Objective 5: Promote Evidence-Based Policies and Programs

Supporting national researchers in ethical operational research and enhancing their capacities over time is a further priority activity as is working with universities to develop program curricula to enhance the knowledge and skill sets of current and future practitioners.

The U.S. Government will lead efforts to fill critical gaps in the evidence base and available methodological tools, recognizing the importance of always collecting sex- and age-disaggregated data; provide direct support to promising efforts in this area on the part of partners; and complement the work of other organizations, institutions, and coordination groups. 

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  • Outcome 5.1

    The number of prevalence studies that measure and track trends in children’s exposure to violence, exploitation, abuse, and neglect is increased.

    Work with governments, universities, international organizations, and other partners to use appropriate and ethical tools and methods to identify and enumerate children living outside of family care.

    • Department/Office: PEPFAR
    • Activity: Support national governments to address care reform and deinstitutionalization as part of existing national plans of action for orphans and vulnerable children.
    • Country Focus: The actions will be tailored to fit country context and prioritization but the objectives are currently and will continue to be a part of PEPFAR programming in all PEPFAR countries with OVC portfolios. For PEPFAR priority countries see www.pepfar.gov.
    • Outcome/Indicator: N/A
    • Time Frame: Ongoing.
    • Budget: Budget for PEPFAR Ongoing Programming for all three of the above objectives is 10% of PEPFAR programming budget at country level (differs by fiscal year). Because PEPFAR programs and projects are integrated and comprehensive and address multiple objectives simultaneously, it is not possible to break the funding down by objective.

    • Department/Office: USAID, Bureau for Democracy, Conflict, and Humanitarian Assistance (DCHA), Office of Foreign Disaster Assistance (OFDA)
    • Activity: Support efforts to identify children living outside of family care in humanitarian settings.                 
    • Country Focus: Due to the contingency nature of funding, OFDA cannot commit to implementation in specific countries.                 
    • Outcome/Indicator: Number of OFDA-funded programs addressing children outside of family care in humanitarian settings, as measured through awards and partner reports.                 
    • Time Frame: Ongoing.
    • Budget: Due to the contingency nature of OFDA programs, OFDA cannot commit to specific countries.
    • Department/Office: USAID, Center of Excellence on Children in Adversity (CECA), PL 109-95
    • Activity: Develop, with partners, a global methodology to identify and enumerate ‘Children Outside of Family Care’ (COFC) that is nationally representative and comparable across countries and time.                 
    • Country Focus: Pilot in two countries.
    • Outcome/Indicator: Draft survey methodology is developed. Draft methodology is tested in two countries. Final methodology is created.
    • Time Frame: TBD
    • Budget: No funds have been allocated.
    • Department/Office: USAID, Center of Excellence on Children in Adversity (CECA), PL 109-95
    • Activity: From Strong Beginnings to Youth Resilience:  Pathways out of Adversity. USAID is developing a long term adversity research initiative to be located in an African and an Asian country.  It seeks to identify and subject promising practices to the kind of rigorous efficacy, cost effectiveness and sustainability trials required to inform national and global investments. 
    • Country Focus: CECA is working with relevant USAID bureaus and missions to identify appropriate countries.
    • Outcome/Indicator:
    • Time Frame: 2013-2017.
    • Budget: No funding has been allocated.
    • Department/Office: CDC, National Center for Injury Prevention and Control (NCIPC), Division of Violence Prevention
    • Activity: Include measures on national VAC Surveys to identify children living outside the care of their biologic families.
    • Country Focus: PEPFAR Prioritized Countries: Malawi, Haiti. Uganda, Nigeria, Botswana, Rwanda, Zambia (under consideration). Other Countries: Cambodia, Indonesia. Laos, Malaysia, Philippines, Viet Nam, Guatemala (under consideration).
    • Outcome/Indicator: Increased surveillance of violence against children in these populations. Number of violence against children surveys (VACS).
    • Time Frame: 2013-2015.
    • Budget: Budget for PEPFAR prioritized countries: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known. Budget for other countries: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known. 
  • Support governments and partners to use appropriate and ethical tools and methods to assess the prevalence and root causes of children’s exposure to violence, exploitation, abuse, and neglect at household, community, and/or national levels.

    • Department/Office: DOL, International Labor Affairs Bureau (ILAB)
    • Activity: Grantees support local and other partners to carry out child labor surveys or other types of data collection and research in a multitude of countries.  This improves knowledge of child labor abuses and increases local knowledge to carry on such work in the future.
    • Country Focus: Currently, DOL is supporting 13 National Child Labor Surveys in Bangladesh, Cambodia, Ghana, Cote d’Ivoire, Tanzania, Morocco, Mozambique, Vietnam, Ukraine, Zambia, Lebanon, Belize, and Panama and 4 Sector-Based Child Labor Surveys in Dominican Republic, Indonesia, Morocco, and Swaziland.
    • Outcome/Indicator: Number of countries with increased capacity to address child labor. This reflects each instance where a grantee institutionalizes child labor research/data collection on child labor. Increased capacity of child labor survey research is counted at the following different stages/points: 1) A survey has been designed and there is an implementation plan. 2) Data has been collected. 3) A report has been published.                 
    • Time Frame: Projects typically last 4 years, and no more than 5. Current projects were funded each year from FY 2008 to FY 2012 and will end from FY 2013 to FY 2017. Reporting: Semi-annually.
    • Budget: Current projects listed have been obligated.  DOL is currently planning the obligation of FY 2013 funds.
    • Department/Office: PEPFAR
    • Activity: Development of the 2013 USAID OVC Program Evaluation Toolkit, through the MEASURE Evaluation project. Support national research plans, the implementation of independent research studies, rapid assessments, and the dissemination of research findings.
    • Country Focus: The actions will be tailored to fit country context and prioritization but the objectives are currently and will continue to be a part of PEPFAR programming in all PEPFAR countries with OVC portfolios. For PEPFAR priority countries see www.pepfar.gov.
    • Outcome/Indicator: N/A
    • Time Frame: Ongoing.
    • Budget: Budget for PEPFAR Ongoing Programming for all three of the above objectives is 10% of PEPFAR programming budget at country level (differs by fiscal year). Because PEPFAR programs and projects are integrated and comprehensive and address multiple objectives simultaneously, it is not possible to break the funding down by objective.

