Principle-driven program design versus manualized programming in humanitarian settings

Providers of psychosocial support in humanitarian settings have been accused of doing harm when western experts offer interventions that ignore the culturally needs of populations under stress. Instead, when designing treatment, prevention, and mental health services in humanitarian settings, it’s fundamental considering cultural and social processes. In this paper, we review different ways of designing and delivering psychosocial support programs in humanitarian settings, describing a range of approaches that increase sensitivity to the cultural and contextual differences of program participants. A five rung “Ladder of Program Adaptation” is proposed to differentiate approaches to the development and implementation of PSS programs in humanitarian settings. In particular, the barriers to the implementation of manualized programming in emergency settings are identified and addressed and a principle-driven design is proposed as a more culturally sensitive alternative. Finally, to illustrate the application of a principle-driven approach to practice, a case study of the Tutor of Resilience (TOR) program is presented.