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Chestertown Rotary Club & Rotary Club of Lusaka Central's global grant project "Addiction as Disease: Training to Provide Treatment Materials to Zambian NGOs Aiding Street Youth" will provide a training in "Literacy-Free 12 Step Expressive Arts Therapy", curriculum materials and a small operational budget for expressive arts supplies for participating NGOs and mental health professionals for the purpose of enhancing the mental health infrastructure of local communities in Zambia who are reaching or hope to reach street youth and young adults with drug and alcohol addiction.
Christiana Rotary Club, Newark Morning Rotary Club, Kent Island Rotary Club and Centreville Rotary Club have also come alongside Chestertown Rotary Club and Rotary Club of Lusaka Central in this global grant application.
AREA OF FOCUS:
This project is in the Disease Prevention area of focus: non-communicable diseases. Scientific advances over the past 20 years have shown that addiction is a chronic brain disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. It is considered a brain disease because drugs change the brain structure and how it works. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs. (National Institute on Drug Abuse, 2014). It is also considered by World Health Organization to be a risk factor for Non-Communicable Diseases (World Health Organization, 2017).
The wide array of resources that we have for addiction prevention and treatment in the US is not available in Zambia. Historically, addiction has been viewed by Zambian society as a criminal behavior or moral problem. It has largely remained unaddressed in terms of accessible psychotherapeutic or medical treatment.
The most vulnerable population in Zambia to substance use is street children and youth. In the city of Lusaka alone, where we will do this training, there are an estimated 30,000 children living on the streets (U.S. Dept of Labor Bureau of International Labor Affairs, 2005). Children and youth go to live on the streets for many reasons - often because of leaving home to due to poverty, being orphaned by AIDS, or fleeing abuse in the home environment. Some children go to the streets just during the day and some come to live there permanently (Lemba, 2002). Early substance use is very common.
According to an assessment done by Project Concern, 1 in 4 street children admit to using drugs/ alcohol. Most popular drugs are marijuana & sniffing glue. This number of substance users can be estimated to be much higher given the stigma associated with admitting substance use/ dependence (Lemba, 2002). These findings are also consistent with reports from BBC News on the rise of street drugs in Lusaka (Matheson, 1999; Smith, 2011).
Research confirmed a lack of treatment options. While Zambia's Drug Enforcement Council (DEC) runs a rehabilitation program, psychotherapy is not on the list of services provided there. They offer support in terms of greater policing, offerings of life skills counseling and encouragement towards employment (Lusaka Times, 2011). That being true, in a news article, Smith (2011) points out that despite the DEC offering rehabilitative services, Zambians are not likely to seek out their services for fear of being criminalized. The few counseling offerings that are available in the area are completely unaffordable for the average Zambian. "Lack of rehabilitation facilities poses a serious problem...there needs to be a drive in the health ministry for a vibrant service for drug and alcohol addiction throughout the country." (Smith, 2011) Substance use in Lusaka, Zambia still remains largely untreated in terms of psychotherapy and criminalized in terms of society.
Chestertown Rotary Club & Rotary Club of Lusaka Central's global grant application utilizes the demographic data from CoLaborers International's clinical studies done in the community as its community assessment, totaling 219 youth ages 6-23 addicted to alcohol, marijuana, glue/inhalants and/or cigarettes.
This idea is community driven. When Rotary Club of Lusaka Central and CoLaborers staff members shared about the grant and training proposal through their networks, we had immediate response. Already over 25 organizations, including the premier mental health hospital of Zambia, Chainama Hills College Hospital, have signed up to be trained in this curriculum. According to their registration information, combined these groups serve an estimated 7,750 people each month with their services.
1. Chainama College Hospital
2. Partners for Life Advancement and Education Promotion (PLAEP)
3. Regional Psychosocial Support Initiative (REPSSI)
4. Chisomo Centers
5. Action for Children Zambia
7. Blessed to Bless
8. Child and Adoption Society of Zambia
9. Footprints Foundation For Children in Zambia
10. Mapanza Trust
11. Prime Care ltd
12. Abba's Heart for Zambia
13. Zambian Association for Child Care Workers (ZACCW)
14. City of Hope
15. Jesus is the Answer
16. UP Zambia
17. Forgotten Voices
18. Serenity Harm Reduction Programme Zambia (SHARPZ)
19. Beautiful Gate Youth Adventure Camps Zambia
20. Child Hope Zambia
21. St John Zambia
22. Prisoners Future Foundation
23. Hope for Africa International
25. Brethren in Christ Church
26. Chikumbuso Women and Orphans Project
We anticipate that more will sign up and have a contingency in the budget for that as word gets out about Rotary putting on this training. Each organization has at least 1 and as many as 30 professionals attending.