  • Encourage interagency assessments of child protection in humanitarian and development settings, including particular attention to children outside of family care.

    • Department/Office: PEPFAR
    • Activity: Launch of the Inter-agency Learning Initiative on Community Based Child Protection Mechanisms and Child Protection Systems.
    • Country Focus: The actions will be tailored to fit country context and prioritization but the objectives are currently and will continue to be a part of PEPFAR programming in all PEPFAR countries with OVC portfolios. For PEPFAR priority countries see www.pepfar.gov.
    • Outcome/Indicator: N/A
    • Time Frame: Ongoing.
    • Budget: Budget for PEPFAR Ongoing Programming for all three of the above objectives is 10% of PEPFAR programming budget at country level (differs by fiscal year). Because PEPFAR programs and projects are integrated and comprehensive and address multiple objectives simultaneously, it is not possible to break the funding down by objective. 
    • Department/Office: USAID, Bureau for Democracy, Conflict, and Humanitarian Assistance (DCHA), Office of Foreign Disaster Assistance (OFDA)
    • Activity: Support efforts, including rapid child protection assessments, to identify and assess the needs of children living outside of family care in humanitarian, disaster, and conflict settings.
    • Country Focus: Due to the contingency nature of funding, OFDA cannot commit to implementation in specific countries.                 
    • Outcome/Indicator: Number of OFDA-funded child protection assessments and programs addressing children outside of family care in humanitarian settings, as measured through awards and partner reports.
    • Time Frame: Ongoing.
    • Budget: Due to the contingency nature of OFDA programs, OFDA cannot commit to specific countries.

  • Outcome 5.2

    The number of published (easily searchable) outcome/impact evaluations on interventions to assist children outside of family care or minimize exposure to violence, exploitation, abuse, and neglect that can be generalized to larger target groups is increased.

    Establish a mechanism to define and implement and interagency research agenda on children outside of family care.

    • Department/Office: USAID, Center of Excellence on Children in Adversity (CECA), PL 109-95
    • Activity: Develop, with partners, a global methodology to identify and enumerate ‘Children Outside of Family Care’ (COFC) that is nationally representative and comparable across countries and time.
    • Country Focus: Pilot in two countries.
    • Outcome/Indicator: Draft survey methodology is developed. Draft methodology is tested in two countries. Final methodology is created.
    • Time Frame: TBD.
    • Budget: No funds have been allocated.
  • Establish a research and evaluation expert group to advise the U.S. Government’s evidence-building program.

    • Department/Office: USAID, Center of Excellence on Children in Adversity (CECA), PL 109-95
    • Activity: An informal experts group has been formed to advise on evidence building and implementing evidence-based best practices.
    • Country Focus: N/A
    • Outcome/Indicator:
    • Time Frame: 2013-2017.
    • Budget:

  • Establish a measurement expert group to identify and recommend practical methods to enumerate and track hard-to-reach children in adversity (e.g., children outside of family care) and sensitive issues (e.g., violence and abuse).

    • Department/Office: USAID, Center of Excellence on Children in Adversity (CECA), PL 109-95
    • Activity: The measurement experts group has been convened. The group is contributing to the development of a global methodology to identify and enumerate ‘Children Outside of Family Care’ (COFC) that is nationally representative and comparable across countries and time.                 
    • Country Focus: Pilot in two countries.
    • Outcome/Indicator: Draft survey methodology is developed. Draft methodology is tested in two countries. Final methodology is created.
    • Time Frame: February 2013 – ongoing.
    • Budget: No funds have been allocated.
  • Promote inclusion of the principles and objectives of this strategy within data safety and monitoring boards, and ensure that U.S. Government-funded researchers and investigators receive guidance regarding appropriate and culturally-relevant approaches for working with vulnerable children.

    • Department/Office: PEPFAR
    • Activity: Support the adoption of USG Child Safeguarding Principles and policy. Include guidance on ethical research with and for vulnerable children in OVC evaluation toolkit.
    • Country Focus: The actions will be tailored to fit country context and prioritization but the objectives are currently and will continue to be a part of PEPFAR programming in all PEPFAR countries with OVC portfolios. For PEPFAR priority countries see www.pepfar.gov.
    • Outcome/Indicator: Globally, PEPFAR programs report "the number of eligible adults and children provided with a minimum of one care service." The Office of the Global AIDS Coordinator is currently leading the development of a PEPFAR Monitoring, Evaluation, and Reporting Strategy and Operational Guidance that will likely result in changes to the existing M&E guidance, including the addition of several new indicators that will in large part be outcome indicators derived from the OVC Program Evaluation Toolkit. In addition to globally reported indicators, PEPFAR OVC programs are also guided by the PEPFAR Program Evaluation Toolkit which provides measurement of comprehensive child and caregiver well-being outcomes. The toolkit can be accessed at http://www.cpc.unc.edu/measure/our-work/ovc/ovc-program-evaluation-tool-kit.
    • Time Frame: Ongoing.
    • Budget: Budget for PEPFAR Ongoing Programming for all three of the above objectives is 10% of PEPFAR programming budget at country level (differs by fiscal year). Because PEPFAR programs and projects are integrated and comprehensive and address multiple objectives simultaneously, it is not possible to break the funding down by objective.

    • Department/Office: USAID, Center of Excellence on Children in Adversity (CECA), PL 109-95
    • Activity: From Strong Beginnings to Youth Resilience: Pathways out of Adversity. USAID is developing a long term adversity research initiative to be located in an African and an Asian country. It seeks to identify and subject promising practices to the kind of rigorous efficacy, cost effectiveness and sustainability trails required to inform national and global investments. The principles of this Action Plan have been incorporated into this research and capacity-building strategy.
    • Country Focus: CECA is working with relevant USAID bureaus and missions and interagency partners to identify appropriate countries.
    • Outcome/Indicator: Appropriate implementing mechanism created, funded, and issued.                 
    • Time Frame: 2013-2017.
    • Budget: No funding has been allocated.

