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Background: Forcibly displaced adolescents face increased risks for mental illness and distress, with adolescent girls disproportionately affected in part due to heightened gender inequity. Although the family unit has the potential to promote healthy development in adolescents, few family interventions have employed a gender transformative approach or included male siblings to maximize benefits for adolescent girls. Methods: This study will assess a whole-family and gender transformative intervention-Sibling Support for Adolescent Girls in Emergencies (SSAGE)-to prevent mental health disorders among adolescent girls in Colombia who were recently and forcibly displaced from Venezuela. The study will employ a hybrid type 1 effectiveness-implementation pilot randomized control trial (RCT) to test the program's effectiveness to explore determinants of implementation to establish the feasibility, acceptability, and fidelity of SSAGE. To address these aims, we will enroll 180 recently arrived, forcibly displaced adolescent girls in an RCT and examine the program's effectiveness in the prevention of mental illness (through reduction in anxiety, depression, interpersonal sensitivity, and somatization symptoms) one-month post-intervention. We will use contextually adapted to collect data on the hypothesized mechanistic pathways, including family attachment, gender-equitable family functioning, self-esteem, and coping strategies. The implementation evaluation will employ mixed methods to assess the program's feasibility, acceptability, fidelity, and barriers and facilitators to successful implementation. Discussion: Findings can support humanitarian program implementation, as well as inform policy to support adolescent girls' mental health and to prevent the myriad disorders that can arise as a result of exposure to displacement, conflict, and inequitable gender norms. [ABSTRACT FROM AUTHOR]

Objective: Colombia hosts 1.8 million displaced Venezuelans, the second highest number of displaced persons globally. Colombia's constitution entitles all residents, including migrants, to life-saving health care, but actual performance data are rare. This study assessed Colombia's COVID-era achievements. Methods: We compared utilization of comprehensive (primarily consultations) and safety-net (primarily hospitalization) services, COVID-19 case rates, and mortality between Colombian citizens and Venezuelans in Colombia across 60 municipalities (local governments). We employed ratios, log transformations, correlations, and regressions using national databases for population, health services, disease surveillance, and deaths. We analyzed March through November 2020 (during COVID-19) and the corresponding months in 2019 (pre-COVID-19). Results: Compared to Venezuelans, Colombians used vastly more comprehensive services than Venezuelans (608% more consultations), in part due to their 25-fold higher enrollment rates in contributory insurance. For safety-net services, however, the gap in utilization was smaller and narrowed. From 2019 to 2020, Colombians' hospitalization rate per person declined by 37% compared to Venezuelans' 24%. In 2020, Colombians had only moderately (55%) more hospitalizations per person than Venezuelans. In 2020, rates by municipality between Colombians and Venezuelans were positively correlated for consultations (r = 0.28, p = 0.04) but uncorrelated for hospitalizations (r = 0.10, p = 0.46). From 2019 to 2020, Colombians' age-adjusted mortality rate rose by 26% while Venezuelans' rate fell by 11%, strengthening Venezuelans' mortality advantage to 14.5-fold. Conclusions: The contrasting patterns between comprehensive and safety net services suggest that the complementary systems behaved independently. Venezuelans' lower 2019 mortality rate likely reflects the healthy migrant effect (selective migration) and Colombia's safety net healthcare system providing Venezuelans with reasonable access to life-saving treatment. However, in 2020, Venezuelans still faced large gaps in utilization of comprehensive services. Colombia's 2021 authorization of 10-year residence to most Venezuelans is encouraging, but additional policy changes are recommended to further integrate Venezuelans into the Colombian health care system. [ABSTRACT FROM AUTHOR]

As the global rate of displacement reaches new highs and the average length of displacement extends from years to decades, integration is an increasingly crucial lifeline for refugees and displaced communities seeking to rebuild their lives. Health systems serve as an ideal conduit for integration due to universal need, system complexity, and the interplay of political, social, and economic factors on health outcomes. Using lessons learned from case studies in Colombia and Jordan, this paper will explore different strategies for integration of refugee health services with host population health systems. It will highlight successful policy implementation and innovative approaches as well as predict potential barriers to success via a population-centered approach that emphasizes the importance of supporting host communities concurrently with displaced populations. It offers the following findings and recommendations for governmental and humanitarian actors. Effective integration requires a "whole of person" approach which acknowledges and responds to the linkages between legal status, economic needs, and mental and physical health and wellbeing. Addressing the health needs of populations experiencing protracted displacement must go hand-in-hand with, and cannot be decoupled from, addressing the needs of host communities. Demographic and epidemiologic data inclusive of both host and displaced populations enables governments and service providers to better plan for and respond to key health and non-health needs. Donors and financing structures can play a critical role in facilitating greater integration of health and other services. [ABSTRACT FROM AUTHOR]

