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Integrated Approach to Dealing with Disability

Introduction
Interventions for the differently abled persons (DAPs) have been an important component of the project in Mahabubnagar right from the early stages of the project implementation. While the activities relating to health and disability are restricted to 3-5 mandals in all the DPIP districts, inMahabubnagar, they are extended to all the project mandals. The decision to do so is justified by the fact that the proportion of the disabled inMahabubnagar is relatively high. Adoption of a CBR approach and dealing with disability in a holistic manner, make this to be one of the best practices in the district. The interventions with the disabled not only focused on the preventive and curative aspects, but also included activities directed towards building the potentialities of the disabled for self-management. Organizations of the disabled were promoted and then federated in order to facilitate peer support and collective strength. The disabled were enabled to contribute to the household income through the special CIF-SPs, sanctioned to them. This brought about a change in the attitude of the family towards the disabled, who are now considered as productive individuals. Family members facilitate the process of group formation and functioning, by ensuring membership and attendance at meetings. The key factor to the best practice is the promotion of a cadre of social workers from among the disabled who are responsible for the implementation of activities in their respective clusters. This approach not only provided a livelihood to these social workers, but also developed their self-esteem.

Adoption of an Integrated Approach

The adoption of an integrated approach to dealing with problems relating to disability, has achieved the desired results and the DAPs in the district today function with more dignity and respect, than before. The details of the intervention described in the sections to follow, would explain the process adopted and the activities undertaken. What is of importance here is the planning that took place to embrace all aspects relating to the disabled. Each of the steps included in the process, is an indication of the projects commitment towards the disabled. It also speaks of the conviction of the staff involved in its planning and implementation.

Introducing the component into the project

The decision to work with the disabled in the district was a result of two influencing factors, namely, the higher incidence of disability prevalent in the district the work done by NGO-COMMITMENTS which successfully adopted the CBR approach. Lessons drawn from the experiences of this NGO formed the basis for the planning of interventions in the project. It was at this stage that the SPMU also proposed to introduce the health, nutrition and disability (HN&D) component into the project for implementation as a pilot in 3-5 mandals of all DPIP districts. In Mahabubnagar too, the work with the disabled, was first initiated in 5 mandals in collaboration with COMMITMENTS. It was later extended to all the project mandals in a phased manner. The process of expansion to all the mandals, started with a survey to identify the disabled.

Identification of People with Disabilities

The first step towards the empowerment of the disabled, was the identification of the disabled in the project mandals through a household survey. To start with, it was the CCs and the CRPs in the respective mandals who conducted the survey, as they were already working in those villages and were familiar with the communities and the HHs. A seventeen column format designed by the project, was used to conduct the survey. Analysis of the survey data facilitated the disaggregation based on sex, age, type and extent of disability. As an activity by itself, the survey had been considered as a value addition by the line department, in view of the rich data based on the disabled that is now available in the district. The line department used the data in planning its strategies and interventions. The yet another aspect of the contribution of this activity is the convergence with the line department in all activities that followed the survey.

Identification and Capacity Building of CDWs

The introduction of a cadre of grass root level workers was considered essential to take the agenda forward. At this point of time, the survey in the first few mandals was completed. During the analysis, it was noticed that there were a good number of young boys and girls among the disabled who were educated up to 10th class and above. It struck the DPM that some of these youngsters could be trained and involved in the implementation of activities relating to the disabled. It was also expected that these DAPs would work with an empathic understanding as they are themselves disabled. The expectation was not wrong as

these young people turned out to be a cadre of best workers in the project. The selection of the Community Development Workers (CDWs) was done by the VOs and MMSs under the guidance of the CCs and the APMs. One CDW was placed in each CC cluster and or which was expected to work in co-ordination with the CCs and other project staff in the cluster.

The selection of the CDWs was followed by their capacity building through a well planned training strategy. The twenty five day training provided by the DPM and the SPM did the magic. They were inspired enough to feel highly motivated to work with the disabled. The training consisted of both the classroom sessions and field placement. While the classroom sessions focused on the knowledge base, roles and responsibilities, strategies to be adopted, activities to be undertaken, the related processes etc., the field placement provided an opportunity to put into practice all that was learnt in the classroom session. This was considered by the CDWs as an important contribution to their success as development workers. The trained CDWs conducted the survey in the next phase mandals and identified DAPs for selection. The process continued until all the mandals were covered.

Organization of DAP-SHGs and MVSs

Once the survey was completed and the list of DAPs prepared, the next important task of the CDWs was to organize the DAPs into SHGs. The purpose was to have a homogenous group in order to access peer support. It was more of helping them with self-management skills than promoting micro finance (savings and credit) as in the case of other SHGs of women. The SHGs of the DAPs were, however, encouraged to save as much as they could as this would be one of the motivating factors to keep the groups going. The one common aspect that formed the basis for group formation was disability. The factors like, age and sex really did not matter, and therefore, DAPs of all ages and of both sexes, were brought together in the village and formed into one SHG of the DAPs. The need for separate DAP-SHGs was felt in view of the special needs of the disabled and also to provide an opportunity for an overall development, which would not be possible in an integrated group. The DAPs, it was felt, would never be able to take up key roles and responsibilities in the common SHGs. Above all, the SHG membership provided the DAPs an opportunity to come out from the closed environment and interact with others on a regular basis. This is particularly true of the mentally retarded. The SHGs of DAPs were later motivated to join the VOs and MMSs and the process was facilitated by the CDWs. It was later realized that the DAPs did not find place either in the EC

or any of the committees. It was, therefore, proposed to have a separate samakhya for the DAPs at the mandal level. The same was facilitated in all the project mandals and called as the Mandala Vikalangula Samakhya (MVS). Unlike the existing MMSs, the presidents of SHGs were the members of the MVS. In view of the small number of SHGs in a given GP, no separate VOs were promoted. The DAPs and their SHGs were, however, members of the regular VOs in the GP. In order to build an organic linkage between the MVS and the MMS, the office bearers of the MVS attended the monthly meeting of MMS. Further, the president of the MMS was the ex-officio member of the MVS. The MVS had an independent budget and the leaders were trained both in institution building and accounting systems. It appears that the strategy of having separate institutions for the DAPs has in a great way, facilitated the capacity building process of the DAPs.

Access to Services through Convergence

The developmental strategy planned for the DAPs, had a component built into it, to address the various needs of the target group. It was planned that the services to address these needs would be accessed through convergence with line departments and other related institutions. The following three key areas were identified for a suitable intervention.

Aids and Appliances

Multi purpose health camps were conducted in convergence with the Department for the Welfare of the Disabled. An assessment of the need for aids and appliances was also undertaken during these camps. The needed appliances were provided free of cost to the DAPs with the support of the Department of Disabled Welfare and a Hyderabad based NGO, which conducts research in this area and makes light weight appliances. The DPM identified the resource in this agency and developed the linkage. The NGO staff, all of whom are technically trained, based themselves in the district for two weeks, assessed individual after individual and provided the suitable aids and appliances to all the DAPs who were in need of them. The staff trained the DAPs in the use of these appliances which enabled them to overcome the initial teething problems. The intervention was well received and appreciated by the DAPs and their families. A good number of DAPs with disability in the lower limbs, could walk for the first time and the joy was immeasurable.

Surgical Corrections
The multipurpose health camps resulted in the identification of a larger number of DAPs who required surgical corrections. By themselves, the DAPs were not in a position to get

the surgery done in view of the limited knowledge and resources available with them. Having determined to do something about the problem, the DPM began its search for a suitable institution that could provide the service. He had come to know about the BIRRD hospital in Tirupati which provides free medical care and support. The DPMU approached the Director of BIRRD, through the District Collector, who had readily agreed to provide the service. The local SVS hospital was approached for the use of operation theatre and nursing facilities. A local NGO called Rogi Sahayatha Trust, provided the medicines, while the DPMU met the costs of the travel and food. The CDWs were trained for the post-operative care, and were required to provide these services under the guidance of the PHC doctors. The entire process is indeed the best example of a very successful convergent approach. For 500 plus DAPs who went through the surgical corrections, the initial inconvenience was not at all a matter of concern. The new life after the surgery was all that mattered.

Houses through IAY

The DAP identification survey revealed that a majority of the DAPs were dependants on their parents, caregivers and siblings for their livelihood. The DPIP, as part of improving the socio- economic status of the DAPs, decided to facilitate the sanction of houses for the DAPs under the IAY. Accordingly, a resolution was passed in the ZP meeting. Following the decision, the CDWs had identified the DAPs with house site but without a house and prepared the list. The list had got the approval of the government for the construction of houses for 650 DAPs. Expenditure required for the construction of houses is to be met from both the IAY and the project. While the expenditure for laying the foundation is given under the social CIFSP, the rest came from the IAY. Technical guidance and support were provided by the APM (Engineering). The progress of the work was monitored by the local CBOs.

