Preventive Interventions Help Secure Attachment in Maltreated Infants

Child maltreatment presents threats to child developmental processes, including long-term maladjustment and development of psychopathology. Cicchetti, Rogosch, and Toth’s (2006) study examines the effectiveness of two preventive interventions: psychosocial parenting education (PPI) and infant-parent psychotherapy (IPP). Based on the theory that secure attachment is derived from parental knowledge and skills, PPI involves a series of psychoeducation-focused home visits with mothers to improve parenting skills, increase mothers’ knowledge of child development, and enhance coping and social support skills. IPP is based on attachment theory and includes an exploration of the parent-child relationship through therapy. The hypothesis that PPI or IPP interventions will be most effective for ameliorating the effects of maltreatment of infants is explored in this study. The study sampled mothers and their infants in maltreating families (n=137). Subjects were randomly assigned to one of three cohorts: (1) psychosocial parenting education (PPI), (2) infant-parent psychotherapy (IPP), or (3) community standard (CS). A normative comparison (NC) group of non-maltreated infants and their mothers (n=52), with similar demographics to the intervention group, was also included. Using validity tested measures, the authors found that mothers and children in the PPI and IPP groups showed greater increases in secure attachment than mothers and children in the CS and control groups. This study supports evidence that preventive intervention programs can alter attachment organization and ameliorate the negative developmental consequences of maltreatment.

As compared to results from the CS group, the authors provide evidence that the PPI and IPP interventions result in greater increases of secure attachment in maltreating families. However, the non-maltreating control group varied greatly from the maltreating group, with maltreating mothers reporting higher rates of maltreatment in their own childhoods, more insecure relationships with their mothers, more maladaptive parenting attitudes, more parenting stress, and lower family support. Similarly, despite trying to maintain uniform adherence to the therapeutic intervention, the therapy was not completely standardized, because the intervention used different therapists. Lastly, the intervention groups were actively pursued to follow the therapy schedule, which is not commonly done in treatment modalities such as the CS group.
The authors attempt to eliminate any self-selection bias, by seeking out maltreating families rather than the families seeking to be enrolled in the study.

Reference:
Cicchetti, D., Rogosch, F.A., and Toth, S.L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623-649.

Child-Centered Spaces are Beneficial to Young Children Affected by War in Northern Uganda

A widely used approach to aid children and their families in emergencies is the implementation of child-centered spaces (CCSs), which are physical spaces providing structured activities and support for children and their caregivers in emergencies. Despite the prevalence of CCSs, there has been little systematic research to assess their impact. Kostelny and Wessell’s (2008) evaluation of safe spaces in an internally displaced persons (IDP) camp in northern Ugandan is the first of its kind. The study uses both qualitative and quantitative methods to determine if CCSs protect young children (3-6) from risks and threats in their environment, improve children’s psychosocial well-being, and increase children’s knowledge and life-skills levels. Qualitative data were collected from focus group discussions with 92 caregivers and community members. Qualitative data informed development of a tool based on locally-derived indicators of child well-being in the northern Uganda context. Using the locally derived indicators and a Western developed screening tool for emotional and behavioral difficulties, quantitative data were collected from interviews with caregivers. The study randomly selected 176 caregivers of children attending CCS program and 118 caregivers randomly selected from a nearby IDP camp where there were no CCS services available. Significant benefits for children in the CCSs occurred within the domains of protection, psychosocial well-being, and life skills. The authors conclude that if positive effects can occur in as challenging an environment as northern Uganda, then the implementation of CCSs might have similar positive effects in other difficult settings.

This study uses locally appropriate measures to bypass questions of validity inherent in Western measures’ application to non-Western settings. Furthermore, the study focuses on outcomes versus process indicators, which rarely describe the actual benefits of a program in regards to child development, protection, and well-being. Nevertheless, the authors recognize limitations to their study. First, intervention and control groups weren’t systematically matched. Secondly, because the data rely on self-reports, the study may have experienced self-preservation bias with the intervention group reporting more favorable outcomes. Lastly, the external validity of the findings should be considered with caution, since this evaluation only addresses one specific context. In order to gain support that child-centered spaces are beneficial for children in crisis settings, more research must be conducted in other contexts.

Reference:
Kostelny, K. and Wessells, M. (2008). The protection and psychosocial well-being of young children following armed conflict: outcome research on child-centered spaces in northern Uganda. The Journal of Developmental Processes, 3(2), 13-25.

