A 15-year study of former child soldiers and other youth affected by war began in 2002. This longitudinal analysis demonstrated that poor mental health in former child soldiers resulted from both war-related trauma and post-conflict experiences such as stigma, social support, and access to school. It found that stressors such as childhood exposure to war/armed conflict are not deterministic and documented the need for greater attention to the post-conflict environment and the nature of family, peer, and community relationships that surround young people who have lived through war-related trauma. We are currently in the fourth phase of this project which includes data collection with the index sample and their intimate partners/children. This early research was critical to our subsequent work in Sierra Leone to develop and test the Youth Readiness Intervention (YRI).
Previously, research to address the mental health of war-affected youth had focused on classic elements of PTSD offering exposure-based PTSD treatment with little attention to the issues of anger and interpersonal difficulties that can impede future success as war-affected youth pursue educational and employment opportunities. Our research indicates that malleable protective factors (e.g., social support, staying in school, securing a livelihood) were key influences associated with better life outcomes and deserved priority attention in intervention development. The Youth Readiness Intervention (YRI) integrates six cognitive behavioral therapy-based practice elements, which are empirically supported and shown to have transdiagnostic efficacy across disorders ranging from major depressive disorder to PTSD and conduct disorders. The YRI is an integral part of our newest project ‘Youth FORWARD’.
Youth Functioning and Organizational Success for West African Regional Development (FORWARD) will study the delivery of mental health services in the alternate setting of youth employment programs tied to regional economic development led by governments and invested non-governmental organizations. It will also examine the use of a collaborative team approach to supervision and intervention delivery as an implementation scale-up strategy that addresses the human resource and related access to care and capacity challenges in Low and Middle Income Countries (LMICs). This work will include increasing investment in youth employment programs as a cost effective alternate system for delivery of mental health services. LMICs with limited mental health care infrastructure and personnel can build new capacity to address the mental health treatment gap through an integrated YRI and Youth Employment Scheme.
The Youth FORWARD Annual Meeting took place on August 8th and 9th, 2018 in Freetown, Sierra Leone. Read the Annual Meeting Report here.
With funding under the National Institute on Minority Health and Health Disparities (NIMHD) Community Based Participatory Research (CPBR) Program we successfully completed a needs assessment of the Somali Bantu and the Lhotshampa Bhutanese communities. Our CBPR research results were the first to demonstrate empirically the promise of power sharing and participatory approaches for addressing mental health disparities facing refugee children and families who have resettled in the U.S. This led to the development of the FSI-R pilot.
As part of our CPBR partnership with the Somali Bantu and Bhutanese refugee communities in Massachusetts, we are currently conducting a pilot of a Family Strengthening Intervention for Refugee Families (FSI-R), which adapts elements of the FSI to the refugee experience. Each family member’s experience is woven into a forward-looking “Family Narrative” that highlights and reinforces the strategies they used to cope and family resilience. The FSI-R incorporates psychoeducation on mental health and promoting resilience and provides coaching to enhance parenting skills throughout the intervention, which may be tailored to individual family needs. We will assess feasibility, acceptability, and satisfaction with FSI-R.
Since the time of our HIV/AIDS-focused work, the Government of Rwanda has made great strides in its focus on prevention and its investments to promote better outcomes for vulnerable children and families. In partnership with the World Bank, we began exploring the potential for an early childhood development version of the Family Strengthening Intervention (FSI-ECD) that could be integrated and tested within the alternate delivery platform of Rwanda’s flagship poverty reduction initiative, Vision 2020 Umurenge Program (VUP). The RPCA team is conducting a Hybrid Implementation-Effectiveness Trial of the Family Strengthening Intervention for Early Childhood Development (FSI-ECD) to: (a) assess effectiveness of FSI-ECD in promoting responsive parenting, reducing violence and harsh punishment, and promoting early child development in families living in poverty; (b) assess the interaction between FSI-ECD and family-friendly cash for work initiatives in Rwanda; and (c) assess costs, barriers, and facilitators of integrating the FSI-ECD package into the VUP.
Despite operating in a state of emergency, we were able deploy our well-trained local team to conduct research among a cross-sectional representative sample of adults at the height of the Ebola Virus Disease (EVD) epidemic (2014-2015) in order to examine how mental health and past trauma contributed to uptake of public health messages and participation in both risky and health promoting behavior among a community sample. Our findings indicate that effects of war-related trauma on both EVD risk and EVD prevention behaviors are mediated through two key mental health variables: depression and post-traumatic stress symptoms.
Much of the focus surrounding HIV/AIDS has concerned those affected by the disease but little research had examined the issue of children more broadly affected by HIV due to caregiver illness and family social and economic stressors. In 2007, Dr. Betancourt launched a body of research to explore factors contributing to mental health and family functioning in children and families affected by HIV/AIDS. This study revealed that children affected by caregiver HIV/AIDS not only showed similar rates of distress (anxiety, depression, conduct problems) compared to children living with the HIV, but also were more likely to experience harsh punishment and had lower social support than children living with HIV. This early observational research was critical to later work in Rwanda to develop and evaluate a family-based preventive intervention for children affected by HIV, the Family Strengthening Intervention (FSI-HIV).
The Family Strengthening Intervention for Children Affected by HIV (FSI-HIV) is a manualized, modular intervention delivered in weekly home visit sessions (~90 minutes per session). Its four core components directly address the key risk factors for children affected by HIV. Core components are: psychoeducation about HIV and its effects on families (with supplementary psychoeducation on Rwandan Genocide-related trauma if a family raises the issue); skills development in communication, responsive parenting, and alternatives to violence and harsh punishment; a family strengths-based narrative to identify sources of resilience and help families find a sense of hope; and assistance in problem solving and navigating support systems. The FSI-HIV has been adapted to use with refugee populations and as an early childhood development intervention.
The SAFE Model is a rights-based holistic child protection framework inclusive of four fundamental and interrelated domains of children’s security including: Safety/protection, Access to health care and basic physiological needs, Family/connection to others, and Education/economic security. The theory behind the acronym SAFE is that—as opposed to a hierarchy of needs—children’s basic security needs are interdependent and interrelated. Children (and their parents/caregivers) are constantly exerting their agency to meet them. If the interrelated security needs of children and caregivers are ignored, the effectiveness of interventions may be undermined and investments in child protection may not be cost-effective.