The Bartholomew J. Lawson Foundation for Children, a US based 501(c)(3), created REACH Grenada in 2008 as a principle program to specifically improve the health and wellbeing of Grenada's most vulnerable youth. reachwithin is a multi-faceted program developed to improve the lives of formerly maltreated children living in residential care facilities in Grenada. The program teaches valuable skills to support children in leading empowered lives and overcoming adversity, reachwithin is a 12 session, group experience for children that builds resilience and promotes positive relationships through the development of self-regulation, emotional literacy and social skills.

In 2013 the name REACH Grenada was changed to reachwithin due to program interest from other Caribbean islands.

Dedication

This manual is dedicated to the inspiring children, staff and directors of Grenada's children's homes who have participated in our youth program and inspired its growth and evolution. Thank you for allowing us to participate in your lives.

We would like to thank Bart, Mackenzie and Katia Lawson for their shining example of resilience and for their participation in building reachwithin.

Disclaimer

The exercises and information in this manual are meant to be tools but not treatment or assessments for mental or emotional conditions. If you suspect that a participant in your group is experiencing a clinical condition such as Post-Traumatic Stress Disorder, please consult with a doctor, mental health specialist or child protection professional.

Not all exercises are suitable for everyone. Please adjust to your level and the level of your class. To reduce the risk of injury, never force or strain; always listen to your body and watch your participants. If you or people in your class experience pain or discomfort during this exercise, stop immediately and consult a doctor. The instruction presented is a guide and a suggestion. It is neither a prescription nor a substitute for medical advice.

Overview

About this manual

This manual is a workbook guide for youth program facilitators and caregivers taking part in a reachwithin training program. In this manual you will find information about working with at-risk youth, a review of yoga basics, a rationale for the program's model, as well as teaching instructions, lesson plans and resources for leading a reachwithin youth program at your site or in your community. This manual should be used in conjunction with attending a reachwithin training workshop where the material is explored in greater detail and skills for facilitators are practiced and discussed.

Use the manual, experience and knowledge you gain from a reachwithin training workshop as a framework to create your own program that you can adjust to meet the specific needs of your setting, population, and resources.

Ask yourself:

• What do I hope to get out of reading this manual?

• What will be helpful about this program for the children I work with?

Population Overview: Vulnerable and At-Risk Youth

reachwithin was created to help youth in residential care facilities develop skills and draw on internal resources to build strength and overall wellbeing. You may find it helpful to use this manual with a wide range of vulnerable or at-risk youth, including survivors of trauma. reachwithin can be delivered in care facilities, community centers, and schools.

Who are at-risk youth?

"At-risk" youth, also called "vulnerable" youth, is a broad category. The term includes children who are living in difficult circumstances that threaten healthy growth and development. Vulnerable youth include: children separated from their caregivers (due to illness, death, incarceration or maltreatment), children experiencing abuse or neglect, children who have experienced other trauma (including domestic or community violence, war or natural disasters), children who become homeless or "street" children, and children growing up in poverty or witnessing violence.

Children can be extremely resilient. Being resilient means having the ability to appropriately manage or recover from difficulties and/or challenges in life. With more and more negative experiences, however, one's adaptive resources can become overwhelmed. This is more likely to lead to unhealthy outcomes or chronic problems. Working with new at-risk youth or those who have not had a chance to receive adequate intervention(s), you may see some or all of the following negative outcomes becoming established: low self-esteem, relationship and attachment difficulties, drug use, age-inappropriate sexual behaviors, aggression, mental health difficulties and/or behavioral issues .

You can promote health and decrease the likelihood of negative outcomes by promoting adaptive management (coping) techniques and supporting children in using their natural strengths and internal resources.

Ask yourself:

• What does it mean for children in my community to be vulnerable?

• In my job or community, what experiences lead to children being at-risk?

• What sort of strengths and natural coping resources did I draw on as a child?

• What coping skills do I see the children I work with using? Are they adaptive or maladaptive?

Understanding Types of Vulnerable Youth

Children living outside the home:

In the best of circumstances "home" (however that is defined in the child's culture, including living with biologic parents) provides children with a sense of safety, caring support, and attention that allows them to grow, know themselves and engage in healthy relationship development. Living outside of the "home" often involves frequent changes of residence, disruptions in safety, security, learning, as well as less attention and less consistent long term healthy relationships. This is especially the case for youth in child welfare systems who have been removed from their homes due to abuse or neglect.

