Week 2 in the community...."on the way up"

WOW what a week it has been, coming in from last week when we were so overwhelmed with everything happening and the things that we still needed to do, and now its the end of the week and we have found new ways to overwhelm ourselves. The thing about community is the more you start to understand the community, the more you find the needs and want to meet all of them. We have added a few new projects this week because we have found a need and its too big to just ignore. It has been great though because we have all found projects that we have a passion for and are coming up with great ideas. 

My new project is the wellness group that runs on a Monday from 10 till 1, it involves a group of older ladies that get together to perform Leisure activities but mainly gossip with each other. Meeting them on Monday was just such a great start to the week because they all welcomed us with open arms and there is so much love in that room. There is though a need for them to be involved in more planned activities with the aim to prevent the effects of old age e.g loss of memory, joint problems. So I have decided to base the group on Reminiscence Therapy which is defined by the American Psychological Association (APA) as 'the use of life histories-written, oral or both-to improve psychological well being." It is used to help maintain good mental health, boredom reduction, reducing stress, prepare for death, conversation, finding identity, maintaining and introducing new relationships, problem solving, and to teach/inform. These aims and principles will be melded with activities to make it fun and functional. For the first week we will be doing a scrap booking activity. They will be using a photo from "the good old days" and will each be required to explain why they chose that photo and the importance of it to them. They will then get creative and design a special page around this photo to put up in their houses. Other activities that will be introduced are knitting items for the community, cooking meals together which will focus on their senses, memories related to everyday objects etc. This is such an exciting project because these ladies are the heart of the community and have a huge influence on it. To target them and help them will in turn help the community because they are living with the families and have influence on those younger than them. 

One of the biggest breakthroughs this week was our meeting with the counselor  The group before had struggled the whole of their block to see him but we finally got through to him and were able to meet with him. During the meeting we discussed with him the projects that we were doing in the community and what the problems and drawbacks were that we had found. He showed lots of interest in what we were doing and identified with the problems that we had found. He then asked us to make a list for him of the things that we would like him to do for us because he was having a meeting with the big boss and wanted to bring up the list. He also organised a meeting with us on Monday when he will bring the people who could help us and discuss what the plan would be to move forward and better the community. All of this got us very excited because if he came through on all of the asks we would be able to do even more in the community. After the meeting however we discussed it with our supervisor and members of the previous group and they voiced some concerns of us being too excited and the possibility of him not delivering on all his promises. It took me back because I tend to be very optimistic and always think the best of people and believe that they will deliver on what they say, but getting this reality check was good for me because it made me realise that he might not deliver on everything and I shouldn't be disappointed if he does. I am still excited and hoping for the best but even if we get one thing that we asked for it would be great because we are also wanting to improve his relationship with the community members. 

One of my tasks that I had for this week was assessing both the Grade R classes at the creche which proved tougher than I thought. I designed an obstacle course to assess their gross motor abilities, they then moved onto a cut and colour activity and finally copied one part of the VMI. The children took a great liking to the obstacle course and all wanted to do it at the same time which was a problem for the one doing the course because they were being distracted by those wanting to do the course. This was solved by having the rest of the class waiting inside till they were called to come do the obstacle course. The other two parts of the assessment were done as a group which helped show the difference in the work speed. We noticed lots of delays in gross motor, fine motor and perception. One child was struggling with the activities because he was unable to see out of one of his eyes, his glasses had broken a long time ago and nothing had been done about it so he was struggling in school. It is so sad that a lack of information and finances could lead to this child been delayed in school because he is unable to see. Plans are being made to take him to Spec Savers for a free assessment and frames so that the assessment can be redone and see if there are any problems. 

All in all it has been a very productive week with lots of planning and foundation work that will hopefully start producing change from this next week. We are all so excited about the meeting with the counselor on Monday and are hoping he comes through with his promises. There are three short weeks left and so much still to do. I will leave you with this quote, I have found this in community, it isn't about you and your ego but rather about the bigger picture and wanting to make a change and using your talents to do so.

This is what gets us through each week...

Adolescent Community Reinforcement Approach

The Adolescent Community Reinforcement Approach (A-CRA) is a behavioural intervention that works on improving family, social and educational areas in an adolescent's life to support recovery from substance abuse and dependence. This also involves sessions with the learners by themselves, then with their guardians alone and then finally them together. Treatment sessions would include problem-solving skills to cope with stress, communication skills, and participation in constructive social and recreational activities with the goal of improving life satisfaction and eliminating substance use problems.

The goals of the Adolescent Community Reinforcement Approach (A-CRA) are to:

• Promote abstinence from alcohol, marijuana, and other drugs.
• Promote positive social activity. 
• Promote positive peer relationships and improved relationships with family. 
• Motivate caregiver participation in the A-CRA treatment process. 
• Promote the caregiver’s support of the adolescent’s abstinence from alcohol, marijuana, and other drugs. 
• Provide information to the caregiver about effective parenting practices. 
• Help the adolescent and caregiver(s) create a home and community environment conducive to recovery. 
• Teach the adolescent problem-solving, communication, and other important skills through the use of role-playing

A-CRA can best be understood as a toolbox of different procedures that clinicians are trained to use as appropriate with a participant. For these procedures please go to the link below for the list in order to implement this approach. 

