EDUCATION WORKING PAPER No. 6 | NOVEMBER 2024 The Effects of Early Childhood Development (ECD) programs on the socio-emotional well-being of children and caregivers in refugee and forced displacement settings Estela Armijo and Tina Asnake © 2025 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington DC 20433 Telephone: 202-473-1000 Email: AskEd@worldbank.org Internet: www.worldbank.org/en/topic/education This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. 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Cover design: Marianne Siblini Working Paper: The Effects of Early Childhood Development (ECD) programs on the socio-emotional well-being of children and caregivers in refugee and forced displacement settings Estela Armijo and Tina Asnake 1 Table of Contents Page Acronyms......................................................................................................................................4 Abstract ........................................................................................................................................6 Acknowledgments.........................................................................................................................7 I. Introduction ...............................................................................................................................8 Concept 10 Risks to the Physical, Socioemotional, Well-being and Human Development of Forcibly Displaced Children ............... 11 The Nurturing Care Framework in Contexts of Fragility, Conflict, and Violence ............................................................... 14 Enhancing Socioemotional and Psychosocial Well-being through ECD Programs in Forced Displacement Settings ..... 17 II. Methodology .......................................................................................................................... 21 Literature Search..................................................................................................................................................................... 21 Key Informants’ Interviews .................................................................................................................................................... 24 Interview Guide Development .............................................................................................................................................. 24 Qualitative Analysis for the Key Informant Interviews ........................................................................................................ 25 III. Findings ................................................................................................................................. 26 Findings from Scope Review .................................................................................................................................................. 27 Results From Interventional Studies ..................................................................................................................................... 30 Findings from Interviews ........................................................................................................................................................ 42 Challenges and Opportunities for ECD in Conflict, Fragile and Forced Displacement Settings ........................................ 48 IV. Conclusion ............................................................................................................................. 55 V. Recommendations .................................................................................................................. 58 Recommendation for World Bank Task Team Leaders ....................................................................................................... 61 References .................................................................................................................................. 67 Appendices ................................................................................................................................. 71 Appendix A. Summary of Research Articles Analyzed ......................................................................................................... 71 Appendix B: Questionnaires .................................................................................................................................................. 80 2 3 Acronyms AAH Action Against Hunger ASA Advisory Services and Analytics ASF Ahlan Simsim Families BRAC Bangladesh Rural Advancement Committee CAR Central African Republic CFS Child Friendly Space CHV´s Community Health Volunteers CSI Caregiver Support Intervention CSO Civil Service Organizations CTP Cognitive Training Program CTSD Continuous Traumatic Stress Disorder ECD Early Childhood Development ECE Early Childhood Education ECEC Early Childhood Education and Care ELP Early Learning Partnership FCV Fragility, Conflict, and Violence FRD Fundacja Rozwoju Dzieci’s Spynka GEMS Geo-Enabling Initiative for Monitoring and Supervision HNP Health, Nutrition, and Population HPL Humanitarian Play Lab IDP Internally Displaced Persons INEE Inter-Agency Network on Education for Emergencies INSPIRE Inclusion Support Program for Refugee Education IPV Intimate Partner Violence IRC International Rescue Committee KII Key Informant Interview LMIC Low- and Middle-Income Countries MHPSS Mental Health and Psychosocial Support MOCEP Mother-Child Education Program MSP Mother Support Program NCF Nurturing Care Framework NGO Non-Governmental Organization NYU New York University PI Plan International PTSD Post-Traumatic Stress Syndromes RCT Randomized Controlled Trials RELP Remote Early learning program RFD Refugee and Forcibly Displaced 4 RUL Reach Up and Learn SGBV Sexual and Gender-Based Violence SPJ Social Protection and Jobs TTL Task Team Leader UN United Nations UNESCO United Nations Educational, Scientific and Cultural Organization UNHCR United Nations High Commissioner for Refugees UNICEF, United Nations Children's Fund WASH Water Sanitation and Hygiene WB World Bank WHO World Health Organization 5 Abstract Early childhood is a crucial period for skills development and socio-emotional growth. Forcibly displaced children experience significant trauma, necessitating effective interventions. This paper examines the effect of Early Childhood Development (ECD) programs on the psychosocial and socio- emotional well-being of forcibly displaced caregivers and children between the ages of 0 and 8 years through a systematic literature review and key informant interviews. Findings indicate the crucial links between parents’ mental well-being and children’s development. Despite challenges, ECD interventions show promising outcomes and fill important gaps to build developmental foundations and school readiness. ECD interventions must be well designed, target both the caregivers and the child, and be culturally sensitive, child-friendly, and trauma-informed. The recommendations here focus on sustaining impact, leveraging technology, securing sustainable funding and advocating for sustained investments in the early years in fragile and conflict settings. 6 Acknowledgments This paper was prepared under the overall guidance of our beloved coach Catalina Quintero (Consultant, Early Learning Partnership, World Bank). We would like to thank the fellowship coordination team: Alisa Katharina Arif Currimjee and Melissa Diane Kelly (Early Learning Partnership, World Bank) for providing useful guidance during various stages of the study. We greatly appreciate our peer reviewers Santiago De la Cadena Becerra (Human Development Economist, World Bank), Marguerite Marlow (Senior Researcher and Technical Research Lead, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences in the University of Stellenbosch, South Africa), Dr. Mubarek Abera (Associate Professor at Jimma University, Ethiopia), and Gabriella Brent (Director of Programs, Amna Refugee Healing Network) for their very helpful comments and suggestions in the different stages. We also thank all the interviewees that gave us their valuable time to learn from their experience delivering ECD and socioemotional well-being programs and their research in refugee and forcibly displaced settings. This paper is the result of all their work. This evidence review has been made possible through a grant from the World Bank’s Early Years Fellowship Program, which is supported by the Early Learning Partnership (ELP) multi-donor trust fund. 7 I. Introduction An alarmingly large and growing number of young children are impacted by situations of fragility, conflict, and violence (FCV) and forced displacement. The world’s forcibly displaced populations, including refugees, 1 internally displaced persons 2 (IDPs), and asylum seekers are increasing. 3 The 2024 UNHCR Global Trends report reveals that global forced displacement reached a record of over 120 million people by the end of April 2024. This increase, compared to 117.3 million at the end of 2023, represents a continuous growth of displaced persons due to conflicts, persecution, and human rights violations. In 2023, forced displacement rose by 8%, affecting 1 in every 69 people worldwide. This phenomenon is driven by conflicts in Sudan, Myanmar, Haiti, and Palestine, and exacerbated by climate change. Children make up 30% of the world’s population and 40% of all forcibly displaced people (UNHCR 2024). These children face heightened vulnerability to anxiety, post-traumatic stress syndromes (PTSD or CTSD), depression, and toxic stress, making them one of the most vulnerable groups among displaced populations (Shonkoff, Garner, & Dobbins 2012; Johnson, Riley, & Granger 2013; Garner & Shonkoff 2012; Bucci et al. 2012; Blackmore et al. 2020; UNESCO 2018). As this paper will discuss, there is substantive evidence that demonstrates that implementing early childhood development (ECD) programs in refugee and forced displacement contexts is crucial to mitigate the negative effects of displacement on young children’s development and in building human capital. These programs shield children and their caregivers from the effects of toxic stress and trauma while also helping to improve the socioemotional wellbeing of refugees by providing safe spaces for 1A refugee is someone who has been forced to flee his or her country because of persecution, war, or violence. A refugee has well-founded fear of persecution for reason or race, religion, nationality, political opinion, or membership in a particular social group. In most cases, the refugee cannot return home or is afraid to do so. https://refugeesmigrants.un.org/definitions 2 Internally displaced persons (IDPs): According to the United Nations Guiding Principles on Internal Displacement, IDPs are “persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized state border.” https://emergency.unhcr.org/protection/legal-framework/idp-definition 3An asylum seeker is a refugee who is also seeking international protection from dangers in his or her home country, but whose claim for refugee status has not been determined legally. Asylum seekers must apply for protection in the country of destination—meaning they must arrive at or cross a border to apply. https://www.rescue.org/article/migrants-asylum- seekers-refugees-and-immigrants-whats-difference 8 refugee families to come together, build relationships, and rebuild social cohesion in places where wars and conflicts have broken ties among communities. In this way, human capital is also built and maintained so that these children grow up and achieve their full potential. When programs are delivered in a manner that is equitable and inclusive of all, including both forcibly displaced and host communities, ECD interventions in FCV contexts can have a further positive impact on building human capital, establishing peace, and preventing conflict. However, international development aid allocated to ECD in crisis contexts represents a limited portion of the total assistance directed to those countries. In 2017, 85% of the $192 billion in international assistance was dedicated to development aid, while only 15% was allocated to humanitarian aid. However, despite the increase in funds for ECD in crisis-affected countries, reaching $2.5 billion in 2017, this amount represents just 3.3% of the total Official Development Assistance directed to these countries (Moving Minds Alliance 2020). Additionally, the distribution of ECD funds shows a significant concentration in specific sectors, with over 90% of the funding allocated to health and nutrition interventions. Equally essential sectors, such as preschool education and water, sanitation, and hygiene (WASH) services, receive only 1% and 2%, respectively. Even more concerning is the lack of data on funding for child protection and responsive caregiving, making it difficult to track and allocate resources effectively for these critical needs (Moving Minds Alliance 2020). Therefore, the purpose of this study is not only to highlight the importance of integrating socioemotional and psychosocial components into ECD programs in FCV contexts, but also to provide evidence of their effects on the well-being of refugee children and caregivers. Additionally, this paper broadly proposes examples of how a Nurturing Care Framework (NCF) can be adapted to FCV contexts, aiming to create more supportive environments for refugees and host communities alike. In this way, governments, development actors, and World Bank teams can target interventions to vulnerable populations, including those forcibly displaced, that go beyond humanitarian response in FCV settings to building human capital. This study seeks to explore the question: "What is the effect of early childhood development (ECD) programs on the psychosocial and socio-emotional wellbeing of forcibly displaced caregivers and children between the ages of 0-8?" Through a systematic literature review and key informant interviews, this study aims to collect evidence about ECD programs on the socioemotional well-being 9 of forcibly displaced children and their caregivers. It also aspires to evaluate what seems to work in supporting these populations to better inform the work of practitioners who are designing and implementing interventions for these populations. This paper is divided into five sections: first, we describe the risks young forcibly displaced children face in fragile and conflict-affected settings and adapt the nurturing care framework to these settings to guide our research. Second, we discuss our methodology. In the third section we discuss the core findings of the literature review and key informant interviews. In the fourth we provide some conclusions. The fifth and last section provides recommendations for practitioners and policymakers in the ECD, humanitarian, and international development spheres, and specifically for World Bank TTLs seeking to integrate ECD interventions into their projects. Concept Before delving deeper into the integration of these concepts into Early Childhood Development (ECD), it is crucial to establish a clear understanding of key concepts/terminologies. According to the Inter- Agency Network on Education for Emergencies, mental health, and psychosocial support (MHPSS) is an overarching term encompassing all forms of support aimed at promoting mental health and psychosocial well-being. It encompasses promotive, preventative, and curative measures. Socioemotional learning, on the other hand, is defined as a subset of MHPSS that focuses on developing core competencies for managing emotions, setting, and achieving goals, appreciating the perspectives of others, establishing, and maintaining positive relationships, and making responsible decisions. Well-being, also defined as a holistic concept, encompasses physical, emotional, social, and cognitive health and the process of achieving it. These concepts are primarily used in the learning environment for children, but their significance is gradually being recognized and integrated into other aspects of ECD (INEE 2018). Psychosocial support interventions can be effective in promoting socioemotional well-being and can be provided by professionals, including mental health professionals, social workers, educators, and community workers. Psychosocial support interventions can be delivered in various settings, including schools, clinics, community centers, and homes. These programs support caregivers as well as children in ways to manage their emotions, ways to strengthen relationships, and how to make responsible decisions. Some programs’ approach focuses on helping individuals identify and change negative thought patterns and behaviors (INEE 2016). For example, a study of a school-based psychosocial 10 support program found that the program significantly improved students' emotional regulation, self- esteem, and social skills (Durlak et al. 2011). Risks to the Physical, Socioemotional, Well-being and Human Development of Forcibly Displaced Children Forcibly displaced children face unique challenges that markedly differ from those experienced by their non-refugee peers, particularly in their socioemotional and psychosocial development. Firstly, their exposure to trauma and stress is more intense and multifaceted. These children confront the direct impact of conflict and forced displacement and prolonged exposure to violence and multiple levels of adversity (Save the Children 2019). These include traumatic experiences such as being threatened, physically injured, sexually assaulted, or losing a loved one. They also include the loss of a home, challenging migration journeys, and difficult resettlement processes that often-last decades (Taylor & Kaplan 2023). Such continuous exposure to profound loss, multiple grief, and traumatic situations leads to a deeper and more entrenched impact on children’s emotional and social development, including their mental health, leading to increased likelihood of diagnoses including post-traumatic stress disorder, anxiety, and depression (Fazel 2002; Lustig et al. 2004). Refugee children and their caregivers not only suffer the traumatic events of past conflict, but this is compounded by becoming refugees and by the adversities and hostilities communities must consequently endure including poverty, discrimination, and homelessness. In the first five years of life, the brain develops faster and is as malleable as it will ever be. Therefore, for the youngest children, the psychological and developmental impacts of forced displacement can be devastating. In forced displacement settings, social services are commonly disrupted, impeding opportunities for children to receive stimulation, nutrition, and psychosocial and educational access and support. Childhood exposure to intense and chronic stress, especially during early developmental stages, can cause prolonged stress-response activation. This may result in lasting harm to both physical and mental health, known as toxic stress. 4 Displaced children are particularly vulnerable to toxic stress due to the severity and persistence of their stressors, which can negatively impact their learning, behavior, and health throughout their lives (Taylor & Kaplan 2023). 4 Toxic stress occurs when someone faces adversity that is strong, frequent, and prolonged over time without appropriate adult support. This can include neglect, physical or sexual abuse, emotional abuse, exposure to violence, drug addiction, or burdens assumed due to poverty (BBC 2018). 