Many of the Afghans displaced by the Taliban takeover of Kabul in 2021 found refuge in the United States through Operation Allies Welcome (OAW) and the ongoing Operation Enduring Welcome (OEW) Response. OAW was an interagency initiative that coordinated efforts across the federal government, military, state and local governments, NGOs, and private partners to manage the resettlement of nearly 90,000 Afghans. As Afghan newcomers began arriving in the US in 2021—amid the COVID-19 pandemic—resettlement agencies worked alongside federal offices, healthcare systems, public health departments, social service providers, and community-based organizations to provide much-needed assistance.
Resettled Afghans are acclimating to life in the United States, enriching their new communities, securing public benefits, and seeking opportunities for their families. At the same time, they are experiencing ongoing challenges related to the trauma of sudden displacement and navigating complex systems like healthcare as English-language learners.
Afghan Newcomer Parents’ Challenges in the U.S.
Afghan newcomer refugee, immigrant, and migrant populations having endured the trauma of fleeing their homelands, often carry the scars of violence and forced displacement, which can affect their ability to practice positive and engaged parenting. This challenging background, coupled with limited education and English proficiency, may create significant barriers for these families in supporting their children's cognitive development and accessing crucial services in the United States. These families may face multiple challenges in raising young children in a new environment, including a lack of social support networks, unfamiliarity with developmental milestones (i.e., brain development, language, and communication skills, etc.), difficulty accessing early childhood development resources, and barriers in navigating community and healthcare services. Addressing these gaps is essential for helping Afghan families integrate into their new community and improve their ability to support their children's growth and development in the United States.
Tucson’s Early Childhood Development Program
Since its establishment, the International Rescue Committee (IRC) Tucson office has been actively supporting Afghan newcomers through various programs. In 2021, the office experienced an influx of Afghan pregnant women and parents of children aged two and under. Initial needs assessments revealed that parents of young children desired more parental support. Many Afghan families faced challenges attending medical appointments for their children without IRC staff assistance. Additionally, Afghan women faced increased barriers to accessing healthcare for their children without their male partners/spouses. Health issues such as high blood lead levels among children aged two and under, vaccination adherence, and the lack of attendance to preventive health well-child visits, were compounded by the absence of culturally and linguistically appropriate early childhood development resources in the Tucson area. Moreover, preschool enrollment rates for Afghan children were notably low. Responding to these gaps, IRC Tucson launched the Early Childhood Development (ECD) program in early 2022 for Afghan parents of children aged zero to two.
Early Childhood Development (ECD) interventions are crucial in the first years of life, promoting healthy physical, emotional, social, and intellectual growth. These programs are particularly beneficial for disadvantaged children, especially those from low-income families with parents who have limited education or English proficiency. By addressing early developmental needs, ECD interventions bridge gaps and build a strong foundation for children's future success, regardless of socioeconomic or linguistic challenges.
The IRC Tucson office implemented a comprehensive ECD program aimed at helping Afghan refugee families understand children's developmental milestones, facilitating access to healthcare such as well-child visits and vaccinations, and providing general children’s health information through workshops and personalized support.
The program's objectives include:
- Increasing parental knowledge of developmental milestones and age-appropriate activities
- Offering culturally relevant resources, promoting positive parent-child interactions
- Addressing barriers to accessing preventive healthcare and community resources
Program Design and Activities
The ECD program covers topics such as positive child-parent interactions, childhood development stages, healthcare navigation, preventative health, and the importance of vaccinations. The ECD Program curriculum merges lessons learned from successful parental support programs widely implemented in low-and middle-income counties by the WHO/UNICEF, “Care for Child Development” and “Reach Up and Learn.” IRC Tucson also collaborated with Pima County Health Department staff to incorporate sessions from their English and Spanish ECD curriculum.
IRC Tucson’s Maternal and Child Health Program Coordinator (MCC) and the Community Health Worker (CHW) conduct home visits to assess each family's knowledge and needs related to ECD. During the home visits, the MCC and CHW distribute and introduce the ECD kits to families and explain their use. ECD kits are distributed to all enrolled participants containing age-appropriate developmental toys and books. ECD kits include materials curated with consultations with Afghan families to ensure that the toys, books, and educational materials are relevant and useful to parents and caregivers to support their children’s growth and development. IRC staff model the use of the ECD kit contents during group sessions and home visits. Modeling the use of the kits reinforces how their use facilitates early learning, gross motor and fine motor skill development, and increases the child-caregiver bond through affectionate interactions.
