In Guatemala: One city, two models for children with disabilities

One of the lovely things about my Spanish school, Proyecto Lingüistico Quetzalteco de Español, is that they offer “Spanish for social workers” where students are matched with teachers who have social work backgrounds. One week, after practicing my spiel in Spanish about my research interests around orphanages and deinstitutionalization, my teacher asked if I was interested in visiting an orphanage. At first I hesitated, given the ethically problematic nature of orphanage tourism, but when it became clear that she had personal connections to the homes and our visits would be brief and educational, I agreed.

We ended up visiting two very different establishments, neither of which were strictly “orphanages,” but perfectly illustrate the old and the new when it comes to care for children with special needs.

The institution for individuals with disabilities

The first establishment we visited was a residential center funded and run by a local Catholic church. The complex was huge and well-kept, made up of several interconnected buildings, a playground in the middle, beautiful, grassy grounds, some livestock in pens, and a shrine dedicated to the church’s patron saint. Inside there were several therapy rooms—one for speech and language therapy, one for physical therapy, one for special education, and several others too, including one that looked like it was for computer classes. It was well-staffed and there were some young people who looked like interns from a local university working there as well.

I did not take this picture, but it is very similar to what I saw in the institution. (Photo: DRI)

But it definitely felt like, well, an institution. Residents young and old were all in wheelchairs (nice, modern ones at that), and the majority were tightly restrained to their wheelchairs with blankets and cloths. (I think most residents I saw were between 10 and 30, but I was told babies as young as two live there too.) These young men and women mostly appeared non-verbal, and some clearly had microcephaly or Down’s syndrome, while it was unclear what sorts of disabilities other youth had. Nurses were bottle-feeding youth two at a time, a bottle in each hand. Sometimes they wheeled them into the chapel and left them to sit, perhaps hoping the young people would receive graces from God by being in the presence of the tabernacle.

All of the children and adults in this home lived there full time. And the staff told me that almost none of them had family who visit them. Their physical needs were being taken care of, but they had been abandoned by any family and were completely segregated from the wider community. My teacher explained that while some families simply live far away, it is mostly the stigma of disability that leads them to abandon their children in this way. And especially if they are told that there is no hope for the child to “recover” from their condition, they may just give up on them. I was given the impression that the institution was the better alternative to being neglected at home, living on the streets, or worse.

Community center for children and families: Fundabiem

The next day we visited Fundabiem, a nationwide organization with several locations throughout Guatemala. This Fundabiem location was in a much smaller structure than the institution, but was similarly well-kept and staffed with professionals and student interns. In later conversations with other Guatemalans, I was told that Fundabiem is well-known for its fundraising telethons whereby they raise large amounts of money.

Their model is quite opposite from that of the church-affiliated institution.

Photo from Fundabiem’s website that represents what I saw there

Nobody lives in Fundabiem; rather, a van (or microbus, as it’s called in Guatemala) collects children and their caregivers from their rural homes once a week and brings them into the city to  Fundabiem. There, the caregiver (usually a mother but perhaps also a grandmother or other relative) attends a series of therapies with their child throughout the day: occupational therapy, speech and language therapy, special education, physical therapy, even, if needed, hydrotherapy in Fundabiem’s pool. The children and parents rotate throughout the different therapy rooms the way American middle schoolers go from class to class throughout the school day. Unfortunately, the therapies are not one-on-one. I saw moms in indigenous clothing showing their little children with Down’s syndrome flash cards as part of speech therapy, presumably at the therapist’s instruction; in the special education room, moms and dads helped their children complete an arts and crafts project; in physical therapy, parents looked on as young professionals taught children with conditions like cerebral palsy how to walk, and when a therapist wasn’t working with them, the parents continued to.

At the end of the day, the van takes the families back to their homes, where the parents are encouraged to continue therapies with their children until they return a week later. The next day a new cohort of families comes in for their round-robin of therapies. They pay what they can; most pay nothing at all.

