Research In Humanitarian Settings Research Articles

Measuring the psychosocial wellbeing of Rohingya mothers in Cox’s Bazar, Bangladesh: Psychometric properties of an MHPSS assessment battery

Background Psychosocial research in humanitarian settings has been historically dominated by a focus on distress and disorder. As such, there is a need to establish the validity of instruments for a broad range of psychosocial outcomes, particularly among highly affected and under-represented populations. The current study describes the adaptation and testing of multiple psychosocial instruments among displaced Rohingya mothers in Bangladesh. Methods We used baseline data from 600 mothers of malnourished children aged 2 and under enrolled in an intervention study in Cox’s Bazar, Bangladesh. Instruments assessed distress (items from the International Depression Symptom Scale [IDSS] and Kessler-6 [K-6]); functional impairment (World Health Organization Disability Assessment Schedule [WHODAS]); subjective wellbeing (global Satisfaction With Life [SWL] and Personal Wellbeing Index [PWI]; and, coping (items from the Brief COPE and locally developed coping items). Instruments were piloted and refined, then used for data collection by Bangladeshi-Rohingya interviewer pairs. We conducted exploratory factor analysis, evaluated internal consistency, examined construct validity through correlation with other scales, and used regression models to explore demographic factors associated with psychosocial health. Results Both the WHODAS and coping items fit 2-factor models; other scales were unidimensional. Cronbach’s alphas ranged from .76 to .90 for the refined scales. With the exception of coping, scale correlations supported construct validity; separate measures of the same construct were highly correlated, distress and impairment were moderately correlated, and both were inversely correlated with wellbeing. Correlates of poorer psychosocial health included relative socioeconomic disadvantage, current pregnancy, and being unmarried. Conclusions Most of the standard psychosocial assessment tools performed adequately, but they did not appear to fully capture local experiences and included items of little local relevance. Findings highlight the need for further mixed methods research to develop a rich battery of instruments with cross-cultural validity, particularly for positive outcomes such as coping which was particularly challenging to assess.

Community-engagement in research in humanitarian settings.

Community-engagement in research in humanitarian settings.

‘How much do we need to know?’ On the Ethical implications of Operational Research in Humanitarian Settings

International Non-governmental Organisations (INGOs) have long been conducting operational research (OR), which is a mode of research that follows very specific principles. In the present work, I reflect upon my experience of conducting operational research with migrants and asylum seekers in Mexico, while working for an INGO. By centring my analysis on a question that was often posed by colleagues– “how much do we need to know?” - I explore three interrelated topics. First, I look at the advantages and the ethical dilemmas that emerge from the organisation’s ambivalent role as practitioner and researcher. I then discuss how research is not only being used to evaluate programs, but also as form of témoignage, and how hierarchical research designs may incur process of othering. I follow with an appreciation of how surveys implemented in such contexts contribute to framing migrants’ experiences according to pre-determined categories of trauma and suffering.

NGO-academia research co-production in humanitarian settings: opportunities and challenges.

The term 'co-production' is increasingly used to describe varied forms of research partnerships, expanding from its application within the health sector to other areas. In humanitarian settings, alongside more calls for localisation and decolonising aid, research co-production is emerging as a means of tackling power dynamics within NGO (non-governmental organisation)-academia research partnerships. Based on semi-structured interviews with practitioners and academics with experience of co-producing research and participating in research partnerships, this paper presents the opportunities and challenges associated with co-producing research in humanitarian settings. The findings suggest that similar to other buzzwords in the humanitarian sector, the label of 'co-production' is sometimes uncritically applied to any kind of research partnership. The study emphasises the importance of centring power within co-produced research in humanitarian settings and suggests that while the term co-production is sometimes misappropriated, the principles underlying this concept remain essential to unravelling power hierarchies within the humanitarian sector.

