Developing a Train-the-Trainer (TTT) model for social work education in Kazakhstan

Abstract

This Brief Note reports on the development, implementation, and evaluation of a Train-the-Trainer (TTT) model for training social workers in Kazakhstan. The project took place over a two-year period and included a needs assessment, community outreach, curriculum development, and training in Kazakhstan and New York. We discuss the development, implementation, and evaluation of TTT the project.

Keywords

Cross-national training Kazakhstan social work education social work practice Train-the-Trainer program

Introduction

This article reports on the development, implementation, and evaluation of a Train-the-Trainer (TTT) model for training social workers in Kazakhstan. Our goal was to develop an intensive five-day training curriculum designed to teach attendees the fundamentals of social work professional practice skills that they could replicate in subsequent trainings. In this brief report we describe the development of this curriculum, the evaluation of the initial training, and the evaluation of the trained facilitator’s later delivery of the curriculum. Implementation took place over a two-year period, and was funded by the American International Health Alliance (AIHA) as part of a project to develop a social work training center at the Demeu Family Medicine Clinic in Astana, the capital of Kazakhstan, that would serve as a model to be replicated in other sites in Kazakhstan. The Demeu Family Medicine Clinic provides a broad range of services including primary health care services, and social programs such as an after-school program, a psycho-social club for the elderly, and a substance abuse intervention program. The authors worked with the director and health care professionals at the Demeu Family Medicine Clinic to develop the training. The project included a needs assessment, community outreach, curriculum development, and training first in Astana, later in New York City, and again in Astana.

Background

The Republic of Kazakhstan became an independent nation in 1991, following the dissolution of the Soviet Union. Along with other Commonwealth of Independent States (CIS) in Central Asia, Kazakhstan has moved rapidly towards industrialization and modernization and now has a market economy (Pomfret, 2006). Independence from the Soviet Union resulted in a loss of infrastructure and brought about social and economic instability and a sharp increase in unemployment, poverty, health concerns, and other social problems (Grebneva, 2006). As in other CIS nations, there has been a growing recognition of the need to develop community-based services to provide care for vulnerable populations (Tobis, 2000) and a shift in the medical field towards providing health care in primary health care clinics. Through this shift, health care leaders have recognized the crucial need for trained social workers who are knowledgeable about social issues and able to respond to psychosocial needs in the context of systems of support and organizational infrastructure (Driedger, 1995).

In a study conducted for the Social Transition Team of the USAID Bureau for Europe and Eurasia, Davis and Black (2008) traced the development of social work as a profession in 21 countries in the former Soviet bloc. In the former Soviet Union social problems were mostly unrecognized and social work was perceived as an ‘unsuitable activity for petite-bourgeois’ and ‘unnecessary’ (Zavirsek, 2008: 743, cited in Davis and Blake, 2008). However, regions with a history of socialism rather than communism viewed social work as key to combating social problems. Thus, in the former Yugoslavia Republic (i.e. Croatia; Macedonia; Serbia and Montenegro; Bosnia and Herzegovina) social work education was established at university level during the 1950s. Centers for Social Work (CSW) were created in urban municipalities in the early 1960s, and served as the main employer of social workers (Davis and Blake, 2008).

Following the collapse of the Soviet Union, social work education proliferated among many countries in the region. In the Balkan nations, social work education was established in the early 1990s and primarily associated with social protection. For example, in Romania, social work programs emerged in response to international outcry against the maltreatment of the vast numbers of children who lived in state-run orphanages. Romania’s orphanages were a legacy of the former President, Nicolae Ceausescu (1965–1989), who banned birth control and left under-financed state institutions to care for the wave of abandoned children that followed (Smith, 2006). In Russia, Belarus, and Ukraine, five-year social work education programs (four years for a BA and one additional year for specialized education) were established in the early 1990s, leading to a ‘social work specialist’ degree. These programs grew out of the need to address challenges related to migration from rural to urban areas (Davis and Blake, 2008; Templeman, 2004). In Armenia, social work emerged as a profession in response to community trauma associated with the catastrophic earthquake of 1988. In Georgia, social work education began to take shape in 2004 and Azerbaijan followed suit shortly thereafter.