The main objectives of this Global VTT Project is to:
1) provide free "Literacy-Free 12 Step Expressive Arts Therapy" training
2) to provide free curriculum to Zambian-led NGOs and mental health providers seeking to treat substance dependent youth and young adults in Lusaka and Ndola in Zambia, Central Africa
3) to offer reimbursement for up to $100 per organization for expressive arts supplies to enact the curriculum in their facilities (such as purchasing paints, drums, gourds, paper, etc..)
Trainings would occur June 2018 and would be in Lusaka 11-12 June and in Ndola 14-15 June. It would involve Rotarians from the Rotary Club of Lusaka Central to host, help with logistics, registration, and coordinate with CoLaborers International for follow-up measures. Rotarians would have outcome measure surveys that they would send to participating organizations later that year following the training to attempt to measure the impact. These are detailed in the sustainability section of the application. To create this follow up measures questionnaire, CoLaborers International consulted with the Zambian organizations and mental health providers that have already registered for the training, as well as with the Center for Disease Control.
Zambian NGOs and mental health providers reaching substance dependent youth and young adults would be invited to freely participate in training and receive curriculum materials so they can build on the capacity of services being offered at their centers. We would also like to provide them a reasonable stipend to purchase expressive arts supplies for their facilities.
The best way to provide continuous access to treatment for people suffering drug addiction is through these NGOs and mental health providers because they are already offering free, accessible services, do outreaches and are known in the community. In a rapid assessment done by Project Concern, 1/3 of street children were found to already be receiving help from Zambian NGOs (Lemba 2002). This project would be sustainable as the Zambian NGOs and mental health providers would able to address community addiction disease prevention and treatment needs after the Rotary club has completed its work because they would have received the training, curriculum and materials to continue offering treatment at their own organizations.
In 2015, CoLaborers International (EIN: 64-0960198) introduced a curriculum "Literacy-Free 12 Step Expressive Arts Therapy" to be used in treatment programs and clinical studies for street children and youth at Chisomo Centers, a Zambian NGO. This was done in response to a request from the director of the center, sharing that treatment for drug and alcohol was largely unavailable or inaccessible for street youth. CoLaborers International performed clinical studies of the curriculum which took place in July 2015, January 2016 and in a longitudinal study from February through November 2016 as well as in the U.S October - December 2015. The studies were all IRB approved (Washington College).
The "Literacy-Free 12 Step Expressive Arts Therapy" curriculum uses expressive arts as therapeutic metaphor for addiction recovery in a culturally appropriate, de-stigmatizing way. This curriculum fills a niche need. There is nothing else like this available. It is:
1) Scientifically Valid
The US clinical study of this particular curriculum was presented at Eastern Psychological Association's Annual Conference this year and is in the submission process to a peer reviewed scientific journal.
The "Literacy-Free 12 Step Expressive Arts Therapy" curriculum was used in treatment of 47 patients at a dual diagnosis residential rehabilitation facility. Participants were given a testing measure before and after sessions. Using a paired sample T-Test at a 95% confidence level, statistically significant positive increases in all areas were found (p < .05 in all cases). Specifically, commitment to recovery commitment to a drug and alcohol free life [t(46) = -2.12, p = .040, pre M = 4.02, post M = 4.26 ], development of a positive attitude towards lifestyle changes [t(46) = -6.42, p < .001, pre M = 3.66, post M = 4.36], and rise in feelings of hopefulness overall [t(46) = -4.66, p < .001, pre M = 3.40, post M = 4.00].
Compared to the facility's total population, retention rate and likelihood of success was much greater for expressive arts participants. There were 47 voluntary participants at the facility in the expressive arts curriculum sample compared to 101 at the facility not receiving expressive arts curriculum treatment. The participants receiving curriculum had a completion rate of 87.2% compared to 62.4% for those who did not receive the curriculum. An impressive 46.8% of participants receiving the curriculum continued treatment by enrolling in follow up services compared to a mere 3% enrollment rate of those not receiving the curriculum. Lastly, it seemed to help with program retention as only 10.6% of expressive arts curriculum participants left treatment against medical advice while 32.7% of those not receiving the expressive arts curriculum left treatment against medical advice.
After this study was completed, the rehab facility purchased the curriculum and had their mental health practitioners trained in it in efforts to increase retention. Full study available upon request.