11 Toxic stress, particularly in contexts of displacement, has far-reaching effects on multiple aspects of human development, including health, education, and long-term economic stability. Assets, economic opportunity and toxic stress, a study by Shanks and Robinson (2012) established as a foundational understanding that exposure to prolonged adversity during childhood can significantly disrupt brain development. The study found that this disruption affects the prefrontal cortex, which is crucial for decision making, emotional regulation, and executive functions. As a result, children exposed to toxic stress are more likely to struggle with learning difficulties, attention deficits, and behavior issues, which undermine their educational achievements. This lack of educational success becomes a significant barrier to accessing quality jobs, perpetuating a cycle of poverty. Additionally, chronic health problems created by toxic stress and the lack of academic skills limit their job options and employment prospects (Shanks and Robinson 2012). Furthermore, the Shanks and Robinson study emphasized that the effects of toxic stress and poverty are difficult to reverse, highlighting the importance of early intervention to mitigate these negative impacts. A recent systematic review and meta-analysis examined the mental health of 779 child and adolescent refugees and asylum seekers from the Middle East, Africa, and Southern Asia, who were residing in Germany, Malaysia, Norway, Sweden, and Türkiye. The study aimed to determine the prevalence of mental illness among these young refugees and asylum seekers across five countries. Findings from the study, as reported by Blackmore et al. (2020), indicate significantly higher rates of PTSD, anxiety, and depression (23%, 16%, and 14%, respectively) when compared to their counterparts in the general population. These mental health challenges and the impact of toxic stress can result in behaviors that manifest this overwhelm of experiences. The behaviors include challenges forming safe, sustained relationships, tendencies toward isolation and withdrawal, or engagement in aggressive or destructive behaviors (Centers for Disease Control and Prevention 2023). Furthermore, research from the World Health Organization indicates that displaced children are at risk of developing learning impairments, physical health issues, and socioemotional difficulties (WHO 2022; Polushkin 2018; Dahab et al. 2020). Family disruption is a more pressing reality for refugee and forcibly displaced (RFD) children. In crisis with limited resources, the need for additional support for the development and well-being of young children is recognized. Responsive care, where parents sensitively respond to their children's signals, fostering positive attachment relationships, is crucial. Psychosocial stimulation, through early learning 12 environments and play opportunities, is also essential for the cognitive and emotional development in these contexts (Ereky-Stevens, Siraj and Kong 2022). Caregivers’ mental health plays a crucial role in being responsive and mediating the impact of conflict on children’s mental health. The loss of familial support networks and structures through separation from loved ones, community, and land can significantly impact adults’ and caregivers’ well-being and children´s socioemotional development opportunities. Children depend exclusively on parents or caregivers as a source of resilience, support, and care and while both are impacted, there is evidence that younger children are more vulnerable than older children to developing adaptive responses caused by parental separation (Briggs-Gowan et al. 2019). The pervasive impacts of stress, grief, loss, and traumatic events can inevitably affect caregivers’ ability to provide attuned and responsive parenting. This reduces stimulation and interaction with children and so influences children’s development (Global Education Monitoring Report Team 2018; Palamaro et al. 2012). The displacement period also imposes additional challenges on the developing brain, making it susceptible to malnutrition, and a dearth of cognitive stimulation and affectionate interactions (The Science of Early Childhood Development 2015), loss of environment, or disruption of routines (UNESCO 2018).. The disruption of social structures and loss of immediate environments, such as the community, school, and friends (Center on the Developing Child 2015; Mak & Wieling 2022) is especially acute for refugee and internally displaced children, as displacement itself is often caused by sudden violence or conflict. This disruption can be even more severe and prolonged compared to poverty without displacement. While poverty can negatively impact all children, the experience of forced displacement adds another layer of stress and trauma for refugee and internally displaced children, further compounding their mental health and development (Bean, Eurelings-Bontekoe, and Spinhoven 2007; Fazel et al. 2012; Fazel & Betancourt 2018; Heptinstall et al. 2004; Porter & Haslam 2005; Reed et al. 2012). Finally, cultural, and linguistic challenges pose an additional barrier for refugee children. The need to integrate into new sociocultural and linguistic environments and learn new languages to be able to communicate with their peers (children) and access services (caregivers) can be disorienting and isolating, affecting their ability to form new relationships and integrate into communities. This contrasts with the experience of non-refugee children, who usually grow up in consistent cultural and 13 linguistic environments, aiding their socioemotional development and social integration (Al-Janaideh et al. 2023). The Nurturing Care Framework in Contexts of Fragility, Conflict, and Violence The Nurturing Care Framework (NCF) 5 has become a widely respected, research-informed, and holistic understanding of what is required in the optimal development of a child in the early years, including health, nutrition, security and safety, responsive caregiving, and opportunities for early learning. Although ECD interventions encompass a variety of areas including health and nutrition, this study pays particular attention to those designed with a pronounced focus on enhancing the socioemotional well-being of children and their caregivers in refugee and forced displacement contexts (see Box 1 for a definition of socioemotional well-being). 5 The Nurturing Care Framework for Early Childhood Development is a framework for helping children survive and thrive to transform health and human potential. It draws on state-of-the-art evidence on how early childhood development unfolds to set out the most effective policies and services that will help parents and caregivers provide nurturing care for infants and young children. It is designed to serve as a roadmap for action, helping mobilize a coalition of parents and caregivers, national governments, civil society groups, academics, the United Nations, the private sector, educational institutions, and service providers to ensure that every infant and young child gets the best start in life. https://nurturing-care.org/ncf-for-ecd 14 Box 1. Socioemotional Well-being Socioemotional well-being is a state characterized by positive emotions, positive relationships, and the ability to manage challenging emotions and situations. The components of socioemotional well- being for young children include: • Self-regulation: The ability to manage emotions and behaviors, such as calming oneself down when upset or staying focused on a task. Social competence: The ability to form and maintain positive relationships with others, such as making friends and sharing. • Emotional understanding: The ability to understand and respond to the emotions of others, such as empathy and compassion. Source: https://www.virtuallabschool.org/preschool/social-and-emotional-development/lesson-2 In World Bank operations, nurturing care interventions for ECD are strategically positioned within the Education; Health, Nutrition, and Population (HNP); and Social Protection (SP) operations. These interventions are critical in nurturing socioemotional well-being, which is fundamentally linked to educational attainment, health outcomes, and the broader construct of human capital. By fostering socioemotional skills such as resilience, empathy, and cooperation from an early age, ECD programs lay a foundation for lifelong learning and adaptability, which are essential for success in an ever- evolving global economy. In SP, the initiatives are designed to provide support to the most vulnerable populations, including young children and their families by creating safety nets and programs that promote access to basic needs and services. By doing so, SP interventions help to ensure that children grow up in environments conducive to their physical, cognitive, and socioemotional development. In HNP, ECD interventions support the holistic development of children, ensuring they reach their full physical and mental potential. Education sector projects with ECD interventions, on the other hand, provide structured early childhood education (ECE), where children can engage in play-based learning, which is crucial for reinforcing the socioemotional skills developed through early stimulation. ECE is instrumental in preparing children for the transition to formal schooling, where socioemotional competencies become the basis for academic success and positive peer interactions. This comprehensive approach to human capital development in line with the NCF is vital for equipping future generations with the tools necessary to thrive and contribute to sustainable, inclusive economic growth. 15 When applied in contexts of fragility, conflict, and violence (FCV), nurturing care interventions need to be adapted to address the unique realities as well as challenges of these environments. In this paper we propose a version of the NCF that is further adapted to the psychosocial and socioemotional needs of children and caregivers who have undergone trauma and adversity through forced displacement and other conflict-related experiences. We reviewed existing evidence and conducted expert interviews on promising interventions aligned with the NCF domains, emphasizing these aspects. Table 1, informed by the research of Ereky-Stevens, Siraj and Kong (2022), details the application of the NCF in FCV contexts and how this application differs compared to non-FCV (normal) contexts. It highlights that while the domains of nurturing care remain the same, the approach to supporting these domains differs in FCV contexts. In non-FCV contexts, the focus is on providing an enriching environment for cognitive, emotional, and social development. However, in FCV contexts, the priority shifts toward creating a safe and stable environment that can help children recover and adapt after traumatic experiences. This includes the provision of psychosocial support and mental health care. Similarly, educational strategies in non-FCV contexts emphasize playful learning, language development, and socialization, while in FCV contexts these strategies are adapted to be more flexible and trauma sensitive. They may include activities that foster resilience, emotion management, and trauma recovery. Caregivers in non-FCV contexts receive general training in child development and educational techniques, while caregivers in FCV contexts require specific training on how to manage stress and trauma, both in themselves and in children. Additionally, the resources and materials used in non-FCV contexts are more focused on learning and development, while in FCV contexts there is a greater need for basic resources that help create a safe and comforting environment and help children in processing their experiences. Table 1 provides a comparative overview to elucidate the distinct approaches needed for nurturing care in different contexts. This is important for stakeholders involved in program design and implementation, as it informs the development of context-specific interventions that can effectively address the psychosocial and educational needs of children affected by conflict and instability. 16 Table 1. Comparative Overview of Nurturing Care Framework in FCV and Non-FCV/ Normal Context Approaches Non-FCV/normal context FCV context General Focuses on providing an enriching Prioritizes creating a safe and stable environment for cognitive, environment that can help children recover emotional, and social development. and adapt after traumatic experiences. This includes psychosocial support and mental health care. Educational Educational strategies focus on Strategies are adapted to be more flexible strategies playful learning, language and trauma sensitive. They may include development, and socialization. activities that foster resilience, emotion management, and trauma recovery. Training and Caregivers receive general training Caregivers need specific training on how to support for in child development and manage stress and trauma, both in caregivers educational techniques. themselves and in children. This may include techniques for emotional and psychological support. Resources and Educational resources and Resources may need to be more basic and materials materials are more focused on focused on creating a safe and comforting learning and development. environment. There may be a greater need for materials that help children process their experiences. Source: Original compilation based on Ereky-Stevens, Siraj, and Kong 2022. Enhancing Socioemotional and Psychosocial Well-being through ECD Programs in Forced Displacement Settings Socioemotional well-being is a crucial aspect of ECD, encompassing a child’s ability to manage emotions, build relationships, and make responsible decisions. ECD programs are vital in fostering these essential skills, laying the foundation for lifelong success (Ferreira et al. 2021). By providing nurturing environments, engaging activities, and responsive interactions, ECD programs can help children develop self-awareness, self-regulation, empathy, and social competence. These skills enable children to navigate challenges, build healthy relationships, and approach learning with confidence (Housman 2017). THE IMPERATIVE OF EARLY CHILDHOOD DEVELOPMENT (ECD) ECD programs in forcibly displaced environments can buffer and protect children and their caregivers from the impacts of adverse situations they may face. There is a critical opportunity to address mental 17 health challenges through the promotion of resilience and the prevention of the onset of these symptoms. A fundamental approach lies in attending to the socioemotional and psychosocial abilities of refugee children, which can provide them with the necessary tools to adapt and thrive in their new lives. Studies suggest that socioemotional abilities, such as emotional regulation, empathy, and optimism, can serve as protective factors, helping refugee children better cope with pre-migratory adversities and promoting better mental well-being. The loss of hope can result from war, conflict, and displacement. Programs that promote optimism have proven to be a robust moderator of the link between pre-migratory adversity and the mental health of refugee children, protecting them from the harmful effects of such adversities (Al-Janaideh et al. 2023). These interventions can include access to quality education, health care, and social services, as well as instruction to enable parents to understand the needs and behaviors of their children including skills for self-regulation and problem-solving. They also include improving the parent-child relationship, emphasizing child-led play, and promoting nonviolent discipline. It is also important to provide economic support to caregivers, so that they can provide their children with the best possible care (Dinarte-Díaz & Cuartas 2023; UNESCO 2018). Despite this evidence, interventions aimed at early childhood development are not commonly integrated or implemented within refugee and displacement contexts to enhance children’s developmental outcomes. Furthermore, the socioemotional well-being of children and their caregivers is sometimes an afterthought, particularly in fragile and conflict-affected environments and among forcibly displaced populations who are already considered a burden by many of the states and communities that host them. Many states consider that funding ECD and other interventions to support refugees, given that they are another country’s nationals, is not their responsibility. Additionally, governments in FCV contexts often face the challenge of competing sectors’ needs, and ECD is not often recognized as important. Family-centric approaches to ECD There is evidence supporting the theory that positive parenting skills coupled with strong family cohesion and support are associated with improved mental health in young children (Taylor & Kaplan 2023). Integrated programs can help to address multiple risks in one setting, pooling resources and maximizing contact points with families. In humanitarian settings, psychosocial interventions can be integrated into early childhood health and development services to support maternal mental health. 18 By adopting a nurturing care approach, practitioners can holistically engage with families by providing resources that address both children's needs and caregiver's well-being. This comprehensive approach involves prioritizing caregivers’ mental health from pregnancy onward, employing a range of interventions such as community-based support by peer and lay counselors (WHO 2020). Ereky-Stevens et al. (2022) identify three crucial areas of focus needed in psychosocial and socioemotional programs aimed at refugee children: (1) implementation of stable and clear structures is essential to counteract instability, trauma, and conflict, providing a safe and predictable learning environment that fosters a sense of normality and control; (2) pedagogical strategies that offer children meaningful opportunities to express and process their emotions, particularly through playful and artistic activities, which are vital for emotional understanding and management; and (3) educational interventions that are trauma-informed, focusing on developing children's self-confidence and resilience and promoting emotional regulation skills and the building of trust-based interpersonal relationships (Ereky-Stevens, Siraj and Kong 2022). Balancing ECD needs with investment The evidence underscores the vital importance of ECD programs, which assist refugee children in regulating their emotions and forming relationships, allowing them to cope with the stress, anxiety, and hardships of displacement while also building a brighter future for themselves by improving caregivers’ well-being, supporting families (Global Education Monitoring Report Team 2018; Dinarte- Diaz and Cuartas 2023). However, despite the plain benefits of ECD programs, the investment is insignificant. As of 2017, only 3.3 % of total development aid funds were distributed to ECD programs in refugee settings (Moving Minds Alliance 2020). As mentioned, earlier, there is limited engagement by governments, particularly in FCV contexts where other sectors that are considered of higher priority take the lead. In addition, while there is plenty of evidence available on ECD programs, the knowledge is still nascent on the effects these programs have on children and their families in refugee and forced displacement settings. One of the main findings of the World Bank and UN Joint Data Center’s second research conference on forced displacement, held in January 2022, was that there is limited research on children in refugee and forced displacement settings (World Bank, Joint Data Center on Forced Displacement, & UNHCR 2022). Besides the existing information gap, the prioritization of ECD programs as a vital part of interventions has not been achieved, especially concerning the mental health of caregivers and 19 children. Most of these programs do not intentionally address mental health, and few focus on this aspect in the refugee context. This is particularly concerning given that studies on older children, focusing on mental health interventions, are more abundant, while the unique needs of younger children in crisis situations are often overlooked (Murphy et al. 2018). Additionally, the gray literature, consisting of descriptive accounts, provides insights into various models but leaves a chasm when it comes to their evaluative impact (Murphy et al. 2018). 20 II. Methodology Aiming to figure out the effects of ECD programs on the socioemotional well-being of children and caregivers in refugee and forced displacement settings globally, we executed a meticulous evidence review. Initially, to guide our data collection and literature synthesis, we developed a database worksheet and a semi-structured interview guide, based on the research questions and objectives, which aided us in extracting relevant information from literature and interviews with key informants. Literature Search A rigorous literature search was conducted to find primary studies reporting on ECD interventions in the context of refugee and forced displacement settings and their effect on children’s and their caregivers’ socioemotional wellbeing. The review process, also illustrated in Figure 1, involved the following steps. 1. Developing and applying a Research Framework and search strategy: Pertinent keywords were identified, and then a search query was executed, thus: “Early Childhood Development” OR “preschool education” OR “maternal mental health” AND “Refugees” OR “Displaced Persons” OR “forced migration” OR “humanitarian crisis” AND “emotions” OR “psychosocial” OR “resilience” OR “trauma” OR “coping”. 2. Literature search: We searched multiple databases (Google Scholar, PubMed, MEDLINE, and Cochrane) for relevant literature on the effectiveness of ECD interventions in refugee and forced displacement settings. We limited our search to peer-reviewed academic journals and empirical research published between 2013 and 2023. We also prioritized studies that employed a control group, before-and-after designs, clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews. 3. Gray literature search: A supplementary search was done to find relevant gray literature, aiming to find information not published in traditional academic journals. Reports from international and local developmental partner organizations, including the World Bank library, were reviewed to understand the current state of ECD interventions in refugee and displacement scenarios and their consequential psychosocial ramifications. 4. Article selection: We selected studies for in-depth review based on the following criteria: (1) Relevance to our topic and objective, including the target population (children below age 8 21 and caregivers; (2) Clarity of research design and methods (quantitative, qualitative, or mixed); and (3) Year of publication (studies published between 2013 and 2023). 5. Final selection: We selected 44 full-text articles for in-depth review by the two lead investigators. Of these, 15 articles (including four from the gray literature) investigated the effectiveness of ECD interventions in refugee and forced displacement settings and were selected for narrative synthesis. 