Corazon Contento Mother Coaching Program

The last Nicaraguan census in 2016 shows that there are 131,800 people with special needs in the country. The actual number is much higher. Unfortunately, public services for people with disabilities do not exist. The city of Granada, Nicaragua, where we operate, has no other service or support for such families.

We empower mothers of babies with any type of disability or who are at risk of having a disability (premature babies) to play an active role in their child’s development. We provide training in appropriate physical therapy and early intervention techniques. Our training also aims to reduce the stigma toward people with disabilities and creates an emotional bond between mothers and their babies.

Mothers who participate in this coaching program will be able to give their children a better start in life thus reducing barriers that would otherwise arise in later stages of life.

No public institution in Nicaragua adequately addresses the needs for people with disabilities. Parents lack support in caring for newborns with disabilities. Corazon Contento is the only center providing these services in the area. Demand is constantly growing and those in need are put on a wait-list. Our center currently offers physical therapy sessions to families with babies and children with disabilities. However, for strong early childhood development, therapy needs to be done on a daily basis at home. Home therapy has proven to be even more important in the context of the current COVID-19 pandemic. Our center has been forced to cancel in-person sessions and move to an online format for the time being.

It is also important to note that the responsibility of caring for children falls largely on mothers. Nicaraguan society puts strong social pressure on mothers to be the primary caregivers. Mothers make up 90% of parents participating in physical therapy sessions and need to be trained to give continuity to these therapies at home. Emphasis is placed on getting the whole family involved, however women largely serve as facilitators at home, teaching their husbands and families how to take care of the baby.

We will train mothers (or caregivers) in early stimulation therapies related to the following disabilities: microcephaly, cerebral palsy, prematurity, Down syndrome, and hemiparesis.

The program is a 3 month course focused on the following areas:

• Education, definitions and facts about the disability: Mothers will understand what condition their child has, eliminate feelings of guilt and work through the process of accepting the disability in a positive way. This area will be addressed by psychologists and physiotherapists.
• Exercises and techniques to practice at home: The necessary daily care will be taught by physiotherapists, music therapists and nutritionists.
• Monitoring: Ongoing monitoring will take place on how the mother is applying what she has learned at home. There will also be guidance on creating useful material to be used during home therapy such as upright walkers or sensory stimulation games.

The training is part of an ongoing effort to educate, empower and support parents regarding the development of their children with disabilities. While in-person therapy sessions are important, they must go hand in hand with ensuring parents take an active role in the development, health, learning and wellbeing of their children. (In-person sessions are temporarily suspended due to COVID-19)

The Corazon Contento Mother Coaching Program serves 150 babies with disabilities or at-risk of disability and their mothers or caregivers. Although we promote empowering all members of the family, we have seen that the majority of those participating in our programs are mothers, and it is the mother who transmits what they have learned to their families. Many of the families who benefit from our services are low-income families who do not have access to other care options. This initiative also creates a support group for mothers who can share their stories and knowledge with each other as well as voicing their concerns and feedback with our staff. 

Corazon Contento also focusses on serving the larger community by raising awareness and eliminating the stigma attached to disabilities. Participating mothers visit local school to give talks about disability which promote respect and acceptance. 

Our solution and target population relates to the Challenge and selected dimension in that it directly improves the quality of life for mothers and babies focusing on early intervention for positive physical, mental and social development. Early stimulation in the first days of life is fundamental in the development of the disability, since neuronal connections will be created that will favor the future autonomy of the child when they grow up, as much as the disability allows. Mothers will also achieve emotional stability in their maternity that will benefit their general caregiving capacity. 

Our training program for mothers is unique in the community. The only similar services are the public health center that provides physical therapy for children with disabilities with limited capacity. These centers are crowded with patients, serving children and adults alike, and do not offer any support or follow-up. Here patients receive 20 minute sessions with a physical therapist but lack continuity and consistence. As far as support for mothers is concerned, there is an institution called ITXEN that attends to women focusing on reproductive health, however, there is no specific service or program for mothers with disabled children.

