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

• In Event: A Deeper Dive: Examining implementation of early childhood interventions across three countries

Abstract

High quality investments during this critical period -from birth to age 5- 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, forceful displacement and poverty- impose a double threat. First, by directly affecting early childhood development: forced displacement and exposure to violence during early childhood, coupled with deficits in nurturing relationships, can trigger toxic stress, affect 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 early childhood development (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. This 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. In this phase, the program reached more than 700 families, 82% direct victims of violence and 57% were internally displaced. The process evaluation combined qualitative and quantitative methodological approaches. Qualitative data was levied through in-depth interviews with caregivers who were invited to participate in the program, the program’s implementation team, and the team that designed the curriculum and trained and provided support to the implementation team. This primary data collection aimed at identifying enabling mechanisms and barriers relevant for future scale-up phases and by focusing on standard measures of implementation quality, such as fidelity, acceptability, adoption, appropriateness, feasibility, penetration and sustainability. In addition, quantitative data collected through the program’s digital monitoring system was used to perform a statistical survival analysis to describe and understand the mechanisms behind the observed variation in the level of adherence, take-up and “dosage” received by participants. In addition to the general acceptability and satisfaction of the participants, results from the qualitative analysis suggest several salient components of the program that promoted its adoption, appropriateness and feasibility: a rigorous cultural adaptation, well-structured team selection and training methodologies, and a team support and supervision system to provide continuous capacity building and prevent burn-out (among other work-related risks). Also, cultural and logistic constraints around the adoption and use of the monitoring system, highlight both the challenge and necessity in the deployment of high-frequency data collection systems that play a key role quality control and improvement cycles. The statistical analysis using monitoring databases and data from a baseline socioeconomic characterization survey identified the following person- and household-level predictors of adherence and final dosage: attendance to at least two of the three first sessions, caregiver’s age, gender, formal employment status and program cohort. This study provides evidence for the construction the important structural, organizational, and procedural processes for the adoption, appropriate adaptation and high-fidelity delivery of SA in territories affected by extreme community violence.

Authors

• Arturo Harker Roa, Universidad de los Andes (Uniandes)
  Presenting Author

• Andres Moya, Universidad de los Andes School of Economics

• Maria Fernanda Piñeros Leaño, Boston College

• Natalia Cordoba, Universidad de los Andes