  • Create a mechanism to ensure that evidence-based best practices are widely disseminated and fed back into policy and program development processes.

    • Department/Office: USAID, Center of Excellence on Children in Adversity (CECA), PL 109-95
    • Activity: Develop, with partners, technical guidance on evidence-based best practices for the first 3 core objectives of the Action Plan and distribute to the US government and implementing partners.                 
    • Country Focus: Global.
    • Outcome/Indicator: Technical guidance issued for interagency and implementing partners.
    • Time Frame: 2013-2017.
    • Budget: No funding has been allocated.

  • Outcome 5.3

    The number of national governments and universities leading rigorous data collection, research, and monitoring and evaluation studies related to child welfare and protection is increased.

    Support the development of integrated knowledge transfer mechanisms through partnerships between policy makers, universities, research think tanks, and civil society.

    • Department/Office: National Institutes of Health, Fogarty International Center (FIC)
    • Activity: FIC administers research and training grants and fellowship programs at sites in more than 100 countries with a number of research and research training programs that are relevant to children in adversity. These programs include the International Tobacco and Health Research and Capacity Building Program, Brain Disorders in the Developing World: Research Across Lifespan, and the Chronic Non-Communicable Diseases and Disorders Across Lifespan program.  Activities supported by these platforms include studies the drivers of addiction and substance abuse in adolescents, neurological outcomes and interventions for vulnerable children, and mental health issues and learning disabilities among orphans and vulnerable children.                  
    • Country Focus: FIC's country focus is diffuse but a sampling of the few countries that FIC researchers work in include: Vietnam, Botswana, Zambia, South Africa and Uganda.
    • Outcome/Indicator: For FIC research programs, the number of published studies on vulnerable children and new insights gained for working with this marginalized group will serve as performance measures. For research training programs, the number of trainees engaging in research on OVCs, the number of independent funding received by past FIC trainees for research on OVCs,  and the formation of new curriculums, departments, and institutional networks  devoted to children's issues may also be performance measures. An example of this type of performance benchmark is the development of the first clinical child psychology program in Vietnam.
    • Time Frame: 2010-ongoing.
    • Budget:
    • Department/Office: PEPFAR
    • Activity: OVC Program Evaluation Toolkit used by in-country, local implementing partners and capacity of local researchers expanded in evaluation studies.  
    • Country Focus: The actions will be tailored to fit country context and prioritization but the objectives are currently and will continue to be a part of PEPFAR programming in all PEPFAR countries with OVC portfolios. For PEPFAR priority countries see www.pepfar.gov.
    • Outcome/Indicator: Globally, PEPFAR programs report "the number of eligible adults and children provided with a minimum of one care service." The Office of the Global AIDS Coordinator is currently leading the development of a PEPFAR Monitoring, Evaluation, and Reporting Strategy and Operational Guidance that will likely result in changes to the existing M&E guidance, including the addition of several new indicators that will in large part be outcome indicators derived from the OVC Program Evaluation Toolkit. In addition to globally reported indicators, PEPFAR OVC programs are also guided by the PEPFAR Program Evaluation Toolkit which provides measurement of comprehensive child and caregiver well-being outcomes. The toolkit can be accessed at http://www.cpc.unc.edu/measure/our-work/ovc/ovc-program-evaluation-tool-kit.
    • Time Frame: Ongoing.
    • Budget: Budget for PEPFAR Ongoing Programming for all three of the above objectives is 10% of PEPFAR programming budget at country level (differs by fiscal year). Because PEPFAR programs and projects are integrated and comprehensive and address multiple objectives simultaneously, it is not possible to break the funding down by objective.

    • Department/Office: CDC, National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention
    • Activity: Work with partners in countries to develop integrated data surveillance systems (i.e., systems that are able to collect and use data from at least 2 sources, e.g.: hospital, police, health, and other sectors) that are capable of documenting the burden of and risk factors for road traffic injuries, including injuries to children.
    • Country Focus: Tanzania and Thailand.
    • Outcome/Indicator: Number of countries with an integrated data surveillance system capable of documenting the burden and factors contributing to road traffic injuries among children.
    • Time Frame: Tanzania (planned for September 30, 2013-September 29, 2014); Thailand (completed: September 30, 2011-September 29, 2013 & planned for September 30, 2013-September 29, 2014).
    • Budget: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known.
    • Department/Office: National Institutes of Health, NICHD other NIH Institutes also have representation on this Committee.
    • Activity: The Interagency Committee on Human Nutrition Research (ICHNR) works across agencies to improve the coordination of and increase the effectiveness and productivity of federal agencies engaged in nutrition research. Currently, ICHNR is considering a proposal for a global nutrition subcommittee.                 
    • Country Focus: N/A
    • Outcome/Indicator:
    • Time Frame: Ongoing.
    • Budget:
    • Department/Office: National Institutes of Health, NICHD
    • Activity: Interagency committee for Feed the Future, USG's global hunger and food security initiative. The committee with representation from CDC, USDA, OSTP, USAID, and NIH is considering economic and agricultural development for improved food production. The focus is on the first 1,000 days after conception.
    • Country Focus: N/A
    • Outcome/Indicator:
    • Time Frame: 2013.
    • Budget:

    • Department/Office: National Institutes of Health, NICHD
    • Activity: The Biomedical/Behavioral Research Administrators Development Award (BRAD) develops scientific leadership and initiatives in colleges and universities worldwide that will encourage, facilitate, and increase participation of diverse populations and developing nations in biomedical and behavioral research endeavors; and disseminate evidence-based research findings that can be used to ultimately eliminate differences in health outcomes.                 
    • Country Focus: BRAD supports research institutions in building administrative research capacity in Sub-Saharan Africa and India. It recently added low, lower middle and middle income countries in Latin America and the Caribbean. 13 universities in Sub-Saharan Africa and 2 universities in India are currently being supported by BRAD.
    • Outcome/Indicator:
    • Time Frame: 2013-2018.
    • Budget:
    • Department/Office: USAID, Bureau for Democracy, Conflict, and Humanitarian Assistance (DCHA), Office of Democracy, Human Rights, and Governance (DRG), Displaced Children and Orphan’s Fund (DCOF)
    • Activity: Develop network learning agenda with an active cadre of member organizations capable of assessment methodologies and identifying, quantifying, and understanding causes and consequences of child protection concerns in crisis situations.
    • Country Focus: N/A
    • Outcome/Indicator: Assessment methodologies able to identify, quantify, and understand causes and consequences of child protection developed.
    • Time Frame: 2012-2014
    • Budget: DCOF’s annual Fiscal Year budget in recent years has been approximately $13,000,000.