2) Culturally Appropriate
This curriculum includes expressive arts that are culturally specific to Zambia, namely lessons utilizing gourd art, dance, as well drum circles with traditional songs in the call and response style of singing in local languages (Bemba, Tonga, Lozi, Nyanja and Shona, a Zimbabwean language).
3) Literacy- Free
Substance use counseling materials are not widely available in Zambia, let alone materials like this curriculum, which is culturally appropriate, youth oriented and does not require literacy. The literacy rate in Zambia is 64% among the youth population (Education Policy and Data Center, 2014).
VOCATIONAL TRAINING TEAM
The primary objectives of the training are that attendees will be introduced to and become proficient in the curriculum. We expect the training participants to gain the ability and will to implement the curriculum in their various organizations by improving their understanding of therapeutic response to substance abuse as well as their confidence and proficiency in the curriculum. This is possible because of the training team's expertise in child psychology, drug and alcohol counseling, implementation of the curriculum, and understanding of Zambian culture.
The team leader would be Chestertown Rotarian Dr. John Murray, child psychologist. He has also taught and researched child psychology. At the training, he will provide insight into the dynamics of children and adolescents suffering addiction as disease. You can read detailed information about his expertise in his individual VTT application.
The team members would include Chestertown Rotarian Melissa Stuebing M.A., CAC-AD, who is the author of the "Literacy-Free 12 Step Expressive Arts Therapy" curriculum and provides trainings in this curriculum regularly for CoLaborers International. She is a licensed drug and alcohol counselor in the US. Her license, degrees and copyright details of her curriculum were submitted to the Ministry of Health in Zambia for the proper clearance with the help of Onechi Lwenje, president of Rotary of Lusaka Central. Melissa does not serve on the grant committee and we have disclosed a conflict of interest statement later in this application.
Additional team members include Hjordis Lorenz, Allyson Olkowski-Arnold, Jason Stansbury, Mike Peck, CSC-AD and David Stuebing. They have been a part of past efforts in Zambia, previous clinical studies, have trained in and administered this curriculum before, have Zambian language skills (Nyanja) and/or have some experience working in Zambia with street children and youth with substance dependence. Hjordis is in doctoral studies at Oxford and in addition to her work with addiction, and two previous clinical studies with this curriculum, also specializes in trauma. Mike Peck has been an addiction counselor for almost 20 years in the US in addition to his time in Zambia. Ally, under the supervision of Jason, ran a year-long longitudinal study of this curriculum in Zambia with substance dependent street children. David was born and raised in Zambia, runs the drum circle portion of the training and has been a part of past trainings. Additionally, Jason, Mike and Ally both already hold work permits in Zambia.
There is a lot of excitement about this grant opportunity, both in the US and Zambia. Rotary International would have the opportunity to produce grassroots sustainable change in Zambia to treat and prevent the disease of addiction, particularly among vulnerable populations like youth and children in a way that it is not being addressed currently. This training introduces a program that will continue to be a part of indigenous-led organizational offerings to unserved populations long after this training is over, changing the future for substance dependent Zambians.
Education Policy and Data Center. (2014, October 07). Zambia National Education Profile. Retrieved November 04, 2017, from https://www.epdc.org/education-data-research/zambia-national-education-profile
Lemba M. (2002). Rapid Assessment of Street Children in Lusaka. Lusaka: Project Concern International Zambia.
Lusaka Times. DEC constructing drug addicts rehabilitation centre. (2011, April 11). Retrieved December 3, 2014, from http://www.lusakatimes.com/2011/04/11/dec-constructing-drug-addicts-rehabilitation-centre/
Matheson, I. (1999, July 30). Children high on sewage. Retrieved November 14, 2014, from http://news.bbc.co.uk/2/hi/africa/406067.stm
National Institute on Drug Abuse. (2014, July 1). Drugs, Brains, and Behavior: The Science of Addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction on 2017, July 6
Smith, G. (2011, March 28). Zambia struggles with growing drug menace. Retrieved November 13, 2014, from http://www.bbc.co.uk/news/world-africa-12806083
U.S. Dept of Labor Bureau of International Labor Affairs. (2005). The Department of Labor's 2004 Findings on the Worst Forms of Child Labor. Retrieved January 17, 2011 from http://www.dol.gov/ilab/media/reports/iclp/tda2004/zambia.htm
World Health Organization. (2017). Non communicable diseases. Retrieved July 06, 2017, from http://www.who.int/mediacentre/factsheets/fs355/en/