Kazakhstan has emerged as the most economically developed politically stable country in the region since the collapse of the USSR. As a result, the nation draws large numbers of immigrants from surrounding countries, and attracts myriad accompanying social problems (Gilbert et al., 2010). In spite of this, professional social work is still in its developmental stage in Kazakhstan. Social work as a profession did not exist in the Soviet Union, and the practice of social work was introduced first in Kazakhstan by international NGOs during the 1990s (Grebneva, 2006).

Although some professionals identify as social workers and some have been trained formally in the United States or elsewhere, most of those who consider themselves social workers do not have either formal education or training. For example, most of those persons referred to as ‘social workers’ worked with socially isolated older adults or ‘pensioners’ and would be referred to as ‘home health aids’ (i.e. paraprofessionals) in the United States. This view of social work is similar to that in other developing nations that are transitioning to a market economy (Hugman et al., 2007; Moldovan and Moyo, 2007). It contributes to a lack of understanding of the international standards that guide the profession and a lack of clarity regarding the role of social workers in interdisciplinary settings.

The training

Planning phase: Needs assessment

In a TTT model, professionals disseminate information and skills to trainers who in turn disseminate the information or skills to their colleagues (Connell et al., 2002). In our project, five Demeu personnel formed the core Astana training team and collaborated with the New York team for the duration of the project. Headed by the Physician Director of Demeu, the Astana team included a psychologist who also taught at Eurasia University, and three full-time staff who identified as social workers. The social workers had varied educational backgrounds, and had previously worked as a natural science teacher, an engineer and a sociologist. At Demeu the team members provided case management services and ran a psychosocial club for the elderly, a social club for those recovering from substance abuse, and an after-school program for youth at risk. The four members of the New York team consisted of the authors, including two full-time social work professors with extensive experience in direct and cross-systems social work practice, a Director of a Social Work Department at a major psychiatric teaching hospital in New York City, and a social work doctoral student. In addition, an MSW student who was originally from Astana served as interpreter and translator.

During the planning phase, the New York team conducted a needs and assets assessment in Astana. The first and third author engaged in a series of planning meetings and focus groups both at Demeu and with representatives of various government agencies and academic groups. They also gathered ideas from two Volunteer Services Overseas (VSO) social workers assigned to Demeu and another clinic in Astana. VSO social workers are stationed overseas for a period of two years, and at the time of the project, both had been in Astana for approximately one year. They concurred with the perspective that social work is not viewed as a profession in Kazakhstan, and that there was no clear working definition of social work practice.

After synthesizing and sharing the findings from the needs assessment, the New York team worked with the Astana team and the VSO workers to design a training program that aimed to enhance theoretical knowledge of professional social work practice and international social work standards, with a particular focus on challenges faced by those seeking services at primary health care clinics.

Train-the-Trainer (TTT) program in Astana

The first phase of the TTT in Astana took place over a five-day period in July 2005. Together the New York and Astana teams developed 10 curriculum modules. Topics comprised: 1) social work values, 2) assessment and formulation, 3) psychoeducation, 4) loss and grief, 5) community organizing, 6) fundamentals of community practice, 7) small group intervention, 8) work with families, 9) crisis intervention, and 10) supervision of direct practice. In addition to the five primary trainers from Demeu, 13 others attended the training, including psychologists, social workers, physicians, and nurses from Demeu and other health clinics in Astana. Representatives from clinics in other major cities in Kazakhstan (Almaty and Arka), faculty from a local university, and AIHA staff participated as well. Including professionals from a range of backgrounds was important; it provided a forum to develop a shared perspective and new language for dealing with social problems and to build awareness of the value and potential for social work as a profession.