The fact that our program is based on training providing mother and caregivers the necessary knowledge and skills to care for their babies is new in the context of Nicaragua. Government social programs in the country have normally been based on a welfare system rather than education. Our training is based on the idea of sharing and multiplying knowledge and above all EMPOWERING women and families. Empowerment is something that Nicaragua and our community of Granada needs, resulting in lasting improvements and allowing for citizens in this case, mothers, to achieve their objectives by themselves. 

The methodology of our training program is characterized by the following components:

Individualized: The training, in addition to having common components for all, will include specialized individual training that adapts to the reality of the current situation of the mother and family, the condition of the child, emotional and social health, level of resources available, living conditions etc.

Emotional Wellbeing: Psychological support will be fundamental to help in the process of empowerment.

Effective: The goal is that therapies given at the center are complemented by constant support at home and thus achieve greater progress in the baby's development.

Multiplier: Mothers will transmit this knowledge to the rest of their families and will participate in workshops in local schools promoting respect and tolerance towards people with disabilities.

Comprehensive: The main objective of the program is that these babies reach their full potential and become autonomous and independent adults as much as possible.

Inclusive: There will be no discrimination of any kind and will be open to any mother (or primary caregiver) who needs and has the willingness to participate in the program.

The ZOOM application will be used for maintaining contact, monitoring and following up with mothers once the course is completed. We must adapt to the context of Nicaragua where knowledge of technology is very limited and this type of application is new for most of our participants.

The methodologies that will be used during the courses will be dynamic, active and multidisciplinary since they will have several professionals involved. 

Corazon Contento Comprehensive Development Center has been working with people with disabilities for 10 years. We have clear examples of some mothers who have already decided on their own to work with their babies at home under the advice of our physiotherapists and the advances in development are evident. In these cases after about 2 years of therapy children have been able to walk and reach a higher level of development than those babies who have only attended their face-to-face therapies and whose parents do not show total involvement during therapy sessions. There are many studies that show that parents’ involvement during the clinical process is essential to promote the bond they have with their children and to motivate them to continue with the treatment once they return home, although always with medical supervision.

We have already been working with this remote method during the past 3 months due to the COVID-19 pandemic and in this time we have seen that parents have been able to successfully carry out therapy at home when given the tools and knowledge to do so. 

Training/Education

Activities / Inputs

-          Classes are held for mothers teaching physical therapy techniques.

-          Classes are held providing general knowledge about their babies’ disability.  

-          Workshops in local schools promoting attitudes of tolerance and respect for people with disabilities in the community.

Outputs

-          Mother’s gain experience in doing home therapy with their babies using the tools and knowledge acquired.  

-          Mother’s gain ongoing access to support and resources from professional staff.

-          Creation of a self-help support group of mothers.

-          Increased community awareness of issues related to people with disabilities.

Short Term Outcomes

-          Mother’s demonstrate their ability to provide the necessary care for their children.

-          Mother’s share their knowledge with family members, allowing for the whole family to be involved in the development of the child. 

-          Psycho-emotional support for mothers to accept their child’s disability and adapt to the changes and difficulties that may come as a result of it.

-          Improved quality of life for babies with disabilities.

-          Less stress and feelings of helplessness for mother’s and families.

Long Term Outcomes

-          Mothers are empowered to take an active role in their child’s development, not only depending on the doctor or physiotherapist, but will feel confident to depend on themselves.

-          Better relations with family and friends.

-          Improved overall wellbeing of babies and children with disabilities as well as their families.

-          The babies will reach their full potential later in life, living independent lives as much as the disability allows.

-          Less stigma attached to disabilities and changes in attitudes in the community that supports full inclusion of people with disabilities.

-          Tolerance and respect for people with disabilities in the community.