Promoting Livelihoods through CIF-SPs

Steps were initiated in the project to promote the livelihood opportunities for the DAPs. A part of the CIF amount allocated to the VO, was set aside for the DAPs. Separate subprojects were sanctioned to DAPs on individual and group basis. The comprehensive strategy adopted by the project has added to the self-esteem of the DAPs and their status within the family and the outside. More significantly, the strategy opened up new livelihood opportunities to the DAPs.

Replicability

The comprehensive approach adopted for the rehabilitation of the disabled in Mahabubnagar district can be replicated in other districts as well. However, the replicability critically hinges on the support of the local resource organizations and the willingness of the line departments to support the intervention. As the DRDA enjoys good rapport with other line departments/agencies, replicability of the comprehensive approach should not pose any problem.

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Addressing Social Issues Through Kalajatha

Introduction
Over the years, the DPIP-Mahabubnagar made a name for itself for its work on social issues which had adversely affected the poor and their livelihoods. Three issues of the kind which were successfully handled, include the Jogini system, the practice of caste-based discrimination and the prevalence of child labour. An analysis of the process adopted to work on such deep rooted issues and a search for the identification of the factors contributing to the same, suggest that the use of Kalajatha had a tremendous impact on the target community. It was successful not only in generating an awareness about the ill effects of such practices but also in mobilizing the target audience for collective action. The spread effect was unimaginable. More and more areas were identified for coverage for generating an awareness and for initiating action. The geographical area got expanded, and the Kalajatha teams were in great demand. These agents of change were utilized by the line departments to take their messages across the community. Kalajatha has also become an important livelihood strategy to the local artists, who have been trained to use their talent and potential effectively.

The Genesis
The DPMU, in its attempt to analyze the causes of poverty in the district, looked at both income and social poverty and identified, certain social issues that were impacting on the poverty situation. It was also felt that any attempt to attack poverty without addressing the social issues, would amount to a half hearted approach and would not bring in the desired results. The decision to work on three social issues was, therefore, taken by the DPMU. These include the Jogini system, the practice of caste-based discrimination and the institution of child labour.

Selection of a Strategy
Once the decision was taken to work on the identified social issues, the next step was to select a suitable strategy. In view of the deep rooted nature of the issues identified, and the strong action that is required, a strategy aimed at attitudinal and behavioural change was all that was required. The one effective way of touching the hearts of the people was through the local cultural medium Kalajatha. It was expected that this would have a very strong

impact on the people affected by these practices. As a result, a DPM was appointed to work exclusively on the social issues through the use of Kalajatha.

Identification and Training of Local Teams

The DPM, a very much talented person, worked initially on developing the material for use through the local media. This included writing songs, developing suitable tunes, providing musical background, conduct of dance and drama rehearsals and support for staging of street plays etc. The outcome was superb. The message was clear, the music catchy and touched the people concerned, at the right place. The DPM himself moved from one community to the other with a small team of artists. However, when the DPMU decided to go about on a large scale, this effort was not adequate. It required great number of artists to manage the scale and facilitate a collective action. In response to this growing demand and also to ensure sustainability of the intervention, it was decided to identify the local talented youth (boys and girls) and train them in an effective use ofKalajatha as a medium of change. The decision was put into practice immediately. Youth from the project area, were identified and trained. The trained youth now undertake kalajatha in the communities.

Linking with Mandal Samakhyas

The trained Kalajatha teams are attached to the respective mandal samakhyas. Line departments and organizations needing their services, are required to approach the MMS. The youth teams prepare the Kalajatha items on the basis of the task assigned and the target community to be addressed. This system has gradually led to the institutionalization of the process. A large number of line departments are using the services of the teams. These include the Departments of Social Welfare, Tribal Welfare, Health, Education, ICDS and Panchayati Raj. The teams have been effective and the outcome are evident. The incidence of dedication of girls into Jogini system was found to be on the decline. The instances of open acts of caste based discrimination and the incidence of child labour, were also reported to be on the decline. The teams also are enabled to earn a livelihood through the Kalajatha. LDs and NGOs make an extensive use of their services, primarily because of their being effective.

Replicability
The practice of using trained and talented youth to eradicate and excommunicate social evils can be replicated in other project districts. It is, however, important to note that eradication of deep rooted social practices is a long process and Kalajatha campaign alone

would not be able to achieve the desired results. Effective Kalajatha campaign would however, create the necessary sensitization and environment for change. Other instruments would have to be used to achieve the desired change. This would include effective enforcement legal provisions against the Joginisystem, the practice of caste-based discrimination and the institution of child labour. The commitment with which line departments work against the practices ultimately determines the success.

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Balanagar MMS Manages the Crisis to Emerge As a Sustainable Institution

Introduction
The case study refers to the Balanagar MMS and the way in which the office bearers and EC members managed the crisis and protected the institution from collapsing. The office bearers and EC, having gradually freed the MMS from the clutches of the project staff, manage its functioning independently. The MMS-EC members have developed keen interest and worked with commitment to develop it into a sustainable self-managed institution of the poor. They are able to undertake various activities and organize different programmes for the benefit of the members. Their understanding of the MMS accounting systems, is notable. In spite of being illiterate, these women having learnt the details of all the related systems manage to keep the information at their fingertips. The MMS leaders have successfully developed the AWFP for the Samakhya on their own. They have realized the importance of monitoring which resulted in the preparation of an action plan to monitor the work of their staff at different levels. Today, the Balangar MMS is capable of managing its own affairs with little guidance and support from the APM, CCs and MBK.

The Rise and Fall of MS

The MMS of Balangar was one of the first mandal level federations to be formed in the district under the DPIP. The four year old samakhya, has a membership of 36 VOs and 644 SHGs to its credit. The EC of the MMS meets on the 4th of every month, while the office bearers hold a review meeting for the benefit of all their staff on the 20th of every month. The fact that these systems have been in tact for years, is to be ascribed to the planned effort of the then APM who had worked in the initial stages of formation of the MMS. The CCs were very supportive and facilitated the capacity building of the samakhya. The VOs functioned effectively and so also a large number of SHGs. The mandal was also in the forefront in respect of the preparation, submission and sanction of CIF-SPs. A good number of members benefited from the SPs, and the members acknowledged the impact on the livelihoods. That was the situation of the MMS until about a year ago, when certain changes took place. There were certain changes in the CCs posted to the mandal. The older CCs were

promoted as APMs. The MMS leaders were also changed during this period as they completed their term. The MMS, therefore, had new office bearers and new CCs and APM. This was a turning point in the working of the Samakhya. The new CCs and APM found it difficult to cope with the work. They did not exhibit the same enthusiasm as their predecessors. The staff did not facilitate the regular conduct of the MS meetings. When meetings were held, attendance declined drastically. The institution began its downslide. Very soon, it reached the lowest ebb. At this stage, it was no longer one of the best samakhyas and did not have any lessons to offer to the other institutions. The institution slowly started collapsing and forced the OBs and EC to reflect on the situation.

The Mid-Way
The decline of MS had its impact on the functioning of the VOs and SHGs. The EC members realized that the attendance at the MMS monthly meetings was gradually declining which was also considered as a reflection of the ineffective functioning of the VOs in the mandal. Some of them, therefore, decided to work towards strengthening them. As a first step to the process, these members decided to review the monthly action plan submitted by the CCs. The method that they adopted was, however, different. This time, they did not restrict themselves to the office level review (as is the case always) but decided to go to the field as per the action plan. The EC got itself divided into small teams and started visiting the VOs and SHGs as per the advance work plan given by the CCs. The CCs were not found in the field as per the action plan and this shocked the MMS members. The MMS members realized that the CCs had been neglecting the VOs and SHGs. The poor functioning of the CCs was an eye opener to the EC members. The members resolved to free the MMS from the control of the CCs. At this stage, the EC members consulted the former leaders of the MMS for advice and guidance. The members realized that they relied quite heavily on the project staff for the day to day functioning of the Samakhya. As the MMS was functioning well, they became complacent enough to think that the situation would continue. Further, their being new to the role as leaders, also allowed (though unconsciously), the deterioration to take place. Soon after the field visits, the office bearers held a review meeting with all the staff (which became irregular after the new leaders were elected) and conducted an enquiry into the functioning of the CCs and MBKs. The staff were defensive and could not appreciate the action of the MMS. The real trouble began in the form of non-cooperation from the staff. Taking note of the situation, the MMS leaders decided to attend the MMS office on rotation.