  • Facilitate regional and international exchanges to support cross-country learning and sharing of best practices on child welfare and protection.

    • Department/Office: PEPFAR
    • Activity: Translation & dissemination of informal, formal and alternative care guidelines (w/UNICEF). Continued dissemination of PEPFAR OVC Programming Guidance to guide implementation partners and to interested partners.
    • Country Focus: The actions will be tailored to fit country context and prioritization but the objectives are currently and will continue to be a part of PEPFAR programming in all PEPFAR countries with OVC portfolios. For PEPFAR priority countries see www.pepfar.gov.
    • Outcome/Indicator: Globally, PEPFAR programs report "the number of eligible adults and children provided with a minimum of one care service." The Office of the Global AIDS Coordinator is currently leading the development of a PEPFAR Monitoring, Evaluation, and Reporting Strategy and Operational Guidance that will likely result in changes to the existing M&E guidance, including the addition of several new indicators that will in large part be outcome indicators derived from the OVC Program Evaluation Toolkit. In addition to globally reported indicators, PEPFAR OVC programs are also guided by the PEPFAR Program Evaluation Toolkit which provides measurement of comprehensive child and caregiver well-being outcomes. The toolkit can be accessed at http://www.cpc.unc.edu/measure/our-work/ovc/ovc-program-evaluation-tool-kit.
    • Time Frame: Ongoing.
    • Budget: Budget for PEPFAR Ongoing Programming for all three of the above objectives is 10% of PEPFAR programming budget at country level (differs by fiscal year). Because PEPFAR programs and projects are integrated and comprehensive and address multiple objectives simultaneously, it is not possible to break the funding down by objective.
    • Department/Office: National Institutes of Health (NICHD)
    • Activity: The Helping Babies Breathe Study (HBB) is a pre-post evaluation of a health facility-based training program implemented in selected Global Network clusters.  The primary objective is to test the impact on perinatal mortality of training birth attendants in a neonatal resuscitation program (HBB) and Essential Newborn Care curricula. This study is designed to test the effectiveness of training in these curricula, but can be viewed as an example of how cross-country learning and sharing best practices can be implemented in low-resource settings.
    • Country Focus: This study is being conducted in 3 Global Network sites: Belgaum, India; Nagpur, India; and Eldoret, Kenya.
    • Outcome/Indicator: The study program includes extensive country-level training activities of Master Trainers and facility-level training and retraining of birth attendants. The primary outcome, perinatal mortality rate before and after the training programs, will be collected through the Maternal Newborn Health Registry. Quality improvement activities are a key feature of the project.                 
    • Time Frame: Data collection is scheduled to be completed in October 2013.          
    • Budget:          
    • Department/Office: National Institutes of Health (NICHD)
    • Activity: The Antenatal Corticosteroids Trial (ACT) is a cluster randomized trial designed to evaluate whether a multi-faceted intervention including training to improve identification of pregnancies at high risk of preterm birth, and providing and facilitating the appropriate use of steroids, reduces 28-day neonatal mortality in preterm newborns compared with standard of care in selected populations in developing countries. This trial also serves as a demonstration of establishing an infrastructure to share best practices and improve outcomes.
    • Country Focus: The Global Network Maternal and Newborn Health Registry (MNH) is being conducted in communities in all 7 Global Network clinical sites.  Data is collected from community clusters with at least 250 deliveries per year. 
    • Outcome/Indicator: The intervention is designed to increase the administration of steroids to women at high risk for preterm birth by diffusing recommendations to health care providers; training health care providers on identification of women at risk; providing a kit containing the needed treatment, and improving determination of gestational age. The primary outcome, neonatal mortality at 28 days of life, will be collected via the Registry.
    • Time Frame: The participant recruitment period of 18 months will end in most sites around October 2013. Infant follow up is at 42 days of life.
    • Budget:
    • Department/Office: National Institutes of Health (NICHD)                 
    • Activity: The Biomarkers of Nutrition for Development (BOND) project establishes reliable and valid biomarkers to assess nutrient exposure, status, function, and effect. This is important for addressing micronutrient deficiencies, a major contributor to undernutrition that disproportionately impacts children under 5 in developing countries.
    • Country Focus: N/A
    • Outcome/Indicator: For each of the 6 nutrients studied (iodine, folate, vitamin A, vitamin B12, iron, & zinc), BOND brings together a panel of experts to review the literature and based on the evidence, establish what biomarkers are best for supporting research, programs, and evaluation. One outcome of the BOND program is the query-based system that will provide users with a process by which to make decisions regarding potential biomarkers. Reviews for all 6 biomarkers will be published in 2013.
    • Time Frame: 2010-2013.
    • Budget:                                                         
    • Department/Office: National Institutes of Health (NIMH)
    • Activity: Study of cultural effects on stress, coping, and symptom expression: This study will increase scientific understanding of how culture is related to mental health and mental illness symptomatology by focusing on stress, coping, and symptom manifestation. The study will inform the development/modification of culturally informed psychosocial interventions for adolescents from different cultural backgrounds who experience life stressors.
    • Country Focus: Vietnam - Vietnamese have immigrated to the U.S. in three waves, often facing hardship in Vietnam and on their journey to the U.S. A portion of Vietnamese adolescents have not successfully transitioned to the new country. The study will increase understanding of how stress and coping link to mental health symptoms in Vietnamese youth.                 
    • Outcome/Indicator: Published findings will increase understanding of how culture and cultural variation are related to mental health and mental illness symptomatology. This information may be used to improve the quality of mental health interventions for different cultural subgroups. The study is monitored and assessed using a range of means, including annual progress reports, review of study protocols by Institutional Review Boards, and presentation of scientific findings at scientific conferences and publication in peer reviewed journals.                 
    • Time Frame: 2010-2015.
    • Budget:

