Tuesday, November 17, 2009

Study Finds Sexually Abused Children in Turkey Exhibit More Psychiatric Disorders at Initial Assessment than Two-Years Later

Prior research indicates that children who have been sexually abused are at risk of developing various negative short and long-term psychological sequelae. However, there is little research on the effects of sexual abuse on children living in non-Western contexts. In this study, Ozbaran et al. (2009) aim to explore the emotional and psychological impact of sexual abuse among a sample of children in Turkey at referral and two years after referral. Over 300 parents and their children (ages 5-16) were referred to the Department of Child and Adolescent Psychiatry at Ege University in Turkey, and 20 parents and their children agreed to participate in the research. At referral, the parent-child pairs (N=20) completed the first evaluation, which included a detailed psychiatric examination of each participant, completion of the Child Behavior Checklist by the mother, and an evaluation of the child’s mental capacity by a clinical psychologist. Over a period of two years, the sample participated in a combination of the following interventions, depending on the child and family’s needs: psychopharmacologic medication, parental support groups, family meetings with social workers, school counseling services, sport and art activities, and outpatient occupational therapy. After two years, the parent and child were asked to return for a follow-up evaluation. The study found that children who were sexually abused had more psychiatric disorders during the first assessment (55%) than during the second-stage evaluation (0%). However, the study also found that there was no statistically significant relationships between psychiatric diagnoses, socio-demographic features, duration of abuse, or abuse type.

The study methodology lacked rigor in that it was not clear that there was a systematized method for conducting the first and second-stage evaluations. However, the implementation of blind psychiatric interview during the second-stage evaluation was strength of the study, because it lessens the likelihood that the therapist’s impressions will be biased. The small sample size (N=20) of the study, ensured that no participants were lost to follow-up. However, the small sample size - and therefore the decreased statistical power - also made it difficult to draw any statistically significant conclusions. The lack of a control group in the study design also made it a challenge to directly demonstrate a causal relationship between sexual abuse and development of a psychiatric diagnosis or behavioral problems. The authors’ statement that the condition of the sexually abused children in their sample improved significantly as a result of time is misleading, because the study design doesn’t discern whether this is attributed to time or to the array of intervention services that the children and their families received during the study period. Lastly, sampling bias may pose a threat to the external validity of the study, as the sample reflected less than 7% of the initial referrals (over 300) to the hospital. This small sample may have characteristics that the general population does not exhibit. In light of these limitations, this study still adds to the sparse literature on the topic of children affected by sexual abuse in non-Western settings and represents an obvious precursor to more rigorous studies.

Source:
Ozbaran, B., Erermis, S., Bukusoglu, N., Bildik, T., Tamar, M., Ercan, E.S., Aydin, C., and Cetin, S.K. (2009). Social and emotional outcomes of child sexual abuse: a clinical sample in Turkey. Journal of Interpersonal Violence, 24(9), 1478-1493.

Parenting Program Effective in Improving Mothers’ Parenting and Child Well-Being

Empirical evidence indicates that poor parenting and child exposure to marital conflict are powerful predictors of psychological disorders in children. Yet, these two risk factors have been found to be mediated by preventive interventions. Bodenmann et al. (2008) conducted a randomized control trial in Switzerland to determine the effectiveness of a parenting program to improve parenting skills and children’s well-being. The Triple P-Positive Parenting Program is a multi-level program for parents to enhance their knowledge, skills, and confidence as caregivers. Researchers used public advertisements to recruit couples (N=150) with children between the ages of 2 and 12 years old. Couples were randomly assigned to one of three programs: a parenting-oriented program (Triple P), a marriage-oriented couples coping enhancement training (CCET), or a non-treatment control group. Data were gathered using self-report questionnaires measuring marital relationship, parenting, and child behavior. Questionnaires were administered to both parents at four separate times: (1) two weeks prior to intervention, (2) two weeks after completion of intervention, (3) six-months follow-up, and (4) one-year follow-up. The control group completed questionnaires at the same time as the other groups. Results indicated that mothers in the Triple P group showed improvements in parenting and parenting self-esteem, a decrease in parenting stressors, and lower rates of reports of child misbehavior as compared to the other two groups. Fathers in all three groups showed no improvements in parenting behaviors.

The strength of this study is in its randomized control design, allowing researchers to determine the effectiveness of Triple P, while ruling out the plausible competing hypothesis, a marriage-oriented program. Overall, the attrition rate was fairly small and heterogenous across groups, though there was a higher rate of dropout among fathers (13.3%) than mothers (10.7%). Furthermore, the lack of significant results from the fathers was surprising in that both mothers and fathers equally participated in the Triple P program. On the other hand, it was not surprising considering the authors’ hypothesis that mothers would benefit more from Triple P than fathers, because the former are more likely to be directly involved in child rearing, especially in the Swiss context. This raises an interesting question about the importance of paternal involvement in the efficacy of Triple P, which might indicate an area of future research. One limitation of the study is the single source of data relying on parent self-report. For example, the parent’s positive or negative views of their own parenting skills may have impacted how they rate their own child’s behavior. The study could have been strengthened if data included assessments from external sources (e.g., therapist, clinician) or even child self-reports, (although the authors do concede that the mean age of the children was 6.6 years). Overall, this study adds to the growing body of evidence about what programs are effective for improving parenting skills and child behavior.

Source:
Bodenmann, G., Cina, A., Ledermann, T., and Sanders, M.R. (2008). The efficacy of the Triple P-Positive Parenting Program in improving parenting and child behavior: a comparison with two other treatment conditions. Behavior Research and Therapy, 46, 411-427.

Monday, November 16, 2009

Risk & Society

The concept of risk society describes a modern worldview where tradition has broken down and scientific advances, rather than nature, are dominant. The consequences of human actions as a function of modernity and industrialization across a range of areas have introduced a wide array of risks and uncertainties, which exacerbate the risk of the everyday. A central paradox of risk society is that risks are generated by the very methods of modernization that are trying to control them. In this way, the traditional certainties and securities of the pre-modern society can no longer be relied upon. Fundamental to an understanding of risk society is the breakdown of the expert systems of trust in science, which has implications for how children and families function.

Beck (1992) focuses on this breakdown in the expert systems of science by drawing attention to the fact that science often draws different conclusions about the same thing, thus creating mistrust in a society that relies upon certainty and security. For example, as an element of traditional childrearing, there have been conflicting messages about breastfeeding throughout the world, with contradictions coming from both science and the media. On the one hand, this had disastrous consequences for many children in developing contexts, as many mothers chose the financially unsustainable method of formula feeding. Mothers were not able to sustain the expensive modern method of formula feeding, and therefore the baby’s nutrition and subsequent growth suffered. On the other hand, in some developed countries such as the United States, there have been breastfeeding advocacy campaigns aimed at mothers that have relied upon scare tactics rather than evidence-based advice. Mothers who use formula are portrayed as “bad mothers” who are actively harming their children, because they are not using “natural” methods to raise their children. Strong attitudes towards such childrearing practices are driven by ideology and politics and framed by blame, rather than concern for the individual. There are multiple examples of contradictions like this present in risk society.

This example proves that risk society has fundamentally changed the modern worldview, including the way children are raised. Claims about the risks to children’s health and well-being continue to proliferate and revolve around debates about what it means to be a “good parent”. This concept is more often linked to common perceptions of risk than to scientific evidence.

