Poverty and AIDS in Developing Nations: A Global Call to Service for Western Psychologists

Susan E. Hawes

Working paper presented at The University of Hartford’s Annual Diversity Conference, Toward a Global Diversity: Psychology as an International Phenomenon, November 11, 2008

The combined effects of a history of colonization with its legacy of extreme poverty and the ravages of the HIV/AIDS pandemic are devastating southern African countries’ capacities for economic, social and political development. Similar conditions exist in other underdeveloped and developing regions of the world. In 2007-2008, concerns about the negative effects of poverty alone on stunting early childhood cognitive and social development have been pushed to the forefront of international development agencies, such as UNICEF and the World Health Organization. Recent international research publications, drawing on western research and a few studies in developing countries, identify the brief period from prenatal to eight years as “a critical foundation for [a child’s] entire life course” because the physical, social-emotional, and language/cognitive development that occurs in early life “strongly influences basic learning, school success, economic participation, social citizenry, and health” (Iran, Siddiqi & Hertzman, 2007, p. 3). Deprivations in nutrition, sanitation, and quality of maternal care, among other wants, have been found to result in debilitated achievement potential; stunted physical, cognitive and social-emotional capacities mean the continuation of restricted employment potential, as well as the skills needed to participate in fragile democratic political systems. These urgent global conditions call out to us:

1.        For more research on the psychological effects of AIDS and poverty on children in the developing world.

2.      For designing and implementing culturally sensitive and evidence based intervention programs to improve the conditions of infants’ and young children’s psychological development in impoverished communities across the globe (in cooperation with community health services);

I will add one more:

3.       For our donated services are desperately needed. “At no other time have children in the developing world, especially in southern Africa needed the combined skills and efforts of the international infant and child development community so much” (Richter, 2003, p. 247).

Professional psychologist’s competencies in western-based research, assessment, and intervention are skills can contribute, in collaboration with efforts in developing countries to construct “globally accepted measurements and indicators for child development that can be adapted across countries for monitoring, planning, and assessment” (Engle, et al., 2007). At the same time, western psychology with its constricted epistemology, the simplistic individualism of its ontology, and its negligible interest in poverty and countries outside the developed world, has also been shown to be insufficient to understand the matrix of psychological, historical, social, cultural, political, and economic processes effecting the developmental trajectories of the poor, particularly those living in the southern hemisphere.

Historically, global health initiatives have focused on medical definitions of health and neglected mental health, accepting Maslow’s erroneous hierarchy which suggests that, among the poor, the “need for food and shelter is greater than their need to feel loved by others and to respect themselves” (Richter, 2003, p. 245). I believe that it has been psychology’s general avoidance of the messiness of poverty (or its multi-determined, interdisciplinary implications) that has contributed to the lack of attention to psychological needs in global poverty initiatives until this late date. The need for psychologists all over the world to help put an end to both poverty’s stranglehold on over 200 million children’s futures and the intergenerational transmission of poverty has never been so clear or critical.

This paper will discuss these global problems, using South Africa as an example, and present suggestions on what we can do to help.

Threats to Child Development in Developing Countries

In 2007, The Lancet published a significant and influential series, Child Development in Developing Countries, which reviews research demonstrating (a) the failure in developing countries of over 200 million children under 5 years of age to achieve their developmental prospects, (b) the biological and psychosocial risks faced by these children living in extreme poverty, and (c) effective interventions which are as yet underutilized in countries where they are needed most.

The failures of children to reach their developmental potential in developing countries can be attributed to poverty and its correlates—poor health and nutrition and inadequate care results in “poor levels of cognition and education, both of which are linked to later earnings” (Grantham-McGregor, et al., 2007, p. 60). Grantham-McGregor, et al (2007) estimate that the percentage of children who are living in poverty and physically stunted in Sub-Saharan Africa, South Asia, and developing countries are 61%, 52% and 39%, respectively. These children will achieve fewer years of schooling and learn less per year than children in wealthy parts of the world, resulting in an estimated 19.8% deficit in adult yearly income. Poverty begets poverty, and this intergenerational transmission of poverty results growing numbers of citizens unable to become active contributors to improving their nation’s fragile development goals in the face of globalization. Most nations who are members of the United Nations have ratified the articles in the 1998 Convention on the Rights of the Child (Article 6: Survival and development) and their development goals are reflected in the 2000 UN Millennium Declaration; six of the latter’s eight goals are relevant to child development and meeting the articles of the UN’s Rights of the Child.