Measuring the psychosocial wellbeing of Rohingya mothers in Cox’s Bazar, Bangladesh: Psychometric properties of an MHPSS assessment battery

Background: Psychosocial research in humanitarian settings has been historically dominated by a focus on distress and disorder. As such, there is a need to establish the validity of instruments for a broad range of psychosocial outcomes, particularly among highly affected and under-represented populations. The current study describes the adaptation and testing of multiple psychosocial instruments among displaced Rohingya mothers in Bangladesh. Methods: We used baseline data from 600 mothers of malnourished children aged 2 and under enrolled in an intervention study in Cox’s Bazar, Bangladesh. Instruments assessed distress (International Depression Symptom Scale [IDSS] and Kessler-6 [K-6]); functional impairment (World Health Organization Disability Assessment Schedule [WHODAS]); subjective wellbeing (global Satisfaction With Life [SWL] and Personal Wellbeing Index [PWI]; and, coping (Brief COPE and locally developed coping items). Instruments were piloted and refined, then used for data collection by Bangladeshi-Rohingya interviewer pairs. We conducted exploratory factor analysis, evaluated internal consistency, examined construct validity through correlation with other scales, and used regression models to explore demographic factors associated with psychosocial health. Results: Both the WHODAS and coping items fit 2-factor models; other scales were unidimensional. Cronbach’s alphas ranged from .76 to .90 for the refined scales. With the exception of coping, scale correlations supported construct validity; separate measures of the same construct were highly correlated, distress and impairment were moderately correlated, and both were inversely correlated with wellbeing. Correlates of poorer psychosocial health included relative socioeconomic disadvantage, current pregnancy, and being unmarried. Conclusions: Most of the standard psychosocial assessment tools performed adequately, but they did not appear to fully capture local experiences and included items of little local relevance. Findings highlight the need for further mixed methods research to develop a rich battery of instruments with cross-cultural validity, particularly for positive outcomes such as coping which was particularly challenging to assess.

Operational challenges and considerations for COVID-19 research in humanitarian settings: A qualitative study of a project in Eastern Democratic Republic of the Congo and South Sudan.

Since the beginning of the COVID-19 pandemic, much research has been conducted globally, but relatively few studies have been carried out in complex emergency settings that pose numerous operational challenges. We conducted a qualitative study to explore the barriers and enablers of a COVID-19 cohort study conducted in South Sudan and Eastern Democratic Republic of the Congo, to inform future research on COVID-19 and infectious diseases in humanitarian settings. We used a case study design embedded within the original prospective cohort study. Qualitative data was collected through four health facility assessments, 28 key informant interviews, and a focus group discussion. Data were analyzed using a manual thematic analysis approach and summarized against four primary themes: testing challenges and enablers, perceptions and attitudes towards COVID-19, national health system considerations, and study management considerations. Findings suggest most of the challenges affecting the cohort study were not specific to COVID-19 research but have been a feature of previous infectious disease research carried out in complex emergencies. However, the pandemic has exacerbated certain problems. The high proportion of travellers enrolled due to testing mandates, stigmatization of infected individuals linked to the heavy global focus on COVID-19, strained resources during waves of increasing infections, and remote management requirements all negatively impacted the cohort study. Factors that facilitated the research included proactive management, data quality oversight procedures, and strong collaboration with national health stakeholders. The global impact of COVID-19, its high public profile, and specific pandemic policies pose further operational challenges for research in already complex humanitarian settings. Future studies could plan mitigation measures that include flexibility in staffing and budgets, strategies to expand testing, and early partnerships with local organizations and health authorities.

Self-care interventions for sexual and reproductive health in humanitarian and fragile settings: a scoping review