During the home visits, the MCC emphasizes education focused on the importance of early vaccinations and well-child visits. Healthcare coordination is provided for all ECD program-enrolled children by establishing them with a primary care physician who provides culturally and linguistically appropriate services. The parent and the child are provided transportation and advocacy to their initial well-child check appointments and are trained on how to access health care independent of IRC support. Training on how to schedule appointments and secure reliable transportation (e.g., public transportation, Medicaid taxis, and/or navigating directions to medical facilities) are provided during home visits as MCC provides 1-on-1 health navigation support to ensure that children are following their well-child visit and vaccination schedules.
In addition, IRC Tucson staff work closely with local organizations to obtain essential baby items like clothing, diapers, cribs, and car seats to address immediate practical needs. These home visits and individualized support help to build trust with families to discuss sensitive topics.
When in need of subject matter expertise to present ECD topics such as child development from pregnancy through early childhood, brain development, discussion on the importance of immunizations conducted by pediatricians as well as CPR and car seat safety carried out by certified staff. IRC Tucson invites guest speakers to co-host classes and secure interpretation. Through partnerships with organizations like the county's WIC program, the IRC co-hosted nutrition education classes and guided families on how to fully utilize services like food stamps, nutrition assistance vouchers, breastfeeding support, and loaner breast pumps. In fiscal year 2023 (October 2022-September 2023), 33 parents completed these educational sessions.
The program organizes discussion sessions where parents can share their experiences, challenges, and successes in using the ECD kits and implementing early childhood development activities. These groups provide valuable feedback for program improvement and allow parents to learn from each other.
Recruitment and Participation
The program focuses on families with children aged two and under, recruiting participants through IRC’s Afghan client lists and referrals from the Pima County Health Department, local doctors, Ethnic Community-Based Organizations (ECBOs), and other resettlement agencies. Staff reach out to these families via phone calls to explain the ECD program and secure their consent for participation. The ECD program makes a concerted effort to include both parents of a household and provides opportunities for both to be actively engaged in programming even though the participants end up being primarily Afghan mothers. This approach is particularly important from an Afghan cultural perspective, as male heads of households often play a crucial role in family decisions. In many Afghan families, men are more likely to have access to transportation and may have better English language skills compared to their female counterparts. Rania, IRC Tucson’s MCC, emphasizes,
“It’s not only for mom; the dad, mom, and older kids are usually there, and the older kids can be involved in playing with the two-year-old using the kit.” She adds, “Parents can notice if the child cannot reach, play, look at, or follow with the balls, as that could indicate an issue. The kid is expected to meet certain milestones by zero to six months when playing with the balls.”
Components of the ECD Kit and Programmatic Activities
The ECD program includes several key components designed to support the developmental needs of children from Afghan families.
- Materials and Resources: The ECD kits contain various items aimed at promoting early childhood development. These include toys and books that help with cognitive, social, emotional, and physical development: Toys such as balls that parents can shake can help develop sensory skills in infants aged 0–6 months; Shape sorting and stacking toys to build cognitive abilities for older infants aged 8 months to 2 years old; Books in Dari and Pashto with letters, numbers, and sounds to promote early literacy; A booklet of different games and low- or no-cost things that people can purchase and use around their house or activities that address, for example, cognitive development.
- Educational Sheets: Each kit includes a sheet in both Dari and Pashto that explains the purpose of each toy and how it can be used to support child development and parent-child bonding.
Accessibility and Cultural Considerations
The IRC Tucson staff adapted the program several times to better serve Afghan families. At first, the team considered offering group classes, but they discovered that home visits were more effective to give parents additional time to understand the program’s content and ask questions. An Afghan staff member fluent in Pashto or Dari conducts these visits, ensuring effective communication and cultural sensitivity. The visits typically last about an hour and include verbal education about the benefits of the ECD kits and how to use them. ECD kits are designed with practicality and cultural considerations in mind, considering the living conditions and preferences of Afghan families. Rania, IRC Tucson’s MCC explained:
“We kept in mind to choose something that you can hide without it taking space or putting any pressure on mom when the baby is playing with it, or the kids are playing with it; it’s not going to take much space. And especially, they live in a small apartment with other kids, too, so we kept this in mind when choosing those.”
Impact
Supporting Afghan families and nurturing young minds have been at the heart of the ECD program's mission in Tucson. From October 2022 to September 2023, 33 parents actively engaged in and completed ECD classes, while the team successfully connected 43 unduplicated children aged two and under with crucial ECD services through focused referrals.
The program received positive feedback from participating clients. Post-survey results showed that 100% of clients (n=12) reported they were satisfied with the quality of services received from the program. Rania, the maternal and child health coordinator, said,
“Parents found the ECD kits very helpful. They say they find it really helpful.”
This aligns with the program’s goal of supporting early childhood development and parenting skills among resettled Afghan families.
