The Research Program on Children and Global Adversity is guided by a “risk and resilience” framework that focuses on core threats to the security of children. In considering intervention models, this approach first seeks to leverage naturally existing protective processes, then to supplement them with evidence based services. The program works from a social ecological perspective, which differs from individualized approaches in that it considers the socially-mediated impacts of adversity on children and families, and actively works to identify supports at the family, peer and community level. The program works from a child rights perspective that regards health, security, and opportunities for development as the birthright of every child, regardless of nationality, location, or socioeconomic status. The RPCGA’s research agenda is grounded in an integrated view of “health” as encompassing primary care, early childhood development, nutrition, mental health, and prevention services. The program targets children under the age of 18 as well as youth under the age of 25.

The program focuses on implementation science as it relates to the following core areas of a child’s basic security and developmental needs:

• Safety and protection from harm
• Physical and mental health
• Family and connection to others
• Education, livelihoods and opportunities to be productive

The team is presently engaged in two in-depth research studies, one on mental health care for children in Rwanda affected by HIV/AIDS, and the other exploring psychosocial adjustment and social reintegration among former child soldiers in Sierra Leone. A study of Somali Bantu refugee children and families in the Boston area is currently in development.

In 2007 the RPCGA team completed a qualitative study in Rwinkwavu, Rwanda in collaboration with Partners In Health. This research was funded by the Peter C. Alderman Foundation, the Harvard Research Enabling Grants Program and the HSPH Career Incubator Fund. The goal of this research was to identify common mental health problems that face HIV/AIDS-affected children using local terms and concepts. A follow-up qualitative study was conducted in January/February 2009 to identify naturally occurring processes in families and communities that can foster resilience in children facing adversity. Information gathered from the qualitative data is being used to create/adapt measures of local mental health syndromes and protective processes for use in southeastern Rwanda. Over the summer of 2010 the research team is conducting two concurrent streams of work in Rwanda: a validity study of the adapted measures of locally-relevant mental health problems and protective processes, and a collaborative process to adapt an evidence-based preventive mental health intervention called the Family-Strengthening Intervention for Rwandan Families (FSI-R). This intervention is based on Family Talk, an intervention developed by Dr. William Beardslee to prevent depression in the offspring of depressed caregivers. Dr. Beardslee, Chair Emeritus at Children’s Hospital Boston and an expert in prevention science, is a co-investigator on the project. In addition to cultural adaptation, the intervention is being adapted to address multiple adversities such as the after-effects of the genocide and HIV/AIDS on parenting and family functioning. In subsequent phases of this research, the team plans a pilot study to test the feasibility and acceptability of the adapted mental health intervention in this setting. A randomized controlled trial of the FSI-R is also planned for the future, as well as adaptations to address other forms of family adversity in Rwanda. Eventually the research team, PIH and Rwandan government partners aim to prepare a version of the FSI-R which can be successfully delivered by trained and supervised community health workers.

In 2002, Dr. Betancourt began a longitudinal study of psychosocial adjustment and community acceptance among former child soldiers and other war-affected youth in Sierra Leone. The study was designed to examine the risk and protective factors that shape social reintegration and psychosocial adjustment over time with equal attention to both war related experiences and post conflict factors. Dr. Betancourt and her team returned in 2003/2004 to collect follow-up data on the same cohort of youth, and completed a third wave of data collection in 2008/2009. This research has led to several publications about how war-related and post-conflict experiences affect the longer term mental health and psychosocial adjustment of former child soldiers. The study is the first longitudinal study of its kind to involve male and female former child soldiers and other war-affected youth in Sub-Saharan Africa. Among the issues examined in this study are the challenges and successes that these youth experience in securing a livelihood, caring for families, completing school, avoiding high-risk behavior, and contributing to civil society. The goals of the research are to identify naturally existing supports and protective processes that can be targeted in the design of psychosocial interventions, and to highlight priority issues for policy makers and program developers. This research contributes to one of the major goals of the RPCGA by developing an evidence base to help drive policy reform that supports improved protections and services for children facing adversity. To this end, Dr. Betancourt presented findings from the first two waves of data to the United Nations Special Representative of the Secretary-General for Children and Armed Conflict in July 2008. In October 2009, the FXB Center collaborated with Sierra Leonean government ministries as well as UN and NGO partners to coordinate a symposium on evidence-based approaches to addressing youth issues in Sierra Leone. Aimed at linking research and practice, the symposium provided a platform for dialogue among more than 100 stakeholders representing a broad range of government offices, NGOs, UN agencies, youth groups, student organizations, and universities. The event highlighted critical issues confronting children and youth, promising intervention approaches, and agenda-setting for future research and action. Building on this work, the RPCGA is also exploring the potential to conduct a pilot intervention study with war-affected youth in Sierra Leone that will integrate mental health and psychosocial services along with other components such as accelerated learning and livelihoods activities.

The intent of this project is to understand perceptions of relevant mental health problems and service needs among Somali Bantu refugees in the greater Boston area, where numerous Somali Bantu refugee families have resettled since 2004. This work will be conducted in collaboration with Children’s Hospital Boston/Center for Refugee Trauma (CHB/CRT) in association with the National Child Traumatic Stress Network (NCTSN) and several local mutual assistance organizations. Data collection is planned for 2010 and will involve qualitative interviews with Somali refugees, including Somali Bantu youth, families, and community members. The RPCGA team will work in partnership with members of the Somali Bantu community, and with community organizations serving this population. A local research team of Somali Bantu refugees will be recruited and trained to work closely with our team in conducting research interviews and data collection. Ultimately, this research will inform the development of family-based preventive interventions in collaboration among Somali mutual assistance organizations and Children’s Hospital Boston and its Center on Refugee Trauma and Resilience.

This research project considers new ways of thinking about child protection and security through an integrated framework called SAFE, which represents four domains: Safety and protection; Access to care; Family and community connectedness; and Education and livelihoods. The intended goal of this project is to develop a broader series of SAFE-informed tools that can be readily adapted and applied to consider child protection and security within a wide range of contexts. This project includes field work in Rwanda, India, and post-earthquake Haiti. One outcome of this research effort is to develop a methodology for creating “children’s security impact statements” (CSIS) to help promote the development of improved systems of care and protection for children and families. The CSIS methodology will be applied to different contexts of development and globalization ranging from construction zones in urban centers to post-disaster reconstruction and development efforts.