Advertisement

Supporting Children Affected by War: Towards an Evidence Based Care System

  • Mark J. D. JordansEmail author
  • Myrthe van den Broek
  • Felicity Brown
  • April Coetzee
  • Rinske Ellermeijer
  • Kim Hartog
  • Frederik Steen
  • Kenneth E. Miller
Chapter

Abstract

One in ten children globally lives in an area affected by armed conflict. Armed conflict has both direct and indirect effects on children’s social, emotional, and educational outcomes, and impacts can occur at multiple levels of the child’s ecosystem- the individual, family, community, and society. This chapter will provide an overview of the impacts of war on children, outline existing intervention research and sector standards, and provide recommendations and future directions for research and implementation. The chapter will then detail War Child Holland’s research and development agenda which aims to develop a multi-sectoral, multi-level system of care for children affected by war that addresses children’s needs across different ecological levels. This system of care is complemented by mechanisms to ensure access and quality of care. The chapter describes how evidence-based principles can be developed and implemented in such a way that they are scalable and can achieve actual real-world impact, despite the complexities and challenges of working in low-resource humanitarian settings.

Keywords

Armed conflict Psychosocial Mental health Child protection Education Integrated care 

References

  1. Ager, A., Akesson, B., Stark, L., Flouri, E., Okot, B., McCollister, F., & Boothby, N. (2011). The impact of the school-based psychosocial structured activities (PSSA) program on conflict-affected children in northern Uganda. Journal of Child Psychology and Psychiatry, 52(11), 1124–1133.  https://doi.org/10.1111/j.1469-7610.2011.02407.x PubMedGoogle Scholar
  2. Anderson, A. A. (2004). The community builder’s approach to theory of change: A practical guide to theory development. Retrieved from http://www.dochas.ie/Shared/Files/4/TOC_fac_guide.pdf
  3. Arjadi, R., Nauta, M. H., Chowdhary, N., & Bockting, C. L. H. (2015). A systematic review of online interventions for mental health in low and middle income countries: A neglected field. Global Mental Health, 2, e12.PubMedPubMedCentralGoogle Scholar
  4. Attanayake, V., McKay, R., Joffres, M., Singh, S., Burkle, F., & Mills, E. (2009). Prevalence of mental disorders among children exposed to war: A systematic review of 7,920 children. Medicine, Conflict and Survival, 25, 3–17.Google Scholar
  5. Barber, B. K. (1999). Political violence, family relations, and palestinian youth functioning. Journal of Adolescent Research, 14(2), 206–230.Google Scholar
  6. Barber, B. K. (2013). Annual research review: The experience of youth with political conflict–challenging notions of resilience and encouraging research refinement. Journal of Child Psychology and Psychiatry, 54(4), 461–473.PubMedGoogle Scholar
  7. Barenbaum, J., Ruchkin, V., & Schwab-Stone, M. (2004). The psychosocial aspects of children exposed to war: Practice and policy initiatives. Journal of Child Psychology and Psychiatry, 45(1), 41–62.PubMedGoogle Scholar
  8. Barry, M. M., Clarke, A. M., Jenkins, R., & Patel, V. (2013). A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health, 13(1), 835.PubMedPubMedCentralGoogle Scholar
  9. Bartels, S., & Hamill, K. (2014). Running out of time: Survival of Syrian refugee children in Lebanon. Boston, MA: FXB Center for Health and Human Rights at Harvard University.Google Scholar
  10. Benish, S. G., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology, 58(3), 279–289.PubMedPubMedCentralGoogle Scholar
  11. Bernal, G., & Sáez-Santiago, E. (2006). Culturally centered psychosocial interventions. Journal of Community Psychology, 34(2), 121–132.Google Scholar
