UNICEF



BRIEFING NOTE ON THE SECOND TRAINING WORKSING USING THE ADAPTED CARE FOR CHILD DEVELOPMENT TRAINING PACKAGE FOR LATIN AMERICA AND THE CARIBBEAN (ENGLISH VERSION)BackgroundFollowing the development of Spanish and English language versions of a regionally adapted Care for Child Development training package for Latin America and the Caribbean (CCD-LAC) in 2013 that drew on recommendations made by ECD experts from throughout the region in 2012, both versions have been subsequently trialed. The first was a national training workshop and used the Spanish CCD-LAC in Santiago de Veraguas, Panama in November 2013, and the second was a sub-regional training workshop for 8 Caribbean countries and used the English CCD-LAC in St. John’s, Antigua.In brief, the CCD-LAC adaptations in Spanish and English contain more detailed information on:the rights and involvement of fathersadditional play and communication activities (Counseling Card)an expanded section on the specific context of the family (Checklist) recommendations to improve the coordination of early interventions for children at risk, including children with disabilities and those subject to violence, including by making referrals to related services, where necessary (Counseling Card and in specific sections of CCD documents)ways to strengthen the environments where young children spend most of their time through support to their familiesAs with the original training package, CCD-LAC is meant to be integrated into existing programmes and services for young children and their caregivers as well as professional development and training programmes for frontline workers rather than as a “stand-alone” initiative. The flexibility of the approach; that is, its potential integration into not just health services but any relevant service aimed at children 0-3, including ECD, has been stressed in the CCD-LAC adaptation. September 2014 CCD Training Workshop in AntiguaThere were a total of 21 participants who undertook the sub-regional CCD-LAC from September 16-19, 2014 in St. John’s Antigua. Of these, there were 3 UNICEF focal points and 18 national counterparts from the health (7 participants), education (7 participants) and social services ministries (4 participants). A representative of PAHO in Antigua also attended some parts of the training. The CCD-LAC approach and tools were very well received and seen as relevant by all participants as a means of improving existing programmes for young children and their families.The three parallel practice sessions, held on the second, third and fourth mornings of the workshop, were held. The first practice session focused on the health setting. The other two practice sessions offered a mix of health and private-sector ECD/daycare settings. There was also a deliberate mix of sites from the city centre as well as those on the periphery and in rural locations to offer as wide a range of practice as possible. (See table below.) Site #1Site #2Site #3Site #4Practice #1 (Day 2)Health Centre (child health clinic)Pediatrics Ward, HospitalMaternity Ward, HospitalN/APractice #2 (Day 3)Health Centre (child health clinic)ECD centre #1ECD centre #2ECD centre #3Practice # 3 (Day 4)Health Centre (child health clinic)ECD centre #4ECD centre #5ECD centre #6The variety of practices built up to policy discussions scheduled for the fourth and final day in which each country presented on the most promising entry points and next steps, such as required coordination mechanisms and resources for future implementation. Lessons LearnedThe CCD materials are geared to a situation where a country has already made a decision to implement the CCD approach. As noted below in Next Steps, there is much road to travel at both the regional and country level before such a decision could be made, including initial policy discussions and decision-making. Consequently, the lessons learned in this document have been divided into two categories: general points and those more relevant to the initial policy discussions that would inform an eventual decision on the use of CCD.A) GeneralInvolving Participants from Different Sectors: As with the two previous CCD training sessions held in LAC, the wide range of participants in the Caribbean training workshop (UNICEF, health, education/ECD and social services) enriched both the learning opportunities and the policy discussions. The diversity served to promote the development of a holistic approach to ECD policy and programming by bringing together key national stakeholders.Preparation Time: More time for preparation was built into the 2014 Caribbean training workshop based on previous experiences. It is critical for ensure the conference room in the hotel is properly set up to facilitate the sharing of experiences (e.g., round tables, with visibility among all the tables and the front of the room, etc.). Prior preparation is also required to organize the practice sites, including:confirming the day-to-day flow of children 0-3 years in the service or programme and the best time of day (e.g., there may be more time with parents when they pick up their children from an ECD centre than when they are dropping them off before work), so that there are sufficient numbers of children and parents and other family members with whom to practiseidentifying children with disabilities who could be involved in practice session or exploring the possibility of having a practice site at a centre that works with children with disabilities and their familiesexchanging information about the date and time of the practice session with the supervisor at each practice site as well as obtaining that person’s advice about the maximum number of participants that could be absorbed into each locationensuring that supervisors and other centre or clinic staff understand how the practice sessions work (e.g., in pairs; certain days with caregivers and certain days with children only) and allaying any misconceptions that the practice is an evaluation of their service, etc.ensuring adequate physical space for participants to practice (e.g., separate rooms are best, including the use of the lunchroom or a small office) so that participants are not in the way and there is sufficient privacy, andleaving consent forms so that parents will have time to read them and fill them in advanceThe additional preparation was extremely helpful and ensured a smoother flow in the practice sessions, key to CCD training. Indeed, the facilitators’ team feels that it would be helpful to include a half day in future training workshops devoted specifically to preparing the directors or supervisors of the practice sites. Toys: One helpful change to the toys was the use of plastic adhesive film to cover the coloured shapes and toilet paper