【世界银行】儿童早期发展（ECD）项目对难民和被迫流离失所环境中儿童和看护人的社会情感福祉的影响

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No.6|NOVEMBER2024

TheEffectsofEarlyChildhood

Development(ECD)programson

EDUCATION

WORKINGPAPER

PublicDisclosureAuthorized

thesocio-emotionalwell-beingofchildrenandcaregiversinrefugeeandforceddisplacementsettings

EstelaArmijoandTinaAsnake

Educationoperations

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WorkingPaper:TheEffectsofEarlyChildhood

Development(ECD)programsonthesocio-emotionalwell-beingofchildrenandcaregiversinrefugeeandforceddisplacementsettings

EstelaArmijoandTinaAsnake

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TableofContents

Page

Acronyms 4

Abstract 6

Acknowledgments 7

I.Introduction 8

Concept10

RiskstothePhysical,Socioemotional,Well-beingandHumanDevelopmentofForciblyDisplacedChildren 11

TheNurturingCareFrameworkinContextsofFragility,Conflict,andViolence 14

EnhancingSocioemotionalandPsychosocialWell-beingthroughECDProgramsinForcedDisplacementSettings 17

II.Methodology 21

LiteratureSearch 21

KeyInformants’Interviews 24

InterviewGuideDevelopment 24

QualitativeAnalysisfortheKeyInformantInterviews 25

III.Findings 26

FindingsfromScopeReview 27

ResultsFromInterventionalStudies 30

FindingsfromInterviews 42

ChallengesandOpportunitiesforECDinConflict,FragileandForcedDisplacementSettings 48

