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No.6|NOVEMBER2024

TheE?ectsofEarlyChildhood

Development(ECD)programson

EDUCATION

WORKINGPAPER

PublicDisclosureAuthorized

thesocio-emotionalwell-beingofchildrenandcaregiversinrefugeeandforceddisplacementsettings

EstelaArmijoandTinaAsnake

Educationoperations

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WorkingPaper:TheEffectsofEarlyChildhood

Development(ECD)programsonthesocio-emotionalwell-beingofchildrenandcaregiversinrefugeeandforceddisplacementsettings

EstelaArmijoandTinaAsnake

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TableofContents

Page

Acronyms 4

Abstract 6

Acknowledgments 7

I.Introduction 8

Concept10

RiskstothePhysical,Socioemotional,Well-beingandHumanDevelopmentofForciblyDisplacedChildren 11

TheNurturingCareFrameworkinContextsofFragility,Conflict,andViolence 14

EnhancingSocioemotionalandPsychosocialWell-beingthroughECDProgramsinForcedDisplacementSettings 17

II.Methodology 21

LiteratureSearch 21

KeyInformants’Interviews 24

InterviewGuideDevelopment 24

QualitativeAnalysisfortheKeyInformantInterviews 25

III.Findings 26

FindingsfromScopeReview 27

ResultsFromInterventionalStudies 30

FindingsfromInterviews 42

ChallengesandOpportunitiesforECDinConflict,FragileandForcedDisplacementSettings 48