Our center currently serves a total of 300 people but that number includes the areas of physiotherapy, speech therapy and psychology. Our challenge will serve directly affect the physical therapy area. In this area we currently serve 65 babies.

With this program we will be able to duplicate the number of babies being attended to. In one year we can provide service to 150 babies and their mothers. In 5 years it is estimated that 750 babies and their mothers will have benefited from our services.

It is also estimated that more than 500 students will be reached during this period of time in the school inclusion workshops.

We took up the objectives that had already been mentioned. In one year:

- To provide 150 mothers with the tools and knowledge necessary to address the needs of their children with disabilities.

- To offer 150 mothers the psycho-emotional support to accept the disability and adapt to the changes and difficulties that may come as a result of it.

- Create self-help networks of mothers with children with disabilities.

- Create attitudes of tolerance and respect for people with disabilities in the community.

- Give workshops on inclusion of people with disabilities to 150 secondary and primary school students.

After five years these objectives will be multiplied by 750 mothers and babies and up to 500 students in the workshops.

In order to achieve these objectives, training programs will be carried out every three months in groups of mothers according to the problem their child presents. After the completion of the course, follow-up will be carried out at home.

Finally, groups of mothers will be created that with our supervision will design and carry out the activities in the schools with games and dynamics that will lead the students to reflect on the importance of respecting and including people with disabilities.

The barriers that exist to accomplish our goals can be seen in cultural barriers which make active participation in some cases difficult as family decisions rely heavily on the consent of the father figure. In terms of technology and following up with Zoom, there can be problems with accessing internet or bad connections that can make video calls difficult.

Exclusion would be another barrier but we have been fighting it during the last years and we have made many success in it. 

The last barrier is the uncertain economic and political environment in Nicaragua which has reduced donor capacity to continue proving funds.  

We will address these barriers by providing psychological support to families in cases where there is resistance or uncertainty from male partners. 

In the case of the internet connectivity we will simply have enough flexibility to adapt the times and activities of online meetings. And we will also look for specific financing to ensure good Internet connections for our participants. 

And overcoming exclusion will continue because we are doing that from our centre day by day and people and society are getting to inclusion. 

Our solution team consists of the following full-time staff members: Two physical therapists and one psychologist.

Our team also includes one musical therapist and one nutritionist on a part-time basis. The music therapist will teach music-based activities to foster mother-baby bonding and to work on both the physical and emotional development. The nutritionist will be in charge of advising mothers about the needs and health aspects that they should take into account in the day-to-day care of their children with disabilities.  

We have a long and well-known experience in the area of physical therapy. Corazón Contento has provided this service for more than 9 years and we have earned the confidence of parents and other institutions such as the Public Health Department. For the last 6 years, the Public Hospital of Granada Amistad Japón has been sending every child born prematurely to our center when they are discharged. This is an example of the experience of our team. Our two physiotherapists have participated in specialized courses and training such as EQUINOTHERAPY.

Also in the psychological area, our psychology team is renowned in the city and has participated in local and national activities in schools and other institutions. Institutions like ITXEN that work with women send cases to our center when they need psychological support. 

CHILDREN WELLNESS FUND is an international institution that has been working for more than 10 years on health and nutrition issues for children in the city of Granada. This institution collaborates with us supporting our children with nutrition and medication as needed. At the same time we offer their patients psychological and physiotherapy. If they become aware of a mother in their area who needs to enter the Mother’s Coaching Program, she can participate in it.

TIGO: A telecommunications company that has supported us in specific fundraising activities and with which exists the possibility of donating internet modems to those mothers who do not have sufficient resources to have an internet connection.

DEPARTMENT OF PUBLIC EDUCATION OF NICARAGUA: We have been working with this public institution with workshops and awareness activities about disability. This institution together with some private schools, with whom we have been collaborating previously, will provide us with the spaces and students who will participate in the workshops that the mothers will carry out at the end of their course to raise awareness about respect and tolerance for people with disabilities. 

