Running head: RESOURCE DEVELOPMENT RATIONAL
Resource Development Rational: For a Two to Four Year old Girl in a Haitian Refugee Camp
Julina M Minter
University of the Sunshine Coast
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Resource Development Rationale
Haiti has a population of nine million people, with children making up almost half of
the population (Satchit, Lemery, Williams, & Nelson (2010). In 2010, Haiti suffered from
three national emergencies; an earthquake which killed over 200, 000 people and injured a
further 300, 000; a cholera outbreak which caused even more deaths; and Hurricane Tomas
which brought additional destruction (Estupiñán-Day, Lafontant, & Acuña, 2011). These
national emergencies exacerbated Haiti’s deficient infrastructure and services, and high
incidence of poverty (Estupiñán-Day, Lafontant, & Acuña, 2011). Now more than 500,000
people have been displaced from their homes and live in more than 800 refugee camps across
Haiti (Currie, 2012). Children growing up in Haitian refugee camps experience occupational
deprivation and injustice and are in desperate need of resources to help support their
occupations and occupational performance of daily living.
Children between three and 10 years may have memories of the natural disasters and
use much physical, mental, and emotional energy to defend against anxiety and threatening
thoughts, rather than for natural development and healthy relationships (Orr, 2007).With
these considerations in mind the development of a resource box (Appendix 1) will be created
for a two to four year old girl from a Haitian refugee camp. The person- environmentoccupation model is commonly used in occupational therapy practise, and can be used to
understand the dynamic interaction between person, occupation and environment (Law et al,
1996). The occupations this child engages in can be further broken down and looked at in
terms of self- care, leisure or productive occupations.
Self-Care Occupations
A day in the life of a Haiti refugee includes struggling to find money to pay for water
and food, and no clean water to cleanse (Walters & Ivers, 2007). The unexpected cholera
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epidemic is a major problem in Haiti refugee camps, there is lack of adequate water and
people are living in crowded and unsanitary conditions (Dunkle et al, 2011). Cholera is a
disease that causes acute diarrhoea, and sometimes vomiting and leg cramps (2011). By
November 2010, there was a reported 11,125 hospitalized patients and 724 confirmed deaths
from cholera (Walters and Ivers, 2007). Hygienic routines are of utmost importance to help
reduce the risk of disease. Dunkle et al, (2011) found that the risk of cholera would decrease
with protective measures such as hand washing with soap, therefore the resource of soap will
be included. Toothbrushes and toothpaste are also included so that the child can get into the
habit and routine of learning to brush their teeth.
The self-care tasks of brushing teeth and washing the hands and body with soap can
be understood through an aquisitional frame of reference using a developmental approach.
Children at the age of two to four are at the developmental level to be able to wash their
hands, and body, and too brush their teeth (Hoffnung et al, 2010). The child can use the soap
for practising the routine of washing oneself with soap, washing hands after the toilet and
before and after meal times. The biomechanical frame of reference is also being used as the
child is improving fine-motor and gross-motor co-ordination (Case- Smith, 2010). The
cognitive-perceptual frame of reference is also used, using a top down approach as the focus
is on developing the occupational task (Duncan, 2006).
Leisure Occupations
Soccer is Haiti’s National Sport and is commonly played within the community
(Wise, 2011). The inclusion of a soccer ball in the resource box would be both socially and
culturally appropriate, and will help teach the child an important component of the ethnic
nationalism and heritage (Wise, 2011). Soccer can also give sense of belonging and identity,
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to connect the child to their community (Wise, 2011). A ball pump will be included too
increase the sustainability of the activity.
The developmental approach has been considered, under the aquisitional frame of
reference. According to Hoffnung et al, (2010) the motor development of two to three year
olds includes being able to run in a straight line and jump in the air with both feet. By three to
four years old they should be able to run at one- third that of adult speed, and throw and catch
a large ball. Creating opportunities for the child to be exposed to these resources, in this
important developmental phase, will improve occupational performance (Case- Smith, 2010).
There is a focus on the motor learning approach, as motor- learning will be achieved through
biofeedback from the sensory systems such as vision, proprioception, sensation and
kinaesthesia (Case- Smith, 2010). Using a biomechanical frame of reference soccer is also
improving the child’s gross motor and co-ordination skills.
