Do No Harm: Challenges in Organizing Psychosocial Support to Displaced People in Emergency Settings

Psychosocial assistance in emergencies plays an important role in alleviating suffering and promoting well-being, but it is often a source of unintended harm. A prerequisite for ethically appropriate support is awareness of how psychosocial programs may cause harm. This paper underscores the importance of attending to issues of coordination, dependency, politicization of aid, assessment, short-term assistance, imposition of outsider approaches, protection, and impact evaluation. With regard to each of these issues, it suggests practical steps that may be taken to reduce harm and maximize the humanitarian value of psychosocial assistance.L’assistance psychosociale dans des situations d’urgences joue un rôle important dans le soulagement de la souffrance et la promotion du bien-être ; mais, souvent, elle est la source de préjudices non intentionnels. Une connaissance de la façon dont les programmes psychosociaux peuvent causer des préjudices est un préalable pour un support éthiquement convenable. Cet article souligne l’importance de la prise en considération des problèmes liés à la coordination, la dépendance, la politisation de l’aide, l’évaluation, l’assistance à court terme, l’imposition des approches par des personnes extérieures, la protection, et l’évaluation de l’impact. Il suggère des mesures pratiques qui peuvent être prises par rapport à chacun de ces problèmes pour réduire les préjudices et optimiser la valeur humanitaire de l’assistance psychosociale.L’assistance psychosociale dans des situations d’urgences joue un rôle important dans le soulagement de la souffrance et la promotion du bien-être ; mais, souvent, elle est la source de préjudices non intentionnels. Une connaissance de la façon dont les programmes psychosociaux peuvent causer des préjudices est un préalable pour un support éthiquement convenable. Cet article souligne l’importance de la prise en considération des problèmes liés à la coordination, la dépendance, la politisation de l’aide, l’évaluation, l’assistance à court terme, l’imposition des approches par des personnes extérieures, la protection, et l’évaluation de l’impact. Il suggère des mesures pratiques qui peuvent être prises par rapport à chacun de ces problèmes pour réduire les préjudices et optimiser la valeur humanitaire de l’assistance psychosociale

The effects of reinforcement upon the prepecking behaviors of pigeons in the autoshaping experiment.

The autoshaping procedure confounds the effects of pairing a keylight and food with the effect of adventitious food reinforcement of responses that typically occur before the pecking response. In Experiment I, acquisition of the orientation to the key, the approach toward the key, and the peck at the key were systematically monitored. Orientations to the key and approaches toward the key frequently occurred in contiguity with food presentation before peck acquisition. In Experiment II, a negative contingency procedure was used to assess the sensitivity of the approach toward the key to its consequences. When the approach toward the key resulted in nonreinforcement, the probability of occurrence of that response decreased to zero despite repeated light-food pairings. In Experiment III, peck probability was shown to be determined during the approach toward the key by the presence of stimuli that had previously been either paired or nonpaired with food. In Experiment IV, it was shown that the effects of the stimulus present during the approach toward the key were not due solely to the effects of pairing that stimulus with food. Autoshaped key pecking appears to be determined by the interacting effects of stimulus-reinforcer and response-reinforcer variables upon orientations to, approaches toward, and pecks at the lighted key

Guidance Note on Psychosocial Support: Facilitating psychosocial wellbeing and social and emotional learning

This INEE Guidance Note addresses a gap in the tools that are currently available to educators and professionals operating in emergency and crisis contexts. Although many resources specific to psychosocial programming exist, including the foundational guidance for the humanitarian sector referenced in this document, INEE members working in contexts as diverse as the Ebola crisis in West Africa, the aftermath of the Nepalese earthquake, and the ongoing Syrian crisis expressed a need for PSS guidance that was specifically oriented to the education sector. This INEE Guidance Note encourages more intentional and consistent implementation of practical, good-quality psychosocial interventions on the education frontlines by teachers, education administrators, parents, counselors, peers, ministries, and other education personnel in three concrete ways: •The Guidance Note clarifies the education sector’s importance in supporting the psychosocial wellbeing of children and youth. •The Guidance Note provides educators with practical tips and advice about how to integrate PSS into formal and non-formal education efforts. •The Guidance Note highlights linkages between PSS in education and other sectors

Building meaningful participation in reintegration among war-affected young mothers in Liberia, Sierra Leone and Northern Uganda