  12. Betancourt, T. S., & Khan, K. T. (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry, 20(3), 317–328.PubMedGoogle Scholar
  13. Betancourt, T. S., McBain, R., Newnham, E. A., Akinsulure-Smith, A. M., Brennan, R. T., Weisz, J. R., & Hansen, N. B. (2014). A behavioral intervention for war-affected youth in Sierra Leone: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(12), 1288–1297.Google Scholar
  14. Betancourt, T. S., Meyers-Ohki, S., Charrow, A., & Tol, W. A. (2013). Interventions for children affected by war: An ecological perspective on psychosocial support and mental health care. Harvard Review of Psychiatry, 21(2), 70–91.PubMedPubMedCentralGoogle Scholar
  15. Blanchet, R., Sistenich, V., Ramesh, A., Frison, S., Warren, E., Smith, J., … Roberts, B. (2015). An evidence review of research on health interventions in humanitarian crises. Retrieved from http://www.elrha.org/wp-content/uploads/2015/01/Evidence-Review-22.10.15.pdf
  16. Boydell, K. M., Hodgins, M., Pignatiello, A., Teshima, J., Edwards, H., & Willis, D. (2014). Using technology to deliver mental health services to children and youth: A scoping review. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 23(2), 87–99.PubMedPubMedCentralGoogle Scholar
  17. Brown, F. L., Graaff, A. M., Annan, J., & Betancourt, T. S. (2017). Annual research review: Breaking cycles of violence – A systematic review and common practice elements analysis of psychosocial interventions for children and youth affected by armed conflict. Journal of Child Psychology and Psychiatry, 58(4), 507–524.PubMedGoogle Scholar
  18. Castro, F. G., Barrera, M., Jr., & Holleran Steiker, L. K. (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology, 6, 213–239.PubMedPubMedCentralGoogle Scholar
  19. Catani, C., Schauer, E., & Neuner, F. (2008). Beyond individual war trauma domestic violence against children in Afghanistan and Sri Lanka. Journal of Marital and Family Therapy, 34(2), 165–176.PubMedGoogle Scholar
  20. CPWG. (2012). Minimum standards for child protection in humanitarian action. Geneva, Switzerland: Child Protection Working Group.Google Scholar
  21. CPWG. (2014). Inter agency guidelines for case management & child protection. The role of case management in the protection of children: A guide for policy & programme managers and caseworkers. Retrieved from http://cpwg.net/wp-content/uploads/sites/2/2014/09/Interagency-Guidelines-for-Case-Management-and-Child-Protection.pdf
  22. CPWG. (2015). A matter of life and death: Child protection programming’s essential role in ensuring child wellbeing and survival during and after emergencies. Retrieved from http://cpwg.net/?get=010222|2015/10/A_Matter_of_life_and_death_LowRes.pdf
  23. Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. British Medical Journal, 337, a1655.  https://doi.org/10.1136/bmj.a1655 PubMedGoogle Scholar
  24. de Jong, J. T. V. M. (Ed.). (2002). Trauma, war, and violence: Public mental health in socio-cultural context. New York, NY: Kluwer Academic/Plenum Publishers.Google Scholar
  25. Dybdahl, R. (2001). Children and mothers in war: An outcome study of a psychosocial intervention program. Child Development, 72(4), 1214–1230.PubMedPubMedCentralGoogle Scholar
  26. ECHO. (2016). ECHO factsheet – Education in emergencies. Retrieved from: http://ec.europa.eu/echo/files/aid/countries/factsheets/thematic/education_in_emergencies_en.pdf
  27. Fairburn, C. G., & Cooper, Z. (2011). Therapist competence, therapy quality, and therapist training. Behaviour Research and Therapy, 49(6), 373–378.PubMedPubMedCentralGoogle Scholar
  28. Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors. The Lancet, 379(9812), 266–282.Google Scholar