Old and new

Although I know I only had tiny snapshots of each place, and things are undoubtably more complex than they seem, my visits felt metaphorical. I felt like I had traveled in time and space straight from a Post-Soviet institution for children with disabilities to one of the community centers into which deinstitutionalization advocates argue orphanages should be converted, even though the two establishments were only a few miles apart. The institution mirrors the “old way” of caring for children with disabilities, while Fundabiem could serve as a model for the “new way”: what supports to families could look like post-deinstitutionalization.

My teacher pointed out that many children in Fundabiem had “less severe” disabilities than the youth in the other institution. On average, this was true, but not across the board. There were girls with Down’s Syndrome in both places—but receiving therapies with mom in one, and restrained to a wheelchair without any stimulation in the other. There was a young man zooming across the halls in his wheelchair in the church-affiliated institution who didn’t seem to have severe cognitive disabilities, and yet he was in a residential home segregated from society. Many of the youth in the institution looked, as they say, “low functioning,” but I wondered what they could have achieved had they been living with the attention and care of a family and the services of Fundabiem instead.

In both establishments, children had someone taking care of their physical needs and had access to therapeutic and educational services. But I think the benefits of Fundabiem over the institution are numerous; for example:

  • The children live with families (a human right stipulated in article 23 of the Convention on the Rights of Persons with Disabilities).
  • The children live in their communities rather than being segregated from society (see article 19).
  • The children receive all therapies alongside their parents, fostering parental involvement in their services and treatment (well-documented as a huge contributor to kids’ success in special education and therapy).
  • I bet that by being involved at Fundabiem, seeing other children’s progress, and being around adults who treat children with disabilities with care and dignity, parents’ own negative perceptions around disability may be lessened.
  • I also imagine that the families have the opportunity to create community with other parents of children with disabilities, helping to reduce stigma and create networks of social support.
Beautiful Guatemala

But through talking with my teacher, I also came to understand that there would be vast, vast challenges in trying to deinstitutionalize places like the ones I saw. The still-strong stigma against people with disabilities would have to be tackled by huge advocacy campaigns, not only towards the families of children with disabilities but also towards society at large. And as long as there remains little in the way of government social services, poor, rural, and indigenous families will continue to lack access to the services necessary (medical, therapeutic, special education) for caring for a child with severe disabilities in a home environment. I doubt a private charity like Fundabiem could (or should!) carry a whole nation on its back, and its once-a-week offerings are certainly not enough for most children.

While Fundabiem is a shining example of the way things can be, as far as I know now, efforts to implement family-based care for orphaned and abandoned children in Guatemala remain small-scale, scattered, and not particularly targeted at children with disabilities. (The only examples I know of: Buckner’s foster care pilot and SOS Children’s Villages.) I wonder, how much time, money, and political would it take to leave the old way behind entirely? Will those young people living in the institution ever enjoy the human rights—autonomy, inclusion, family—to which they are entitled?

Mi primera vez en Guatemala

I am spending four weeks in Quetzaltenango (aka Xela), Guatemala, to attempt to learn as much Spanish in as short a time as possible. I’m mainly doing this because my husband is Puerto Rican, but a lucky side effect is that if I manage to get pretty proficient, I might eventually get the opportunity to research or work in child welfare in Latin America.

On my flight here, I finally read Finding Fernanda by Erin Siegal. What an incredible read. Siegel painstakingly details the way international adoption circa 2008 was carried out, and gives a really damning argument for how the entire system was steeped in corruption. Her book reinforced my opinion that when government systems are so weak, decentralized, and with so little oversight, it’s just not worth it to have international adoption at all, and the problems outweigh the potential benefits to children. In places like this, Western adoptive parents’ cash automatically creates an  adverse incentive systems that will just going to turn children into commodities and create a market of babies.

Siegel described the messy Guatemalan bureaucracy as no branch of government or local court working on one child’s case having any idea if another had processed any documents or received any information about the same child. (Resulting in officials working on Fernanda’s international adoption having no idea that her biological mother had reported her kidnapping.) This, to me, also made a good argument in favor of the Hague Convention’s requirement for sending countries to establish a central authority for international adoption.