1.      Eradicate extreme poverty and hunger

2.    Achieve universal primary education

3.    Promote gender equality and empower women

4.    Reduce child mortality

5.      Improve maternal health

6.    Combat HIV/AIDS, malaria and other diseases

Both the World Health Organization (WHO) and UNICEF have since the UN Millennium Declaration made substantial financial contributions to support child development programs in developing countries, and progress has been made in the Education for All (EFA) Millennium Goal (EFA Global Monitoring Report, 2007). Yet the focus on young children’s early development has only recently come to the attention of global service organizations, to some degree incited by the 2007 Lancet series, and further verified by the 5th edition of the EFA Global Monitoring Report (2007).

““Poverty is not a distinct episode or state; rather, it is a conglomerate of conditions and events that create pervasive hardship and stress” and affects children through multiple mechanisms (Richter, 2003, p. 244). Poverty increases risk factors in children and their parents and support systems; protective factors for all three are less present than in the more affluent. According to South African research, Linda Richter, “risk  factors accumulate and concentrate over time, and few opportunities are available for children in poverty to escape from these cumulative effects or to benefit from interventions that might ameliorate their impact” (Richter, 2003, p. 224).

Risk factors for poor child development under conditions of poverty identified in the few existing research publications can be distributed into two categories: biological and psychosocial risks (Walker, Wachs, Lozoff, Wasserman, et al., 2007). Excluding genetic factors, the biological risks are poor nutrition (low birth weight and stunting), iodine and iron deficiencies, vulnerabilities to infectious diseases, and environmental exposures (lead, arsenic, and pesticides in-utero) (Walker, et al., 2007). Psychosocial risks can be clustered into inadequate parenting factors and exposure to violence; studies have found the former to be consistently related to children’s cognitive and social-emotional competencies (Walker, 2007). The most reliable parenting characteristics associated with positive early developmental outcomes are cognitive stimulation and child learning opportunities, caregivers’ sensitivity and responsivity to the child, and maternal mood (depression) (Walker, 2007).

Tragically, many children growing up in developing countries are exposed to considerable levels of violence, whether in their homes or in their communities, and the likelihood of being exposed to violence is increased when there are disruptions in family cohesion or the mental health of primary caregivers (Walker, 2007). Most of the poorest nations are undergoing violent political unrest, civil wars, and violently oppressive governments, so the odds of children feeling unsafe in their communities or becoming victims of traumatic events are high. Further, the HIV/AIDS pandemic (more later) is decimating the working age adults in sub-Saharan Africa and south Asia, resulting in child-headed households that expose children to greater risk of becoming objects of violence or exploitation in order to survive. Another common outcome for children orphaned by AIDS is to live in grandmother-headed households; their grannies are typically beyond their wage-earning capabilities, which magnifies the degree of poverty experienced by family, leading to the inability to pay school fees, school drop-outs, delinquency, unemployment, etc.

The conditions of impoverished communities foment violence among members, whether due to the effects of drug and alcohol abuse on parents’ self-regulation skills and poor judgment in the care of their children, or due to the violence caused by delinquent youth, civil wars, and systematic government oppression. It is no stretch of the mind to come up with a list of international communities where violence has been the norm for long periods of time: Los Angeles, El Salvador, Guatemala, Columbia, Haiti, Afghanistan, Iraq, Palestine, Lebanon, Israel, Northern Ireland, Somalia, Rwanda, the Democratic Republic of Congo, Zimbabwe, Black South African townships, to name a few. Research on the effects of exposure to violence on children asks us to make a distinction between acute danger and chronic danger (Garbarino, 1993). Children’s recovery from acute danger requires a change in their conditions of life and new ways of understanding of life events; chronic danger, on the other hand, requires developmental adjustments that are likely to include “developmental impairment, physical damage, and emotional trauma, and will be socialized into a model of fear, violence, and hatred…” (Garbarino, 1993, p. 107). While the psychological availability and reassurance of parents and caregivers can improve children’s long-term prognosis after events of acute violnece, chronic violence in the community negatively impacts parents, whose own psychological resources are destabilized or destroyed (Garabino, 1993). For example, in Rwanda where there is a very high number of adolescent-headed households due to both AIDS and the genocide of 1994, the high levels of emotional suffering in young children are related to “high levels of depressive symptoms and social isolation” experienced by their heads of household (Boris, Thurman, Snider, Spencer, & Brown, 2006).

