Studying the Effects of Global Adversity, Two Generations at a Time
By Millicent Lawton
When humanitarian crises hit around the world, nongovernmental organizations rush into the fray, intensively focused on urgent survival needs, not necessarily on longer-term impacts that may take an even greater toll on the country and its citizens. Theresa Betancourt, a Center-affiliated faculty member who studies children in adversity and has worked alongside NGOs, wants to help them see that farther horizon: Combining short-term survival efforts with attention to children’s developmental needs only magnifies the long-range benefits for individuals and societies.
“We know from the science...that these investments in early childhood and in healthy life trajectories for young people in adversity have a social and an economic impact,” says Betancourt, an associate professor of child health and human rights in the department of global health and population at the Harvard School of Public Health, and director of the Research Program on Children and Global Adversity at the François-Xavier Bagnoud Center for Health and Human Rights. “So, just keeping children alive isn’t sufficient, given the leveragable opportunities that exist to invest in their social capital and to maximize that next generation of young people.”
Betancourt, who is currently studying both former child soldiers in Sierra Leone and children whose parents have HIV/AIDS in Rwanda, says that one reason NGOs may not have incorporated the latest thinking into what they are doing is that there just haven’t been enough studies done on global child mental health. “I can’t change that NGOs work on very tight timelines and are underfunded,” says Betancourt. “But what I can change is having research that’s more oriented towards addressing some of the key questions that they need to understand and then being good at being in those circles, so that we can translate that evidence base strategically.”
Regions rife with armed conflict and areas affected by HIV/AIDS represent the two major exceptions worldwide to recent gains in children’s health and development, notes Betancourt, which helps explain why the two research projects in sub-Saharan Africa have drawn her interest. For both projects, Betancourt says, the Center on the Developing Child contributed seed funding that enabled her to secure or fill gaps in larger federal grants.
Returned Child Soldiers: The Intergenerational Impact
Betancourt has actually been researching former child soldiers in Sierra Leone for a decade. In 2002, the long civil war in Sierra Leone was ending, and girls and boys who had been abducted into armed groups—and socialized for lethal warfare—were being released. Betancourt and her colleagues began following these children (who were 10-to-17 years old at the time) and their reintegration into their families and home communities. By tracking the children since then, she says, “We’ve been able to talk about what influences more risky or more resilient trajectories of development.”
Ten years later, those children are young adults. Recently, Betancourt’s project won a five-year grant from the National Institutes of Health (NIH) to again locate this cohort of war-affected youth—many of them former child soldiers—for follow-up and to assess their relationships with their intimate partners and the health and development of their offspring—essentially pulling back the curtain on those experiences for the first time. “We have no information on that whatsoever, in terms of understanding the intergenerational transmission of emotional-behavioral disruptions due to war in sub-Saharan Africa. All of our research on these intergenerational topics has come from Western populations such as studies of the Holocaust,” she notes. “So, we’re positioned now to do something unique in this particular context.”
Betancourt says that she does not think the early childhood dimension of this latest phase of the Sierra Leone work would have occurred had she not been an affiliate of the Center. Her clinical training and prior work had focused on adolescents and young adults. “I don’t think I would’ve had the confidence,” to do it, she says, without knowing that she could “network in a community that’s more versed in those elements of early childhood assessment.”
If she can better understand the issues related to parent-child interactions and mental health underlying such adversities, Betancourt says, she can help develop better interventions to address them. In Sierra Leone, for example, “We’ll be able to understand the longer-term adult functioning of people who’ve been through a range of toxic stress exposures—and the impact on their intimate partners—and understand the dynamics of parenting and child-rearing where interventions might be helpful.” Such findings, she says, may have application as well to war refugees in the United States and even for members of the U.S. military.
Strengthening Families in the Face of HIV
Designing an intervention is at the heart of Betancourt's work in Rwanda. For instance, despite having good access to antiretroviral therapy, many HIV-infected parents in Rwanda see their diagnosis as a death sentence rather than thinking of their condition as a chronic illness, like diabetes, that they could live with and still be great parents. Likewise, their children can harbor lingering fears and misunderstandings about HIV infection—in some cases, afraid to touch their parents or eat from the same cooking pot. “Those worries and concerns fester,” Betancourt says, “so a few years in, you may see conduct problems, depression, kids dropping out of school, parent–child relationships that are really strained.”
With a seed grant from the Center, Betancourt was able to collaborate with another Center-affiliated faculty member, William Beardslee, to adapt his family-based preventive intervention, Family Talk, for use in Rwanda. Beardslee is the Gardner/Monks Professor of Child Psychiatry at Harvard Medical School. Noting that one of the greatest risk factors for children developing depression is having a parent who had depression, Beardslee’s model was designed to improve family communication and parenting to prevent depression in the offspring of depressed caregivers. The original intended treatment group offered striking parallels to families living with an HIV-infected parent, Betancourt says: “You’ve got a parent living with chronic illness, where there’s misunderstanding and miscommunication about it and that parent needs support to still feel empowered and to be able to care for their children.”
The Rwanda project, too, has received a three-year grant from the NIH and is now working with 80 families. The earlier 20-family pilot has brought about “extremely powerful” transformations, Betancourt says, prompting outside interest in doing family-based interventions with groups experiencing other forms of adversity, such as extreme poverty or communal violence. “There are very few prevention-oriented interventions in global mental health for children,” Betancourt notes. “And doing that work earlier in a preventive model is going to be so much more cost-effective than waiting for [children] to get severely depressed and suicidal, or drop out of school. Then, you’re trying to undo those very severe sorts of consequences.”
Photo by Fred Field