22 Identification Records identified through Additional records identified through other database searching (4,120) sources (WB library, organization websites,) (N=96) Screening Total titles and abstracts In PUBMED, MEDLINE (N=367) reviewed/screened (N=3,849) Excluded (Filters applied: Clinical Trial, Meta-Analysis, Randomized Controlled Trial, Review, Systematic Review, publications between 2013- 2023) Records excluded by relevance for the research questions and objective (N=3,805) Full-text articles assessed for Eligibility eligibility (N=44) Full-text articles excluded (N=27) (n=20: not relevant design (n=7): not focused on RFD population (n=2): included in the background Documents included in narrative narratives synthesis (N=15) Included Figure 1. Flowchart of Study Selection 23 Key Informants’ Interviews The key informant interviews (KIIs) were conducted with fifteen selected global experts (from twelve organizations) who specialized in ECD interventions in forced displacement contexts and were audio- recorded and transcribed verbatim. The selection of key informants for interviews involved a systematic approach, starting with a list of potential key informants generated through recommendations from the research team and guided by the following rationale: • Key informants were chosen based on their recognized expertise and experience in the field related to our research question. • To capture a wide range of insights, they were selected to represent a diversity of perspectives, including different geographical regions and organizations (e.g., the UN, international organizations, academia, and international NGOs). • Snowball Sampling was used: First key informants were asked to recommend other potential informants who met our criteria, allowing us to use their networks to identify additional sources of valuable information. The key informants complemented the literature review, providing valuable insights on emerging trends in the field and recommendations for future research and practices, which collectively enriched our understanding of the effect of ECD programs on the socioemotional well-being of children and caregivers in refugee and forced displacement settings. The following outlines the step-by-step procedure. Interview Guide Development We developed a semi-structured interview guide to guide the key informants (see Appendix B). The interview guide was developed based on the research questions and objectives, and it included open- ended questions to elicit the experts' insights on the effects of ECD programs on the socioemotional well-being of children and caregivers in refugee and forced displacement settings. 24 Qualitative Analysis for the Key Informant Interviews For the analysis of the interviews, the approach of structural discourse analysis 6 was adopted. To organize the discourses, questions were classified into broader categories (discussed next) and Excel spreadsheets were used to associate the responses with the corresponding categories. The interviewees were divided into four distinct categories: academics and researchers (3 interviews), participants from international organizations of the United Nations (3), representatives of international NGOs (7 participants), and representatives of the World Bank (2). Subsequently, subcategories were generated within each main category, and Squat 5 software was used for the creation of conceptual maps. This allowed for the grouping of words and ideas within each subcategory, and later, comparative tables were developed to identify points of convergence and divergence among the subcategories. These comparative tables served as a fundamental tool for the drafting of the document, allowing for a structured and detailed presentation of the findings. This methodological process not only facilitated the organization of the collected data but also provided a foundation for qualitative analysis, reflecting how different perspectives and experiences contribute to the global understanding of the socioemotional well-being of forcibly displaced children and their caregivers. 6 Discourse analysis (DA) is a broad term for various qualitative methods that explore the structure and expression of language within its social and cultural context. It looks at the linguistic content (what's said) and language use (how it's used) in each text to convey meaning in different social settings. 25 III. Findings “We are born with the tendency to empathize, but we need to nurture, to create much more empathetic, loving, and understanding social human beings who socially engage.” Interview with an international organization, September 2023. A synthesis of 15 scholarly works, including one meta-analyses, two systematic reviews, and 12 interventional studies (eight on caregivers and four on children) including randomized controlled trials (RCTs), longitudinal research, impact evaluations, and pilot studies, published from 2013 to 2023, was undertaken to explore the impact of early childhood development (ECD) interventions on the socio- emotional well-being of refugee and forcibly displaced children and their caregivers (see Appendix A for a table summarizing the articles reviewed). The majority of the studies were carried out in refugee camps and in refugee host communities in various regions of the world including the Middle East (Jordan, Lebanon), East Africa region (Uganda), East and Southeast Asia (Bangladesh, Thailand), Eastern and Western Europe (Ukraine, Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland). Refugee families were originally from Bosnia and Herzegovina, Burundi, Central African Republic (CAR), Ukraine, the Democratic Republic of Congo, Jordan, Kenya, Myanmar, Lebanon, Rwanda, Senegal, South Sudan, Somalia, and Syria. ECD interventions evaluated in the interventional studies were either targeting the caregivers/parents or the child. The results from the literature review and KIIs are presented below under the following three sections: • Findings from scope review and overall key informant interviews on the effect of ECD interventions on the socioemotional and psychosocial wellbeing of forcibly displaced children and their caregivers. • Results from interventional studies on the effectiveness of ECD interventions for the socioemotional and psychosocial well-being of forcibly displaced children and their caregivers. • Challenges and opportunities for ECD in FCV and forced displacement settings. 26 Findings from Scope Review This section provides a comprehensive synthesis of findings from key informant interviews and three systematic reviews of the literature that has analyzed interventions in the field and the different approaches to implementing ECD programs in forced displacement and conflict-affected settings. FINDINGS OF STUDIES ON ECD PROGRAMS IN FORCED DISPLACEMENT CONTEXTS The following three studies employed a mixed-methodology approach, combining interviews with a thorough review of literature on quantitative interventions. This includes an examination of quasi- experimental designs and randomized controlled trials. The first study, “Implementation Research on Early Childhood Development Programming in Humanitarian Contexts,” by Murphy et al. (2018), focused on offering psychosocial support to caregivers for better early developmental outcomes and reached four major findings: 1. There is a notable scarcity of impact evaluation studies, specifically studies that delve into the implementation of such programs, and this highlights an insufficient collection and analysis of implementation data. 2. Existing evaluations focus on providing psychosocial support to caregivers, suggesting a model where the stress and mental health of caregivers, influenced by conflict situations, directly affect the quality of parenting and, so the outcomes of child development. 3. There is significantly more attention given to mental health interventions aimed at older children and adolescents, leaving a gap in interventions designed to strengthen the ability of caregivers to provide nurturing care to the youngest. 4. The potential of mental health interventions as promising strategies to improve caregivers’ capacity is recognized, emphasizing the need to develop and systematize mechanisms for evaluating the implementation of these programs (Murphy et al. 2018). The second study, “A Critical Review of the Research Evidence on Early Childhood Education and Care in Refugee Contexts in Low- and Middle-Income Countries” (Stevens et al. 2023) aimed to evaluate ECEC programs’ accessibility, quality, and impact on young children in these refugee contexts and provides empirical evidence on effectiveness. The study highlights s five points: 27 1. The programs were found to have a positive impact on key areas of child development, such as cognition, literacy and numeracy skills, linguistic competencies, physical and motor development, hygiene practices, and socioemotional progress. 2. A crucial finding is the effectiveness of home-based provision models in mitigating common barriers to access, such as accessibility and space limitations, cultural and linguistic barriers, and security concerns, underlining these models’ ability to facilitate broader participation. 3. The findings emphasize the importance of adopting innovation pedagogical strategies such as play-based learning and holistic approaches to basic needs, promoting comprehensive child development. 4. Community and family engagement play a vital role, and culturally sensitive practices are also important as well, in addition to promoting continuous professional development among ECEC staff. 5. Finally, in addressing methodological challenges in research on ECEC in these contexts, the study points out the critical need to establish trustful relationships with refugee communities for data collection and for further, detailed longitudinal studies (Stevens et al. 2023). The third study, The Aftermath of War: Improving Psychosocial Measures to Address Trauma in Child Refugees in the Schengen Zone (Meyyappan 2018) found that structured psychosocial programs, with cultural competence, recognition of resilience, and fostering a welcoming environment for refugee children’s programs, particularly those emphasizing language and education, play an important role in normalizing the situation for refugee children. Overall, the study emphasizes the importance of providing comprehensive and tailored mental health services to address the specific issues that refugee children encounter, such as integration into their new environment (Meyyappan 2018). This is important for normalizing the situation for refugee children because these structured programs offer consistent and reliable support, which helps mitigate the instability they have experienced. Collectively, the three studies highlighted the importance of psychosocial and socioemotional support in early childhood development programs, particularly in humanitarian contexts for forcibly displaced children and caregivers. These papers and the overall literature converge on the following themes: the need for culturally sensitive and tailored interventions, the importance of caregivers’ engagement in ECD programs, and the critical role of psychosocial support for both children and caregivers. Furthermore, all three papers point to the need for more longitudinal research to better understand and improve the effectiveness of ECD programs. 28 Table 2. Scope Review of ECD Programs or Interventions Focused on Forcibly Displaced Caregivers No Author and date Title of study Country Study Sample /Target Result Design group 1 Katie Maeve “Implementation Studies Mixed Implementation The research highlights the importance of Murphy, research for early from Bosnia, method: research for ECD psychosocial support for caregivers to improve early Hirokazu childhood development South literature programming child development (ECD) outcomes in humanitarian Yoshikawa, and programming in Sudan, review and (targeting settings. It notes a lack of focus on young children's Alice J. Wuermli humanitarian contexts” Lebanon, interviews children 0–8) in mental health and suggests that interventions and Uganda with experts humanitarian targeting caregiver mental health could enhance 2018 settings ECD. The study calls for detailed assessments of ECD program implementation to better understand their effectiveness in these environments. 2 Katharina Ereky- “A critical review of the Low- and Mixed Refugee children ECEC programs can have a positive impact on the Stevens, Iram research evidence on middle- method: at preschool age well-being and developmental outcomes of refugee Siraj, Kimberley early childhood income Academic in LMICs children. The most effective ECEC programs are Kong education and care in countries literature those that are culturally responsive and that refugee contexts in low- (LMICs) search, gray consider the specific needs of refugee children and 2022 and middle-income literature, families. ECEC programs should be play-based and countries.” interviews should focus on socioemotional development. ECEC with experts programs should be delivered by trained and qualified staff. 3 Nivedha The Aftermath of War: Schengen Mixed Child refugees in Improving consolidation of psychosocial programs Meyyappan Improving Psychosocial Zone method: the Schengen and focusing on education are important. Having Measures to Address literature zone suffering greater cultural awareness when working with 2018 Trauma in Child review and from war trauma children is crucial, and so is acknowledging the Refugees in the interviews resilience of children when addressing trauma. Schengen Zone with experts 29 Results From Interventional Studies “Families leaving the program have told us about how on their onward journeys, they have sung songs together, played games together and held the safe space within them. That has given them resource and resilience on their onward journeys.” (Interview, international NGO, August 2023) Eight programs aimed at parents or caregivers were identified. Of these: two were focused on maternal mental health, contributing to the overall well-being of both women and children by using the MOCEP7 methodology; one was a home-based program offered psychosocial support sessions to mothers by trained psychologists, covering key areas of ECD such as nutrition, education, and cognitive development; (3) four provided psychosocial support along with key ECD areas, one of which was the only one that included both mothers and fathers while another used stress management through meditation techniques; and the eight program was a phone-based parenting program that offered information on key ECD and psychosocial support to caregivers. Below are detailed the most important conclusions found in the literature review, according to the two basic types of intervention: those centered on caregivers and those focused on children. This division is made because the evidence consistently highlighted the importance of programs that equip caregivers with necessary parenting skills and address their mental health as a crucial component in the ECD framework, ensuring the socioemotional well-being of children. For more comprehensive details of the reviewed studies, please refer to Appendix A and Table 4, which list the interventions for caregivers. The interventions and programs are listed as they were identified in the bibliographic review conducted, not in any specific order. INTERVENTIONS FOCUSED ON FORCIBLY DISPLACED CAREGIVERS A randomized controlled trial in Lebanon with 480 caregivers from Syrian refugee families who provided a series of nine preventive sessions of the Caregiver Support Intervention (CSI) 8 program by War Child 7 MOCEP was implemented in 25 sessions through group meetings that each lasted approximately 3 hours. The core curriculum includes child development, the importance of play in development, parenting practices, health and hygiene, and maternal empowerment. The program combines lectures, practical demonstrations, and assignments to be completed in the home. The group meetings are the Mother Support Program (MSP) component of MOCEP, whereas the second component, the Cognitive Training Program (CTP), provides mothers with techniques to support several child development domains. Mothers were asked to implement CTP activities with their children at home. 8 Caregiver Support Intervention (CSI) is a nine-session preventive group intervention for primary caregivers of children aged 3–12 affected by armed conflict and forced migration. The CSI aims to strengthen parenting through 30 Holland resulted in a 17% reduction in harsh parenting and a 33% reduction in caregiver stress between September 2019 and December 2020. The effects were achieved despite a pandemic-related lockdown that impacted implementation, a severe economic crisis, and widespread social unrest. The study concluded that the CSI is a promising intervention for strengthening parenting in adversity, and that replication under less extreme conditions may more accurately demonstrate its full potential (Miller et al. 2022). In Bangladesh, a field study in Cox’s Bazar indicated that the community-based Parental Support Intervention offered to Rohingya refugee women by Action Against Hunger (AAH) significantly improved maternal mental health status and their self and childcare awareness. The maternal mental health support during the perinatal period (to reduce prenatal distress), including reinforcing maternal resources for childcare and maternal well-being through group support, helped to improve mothers’ self-esteem and is also a key factor for good childcare, children's wellbeing, and early childhood development. The improvement was observed in almost all outcome measures of mental health and maternal and childcare knowledge, although the study design had some limitations, such as being a single-group pre- and post- evaluation study instead of a randomized controlled trial (RCT), meaning the researchers could not exclude other contextual variables that might have contributed to the observed changes in measures. Although the study cannot establish causality and may require further research to establish its causal effectiveness, the finding that the intervention is feasible to implement in a short duration and with limited resources makes it an important option to consider for mental health programming in humanitarian contexts, where resources are often scarce (Corna et al. 2019). A cross-sectional study with Syrian Mothers in Lebanon evaluated the role of perceived social support in promoting their psychological and parenting resilience or parenting behavior. Given the level of exposure to war trauma, the study found that perceived social support was associated with psychological and parental resilience among refugee mothers, even after controlling for other factors. Specifically, emotional support was found to be significantly associated with mothers’ psychological resilience. This suggests that emotional support, such as care and empathy, plays a crucial role in promoting better-than- expected mental health among refugee mothers (Sim et al. 2019). two pathways: (a) directly, by strengthening participants’ knowledge and skills related to evidence-based parenting methods that have strong cross-cultural support, and (b) indirectly, by improving the mental health and psychosocial well-being of caregivers. 31 One study delved into the execution and consequences of AÇEV’s Mother-Child Education Program (MOCEP) in Beirut, Lebanon, particularly within refugee and other underprivileged communities, utilizing a pilot RCT as its methodological approach. The MOCEP group intervention was formulated with the goal of alleviating stress and enhancing parenting strategies in these notably fragile and challenging contexts. Noteworthy outcomes were identified, including a reduction in stringent parenting practices and a decrease in parental stress among mothers in the intervention group despite a premature withdrawal from the study by 38% of families, for reasons including new employment (6%), program burden (5%), change in life circumstances (4%), illness of family member (4%), travel (4%), illness of the participant (1%), or no reason reported (2%). Nonetheless, there were no discernible positive impacts on the children’s emotional or behavioral outcomes. The study concludes that while MOCEP has exhibited a positive influence on disciplinary practices and parental stress, the breadth of effects on other outcomes may hinge upon program attendance and the accessibility of additional services (Ponguta et al. 2020). The phone-delivered Reach Up and Learn parenting support program, in Jordan, 9 offered Syrian and Jordanian families support, leading to reduced depression in caregivers. The way the program was delivered, with empathetic and nonjudgmental interactions from community health volunteers (CHVs), created a trusting relationship with families. This allowed the caregiver to feel comfortable in seeking help and receiving support, while CHVs’ provision of tailored support and resources also played a key role in this positive outcome (TIES for Children 2023c). A pilot study in refugee camps in Lebanon and Jordan with 125 Syrian parents offered group training to parents, aiming to improve their interactions with their children ages 3 to 6 years. After the program, parents reported a reduction in stress and improved mental well-being, as well as fewer behavioral problems in their children. However, the effect of the program diminished once it ended, suggesting that the benefits were not sustained in the long term. Additionally, the evaluation lacked a control group, limiting the ability to isolate and accurately measure the specific impact of the intervention (Lakkis et al. 2020). 