When young mothers, formerly associated with armed groups, return to communities, they are typically social isolated, stigmatised, and marginalised. This creates reintegration challenges for themselves, and their communities. Their children face child protection problems such as neglect, rejection and abuse. In this paper, the authors describe an innovative field practice - community based, participatory action research (PAR) - that meaningfully involved formerly associated young mothers, and other vulnerable young mothers, in their communities. The project took place in 20 field sites in three countries: Liberia, northern Uganda and Sierra Leone. It was implemented through an academic, nongovernmental organisation (NGO) partnership. The participants were 658 young mothers, both formerly associated with armed groups and other mothers seen to be vulnerable. Within the context of caring psychosocial support, these young mothers organised themselves into groups, declined their problems, and developed social actions to address and change their situations. Some project outcomes included: young mothers and their children experiencing improved social reintegration evidenced by greater family and community acceptance; more positive coping skills; and decreased participation in sex work for economic survival

Community-based reintegration of war affected young mothers: participatory action research (PAR) in Liberia, Sierra Leone and Northern Uganda

In this report, we describe a community-based participatory action research (PAR) project involving approximately 658 young mothers and over 1200 of their children living in the three war-torn countries of Liberia, Sierra Leone, and Northern Uganda. Instead of using internationally-defined notions and adult-centric statements about what reintegration is, we sought to understand reintegration from the young mothers’ perspectives, learning from them about what constitutes successful reintegration for themselves and their children. The project supported the young mothers in implementing actions that they thought would assist them in achieving their notion of successful reintegration. The project was implemented through an academic-NGO partnership that brought together a team from 10 non-governmental organizations, three African academics and four Western academics collaborating on the project over the course of nearly four years. A central goal of the project was to support the implementation of the Paris Principles by providing inputs from the field about how to do reintegration with a strong emphasis on participation in different country contexts. The project centrally involves young mothers as highly-active participants who take leadership roles in program development, implementation, monitoring and evaluation, working to reduce the powerful stigma they face through their garnering of local resources. The project works to develop organizational capacity to implement programs using highly participatory approaches. Underpinning all our work was the principle of “Do No Harm.” Operationally, the project took place in twenty field sites in the three countries. At each field site, agency partners established groups of approximately thirty young mothers who joined together to work collaboratively to identify the problems they and their children were facing and implement initiatives to try and mitigate those problems. Problems identified across the twenty sites were remarkably similar, reflecting difficulties with social stigma, access to education for the participants and their children, access to affordable medical care, and sustainable livelihoods. With local supports and social action funds, young mothers’ groups prioritized their problems and came up with ways of addressing these challenges. Creative social action initiatives included hiring a nurse to teach about hygiene and sanitation, micro-credit to support individual petty trading, opening group businesses like a restaurant or a weaving cooperative, and building a collective groundnut farm on land donated by community members. In addition to the support experienced through the group process, these actions worked to increase the well being of the young mothers and their children and to bring them into the fold of the community. The findings of this multi-year project are highlighted below, followed by recommendations to practitioners, donors, and policy makers operating in the field of reintegration and post-conflict child protection. Multi-media presentations are available on the project’s website: www.pargirlmothers.co

Participation as principle and tool in social reintegration: young mothers formerly associated with armed groups in Sierra Leone, Liberia and Northern Uganda

Experience of traumatic stressors within armed groups can negatively impact social cognitions of mastery, self-efficacy, and control. This could be compounded by postreturn conditions of stigma, little access to education, and limited means of livelihood. We explore an intervention that placed girlsâ participation as a central organizing principle. Based on study reports and ethnographic field work, we examine how young mothers transformed their identity and membership within communities of return through drama, songs and poetry, and engagement in social actions. Meaningful participation offers a culturally grounded intervention in which the impacts of traumatic stressors on individual functioning and the social relational world are directly targeted, resulting in a positive modification of developmental trajectories for young women and, ultimately, their children

Ecologies of care: mental health and psychosocial support for war-affected youth in the U.S.

Background Youth resettling to the U.S. from conflict-affected countries in the Middle East and North Africa (MENA) face countless challenges. As they cope with their experiences of armed conflict and forced migration, these girls and boys must also adjust to the language and social norms of their new society, often encountering prejudice and discrimination along the way. Previous studies indicate that schools can play a central role in facilitating this adjustment while also promoting mental health and psychosocial wellbeing. This qualitative study aims to understand the lived experiences of MENA newcomers resettled in Austin, Texas and Harrisonburg, Virginia and to assess how schools, families, and communities support their mental and psychosocial wellbeing. Methods We held six focus group discussions across the two cities with a total of 30 youths (13–23 years) from Iraq, Syria, and Sudan. We also conducted semi-structured interviews with 30 caregivers and 27 key informants, including teachers, administrators, service providers, and personnel from community-based organizations. Results Guided by Bioecological Theory, our thematic analysis identifies several means by which various actors work together to support resettled adolescents. We highlight promising efforts that seek to enhance these supports, including sheltered instruction, school-parent collaboration, peer support programming, social and emotional learning initiatives, and integrated mental health centers. Conclusion While this study underscores the resilience of newcomers and the value of local support systems, it also reflects the importance of investment in schools, mental health systems, and resettlement programs that can enable newcomers to achieve their full potential

