes consistent with “Enhance parental skills”, a programme created in 1997-98 in Quebec, specifically designed for the Haitian community. The goal is to replace corporal punishment and other ineffective parenting styles with effective, proven, child-friendly parenting skills. The natural caregivers were also trained to run these workshops.

Key drivers

Open Communication with Stakeholders

Maintaining open lines of communications with the local communities, health institutions, and governmental agencies.

Establishing Key Networks and Partnerships

  • Establishing networks with local non-profit organizations, associations and community leaders (e.g.  religious leaders)
  • Establishing a partnership with the Grand Goâve general hospital and Port-au-Prince psychiatric hospital resulting in referrals from/to general practitioners and referrals to/monthly consultations by psychiatric interns in Grand Goâve
  • Sustaining a relationship with the Ministry of Public Health and Population which helped to promote the national visibility of GROSAME services and maintain the political support to this initiative3

Support Provision to Ensure Ownership Amongst Caregivers

The project’s action research framework was developed to support the community workers in their project tasks by constantly adapting the project to local needs (reflecting the direct contact between the local team and the population).

Local relationships with different partners (community organizations, associations, hospitals, ministries, police services, etc.) were formed and maintained by the local workers, with the support of our Quebec team, to reinforce sustainability of the partnerships. 

Challenges

  • Lack of mental health policies, funding and services
  • Scarcity of primary resources (housing, food, etc.) made it difficult to address mental health issues specifically as considering the limited possibility to meet primary basic needs
  • Limited access to internet which affected training and supervision from Quebec

Continuation

The guiding principle of this project is to create, implement and evaluate an innovative model that could become a sustainable and scalable program throughout Haiti (especially rural regions). The team has already started to expand the services to the rural district of Grand Goâve. The intent is to widen this community approach to Haitian citizens from different Haiti regions.

Partners

Funder

Evaluation methods

Consistent with the project’s participatory action research design, the approach elected to evaluate this project relied on a systematic description of the services offered and the impact on the target population, in collaboration of the natural caregivers.

Simultaneously, the project’s local research coordinator and research assistant implemented a progressive inquiry on expectations, satisfaction, learning, and needs, of the population that used GROSAME services. In addition, the team reported on progress through direct observation (6 missions in Haiti) and supervision (an average of twice per week via skype) by mental health professionals from Quebec. This setting gave an overall understanding of how well the services were working and how much the local providers had improved their mental health literacy within the umbrella of the intervention.​

The preliminary qualitative results helped us to gradually and consistently revisit, adjust and develop a culturally-appropriate approach. Moreover, this data provided a real-life contextual and multi-level understanding of the impact of the project as it included cultural influences.

Quantitative data was also gathered, including some characteristics of the population, to assess the reach of services. In addition, the impact on knowledge and behavior of the targeted population will also be evaluated.

Cost of implementation

Total cost of the research project is approximately $250,000 CAD; no cost-effectiveness measure

Impact details

  • 9 natural caregivers were trained in the psychosocial intervention
  • 71 citizens consulted natural caregivers at the GROSAME to obtain mental health services
  • 9 thematic meetings were offered on different mental health topics, reaching 177 citizens
  • 78 radio shows were broadcasted
  • 804 parents attended workshops on parental skills, indirectly reaching 2,610 children
  • 66 mothers were approached, supported and  informed with home visits and/or workshops, indirectly reaching 66 children under 2 years old
  • 8 teachers were trained to implement Zippy’s Friends, reaching 219 first grade children (6 to 7 years-old)

References

  1. World Health Organization. (2009) Improving health systems and services for mental health.
  2. Zippy’s Friends – Partnership for Children
  3. Ministere de la santé publique et de la population. (2014) Composante Sante Mentale de la Politique Nationale de Sante. 

Associates

Ronald Jean Jacques
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Country

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