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

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