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Mental Health and Psychosocial Support for Children in Humanitarian Settings: an Updated Review of Evidence and Practice

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Mental Health and Psychosocial Support for Children in Humanitarian Settings: an Updated Review of Evidence and Practice ROSA: Bangladesh © UNICEF/UNI359532/Chakma Mental Health and Psychosocial Support for Children in Humanitarian Settings: An Updated Review of Evidence and Practice November 2020 Acknowledgments This 2020 Review has been commissioned by UNICEF with support from IOM and USAID and carried out in coordination with the MHPSS Collaborative and the MHPSS UK Civil Society Group. The report was updated by Ruth O’Connell, Claire O’Kane, and Annabel Trapp (Proteknôn). Particular thanks are extended to members of the steering group who have provided their invaluable support and expertise, including Marcia Brophy (IMC), Annalisa Brusati (IRC), Catherine Boland (IRC), Erica Hall (World Vision), Zeinab Hijazi (UNICEF), Anna Koehorst (UNICEF), Rachel Smith (INEE), Leslie Snider (the MHPSS Collaborative), Carmen Valle Trabadelo (the MHPSS Collaborative), and Patricia Young (Tdh UK). Particular thanks to Zeinab Hijazi and Patricia Young for managing this study. The original 2015 Review was researched and developed by Zeinab Hijazi and Sarah Meyer (Independent MHPSS Research Consultants), with support from Melissa Tucker and Katy Wall (Research Associates, Humanitarian Assistance Applied Research Group), and Josef Korbel (School of International Studies University of Denver). Thanks to members of both the CP Alliance Task Force on Community Child Protection (CCP-TF) and the IASC MHPSS WG on Community-based MHPSS for their technical inputs and support. Special thanks to practitioners from a wide range of agencies from around the world who shared their insights, especially on MHPSS and participation barriers during our July 2020 webinar; and to the MHPSS Reference Group co-chairs Fahmy Hanna, Sarah Harrison, and colleagues Marcy Levy, Sara Lim, Cecile Mazzacuriti, Saji Prelis, Michelle Van Akin, and Brikena Zogaj who helped us reach out to various networks. Appreciation to colleagues who took the time to send us relevant documents: Anouk Boschma, Maria Bray, Glynis Clacherty, Rinske Ellermeijer, Lucy Hillier, Lynne Jones, Lindsay Rogers, Karin Schmidt Martinez, Morten Skovdel, and Caroline Veldhuizen. Special thanks to colleagues who applied our protocol to organize consultations with children and adolescents. Thank you to Amina Hambali Abdulsalam (SFCG Nigeria), Rachel Walsh (SFCG), Clementine Cholat (UNICEF Cameroon), and colleagues from NGO partners (ALVF, CIPRCRE, CBCHS), and the Danish Refugee Council in Cameroon: Andro Rabeanto, Augustine Balla, Choiselle Leonnette Menom, Clarissa Otele, Daniel Esibe, Fatimatou Gali, Ful Fuen, Haingo Manga Ada, Jane Mufua, Joan Ndinttek, Kongnyu Ndintek, Liku Osang, Mathieu Foka, Michelline Kegni, Theresa Njamgue, Tubuah Prisca Buindi, and Xavier Ambe. Very special appreciation to children and adolescents from Cameroon and Nigeria who shared their views and suggestions. 2 Contents: Acknowledgments .......................................................................................................................... 2 ACRONYMS ..................................................................................................................................... 4 INTRODUCTION .............................................................................................................................. 6 Section 1: INDIVIDUAL ................................................................................................................. 13 1.1 EXPOSURE TO SEVERE DISTRESS/TRAUMA ................................................................................... 14 1.2 DAILY STRESSORS AND POST-CONFLICT HARDSHIPS ..................................................................... 21 1.3 RESILIENCE ................................................................................................................................ 25 Section 2: PARENTS/CAREGIVERS ............................................................................................ 32 AREA 2.1: CAREGIVER MENTAL HEALTH AND COMPOUNDED STRESS ................................................... 33 AREA 2.2: ALCOHOL AND SUBSTANCE USE ........................................................................................ 39 AREA 2.3: POSITIVE PARENT-CHILD RELATIONSHIPS ......................................................................... 44 AREA 2.4: CARING FOR CAREGIVERS ................................................................................................ 49 Section 3: EDUCATION ................................................................................................................ 