BackgroundSelf-care is the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and manage illness and disability with or without a health care provider. In resource-constrained settings with disrupted sexual and reproductive health (SRH) service coverage and access, SRH self-care could play a critical role. Despite SRH conditions being among the leading causes of mortality and morbidity among women of reproductive age in humanitarian and fragile settings, there are currently no reviews of self-care interventions in these contexts to guide policy and practice.MethodsWe undertook a scoping review to identify the design, implementation, and outcomes of self-care interventions for SRH in humanitarian and fragile settings. We defined settings of interest as locations with appeals for international humanitarian assistance or identified as fragile and conflict-affected situations by the World Bank. SRH self-care interventions were described according to those aligned with the Minimum Initial Services Package for Reproductive Health in Crises. We searched six databases for records using keywords guided by the PRISMA statement. The findings of each included paper were analysed using an a priori framework to identify information concerning effectiveness, acceptability and feasibility of the self-care intervention, places where self-care interventions were accessed and factors relating to the environment that enabled the delivery and uptake of the interventions.ResultsWe identified 25 publications on SRH self-care implemented in humanitarian and fragile settings including ten publications on maternal and newborn health, nine on HIV/STI interventions, two on contraception, two on safe abortion care, one on gender-based violence, and one on health service provider perspectives on multiple interventions. Overall, the findings show that well-supported self-care interventions have the potential to increase access to quality SRH for crisis-affected communities. However, descriptions of interventions, study settings, and factors impacting implementation offer limited insight into how practical considerations for SRH self-care interventions differ in stable, fragile, and crisis-affected settings.ConclusionIt is time to invest in self-care implementation research in humanitarian settings to inform policies and practices that are adapted to the needs of crisis-affected communities and tailored to the specific health system challenges encountered in such contexts.

Addressing recall bias in (post-)conflict data collection and analysis: lessons from a large-scale health survey in Colombia

BackgroundMuch applied research on the consequences of conflicts for health suffers from data limitations, particularly the absence of longitudinal data spanning pre-, during- and post-conflict periods for affected individuals. Such limitations often hinder reliable measurement of the causal effects of conflict and their pathways, hampering also the design of effective post-conflict health policies. Researchers have sought to overcome these data limitations by conducting ex-post surveys, asking participants to recall their health and living standards before (or during) conflict. These questions may introduce important analytical biases due to recall error and misreporting.MethodsWe investigate how to implement ex-post health surveys that collect recall data, for conflict-affected populations, which is reliable for empirical analysis via standard quantitative methods. We propose two complementary strategies based on methods developed in the psychology and psychometric literatures—the Flashbulb and test-retest approaches—to identify and address recall bias in ex-post health survey data. We apply these strategies to the case study of a large-scale health survey which we implemented in Colombia in the post-peace agreement period, but that included recall questions referring to the conflict period.ResultsWe demonstrate how adapted versions of the Flashbulb and test-retest strategies can be used to test for recall bias in (post-)conflict survey responses. We also show how these test strategies can be incorporated into post-conflict health surveys in their design phase, accompanied by further ex-ante mitigation strategies for recall bias, to increase the reliability of survey data analysis—including by identifying the survey modules, and sub-populations, for which empirical analysis is likely to yield more reliable causal inference about the health consequences of conflict.ConclusionsOur study makes a novel contribution to the field of applied health research in humanitarian settings, by providing practical methodological guidance for the implementation of data collection efforts in humanitarian contexts where recall information, collected from primary surveys, is required to allow assessments of changes in health and wellbeing. Key lessons include the importance of embedding appropriate strategies to test and address recall bias into the design of any relevant data collection tools in post-conflict or humanitarian contexts.

A combination sampling approach for epidemiologic research in humanitarian settings: a case analysis of a study of depressive disorder prevalence among refugees in Greece

BackgroundUnderstanding the burden of common mental health disorders, such as depressive disorder, is the first step in strengthening prevention and treatment in humanitarian emergencies. However, simple random sampling methods may lead to a high risk of coercion in settings characterized by a lack of distinction between researchers and aid organizations, mistrust, privacy concerns, and the overarching power differential between researchers and populations affected by crises. This case analysis describes a sampling approach developed for a survey study of depressive disorder in a Syrian refugee camp in Greece (n = 135).DiscussionSyrian refugees face an extraordinarily high burden of depressive disorder during the asylum process (43%), necessitating population screening, prevention, and treatment. In order to preserve the informed consent process in this refugee camp setting, the research team developed a two-phase sampling strategy using a map depicting the geographical layout of the housing units within the camp. In the first phase, camp management announced a research study was being undertaken and individuals were invited to volunteer to participate. The participants’ container (housing) numbers were recorded on the map, but were not linked to the survey data. Then, in the second phase, the camp map was used for complementary sampling to reach a sample sufficient for statistical analysis. As a result of the two phases of the sampling exercise, all eligible adults from half the containers in each block were recruited, producing a systematic, age- and sex-representative sample.ConclusionsCombining sampling procedures in humanitarian emergencies can reduce the risk of coerced consent and bias by allowing participants to approach researchers in the first phase, with a second phase of sampling conducted to recruit a systematic sample. This case analysis illuminates the feasibility of a two-phase sampling approach for drawing a quasi-random, representative sample in a refugee camp setting.

