Publications – English

Evaluation of The Bay, an eco-therapy project

Sue Holden Publications - English

Front cover of final report Exploring green social prescriptions and community events to support mental health and enhance the environment

The Bay: A Blueprint for Recovery is a multi-agency partnership between The Wildlife Trust for Lancashire, Manchester and North Merseyside, Cumbria Wildlife Trust, The Eden Project, and Lancashire and South Cumbria NHS Foundation Trust.  It aims to reduce loneliness and isolation in Morecambe Bay’s communities while also delivering ecological benefits.

I worked as Lancaster University’s Research Associate for an evaluation of the first 19 months of the project’s work, funded by the People’s Postcode Lottery.  I was responsible for interviewing stakeholders, creating surveys and running focus groups, along with analysis of all data generated by the evaluation and by the project’s own monitoring and evaluation processes.

You can download a summary of our report here, or the whole evaluation report here.

Evaluation of Butterfly Conservation’s Morecambe Bay Woodlands Project

Sue Holden Publications - English , , ,

Front cover of final evaluation report for Butterfly Conservation

Evaluating work for the good of butterflies, their habitats and local communities

In this evaluation I had great fun working in woodlands alongside Butterfly Conservation staff and volunteers.  I used participant observation to understand the project’s community engagement, and assessed outcomes regarding employment and skills training, and habitat management against the project plans.  I also used surveys to get feedback from a wider group of stakeholders and from volunteers.

Overall I found high levels of achievement, with a small team of people delivering on seven of the National Lottery’s Heritage Funds’ outcomes in a short period of time.  Their work was clearly to the benefit of our limestone heritage landscapes, their fauna and flora, and the people that visit them.

You can download the report here.

Refugee Matters: Preparing for Life and Living in the UK

Sue Holden Publications - English
Refugee Matters: Preparing for Life and Living in the UK final report

Refugee Matters: Preparing for Life and Living in the UK Final evaluation report of a 5 year lottery funded project supporting asylum seekers and refugees in Lancaster District

A final evaluation for Global Link Development Education Centre

I undertook this evaluation to assess Global Link‘s performance in a 5 year project.  They received funding from the Big Lottery Fund to provide support services to asylum seekers and refugees in Lancaster.  For quantitative analysis I used a survey of asylum seekers and refugees, and also a survey of key stakeholders.  For a qualitative perspective I relied on observation, workshop discussions, and interviews with individuals.

The research was a collaborative effort with Global Link’s staff and volunteers: Hisham Attir, Bashar Bakhou, Abdulsalam Dallal, Eleanor Denvir, Sofia Ghebrekristos, Ali Edalati, Bayan Faiq, Sophie Fosker, Victoria Frausin, Ziaur Khan, Sara Nobili, Gisela Renolds, Abinet Tadesse, Wael Tarah and Dorothea Williamson; Latifa Alkhanjary and Flo Horton also assisted.

You can download the report here.

Building resilience to adverse childhood experiences

Sue Holden Publications - English , , ,
HEJ article

HEJ article - Building resilience to adverse childhood experiences An assessment of the effects of the Stepping Stones with Children training programme on Tanzanian children affected by HIV and their caregivers

In this article, published in the Health Education Journal, my colleagues and I presented the effects of the Stepping Stones with Children programme on children aged 5–14  years affected by HIV and their caregivers.  The findings are from the community workshops conducted by PASADA in four communities in Tanzania.

Although we intentionally excluded ‘disclosure’ of HIV sero-status to children as an indicator, the proportion who knew their sero-status increased from 27% to 93%. Assessment of clinical data before and after the workshops showed a statistically significant increase (p-value of <.01) in the CD4 count among the child participants living with HIV (n = 85, mean CD4 change + 317; from 530 to 847) compared with the control group (n = 91, mean CD4 change + 133; from 557 to 690). The mean weight gain was 3.51 kg for child participants and 1.33 kg for controls. Other benefits included improved relationships and reduced violence against the children, greater confidence, more willingness to use HIV services and better networks of support.  We concluded that the Stepping Stones with Children programme can achieve multiple outcomes, including disclosure and better adherence to treatment, to reduce the impact of the adverse childhood experience of being affected by HIV. The work also demonstrated that it is possible and acceptable to include children aged five and over in learning about HIV, sexual health and skills to improve their resilience.

Stepping Stones with Children

Sue Holden Publications - English , ,
StStwC front cover

StStwC front cover A transformative training for children affected by HIV and their caregivers

Children living with HIV can live normal, healthy lives if they have love, care, and treatment when they need it. Yet they and their caregivers face many challenges, including stigma and self-stigma, discrimination, violence and abuse, and services that may not serve children well. While we would all prefer to experience relationships of love, appreciation, and compassion, challenges including grief, bereavement, stress, and poverty can get in the way. The result is that children suffer in many ways, and some die because they have not received treatment, and the care and support needed to take it, in time. Stepping Stones with Children is a response to this, enabling children and their caregivers to explore and change norms, learn and practise skills, and develop healthier and happier ways of living.