53 3.1: ACCESS TO SAFE AND SUPPORTIVE LEARNING ENVIRONMENTS................................................... 54 Section 4: COMMUNITY ................................................................................................................ 62 4.1 STIGMA ...................................................................................................................................... 63 4.2 COMMUNITY PARTICIPATION AND SOCIAL SUPPORT ...................................................................... 69 Section 5: MULTI-LAYERED APPROACHES ............................................................................... 75 5.1 VIOLENCE AGAINST CHILDREN AND GENDER-BASED VIOLENCE ...................................................... 76 5.2 CHILDREN’S PARTICIPATION ........................................................................................................ 82 5.3 MULTI-LAYERED APPROACHES .................................................................................................... 89 Section 6: CONCLUSION WITH CROSS-CUTTING ISSUES ....................................................... 96 REFERENCES ................................................................................................................................. 100 3 ACRONYMS ACF Action Contre la Faim (Action Against Hunger) AUD Alcohol Use Disorder CBI Classroom/School-Based Intervention CBT Cognitive Behavior Therapy CB MHPSS Community-Based Approaches to Mental Health and Psychosocial Support CFS Child-Friendly Spaces CP Child Protection CPRQ Children’s Participation Rights Questionnaire AUDIT Alcohol Use Disorders Identification Test CPWG Child Protection Working Group CYP Children and Young People CYRM Child and Youth Resilience Measure EA$E Economic and Social Empowerment for Women EBP Evidence-Based Practice ECD Early Child Development EPP Employment Promotion Program FGD(s) Focus Group Discussion(s) GBV Gender-Based Violence GFS Girl Friendly Space ODI Overseas Development Institute IASC Inter-Agency Standing Committee IICRD International Institute for Child Rights and Development IOM International Organization for Migration IPV Intimate Partner Violence IRC International Rescue Committee ISPCAN International Society for the Prevention of Child Abuse and Neglect KLT Kids’ Life and Times LETs Local Evaluation Teams LGBTQI Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex LMIC Low- and Middle-Income Countries LSWAY Longitudinal Survey of War-Affected Youth MHPSS Mental Health and Psychosocial Support MNS Mental, Neurological, and Substance Abuse MoLSA Ministry of Labor, Social Affairs, and Social Services NET Narrative Exposure Therapy NGO Non-Governmental Organizations ODI Overseas Development Institute OSRSG Office of the Special Representative of the Secretary-General PAR Participatory Action Research PEPFAR President's Emergency Plan For AIDS Relief PM+ Problem Management Plus PTSD Post-Traumatic Stress Disorder PRA Participatory Rural Appraisal PSS Psychosocial Support RCT Randomized Controlled Trial RUL Reach Up and Learn SAM Severe Acute Malnutrition SF Strong Families SFP Strengthening Families Program TaT Talking about Talking TF-CBT Trauma-Focused Cognitive Behavioral Therapy TLC Temporary Learning Centers 4 TRT Teaching Recovery Techniques UNGEI United National Girls’ Education Initiative UNICEF United Nations International Children's Fund UNODC United Nations Office on Drugs and Crime VAC Violence Against Children VAW Violence Against Women YRI Youth Readiness Intervention VSLA Village Savings and Loan Association WHO World Health Organization YEP Youth Empowerment Program YRI Youth Readiness Intervention 5 INTRODUCTION 6 Why this Review? The escalation of conflicts and conflict-related displacement around the world has significant impacts on the development and overall well-being of children. Disasters and infectious diseases also disrupt lives and negatively affect the mental health and well-being of children and their caregivers. Different forms of humanitarian crises have adverse impacts on children and adolescent’s education, development, protection, and psychosocial well-being, while also negatively affecting the delivery of quality services and the social fabric of families and communities. The composite term mental health and psychosocial support (MHPSS) describes any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder. (IASC, 2007). Despite acute challenges, MHPSS practitioners and other sectoral staff integrating MHPSS approaches endeavor to bring high-quality interventions to scale in unstable environments. With an emerging evidence base for MHPSS interventions for children and families in humanitarian settings, we are better informed about how to best support children in programming interventions (Bangpan et al., 2017; Kamali et al., 2020; ODI, 2018; Haroz et al., 2020; Promundo & Sonke, 2018). Interventions such as Child-Friendly Spaces
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