    • Department/Office: National Institutes of Health (NIMH)
    • Activity: Study of psychiatric disorders following intrauterine stress: This study will assess the effects of war-related in-utero stress exposures on subsequent development of psychiatric illness.  Results may be used to develop targeted interventions to reduce risk of psychiatric disease in youth whose mothers experienced war during pregnancy.                 
    • Country Focus: Israel - Conflict in the Middle East has resulted in stress for the region's populations, including pregnant women.  This study will measure the incidence of psychiatric disorders in individuals who were in utero at different stages of gestation during two wars involving Israel, and will assess cognitive and social functioning in adolescents whose mothers were pregnant with them during war time.
    • Outcome/Indicator: Published findings will increase understanding of risk for psychopathology that is related to intrauterine exposure to violence and trauma, and, ultimately, may inform targeted interventions to reduce such risk. The study is monitored and assessed using a range of means, including annual progress reports, review of study protocols by Institutional Review Boards, and presentation of scientific findings at scientific conferences and publication in peer reviewed journals.
    • Time Frame: 2009-2014.
    • Budget:
    • Department/Office: National Institutes of Health (NIMH)                 
    • Activity: Study of telomeres as an epigenetic marker of neurodevelopment and early adversity: This study examines a novel mechanism linking early adversity, neural development, and cellular aging in a longitudinal study of children, and in so doing will help to refine theories of early adversity and brain development.                 
    • Country Focus: Romania - This study involves Romanian children who were abandoned as infants/toddlers and then institutionalized. Results will shed light on the effects of early and severe social deprivation on social, emotional, neurobiological, and cognitive development. Results may also help Romania and other countries develop more informed child welfare programs for children living apart from their biological families.                                   
    • Outcome/Indicator: This study may open new research on early adversity, because most current measures of adversity are subjective and vulnerable to bias. Published findings will increase understanding of the mechanism by which early adversity alters normal developmental trajectories and the sensitive periods when exposure to adversity alters neurodevelopmental trajectories. The study is monitored and assessed using a range of means, including annual progress reports, review of study protocols by Institutional Review Boards, and presentation of scientific findings at scientific conferences and publication in peer reviewed journals.
    • Time Frame: 2011-2013.
    • Budget:
    • Department/Office: USDA, Food and Nutrition Service
    • Activity: Work with U.S. Government interagency partners to promote information and learning exchanges from successful domestic nutrition and food assistance programs targeting vulnerable children.                                   
    • Country Focus:
    • Outcome/Indicator: Number of information and learning exchanges conducted with international officials.                                   
    • Time Frame:
    • Budget:
    • Department/Office: CDC, National Center for Chronic Disease Prevention and Health Promotion (NCDPHP), International Micronutrient Malnutrition Prevention and Control Team (IMMPaCt)
    • Activity: Address vitamin and mineral deficiencies in children 0-59 months, and women of reproductive age.
    • Country Focus: Africa: DRC, Uganda, Ethiopia, Tanzania. Asia: Kyrgyzstan, Kazakhstan, Nepal. Other: Iraq. Recently completed work in Africa: Malawi and Niger.
    • Outcome/Indicator: Monitoring and evaluation systems developed for home fortification interventions.
    • Time Frame: Continuous updates and technical assistance as information becomes available.
    • Budget: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known.        
    • Department/Office: CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). International Micronutrient Malnutrition Prevention and Control Team (IMMPaCt).
    • Activity: Support the testing of a new vitamin A supplementation framework (with Global Alliance for Vitamin A and UNICEF).
    • Country Focus:                   Africa (one country to be selected as pilot).
    • Outcome/Indicator: Use feedback of the new VA program framework to further update new global vitamin A deficiency guidelines.
    • Time Frame: 2013-2014.
    • Budget: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known.
    • Department/Office: CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), International Micronutrient Malnutrition Prevention and Control Team (IMMPaCt)
    • Activity: Integrated Nutrition Surveillance Systems.
    • Country Focus: Guatemala.
    • Outcome/Indicator: In these surveillance systems, data will be collected through continuous household surveys. The systems will provide annual representative data for key programmatic nutrition and maternal child health process and outcome indicators. The core content covers fertility, child mortality, infant and young child feeding, child health, maternal and perinatal health, women’s health, and household level indicators.
    • Time Frame: 2013-2014.
    • Budget: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known.
    • Department/Office: CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), International Micronutrient Malnutrition Prevention and Control Team (IMMPaCt)                 
    • Activity: Micronutrient Powders Workshops with UNICEF for North Africa & Middle East.
    • Country Focus: Workshop will take place in Turkey.
    • Outcome/Indicator: Strategy for improving the quality of complementary feeding. Lessons from each workshop are used to build the subsequent workshop for various global regions. A publication of CDC-UNICEF Home Fortification Workshops is being completed.                 
    • Time Frame: May 2013.
    • Budget: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known.
    • Department/Office: USAID, Center of Excellence on Children in Adversity (CECA), PL 109-95
    • Activity: From Strong Beginnings to Youth Resilience:  Pathways out of Adversity. USAID is developing a long term adversity research initiative to be located in an African and an Asian country. It seeks to identify and subject promising practices to the kind of rigorous efficacy, cost effectiveness and sustainability trails required to inform national and global investments.
    • Country Focus: CECA is working with relevant USAID bureaus and missions and interagency partners to identify appropriate countries.
    • Outcome/Indicator: Appropriate implementing mechanism created, funded, and issued.
    • Time Frame: 2013-2017.
    • Budget: No funding has been allocated.

  • Outcome 5.4

    The number of U.S. Government-supported interventions for children in adversity designed using data from rigorous research methodologies is increased.

