Research Program on Children and Global Adversity

Recent history has witnessed unprecedented improvements in child health and well being, with two exceptions: regions affected by armed conflict and those affected by HIV/AIDS (see note below). In response, the François-Xavier Bagnoud Center for Health and Human Rights has established a Research Program on Children and Global Adversity (RPCGA), focused on the implementation of protections and care for children and families facing these two situations of adversity.

The RPCGA, launched in 2007, is directed by Dr. Theresa Betancourt, ScD , MA , Assistant Professor of Child Health and Human Rights in the Department of Population and International Health at the Harvard School of Public Health. The RPCGA is devoted to applied research in global child health and human rights that grapples directly with the implementation gap. The goals of the RPCGA are to advance an evidence base regarding strategies and methods for closing the global implementation gap in child health and increasing protections and effective services for children in adversity.

Guiding Principles

The RPCGA is guided by a risk and resilience framework focused on core threats to children’s security. In considering intervention models, this approach looks first to leveraging naturally existing protective processes and supplementing them with evidence based services. We work from a social ecological perspective, which, in contrast to individualized approaches, takes into account the socially mediated impacts of adversity on children and families and seeks to identify supports at the family, peer and community level. Our work is based on a child rights perspective that considers health, security and opportunities for development to be the birthright of every child, regardless of nationality, location, and socioeconomic status.

The RPCGA takes a comprehensive view of “health” – encompassing primary care, early childhood development, nutrition, mental health and prevention services. The program’s target age group is children under the age of 18 and youth under the age of 25.

Areas of Focus

The RPCGA focuses on Implementation Science related to the following core areas of children’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

Current Activities

Research Initiatives:Applied Research on Child Health in Adversity

The RPCGA is developing an active field research presence in a number of sites. Activities include field-based applied research with Government and NGO partners targeting the implementation gap in child health and protection services.

Ongoing Research Includes:

• Improving Psychosocial Care for HIV/AIDS-affected youth in Rwanda: The RPCGA team recently completed a qualitative study in Rwinkwavu , Rwanda in collaboration with Partners In Health. This research was funded by the Peter C. Alderman Foundation and the Harvard Research Enabling Grants Program. The overall goal of the study was to identify common mental health problems facing HIV/AIDS-affected children, using local terms and concepts. The next phases of this research, currently in preparation, are a prevalence study of mental health problems among HIV/AIDS-affected children in this area and the development and evaluation of a mental health intervention for children in this setting.

• A Longitudinal Study of Psychosocial Adjustment and Social Reintegration Among Former Child Soldiers in Sierra Leone: Dr. Betancourt began working on a longitudinal study of former child soldiers in Sierra Leone in 2002, in collaboration with the International Rescue Committee. Follow up data was collected in 2003/2004. A third wave of data collection, planned for the spring of 2008, will examine the risk and protective factors that shape social reintegration and psychosocial adjustment in these youth. A number of issues relevant to young adulthood will also be examined such as the success these young people have had with securing a livelihood, caring for families, completing school, avoiding high risk sexual behavior and contributing to civil society. This research will also explore sources of insecurity that have plagued the Mano River region, such as the re-recruitment of former child soldiers into militia movements.

The study aims to identify issues of priority to policy makers and program developers that can be the target of improved policies and services in this setting. Beyond Sierra Leone , the general patterns and lessons learned from this research have the potential to improve services for former child soldiers in many other regions where children are involved with fighting forces. The RPCGA is also exploring the potential for conducting a pilot intervention study with war-affected youth in Sierra Leone .

Future Activities

As the RPCGA grows, the following activities will be incorporated into the program:

Educational and Training Activities on Children and Adversity

• HSPH Masters Concentration in Global Child Health and Human Rights
• Field Based Operational Research Practicum for Students (Multidisciplinary)
• Leadership Training in Global Child Health Implementation

Dissemination and Policy Reform

• Dissemination of evidence-based practices in aspects of global child health via published reports and other forms of communication
• Provision of toolkits highlighting operational research methodologies and case studies to field agencies
• Consultation to governments and field-based operational agencies regarding implementation of child health and mental health services
• National and global leadership resulting in improved implementation of services for children and families facing adversity in low-resource settings

1. UNICEF. In a child survival milestone, under-five deaths fall below 10 million per year. New York : UNICEF; 13 September 2007.

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