  29. Fazel, M., & Tol, W. A. (2014). Mental health interventions in schools in low-income and middle-income countries. The Lancet Psychiatry, 1(5), 388–398.PubMedGoogle Scholar
  30. Griner, D., & Smith, T. B. (2006). Culturally adapted mental health interventions: A meta-analalytic review. Psychotherapy: Theory, Research, Practice, Training, 43(4), 531–548.Google Scholar
  31. Harper, M. S., Heim, E., Chowdhary, N., Maercker, A., & Albanese, E. (2016). Cultural adaptation of minimally guided interventions for common mental disorders: A systematic review and meta-analysis. Journal of Medical Internet Research Mental Health, 3, 1–27.Google Scholar
  32. HIIK. (2016). Conflict barometer 2015. Retrieved from http://www.hiik.de/en/konfliktbarometer/pdf/ConflictBarometer_2015.pdf
  33. IASC. (2007). IASC guidelines on mental health and psychosocial support in emergency settings. Geneva, Switzerland: Inter-Agency Standing Committee.Google Scholar
  34. INEE. (2012). Minimum standards for education: Preparedness, response, recovery. New York, NY: Inter-Agency Network for Education in Emergencies.Google Scholar
  35. Jordans, M. J. D., Kohrt, B. A., Luitel, N. P., Komproe, I. H., & Lund, C. (2015). Accuracy of proactive case finding for mental disorders by community informants in Nepal. The British Journal of Psychiatry, 207(6), 501–506.PubMedPubMedCentralGoogle Scholar
  36. Jordans, M. J. D., Kohrt, B. A., Luitel, N. P., Lund, C., & Komproe, I. H. (2017). Proactive community case-finding to facilitate treatment seeking for mental disorders, Nepal. Bulletin of the World Health Organization, 95(7), 531–536.PubMedPubMedCentralGoogle Scholar
  37. Jordans, M. J. D., Komproe, I. H., Tol, W. A., Susanty, D., Vallipuram, A., Ntamatumba, P., … de Jong, J. T. V. M. (2010). Practice-driven evaluation of a multi-layered psychosocial care package for children in areas of armed conflict. Community Mental Health Journal, 47(3), 267–277.  https://doi.org/10.1007/s10597-010-9301-9 PubMedPubMedCentralGoogle Scholar
  38. Jordans, M. J. D., Pigott, H., & Tol, W. A. (2016). Interventions for children affected by armed conflict: A systematic review of mental health and psychosocial support in low- and middle-income countries. Current Psychiatry Reports, 18(9), 1–15.Google Scholar
  39. Jordans, M. J. D., & Tol, W. A. (2013). Mental health in humanitarian settings: Shifting focus to care systems. International Health, 5(1), 9–10.PubMedGoogle Scholar
  40. Jordans, M. J. D., & Tol, W. A. (2015). Mental health and psychosocial support for children in areas of armed conflict: Call for a systems approach. British Journal of Psychiatry International, 12(3), 72–75.PubMedGoogle Scholar
  41. Jordans, M. J. D., Tol, W. A., Komproe, I. H., & de Jong, J. T. V. M. (2009). Systematic review of evidence and treatment approaches: Psychosocial and mental health care for children in war. Child and Adolescent Mental Health, 14(1), 2–14.Google Scholar
  42. Jordans, M. J. D., Tol, W. A., Komproe, I. H., Susanty, D., Vallipuram, A., Ntamatumba, P., & de Jong, J. T. V. M. (2010). Development of a multi-layered psychosocial care system for children in areas of political violence. International Journal of Mental Health Systems, 4(15), 1–12.Google Scholar
  43. Jordans, M. J. D., Tol, W. A., Ndayisaba, A., & Komproe, I. H. (2013). A controlled evaluation of a brief parenting psychoeducation intervention in Burundi. Social Psychiatry and Psychiatric Epidemiology, 48(11), 1851–1859.PubMedGoogle Scholar
  44. Khamis, V. (2014). Does parent’s psychological distress mediate the relationship between war trauma and psychosocial adjustment in children? Journal of Health Psychology, 21(7), 1361–1370.PubMedGoogle Scholar