IV.Conclusion 55

V.Recommendations 58

RecommendationforWorldBankTaskTeamLeaders 61

References 67

Appendices 71

AppendixA.SummaryofResearchArticlesAnalyzed 71

AppendixB:Questionnaires 80

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4

Acronyms

AAHActionAgainstHunger

ASAAdvisoryServicesandAnalytics

ASFAhlanSimsimFamilies

BRACBangladeshRuralAdvancementCommittee

CARCentralAfricanRepublic

CFSChildFriendlySpace

CHV′sCommunityHealthVolunteers

CSICaregiverSupportIntervention

CSOCivilServiceOrganizations

CTPCognitiveTrainingProgram

CTSDContinuousTraumaticStressDisorder

ECDEarlyChildhoodDevelopment

ECEEarlyChildhoodEducation

ECECEarlyChildhoodEducationandCare

ELPEarlyLearningPartnership

FCVFragility,Conflict,andViolence

FRDFundacjaRozwojuDzieci’sSpynka

GEMSGeo-EnablingInitiativeforMonitoringandSupervision

HNPHealth,Nutrition,andPopulation

HPLHumanitarianPlayLab

IDPInternallyDisplacedPersons

INEEInter-AgencyNetworkonEducationforEmergencies

INSPIREInclusionSupportProgramforRefugeeEducation

IPVIntimatePartnerViolence

IRCInternationalRescueCommittee

KIIKeyInformantInterview

LMICLow-andMiddle-IncomeCountries

MHPSSMentalHealthandPsychosocialSupport

MOCEPMother-ChildEducationProgram

MSPMotherSupportProgram

NCFNurturingCareFramework

NGONon-GovernmentalOrganization

NYUNewYorkUniversity

PIPlanInternational

PTSDPost-TraumaticStressSyndromes

RCTRandomizedControlledTrials

RELPRemoteEarlylearningprogram

RFDRefugeeandForciblyDisplaced

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RUL

ReachUpandLearn

SGBV

SexualandGender-BasedViolence

SPJ

SocialProtectionandJobs

TTL

TaskTeamLeader

UN

UnitedNations

UNESCO

UnitedNationsEducational,ScientificandCulturalOrganization

UNHCR

UnitedNationsHighCommissionerforRefugees

UNICEF,

UnitedNationsChildren'sFund

WASH

WaterSanitationandHygiene

WB

WorldBank

WHO

WorldHealthOrganization

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Abstract

Earlychildhoodisacrucialperiodforskillsdevelopmentandsocio-emotionalgrowth.Forciblydisplacedchildrenexperiencesignificanttrauma,necessitatingeffectiveinterventions.ThispaperexaminestheeffectofEarlyChildhoodDevelopment(ECD)programsonthepsychosocialandsocio-emotionalwell-beingofforciblydisplacedcaregiversandchildrenbetweentheagesof0and8yearsthroughasystematicliteraturereviewandkeyinformantinterviews.Findingsindicatethecruciallinksbetweenparents’mentalwell-beingandchildren’sdevelopment.Despitechallenges,ECDinterventionsshowpromisingoutcomesandfillimportantgapstobuilddevelopmentalfoundationsandschoolreadiness.ECDinterventionsmustbewelldesigned,targetboththecaregiversandthechild,andbeculturallysensitive,child-friendly,andtrauma-informed.Therecommendationsherefocusonsustainingimpact,leveragingtechnology,securingsustainablefundingandadvocatingforsustainedinvestmentsintheearlyyearsinfragileandconflictsettings.

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Acknowledgments

ThispaperwaspreparedundertheoverallguidanceofourbelovedcoachCatalinaQuintero(Consultant,EarlyLearningPartnership,WorldBank).Wewouldliketothankthefellowshipcoordinationteam:AlisaKatharinaArifCurrimjeeandMelissaDianeKelly(EarlyLearningPartnership,WorldBank)forprovidingusefulguidanceduringvariousstagesofthestudy.

WegreatlyappreciateourpeerreviewersSantiagoDelaCadenaBecerra(HumanDevelopmentEconomist,WorldBank),MargueriteMarlow(SeniorResearcherandTechnicalResearchLead,InstituteforLifeCourseHealthResearch,DepartmentofGlobalHealth,FacultyofMedicineandHealthSciencesintheUniversityofStellenbosch,SouthAfrica),Dr.MubarekAbera(AssociateProfessoratJimmaUniversity,Ethiopia),andGabriellaBrent(DirectorofPrograms,AmnaRefugeeHealingNetwork)fortheirveryhelpfulcommentsandsuggestionsinthedifferentstages.

WealsothankalltheintervieweesthatgaveustheirvaluabletimetolearnfromtheirexperiencedeliveringECDandsocioemotionalwell-beingprogramsandtheirresearchinrefugeeandforciblydisplacedsettings.Thispaperistheresultofalltheirwork.

ThisevidencereviewhasbeenmadepossiblethroughagrantfromtheWorldBank’sEarlyYearsFellowshipProgram,whichissupportedbytheEarlyLearningPartnership(ELP)multi-donortrustfund.

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I.Introduction

Analarminglylargeandgrowingnumberofyoungchildrenareimpactedbysituationsoffragility,conflict,andviolence(FCV)andforceddisplacement.Theworld’sforciblydisplacedpopulations,includingrefugees,

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internallydisplacedpersons

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(IDPs),andasylumseekersareincreasing.

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The2024UNHCRGlobalTrendsreportrevealsthatglobalforceddisplacementreachedarecordofover120millionpeoplebytheendofApril2024.Thisincrease,comparedto117.3millionattheendof2023,representsacontinuousgrowthofdisplacedpersonsduetoconflicts,persecution,andhumanrightsviolations.In2023,forceddisplacementroseby8%,affecting1inevery69peopleworldwide.ThisphenomenonisdrivenbyconflictsinSudan,Myanmar,Haiti,andPalestine,andexacerbatedbyclimatechange.Childrenmakeup30%oftheworld’spopulationand40%ofallforciblydisplacedpeople(UNHCR2024).

Thesechildrenfaceheightenedvulnerabilitytoanxiety,post-traumaticstresssyndromes(PTSDorCTSD),depression,andtoxicstress,makingthemoneofthemostvulnerablegroupsamongdisplacedpopulations(Shonkoff,Garner,&Dobbins2012;Johnson,Riley,&Granger2013;Garner&Shonkoff2012;Buccietal.2012;Blackmoreetal.2020;UNESCO2018).