Youth violence poses a substantive public health burden in Latin America, particularly among adolescent boys and young men. Understanding predictors of youth violence perpetration among boys and young men is critical to more effectively target and tailor prevention programs, especially in Colombia, which has endured decades-long internal armed conflict. This study uses Colombia's nationally representative 2018 Violence Against Children and Youth Survey data to examine risk and protective factors associated with violence perpetration among 13- to 24-year-old male. Amongst adolescent boys and young men in Colombia, the prevalence of ever perpetrating violence against someone other than an intimate partner was approximately 23%. Multivariable logistic regression models revealed that physical violence victimization by peers, emotional violence victimization by caregivers, having lost or been separated from a mother during childhood, and witnessing community violence were all associated with lifetime perpetration of youth violence. Programs targeting reduction of youth violence among boys might consider addressing the previously identified predictors earlier in the life course and at the individual, family and community levels. [ABSTRACT FROM AUTHOR]

Colombia provides a unique setting to understand the complicated interaction between health systems, health insurance, migrant populations, and COVID-19 due to its system of Universal Health Coverage and its hosting of the second-largest population of displaced persons globally, including approximately 1.8 million Venezuelan migrants. We surveyed 8,130 Venezuelan migrants and Colombian nationals across 60 municipalities using a telephone survey during the first wave of the pandemic (September through November 2020). Using self-reported enrollment in one of the several Colombian health insurance schemes, we analyzed the access to and disparities in the use of health-care services for both Colombians and Venezuelan migrants by insurance status, including access to formal health services, virtual visits, and COVID-19 testing for both groups. We found that compared with 3.6% of Colombians, 73.6% of Venezuelan telephone survey respondents remain uninsured, despite existing policies that allow legally present migrants to enroll in national health insurance schemes. Enrolling migrants in either the subsidized or contributory regime increases their access to health-care services, and equality between Colombians and Venezuelans within the same insurance schemes can be achieved for some services. Colombia's experience integrating Venezuelan migrants into their current health system through various insurance schemes during the first wave of their COVID-19 pandemic shows that access and equality can be achieved, although there continue to be challenges. [ABSTRACT FROM AUTHOR]

Increasingly, researchers and practitioners are examining connections between public and private cycles of violence. In complex emergency settings, these cycles of violence often intersect with conflicting norms and values as societies work toward sustainable peace. Gender norms, particularly norms of masculinity, are not often highlighted in transdisciplinary violence studies. Furthermore, few studies on either subject capture the perspectives and experiences of adolescent boys. This study seeks to explore adolescent boys' (13-17 years) experiences with violence at home and in the community in "post-conflict" Colombia. Thematic qualitative analysis of 20 interview transcripts from 14 Colombian boys in Cundinamarca (n = 5) and Córdoba (n = 9) revealed themes of conflict avoidance, hegemonic masculinity, and opportunities for change in the form of positive coping habits. Further research into social and emotional coping behaviors and linkages to perpetuating violence between adolescence and adulthood is needed. [ABSTRACT FROM AUTHOR]

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Introduction: High quality investments during early childhood allow children to achieve their full potential by setting developmental foundations. However, challenges in the scale-up of evidence-based interventions make across-the-board implementation a non-trivial matter. Moreover, extreme contextual conditions -such as community violence, forced displacement, and poverty- impose a double threat. First, by directly affecting early childhood development (ECD), forced displacement and exposure to violence during early childhood, coupled with deficits in nurturing relationships, can trigger toxic stress, affecting children's mental health and social and emotional learning. Second, contexts of extreme adversity exacerbate common implementation pitfalls in the scale-up of interventions. Recognizing and documenting "what it takes" to successfully implement "what works" can contribute to the expansion and effectiveness of evidence-based programs that promote ECD in these settings. Semillas de Apego (SA, onward), a community-based psychosocial support model for caregivers, materialized as a strategy to promote ECD in communities affected by violence and forced displacement., Methods: This article presents the results of the process evaluation of SA during the 2018-2019 implementation in Tumaco, a violence ridden municipality in the south-west border of Colombia, South America. In this phase, the program reached 714 families, 82% direct victims of violence and 57% were internally displaced. The process evaluation combined qualitative and quantitative methodological approaches to produce evidence of factors that promoted implementation quality., Results: Findings identified salient components of the program that promoted the program's acceptability, adoption, appropriateness, fidelity and sustainability: a rigorous cultural adaptation; well-structured team selection and training methodologies; and a team support and supervision protocol to provide continuous capacity building and prevent burn-out and other occupational hazards common among professionals in mental health and psychosocial support interventions. The statistical analysis using monitoring data identified key predictors of the dosage delivered (a measure of fidelity). Evidence suggests that initial attendance to the program and observable characteristics -such as educational attainment, violence victimization and employment status-predict a successful compliance (in terms of dosage to benefit from the program)., Discussion: This study provides evidence for the development of structural, organizational, and procedural processes for the adoption, appropriate adaptation, and high-fidelity delivery of psychosocial support models delivered in territories affected by extreme adversity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Harker Roa, Córdoba Flechas, Moya and Pineros-Leano.)