The EC members worked out a roster duty schedule to ensure the availability of a few of them in the MMS every day. The EC members stayed in the MMS overnight for a few days, until the issue was settled. During their daily visit to the MMS, the MS-leaders looked into the accounts and realized that these needed verification and rectification. They could not receive funds from the DPMU as the utilization certificates were not sent regularly. Unable to digest the process initiated by the MMS, the CCs stopped coming to the MMS. At this stage, the MMS approached the DPMU and requested for support. The DPMU intervened and reprimanded the CCs and insisted that they should abide by what the MS decides. The CCs had no other go except to fall in line. The systems were back in place. The meetings of the MMS were held regularly and the attendance of the CCs and the VO representatives at these meetings was insisted upon. This indirectly facilitated the process of strengthening the VOs. On the otherhand, the MMS-EC members gradually started participating in the monthly meetings of the VOs with the intention of reviving and activating them. This turned out to be a source of real strength for the Samakhya. The VO leaders, who are also members of the MMS, started attending the MMS meetings and expressed their commitment to rebuild the institution into a sustainable and self-managed organization of the poor women. Thus, by Dec. 05, the Balanagar MMS exhibited the features of a sustainable institution. By Nov. 05, the samakhya had received an amount of Rs.84.20 lakh as CIF. The amount was distributed to 93 VOs and 254 SHGs to benefit about 3,000 households. In addition, the SHGs were able to access substantial amounts of bank loan to undertake several income generating activities. The VOs were actively engaged in recycling the CIF for the benefit of a larger number of households. The MS provided continuous support-supervision to the VOs. The institution has virtually attained a take-off stage. It was made possible through the collective efforts of all the members, though the EC members and office bearers understandably had a key role to play.

The MMS Today

The current status of the MMS is what justified its selection as a best practice for the district. The members have learnt their lessons from experience and these lessons would guide their actions in future. The key lesson that the members have learnt and openly admit is that, they have to develop a sense of ownership of the institutions, if they really want them to be sustainable and beneficial to the members and evince an abiding interest in the

growth of institutions. The Balanagar MMS, in its current form, exhibits the following features:

Independent Functioning
The EC and the office bearers manage the day-to-day affairs of the samakhya by turns without solely depending on the project staff. This has enhanced the control of the MS-EC over the staff.

Good Understanding of the Accounting Systems

The office bearers of the MMS ensure that accounts are regularly maintained and the utilization certificates sent on time. The office bearers enquire into the purpose of expenditure before signing each cheque and go to the bank personally for drawing the money. Their understanding of the financial transactions has vastly improved.

Crisis Management through Collective Action

The experience has enhanced the resolve and determination of the members. The members do not run away from crisis as they are even prepared to face any critical situation. The ability to withstand the crisis is the hallmark of good leadership.

Monitoring the Functioning of the VOs and SHGs

The MS sub-committees have been formed and are assigned specific area wise responsibilities. The sub-committee members undertake regular visits to the VOs and SHGs and the feedback is shared at the MMS meetings. The staff reviews are held regularly as per schedule. The new CCs are briefed on the systems and are advised to adhere to the work norms stipulated. This has facilitated the integration the CCs into the MS fold. The CCs and MBKs now realize that they are employees of the MMS and answerable to it.

Sustainable and Self-Managed Institution of the Poor

The EC/OBs are committed to transforming the MS into a sustainable and self-managed institution of the poor. The institution is slowly emerging as a self-managed institution. The leaders have commitment, purpose and vision. The EC has full knowledge of the project activities and their progress in the mandal. The EC has taken full control of the financial administration of the MS. More significantly, it has made the project staff accountable.

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An Innovative Approach to Organization of the Chenchus Introduction

The Chenchus are a primitive tribal group with a considerable presence in the district. The community lives in conditions which are much below the acceptable minimum standards of living. The Chenchu habitations are not only small but widely scattered. Known as Pentas, there are 91 widely scattered habitations of Chenchus in the district. Located in interior forest areas, the Pentas do not have minimum facilities. In view of their pathetic situation and in order to provide sustainable livelihoods to these poorest of the poor sections, the DPIPMahabubnagar decided to have a special focus on them. To start with, the CCs were placed in these areas as it was done in other mandals and were advised to organize the women into SHGs and facilitate their membership in the VOs. It was indeed a tough job for the CCs. The Chenchus were away in the forest for days collecting the NTFP. Even when they were available, they hardly spared time to listen and act upon the strategy suggested by the CCs. The promotion of the SHGs proved to be a difficult task. The CCs did not give up. The SHGs were formed and the SHG meetings were scheduled at times convenient to the Chenchus to attend. The Chenchus were sanctioned a few CIF-SPs for understanding the procurement and marketing of the NTFP collected by the Chenchus. As the members started realizing the benefits, the Chenchus started gradually showing more and more interest in the SHGs. Meetings were held regularly and the institutional functioning recorded a steady progress. However, the process did not move beyond the SHGs. The SHG leaders who were supposed to participate the VO-EC meetings, hardly attended the meetings and not a single Chenchu became the leader of the VOs. They hardly attended any MMS meeting and some of them had not even heard of MMS. It was at this stage that the DPMU felt the need for a special strategy to build the capacities of the Chenchus and found an answer in the form of separate institutions for the Chenchus i.e., VOs and MMS. The proposal was supported by the SPMU which justified the stand by highlighting the special needs of these poor tribals. The idea was put into action immediately and the institutions of the Chenchus came into being.

Integrated Strategy Adopted

One of the major contributions of the project in Mahabubnagar DPIP is its contribution to the livelihoods of the Chenchus. The DPMU had adopted an integrated strategy for the overall development of the Chenchus. The strategy addressed the varied needs of the Chenchus in an effective manner. The key interventions which had formed a part of this special strategy include the following:

Enumeration of the Chenchus

In order to have a clear understanding of the situation of the Chenchus and the actual number of them living in the three mandals, the DPMU undertook a household survey which revealed that there were about 3,000 Chenchu households which need support. The capacities of the Chenchutribals were limited as they hardly moved around. Their life was limited to the village and the forest on which they depended for their livelihood. The analysis led to the development of a special strategy by the DPMU.

Developing Local Human Resource

The situation of the Chenchus was such that it demanded that the exclusive attention of the CCs. The normal responsibilities of a CC are so diverse that they could not devote exclusive attention on the Chenchus. Further, as the Chenchu inhabited areas come under the naxal influence, the CCs were not able to spend long hours in the Pentas. Given the situation, a via media was looked for and it was decided to promote the local youth as community activists and community organizers. About 40 such Chenchu youth were identified in a participatory manner and trained for four days at SMELC, Oorvakal, Kurnool district. The training focused on developing community organization and institution building skills. On completion of the training, the youth were placed as community organizers (COs) and an honorarium of Rs.1,500/- per month was paid to each. The COs seemed to have obtained the clearance from the naxalites before they started organizing the Chenchus. The strategy proved to be useful in mobilizing theChenchus and promoting their livelihoods. The CCs and APMs extended the required support as and when necessary.

Provision of Basic Needs through Convergence with LDs

The survey revealed that a large number of Chenchus were deprived of basic amenities and services such as houses, ration cards, electricity and street lights. The DPMU facilitated the access of the Chenchus to some of the basic services in convergence with the line departments, which not only served the purpose of meeting their needs but also won their hearts and confidence. About 600 households, which never had a ration card before, now

received one and thus the problem of food insecurity was largely addressed. In addition, the list of households without a house, was prepared and submitted to the housing corporation which had agreed to sanction pucca houses to the houseless Chenchus on a priority basis. A similar process was adopted to meet other needs. The Community Organizers were involved in the process such that they could acquaint themselves with the programs and take the agenda forward, even beyond the project.

Exclusive Institutions for the Chenchus

The DPIP has contributed a great deal to the development of the institutions of the poor. The approach to institution building is well established and has provided a number of successful stories. The project, however, has not had the same success with regard to the IB of theChenchus. The membership in the SHGs and VOs hardly had an impact on the Chenchus. The main factor responsible for this was the low participation of the Chenchus in the institutions in which members other than Chenchus constitute the majority. The Chenchus are a very shy people and do not mingle other communities. The leadership, which has a lot to do in the institutional development process, rarely came to the Chenchus as the selection was always in favour of more articulate members from other communities. The SHG leaders of the Chenchu groups were reluctant to attend the meetings of the VOs. At this juncture, it was decided that the only way of building the capacities of these people was by promoting separate institutions and their federations. As a result SHGs, VOs and MMS meant exclusively for the Chenchus, came into existence. The strategy paid off and yielded the desired results. The Chenchu women openly acknowledged the change and the contribution that these institutions have made to their livelihoods. They have realized that there are different ways of earning livelihood and the collection of NTFP was only one among them. They also look at the VOs and MMS as a platform for them to meet, interact, learn, grow and develop. These women are not their old selves as they have marched ahead, realizing that there is a long way to go.

