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2021 Annual Report & Accounts

What we do and why

This has been a truly terrible year for the world’s children. The pandemic has disrupted the education of children everywhere, many of whom have lost parents, family, and support networks as a result of over 4 million deaths to date. Many others have become refugees. 48% of the 82 million displaced people worldwide are under the age of 18. That makes nearly 35 million children suffering from the anxiety of dislocation, as well as bereavement, now without a safe or secure community in which to grow up. Consider in addition the impact of ongoing or new conflicts: the Syrian war is now 10 years old, and that in Yemen nearly 8 years old. Many children have never known peace. In Gaza and in Armenia, children have very recently been in the midst of renewed conflict and have directly experienced bombardment and death. The work done by ACT International has never been more needed, and we are proud to say we are working in many of these countries to promote and develop the skills of local people to cope with the impact of trauma.

Of course, over the past year, we have been unable to travel and our planned in-person trips out of the UK were put on hold. However, this gave us the space to develop online materials and different kinds of training to meet specific needs. This report will tell you more about our anxiety and resilience (A&R) training, which is more appropriate than the Children’s Accelerated Trauma Technique (CATT) for areas where there is ongoing instability or conflict, and Tortu the ‘very worried tortoise’ who is helping anxious children settle back to schools closed by the threat of coronavirus. We have taught Children and War’s ‘Teaching for Recovery Technique’ entirely in Spanish online to Colombian childcare professionals, and invested more in local initiatives, run by individuals we trust, who deliver high-quality training and support to children in their home communities, including refugee camps. We are now delivering online trauma and anxiety management training to people in three out of the top five countries hosting refugee children (Uganda, Colombia, and Turkey). This means that your money can go further and help more children without being spent on costly flights and hotel accommodation. So we have also become a ‘greener’ organization in the process, and we anticipate that climate change is set to be a major cause of displacement and stress in the future. But we have really missed seeing and consoling our many friends around the world and hope that we will see you again before too long!

Don’t forget: we can’t change what has happened to all these children, but we can – and do – change what happens next. By healing young minds, we give them another chance at a normal life.

Reference and administration details

Charity name and details

Luna Children’s Charity, working name: Action for Child Trauma International. Registered Charitable Incorporated Organisation (CIO) in England & Wales, Number 1272010

Registered address: 184 Medstead Road, Beech, Alton, Hampshire GU34 4AJ

Website: www.actinternational.org.uk

Facebook: www.facebook.com/ActionChildTraumaInternational

Twitter: https://twitter.com/LunaChildren

Charity trustees

  • Victoria Burch (Clinical Lead Trustee)
  • Stella Charman (Chair)
  • Jenny Cuffe (from 9.6.20)
  • Dr Yara Fardous
  • Anne Feeney
  • Saif Ghauri (from 9.12.20)
  • Brenda Graham (Safeguarding Lead)
  • Martyn Legg (Treasurer)
  • Philip Sarell

Officers

  • Dr Ghalia Al Asha – Middle East Operations Manager & senior trainer
  • Shellee Burroughs - Clinical Operations Manager & senior trainer
  • Elias Byaruhanga - Uganda Operations Manager & senior trainer
  • Tamara Curtis – Gaza Partnership Project manager

Specialist volunteers this year

  • ‘Among Equals’ communications/PR & design team
  • Armenian interpreter and translator – Anush Gabrielyan
  • Fundraisers:
    • Penny Jeffcoat
    • Anna Jeffcoat
    • Rosemarie Ghazaros
    • Rosemary Lambert (Marine House at Beer)
  • Psychology assistant – Lily Holland
  • Website & IT support – Hector Riley

Interns

  • Zara Bracegirdle – University of Sussex, working on Colombia training
  • Ruby Turok-Squire – University of Warwick, as general operations assistant
  • Eve Hatcher – University of Sussex, working on Armenia research & Facebook

UK-based trainers active this year

  • Pippa Gray
  • Lola Perez-Gavino

Spanish trainers active this year

  • Almudena Garcia Perea
  • Pilu Rivas Lobo

Uganda-based trainers active this year

  • Sister Florence Achulo
  • Syson Katushabe
  • Alice Janet Namaganda
  • Candia Umar

