The Monitoring & Evaluation of Trauma Informed Movement Programs for Peacebuilders
Emily Pantalone & Samara Andrade
Communities affected by conflict require comprehensive social, economic and psychosocial support. However, funding and programming to address the effects of stress and trauma on the body is often deprioritized or undervalued by the national Government, donors, and organizations working on post-conflict recovery. Often times, communities affected by conflict are asked to engage in a variety of peacebuilding and civic engagement programs while still coping with the aftermath of witnessing and experiencing profoundly traumatizing events, which have deeply impacted their brain, and consequently, their ability to engage in social or inter-personal interactions.
For example, in Sudan, assessments with ex-combatants and community members who were part of a community-based social reintegration program in the Three Areas[fn]The Three Areas referred to to Blue Nile, South Kordofan and Abyei[/fn], indicated that participants were often triggered by loud noises, planes, or those wearing uniforms. Unaddressed psychosocial issues can also lead to the use of negative coping mechanisms; including antisocial behavior, alcohol, drugs, violence, or withdrawal from social interactions, which can affect one’s ability to meaningfully and positively engage in the fabric of their community, family, and individual life and potentially impacting fragile peace.
The impacts of experiencing trauma can also be closely intertwined with challenges in successfully engaging in livelihoods. Where post-conflict community relationships, and interactions, may be fragile, the inability to maintain livelihoods, combined with scarce resources, can exacerbate community tensions, impacting social cohesion, fuel latent tensions, and potentially lead to conflict. Such examples point to why peacebuilding programs should strongly consider the ways in which they integrate complementary approaches to addressing psychosocial needs, which impact the individual, the family, community and societal relationships through the lens of trauma (see Fig. 1 Social Ecological Model© Feet on the Ground (2016).
Leading trauma research[fn]Van der Kolk, B. The Body Keeps Score (2015), Penguin Books. Van der Kolk, B., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., and Spinazzola, J. Yoga as an adjunctive treatment for posttraumatic stress disorder (2014). Emerson, D. & Hopper, E. Overcoming Trauma through Yoga (2011). Justice Resource Initiative. Emerson, D. Trauma-Sensitive Yoga in Therapy: Bringing the Body into Treatment (2015), W. W. Norton & Company. West, J., Liang, B., Spinazzola, J. Trauma Sensitive Yoga as a Complementary Treatment for Posttraumatic Stress Disorder: A Qualitative Descriptive Analysis (2016), International Journal of Stress Management. [/fn] underpins why complementary, trauma informed movement programs, which focus on cultivating interoception and choice making, can be a powerful tool to help individuals reconnect with themselves, their families, and their communities. In turn this allows them to more effectively engage in the social fabric of their communities, including in peacebuilding programs. Such programs are also cost effective, which makes operating in environments where funding and resources are limited or culturally and financially feasible, ideal. Trauma informed movement programs may be adapted to local contexts, drawing on cultural movement practices which many communities have used for years to deal with trauma.
Figure 1- Social Ecological Model Through the Lens of Trauma ©2016 Feet on the Ground
Where organizations have determined, through assessments, that the psychosocial needs of the community are present, and trauma-informed movement programs may be beneficial, they may consider running a pilot project with monitoring and evaluation targets to measure impact. Baseline surveys which can include impact on the individuals, as well as their ability to engage in broader peacebuilding programs. While this blog focuses on M&E rather than project assessments and design, these are areas where organizations can reach out to Feet on the Ground should they be interested in further exploring assessment methodologies, including mapping existing resources and approaches, as well as project approaches and design.
The baseline assessment should provide a strong foundation for M&E of the project. The assessment should map not only the community needs, disaggregated by sex, age, and cultural/ethnic/religious demographics (taking into consideration gender differences in exposure to trauma), but also map the psychosocial resources existing in the community through both formal and informal mechanisms. Understanding the specific cultural nuances toward dealing with trauma, and any potential stigma, is extremely important. Programs should consider if a mental health de-stigmatization campaign may be an important part of the project. In Sudan, the same organization used community based radio dramas, low literacy print campaigns and community events to effectively raise awareness on mental health. .