Promoting Livelihoods through CIF-SPs

An important aspect of the integrated strategy was to promote livelihoods. Migration was a common practice among these tribals during the summer as the district was caught in the clutches of severe drought. A food security scheme was introduced through the sanction of a VO level CIF-SP. A micro-plan was prepared at the household level to identify the needs

in terms of rice, dhal, oil etc. This was then consolidated for the SHG and then the VO. The VO then made a bulk purchase of these commodities and distributed among the members. The intervention not only addressed the food requirements but also supplied the commodities at lower prices as a result of bulk purchase. The members were allowed to pay the amount towards these provisions in three installments. As the purchases were made by a five member committee formed in the VO, the members had faith and accepted the accounting system. The Chenchus stopped pledging their ration cards, which was a common practice prior to the intervention. The system was gradually institutionalized and was running smoothly. The next area of livelihoods intervention was the establishment of the procurement centers to purchase and market the NTFP, collected by theChenchus. As the centres were established in their villages and managed by a committee formed with members from among themselves, theChenchus from the surrounding villages readily accepted them. The multiple benefits accruing in terms of grading of products, relatively better price, correct weighing, immediate cash payment etc., were perceived and acknowledged by the members. These have not only enhanced the income but also reinforced the faith of the poor in their capacities and the potential it holds for a better future. The individual CIF-SPs sanctioned to theChenchus as a special case, further strengthened the livelihoods. The Chenchus today look towards a bright future for their younger ones and are committed to building their institutions.

Annex - 1 Summary of Select Best Practices : Mahabubnagar DPIP S. No.

1.

Project Component/ Area of Best Practice

IHCB/MMS functions as an effective monitoring agency

Why Considered Best Practice

MMS-OBs take over the samakhya from the CCs/APM and manage it independently. MMS office bearers have clear understanding of the accounting systems. MMS efficiently manages crisis situation on its own. MMS conducts field visits based on the CCs action plan to monitor

What Made It Happen

Gaps in the functioning of the CCs which resulted in poor functioning of VOs. Misappropriation by project staff leading to the monitoring role of MMS.

Scope for Replication

Systems adopted by MMSs could be replicate d to promote strong and sustaina ble institutio ns irrespect

their work. MMS independently prepared the AWFP, under the guidance of the DPM. Contributes to the project goal of building sustainable, self-reliant institutions of the poor. The strategy adopted, effectively addresses the varied needs of the DAPs. The development of a cadre of grass root level workers from among the DAPs. Promotion of separate institutions of the DAPs. The parental training causes attitudinal change and increased care and concern for the DAPs. The surgical intervention brings mobility to a large number of DAPs, who were immobile for years.

ive of the staff functioni ng. MMSs need not wait until somethin g goes wrong. An integrated approach meticulously planned and implemented by the DPM. Capacity building of the social workers. Use of a convergent approach to facilitate the surgical intervention.

2.

Disability/Integrated approach to dealing with disability

Highly replicabl e through the adoption of the integrat ed approac h.

S. No.
3.

Project Component/ Area of Best Practice

Communication and documentation/ awareness building through Kalajatha

Why Considered Best Practice

Locally trained youth take messages relating to key issues, to the target community and then, by increasing their awareness. Awareness building through the use of local media causes collective action on issues such asJogini.

What Made It Happen

The identification of issues for building an awareness through the Kalajatha felt needs of the community.

Scope for Replication

Replicable under conditions where talented youth are available. The strategy per se is

Services of the trained cultural team are accessed by the line departments and other NGOs in the district. The activity brings out the talent of the local youth and provides for their livelihood.

The impact on the target community through the use of effective media. The adoption of a well planned strategy by the DPM. His talent in reaching the target community. The continued backwardness of Chenchus i n spite of the SHG membership. Irregularity of Chenchus i n attending SHG/VO meetings which resulted in the search for an alternative strategy. Capacity building of theChenchus.

replicable.

4.

IHCB/ An integrated approach to the organization of Chenchus

The POP and nomadic tribes get organized into institutions and their federations at different levels. Separate institutions for Chenchus develp their organizational and leadership capacities. The NTFP and food security related interventions effectively address the livelihood needs of the poor Chenchus. System of differential saving (as per the members capacity) facilitates more membership in SHGs and regularity in savings.

The approach is highly replicable in similar conditions.

Annex - 2 Best Practices Listed by DPMU Staff : Mahabubnagar DPIP

Best Practice Identifie d/ Level/ Place Scope for Replicatio n/ Conditions under which it

S. No .

Project Compone nt

Area/ SubCompone nt

Why is it a Best Practice

What Made it Happen

Persons Responsib le

could be replicated 1. IHCB including MF Institution al Building and Micro Finance Balanagar MS Gopalpet Institution has developed and able to organize different programm es of the benefit of POP groups Regular functionin g of VO with good book keeping with awareness among members VO financing among members Active participati on of women empowere d with village activities and para professiona ls skills Give to constant training given to VO for maintains of accounts and its transparen ce Prompt repayment by members loan raised by them Prompt repayment by members loan raised by them MMS/VO Yes Developing the well MMS & VO members has knowledge resource persons to other area. - DO -

Book Keeping

Antharam VO of Doultaba d mandal

MMS/VO

Bank Linkage

MMS Pangal

MMS/VO

- DO -

Recycling

Chennara m VO of Gopalpet Mandal

100% repayment of CIF amount

Best effort of VO

- DO -

S. No

Project Component

Area/ SubComponent

Best Practice Identified/ Level/ Place

Why is it a Best Practice

W i

2.

CIF-SPs including marketing and NTFP

Agricultural commodity redgram

MMS, Doultabad and Kosgi

Collective marketing

Me re go se co in re ex sa

Mess center

MMS, Gattu

100% loan repaid by the group and unit is successfully running till to date. Providing food assurance scheme for poor from 5 months for performing civil identified works

Gr be di inc th sta

Food Assurance (Social)

Eklaspur, Chinna Jatram and Ammireddy pally VOs of Narayanpet

Ge em an re fro mi

NTFP

Appaiapally, Sri Rangapoor, Petral cheru, Errapenta, Vadderayavaram, Surlapally villages of Lingala, Amrabad mandals

Selfmanaged women procurement centers were constituted

W dr de Th ha inc du se NT

S. N o

Project Componen t

Area/ SubComponent

Best Practice Identifie d/

Why is it a Best Practice

What Made it Happen

Persons Responsible

Scope for Replicati on/

Level/ Place

Conditio ns under which it could be replicat ed Resource trainer and singer Selected as resource persons in A.P. network, Hyderabad Prevented child marriages andJogini sy stem at Bomraspet, Maganoor, Utkoor, Narayanpet and Makthal MMS/VO - DO -

3. Documenta tion and Communic ation

Success stories

Nagamm a, Pangal

Case Studies

Screen plays and case studies on child labour at Gattu, Telkapal ly, Marrikal, Jadcherl a and Pangal Success case studies and intervie ws publishe d in various telugu daily and weekly papers and also in well known telugu channels Cultural wing perform

Publishe d various articles in well known daily news papers and eminent telugu channels

Concerned MMS

- DO -

Press Electronics Media

Gattu, Telkapal ly, Marrikal on child labour eradicati on

Impressed by child labour and come forward for taking admission in various RBC centers and other schools

Bhaskar Doc. Asst., I/C Communica tions

Yes

CulturalKalaj athas

Publishe d many articles

Awareness among groups

Bhaskar Doc. Asst., I/C

Yes

ed vital role in Mannam Konda, Kurumur thi, Polepall y Jatharas

in news papers and also telecast the program mes of Nagamm a, Balamm a, Yadamm a, Salamma and Bouram ma

Communica tions

S. No .

Project Compon ent

Area/ SubCompon ent

Best Practice Identifie d/ Level/ Place

Why is it a Best Practice

What Made it Happen

Person s Respo n-sible

Scope for Replicati on/ Condition s under which it could be replicate d Yes

4.

Health Nutrition & Disability

Surgical Camps

Surgical correctio ns was made to 428 disabled persons

428 disabled persons were benefited due to surgical corrections

They can gain their livelihood without help of others The disabled persons can perform their works by own Disabled persons rehabilita ted mentally

DPMU

Tricycles

1,000 1,000 persons were tricycles benefited due to were giving tricycles distribute d among disabled persons Gundmal village Neighbourhood center

DPMU

Yes

Neighbou r-hood center

VO Gundm al

Yes

Disability

Bandagon da village, Narayanp et mandal

Mangamma disabled person. Nagamma blind disabled person

Became resource person to aware the disabled persons about their livelihood To benefit rural people in case of emergenc y health services 428 disabled poor beneficiar ies were benefited without any expenditu re

VO

Yes

5.

