Jul. 15 2010

The earthquake in Haiti was another in a litany of crises that has revealed the risks to children of neglect, exploitation, and abuse in situations of disaster or conflict. By studying the judgments of leading experts across the world, researchers at Columbia University’s Mailman School of Public Health have explicitly documented the principles and practices that underpin humanitarian efforts to address these risks in successive crises.

Alastair-Ager.jpgAlastair Ager, PhD

Engaging with senior practitioners with the leading humanitarian agencies, the study for the first time distills the core knowledge that is used in designing programs to assist children at risk in these situations. Comparing this knowledge to current scientific evidence provides both a “scorecard” for the field of humanitarian work with children, as well as a model for bringing  current child development research to this field.

The study published in the July/August 2010 issue of Child Development, provides suggestions of best practices in the field from experts working in senior roles with such international agencies as UNICEF and Save the Children, and responding to humanitarian crises.

‘We consolidated suggestions into a list of approximately 200 statements that were further reviewed and rated by many experts utilizing the ‘Delphi’ process, a means  of review and distillation,” said Alastair Ager, PhD, of the Mailman School’s Program on Forced Migration and Health, and first author. “Repeating this process of review and distillation three times resulted in just over 50 statements that received high levels of endorsement by all participants. This represents the core “knowledge base” that is used in the design of programs in such situations as Haiti.

“Agencies now place major emphasis upon the local resources that can be mobilized to support the recovery of children and their families,” noted Dr. Ager, who also serves as the executive director of the Mailman School’s Global Health Initiative. “Ensuring active participation of whole communities – rather than passive receipt of services by a targeted minority of ‘vulnerable children’– is another major concern.”

Some important insights from the scientific study of child development are shaping agency practice. The paper points out that the social ecology, or complex network of social relationships --through family, school, and community -- that is disrupted in crisis is appropriately seen as a key to guiding sustained response, for instance. “Agencies are seeking to base their approach on a quite sophisticated understanding of the multiple influences that shape a child’s life and how these can compensate for each other in times of crisis,” suggests Dr. Ager. “Agencies are also appropriately putting more emphasis on sources of resilience and strengthening the ones that focus on identifying ‘vulnerable children’.”

However, this is an area where greater use of recent developmental research could be made. “Agencies are rightly focused on the concept of resilience, but scientific studies have indicated that there may be quite different processes involved in stabilizing the circumstances of a child – helping them ‘hang in there’ in the first phase of a crisis – and then enabling them to recover and even thrive in the aftermath of the crisis. Programs could become more sophisticated – and effective – by recognizing such differences.”

The study also provides a basis to critique the current focus of child development research. “Although the study enables us to call humanitarian agencies to account with respect to scientific evidence, it also allows us to call the research community to account for its relevance to this key area of work with children. There is valuable research being conducted, but too little is focused in diverse cultural settings.”

Marie de la Soudiere, who has worked with the International Rescue Committee and UNICEF in the field of humanitarian assistance to children in many crisis settings since her initial work 30 years ago with children displaced across the Thai-Kampuchea border, was one of the expert participants in the study.  Recently returned from Haiti, she notes, “Practice has advanced significantly in the field over the last three decades, and it is helpful to see current consensus set out so clearly.” However, de la Soudiere strongly endorses the message of the paper regarding humanitarian agencies and academics needing to work more closely together. “We owe it to children facing such difficult circumstances to develop a much stronger evidence-base for work. That means agencies being open to the effectiveness of their programs being rigorously evaluated…and researchers showing humility and commitment to work in unstable and demanding situations.”

“We need to support children's resilience by restoring the cultural, social and educational institutions that normally support children within the local culture,” said Dr. Ager.

About the Mailman School of Public Health

The only accredited school of public health in New York City and among the first in the nation, Columbia University’s Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting millions of people locally and globally.

The Mailman School is the recipient of some of the largest government and private grants in Columbia University’s history. Its more than 1000 graduate students pursue master’s and doctoral degrees, and the School’s 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as infectious and chronic diseases, health promotion and disease prevention, environmental health, maternal and child health, health over the life course, health policy, and public health preparedness