  45. Kohrt, B. A., Jordans, M. J. D., Rai, S., Shrestha, P., Luitel, N. P., Ramaiya, M. K., … Patel, V. (2015). Therapist competence in global mental health: Development of the ENhancing assessment of common therapeutic factors (ENACT) rating scale. Behaviour Research and Therapy, 69, 11–21.PubMedPubMedCentralGoogle Scholar
  46. Loughry, M., Ager, A., Flouri, E., Khamis, V., Afana, A. H., & Qouta, S. (2006). The impact of structured activities among Palestinian children in a time of conflict. Journal of Child Psychology and Psychiatry, 47(12), 1211–1218.PubMedGoogle Scholar
  47. McLeod, J. D., & Shanahan, M. J. (1993). Poverty, parenting, and children’s mental health. American Sociological Review, 58(3), 351–366.Google Scholar
  48. Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9), S63–S67.PubMedGoogle Scholar
  49. Miller, K. E., & Jordans, M. J. D. (2016). Determinants of children’s mental health in war-torn settings: Translating research into action. Current Psychiatry Reports, 18(6), 58.PubMedGoogle Scholar
  50. O’Callaghan, P., McMullen, J., Shannon, C., Rafferty, H., & Black, A. (2013). A randomized controlled trial of trauma-focused cognitive behavioral therapy for sexually exploited, war-affected Congolese girls. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4), 359–369.Google Scholar
  51. O’Mathúna, D. P., & Siriwardhana, C. (2017). Research ethics and evidence for humanitarian health. The Lancet, 390, 2228–2229.  https://doi.org/10.1016/S0140-6736(17)31276-X Google Scholar
  52. O’Sullivan, C., Bosqui, T., & Shannon, C. (2016). Psychological interventions for children and young people affected by armed conflict or political violence: A systematic literature review. Intervention Journal, 14(2), 142–164.Google Scholar
  53. Panter-Brick, C., Goodman, A., Tol, W. A., & Eggerman, M. (2011). Mental health and childhood adversities: A longitudinal study in Kabul, Afghanistan. Journal of the American Academy of Child & Adolescent Psychiatry, 50(4), 349–363.  https://doi.org/10.1016/j.jaac.2010.12.001 Google Scholar
  54. Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), 24–34.PubMedGoogle Scholar
  55. Puffer, E. S., Annan, J., Sim, A. L., Salhi, C., & Betancourt, T. S. (2017). The impact of a family skills training intervention among Burmese migrant families in Thailand: A randomized controlled trial. PLoS One, 12(3), e0172611.PubMedPubMedCentralGoogle Scholar
  56. Saltzman, W. R., Layne, C. M., Steinberg, A. M., Arslanagic, B., & Pynoos, R. S. (2003). Developing a culturally and ecologically sound intervention for youth exposed to war and terrorism. Child and Adolescent Psychiatric Clinics of North America, 12(2), 319–342.PubMedGoogle Scholar
  57. Shidhaye, R. (2015). Implementation science for closing the treatment gap for mental disorders by translating evidence base into practice: Experiences from the PRIME project. Australasian Psychiatry, 23(6 suppl), 35–37.PubMedGoogle Scholar
  58. Sim, A., Annan, J., Puffer, E., Salhi, C., & Betancourt, T. S. (2014). Building happy families: Impact evaluation of a parenting and family skills intervention for migrant and displaced Burmese families in Thailand. New York, NY: International Rescue Committee.Google Scholar
  59. Slone, M., & Mann, S. (2016). Effects of war, terrorism and armed conflict on young children: A systematic review. Child Psychiatry and Human Development, 47(6), 950–965.PubMedGoogle Scholar
  60. Srivastava, K. (2011). Child labour issues and challenges. Industrial Psychiatry Journal, 20, 1–3.PubMedPubMedCentralGoogle Scholar
  61. Stichick, T. (2001). The psychosocial impact of armed conflict on children. Rethinking traditional paradigms in research and intervention. Child Adolescent Psychiatric Clinics of North America, 10(4), 797–814.PubMedGoogle Scholar
  62. Thornicroft, G. (2008). Stigma and discrimination limit access to mental health care. Epidemiology and Psychiatric Sciences, 17(1), 14–19.Google Scholar