IV.Conclusion 55

V.Recommendations 58

RecommendationforWorldBankTaskTeamLeaders 61

References 67

Appendices 71

AppendixA.SummaryofResearchArticlesAnalyzed 71

AppendixB:Questionnaires 80

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4

Acronyms

AAHActionAgainstHunger

ASAAdvisoryServicesandAnalytics

ASFAhlanSimsimFamilies

BRACBangladeshRuralAdvancementCommittee

CARCentralAfricanRepublic

CFSChildFriendlySpace

CHV´sCommunityHealthVolunteers

CSICaregiverSupportIntervention

CSOCivilServiceOrganizations

CTPCognitiveTrainingProgram

CTSDContinuousTraumaticStressDisorder

ECDEarlyChildhoodDevelopment

ECEEarlyChildhoodEducation

ECECEarlyChildhoodEducationandCare

ELPEarlyLearningPartnership

FCVFragility,Conflict,andViolence

FRDFundacjaRozwojuDzieci’sSpynka

GEMSGeo-EnablingInitiativeforMonitoringandSupervision

HNPHealth,Nutrition,andPopulation

HPLHumanitarianPlayLab

IDPInternallyDisplacedPersons

INEEInter-AgencyNetworkonEducationforEmergencies

INSPIREInclusionSupportProgramforRefugeeEducation

IPVIntimatePartnerViolence

IRCInternationalRescueCommittee

KIIKeyInformantInterview

LMICLow-andMiddle-IncomeCountries

MHPSSMentalHealthandPsychosocialSupport

MOCEPMother-ChildEducationProgram

MSPMotherSupportProgram

NCFNurturingCareFramework

NGONon-GovernmentalOrganization

NYUNewYorkUniversity

PIPlanInternational

PTSDPost-TraumaticStressSyndromes

RCTRandomizedControlledTrials

RELPRemoteEarlylearningprogram

RFDRefugeeandForciblyDisplaced

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RUL

ReachUpandLearn

SGBV

SexualandGender-BasedViolence

SPJ

SocialProtectionandJobs

TTL

TaskTeamLeader

UN

UnitedNations

UNESCO

UnitedNationsEducational,ScientificandCulturalOrganization

UNHCR

UnitedNationsHighCommissionerforRefugees

UNICEF,

UnitedNationsChildren'sFund

WASH

WaterSanitationandHygiene

WB

WorldBank

WHO

WorldHealthOrganization

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Abstract

Earlychildhoodisacrucialperiodforskillsdevelopmentandsocio-emotionalgrowth.Forciblydisplacedchildrenexperiencesignificanttrauma,necessitatingeffectiveinterventions.ThispaperexaminestheeffectofEarlyChildhoodDevelopment(ECD)programsonthepsychosocialandsocio-emotionalwell-beingofforciblydisplacedcaregiversandchildrenbetweentheagesof0and8yearsthroughasystematicliteraturereviewandkeyinformantinterviews.Findingsindicatethecruciallinksbetweenparents’mentalwell-beingandchildren’sdevelopment.Despitechallenges,ECDinterventionsshowpromisingoutcomesandfillimportantgapstobuilddevelopmentalfoundationsandschoolreadiness.ECDinterventionsmustbewelldesigned,targetboththecaregiversandthechild,andbeculturallysensitive,child-friendly,andtrauma-informed.Therecommendationsherefocusonsustainingimpact,leveragingtechnology,securingsustainablefundingandadvocatingforsustainedinvestmentsintheearlyyearsinfragileandconflictsettings.

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Acknowledgments

ThispaperwaspreparedundertheoverallguidanceofourbelovedcoachCatalinaQuintero(Consultant,EarlyLearningPartnership,WorldBank).Wewouldliketothankthefellowshipcoordinationteam:AlisaKatharinaArifCurrimjeeandMelissaDianeKelly(EarlyLearningPartnership,WorldBank)forprovidingusefulguidanceduringvariousstagesofthestudy.

WegreatlyappreciateourpeerreviewersSantiagoDelaCadenaBecerra(HumanDevelopmentEconomist,WorldBank),MargueriteMarlow(SeniorResearcherandTechnicalResearchLead,InstituteforLifeCourseHealthResearch,DepartmentofGlobalHealth,FacultyofMedicineandHealthSciencesintheUniversityofStellenbosch,SouthAfrica),Dr.MubarekAbera(AssociateProfessoratJimmaUniversity,Ethiopia),andGabriellaBrent(DirectorofPrograms,AmnaRefugeeHealingNetwork)fortheirveryhelpfulcommentsandsuggestionsinthedifferentstages.

WealsothankalltheintervieweesthatgaveustheirvaluabletimetolearnfromtheirexperiencedeliveringECDandsocioemotionalwell-beingprogramsandtheirresearchinrefugeeandforciblydisplacedsettings.Thispaperistheresultofalltheirwork.

ThisevidencereviewhasbeenmadepossiblethroughagrantfromtheWorldBank’sEarlyYearsFellowshipProgram,whichissupportedbytheEarlyLearningPartnership(ELP)multi-donortrustfund.

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I.Introduction

Analarminglylargeandgrowingnumberofyoungchildrenareimpactedbysituationsoffragility,conflict,andviolence(FCV)andforceddisplacement.Theworld’sforciblydisplacedpopulations,includingrefugees,

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internallydisplacedpersons

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(IDPs),andasylumseekersareincreasing.

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The2024UNHCRGlobalTrendsreportrevealsthatglobalforceddisplacementreachedarecordofover120millionpeoplebytheendofApril2024.Thisincrease,comparedto117.3millionattheendof2023,representsacontinuousgrowthofdisplacedpersonsduetoconflicts,persecution,andhumanrightsviolations.In2023,forceddisplacementroseby8%,affecting1inevery69peopleworldwide.ThisphenomenonisdrivenbyconflictsinSudan,Myanmar,Haiti,andPalestine,andexacerbatedbyclimatechange.Childrenmakeup30%oftheworld’spopulationand40%ofallforciblydisplacedpeople(UNHCR2024).

Thesechildrenfaceheightenedvulnerabilitytoanxiety,post-traumaticstresssyndromes(PTSDorCTSD),depression,andtoxicstress,makingthemoneofthemostvulnerablegroupsamongdisplacedpopulations(Shonkoff,Garner,&Dobbins2012;Johnson,Riley,&Granger2013;Garner&Shonkoff2012;Buccietal.2012;Blackmoreetal.2020;UNESCO2018).

