Child friendly spaces impact across five humanitarian settings: a meta-analysis

Abstract

Background Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces (CFS), one such commonly implemented intervention after humanitarian emergencies. Methods We completed baseline and endline (three-six months post-baseline) assessments regarding protection concerns, psychosocial wellbeing, developmental assets and community resources for a total of 1010 children and 1312 carers in catchment areas for interventions with humanitarian populations in Ethiopia, Uganda, Iraq, Jordan, and Nepal. We estimated intervention effect-sizes with Cohen’s d for difference in mean difference scores between attenders and non-attenders – who proved comparable on baseline measures – by site. We then pooled findings for a meta-analysis summarizing overall impacts across domains. Results Amongst children aged 6–11, significant intervention impacts were observed through site-level analysis for protection concerns (Ethiopia, Cohen’s d = 0.48, 95% CI 0.08–0.88), psychosocial wellbeing (Ethiopia, d = 0.51, 95% CI 0.10–0.91; and Uganda, d = 0.21, 95% CI 0.02–0.40), and developmental assets (Uganda, d = 0.37, 95% CI 0.15–0.59; and Iraq, d = 0.86, 95% CI 0.18–1.54). Pooled analyses for this age group found impacts of intervention to be significant only for psychosocial wellbeing ( d = 0.18, 95% CI 0.03–0.33). Among children aged 12–17, site-level analysis indicated intervention impact for protection concerns in one site (Iraq, d = 0.58, 95% CI 0.07–1.09), with pooled analysis indicating no significant impacts. Conclusion CFS can provide – albeit inconsistently - a protective and promotive environment for younger children. CFS show no impact with older children and in connecting children and carers with wider community resources. A major reappraisal of programming approaches and quality assurance mechanisms is required. Electronic supplementary material The online version of this article (10.1186/s12889-019-6939-2) contains supplementary material, which is available to authorized users.

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

“…Findings showed variation in benefits across sites and outcomes. Analyses support earlier findings [ 28 ] of small to moderate impacts on psychosocial wellbeing indicators after participation in CFS [ 29 ]. However, with improved well-being amongst comparison populations over time, these intervention benefits were generally not evident at 1-year follow-up.…”

“…De Jong, Ager and coworkers conducted an evaluation of psychological first aid as applied in the Ebola crisis in Liberia and Sierra Leone [ 27 ]. Savage and colleagues evaluated child friendly spaces across crises in Jordan, Nepal and Uganda [ 28 , 29 ], and are now conducting a trial of an enhanced CFS-design in Uganda.…”

Measuring the psychosocial, biological, and cognitive signatures of profound stress in humanitarian settings: impacts, challenges, and strategies in the field

“…The field of mental health and psychosocial support (MHPSS) is poised to consolidate robust evidence on what works in humanitarian settings; specifically, it must assess why program impacts (often measured using self, parent, or teacher reports) are mostly small, variable, or nil, especially over the long-term [17]. Psychosocial interventions for children and adolescents are one of the most frequently implemented, yet poorly evaluated, interventions in crisis settings [1,18,19]. This proves frustrating for humanitarians looking for credible, actionable evidence in MHPSS programming.…”

Psychosocial Support and Emergency Education: An Explorative Study of Perceptions among Adult Stakeholders in Sudan and South Sudan

“…The representatives from the NGOs said that they did not have the staff to take care of traumatized children, and they pointed to a need for capacity building. Although they had started up child-friendly spaces [37,38], these should be supplied with treatment/care facilities to which the children could be referred. The following quote from an NGO representative demonstrates this: "Youths who come directly from war-affected areas need some kind of assistance.…”

“…This was illustrated by the findings on introducing child-friendly places, where human resources were a challenge. CFSs were presented as a psychosocial initiative, although other studies have found limited evidence for the effects of CFSs [37,38].…”