Similarly, Castel (1991) argues that many discourses on risk dissolve the notion of a subject or concrete individual, and put in its place risk factors. He critiques this modern view because it excludes any face-to-face relationship between the carer and the cared, the helper and the helped, the professional and the client. It clusters people as groups of risk factors, and only intervenes in cases when the risk factors produce dangerous combinations within individuals. Castel uses the example of the 1976 GAMIN system in France, when children were screened at a few days, a few months, and two years after birth. The combination of predetermined factors triggered automatic alerts, which prompted a social worker “to confirm or disconfirm the real presence of danger, on the basis of the probabilistic and abstract existence of risks” (p.287-288). Though Castel makes his distaste for such a system known, one must wonder if we are heading towards a global, and perhaps more intrusive, surveillance system such as GAMIN. The main question, however, is whether or not risk society or surveillance of risk factors, can account for the accidental and unpredictable nature of unique human beings.

Sources:
Beck, U. (1992). Risk Society: Towards a New Modernity. London: Sage Publications.
Castel, R. (1991). From dangerousness to risk. In G. Burchell, C. Gordon, and P. Miller (Eds.), The Foucault Effect: Studies in Governmentality. Chicago, IL: University of Chicago Press.

Tuesday, October 20, 2009

Study Addresses Stress in Families of Children with Seizures

There is little research exploring the impact of having a sibling with epilepsy. Mims (1997) explored sibling concerns about epilepsy between two groups of children: siblings of children with frequent seizures (n=10) and siblings of children with infrequent seizures (n=10). The author also compared family stress among families of children with frequent seizures, families of children with infrequent seizures, and families of children with no chronic illness (n=11). Case subjects included children, between the ages of 8 to 12 years, with siblings who have had epilepsy for at least three years and were being treated through The Minnesota Epilepsy Group outpatient clinic. Control subjects were recruited from a neighborhood public school. An additional three control subjects were recruited after suggestion of enrolled subject families. Case siblings were matched to control siblings based on age, gender, and birth order. The dependent variables of self-esteem and behavior of unaffected siblings were compared among the three groups. Self-esteem and behavioral and social functioning were measured using the Piers-Harris Self-Concept Scale and the Child Behavior Checklist, respectively. Family stress was measured using the Family Inventory of Life Events. Sibling concerns were measured using the Sibling Concern About Seizure Scale. The author hypothesized that there would be a relationship between epilepsy and adverse affects in siblings, including lowered self-esteem, increased behavior problems, and more concerns surrounding epilepsy; yet there were no significant differences among any of these variables. Nevertheless, statistically significant levels of family stress were reported in families of children with frequent seizures compared to families of children with infrequent seizures. The finding that the majority of siblings of children with epilepsy have concerns surrounding epilepsy has implications for policy, in that programs for children with epilepsy should also address the needs of siblings.

The author attempts to control for secondary variables (age, gender, birth order) that might confound the results by designing and implementing a cross-sectional case control study. Because of the cross-sectional nature of the study, causal relationships cannot be determined. The author doesn’t describe the procedures for data collection in detail, making it difficult to determine if there were any threats to internal validity, which may have compromised the study. The author does indicate that all study participants were “pleased to be included” indicating that there may be a sampling bias based on self-selection. Perhaps most notable is that the small sample size (n=31) decreases the study’s power and makes it difficult to detect any differences among the groups. Further research with a larger sample size should be conducted to compare to findings from this study.

Reference:
Mims, J. (1997). Self-esteem, behavior, and concerns surrounding epilepsy in siblings of children with epilepsy. Journal of Child Neurology, 12(3), 187-192.

Sunday, October 18, 2009

Phenomenology and Social Construction

As learners, ‘experts’ tell us what the truth is and we understand this explanation as our own. Yet as researchers, how do we really know what we know? We often call upon our knowledge, beliefs, and ethics to explore and interpret phenomena. This speaks to the world of research. For example, Schutz (1967) explains the process of how we grapple with our understanding of others:

On the one hand, what is understood is the sign itself, then again what the other person means by using this sign, and finally the significances of the fact that he is using the sign, here, now, and in this particular context (p.269).

In grappling with the meanings of others and their actions, we contribute to the accumulation of scientific inquiries.

Schutz’s work testifies to his support of Weber. He emphasizes Weber’s value of freedom in social scientific research, with science asserting itself through other areas of life. As opposed to its association with the natural sciences, Schutz frames social science as a science in its own right, with its own meaning-making strategies, (i.e., research methodologies). The main tenet of science is the same across disciplines: science offers an approach to discover and know reality through experience.

Schutz specifically describes knowledge-gathering through actions without communication, which draws parallels to the role of the complete observer in qualitative methodologies. Even if what we study is very abstract and difficult to explain, there is something in our lived reality that we can use in the interpretation. In raising awareness of others’ experiences, we create our own meaning-context. At the same time, others have arranged their own meaning-contexts. Yet there is a danger in completely adopting the point of view of another. By abandoning objectivity in favor of empathy, there is the risk of losing an understanding of the phenomenon from alternate frames of reference.

What are the labels that we use to give meaning to others? Labels for concepts are merely devices used to organize phenomena and communicate with others. This premise was first described by Berger and Luckmann (1966) as mental representations of other’s actions. These typifications eventually become a part of the social dialogue of meaning-making. As time moves forward, the developed meaning is embedded into the fabric and structure of society, thereby becoming a social construct. Quantitative research methodologies force us to choose constructs and fit people into those constructs. Individuals are viewed, labeled, and analyzed in regards to social constructs, such as gender, age, and socioeconomic status. Some may argue that the shared experience may be lost in quantitative methods, as the individual is often reduced to his constructs.

There is a great need for social researchers to treat the beliefs they study as worthy of respect rather than as objects of condemnation. This can be done by allowing participants to determine the meanings attributed to the phenomena being described in the study. A promising methodology is mixed methods research, which combines qualitative and quantitative approaches to provide a better understanding of research problems than using either single approach alone. In utilizing aspects of both methods, the researcher acknowledges alternate frames of reference for interpreting meaning in others’ lives.

References:
Berger, P. and Luckmann, T. (1966). The social construction of reality: A treatise in the sociology of knowledge. New York, NY: Anchor Books.
Schutz, A. (1967). The phenomenology of the social world. In S. Appelrouth and L. Dasfor Eldes (Eds.), Social theory in the contemporary era: Text and readings. Thousand Oaks, CA: Sage.

Tuesday, October 13, 2009

Study Finds Integrated Service Delivery Network Increases Quality of Life Among Frail Elderly in Eastern Quebec

***What does this study of frail elderly have to do with children? one reader asks. Not much. But it's a good example of quasi-experimental study design, which will help with developing research methodologies for all populations.***

Integrated service delivery (ISD) is a coordinated model emphasizing social interventions based on cooperation between multiple levels of service planning for frail elderly. In their study, Tourigny et al. (2004) evaluated the effectiveness of an ISD network of health and social services for frail elderly living in two semi-urban communities in Quebec. The sample included people 75 years and older (n=482) from two communities. Individuals from Bois-Francs served as the experimental group (n=272) and participants from Drummondville, where there were no ISD services available, served as the control group (n=-210). Measures were taken from both groups prior to the intervention, and every year thereafter for three years. Measures included data on basic demographics, functional autonomy, desire to be institutionalized, caregiver burden, and service utilization. Results did not indicate that ISD had any effect on mortality rates. Nevertheless, the study shows that ISD may contribute to increased quality of life, including less desire to be institutionalized, less deterioration, and decreased caregiver burden. There was no indication that ISD had an effect on utilization of services in either group.