While there are yet few quality studies on the effectiveness of ECD interventions in the developing world, there are promising results in existing international examples. The most common interventions originate from health care and educational programs that monitor the growth and improve hygiene and health services, or offer child care in centers outside the home (Engle, et al., 2007). ECD programs are center-based, home-base, including parent training and parent-child support, and comprehensive (center & home-based care). According to Engle, et al. in the 3rd Lancet article (2007),

The most effective interventions are comprehensive programmes for younger and disadvantaged children and families that are of adequate duration, intensity, quality, and are integrated with health and nutrition services. Providing services directly to the children and including an active parenting and skill-building component is a more effective strategy than providing information alone. p. 239[i]

The 2007 Lancet series on early child development in developing countries is a call to governments, NGOs and civil society is to step up the proliferation of effective and efficient early child development programs, bringing them to up to match the enormous scale of the problem (Engle, Black, Behrman, Cabral de Mello, Gertler, Kapiriri, Young, & the International Child Development Steering Group, 2007).

There is something a little too reassuring about the Lancet’s reports on research on early childhood development risks and interventions, with its emphasis on bringing specific, empirically researchable programs to scale in developing (aka, impoverished) countries. This illusion of confidence is based on the absence of any critique of the economic and political systems that create and perpetuate poverty and oppression.  Omitted is any reference to the role of globalization, as global capitalism, in creating and maintaining economic hardship in some parts of the world. I will not tackle that here, except to say that the policies of the International Monetary Fund (IMF) and World Bank (WB) have led to the eroded the health care systems and increases in poverty in Africa (Hunter, 2003); the resulting lack of basic resources (food, clothing, water, sanitation, shelter, employment, access to health care, and lack of education) was fodder to the mushrooming AIDS pandemic.

The Lancet’s other omission is having given bare attention to the complex, gnarly and devastating repercussions from the mushrooming HIV/AIDS pandemic on the poorest regions of the globe. With the spread of the virus, most pre-existing family and community systems of the poor in developing countries have fallen apart, not only further diminishing the capabilities of parents to care for their young children, but removing parents from the equation altogether. AIDS is overwhelming children’s already overburdened communities as well as decimating the rolls of current and potential service providers, both professional and non-professional. For example, when Botswana finally was able to distribute antiretroviral treatments to its devastated citizens, there were no longer enough living adults in health care to administer the treatments.

The HIV/AIDS Pandemic

According to the UNAIDS data (2006), Southern Africa is the world region most affected by HIV/AIDS, and that is where most of the children living with HIV live. Other high infection regions are in the Caribbean, Latin America, and South/Southeast Asia. South Africa, where I have direct experience, has the 6th highest prevalence in the world; almost 20% of its citizens are estimated to be infected, and new infections are increasing with no sign of reaching a natural limit. However, the disease is not equally distributed among South African society: Black Africans have the highest prevalence (18.4%) compared to other racial groups (whites-6%; coloured-7%; indians-2%).

Indeed, while anyone can get the virus under the right conditions, HIV/AIDS is not an egalitarian disease; even in affluent countries the groups most at risk for contracting the virus have shifted to the poor, and particularly the female poor. Like the history of Tuberculosis, which today can only be found in impoverished and abandoned communities in the poorest regions of the world (or the poorest sections of western cities), global economic inequities insure that HIV/AIDS is selective of its victims; it is most virulent among the poor in the poorest nations and there is evidence that the highest rates of infection now occur in women (Farmer, 2001; Walker, 2007). The highest death rates occur among employable adults, decimating the income-generating members of communities, leading to lower tax income to support community infrastructures, such as education and the now over utilized health services. This cycle of AIDS and poverty has meant that South Africa has dropped dramatically over the course of the last five year on the scale of economic development, creating greater numbers of poor and people vulnerable to the virus and without adequate services.