Middle-East based trainers active this year

  • Dr Ghalia Al Asha
  • Mohammed El Sharef

Governance and management

The pandemic year 2020-21 has been a challenging year for all charities, many of which have seen revenues fall, projects curtailed and staff made redundant. For once our small size has helped us to weather the adversities, as in the absence of significant overheads and only voluntary staffing, our expenditure is easily reduced in line with income. Section 5 provides a more detailed overview of our sound financial position. We have used this year, in which we have been unable to travel, to develop new training materials and to improve our online presence and skills. In addition, we have strengthened our policies and procedures and built new relationships with umbrella organisations such as Keeping Children Safe and the Consortium for Street Children. We have both benefitted from their resources and expertise, and contributed ours to them. Partnership working with likeminded agencies that share our objectives is an important plank of our strategy for sustainability and growth. This report illustrates how over the course of the year we have worked with many other charities to ensure skilled psychosocial support reaches more children.

This year we recruited two new Trustees. Jenny Cuffe is a BBC-trained freelance journalist who has travelled extensively to countries or regions experiencing conflict or political turmoil and environmental disaster. Since 2000, she has made several programmes about asylum seekers in the UK, as well as a series of programmes about migration from sub-Saharan Africa. She is also a visitor for the Southampton & Winchester Visitors’ Group and has befriended and supported a number of asylum seekers. Saif Ghauri is a business graduate and qualified accountant with 40 years’ experience, including 20 years in the shipping sector. Since 2006, he has worked as a management consultant in the UK and internationally, spending time in the Gambia and Uganda on behalf of the Medical Research Council. In April 2021 he replaced Martyn Legg as Treasurer. Martyn assisted in Saif’s recruitment and handed over his responsibilities in the full knowledge that he would not be able to continue beyond March 2021. Very sadly, Martyn passed away in June. He had been our Treasurer since 2015 and was responsible for setting us up as a CIO in 2017. Martyn was a dependable and much respected Treasurer and Trustee, and we would not be in such a sound position today without him. We pay tribute to him here.

Sussex University has once again been a source of two capable volunteer interns providing operational and project support: Eve Hatcher and Zara Bracegirdle. Eve combined follow-up work on our training in Armenia with the research dissertation for her Masters in Human Rights and also took over the Facebook page from Lucy Rolington. It is a pity she was unable to travel to Armenia as originally planned. Zara, who has been studying Spanish in addition to International Development and Psychology, has been supporting training by the Spanish team in partnership with Children Change Colombia. In addition, Ruby Turok-Squire, a Warwick University International Development Law and Human Rights Masters student, has been helping with general operational tasks and, particularly, analysing feedback from the growing number of online training courses. Without the additional management capacity and youthful energy and skills provided on a voluntary basis by these interns, we would have been unable to achieve so much in 2020/21, and we are so grateful to them all.

Objectives and activities

ACT International exists to advance the rights, education and health of children and young people affected by conflict and trauma. Formally, its objectives are:

  1. The advancement of education and preservation of good health of children and young people affected by conflict and/or trauma

  2. To advance the education of the public in children and young people’s rights in part, but not exclusively, under the UN Convention of the Rights of the Child

In the past ACT International’s charitable objectives have been primarily achieved through the delivery of training in the Children’s Accelerated Trauma Technique (CATT). However, over the past three years we have been broadening our activities so that we now fulfil our purpose through a wider range of training, both online and in person, and by supporting people working with children affected by conflict and/or trauma. These activities are:

Training of people working with children in their communities, both in person and online:

  • Children’s Accelerated Trauma Technique (CATT) created by Dr Carlotta Raby
  • Anxiety and Resilience Programme (A&R) compiled by Victoria Burch
  • Teaching for Recovery Technique (TRT) developed by Children & War Foundation
  • PTSD Awareness: bespoke training to meet needs of local culture or experience
  • Safeguarding, based on Keeping Children Safe guidance for relief and development charities, and integrated into all our training as appropriate to the local culture or context.

Special projects offering wider support in areas of particular need or for specific types of children (e.g. trafficked girls cared for by the Bishop Asili Community Development Foundation).

Supporting individuals who work unaided or in isolation, in areas of need (e.g. Alhagie Camara for the Gambia).

Developing materials for use with children (eg Tortu the Very Worried Tortoise by Victoria Burch) in specific contexts, or to support good practice.

The Trustees confirm that they have complied with their duty, under section 4 of the Charities Act 2011 to have regard to the Charity Commission’s guidance and regulations on public benefit and that the public benefit requirement has informed the activities of the Charity in the year to March 31st 2021.