rolls to make them easier to clean. Another change was shifting the focus of the toys session on the first day from making toys to reviewing the bag of materials with the participants before the practice sessions. This time was also used to discuss the utility of everyday items from the home, which can be just as effective as store bought toys to support healthy child development. This approach helped to prevent errors seen in previous workshops (e.g., taking all the toys out at the same time, stressing play over communication activities etc.). Note: The importance of highlighting communication activities using these materials is addressed in further detail in the final report of the Antigua workshop.Other changes to the sample agenda: Because the 2014 CCD workshop in Antigua was an introduction to the model prior to a decision about national implementation, time was built into the agenda to discuss existing programmes and services for children 0-3 years of age (and associated tools and instruments) as well as 2-3 hours on the final day to discuss policy issues related to implementation, including the current level of interest in ECD in each country, possible programmatic entry points for CCD, and required resources. An additional session was added on learning spaces and transitions, which specifically covered learning spaces for at-risk children, including those with disabilities. Given these additions, there was no time to discuss monitoring and evaluation in any detail, although participants agreed it is a key implementation issue.Written Consent: In this training, written consent forms were used to explain to parents that videos and photos would be taken of the interactions between child/care giver and workshop participants for this and possible future training sessions or materials. No filming took place in the absence of consent, although parents were able, and did, consent to participate even if they did not want the practice recorded. The consent forms worked well overall. Related practical issues include: sensitivity where parents have low literacy skills; the need to distribute the forms in advance of the practice sessions; and telephone consent as an alternative mechanism. A final reflection is that the consent form covered caregivers and their children but not specifically the workshop participant.Parallel Practice Sessions: As with the 2013 national workshop held in Panama, parallel practice sessions were organized, although in the Caribbean training, a greater number of sites were added. The parallel sessions add complexity to the organization and the logistics, but offered several benefits. For example, having multiple sites meant that participants were divided into smaller groups, which meant that they were more easily accommodated in the various locations and less intrusive to the service in question. It also meant that participants had greater variety in their practices: each had the opportunity to practice in a health and ECD setting, and care was taken to expose them to locations in the city as well as those located further out of town or in more rural areas. As such, the parallel sessions were in keeping with efforts to ensure a multidisciplinary, holistic approach to ECD.Order of the Practice Sessions: Feedback from this training workshop as well as previous CCD trainings in LAC suggested that it would be better not to organize the first practice session in a hospital. Participants recommended starting in an ECD centre. B) Lead up to a Policy Decision on the Implementation of CCDAs noted earlier, the CCD materials have been designed to train frontline workers with contact with children aged 0-3 years. This skips too far ahead, missing the initial decision-making stage and country-level preparation/adaptation. Seen from this perspective, there are gaps in both methodology and content that need to be addressed.In terms of methodology, it would be helpful to acknowledge explicitly that different workshops will likely be required along the path to national implementation:The experience from LAC suggests that there will need to be an introductory workshop with a mix of policy-makers, professional training centres and potential frontline implementers that allows time for policy discussions related to potential implementation, including a review of existing programmes and tools, key partnerships and required resources. Once national policy-makers and other key actors have been introduced to the model and have agreed to move forward, this could be followed by a workshop to delve into country-level implementation in more detail and then a country-level Training of Trainers.In terms of expanded content, it would be helpful to have an:expanded Facilitator Guide that addresses the Training of Trainers step in addition to regular frontline training, andImplementation Strategies Manual to guide the country-level implementation workshop, including monitoring and evaluation.Next Steps Some next steps identified in the 2014 CCD-LAC training workshop in the Caribbean include:Country levelParticipants report to home Ministries and support decision-making process based on more detailed analysis of existing programmes and services as well as associated tools, instruments and norms.Identify trainers from Caribbean to participate in Master Trainers’ workshop in 2015.Make arrangements for Training of Trainers to establish core group of national trainers.Develop national action plan to support rollout and identify necessary resources. These plans would need to address the specific preparatory steps necessary in the specific country context, including undertaking the necessary translations and any other country specific adaptations (e.g., inclusion of a reference to the specific tool already used in the country when working with children 0-3 years, such as a health passport; inclusion of images that reflect the local population, etc.).Regional LevelContinue to include and deepen commitment to CCD-LAC in UNICEF-WHO/PAHO joint work plans. As part of this work:make last changes to CCD-LAC regional adaptations (including expanding content for Facilitator Guide to support rollout at the country-level)review final drafts with an editor and a graphic designerundertake a “finalization” process in both UNICEF and WHO/PAHO for CCD-LACFacilitate a networking process among countries in LAC rolling out CCD.Hold training of Master Trainers in early 2015, including trainers from the Caribbean.Provide technical assistance from the regional office to support country level roll-out in LAC. Document and share LAC experiences to support global rollout.PREPARED BY: Janet Lennox, Consultant, UNICEF LACRODATE: 13 October 2014 ................
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