Challenges in public health and epidemiology research in humanitarian settings: experiences from the field

BackgroundHumanitarian settings often present unique scientific challenges and conditions that distinguish them from standard research settings. While a number of these challenges are faced in both standard settings and humanitarian settings, factors unique to humanitarian settings such as inaccessibility and time sensitivities further exacerbate the effects of these challenges. This analysis focuses on experiences in post-disaster contexts such as Indonesia and India following the 2004 Indian Ocean Tsunami, the Philippines following Typhoon Haiyan in 2013, and Nepal following the 2015 earthquake.DiscussionParticular issues that we faced in undertaking research in post-disaster settings include challenges with uncharted ethical and cultural considerations, non-standardised administrative methods for record keeping, data sharing and dissemination. While these issues are not unique to post-disaster humanitarian settings, the time-sensitive nature of our work exacerbated the effects of these concerns. Relying on local partners and making quick decisions to tackle issues is imperative for navigating both foreseen and unforeseen challenges. While pre-emptive action to address these concerns is the most efficient means to expedite research protocols, adaptability and contingency planning are key components of practical research implementation in dynamic situations.ConclusionsResearch is not always a priority in humanitarian settings, so innovative methods are necessary to conduct meaningful and situationally appropriate research in these venues. By understanding available resources, local culture, and political considerations and working efficiently and decisively, we can begin to jump hurdles associated with epidemiologic research in humanitarian settings.

Research challenges in evaluating gender-based violence response services in a refugee camp

ABSTRACT This article presents a case study of research in Dadaab, Kenya to highlight some of the relevant challenges encountered while conducting gender-based violence research in humanitarian settings. A longitudinal mixed-methods design was used to evaluate a comprehensive case-management intervention in the refugee complex near the border of Kenya and Somalia. We present an overview of both expected and unexpected challenges during preparation and implementation of the research, adaptations made to the research design, and lessons learned for future research in similar contexts. Some of the key challenges were attributed to the highly securitized and remote environment of Dadaab refugee camp, like many refugee camp settings, which created limitations for sampling designs, interview locations, and also created particular burdens for the research team members conducting interviews. In addition to the camp environment, the dynamic nature of events and trends in the camp setting created barriers to follow-up with longitudinal cohort participants as well as uncertainty on how to plan for future implementation of research design phases in response to camp changes. Conducting research in humanitarian settings requires a flexible approach to accommodate the challenges that can impact both service delivery and research activities. The discussion presented in this article contributes to the evolving practical guidance on conducting research in humanitarian settings.

Carrying out embedded implementation research in humanitarian settings: Aqualitative study in Cox's Bazar, Bangladesh.