KEY RESOURCES:

• Staff (physiotherapists, psychologist, music therapist and nutritionist)
• Materials for school workshops
• Materials for therapy (mats, pens, toys, etc...)
• Technological resources (Projector, internet connection for staff and mothers, Zoom app)

PARTNERS AND KEY STAKEHOLDERS

• Mothers and babies with disabilities or are at risk of having one.
• Local schools 

KEY ACTIVITIES

• Early stimulation education
• Workshops in local schools promoting respect towards people with disabilities
• Nutritional education
• Music Therapy
• Follow-up support

TYPE OF INTERVENTION 

• Educational workshops
• Ongoing monitoring and follow-up service 
•  Materials to be used at home will be created to help in therapies such as baby seats or uprights

CHANNELS

• Public and private health systems, as they refer patients who need our services to our center.
•  Word of mouth, as we have a great impact and presence in the city
• www.facebook.com/pg/CentroIntegralDeDesarrolloCorazonContento
• www.corazoncontentogranada.org

SEGMENT

• Direct beneficiaries are the babies and their mothers.
• Indirect beneficiaries are school students and society in general. 

BENEFICIARY VALUE PROPOSITION

• Ability to carry out early intervention techniques with their children.
•  Increased likelihood of full integration

IMPACT MEASUREMENTS

• Babies will be tested before and after the course using the CLAP scale, a scale used to evaluate children's physical, social and language development.
• Workshop questionnaires
• # of participants completing the course

COST STRUCTURE

• Staff salaries
• Travel expenses 
• Educational materials

REVENUE

• External funding from large-scale donors
• Optional donations/service fees       

Our path to financial sustainability includes a combination of fundraising and income generating activities.

• We will continue to strengthen long-term partnerships with current donors and at the same time continually explore new donor opportunities.
• Local annual fundraising events such as our Charity Run.
• Sale of products. We have commercialized several products made at Corazon Contento such as recycled paper handicrafts, art, Corazon Contento brand products, an on-site café and most recently artisan chocolate. This year we have implemented a pilot income generating project from the sale of artisanal chocolate of which we will use as an example to create a business managed by the mothers themselves.
• Voluntary contributions from beneficiaries who are able to pay a nominal fee for our services. 

SOLVE can help us reach more families with disabled or at-risk babies. By providing mothers with the knowledge and tools they need to be able to perform therapy at home we can then attend to more babies and children in our center who also need the support. The empowerment of families through education is essential for overcoming all barriers especially regarding gender roles in a male dominated society. Women will become confident actors in their own child’s development and will be able to involve the whole family in this process. This is especially important where mobility is an issue and regularly visits to the center are not always possible. SOLVE will help us to take a step towards INCLUSION, which is our ultimate goal. Thanks to early stimulation these babies and children will be able to reach their full potential as autonomous and independent adults. Throughout their lives they will be capable of being included in the school system, social circles and even in some cases the labor world. This will change the mentality of the society towards attitudes of respect and tolerance. 

We need funding sources in orden to continue with our everyday operations, which produce an important service for the community and families who have children with dissabilities. Due to the worldwide economic decline we have experienced a decrease in donations and therefore need to find additional sources of support. As there is no other center that offers the same services in this area, it is essential that we continue operations.

We are open to partnering with any organization or member that has experience working with babies and children with disabilities and share our philosophy of empowering families take an active role in their child’s development. We would be most interested in partnerships focused on education in the areas of physical therapy and psychology.

We have had positive partnerships with nursing students from the Seattle University with groups visiting us for one month during Spring break over a 6 year period. The results proved to be successful. Students performed medical examinations to all our babies and children and provided reports and recommendations to their families. They also coordinated workshops with parents about nutrition and health for babies with disabilities. We have also had similar partnerships with other universities in the areas of psychology, education or health. This type of collaboration would be potential partners for the future.