The New York team and VSO social workers conducted the initial training. We prepared lecture handouts and PowerPoint presentations in advance that were translated into Russian. A professional interpreter provided simultaneous translation and participants used headphones throughout the training. All lectures and exercises were videotaped. We collected evaluations for each of the 10 modules and administered a brief open-book knowledge test (16 items) at the end of the training to assess comprehension and retention. Satisfaction measures demonstrated overall satisfaction with the training, with a mean of 4.9 on a Likert-like scale that ranged from 0 to 5. Scores for the knowledge test ranged from 56 to 94, with a mean score of 82 (out of a possible score of 100). Not surprisingly, the five members of the Demeu team reported that they needed additional preparation to become trainers. Thus we conducted a second round of training for this core group in New York City in October 2005.

Follow-up training for the trainers in New York City

The five-day training in New York City aimed to help participants understand: 1) how social work services are delivered in various settings in the United States; 2) the mechanisms of agency-based social work services including, but not limited to case management and formulation, documentation, quality assurance, in-service training, and supervision; 3) models of field instruction; and 4) the parallels between training, field supervision, and social work practice. The training included lectures, discussions and role play as well as visits to various social work agencies across New York City.

Train-the-Trainers program by Kazakh trainers, and evaluation

Eight months after the follow-up training in New York City, the five Kazakh trainers conducted a five-day training at Demeu for 19 participants including primary care physicians, university faculty, nurses, dance and massage therapists, and those who identified as social workers. They had adapted the content by incorporating teaching materials that were socially and culturally relevant for Kazakhstan by including case material from Demeu. They had also invited former clients as guest speakers to share the positive outcomes of their interventions.

The Demeu team evaluated the training using the same survey that was used at the initial TTT program in Astana and a similar knowledge test. The New York team analyzed the data and conducted a content analysis to evaluate open-ended questions. Participants were asked to comment on 1) what they found most helpful about the training, and 2) areas of the training that needed improvement. Overall, the evaluations were positive, with all sessions receiving an overall mean score of 4.6 (ranging from 2.4 to 5.0). The knowledge test scores were somewhat lower than for the original training and revealed a number of weak spots, particularly regarding 1) confidentiality and ethics, 2) the role of the social worker in a crisis situation, 3) understanding the ecological systems model, and 4) practice–issues involving families.

To further assess skills and fidelity to the TTT model, these training sessions were videotaped and reviewed by the New York team with the assistance of the bilingual MSW student. Each segment was rated for 1) overall structure, 2) content, 3) delivery, and 4) presenter–participant interaction, using a rating scale of 1–5 (1 = needs improvement to 5 = outstanding). We also provided written feedback. Overall, the Kazakh trainers scored an average of 4.8 (with a range from 3 to 5) in the four areas.

Even given the strong adherence to the TTT model, the New York team observed that the trainers had difficulty with the delivery of some concepts related to social work practice. For example there appeared to be confusion around the concept of ‘helping relationships’ as conceptualized from a Western perspective. This construct appears to be culturally-based, and it was difficult to find equivalent terminology in the translation from English to Russian. Professional relationships in Kazakhstan tend to be more paternalistic and hierarchical than in Western cultures (Ardichvili and Gasparishvili, 2001; Muratbekova-Touron, 2002). As with other countries in the former Soviet bloc, the organizational culture and relationship between supervisor/manager and employee in Kazakhstan has faced challenges in the transition from the state-controlled industries to privatization of these same industries. During the Soviet era, a supervisor in state-owned industries had unlimited authority over an employee in all areas. During the transition to independence, superiors and supervisors continued in this role to provide guidance, protection and assurance of employment in the newly evolving and competitive market economy (Cshe, 2004). During the training we found that it was challenging for attendees to move away from the historically bound paternalistic relationship between the helper (i.e. ‘superior’) and the person seeking help (i.e. ‘subordinate’). In the role-play, case-formulations/presentations and videotapes, we observed the tendency to offer concrete advice and direction to the ‘clients’ without attention to process and context or any form of shared decision-making. This approach is in direct contrast to the Western conceptualization of a helping relationship which focuses on enhancing the client’s decision-making capacity while honoring self-determination. When these situations occurred during our initial training, they became opportunities for critical dialogue regarding culturally determined approaches to professional social work. As the profession develops in Kazakhstan, finding an approach to social work that is balanced and culturally attuned will be an evolving process.