Achievements and performance

CATT training and ongoing support for practitioners: Uganda

CATT Practitioners Conference in Kampala

We were well down the road with the planning for a 2-day conference in May 2020 at Butabika Hospital, for 50 of our Ugandan CATT practitioners, when the pandemic struck and we were unable to travel. Discussions were held about the possibility of transferring this to an online event, but we concluded that this was unlikely to be successful due to unreliable internet connectivity in Uganda. Furthermore, the Ugandan team was keen to have colleagues from the UK present in person. Since then, Uganda has experienced a challenging third wave of infections and a second lockdown, and has been placed on the UK’s ‘red list’ for travel, so we sadly have no dates for this postponed event as yet.

Oruchinga Refugee Settlement

Between the two lockdowns, Elias Byaruhanga has been able to travel within Uganda. In August 2020, he and Syson Katushabe delivered CATT training to 15 health workers and counselors working in this settlement in southern Uganda, which is home to more than 6,800 refugees from Burundi, DRC (Democratic Republic of Congo), and Rwanda. 13 people completed the training successfully. Elias continues with regular supervision of CATT practitioners here.

CRESS CATT team

860,000 South Sudanese refugees live in Uganda (UNHCR February 2021). In partnership with CRESS (Christian Relief and Education for South Sudan), we trained 19 CATT practitioners back in 2019, who now form the South Sudanese CATT team based in Northern Uganda. CRESS obtained funding for the ongoing work of the team, to which we also contributed this year. It has helped a total of 91 children and young people with CATT. Most of them are school dropouts and orphans, many of whom have been raped, trafficked, tortured or are the victims of neglect and war. Many have unmet basic needs due to escalating poverty in their refugee settlements in the north of Uganda, increased by coronavirus and lockdowns. This yea,r the team has run an emotional health and PTSD awareness programme for the South Sudanese community, and as a result enough South Sudanese refugees and Ugandans nationals have shown interest to be trained as CATT practitioners to run another course in 2021/22.

CATT training and ongoing support: Middle East

Anxiety & Resilience Programme Training

The new Anxiety and Resilience (A&R) Programme was designed for children in challenging post-conflict or post-disaster settings by our Clinical Trustee Victoria Burch, after discussion with our Middle East partner charity UOSSM. By early 2020 it had been translated into Arabic and was ready to be piloted when the surge in Covid cases forced most of our partner organisations across the world to halt face-to face work, or to concentrate on pandemicrelated support. Training in new methodologies was no longer a priority. However, we realised that there was a great need for training in ways to help children and families cope with the anxieties caused by the pandemic and the economic and social hardships associated with it. So we quickly developed a short single session course in managing anxiety in the context of a pandemic, with ‘tools’ from the A&R programme. Over the winter, this was delivered online to CATT counsellors working in Northern Uganda, then in Arabic to 3 partner organisations in the Middle East. An adapted version was delivered as part of the annual conference of the Consortium for Street Children (CSC), to which we are affiliated, to staff of NGOs in the CSC network across 4 continents. These short courses were well received and provided valuable learning experiences for the ACT International team as we took our first steps into online training.

Early in 2021 UOSSM invited ACT International to train mental health professionals in Syria in the full Arabic A&R programme. This had to be an online course, and led us to realise that by working online we can reach and support our partner organisations in areas to which it would be impossible to travel. The UOSSM training was delivered in early March by our Middle East Operations Manager and senior trainer, Dr Ghalia Al Asha. Initial feedback from the trainees was very enthusiastic, both for the quality of teaching and the course itself. UOSSM mental health staff have started to work with groups of children, and feedback suggests that the programme has been well received and is benefitting the children. We are now eagerly waiting for the full results of the pilot study on its effectiveness. Meanwhile 3 further NGOs working with Syrian and local children in the Middle East have requested A&R training for their staff, which we plan to deliver later in 2021.

Online training is not easy. Inconsistent internet connections pose frequent challenges, with poor sound quality, signals dropping out, and trainees needing to catch up on sections they have missed. Due to the situations in which they are working, trainees may sometimes be very stressed themselves, so we have learned to build extra time for self-care and for discussion into the courses. We also realise how essential it is to have at least 2 trainers for each online course, so that one trainer can deal with IT issues or provide extra support for a trainee, while the principal trainer delivers the course.

