Disability Inclusion in Psychosocial Support Programs in Lebanon:
Other resources developed in the project include:
Approximately 15 per cent of any community may be persons with disabilities. 1 There may be even higher rates of disability in communities affected by crisis or conflict, 2 as people acquire new impairments from injuries and/or have reduced access to health care. In Lebanon, it is estimated that 900,000 persons are living with disabilities. 3 Studies demonstrate that children with disabilities are at a greater risk of experiencing physical and sexual violence than children without disabilities. 4 They may be hidden in communities due to stigma and discrimination and excluded from school and other educational opportunities. Adolescent girls and boys with disabilities, particularly those with intellectual disabilities, may be excluded from activities that increase their knowledge about violence, sex and healthy relationships, as well as from peer networks that might protect them from violence. 5
The Lebanon Crisis Response Plan (LCRP) 2017 — 2020 recognizes that children with disabilities are at a higher risk of violence, abuse and exploitation, both inside the home and in the wider community, with women and girls with disabilities being among the most vulnerable to GBV. Both the LCRP and the Ministry of Social Affairs National Plan to Safeguard Children and Women in Lebanon 2014 — 2015 highlight commitments to strengthening national protection, child protection (CP) and GBV systems ensuring that women, girls and boys at risk and survivors of violence, exploitation and abuse have access to improved and equitable prevention and response services. 6 7
Disability Inclusion in Psychosocial Support Programs in Lebanon: Guidance for Psychosocial Support Facilitators is designed to support PSS Facilitators to strengthen inclusion of children and adolescents 6 with disabilities in a range of PSS activities, including community based and focused activities. It includes guidance, key actions and tools to improve outreach and identification of children with disabilities for PSS activities; to adapt existing PSS activities; and to support children and adolescents with disabilities who are at medium to high risk of child protection concerns.
Part 2: PSS Outreach, Identification and Referral of Children with Disabilities
Target audience — Community volunteers and mobilisers; CBPSS Facilitators; FPSS Facilitators
Part 3: Including Children with Disabilities in PSS Activities
Part 4: Supporting Medium to High Risk Children and Adolescents with Disabilities
The definition of disability continues to evolve over time. It is important to remember that persons with disabilities are not a homogenous group; they have different capacities and needs and contribute in different ways to their communities. 9
The national Lebanese Law 220/2000 defines a person with a disability as “a person whose capacity to perform one or more vital functions, independently secure his personal existential needs, participate in social activities on an equal basis with others, and live a personal life that is normal by existing social 7 standards, is reduced or non-existent because of partial or complete, permanent or temporary, bodily, sensory or intellectual functional loss or incapacity, that is the outcome of a congenital or acquired illness or from a pathological condition that has been prolonged beyond normal medical expectations.” 10
Article 1 of the UN Convention on the Rights of Persons with Disabilities (CRPD) states:
“Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.” 11
An impairment is a problem in the body's structure or function. 12 Impairments may be physical, intellectual, psychosocial and sensory.
The social and rights-based models, however, put persons with disabilities at the center of decisions that affect them, and emphasize the removal of barriers to ensure equal access and opportunities. These approaches are aligned with the principles and approaches for child protection, which highlight that children are rights-holders, with skills and capacities to contribute to their families, peers, communities, and to our programming. 14
Previous needs assessments in Lebanon have highlighted that family members, communities and service providers all view children and adolescents with disabilities through medical or charitable models, failing to recognize other social factors, such as age and gender, that may increase their vulnerability to child protection concerns. 15
Both the Convention on the Rights of Persons with Disabilities (CRPD) and the Convention on the Rights of the Child (CRC) highlight the active participation of children with disabilities in the community. Children with disabilities should have access to services that are “age-, gender- and disability-sensitive.” 16 Exclusion of children with disabilities from existing programs and activities, whether inadvertent or purposeful, is therefore a form of discrimination. 17 PSS program staff must recognize the 9 diversity of the populations they serve, including the different risks faced by girls and boys with different types of disabilities at different life stages, and by those living in households with persons with disabilities. The inclusion of children and youth with disabilities and those affected by disability in PSS activities is critical to reducing their protection risks and supporting their mental health and psychosocial well-being. Inclusion of children with disabilities in PSS programming is a core dimension of programming — not something “special” or separate.
Law 422 on the Protection of Juveniles in Conflict with the Law or At Risk, defines a child at risk as: a child exposed to 1) exploitation or threat to health/safety/upbringing; 2) Sexual abuse or physical violence that exceeds non-harmful measures; 3) begging and on the streetsChildren with disabilities have been identified as a “vulnerable group” for prioritization in community-based PSS interventions. . 23 Given the high-level of violence, abuse and exploitation experienced by children and adolescents with 13 disabilities globally, PSS actors must be aware of and alert to the possibility that a child with disabilities may also be considered “medium to high risk” and require referral also to Focused PSS activities.