Asthispaperwilldiscuss,thereissubstantiveevidencethatdemonstratesthatimplementingearlychildhooddevelopment(ECD)programsinrefugeeandforceddisplacementcontextsiscrucialtomitigatethenegativeeffectsofdisplacementonyoungchildren’sdevelopmentandinbuildinghumancapital.Theseprogramsshieldchildrenandtheircaregiversfromtheeffectsoftoxicstressandtraumawhilealsohelpingtoimprovethesocioemotionalwellbeingofrefugeesbyprovidingsafespacesfor

1Arefugeeissomeonewhohasbeenforcedtofleehisorhercountrybecauseofpersecution,war,orviolence.Arefugeehaswell-foundedfearofpersecutionforreasonorrace,religion,nationality,politicalopinion,ormembershipinaparticularsocialgroup.Inmostcases,therefugeecannotreturnhomeorisafraidtodoso

./definitions

2Internallydisplacedpersons(IDPs):AccordingtotheUnitedNationsGuidingPrinciplesonInternalDisplacement,IDPsare“personsorgroupsofpersonswhohavebeenforcedorobligedtofleeortoleavetheirhomesorplacesofhabitualresidence,inparticularasaresultoforinordertoavoidtheeffectsofarmedconflict,situationsofgeneralizedviolence,violationsof

humanrightsornaturalorhuman-madedisasters,andwhohavenotcrossedaninternationallyrecognizedstateborder.”

/protection/legal-framework/idp-definition

3Anasylumseekerisarefugeewhoisalsoseekinginternationalprotectionfromdangersinhisorherhomecountry,butwhoseclaimforrefugeestatushasnotbeendeterminedlegally.Asylumseekersmustapplyforprotectioninthecountryofdestination—meaningtheymustarriveatorcrossabordertoapply.

/article/migrants-asylum-

seekers-refugees-and-immigrants-whats-difference

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refugeefamiliestocometogether,buildrelationships,andrebuildsocialcohesioninplaceswherewarsandconflictshavebrokentiesamongcommunities.Inthisway,humancapitalisalsobuiltandmaintainedsothatthesechildrengrowupandachievetheirfullpotential.Whenprogramsaredeliveredinamannerthatisequitableandinclusiveofall,includingbothforciblydisplacedandhostcommunities,ECDinterventionsinFCVcontextscanhaveafurtherpositiveimpactonbuildinghumancapital,establishingpeace,andpreventingconflict.

However,internationaldevelopmentaidallocatedtoECDincrisiscontextsrepresentsalimitedportionofthetotalassistancedirectedtothosecountries.In2017,85%ofthe$192billionininternationalassistancewasdedicatedtodevelopmentaid,whileonly15%wasallocatedtohumanitarianaid.However,despitetheincreaseinfundsforECDincrisis-affectedcountries,reaching$2.5billionin2017,thisamountrepresentsjust3.3%ofthetotalOfficialDevelopmentAssistancedirectedtothesecountries(MovingMindsAlliance2020).

Additionally,thedistributionofECDfundsshowsasignificantconcentrationinspecificsectors,withover90%ofthefundingallocatedtohealthandnutritioninterventions.Equallyessentialsectors,suchaspreschooleducationandwater,sanitation,andhygiene(WASH)services,receiveonly1%and2%,respectively.Evenmoreconcerningisthelackofdataonfundingforchildprotectionandresponsivecaregiving,makingitdifficulttotrackandallocateresourceseffectivelyforthesecriticalneeds(MovingMindsAlliance2020).

Therefore,thepurposeofthisstudyisnotonlytohighlighttheimportanceofintegratingsocioemotionalandpsychosocialcomponentsintoECDprogramsinFCVcontexts,butalsotoprovideevidenceoftheireffectsonthewell-beingofrefugeechildrenandcaregivers.Additionally,thispaperbroadlyproposesexamplesofhowaNurturingCareFramework(NCF)canbeadaptedtoFCVcontexts,aimingtocreatemoresupportiveenvironmentsforrefugeesandhostcommunitiesalike.Inthisway,governments,developmentactors,andWorldBankteamscantargetinterventionstovulnerablepopulations,includingthoseforciblydisplaced,thatgobeyondhumanitarianresponseinFCVsettingstobuildinghumancapital.