Dr Ghalia is an expert teacher and we thank her for all the work she has put into preparing the A&R training materials for online teaching, and for teaching so superbly in often trying circumstance: she consistently receives very high praise for her teaching, support and goodhumoured unflappability in feedback after courses. In March 2021 we were pleased to welcome Mohammed El Sharif from our team in Gaza as an Arabic-speaking A&R trainer, and will shortly be recruiting additional trainers for this programme.

The Yemen

In December 2020 we were introduced to Kawkab Alwadeai, a Yemeni refugee in Canada, by our sister charity Firefly International. She is a researcher and mental health counsellor seeking mental health training for her network of mental health workers, psychologists and teachers in the Yemen. Our A&R programme in Arabic (see 4.2.1 above) was the ‘perfect fit’ for this, but working in a war-torn country with poor internet presented us with real logistical difficulties. Dr Ghalia and Mohammed El Sharef managed to deliver a pilot course in March 2020 to people in the province of Taiz, but learned that we would have to find a way of bringing trainees together somewhere with a reliable connection, if we were to roll out this training to other parts of the country. Thanks to the support and networking capability of the British Yemeni Society, we now believe we have overcome these difficulties and are planning to extend the training to four other provinces in 2021/22, with additional funding from IMET 2000.

CATT training & follow-up: Armenia

Following our CATT training trip in November 2019, intern Eve Hatcher contacted the new practitioners with the help of interpreter Anush Gabrielyan, to find out how they were using CATT and who we might train as trainers of the future. Sadly, plans for her to visit Armenia were cancelled due to the pandemic, as was the follow-up trip with the training of trainers course scheduled for the end of 2020. Of the 26 professionals who had completed the CATT training, 16 agreed to take part in Eve’sresearch, which involved a questionnaire and in-depth interviews. All those who took part agreed that it had helped them in their day-to-day work with children and were actively using the technique. The full report plus a summary of it is available on our website.

In September 2020 Armenia and Azerbaijan went to war in Nagorno-Karabakh/Artsakh, and the focus of our partner charity, the Yerevan Children’s Center, turned firmly to the Armenian children subjected to bombardment, and now trapped in the enclave which was captured by the Azeris. So we have put CATT training on hold and are planning instead to deliver A&R training as soon as we can, as it is more suited to helping children deal with ongoing insecurity and fear.

CATT training: the Gambia

Throughout the year, we have continued to work in partnership with WAYAS, a Gambianregistered NGO, with the aim of offering a CATT training programme for 20 social workers and community nurses towards the end of 2021. Tom Anson, an intern from the University of Sussex, will lead on fund-raising for this project. In March, we introduced Alhagie Camara, Executive Director and founder of WAYAS, to therapist Pippa Gray who then ran four online training sessions for independent sexual violence advisors. We will build on the success of this programme to explore further opportunities for child-focussed mental health training in a country where services are chronically under-developed.

TRT and CATT training: Colombia

Over the course of the year we have been developing our relationship with Children Change Colombia (CCC), and fundraising for a TRT and CATT training trip to be delivered by our three Spanish-speaking trainers. In September, we held an online introductory session to help us assess need among the staff of the NGOs supported inside Colombia by CCC, and to design the training we should offer. However, with coronavirus infections surging in South America, it was decided not to wait until we could travel again, but to go ahead with online TRT courses as soon as possible to meet immediate need. A tremendous amount of work took place to improve and update the Spanish teaching materials provided by Children and War, and arrangements made to hold the training for up to 30 people in April and May. A full account and evaluation of this work, which hopefully will include in-person CATT training in Colombia in early 2022, will be provided in next year’s Annual report.

Special Project: Child Trauma Clinic for Gaza

In July 2020 the child trauma service for Gaza, which was set up with the support of our partners IMET2000 and Firefly International, celebrated its first birthday. It offers PTSD awareness sessions for caregivers and CATT treatment to children with PTSD, and is run by a clinical team of two: Mohammed El Sharif and Haithem Shamiyah, supported by volunteer Project Manager Tamara Curtis and Clinical Supervisor Dr Ghalia El Asha (see below). By the end of the period covered by this report, to March 2021, and despite COVID-19 restrictions, it had treated 94 children at a cost of just over $300 per child, with overwhelmingly positive outcomes.