Today I had the pleasure of sitting down with some folks I met on Facebook to chat about the status of child welfare in Guatemala. Here’s a little bit of what I learned.

There is a state-run system for removing abused children from their families. During the investigation (which might take months or years), these children reside in hogares temporales (temporary children’s homes). A huge issue is that these homes are “one size fits all” and don’t provide specialized enough services for the youth, many of whom have severe needs (e.g., had experienced sexual abuse by family members, teen pregnancy and motherhood, etc.). The youth don’t receive enough one-on-one service and there is nobody to, e.g., help them navigate the legal system.

After the investigation, the state may decide to place the child with a family or in a hogar permanente, a permanent children’s home. There is a hogar temporal here in Xela. The tragic fire from last year was in a hogar permanente in Guatemala City, which was severely overcrowded.

What changes has the government made since the fire? None really, except they moved the girls from Guatemala City to various other hogares (many of which are also overcrowded or unsafe), including the hogar temporal in Xela. The issue is very divisive in Guatemala, but child welfare is also not a priority to the government. Delinquent children are seen as a problem, not as a symptom of larger societal issues.

What other state programs are there for orphans? The Comité de Adopciones facilitates domestic adoption (familias sustitutas), but adoption is still a new concept in Guatemala, and adoptees are discriminated against. Even so, there are probably 200 families waiting in line to adopt just one child. The waiting lists are long, and the process of adoption is also long – a child adopted at birth will not have true permanency until 11 years or so later, at which point the adoption is finalized. At any time in between the state can reclaim the child, if, e.g., a biological relative wants to take custody of him. (However, apparently the child is the one who can make the decision about whom to live with.)

There is also official foster care (familias temporales), but there are generally not enough families willing to foster children. He’s not aware of any NGOs here that run foster care programs.

The state will also place orphaned children (e.g., children orphaned by the volcano) with extended biological family, or if that’s not possible, in hogares, or orphanages, the vast majority of which are run by churches who are filling in the state’s gaps in services. You can adopt directly from an hogar – my new friend described adoptive parents he knew walking into an hogar where 100 children clamored to be chosen by the parents. In this case, finalization only took a year, since it wasn’t through the Comité de Adopciones. Children in hogares in Guatemala, like in other places in the world, aren’t usually literal “orphans” (where both parents have died).

I’ve heard from one woman here that only rich people are able to adopt. He said, however, that lower middle class folks can adopt just as easily.

And I’ve heard from multiple Guatemalans – three or four at this point – that the international adoption system of the 2000s was literally “selling” children. So far, I believe that’s the general perception in Guatemala, but I’m interested in talking to more people about it.

My overall impression, so far, is that although there is a state child welfare system, the bulk of orphan care is done by local churches running orphanages. I am interested to learn about how much oversight and case management the state provides, but my sense so far is that it is either 1) not doing much or 2) does provide oversight, but only to the limited number of children with whom it works, and not to children cared for in private/religious orphanages.

What do you think? What do you know? If anyone has info that supports or contradicts this, please post in the comments. I have only just started to learn about Guatemala and am eager to hear about others’ experiences!

Edited on June 20, 2018, to correct some information about hogares temporales.

Pre-adoption preparation of parents adopting from China’s Waiting Child list

Last month I presented a poster at the 2018 Rudd Adoption Conference. Here is a copy of my poster for whoever is interested:


Click the thumbnail to see the full size poster


My study asked parents who had adopted “special needs” children from China about their pre-adoption preparation. I asked them to report what kinds of preparation methods they completed (e.g., reading books, in-person classes…) and rate how helpful each of them was. I also asked them to rank how prepared they felt in adoption-related issues (e.g., attachment, food issues, sleep issues, racial issues…) and how important they thought the issues were. Check out the poster to see the results!

Common Orphan Statistics in Context – Part 2

In part 1, I looked into the sources of some commonly used statistics on orphaned children, specifically:

  1. “140 million children are orphans”
  2. “80% of children in orphanages have a living parent”
  3. “2.7 million children are in orphanages”

Here’s three more for part 2. This time I went so deep, I had to request two actual books from a physical library!