A quasi-experimental study design was chosen because randomization was not possible in this context. The researchers took great care to select a comparable control environment to control any potential biases due to differences between the treatment and control groups. In comparison to the study environment, the control environment had similar percentages of people over 65 (11%), all who had similar access to services and utilization rates of these services. Furthermore, the rate of participants who refused to continue in the study (less than 5%) and the desire to be institutionalized (about 25%) was similar for both groups. Nevertheless, there were some important differences between the groups, which could pose a threat to the study’s internal validity. Groups differed in their score of functional autonomy, with the treatment group measuring as more autonomous than the control group. As the study proceeded, there was a significant loss of subjects - 72% remained for the first year, 54% for the second year, and 45% for the third and final year of the study - due to death and institutionalization. Though this was similar in both groups, thereby eliminating internal validity due to maturation, the cumulative attrition could have an effect on the study’s overall power. Lastly, because this study explored a specific program for a small cohort in only two communities, the generalizability of the results is limited.

Reference:
Tourigny, A., Durand, P.J., Bonin, L., Hebert, R., and Rochette, L. (2004). Quasi-experimental study of the effectiveness of an integrated services delivery network for the frail elderly. Canadian Journal of Aging, 23(3), 231-246.

Thursday, October 8, 2009

Interactionism and Self in the World

Humanitarianism identifies groups of displaced persons (e.g., refugees and internally displaced persons) as dependent on outside assistance. Rather than being perceived as individuals, people in need are viewed collectively, identified by their ‘problems’ and oftentimes stripped of their individual rights and self-dignity. Interactions between humanitarian ‘helpers’ and the recipients of their help constitutes a power relationship, with the recipients held in a position of obligation to the benefactors. The distribution of goods and services to these populations indicates not simply a material transaction, but also a moral transaction. As an individual in one of these groups, how might one perceive oneself and others and what are the implications of these perceptions? How do perceptions of ‘otherness’ color interactions and meanings developed through these interactions?

The theory of symbolic interactionism contributes to our understanding of the different meanings attributed to individuals and groups in various settings. In differentiating between the ‘I’ and the ‘Me’, Mead (1934) develops his idea of a generalized ‘other’. ‘Other’ and how one thinks one’s group perceives oneself is dependant upon human interaction. It is in realizing one’s role in relation to others that selfhood arises. Furthermore, the ‘I’ represents the self as a subject, whereas the ‘me’ identifies the self as object. Mead addresses the concept of self through his idea that the individual is a product of social interaction. One is first perceived as an object to others. Self is developed when one has an awareness that he himself is an object. This development of self is supported by human action, specifically communication. Language allows us to speak about ourselves in the same way we speak about others, thereby perceiving other and self as interacting objects.

In supporting Mead’s ideas, Blumer (1969) outlines three points related to the methodology of symbolic interactionism. First, people perceive an object depending on the meaning that they attribute to that object. Secondly, meaning is developed based on the process of social interaction. And finally, meanings can change over time. Human society is influenced by culture, derived from what people do rather than what people are. One’s status in society is defined by the way that people interact with others. Using the example of humanitarianism, the action of receiving help from humanitarians defines the recipients as dependent upon this assistance. The concept of culture also contributes to definitions of ‘otherness’.

Being an outsider in a culture speaks to Goffman’s (1959) assertion that society is not homogenous, and therefore we must modify behavior for various settings. Goffman uses the analogy of life as a theater, with the necessity for a parking lot and a cloakroom as well. In other words, the individual is responsible for the maintenance of the social world by playing his role, while at the same time considering the broader context behind simple face-to-face symbolic interactionism. “Putting on a show for the benefit of other people” (p.28) is related to a conception of what others perceive of oneself.

Mead, Blumer, and Goffman speak to the importance of self in relation to other. Rights-based humanitarianism addresses the division between the two. By encouraging interaction with individuals in the group, rather than viewing the group as its own entity defined by ‘other’, the individual rights and dignities of displaced populations are maintained. Meanings should shift away from viewing displaced populations as “vulnerable” and more towards a definition of survival in adverse circumstances.

References:
Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs, NJ: Prentice-Hall.
Goffman, E. (1959). The presentation of self in everyday life. London, UK: Penguin Books.
Mead, G.H. (1934). Mind, self, and society. Chicago, IL: University of Chicago Press.

Monday, October 5, 2009

Study Finds Group Interpersonal Psychotherapy Reduces Symptoms of Depression Among Adolescent Girls Affected by War in Northern Uganda

Prior research indicates that war-affected youth are at increased risk of mental health issues, and many humanitarian organizations have been implementing interventions to ameliorate these problems. Yet, few rigorous evaluations have been conducted and even fewer have implemented a randomized control design. Using a randomized control design, Bolton et al. (2007) examined the effectiveness of a group interpersonal psychotherapy intervention (IPT-G) and a creative play intervention (CP), as compared to a wait-list control group, in decreasing depression symptoms, anxiety symptoms, and conduct problems among war-affected adolescents. The authors first developed locally derived measures for depression, anxiety, conduct problems, and functioning to create the Acholi Psychosocial Assessment Instrument (APAI), which was found to have strong test-retest reliability and criterion validity. Stage one of the screening asked community leaders, teachers, community workers, and adolescents to create a list of 14 to 17-year-olds who exhibited at least one of the locally-derived depression symptoms. Stage two of the screening process administered the locally derived instrument to community-identified children to determine who should be included in the study. The study employed a pretest-posttest control group design, with participants randomly assigned to one of the three groups. The authors found that all three groups experienced decreased symptoms of depression. However, only girls experienced statistically significant reductions in their depressive symptoms after participating in IPT-G. Neither IPT-G nor CP were associated with improvement in anxiety, conduct problems, or functioning.

Based on previous RCTs in sub-Saharan populations, the authors recognized that attrition could pose a threat to the study’s validity by decreasing sample size and power and compromising the integrity of the random assignment. To address this, the authors employed intent-to-treat analysis, using pretreatment data from subjects who have dropped out as both pre- and post-test data. Intent-to-treat analysis also provided a conservative test of the hypothesis, making the effect of IPT-G all the more compelling. To decrease attrition further, the experimenters used a unique method of obtaining informed consent from the sample, both before the administration of the pre-intervention measure and after random assignment to one of the three groups. This study contributes to the growing knowledge base about ways to address the effects of war among adolescents, and proves that randomized control study designs can be implemented in difficult contexts with vulnerable populations.

Reference:
Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K.F., Neugebauer, R., Murray, L., and Verdeli, H. (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in Northern Uganda: A randomized control trial. Journal of the American Medical Association, 298(5), 519-527

Thursday, October 1, 2009

Behavior, Development, and Society

In his sixth chapter of Introductory Lectures on Psychoanalysis, Freud focuses on the interpretation of cultural phenomena. Using analysis of the dream world as the basis of interpretation, he suggests “We want something that is sought for in all scientific work – to understand the phenomena” (p. 129). In exploring phenomena, Freud’s writings seem wholly focused on the individual as a singular entity to explore through analysis. Nevertheless, Freud expounds upon the contradictory demands of the individual and society; the interpretation, translation, and analysis of cultural phenomena are associated with the clash between the individual and society.