    Design programs that include outcome research or evaluations to establish reliable baselines and observe change among targeted populations.

    • Department/Office: PEPFAR
    • Activity: Include in PMP baseline and evaluation plans in the RFA and program plan that include core indicators that monitor and evaluate for child and HH wellbeing outcomes.                 
    • Country Focus: The actions will be tailored to fit country context and prioritization but the objectives are currently and will continue to be a part of PEPFAR programming in all PEPFAR countries with OVC portfolios. For PEPFAR priority countries see www.pepfar.gov.
    • Outcome/Indicator: Globally, PEPFAR programs report "the number of eligible adults and children provided with a minimum of one care service." The Office of the Global AIDS Coordinator is currently leading the development of a PEPFAR Monitoring, Evaluation, and Reporting Strategy and Operational Guidance that will likely result in changes to the existing M&E guidance, including the addition of several new indicators that will in large part be outcome indicators derived from the OVC Program Evaluation Toolkit. In addition to globally reported indicators, PEPFAR OVC programs are also guided by the PEPFAR Program Evaluation Toolkit which provides measurement of comprehensive child and caregiver well-being outcomes. The toolkit can be accessed at http://www.cpc.unc.edu/measure/our-work/ovc/ovc-program-evaluation-tool-kit.
    • Time Frame: Ongoing.
    • Budget: Budget for PEPFAR Ongoing Programming for all three of the above objectives is 10% of PEPFAR programming budget at country level (differs by fiscal year). Because PEPFAR programs and projects are integrated and comprehensive and address multiple objectives simultaneously, it is not possible to break the funding down by objective.