4. “There are 8 million children in orphanages worldwide”

Last time I looked into the claim that there are 2.7 million children in orphanages, but a big thanks to Rob Oliver and Leigh Mathews for pointing out that 8 million is more frequently cited as the total.

This Lumos video highlights the 8 million figure

Leigh said that the figure comes from Pinheiro’s 2006 World Report on Violence Against Children for UNICEF, where it says, “By some accounts, as many as eight million boys and girls around the world live in institutional care.” You’ll find it on p. 183 (p. 14 of the PDF) here in chapter 5.

This “account” is Save the Children’s 2003 report A Last Resort: The Growing Concern about Children in Residential Care.

In turn, this report cites the “8 million” figure as coming the 1995 book Roofs and Roots: The Care of Separated Children in the Developing World by David Tolfree.

And then THIS book cites ANOTHER source in a footnote: Defence for Children International, 1985, “Children in Institutions”, DCI, Geneva.

I haven’t gotten my hands on a copy of this…report? book? vinyl record?…um, product, yet. (I emailed DCI but didn’t hear back.) But wow, what a rabbit hole! It’s certainly not what I was expecting: it turns out that this data is at least 33 years old. Definitely not relevant to today, as the children counted back then are now adults, and there’s no reason to assume institutionalization rates stay constant over time.

While 2.7 million could easily be an underestimate, since it relies on government-reported data that probably overlook unregistered orphanages, this 8 million figure seems not to be based on any recent, reliable, or even accessible information at all. I would prefer to stick to 2.7.

5. “For orphans who age out, 10-15% commit suicide before age 18, 60% of girls become prostitutes, and 70% of boys become criminals”

These numbers are ubiquitous. I had an extremely hard time finding their original source, because orphan care NGO after orphan care NGO seemed to copy and paste the same numbers on their websites without any references! As I searched, there were a lot of broken links and dead ends along the way, so I began to realize that the original data must be quite old…

A UNICEF report (p. 89) eventually led me to a 1996 book by Judith Harwin (a physical book!). It says on p. 147:

The Russian Procuracy General found that one in three care leavers becomes homeless, one in five ends up with a criminal record, while as many as one in ten commits suicide.

Her citation is a 1994 article in the Rossiyskaya Gazeta–which is apparently too old to be cataloged in online databases, and though a hard copy seems to exist in my city, I’m not sure it will be possible to use Google Translate on a newspaper microfilm. I can’t find the Procuracy General report, either, unfortunately–but it clearly predates the mid-1990s.

So, again, these data are just too old to apply to the current day. When I asked care leaver and children’s advocate Vadim, he agreed that far too much has changed in the former Soviet Union since twenty years ago for survey data like these to be relevant to today’s care leavers.

But perhaps other research exists that NGOs can use to help garner support for their programs. I would follow the following guidelines when selecting studies to use:

  • Only look at studies specific to your context. If you want to say something about orphanage alumni in China, do not look to research on care leavers from Eastern Europe.
  • Consider how old the studies are. Have significant political or societal changes happened since the research was conducted? I wouldn’t use data more than 15 years old (but the newer, the better).
  • Review the sampling. Look for phrases like “nationally representative” or “generalizable.” In order for a study to be generalizable (i.e., the findings apply to the whole population of care leavers from that country, not just the sample of kids who participated in the survey), the participants should be selected randomly (or as close to randomly as possible) and the sample should be somewhat large.

6. “For every 3 months a child spends in an institution, they lose 1 month of development”

Dr. Delia Pop makes the claim in this video

I hear this one sometimes from adoption, deinstitutionalization, and orphanage improvement advocates. It’s a very effective way to communicate the harm of severe deprivation. But where does it come from, and to what can it be generalized?

I did a search for this phrase in articles and reports and dug into their citations. At first I mis-remembered the quote as children losing one month of brain development, but it turns out this is not the case.