Whereas Freud emphasizes the conflict between the interests of society and the demands of the individual, Parsons (1954) highlights that these elements are independent, as well as interactive with each other. In other words, the individual supports society, just as society supports the individual. With an emphasis on order and cohesion, Parsons, like Freud, also believes that social phenomena can be described, analyzed, and explained. Parsons’ four-factor model of social system dimensions – adaptation, goal attainment, pattern maintenance, integration – can be used as a model for analyzing any kind of relationship. In beginning to outline his concept of structural-functionalism, Parsons proposes a theory of social action, depicting human action as a system. This system is composed of four interdependent and interaction units making up “a body of logically interdependent generalized concepts of empirical reference” (p. 212): individual, personality, social system, and culture. In Parsons’ world, theory’s purpose is to facilitate description and analysis. By description, he refers to determining verifiable answers to all the scientifically important questions. By analysis, he refers to ensuring that the conceptual structure is delineated through propositions, or building larger concepts upon smaller ones.

Erikson’s (1997) “Major Stages of Psychosocial Development” illustrates Parsons’ concept of propositions, with one stage building upon another like a developmental ladder. Erikson provides an outline of his theoretical system, from infancy through old age, as the individual “gradually becoming what one has caused to be, one eventually will be what one has been” (p. 79). At first glance, the stages alone do not seem to take into account contextual variation among individuals. Yet, the fact that the stages are general and not stringently outlined, makes it more applicable to various contexts. Erikson’s framework of psychosocial development is particularly mindful of the cultural location of the developmental tasks and of the ways in which the natural movement through development may be distorted by external forces. As a powerful external force, armed conflict disrupts the developmental processes of the individual, family, and community. In particular, the role of caregivers is compromised, as they face increasing external demands that prioritize safety and survival. As a result, developmental needs of children are compromised and movement between stages is stalled.

Are the theoretical concepts of Freud, Parsons, and Erikson relevant today? In order to address issues of human development in today’s society, culture must be considered. All individuals are participants in cultural communities, engaging with others in shared endeavors and building upon cultural practices of previous generations. Human development is a process of participation in society, while society represents the culmination of various individuals interacting with others. External forces, such as global crises, create another contextual layer through which the individual must interact and contend with.

References:
Erikson, E. (1997). The Life Cycle Completed. New York, NY: W.W. Norton.
Freud, S. (1991). Introductory Lectures in Psychoanalysis. London, UK: Penguin Books.
Parsons, T. (1954). Essays in Sociological Theory. New York, NY: Macmillan Company.

Monday, September 28, 2009

Parental Education Program Improves Mental Health and Adjustment in Parents of Children with Autism

Research indicates that parents of children with autism experience a high level of stress. Parent training interventions reflect an attempt to address this stress and improve parental mental health. In Tonge et al.’s (2006) study, parents of preschool children recently diagnosed with autism were sampled from four geographically separate metropolitan and rural regional assessment services for young children suspected of having autism. The sample was assigned to either the intervention group (n=70) or control group (n=35). Parents from the intervention group were further randomly assigned to a parent education and behavior management (PEBM) group (n=35) or a parent education and counseling (PEC) group (n=35). Subjects were administered a questionnaire at pre-intervention, post-intervention, and six-month follow-up. Parental health was determined using the General Health Questionnaire, a widely-used reliable, and valid self-administered adult screening test designed to detect mental health issues in community settings. Results showed that both interventions improved the mental health and well-being of parents with children recently diagnosed with autism, especially among parents who had preexisting mental health problems. There were no statistically significant results supporting the superiority of either PEBM or PEC.

The authors anticipate several potential threats to validity, and attempt to minimize these threats through the study design. First, by sampling populations in geographically distant rural and urban communities, the investigators attempted to control cross-contamination of groups as a threat to validity. Second, the investigators made attempts to control for any threats to internal or construct validity by training therapists to strictly follow guidelines for the specific interventions and providing supervision and training to therapists throughout the study. Therapists also administered both treatments and were rotated between therapies. The investigators videotaped a random 10% of the intervention group for content review and intervention adherence. Third, the authors address timing of measurement as a potential threat to external validity by testing all subjects six months after the study. Consequently, results showed that alleviation of symptoms became more apparent over the long-term, reflecting a possible cumulative effect of treatment. Nevertheless, the study also exhibits limitations. By selecting samples from rural and urban communities, access to services may have created notable differences between the groups. Because parents were included in the study based on their children’s diagnosis, the group may exhibit wide variation in regards to mental health. This diversity of subject characteristics made it difficult for the investigators to determine a difference between groups. Overall, the study reveals promising findings about the effectiveness of parent training as an important element of interventions for children with autism.

Reference:
Tonge, B., Brereton, A., Kiomall, M., Mackinnon, A., King, N., and Rinehart, N. (2006). Effects of parental mental health of an education and skills training program for parents of young children with autism: A randomized control trial. Journal of the American Academy of Child and Adoelscent Psychiatry, 45(5), 561-569.

Mind-Body Skills Intervention Decreases Symptoms of Post-Traumatic Stress Disorder in Postwar Kosovar Adolescents

Incidence of post-traumatic stress disorder (PTSD) has been reported among war-affected children and adolescents. Yet few studies have evaluated the effectiveness of PTSD treatment programs for this population. Gordon, et al. (2009) conducted a randomized control trial to determine the effectiveness of an intervention aimed at ameliorating the effects of PTSD in adolescents. All children in Jeta e Re (“New Life”) High School in Kosovo were screened to participate in the study. Eighty-two students met the criteria for PTSD and were randomly assigned to two groups: (a) intervention group and (b) delayed intervention group. The intervention group participated in a comprehensive mind-body skills group program, a 12-session program consisting of meditation, guided imagery, breathing exercises, relaxation activities, therapeutic discussion, and art therapy. The delayed intervention group received the same intervention once the intervention group had completed the program, approximately 6 weeks later. The study shows that students receiving the mind-body skills group program had significantly reduced levels of PTSD symptoms as compared to the delayed intervention control group.

This study is the first randomized control study to examine the effects of a therapeutic intervention on war-affected adolescents. The study design overcomes the ethical dilemma of withholding promising treatment from the control group by providing treatment to the control group after the intervention group has completed post-intervention interviews. Nevertheless, expectation bias poses a threat to the study’s internal validity, because the results of the improved outcomes may be due to the participants’ expectations that the intervention would be effective. This threat to internal validity is supported by the fact that the intervention was piloted in the school prior to the study, building even more anticipation, as students are bound to share their experiences with other students. This is also be related to the process of testing, which could be a threat to internal validity, because students may become familiar with the measures being used. Because teachers both facilitated the intervention and administered the measures, unintentional expectancy effects pose a threat to the study’s construct validity. In this case, teachers may have subconsciously expected students to show fewer PTSD symptoms in the post-test. Similarly, the students may have wanted to please the facilitators by showing improvements in the post-test. Despite the authors’ explanation that these students would only be comfortable speaking with a familiar adult, future studies should utilize external experimenters to administer the pre- and post-test, because they will be na├»ve to which students received the intervention and will have no vested interest in the outcome of the intervention.