In South Africa, the afflicted in the early years were predominantly heterosexual men who, due to Apartheid’s system of separate homelands for Black South African employable men, who were forced to become migrants in order to earn a living for white mines and factories in large cities. Far from their rural village homes and their wives, these men caught and spread the virus through their exchanges with sex-workers, who also had migrated to cities for money to survive. By 2003, the HIV/AIDS epidemiology showed a gender switch: women came to make up two-thirds of Africans infected with HIV (Hunter, 2003). South African women also came to have a higher prevalence than men; 18% compared to 13%, and that gender infection gap is thought to be widening. Women, like children, are more vulnerable than adult men because they have no power or rights in their communities. However, global statistics remind us that, even in our own country, it is poverty that makes misogyny so toxic. [UN on Women}

The high occurrence of HIV in southern African women has meant that, due to vertical infection, rates of HIV in children have also risen.  About 90% of infected children get virus from their mothers during pregnancy, birth, and/or breast milk. Without antiretroviral treatment (HAART): (a) 1 in 3 infected newborns will die before age one, (b) over ½ die before reaching their 2nd birthday, and (c) most are dead before 5 years. In Zimbabwe and Botswana child mortality rates have doubled since 1990. Tragically, only 15% of the 780,000 children living with HIV in these regions were receiving treatment at the end of 2006; every hour, 40 children die due to AIDS.

As the greatest number of infections and deaths are adults ages 20-35, the physical, emotional and cognitive impacts of HIV/AIDS on infants and children has reached a tragic scale; more and more poor households are headed by grandmothers and children who have, respectively, lost their children and parents to AIDS-related diseases. In addition to suffering the stresses of multiple losses, upheaval of their family systems, inadequate care from ill-prepared or frail caregivers, and removal from their homes, infants have been infected with the virus by their HIV+ mothers. Before ART, infection was an early death sentence for a child; with treatment, these children still face the stresses above, and many will grow up in institutional settings.

US-AID (Smart, 2003) was the first to use the term “Orphaned and Vulnerable Children” to recognize the burden HIV/AIDS has laid upon the world’s children. Linda Richter and colleagues of South Africa’s Human Sciences Research Center (HSCR) report that “it has been argued, particularly where children are concerned, HIV/AIDS needs to be treated as a broad developmental concern rather than as a narrow health or even public health issue” (Richter, Manegold & Pather, 2004, p. 4).

HIV/AIDS has torn apart South African family structures more effectively than Apartheid’s homeland and migrant worker systems.  Here is a partial list of the impact of the virus on South African families (Richter, Manegold & Pather, 2004, p. 5):

1.        The emergence of child- or adolescent-headed households

2.      An increase in elderly caregivers, and children caring for old people;

3.       Increases in household dependency ratios;

4.      Separation of siblings

5.      Family breakdown

6.      Child abandonment

7.      Remarriage”

AIDS has also impacted communities by producing declines in skilled and professional services, strains on health care and educational service delivery, and extreme stress on small communities who must absorb the children of the dead and dying into their care (Richter, Manegold & Pather, 2004, p. 6). HIV/AIDS is ravaging sub-Saharan societies, especially by diminishing health, welfare & education systems due to the extreme volume of needs due to the epidemic, loss of people to staff these institutions due to AIDS-related illness & death, and reduced tax-base because of the illness & death of employable persons (Richter, Manegold & Pather, 2004, p. 5).

