It found that children who live in Afghanistan were particularly affected by a multitude of war stressors which increase the likelihood of developing PTSD, such as child labour, trauma, family and military violence. They witnessed bombings, abuse, and were exposed to other war stressors on a daily basis. Therefore, the treatment needs to include other factors than war experiences, Catani and her team say.

The research was based on clinical interviews with approximately three hundred Afghan school children.

Read more: Afghani children suffering from post traumatic stress.

83 per cent of the participants reported that they felt better equipped to deal with issues they previously found challenging.

The survey results showed the extent of post traumatic symptoms (PTSD) within the population: each participant estimated knowing an average of 105 clients at risk of PTSD. Each social worker has a caseload of over 100 child clients, according to the report.

21 participants from the Counseling and spiritual development department, the Social work department and the Public health department (CHE) including the departmental heads, participated in an eight day training in the Mathare slum in Nairobi, Kenya, in April.

The training was conducted by Serena Smith-Patten, who attended the November CAW training in Nairobi. She was assisted by by Fred Otieno Juma, head of the CHE department. Fred and Josephine Mwai, head of Social Work department, lead the session on implementation.

The Missions of Hope International (MOHI) centre is an educational organisation that serves approximately 4,000 orphans and vulnerable children in the Mathare slum. The centre runs ten schools including a boarding school where students from difficult home environments and orphans are able to experience a clean environment outside the slum.

Slum resembles war experiences

The traumatic events in Mathare closely resemble the experience of children who have experienced war. “Children of Mathare routinely experience many stressors both vicariously and directly. The urban slum is frequent to abject poverty, crime, violence, substance abuse, accidents, disease and unhealthy living conditions,” the report says.

The children of Mathare have exposure to 9 of 12 areas of exposures defined by Leila Gupta Ph. D. in her Psychosocial assessment of displaced children exposed to war related violence in Sierra Leone, according to Smith-Patten.

Bereavement session important

As traumatic loss and bereavement are prevalent in the lives of these children, the session on bereavement was of particular importance. For example, children had lost parents to AIDS, disappearance in the post-election violence and suicide in the presence of the child.

“Social workers appeared to enjoy this rare opportunity to hear from their colleagues the challenges of telling a child that they have been bereaved and then walking with that child through the grieving process. ”

Survey comments indicate that participants found the training valuable and gained skills to serve both adult and child clients better.

The sessions were held for two hours each afternoon. A pre-training and post-training evaluation were carried out. The Children and War Foundation covered expenses for printing the manual.

Implementation of the manual

Since the training took place, a training team of nine has been established to continue discussions on implementation and contextualising the manual. The training team is reviewing the manual to create a MOHI workbook for future use and training.

In addition, a pilot of 20 children from two classes at the Bondeni centre began 5 June. An August training was proposed to include a pastoral team who missed the first training, as well as others.

William Yule and Patrick Smith will teach participants from mental health and educational professionals on how to run groups for young people who have been affected by exposure to the traumas of war and disasters.

The Teaching Recovery Techniques workshop is based on the Foundation’s manual which has been widely used after earthquakes in Iran, Greece and China to mention some places.

Please be aware that places are limited.

Teaching Recovery Techniques

A Children and War Foundation Workshop

The aim of this 2-day workshop is to enable participants to teach others to run groups for young people (and their parents) who have been affected by exposure to the traumas of war and disasters. The workshop is based on the Children and War Foundation manualised group protocol. By the end of the workshop, participants should also be able to train colleagues to run groups according to the manualised protocol.

The workshop is intended for mental health and educational professionals who work with children and teenagers (e.g. counsellors, psychologists, psychiatrists; teachers, pedagogues).

Thursday 21 October
9.30 – 10.30 Introductions and introduction to the training. Group work with children: introduction and overview
10.30 -11.00 Coffee
11.00 -12.30 Recovery techniques for intrusive memories (1)
12.30 – 1.30 LUNCH
1.30 – 3.00  Intrusions (2)
3.00 – 3.30  TEA
3.30 – 5.00 Relaxation and arousal reduction

Friday 22 October
9.30 – 11.00    Recovery techniques for avoidance (1)
11.00 – 11.30   COFFEE
11.30 – 12.30   Avoidance (2)
12.30 – 1.30     LUNCH
1.30 – 3.00       Helping bereaved children; Running parallel groups for parents and carers
3.00 – 3.30      TEA
3.30 – 5.00   Evaluation strategies, measures. The new writing manual.