Reference:
Gordon, J.S., Staples, J.K., Blyta, A., Bytyqi, M., and Wilson, A.T. (2008). Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: A randomized controlled trial. Journal of Clinical Psychiatry, 69(9), 1469-1476.

Tuesday, September 22, 2009

Combination of Education and Trauma Healing Activities Decreases Trauma Symptoms in War-Affected Children in Sierra Leone

Though research indicates that higher levels of traumatic events among war-affected children leads to greater incidence of negative mental health outcomes, there is little evidence about the effectiveness of psychosocial interventions to mitigate these consequences. Gupta and Zimmer (2008) focus on determining the effectiveness of a psychosocial intervention study among children affected by the conflict in Sierra Leone. The sample was randomly drawn from school registration lists provided by the Ministry of Education, which contains all school-age children residing in the Grafton and Trade Center camps for internally displaced persons. The sample focused on an equal number of boys and girls ages 8-17, for a total sample size of 315 children. The Rapid-Ed intervention consisted of an education module enhanced with eight sessions of structured trauma healing activities and unstructured recreation activities. Children were interviewed for the pre- and post-test by trained camp teachers using a semi-structured questionnaire, which was translated and back-translated into the local language (Creole). The pre-test was administered approximately 9-12 months after the start of armed conflict, and the post-test was administered 4-6 weeks after participants completed the intervention. Results show that 96% of children reported a significant reductions in concentration problems, sleep disturbances, bad dreams, and intrusive images after participating in the Rapid-Ed intervention. The study also found that there was a slight increase in avoidance symptoms after the intervention.

The study addresses selection bias by randomly selecting children from the target communities. Also, the low attrition rate (3%) was a strength, and most likely due to the accessibility and reliability of finding the students in formal schooling programs. However, the results of this study would be strengthened with the addition of a control group. Use of a control group would indicate whether it was the intervention that caused the decreased psychological distress or whether other factors were responsible. Firstly, maturation poses a threat to the internal validity, because the study is unable to discern whether the intervention was the cause of improved psychosocial outcomes or whether it was due to the subjects’ internal healing processes. Secondly, statistical regression may pose a threat to the internal validity, because the change due to the intervention cannot be distinguished from the effect of scores reverting toward the mean. A control group would have addressed these concerns and greatly improved the study’s internal reliability. However, the sensitive context creates ethical challenges in regards to whether one group can receive the intervention and the other one doesn’t.

Reference:
Gupta, L. and Zimmer, C. (2008). Psychosocial intervention for war-affected children in Sierra Leone. The British Journal of Psychiatry, 192, 212-216.

Monday, September 21, 2009

Longitudinal Research Finds Sibling Relationships as Protective for Children Who Experience Stressful Life Events

Prior research indicates that children who experience stressful life events are at risk of developing emotional difficulties and displaying internalizing behavior, yet few studies have looked at the sibling relationship as a moderating factor against these risks. Furthermore, there is conflicting research examining the link between stressful life events and externalizing behaviors. The authors conducted a two-wave longitudinal study to determine the extent to which sibling relationship moderates risks in siblings experiencing stressful events. Data were gathered through the Avon Longitudinal Study of Parents and Children (ALSPAC), with a total of 196 families agreeing to participate after meeting the selection criteria. Interviews were conducted with families twice: first, at baseline and again, two years later. Interviews measured number and qualtity of stressful life events, quality of sibling relationship, quality of mother-child relationship, children’s externalizing and internalizing behaviors, socioeconomic status, age, and gender. The study found that positive sibling relationships positively influenced the relationship between stressful life events and internalizing symptomatology, but not the relationship between stressful life events and externalizing symptomatology. The study also found that the protective effect is not dependant upon the quality of the mother-child relationship.

This study is the first of its kind. No other study has examined if sibling relationships are protective for children who experience stressful life events. The choice of a longitudinal design was a strength, because the results are more likely to be attributed to a causal relationship between the positive sibling relationship and the amelioration of internalizing symptomatology. Also, the measures utilized the responses of multiple respondents, making a more accurate determination of scale. However, there may be plausible rival hypotheses due to variables that may not have been included in the research. Maturation may be a threat to internal validity, as children who are two years older might show improved internalizing behaviors. This study would have improved with the implementation of a control group of children who experience stressful events, but do not have a sibling. The control group would have evidenced that the protective effect of the sibling relationship is responsible for decreased internalizing behaviors.

Reference:
Gass, K., Jenkins, J., and Dunn, J. (2007). Are sibling relationships protective? A longitudinal study. Journal of Child Psychology and Psychiatry, 48(2), 167-175.

Friday, September 18, 2009

Class Society and Structure

Marx and Engels’ (1952) most renowned statement – that which opens Manifesto of the Communist Party – reads, “The history of all hitherto existing society is the history of class struggles” (p. 473). The dawn of capitalism has greatly increased production, yet Marx and Engels argue that this increase of wealth has not been distributed evenly to the detriment of the working class poor. The system operates narrowly, with the only focus on increasing property and wealth trickling up to benefit the upper class. Marx and Engels assert that the more wealth the worker produces - “the more his production increases in power and scope” (p. 133) - the poorer he becomes.

This message resonates today. In many societies, the struggles of the poor and inequalities of power are a matter of life or death. The impoverished pregnant women who is unable to access health care, the worker who is not paid a living wage, the young girl who is denied access to education all provide examples of structural inequality, which have dire circumstances for life outcomes. This unequal distribution of “wealth” (e.g., health care access, wages, education) leads to decreases in quality of life and increases in morbidity and mortality.

Those who struggle are acutely aware of the injustices they experience, with struggle influencing each of their worldviews. Mills (1959) remarks that individuals are greatly influenced by the world around them: “What ordinary men are directly aware of and what they try to do are bound by the private orbits in which they live” (p. 3). In other words, they work within structures, but are also at the mercy of these structures. Mills refers to “personal troubles of the mileau” (p. 8) related to internal mechanisms as opposed to “public issues of social structure” (Ibid). The latter can become a form of “structural violence” (Farmer, 2005), forces of poverty, racism, and socioeconomic inequality that impact impoverished populations. Structural violence represents existing constructions such as gender, religion, race, or class that may shape risk and influence an individual’s life outcome. This concept is often oversimplified as inequality, but it is actually a much stronger and prevalent force that persists day-to-day, transnationally. Structural violence includes the result of the inequality - marginalization, discrimination, stigma, restricted access, victimization - and the context in which inequalities develop and are addressed.

Structural violence is a helpful mechanism to view class society and structure because it focuses on the societal factors outside of the individual’s control. In order to overcome structural barriers, social work interventions must understand and address the complex social issues that keep individuals from utilizing their full resources, understanding that these social issues are weighed differently in different settings. Empowerment of individual agency, fortification of communities, and an increase in access to social services combined with an understanding of existing structural barriers add to our understanding and denouncement of systems, structures, and mechanisms that create conditions where the rich get richer and the poor get even poorer.

References:
Farmer, P. (2005). Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, CA: University of California Press.
Marx, K. and Engels, F. (1952). Alienation and social class. In. R.C. Tucker (Ed.) (1978), The Marx-Engels Reader. New York, NY: W.W. Norton and Company, p. 133-135.
Marx, K. and Engels, F. (1952). Manifesto of the communist party. In. R.C. Tucker (Ed.) (1978), The Marx- Engels Reader. New York, NY: W.W. Norton and Company, p. 473-500.
Mills, C.W. (1959). The promise. In C.W. Mills, Sociological Imagination. New York, NY: Oxford University Press.