The next set of influences on the impact of AIDS in South Africa will leave us in no doubt of its complex web of psychological, social, physical forces and needs. This set consists of the influences of gender, age, and household location (Richter, Manegold and Pather, 2004, p. 7-8):

1.        Gender

a.      Education for boys valued more highly (they are considered to be potentially more economically productive), so girls are often the ones to leave school or work to care for the sick or younger children;

b.      Female-headed households are poorer than those headed by men;

c.       Female-headed households tend to allocate more of the family’s resources to children’s healthcare and education than male heads;

2.      Age

a.      Infants and toddlers are most vulnerable to effects of AIDS and health risks;

b.      Preschoolers are vulnerable to malnourishment, abuse and neglect, poor stimulation, and lack of opportunities for schooling;

c.       Adolescents are vulnerable to school drop-out, sexual exploitation, and overwork;

d.      All children are vulnerable to the emotional consequences of multiple losses, including parents, and to being separated from their homes and communities.

3.       Location of household

a.      Rural households are typically poorer and have fewer employed adults than urban households;

b.      Children are expected to contribute substantially to subsistence activities

c.       Social networks in informal urban areas are less developed and less supportive;

d.      Caregivers often leave their children alone because of their “livelihood activities.”

As they are on the global stage, South African HIV positive children’s mental health and cognitive developmental needs have historically been neglected in the child development research and in most intervention programs. South Africa is not the only developing country lacking national psychoeducational data. Most child development research and programming has been done with U.S. and European samples, and few psychologists in western nations have concerned themselves with internationalizing their theories and studies, particularly in those parts of the globe with the greatest needs for help and understanding. In the international and national responses to the HIV/AIDS pandemic in southern Africa, “psychological” has, until recently, been considered a less important or less acute problem than HIV/AIDS affected children’s nutrition and shelter, as if, Linda Richter (2003) suggests, their “need for food and shelter is greater than their need to feel loved by others and to respect themselves” (p. 245). The 2007 HIV and AIDS and STI Strategic Plan for South Africa, 2007-2011, makes no mention of insuring that children’s conditions actively contribute to rather than undermine their emotional and social development, and by extension their academic achievement and potential to contribute to South African society. This oversight confirms the relative neglect of orphans’ and vulnerable children’s mental health and its influence on achievement by funders and policy makers, at least in South Africa, in spite of this country’s impressive budget allocations to social support systems when compared to other nations. National policies that support multifaceted treatments in the services of children’s development are crucial components of meeting the first and second UN Millennium Development Goals: (a) eradication of extreme poverty and hunger, and (b) insuring that all children complete primary schooling.

As the preceding suggests, we know a fair amount about the risks and stressful conditions that occur under conditions of chronic poverty and HIV/AIDS; however, there are as yet only a few studies on the psychological effects of HIV/AIDS and poverty on South Africa’s (and other severely affected nations’) children, including their cognitive functions, academic achievement, and mental health (Cluver, 2007; Richter, 2003; Walker, 2007). For example, studies on the mental health of AIDS orphans are not only few in number but incapable being interpreted across studies; the variabilities of procedures, measures and samples used makes it impossible to come to firm conclusions. There are strong suggestions, however, that conditions of poverty lead to higher levels of psychological problems in AIDS African orphaned children, such as internalizing problems (hence depression and anxiety), symptoms of post-traumatic stress, behavioral problems, and delinquency (Cluver & Gardner, 2007; Cluver, Gardner & Operario, 2007). However, more research on the mechanics of increased mental health problems in these children is needed in order to better understand the factors in their lives “which are acting as stressors or buffers in mental health outcomes” in order to inform options for therapeutic intervention” (Cluver & Gardner, 2007, p.9).

A 2003 round-table on mental health consequences of the pandemic, compiled by South Africa’s Human Sciences Research Council includes a list of people projected to be likely to experience mental health problems due to AIDS by 2015: people uncertain about their HIV status, people living with the infection, families and caregivers of people with HIV/AIDS, children and adolescents orphaned by AIDS, people caring for AIDS orphans, and those who fit into more than one of the previous categories (Social Aspects of HIV/AIDS and Health Research Programme, 2003, p. 40).

