Theresa Betancourt, a researcher at Boston College who designs programs to improve the cognitive development and mental health of some of the most vulnerable children in the world, says that her long-term professional goal is to put herself out of business.
“We want to bring up the next generation to diversify the workforce and the scientific leadership so in the future we’re seeing people from affected communities in leadership roles, conceptualizing the research questions, and leading the research,” says Betancourt, who directs the Research Program on Children and Adversity in the School of Social Work. “If nothing else, I’d like to develop deployment-focused interventions that are affordable, scalable, and effective and that make an impact on the mental health, wellbeing, and development of vulnerable children and their families in a range of different settings.”
Betancourt, the Salem Professor in Global Practice, recently received the 2020 Blanche F. Ittleson Award from the Global Alliance for Behavioral Health and Social Justice for developing psychosocial interventions for kids and parents in Rwanda, Sierra Leone, and the United States who have been displaced from their homes, traumatized by war, and affected by HIV.
She says she was honored to receive the award, which is named after a philanthropist who pioneered treatment and vocational training for children with developmental disabilities. “I really relish the opportunity to spread our approaches and thinking about making a sustainable impact at scale in global mental health and child and adolescent development,” she says. “I am joining a wonderful group of fellow honorees and really looking forward to sharing a little bit about our work.”
As the coronavirus forces Betancourt and her team to reshape the way in which they deliver programs to people around the world, she reflected on her career trajectory, the positive impact her work has had on mental health, and her role in solving some of the most intractable problems of the day.
You earned your bachelor’s degree in psychology and your master’s degree in expressive arts therapy and then went on to earn your doctor of science degree in maternal and child health. How did you decide to focus your research on the health of children and families and what’s kept you in this field of research for two decades?
When I made the jump from my doctoral work, I was considering going on further in clinical psychology, but I felt that after working in direct service in school-based mental health and family home visiting, I wanted to focus more on prevention. I felt like there were opportunities to move upstream and help to prevent some of the determinants of poor mental health and the stressors facing children and families.
I got very interested in public health as a paradigm, and I had taken some time off to work in the summers in the field of human rights. I had volunteered to support journalists covering the World Conference on Women in Beijing in 1995, when I got the opportunity to work for the United Nations High Commissioner for Human Rights in New York City and met a doctoral student at the Harvard T.H. Chan School of Public Health who was working with indiginous people. I eventually applied to work with Tony Earls, a well-known child psychiatrist doing research on human development. In my doctoral work, I focused on maternal and child health and psychiatric epidemiology, which allowed me to look at prevention approaches to child and adolescent mental health. I decided rather than receive more training to treat the mental health consequences of trauma, I’d go upstream and think about how we can have more health-promoting environments so that we have less trauma to treat in the first place.
The Research Program on Children and Adversity works with children and families in Rwanda, Sierra Leone, and the United States to design targeted psychosocial interventions that support positive life outcomes that can be effectively delivered at scale in settings with few resources. Could you please give me a few examples of the kinds of changes you have seen in the lives of children and families as a result of the work that you and your research partners have done in these countries?
When we do mental health services research, we’re oftentimes engaging in mixed method data collection. So we have quantitative data on impacts, but we also collect qualitative data on people’s experiences. In both the recent research we’ve been doing in Sierra Leone on the Youth Readiness Intervention and in Rwanda with the Sugira Muryango home-visiting intervention to promote early childhood development and prevent violence in kids affected by extreme poverty, we hear wonderful stories from families and young people themselves. As part of the Youth Readiness Intervention, which is designed to improve the mental health of children affected by war, village leaders have talked about how youth were better able to solve problems and modulate their strong reactions to frustrating experiences. This has contributed to people being less violent, more focused on solutions, and better able to manage strong emotions.
We also heard stories from young people who have talked to their frontline counselors about experiences they had where normally they would have lost their temper and had real challenges with people in their communities. One of our interventionists in Sierra Leone was talking to a young man who said someone had moved his laundry outside and normally he would have lost it and become physically aggressive with the woman who had moved it, but he was able to calmly explain why he had been frustrated with the situation and problem solve better.
In the Sugira Muryango home-visiting intervention in Rwanda, we are engaged in frontline home visiting. Coaches who are well trained go to very vulnerable households and teach parents how to increase play and stimulation with children under the age of 3. Sugira Muryango, which means “strengthen the family,” very much focuses on engaging fathers and we’ve been hearing wonderful stories about how powerful that father engagement piece is. We have seen an improvement in our pre-to-post impact evaluation in terms of the mental health of caregivers, including the mental health of fathers, who are involved in a more positive way in the lives of their young children. Health workers in the community have also reported that they see kids who have received Sugira Muryango as bright, responsive, and well cared for, and they link it to the program.
