Current State of Knowledge on ECCD in Current State of Knowledge on ECCD in Emergencies: Emergencies:

What Do We Know and What Do We Need What Do We Know and What Do We Need To Know?To Know?

CGECCD Annual Consultation on CGECCD Annual Consultation on

ECCD in Emergencies Working GroupECCD in Emergencies Working Group

Bree AkessonBree AkessonProgram on Forced Migration and Health, Program on Forced Migration and Health,

Mailman School of Public Health, Columbia Mailman School of Public Health, Columbia UniversityUniversity

October 14th, 2008October 14th, 2008

Taking StockTaking Stock

Where Are We Now Where Are We Now in Our Knowledge in Our Knowledge Base of ECCD in Base of ECCD in Emergencies? Emergencies?

And Where Should And Where Should We Be 10 Years We Be 10 Years From Now?From Now?

Current State of PracticeCurrent State of Practice Graca Machel study was tipping point Graca Machel study was tipping point

in care and protection of children, but in care and protection of children, but fundamental gaps remainfundamental gaps remain

Don’t know prevalence or incidence Don’t know prevalence or incidence rates of child protection concernsrates of child protection concerns

There are mixed attempts to There are mixed attempts to incorporate local understandings and incorporate local understandings and definitions of well-being in response definitions of well-being in response and programmatic interventionsand programmatic interventions

There is a lack of evidence on There is a lack of evidence on interventions that have worked to interventions that have worked to improve lives of childrenimprove lives of children

Percentage of CAP Coverage for Percentage of CAP Coverage for Protection/Human Rights/Rule of Protection/Human Rights/Rule of

Law Law vs. All Other Sectors (2000-2007)vs. All Other Sectors (2000-2007)

0%

20%

40%

60%

80%

100%

2000

2001

2002

2003

2004

2005

2006

2007

What Does the Current What Does the Current Research Say About ECCD Research Say About ECCD

in Emergencies?in Emergencies?

Holistic Impact of Holistic Impact of Emergencies on Young Emergencies on Young

ChildrenChildren SecuritySecurity

HealthHealth DevelopmentDevelopment

Family relationsFamily relations MortalityMortality

RolesRoles Nutrition Nutrition

ResilienceResilience Spiritual well-being Spiritual well-being

Biological and Biological and Physiological DevelopmentPhysiological Development

Elevated stress Elevated stress hormones and hormones and altered key brain altered key brain chemicals disrupt chemicals disrupt brain development brain development and affect immune and affect immune system, metabolic system, metabolic regulatory regulatory functions, and functions, and general mental general mental healthhealth

Health & NutritionHealth & Nutrition 220 million children under-5 in 220 million children under-5 in

developing world have developing world have significantly impaired growthsignificantly impaired growth

Malnourishment limits child’s Malnourishment limits child’s chance of survival, severely chance of survival, severely affects long-term growth and affects long-term growth and mental developmentmental development

Low birth weight and under Low birth weight and under nutrition in infants affects nutrition in infants affects cognitive and psycho-motor cognitive and psycho-motor developmentdevelopment

Children who were severely Children who were severely malnourished as infants do less malnourished as infants do less well in school, have less chance well in school, have less chance of doing productive work and of doing productive work and forming healthy relationships, forming healthy relationships, and are more vulnerable to and are more vulnerable to mental illnessmental illness

Maternal DepressionMaternal Depression Infants of mothers who are Infants of mothers who are

depressed show poorer growth depressed show poorer growth outcomes than infants whose outcomes than infants whose mothers are not depressedmothers are not depressed

Postnatal depression and Postnatal depression and maternal intelligence are maternal intelligence are significantly related to ‘failure-significantly related to ‘failure-to-thrive’ in infantsto-thrive’ in infants

Mothers less able to provide the Mothers less able to provide the physical and emotional care physical and emotional care required are less responsive to required are less responsive to infant demandsinfant demands

In long term, undernourished In long term, undernourished children may contribute to children may contribute to maternal depression by maternal depression by increasing feelings of guilt and increasing feelings of guilt and incompetenceincompetence

Children with greater Children with greater psychosocial skills are better psychosocial skills are better able to engage with caregivers able to engage with caregivers and may be more effective in and may be more effective in demanding fooddemanding food

Treating maternal depression Treating maternal depression improves growth outcomesimproves growth outcomes

Education & LearningEducation & Learning Cognitive stimulation Cognitive stimulation

and learning activities and learning activities for young children for young children increases cognitive increases cognitive functioning and socio-functioning and socio-emotional emotional competence, which competence, which carries over into carries over into adulthoodadulthood

There is promising There is promising research on the research on the effectiveness of Child effectiveness of Child Centered Spaces Centered Spaces (CCS)(CCS)

