Implementing psychosocial support models in contexts of extreme adversity: lessons from a process evaluation in Colombia

Abstract

IntroductionHigh quality investments during early childhood allow children to achieve their full potential by setting developmental foundations. However, challenges in the scale-up of evidence-based interventions make across-the-board implementation a non-trivial matter. Moreover, extreme contextual conditions -such as community violence, forced displacement, and poverty- impose a double threat. First, by directly affecting early childhood development (ECD), forced displacement and exposure to violence during early childhood, coupled with deficits in nurturing relationships, can trigger toxic stress, affecting children’s mental health and social and emotional learning. Second, contexts of extreme adversity exacerbate common implementation pitfalls in the scale-up of interventions. Recognizing and documenting “what it takes” to successfully implement “what works” can contribute to the expansion and effectiveness of evidence-based programs that promote ECD in these settings. Semillas de Apego (SA, onward), a community-based psychosocial support model for caregivers, materialized as a strategy to promote ECD in communities affected by violence and forced displacement.MethodsThis article presents the results of the process evaluation of SA during the 2018–2019 implementation in Tumaco, a violence ridden municipality in the south-west border of Colombia, South America. In this phase, the program reached 714 families, 82% direct victims of violence and 57% were internally displaced. The process evaluation combined qualitative and quantitative methodological approaches to produce evidence of factors that promoted implementation quality.ResultsFindings identified salient components of the program that promoted the program’s acceptability, adoption, appropriateness, fidelity and sustainability: a rigorous cultural adaptation; well-structured team selection and training methodologies; and a team support and supervision protocol to provide continuous capacity building and prevent burn-out and other occupational hazards common among professionals in mental health and psychosocial support interventions. The statistical analysis using monitoring data identified key predictors of the dosage delivered (a measure of fidelity). Evidence suggests that initial attendance to the program and observable characteristics -such as educational attainment, violence victimization and employment status-predict a successful compliance (in terms of dosage to benefit from the program).DiscussionThis study provides evidence for the development of structural, organizational, and procedural processes for the adoption, appropriate adaptation, and high-fidelity delivery of psychosocial support models delivered in territories affected by extreme adversity.

Task Sharing and Remote Delivery of Brief Interpersonal Counseling for Venezuelan Migrants and Refugees Living in Peru during the COVID-19 Pandemic: A Mixed-Methods Pilot Study

“…Several clients and providers recognized that the ability to identify with each other strengthened the trust and rapport, thus facilitating engagement and participation. The benefits of training community members as providers and delivering MHPSS in community-based settings have also been observed in other MHPSS studies conducted among refugees and migrants and displaced populations in Latin America [55][56][57]. Community-based MHPSS interventions delivered through task sharing have been tested in multiple refugee settings and has been recommended as a strategy to bridge gaps in the availability, appropriateness, and accessibility of MHPSS in these communities [19].…”

Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America

“…Few studies have also included host community members as lay providers (Cohen and Yaeger, 2021 ). Many of these studies have identified that the peer- and group-based nature of mental health and psychosocial interventions is a valuable aspect of the intervention format for study participants (Dickson and Bangpan, 2018 ; Cohen and Yaeger, 2021 ; Harker Roa et al, 2023 ). Prior research has also reinforced the centrality of community stakeholder engagement to the successful implementation of mental health and psychosocial support in low-income and humanitarian contexts (Dickson and Bangpan, 2018 ; Greene et al, 2021 ; Harker Roa et al, 2023 ).…”

“…For example, a process evaluation of Semillas de Apego, a psychosocial program for caregivers in Colombia, similarly found that the group format formed and strengthened social support networks. Participants also described that mindful breathing and other relaxation techniques were useful skills to manage stress and promote well-being (Harker Roa et al, 2023 ).…”