Another challenging area for the Kazakh trainers was the conceptualization and formulation of cases (including identification of problems and strengths, assessment and strategies for social work intervention). In our feedback, we recommended that the Kazakh trainers receive ongoing supervision and training from VSO social workers stationed in Kazakhstan to further develop and refine their skills in this arena. We also encouraged participants to consider and think through ways to draw on and adapt Western perspectives while simultaneously supporting Kazakh values and patterns of communication.

Follow-up plans

Since completing the TTT project, the Demeu staff have been involved in a series of new projects including a preparation school for new mothers and a youth clinic. Those who participated in our training have taken on leadership roles in the youth clinic at Demeu, and have incorporated the biopsychosocial perspective and the psychoeducational model from our initial work. Recently the Demeu Clinic received funding from the government to conduct an additional training in late 2011. The charge was for the trained Kazakh team members to conduct a first week of training using the original curriculum developed in 2004. The first and third author would then return to Kazakhstan to conduct the next level of training in social work practice during a subsequent second week. The Demeu team requested that the second-level training focus on working with adolescents and their families. This age group has especially been challenging for parents and as such challenging for the staff at Demeu. Kazakhstan has the highest incidence of suicides recorded among girls aged 15 to 19, and the second highest for boys, after Russia, according to the most recent report from the United Nations Children’s Fund (UNICEF) (Refworld, 2011). Adolescents in Kazakhstan are confronted with a host of psychosocial stressors, particularly related to bullying, lack of employment opportunities, substance abuse, and high rates of domestic violence. Educational and employment opportunities that were previously offered to everyone are now constrained by fierce competition. Young people with disabilities and deformities, the consequence of long-term above-ground nuclear testing in the area during the Soviet period, are challenged with limited care and services. Given this, the second-level training, again developed in collaboration with the Demeu team, will focus on adolescents and their families with emphasis on wellness management, cross-systems and interdisciplinary practice, suicide assessment and prevention, and community collaboration and program development. Strategies for building practice domains and professional licensure also will be addressed. The training will be evaluated following the guidelines established for the earlier series of trainings.

Conclusion

We have learned several lessons from this ongoing collaboration. First, the US and Kazakh teams worked well during the planning and implementation phase despite distance and language differences. We attribute this to the knowledge and cultural exchange that ensued among members of the two teams during the initial needs assessment. Second, the US team remained open and flexible as issues specific to the Kazakh culture and society became apparent during the training, enabling us to tailor the curriculum in the moment and promote social work values while simultaneously honoring Kazakh values and traditions. Nonetheless, we observed that social work concepts are grounded in Western cultural assumptions and were often ‘lost in translation’ because of the cultural and contextual differences between the two countries. The US team worked with the Kazakh team and participants to explore English terminology that was not readily transferable to decide on meaningful Russian terminology that captured intent. We found that an ongoing and sustained dialogue between members of both teams was fundamental to clarifying cultural differences. Identifying ways to bridge differences and build common understanding while maintaining the integrity, principles, and values of the social work profession will be a continuing challenge as the profession evolves in Kazakhstan. Finally, a structured evaluation component was crucial in assessing the outcome of trainings.

Footnotes

Author biographies

Helle Thorning has served as clinical professor, program chair of field education and assistant dean of field learning and community partnership at the Silver School of Social Work at New York University since 2006. Here she directs the field learning curriculum for social work bachelors and masters students. Dr. Thorning’s main research area is in the development and application of educational and psychoeducational interventions for consumers, families, and communicaties faced with mental illness and trauma.

Tazuko Shibusawa is Interim Associate Dean and Director of the MSW Program at the Silver School of Social Work at New York University.

Ellen Lukens is the Firestone Centennial Professor of Clinical Social Work at the Columbia University School of Social Work and a Research Scientist (part time) at New York State Psychiatric Institute. Her background in clinical practice, program development, evaluation and research as related to psychoeducational and other evidence based interventions for persons facing mental health challenges and trauma in both local and international settings.

Lin Fang is an Assistant Professor in the Factor-Inwentash Faculty of Social Work, University of Toronto, and an Associate Research Scientist at Columbia University.

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