Asthispaperwilldiscuss,thereissubstantiveevidencethatdemonstratesthatimplementingearlychildhooddevelopment(ECD)programsinrefugeeandforceddisplacementcontextsiscrucialtomitigatethenegativeeffectsofdisplacementonyoungchildren’sdevelopmentandinbuildinghumancapital.Theseprogramsshieldchildrenandtheircaregiversfromtheeffectsoftoxicstressandtraumawhilealsohelpingtoimprovethesocioemotionalwellbeingofrefugeesbyprovidingsafespacesfor

1Arefugeeissomeonewhohasbeenforcedtofleehisorhercountrybecauseofpersecution,war,orviolence.Arefugeehaswell-foundedfearofpersecutionforreasonorrace,religion,nationality,politicalopinion,ormembershipinaparticularsocialgroup.Inmostcases,therefugeecannotreturnhomeorisafraidtodoso

./definitions

2Internallydisplacedpersons(IDPs):AccordingtotheUnitedNationsGuidingPrinciplesonInternalDisplacement,IDPsare“personsorgroupsofpersonswhohavebeenforcedorobligedtofleeortoleavetheirhomesorplacesofhabitualresidence,inparticularasaresultoforinordertoavoidtheeffectsofarmedconflict,situationsofgeneralizedviolence,violationsof

humanrightsornaturalorhuman-madedisasters,andwhohavenotcrossedaninternationallyrecognizedstateborder.”

/protection/legal-framework/idp-definition

3Anasylumseekerisarefugeewhoisalsoseekinginternationalprotectionfromdangersinhisorherhomecountry,butwhoseclaimforrefugeestatushasnotbeendeterminedlegally.Asylumseekersmustapplyforprotectioninthecountryofdestination—meaningtheymustarriveatorcrossabordertoapply.

/article/migrants-asylum-

seekers-refugees-and-immigrants-whats-difference

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refugeefamiliestocometogether,buildrelationships,andrebuildsocialcohesioninplaceswherewarsandconflictshavebrokentiesamongcommunities.Inthisway,humancapitalisalsobuiltandmaintainedsothatthesechildrengrowupandachievetheirfullpotential.Whenprogramsaredeliveredinamannerthatisequitableandinclusiveofall,includingbothforciblydisplacedandhostcommunities,ECDinterventionsinFCVcontextscanhaveafurtherpositiveimpactonbuildinghumancapital,establishingpeace,andpreventingconflict.

However,internationaldevelopmentaidallocatedtoECDincrisiscontextsrepresentsalimitedportionofthetotalassistancedirectedtothosecountries.In2017,85%ofthe$192billionininternationalassistancewasdedicatedtodevelopmentaid,whileonly15%wasallocatedtohumanitarianaid.However,despitetheincreaseinfundsforECDincrisis-affectedcountries,reaching$2.5billionin2017,thisamountrepresentsjust3.3%ofthetotalOfficialDevelopmentAssistancedirectedtothesecountries(MovingMindsAlliance2020).

Additionally,thedistributionofECDfundsshowsasignificantconcentrationinspecificsectors,withover90%ofthefundingallocatedtohealthandnutritioninterventions.Equallyessentialsectors,suchaspreschooleducationandwater,sanitation,andhygiene(WASH)services,receiveonly1%and2%,respectively.Evenmoreconcerningisthelackofdataonfundingforchildprotectionandresponsivecaregiving,makingitdifficulttotrackandallocateresourceseffectivelyforthesecriticalneeds(MovingMindsAlliance2020).

Therefore,thepurposeofthisstudyisnotonlytohighlighttheimportanceofintegratingsocioemotionalandpsychosocialcomponentsintoECDprogramsinFCVcontexts,butalsotoprovideevidenceoftheireffectsonthewell-beingofrefugeechildrenandcaregivers.Additionally,thispaperbroadlyproposesexamplesofhowaNurturingCareFramework(NCF)canbeadaptedtoFCVcontexts,aimingtocreatemoresupportiveenvironmentsforrefugeesandhostcommunitiesalike.Inthisway,governments,developmentactors,andWorldBankteamscantargetinterventionstovulnerablepopulations,includingthoseforciblydisplaced,thatgobeyondhumanitarianresponseinFCVsettingstobuildinghumancapital.

