What makes SALT home visits effective?

[Rituu B. Nanda]

NGOs often undertake various community based awareness, peer education activities and home visits as part of ongoing care and support effort for people living with HIV.

I wondered if home visits worked. I had no experience of doing  home visits for community engagement and mobilization. The thought of turning up at someone's front door unannounced or for the matter someone even at my door did not go well with me. There were other things to fuel my anxiety like the uncertainty of what you're going to find on the other side of the door. 

I got an insight into home visits when I was part of the Glocon Team with Ian and Alison in India (Mizoram and West Bengal) in February this year. The plan was that we would divide into 3-4 teams and go to different homes. After the visit, the team congregated at a common place in the village, sometimes joined by local community members, we would reflect on our home visits. 

A key lesson was that you don’t just drop in someone’s home. Home visit is done by invitation and time suitable to the family members. I found that we were usually welcomed by the family and even offered drinks and refreshments. Also we always had a person known to the family in our team. Alison Campbell underlines the most important factor “I think the key is in the way home visits are done. SALT approach is key.  Lots of home visits are done in a different attitude, more provider or teacher than alongside.” 

Local Salvation Army team, CHAN in Mizoram has set a fine example of home visits. CHAN has fostered positive relationships with local community members through home visits. Realizing that the community is too huge to be covered by the Salvation Army team, it has encouraged formation of volunteer youth groups within the community which do regular home visits. Over last six years, local neighborhoodsin Dinthar have determined their own response to HIV through home visits, community-led change and youth response. 

“ Willingness to meet is developed by the home visits, because people share more openly and privately at home. The concerns are gradually shared, until the community is ready to meet together.” – Alison . What happens in home settings is through community conversation a personal connection is build with the family. This is community counseling in nature where community members reflect on theirsituations and see the issue in their own context. Home visits also act as stimulation for the visiting SALT team and growth of dignity for those visited.  ''Accompaniment in the home and neighborhood environment a source of self confidence development” observes Onesmus, an experienced facilitator from Kenya. 

Another critical lesson I learned about home visits was from Nagaland. To focus on selected homes can be stigmatizing. Therefore, selecting a group of homes in the neighbourhood is done.  I recall a peer educator working on PPTCT project in Nagaland shared with me . “I used to go for home visits alone under PPTCT programme…people used to shun me away as I visited only homes of potential clients…Now after SALT programme I go with village youth teams and visit homes in the neighbourhood without targeting any particular house. We have moved away from information providers to facilitating conversation about HIV in the family. Referrals to the hospital for HIV testing have shot up. Now women come to me to take them for testing”

In the context of HIV and associated risk factors such as injecting drug use, the experience of personal stigma within local neighborhoods grows. Ian Campbell shares how home visits can lead to acceptance and openness.”The expansion of HIV related community response is noticed through home care with one person and relatives, that 'infects' neighbours with a realisation of shared concern, and the possibility of reaching for a better future” .To illustrate, here is a stoey from village leader in Dinthar, “I myself did a home visit to the home of a positive person who had passed away. I am the one who prepared his body for funeral and by touching his body demonstrated that HIV cannot be transmitted by touching”. 

Ian during Glocon Kenya found the communities  continue to respond to their issues without external stimulation or support for nearly two decades. Moreover this has been transferred to several other communities. “We see accumulated effect – it is alive, because neighborhood groups take ownership. Ownership is facilitated by home visits, don’t forget. Both home and group/neighborhood processes are needed. The team is still working because it is beyond the boundaries of any one institution. Always think beyond institutions, to the Spirit of God, and the human connection. " comments Ian.

The question is how many NGOs are exposed to the concept of home and neighbourhood life. Experience shows that rather than being limited to delivery of services as response to HIV, organizations can explore learning based in local experience and action. It must also be kept in mind that mindset with which home visit is done can be a determining factor in its success.