9 Reach Up and Learn (RUL) focuses on caregivers of infants and toddlers and is based on a home visiting program originally implemented in 1986-87 in Jamaica that has since been adapted for Bangladesh, Colombia, India, Peru, and other contexts. In 2016, the International Rescue Committee (IRC), in collaboration with the Arab Resource Collective, further adapted RUL for Syrian refugee and host community families in Jordan, Lebanon, and Syria. From 2016 to early 2020, the IRC delivered RUL through in-person home visits with caregivers of children ages. 6 to 42 months in Jordan, Syria, and Lebanon, first as part of its child protection and health programming and later, in partnership with Sesame Workshop, as part of the Ahlan Simsim early childhood initiative. 32 In Bangladesh, a large-scale RCT investigated the Humanitarian Play Lab (HPL) intervention, aimed at refugee mothers and the comprehensive development of their children under age 2, through psychosocial education, parenting support, and play activities, provided weekly for a year. This multifaceted program proved successful in improving the mental health of mothers and children, while also significantly reducing the prevalence of stunting and wasting among the children and enhancing the socioemotional, physical, and cognitive development of the children following the intervention. Moreover, its low cost and the use of human resources from the refugee community make it highly scalable and attractive to policymakers (Islam et al. 2022). The Families Make the Difference parenting intervention conducted by the IRC for Syrian refugees showed that parenting interventions in humanitarian settings have the potential to reduce child psychosocial problems and caregivers’ mental health symptoms, in addition to reducing child maltreatment (Sim, Bowes and Gardner 2020). This parenting program focuses on directly teaching parenting skills, which can be useful for caregivers who have no access to strong social networks or who need additional guidance on how to care for themselves and their children. Overall, the studies presented above underlined that the interventions provided for caregivers have been shown to improve their mental health well-being and lead to better care for their children. Because these caregivers are often isolated and with disrupted social support, the group session is an opportunity to support one another; however, combining social support with targeted skill-building programs will be the ideal approach. The evidence from these studies highlights that in a stressful setting, addressing the underlying mental health of caregivers through support mechanisms might be an important first step. In addition, delivering the interventions with sensitivity to trauma and in a nonjudgmental way is crucial to get trust from the family, which will enhance their help seeking practice and receiving support, doing this has been shown to be effective in having a positive impact on the well-being of both caregivers and their children. Below is a table summarizing the programs and interventions that we found through our research that focus on forcibly displaced caregivers. 33 Table 3. ECD Programs and Interventions Focused on Forcibly Displaced Caregivers No. Country Study Design Sample Intervention design Implementing Outcome organization 1 Lebanon Randomized 480 caregivers CSI: nine preventive sessions for primary War Child No effects on parental warmth controlled from Syrian caregivers (Sep 2019–Dec 2020) focus on and responsiveness, trial (RCT) refugee caregiver well-being and stress management psychosocial well-being, stress, families techniques or stress management. Changes in caregiver well-being partially mediated the impact of this caregiver support initiative (CSI) on harsh parenting, accounting for 37% of the reduction in harsh parenting. 2 Bangladesh Post study 260 pregnant Psychosocial support group intervention for Action Maternal wellbeing and Rohingya pregnant women (3 months, Mar-Jun 2012). A Against childcare knowledge improved refugee group-based intervention, run twice a month, Hunger (AAH) significantly over the three women which allowed women to share feelings, fears, months of intervention. and thoughts about being pregnant and led Psychosocial intervention can be women to seek culturally and socially effective despite the chronic appropriate solutions. Women also received stressful conditions of the psychosocial care at home through home visits. refugees in the camps. 3 Lebanon Cross- 291 Syrian Evaluation of perceived social support (Aug International Mothers perceived social sectional refugee 2016–Mar 2017). Rescue support as associated with both study mothers Committee’s psychological and parenting MOCEP was implemented over 25 sessions (IRC) resilience. Emotional support, through group meetings that each lasted but not instrumental support, * approximately 3 hours. The core curriculum was associated with mothers’ includes child development, the importance of psychological resilience. Social play in development, parenting practices, support may have a promotive health and hygiene, and maternal effect on mothers’ mental empowerment. The program combines health and parenting behavior in lectures, practical demonstrations, and 34 assignments to be completed in the home. The a context of ongoing conflict and group meetings are the Mother Support displacement. Program (MSP) component of MOCEP, whereas *Instrumental support is when the second component, the Cognitive Training behaviors that directly help Program (CTP), provides mothers with those in need are performed. techniques to support several child development domains. Mothers were asked to implement CTP activities with their children at home. 4 Lebanon RCT 106 mother- Mother-Child Education Program (MOCEP): 25 Designed by Mothers in the intervention child dyads sessions (6-8 months, 2015) Mother Child group showed a reduction in from refugee Education their harsh parenting practices and other Foundation and in their level of parenting marginalized (AÇEV) in stress. communities Türkiye and implemented by local partners 5 Jordan RCT Syrian and Phone-delivered parenting program (6 months, International The analysis found no effects of Jordanian Nov 2020–Jan 2022) Rescue the addition of the Reach Up caregivers Committee’s and Learn ECD messages on (IRC) caregiver-reported parenting behaviors, child learning and development, caregiver anxiety symptoms, caregiver stress related to caregiving, or caregiver self-efficacy. The analysis did find a statistically significant, small reduction in caregiver depressive symptoms. 6 Lebanon Pilot cohort 125 Syrian Positive parenting intervention: 21 weekly This study is The intervention improved and Jordan study parents in sessions (16 on ECD + 5 on psychosocial part of the parenting practices and reduced refugee camps support) Health, distress and behavioral issues in 35 Education children ages 3 to 6, suggesting and benefits to parental well-being. Protection Further research is needed to Parenting assess long-term effects and Project adaptations for refugees and (HEPPP) marginalized groups. managed by Arab Resource Collective (ARC) in Lebanon in coordination with Plan International (PI) in Jordan. 7 Bangladesh Large scale 2,845 mother- Humanitarian Play Lab (HPL) intervention Bangladesh A multifaceted intervention in RCT child pairs targeting refugee mothers and their children's Rural refugee camps, offering (children under mental health and ECD through psychological Advancement psychological education, age 2) education, parenting support, and play Committee parenting aid, and play, activities (weekly for a year, from October 2019 (BRAC) significantly bolstered mental until September 2020) Bangladesh health in mothers and children, reduced child malnutrition, and enhanced overall child development. Costing just $45 per family, it is a scalable, low- cost solution for resource- limited settings. 36 8 Lebanon Impact 292 parents The Families Make the Difference program is a IRC Decrease in severe punishment evaluation and 88 children 10-session group parenting intervention, and rejection by parents; participated in manually developed by the IRC in 2014 to improvements in children's assessment address the specific challenges of families psychosocial problems; before and displaced by the war in Syria improvement in parental mental after a group- health and perceived social based support. These results should be parenting interpreted with caution due to intervention the lack of a control group and implemented validated norms for this by an NGO population. serving refugee and vulnerable Lebanese communities Source: Original compilation based on literature review. 37 ECD PROGRAMS AND INTERVENTIONS FOCUSED ON FORCIBLY DISPLACED CHILDREN In Lebanon, Ahlan Simsim’s Remote Early learning program (RELP) 10 was delivered by teachers in hard- to-access settings through WhatsApp in 20–30minute calls with caregivers who collaborated with Syrian (96%) and Lebanese (4%) children. The lessons related to cognitive and socioemotional learning as well as activities caregivers can do at home with children such as working with letters, colors, numbers, and shapes, observation skills, socioemotional skills, and health activities, like caring for children’s wellbeing. Teachers provided 1:1 follow-up call with the caregivers, as needed. The program showed improved language, numeracy, motor, and socioemotional skills of Syrian children. Notably, benefits were seen regardless of caregiver education or literacy. This highlights the potential of social media and mobile technology to reach many children and promote positive social-emotional learning in challenging settings (TIES for Children 2023a). Moreover, this evidence also indicated a reduction of caregiver reports of children being spanked in the previous month, when the RELP program was delivered in combination with Ahlan Simsim Families (ASF) 11, a parenting support program. The adaptation of the RELP program for remote delivery, flexibility in implementation, comprehensive caregiver involvement, and participation of teachers as well as the commitment of all involved despite challenges were keys to the success of the RELP program. Uganda and other countries. Two studies in the Rwamwanja Refugee Settlement, Uganda, and quasi- experimental research conducted in Ethiopia, Uganda, Iraq, Jordan, and Nepal assessed Child Friendly Space (CFS) 12. The studies indicate that high-quality CFSs can improve children’s psychosocial well-being and developmental assets. Though it is difficult to say definitively what elements of CFSs made them especially impactful, the study by Metzler et al. (2019) indicated that the impact was stronger for girls. The second study, by Hermosilla et al. (2019), was undertaken across multiple countries and revealed that CFSs have a positive impact for younger children (ages 6 to 11 years) but are less impactful for older children. Although these studies provide no detailed explanation for the observed differences in impact 10 Remote Early Learning Program: A learning program delivered by teachers through WhatsApp and phone calls with caregivers on lessons related to cognitive and social-emotional learning. 11 Ahlan Simsim Families: A modular and flexible program targeting caregivers of children 0 to 8 years. The program convenes groups of caregivers to discuss topics related to child development, play, and parenting, with tools and activities for follow-up. 12 Child-Friendly Spaces (CFSs) are safe places for children affected by emergencies, such as those in refugee settings, to play, learn, and receive psychosocial support. CFSs are designed to help children recover from trauma, continue their education, and feel a sense of normalcy. They also protect children from abuse, exploitation, and violence. between girls and boys or between younger and older children, we could hypothesize that the effect in girls relates to their different emotional and psychological needs. The activities and support provided in the CFS may have been more aligned with the needs of girls, offering a safer and more supportive environment compared to their daily experiences. Additionally, it is possible that girls were more likely to fully participate and benefit from these high-quality environments. In any case, this finding underscores the importance of considering gender when evaluating the effectiveness of psychosocial interventions, although further research is needed to fully understand why girls benefited more in this specific context. Thailand. In “Assessment of the Psychosocial Development of Children attending Nursery Schools in Karen Refugee Camps in Thailand,” Tanaka (2023) highlights the positive role of nursery schools in supporting the well-being of young children in refugee camps. The study revealed that children attending nursery schools showed better cooperative play and increased awareness of emotions compared to those not attending. It also highlighted that child attending for more than a year displayed greater improvement in cooperative play and emotional awareness. Further research could explore the specific mechanisms behind these benefits and tailor interventions to address potential challenges faced by different age groups and newcomers (Tanaka 2023). This study illustrates the potential of child-centered educational interventions to promote healthy psychosocial development in prolonged refugee situations. Summary. These studies collectively emphasize the importance of well-designed and culturally adapted interventions that address the holistic needs of children in refugee situations. They highlight the efficacy of providing safe and stimulating environments that support the psychosocial well-being and development of children affected by crises, while also underscoring the need for continued research to better understand the complexities of ECD in displacement and crisis contexts. The evidence suggests that such interventions are not only viable but essential to mitigate the negative impacts of forced displacement on early child development. Table 4 summarizes the programs and interventions discussed above focused on forcibly displaced children, providing addition detail. Table 4. ECD Programs and Interventions Focused on Forcibly Displaced Children* No. Country Study Design Sample Intervention design Implementing organization(s) Outcome 1 Lebanon Randomized Syrian refugee Remote Early Learning International Rescue Significant impact on child controlled trial (96%) Program (RELP) delivered Committee (IRC) in development outcomes (RCT) caregivers with alone and in combination partnership with Sesame 5–6-year-old with Ahlan Simsim Families Workshop as part of the children and 4% (ASF), a parenting support Ahlan Simsim initiative Lebanese program (11 weeks in mid- caregivers 2022) 2 Uganda Longitudinal Congolese Child Friendly Space World Vision Uganda and Attendance at CFSs, especially those study with refugee Interventions (CFSs) Save the Children in Uganda with higher-quality programming, quasi- children addressing the psychosocial supported children’s psychosocial experimental residing in well-being and well-being and development. design Rwamwanja developmental assets of Refugee children and adolescents. Settlement Baseline, endline (3–6 months later), and follow- up (18 months after baseline) assessments 3 Thailand Impact Two to five- Nursery school program Karen women’s organization Children who attended nursery evaluation year-old Karen addressing child with the support of an schools for more than a year were refugee development holistically, international NGO (not better at playing cooperatively with children in including physical, specified) other children and were more aware nursery schools cognitive, and psychosocial of their own and others’ feelings. domains. The program Children who were newer to the offered a safe place, nursery schools were more polite and nutritious meals, good better at following rules and hygiene practices, and a controlling their feelings when child-centered curriculum frustrated. Overall, the nursery schools can be a promising practice to promote healthy psychosocial development of children in protracted refugee situations 4 Ethiopia, Quasi- 1,010 children Child Friendly Spaces (CFS) Columbia University; World This study found that Child Friendly Uganda, experimental and 1,312 impact evaluation on Vision International; Save the Spaces (CFS) modestly improve Iraq, research caregivers in protection concerns, Children; UNICEF; and other psychosocial well-being in children Jordan, design humanitarian psychosocial well-being, members of the Child ages 6–11 but are less effective for Nepal populations developmental assets, and Protection Working Group of those ages 12–17 and do not enhance community resources the UN Protection Cluster community resource connections. It among children and suggests the need for tailored and caregivers (baseline and monitored CFS programs to better endline evaluations 3 to 6 serve children in humanitarian crises. months after baseline) *Original compilations are based on the literature review. Findings from Interviews This section presents the most relevant findings from interviews conducted with key informants working in the field of ECD in FCV contexts. The findings are summarized under two headings: (1) investing in ECD in FCV; (2) approaches adopted by different organizations. INVESTING IN ECD IN FCV Key informants from a variety of organizations emphasized the importance of ECD interventions for forcibly displaced children and their families. Benefits they cited include improved child development, school readiness, reduced behavioral problems, strengthened parent-child relationships, and improved mental health of caregivers and children. They agreed that ECD interventions should be culturally sensitive, and trauma informed. All the key informants indicated that investment in child development/ECD in FCV settings is crucial as emergencies are less conducive for development. They reported engaging in various ECD projects, from community engagement to policy advocacy, focusing on creating nurturing care frameworks, addressing trauma, and ensuring high-quality education, while being responsive to the urgent needs caused by war and displacement. Informants also noted the importance of integrating ECD within broader humanitarian services, focusing on holistic development including socioemotional well-being through play and support for families and caregivers to develop health, nutrition, and ECD-related skills with both remote and in-person approaches. The importance of holistic interventions or targeting all nurturing care components was also highlighted: “Providing early childhood development (ECD) interventions in refugee and forced displacement settings is important. The nurturing care components, such as good health, nutrition, safety, security, and early learning opportunities are important in this setting.”—Interview, UNICEF, August 2023 “The concept of nurturing care is supported by evidence that if you conduct these interventions, it has an impact on children's development in multiple domains.”—Interview, World Health Organization, October 2023 APPROACHES ADOPTED BY DIFFERENT ORGANIZATIONS The World Health Organization (WHO) emphasized a holistic, step-by-step approach to addressing the basic needs and psychosocial well-being of caregivers and children in emergency or protracted displacement situations. This approach starts with fulfilling essential needs like health, nutrition, and safety, emphasizing the importance of providing a safe environment and mitigating stressors for both caregivers and children. As the situation stabilizes, services promoting psychosocial support, early learning, and responsive caregiving are systematically implemented. This approach reflects a progression from addressing immediate needs to establishing comprehensive long-term services for the development and well-being of children and caregivers: “An integrated approach to well-being in crisis situations focuses on providing basic services such as health, nutrition, and safety, supporting caregivers and children through trauma, and offering tools and strategies for effective childcare. This approach aims to meet immediate physical needs while also strengthening emotional and psychosocial well-being, crucial for enhancing the relationship between parents and children in adverse contexts by offering stability, security, and skills for managing difficult situations.” —Interview, WHO, August 2023. The ECD interventions implemented by WHO and UNICEF in refugee and displacement settings focus on health, nutrition, safety, and early learning opportunities. WHO uses remote models and home visits to support caregivers in developing heathy and nutritious behaviors, while UNICEF emphasizes the importance of these interventions in emergencies to mitigate toxic stress affecting child development. Both organizations combine specific parenting and stress mitigation intervention with protective measures like nutrition through the nurturing care approach. A researcher for Tamales University, South Africa, who is also a consultant for the World Bank´s “Read at Home” initiative, has developed and implemented a shared reading intervention in high-violence settings such as Cape Town. Through this intervention, which focused on improving caregiver sensitivity toward their children and reducing harsh parenting practices, improvements were observed in children’s language development and behavior, as well as some progress in their socioemotional development. Another researcher involved in child development interventions in refugee and forced displacement contexts, has observed that in humanitarian crisis contexts, parents experience a profound sense of loss of control due to the chaotic and stressful circumstances surrounding them. This feeling of helplessness can severely impact their ability to effective care for their children. To address this challenge, this expert is implementing psychosocial support interventions that help parents reconnect with their children and regain a sense of control amidst the chaos. By providing them with guidance and concrete strategies, parents learn practical ways to show love and care for their children, which not only improves the parent-child relationship but also mitigates some of the negative effects of stress and uncertainty. As the consultant points out: “When you are supported through a psychosocial support intervention…you can say, no, there are still things you can do, even in these circumstances.”