What’s the status of your research projects in Rwanda, Sierra Leone, and the United States?
All three of our projects are underway right now, but in different stages. I really love what we’re doing with the refugee intervention to improve the health and wellbeing of families in the Bhutanese refugee community in New England. We have a large collaboration in Springfield, Massachusetts, and Lewiston, Maine, and we’re working with Sunand Bhattacharya, associate vice provost for design and innovation strategies at Boston College, to develop a digital platform for that intervention to deliver it remotely. We want to help refugees navigate this new environment of remote learning and that means helping families communicate and be more engaged in their schools and understand what the expectations are as parents and how to support their kids. These are oftentimes parents who haven’t had the chance to learn to read and write in their own language, let alone English, nor have they had a lot of exposure to using digital tools.
In Sierra Leone, we’ve finished pre-to-post testing of the Youth Readiness Intervention and we’re hopeful that we’ll be able to do a 12-month follow up looking at economic self-sufficiency, but that’s uncertain now given the coronavirus.
In Rwanda, things have been able to keep moving forward quite readily. We have a really wonderful relationship with the Rwandan government and have received permission to scale out the intervention in collaboration with a local partner on the ground to reach 10,000 families in poverty. The home visitors will now be government-linked child protection volunteers who we and our partners in Rwanda, FXB Rwanda, will be working to train and supervise. And we’re testing a strategy called the PLAY Collaborative, a multi-level initiative to scale out and sustain quality improvement with the intention it reaches more families living in extreme poverty.
How has the coronavirus affected the ability of your team to conduct research and what changes have you made to adapt to the pandemic?
We have always had a collaborative approach that involves remote partners. We were using Zoom a long time ago and we’ve been using WhatsApp as another platform. Our team in Rwanda has really innovated around using WhatsApp as a training platform for new members of the PLAY Collaborative to expose them to the training materials and set up short quizzes and discussion groups. We really didn’t miss a beat because we’ve been working remotely across different time zones and with people we can’t always be with in person.
We do worry that the pandemic presents new stressors. If the market collapses, for example, and the economy is no longer what it was, no matter what interventions young people have gotten, it may be harder to find suitable work and cause further distress. Similarly, malnutrition and family violence could be exacerbated in many settings.
The refugee project has had to move to remote delivery. And that’s a lot harder in collectivist cultures, where people are used to trusting relationships and having home visitors who come from the refugee community, which is a really important feature of doing that intervention well. We’re adjusting to think about how we can still keep local people engaged as we use digital tools.
In Rwanda, we had to pause face-to-face work for some months. But as the rates of infection come down in Rwanda, there are other home visiting programs starting back up. We’re hopeful that later this fall we’ll be able to set up appropriate health precautions and equipment so all parties will be safe to resume elements of our activities there.
You’ve worked to promote health and child welfare for nearly 20 years. What’s been the most rewarding part of the work for you?
The most rewarding element is bringing up the next generation of researchers, both from the affected communities as well as junior trainees in our graduate programs. It was a big part of my excitement in accepting the Salem Professorship to have a platform for doing that and investing in capacity building and mutual learning. There’s a lot we can learn from low resource settings that applies to addressing racial and ethnic disparities in the United States. The models we can innovate out of necessity in low resource settings can really help us do our best work for underserved communities.
What is the ultimate goal of the work that you and your research partners have done since you arrived at Boston College in 2017 to direct the Research Program on Children and Adversity?
Our ultimate goal is to put ourselves out of business in a way. We want to bring up the next generation to diversify the workforce and the scientific leadership so in the future we’re seeing people from affected communities in leadership roles, conceptualizing the research questions, and leading the research. I think these community-based participatory research partnerships are a huge part of that. If nothing else, I’d like to develop deployment-focused interventions that are affordable, scalable, and effective and that have the potential to be sustained with quality over time and make an impact on the mental health, wellbeing, and development of vulnerable children and their families in a range of different settings.
What does it mean to you to receive the 2020 Blanche F. Ittleson Award?
It’s a tremendous honor. I’m absolutely thrilled to receive the Blanche F. Ittleson Award and really relish the opportunity to spread our approaches and thinking about making a sustainable impact at scale in global mental health and child and adolescent development. I am joining a wonderful group of fellow honorees and really looking forward to sharing a little bit about our work. We’re grateful for the opportunities Boston College has provided us and thrilled by the partnerships we’ve been able to establish and amplify over years, from our work with resettled refugees in the United States to the long-lasting partnerships in Rwanda and Sierra Leone. We hope we can do our little part to contribute because there are big problems out there yet to be tackled.