Please note, Gill Gordon is the author of Stepping Stones with Children; as manager of the project I played a role in shaping the materials by editing them and contributing some exercises, so am listed as a co-creator.  The manuals are available for purchase from Practical Action Publishing; if your organisation cannot afford to buy them please apply for free copies.

Stepping Stones with Children Counselling Guide

Sue Holden Publications - English , , , , ,
Stepping Stones Counselling

Stepping Stones with Children Counselling Guide

This guide accompanies the Stepping Stones with Children manuals.  I wrote it with Jovin Riziki, focussing on the additional knowledge and skills that HIV counsellors need to work with both children who are affected by or living with HIV and their caregivers. We explore the differences between counselling adults and children, and outline the key steps to follow in different counselling situations involving children and caregivers. You can download the guide for free here (scroll down the page); you may need to register with the Salamander Trust’s website to access the document. Also available in KiSwahili.

Extract

We’ve written this guide for people who already have the knowledge, skills and experience needed to counsel adults about HIV and related issues. We haven’t included basic information, such as what counselling is or key skills for counselling. Instead we’ve focused on the additional knowledge and skills that counsellors need to work both with children who are affected by or living with HIV, and with their caregivers. We also outline the key steps to follow in different counselling situations involving children and caregivers. This guide accompanies the Stepping Stones with Children manuals. Children and caregivers who attend Stepping Stones with Children workshops learn to appreciate their abilities, and to find ways of using these to improve their lives. For example: caregivers learn how to discipline children rather than hitting or otherwise punishing them, while children learn how to set boundaries regarding sexual intimacy, and how to protect themselves and others from sexual abuse. Basics of counselling children HIV counselling with children, as with adults, aims to help them cope with emotions and challenges relating to HIV and its effects, and to make informed choices that will improve their quality of life. Though the focus may be on HIV, counsellors need to see and work with the whole child: all the things that affect their life. Counselling children includes:

  • helping them tell their story;
  • listening carefully;
  • giving them correct and appropriate information;
  • helping them make informed decisions;
  • helping them recognize and build on their strengths;
  • helping them develop a positive attitude to life.

Counselling children does not include:

  • making decisions for them;
  • judging or blaming them;
  • interrogating or arguing with them;
  • making promises you cannot keep;
  • preaching to or lecturing them;
  • imposing your own beliefs on them.

Our key tasks during counselling sessions with children and caregivers include:

  • helping them understand their situation and how they are feeling by reflecting back what they have told us, both verbally and non-verbally;
  • helping them explore their regrets and feelings of blame and anger;
  • supporting them in seeing what they may be able to do to improve their situation, even though many factors are beyond their control;
  • supporting them in making informed decisions;
  • sharing useful information with them;
  • supporting them in developing the courage and confidence to come up with their own strategies and hopes and plans for their future.

What’s different about counselling children? There are four key differences when counselling children as opposed to adults.

  1. We must adjust what we say and do to suit the age and development stage of each child. There should be a big difference between the way we work with a five-year-old who may not yet be able to write, and a 15-year-old who may already be emotionally mature.
  2. We usually work not with a single client, but with a child and their caregiver(s). We must attend to their different hopes and needs, and support them in working together.
  3. We have to be willing and able to talk with children about sex and sexuality, and we may find this difficult.
  4. We need to be mindful of local rules and laws regarding children, for example, knowing at what age and under what circumstances a child can get an HIV test without a caregiver’s consent.

Planning and Support Tool for Empowering Approaches to SRHR Education with Young People

Sue Holden Publications - English , , , ,
Planning and Support Tool for Empowering Approaches to SRHR Education with Young People

Stop Aids Now! Planning & Support Tool

Evidence and Rights-based Planning and Support Tool for Empowering Approaches to SRHR Education with Young People

STOP AIDS NOW! and Rutgers asked me to revise their Planning and Support Tool, which they had first published in 2009.

This involved a good deal of research, consultation and writing, to bring the document into line with the agencies’ changing approaches and to respond to users’ requests.

Download the 2016 PDF (2.2Mb).

Extract

This tool is designed to assist organisations that want to promote young people’s sexual and reproductive health and rights (SRHR) and to empower them to enjoy their (sexual) development, relationships, attain their rights and have a greater sense of wellbeing. It focuses mainly on the strategy of SRHR education, also known as (comprehensive) sexuality education.