—Interview, Academic sector, August 2023. One expert, who works in Colombia, has been directly involved in the development of support programs for displaced families in a context of armed conflict and poverty. His work on the Semilla de Apego program (meaning ‘seed of attachment” in English) focuses on psychosocial support for caregivers, addressing the effects of displacement and supporting the mental health and emotional well-being of both children and their families. He highlighted the importance of the program’s interventions that specifically address psychosocial trauma while also working to rebuild social cohesion in group activities that renew ties among community members. He explained how this was highly effective in enhancing the resilience and well-being of displaced families. The informant from BRAC has developed play-based interventions in Bangladesh that integrate mental health into ECD, with a strong emphasis on co-creation with local communities. The expert explained that the program has designed a monthly home visit model where play is used not only as a learning tool but also as a crucial component for the social and emotional development of children and their parents. This approach includes direct collaboration with communities to adapt programs to their specific needs, promoting the mental well- being of parents and strengthening families’ relationships through play and interaction. In addition, one of the academics who worked with WHO explained that she uses educational tools to engage parents and children in south Africa, expanding the content to support caregiver mental health as part of a WHO-endorsed intervention package. Her approach includes book-based activities that promote positive parenting, and she has expanded the program to include specific content that helps caregivers manage stress and difficult emotions. “What the intervention does quite nicely is [to] use the book activities as an avenue to promote positive parenting.”—Interview, Academic sector, August 2023. The “Play to Learn” program, supported by the LEGO Foundation, utilized videos to cover various development topics, adaptable to different curricula in different country (Lebanon, Bangladesh, Uganda, and Ethiopia). This approach focuses on inclusivity, feasibility in low-connectivity areas, and the use of support materials including projectors and tablets. Additionally, they are piloting the program in various regions to assess content adaptability and effectiveness in different settings. A key point is the integration of ECD with broader humanitarian services, focusing on holistic development through play. The Baytna (meaning 'our home' in Arabic) program by Amna in Greece for refugee families, takes a whole- family approach, considering potential trauma without assuming universal trauma in displaced families. It emphasizes the varied identities of participants and the impact of trauma on the family unit. Baytna works with families and caregivers to develop knowledge, attitudes, and skills related to health, nutrition, and ECD-related behaviors. This approach helps caregivers better manage children´s emotional, improving attunement and responsiveness to their needs: “Parents have also shared with us how have helpful the programs have been for them because they have acquired tools on how to really be there and support in regulating manner their children when they feel overwhelmed.”—AMNA, interview, June 2023 The International Rescue Committee’s (IRC) major intervention is at the household level, especially for children ages zero to two years, aiming to empower parents and caregivers with the necessary skills and knowledge. The IRC uses remote models for message delivery and in-person household support. It also trains volunteers and facilitators for direct household engagement to foster development. The focus is on supporting parents and caregivers directly at home, emphasizing both remote and in-person education and stress management: “The program contributed to increasing a child´s play time, changing behavior in terms of vaccination and reducing hard discipline.”—IRC, interview, August 2023 In Poland, Fundacja Rozwoju Dzieci’s Spynka (FRD) (Foundation for Child Development in English) has responded to the emergency of refugees arriving in Poland by emphasizing ECD education and psychological support. Parents are supported through the adaptation process, which helps normalize their relationships with their children after trauma; children who have been exposed to trauma also have access to a supportive educational environment. The program focuses on creating nurturing care frameworks, addressing trauma, and ensuring high-quality education while being responsive to the urgent needs caused by war and displacement: “One of the studies shows that this socio-emotional development improved after one year [of] intervention because we provide remote service visit ECD Program.” FRD, interview, August 2023 “Play Matters,” supported by the LEGO Foundation, focuses on teachers’ professional development and learning through play. The Play Matters project spans multiple countries and educational systems, advocating for play-based learning at both the system and policy levels. One of the focuses of this project is to improve educational quality through the integration of play activities, involving the community, and adopting content to diverse linguistic and educational contexts: “We did learn form caregivers that they see the value of play for learning, but not for learning academic skills; they struggle to see the connection with academics (…) We trying to support parents to understand that play can also active learning.”—Interview, August 2023. Representatives from the World Bank and another group of academics demonstrated a strong interest in understanding the interaction between culture and parental practices. They emphasized the importance of designing interventions that are sensitive to cultural context and can effectively integrate into the local social fabric. In other words, it is important to understand how social norms and gender roles can affect the acceptance and success of interventions, particularly in terms of engaging male caregivers more effectively and adapting practices to meet the needs of diverse family structures. They noted that in some cases, before implementing an intervention it may be necessary to modify behaviors or increase the acceptance of these interventions. For example, in the interviews, the World Bank representatives noted an increase in stress among male caregivers because of an intervention, a finding that highlights the need to consider gender differences in response to psychosocial interventions. This perspective implies a more focused approach, recognizing that the context in which individuals operate can significantly alter their attitudes and behaviors. Understanding the specific circumstances and challenges faced by diverse groups allow for more tailored and effective interventions. For instance, male caregivers might experience unique stressors that differ from those of female caregivers, necessitating gender-sensitive strategies. Ignoring these contextual nuances can lead to interventions that inadvertently exacerbate stress or fail to address the core issues. Therefore, it is crucial to pay attention to these contextual factors to ensure that interventions are supportive and beneficial for all affected groups, ultimately leading to better outcomes in terms of mental health and overall well-being: “The intervention did not work in terms of reducing mental distress; in fact, it actually increased the stress of caregivers, which was driven by an increase in the stress of male caregivers.”—Interview, World Bank, August 2023. While all the key informants shared the common goal of improving socioemotional or psychosocial well-being in forcibly displaced children, they differed in their approach, methodologies, target populations, and specific expected outcomes in their programming. Some focused more on direct socioemotional and psychosocial support, for both children and caregivers, embedded within multisectoral programs, while others focused on behavior modification and education in parenting practices. These differences reflect the different areas of interest and the variety of modalities in which various actors integrate these elements into their programming. Tale 5 summarizes the approaches and methods mentioned by the key informants. It is important to note that what is discussed above and listed in the table represent only some of the aspects highlighted by the participants and neither is an exhaustive list. Table 5. Overview of Approaches and Methodologies of ECD Programs or Interventions with Refugees and Forcibly Displaced Populations Intervention Focus on socioemotional or Methodology Expected outcomes psychosocial well-being WHO and Combination of programs Multisectoral programs Improvement in children's UNICEF including social protection integrating psychosocial socioemotional support and social protection development Emotional and psychosocial Meeting physical needs and Emotional stability and crisis well-being in crisis situations integrated psychosocial management skills support Academic Mental health and recovery Therapeutic approach to Improvement in caregivers Sector from psychosocial traumas mental health and emotional and children's mental health well-being Sesame; Emotion management and Healing play approaches with Emotional resilience and AMNA; FRD; behavioral regulation children and caregivers to self-regulation in children LEGO promote emotional and caregivers Foundation; regulation and safety and Play strengthen caregiver-child Matters; bonds Ways of interacting and IRC; BRAC playing with their children, thus supporting child development, and strengthening the parent- child relationship, while also benefitting the parent´s mental health. Socioemotional impact Playful interventions for Emotional well-being and through educational play emotional development and development of education socioemotional skills World Bank Behavior modification and Education in parenting Change in behavior toward nonviolent parenting practices and extended positive parenting practices family support approaches Note: Original compilation is based on the key informant interviews. Amna; BRAC; FRD; IRC. Overall, as discussed in the section above on the adaptation of nurturing care for FCV or forced displacement contexts, the evidence we have gathered demonstrates that while ECD interventions can be an effective way to improve the psychosocial and socioemotional well-being of refugee children and their families, the interventions cannot simply be delivered the same way as they are in normal/non-FCV situations. Rather, they must be tailored to meet the forcibly displaced populations’ needs, and they should include psychosocial and socioemotional support for both children and caregivers as a core component of a holistic ECD program delivery. Challenges and Opportunities for ECD in Conflict, Fragile and Forced Displacement Settings Based on research and interviews with experts, several challenges, and opportunities in conducting ECD intervention in fragile, conflict-affected, and forced displacement settings were identified. RESOURCES AND FINANCING The primary difficulty identified by almost all the interviewees from international organizations, government agencies, NGOs, and academia are the scarcity of resources and financing for ECD initiatives in refugee and displacement contexts. Most participants raised the need for advocating for dedicated funding for comprehensive ECD interventions, and one participant mentioned the significance of direct funding to local NGOs and involving local communities in creating solutions, emphasizing the use of local knowledge and resources. Securing dedicated financing for ECD interventions is crucial, and there is a growing recognition of the early years' role. A significant opportunity lies in advocating for governments to prioritize and increase targeted funding that supports comprehensive ECD programs, particularly in contexts of rising displacement due to wars, climate crises, and other situations. This advocacy should aim to ensure that ECD becomes a central part of national and international agendas, enabling the development and implementation of government programs that are responsive to the specific needs of displaced populations and the communities they integrate into. ADHERENCE TO QUALITY OF IMPLEMENTATION AND MEASURING DEVELOPMENTAL OUTCOMES IN DISPLACED POPULATIONS The complexity and challenges in accurately measuring developmental outcomes in displaced populations were identified as significant difficulties. Ensuring adherence to the quality of implementation and effective progress monitoring is complicated by the inherent instability of these populations, who often face constant changes in their environment and living conditions. Additional factors, such as frequent mobility, lack of consistent records, and limited access to essential resources can hinder the collection of accurate and continuous data. Moreover, the diversity of tools used to measure different psychosocial aspects adds another layer of complexity, making it difficult to compare and standardize the same variables across different populations. These tools can vary in terms of focus, metrics, and cultural sensitivity, further complicating the development of a coherent and universal framework for evaluating psychosocial interventions in displacement contexts. An opportunity arising from this challenge is the use of technologies to improve access and the quality of ECD intervention. Mass media, including educational programs on radio broadcast and on digital platforms, as well as messaging apps can effectively connect families, reducing reliance on in-person services. While acknowledging the limited evidence of technology's effectiveness in maintaining program effects over time in challenging settings, informants still saw it as a valuable tool for reaching families and providing ongoing or additional support, though they recommended conducting research to assess its effectiveness. Moreover, some informants noted that scaling up efforts through government collaboration and online methods is a potential strategy. Some of the comments in this regard point out that technology not only facilitates the remote delivery of education and psychosocial support but also allows for reinforcement sessions that can help sustain the effects of interventions over time. Additionally, the capability of digital technologies to collect and analyze data in real time can significantly improve the monitoring and evaluation of programs, providing critical insights that can be used to continuously adapt and optimize interventions. However, it is essential to conduct further research to assess the effectiveness of these technologies in complex settings, ensuring that benefits are maximized while minimizing potential drawbacks such as the exclusion of those without access to advanced technologies: “Technology can help maintain program effects over time, despite limited evidence in challenging settings.”—Senior Researcher, August 24, 2023 A digital intervention targeting caregivers in El Salvador revealed that gender, economic status, and living with a partner significantly influenced effectiveness of the program. Men experienced increased stress and poorer interactions with children, especially if they were poorer or cohabitating. Women showed no major mental health shifts but reduced physical violence against children by 18%. These outcomes highlight the need to tailor interventions to the caregivers’ economic and cultural backgrounds (Amaral et al., 2021). SUSTAINABILITY OF THE INTERVENTIONS AND THEIR IMPACT Interview participants mentioned that sustaining intervention impacts in humanitarian settings is challenging due to the resources needed to support the intensity of the interventions and the restricted policies of the government to accept and institutionalize these services: “Sustaining the effects of interventions over time is a challenge, but continuity and support can help achieve long-term results.”—Interview, WHO, October 2023 Furthermore, few interventions primarily aim to have a long-term impact, which adds to the complexity and mobility challenges of working with these populations. Two senior researchers also highlighted that the effects of interventions tend to fade over time, especially without long-term follow-up due to funding limitations. Both suggested the need for “boosting” activities or additional sessions using technology to sustain the effect, as it is difficult to change behavior with short interventions: “A meta-analysis revealed that the effects tend to disappear after two years, so it is good to provide additional sessions after a year or so even using technology.”—Senior Researcher, September 27, 2023 It was also highlighted that embedding ECD programs into existing social service infrastructure, such as by leveraging strong conditional cash transfers to support child development programs, will play a key role in achieving program sustainability. An opportunity that may be derived from this challenge is to create safe and emotional supportive environments, which are essential in the context of refugee and forcibly displaced populations. This involves the development of child- and family-friendly spaces that not only encourage learning through play but also provide psychosocial support. The spaces should be designed as safe where children can explore, learn, and recover from adversities. Such environments are key to providing a stable and nurturing foundation that supports the overall well-being and development of individuals. SERVICE DELIVERY AND PSYCHOSOCIAL CARE IN HUMANITARIAN CONTEXTS AND THE LACK THEREOF. Another set of challenges includes the frequent oversight of the psychosocial dimension in humanitarian initiatives, a wide range of socioemotional and psychological issues such as elevated levels of stress, depression, anxiety, and in some cases, several types of violence, including domestic violence. As most humanitarian responses tend to concentrate on the delivery of water, sanitation, and hygiene (WASH) facilities along with food assistance, there is limited focus on the necessary psychosocial support. Lack of access to psychosocial services exacerbate socioemotional and psychological issues, leaving many individuals, including caregivers, without the support needed to cope with their circumstances, which can erode caregivers’ capacity to be present and engage effectively with their children. What is needed is to design approaches that improve the broader well-being of families, beyond teaching skills to manage emotions, for sustainable change. “We often focus a lot within interventions on the individual capacities of parents or caregivers, when there are often quite pervasive kind[s] of social and structural factors that affect their ability to engage in those kinds of interactions with children.”