Thisstudyseekstoexplorethequestion:"Whatistheeffectofearlychildhooddevelopment(ECD)programsonthepsychosocialandsocio-emotionalwellbeingofforciblydisplacedcaregiversandchildrenbetweentheagesof0-8?"Throughasystematicliteraturereviewandkeyinformantinterviews,thisstudyaimstocollectevidenceaboutECDprogramsonthesocioemotionalwell-being

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offorciblydisplacedchildrenandtheircaregivers.Italsoaspirestoevaluatewhatseemstoworkinsupportingthesepopulationstobetterinformtheworkofpractitionerswhoaredesigningandimplementinginterventionsforthesepopulations.

Thispaperisdividedintofivesections:first,wedescribetherisksyoungforciblydisplacedchildrenfaceinfragileandconflict-affectedsettingsandadaptthenurturingcareframeworktothesesettingstoguideourresearch.Second,wediscussourmethodology.Inthethirdsectionwediscussthecorefindingsoftheliteraturereviewandkeyinformantinterviews.Inthefourthweprovidesomeconclusions.ThefifthandlastsectionprovidesrecommendationsforpractitionersandpolicymakersintheECD,humanitarian,andinternationaldevelopmentspheres,andspecificallyforWorldBankTTLsseekingtointegrateECDinterventionsintotheirprojects.

Concept

BeforedelvingdeeperintotheintegrationoftheseconceptsintoEarlyChildhoodDevelopment(ECD),itiscrucialtoestablishaclearunderstandingofkeyconcepts/terminologies.AccordingtotheInter-AgencyNetworkonEducationforEmergencies,mentalhealth,andpsychosocialsupport(MHPSS)isanoverarchingtermencompassingallformsofsupportaimedatpromotingmentalhealthandpsychosocialwell-being.Itencompassespromotive,preventative,andcurativemeasures.Socioemotionallearning,ontheotherhand,isdefinedasasubsetofMHPSSthatfocusesondevelopingcorecompetenciesformanagingemotions,setting,andachievinggoals,appreciatingtheperspectivesofothers,establishing,andmaintainingpositiverelationships,andmakingresponsibledecisions.Well-being,alsodefinedasaholisticconcept,encompassesphysical,emotional,social,andcognitivehealthandtheprocessofachievingit.Theseconceptsareprimarilyusedinthelearningenvironmentforchildren,buttheirsignificanceisgraduallybeingrecognizedandintegratedintootheraspectsofECD(INEE2018).

Psychosocialsupportinterventionscanbeeffectiveinpromotingsocioemotionalwell-beingandcanbeprovidedbyprofessionals,includingmentalhealthprofessionals,socialworkers,educators,andcommunityworkers.Psychosocialsupportinterventionscanbedeliveredinvarioussettings,includingschools,clinics,communitycenters,andhomes.Theseprogramssupportcaregiversaswellaschildreninwaystomanagetheiremotions,waystostrengthenrelationships,andhowtomakeresponsibledecisions.Someprograms’approachfocusesonhelpingindividualsidentifyandchangenegativethoughtpatternsandbehaviors(INEE2016).Forexample,astudyofaschool-basedpsychosocial

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supportprogramfoundthattheprogramsignificantlyimprovedstudents'emotionalregulation,self-esteem,andsocialskills(Durlaketal.2011).

RiskstothePhysical,Socioemotional,Well-beingandHumanDevelopmentofForciblyDisplacedChildren

Forciblydisplacedchildrenfaceuniquechallengesthatmarkedlydifferfromthoseexperiencedbytheirnon-refugeepeers,particularlyintheirsocioemotionalandpsychosocialdevelopment.Firstly,theirexposuretotraumaandstressismoreintenseandmultifaceted.Thesechildrenconfrontthedirectimpactofconflictandforceddisplacementandprolongedexposuretoviolenceandmultiplelevelsofadversity(SavetheChildren2019).Theseincludetraumaticexperiencessuchasbeingthreatened,physicallyinjured,sexuallyassaulted,orlosingalovedone.Theyalsoincludethelossofahome,challengingmigrationjourneys,anddifficultresettlementprocessesthatoften-lastdecades(Taylor&Kaplan2023).Suchcontinuousexposuretoprofoundloss,multiplegrief,andtraumaticsituationsleadstoadeeperandmoreentrenchedimpactonchildren’semotionalandsocialdevelopment,includingtheirmentalhealth,leadingtoincreasedlikelihoodofdiagnosesincludingpost-traumaticstressdisorder,anxiety,anddepression(Fazel2002;Lustigetal.2004).Refugeechildrenandtheircaregiversnotonlysufferthetraumaticeventsofpastconflict,butthisiscompoundedbybecomingrefugeesandbytheadversitiesandhostilitiescommunitiesmustconsequentlyendureincludingpoverty,discrimination,andhomelessness.