A study was conducted on the first 69 children treated to December 2020. It showed that CATT was an effective treatment for symptoms of trauma in children and young people, including several who had lived with the effects of PTSD for 4 or more years, and despite continued exposure to potentially traumatising events. Parents and children also reported progress in life skills and psychosocial adjustment after CATT. A small group of children were seen for a follow-up review six to seven months after finishing CATT. No child in the group of 69 showed an adverse mental health event (e.g. marked mood swings or high levels of anxiety) during the treatment period, indicating that CATT is a safe treatment in this environment. You can read more about this study in section 4.11 of this Report, and it is also downloadable from the research and audit section of our website.

Unfortunately, a further finding of this study, that CATT may help children and young people to develop their psychological resilience to cope with further traumatic events, was dramatically put to the test in May when Gaza suffered 11 days of continuous bombardment. The clinic was housed in the Adam Center on 7th Floor of Al Jawhara Tower, which was destroyed on the second day. We received daily reports from Mohammed and Haitham who thankfully survived with their families, and all clinical data, saved in electronic form, was preserved. As this occurred outside the period of this Report, the full story of how the service has responded and been rebuilt will appear in the 2021-22 Report. But we pay tribute here to the courage and resilience of Haitham and Mohammed, and their determination to bring new hope to Gaza’s children.

Special project: The Friends of Butabika Children’s Ward

The Friends’ Project continues, albeit without a Project Manager, so activity is limited to funding Dismas Lwagula to work on the children’s ward for four days per week, and providing him with equipment. Unfortunately, during Uganda’s first coronavirus lockdown, which lasted for several months from April 2020, he was unable to work on the ward, as he was not designated a key worker. We were unable to send anyone to visit the ward until November 2020, when Elias Byaruhanga took funds and met with Reverend Dismas of St Luke’s Chapel, which is formally our ‘partner’ for this work and supervises Dismas Lwagula. Elias was able to visit for a second time in April 2020, He reported that the ward is kept clean and the children (around 30 inpatients) are properly fed. However, there are ongoing staffing and safeguarding concerns, which we are attempting to address with Butabika hospital management via the Uganda/East London NHS Health Link. We will make this a priority in the coming year.

Special project: Bishop Asili Community Development Foundation

During this very challenging year in Uganda, the Foundation, led by Director Sister Florence Achulo, has faced locusts, floods and the coronavirus pandemic. However, it has valiantly continued its work of providing counselling (including CATT) and education for the poorest and most disadvantaged families and children in the area around Lira. Sister Florence has been focusing her work on children who have been abused or trafficked, and in the early part of 2021 she identified over 40 trafficked children (mainly sexually-trafficked girls aged 10-15) in her local community who desperately needed help, and for whom she required funds. ACT International did not send any funding to the Foundation during 2020-21, but in March the Trustees decided to respond to this appeal and sent £600 in April. In addition, Elias Byaruhanga was asked to visit Lira to offer consultation and advice on individual children, assess the overall need and, in particular, to advise us on training needed by Foundation staff, volunteers and the local community. A full report on his visit and its outcome will appear in next Year’s Annual Report.

Tortu the Very Worried Tortoise

All over the world there have been high levels of concern about the impact of the pandemic, and the restrictions and changes linked to it, upon children’s mental health. In April 2020 there was a call from various teaching bodies for materials for teachers to use to support children with Covid-related anxiety in the UK. Clinical Trustee Toria Burch thought that Tortu, a lively but anxious small tortoise who is the central character of the ACTI Anxiety and Resilience Programme, might be able to help children in the UK as well as in refugee camps. An excellent team of volunteers came together to develop a story to about Tortu and his little friends, some at school, some at home on Mum’s phone or a laptop, all with questions and worries about the pandemic, and also full of ideas about how to feel better when they are low or anxious. The story helps adults caring for young children to talk to them about what makes them feel sad, anxious or cross, especially things related to the pandemic and school. It teaches children a bit about emotions and introduces some simple ways for them to manage difficult feelings and feel better. There are notes for teachers and parents, and follow-up activities for children. The story was updated after Christmas to reflect changes in the Covid situation. In March this year, communications agency ‘Among Equals’ offered to help us update the story again, as children went back to school. We are very grateful to Rachel Su, artist and designer at Among Equals, for updating the pictures based on the original drawings by Lily Holland. The stories seem to have struck a chord with many people and have been downloaded (for free) from the ACTI website and the TES Resources website all over the UK, and in countries as diverse as UAE, Italy, South Africa and Bulgaria. Tortu now has his own little website: www.meettortu.org and there are plans to develop more Tortu materials for children with normal childhood anxieties. All funds generated will go to ACT International.