Embedded implementation research (IR) promotes evidence-informed policy and practices by involving decision-makers and program implementers in research activities that focus on understanding and solving existing implementation challenges. Although embedded IR has been conducted in multiple settings by different organizations, there are limited experiences of embedded IR in humanitarian settings. This study highlights some of the key challenges of conducting embedded IR in a humanitarian setting based on our experience with the Rohingya refugee population in Cox's Bazar, Bangladesh. We collected qualitative data in between January and July 2019. First, we visited Rohingya refugee camps and interviewed representatives from different humanitarian organizations. Second, we conducted interviews with researchers from BRAC University who were engaged with data collection and analysis in a broader embedded IR study on maternal, newborn, child, and adolescent health (MNCAH) program implementation challenges. Data were analyzed using a thematic analysis approach. Two researchers developed and agreed on codes and relevant themes based on the objectives of this study. The findings of this study highlight several challenges encountered while conducting embedded IR in the Rohingya emergency setting in Cox's Bazar, which may have implications for other humanitarian settings. The overall context of the camps was complex, with more than 100 organizations devoted to providing health services for approximately 1 million refugees. Despite the presence of the Bangladesh government, United Nations agencies and other international organizations played key roles in making programmatic and policy decisions for the Rohingya. Because health service delivery modalities and policies and related implementation challenges for MNCAH programs for the refugees changed rapidly, the embedded IR approach used was flexible and able to adapt to changes identified, with research questions and methods modified accordingly. Access to the camps, reaching Rohingya respondents, overcoming language barriers in order to get quality information, and the limited availability of local research collaborators were additional challenges. Working with researchers or research institutes that are familiar with the context and have experience in conducting implementation and health systems research can help with collection of quality data, identifying key stakeholders and bringing them on board to ensure the execution of the project, and ensuring utilization of the research findings. Study limitations include possible constraints in generalizing our conclusions to other humanitarian settings. Implementation research conducted in additional humanitarian settings can contribute to the evidence on this topic. Findings indicate that embedded IR can be done effectively in humanitarian settings if the challenges are anticipated, and appropriate strategies and in-country partners put in place to address or mitigate them, before commencing the funding or starting of the project. Understanding the context and analyzing the role of relevant stakeholders prior to conducting the research, considering a simple descriptive method appropriate to answering real-time IR questions, and working with local researchers or research institutes with specific skill sets and prior experience conducting research in humanization contexts may reduce costs and time spent, and ensure collection of quality data relevant for policy and practice.

Measuring the psychosocial, biological, and cognitive signatures of profound stress in humanitarian settings: impacts, challenges, and strategies in the field

BackgroundEvidence of ‘what works’ in humanitarian programming is important for addressing the disruptive consequences of conflict and forced displacement. However, collecting robust scientific evidence, and ensuring contextual relevance, is challenging. We measured the biological, psychosocial, and cognitive impacts of a structured psychosocial intervention, implemented by Mercy Corps with Syrian refugees and Jordanian host-community youth. In this paper, we present a case analysis of this evaluation study and reflect on the scientific contributions of the work, the challenges experienced in its delivery, and the strategies deployed to address them.DiscussionWe identified challenges with respect to study design, methods, and dissemination: these included the logistics and acceptability of implementing a randomized controlled trial in a humanitarian context, the selection and refinement of culturally-relevant research tools and community-based practices, and the dissemination of results to multiple stakeholders. We demonstrated beneficial and sustained impacts on self-reports of insecurity, stress, and mental health; developed a reliable and culturally-relevant measure of resilience; experimentally tested cognitive skills; and showed that levels of cortisol, a biomarker of chronic stress, reduced by one third in response to intervention. Using stress biomarkers offered proof-of-concept evidence, beyond self-reported data: interventions targeting mental health and psychosocial wellbeing can regulate physiological stress in the body as well as improve self-reported mental health and wellbeing. We built constructive dialogue between local communities, scholars, humanitarian practitioners, and policy-makers.ConclusionsOur work shows the value of rigorous research in humanitarian settings, emphasizing relevance for local communities and meaningful ways to build research ownership. Findings encourage the adoption of cognitive measures and stress biomarkers alongside self-report surveys in evaluating programme impacts. High-quality scientific research with youth can be feasible, useful, and ethical in humanitarian settings.

Conducting operational research in humanitarian settings: is there a shared path for humanitarians, national public health authorities and academics?

In humanitarian contexts, it is a difficult and multi-faceted task to enlist academics, humanitarian actors and health authorities in a collaborative research effort. The lack of research in such settings has been widely described in the past decade, but few have analysed the challenges in building strong and balanced research partnerships. The major issues include considering operational priorities, ethical imperatives and power differentials. This paper analyses in two steps a collaborative empirical endeavour to assess health service utilization by Syrian refugee and Lebanese women undertaken by the International Committee of the Red Cross (ICRC), the Lebanese Ministry of Public Health (MoPH) and the Harvard François-Xavier Bagnoud (FXB) Center.First, based on challenges documented in the literature, we shed light on how we negotiated appropriate research questions, methodologies, bias analyses, resource availability, population specificities, security, logistics, funding, ethical issues and organizational cultures throughout the partnership.Second, we describe how the negotiations required each partner to go outside their comfort zones. For the academics, the drivers to engage included the intellectual value of the collaboration, the readiness of the operational partners to conduct an empirical investigation and the possibility that such work might lead to a better understanding in public health terms of how the response met population needs. For actors responding to the humanitarian crisis (the ICRC and the MOPH), participating in a technical collaboration permitted methodological issues to be worked through in the context of deliberations within the wider epistemic community.We find that when they collaborate, academics, humanitarian actors and health authorities deploy their respective complementarities to build a more comprehensive approach. Barriers such as the lack of uptake of research results or weak links to the existing literature were overcome by giving space to define research questions and develop a longer-term collaboration involving individual and institutional learning. There is the need ahead of time to create balanced decision-making mechanisms, allow for relative financial autonomy, and define organizational responsibilities. Ultimately, mutual respect, trust and the recognition of each other’s expertise formed the basis of an initiative that served to better understand populations affected by conflict and meet their needs.