Crafting a comprehensive M&E strategy, that can take into account both programming effects on individual as well as community. For measuring individual effects, organizations can measure changes in interoception, mindfulness, and post-traumatic stress, rather than simply assessing if a participant feels better or worse than before a project started. This is because for some individuals, the process of being more embodied, and having greater connection with one’s internal landscape, may stir up emotions or memories. Changes at the individual level can also be complemented by changes in their interest/ability to engage in broader peacebuilding programs, livelihood, and even family relationships. Broader social/community indicators where a program is also using mental health communications campaigns (including literacy appropriate materials, radio, community events, etc.), may also be important,. These indicators include level of community cohesion, number of violent incidents, etc.
On a class to class basis it might be helpful to have simple literacy approaches for check ins. For example, if the project is looking at helping people address the traumas of what they’ve been through, an organization could monitor the emotional experience of your participants at the end of each class, perhaps using low literacy version of facial expressions they point to (e.g. have a set of pictures showing different expressions of emotion and have them pick which one most closely matches their experience before and after every class). It is important to note that not everyone will feel ‘better’ after a class and therefore many people may point to a sad face, which does not mean the approach is not effective. This is why combining this with broader indicators is important.
Qualitative protocols such as semi-structured interviews could be used, only if there is a trained interviewer and psychosocial referral services are available.Through this, a participant can tell the story of how they’re feeling at the beginning and end of the program on a variety of different life aspects. Such stories could be turned into quantitative data, for example, the number of people who seemed to demonstrate changes across different categories. As Jill Miller says in her therapeutic yoga training Yoga Tune Up® – think outside of the boxana!
For pre/post-test, an organization might consider having a mix of quantitative and qualitative protocols to establish a baseline and then measure change. In Sudan, UNDP worked on developing a psychosocial referral system in conjunction with the Ministry of Health and Africa University’s Psychology Department in Khartoum, to provide screening at the start of a program and again at the end. The program entailed pre/post-test using rapid version of the Clinically Administered PTSD Scale (CAPS), and training lay persons such as nurses, teachers, and other community members at local level to provide basic counseling, referring more severe cases up to clinicians, and also utilized community engagement events, radio dramas and communications campaigns geared towards de-stigmatizing psychosocial issues such as post-traumatic stress from the war.
Some of the emerging best practices in more clinical versions of trauma informed movement programs have done just the same. They have used pre/post tests administering the comprehensive clinical diagnostic test for post-traumatic stress [disorder] – the Clinically Administered PTSD Scale (CAPS) in the United States, or the World Health Organization ICD-10 (ICD -11 due out shortly) to assess changes in levels of post traumatic stress. These tests need to be administered by clinicians. While this may sound challenging in peacebuilding contexts, it is possible.
Any trauma informed movement programming, and all components of a M&E strategy, must be developed through the lens of Do No Harm, ensuring that trained staff and an appropriate psychosocial referral system are in place. Pilot programs with a strong M&E foundation can lay the foundation for demonstrating success, not only within your own organization, but also enabling you to mobilize additional funding to keep such important programs going as a key complement of peacebuilding and social cohesion.
Emily Pantalone is a yoga and yoga therapy instructor based in New York City. She was introduced to trauma-informed yoga practices by Jenn Turner, co-creator of Trauma-Sensitive Yoga (TSY) from the Trauma Center in Brookline, MA. Emily has since taught trauma-informed classes to adults, kids, and teens in public schools and homeless & domestic violence shelters. She currently teaches with Hosh Kids – bringing wellness programs to children who need it most and can afford it least – and with Exhale to Inhale – an organization connecting yoga teachers to shelters serving survivors of sexual abusive and domestic violence. Emily is co-founder of Feet on the Ground. www.emilypantalone.com
Samara Andrade is a yoga teacher, movement educator and international aid worker based in New York City. She has worked in peace and security for over 10 years and holds a M.A. in International Policy Studies from Middlebury University at Monterey. Samara has taught yoga to aid workers, diplomats, police, veterans, and civil servants in Sudan, Nepal, and Afghanistan. She currently teaches yoga for female veterans with Connected Warriors, yoga for survivors of sexual and domestic violence with the NYC Mayor’s Family Justice Center and Exhale to Inhale, and trauma-informed yoga for United Nations staff in New York, in addition to her regular studio classes. She has studied Mindful Yoga Therapy for Veterans with Suzanne Manafort and the Give Back Yoga Foundation, trained with David Emerson and Jenn Turner, creators of Trauma-Sensitive Yoga from the Trauma Center in Brookline, MA and studied trauma-informed yoga and self-regulation with Hala Khouri and Lisa Danylchuk. Samara is co-founder of Feet on the Ground and the Aid Worker Wellness Directory.