Tuesday, September 15, 2009

Study in Afghanistan Finds Trauma Exposure and Caregiver Mental Health Predict Risk of Negative Mental Health Outcomes in War-Affected Youth

Research conducted in war-affected situations has found an association between exposure to traumatic events and mental health outcomes. However, there have been few studies focusing on the mental health outcomes of children and adolescents affected by war. Panter-Brick, et al. (2009) conducted a study aimed at determining a causal relationship between war and mental health problems, specifically looking at associations related to gender, traumatic events, caregiver mental health, and socio-demographic characteristics. The sample targeted children ages 11 to 16, who were randomly drawn from randomly selected schools in three purposively chosen regions of Afghanistan. Data were gathered from three informants (children, caregivers, and teachers), who were interviewed with a variety of brief measures. Measures were chosen because they had high reliability in other contexts of instability. To increase instrument diagnostic validity, measures were translated, back-translated, and reviewed by a multi-disciplinary team. The research found that the variables of exposure to multiple trauma and caregiver mental health were predictive of psychopathology for in-school Afghan adolescents. Previous research corroborates this finding and adds to the study’s external validity. Furthermore, the study found that girls were more likely than boys to develop poor mental health outcomes, such as depression.

The authors explore the quality of traumatic events to include not just war-related events, but accidents, corporal punishment, illness, death of a relative. The quality of the particular incident is not indicative of predicting poor mental health, but rather the accumulation of traumatic events contribute to risk factors for mental health problems. The study includes a few threats to validity. By only sampling school children, the study neglects out-of-school youth, who may be at high risk of developing psychopathology. Furthermore, even though the sample of in-school youth was stratified to include accurate proportions of boys and girls, the focus on in-school youth disproportionately excludes girls, because boys are more likely to attend school than girls. The school samples were restricted to three urban areas, affecting external validity and indicating that future research might consider including a sample from a rural setting. Despite its limitations, this study indicates the value of working within the school system to assess children’s mental health needs and proves the value of school-based mental health services. Furthermore, the findings contribute to the small but much needed knowledge base about the mental health of war-affected children.

Reference:
Panter-Brick, C., Eggerman, M., Gonzalez, V., and Safdar, S. (2009). Violence, suffering, and mental health in Afghanistan: a school-based survey. The Lancet, 374, 807-816.

Quality of Parental Involvement More Relevant Than Use of Child Corporal Punishment in Development of Negative Adolescent Outcomes

Child development researchers have long suggested that corporal punishment is a predictor of negative behavioral outcomes in children. However, because they suffer from serious methodological limitations, studies on the effects of corporal punishment have yet to definitively determine if corporal punishment is causally related to negative adolescent outcomes. In this study, the authors attempt to determine the extent that quality of parental involvement and corporal punishment independently predict adolescent maladjustment, specifically adolescent aggressiveness, delinquency, and psychological well-being. The authors used a prospective study design, interviewing 332 families annually over a three-year period. Interviews consisted of parent self-reports, adolescent reports, and observed ratings of family interaction tasks. Corporal punishment was determined by time (i.e., consistent use of physical discipline over the three-year study period), age-appropriateness (i.e., continuing during adolescence, indicating harsh discipline), and type (i.e., use of object, being shoved or pushed.) Quality of parental involvement was determined by display of warmth and affection, monitoring and supervision, consistency of discipline, and use of inductive reasoning to explain rules and expectations. The authors found that once other dimensions of parenting are controlled for, there exists a significant relationship between quality of parental involvement and adolescent outcomes. Contrary to past research on this topic, the study found no significant relationship between corporal punishment and the adolescent outcomes.

This study’s main strength lies in its design aimed at isolating other parenting behaviors to determine that quality of parental involvement, rather than corporal punishment, was a predictor of maladaptive behavior among adolescents. The study’s use of self-reports from parents and adolescents, combined with observation of family interactions, created a more comprehensive depiction of family interaction. However, the sample selection presents some limitations to the study. Firstly, the sample represents a rural population, highlighting the need for the study to be replicated in an urban setting. Furthermore, though 451 families were recruited for the study, only 404 families completed all four waves, 19 families were not eligible after divorcing during the study period, and there was incomplete data for 53 of the families. Secondly, the authors emphasize that corporal punishment should not be confused with physical abuse, for in this study, the corporal punishment wasn’t extreme enough to be considered physical abuse; therefore, additional studies should be conducted to examine the effects of physical abuse on adolescent outcomes, independent of other parental behaviors. Thirdly, there might be other adolescent dimensions not addressed in this study that would be important indicators of maladjustment; the authors suggest looking at autonomy, self-reliance, and creativity in future research.

Reference:
Simons, R.L., Johnson, C., and Conger, R.D. (1994). Harsh corporal punishment versus quality of parental involvement as an explanation of adolescent maladjustment.
Journal of Marriage and the Family, 56(August 1994), 591-607.

Thursday, September 10, 2009

Historical Roots of Community Engagement and Mobilization

Programs for disadvantaged populations risk encouraging passivity and creating dependency, which are adverse to recovery and sustainability. Social settlements, one of the cornerstones of modern social work, were founded on the tenet of collective action built on a basis of trust and cooperation with community members and local institutions to improve community life. The first settlement house was developed in late 19th-century London as a response to growing numbers of people living in poverty, especially immigrants. Soon thereafter, Jane Adams developed a settlement house in the United States, Chicago’s Hull House, which quickly took on several vital roles within the community – a center for social activity and learning, with youth clubs, women’s clubs, athletic classes, and college extension classes, as well as community advocacy. Though Adams’ settlement house movement did not only target vulnerable populations but rather “all sides of neighborhood life”, it is regarded as the starting point of social services to address the needs of the vulnerable within the community. Adams (1892) essay “The Objective Value of a Social Settlement” focuses on the tenets behind the settlement model, most importantly providing people with opportunities so they can help themselves, rather than relying on charity. Likewise, Agnew’s (2004) chapter on Mary Richmond, tells of her discouraging begging and handouts and focusing on educational and employment opportunities for the needy. Both emphasize that drawing upon all the resources that social programs offer as well as the resources of the community allows for collective strength and cooperation.

In the field of international child protection, community engagement and mobilization around the needs of children has always been key to creating a protective environment for children. For example, Richmond engaged with the community to safeguard children’s interests around regulating child labor. When a community is engaged to identify the needs of children in their community, children are prioritized. Collective planning facilitates the empowerment of adults and creates a sense of autonomy in uncertain and disempowering circumstances. Even in emergencies, communities still maintain structures and capacities for coping, aligned with their ideals, values, and relationships. Although pre-crisis coping mechanisms may be undermined during times of crisis, the community does not lose its capacity for developing solutions and rebuilding community life. Wessells and Monteiro (2008) suggest using an empowerment model rather than a service model to connect with the community in a front-line response to create a protective environment for young children and aid in their own recovery. Psychologically, part of community recovery is a reinstatement of collective efficacy and action to help monitor and reduce risks and prevent abuse and exploitation. In this way, caregiving structures for children in the community are strengthened. When the capacity of communities to recovery from crisis is recognized, feelings of hope and autonomy are increased. As Adams (1893) says, “They require only that their aspirations be recognized and stimulated, and the means of attaining them put at their disposal” (p. 61).