International and national studies are unanimous on calling for internationally accepted measures and indicators for child development for planning, monitoring, and assessment (Cluver & Gardner, 2007; Engle, et al., 2007; Irwin, Siddiqi, & Hertzman, 2007; Social Aspects of HIV/AID and Health Research Programme, 2003). “Very few of the programs that try to intervene for children, families and communities have been monitors systematically and none have been rigorously evaluated (experimentally). This has meant an over-reliance on local knowledge to the detriment of building a knowledge base on “the real impacts of AIDS” and “what the responses should be in any given context” (Richter, Manegold & Pather, 2004, p. 7).

Need for Interventions

At this point, I must ask, where are the western psychologists when there is so much global poverty? A South African psychologist has asked, why it is that in psychology, have we such a “lack of knowledge in terms of interventions to prevent and ameliorate the effects of poverty on infants and small children. In our professional child development journals and conferences, why is there no strong and growing theme that expresses concern for the compromised conditions which the majority of infants and small children in the world live” (Richter, 2003, 245)?

There are urgent needs for the design and implementation of culturally sensitive and evidence based intervention programs to improve the conditions of infants’ and young children’s psychological development in impoverished communities across the globe. More than ever, psychologists need to prioritize humility and collaboration as practices by cooperating with local networks of community health services (professional and paraprofessional), community members and leaders, nongovernment organizations, and politicians in order to be effective in the developing world. Psychologists living in developing countries are hard at work trying to meet these needs, but there are not enough of them to tackle these problems on their own. Where should we Western psychologists turn, if we want to make a difference?

Thankfully, there are a number of opportunities for western psychologists to explore of sufficient diversity that we can choose the type and degree of investment we want to make from international and global psychological associations and publications. Another way we can help is to expand the engagement of psychologists and trainees in the field of international/global psychology by developing undergraduate and graduate curricula and practice opportunities.

Global Psychology

Internationalism is on the rise, especially over the last decade. Academic institutions like mine are hoping to mine the globe for increased enrollment and revenues. International experiences in undergraduate institutions are increasingly popular, trickling down to many high school optional curricula. We have realized that multicultural sensitivity training for the privileged is most affecting when it occurs in confrontation with one’s own otherness in unfamiliar contexts. According to the editors of the text, Handbook of International Psychology, the growth of international psychology is responding to:

1.        Increasing diversities within countries, multiculturalism (Denmark in Stevens & Wedding)
2.      Changing Diasporas-migrations & new immigrants

a.      Somalis in Maine & other US states

b.      Iraqis moving wherever they can

c.       South Africa’s burgeoning immigrants from Mali, Zimbabwe, Malawi, etc.

d.      Migrant camps on countries bordering conflict regions, e.g., Ruwanda, Republic of Congo, Somalia, Chad, Zimbabwe

3.       Discontent with Western psychology as well as emerging local and indigenous psychologies leading to greater dialogue between international colleagues (S&W).

4.      Globalization of market-based economics pushing developing world to psychology as a “means of enhancing national achievement and personal well-being” (S&Wp3).

The growth of interest in internationalism is evident in the growing number of international conferences in psychology over the last decade.  Psychological associations identified as international in their area of concern and in their membership are not new The International Council of Psychologists was founded in 1941 and the Committee on International Relations (CIRP) was formed in 1944. APA is one of the six psychology organizations with representation on the United Nations, and there has been an APA Division of International Psychology (52) since 1997.

“The chief aim of international psychology is to promote communication and collaboration among psychologists worldwide in the areas of teaching, research, practice, and public service” (S & W, p. 1). International psychologists recognize that solutions are needed to “problems that have no borders” (S&W, p2), understand problems as “rooted in a complex matrix of culture, economics, history, politics, psychology, and religion, and realize that a comprehensive approach to explanations and solutions to these problems requires “both a multidisciplinary and transnational framework” (S&Wp2). International psychology embraces a social justice mission and, providing “an “antidote to the uncritical application of Western psychology” questions “claims of objectivity that supersede culture and a universally applicable investigative methodology” (S&W, p. 4). International psychologists acknowledge “psychology’s history and capacity to unwittingly support institutions that maintain oppressive values” and “takes responsibility for being value-laden and identifies itself, in part, as a force for justice and human welfare” (S&W, p. 4).