Do Child Soldiers Influence UN Peacekeeping?

The use of child soldiers in conflicts has received increasing academic attention in recent years. This article examines post-conflict periods to see whether the use of child soldiers mobilizes United Nations peacekeeping operations (UN PKO) in the aftermath of a conflict. Taking into consideration how child soldiers affect conflict and how important their reintegration is to sustainable peace and post-conflict development, we analyse whether the presence of child soldiers in a civil war increases the likelihood of the presence of a PKO. We argue that the UN deems a conflict with child soldiers as a difficult case for conflict resolution, necessitating a response from the international community. This is in line with our empirical results confirming that the use of child soldiers significantly increases the likelihood of peacekeeping

Relevance or Excellence? Setting Research Priorities for Mental Health and Psychosocial Support in Humanitarian Settings

Background: Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus-based research agenda. Methods: From August 2009 to February 2010, we contacted policymakers, academic researchers, and humanitarian aid workers, and conducted nine semistructured focus group discussions with 114 participants in three locations (Peru, Uganda, and Nepal), in both the capitals and remote humanitarian settings. Local stakeholders representing a range of academic expertise (psychiatry, psychology, social work, child protection, and medical anthropology) and organizations (governments, universities, nongovernmental organizations, and UN agencies) were asked to identify priority questions for MHPSS research in humanitarian settings, and to discuss factors that hamper and facilitate research. Results: Thematic analyses of transcripts show that participants broadly agreed on prioritized research themes in the following order: (1) the prevalence and burden of mental health and psychosocial difficulties in humanitarian settings, (2) how MHPSS implementation can be improved, (3) evaluation of specific MHPSS interventions, (4) the determinants of mental health and psychological distress, and (5) improved research methods and processes. Rather than differences in research themes across countries, what emerged was a disconnect between different groups of stakeholders regarding research processes: the perceived lack of translation of research findings into actual policy and programs; misunderstanding of research methods by aid workers; different appreciation of the time needed to conduct research; and disputed universality of research constructs. Conclusions: To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between the goals of “relevance” and “excellence.” Research needs to be more sensitive to questions and concerns arising from humanitarian interventions, and practitioners need to take research findings into account in designing interventions. (Harv Rev Psychiatry 2012;20:25–36.

Over-Expression of DSCAM and COL6A2 Cooperatively Generates Congenital Heart Defects

A significant current challenge in human genetics is the identification of interacting genetic loci mediating complex polygenic disorders. One of the best characterized polygenic diseases is Down syndrome (DS), which results from an extra copy of part or all of chromosome 21. A short interval near the distal tip of chromosome 21 contributes to congenital heart defects (CHD), and a variety of indirect genetic evidence suggests that multiple candidate genes in this region may contribute to this phenotype. We devised a tiered genetic approach to identify interacting CHD candidate genes. We first used the well vetted Drosophila heart as an assay to identify interacting CHD candidate genes by expressing them alone and in all possible pairwise combinations and testing for effects on rhythmicity or heart failure following stress. This comprehensive analysis identified DSCAM and COL6A2 as the most strongly interacting pair of genes. We then over-expressed these two genes alone or in combination in the mouse heart. While over-expression of either gene alone did not affect viability and had little or no effect on heart physiology or morphology, co-expression of the two genes resulted in ≈50% mortality and severe physiological and morphological defects, including atrial septal defects and cardiac hypertrophy. Cooperative interactions between DSCAM and COL6A2 were also observed in the H9C2 cardiac cell line and transcriptional analysis of this interaction points to genes involved in adhesion and cardiac hypertrophy. Our success in defining a cooperative interaction between DSCAM and COL6A2 suggests that the multi-tiered genetic approach we have taken involving human mapping data, comprehensive combinatorial screening in Drosophila, and validation in vivo in mice and in mammalian cells lines should be applicable to identifying specific loci mediating a broad variety of other polygenic disorders