References:
Adams, J. (1893). The objective value of social settlement. In C. Lasch (1982), The Social Thought of Jane Adams. New York, NY: Irvington Publishers, p.44-61.
Adams, J. (1915). Subjective necessity for social settlements. In Twenty Years at Hull House. New York, NY: The Macmillan Company, p. 113-127.
Agnew, E. (2004). Families and the circle of reform. In From Charity to Social Work: Mary E.
Richmond
and the Creation of an American Profession. Ubana, IL: University of Illinois Press,
p. 95-131.

Wessells, M. and Monterio, C. (2008). Supporting young children in conflict and postconflict
situations:
Child protection and psychosocial well-being in Angola. In M. Garcia, A. Pence, and
J. Evans (Eds.), Africa’s future, Africa’s challenge: Early childhood care and development in
sub-Saharan Africa (pp.317-329). Washington, DC: World Bank.


Tuesday, September 8, 2009

Preventive Interventions Help Secure Attachment in Maltreated Infants

Child maltreatment presents threats to child developmental processes, including long-term maladjustment and development of psychopathology. Cicchetti, Rogosch, and Toth’s (2006) study examines the effectiveness of two preventive interventions: psychosocial parenting education (PPI) and infant-parent psychotherapy (IPP). Based on the theory that secure attachment is derived from parental knowledge and skills, PPI involves a series of psychoeducation-focused home visits with mothers to improve parenting skills, increase mothers’ knowledge of child development, and enhance coping and social support skills. IPP is based on attachment theory and includes an exploration of the parent-child relationship through therapy. The hypothesis that PPI or IPP interventions will be most effective for ameliorating the effects of maltreatment of infants is explored in this study. The study sampled mothers and their infants in maltreating families (n=137). Subjects were randomly assigned to one of three cohorts: (1) psychosocial parenting education (PPI), (2) infant-parent psychotherapy (IPP), or (3) community standard (CS). A normative comparison (NC) group of non-maltreated infants and their mothers (n=52), with similar demographics to the intervention group, was also included. Using validity tested measures, the authors found that mothers and children in the PPI and IPP groups showed greater increases in secure attachment than mothers and children in the CS and control groups. This study supports evidence that preventive intervention programs can alter attachment organization and ameliorate the negative developmental consequences of maltreatment.

As compared to results from the CS group, the authors provide evidence that the PPI and IPP interventions result in greater increases of secure attachment in maltreating families. However, the non-maltreating control group varied greatly from the maltreating group, with maltreating mothers reporting higher rates of maltreatment in their own childhoods, more insecure relationships with their mothers, more maladaptive parenting attitudes, more parenting stress, and lower family support. Similarly, despite trying to maintain uniform adherence to the therapeutic intervention, the therapy was not completely standardized, because the intervention used different therapists. Lastly, the intervention groups were actively pursued to follow the therapy schedule, which is not commonly done in treatment modalities such as the CS group.
The authors attempt to eliminate any self-selection bias, by seeking out maltreating families rather than the families seeking to be enrolled in the study.

Reference:
Cicchetti, D., Rogosch, F.A., and Toth, S.L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623-649.

Child-Centered Spaces are Beneficial to Young Children Affected by War in Northern Uganda

A widely used approach to aid children and their families in emergencies is the implementation of child-centered spaces (CCSs), which are physical spaces providing structured activities and support for children and their caregivers in emergencies. Despite the prevalence of CCSs, there has been little systematic research to assess their impact. Kostelny and Wessell’s (2008) evaluation of safe spaces in an internally displaced persons (IDP) camp in northern Ugandan is the first of its kind. The study uses both qualitative and quantitative methods to determine if CCSs protect young children (3-6) from risks and threats in their environment, improve children’s psychosocial well-being, and increase children’s knowledge and life-skills levels. Qualitative data were collected from focus group discussions with 92 caregivers and community members. Qualitative data informed development of a tool based on locally-derived indicators of child well-being in the northern Uganda context. Using the locally derived indicators and a Western developed screening tool for emotional and behavioral difficulties, quantitative data were collected from interviews with caregivers. The study randomly selected 176 caregivers of children attending CCS program and 118 caregivers randomly selected from a nearby IDP camp where there were no CCS services available. Significant benefits for children in the CCSs occurred within the domains of protection, psychosocial well-being, and life skills. The authors conclude that if positive effects can occur in as challenging an environment as northern Uganda, then the implementation of CCSs might have similar positive effects in other difficult settings.

This study uses locally appropriate measures to bypass questions of validity inherent in Western measures’ application to non-Western settings. Furthermore, the study focuses on outcomes versus process indicators, which rarely describe the actual benefits of a program in regards to child development, protection, and well-being. Nevertheless, the authors recognize limitations to their study. First, intervention and control groups weren’t systematically matched. Secondly, because the data rely on self-reports, the study may have experienced self-preservation bias with the intervention group reporting more favorable outcomes. Lastly, the external validity of the findings should be considered with caution, since this evaluation only addresses one specific context. In order to gain support that child-centered spaces are beneficial for children in crisis settings, more research must be conducted in other contexts.


Reference:
Kostelny, K. and Wessells, M. (2008). The protection and psychosocial well-being of young children following armed conflict: outcome research on child-centered spaces in northern Uganda. The Journal of Developmental Processes, 3(2), 13-25.

Tuesday, August 11, 2009

The Spirit Catches You and You Fall Down

Anne Fadiman's excellent examination of the clash of two cultures - one the Hmong refugees, and the other, Western medicine - not only proves the importance of holistic child development and a family-centered approach, but also draws attention to the struggle many families in forced displacement must face. The following passage, describing how families with young children coped during their flight, is horrifying, yet still (unfortunately) within the boundaries of comprehension in the context of armed conflict.

"Many people carried children on their backs. The babies presented a potentially fatal problem: they made noise. Silence was so essential that one Hmong woman, now living in Wisconsin, recalled that her son, who was a month old when the family left their home village, didn't know a single word when they arrived in Thailand two years later, because no one had talked that entire period except in occasional whispers. Nearly every Hmong family I met in Merced had a story to tell about a baby - a relative's child, a neighbor's child, a member of the group they escaped with - who had been drugged with opium. 'When the babies would cry,' a young mother named Yia Thao Xiong told me, 'we would mix the opium in the water in a cup and give it to them so they would be quiet and the soldiers would not hear, because if they heard the babies, they would kill all of us. Usually the baby just went to sleep. But if you give too much by mistake, the baby dies. That happened many, many times.' When I heard these stories, I recalled something I had once read about an Israeli child, hiding from Palestinian terrorists, who, when she began to cry, was accidentally smothered to death by her mother. That death, in 1979, was said to have driven the entire Israeli nation into mourning. The horror of the opium overdoses was not only that such things happened to the Hmong, but that they happened so frequently that, far from driving a nation into mourning, they never made headlines, never caught the world's ear, never reached beyond a community of families that numbly accepted them as a fact of life" (p. 162).