With many thanks to:

Lily Holland: Character development and artist Charlotte Frere-Cook: Education consultant Hector Riley: IT and design assistant Rachel Su: Artist /designer And all at amongequals.com

Fundraising

We had expected 2020-21 to be a poor one in terms of fundraising, but by the year end the total (approaching £21k) was rather better than we had expected, thanks to the ongoing generosity of our supporters and volunteers. Penny Jeffcoat prepared a number of grant bids for us, which have not borne fruit as yet but we remain hopeful. Without funding from international aid sources, we were unaffected by the recent government cuts which have so badly impacted upon larger international charities.

Donations from corporate sponsors, charitable and grant-giving foundations

  • £2,482 East London/Butabika NHS Health Link
  • £5,000 from Joan Ainslie Trust 18
  • £2,000 from Marine House at Beer Art Gallery
  • £1,000 from Chartwell Industries Ltd/Cripps Foundation

Churches, clubs and societies

  • £6,000 from United Church Winchester for Middle East training

Campaigns and events via Virgin Moneygiving

  • £725 raised by Zara Bracegirdle for Colombia
  • £420 raised from an art exhibition by the Sopwith Family
  • £260 from the Friends of Butabika Children's Ward

Individual donors

  • £363 Funeral proceeds
  • £2307 from miscellaneous donations made by individuals, including Neil Appleyard, Ian Tegner and Yvonne North, and others who prefer to remain anonymous
Funding sources (%) year ended March 2021
Funding source amount %
Charitable Trusts/Foundations 10,684 51%
Corporate donors 0 0%
Schools, youth groups, colleges & universities 0 0%
Churches, clubs & societies 6,000 29%
Campaigns & events 1,451 7%
Individual donations 2,670 13%
Earning from activities/interest 19 0%
TOTAL 20,824 100%

Website and social media

The website https://actinternational.org.uk/ is now functioning well as our ‘front door’ and had 2.5k unique visitors (i.e. not counting repeat visits) over this year. The largest source of these was direct visits, but Google also accounts for a large number of visits (i.e. people who found ACT International as a search result) and also visits occurred via our public Facebook page, with a few from Twitter.

The original Tortu post (‘Developing resources to help children with COVID related anxiety’) was the second most popular page on the website after the home page (i.e. where everyone is first sent when they go to the website).

75% of visits to the website have been from the UK. Other significant sources of traffic are the US, Canada, The Netherlands, and China. There are visitors, in smaller numbers, from other parts of Europe, the Middle East and Sub-Saharan Africa.

784 people follow our public Facebook page and we have increased the number of posts this year so that it provides lively and up-to-date publicity about our work. The private group, for CATT practitioners only, now has 68 members and provides information and resources related to trauma treatment for children and publicises opportunities for extended training and trainer training. 244 people or organisations now follow us on Twitter and our tweets also appear on the home page of the website, so visitors can see that we are active and committed to our work and read about our latest fundraising initiatives.

Quality Assurance & Research

ACT International has a multi-pronged approach to ensuring quality. Our training courses have been developed by knowledgeable and experienced clinicians and are regularly reviewed to ensure that they reflect new knowledge and thinking in the field of international children’s mental health. Our lead trainers are clinically experienced and well-trained as trainers. We gather and analyse feedback on each training course about the effectiveness of the training and the appropriateness of the materials. We try to offer clinical support to all new CATT trainees for the first few months after each course, and they are invited to join our closed Facebook group. We request clinical feedback from counsellors in the form of case studies, and periodically we gather more information about cases for more formal audits with data for statistical analysis. Despite the difficulties and restrictions due to Covid, we have been as busy as ever over the last year.

The pandemic and the economic and social hardships associated with lockdowns and curfews have, of course, had an enormous impact on the communities with which we work, and our thoughts have been with our colleagues, many of whom were already working in very challenging environments. As lockdowns and curfews began to effect Uganda and the Middle East, home to many of our partner organisations, our closed Facebook group (see previous section) was used to share some ways to support children emotionally during the pandemic. In December 2020, aware of the rise of Covid-related anxiety across the world, we sought to give our CATT counsellors, especially those who do not have extensive mental health training, additional tools for supporting children through short courses in anxiety management delivered via Zoom in English and Arabic.