Setting up groups, on-going supervision, burnout prevention

Participants will obtain pdf files containing the manuals and workbook prior to the training.

Venue: Association for Child and Adolescent Mental Health, St Saviour’s House, 39/41 Union Street, London SE1 1SD

Cost: £300 includes all refreshments
Maximum number: 25

To book a place, e-mail the Foundation at contact@childrenandwar.org before 30 September 2010.
Places are strictly limited and confirmation will be sent on payment of the fee.

Photo: Lucia Puertas

A recent evaluation of the Recovery Manual in Palestinian schools found a significant decrease in traumatic stress reactions among adolescents who participated in the group intervention.

The randomised controlled trial was carried out by the Centre for Applied Research in Education (Palestine) in collaboration with University of Dundee and the Children and War Foundation.

School counsellors from the West Bank took part in three days of training in Recovery Manual techniques, delivered by trainers from the Children and War Foundation. A screening survey was then carried out in schools in Nablus City and the surrounding region.

Based on this survey, 133 students (11-14 years old) who reported elevated symptoms of post traumatic stress were randomly allocated to either participate in the session group intervention for five weeks, or to a waiting list for five weeks.

Before the intervention, an adapted war trauma questionnaire gave a measure of young people’s exposure to traumatic events. A range of standardised questionnaires was used to assess traumatic stress reactions, depressive feelings, and grief reactions before and after the groups had been carried out.

Results showed that exposure to traumatic events among school-children in Nablus was high. Young people who took part in the groups reported significant decreases in post traumatic stress reactions, depression, and traumatic grief, compared to students who did not take part in the groups. Students who participated in the groups also reported significant reductions in conduct problems and peer-relationship difficulties – as well as improvements in pro-social behaviour.

‘Writing for Recovery’ helps writers to focus on specific traumatic events using structured writing exercises.

Writing tasks took place over three consecutive days. Cortisol salivary samples were taken at five measure points: (1) pre-writing on Day One, (2) 20 minutes after writing on Day One, (3) pre-writing on Day Three, (4) 20 minutes after writing on Day Three, and (5) after two weeks.

As there are very few practical tools available to address the need of small children aged 0-6 years of age following war and disasters, the Foundation thinks it is important to develop such a manual. There is much research to base good, practical advise to parents on following disasters, but it needs to be worked into a practical tool or handbook that parents other child caretakers can use to support children following large scale natural or man-made disasters.

The Children and War Foundation has previously supported the development of several manuals. By gathering world experts in a certain professional field and having them work together for a week to produce a concrete product (manual), we have been very successful in creating very practical manuals to help children and adolescents following war and disasters.

Photo by Lars Svenkerud.

Being orphaned by a war during childhood or adolescence is associated with a high likelihood of depression, anxiety disorders and other psychological distress in young adulthood, results from the Kosovo study indicates.

The Children and War Foundation funded a project that investigated mental health of 179 bereaved young adults and 175 non-bereaved young adults who experienced the Kosovo war a decade ago as children or adolescents. All bereaved participants reported the killing of the father during the war.

Dr. Nexhmedin Morina from the University of Amsterdam and Dr. Ulrike von Lersner from the Free University of Berlin has now completed the project, and has summarised the study.

Results indicated that about 60 per cent of the orphaned young war survivors met criteria for either major depressive disorder or an anxiety disorder, as compared to 40 per cent of non-bereaved young war survivors.

Among orphaned war survivors, participants with clinical symptoms of prolonged grief were three times more likely to suffer from either depression or an anxiety disorder and nearly eight times more likely to report current suicide risk.

Furthermore, bereaved participants with clinical symptoms of prolonged grief reported significantly more somatic symptoms, higher general health distress, and higher scores of negative affect as compared to bereaved participants without such symptoms. These findings indicate that being orphaned by the war during childhood or adolescence is associated with a high likelihood of depression, anxiety disorders, and other psychological distress in young adulthood.

The Child Psychosocial Distress Screener (CPDS) is a primary screener for children between 8 and 14 years old. It can be downloaded free of charge.

Raija-Leena Punamäki, Samir R. Quota and Esa J. Palosaari have also undertaken a follow-up study to check the effectiveness of the Teaching Recovery Techniques manual. More details will be published once the final paper has been published.

The authors represent the University of Helsinki, the Islamic University, Gaza, Palestine and the University of Tampere respectively.