International psychologists also hold that remediation and prevention are possible when therapeutic goals include social justice and equality, and treatment incorporates activism and advocacy. They employ conventional, innovative, and indigenous methods (e.g., bearing witness, attitudinal healing programs) to raise individual and collective awareness of how oppression affects mental health. Furthermore, they work to transform alienation into affirmation, empowerment, solidarity, and commitment to social action. (S&W, p. 11)

What Skills Can We Contribute?

Psychologists trained in the Practitioner-Scholar model of professional psychology can draw upon their competencies as resources to identify what skills they might contribute to serving the needs of children and families in the developing world. All of our skills, however, must be grounded in a set of intentions that we can relate to the Relationship and Diversity Competencies, and assume a social justice sensibility.

1.        Humility

2.      Compassion

3.       Openness & Acceptance

4.      Flexibility

5.      Curiosity

6.      Critical Thinking

7.      Understanding of the Effects of History

8.      Reflexivity

9.      Advocacy

10.   Empowerment

The following are preliminary suggestions of skills we might offer according to some of our other professional psychology competencies. I welcome your suggestions.

Consultation & Education/Supervision & Management/Intervention

1.        Provide Staff training or workshops

2.      Support staff professional development

3.       Bridging communities & organizations

4.      Interdisciplinary collaboration (primary health—education—mental health)

5.      Participatory Action Research

6.      Collaborate with locals on designing programs that incorporate psycho-social needs

7.      Help compile information resources for community knowledge banks

8.      Modeling dialogic practices for conflict resolution and group empowerment


1.        Develop methods of ethical, locally-sensitive, globally useful assessment of development, cognitive processes, learning processes and outcomes, psychopathology

2.      Insure that assessments can inform actions and interventions in relevant settings in the best interests of the child without hegemonic effects

3.       Collaborate with local psychologists in holistic approaches to assessment to adapt or replace western tests

4.      Provide assessment services for health clinics and NGO’s providing HIV/AIDS and ECD services in poor communities.

5.      Collaborate with local psychologists in holistic approaches to assessment

6.      Help compile information resources for community knowledge banks

Research and Evaluation

1.        Participatory action research to support learning communities and empower staff, clients, and their communities

2.      Help NGOs and other local service delivery organizations to meet global accountability goals by designing program evaluations or consulting on methods of program evaluation

3.       Collaborate with local academics on local research programs

4.      Create or work in evaluation networks to share & support evaluation in the interest of community development

5.      Help compile information resources for community knowledge banks


We have many things to offer as international psychologists to serve the psychological and social justice needs of children and families in developing countries. We also have several options for ways we might be of service. A few of us might consider making the great commitment of moving to one of these regions for a year or more by pursuing grants or fellowships and collaborating with our international colleagues on research or service delivery projects. There are numerous fellowships for students and post-graduates to support international projects. We may also use many of the international volunteering organizations, but these tend not to be designed for professional services. It is also possible to contact NGOs in developing countries and ask if we might be able to provide them with some free professional skills to be used as they see fit, in exchange for inexpensive lodging. APA’s Office of International Affairs provides two suggestions for information on NGO volunteering opportunities for psychologists:

I have lately considered how beneficial it might be to create a non-profit institute of international professional psychologists that could be in a position to apply for more substantive funding for collaborative projects in developing countries.

Training for International Service

In conclusion, I would like to advocate for the inclusion of international psychology and experiences in international services in the training of professional psychologists.


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[i] “Characteristics of successful early childhood development interventions:

·          Integration of health, nutrition, education, social, and economic development, and collaboration between government agencies and civil society

·          A focus on disadvantaged children

·          Sufficient intensity and duration and include direct contact with children beginning early in life

·          Parents and families as partners with teachers or caregivers in supporting children’s development

·          Provide opportunities for children to initiate and investigate their own learning and exploration of their surroundings with age-appropriate activities

·          Blend traditional child-rearing practices and cultural beliefs with evidence-based approaches

·          Provide early child development staff with systematic in-service training, supportive and continuous supervision, observational methods to monitor children’s development, practice, and good theoretical and learning material support” (p. 234).