Predictors of Literacy and Attitudes Toward Reading Among Syrian Refugee Children in Jordan

Does volunteering impact refugee women's life satisfaction, empowerment, and wellbeing? Experimental evidence, local knowledge, and causal reasoning

BACKGROUND

There are gaps in the evidence base addressing whether volunteering programs enhance the wellbeing, empowerment, and life satisfaction of individual volunteers. Program impacts are seldom rigorously evaluated, whilst construct meanings remain largely unspecified, especially in the Middle East. This study tested the impacts of We Love Reading, a program training volunteers to read aloud in their local communities. It also mapped local knowledge representation.

METHODS

We conducted a mixed-method program evaluation based on a randomized cluster trial with 105 Syrian refugee women from poor households in Amman, Jordan. At three time points (baseline, 5-month and 12-month-follow-up), we implemented a survey to measure levels of life satisfaction (Cantril), psychological empowerment (PE), and psychological wellbeing (PWB). We used regression models on panel data to estimate individual-level impacts, adjusting for women's characteristics and the moderating effects of their social networks. We also conducted net-mapping sessions to clarify local concepts and their causal connections, generating thematic analyses and fuzzy cognitive maps (FCMs) to represent local knowledge and causal influences.

RESULTS

Life satisfaction was the only outcome variable showing a significant impact for We Love Reading (Cantril, β = 3.00, p = 0.002). Thematic analyses and FCMs made explicit the multi-dimensional aspects of lived experiences: emphasis was placed on reaching goals, having "the full right to act," the freedom to take decisions, willingness and determination. Women explained that building their empowerment and agency was a main driver of life satisfaction, and that volunteering boosted the resolve of "not giving up" on life goals.

CONCLUSION

This program evaluation integrates scientifically-rigorous and culturally-relevant methodologies to identify impacts, local knowledge systems, and causal pathways of influence. This helps clarify how and why volunteering works in real-life situations across cultural contexts, calling attention to what programs seek to achieve, how they avoid volunteer burden, and why they generate social change.

Maternal Trauma and Psychopathology Symptoms Affect Refugee Children's Mental Health But Not Their Emotion Processing

Refugee children's development may be affected by their parents' war-related trauma exposure and psychopathology symptoms across a range of cognitive and affective domains, but the processes involved in this transmission are poorly understood. Here, we investigated the impact of refugee mothers' trauma exposure and mental health on their children's mental health and attention biases to emotional expressions. In our sample of 324 Syrian refugee mother-child dyads living in Jordan (children's Mage=6.32, SD = 1.18; 50% female), mothers reported on their symptoms of anxiety and depression, and on their children's internalising, externalising, and attention problems. A subset of mothers reported their trauma exposure (n = 133) and PTSD symptoms (n = 124). We examined emotion processing in the dyads using a standard dot-probe task measuring their attention allocation to facial expressions of anger and sadness. Maternal trauma and PTSD symptoms were linked to child internalising and attention problems, while maternal anxiety and depression symptoms were associated with child internalising, externalising, and attention problems. Mothers and children were hypervigilant towards expressions of anger, but surprisingly, mother and child biases were not correlated with each other. The attentional biases to emotional faces were also not linked to psychopathology risk in the dyads. Our findings highlight the importance of refugee mothers' trauma exposure and psychopathology on their children's wellbeing. The results also suggest a dissociation between the mechanisms underlying mental health and those involved in attention to emotional faces, and that intergenerational transmission of mental health problems might involve mechanisms other than attentional processes relating to emotional expressions.

Feasibility and acceptability of phone-delivered psychological therapy for refugee children and adolescents in a humanitarian setting

BACKGROUND

Refugee children are at high risk of mental health problems but face barriers to accessing mental health services, a problem exacerbated by a shortage of mental health professionals. Having trained lay counsellors deliver therapy via telephone could overcome these barriers. This is the first study to explore feasibility and acceptability of telephone-delivered therapy with refugee children in a humanitarian setting.

METHODS

An evidence-based intervention, Common Elements Treatment Approach, was adapted for telephone-delivery (t-CETA) and delivered by lay counsellors to Syrian refugee children in informal tented settlements in the Beqaa region of Lebanon. Following delivery of t-CETA, semi-structured interviews were conducted with counsellors (N = 3) and with children who received t-CETA (N = 11, 45% female, age 8-17 years) and their caregivers (N = 11, 100% female, age 29-56 years) (N = 25 interviews). Thematic content analysis was conducted separately for interviews with counsellors and interviews with families and results were synthesized.

RESULTS

Three themes emerged from interviews with counsellors and four themes from interviews with families, with substantial overlap between them. Synthesized themes were: counselling over the phone both solves and creates practical and logistical challenges; t-CETA is adapted to potential cultural blocks; the relationship between the counsellor and the child and caregiver is extremely important; the family's attitude to mental health influences their understanding of and engagement with counselling; and t-CETA works and is needed. Counselling over the phone overcame logistical barriers, such as poor transportation, and cultural barriers, such as stigma associated with attending mental health services. It provided a more flexible and accessible service and resulted in reductions in symptoms for many children. Challenges included access to phones and poor network coverage, finding an appropriate space, and communication challenges over the phone.

CONCLUSIONS

Despite some challenges, telephone-delivered therapy for children shows promising evidence of feasibility and acceptability in a humanitarian context and has the potential to increase access to mental health services by hard-to-reach populations. Approaches to addressing challenges of telephone-delivered therapy are discussed. Trial Registration ClinicalTrials.gov ID: NCT03887312; registered 22nd March 2019.

Pathways to resilience and pathways to flourishing: Examining the added-value of multisystem research and intervention in contexts of war and forced displacement

This paper examines the added-value that multisystem approaches bring to research and intervention in contexts of war and forced displacement. I highlight what is useful and truly innovative about systems-level work, aware that providing data-related evidence is only part of the story when connecting research to policy and practice. I discuss four types of added-value: these are conceptual, instrumental, capacity-building, and connectivity impacts that, respectively, aim to change current knowledge, improve implementation, build research skills, and strengthen network connectivity. Specifically, systems-based research can help transform the key frames of humanitarian work, fostering the more integrated and distributive models of professional assistance known as resilience and network humanitarianism. I argue that systems-level approaches on resilience and flourishing in war-affected and refugee populations help to articulate new mindsets, methodologies, partnerships, and ways of working relevant for humanitarian research, policy and practice. I focus attention on interdisciplinary, interventionist, prospective, transgenerational, and network-building initiatives. My specific examples cover the family context of mental health and trauma memory in Afghanistan, as well as program evaluation with Syrian refugees in Jordan, connecting stress biology to human experience, and social networks to psychological empowerment. The paper suggests future directions to support more effective and impactful systems-level work in protracted humanitarian crises.