Psychosocial and Mental Psychosocial and Mental HealthHealth

““Huggy-Puppy” intervention Huggy-Puppy” intervention successfully eased the stress successfully eased the stress and improved outcomes for and improved outcomes for young children in Israel young children in Israel exposed to violence during exposed to violence during the second Israeli-Lebanon the second Israeli-Lebanon war in 2006 (Sadeh et al, war in 2006 (Sadeh et al, 2008)2008)

Dybdahl (2001) evaluated a Dybdahl (2001) evaluated a psychosocial program for psychosocial program for mother-child dyads in mother-child dyads in Bosnia combining different Bosnia combining different approaches and found a approaches and found a positive effect in positive effect in intervention groupintervention group

Case Study: IRC’s Safe Case Study: IRC’s Safe Motherhood Program, Motherhood Program,

Chechnya 2005Chechnya 2005 Psychosocial GroupsPsychosocial Groups

Informational and Informational and supportive, with mental supportive, with mental health componenthealth component

Safe Motherhood TrainingSafe Motherhood Training Education, distribution Education, distribution

of supplies, and access of supplies, and access to resourcesto resources

Social Support SystemsSocial Support Systems Indigenous, community-Indigenous, community-

based systemsbased systems

Three types of social Three types of social supportssupports Emotional supportEmotional support

Family and communityFamily and community Cognitive supportCognitive support

Information and knowledgeInformation and knowledge Material supportMaterial support

Tools and access to Tools and access to servicesservices

Case Study: ChechnyaCase Study: Chechnya

But, what’s missing is…evaluation! But, what’s missing is…evaluation!

How do we know that this program is How do we know that this program is GOOD?GOOD?

Importance of CultureImportance of Culture There is an evidence There is an evidence

base based on base based on Western experiences Western experiences with ECCD, but not in with ECCD, but not in non-Western contextsnon-Western contexts

Research should be Research should be geared to develop geared to develop tools and tools and methodologies that methodologies that are culturally and are culturally and context sensitive context sensitive specificspecific

Looking towards Looking towards culture may also point culture may also point towards areas of towards areas of healinghealing

Focus on FamiliesFocus on Families Most research Most research

focuses on the focuses on the mother-child bondmother-child bond

Focus should shift to Focus should shift to family and family and community as a community as a protective (or non-protective (or non-protective?) protective?) environment for childenvironment for child

In emergencies and In emergencies and varied cultures and varied cultures and settings, fathers, settings, fathers, siblings, grannies, siblings, grannies, etc. may all play an etc. may all play an important role in important role in caring for the childcaring for the child

Rethinking “What is Rethinking “What is Family?”Family?”

Young children may Young children may be cared for by very be cared for by very young “caretakers”, young “caretakers”, who may be only a who may be only a few years olderfew years older

Plurality of Plurality of socializing forces socializing forces (community, school, (community, school, etc.)etc.)

Autonomy of childrenAutonomy of children

Lack of Appropriate Lack of Appropriate IndicatorsIndicators

Evidence shows that it Evidence shows that it is important to is important to specifically target specifically target children under 8, children under 8, however identifying however identifying the positive or the positive or negative negative developmental developmental indicators can be indicators can be challengingchallenging

We don’t know a lot We don’t know a lot because we don’t have because we don’t have the appropriate the appropriate indicatorsindicators

Cross-Cutting IssuesCross-Cutting Issues GenderGender: Gender : Gender

within the early years within the early years is an often neglected is an often neglected topictopic

DisabilitiesDisabilities: Very little : Very little research on young research on young children with children with disabilitiesdisabilities

Developmental Developmental phasesphases: Lack of : Lack of understanding of child understanding of child protection across protection across developmental phasesdevelopmental phases

Focus on ResilienceFocus on Resilience We shouldn’t just We shouldn’t just

focus on a deficits focus on a deficits approach, but approach, but also on strengths also on strengths and resilience in and resilience in the child, family the child, family and communityand community

Exploring this Exploring this resiliency is resiliency is where we can where we can develop programs develop programs for recoveryfor recovery

Looking ForwardLooking Forward We are where we We are where we

were about 10 were about 10 years ago in the years ago in the field of child field of child protection, which protection, which means we are on means we are on “the tip of the “the tip of the iceberg” in terms iceberg” in terms of discovering of discovering knowledge about knowledge about how to best how to best address ECCD in address ECCD in emergenciesemergencies

IASC MHPSS GuidelinesIASC MHPSS GuidelinesAction Sheet 5.4: Facilitate Action Sheet 5.4: Facilitate

support for young support for young children (0-8 years) and children (0-8 years) and their caregiverstheir caregivers

Keep children with their Keep children with their mothers, fathers, family mothers, fathers, family or other familiar or other familiar caregiverscaregivers

Promote continuation of Promote continuation of breastfeedingbreastfeeding

Facilitate play, nurturing Facilitate play, nurturing care and social supportcare and social support

Care for caregiversCare for caregivers

Care and Protection of Children in Care and Protection of Children in Crisis-Affected Countries (CPC) Crisis-Affected Countries (CPC)

InitiativeInitiative

Committed to Committed to improving the improving the care and care and protection of protection of children affected children affected by crisis through by crisis through identifying and identifying and promoting promoting promising and promising and best practice.best practice.