You may see problems in physical growth and/or emotional development among children in the aforementioned circumstances. In the child welfare system, five times as many children are observed to have developmental, emotional or behavioral problems as compared to other children in the community (Caulsen et al., 1998; Landsverk et al., 2009). For example, an assessment in the Caribbean found that over 60% of children living in group foster homes showed significant emotional or behavioral difficulties, and over 80% had experienced trauma (REACH Grenada, 2011). So what is it about being away from home that causes so much developmental disruption for children?

Once removed from their homes, children in child welfare systems often experience stress from being away from the family they have known even if they lived in adverse circumstances. They often experience multiple, drastic changes, such as housing changes, school disruptions or changes, separation from friends, and loss of familiar environment as well as changes in schedules and activities. Also, they receive less one-to-one attention than children living in stable family settings. There is a loss of reliable, predictable, respectful patterned interactions that enable a healthy developing child to feel supported, safe and secure. That is partly why children living in residential group homes appear to have poorer mental wellbeing, social and/or behavioral functioning than children in kinship care or foster placements in communities (Cooper, J.L., Banghart, P, Aratani, P, 2010).

The longer children remain in the child welfare system, the more likely they are to experience problems in growth and healthy development. However, it is likely that a large portion of the mental health problems that these children develop have to do with the past trauma, maltreatment or neglect which originally led them to be identified by child protective agencies.

Ask Yourself:

• What does home mean to me?

• What is a traditional "home environment" like for children in the community I serve?

• For children not living at "home," where do they go?

• What kinds of experiences lead to difficulties for children in my community or work setting who no longer live at "home?"

• What is something I can do to help children experience a sense of home away from home?

Children experiencing trauma:

Unfortunately trauma in childhood is not uncommon. Research tells us that 14 to 43 percent of children have experienced at least one traumatic event. Childhood trauma can result from anything that makes a child feel helpless and disrupts their sense of safety and security. This may include: sexual, physical or verbal abuse, domestic violence, an unstable or unsafe environment, separation from a parent, bullying, and serious illness or injury.

Not all children exposed to a traumatic event will have negative outcomes. Many different factors contribute to whether or not a child develops negative outcomes from a traumatic experience — also called traumatic stress. A child's age and developmental level, life history, strengths and weaknesses, or access to a supportive caregiver are some of the factors that pertain to children's responses to trauma and later outcomes. Children living in adversity, like poverty or violence, are at higher risk for negative outcomes due to trauma.

Traumatic stress can be disruptive to a child's growth in many ways, but is different for every child. Trauma can have a direct impact on the structural and functional development of children's brains and bodies. Traumatic stress can make it hard for children to concentrate, learn, and perform in school. It can also make it difficult for them to make and maintain healthy relationships. Trauma often changes how children view the world, their futures, and may lead to chronic health and/or behavioral problems over time.

Ask yourself:

• What types of trauma do children I work with commonly experience?

• How do I see the children I work with actively coping with their experiences?

• What are some of the coping behaviors I remember seeing children use?

• Are there any behaviors that I find difficult in the children I work with? How might these behaviors be related to traumatic stress?

• What are some ways that I have learned to cope with some of the difficult things I've experienced in my own life?

Children in poverty:

Growing up in extreme poverty is a big source of stress and vulnerability for youth. Psychological research has shown that living in poverty can have negative effects on the physical and mental health and well-being of children around the world.

Overall, children who grow up in poverty are exposed to more trauma, and often have less access to education and healthcare. Children in poverty are at risk for poorer academic performance, more health problems, and worse malnutrition. They are also at greater risk of behavioral and emotional problems (including anxiety, depression, hyperactivity and aggression). Children who live in poverty sometimes also live in unsafe neighborhoods that expose them to violence; this puts children at greater risk of injury, entry into juvenile justice system, and mortality.

Living in poverty is also particularly difficult for parents. Living in poverty in adulthood may result in overwhelming stress on a day-to-day basis. Parents dealing with poverty and stress often use harsh parenting and discipline techniques. Harsh parenting styles are linked to poor social and emotional outcomes in children.

Ask Yourself:

• How do I see poverty playing a role with children in my community?

• Are there specific characteristics of children impacted by poverty in my community?

• Have the children I am working with experienced poverty from a young age?

How do I think this history plays a role in their lives today?