A psychosocial approach has been used as the child has experiencing a natural
disaster, which includes a loss of a home, witnessing death and injury; and the possibility of
the loss of a family member. These increase issues such as post-traumatic stress disorder,
anxiety and depression (Eksi et al, 2007). Not only will soccer initiate social participation
with other children, it will distract from the hardships of living in a refugee camp (Wise,
2011). Developing relationships with peers is important as social skills help develop positive
coping strategies in children with psychosocial dysfunctions and improve self-esteem,
positive affect, problem-solving and social behaviours (Case- Smith, 2010).
Using a play therapy approach, a puppet doll has also been included into the resource
box. Play therapy helps to facilitate the expression, understanding, and control of experiences
and reduces anxiety and internalising and externalising behaviours (Westhington et al, 2008).
Lieberman and Knorr (2007) stated that because young children have limited coping skills,
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and are particularly at risk for negative outcomes associated with traumatic events.
Evidenced-based research has shown play therapy to be a developmentally effective
intervention with traumatised children (Dugan, 2010). Play therapy allows children to access
and process these memories in a safe environment (Dugan, 2010). The doll can be used for
imaginary play enabling the child to think beyond the limits of reality. Children aged two to
five years old identify with dolls and absorb their characteristics, and the doll becomes an
‘alternative self’ (Smirnova, 2001). The puppet doll has clothes, and can be used as a puppet,
which helps to facilitate imaginary play and encourages socialising with others. To make the
play more culturally appropriate and meaningful for the child, the doll represents a person of
Haitian appearance.
The child may very well have lost their parents, or will lose their loved ones around
them due to disease or malnutrition and therefore is more vulnerable to have attachment or
coping skill problems. According to Maslow’s Hierarchy of needs; physiological, safety, and
belongingness and love needs, need to be met before an individual can gain self-esteem in
order to make productive effects on themselves and their environments (Huitt, 2007). The
introduction of a doll to hold and to hug will help the child feel safe and secure and loved as
they have a companion and a friend.
Productive Occupations
3,978 schools were damaged or destroyed by the earthquake (UNOCHA website,
2011). In Haiti’s large refugee camps, schools in large tents holding up to 200 children are
being developed, with children starting kindergarten at three years old (Hirsh, 2010). Writing
is an important fine motor skill that develops markedly during the preschool years, and much
preschool activity is devoted to this skill. A vital precursor to writing, is drawing, which
emerges at the end of early childhood (Hoffnung et al, 2010). Coloured pencils are included
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as a resource, along with a note pad to draw and write in, and a pencil sharpener. The
triangular shape of the pencils teaches the child to position the fingers in a tripod pencil grasp
and the pencils are thicker to grade the acquisition of fine motor skills. Having coloured
pencils will give the child the skills to be able to draw artwork and to learn how to write for
school.
Drawing and handwriting comes under the aquisitional frame of reference, using a
developmental approach. According to the Queensland Health website (2012) by the age of
two years old, a child should have a proper pencil grasp, and be able to imitate a horizontal
line. By three years old they should be able to draw a two-part person. Using a motor learning
approach of practise, the intervention will help the child achieve fine motor skills, through
intrinsic feedback from the child’s sensory systems. A neuromaturational frame of reference
is used as learning to draw and write, will increase the myelination of neurons, resulting in
better balance and improved co-ordination of both fine and gross movements (Case- Smith,
2011).
A psychodynamic frame of reference can be used, through an art therapy approach. A
child of two to four years old is still developing their language skills, and must express
themselves through non-verbal means such as art. Art therapy is an approach based on the
belief that being creative can act as a form of subconscious expression, and can help identify
inner conflicts, increase self-esteem and self-awareness and reduce stress. Art is said to be
able to rebuild an overall physical, emotional, and social sense of well-being (Hussain, 2010).
Art therapy is thought to be especially valuable for children who have experienced trauma as
it engages the body in relaxation and allows the child to create a piece of artwork that is
introspective and personalised (Hussain, 2010).
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Conclusion
The resource box contains a bar of soap, toothbrush and toothpaste, coloured pencils,
a sharpener and a notebook, a soccer ball, a ball pump, and a puppet doll. These resources
will enhance the occupational performance of a two to four year old girl in a Haitian refugee
camp by helping to improve the child’s cognitive and physical development, and
psychosocial functioning. These resources focus on enabling the child to engage in
meaningful occupations within the refugee camp, improving health outcomes and giving a
better quality of life.
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