Convergence

Ambulan ce Services

64 mandals

Providing medical benefit to members (women)

MMS

Yes

Surgical Correctio ns

428 disabled persons were benefited

Free accommodation, doctors services and free operation theater given by SVS Medical College Hospital, Mahabub nagar

DPMU

Yes

S. No .

Project Compone nt

Area/ SubCompone nt

Best Practice Identifie d/ Level/ Place District

Why is it a Best Practice

What Made it Happen

Persons Responsib le

Scope for Replicatio n/ Conditions under which it could be replicated Yes Rehabilitat ed will be RP Yes Rehabilitat ed will be RP

Joginies

Rehabilitat e theJoginies in develops their lives Rehabilitat ed the disabled by providing houses Concession in traveling to disabled persons

Awareness among the benefited women Asset create to members

MMS

IAY Houses

District

MMS

Bus passes and medical certificat es

District level

Rehabilitati on

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Practicing what we teach: using case studies from 9/11 to teach crisis intervention from a generalist perspective.
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Abstract: Populations traditionally served by social workers are experiencing increasingly severe psychosocial stressors, necessitating that students be trained in crisis intervention. This paper provides educators with a theoretical framework integrating generalist practice and crisis intervention, which is applied to compelling case studies from September 11 with individuals, families, groups, organizations, and communities. The authors provide guidelines for discussion and teaching points to structure didactic and collaborative problem-based learning and encourage instructors to use examples from their own and their students' practice. Students learn to intervene with their clients and to appreciate the vital role that social workers assume in responding to disasters.

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Subject: Crisis intervention (Psychiatry) (Study and teaching) Social work education (Methods) Education (Methods) Authors: Gelman, Caroline Rosenthal Mirabito, Diane M. Pub Date: 09/22/2005 Publication:
Name: Journal of Social Work Education Publisher: Council On Social Work Education Audience: Academic; Professi onalFormat: Magazine/Journal Subject: Education; Sociology and social work Copyright: COPYRIGHT 2005 Council On Social Work EducationISSN: 1043-7797

Issue:
Date: Fall, 2005 Source Volume: 41 Source Issue: 3

Topic:
Event Name: World Trade Center and Pentagon Attacks, 2001

Geographic:
Geographic Scope: United States Geographic Code: 1USA United States

Accession Number: 139433531 Full Text: THE INCREASINGLY SIGNIFICANT LEVEL OF TRAUMA and crisis in the populations traditionally served by social workers, coupled with the challenges we have faced from the events of September 11 and the subsequent war on terrorism (see, for example, Galea, Ahern, Resnick, Kilpatrick, Bucuvalas, Gold, & Vlakov, 2002), support the critical need for classroom instruction that prepares students to

respond immediately to multiple-client systems in crisis (Graziano, 2001; J. Miller, 2002a). Studies of social work field training concur that the growing challenges of contemporary practice require social workers to assume a variety of roles and intervene at multiple levels with people who are experiencing severe psychosocial stressors and crises (Bocage, Homonoff, & Riley, 1995; Jarman-Rohde, McFall, Kolar, & Strom, 1997; Plionis, Bailey-Etta, & Manning, 2002; Reisch & Jarman-Rohde, 2000). This paper provides social work educators with both a conceptual framework and rich practice vignettes that integrate key theoretical aspects of generalist practice and crisis intervention for teaching social work students intervention with individuals, families, groups, organizations, and communities in situations of crisis and disaster. This framework will be applied to vignettes of social work practice undertaken by the authors, their students, and colleagues following the events of September 11, 2001, in New York City. The authors first present and explain how key elements of generalist practice and crisis intervention are integrated. They then apply this integrated approach to vignettes with client systems of all sizes from diverse socioeconomic and ethnic groups--ranging from college students to disenfranchised immigrants and disempowered employees--all of whom were affected by the events of September 11. Through these vignettes, the authors illustrate how key elements of generalist practice and crisis intervention are brought together so that social work students learn a model of intervention that they can apply in work with their clients who experience crises. The generalist approach, mandated by the Council on Social Work Education (2001), provides a highly relevant framework for social work intervention in dealing with situations of crisis and disaster because it addresses all systems and levels of intervention, integrates practice, policy, and research, and is based on the fundamental social work tenet of "starting where the client is." Crisis intervention is an equally essential practice approach in these situations because of its immediate, active, and directive focus on restoring client systems to their previous level of functioning by capitalizing on the heightened motivation, capacity, and opportunity engendered by crisis (Ripple, Alexander, & Polemis, 1964). Social work practice undertaken in response to the events of September 11 was chosen to illustrate how to teach crisis intervention from a generalist perspective for several reasons. Because everyone in this country experienced the events of September 11 either directly or indirectly, the practice vignettes provide compelling examples of the diverse roles generalist practitioners assume across micro, mezzo, and macro levels of intervention. The illustration of all three levels of practice is especially important, because as noted by Abel and Kazmerski (1994), an increased focus on micro-level practice in social work education has eroded macro-level curriculum content. Moreover, the use of vivid and contemporary examples to illustrate fundamental social work concepts and skills renders the material highly relevant and accessible to students (Carter, 2000; Fellin & Brown, 1989; Whipple, 2001). Finally, the use of examples of practice undertaken by classroom instructors allows educators to model what they are teaching, highlights for students the importance of integrating theory with practice, and underscores the crucial roles that social workers have assumed and can continue to take in response to situations of crisis and disaster (Anderson, Ressler, & Wallace, 2002; Malekoff, 2001; J. Miller 2002b). Results of a recent survey indicate that students perceive instructors who have current practice experience as being more effective teachers and role models and report that these instructors engage in classroom behaviors that help students apply and integrate their classroom learning more successfully (Knight, 2002).
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The vignettes presented can be used to structure both didactic and collaborative, problem-based learning through discussion and role-plays in the classroom. This learning strategy allows for deep engagement with the material, leading to greater understanding and ability to apply critical concepts to other situations (Wilkerson & Gijselaers, 1996). In addition, instructors are encouraged to use examples from their own and their students' practice, which might include work with individuals, families, groups, and communities affected by natural disasters such as earthquakes and floods, man-made disasters such as arson, or violent crimes such as school shootings. Key Elements of Generalist Practice and Crisis Intervention As mandated by the Council on Social Work Education (2001), students are introduced to key elements of generalist social work practice (Kirst-Ashman & Hull, 1999; Miley, O'Melia, & DuBois, 2001; Poulin, 2000). These include: 1. The person-in-environment perspective as the theoretical underpinning guiding assessment and intervention. 2. Multiple levels of intervention--micro, mezzo, and macro--based on a thorough assessment. 3. The capacity to assume diverse roles, such as direct service provider, case manager, educator, program developer, advocate, and researcher, as indicated by the assessment of needs. 4. The integration of direct practice, policy, and research through the assumption of these multiple roles. 5. Practice conceptualized as consisting of five stages: Engagement, assessment, and the planning, implementation, and evaluation of interventions. In keeping with these components of generalist practice, social workers view each situation in context and intervene at the different system levels affected using a wide repertoire of roles and skills. Rather than being constrained by a particular method or modality of intervention, such as individual or group counseling, the type and location of interventions is based on a careful assessment of needs. This process allows the practitioner to think broadly, flexibly, and creatively about practice. To respond effectively to populations increasingly affected by psychosocial stressors, students are provided with a strong foundation in crisis intervention. The key elements of crisis intervention that are introduced include: 1. Definition of crisis as a state of acute emotional disequilibrium during which individuals are often more receptive and better able to utilize professional intervention (Hoff, 2001). 2. Delineation of the phases of a crisis: The hazardous event, vulnerable state, precipitating factor, state of active crisis, and reintegration or crisis resolution (Golan, 1978). 3. Discussion of common and expectable emotional, cognitive, physical, and interpersonal responses to trauma and of disorders that can occur as a result of trauma, such as post-traumatic stress disorder (PTSD) (Ell, 1996). 4. Immediate, active, and directive interventions such as education, clarification, and reassurance about normative, expectable reactions to trauma designed to reduce symptoms, provide support, and return clients to their highest possible level of functioning (Parad & Parad, 1990). The Integration of Generalist Practice and Crisis Intervention In applying crisis intervention skills from a generalist perspective, students are taught to intervene immediately, actively, and directively from a client-centered, problem-focused perspective, differentially applying a wide repertoire of skills at varying system levels depending on context, setting, and need. A person-in-environment perspective guides the practitioner to seek support for the client, be it an individual, family, group, organization, or community, not only from inner, but also environmental, resources.