CPC’s Methodological CPC’s Methodological DevelopmentDevelopment

CPC aims to: CPC aims to:

pilot new assessment pilot new assessment methodologies to identify methodologies to identify critical child care and critical child care and protection needs;protection needs;

gather an evidence-base gather an evidence-base for effective child care for effective child care and protection programs; and protection programs; andand

recommend common recommend common measures to use in the measures to use in the design, evaluation, and design, evaluation, and implementation of child-implementation of child-focused programs.focused programs.

Consensus methodologies with child Consensus methodologies with child protection expertsprotection experts

Constructing local calendars for Constructing local calendars for retrospective evaluationsretrospective evaluations

Methodology developments include…

Methodology developments include…

Narrative methodsNarrative methods

Methodology developments include…

Means of eliciting local Means of eliciting local measures of child well-beingmeasures of child well-being

Using Brief Ethnographic Using Brief Ethnographic InterviewingInterviewing

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Common Theme Common Theme Common Theme

INTERVIEWS

RESPONSES

SORTER(S) 1SORTER(S) 2

SORTER(S) 3

Care and Protection of Children(CPC) Learning Network

Goal of CPC Learning Goal of CPC Learning Network Network

Realize child care and protection in emergency settings through the collaborative action of humanitarian organizations, local institutions, and academic partners. • Develop community protection program knowledge. • Foster organizational collaboration. • Promote effective policy change.

CPC Learning NetworkCPC Learning Network

Secretariat

Global Technical Groups

Board of Advisors

Program Learning Groups (PLGs)

ECCD Global Technical ECCD Global Technical GroupGroup

Strengthen capacity development of Strengthen capacity development of stakeholders to effectively act for young stakeholders to effectively act for young childrenchildren

Inform and address the current gap in Inform and address the current gap in understanding that programming must meet the understanding that programming must meet the rights as well as address holistic and diverse rights as well as address holistic and diverse needs of young children throughout different needs of young children throughout different emergency and transition phasesemergency and transition phases

Further develop tools and publications for Further develop tools and publications for disseminationdissemination

Advocate for improved investments, policies, Advocate for improved investments, policies, and commitment to actionand commitment to action

In 3 Years, What Will Be In 3 Years, What Will Be Different As A Result of the Different As A Result of the

CPC Learning Network?CPC Learning Network? A body of evidence-based good A body of evidence-based good

practice on community-based practice on community-based approaches thereby approaches thereby professionalizing and increasing the professionalizing and increasing the accountability of the field and accountability of the field and establishing the expectation that all establishing the expectation that all programs will produce programs will produce meaningfulmeaningful and and measurablemeasurable benefitsbenefits

A cadre of Southern and Northern A cadre of Southern and Northern partners who actively work togetherpartners who actively work together

A more favorable policy A more favorable policy environment, yielding more donor environment, yielding more donor contributions allocated to initiatives contributions allocated to initiatives based on proven practicesbased on proven practices

Where Should ECCD Be 10 Where Should ECCD Be 10 Years From Now?Years From Now?

Interventions will be based Interventions will be based on promising “evidence-on promising “evidence-informed” practiceinformed” practice

ECCD will be integrated into ECCD will be integrated into the CPC Learning Network, the CPC Learning Network, with its own evidence base of with its own evidence base of promising and good practicepromising and good practice

ECCD working in ECCD working in coordination with other coordination with other humanitarian sectors (child humanitarian sectors (child protection, GBV, livelihoods, protection, GBV, livelihoods, etc.) and with other academic etc.) and with other academic research institutionsresearch institutions

How Do We Get There?How Do We Get There?

We need to link more fully with other sectors, including We need to link more fully with other sectors, including child protection, GBV, livelihoods, and with academic child protection, GBV, livelihoods, and with academic research institutesresearch institutes

We need to focus and prioritize – we cannot accomplish We need to focus and prioritize – we cannot accomplish EVERYTHING, especially in situations of conflictEVERYTHING, especially in situations of conflict

We need more studies based on robust methods using We need more studies based on robust methods using randomization and comparison groups and looking at randomization and comparison groups and looking at multiple interventionsmultiple interventions

Thank You! Thank You!

www.forcedmigration.columbia.eduwww.cpclearningnetwork.org