Thisstudyseekstoexplorethequestion:"Whatistheeffectofearlychildhooddevelopment(ECD)programsonthepsychosocialandsocio-emotionalwellbeingofforciblydisplacedcaregiversandchildrenbetweentheagesof0-8?"Throughasystematicliteraturereviewandkeyinformantinterviews,thisstudyaimstocollectevidenceaboutECDprogramsonthesocioemotionalwell-being

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offorciblydisplacedchildrenandtheircaregivers.Italsoaspirestoevaluatewhatseemstoworkinsupportingthesepopulationstobetterinformtheworkofpractitionerswhoaredesigningandimplementinginterventionsforthesepopulations.

Thispaperisdividedintofivesections:first,wedescribetherisksyoungforciblydisplacedchildrenfaceinfragileandconflict-affectedsettingsandadaptthenurturingcareframeworktothesesettingstoguideourresearch.Second,wediscussourmethodology.Inthethirdsectionwediscussthecorefindingsoftheliteraturereviewandkeyinformantinterviews.Inthefourthweprovidesomeconclusions.ThefifthandlastsectionprovidesrecommendationsforpractitionersandpolicymakersintheECD,humanitarian,andinternationaldevelopmentspheres,andspecificallyforWorldBankTTLsseekingtointegrateECDinterventionsintotheirprojects.

Concept

BeforedelvingdeeperintotheintegrationoftheseconceptsintoEarlyChildhoodDevelopment(ECD),itiscrucialtoestablishaclearunderstandingofkeyconcepts/terminologies.AccordingtotheInter-AgencyNetworkonEducationforEmergencies,mentalhealth,andpsychosocialsupport(MHPSS)isanoverarchingtermencompassingallformsofsupportaimedatpromotingmentalhealthandpsychosocialwell-being.Itencompassespromotive,preventative,andcurativemeasures.Socioemotionallearning,ontheotherhand,isdefinedasasubsetofMHPSSthatfocusesondevelopingcorecompetenciesformanagingemotions,setting,andachievinggoals,appreciatingtheperspectivesofothers,establishing,andmaintainingpositiverelationships,andmakingresponsibledecisions.Well-being,alsodefinedasaholisticconcept,encompassesphysical,emotional,social,andcognitivehealthandtheprocessofachievingit.Theseconceptsareprimarilyusedinthelearningenvironmentforchildren,buttheirsignificanceisgraduallybeingrecognizedandintegratedintootheraspectsofECD(INEE2018).

Psychosocialsupportinterventionscanbeeffectiveinpromotingsocioemotionalwell-beingandcanbeprovidedbyprofessionals,includingmentalhealthprofessionals,socialworkers,educators,andcommunityworkers.Psychosocialsupportinterventionscanbedeliveredinvarioussettings,includingschools,clinics,communitycenters,andhomes.Theseprogramssupportcaregiversaswellaschildreninwaystomanagetheiremotions,waystostrengthenrelationships,andhowtomakeresponsibledecisions.Someprograms’approachfocusesonhelpingindividualsidentifyandchangenegativethoughtpatternsandbehaviors(INEE2016).Forexample,astudyofaschool-basedpsychosocial

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supportprogramfoundthattheprogramsignificantlyimprovedstudents'emotionalregulation,self-esteem,andsocialskills(Durlaketal.2011).

RiskstothePhysical,Socioemotional,Well-beingandHumanDevelopmentofForciblyDisplacedChildren

Forciblydisplacedchildrenfaceuniquechallengesthatmarkedlydifferfromthoseexperiencedbytheirnon-refugeepeers,particularlyintheirsocioemotionalandpsychosocialdevelopment.Firstly,theirexposuretotraumaandstressismoreintenseandmultifaceted.Thesechildrenconfrontthedirectimpactofconflictandforceddisplacementandprolongedexposuretoviolenceandmultiplelevelsofadversity(SavetheChildren2019).Theseincludetraumaticexperiencessuchasbeingthreatened,physicallyinjured,sexuallyassaulted,orlosingalovedone.Theyalsoincludethelossofahome,challengingmigrationjourneys,anddifficultresettlementprocessesthatoften-lastdecades(Taylor&Kaplan2023).Suchcontinuousexposuretoprofoundloss,multiplegrief,andtraumaticsituationsleadstoadeeperandmoreentrenchedimpactonchildren’semotionalandsocialdevelopment,includingtheirmentalhealth,leadingtoincreasedlikelihoodofdiagnosesincludingpost-traumaticstressdisorder,anxiety,anddepression(Fazel2002;Lustigetal.2004).Refugeechildrenandtheircaregiversnotonlysufferthetraumaticeventsofpastconflict,butthisiscompoundedbybecomingrefugeesandbytheadversitiesandhostilitiescommunitiesmustconsequentlyendureincludingpoverty,discrimination,andhomelessness.