In crisis situations, the practitioner intervenes at whatever level is necessary--micro, mezzo, or macro--to help the client system return to the previous state of equilibrium. The practitioner takes on multiple roles, including direct service provider helping clients express their emotions, educator providing practical information, case manager securing tangible support, and advocate or broker mobilizing available social and environmental systems. In carrying out these diverse roles, the social work practitioner may move from direct practice to developing policies and programs, identifying areas for further study, and subsequently undertaking needed evaluation and research (Padgett, 2002). The five stages of generalist practice take on special characteristics in situations of crisis and disaster. Engagement, assessment, and the planning, implementation, and evaluation of interventions all occur in an expeditious manner so that prompt assistance is provided to the client, capitalizing on the window of opportunity afforded by the client's receptivity to helping efforts engendered by crises. Students are trained to conduct a thorough and focused assessment of needs within the entire client system, identifying problems that require resolution, and determining at which levels of intervention change efforts should be planned and implemented. Specific skills taught include assessment of coping styles in previous situations of crisis, assessment of pre-existing vulnerable states, and the exploration of emotionally charged and difficult areas prevalent in crises, such as suicidality, grief, and loss. Finally, students are introduced to the concept of vicarious traumatization (O'Halloran & Linton, 2000; Ryan, 1999; Sexton, 1999) and taught about the importance of training, support, and supervision in mitigating its potential effects (Dane, 2002; Miller, 2001; Miller, 2002b; Tosone, Bialkin, Campbell, Charters, Gieri, Gross et al., 2003). The primary goal of intervention in crisis situations is the reduction of symptoms and the strengthening of problemsolving strategies and effective coping. Interventions on both individual and collective levels focus on providing practical information, tangible support, and assistance to help people mobilize and further develop support systems. The outcomes of interventions are assessed, monitored, and evaluated to identify individuals who may require more intensive professional assistance. Teaching Crisis Intervention From a Generalist Perspective: Case Studies From 9/11 In the classroom, this integrative framework combining core principles of generalist practice and crisis intervention is illustrated for students through case studies of actual interventions undertaken by social workers with a variety of client systems in the aftermath of September 11. The remainder of this article presents practice vignettes at the micro level with individuals, families, and groups; at the mezzo level within a large organization; and at the macro level within the community. After a description of each case study, the authors provide a set of questions for classroom discussion that allow for exploration of potential ways of intervening in each situation. The actual interventions utilized are then presented, providing the class with opportunities to critically assess and evaluate practice outcomes. In addition, we provide a set of teaching points highlighting salient concepts of generalist practice and crisis intervention that can be applied to vignettes generated by instructors' and students' cases. Students are asked to consider the forms of crisis that their clients, who are often members of vulnerable, disenfranchised, marginalized, or at-risk populations, experience in their daily lives and how crisis intervention using a generalist social work practice approach might serve them. The vignettes, questions for classroom discussion, and teaching points are all intended to maximize opportunities for didactic instruction, classroom discussion, and development of practice skills through the role-playing of different outcomes. Micro Level Practice Assessment and Intervention With Individuals: University Counseling Center Ursula. Ursula, a 28-year-old Croatian graduate student, was brought to the counseling center by her professor 9 days after the attacks on the World Trade Center. Ursula presented in a state of acute anxiety and depression, stating that she was concerned she might hurt herself. Ursula had been hospitalized 3 days before September 11 because of a miscarriage. During her hospitalization, she experienced unexpected cardiac problems, for which she

was treated. Upon discharge, 2 days after the attacks, Ursula began to feel increasingly depressed, had nightmares about the attacks, and reported recurrent thoughts about hurting herself, including hearing voices that told her to harm herself. Ursula had moved to New York City 5 years earlier from the former Yugoslavia, where she had experienced the effects of war for many years. In addition to recounting her memories of living in a war-torn country, Ursula reported that her father had physically abused her on a daily basis between the ages of 13 and 18. During the time of the abuse, Ursula made two suicide gestures, including ingestion of pills and an attempt to cut her wrists with a razor. At that time, Ursula was taken to an emergency room, but she did not receive any treatment for depression. Classroom Discussion Questions * How might the social worker engage Ursula and conduct a focused biopsychosocial assessment and mental status exam, including exploration of depression and suicidality? * How would the social worker assess and intervene in relation to the effect of past trauma and current stressors on Ursula's functioning? * How would the social worker determine the need for a psychiatric evaluation? What factors would be considered? * How would the social worker develop a concrete plan for safety as well as a plan for Ursula to receive ongoing mental health services? * How could Ursula's support system be mobilized and utilized? Actual Social Work Interventions The social worker engaged Ursula by communicating clear concern about her safety and well-being. She identified that the purpose of their meeting was to ensure Ursula's safety, assess her needs, and arrange for future services. Concerned about the level of depression that Ursula was reporting, the social worker assessed not only the immediate crisis of her suicidality but also the history and course of her depression and other trauma she had experienced in the past. In addition, the social worker conveyed understanding and empathy regarding the hardship and distress Ursula had experienced recently as well as in the past. Based on an assessment of current suicidal ideation, the social worker's first priority was to develop a safety plan by obtaining a verbal contract from Ursula that she would not harm herself. The safety plan specified the actions that Ursula would take if she again felt that she might hurt herself. These included speaking with her boyfriend about suicidal feelings and, if they persisted, having her boyfriend bring her directly to the hospital emergency room. In addition, the social worker discussed with Ursula her plan to consult with the center's psychiatrist about her depressive and suicidal symptoms so that she could help Ursula develop a follow-up plan. Having secured Ursula's agreement, the social worker consulted with the psychiatrist, who agreed to provide a full psychiatric evaluation the following day. Ursula called her boyfriend and requested that he come to the counseling center to pick her up. Together, Ursula and the social worker reviewed with Ursula's boyfriend the safety and follow-up plans that they had jointly developed, which included a complete intake evaluation with a social worker and a psychiatric evaluation scheduled for the next day. Teaching Points * The development of skills in: rapid engagement and assessment of: depression, suicidality, abuse and neglect, mental status, imminent risk and safety, and client's current and past functioning;

working collaboratively with the client to thoroughly assess needs, develop a concrete safety plan, mobilize their support system, and provide referrals for future ongoing concrete and mental health services; interdisciplinary collaboration, including how to determine the need for a psychiatric evaluation and consult with a psychiatrist regarding the client's medical and psychiatric needs. * The importance of understanding how to assess the effect of past trauma on current functioning. Assessment and Intervention With Families: Public School Setting The Bell family. Emily, a 9-year-old in the fifth grade, was the only child in her elementary school to lose a parent in the World Trade Center attacks. Her father worked as an accountant in one of the financial companies. Emily has two younger brothers, Daniel, age 6, and Alex, age 4. Emily had been absent from school for 1 week following the attacks and upon returning she was aggressive and oppositional, fighting with her classmates and refusing to follow her teacher's directions. Emily's teacher had become increasingly impatient with her disruptive and attention-seeking behavior and by November requested that Emily be removed from her class. When Emily's aggressive outbursts continued in a new classroom, the principal asked a school-based social worker to evaluate her. The social worker contacted Emily's mother to request permission to meet with Emily and also to assess how the family was coping with Mr. Bell's death. Mrs. Bell reported that despite support from her extended family, synagogue, and neighbors, she and the children were profoundly distressed. In addition, she was concerned about financial matters, as the family had been dependent on her husband's income. Mrs. Bell was surprised that Emily was presenting behavior problems in school because at home she was sad and tearful, while Alex was exhibiting aggression. Moreover, Daniel, who had always been an anxious child, afraid of the dark, of being separated from his mother, and of going anywhere by himself, was expressing intense fears following September 11. Recently, Daniel had told her, "It's not fair that I'm never going to grow up to be a dad, and that everyone else will be big, but I am going to die." She had considered seeking help, as she was frightened and confused about the children's very different reactions and was feeling quite overwhelmed. Consequently, the social worker's phone call came at a propitious time. Classroom Discussion Questions * As a generalist practitioner, how would you define the client system in this case? What systems have been affected by the events of September 11? At what level(s)--micro, mezzo, macro--would you intervene? * How would you engage and assess the family system? In conducting a comprehensive family assessment, what other information would you want to know about the strengths and needs of the family? How would you address both emotional and concrete concerns for family members? Using a person-in-environment perspective, what potential sources of support are available to the Bell family? * If you were the school social worker, how would you assess and intervene within the school? Why? How might the school social worker have intervened with Emily's teacher and other teachers in preparation for Emily's return to school? * What generalist social work roles does the social worker assume in this case? Actual Social Work Interventions The social worker met with the family over several sessions to conduct an assessment of the family system. During the course of the assessment, she normalized the wide range of responses Mrs. Bell and her children had to this extremely traumatic event. The social worker referred the Bells to a community mental health center for family counseling and a support group for families affected by September 11. In addition, Mrs. Bell gave permission for