The following table describes the risks faced by children with disabilities and their caregivers (identified through the needs assessment) and how this relates to risk categories for PSS activities. 24 25
A note about parents of children with disabilities: Many mothers described difficulties adjusting to having a child with disabilities, often leading to fear and depression about the future — for them and their child. 26
We are interested in identifying children with different types of disabilities, including:
Community mobilizers / volunteers and PSS staff should seek to understand the concerns, priorities and goals not only of children with disabilities, but also of parents and others who may be taking on caregiving roles for children with disabilities. As mentioned above, many parents have their own PSS 16 needs, and they may be more open to fostering the participation of children with disabilities in PSS activities, if their own needs are also being considered and addressed.
Children with disabilities may experience all of the medium — high risks identified under Law 422 on the Protection of Juveniles in Conflict with the Law or At Risk (e.g. being involved in any of the worst form child labor or being an unaccompanied or separated child). 27 Any child with disabilities experiencing these risks should be referred to age- and gender-appropriate Focused PSS activities. Needs assessment findings suggest that children with disabilities who are particularly vulnerable to these risks include those who are:
The four main indicators of individuals requiring specialized support 28 and some disability considerations are described below:
18They can get free support with things like health, the law and a safe place to live.
Some considerations for children with disabilities when implementing the Look, Listen, and Link principles 32 are:
In most cases, persons with disabilities can communicate directly with staff with no adaptions, or relatively small adaptions. In other cases, it may be more difficult to determine the best way to communicate with the individual, and additional steps may be required. It is important when working with persons with disabilities that you take time to watch and listen. Each time you meet the person you will learn something new about them and understand better how they communicate and what they mean. 33
Use respectful language. Different language is used in different contexts to describe disability and to refer to persons with disabilities. Some words and terms may carry negative, disrespectful or discriminatory connotations and should be avoided in our communications. The Convention on the Rights of Persons with Disabilitiesis translated into many languages, including Arabic, and can be a useful guide to correct interpretation of different disability terms. 34
25AVOID... | CONSIDER USING... |
Referring to other people as “normal” or “healthy” | Try using “persons without disabilities” |
“We are giving lessons of sign language to the girls without disabilities [in our group], so we will understand them, and they will understand us, because we can't speak. Through sign language we understand each other. These girls without disabilities learn things and us, too. We have a common language through these sign language classes. We also use phones, we text, and we also use written notes to communicate with each other. We really like drawing. We think about things and everything that we think about, we show in our pictures. And we also like very much to play different types of games.” 35
“When I was in the Congo, I lost my leg. In school, I can work hard and I can prove that despite what they said in the hospital in the Congo, I am not ‘worthless.’ Instead, I am a girl with a lot to share and to offer. Over the past year, I have most enjoyed going to awareness sessions. It is important to me that the community sees me as not just a girl without a leg, but as a person with rights and a future. I also really appreciate the materials from IRC, especially sanitary napkins and supplies, because often people forget that girls our age need them. With my new leg and my chance to have an education, I feel safer, smarter and less likely to be taken advantage of.” 37
To read the full Story of Change prepared by Sifa, please go to:
In this example, children with and without disabilities are telling a story about risks in their community, using objects that represent the different roles and experiences that girls, boys, young women and young men with and without disabilities assume at different life stages. They are also using objects that represent places or activities that they like or dislike. The objects are a prompt to help the child talk or communicate about the topic. 38
A “Communication Toolbox” can include:
Table: Using tools with children with different types of impairments 39
Some general principles that will help you to identify the skills, capacities and communication preferences of children with disabilities include: 40
All PSS actors are responsible for ensuring a safe environment for children who are accessing their activities. This includes ensuring that activities are held in a location that can be reached safely by children and their families; that the space is free of hazards that could cause harm (e.g. sharp objects, uncovered electricity plugs, etc.); that the space is accessible to all children; and that children feel safe, comfortable and respected. 41 There are a few simple actions that that PSS facilitators can take to make children with disabilities feel welcome and build a safe environment in their activities.