Inthefirstfiveyearsoflife,thebraindevelopsfasterandisasmalleableasitwilleverbe.Therefore,fortheyoungestchildren,thepsychologicalanddevelopmentalimpactsofforceddisplacementcanbedevastating.Inforceddisplacementsettings,socialservicesarecommonlydisrupted,impedingopportunitiesforchildrentoreceivestimulation,nutrition,andpsychosocialandeducationalaccessandsupport.Childhoodexposuretointenseandchronicstress,especiallyduringearlydevelopmentalstages,cancauseprolongedstress-responseactivation.Thismayresultinlastingharmtobothphysicalandmentalhealth,knownastoxicstress.

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Displacedchildrenareparticularlyvulnerabletotoxicstressduetotheseverityandpersistenceoftheirstressors,whichcannegativelyimpacttheirlearning,behavior,andhealththroughouttheirlives(Taylor&Kaplan2023).

4Toxicstressoccurswhensomeonefacesadversitythatisstrong,frequent,andprolongedovertimewithoutappropriateadultsupport.Thiscanincludeneglect,physicalorsexualabuse,emotionalabuse,exposuretoviolence,drugaddiction,orburdensassumedduetopoverty(BBC2018).

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Toxicstress,particularlyincontextsofdisplacement,hasfar-reachingeffectsonmultipleaspectsofhumandevelopment,includinghealth,education,andlong-termeconomicstability.Assets,economicopportunityandtoxicstress,astudybyShanksandRobinson(2012)establishedasafoundationalunderstandingthatexposuretoprolongedadversityduringchildhoodcansignificantlydisruptbraindevelopment.Thestudyfoundthatthisdisruptionaffectstheprefrontalcortex,whichiscrucialfordecisionmaking,emotionalregulation,andexecutivefunctions.Asaresult,childrenexposedtotoxicstressaremorelikelytostrugglewithlearningdifficulties,attentiondeficits,andbehaviorissues,whichunderminetheireducationalachievements.

Thislackofeducationalsuccessbecomesasignificantbarriertoaccessingqualityjobs,perpetuatingacycleofpoverty.Additionally,chronichealthproblemscreatedbytoxicstressandthelackofacademicskillslimittheirjoboptionsandemploymentprospects(ShanksandRobinson2012).Furthermore,theShanksandRobinsonstudyemphasizedthattheeffectsoftoxicstressandpovertyaredifficulttoreverse,highlightingtheimportanceofearlyinterventiontomitigatethesenegativeimpacts.

Arecentsystematicreviewandmeta-analysisexaminedthementalhealthof779childandadolescentrefugeesandasylumseekersfromtheMiddleEast,Africa,andSouthernAsia,whowereresidinginGermany,Malaysia,Norway,Sweden,andTürkiye.Thestudyaimedtodeterminetheprevalenceofmentalillnessamongtheseyoungrefugeesandasylumseekersacrossfivecountries.Findingsfromthestudy,asreportedbyBlackmoreetal.(2020),indicatesignificantlyhigherratesofPTSD,anxiety,anddepression(23%,16%,and14%,respectively)whencomparedtotheircounterpartsinthegeneralpopulation.

Thesementalhealthchallengesandtheimpactoftoxicstresscanresultinbehaviorsthatmanifestthisoverwhelmofexperiences.Thebehaviorsincludechallengesformingsafe,sustainedrelationships,tendenciestowardisolationandwithdrawal,orengagementinaggressiveordestructivebehaviors(CentersforDiseaseControlandPrevention2023).Furthermore,researchfromtheWorldHealthOrganizationindicatesthatdisplacedchildrenareatriskofdevelopinglearningimpairments,physicalhealthissues,andsocioemotionaldifficulties(WHO2022;Polushkin2018;Dahabetal.2020).

