Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providers’ attitudes, knowledge, confidence, and practice in humanitarian settings

Background: Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. In response, the International Rescue Committee developed a multimedia training tool to encourage competent, compassionate, and confidential clinical care for sexual assault survivors in low-resource settings. This study evaluated the effect of the training on healthcare providers’ attitudes, knowledge, confidence, and practices in four countries. Methods: Using a mixed-methods approach, we surveyed a purposive sample of 106 healthcare providers before and 3 months after training to measure attitudes, knowledge, and confidence. In-depth interviews with 40 providers elaborated on survey findings. Medical record audits were conducted in 35 health facilities before and 3 months after the intervention to measure healthcare providers’ practice. Quantitative and qualitative data underwent statistical and thematic analysis. Results: While negative attitudes, including blaming and disbelieving women who report sexual assault, did not significantly decrease among healthcare providers after training, respect for patient rights to self-determination and non-discrimination increased from 76% to 91% (p < .01) and 74% to 81% (p < .05) respectively. Healthcare providers’ knowledge and confidence in clinical care for sexual assault survivors increased from 49% to 62% (p < .001) and 58% to 73% (p < .001) respectively following training. Provider practice improved following training as demonstrated by a documented increase in eligible survivors receiving emergency contraception from 50% to 82% (p < .01), HIV post-exposure prophylaxis from 42% to 92% (p < .001), and STI prophylaxis and treatment from 45% to 96% (p < .01). Conclusions: Although beliefs about sexual assault are hard to change, training can improve healthcare providers’ respect for patient rights and knowledge and confidence in direct patient care, resulting in more competent and compassionate clinical care for sexual assault survivors

Promoting Children's Learning and Development in Conflict-Affected Countries: Testing Change Process in the Democratic Republic of the Congo (2016)

RLOsImproving children's learning and development in conflict-affected countries is critically important for breaking the intergenerational transmission of violence and poverty. Yet there is currently a stunning lack of rigorous evidence as to whether and how programs to improve learning and development in conflict-affected countries actually work to bolster children's academic learning and socioemotional development. This study tests a theory of change derived from the fields of developmental psychopathology and social ecology about how a school-based universal socioemotional learning program, the International Rescue Committee's Learning to Read in a Healing Classroom (LRHC), impacts children's learning and development. The study was implemented in three conflict-affected provinces of the Democratic Republic of the Congo and employed a cluster-randomized waitlist control design to estimate impact. Using multilevel structural equation modeling techniques, we found support for the central pathways in the LRHC theory of change. Specifically, we found that LRHC differentially impacted dimensions of the quality of the school and classroom environment at the end of the first year of the intervention, and that in turn these dimensions of quality were differentially associated with child academic and socioemotional outcomes. Future implications and directions are discussed. Please note: we do not have permission to upload this as a record but you can follow the link to the full document externally.ESRC-DFI

Improving Primary Education in the Democratic Republic of the Congo: End-Line Results of a Cluster-Randomized Wait-List Controlled Trial of Learning in a Healing Classroom

RLOsWe used a cluster-randomized, wait-list controlled trial to examine impacts of a school-based social-emotional learning intervention on Congolese students and teachers. Seventy-six school clusters in two groups (A and B) were randomized to treatment or control. The groups differed in geographic location, accessibility, exposure to violence, and external donor investment. We estimated causal impacts in Group A, tested whether those impacts were replicated in Group B, and conducted sensitivity analyses on the pooled sample. Pooled analyses had higher statistical power and were therefore more likely to represent the true average impacts of the program. Improvements in students’ perceptions of school predictability and in addition and subtraction, geometry, and reading performance were specific to Group B. Only the effect on addition and subtraction remained significant in the pooled analysis. Improvements in teachers’ sense of accomplishment were found in Group A and remained significant in the pooled analysis. We detected no impacts on other outcomes. School-based interventions embedding social-emotional learning principles into the academic curricula are a promising but not yet proven approach to improving children’s outcomes in low-income countries affected by war

Impacts After One Year of “Healing Classroom” on Children's Reading and Math Skills in DRC: Results From a Cluster Randomized Trial

RLOshis article examines the effects of one year of exposure to “Learning to Read in a Healing Classroom” (LRHC) on the reading and math skills of second- to fourth-grade children in the low-income and conflict-affected Democratic Republic of the Congo. LRHC consists of two primary components: teacher resource materials that infuse social-emotional learning principles into a reading curriculum and collaborative school-based teacher learning circles to exchange information about and solve problems in using the teacher resource materials. To test the impact of LRHC on children's reading and math skills, 40 school clusters containing 64 schools and 4,465 students were randomized to begin LRHC in 2011–2012 or to serve as wait-list controls. Hierarchical linear models (students nested in schools, nested in school clusters) were fitted. Results indicate marginally significant positive impacts on children's reading scores (dwt = .14) and geometry scores (dwt = .14) but not on their addition/subtraction scores. These results should be treated with caution given the reported significance level of p < .10. The intervention had the largest impacts on math scores for language minority children and in low-performing schools. Research, practice, and policy implications for education in low-income conflict-affected countries are discussed. Please note: we do not have permission to upload this as a record but you can follow the link to the full document externally.ESRC-DFI