Health Promotion

R is for Refugee: A Novel Approach to Mitigating the Impacts of Toxic Stress

By: Erin Cornell, MPH

In a proposed reimagining of the classic Sesame Street program, R will stand for Refugee.

Recognizing the significant need among children and families both facing and displaced by the conflict in the Middle East, Sesame Workshop and the International Rescue Committee will develop a novel intervention designed to address toxic stress among children living in the Syrian response region and refugees abroad. Their innovative proposal won the 100&Change competition of the MacArthur Foundation, and their five-year, $100 million grant will be the biggest ever awarded by the foundation.

We couldn’t be more pleased to learn of this investment, which will support a population of young children and families facing considerable adversity. The experiences central to those affected by the conflict in the Middle East – destruction, loss of loved ones, exposure to violence – are poignant and powerful examples of “adverse childhood experiences,” or ACEs, a term which applies to sources of toxic stress in the lives of young children, such as physical abuse or neglect. Toxic stress, in turn, refers to prolonged stress during the early years of life, without the buffering presence of a supportive caregiver. Work by our colleagues Nadine Burke Harris of the Center for Youth Wellness and Jack Shonkoff of the Center on the Developing Child at Harvard University, among others, has highlighted the significant impact of toxic stress on child development. Left unchecked, children’s experiences with ACEs can result in negative effects on learning, behavior, and health.

Given the recent advances in our understanding of the scientific underpinnings of the biology of adversity, the types of stressors common to children living in areas of conflict, or as refugees in foreign countries, have yet to be the focus of interventions designed to prevent or mitigate the impacts of toxic stress. And, given the unique experiences of those that live, or have lived, among such devastation, existing paradigms are likely to be insufficient to address the needs of this population. The proposed project by Sesame Workshop and the International Rescue Committee will solve a critical contemporary social problem by delivering a tailored intervention, consisting of culturally-responsive educational resources and programming, to those residing in or recently emigrating from conflict zones. Customized content will reach this population through television and mobile phones, as well as through in-person mediums such as home visiting and child development centers. Such content, which builds on strategies used for decades to foster early childhood development in the U.S. and other countries, is likely to improve social, emotional, and intellectual outcomes.

Our own work in the area of toxic stress, made possible with support from The JPB Foundation, relies on a comprehensive approach to supporting child health providers in mitigating the impact of toxic stress through education, quality improvement, and promoting access to community resources. Providing support to pediatric practices to enable service linkage for children at risk for developmental and behavioral problems and their families strengthens protective factors, such as parental resilience and knowledge of child development. Our efforts in child health services transformation have led us to recognize the need to expand our target population from an exclusive focus on children with delays, disorders, and diagnoses to a universal approach that promotes the optimal health and well-being of vulnerable children, as well as the need to be proactive in strengthening families to promote children’s optimal healthy development.

Research has affirmed among the refugee population the importance of such concepts as the role of resiliency in mitigating the impacts of toxic stress. Even in this challenging global context, resilience is promoted in similar ways to our U.S. efforts through an emphasis on enhancing family capacity to access needed resources, leveraging community support, building social connections, and fostering healthy relationships. Initiatives such as Help Me Grow promote resilience by building community capacity to support early detection of vulnerable young children and families, assisting families in navigating existing service systems, and linking families to needed programs and supports. Yet we recognize that, as a field, we have a long way to go to ensure the diverse needs of those affected by conflict are met.  We applaud the groundbreaking efforts of Sesame Street and the International Rescue Committee for both the anticipated impact of their project and the extent to which it will inform our own efforts.

If we don’t address toxic stress, strengthen and support families, and build those factors that we know are protective, we will fail to enable all children to reach their full potential. This innovative approach will ultimately advance our collective efforts, relying on the appeal of Bert, Ernie, and a few new characters that represent our changing world and the new ways we can work to overcome adversity. Forgive the pun, but we think this work will tell us how to get, how to get to better outcomes for children.

Erin Cornell, MPH, is the program manager for research, innovation and evaluation at the Help Me Grow National Center.

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