The reachwithin Model

Overall, reachwithin aims to: 1) promote well-being, 2) increase resiliency, and 3) decrease distress among vulnerable youth. We do this by providing children with an opportunity to build a sense of meaning and belief in themselves and their abilities. This is also referred to as self-efficacy. Our lessons offer activities where children get to be part of a group, build relationships, have fun and interact in a safe environment. Our instructions and activities are written to be sensitive to some of the difficult life experiences affected children may have had. They also focus on the current moment and building skills.

Objectives:

Many of the lessons target specific objectives or goals. These include:

1. Increasing emotional literacy

2. Improving self-regulation

3. Enhancing social skills

Emotional literacy refers to the ability to identify and understand feelings and emotions. Self-regulation refers to the ability to notice and tolerate difficult feelings, and manage mood or behavior. Social skills refer to the ability to communicate with others, form relationships, and participate in community in a pro-social adaptive manner.

Ask Yourself:

• Naming and understanding emotions can be complicated and difficult. Is knowing what I'm feeling easy or difficult for me in my own life? Do I notice this being easy or difficult for the children I work with?

• Name three things I do for myself when I'm experiencing a difficult emotion. (These are the ways I engage in self-regulation.) How do these help me?

• Think of three ways lama great communicator. What are the social skills I use every day? How do these help me?

Theory-base:

The ideas and work of many talented people working successfully with children around the world helped to shape the reachwithin model. Several different view points and specific exercises were incorporated in developing our multi-dimensional approach towards working with youth. For more information on these sources, please see Appendix A.

When working with children, especially at-risk children, one usually comes in with their own ideas or theories about what helps children and how to understand their behavior. Use your own experience and understanding alongside the ideas you will find in this manual. Please be mindful that trauma survivors live with a deep sense of mistrust; being friendly and supportive is obviously necessary but will not by itself solve their issues.

Ask Yourself:

• What ideas, experiences, or theories help me in understanding my work with children?

• What would I like to keep in mind for working with youth in my setting?

• What associations or ideas do I have about the theories used in the reachwithin model?

Framework:

Each of the twelve lesson topics are designed to help children gain skills in certain areas. Examples of these areas include: self-acceptance, healthy boundaries, and anger management.

With the children in your community, you might decide to use an entire lesson, or certain sections of a lesson, as seems appropriate for your group setting or time constraints. If you are using the program as a whole, the lessons are written with the purpose of being taught in order. This is because the lesson topics build on each other and what was taught in the previous session. In each session, do highlight the importance of community, safety, self-awareness, regulation and relationships.

The twelve lesson topics include:

Lesson Plan Outline by Topic Areas

Topic 1- Healthy Boundaries- "We set boundaries to feel safe"

Topic 2- Mindfulness/Present Moment- "We notice what's going on inside and around us"

Topic 3 - Choices- "We are making choices all the time"

Topic 4 - Self-Regulation- "We can learn to control our actions"

Topic 5 - Caring and Empathy- "We can listen and share"

Topic 6 - Self-Acceptance-"We all have strengths"

Topic 7 - Emotional Awareness- "We all have feelings"

Topic 8 - Positive Thinking- "We can think in helpful ways"

Topic 9 - Anger Management- "We can control our anger and communicate what we want"

Topic 10 - Conflict Resolution- "We work together to solve problems"

Topic 11 - Coping/Moving Forward- "We can care for ourselves when hard things happen"

Topic 12 - Goals-"We have hopes and dreams"

Format:

The reachwithin lesson manual has 12 topic areas. Each topic area includes two to four primary lesson activities. The reachwithin model was designed to be delivered weekly using a different lesson activity each week but can be adjusted to a shorter or longer time frame based on the needs of your site. Additional activities can be added or for shorter programs, you can delete one or two of the activities for each lesson area. The program can always be repeated to create opportunities for children to gain greater appreciation and exploration of the topics covered. If you decide to shorten the program, be sure to create opportunities for children to apply the material outside of the group sessions and have time to understand the topic material. On the other hand, if you lead the program over a longer period of time, be sure to review the concepts and topics that have already be covered when introducing new lesson topics.

Whenever possible, it is best for children to attend all of the group sessions from start to finish, so that they can form relationships and build trust in the group. However, this may not be possible for your setting. If consistent participation and attendance is not possible, review group rules at the beginning of each session, conduct weekly introductions of yourself and other group members, and focus on building relationships whenever possible. These reminders are helpful for all children, but they are particularly important for children that have experienced trauma. This is because consistency and knowing what to expect allows children to stay better regulated and engaged in the group activities.