During the Activity Facilitation
They also reported changes in peer networks and feeling depressed as they adjusted to their life as a person with disabilities. A young man described the breakdown of his relationship with his girlfriend, as well as confusion and a lack of information from professionals about his sexual health following his injury. 43
Coping and adjusting to a disability is an individualized process — some individuals will develop coping strategies in a relatively short amount of time, while others require more time to adjust — two people with similar impairments may have very different outcomes and experiences. 44
Some of the stages that people go through when adjusting to a new disability include:
Extracted from: Wendy Taormina-Weiss (2012) Psychological and Social Aspects of Disability.
https://www.disabled-world.com/disability/social-aspects.php
A child with a new disability may experience fatigue, negative emotions, a sense of powerlessness, and even confusion. Focused PSS can support them to develop coping skills and emotional supports, while providing opportunity to strengthen peer networks that foster their emotional and mental health wellbeing. It is important to remember that children with new disabilities are also very resilient — The majority of persons with new disabilities adjust in ways they never believed possible. 45 Focused PSS Facilitators and peers can play a critical role in highlighting their new abilities to cope with challenging situations, building confidence, creativity and capacity.
Parents of children and young people with intellectual disabilities who are refugees living in Lebanon report deterioration in their skills and behaviors, which they attribute to these individuals having witnessed violence. The most common ways in which this affects children and young people with disabilities is through a change in their communication and social skills — parents described how children have stopped speaking, and / or become socially withdrawn — not wanting to speak with others or join activities with peers. There was also a couple of more severe examples where young people with intellectual disabilities, who were once independent with their self-care and engaging with peer networks in their community, were now needing full assistance with personal hygiene, such as toileting and washing. 46
Furthermore, children and adolescents with intellectual disabilities — both girls and boys — are at a higher risk of sexual abuse, with parents highlighting this as the most immediate and urgent risk during the needs assessment in Lebanon. 47 Along with physical signs of abuse, such as bruises, sexually transmitted diseases and / or pregnancy, the other two primary indicators are reports from the child 41 that abuse has occurred and changes in the child's behavior. 48 Children with intellectual disabilities who are survivors of sexual abuse may have psychosomatic symptoms, such as stomach aches, headaches, seizures and problems with sleeping. Common psychological consequences include depression, anxiety, panic attacks, low self-esteem, shame and guilt, irrational fear, and loss of trust. Behavioral difficulties include withdrawal, aggressiveness, self-injurious and sexually inappropriate behavior. 49 “Challenging behaviors” are often attributed to the child's disability and leads to exclusion from activities that might support the child to better understand and express what they have experienced and how they are feeling. All children who experience sexual violence, even those with complex communication difficulties, should have access to counselling and psychosocial support. 50
Working with parents and caregivers, as well as children with disabilities, is cirtical in ensuring the psychosocial needs of children with disabilities are met. In the needs assesssment in 2017, many mothers described difficulties adjusting to having a child with disabilities, often leading to fear and depression about the future — for them and their child. There were some isolated examples where caregivers reported resorting to residential care for children with disabilities, which may expose such children to further risk and exclusion in society. 51
Providing good support for caregivers is one of the most effective ways to improve the safety and well-being of children with disabilitiesIt may be useful to work separately with caregivers, creating a safe space for them to talk about the issues that affect them, their own emotions — positive and negative — without feeling that they are being demanding or selfish, or that they are not properly heard. It is also important to recognize that feelings about being a caregiver are complex, and it is normal to feel frustration, resentment and anger, along with love and concern. Helping mothers to develop ways to understand and manage these feelings can be very helpful in strengthening the core relationship between the caregiver and the child with a . 42 disability. 52
Discuss strategies for paying attention to their own feelings and needs such as:
1 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/
2 Handicap International & HelpAge International (2014) Hidden Victims of the Syrian Crisis: Disabled, Injured and Older Refugees. http://d3n8a8pro7vhmx.cloudfront.net/handicapinternational/pages/454/attachments/original/1397045203/Hidden_Victims_of_the_Syrian_Crisis—disabled__injured_and_older_refugees.pdf?1397045203
3 This estimate is determined using a global estimate that 15% of any population will be persons with disabilities (WHO & World Bank, 2011), and that the population of Lebanon is approximately 6 million people (World Bank, 2016, https://data.worldbank.org/indicator/SP.POP.TOTL?locations=LB).
4 UNICEF (2013) State of the World's Children: Children with Disabilities. https://www.unicef.org.uk/publications/sowc-report-2013-children-with-disabilities/
5 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible
6 Government of Lebanon & the United Nations (2017) Lebanon Crisis Response Plan 2017–2020. http://www.3rpsyriacrisis.org/wp-content/uploads/2017/01/Lebanon-Crisis-Response-Plan-2017–2020.pdf
7 Building Resilience and Development Programme: The MoSA National Plan to Safeguard Children and Women in Lebanon 2014–2015.
8 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Psychosocial Support (PSS) Programs, November 2017.