[Frank Adu-Asare]

Thank you for this opportunity for Work and Happiness, an NGO based in Ghana West Africa to also share its experience on home visitation as parts of its tool to get to the communities to support the needy and the vulnerable. We work in collaboration with the social welfare department and World Vision Ghana.we are in charge of two deprived communities who also have cases of HIV/AIDS incidence and therefore have rendered a number of the kids there orphans. What we do is that we we go into the community to register children who fall within the category of Orphans and Vulnerable Children (OVCs) who are below 18rys. This is how we do it, we visit the basic schools within the community and have a discussion with the heads and eventually the teachers who help us identify needy children who are also orphans, and are in the schools, the results are so clear they call these children out for us to interview them as well as their guardians and the information we gather are so glaring, we register these kids, take their bio data and every information we need to take including going to see their homes. After this selection exercise social welfare move into the communty to cross check the information we have picked from the ground. We then request for a volunteer teacher who will monitor the progress of the kids in the school and as well will form part of the home visitation team, this team is made up two people from the community and one teacher. we organise orientation for for them on how to go about the visitation, the objective is to monitor the health and educational progress of the kids both at home and at school. World Vision Ghana, support the kids with school supplies and and medical care, this is done through the data we pick from the ground. Personally i have been part of the visitation team before and the beauty is that it brings you face to face with challenges that people are facing in their closet, and if you politely show genuine concern to assist them, put yourself in their shoes as we say it here, then they will be willing to share, the experience has always humbled me in every venture i undertake, and apart from that you also monitor and evaluate the extent of progress the support is making in the lives of these kids. As we speak we are organising to gather clothes and again other school materials to go to the support of these kids as follow up and to cheack on thier progress at school as well.

[Rituu B. Nanda]

Abednego's experience of home visits in Kenya

Comment by Abednego mutungwa on December 21, 2013 at 6:24pmDelete 

on our way to an home visits where we were invited we are living with disability but that does not stop us being present in others life  as they realize their own strengths ,the future looks bright

[Rituu B. Nanda]

Joma Neihsial When we talk about community counselling to me it is a process where we discuss community issues with the people from the commmunity in group.People from the community share what is happening in the community, identifying the issues and looking for resource which is available within their reach. This is facilitate by a team who have work in different community. The process itself bring a positive outcome at the spot,as people accept the the issues is of their own,and they are the only best people who could solve that, they could form a team or group who visit people at homes. This is what we find different and more indepth than a home visit done by TI implementing agencies. Who come and go. But the community are always there, I should say what is sustainability morethan this.??? At the same time the activity of the community volunteer could be transfer to other community, and they become a very effective facilitator.

 

Joy Ganguly Home visits, home based care, home detox and family counselling at homes of drug users is the most effective way of involving the families of the effected community...in any issues...let they be drugs or HIV/AIDS issues.

 

 

 

Anand Chaudhuri ‎

http://www.harmreductionjournal.com/content/9/1/11

Reaching out and reaching up - developing a low cost drug treatment...

www.harmreductionjournal.com

[Rituu B. Nanda]

Experiences from friends in India Civil Society: Dr Suresh Sundar, Anand Chaudhuri and Anita Rego

 

 

Suresh Sundar Thanks.  Well, I was referring to the counseling and care process from a broader perspective. Service providers often think of Positive individuals as a number or case.  Many a times, the partners/ other family members are kept unaware of the issue. Based on successful strategies of working with families/ households in cases of TB, Alcoholics (AA), I was wondering if all can be roped in while managing this medical cum social issue.  No doubt, home visits could be one of the approaches to reach out to the homes and members.  Prevention/control can never be achieved if efforts are directed only towards the Positive individuals.

 

 

Rituu Competence Dr Suresh Sundar  i know what you meant, here I only touched upon community counselling. But Salvation Army for instance in Mizoram is using this concept and engaging the general community in conversations which take the form of counselling. I have seen remarkable results. I fully support what you say. That's why its my dream to promote communities in taking lead in their own issues. Communities here can be groups of people with common issues or working together or living in the same geographical region.