The ethical contours of research in crisis settings: five practical considerations for academic institutional review boards and researchers.

The number of research studies in the humanitarian field is rising. It is imperative, therefore, that institutional review boards (IRBs) consider carefully the additional risks present in crisis contexts to ensure that the highest ethical standards are upheld. Ethical guidelines should represent better the specific issues inherent to research among populations grappling with armed conflict, disasters triggered by natural hazards, or health-related emergencies. This paper seeks to describe five issues particular to humanitarian settings that IRBs should deliberate and on which they should provide recommendations to overcome associated challenges: staged reviews of protocols in acute emergencies; flexible reviews of modification requests; addressing violence and the traumatic experiences of participants; difficulties in attaining meaningful informed consent among populations dependent on aid; and ensuring reviews are knowledgeable of populations' needs. Considering these matters when reviewing protocols will yield more ethically sound research in humanitarian settings and hold researchers accountable to appropriate ethical standards.

Mention of ethical review and informed consent in the reports of research undertaken during the armed conflict in Darfur (2004\u20132012): a systematic review

BackgroundArmed conflict in Darfur, west Sudan since 2003 has led to the influx of about 100 international humanitarian UN and non-governmental organizations to help the affected population. Many of their humanitarian interventions included the collection of human personal data and/or biosamples, and these activities are often associated with ethical issues. A systematic review was conducted to assess the proportion of publicly available online reports of the research activities undertaken on humans in Darfur between 2004 and 2012 that mention obtaining ethical approval and/or informed consent.MethodsThis systematic review is based on a systematic literature search of Complex Emergency Database, ReliefWeb, PubMed), followed by a hand search for the hardcopies of the eligible reports archived in the Centre for Research on the Epidemiology of Disasters (CRED) in Brussels.ResultsThe online search showed that out of the 68 eligible studies, 13.2% (9) reported gaining ethical approval and 42.6% (29) that an informed consent was obtained from the participants. The CRED search included 138 eligible reports. None of these reports mentioned gaining ethical approval and 17 (12.3%) mentioned obtaining informed consent from their participants.ConclusionsThe proportion of studies reporting ethical review and informed consent was smaller than might be expected, so we suggest five possible explanations for these findings. This review provides empirical evidence that can help in planning ethical conduct of research in humanitarian settings.

Implementation research for early childhood development programming in humanitarian contexts

Young children living in conditions of war, disaster, and displacement are at high risk for developmental difficulties that can follow them throughout their lives. While there is robust evidence supporting the need for early childhood development (ECD) in humanitarian settings, implementation of ECD programming remains sparse, largely due to the lack of evidence of how and why these programs can improve outcomes in humanitarian settings. In order to build the evidence base for ECD in humanitarian settings, we review the current state of implementation research for ECD programming (targeting children 0-8) in humanitarian settings, through a literature review and a series of key informant interviews. Drawing from existing frameworks of implementation research and the findings from our analysis, we present a framework for ECD implementation research in humanitarian settings and propose an agenda for future research.

Relevance or excellence? Setting research priorities for mental health and psychosocial support in humanitarian settings.