    • Department/Office: DOL, International Labor Affairs Bureau (ILAB)
    • Activity: DOL is currently funding 6 studies to research the impact of selected OCFT project interventions on reducing child labor, and 8 modular impact evaluations to examine the extent to which non-USDOL-funded projects impact child labor.
    • Country Focus: Bolivia, Egypt, El Salvador, Ghana, Philippines, Peru. Modular IEs: Burkina Faso, Bangladesh/India, Nicaragua, Malawi, Kenya, Zambia.
    • Outcome/Indicator: 6 impact evaluations of OCFT-funded projects. 8 modular impact evaluations of projects funded by other donors.
    • Time Frame: Projects typically last 4 years, and no more than 5. Current projects were funded each year from FY 2008 to FY 2012 and will end from FY 2013 to FY 2017. Reporting: Varies per project.
    • Budget: Current projects listed have been obligated.  DOL is currently planning the obligation of FY 2013 funds.
    • Department/Office: DOL, International Labor Affairs Bureau (ILAB)
    • Activity: DOL is currently working with grantees to conduct baseline and endline surveys for FY2013 projects.
    • Country Focus: DOL is currently planning the obligation of FY 2013 funds.
    • Outcome/Indicator: N/A
    • Time Frame: DOL is currently planning the obligation of FY 2013 funds.
    • Budget: DOL is currently planning the obligation of FY 2013 funds.
    • Department/Office: National Institutes of Health (NIAAA)
    • Activity: Neighborhood Alcohol & HIV Prevention in South African Townships: Examine a home-visiting prevention program delivered by neighborhood Mentor Mothers as an alternative to clinic-based interventions to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition.
    • Country Focus: South Africa.
    • Outcome/Indicator: RCT evaluating the home visiting program, on maternal and child outcomes over 18 months. The impact of the intervention on a comprehensive composite outcome, the mediating, and background predictors of healthy family routines will be monitored during pregnancy, at the child's birth, and 6 and 18 months later.
    • Time Frame: Ends 2013.
    • Budget:
    • Department/Office: National Institutes of Health (NIAAA)                 
    • Activity: Preventing FAS/ARND in Russian Children: increase the sustainable capacity of Russian researchers to pursue FAS/ARND prevention research and to strengthen our existing international multidisciplinary collaboration.                 
    • Country Focus: Russia.
    • Outcome/Indicator:
    • Time Frame: Ends 2013.
    • Budget:
    • Department/Office: National Institutes of Health (NICHD)
    • Activity: The study, "Youth and Adult Microfinance to Improve Resilience Outcomes in DRC" aims to establish a causal relationship between youth and adult microfinance programs and resilience outcomes of youth, families and villages in post-conflict settings. Eastern Democratic Republic of Congo (DRC), the setting for this study, has primarily been characterized by a loss of security, unpredictability and lack of structure in daily life. This study will test the effectiveness of a youth-led animal husbandry microfinance program combined with the adult, Pigs for Peace (PFP), microfinance program on youth, family and community resilience outcomes. 
    • Country Focus: DRC.
    • Outcome/Indicator: This longitudinal, mixed-method, cluster randomized community trial will include households in 24 villages, in DRC, randomized to one of three groups: 1) youth-led microfinance plus PFP microfinance; 2) youth-led microfinance only; and 3) PFP microfinance only. All youth in participating households ages 10-14 years are eligible for the youth-led microfinance program and one parent/caregiver is eligible for the adult program. In addition to the economic benefits of microfinance, there is evidence to suggest that it may be an effective vehicle for improving health and social outcomes for youth and adults.
    • Time Frame: 2012-2016.
    • Budget:
    • Department/Office: National Institutes of Health (NIDA)
    • Activity: NIDA supports a research program to develop interventions and models for taking evidence-based drug abuse prevention to scale. NIDA's prevention research takes a life course developmental perspective, from prenatal through adulthood that targets the initiation of drug use, the progression to abuse and dependence, and the transmission of HIV infection among diverse populations and settings. Within the portfolio, we support research targeting relevant age groups that fit within the children in adversity initiative. Examination of findings from NIDA funded prevention research has demonstrated that many of the NIDA-supported preventive interventions targeting children and adolescents have positive effects on a broad array of outcomes, including intermediate outcomes such as quality of parenting, improved parent-child relationships, reduced risk for child abuse and neglect, and later risk for drug use and abuse and related problem behaviors (e.g., delinquency, involvement in the criminal justice system, etc.). NIDA also supports a number of studies in international settings that may serve as models for establishing the requisite research and evaluation infrastructure for understanding program impacts related to children in adversity.
    • Country Focus: Studies are primarily conducted in the United States. NIDA also supports a number of studies in international settings that may be informative for research designs and models for building research infrastructure to address issues related to children in adversity initiative. For example:  Cambodia, Estonia, India, Kazakhstan, Malaysia, Mexico, Russia, South Africa, Thailand, Ukraine, Vietnam.
    • Outcome/Indicator: Quality of parenting; parent-child relationship; executive function; aggressive/disruptive behavior problems; emotion regulation; peer social skills; drug use and abuse; health risking sexual behaviors; mental health; delinquency; criminal justice involvement. Studies in child welfare settings have examined outcomes such as placement disruptions, neurobiological functioning, executive function, parenting, school outcomes, health risking sexual behaviors, etc.).
    • Time Frame: 2001-2017.                 
    • Budget:
    • Department/Office: National Institutes of Health (FIC)
    • Activity: FIC administers research and training grants and fellowship programs at sites in more than 100 countries with a few research and research training programs that are relevant to Children in Adversity. These programs include the International Tobacco and Health Research and Capacity Building Program, Brain Disorders in the Developing World: Research Across Lifespan, and the Chronic Non-Communicable Diseases and Disorders Across Lifespan program. Activities supported by these platforms include studies the drivers of addiction and substance abuse in adolescents, neurological outcomes and interventions of vulnerable children, and mental health issues and learning disabilities in OVCs.
    • Country Focus: FIC's country focus is diffuse but a sampling of the few countries that FIC researchers work in include: Vietnam, Botswana, Zambia, South Africa and Uganda.                 
    • Outcome/Indicator: For FIC research programs, the number of published studies on vulnerable children and new insights gained for working with this marginalized group will serve as performance measures. For research training programs, the number of trainees engaging in research on OVCs, the number of independent funding received by past FIC trainees for research on OVCs,  and the formation of new curriculums, departments, and institutional networks  devoted to children's issues may also be performance measures. An example of this type of performance benchmark is the development of the first clinical child psychology program in Vietnam.                 
    • Time Frame: 2010-ongoing.
    • Budget:
    • Department/Office: National Institutes of Health (NICHD)                 
    • Activity: The research Infrastructure established by the NICHD Global Network for Women's and Children's Health is a consortium comprised of U.S. and developing country research teams and institutions that facilitate high quality, sustainable collaborative research to address health needs of women and children while simultaneously building the professional capacity and research infrastructure in developing country sites. The GN is not currently conducting studies targeting children in adversity related to violence, abuse, or neglect, but has established a research platform in developing countries that could be leveraged for the conduct of such studies. Each US-Foreign site research unit is composed of a varying number of geographically-defined clusters.  In each foreign clinical site, the local investigators have assembled a network of support staff trained to conduct the activities of the clusters/sites. Among all of the clusters at the current clinical sites, roughly 60,000 births occur each year. Three studies currently underway are described in other sections below.
    • Country Focus: The current cycle of the Global Network is comprised of 7 clinical sites and a data coordinating center: Belgaum, India; Nagpur, India; Pakistan; Kenya; Democratic Republic of Congo; Zambia; Guatemala; the data center is in North Carolina.
    • Outcome/Indicator: Progress in each of the studies being conducted by the Network is closely assessed with a combination of: regular steering committee meetings and conference calls; weekly to monthly study monitoring calls; periodic site visits; rigorous reporting of accumulated data and progress on the ground; regular review by a Data Safety and Monitoring Board; official progress reports submitted to NICHD.                 
    • Time Frame: The Global Network was first established in 2001 and has operated continuously since then. The Network was recently recompeted; first year awards for the current 5-year cycle are scheduled for issue May 1, 2013, to continue through April 30, 2018.