—Senior Researcher, August 24, 2023 An opportunity arising from this challenge is the integration of some services with those of the host community, and this was also seen to improve community relations through shared experiences and learning. The scalability of interventions delivered virtually was noted as an opportunity. One participant pointed out the importance of collaborating with government to ensure that interventions could be implemented on a national scale. “If we really want to implement something at the national level we need to work with the government.” —Interview, Economist, World Bank, August 2023 BALANCING CULTURAL INTEGRATION WITH PRESERVING CULTURAL IDENTITY Navigating the complex interplay between cultural assimilation and the preservation of cultural identity presents a significant challenge for refugees. They are tasked with learning the customs and language of the host community while trying to maintain their own traditions and languages. Effective intervention programs need to be carefully designed to facilitate this balance: they should enable refugees to properly integrate into their new environment without losing their cultural roots. This requires a flexible approach that not only deeply understands the cultural and social needs of refugees but also respects and integrates their cultural identities. A well-balanced approach not only promotes successful integration into the host community but also ensures the preservation of essential cultural ties, which is key to the overall efficacy and acceptability of the programs. An opportunity derived from this challenge is adopting strategic approaches that are flexible, incorporating various approaches, for example remote and in-person visits. This duality allows for broad and adaptive coverage that can be adjusted according to the immediate needs and access restriction of the target population. Utilizing technologies, such as phones, can enhance the delivery of educational contents and emotional support, allowing interventions to overcome geographical and socioeconomic barriers. Also, training, and empowering local facilitators and volunteers to implement these strategies ensures that the interventions will be relevant and respectful of cultural and social context of each community. THE IMPORTANT OF HOST COMMUNITY ENGAGEMENT Almost all key informants mentioned the importance of investing in the host community alongside those in camps as they often bear the brunt of an influx and require similar support and services. It was indicated that forcibly displaced people often end up in areas that already are underserved by the government. The governments cannot cover the basic needs of populations in countries that receive internally displaced people, and this is affecting the services delivered. It is important that there be financial support for the social cohesion of these communities so that they can live in harmony. This requires that both the host community and the displaced receive equitable investments in basic services such as health, education, and housing. Additionally, it is crucial to establish monitoring and evaluation mechanisms to quickly identify and address any signs of emerging tension or conflict. This will allow for adjustments in strategy and the implementation of preventive interventions, which could prevent resentment and inter-communal harms. “I'm just saying Bangladesh is one example where you have a country that deals with disasters every year and has an influx of 1,000,000 refugees coming into already a very populated area.” —International NGO, August 24, 2023 “The lesson from Lebanon was that as programs were put in place for people who were in camps, it was equally important also to invest in the host community and provide them with a similar type of support and services in order to improve their conditions.”—Interview, WHO, October 2023 One key informant highlighted the far-reaching effects of positive interventions for young children, emphasizing that the benefits extend beyond the immediate family to foster mature, empathetic, and resilient communities. These communities are better equipped to comprehend and adapt to changes, paving the way for long-term sustainability and peace. Such interventions contribute to the creation of more egalitarian societies, where the developmental gains of the youngest members have profound implications for the collective well-being and harmony of the community and country at large. “To prioritize young children is not only the right thing to do because it is their right. It is not only because science tells us to do so. It is not only because it is our conviction and it is not only because it is cost efficient and it is economically the smartest investment, but also because it has a radical impact on communities and countries.”—Interview, UNICEF, August 2023 It was also indicated by one of the senior researchers interviewed that the spillover effects of ECD programs on the host community are under-researched. This researcher emphasized the importance of community engagement in ECD programs and leveraging community resources and practices for positive spillover effects. A few key informants pointed out that certain programs not only serve refugees but also the host community by generating employment and opportunities for locals. This dual approach fosters mutual benefits for both local and refugee populations, thereby reducing tensions between them. These informants underscored the necessity for varied strategies aimed at integrating host and refugee communities, with a strong emphasis on inclusiveness and active participation. The interviews highlighted that humanitarian aid in refugee and forced displacement settings overlooks the critical needs of young children and this gap presents an opportunity for advocacy. So, advocating e for priority policies is essential, particularly when it comes to promoting ECD and supporting communities in crisis. Engaging with decision-makers to highlight the critical role of ECD within humanitarian responses is a key example of this advocacy in action. Doing so ensures that the needs of the youngest and most vulnerable are not overlooked during times of emergency. GOVERNMENT POLICIES AND RESTRICTIONS The adoption and institutionalization of ECD programs is significantly influenced by governmental policies and constraints. It was mentioned by the key informants those restrictive policies, such as restrictions on the right to work, prevent economic self-sufficiency and increase dependency on humanitarian aid. Refugees and displaced persons often face limited access to essential services such as health and education, and policies that confine them to living in designated camps, restricting their mobility and access to opportunities outside these spaces. In addition, lengthy and bureaucratic asylum processes can leave individuals in a legal limbo, while aggressive detention and deportation policies can result in their returning to contexts of persecution. It is important not to conflate barriers to accessing ECD services as a participant with barriers to the implementation of government-run ECD programs. The challenges in accessing ECD services include a lack of resources and support for displaced families, while barriers to the implementation of government ECD programs can include a lack of trained personnel and adequate resources in host countries. Furthermore, government managed ECD programs in host countries may not be designed to meet the specific needs of refugee communities, exacerbating the difficulties for these populations to effectively participate. Table 6 presents a summary of some of the implementation challenges and opportunities mentioned in the preceding discussion. Table 6. Challenges and Opportunities of ECD Intervention in FCV Contexts Category Challenge Opportunity Resources and Scarcity of resources and dedicated Securing dedicated financing for ECD Financing funding for sustaining ECD programs interventions and directing funds to local NGOs Government Restrictive policies that hinder the Collaborating with the government to Policies adoption and institutionalization of implement interventions on a national ECD services scale Quality and Difficulty ensuring quality Leveraging digital technologies to improve adherence implementation in transient access and quality of ECD interventions. populations Service delivery Psychosocial dimensions often Creating safe and emotionally supportive overlooked in humanitarian efforts environments for child and family development Target group Diversity of target groups complicating Adopting adaptive and culturally sensitive diversity program design approaches Cultural integration Difficulty balancing cultural integration Facilitating proper integration without with preserving cultural identity losing cultural roots Community Both addressing the needs of the host Advocating for priority policies that Engagement community and engaging caregivers promote early childhood development in preoccupied with survival crisis contexts Measuring Complexity in accurately measuring Using digital technologies to enhance Outcomes developmental outcomes in displaced monitoring and expanding socioemotional populations and educational care practices through digital technologies. Source: World Bank, original compilation based on key informant interviews. IV. Conclusion Many young children are impacted by situations of fragility, conflict, and forced displacement, which poses significant risks to their holistic development and socioemotional well-being and hampers the potential of caregivers to care for their children. This study reviewed a variety of evidence and conducted key informant interviews to explore the effect of ECD programs on the psychosocial and socioemotional well-being of forcibly displaced children and their caregivers and draws the following conclusions. The primary conclusion of this paper is that all the interventions examined are being conducted by an international organization or specialized international NGOs. The insufficient allocation of development aid resources, and the lack of government attention to ECD programs and specifically to the socioemotional well- being of young children and their caregivers, underscores not only the need for organizations like the World Bank to prioritize children in situations of FCV but also the importance of intensifying advocacy efforts with governments. Second, interventions that simultaneously address the needs of both caregivers and children tend to yield better outcomes in child development. Traditionally, it has been observed that providing caregivers with tools to manage stress or depression significantly improves their well-being; however, this improved well-being does not necessarily guarantee a direct positive influence on child development. Third, the need to implement programs that focus on the development of children. While these practices enhance the relationship between caregivers and children and enhance the ability to provide effective care, it is crucial to recognize that improving parental practices alone may not be sufficient to impact the cognitive and emotional development of children, especially in refugee contexts that present unique complexities and stressors. For this reason, in addition to interventions aimed at caregivers, it is vital to implement programs that focus directly on the development of children, such as pre-reading activities and games that promote socioemotional learning, motor skills, and so on. These programs have a direct and evident impact on the cognitive and physical growth of children. Given the reciprocal interaction between caregivers and children (where shared adversities can amplify challenging emotions and behaviors) it is imperative that interventions not only mitigate caregiver stress but also directly address the needs of the child. Fourth, interventions must include programs that are culturally sensitive for children and refugee families. Key informants highlighted that in many communities, discussing depression or mental health issues remain stigmatized. Additionally, the responsibility of childcare predominantly falls on mothers, placing an extra burden on their physical and mental health. In these scenarios, it is crucial to raise awareness about the importance of seeking help and to encourage male caregivers to participate in childcare. A World Bank specialist emphasized the need to research what elements a program should include to motivate male participation, for example. Some NGOs have already developed culturally adapted approaches, including context-specific parenting, healing practices, and other strategies. It is important to disseminate and systematize these approaches. As researchers in this study, we propose that this approach should encompass at least five fundamentals, though not exhaustive, components, that are delineated below under Section 5, recommendation on “Adopt Cultural Sensitivity Programs”. The fifth key conclusion is that trauma oriented and comprehensive ECD programs are needed, as forcibly displaced individuals go through potentially traumatizing situations that can affect their mental well-being, which inherently affect their ability to provide nurturing care for their children. As previously mentioned, being a refugee or displaced person involves facing a series of unique and often extremely difficult challenges that extend beyond adapting to a new culture or environment. Experiences of violence or severe adversity, such as war, persecution, or the traumatic loss of loved ones, can lead to complex psychological conditions like post-traumatic stress disorder, depression, and anxiety. These disorders not only profoundly affect an individual's quality of life but can also impair their ability to function effectively as caregivers. This is particularly critical when considering the needs of the children in their care, who are especially vulnerable and are at a crucial stage of development. Depression and other mental health issues can cause individuals to withdraw and not seek assistance, leading to lower engagement in potentially helpful programs. Although practices like meditation and stress management are useful and can offer considerable benefits, they may not be enough to tackle the profound psychological trauma faced by refugees and displaced individuals. Trauma-informed programs are essential because they directly address the systematic causes of trauma: many refugees and displaced persons have endured human rights violations, physical and emotional abuse, and other forms of violence. A superficial approach that only addresses the symptoms without tackling these fundamental experiences can leave the underlying causes of psychological suffering untouched. Moreover, trauma-informed programs facilitate a more comprehensive and holistic recovery. They are designed to help individuals process and understand their traumatic experiences, reduce the stigma associated with mental illness, and foster a supportive community that can provide understanding and validation. This comprehensive approach ensures that interventions not only mitigate immediate distress but also build a foundation for enduring mental health and well-being, enabling refugees and displaced persons to engage more fully in all aspects of life, including participation in beneficial programs. Implementing holistic approaches that integrate ECD services with basic care, trauma-oriented support, and cultural sensitivity not only alleviates these risks but also maximizes the integral development of the child. Therefore, it is essential to design intervention programs that not only equip caregivers with effective parental skills but also directly enrich the learning and development environment of the child, ensuring that both caregivers and children receive the necessary support to thrive in adverse conditions. Finally, the sixth key conclusion—which also found unanimous agreement among those interviewed— is the necessity of investing in host communities to the same extent as those in displacement camps. This highlights the critical need for financial backing to foster social cohesion within these communities, which is essential for their harmonious coexistence. V. Recommendations As a result of the findings above, and to continue to improve ECD interventions in displacement settings, below are the following recommendations that are based on both the literature review and the interviews conducted with various organizations working in this realm. FOCUS ON BOTH CAREGIVERS AND CHILDREN Adopt an integrated approach to family well-being. Adopt approaches that enhance the overall well-being of refugees and forcibly displaced families. This involves not only teaching parenting skills but also addressing social and structural factors that affect the caregiver’s ability to interact effectively with children or impact their mental health. For example, refugees and forcibly displaced families often face extremely precarious housing conditions in camps or host communities. Lack of privacy, overcrowding, and physical insecurity can significantly increase stress in caregivers and deteriorate the quality of family interactions. An integrated approach could include efforts to improve household conditions. Programs that promote a safe and stable environment allow families to establish a more suitable and functional home, essential for the psychological and emotional well-being of all family members. Adopting comprehensive approaches like the nurturing care framework in FCV contexts (as proposed in Section 1 under “Enhancing Socioemotional and Psychosocial Well- being through ECD Programs in Forced Displacement Settings”) can optimize outcomes, ensuring complete and coherent support for children and their caregivers in emergency situations. Implement both child- and caregiver-centered interventions. Implement dual interventions that benefit both caregivers (primarily mothers) and children, focusing on improving family interactions and reducing parental stress. This focus allows for more effectively addressing the complexities of stress and trauma experienced by both caregivers and children, improving caregiver well-being and child development. Additionally, in circumstances where resources are often limited, implementing interventions that simultaneously address the needs of both can maximize the impact of available resources, offering more cost-effective solutions. Increase participation of fathers in ECD interventions. Conduct campaigns aimed at fathers with specific strategies that recognize and address cultural and structural barriers, as well as perceptions about fatherhood and childcare, and highlight the importance of their active role in the development and well-being of their children, challenging gender stereotypes and promoting a more inclusive view of fatherhood. This will not only support fathers in adjusting to changes in traditional roles in displacement contexts but will also help prevent domestic and gender-based violence, thereby strengthening emotional stability and safety with displaced families. ADOPT CULTURAL SENSITIVITY PROGRAMS It is crucial both to establish close collaboration with community leaders and organizations to ensure an integrated and respectful approach, and to implement therapeutic methods that respect and align with cultural perspectives on trauma and healing. Additionally, it is important to include: • The preliminary collection of quantitative and qualitative data to identify the unique needs and cultural backgrounds essential for program design. • The hiring of individuals with the linguistic skills and cultural knowledge of the target population. • Comprehensive cultural competence training for all program participants to ensure respectful and effective interactions. • The incorporation of family traditions, values, and cultural practices at all stages of program design and execution. • And finally, the customization of services to meet the specific needs of each child and family, considering their context. ADOPT A TRAUMA-INFORMED APPROACH TO PROGRAMS • Integrate trauma-informed training for all staff collaborating with refugee children and caregivers to ensure that they are sensitive to the effects of trauma. • Develop and implement programs that specifically address the psychological and emotional needs of refugee children and caregivers. • Include regular mental health assessments as part of program offerings to identify and address trauma- related issues promptly. • Foster a safe and supportive environment that promotes trust and a sense of security for refugee children and caregivers. • Ensure that program activities are flexible and adaptable to accommodate the varying levels of trauma exposure among participants. • Provide caregivers with resources and education on trauma-informed care to better support their children's emotional and developmental needs. • Connect individuals with medical services that can treat physical conditions related to trauma, and with legal services that can assist in resolving pending legal matters that may be additional sources of stress. • Monitor and evaluate the effectiveness of trauma-informed approaches within programs to continuously improve support for refugee children and caregivers. COMMUNITY INTEGRATION AND SUPPORT • Integration with social services: Embed ECD programs within the existing social service infrastructure of host countries and communities. This is important for supporting child development in refugee settings, because having the structure for ECD in the country will make it easier to optimize resources by leveraging the strengths of the host community's established systems and support refugee populations to utilize the services. In addition, integration into local systems can enhance the sustainability of ECD programs, as they can continue to operate within the host community's framework even after initial humanitarian funding and support may diminish. • Investment in the host community: Investing in the host community alongside those in camps and integrating services for refugees has a potential to promote social cohesion and reduce tensions between refugee and host populations, which often bear the brunt of the influx, by providing services that benefit all children within the community. SUSTAINABILITY AND LONG-TERM EFFECTIVENESS It is recommended that international organizations, NGOs, and/or governments implementing programs for refugee and forcibly displaced people ensure, as much as possible, continuity and sustained support. This is crucial for maintaining the long/term impacts of interventions. • Increase financing for ECD interventions that focus on socioemotional wellbeing of refugee and forcibly displaced children and caregivers: Advocate to governments in FCV contexts, donors, and international organizations for the need for dedicated financing for comprehensive ECD interventions that support the socioemotional well-being of refugees and forcibly displaced people. Work in partnership with local government and/or with local NGOs and other local partners who know the context to strengthen local institutions for service delivery, as they are already working on the ground and understand the specific dynamics and needs of the refugees and forcibly displaced families. These organizations are