The research seems to come from Dana Johnson, a well-known international adoption pediatrician and researcher. In one book chapter he wrote:

The adverse effects of the orphanage environment on linear growth are remarkably consistent worldwide. Whether a child is institutionalized in Romania (Ames, 1997; Johnson et al., 1992), the Former Soviet Union (Albers et al., 1997), or China (Johnson et al., 1996; Johnson & Traister, 1999), analysis of growth data from a variety of orphanage systems indicates that children lose one month of linear growth for approximately every 3 months spent in institutional care.

(If you’re interested, here’s a figure.)

First, by linear growth, he means height, not brain development or any other measure of development. When you take this research and phrase it as simply “children lose one month of development…” it sounds much more compelling than “children lose one month of height”!

Here is proof from an NGO newsletter that lots of people think the statistic is about brain development! (From April 2018)

Second, all five studies are of children after they have been adopted to North America. Children chosen for international adoption might be categorically different than the larger population of children in orphanages–maybe they’re healthier, maybe they’re smaller, who knows…

Third, though, I appreciate that the data comes from multiple countries (I hate when data from one country is used to generalize to the whole Global South), it’s still just Eastern Europe plus China–no data from Africa or Latin America.

And finally, and most importantly, it’s just so old…many of these kids’ heights were measured before I was born. There have been very significant changes in Eastern European and Chinese child welfare systems in the past 25 years and I don’t think we can assume this trend still holds true.

The way Hope and Homes for Children used this statistic in the above video, it’s like they are saying, “We can assume today’s baby homes in Uganda are the same as the Chinese and Eastern European institutions of 25 years ago.” That’s a valid hypothesis, sure, but there’s just little reason to assume it’s true without evidence.

So what should NGOs say instead? Well, I would be satisfied if they just prefaced this factoid with, “Studies of Eastern Europe and China in the 1990s found that…” Then the listener is at least a little more equipped to decide if the statistic is relevant to the issue at hand.

Edit [April 16, 2018]: By happy coincidence, I met Dr. Johnson at the Rudd Adoption conference a few days ago. I asked him about this statistic and he said that yes, it refers to linear growth…But his team did do another study about developmental milestones, which was never published. They found that children were delayed about 1 month in milestones like rolling over and walking for every 3 months they were institutionalized. However, he said, these children experience catch-up growth in middle childhood and so the negative effects are not sustained. So I still stand by my original conclusion.

In Conclusion

A lot of (non-peer-reviewed) reports just cite figures that were included in a prior report, even though report had gotten its figure from an even older report, and so on, without anybody realizing the original data was collected decades ago!

This happens for one major reason: Governments collect far too little data on children living outside parental care. As Lumos put it, “All children count, but not all children are counted.”

If there’s one thing that everyone working in the alternative care space can agree on, it’s that our field desperately needs newer and better data collection and research studies. So we have to press donors and governments to budget for it!

Common Orphan Statistics in Context – Part 1

When I see a nonprofit share an interesting statistic in its marketing materials, I want to know where they got it, because 1) I want to know how reliable of a fact it is, 2) I need to cite its source properly if I want to use it in a paper. Here are a few of the most common orphan stats I’ve investigated…

1. “There are 140 (or 143, or 147, or…) million orphans in the world”

This mug actually exists

This statistic, favored by orphan care ministries and international adoption advocates, probably comes from this UNICEF press release.

The press release carefully explains that in this context, the term “orphan” means a child who has lost one or both parents, an odd definition which grew out of the urgent need in the 1990s to direct attention to all the children who were losing a parent (even just one) from HIV/AIDS.

Strangely, this means that an “orphan” might have a living parent. They probably have other living relatives too, or community members who are willing to care for them. This statistic does not mean “140 million children have nobody to care for them,” “140 million children are living in orphanages,” or “140 million children need to be adopted.”

The press release doesn’t say where its “140 million” figure comes from, just that it’s for the year 2015. But I found the source! UNICEF’s 2015 State of the World’s Children report has detailed stats by country available in Excel format (see the HIV/AIDS tab here). The table says 140 million children are orphaned worldwide, without really specifying how it gets to that sum from its patchy country-level data. And the source for the figures is simply, “UNAIDS, 2013 HIV and AIDS unpublished estimates, July 2014.”