To improve young people’s quality of life and (sexual) health we need effective programmes, but developing and implementing them is not easy. However, experience and evidence gained from work all over the world shows what contributes to effectiveness and what doesn’t. This tool summarises the most important evidence in a logical and easy to use way (much of it comes from research by Kirby and colleagues into HIV and sexuality education programmes around the world). It aims to help organisations to take well-informed decisions about the planning, development, implementation and evaluation of SRHR programmes, and to modify their work as needed. The outcome of using the tool should be more effective interventions which are empowering and rights- and evidence-based.

You can use the tool to analyse existing interventions, in order to identify what is already going well and what needs improvement. You can also use it to assist with designing new interventions.

Users have used the tool for various purposes:
• Analysing existing SRHR education programmes
• Designing of new SRHR education programmes
• As a framework to guide discussion with donor organisations
• Capacity building and improvement of their projects or programmes
• Documenting intervention planning afterwards
• Modifying an existing intervention to use in a different context
• Assessing project proposals
• For defining advocacy strategies
• Linking and learning between different organisations

However, this framework should not oblige you to implement programmes completely according to the tool; the particular context, implementation setting or mandate of your organisation may require choices that are not in line with the tool.

You can use the tool to analyse or plan a variety of SRHR interventions, for example: school based and out-of-school interventions; large and small projects; with different SRHR focuses; targeting children, younger or older people; for orphans and vulnerable children; or for young people who are at work.

DOWNLOAD the full 2016 PDF.

Making It Happen! Training young people to advocate for their sexual and reproductive health and rights

Sue Holden Publications - English , , ,
Making It Happen! Training young people to advocate for their sexual and reproductive health and rights

Making It Happen! Sexual and reproductive health and rightsMaking It Happen!  Training young people to advocate for their sexual and reproductive health and rights

I developed this advocacy training manual for dance4life, based on activities which they had developed. The manual is accompanied by handouts and a facilitators’ journal, and is also available in Spanish.

Download (6.7Mb)

Extract

Some changes just happen; the ground becomes wet because it is raining. But most changes come from someone; the idea to build a shelter to keep dry in the rain, then the work to build it. This training is about enabling young people to create change, to use their ideas and their voices effectively to influence others and to make things happen.

dance4life believes that advocacy is crucial if we are to achieve long term changes which benefit large numbers of young people and the wider community. The drive for those changes should come from young people themselves. They know best the issues they face and the changes that are needed. With support from relevant organisations young people are the best representatives of young people’s issues.

What is the purpose of this training manual?

It’s written to enable (advocacy) staff and facilitators of dance4life National Concept Owners (NCOs) to train young people in national lobby and advocacy. It’s a tool you can use to:

  • Strengthen the knowledge and capacity of young people through learning about advocacy.
  • Help young activists to figure out what they most want to change with regard to their sexual and reproductive health and rights (SRHR).
  • Give them meaningful involvement in refining, finalising and implementing your advocacy plans.

Creating a positive learning context

Remember how boring it can be, being taught? How the teacher’s voice goes on, and your mind wanders? Feeling frustrated there’s no chance to speak? Or feeling worried that you’ll get something ‘wrong’? This training should be NOTHING like that! It will be fun and creative and involve everyone, without fear and anxiety.

Your role is not to be the teacher or the expert! Instead you are a facilitator: someone who eases a process of learning and discovery. The methods in the training sessions help this to happen; they enable participants to figure out things for themselves, rather than being told. Your task is to create a positive context for their learning in the following ways:

  • Lead by example, with a positive approach, willingness to listen, and respectful behavior.
  • Give the sessions structure by following the training plan, explaining what to do, and keeping time.
  • Support groups to stick to the task they are doing, rather than go off the topic.
  • Be open to unexpected but important discussions and be flexible in adapting the plan, explaining changes as needed.
  • Manage how people interact, if necessary, so everyone has the opportunity to add their voice, and no one dominates.
  • Respond to any problems that arise, perhaps by asking the group what to do.
  • Provide everyone with a chance to give feedback about the training and to improve the process.
  • Praise participants for their efforts, and the virtues and leadership they have shown.
  • Use humour and a diplomatic approach to deal with conflicts within the group.

DOWNLOAD full PDF. (6.7Mb)

Know Much More About HIV: Staying positive and healthy in the workplace

Sue Holden Publications - English , ,
Know Much More About HIV

Know Much More About HIVKnow Much More About HIV: Staying positive and healthy in the workplace

SAfAIDS asked me to write a booklet for employees, as part of a toolkit to support workplace responses to HIV. I wanted to give readers more options and more detail than the usual HIV prevention messages, and so set out 26 ways in which individuals can reduce their risk of acquiring HIV.

The booklet also outlines the steps which individuals can take to create a supportive and healthier workplace, and is available in Portuguese.

Download

Extract

What has HIV got to do with your workplace?