better equipped to implement culturally adapted programs. Also, working with government institutions allows for sustainability and scale-up if programs prove effective. • Leverage technology for reinforcement and follow-up: Incorporate reinforcement sessions and use technology to sustain intervention impacts, addressing the need for additional activities after a year or more. • Invest in community training and mobilization: Train community leaders and volunteers in key aspects of ECD and psychosocial support techniques to function as multipliers of good practices within their communities. • Create safe and stimulating community spaces: Develop and maintain child- and family-friendly spaces that promote learning through play, offer educational activities, and provide psychosocial support, thus fostering an environment of cohesion and mutual support among community members. • Promote community participation in planning and implementation of interventions: Actively involve the host community and refugees and forcibly displaced families in identifying needs, designing, executing, and evaluating ECD programs, and ensuring that interventions are culturally relevant and tailored to local needs. POLICY AND STRATEGIC PERSPECTIVES • Advocacy for priority policies: Advocate for policies that prioritize ECD and support local communities in crisis response, ensuring the ECD funding specifically addresses the unique needs of refugees and forcibly displaced families, while also including host communities. • Use the adapted Nurturing Care Framework for FCV contexts: Emphasize the necessity of an approach based on the Nurturing Care Framework adapted to contexts of FCV, as proposed in this paper under the introduction section, which can be developed to integrate not only traditional services but also psychosocial and socioemotional needs of children and caregivers. Recommendation for World Bank Task Team Leaders This paper’s primary focus has been on providing a synthesis of the evidence that exists on the effects of ECD interventions on the socioemotional well-being of refugee children and their caregivers. While this is not a guidance note, based on the evidence above we would like to provide some initial ideas for approaches and strategies that World Bank Task Team Leaders (TTLs) could take when implementing ECD interventions in FCV contexts and with forcibly displaced populations. We developed these strategies based on the recommendations from the adapted nurturing care framework for FCV contexts (presented in Table 1) together with the note on “Ideas on How to Support Early Childhood Development in FCV contexts for WB Task Team Leaders” prepared by Catalina Quintero and Ella Humphry as guidance for World Bank TTLs under the first call for proposals for the funding round window on ECD in FCV contexts. The following are our broad recommendations, and table 7 below presents more details on implementing the below strategies. • Continue to grow and prioritize investment in ECD in FCV contexts, particularly where there is potential for initiatives to be scaled-up: The World Bank has made a substantial contribution over the last decade to ECD and should continue to push the envelope and grow awareness for the need for this kind of programming in FCV contexts. It is essential that the World Bank intensify its efforts to allocate resources to these programs. These resources should be directed not only toward the provision of basic health and education services but also toward the integration of psychosocial support and trauma recovery strategies, especially in displacement contexts where children and families are most vulnerable. Furthermore, supporting the work of TTLs working in these difficult contexts with funding initiatives like the ELP funding windows and INSPIRE program for refugee education is crucial, increasing the chance that pilot projects will be scaled up into government-sponsored nationwide initiatives that ensure sustainability and impact. • Integrate violence prevention and psychosocial and socioemotional support across sectors: All sectors in which the Bank operates ECD programs for refugees, forcibly displaced persons, and host communities (education, health and nutrition, social protection and labor, social development, gender, and others) should evaluate whether incorporating violence prevention and socioemotional support strategies across their projects would be beneficial. This could include not only training TTLs on trauma- informed approaches to ECD interventions, but also on what are the various kinds of approaches and interventions that could foster socioemotional well-being in those populations. Working with organizations that have a deep knowledge of these approaches and adapting them for World Bank interventions could be one way of bringing this knowledge to TTLs. This approach could also be extended to other FCV contexts and other vulnerable populations who would benefit from this kind of support. • Develop and distribute tools and resources adapted to FCV contexts and forcibly displaced populations: The World Bank should lead the development of tools and specific resources that promote, assess, measure, and teach socioemotional well-being in refugee and displaced populations for FCV contexts, enabling governments to efficiently identify and serve the most vulnerable populations. These tools include materials and guidelines for addressing the socioemotional well-being of children and their caregivers in FCV contexts; tailored early learning tools; assessment tools (to assess the needs of children and caregivers and tailor interventions); kits that can be used to set up temporary learning spaces; ECD training packages for frontline health, education and social workers; and resources to help parents support their well-being and nurture their children. Table 7 below provides further detail for implementing the broad strategies recommended above by providing sectoral examples. Table 7. Strategies for Enhancing ECD in FCV Settings With a Focus on Forcibly Displaced Children and Families, by Sector Sector Ways to support ECD in FCV contexts for forcibly displaced children and caregivers Education World Bank education projects in refugee and forced displacement settings can play a pivotal role in nurturing the development of young children through the delivery of different community and center-based quality early childhood education interventions. These Interventions can include: Creating safe learning spaces: These learning spaces can be formal or informal (for example, home-based provision models to overcome barriers to access) and could range from provision of ECE in camp centers to integrating refugee ECE schools with the host community. In regions where refugees are integrated into local communities, bolstering the capacity of host community pre-primary schools is vital to avert issues related to access and quality that arise from overcrowding. Training for refugee ECE teachers: Engage and provide training for refugees/displaced individuals to teach ECE to ensure cultural sensitivity and as an employment opportunity for refugees. Adopt and use classroom observation tools like TEACH ECE to support classroom teaching practice. Train teachers to recognize signs of trauma in children, and provide user- friendly resources, such as quick reference guides, to help implement these strategies effectively without adding extra burden to their work. Special emphasis should be placed on training educators in displacement settings to manage the specific challenges faced by displaced children. Learning content and curriculum that addresses trauma recovery and violence reduction: Adopt curriculums and innovative pedagogical strategies to include programs, activities, and games that promote emotional regulation or social-emotional learning, tailored for children who have experienced forced displacement and trauma. Implement remote early childhood education using EdTech by adapting educational technology to support distance learning for young children in unstable and challenging environments. Engaging families: Support learning at home, through interventions like Read@Home and EdTech. This is particularly important in fragile contexts where displacement may mean loss of access to center-based services. In displacement settings, this could include providing learning materials and guidance through mobile platforms or community outreach. Health and Compared with other sectors, there are more health and nutrition projects supporting young Nutrition children in FCV contexts. This presents an opportunity to integrate additional approaches to supporting young children. The Health, Nutrition, and Population GP can play a crucial role in reinforcing ECD in FCV settings by implementing targeted interventions for both the mother and the young child. These interventions may include: Continuity in basic health: Prioritizing delivery of preventive health services for both the mother and the child across the continuum of care (including antenatal care, skilled delivery, postnatal care, routine immunizations) and nutrition services, with a focus on reaching displaced populations who may have limited access to these services. Integrating mental health services: Embedding mental well-being assessments and referral services into existing health and social services to ensure they are part of a comprehensive care system (the service can be provided for caregivers within the existing maternal and child health service delivery points/care packages (e.g. integrating the service in under 5 outpatient clinics (OPD) for caregivers including fathers)); using antenatal care for expectant mothers and postnatal care to address potential postpartum depression; establishing accessible outreach mental health services, including counseling, therapy, and support groups, tailored to the needs of forcibly displaced children and caregivers; creating child-friendly safe spaces where children can play and express themselves, which can be therapeutic and promote resilience; providing training for humanitarian workers, educators, and healthcare providers on identifying and responding to mental health issues. Counseling for pregnant women, new mothers, and their families: Integrate counseling services on birth preparedness, newborn care, self-care, breastfeeding, domestic violence, stimulation, and responsive care as part of the IDP and refugee reproductive, maternal and child health and nutrition service delivery points to ensure that these services are accessible both in temporary shelters and refugee camps and also for host communities. Establishing support groups for mothers/caregivers: Support women refugees and IDPs by helping to establish support groups that provide a safe space for mothers and caregivers to share experiences, deal with trauma, and provide information on coping and stress management strategies, encouraging early stimulation, and learning at home. This can be facilitated through various outreach platforms such as mothers' support groups, conferences, and community gatherings for growth monitoring and promotion, in addition to distributing educational materials like leaflets on ECD and mental well-being in refugee camps or through mobile health units or specific interventions. Social Women and children are particularly at a disadvantage in most societies from participating in Sustainability economic, political, and social life, and even more so if they are refugees or IDPs. Therefore, and Inclusion ECD programming can support young children and women IDPs and refugees in FCV contexts to feel like they belong in society and have the same right to social services as host communities. Furthermore, ECD interventions are often most successful when there is significant community investment and ownership to ensure quality. Community-driven development projects that strengthen social cohesion and inclusion of forcibly displaced people within host communities in FCV settings have the potential to provide a good entry point to ECD interventions, which include: Ensuring equitable access: Ensure access to safe spaces for infant care services, caregivers, and early play and learning centers with a common and shared vision across diverse communities, including those in refugee camps and displacement sites. Develop infant care collaborative networks among caretakers across diverse communities, with particular focus on displaced populations who may lack established support networks. Implement pro-social skills trainings in early childhood development centers to foster positive social norms and cohesion within the community, including programs tailored to foster integration between displaced families and host communities. Social Household income can mitigate the loss of livelihoods. Specifically targeting vulnerable Protection families with young children can be a critical way to provide vital income support and can be Labor and used as a platform for other interventions. Social protection programs can play a crucial role Employment in supporting ECD in FCV contexts including: Safety net initiatives for refugees and IDPs: These programs offer financial assistance or social safety nets to households with young children. They also create opportunities for displaced families to participate in public or contextually relevant work projects. Such initiatives aim to alleviate economic stress, enabling these families to foster nurturing and stimulating environments for their young children. Information for parents: Such information can be shared, including on nutrition, coping strategies, early learning, and play, and how to recognize signs of severe distress. For displaced families, this could involve targeted information campaigns within refugee camps or through mobile outreach. Distribution of resources: Food, books, and early learning kits can be provided via cash transfer or agricultural extension programs, with specific distribution mechanisms designed for displaced families in camps or informal settlements. Child protection: Ensure that frontline health workers have the information needed to identify child protection and mental health issues, with a focus on addressing the unique challenges faced by displaced children and families. Child protection policies: Strengthen social protection policies to guarantee the safety of children, focusing on addressing heightened risks in FCV contexts, particularly for displaced children who may be at increased risk of exploitation and abuse. Gender Young children are particularly at risk of sexual and gender-based violence (SGBV) and witnessing intimate partner violence (IPV) in FCV contexts due to factors such as the sudden breakdown of family and community structures after forced displacement. Interventions in different sectors could include activities that protect and support young children and their parents, including: Addressing underlying risk factors for interpersonal and gender-based violence: In displacement contexts these programs should focus on addressing social norms and gender roles through sensitivity training and community engagement, but particularly paying attention to trauma and identity-informed interventions that provide safe spaces to families and their children. Integrating basic services and support for those affected by SGBV and/or IPV: Ensure the availability of health and counseling services at the IDP sites and refugee camps with training for healthcare providers on SGBV/IPV and trauma-informed care. Also, make available legal aid and economic opportunities for girls and women survivors of, or those affected by, sexual and gender-based violence. This could also include distributing materials such as dignity kits containing items that displaced people may have left behind such as items for menstrual hygiene, underwear, diapers, and towels. Supporting community-based organizations: In providing maternal and reproductive services and long-term support to survivors, including IDPs and refugees. Involvement of men in childcare: Encourage and facilitate the involvement of men in caregiving roles to promote shared responsibility and reduce the burden on women, while also fostering positive male role models for children. This is particularly important in displacement contexts where traditional family structures may have been disrupted. Crosscutting Leveraging existing technology at the Bank: In FCV contexts, the use of technology for designing intervention, data collection, monitoring, and evaluation can be valuable in understanding the impact of ECD interventions and identifying areas for improvement. This can include leveraging mobile applications and remote sensing technologies, for example the Geo-Enabling Initiative for Monitoring and Supervision (GEMS), which allows for remote project supervision in areas that might be difficult to access. Leveraging more ASA to build evidence: Due to the nascent evidence of what works and the impact of ECD interventions in FCV contexts, conducting diverse analytical works to enhance the understanding of ECD implementation in FCV contexts is key to enlarging and contributing to the body of evidence in this field. Engaging stakeholders: This review has found that governments are not necessarily the main actors when it comes to implementing ECD interventions in FCV contexts. Governments need to be taking the lead in providing ECD services, but in FCV contexts this is often not the reality. Therefore, collaboration with stakeholders working to deliver these services on the ground is necessary between government agencies and multilateral actors such as the World Bank with nongovernmental organizations, UN agencies, local CSOs, local government authorities, traditional authorities, and others. Engaging with various local stakeholders can also help ensure that programs are culturally sensitive and responsive to the needs of the community. References Al-Janaideh, Redab, Ruth Speidel, Tyler Colasante, and Tina Malti. 2023. "Evaluating a social-emotional training program for refugee families and service providers: pilot study." JMIR Formative Research, 1-17. Alliance Moving Minds. 2020. 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Summary of Interventional studies SN Study Title Location/ Study site Study design Sample/Target Intervention/Assessment Duration and delivery method of the Key findings groups intervention 1 Supporting Lebanon Randomized Syrian refugees in Caregiver Support From September 2019–December The CSI reduced harsh parenting by parenting control trial Lebanon. 480 Intervention (CSI) is a nine- 2020. The CSI aims to strengthen 17%. among Syrian caregivers from 240 session preventive group parenting through two pathways: (a) refugees in families were intervention for primary directly, by strengthening The CSI reduced caregiver distress by Lebanon: a randomized to the CSI caregivers of children aged 3– participants’ knowledge and skills 33%. randomized or a waitlist control 12 affected by armed conflict related to evidence-based parenting controlled trial group and forced migration. methods that have strong cross- of the caregiver cultural support, and (b) indirectly, support by improving the mental health and intervention psychosocial wellbeing of caregivers. 2 Supporting Bangladesh, camps of Single arm pre- 260 Rohingya refugee Psychosocial support groups A three-month (March to June 2012) Maternal well-being and childcare maternal Cox’s Bazar post study: pregnant women intervention for pregnant psychosocial intervention knowledge improved significantly mental health measured the women over the three months of of Rohingya improvement on intervention. refugee women mental health during the and childcare Psychosocial intervention can be perinatal period knowledge of effective despite the chronic stressful to promote the group before conditions of the refugees in the child health and and after the camps. wellbeing: a intervention field study in Cox’s Bazar 3 The Promotive Lebanon Cross-sectional 291 Syrian refugee Assessing the role of August 2016 to March 2017 Mothers perceived social support Effects of Social mothers perceived social support in was associated with both Support for promoting their psychological psychological and parenting Parental and parenting resilience resilience. Emotional support, but Resilience in a (better than expected mental not instrumental support, was Refugee health and parenting associated with mothers’ Context: A behavior given level of psychological resilience. Social Cross-Sectional exposure to war trauma) support may have a promotive effect Study with on mothers’ mental health and Syrian Mothers parenting behavior in a context of in Lebanon ongoing conflict and displacement. 4 Effects of the Beirut, Lebanon RCT A total of 106 mother- Evaluating the effects of a MOCEP was implemented over Mothers in the intervention group mother-Child child dyads were group-based intervention, the twenty-five sessions through group showed a reduction in their harsh Education randomly assigned to mother-Child Education meetings that each lasted parenting practices and in their level Program on either the Program (MOCEP), on approximately 3 hours. The core of parenting stress. Parenting Stress intervention group (n parenting stress and practices curriculum includes child and Disciplinary = 53) or the wait-list among two refugee development, the importance of play Practices control group (n = 53). communities and one other in development, parenting practices, Among Refugee marginalized community in health and hygiene, and maternal and Other Beirut, Lebanon. empowerment. The program Marginalized combines lectures, practical Communities in demonstrations, and assignments to Lebanon: A Pilot be completed in the home. The group Randomized meetings are the Mother Support Controlled Trial Program (MSP) component of MOCEP, whereas the second component, the Cognitive Training Program (CTP), provides mothers with techniques to support several child development domains. Mothers were asked to implement CTP activities with their children at home. Data collection and program implementation occurred sequentially in sites 1, 2, and then three. Data collection at baseline and endpoint lasted approximately 1 month per wave in each site. MOCEP’s implementation lasted from 6 to 8 months, depending on the site. Implementation took place from April to October 2015 in site one; from June 2015 to January 2016 in site two; and from October 2015 to April 2016 in site three. 