Emily to meet with the school social worker to help her handle the transition to the new classroom and support her school functioning during this difficult time. The social worker referred Mrs. Bell to the Family Assistance Center (further described on page 490), a multi-service center set up for survivors of September 11, so that she could receive help with her family's finances, insurance benefits, and other important legal and monetary matters. Given the teacher's response to Emily's behavior, the social worker conducted a survey of teachers and staff and determined that they were in need of psychoeducation regarding the children's reactions to the disaster. The social worker developed a 2-hour training session on children's expectable responses to trauma that she conducted in the auditorium for all school staff. Specific strategies for staff to help themselves and their students cope with the traumatic events were provided. Teaching Points * While the social worker began her interventions with Emily, it became apparent that the entire family required assistance. By taking a systems approach, the social worker identified the need for intervention in the wider school system so that Emily's teacher would be more sensitive to her and so that all staff could respond to their colleagues and the students more appropriately. * Individual and family work are examples of micro-level interventions, school-wide training is an example of a mezzolevel intervention, and the Family Assistance Center is an example of macro-level service planning and delivery. * The social worker employed skills in engagement, assessment, and intervention in working with micro and mezzo systems. * The social worker assumed a variety of generalist roles, including direct service provider, broker, case manager, inter disciplinary collaborator, organizational consultant/developer, and trainer. Assessment and Intervention With Groups: Community-Based Service Agency Grupo de Apoyo Esperanza: The Women's Support Group. Members of a long-running, Spanish-speaking support group for HIV-positive women held at a grassroots organization serving the Latino community in a borough of New York City had increasingly been complaining of fear, anxiety, sleep disruption, and physical aches following September 11. The paraprofessional facilitator of the group, Ms. Ponce, uncertain about how to proceed, sought consultation from an experienced bilingual social worker. To more clearly assess the needs of the group and determine how the facilitator could further assist members, the consultant held a 2-hour psychoeducational session at the community center 3 months after the attacks on the World Trade Center. There were nine women present, ranging in age from 28 to 56. The social worker noted that three of the women in the group reported significant distress beyond the expectable reactions the other group members experienced. Ms. Martinez had been a victim and survivor of the war in E1 Salvador before migrating to the United States. The airplanes, fire, and rubble she saw on television reminded her of the war that had killed her father and brother. She was experiencing intrusive thoughts about their death and felt very frightened. Mrs. Gomez had a son who had been murdered in Manhattan 3 years before. The media coverage of this part of the city and the loss of life there were causing her to re-experience the pain that was related to this earlier unresolved loss. Mrs. Molina, whose mother had passed away I year before on September 11, was experiencing an anniversary reaction (Gabriel, 1992). Classroom Discussion Questions * How would the group leader distinguish between normal, expectable reactions to trauma and those that require further intervention? Why do individuals respond differently to the same traumatic event? * How can the group leader elicit members' adaptive and maladaptive coping mechanisms for managing the crisis? * Given the group members' particular needs and characteristics (Latinas, monolingual Spanish-speakers, HIV-

positive), what kind of information is important for the leader to provide to members? How would information best be provided? * How could the social worker help Ms. Ponce, the group leader? * What elements of the group modality do you think are particularly helpful to the members? * What generalist social work roles are assumed? Actual Social Work Interventions Translated materials developed by the Red Cross on common reactions to trauma in adults and children and on coping techniques were distributed and reviewed. The group discussed the special vulnerability of people already living with a serious psychosocial stressor, such as HIV-positive status. This informational format allowed the women to gradually discuss the reactions they were experiencing and how these were similar or different from common, normative responses to stress. The participants learned from each other that they shared many similar feelings, including anger that safety measures and resources were being "poured into Manhattan, where the rich live, and not here where there is only us." An important part of the group process was a discussion of coping strategies and mechanisms group members used to handle their responses to the disaster. Many of the women reported that they found comfort in their religious beliefs and were praying and attending church more often. Several said that coming to the support group had been helpful and pointed to this psychoeducational session as a specific example of that. Others found that talking to friends, listening to music, and walking had helped contain their anxiety. Some shared that they had been overeating to comfort themselves, which led to some joking and the observation that humor could also be helpful. The three women whose prior traumatic experiences significantly exacerbated their responses to September 11 were referred to a community mental health center with Spanish-speaking social workers for ongoing, individualized mental health services. Teaching points * The social worker employed skills in engagement, assessment, and intervention with the group as a whole and with individual members. Differential responses to trauma in the group context are illustrated, as well as the importance of tailoring and balancing interventions according to both group and individual needs. * The importance of assessing the effect of pre-existing vulnerable states and anniversary reactions is illustrated. * Yalom's (1995) curative factors for group-work are used to understand elements that contribute to the value and effect of the group. * The importance of being attentive to diversity and providing culturally competent services is highlighted. The social worker assumed a variety of roles, including consultant to Ms. Ponce, direct service provider (group worker) and educator to the group, and broker for the three women who were referred for additional services. Mezzo Level Practice Assessment and Intervention Within an Organization: Public Child Welfare Agency Within a few days of the September 11 disaster, administrators from a large child welfare agency located two blocks from the World Trade Center approached the faculty of a social work school to request supportive services for its 300 employees. Many had witnessed the collapse of the towers and had been forced to flee their workplace. In addition to handling their own reactions to the disaster, the staff was responsible for the provision of services to children and families who were already experiencing tremendous psychosocial stress prior to September 11.

After a comprehensive needs assessment was conducted with agency leaders, 12 social work faculty conducted more than 40 groups, lasting 1 1/2 hours, comprised of 15-25 staff of all levels, including clerical, casework, supervisory, and managerial. The groups were designed to promote both personal and professional functioning by identifying and solving problems related to specific concerns the staff had about the disaster and the transition back to their jobs. Two prominent themes that emerged in the groups were safety and the difficulties the staff experienced in returning to their jobs. Participants worried about the structural soundness and air quality of the work site and were concerned about the lack of a disaster plan both at the time of the attacks and after. Since staff were asked to return to the building before it was adequately cleaned, many group participants felt the agency was not concerned about their well-being. They described significant difficulties concentrating because of their intense fears and their desire to be at home with their own families. In addition, telephone and computer lines were down and had not yet been replaced, presenting practical obstacles to resuming their jobs. The discussion of these themes led staff to identify longstanding difficulties and frustrations experienced in their everyday work lives. They confronted complex and disturbing issues related to the neglect, abuse, and occasional death of children and the fact that they maintained large caseloads and were offered few resources to help them function effectively in their jobs. Classroom Discussion Questions * How would you go about conducting an assessment of organizational needs? What might be options for intervention given the large number of employees with varying needs, job responsibilities, and exposure to the disaster? * Who might you consult with to determine the best intervention plan? What systems characteristics (e.g., organizational structure and process) would you need to consider in planning your interventions? * What format would you use to design the groups? How would you determine and communicate the purpose of the groups? What would be the leader(s)' role in leading a single-session group intervention? What are the advantages and disadvantages of implementing this kind of group? What specific skills would be used? What elements of the group process do you think would be helpful? * How would the social worker assess and provide for group members who required further intervention? * How could group leaders help staff identify, handle, and bring forward systemic problems within the agency? * What generalist social work roles are used? Actual Social Work Interventions Psychoeducational support groups. The group facilitators encouraged participants to share adaptive coping strategies that they found helpful. They provided psychoeducation and distributed handouts about expectable behavioral, cognitive, emotional, physical, and psychological responses to trauma as well as specific strategies to address and ameliorate these reactions. The facilitators assessed, in an ongoing manner, participants who might need additional interventions or referrals and, when indicated, provided them with relevant referrals for individualized services and encouraged them to attend additional support groups at the agency. Feedback to agency leaders to promote organizational change. These psychoeducational support groups uncovered the need for two additional interventions to address the chronic systemic problems of poor staff morale and inadequate resources to support workers and clients. First, through group discussions, the group facilitators synthesized prominent themes from the groups, drafted a memo, and met with agency leaders to convey staff concerns about workload assignments, the need for additional support services for staff, and improved

communication between staff and administration. Development and implementation of agency-wide training program. Through this process of assessment and intervention, it became evident that in addition to the trauma resulting from September 11, staff encountered daily trauma in their very challenging jobs, placing them at risk for vicarious traumatization. As the second intervention, in collaboration with managers, the social work faculty developed and implemented an agency-wide training program focused on client and staff reactions to trauma to enable staff to work more effectively with children and parents and to reduce the risk of their own vicarious traumatization. Developed for all levels of employees, the training program provided coping strategies adults could utilize to help children and that supervisors could use to support staff. Specific topics included: the definition of traumatic stress and risk factors for its development; normative, age-specific responses to trauma, loss, and disaster; and education specific to children, foster parents, and birth parents. The training program was pilot tested before implementation and subsequently evaluated for its relevance and effectiveness with staff and clients. Teaching Points * Assessment, engagement, and planning interventions at the organizational (mezzo) level requiring knowledge of agency structure, hierarchy, formal and informal rules, and organizational culture. * In planning the psychoeducational support groups, students are introduced to the Critical Incident Stress Debriefing model (Mitchell, 1983), as well as challenges to this model (for example Boudreaux & McCabe, 2000). Inconclusive and contradictory empirical findings underscore the need for further, more rigorous evaluation of this model. * The initial group interventions led to the identification of structural problems within the organization as well as the need for training to better serve both agency staff and their clients. * Development of the training program and advocacy on behalf of staff with agency administrators both illustrate the concept of how crisis is used as an opportunity for growth and development. * Through the assessment of staff needs, implementation of supportive psychoeducational group interventions, initiation of organizational change, and development and evaluation of a training program, social workers assumed generalist roles of group work service providers, brokers, program planners/developers, facilitators, educators/ trainers, consultants, advocates, organizational change agents, and researchers. Macro Level Practice Assessment and Intervention Within A Community: The Family Assistance Center During the week following September 11, the Mayor's Office of Community Affairs set up the Family Assistance Center (FAC) in a public armory to serve as a central location for the provision of a wide range of services to individuals and family members affected by the collapse of the World Trade Center. Diverse, multiple services were organized in one location to meet the needs of a vast number of people affected by the disaster and to maximize access, efficiency, and effectiveness of service delivery. A wide array of both counseling and concrete services was provided. Counseling services included: crisis intervention, supportive counseling, bereavement services, and psychiatric evaluations provided by clergy, social workers, psychologists, and psychiatrists. Concrete services included: law enforcement stations to report missing persons; information on hospitalized individuals; DNA testing to aid in the identification of relatives; the issuance of death certificates; legal and immigration services; financial entitlements for immediate needs such as food, clothing, and personal items; and services related to relocation and housing. One unique and specialized service provided at the FAC were daily boat rides to bring bereaved family members and friends to the site of the World Trade Center and a Memorial Park set up for grieving family members and friends.