Since the numbers are unpublished, we can’t check it any further, but I’d guess that UNAIDS received the data from the various Ministries of Health or Welfare or other government departments. (It’s not so great to keep the source data unavailable, though, when so many NGOs and charities are citing it!)

2. “80% of children in orphanages have at least one living parent”

The data is weak, but it’s not a bad guess

Lumos, Hope & Homes for children, and other groups that advocate for deinstitutionalization frequency cite this figure. They say the source is a 2009 report by Save the Children called Keeping Children Out of Harmful Institutions: Why we should be investing in family-based care.

The number “80%” doesn’t actually appear in this report though–the closest I found is the graphic on page 5, which gives percents for 8 countries in 5 continents. These 8 country percentages come from a range of sources, including one peer reviewed article and six non-peer reviewed reports by governments and NGOs (see no. 33-40 on page 23).

It’s a quick and dirty little sample that gives an okay estimate, and I suppose 80% is a fair average, but it is a tad outdated by now, and I’d love to see someone produce an updated figure produced with the rigor of statistic #3, below…

3. “2.7 million children are in orphanages”

I don’t see this one used all that much, but maybe it should be. This is UNICEF’s best guess at how many children are in alternative care, taken from a 2017 peer-reviewed article in the academic journal Child Abuse & Neglect by Patrowski, Cappa, & Gross.

They sum the data reported by 140 countries to get a figure of 2.3 million children in residential care–then they extrapolate for countries that don’t have data available, coming up with a total of 2.7 million children in residential care worldwide. They explain the process in detail in the article, which is free to access.

[Edit: I should have also mentioned that it’s likely that the 140 countries only reported on the registered residential care homes that they’re aware of. There are likely many unregistered homes, and thus many uncounted children, so 2.7 million is a conservative estimate.]

They tried to make similar estimates for the numbers of children in foster care, but unfortunately, not enough countries reported data to get a reliable worldwide total.


When you put these three stats together, here’s what you get. Something to think about, right?

Response to NCFA’s “In Defense of Adoption”

The National Council for Adoption (NCFA) puts out a monthly bulletin called the Adoption Advocate on various issues (recent publications were on the Foster Care Bill of Rights and on helping adult adoptees with their birth parent searches).

When it comes to international adoption, NCFA is known for its stance on promoting international adoption and fighting its decline, à la Joint Council, CHIFF, and Stuck.

So my interested was piqued when an issue called “In Defense of Adoption: Reforms that Ensure Adoption Meets Its Full Potential” came through my email inbox last week, authored by NCFA CEO Chuck Johnson.

Johnson was inspired to write this piece out of  “frustration that the national discourse on adoption is often negative in tone.” “[D]espite millions of successful outcomes…” he says, “[w]e spend much of our time answering questions and explaining to domestic and international policymakers the reasons for some of the rare negative outcomes in adoption.”

It’s a classic complaint, but instead of simply decrying the “anti-international adoption” crowd’s singular focus on “the bad side of adoption,” Johnson actually “suggest[s] that the adoption community should instead take collective responsibility for each and every negative outcome.” He outlines ways that the adoption industry needs to improve itself, adhere “rigidly” to higher standards of ethics and integrity, and the development of national best practices around home studies, birth parent counseling, and pre- and post-adoption education. (It almost sounds like he’s advocating for more–gasp–red tape!)

I like this. I may not agree with all of NCFA’s policy initiatives or their ideological stances, but I think many of us on “both sides of the aisle” agree that family preservation is important, adoption is a valid option, and the adoption industry needs to be well-regulated and law-abiding. I’m tired of adoption advocacy groups afraid to admit that corruption and poor practice exist, for fear of giving adoption a bad name. It’s important for constructive criticism to come not just from outside the adoption industry, but from the inside as well, if groups like NCFA wants to convince skeptical parents and adoptees that they represent their interests.