Gaza ‘CATT’ study

In Gaza, since the opening of the Children’s Trauma Clinic in July 2019, despite periods of pandemic-related closure of the clinic and the need to support children and families by phone or video, by the end of December 2020, our two clinicians Mohammed El Sharif and Haitham Shamiyah had completed CATT treatment for 69 children. A short assessment for symptoms of psychological trauma (‘CRIES-8’) was given to each child as part of their individual assessments before and after CATT, with high scores indicating PTSD. The drop in scores from before to after treatment for this group was analysed by ACTI volunteer psychologist Lily Holland, and showed that CATT significantly reduced trauma symptom severity.

Some children had suffered disabling PTSD symptoms for as long as 4 years before coming to the clinic, and were now able to return to school, to sleep without nightmares, to play with friends again, and begin to enjoy life free of trauma symptoms. Children and young people in Gaza experience cumulative and ongoing stress from intermittent conflict, violence and associated socio-economic instability. Showing that CATT can successfully treat PTSD in these difficult conditions has implications for treatment of trauma in children in other areas with continuing, intermittent conflict.

The assessments of 10 children seen by clinic staff over the winter for follow-up, six-to sevenmonths after finishing CATT, showed that their treatment had long-lasting positive effects. It also high-lighted several children who needed additional psycho-social support. All children seen at the clinic will now be given a follow-up review. We are very grateful to the clinicians for collecting this data despite many challenges, and to Dr Ghalia Al Asha (Clinical supervisor) and Tamara Curtis (Project Manager) for their support for the team through this very difficult year.

Uganda

Face-to-face work with children in Uganda has been suspended due to travel restrictions and lockdowns for several periods during the last year, as the authorities sought to contain the Covid pandemic. Elias Byaruhanga has provided a valuable point of support and contact for CATT counsellors, remotely and in person when this has been possible. We are grateful for his time and expertise in supporting the work of his colleagues, which helps to maintain high standards of work with the children. The CRESS team of CATT counsellors, supported by Fiona Sheldon of CRESS UK, have continued to see child refugees from South Sudan, are supervised clinically by Umar Candia and collect case data whenever possible. We are look forward to receiving information about the cases they have seen later in 2021.

Anxiety and Resilience Programme study

Our partners in Turkey, UOSSM, have agreed to pilot the new A&R Programme in centres for children affected by the war in Syria. Children’s levels of anxiety will be assessed on a short mental health scale before and after they attend this group programme, and group leaders will feed back their views on the programme, and those of the children and their parents/carers. As well as indicating how effective the programme is, this will help us to see if any changes are needed before offering it more widely.

Online training

As Covid-related travel restrictions continue, it has become clear that much of our training over the next year or so may need to be online. We have started to adapt CATT for online training . We thank Dr. Dom Plant of Trauma Psychology Global and CATT licence-holder Dr. Carlotta Raby of Trauma Psychology UK for sharing with us materials that they have developed for their online courses. This is a big task, but it provides an opportunity to review and update all our CATT materials in line with new research and developments in the field of international trauma work. We hope to be ready to train online by early Autumn 2021.

Future challenges

Offering supervision and support/consultation for counsellors, especially new trainees, is important for maintaining standards of work but can be challenging when many trainees live in remote areas and may be quite isolated. We are continually adding relevant papers to the Research section of our website https://actinternational.org.uk/research and we aim to develop the closed Facebook group as a more effective tool for this. However, these methods do not help people in areas with limited or no IT. Finding ways to provide consultation for trainees who request support for their work with children will become more of a challenge as technology allows us to train in more challenging areas such as the Yemen and will be one focus of our work next year.

Safeguarding

Strategic and practical work on safeguarding has continued, although there have been no overseas visits requiring a risk assessment.

ACTI joined the Keeping Victims and Survivors Safe programme of KCS (Keeping Children Safe – the UK organisation assisting international charities with safeguarding policy and practice). A KCS workshop online for trustees in October was a valuable refresher and enabled KCS to get to know ACTI. Brenda Graham, trustee lead on safeguarding, is working with KCS to risk assess and upgrade our safeguarding policies for both children and vulnerable adults. Our policies must take account of ACTI moving to online delivery of training, to ensure the welfare of beneficiaries and volunteers. KCS membership gave us access to an online worldwide conference with inspiring workshops by small charities working to promote children’s rights and implement safeguarding measures.