Thursday, August 6, 2009

Rethinking ECD

I had an interesting conversation with a colleague about the direction that the Early Childhood Development (ECD) community is heading, especially in light of increased emphasis on ECD in emergency settings. Because the roots of ECD are grounded in development, it is a difficult transition to examine the non-developmental aspects of ECD in emergencies. Yes, one of the most important issues affecting very young children in crisis-affected settings is the impact on their development (from stimulation, separation from caregiver, etc.) because this has such long-term implications for young children as they transition into adolescence and adulthood and even greater implications for the development of nations and future investments in populations. However, in emergencies, there should be an equal importance placed on safety and protection issues, such as addressing the fact that young children are disproportionately affected by natural disasters. It is necessary to rethink ECD through multiple lenses.

Friday, May 15, 2009

Children's Role in Illegal Toxic Waste Dumping in Southern Italy

Roberto Saviano's novel on the Camorra crime family in Naples has been turned into the film "Gamorrah". One of the more disturbing scenes (and there were plenty to choose from), addresses the Comorra's handling of waste disposal in southern Italy. The Camorra has a monopoly of toxic waste dumping, which it has held for over 30 years. Understandably, the results have been devastating for the environment and health of the general population. Heavy metals, industrial waste, chemicals, and household garbage are often mixed together and buried in non-secure sites, leading to severe soil and air pollution. Farmlands are poisoned and the rates of cancer in the area have increased dramatically. What is startlingly about these facts is that the Camorra employs children to drive the waste in for a small price. These children do not complain about the health risks, which are unknown to them. Rather, they eagerly hop into the truck cabs, place cushions on the seat so they can see over the steering wheels, and drive into the quarries filled with toxic waste. The movie notes that if all of the waste managed by the clans were accumulated, it would create a 14,600 meter high mountain with the base measuring three hectares, which would be almost double the height of Mount Everest. As of 2007, the region still has no alternative dumping areas for waste, and no alternatives have been found.

Sunday, May 3, 2009

The Path of Most Resilience

I am currently coordinating the revison of a Position Paper for the Early Childhood Care and Development in Emergencies Working Group (EEWG). The following is an excerpt from the Executive Summary. The final paper will be widely available this summer.

"The Path of Most Resilience" describes an integrated, holistic approach for assisting children affected by emergencies. This Working Paper serves as a starting point, an opportunity to outline foundational principles of the field of early childhood care and development (ECCD) in emergencies.

While the progress toward standardisation of child protection and well-being principles has been remarkable, more needs to be done. Despite the plethora of guidelines and standards, no single document specifically and holistically targets parameters of assistance for young children and their caregivers, families, and communities in emergencies. Emergencies can be considered a ‘window of opportunity’ to introduce ECCD provision and concepts where none existed before. Therefore it is crucial that quality programming, adherence to good practice, and development of minimum standards are a major priority for emergency ECCD response. What is required goes beyond ensuring that humanitarian aid efforts include ECCD programming. Policy makers must rethink the way the emergency response is carried out so that the rights and needs of young children and their families are fully recognised and centred in humanitarian relief. Continued coordinated efforts must be made to make interventions effective and accountable, strengthen collective advocacy, and develop concrete policy and programmatic frameworks to prioritise ECCD as a core intervention in crisis settings.Developing this document has been a collaborative process by an inter-agency partnership of actors: a body recognised as both a Working Group of the Consultative Group on Early Childhood Care and Development (CGECCD) and as a Task Team of the Inter-Agency Network for Education in Emergencies (INEE). The Early Childhood Care and Development in Emergencies Working Group (EEWG) includes more than 100 organizations and individuals working in early childhood, emergencies, and other related fields, including INEE and the Agency Learning Network on the Care and Protection of Children in Crisis-Affected Countries (CPC Learning Network) through the Global Technical Group on Early Childhood (convened by the EEWG). The EEWG is set up to analyse and synthesise information gathered from research, case studies, successful practices, and tools from the field of ECCD and emergencies. This information will be used to:

  • Develop tools and publications and disseminate this information to global actors and stakeholders in ECCD and emergencies.
  • Advocate for improved investments, policies, and commitment to action related to young children in emergency situations.
  • Raise awareness around the importance of including ECCD programming in emergency situations to meet the diverse needs of children in each phase of the emergency, from emergency preparedness and planning to an actual emergency, transition, and recovery.
  • Inform capacity development of stakeholders in ECCD and emergencies to effectively act for children in these settings.
The EEWG is well placed to actively support capacity building, networking, and advocacy efforts to encourage greater recognition and understanding of the role of ECCD in emergencies as a central tool in saving lives and protecting young children’s development and well-being. The INEE is a global, open network of NGOs, UN agencies, donors, practitioners, researchers, and individuals from affected populations working together within a humanitarian and development framework to ensure the right to education in emergencies and post-crisis reconstruction. In coordination with the INEE Minimum Standards Task Team (www.ineesite.org/toolkit) and in response to a growing need for a consolidated practical tool reflecting recent developments in the field of ECCD, the EEWG is updating The Good Practice Guide (based on findings and principles outlined in this document) for those who work in emergency settings.

The first section of this Working Paper presents the situation and rationale: Emergencies pose invisible and visible challenges for young children in already difficult situations. In emergencies, young children are at increased risk of separation from primary caregivers, all forms of abuse and violence, long-term negative emotional and psychological effects, and physical, intellectual, emotional and social disabilities. Of most concern in emergency settings is that young children's developmental needs and well-being are often neglected, with serious consequences for their growth and survival. “ECCD Programming Principles and Guidelines” discusses how the Consultative Group on ECCD’s 4 Cornerstones to Secure a Strong Foundation for Young Children might be interpreted and adapted for work in emergency settings. Other ECCD programming principles that guide the CG’s work are presented. Coordinated action among a range of sectors – Water, Sanitation, and Hygiene; Health; Nutrition; Education; and Protection – is vital to effectively care for young children in emergencies. The third section of this Working Paper emphasises the cross-cutting nature of ECCD programming and indicates potential areas for integrating ECCD activities into emergency humanitarian interventions. Cross-cutting issues of gender, disabilities, and HIV/AIDS are considered in section 4. The document concludes with "A Call to Action" outlining challenges and opportunities as the ECCD in Emergencies agenda is moved forward, as well as a specific action plan on future activities.

Thursday, April 23, 2009

US Immigrant Children in Limbo

Today, the New York Time continues it's series on the illegal immigrant experience with a piece entitled "After Losing Freedom, Some Immigrants Face Loss of Custody of Their Children". The focus is on the children of detained immigrants, who face the consequences of their parents' incarceration. In crackdowns against illegal immigration, these children are unwillingly thrust into the court system, separated from their parents and effectively in limbo while the courts decide their fate. Oftentimes, their is a heated custody battle, as the courts deem the child or children will be better cared for through fostering or adoption. Christopher Huck, a Washington state immigration lawyer, says, "The struggle in these cases is there's no winner."

The implications for this are powerful. In societies where placement of the child in a stranger's home is seen as anathema to accepted cultural practices, this separation from caregiver, family, and community can be devastating.

Thursday, January 15, 2009

Assessing the Well-Being of Child Caregivers in Emergencies

I have proposed research for McGill University’s Ph.D. program, which will examine the well-being of young children serving as caregivers of other household children in situations of crisis. The study will be based upon analysis of breakdowns in normal caretaking practices within the context of crisis. The effects on the young caregiver and the young child being cared for will be then be explored in-depth. The study will combine qualitative and quantitative methods, including focus group discussions, mobility maps and flow diagrams, and semi-structured interviews. Theoretical frameworks for assessing child well-being in this context include risk, resilience, and psychosocial well-being.