Mental health intervention on the boat rides required a high level of comfort, skill, and flexibility on the part of practitioners. Individuals and families had a wide range of responses to the tragedy and losses resulting from the disaster, depending on socioeconomic, cultural, ethnic, and religious differences. Accordingly, generalist practitioners responded with a broad range of concrete and supportive interventions consistent with the varied ways in which the family members mourned. Ms. Perez, a 33-year-old Puerto Rican woman, is an example of a client who came to the FAC seeking help with the payment of her rent. When she was referred to a benefits worker, who began asking questions about her financial situation, Ms. Perez became distressed and tears came to her eyes. She explained to the benefits worker that she was not seeking financial assistance. Rather, she was unable to write a check to her landlord because she had forgotten his name. She was worried she would be evicted because her rent was late. The benefits worker called for a social worker to meet with Ms. Perez. When asked by the social worker where she had been at the time of the disaster, Ms. Perez replied that she worked as a security guard in Tower One and had been patrolling the lobby at the time that the building had been hit. She then recounted her actions in great detail, which she stated she was able to do as she could not stop thinking about and reliving the moments after the impact. Ms. Perez helped evacuate people from the building following the crash. She was escorting a woman whose clothes had been burned off to a waiting ambulance when she heard loud noises, saw people jumping from above, and then realized that the noises were bodies landing beside her. Within minutes, the second tower was hit and Ms. Perez could not further recall her escape. For the past 10 days, Ms. Perez had been unable to sleep, was experiencing nightmares, was hypervigilant, and believed that someone was following her. Although she constantly re-experienced the moments after the impact, she had difficulty remembering most of what had occurred to her and others on and after September 11. The social worker educated Ms. Perez about the symptoms of PTSD and indicated that these were expectable given the extent of her exposure to the trauma. She then encouraged Ms. Perez to obtain further assistance and support and was able to connect her directly with a Spanish-speaking social worker at a community mental health center in her neighborhood. The social worker was also able to use city records to find out the landlord's name so that Ms. Perez could remit her rent. Questions for Classroom Discussion * How would social workers conduct an assessment at the community level? What characteristics of the community, existing resources, services, and residents' needs would be considered? * Why were the services at the FAC set up the way they were? What would be required to plan, design, and implement services for a large urban community after a disaster? How would issues of accessibility (physical, cultural, linguistic), efficiency, and efficacy be addressed? * How would social workers handle the role of assisting family members on boat rides to the site of the World Trade Center? What knowledge and skills specific to grief and mourning would be employed? * How would the social worker assess and intervene to help Ms. Perez? What signs and symptoms are exhibited by Ms. Perez's behaviors and presentation? Based on these signs and symptoms, what would be a differential diagnosis? * How would social workers manage their own reactions to the ongoing trauma while helping others? * What micro and macro generalist roles would be required of social workers at the FAC? Teaching Points * The FAC provided comprehensive micro-level services planned from a macro-level perspective to address the multiple needs of an entire community differentially affected by the collapse of the World Trade Center.

* The diverse scope of services was organized in response to the wide range of urgent physical, emotional, psychological, familial, and concrete needs and to maximize access, efficiency, and effectiveness of service delivery. * Social workers who helped establish the FAC assumed generalist roles as service planners, organizers, and developers, and those who provided services at the FAC assumed generalist roles as counselors, advocates, case managers, and brokers of services. Conclusion The populations traditionally served by social workers are ever-more likely to experience severe psychosocial stressors, making knowledge of crisis intervention increasingly imperative. This article has presented a model for teaching MSW-level students the knowledge base and skills for crisis intervention from a generalist perspective. The integration of these two perspectives--generalist practice and crisis intervention--allows students to intervene in an immediate, direct, and focused manner with all size systems affected at micro, mezzo, and macro levels. This integrated practice approach has been illustrated through the use of case studies of contemporary social work practice conducted with individuals, families, groups, organizations, and the community following the attacks on the World Trade Center in New York City on September 11. By using these examples, the authors have highlighted the significant role the social work profession has taken and can continue to take in response to this and other national disasters. The authors have offered a conceptual framework and provided questions and teaching points that can be used by instructors and their students to guide and structure didactic learning and discussion in the classroom. In addition to using these teaching tools with the case studies provided, the authors encourage classroom instructors to generate rich examples from their own practice and their students' field experiences in order to make the material more accessible and relevant for deeper engagement and interactive, collaborative learning. Acknowledgments The authors contributed equally to this article and would like to thank professors Gary Holden and Judith Mishne for their helpful comments. Accepted: 04/04 References Abel, E. M., & Kazmerski, K. J. (1994). Protecting the inclusion of macro content in generalist practice. Journal of Community Practice, 1(3), 59-72. Anderson, S. C., Ressler, L., & Wallace, J. R. (2002). Social work education collaboration in disasters: Lessons learned from the Murrah Federal Building and World Trade Center disasters. Social Work and Christianity, 29(2), 144-157. Bocage, M. D., Homonoff, E. E., & Riley, P. M. (1995). Measuring the impact of the fiscal crisis on human services agencies and social work training. Social Work, 40, 701-705. Boudreaux, E. D., & McCabe, B. (2000). Critical incident stress management: Interventions and effectiveness. Psychiatric Services, 51, 1095-1097. Carter, C. S. (2000). Church burning: Using a contemporary issue to teach community organization. Journal of Social Work Education, 36, 79-88. Council on Social Work Education. (2001) Educational policy and accreditation standards. Alexandria, VA: Author. Dane, B. (2002). Duty to inform: Preparing social work students to understand vicarious traumatization. Journal of

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Poulin, J. (2000). Collaborative social work: Strengths-based generalist practice. Itasca, IL: Peacock. Reisch, M., & Jarman-Rohde, L. (2000). The future of social work in the United States: Implications for field education. Journal of Social Work Education, 36(2), 201-214. Ripple, L., Alexander, E., & Polemis, B. W. (1964). Motivation, capacity, and opportunity: Studies in casework theory and practice. Chicago: University of Chicago Press. Ryan, K. (1999). Self-help for the helpers: Preventing vicarious traumatization. In N. B. Webb (Ed.), Play therapy with children in crisis: Individual, group, and family treatment (2nd ed., pp. 471-491). New York: Guilford Press. Sexton, L. (1999). Vicarious traumatization of counselors and effects on their workplaces. British Journal of Guidance and Counseling, 27, 393-403. Tosone, C., Bialkin, L., Campbell, M., Charters, M., Gieri, K., Gross, S. et al. (2003). Shared trauma: Group reflections on the September 11th disaster. Psychoanalytic Social Work, 10(1), 57-77. Whipple, E. E. (2001). Keeping pace with current practice: A case study approach to infusing managed care principles into a MSW research methods course. Journal of Teaching in Social Work, 21 (3/4), 53-74. Wilkerson, L., & Gijselaers, W. H. (1996). Bringing problem-based learning to higher education: Theory and practice. San Francisco: Jossey-Bass. Yalom, I. (1995). The theory and practice of group psychotherapy. New York: Basic Books. Caroline Rosenthal Gelman New York University Diane M. Mirabito New York University Caroline Rosenthal Gelman is assistant professor and Diane M. Mirabito is clinical assistant professor, New York University School of Social Work. Address correspondence to Caroline Rosenthal Gelman or Diane M. Mirabito, 1 Washington Square North, New York, NY 10003; e-mail: csr6@nyu.edu or dm78@nyu.edu. Gale Copyright: Copyright 2005 Gale, Cengage Learning. All rights reserved.

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