Inthefirstfiveyearsoflife,thebraindevelopsfasterandisasmalleableasitwilleverbe.Therefore,fortheyoungestchildren,thepsychologicalanddevelopmentalimpactsofforceddisplacementcanbedevastating.Inforceddisplacementsettings,socialservicesarecommonlydisrupted,impedingopportunitiesforchildrentoreceivestimulation,nutrition,andpsychosocialandeducationalaccessandsupport.Childhoodexposuretointenseandchronicstress,especiallyduringearlydevelopmentalstages,cancauseprolongedstress-responseactivation.Thismayresultinlastingharmtobothphysicalandmentalhealth,knownastoxicstress.

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Displacedchildrenareparticularlyvulnerabletotoxicstressduetotheseverityandpersistenceoftheirstressors,whichcannegativelyimpacttheirlearning,behavior,andhealththroughouttheirlives(Taylor&Kaplan2023).

4Toxicstressoccurswhensomeonefacesadversitythatisstrong,frequent,andprolongedovertimewithoutappropriateadultsupport.Thiscanincludeneglect,physicalorsexualabuse,emotionalabuse,exposuretoviolence,drugaddiction,orburdensassumedduetopoverty(BBC2018).

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Toxicstress,particularlyincontextsofdisplacement,hasfar-reachingeffectsonmultipleaspectsofhumandevelopment,includinghealth,education,andlong-termeconomicstability.Assets,economicopportunityandtoxicstress,astudybyShanksandRobinson(2012)establishedasafoundationalunderstandingthatexposuretoprolongedadversityduringchildhoodcansignificantlydisruptbraindevelopment.Thestudyfoundthatthisdisruptionaffectstheprefrontalcortex,whichiscrucialfordecisionmaking,emotionalregulation,andexecutivefunctions.Asaresult,childrenexposedtotoxicstressaremorelikelytostrugglewithlearningdifficulties,attentiondeficits,andbehaviorissues,whichunderminetheireducationalachievements.

Thislackofeducationalsuccessbecomesasignificantbarriertoaccessingqualityjobs,perpetuatingacycleofpoverty.Additionally,chronichealthproblemscreatedbytoxicstressandthelackofacademicskillslimittheirjoboptionsandemploymentprospects(ShanksandRobinson2012).Furthermore,theShanksandRobinsonstudyemphasizedthattheeffectsoftoxicstressandpovertyaredifficulttoreverse,highlightingtheimportanceofearlyinterventiontomitigatethesenegativeimpacts.

Arecentsystematicreviewandmeta-analysisexaminedthementalhealthof779childandadolescentrefugeesandasylumseekersfromtheMiddleEast,Africa,andSouthernAsia,whowereresidinginGermany,Malaysia,Norway,Sweden,andTürkiye.Thestudyaimedtodeterminetheprevalenceofmentalillnessamongtheseyoungrefugeesandasylumseekersacrossfivecountries.Findingsfromthestudy,asreportedbyBlackmoreetal.(2020),indicatesignificantlyhigherratesofPTSD,anxiety,anddepression(23%,16%,and14%,respectively)whencomparedtotheircounterpartsinthegeneralpopulation.

Thesementalhealthchallengesandtheimpactoftoxicstresscanresultinbehaviorsthatmanifestthisoverwhelmofexperiences.Thebehaviorsincludechallengesformingsafe,sustainedrelationships,tendenciestowardisolationandwithdrawal,orengagementinaggressiveordestructivebehaviors(CentersforDiseaseControlandPrevention2023).Furthermore,researchfromtheWorldHealthOrganizationindicatesthatdisplacedchildrenareatriskofdevelopinglearningimpairments,physicalhealthissues,andsocioemotionaldifficulties(WHO2022;Polushkin2018;Dahabetal.2020).