Trustees approved updates to the Trustee and Volunteers Recruitment policy that strengthen our application and selection process. We require self-disclosure by the candidate if they have been the subject of a safeguarding concern or investigation, and a statement from referees 22 on the trustworthiness of the candidate. We aim to demonstrate our commitment to safe recruitment and to deter or reject unsuitable people.

ACTI has developed a memorandum of understanding with Children Change Columbia by sharing safeguarding policies, and agreed to a joint safeguarding risk assessment once a trip to Columbia can be planned.

We continue to advocate for the welfare of children at Butabika Hospital in Uganda. In partnership with Rev Dismas (see section 4.7), we monitor safeguarding standards on the children’s ward. ACTI operations manager Elias Byaruhanga visited the ward in November and reported a number of continuing concerns, including reduced staffing, although the physical care of children was satisfactory. ACTI has asked the East London/Butabika NHS Link for action to support ward staff with implementing the hospital’s updated safeguarding policy, and to follow up its commitment to establish oversight of safeguarding practice.

The Gaza Child Trauma clinic has used the KCS model to develop their safeguarding policy. Project managers have worked with the clinicians to produce a policy based on their professional practice and KCS standards, which includes a code of conduct and guidelines for safe recruitment. Work will be completed in spring 2021.

Financial Review

Like many sectors, the disruption caused by COVID-19 and related uncertainty has had an impact on the planned activities of ACT International. We have been agile and responsive to the challenges and have substituted online training programmes for overseas trips wherever possible. Some initiatives are on hold and others are being tested for viability. Need and demand for the ACT International’s training remain strong. Many charities have not fared well under the various support schemes and some are stressed. Equally there is a need for a cautious approach as countries and markets open up to the continuing risk on several fronts, including that of climate change. Our income year on year has been significantly impacted, but this is not a surprise. Operations have been optimised to add best value. There are smart savings in operations due to changing the mode of delivery, and we also have an increase in liquidity due to programmes on hold. We have ended the year with a surplus of income over expenditure of over £7,000, and with net assets shy of £30,000. Our 2021/22 programme is ambitious and will be stretching. The team is looking at various options to fund the feasible programmes under review and consideration.

  • 1% Armenia CATT training
  • 38% Uganda: all training & Operations Manager
  • 42% Middle East: all training, Gaza clinic & Regional Manager
  • 5% Friends of Butabika Children's Ward
  • 0% The Gambia Special Project
  • 0% Bishop Asili Foundation Special project
  • 15% Project Support & development

Statements of Financial Activities - year ended 31st March 2021

Income and Expenditure Statement for the year ended 31st March 2021

£ £
2021 2020
Incoming resources
Voluntary donations - Unrestricted funds 15,359 22,515
Restricted funds 5,446 13,208
Total donations 20,824 35,782
Other income 19 59
Total incoming resources 20,824 35,782
Resources expended
Programme activities: Unrestricted funds 5,100 3,915
Restricted funds 6,507 11,454
Project support & development 1,969 2,940
Fundraising support & marketing 7,963
Total cost of charitable activities 13,577 26,272
Net surplus/(deficit) for the year 7,247 9,510

Balance Sheet as at 31st March 2021

£ £
2021 2020
Fixed assets -
Current assets
Prepayments 3,035 3,025
Cash at bank and in hand 26,462 19,215
Current liabilities - -
Net current assets 29,497 22,250
Net Assets 29,497 22,250
Funds
Restricted funds 7,039 9,911
Unrestricted reserves 22,459 12,339
Total funds 29,497 22,250

For Professionals

  • Monitoring, evaluation and learning
  • Policies
  • Annual reviews
  • Assessment of CATT in Uganda
  • Gaza clinic audit report

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  • Advice on supporting children after a traumatic event

ACT International

ACT International is the working name for Luna Children's Charity (Reg. Charity No. 1172010). The organisation was formed in December 2008 and became a Charitable Incorporated Organisation (CIO) in April 2017

ACT International trains in a number of countries where children’s rights are violated or have laws which compromise our values. We always do our best to uphold and teach internationally accepted standards of human rights, but may in some circumstances be obliged to adapt our programmes so that neither our trainers, trainees nor the children they serve are put at risk.