Consultancy: Rapid Assessment of Mental Health and Psychosocial Needs and Services for UASC in Greece (national level), duration: 24 March – 24 May 2017 (8 weeks)

If you are a dedicated and qualified professional seeking a unique opportunity to support the Refugee & Migrant Crisis in Europe, there is an opportunity in Athens, Greece, and we encourage you to apply!

*** This vacancy is opened only for Greek citizens

I. Background:

Unaccompanied children (UASC) constitute a highly vulnerable group who are likely to experience various levels of mental health and psychosocial distress. This may be linked to their experiences prior to arrival in Greece (including war, violence, death of loved ones, destruction of homes, and/or displacement, pre-existing mental health issues), experiences faced during the high-risk journey to Greece, and experiences faced upon arrival in Greece (including isolation and related lack of support networks, extended waiting times regarding their asylum applications and related uncertainty about their future).

According to the Greek National Centre for Social Solidarity (EKKA), the past six months have seen an increase in reports by shelter providers of mental health cases among unaccompanied children, including reports of stress-related aggressive or violent behaviour, high levels of anxiety, depression or acts of self-harm and/or increasing incidents of high-risk behaviour.

Shelter providers may not have the necessary experience, skills or expertise to provide appropriate support for these children which may contribute to further exacerbating their distress and which may make it more difficult for staff to manage situations that may as a result. In addition, front line workers have reported a few cases of UASC exhibiting more severe symptoms of mental health and/or psychosocial distress which have resulted in their referral to psychiatric facilities for specialized care and hospitalization. As a result, UASC shelter providers are struggling to deliver appropriate care for these children without the additional support of specialized mental health service providers. In recent months, some shelter providers have declined to accommodate newly referred UACs with more complex needs, and authorities have faced challenges in finding alternative accommodation and care that can suitably meet their specific needs.

The provision of appropriate care for UASC with mental health needs is a priority for the Greek government and efforts are underway to try to find solutions in order to better support them. Opinions on how best to respond are varied - some stakeholders have suggested placing all children with MHPSS needs in dedicated shelters, others are calling for a community based approach tailored to the specific MHPSS support needs of individual children such as therapeutic fostering in families, and yet others are calling for a multi-tiered approach combining skills building of front line workers, targeted professional support to UASC needing specialized care, and increasing options for residential care for the small numbers of UASC with more complex needs. Any decisions should be informed by relevant international guidelines[1] and good practices from other countries[2].

[1] Stockholm Declaration 2003 on children and residential care https://resourcecentre.savethechildren.net/sites/default/files/documents/2584.pdf; IASC MHPSS Guidelines http://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_2007.pdf

[2] For example in some European countries including UK, there has been a historical move away from use of residential care to a more community based care model, as this promotes independence, inclusion in society for all people and more in keeping with human rights.

II. Objectives of Rapid Assessment:

In light of the above, UNICEF is commissioning a rapid assessment of mental health and psychosocial support (MHPSS) needs and services for unaccompanied children (UASC) in Greece, in order to inform planning for expanded services. The specific objectives of the rapid assessment are: 

1. To assess the range, scope and scale of mental health issues facing UAC in Greece including those living in shelters and those in other locations including reception and identification centres (RICs), and reception centres;
2. To map existing MHPSS and child protection legislation, policy and services in Greece and assess the capacity to meet the increased case load, scope and range of specific MHPSS support needs of UASC, including but not exclusively the most severe cases;
3. To identify good practices and possible gaps in the current Greek legal and policy framework as well as service provision response to the increased case load and particular MHPSS needs of UASC;
4. To propose a set of recommendations on how to best address existing gaps including immediate and medium/long term actions in light of the realities of the Greek context.

• III. Scope of Assessment
• The rapid needs assessment will focus on the reported MHPSS needs of UASC living in Greece including those living in shelters, reception and identification centres (RICs), reception centres, and safe zones.[1] The mapping of the current response will look across the range of child protection and mental health legislation, policies and services, working closely with the Ministry of Migration Policy, Ministry of Labour and Social Solidarity, Ministry of Health, and EKKA.
• IV. Research questions:

1. Needs Assessment:
1. Scope of MHPSS issues[1]: What are the range of mental health and psychosocial support needs[2] affecting UASC in Greece (categorized according to symptoms and severity).
2. Scale of MHPSS cases: How many UASC have been identified as having MHPSS needs and what type of needs? What is the estimated number and percentage of UASC in Greece that require primary, secondary or tertiary specialized MHPSS support. How many of these/what percentage may require separate in-patient care?
2. Mapping of existing MHPSS and Child Protection (CP) framework for UASC in Greece[3]
1. What is the legal and policy framework regulating access of UASC children to MHPSS support services, including community based, in-patient and residential care?
2. What are the institutional bodies accountable for MHPSS support to unaccompanied children? What are their functions and what are the challenges and opportunities faced in practice in terms of responding to increased case load and to specific needs of UASC?
3. What specialized services are available to address UAC with MHPSS support needs? Referral: How are children with MHPSS support needs identified, assessed and referred for specialized care if needed? How are needs identified and prioritized? What about UASC?