The Spirit Catches You and You Fall Down

Anne Fadiman's excellent examination of the clash of two cultures - one the Hmong refugees, and the other, Western medicine - not only proves the importance of holistic child development and a family-centered approach, but also draws attention to the struggle many families in forced displacement must face. The following passage, describing how families with young children coped during their flight, is horrifying, yet still (unfortunately) within the boundaries of comprehension in the context of armed conflict.

"Many people carried children on their backs. The babies presented a potentially fatal problem: they made noise. Silence was so essential that one Hmong woman, now living in Wisconsin, recalled that her son, who was a month old when the family left their home village, didn't know a single word when they arrived in Thailand two years later, because no one had talked that entire period except in occasional whispers. Nearly every Hmong family I met in Merced had a story to tell about a baby - a relative's child, a neighbor's child, a member of the group they escaped with - who had been drugged with opium. 'When the babies would cry,' a young mother named Yia Thao Xiong told me, 'we would mix the opium in the water in a cup and give it to them so they would be quiet and the soldiers would not hear, because if they heard the babies, they would kill all of us. Usually the baby just went to sleep. But if you give too much by mistake, the baby dies. That happened many, many times.' When I heard these stories, I recalled something I had once read about an Israeli child, hiding from Palestinian terrorists, who, when she began to cry, was accidentally smothered to death by her mother. That death, in 1979, was said to have driven the entire Israeli nation into mourning. The horror of the opium overdoses was not only that such things happened to the Hmong, but that they happened so frequently that, far from driving a nation into mourning, they never made headlines, never caught the world's ear, never reached beyond a community of families that numbly accepted them as a fact of life" (p. 162).

Rethinking ECD

I had an interesting conversation with a colleague about the direction that the Early Childhood Development (ECD) community is heading, especially in light of increased emphasis on ECD in emergency settings. Because the roots of ECD are grounded in development, it is a difficult transition to examine the non-developmental aspects of ECD in emergencies. Yes, one of the most important issues affecting very young children in crisis-affected settings is the impact on their development (from stimulation, separation from caregiver, etc.) because this has such long-term implications for young children as they transition into adolescence and adulthood and even greater implications for the development of nations and future investments in populations. However, in emergencies, there should be an equal importance placed on safety and protection issues, such as addressing the fact that young children are disproportionately affected by natural disasters. It is necessary to rethink ECD through multiple lenses.

Children's Role in Illegal Toxic Waste Dumping in Southern Italy

Roberto Saviano's novel on the Camorra crime family in Naples has been turned into the film "Gamorrah". One of the more disturbing scenes (and there were plenty to choose from), addresses the Comorra's handling of waste disposal in southern Italy. The Camorra has a monopoly of toxic waste dumping, which it has held for over 30 years. Understandably, the results have been devastating for the environment and health of the general population. Heavy metals, industrial waste, chemicals, and household garbage are often mixed together and buried in non-secure sites, leading to severe soil and air pollution. Farmlands are poisoned and the rates of cancer in the area have increased dramatically. What is startlingly about these facts is that the Camorra employs children to drive the waste in for a small price. These children do not complain about the health risks, which are unknown to them. Rather, they eagerly hop into the truck cabs, place cushions on the seat so they can see over the steering wheels, and drive into the quarries filled with toxic waste. The movie notes that if all of the waste managed by the clans were accumulated, it would create a 14,600 meter high mountain with the base measuring three hectares, which would be almost double the height of Mount Everest. As of 2007, the region still has no alternative dumping areas for waste, and no alternatives have been found.

The Path of Most Resilience

I am currently coordinating the revison of a Position Paper for the Early Childhood Care and Development in Emergencies Working Group (EEWG). The following is an excerpt from the Executive Summary. The final paper will be widely available this summer.

"The Path of Most Resilience" describes an integrated, holistic approach for assisting children affected by emergencies. This Working Paper serves as a starting point, an opportunity to outline foundational principles of the field of early childhood care and development (ECCD) in emergencies.