There are many different things which affect how well you and your colleagues work, and how productive your organisation is. Among those many factors, the impact of the HIV epidemic is likely to be significant. The effects of HIV in the workplace include:

  • If employees become infected with HIV and do not access treatment, then HIV will, in time, badly affect their health and productivity, leading to severe illness and their eventual death;
  • Increased staff absenteeism and higher staff turnover cause problems. These include stalled projects, missed targets, colleagues becoming overworked, managers spending too much time sorting out problems related to health issues, and lower morale in the workforce;
  • Staff costs tend to rise. This is due to higher medical costs, more funeral expenses and death benefits, and increased recruitment and training costs;
  • Efficiency is also undermined when staff are indirectly affected by HIV. For example, caring for sick relatives, or taking on responsibility for relatives’ children, takes time and causes stress.

However, we are not powerless against HIV. We can manage HIV in the workplace in three ways:

  1. Support staff and their family members to protect themselves from HIV infection
  2. Support staff (and sometimes their family members) who are HIV infected to maintain their health and their ability to work.
  3. By advocating for and creating a supportive working environment that implements its HIV policy and operates a wellness programme, with peer educators, educational awareness campaigns and programmes for staff.

What’s in this booklet?

Section 2 covers basic information on HIV transmission, progression to AIDS, and treatments for HIV and the opportunistic infections that arise from it. It may be a useful reminder for you, even though you already know a lot. You can use the information there to work out for yourself if a certain situation has potential for HIV transmission.

Section 3 deals with ways of preventing HIV transmission. This means both protecting yourself from getting infected, and stopping transmission of HIV to others.

Section 3.1 goes beyond the usual ABC of HIV prevention, and gives you 14 different options for reducing the chance of HIV transmission through sex! You may find new options there that you can use.

Section 3.2 concentrates on reducing HIV transmission from mother to child. It includes options for couples who want to get pregnant where one or both of them are infected with HIV.

Section 3.3 looks at ways of maintaining health and preventing opportunistic infections

Section 3.4 looks at ways of reducing HIV transmission through medical, cutting and injecting procedures. This section should also give you food for thought.

In Section 4 we move on to the more general topic of valuing our health. HIV is not the only threat we face, and there is a lot we can do to increase our chances of enjoying good health and productive lives.

Lastly, in Section 5 we set out the key ways in which we can create a supportive workplace for the benefit of all staff.

The Big Picture: A guide for implementing HIV prevention that empowers women and girls

Sue Holden Publications - English , , , , ,
The Big Picture - Implementing HIV prevention

The Big Picture - A guide for Implementing HIV prevention that empowers women and girlsThe Big Picture: A guide for implementing HIV prevention that empowers women and girls

From 2006 to 2010 STOP AIDS NOW! supported an innovative project in Kenya and Indonesia which gave equal weight to HIV prevention, gender equity and human rights. At the end of the project they asked me to set out the theory and practice of their partners’ efforts in a ‘how to’ guide. This is the result, which I co-authored with the project’s manager, Jennifer Bushee.

This guide will be particularly interesting for people working at community level who want to address the structural factors behind the vulnerability of women and girls to HIV.

Download

Extract

This guide provides ‘how-to’ information for developing a ‘transformative approach’ to HIV prevention for women and girls. Such an approach addresses key root causes of vulnerability to HIV and seeks to reshape the beliefs, attitudes and behaviours of individuals and communities in favour of women and girls and gender equality. It also aims to empower women and girls to protect themselves from HIV infection and from the negative impact of living with HIV.

It sets out the rationale for working on HIV prevention using a transformative approach. It also shares experiences and promising practices from the Gender Development Project. It then provides 5 steps based on these for developing HIV prevention work aimed at reducing the HIV risk of women and girl through promotion of gender equality and women’s rights.

This guide will be particularly interesting for people working at community level who want to address the structural factors behind the vulnerability of women and girls to HIV.

We note that the advice in this guide is not fixed and definite; please read it as providing suggestions based on the experiences of the partners in the Gender Development Project. The advice should be adapted to fit local needs and the relevant social, political and cultural context.

We also note that this guide is not comprehensive and is not written to support the development of a whole project cycle. It gives guidance about how to think from a ‘gender transformative’ perspective, but it does not, for example, give step-by-step instructions for doing a needs assessment.

Finally, we note that this guide encourages readers to think differently about how to respond to HIV, using a holistic perspective, the so-called ‘big picture’. This approach gives you wider scope for doing HIV prevention work. It allows you to integrate HIV prevention in other work on gender and rights. It also allows you to respond more closely to the felt needs of girls and women. Crucially, the ‘big picture’ approach, over time, allows you to work in a ‘transformative’ way. This means it helps supports people to transform or change gender relations in ways that are beneficial to all, including—but by no means limited to—by reducing vulnerability to HIV transmission.