• Rapid assessment of MHPSS response for UASC

1. How are existing services (including UASC shelters, in-patient facilities, out-patient care) meeting the needs of UASC with MHPSS needs? What are some examples of good practices? What are the key challenges and primary gaps?
2. What are the factors underlying existing challenges/gaps (i.e. legal and policy framework, technical expertise, human resources, funding, etc.), and how might they be addressed?

[1] A representative sample will be used, and findings generalized for all UASC.   This is not intended to provide a detailed epidemiological assessment, but rather a quick review based on secondary source data and interviews with professionals.

[2] Including medical, social risk and protective factors.

[3] The assessment will start by identifying children's services (i.e for Greek children and youth) with a view to how they can accommodate the specific needs of UASC.

• Recommendations:[1]

The findings of the rapid assessment should include recommendations that address the following:

• What amendments, if any, are needed in existing legal and policy frameworks to better protect UASC with MHPSS needs.

• How can identification and accurate assessment and referral of UASC with MHPSS needs be strengthened among front line workers?

1. How can the capacity of existing care providers (including UASC Shelters) and others working directly with UASC be strengthened to provide MHPSS support to UASC with more generalized (non-severe) MHPSS needs?
2. How can the provision of existing MHPSS services be enhanced to reinforce the capacity of shelter providers to effectively care for UASC with medium level MHPSS support needs (for example through provision of complementary out-patient support).

• How can existing MHPSS/Child Protection services (both in-patient and out-patient) designed for Greek children be enhanced to enable them to service UASC with MHPSS support needs?

1. What model of short and medium term residential care is most appropriate for the small percentage of UASC who may need to be placed in separate facilities?
2. What options are there for the alternative care, including community and residential-based, for UASC who may have higher care needs?
3. How can coordination, referral and cooperation between different MHPSS and CP actors be strengthened?
4. How we include the local communities, implement community sensitization and awareness raising activities in order to combat stigma and exclusion and enhance the inclusion of UASC with MHPSS needs?

[1] Recommendations can be informed by examples of good practices from other European countries in supporting UASC (or adolescents) with mental health including alternative community-based models of care

III. Methodology:

The rapid assessment methodology will include:

• Desk research/ Secondary data review of both qualitative and quantitative data
• Semi-structured interviews with front line workers (shelter staff/RIC staff), mental health providers, government authorities, and technical experts.
• Site visits and observations
• Focus groups with the participation of stakeholders involved and local community representatives

Detailed assessment questions and methods will be developed by the consultant in close consultation with a task force/steering committee set up to oversee the study. The preliminary findings will be shared with stakeholders and recommendations will be refined based on consultative discussions. 

Methodological guidance may also be drawn from the following resource: Assessing mental health and psychosocial needs and resources - Toolkit for humanitarian settings (WHO and UNHCR`(2012) - [1]

•  Time Frame and Deliverables: 

Weeks 1-2 – detailed research methodology and assessment tools

Weeks 3-4 – field research - Site visits (RICs, Shelters, reception centers safe zones), interviews 

Weeks 5-6 – draft report and validation workshop to review findings with stakeholders 

Weeks 7-8 – Final report – (maximum 25 pages); summary of findings and recommendations (maximum 3 pages)

[1] http://apps.who.int/iris/bitstream/10665/76796/1/9789241548533_eng.pdf

Methodological guidance may also be drawn from the following resource: Assessing mental health and psychosocial needs and resources - Toolkit for humanitarian settings (WHO and UNHCR`(2012) - [1]

 Eligibility Criteria

The preferred candidate should meet the following criteria:

• Advanced university degree in mental health field
• Over 10 years of experience in the MHPSS and/or child protection fields, ideally working with refugee children
• Substantive experience carrying out research on MHPSS/CP issues with children
• Familiarity with the Greek child protection and mental health systems
• Excellent analytical, writing, and communication skills, Fluency in English and Greek