Healing the emotional wounds of children who have engaged in work illegally: A multi-country feasibility study of a co-produced arts-based program

童工现象影响到中低收入国家中多达四分之一的儿童，剥夺了年轻人的教育、未来机会和繁荣，并破坏了可持续发展目标的进展。消除童工现象是各国政府、非政府组织和政府间组织的当务之急。在亚洲的一些低收入国家，也有“拯救和重新融入”童工的平行努力。这些方案使年轻人摆脱非法就业，并提供住所、食物、法律的和医疗援助，帮助他们重新融入家庭和接受教育。在非法工作期间经常出现的长期暴露后的情感创伤可能影响年轻人的适应。帮助这些脆弱的年轻人控制焦虑、抑郁和创伤后压力的症状，并建立情绪复原力，是这些年轻人重新适应的一部分，同时也减少了常见的精神和身体非传染性疾病的发病风险，这些疾病增加了中低收入国家的医疗保健负担。艺术干预提供了许多健康益处。在年轻人中，以艺术为基础的项目在减少情绪症状方面显示出一致的、中等规模的效果，包括在经历过创伤的样本中。与这些数据一致，在庇护所工作的工作人员强调每天使用创造性的技术来提升情绪，提高自尊和鼓励乐观。从事非法工作的年轻人还强调，他们发现在治疗中使用艺术很有吸引力，特别是如果艺术还使他们能够分享经验并与同龄人联系。也许因为艺术节目能反映个人的才能和兴趣，不那么正式和污名化，它们可能更容易被这些脆弱的年轻人接受。基于艺术的干预措施在提供的地方也是多方面的然而，由于他们在社会中长期处于边缘地位，而且相对缺乏正规教育环境，为在高风险环境中经历过创伤的年轻人制定的以艺术为基础的方案，收入国家可能需要量身定制，以增加他们的可及性。在这里，我们建议调整，交付和形成性评估的艺术为基础的群体干预，以儿童和青少年谁有非法工作的历史。我们还将致力于传达调查结果。我们将在孟加拉国，印度和尼泊尔进行研究，因为政府和非政府组织努力拯救和重新融入童工，并承诺减少非法雇用的人数。我们还与庇护所建立了长期的合作伙伴关系，可以帮助开拓这项研究。我们提出了4个工作包（WP）。WP1包括在线和面对面的研讨会，我们将与英国的艺术治疗师和来自这些国家的创意从业者共同适应，为有非法工作历史的儿童提供基于艺术的团体干预的手动协议。在WP2中，我们将对该计划进行试点测试，并根据这些年轻人和庇护所工作人员的反馈意见完善手册和协议。在WP3中，我们将在这三个国家的庇护所中进行三项随机对照试验，主要目的是评估可行性（吸收、保留）和可接受性（耐受性，安全性），其次，与情绪症状减轻和幸福感相关的效应量范围增加。我们将把我们的数据传达给主要利益攸关方，并利用这些数据就更广泛的实施途径和障碍展开讨论。研究结果将通过学术和非学术途径进行总结，以最大限度地发挥影响力。与生活经验研究人员的共同制作以及研究团队之间的能力建设将在整个工作方案中进行

Child labour affects up to one in 4 children from low and medium income countries (LMICs) and deprives young people of their education, future opportunities and prosperity, and undermines progress towards the Sustainable Development Goals. Eradicating child labour is an urgent priority for governments, non-governmental organisations and inter governmental organisations. In some Asian LMICs, there are also parallel efforts to "rescue and reintegrate" child labourers. These programmes remove young people from illegal employment and provide shelter, food and legal and medical assistance, and help them to re-integrate with their families and in education. The emotional wounds that follow chronic exposure victimisation that often arises during illegal work can affect young peoples' adjustment. Helping these vulnerable young people manage symptoms of anxiety, depression and post-traumatic stress and build emotional resilience is integral to these young peoples' re-adjustment, while also reducing risks for the onset of common mental and physical non-communicable diseases that add to the healthcare burden of LMICs. Arts interventions offer numerous health benefits. In young people, arts-based programmes show consistent, moderate-sized effects at reducing emotional symptoms including among samples who have experienced trauma. Consistent with these data, staff working in shelters emphasise daily use of creative techniques to lift mood, improve self-esteem and encourage optimism. Young people who have engaged with illegal work also highlight that they find the use of arts in their healing attractive, particularly if they also enable them to share experiences and connect with peers. Perhaps because arts programmes speak to individuals' talents and interests, are less formal and stigmatising, they may be more acceptable to these vulnerable young people. Arts-based interventions are also versatile in where they are delivered (schools and other community settings) and, with training, can by delivered by non-expert practitioners.Yet, because of their longstanding marginalised role in society and their relative lack of exposure to formal education settings, arts-based programmes developed for young people who have experienced trauma in high-income countries may require tailoring to increase their accessibility.Here, we propose to adapt, deliver and formatively evaluate an arts-based group intervention to children and young people who have a history of illegal work. We will also aim to communicate the findings. We will conduct our research in Bangladesh, India and Nepal because of efforts by governments and non-governmental organisations to rescue and re-integrate child labourers and a commitment to reduce numbers employed illegally. We also have long-standing partnerships with shelters that can help pioneer this research. We propose 4 work-packages (WP).WP1 involves online and in-person workshops, where we will co-adapt, with UK-based art therapists and creative practitioners from these countries, a manualised protocol for an arts-based group intervention to children with a history of engaging with illegal work. In WP2, we will pilot test this programme and refine the manual and protocol based on feedback of these young people and shelter staff.In WP3, we will deliver the intervention in shelters in these three countries in 3 randomised controlled trials that aim primarily to assess feasibility (uptake, retention) and acceptability (tolerability, safety) and secondarily, the range of effect sizes associated with emotional symptom reduction and well-being increases.In WP4,we will communicate our data to key stakeholders and use these to generate discussions on broader implementation routes and barriers. Findings will be summarised through academic and non-academic routes to maximise impact. Coproduction with lived experience researchers and capacity-building among research teams will occur across WPs