Growing Up GREAT! Implementation Guide

Developed by Save the Children as a part of the Passages Project, this step-by-step resource is designed for organisations that wish to adopt a scalable, multilevel intervention for improving gender equity and sexual and reproductive health (SRH) for very young adolescents (VYAs) aged 10-14. It was piloted in the Democratic Republic of the Congo (DRC) in 2017-2018 (and scaled up in 2019) under the Passages Project, which aims to address a broad range of social norms, at scale, to achieve sustained improvements in family planning and reproductive health. Throughout, the guide explains to the reader what Save the Children and local partners did and makes suggestions based on lessons learned and outcomes.

Launched on International Youth Day, the implementation guide offers strategies, tools, and materials to help programme implementers work with VYAs and their communities to question and unpack community norms to build a more supportive environment for adolescent development and well-being. A central tenet of this approach is its socio-ecological design, which acknowledges the many actors at different levels who can influence attitudes, perceptions, and decisions about VYAs' health. The idea is that efforts to create lasting normative change must include these actors - parents, caregivers, teachers, and influential community members - who are responsible for engendering a supportive normative environment for change. Growing Up GREAT! also creates opportunities for critical reflection within peer groups that go beyond outreach and messaging. Discussions in VYA clubs and during caregiver testimonial videos and community reflection sessions allow participants to explore and question existing norms within safe spaces and challenge them to engage the wider community in this reflection through a process called organised diffusion. This process is considered to be crucial in overcoming social barriers and realising normative change. It also encourages communication between VYAs and their caregivers by proactively creating opportunities for exchange and mutual learning.

The Growing Up GREAT! sessions focus on confronting power imbalances related to gender and age and creating positive new norms by presenting strong VYA role models who express positive SRH attitudes and demonstrate behaviours like asking their parents and other caregivers questions and advice and calling out gender stereotypes among peers. Two health linkage activities also normalise adolescent service-seeking. Likewise, caregiver video testimonials confront age and gender-based power differentials within the family and spotlight model caregivers in participants' own communities. Each session ends with a concrete call to action that invites participants to try out new behaviours that reflect positive norms.

The implementation guide includes the following:

• Section 1: Overview of Growing Up GREAT! - provides a summary of the intervention design and materials, and the social norms they target. It also describes how Growing Up GREAT! was implemented in Kinshasa, DRC.
• Section 2: Preparatory Activities - offers a brief overview of the preparatory work that should be undertaken before implementation begins. It includes basic guidance on engaging stakeholders, adapting the intervention to your local context, and evaluating the organisational capacity of partners. A separate adaptation guide (Annex A) provides additional in-depth guidance on adaptation.
• Section 3: Implementing the Intervention - features step-by-step guidance and considerations for implementing each of the 4 components of the intervention:
  1. VYA Group Learning Sessions - describes how to implement school-based VYA clubs and classroom-based lessons, as well as community-based VYA clubs for out-of-school adolescents.
  2. Caregiver Testimonial Videos - explains how to screen caregiver testimonial video sessions and facilitate reflective dialogues with caregivers.
  3. Community Reflection Groups - details how to implement community dialogues.
  4. Health System Linkages - outlines how to collaborate with and train health providers to implement health linkage activities for VYAs.
• Section 4: Monitoring & Learning - provides guidance on monitoring and learning activities to accompany implementation, including proposed questions for future implementers.
• Annex A, the Growing Up GREAT! Adaptation Guide - offers detailed guidance on adapting the Growing Up GREAT! intervention and materials to different contexts and integrating the approach into local health, education and social infrastructure. It also offers advice on how to build stakeholder and community support for the intervention throughout the material design and testing phases.
• Annex B, the VYA Toolkit - consists in a package of interactive, age-appropriate materials used during activities with VYAs (i.e., puberty books, flipcharts, activity cards, gameboard, and question cards). It was adapted from materials used in the Gender Roles, Equality and Transformation (GREAT) Project and incorporates elements of other evidence-based programmes for this age group, including Choices, Voices, Promises and GrowUp Smart, a puberty education curriculum for VYAs.

The Growing Up GREAT! intervention design and materials were developed in partnership with the government of the DRC and many other local partners who organisers say were embedded in and trusted by intervention communities. Government and civil society partners were engaged from early stages of formative research and adaptation through the pilot period and evaluation. Organisations using this guide to implement Growing Up GREAT! in new contexts are encouraged to follow a similar process: consulting with key government and civil society stakeholders to adapt content so that it reflects appropriate local systems, values, and terminology.