Familydisruptionisamorepressingrealityforrefugeeandforciblydisplaced(RFD)children.Incrisiswithlimitedresources,theneedforadditionalsupportforthedevelopmentandwell-beingofyoungchildrenisrecognized.Responsivecare,whereparentssensitivelyrespondtotheirchildren'ssignals,fosteringpositiveattachmentrelationships,iscrucial.Psychosocialstimulation,throughearlylearning

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environmentsandplayopportunities,isalsoessentialforthecognitiveandemotionaldevelopmentinthesecontexts(Ereky-Stevens,SirajandKong2022).Caregivers’mentalhealthplaysacrucialroleinbeingresponsiveandmediatingtheimpactofconflictonchildren’smentalhealth.Thelossoffamilialsupportnetworksandstructuresthroughseparationfromlovedones,community,andlandcansignificantlyimpactadults’andcaregivers’well-beingandchildren′ssocioemotionaldevelopmentopportunities.Childrendependexclusivelyonparentsorcaregiversasasourceofresilience,support,andcareandwhilebothareimpacted,thereisevidencethatyoungerchildrenaremorevulnerablethanolderchildrentodevelopingadaptiveresponsescausedbyparentalseparation(Briggs-Gowanetal.2019).

Thepervasiveimpactsofstress,grief,loss,andtraumaticeventscaninevitablyaffectcaregivers’abilitytoprovideattunedandresponsiveparenting.Thisreducesstimulationandinteractionwithchildrenandsoinfluenceschildren’sdevelopment(GlobalEducationMonitoringReportTeam2018;Palamaroetal.2012).Thedisplacementperiodalsoimposesadditionalchallengesonthedevelopingbrain,makingitsusceptibletomalnutrition,andadearthofcognitivestimulationandaffectionateinteractions(TheScienceofEarlyChildhoodDevelopment2015),lossofenvironment,ordisruptionofroutines(UNESCO2018)..

Thedisruptionofsocialstructuresandlossofimmediateenvironments,suchasthecommunity,school,andfriends(CenterontheDevelopingChild2015;Mak&Wieling2022)isespeciallyacuteforrefugeeandinternallydisplacedchildren,asdisplacementitselfisoftencausedbysuddenviolenceorconflict.Thisdisruptioncanbeevenmoresevereandprolongedcomparedtopovertywithoutdisplacement.Whilepovertycannegativelyimpactallchildren,theexperienceofforceddisplacementaddsanotherlayerofstressandtraumaforrefugeeandinternallydisplacedchildren,furthercompoundingtheirmentalhealthanddevelopment(Bean,Eurelings-Bontekoe,andSpinhoven2007;Fazeletal.2012;Fazel&Betancourt2018;Heptinstalletal.2004;Porter&Haslam2005;Reedetal.2012).

Finally,cultural,andlinguisticchallengesposeanadditionalbarrierforrefugeechildren.Theneedtointegrateintonewsocioculturalandlinguisticenvironmentsandlearnnewlanguagestobeabletocommunicatewiththeirpeers(children)andaccessservices(caregivers)canbedisorientingandisolating,affectingtheirabilitytoformnewrelationshipsandintegrateintocommunities.Thiscontrastswiththeexperienceofnon-refugeechildren,whousuallygrowupinconsistentculturaland

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linguisticenvironments,aidingtheirsocioemotionaldevelopmentandsocialintegration(Al-Janaidehetal.2023).

TheNurturingCareFrameworkinContextsofFragility,Conflict,andViolence

TheNurturingCareFramework(NCF)

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hasbecomeawidelyrespected,research-informed,andholisticunderstandingofwhatisrequiredintheoptimaldevelopmentofachildintheearlyyears,includinghealth,nutrition,securityandsafety,responsivecaregiving,andopportunitiesforearlylearning.AlthoughECDinterventionsencompassavarietyofareasincludinghealthandnutrition,thisstudypaysparticularattentiontothosedesignedwithapronouncedfocusonenhancingthesocioemotionalwell-beingofchildrenandtheircaregiversinrefugeeandforceddisplacementcontexts(seeBox1foradefinitionofsocioemotionalwell-being).

5TheNurturingCareFrameworkforEarlyChildhoodDevelopmentisaframeworkforhelpingch