    • Budget:
    • Department/Office: National Institutes of Health (NIMH)                 
    • Activity: Grand Challenges in Global Mental Health - Integrating Mental Health into Chronic Disease Care Provision in Low- and Middle-Income Countries: This initiative will involve a set of research projects designed to promote the establishment of an evidence base on contextually relevant, cost-effective, integrated care interventions for the treatment of patients with co-morbid mental and chronic physical illnesses, including youth in adversity, in low- and middle-income countries. The projects under this initiative will conduct research that (a) builds on existing chronic disease care and treatment platforms within country to incorporate management of mental illness, (b) uses a multi-disease care management approach with potentially high impact for improving patient- and system-level outcomes, and (c) establishes feasible methods for multi-disease management in low- and middle-income countries.                   
    • Country Focus: Low- and middle-income countries.
    • Outcome/Indicator: The work of the Grand Challenge projects will be monitored and assessed through a range of means, including annual progress reports, review of study protocols by Institutional Review Boards, presentation of study findings at conferences and in peer reviewed journals.  
    • Time Frame: 2013-2018.
    • Budget:                  
    • Department/Office: National Institutes of Health (NIMH)
    • Activity: Study to improve health outcomes for orphans by preventing HIV/STD risk: This study is a randomized controlled trial to assess the effectiveness of Trauma-focused Cognitive Behavioral Therapy in treating traumatic grief and traumatic stress for orphaned children and young adolescents in two East African sites with high prevalence of HIV.
    • Country Focus: Kenya, Tanzania.
    • Outcome/Indicator: Published study findings may inform other efforts to scale up mental health interventions for children in low- and middle-income countries who have experienced trauma. The study is monitored and assessed using a range of means, including annual progress reports, review of study protocols by Institutional Review Boards, and presentation of scientific findings at scientific conferences and publication in peer reviewed journals.                 
    • Time Frame: 2012-2016.
    • Budget:
    • Department/Office: National Institutes of Health (NIMH)                 
    • Activity: Reducing violence and HIV risk among war-exposed Liberian youth: This study will develop and test an intervention that combines HIV prevention and mental health care for youth who have been exposed to the violence of war.                 
    • Country Focus: Liberia.
    • Outcome/Indicator: This study will contribute to the science of HIV prevention for highly vulnerable youth. The study is monitored and assessed using a range of means, including annual progress reports, review of study protocols by Institutional Review Boards, and presentation of scientific findings at scientific conferences and publication in peer reviewed journals.
    • Time Frame: 2011-2014.
    • Budget:
    • Department/Office: National Institutes of Health (NIMH)
    • Activity: School support as structural HIV prevention for adolescent orphans in Kenya: The HIV pandemic has left millions of orphans in sub-Saharan Africa. These children are at risk for a host of adverse outcomes, including HIV infection. This study examines schools as a structural support for orphaned children at risk for HIV infection.
    • Country Focus: Kenya.
    • Outcome/Indicator:
    • Time Frame: This study will contribute to the science of HIV prevention for orphaned children.  The study is monitored and assessed using a range of means, including annual progress reports, review of study protocols by Institutional Review Boards, and presentation of scientific findings at scientific conferences and publication in peer reviewed journals.
    • Budget: 2011-2016.                                    
    • Department/Office: CDC, National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention                 
    • Activity: Understand the burden of burn injuries in India, including those among children, both intentional and unintentional (with the Global Alliance for Clean Cookstoves).
    • Country Focus: India.
    • Outcome/Indicator: 15 Hospital Registry established.
    • Time Frame: July 2013 – July 2014.
    • Budget: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known.
    • Department/Office: CDC, National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention
    • Activity: Work with partners in Cambodia to evaluate a motorcycle helmet program for children, called Helmets for Kids. Develop an evaluation protocol and toolkit for partners measure change and ensure that evaluation results are incorporated back into the program to improve the program.
    • Country Focus: Cambodia.
    • Outcome/Indicator: Helmet use among children and number of sites using CDC evaluation tool to monitor child helmet use.
    • Time Frame: September 30, 2010-Septmeber 29, 2013
    • Budget: CDC obligations for FY 2013 are not final. Specific funding levels are not yet known.
    • Department/Office: USAID, Bureau for Democracy, Conflict, and Humanitarian Assistance (DCHA), Office of Democracy, Human Rights, and Governance (DRG), Displaced Children and Orphan’s Fund (DCOF).
    • Activity: Test the effectiveness of trauma-focused behavioral therapy for street children and other orphans and vulnerable children provided by Zambian service providers. If the randomized control trial results are positive, integrate the therapy into the health system.
    • Country Focus: Zambia.
    • Outcome/Indicator: Effectiveness of therapy as tested through randomized control trials.
    • Time Frame: 2012-2013.
    • Budget: DCOF’s annual Fiscal Year budget in recent years has been approximately $13,000,000.
    • Department/Office: USAID, Bureau for Democracy, Conflict, and Humanitarian Assistance (DCHA), Office of Democracy, Human Rights, and Governance (DRG), Displaced Children and Orphan’s Fund (DCOF)
    • Activity: Measure impact of combined Village Savings and Loan intervention with child protection training at the household level.                 
    • Country Focus: Burundi.
    • Outcome/Indicator: % of VSLA members who increase spending on children’s education, food/nutrition, health care, clothes, housing and other areas identified by girls and boys.  % of VSLA members who demonstrate techniques to prevent child neglect, abuse and exploitation.
    • Time Frame: 2012-2013.
    • Budget: DCOF’s annual Fiscal Year budget in recent years has been approximately $13,000,000.
    • Department/Office: USAID, Bureau for Global Health (GH), Office of Health, Infectious Diseases, and Nutrition (HIDN)
    • Activity: Convene an Evidence Summit on Population-Level Behavior Change to Promote Child Survival and Development.
    • Country Focus: Pre-Summits were held in Ethiopia and India
    • Outcome/Indicator: Implementation of an evidence-to-action strategy informed by published reviews and recommendations on evidence-based population-level behavior change to promote child survival and development.
    • Time Frame: 2013.
    • Budget:
    • Department/Office: USDA, McGovern-Dole
    • Activity: The Micronutrient-Fortified Food Aid Products Pilot (MFFAPP) is administered under the McGovern-Dole International Food for Education and Child Nutrition Program. Under MFFAPP, participants were provided resources to develop and field test new or improved micronutrient-fortified food aid products designed to meet the energy and nutrient needs of populations served by McGovern-Dole. Through this effort, USDA hopes to identify new products that would be readily available for distribution through the McGovern-Dole Program. 
    • Country Focus: Cambodia, Guatemala, Guinea-Bissau, Haiti, Tanzania.
    • Outcome/Indicator: Through MFFAPP FAS hopes to identify new products that will be provided regularly by the McGovern-Dole Program.  Pilots were asked to provide the most improvement in nutrition for the targeted beneficiaries in the most cost effective manner. Final evaluations due back to FAS at the conclusion of the pilots are required to contain the benefits and drawbacks of the new product to the populations, using supporting evidence gathered during the trial.  Final evaluations are also required to address the benefits or drawbacks of the new or improved products as compared to traditional food assistance commodities, also using supporting evidence gathered during the pilot.
    • Time Frame: Final reports on the six MFFAPP pilots are due as follows: IPHD1: June 2013; Hormel: January 2014; PATH: June 2014; IPHD2: October 2013; MFK: January 2014; KSU: May 2015.
    • Budget: Congress provided FAS with $10 million in FY2010 to implement MFFAPP. All funds were allocated as of FY2012.  
    • Department/Office: USDA, McGovern-Dole                 
    • Activity: The McGovern-Dole Program has implemented a new monitoring and evaluation policy that is required under all new grants. Grants will be responsible for establishing indicator baseline information which will be used to measure performance.
    • Country Focus: Focus countries not yet determined.
    • Outcome/Indicator: This is a new monitoring and evaluation initiative that has been instituted starting in FY2012-funded grants.  Changes in outcomes and behavior will most likely not be observed until 2-3 years following project implementation.
    • Time Frame: A time frame has not been developed for this action. However, the average lifespan of a McGovern-Dole grant is normally three years.
    • Budget: There is no determined budget at this time.

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