Contributing to the Reduction of Psychological Trauma among Migrant and Displaced Children in Colombia

By 2020, one in five children under five globally was at risk of not fulfilling their developmental potential due to conflict and displacement.

Partners

Abstract

By 2020, one in five children under five globally was at risk of not fulfilling their developmental potential due to conflict and displacement. In Colombia, Universidad de Los Andes adapted the University of California’s Child-Parent Psychotherapy program into Semillas de Apego: a 15-week intervention supporting caregivers of children aged 0 to 5 in processing trauma and building healthy social bonds. After a rigorous impact evaluation demonstrated significant benefits, Universidad de Los Andes scaled the program with support from Heartland Alliance International. With Instiglio and support from the Conrad N. Hilton Foundation, the partners embedded a Results-Based Financing (RBF) mechanism into their 2023 contract, tying roughly 5% of the USD 700,000 budget to critical outputs.

The Challenge

Since the 1950s, Colombia’s internal conflicts have displaced more than 8 million people, including more than 1 million children aged 0 to 5. Nearly 2.5 million Venezuelans, including 300,000 children, have also migrated because of violence and economic hardship. Displacement and exposure to violence cause psychological trauma including stress responses, higher risk of mental health problems, separation distress, and fear for family safety. 

To address this, Universidad de Los Andes created Semillas de Apego, an evidence-backed program piloted in 2015 and evaluated in Tumaco aimed at promoting the mental health of victims by building safe and healthy affective bonds between caregivers and children. Though the program saw strong results in Tumaco, as Heartland Alliance International struggles to scale the program to five additional municipalities while maintaining the participation levels and service delivery quality that was achieved on a smaller scale. 

The Solution

In 2023, Universidad de Los Andes and Heartland Alliance International partnered with Instiglio (with support from the Conrad N. Hilton Foundation) to embed a Results-Based Financing (RBF) mechanism in their delivery contract. The goal was to preserve the fidelity of Semillas de Apego, a 15-week group intervention for primary caregivers of children aged 0 to 5 affected by violence and displacement, as it expanded to five new municipalities in Colombia.

The design started by mapping the theory of change, building an implementation plan, and identifying barriers to scaling. Two bottlenecks stood out: low attendance in caregiver training sessions and difficulties enrolling intended participants (victims of armed conflict or migrants who are primary caregivers of young children. Over 12 collaborative workshops, Instiglio facilitated alignment around three payment metrics tied to critical outputs:

  • Participants who fit the defined profile, verified through an initial survey.
  • Participants attending at least one of the first two sessions.
  • Participants completing at least 12 of the 15 training sessions.

Roughly 5% of the USD 700,000 contract value was now tied to these results. The impact evaluation had demonstrated that these specific behaviors drove the outcomes that mattered for maternal and child mental health.

Implementation ran from April to December 2023, allowing stakeholders to evaluate how incentives influenced participant selection and retention, and to continue refining the RBF design for future cycles.

The Impact

Early lessons from the design and first implementation cycle are informing how RBF models can be used to design incentives responsive to the realities of migrant and conflict-affected populations and sustain outcomes when scaling evidence-backed interventions.

Using Output-level Metrics to Safeguard Fidelity in Evidence-based Interventions

When scaling evidence-backed programs, the priority shifts from discovery to fidelity. Incentivizing outputs, specific behaviors, and activities the impact evaluation already linked to outcomes, rather than outcomes themselves ensures implementers replicate what works, reduces measurement risk, and preserves results at scale.

Leveraging RBF Design as a Capacity-building tool

Outcome payers and service providers often come together with different levels of experience in RBF models. Separate, tailored workshops with each stakeholder surface specific concerns (e.g., non-performance risk), build shared understanding, and limit frustration or bottlenecks during the design process.

Aligning Metrics with Participants Trgeting

Enrolling participants who match the evidence-backed profile is a pre-condition for program impact. Using an initial survey to verify profile fit, and tying that verification to a payment metric, ensures resources flow to the families most likely to benefit.

Designing Metrics Around Program-specific Retention Dynamics

For evidence-backed programs with progressive effects, retention at critical inflection points matters more than overall attendance. Metrics tied to early-session attendance (first two of 15) and session-completion thresholds (12 of 15) align incentives with the specific dosage the evidence supports.