5 Lessons and Lebanon RCT Syrian (96%) and To evaluate the impact of an The program ran for 11 weeks in Significant impact on child Impacts of a Lebanese (4%) 11-week remote early mid-2022. This study was designed development outcomes Remote Early caregivers with 5–6- learning program (RELP) to evaluate the program in hard-to Childhood year-old children and delivered alone and in access regions and capture impacts Education their caregivers in combination with Ahlan in areas with limited in-person Program in four hard to reach Simsim Families (ASF), a services, most likely to need remote Hard-to-Access regions in Lebanon: parenting support program. services. Settings in The Bekaa, Baalbek, Lebanon: A Tripoli, and Akkar. Randomized where there is little to Controlled Trial no other access to ECE. 6 Lessons and Jordan RCT Syrian and Jordanian To evaluate six months of Baseline data: collected from 2,298 The analysis found no effects of the Impacts of a caregivers phone-delivered version of a families from November 2020 to addition of the RUL( Reach Up and Phone-Based parenting program February 2021. Learn ) ECD messages on caregiver- Parenting intervention focused on reported parenting behaviors, child Program for caregiving for young children Midline data: In the last six weeks of learning and development, caregiver Syrian and (0-3 years old) implementing the intervention, a anxiety symptoms, caregiver stress Jordanian random subsample of 311 calls were related to caregiving, or caregiver Families with recorded in both the treatment self-efficacy. The analysis did find a Young Children (167) and control (144) groups. statistically significant, small reduction in caregiver depressive symptoms. Endline data: After the completion of the 6-month program, a second phone-based caregiver survey of 45 minutes was collected between November 2021 and January 2022. 7 Short- and Rwamwanja Refugee longitudinal Congolese refugee Friendly Space Interventions Baseline interviews completed in the Attendance at CFSs particularly longer-term Settlement, Uganda study adopted a children residing in (CFSs) on the psychosocial early weeks of settlement (October– involving higher-quality impacts of Child quasi- Rwamwanja Refugee well-being and November 2012) before the opening programming supported children’s Friendly Space experimental Settlement developmental assets of of CFS locations. For endline psychosocial well-being and Interventions in design with children and adolescents. assessment (which fell 3–6 months development. Rwamwanja randomized- CFSs are safe and supportive later given the phased introduction Refugee cluster sampling spaces where children can of individual CFS), same caregivers Settlement, play, learn, and socialize interviewed during the final weeks Uganda of the CFS program in their respective villages. Caregivers interviewed again 18 months following baseline assessment, when all formal CFS programming had ceased. 8 Assessment of Karen Refugee Camps Impact Two to five-year-old Nursery school program: this To evaluate the impact of the Children who attended the nursery the in Thailand evaluation Karen refugee intervention/program nursery schools on the Psychosocial schools for more than a year were Psychosocial addressed child development development of children better at playing cooperatively with Development of children in nursery holistically, including other children and were more aware Children schools physical, cognitive, and of their own and others’ feelings. Attending psychosocial. They offered a Children who were newer to the Nursery Schools safe place to be during the nursery schools were more polite in Karen day, nutritious meals, a and better at following rules and Refugee Camps sanitary environment, and controlling their feelings when in Thailand good hygiene practices, and frustrated. Overall, the nursery stimulation, interaction, and schools can be a promising practice affection within a child- to promote healthy psychosocial centered curriculum in which development of children in teachers considered protracted refugee situations. ‘‘facilitators’’ of child development. 9 A Pilot Lebanon and Jordan A pilot cohort Parents from Syria The study aimed to improve It lasted for twenty-one weekly By the end of this study, parents’ Intervention to study (125 mothers and parental well-being, parental sessions, each between 2 to 3 hours mental health and wellbeing Promote fathers) in three stress levels, parenting long, comprising 16 sessions on Early improved (p < 0.001, Cohen’s d: Positive Parenting in refugee camps in behavior, and discipline Child Development and 5 sessions 0.61) and their parenting index Refugees from Lebanon and Jordan strategies through a newly on psychosocial support and mental score was reduced (p < 0.001, Syria in designed parenting health. Cohen’s d: 1.24). Some of their Lebanon and Jordan intervention. This dysfunctional interactions with their intervention involved children as well as the perceived interactive and educational difficulties and conduct problems in sessions to enhance parent- their children aged 3 to 6 years were child relationships and also reduced significantly. interactions. The intervention used in this study succeeded in improving some aspects of parenting practices and disciplines and in improving the parents’ wellbeing; however, more research is needed to assess its long- term effects on parents and their children. Moreover, some adjustments need to be made in the intervention to be more adapted to the context of refugees and underprivileged communities. 10 Child friendly Ethiopia, Uganda, A quasi- 1,010 children and Study aimed to measure To assess the impact of Child The study highlights that Child spaces impact Iraq, Jordan and experimental 1,312 caregivers in changes in protection Friendly Spaces (CFS) in four specific Friendly Spaces (CFS) have a across five Nepal research design intervention areas concerns, psychosocial well- areas: protection, psychosocial well- significant impact on the humanitarian to evaluate the with humanitarian being, developmental assets, being, skill development in children settings: a impact of Child populations. The and community resources (comprehensive growth and psychosocial well-being of younger meta-analysis Friendly Spaces sample included among participating children development despite adversity), and children (aged 6 to 11 years), with a (CFS) across children in two age and caregivers. The study community resources. modest but significant effect size (d various ranges: from 6 to 11 included site-level data humanitarian years and from 12 to analysis followed by a meta- = 0.18; 95% CI: 0.03 to 0.33) in contexts. 17 years, allowing for analysis to summarize the pooled analyses. This result Baseline and a comparison of the overall impacts across all demonstrates that, although the endline impact of the CFS domains and sites. This evaluations among these age approach allowed for the overall effect is modest, CFS can (three to six groups. estimation of the significantly contribute to the months after intervention effect sizes and psychosocial well-being in this baseline) were provided a comprehensive conducted understanding of the impact population, improving aspects such of CFS in different settings as self-esteem and emotional regulation in humanitarian crisis contexts. However, the study also concludes that CFS do not show a significant impact on older children (aged 12 to 17 years), nor on the connection of children and caregivers with broader community resources. This suggests that while CFS can be an effective intervention to improve the psychosocial well- being of younger children, their efficacy decreases for older populations and does not significantly contribute to improving knowledge or access to community resources. The conclusion underscores the need to review and improve the programming approaches and quality assurance mechanisms of CFS to make them more effective. The inconsistency in impact suggests that the success of CFS may depend on how they are implemented and adapted to the specific needs and contexts of the target populations. This indicates the importance of careful and adapted programming, as well as rigorous monitoring and evaluation to ensure that CFS fulfill their purpose of providing psychosocial support to children in humanitarian emergency settings. 11 Forced Bangladesh Large-scale 2,845 mother-child Improve the mental health of The intervention in the study was A multifaceted program of psych Displacement, randomized pairs followed until refugee mothers and the provided weekly for a year, from education, parenting support, and Mental Health, controlled trial the end of the study, comprehensive development October 2019 until September 2020, play activities can be successfully and Child designed to of which 1,679 were of their children through a through forty-four hourly sessions. established in resource-poor Development: assess the in the treatment comprehensive psychosocial settings, such as refugee camps in Evidence from impact of a group (from an initial intervention known as the developing countries. Through such the Rohingya multifaceted total of 1,911) and Humanitarian Play Lab (HPL), programs, support can be targeted Refugees* psychosocial 1,166 in the control implemented in refugee and provided weekly to both support group (from an initial camps in Bangladesh. mothers and young children program on the total of 1,588) simultaneously. We found this mental health of multifaceted program to be refugee women successful in many ways. First, it (mothers) and improved the mental health of both the mothers and children and aligned socioemotional, their mental health with each other. physical, Second, it significantly reduced the cognitive, and prevalence of stunting, anthropometric underweight, and wasting among development of children. Third, it improved their children children's socioemotional, physical, under two years and cognitive development old following the intervention. Finally, it was a very low-cost intervention that leverages human resources from the refugee community (costing only USD 45 per dyad), making it highly scalable and attractive to policymakers 12 Acceptability Lebanon Impact 292 parents and The main objective of the The "Families Make the Difference" Decrease in severe punishment and and preliminary evaluation eighty-eight children study was to report on the program is a 10-session group rejection by parents: There was a outcomes of participated in a acceptability and preliminary parenting intervention, manually significant reduction in the use of parenting structured outcomes of a group developed by the International severe punishment and rejection intervention for assessment before parenting intervention aimed Rescue Committee (IRC) in 2014 to behaviors by parents, as reported by Syrian refugees and after a group- at reducing the risk of child address the specific challenges of both parents and children. This based parenting maltreatment among Syrian families displaced by the war in indicates that the intervention had a intervention refugees in Lebanon. Syria. The program content was positive impact on parenting implemented by an adapted from a parenting program practices, promoting more positive international that had previously been evaluated and less punitive approaches. nongovernmental in a post-conflict setting, with organization serving additional content adapted from Improvements in children's refugee and teaching recovery techniques, a psychosocial problems: Parents vulnerable Lebanese manualized intervention based on reported a significant reduction in communities. cognitive-behavioral therapy the total difficulties score of focused on trauma developed by the children, measured by the Strengths Children and War Foundation. and Difficulties Questionnaire . Furthermore, children reported significant reductions in symptoms of depression and anxiety. This suggests that the intervention not only benefited parents in terms of reducing stress and improving parenting practices but also had a direct positive impact on the emotional and psychological well- being of the children. Improvement in parental mental health and perceived social support: Parents reported a significant decrease in symptoms of generalized distress and a smaller decrease in symptoms of post- traumatic stress. They also reported a significant, though small, increase in perceived social support. This indicates that the intervention helped improve parental mental well-being and increased their perception of receiving social support, which is crucial for families in displacement and stress situations. These results should be interpreted with caution due to the lack of a control group and validated norms for this population. 13 Review of Early Refugee children in Mixed method: Low and Middle- To evaluate ECEC Published articles between the years ECEC programs can have a positive Childhood LMICs literature review Income Countries accessibility, quality, and 2013 and 2021 impact on the wellbeing and Education and and interviews impact on young children in developmental outcomes of refugee (LMICs) Care (ECEC) with experts refugee contexts in LMICs children. The most effective ECEC programs for programs are those that are refugee culturally responsive and that children in LMIC consider the specific needs of refugee children and families. ECEC programs should be play-based and should focus on social-emotional development. ECEC programs should be delivered by trained and qualified staff. 14 Implementation Studies from Bosnia, Mixed method: [Does not apply] Review of ECD interventions The studies focused on offering research for South Sudan, literature review in humanitarian contexts psychosocial support to caregivers, early childhood Lebanon, and Uganda. (2000–2017) hinting at a model were caregiver and interviews development stress influences parenting quality programming in with experts and, in turn, early developmental humanitarian outcomes. Research on older contexts children targets mental health interventions, with a sizable number of such programs available. Conversely, young children's care in these settings is not well-explored. The strong connection between caregiver mental health and ECD suggests that mental health interventions might be effective for ECD in humanitarian scenarios. There is a lack of analysis concerning the quality of ECD program implementation within humanitarian contexts. To enhance the understanding of ECD in humanitarian settings, it is crucial to incorporate implementation assessments into monitoring and evaluation frameworks, impact evaluations, and research findings. 15 The Aftermath Schengen Zone Mixed method: The study focuses on Improving consolidation of of War: literature review reviewing evidence to psychosocial programs and focusing Improving understand how to improve on education is important, having and interviews Psychosocial psychosocial care for child greater cultural awareness when Measures to with experts refugees in the Schengen working with children is crucial, and Address zone suffering from war acknowledging the resilience of Trauma in Child trauma. children when addressing trauma. Refugees in the Schengen Zone Appendix B: Questionnaires Section 1: Introductory Information Section 4: Implications for Future Programs What do these outcomes imply for the design and execution of future ECD Please state your name and the organization you represent. interventions? Can you describe your involvement with the Early Childhood Development (ECD) program? Section 2: Program Goals and Structure Section 5: Challenges and Prospects 1. Can you outline the primary objectives of the ECD program you are What challenges have you encountered while implementing ECD programs in refugee involved with and displacement settings? 2. Could you detail the main elements of the program, including how What opportunities do you perceive for enhancing the effectiveness of these it is delivered? interventions? Section 3: Socio-emotional Effects of ECD Interventions Section 6: Recommendations for Improvement Which ECD initiatives are you implementing that focus on psychosocial and What recommendations would you make to improve the socio-emotional impact of trauma-informed approaches to support the socio-emotional well-being of ECD programs in displacement settings? children and their caregivers in displacement settings? From your perspective, what are the best strategies to maximize the socio-emotional benefits of ECD programs for displaced populations? Are there any ECD initiatives you are implementing that, while not directly • What role should local governments and states play? targeting psychosocial support, have nonetheless had a positive impact on the socio-emotional well-being of children and caregivers? • How can international entities, such as the World Bank and international How are the socio-emotional and psychosocial components of the ECD NGOs, contribute? programs designed and executed in displacement settings? Section 7: Concluding Remarks Would you like to add any last thoughts about the socio-emotional effects of these What impacts have you observed from interventions targeting parents and interventions? caregivers on their own and their children's socio-emotional well-being? Thank you for your time and participation in this study. Can you share your observations on the socio-emotional effects of ECD Interview with donors programs on children and caregivers in displacement settings, providing • What ECD interventions have proven most effective in enhancing the socio- specific instances? emotional well-being of children and caregivers in refugee and displacement situations, and how do these interventions affect the relationship between In what ways have ECD programs contributed to enhancing the socio- children and caregivers? emotional health of children and caregivers? • Could you provide concrete examples of successful ECD interventions that have improved the socio-emotional health of displaced children and Do you believe the program has fostered socio-emotional stability or caregivers? improved psychosocial well-being in children and caregivers? If so, how? • How can ECD programs be tailored to address the unique needs of displaced What changes have you noticed in the dynamics between children and children and caregivers? their caregivers following the intervention? • What strategies can be employed to integrate ECD interventions with other How has the intervention influenced children's overall sense of well-being? services for displaced populations? What effects has the intervention had on the well-being of parents and • What are the most effective methods for evaluating the impact of ECD caregivers? interventions on the socio-emotional well-being of displaced children and How have these socio-emotional benefits been maintained over time? caregivers? What challenges and opportunities exist in preserving these benefits? • What influence do ECD programs have on the host communities? • Can you discuss the challenges and opportunities associated with Have you noticed any secondary effects of the interventions on the implementing ECD interventions for displaced populations? parents/caregivers, children, other refugees, or the host community? • What approaches can be taken to ensure the long-term sustainability of ECD a. If yes, could you describe any observed spillover effects? programs for displaced children and caregivers? b. How have these effects been assessed? • How can your organization, along with other international bodies, support the implementation of ECD interventions for displaced populations? ABSTRACT Early childhood is a crucial period for skills development and socio-emotional growth. Forcibly displaced children experience signi cant trauma, necessitating e ective interventions. This paper examines the e ect of Early Childhood Development (ECD) programs on the psychosocial and socio-emotional well-being of forcibly displaced caregivers and children between the ages of 0 and 8 years through a systematic literature review and key informant interviews. Findings indicate the crucial links between parents’ mental well-being and children’s development. Despite challenges, ECD interventions show promising outcomes and ll important gaps to build developmental foundations and school readiness. ECD interventions must be well designed, target both the caregivers and the child, and be culturally sensitive, child-friendly, and trauma-informed. The recommendations here focus on sustaining impact, leveraging technology, and securing sustainable funding and advocating for sustained investments in the early years in fragile and con ict settings.