Background: Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus-based research agenda. Methods: From August 2009 to February 2010, we contacted policymakers, academic researchers, and humanitarian aid workers, and conducted nine semistructured focus group discussions with 114 participants in three locations (Peru, Uganda, and Nepal), in both the capitals and remote humanitarian settings. Local stakeholders representing a range of academic expertise (psychiatry, psychology, social work, child protection, and medical anthropology) and organizations (governments, universities, nongovernmental organizations, and UN agencies) were asked to identify priority questions for MHPSS research in humanitarian settings, and to discuss factors that hamper and facilitate research. Results: Thematic analyses of transcripts show that participants broadly agreed on prioritized research themes in the following order: (1) the prevalence and burden of mental health and psychosocial difficulties in humanitarian settings, (2) how MHPSS implementation can be improved, (3) evaluation of specific MHPSS interventions, (4) the determinants of mental health and psychological distress, and (5) improved research methods and processes. Rather than differences in research themes across countries, what emerged was a disconnect between different groups of stakeholders regarding research processes: the perceived lack of translation of research findings into actual policy and programs; misunderstanding of research methods by aid workers; different appreciation of the time needed to conduct research; and disputed universality of research constructs. Conclusions: To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between the goals of “relevance” and “excellence.” Research needs to be more sensitive to questions and concerns arising from humanitarian interventions, and practitioners need to take research findings into account in designing interventions. (Harv Rev Psychiatry 2012;20:25–36.)

Mental Health and Psychosocial Support in Crisis and Conflict: Report of the Mental Health Working Group

The Working Group on Mental Health and Psychosocial Support was convened as part of the 2009 Harvard Humanitarian Action Summit. The Working Group chose to focus on ethical issues in mental health and psychosocial research and programming in humanitarian settings. The Working Group built on previous work and recommendations, such as the Inter-Agency Standing Committee's Guidelines on Mental Health and Psychosocial Support in Emergency Settings. The objective of this working group was to address one of the factors contributing to the deficiency of research and the need to develop the evidence base on mental health and psychosocial support interventions during complex emergencies by proposing ethical research guidelines. Outcomes research is vital for effective program development in emergency settings, but to date, no comprehensive ethical guidelines exist for guiding such research efforts. Working Group members conducted literature reviews which included peer-reviewed publications, agency reports, and relevant guidelines on the following topics: general ethical principles in research, cross-cultural issues, research in resource-poor countries, and specific populations such as trauma and torture survivors, refugees, minorities, children and youth, and the mentally ill. Working Group members also shared key points regarding ethical issues encountered in their own research and fieldwork. The group adapted a broad definition of the term "research", which encompasses needs assessments and data gathering, as well as monitoring and evaluation. The guidelines are conceptualized as applying to formal and informal processes of assessment and evaluation in which researchers as well as most service providers engage. The group reached consensus that it would be unethical not to conduct research and evaluate outcomes of mental health and psychosocial interventions in emergency settings, given that there currently is very little good evidence base for such interventions. Overarching themes and issues generated by the group for further study and articulation included: purpose and benefits of research, issues of validity, neutrality, risk, subject selection and participation, confidentiality, consent, and dissemination of results. The group outlined several key topics and recommendations that address ethical issues in conducting mental health and psychosocial research in humanitarian settings. The group views this set of recommendations as a living document to be further developed and refined based on input from colleagues representing different regions of the globe with an emphasis on input from colleagues from low-resource countries.

Responding to the needs of children in crisis

This paper explores the issues confronting service providers setting up child and family mental health programmes in conflict, post conflict and disaster areas. Drawing on clinical experience and research in humanitarian settings, it calls for greater attention to the child's perspective, their individuality and the cultural, social and political context in which they live. It argues that those concerned with the psychopathology of children in crises should widen their frame of reference beyond narrowly defined traumatic reactions to include other mental health and psychosocial issues, including the current problems of daily life and the needs of children with pre-existing psychiatric disorders. It recommends culturally valid means of assessment, the creation of age-appropriate services and training for primary healthcare workers. Children's mental health needs in crises are varied, complex and intimately connected with their needs for security, food, shelter, education and family connection. This requires holistic, rights-based approaches that can access resources to address basic needs, advocate for security and protection, and recognize and address the needs of the more vulnerable children. This is the approach recommended by the Inter Agency Standing Committee Guidelines for Mental health and Psychosocial Support in Emergency Settings.