While the progress toward standardisation of child protection and well-being principles has been remarkable, more needs to be done. Despite the plethora of guidelines and standards, no single document specifically and holistically targets parameters of assistance for young children and their caregivers, families, and communities in emergencies. Emergencies can be considered a ‘window of opportunity’ to introduce ECCD provision and concepts where none existed before. Therefore it is crucial that quality programming, adherence to good practice, and development of minimum standards are a major priority for emergency ECCD response. What is required goes beyond ensuring that humanitarian aid efforts include ECCD programming. Policy makers must rethink the way the emergency response is carried out so that the rights and needs of young children and their families are fully recognised and centred in humanitarian relief. Continued coordinated efforts must be made to make interventions effective and accountable, strengthen collective advocacy, and develop concrete policy and programmatic frameworks to prioritise ECCD as a core intervention in crisis settings.Developing this document has been a collaborative process by an inter-agency partnership of actors: a body recognised as both a Working Group of the Consultative Group on Early Childhood Care and Development (CGECCD) and as a Task Team of the Inter-Agency Network for Education in Emergencies (INEE). The Early Childhood Care and Development in Emergencies Working Group (EEWG) includes more than 100 organizations and individuals working in early childhood, emergencies, and other related fields, including INEE and the Agency Learning Network on the Care and Protection of Children in Crisis-Affected Countries (CPC Learning Network) through the Global Technical Group on Early Childhood (convened by the EEWG). The EEWG is set up to analyse and synthesise information gathered from research, case studies, successful practices, and tools from the field of ECCD and emergencies. This information will be used to:

• Develop tools and publications and disseminate this information to global actors and stakeholders in ECCD and emergencies.
• Advocate for improved investments, policies, and commitment to action related to young children in emergency situations.
• Raise awareness around the importance of including ECCD programming in emergency situations to meet the diverse needs of children in each phase of the emergency, from emergency preparedness and planning to an actual emergency, transition, and recovery.
• Inform capacity development of stakeholders in ECCD and emergencies to effectively act for children in these settings.

The EEWG is well placed to actively support capacity building, networking, and advocacy efforts to encourage greater recognition and understanding of the role of ECCD in emergencies as a central tool in saving lives and protecting young children’s development and well-being. The INEE is a global, open network of NGOs, UN agencies, donors, practitioners, researchers, and individuals from affected populations working together within a humanitarian and development framework to ensure the right to education in emergencies and post-crisis reconstruction. In coordination with the INEE Minimum Standards Task Team (www.ineesite.org/toolkit) and in response to a growing need for a consolidated practical tool reflecting recent developments in the field of ECCD, the EEWG is updating The Good Practice Guide (based on findings and principles outlined in this document) for those who work in emergency settings.

The first section of this Working Paper presents the situation and rationale: Emergencies pose invisible and visible challenges for young children in already difficult situations. In emergencies, young children are at increased risk of separation from primary caregivers, all forms of abuse and violence, long-term negative emotional and psychological effects, and physical, intellectual, emotional and social disabilities. Of most concern in emergency settings is that young children's developmental needs and well-being are often neglected, with serious consequences for their growth and survival. “ECCD Programming Principles and Guidelines” discusses how the Consultative Group on ECCD’s 4 Cornerstones to Secure a Strong Foundation for Young Children might be interpreted and adapted for work in emergency settings. Other ECCD programming principles that guide the CG’s work are presented. Coordinated action among a range of sectors – Water, Sanitation, and Hygiene; Health; Nutrition; Education; and Protection – is vital to effectively care for young children in emergencies. The third section of this Working Paper emphasises the cross-cutting nature of ECCD programming and indicates potential areas for integrating ECCD activities into emergency humanitarian interventions. Cross-cutting issues of gender, disabilities, and HIV/AIDS are considered in section 4. The document concludes with "A Call to Action" outlining challenges and opportunities as the ECCD in Emergencies agenda is moved forward, as well as a specific action plan on future activities.

US Immigrant Children in Limbo

Today, the New York Time continues it's series on the illegal immigrant experience with a piece entitled "After Losing Freedom, Some Immigrants Face Loss of Custody of Their Children". The focus is on the children of detained immigrants, who face the consequences of their parents' incarceration. In crackdowns against illegal immigration, these children are unwillingly thrust into the court system, separated from their parents and effectively in limbo while the courts decide their fate. Oftentimes, their is a heated custody battle, as the courts deem the child or children will be better cared for through fostering or adoption. Christopher Huck, a Washington state immigration lawyer, says, "The struggle in these cases is there's no winner."

The implications for this are powerful. In societies where placement of the child in a stranger's home is seen as anathema to accepted cultural practices, this separation from caregiver, family, and community can be devastating.