9 UNHCR. (2011). Working with persons with disabilities in forced displacement. http://www.unhcr.org/publications/manuals/4ec3c81c9/working-persons-disabilities-forced-displacement.html
10 UNESCO (2013) Social Inclusion of Young Persons with Disabilities (PWD) in Lebanon. http://www.unesco.org/new/fileadmin/MULTIMEDIA/FIELD/Beirut/images/SHS/Social_Inclusion_Young_Persons_with_Disabilities_Lebanon.pdf
11 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
12 World Health Organization (n.d.) Health Topic: Disabilities. http://www.who.int/topics/disabilities/en/
13 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf
14 Global Protection Cluster — Child Protection Working Group (2012) Minimum Standards for Child Protection in Humanitarian Action. http://cpwg.net/minimum-standards/
15 WRC (2013). Disability Inclusion in the Syrian Refugee Response in Lebanon. http://wrc.ms/disability-inclusion-syrian-refugees
16 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html
17 UNHCR. (2011). Working with persons with disabilities in forced displacement. http://www.unhcr.org/publications/manuals/4ec3c81c9/working-persons-disabilities-forced-displacement.html
18 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible
19 Jones et al. (2012) Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies, The Lancet, 380 (9845), pp. 899–907. http://dx.doi.org/10.1016/S0140–6736(12)60692-8
20 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/
21 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/
22 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Psychosocial Support (PSS) Programs, November 2017.
24 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Psychosocial Support (PSS) Programs, November 2017.
25 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Gender-Based Violence (GBV) Programs, November 2017.
26 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Psychosocial Support (PSS) Programs, November 2017.
29 WHO with War Trauma Foundation and World Vision International (2011) Psychological First Aid: Guide for Field Workers. http://www.who.int/mental_health/publications/guide_field_workers/en/
30 Meltzer et. al. (2012) The influence of disability on suicidal behavior, European Journal of Disability Research, 6 (1), pp. 1–12. https://doi.org/10.1016/j.alter.2011.11.004
31 Center for Disease Control and Prevention (n.d.) Safety and Children with Disabilities: Aggressive Behavior and Violence. https://www.cdc.gov/ncbddd/disabilityandsafety/aggression.html
32 WHO with War Trauma Foundation and World Vision International (2011) Psychological First Aid: Guide for Field Workers. http://www.who.int/mental_health/publications/guide_field_workers/en/
33 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners. http://wrc.ms/iseethatitispossible-gbv-toolkit
34 The United Nations (2006) Convention on the Rights of Persons with Disabilities (Arabic). http://www.un.org/disabilities/documents/convention/convoptprot-a.pdf
35 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible
36 Women's Refugee Commission & ChildFund International (2016) Gender-based Violence Against Children with Disabilities: A Toolkit for Child Protection Actors. http://wrc.ms/gbv-youth-disabilities-toolkit
37 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible
38 Women's Refugee Commission & ChildFund International (2016) Gender-based Violence Against Children with Disabilities: A Toolkit for Child Protection Actors. http://wrc.ms/gbv-youth-disabilities-toolkit
39 Adapted from: Elena Jenkin, Erin Wilson, Kevin Murfitt, Matthew Clarke, Robert Champain & Laine Stockman, Inclusive practice for research with children with disability: A guide(Melbourne: Deakin University, 2015). http://www.voicesofchildrenwithdisability.com/
40 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit
41 Terre des Hommes — Italy (2017) Community Based Psychosocial Support (2018) Guidelines for Community Volunteers — Final Draft
42 Center for Disease Control and Prevention (n.d.) Safety and Children with Disabilities: Aggressive Behavior and Violence. https://www.cdc.gov/ncbddd/disabilityandsafety/aggression.html
43 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Psychosocial Support (PSS) Programs, November 2017.
44 Stuntzner & Hartley (2014) Resilience, coping, & disability: The development of a resilience intervention. Ideas And Research You Can Use: VISTAS 2014. https://www.counseling.org/docs/default-source/vistas/article_44.pdf?sfvrsn=10
45 Wendy Taormina-Weiss (2012) Psychological and Social Aspects of Disability. https://www.disabled-world.com/disability/social-aspects.php
46 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Psychosocial Support (PSS) Programs, November 2017.
47 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Psychosocial Support (PSS) Programs, November 2017.
48 Davis (2009) Abuse of Children with Intellectual Disability. http://www.thearc.org/what-we-do/resources/fact-sheets/abuse
49 Davis (2009) People with Intellectual Disability and Sexual Violence. https://www.thearc.org/what-we-do/resources/fact-sheets/sexual-violence
50 Davis (2009) People with Intellectual Disability and Sexual Violence. https://www.thearc.org/what-we-do/resources/fact-sheets/sexual-violence