  63. Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., … Henderson, C. (2015). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123–1132.Google Scholar
  64. Tol, W. A., Barbui, C., Galappattti, A., Silove, D., Betancourt, T. S., Souza, R., … Van Ommeren, M. (2011). Mental health and psychosocial support in humanitarian settings: Linking practice and research. The Lancet, 378(9802), 1–11.Google Scholar
  65. Tol, W. A., Jordans, M. J. D., Kohrt, B. A., Betancourt, T. S., & Komproe, I. H. (2013). Promoting mental health and psychosocial Well-being in children affected by political violence: Part I – Current evidence for an ecological resilience approach. In C. Fernando & M. Ferrari (Eds.), Handbook of resilience in children of war (pp. 11–27). New York, NY: Springer.Google Scholar
  66. Tol, W. A., Jordans, M. J. D., Reis, R., & de Jong, J. T. V. M. (2009). Ecological resilience: Working with child-related psychosocial resources in war-affected communities. In D. Brom, R. Pat-Horenczyk, & J. Ford (Eds.), Treating traumatized children: Risk, resilience, and recovery. London, UK: Routledge.Google Scholar
  67. Tol, W. A., Patel, V., Tomlinson, M., Baingana, F., Galappatti, A., Panter-Brick, C., … van Ommeren, M. (2011). Research priorities for mental health and psychosocial support in humanitarian settings. PLoS Medicine, 8, 1–6.Google Scholar
  68. Tol, W. A., Patel, V., Tomlinson, M., Baingana, F., Galappatti, A., Silove, D., … Panter-Brick, C. (2012). Relevance or excellence? Setting research priorities for mental health and psychosocial support in humanitarian settings. Harvard Review of Psychiatry, 20(1), 25–36.  https://doi.org/10.3109/10673229.2012.649113 PubMedPubMedCentralGoogle Scholar
  69. Tol, W. A., Song, S., & Jordans, M. J. D. (2013). Annual research review: Resilience and mental health in children and adolescents living in areas of armed conflict – A systematic review of findings in low-and middle-income countries. Journal of Child Psychology and Psychiatry, 54(4), 445–460.PubMedGoogle Scholar
  70. UN. (2016). Children and armed conflict: Report of the Secretary-General. Retrieved from http://www.un.org/ga/search/view_doc.asp?symbol=S/2016/360
  71. UNHCR. (2015). World at war: UNHCR global trends: Forced displacement in 2014. Retrieved from http://www.unhcr.org/556725e69.pdf
  72. UNICEF. (2016). The state of the world’s children. Retrieved from https://www.unicef.org/publications/files/UNICEF_SOWC_2016.pdf
  73. Wessells, M. G. (2009). What are we learning about protecting children in the community? An inter-agency review of the evidence on community-based child protection mechanisms in humanitarian and development settings. Retrieved from http://educationcluster.net/wp-content/uploads/sites/2/2011/10/What-We-Are-Learning-About-Protecting-Children-in-the-Community_Full-Report.pdf
  74. Wessells, M. G., & Monteiro, C. (2006). Psychosocial assistance for youth: Towards reconstruction for peace in Angola. Journal of Social Issues, 62(1), 121–139.Google Scholar
  75. Williamson, J., & Robinson, M. (2006). Psychosocial interventions, or integrated programming for well-being. Interventions, 4(1), 4–25.Google Scholar
  76. Winthrop, R., & Kirk, J. (2005). Teacher development and student well-being. Forced Migration Review, 22, 18–21.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Mark J. D. Jordans
    • 1
    • 2
    Email author
  • Myrthe van den Broek
    • 2
  • Felicity Brown
    • 2
  • April Coetzee
    • 2
  • Rinske Ellermeijer
    • 2
  • Kim Hartog
    • 2
  • Frederik Steen
    • 2
  • Kenneth E. Miller
    • 2
  1. 1.Faculty of Social and Behavioral SciencesUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Research and DevelopmentWar ChildAmsterdamThe Netherlands

Personalised recommendations