Abstract
Over half a million children between 0 to 5 years of age have been affected by armed conflict and forced displacement in Colombia, while many others have been forced to migrate with their families from Venezuela. While conflict and displacement can bring about devastating effects for young children, healthy ad secure emotional attachments between children and caregivers can help regulate the socioemotional responses to stress and adversities and lay the foundations for proper early childhood development.
In this trial, we will evaluate the impact of integrating Sesame Workshop’s Watch, Play, Learn (WPL) socioemotional content within the Semillas de Apego program (SA). The program is a community and group-based psychosocial intervention focused on restoring mental health and promoting healthy child-parent attachments of caregivers of young children in conflict-affected settings. Between 2018 and 2020, the impact evaluation of SA was implemented in Tumaco, Colombia with a sample of around 1,400 primary caregivers of children ages 2-5. The results of the impact evaluation demonstrate that the program had sizeable and statistically significant effects on caregiver mental health, the style and quality of the child-caregiver relationship, and on child mental health and development.
This new trial evaluates the integration of the WPL socioemotional contents within the SA program to strengthen socio-emotional learning and regulation among the children of the caregivers participating in the SA group sessions. Specifically, the SA and WPL enhanced model integrates 23 socioemotional videos and 3 visual aids from WPL into the SA curriculum. While the SA standard approach targets children indirectly by supporting their caregivers, the enhanced model aims to reach children directly through the delivery of these contents and to strengthen caregivers’ capacities to connect with their children through 1) improved understanding of children’s social-emotional development; 2) specific age-appropriate contents that enable caregivers to engage with their children’s in social-emotional learning ; 3) increased avenues for socioemotional co-regulation (this is, the improved socioemotional regulation of children will have positive effects on their caregivers, which will then create positive feedbacks on children themselves).
In this study, we will analyze whether the enhanced model brings about additional impacts on caregivers’ mental health, caregiver-child relationships, and children’s developmental outcomes. Since we are limited by the study’s sample and underpowered, this trial should be considered as a feasibility study with the hope of a future well-powered impact evaluation. In parallel, we will conduct a process evaluation based on the principles of implementation science to understand the processes and factors that enable or hinder the appropriate integration of the two programs.
The standard and enhanced SA models were implemented in Tumaco and Jamundí, two municipalities in Colombia heavily affected by violence and poverty during the first cohort of 2023 (April – July). Over a time span of 7 months, we will follow the implementation of the enhanced program with 20 groups of on average 16 participants each, all of them mothers or primary caregivers of children 3 to 5, thereby reaching a total of 320 participants and their children.
The impact evaluation is based on a randomized control trial in which we will assign eligible subjects to two experimental arms: the standard program, which serves as the control, and the enhanced model, which in this case will be the treatment group. We randomly assigned the implementation groups (n=19) to the treatment (n=9) and control arms (n=10). In this case, each implementation group corresponds to a different neighborhood, meaning that random assignment was conducted at the neighborhood level.
Participants in both experimental groups participated in 15 group-led sessions over the period of 3 months. Participants in the treatment (enhanced model) group will also have access to WPL videos starting from the 7th session when the program changes focus from the caregiver to the child and their relationship.
We will assess whether the enhanced program brings about differentiated positive and sequential impacts on the following dimensions, relative to the standard program: (i) primary caregiver’s mental health, (ii) child-parent relationship, (iii) quality of the child-parent emotional bond, (iv) children’s mental health, and (v) children’s cognitive and socioemotional development. For this purpose, data will be collected by an independent firm at baseline and two post-intervention assessments: immediately after the intervention and 4 months after the implementation has concluded to understand the short-run impacts of the enhanced model and whether these impacts persist over time.