Familydisruptionisamorepressingrealityforrefugeeandforciblydisplaced(RFD)children.Incrisiswithlimitedresources,theneedforadditionalsupportforthedevelopmentandwell-beingofyoungchildrenisrecognized.Responsivecare,whereparentssensitivelyrespondtotheirchildren'ssignals,fosteringpositiveattachmentrelationships,iscrucial.Psychosocialstimulation,throughearlylearning

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environmentsandplayopportunities,isalsoessentialforthecognitiveandemotionaldevelopmentinthesecontexts(Ereky-Stevens,SirajandKong2022).Caregivers’mentalhealthplaysacrucialroleinbeingresponsiveandmediatingtheimpactofconflictonchildren’smentalhealth.Thelossoffamilialsupportnetworksandstructuresthroughseparationfromlovedones,community,andlandcansignificantlyimpactadults’andcaregivers’well-beingandchildren´ssocioemotionaldevelopmentopportunities.Childrendependexclusivelyonparentsorcaregiversasasourceofresilience,support,andcareandwhilebothareimpacted,thereisevidencethatyoungerchildrenaremorevulnerablethanolderchildrentodevelopingadaptiveresponsescausedbyparentalseparation(Briggs-Gowanetal.2019).

Thepervasiveimpactsofstress,grief,loss,andtraumaticeventscaninevitablyaffectcaregivers’abilitytoprovideattunedandresponsiveparenting.Thisreducesstimulationandinteractionwithchildrenandsoinfluenceschildren’sdevelopment(GlobalEducationMonitoringReportTeam2018;Palamaroetal.2012).Thedisplacementperiodalsoimposesadditionalchallengesonthedevelopingbrain,makingitsusceptibletomalnutrition,andadearthofcognitivestimulationandaffectionateinteractions(TheScienceofEarlyChildhoodDevelopment2015),lossofenvironment,ordisruptionofroutines(UNESCO2018)..

Thedisruptionofsocialstructuresandlossofimmediateenvironments,suchasthecommunity,school,andfriends(CenterontheDevelopingChild2015;Mak&Wieling2022)isespeciallyacuteforrefugeeandinternallydisplacedchildren,asdisplacementitselfisoftencausedbysuddenviolenceorconflict.Thisdisruptioncanbeevenmoresevereandprolongedcomparedtopovertywithoutdisplacement.Whilepovertycannegativelyimpactallchildren,theexperienceofforceddisplacementaddsanotherlayerofstressandtraumaforrefugeeandinternallydisplacedchildren,furthercompoundingtheirmentalhealthanddevelopment(Bean,Eurelings-Bontekoe,andSpinhoven2007;Fazeletal.2012;Fazel&Betancourt2018;Heptinstalletal.2004;Porter&Haslam2005;Reedetal.2012).

Finally,cultural,andlinguisticchallengesposeanadditionalbarrierforrefugeechildren.Theneedtointegrateintonewsocioculturalandlinguisticenvironmentsandlearnnewlanguagestobeabletocommunicatewiththeirpeers(children)andaccessservices(caregivers)canbedisorientingandisolating,affectingtheirabilitytoformnewrelationshipsandintegrateintocommunities.Thiscontrastswiththeexperienceofnon-refugeechildren,whousuallygrowupinconsistentculturaland

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linguisticenvironments,aidingtheirsocioemotionaldevelopmentandsocialintegration(Al-Janaidehetal.2023).

TheNurturingCareFrameworkinContextsofFragility,Conflict,andViolence

TheNurturingCareFramework(NCF)

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hasbecomeawidelyrespected,research-informed,andholisticunderstandingofwhatisrequiredintheoptimaldevelopmentofachildintheearlyyears,includinghealth,nutrition,securityandsafety,responsivecaregiving,andopportunitiesforearlylearning.AlthoughECDinterventionsencompassavarietyofareasincludinghealthandnutrition,thisstudypaysparticularattentiontothosedesignedwithapronouncedfocusonenhancingthesocioemotionalwell-beingofchildrenandtheircaregiversinrefugeeandforceddisplacementcontexts(seeBox1foradefinitionofsocioemotionalwell-being).

5TheNurturingCareFrameworkforEarlyChildhoodDevelopmentisaframeworkforhelpingch