It is only Johnson’s tone that I disagree with. He adamantly emphasizes that adoption is good and necessary in the vast majority of cases, and I tend to linger on the fact that adoption is always and without exception born out of social justice. But our two viewpoints don’t necessarily contradict each other  in practice. In this piece of writing, we agree on the next steps.

I like where this is going.

Webinar recap: CRS’s “Singing to the Lions”

The 4Children team presented on “Singing to the Lions” this morning in an webinar. In their words: “Singing to the Lions: A facilitator’s guide to overcoming fear and violence in our lives is a training manual based on proven psycho-therapeutic interventions that help children and youth overcome fear and violence in their lives. Dr. Jonathan Brakarsh will discuss the background and philosophy behind Singing to the Lions. Dr. Lucy Steinitz will give an overview of the curriculum’s content and lead participants through a sample activity.”

The guide can be found here.


CRS developed Singing to the Lions in hopes of creating a program that could be implemented on a large scale in low-resource environments to improve the lives of people affected by violence and trauma. It’s an integration of the author’s work as a counseling psychologist in Zimbabwe, pulled together from evidence-based programs and his own experiences. (Although the guide does not cite origins/sources for its activities.)

The guide is supposed to be “universal” and transcend cultural contexts, and provides ideas for local adaptation. For example, the lions in Singing to the Lions represents fear, but the lions can be replaced with snakes or other local symbols of fear by the facilitators.



The objectives of Singing to the Lions are to…

  • teach children self-calming techniques
  • change children’s negative views of themselves
  • decrease social isolation
  • identify ways to overcome violence and fear by breaking large problems into small steps
  • give children hope and goals for the future.

Singing to the Lion does this in a three-day workshop (or, alternately, as six 3-hour modules) for around 20 youth (ages 11 and up). Breaking the modules into shorter sessions is highly discouraged.

The supplement to the guide contains basic instructions on how to train facilitators. There are no requirements for the qualifications of the facilitators. Facilitators can be trained in three days.

Singing to the Lions guides participants through a number of activities to teach coping mechanisms and principles. For example:

  • Children draw a tree. On one side of the tree they write the bad things that have happened to them; on the other, they write the good. All the children hang up their pictures next to each other: now the trees have become a forest, which is much harder to destroy than a tree.
  • Children are taught to “change the channel” when they are overwhelmed with negative thoughts – they should practice “switching” to positive thoughts.
  • Children gather sticks or stones outdoors that represent their problems. Together, the children throw the stones away.

Other activities teach children how to not blame themselves for what is not their fault,  to reach out to other people for support, and to utilize breathing techniques to calm themselves when overwhelmed with anxiety.

The tool also should enable facilitators to identify children who need further one-on-one counseling.


So far, Singing to the Lions has only been piloted with one group, as one workshop in a larger project.

It comes with a built-in M&E tool of 20 simple true/false questions (e.g.: “When I get scared, I focus only on all of the horrible things that can happen”). In Sierra Leone, CRS saw 46% “correct” questions at baseline rise to 77% at endline, and 95% three months later.

The supplement also points to more rigorously validated measures of psychological well-being that could be used in an evaluation. However, so far, no evaluation of this kind has been done. In fact, Singing to the Lions has only been implemented once as a pilot, although a larger training-of-trainers is in the works and they are also trying to make a more rigorous evaluation happen.

CRS has made the tool publicly available in hopes that any group who wants to can implement it.


I think these sorts of approaches are great introductions to emotional self-awareness. Singing to the Lions is certainly not a cure-all–some people do years of individual, intensive therapy and still struggle to overcome trauma or recognize their self-worth–but in contexts where children have never been told before that their feelings are valid, or that their experiences are not their fault, this workshop can be a great first step. Another great component is that one of the sections equip children to voice their concerns about violence to their community leaders, attempting to break the cycle of violence in the community.

However I also think there are at least a few other similar programs out there that have been already evaluated with positive results. Specifically, Singing with the Lions is fairly similar to Teaching Recovery Techniques (which already has a lot of evidence behind it). It will be interesting to see more results come out about Singing with the Lions in the future.