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Table 2 Group model building session agenda and description of “Scripts”

From: Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan

Session 1: June 2014, Mazar-e-Sharif, Balkh, Afghanistan: The introductory session took place over the course of an afternoon in Mazar-e-Sharif to explore the interacting factors that may explain low participation of people with mental illness in CBR programs
Activity Description
Introduction to systems, Defining Terms Introduction of the approach of community based system dynamics
Defining concepts – “What do we mean when we say ‘Mental Illness’?
Variable Elicitation Participants nominated factors or variables that responded to the prompt: “What causes Rawani to receive or not receive rehabilitation services”
Stars Participants prioritized the most relevant and impactful variables produced in the previous variable elicitation activity.
CLD Elaboration Based on the priority variables emerging from the stars exercise the facilitators led participants through an exercise to develop a causal loop diagram describing causal structure and feedback relationships.
Model Review At the end of the CLD Elaboration activity, facilitators led participants through a structured exercise to restate common definitions established for Rawani and identify important feedback loops and exogenous variables. A later discussion revisited the model to identify preliminary points for potential intervention by CBR program activities.
Session 2: Febbruary 2015, Kabul, Afghanistan: This session took place over two meetings in three days using a series of models to explore the dynamics of social inclusion of people with mental illness and articulate potential strategies for programmatic intervention
Session 2.1
Introduction Participants had previously been oriented to group model building through a research methods seminar. An opening discussion examined the question “What distinguishes Rawani vs Diwana”? Participants shared examples of scenarios in which a family member or community member might be considered Rawani or Diwana, and prompting facilitators and fellow participants probed to draw contextual distinctions between the two concepts.
Variable Elicitation Participants nominated variables based on the prompt “What would be conditions for including people with ‘psychological problems’ in CBR activities?”.
Priorities Each participant was asked to vote for the three most important variables in the inclusion of people with “psychological problems” in CBR activities.
CLD Elaboration The highest rated variables were used to seed the structure for elaborating a causal loop diagram on sheets of chart paper that had been taped together. Participants nominated causal links, with pauses to discuss the specific assumptions of causality or negotiate definitions of terms as questions emerged.
Model Review At the close of the first day of the session, facilitators identified major themes that emerged from the session, highlighted major feedback loops from the session, and discussed potential areas for further development or exploration.
Session 2.2
Revisiting the CLD Model The first day’s model, was posted beside blank chart paper, and core structure for the second day model building as identified on the old model and redrawn on the new model paper. Questions about translation or recopying were discussed.
CLD Elaboration New causal structure was built onto the seed structure identified in the previous activity.
Model Review At the end of the session major feedback loops, themes, and remaining questions or exogenous variables were identified. A further discussion explored potential points for programmatic or policy intervention revealed by the model.