Taken from: http://www.cebc4cw.org/program/adolescent-community-reinforcement-approach/detailed

This would be a good approach to use with the High School Learners in the Mariann Ridge Community because they are needing to be empowered so therefore by learning all these skills they will be able to implement them in their lives and therefore make a change. One of their biggest problems is the use of substances in their free time or to help them forget about their problems. so these skills will also help them find better ways to use their time and therefore leave their use of substances. An idea that this approach has is to give the learners homework to do to reinforce skills that have been learnt and also to give them responsibility which could work well with the learners because it will also assess their level of commitment and participation in the group.This group of girls and boys is going to be a challenge but this approach could help assist with the drawing up of the programme with regards to the aims and group discussions done. 

Start of something new...*Community Block*

This community was established in 1976 and was where coloured families from Durban were relocated during the Apartheid era. Sarason defined community as "a readily available, mutually supportive network of relationships on which one could depend" (Dalton, Elias & Wandersman, 2007). If you compared this community to what this definition is saying you would see that the Mariann Ridge Community is providing supportive relationships for those in the coloured community but not to others and therefore aren't reaching their full capability of what they could be to one another. 

This week has been an eye opener, after going in with all the confidence in the world I took a big knock. Having experience in working with communities before didn't help me much with what I discovered on Monday morning when we arrived at Mariann Ridge. This community has similar problems to others with regards to unemployment, poverty, children not attending school, disabled people etc yet it is unique in the history it is has and the politics that have made it what it is today. 

Before we entered the community we had a tut with our lecturers as an introduction and to help prepare us. During this a lecturer said something very profound, she said that when we are doing our projects we must not be driven by our personalities and what we want but rather about what the needs of the community are. This really hit me because I often tend to go with what I want and what I think would work best but that is wrong because the people in the community know more than me with regards to what the needs are and what needs to change. 

One of our projects in the community is in the Creche and Primary School in the area, we were coming in and running groups with the children to provide stimulation in order to encourage normal development and to pick up any delays in individuals. We have looked at it and because the OT students come and go it isn't sustainable to only treat the children, a more beneficial way of doing the project is to run an educative programme with the teachers to equip them with the skills and resources that they need. This is focusing on changing the environment that the child is in rather than just treating the child's problem, which in turn aid the treatment of the child's problems. 

We have also started a new project which involves working with the clinic in the area, There is no OT or Physiotherapist that comes to service the clinic so the clinic lacks knowledge of what we do and how we can assist them. We met with the head sister there who sat down with us and told us what patients they see and how we could help them. So from that we have established a need for intervention with mothers and young children with regards to developmental milestones and education for the mothers on stimulation for the child.The checklist we will be basing the project on is the WITS Developmental Profile which gives us the gross motor, fine motor and social developmental milestones a child should of reached at a certain age.This age group is my passion and it fits in with a need of the community but i also want to increase my knowledge and scope of practice so I am going to be speaking to the clinic to see what other needs there are and maybe start a support group with the older members of the community who suffer from chronic illnesses and are needing assistance with regards to function and some education. 

There is also a project at the high school which the Katey and Haseena will be heading up to do with empowerment of the adolescents. This is a tough project because you have to motivate the learners to attend the groups and make them fun but at the same time teaching them valuable things that they can use to change their lives. I will be working as a co-therapist in the groups and I am very excited to be involved because I have been involved with Micah 6 (http://micahsix.blogspot.com/). Katey and Haseena have also been doing a lot of research into this field and have found such amazing resources so I know that it is going to be a success. It is so important to target these adolescents at this age because they are going to be the next generation and the change needs to start with them in order to see long term change.

There have been breakthroughs with some of the things the group before us wanted to achieve. The first of which was getting into contact with DSW in order to get bins for the area outside the Library and Cafe where all the children congregate after school. Bins in the area are normally used to make drugs in so we ordered concrete bins but in the meantime we had new plastic bins delivered and these will have to be taken inside every night so that they aren't stolen. Me and a fellow student got so excited when this happened that we hugged each other and did a happy dance because we know how this will create pride in the area. We are also wanting to create a play area so a clean environment will make it more welcoming for the children after school to use it to play in. This seems like such a small win in the community but all these small wins add up in the end for the change this community needs. 

Another breakthrough was learning about the Institution Level Support Team (ILST) which is a supportive structure at schools that focuses on the screening, identification and support of areas needing development. This team includes the whole school committee, educator support committee and the learner support committee. The support group is still in its formative stages but will be a vital resource to us working in the community as soon as it is up and running. There is going to be a meeting where this team will be discussed and we will be attending in order to give our input and see if they can help sustain our project in the school. 

This is the Social-Ecological Model of Health that focuses on the different factors that will impact on an individual's health. A person's health is impacted by these different factors. It can be used to help us identify the different factors at different levels that contribute to poor health and to develop action plans and approaches to change the physical and social environments rather than modifying only the individual. This is very helpful when working in the community because all the community members are affected by different environments throughout each day so in order to treat them we need to be aware of how each of these environments are affecting them.It is also important to include in therapy their cultural beliefs, religion and values in order to treat them holistically. To see change happen there has to be action on each of these levels in order to reinforce and produce change.

My mind is going crazy with information and trying to solve the problems that we have identified in the community. Think I still need to learn that I can't solve all the problems but rather focus on a few that will make a change. Looking forward to having a weekend to get my mind around what needs to be done, reading up on theory to base my projects on and coming next week with an action plan. 

Mariann Ridge does have a blog although it is outdated, but it does have some information about the community and some of the projects that are running. http://mariannridge.wordpress.com/