 

Suresh Sundar Since we work with communities, we members of India Civil Society understand, but the main question is, do the authorities in-charge of the program and making the policies, understand ??? May be, you all representing at the meetings could highlight this...

 

 

 

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  Anand Chaudhuri community counselling arises as a specific intervention tool or activity when the community is either in denial or acceptence (toal or partial)of a particular situation/event that affects all- here there is no primary client, just incidents that create conflict, misunderstanding, fear, guilt or anger....communities can disorganize and organize around these events/stuations...catharsis and action needs facilitation etc....this skill is perhaps learnt in order to be replicable...am in delhi from 07 may onwards and would love to meet up with likeminded others who believe NACP III summit will lead to better clarity and implementation of future plans...

   
• home visits are discrete activities that will (eventually) have to include primary client, family, local care givers and community but here the ripple is centripetal and may use evidence based advocacy. In Community counselling the effort is centrifugal...leading to consensus building...and would involve evidence base but actually primaly address the negative perception.
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• Though there is no doubt about the effectiveness of peer based interventions some urgent introspection is required on peer effectiveness, 1)the skills required to carry out activities,  2) the skills required to face complex ground realitiues and obstacles and still carry out the tasks as well as 3) education and skills required document progress towards objectives. Additionally, the budgets apprtioned for peer capacity building and peer outreach are inadequate, imbalanced and not nuanced enough to meet local situations. Implementation with adequate budgetary support will lead to equity of quality service delivery and coverage.

Anita Rego I had seen home visits in different context.  First as a counsellor who went discretely to families who had a rapport with me.  Second as a researcher going to home to collect data. Third as a program manager seeking how field functionaries are effective in the way they approach and counsel families and finally as a overvaluation trying to find out the effectiveness of results.  Primarily the purpose of the visit governs the way the home visit is done and its effectiveness.  During CARE days, we used to have specific points for home visits and there was a structured home visit that was promoted unlike the other context wherein the purpose of for visit was known.  From professionals, I have found that the later is effective but for communities the former works well.  Some elements of the structured home visit would be demystified and provided in HIV interventions.  In some context the visits have to be closely made and while in the others they can be staggered.  Recording of home visits are equally important.  How it adds on or converges with the other forms of activities or interventions will be important.

 

 

Anand Chaudhuri Community counselling in in Sihanoukville province, Cambodia...community wanted to jail substance users as they felt they were the dregs of society, created a law and order problem and domestic violence situations etc. After calling a meeting of key stakeholders certain clarities emerged (from discussing the findings of a rapid situation assessment in the same province)..most users (male and female) were in productive work, most were married and were looking after families...merely locking such people or shaming them was not going to change the situation, not all users could be identified through some commonly noticeable identikit/profile....how would one then get "rid"of the problem. Locking up women users would further create a problem situation for childern dependent on her....the community understood that substance use was not a 'bad or mad' situation...it need more health related support and caring along with a look at social marginalization/ostracization etc.

[Ricardo Walters]

Thanks for this post, Rituu.  I find it to be a most critical articulation, and a helpful stimulus to all of us connected to The Constellation.  I know that, for me, and for several other coaches, home visits are an integral part of how we image the progression of Community Life Competence - they are precursors to the major tools such as The Dream, The Self-Assessment and Action Planning, and they continue as those tools are worked out in the context of wider community. 

 

We know from our own personal experience that there are private things, intimate things that we hold close to ourselves, and these are often only exposed in the environment of the private home;  they are not easily shared publicly.  But, a team moving between households in response to invitations can stimulate confidence within the home, and connection between households, so that a link is established between private home and public community life.  There is a point in time where the home visits approach a critical pressure, and "pushes" the response forward towards community-level ownership.  I've found this is often the best time to introduce The Dream and the other tools. 

But, what is our common experience across the CLCP-implementing Constellation?  Are home visits an explicit part of our process?  Should they be?  Are they an essential component, or just a nice-to-have?