Sadeh A, Hen-Gal S, Tikotzky L. Young children's reactions to war-related stress: a survey and assessment of an innovative intervention. Pediatrics. 2008;121:46–53.

Young children's reactions to war-related stress: a survey and assessment of an innovative intervention.

A brief intervention aimed at preventing onset of mental health symptoms and facilitate active coping with stress & war experiences in war-affected children (ages ages 2-7). The intervention involves presenting children with a stuffed puppy doll and teaching them how to hug and take care of the doll, with a focus on being a responsible caretaker. In randomized trials in Israel, the huggy-puppy intervention had strong positive effects on symptoms of traumatic stress reactions in young children. Additionally, child adherence to the intervention and attachment to the doll correlated with improvements in well-being.

Michigan State University

Upstream intervention to address risk and protective factors prior to onset of problems

Prevention interventions for youth affected by war/conflict

A type of intervention with an ecological focus on the individual.

Individual level interventions for youth affected by war/conflict

Betancourt, T. S., Meyers-Ohki, S. E., Charrow, A. P., & 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. https://doi.org/10.1097/HRP.0b013e318283bf8f

Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care

an intervention that aims to improve mental health outcomes in the immediate aftermath of a disaster or conflict by providing practical support, connecting people with existing resources, and identifying those who need specialized services. However, there is no rigorous evidence available to support its effectiveness among children and adolescents affected by war.

Psychological first aid

Huggy-puppy intervention

The act of tracing involves locating a child's primary legal or typical caregivers as well as other family members. Its primary objective is to identify a sustainable resolution that aligns with the child's best interests, often entailing reuniting the child with their parents or other immediate kin. While there is limited research on the effectiveness of child-tracing interventions in improving mental health outcomes, reuniting separated families is an important step towards promoting mental well-being in war zones. However, peer-reviewed studies demonstrating significant links between child tracing, family reunification, and psychosocial adjustment have not yet been published.

Child tracing

In Gaza, a psychosocial intervention focused on promoting positive well-being among children during an active conflict period.
The intervention emphasized aspects like good family and community relationships, trust, problem solving, and hope.
Cross-sectional analyses indicated significant positive effects of the intervention, which lasted for at least four years.
However, its effectiveness was lower in one subgroup assessed two years after the intervention.

School-Based Psychosocial Intervention for Palestinian Children

Students who participated in this project experienced a reduction in symptom severity and cluster symptoms related to trauma.
Significant improvements were observed in reexperiencing and avoidance symptoms compared to the control group.
The study employed a cross-sectional follow-up design.

Schoolwide trauma-reduction project in Bosnia

A school-based intervention combining cognitive-behavioral treatment strategies with activities like drawing, creative play, and group discussion was implemented.
Delivered by teachers
However, no positive effects were observed among the children who received the intervention (n=101), when compared to matched controls (n=93).
Employed a cross-sectional follow-up design.

Classroom-based psychosocial intervention after war in Lebanon

Researchers conducted a nonrandomized trial over one year in the Palestinian Territories to evaluate the impact of structured activities at nongovernmental organization sites on child mental health (internalizing and externalizing), child hopefulness, and parental support (40). The structured activities included traditional dance, art, sports, drama, and puppetry, with the hypothesis that they would (1) aid emotional adjustment in hostile environments by providing routine constructive engagement and opportunities for attachment and expression, (2) have a positive impact on parent-child relationships by providing safe outdoor activities to be shared, and (3) increase children's orientation towards the future. The study ensured a culturally appropriate community focus by translating all materials to the local language, employing local volunteers as providers, implementing cultural activities, and using the community center as the primary location for all activities. The child participants demonstrated improved internalizing/externalizing outcomes compared to a small control group, but no improvements in hopefulness were observed, and parental support improvements were reported at only one of the involved sites.

Structured activities at NGO sites

Aimed at specific at-risk groups. Share similar goals with treatment interventions. 

Selective or indicated school-based programs

A type of psychosocial intervention for young refugees that includes a variety of participant-driven activities like communal games and group debates. In Serbia, researchers examined the impact of youth clubs on the psychological well-being of 128  participants, comparing them to 978 non-participate. The findings revealed significant improvements in self-respect. Boys experienced reductions in withdrawal and anxiety, while girls showed decreases in withdrawal and social problems. However, no reductions in traumatic stress were observed specifically for refugees.

Youth Clubs

In Uganda, a 15-session school-based intervention was tested, incorporating play therapy, drama, art, movement, and community service opportunities to improve emotional outcomes. A follow-up study found that the intervention improved child well-being, especially in girls. In Israel, a universal intervention called Overshadowing the Threat of Terrorism was implemented to reduce PTSD, somatic complaints, and anxiety. The intervention involved cognitive-behavioral techniques, art therapy, body-oriented strategies, and narrative approaches. Positive treatment effects were observed. Two preventive interventions were also identified in Israel. ERASE-Stress used psychoeducation and skill training to reprocess traumatic experiences and boost self-esteem and social supports, while the other intervention focused on social support, self-efficacy, and meaning attribution to moderate psychological distress. Both interventions were effective in moderating psychological distress compared to control groups.

Universal school-based interventions for war-affected children

Interventions with the aim to reduce the chance of relapse.

Maintenance interventions for youth affected by war/conflict



Interventions to reduce either distress and symptoms.

Treatment interventions for youth affected by war/conflict

an intervention where patients share their stories of past traumatic events, which are then analyzed by both the patient and a therapist to identify connections between personal experiences and the social and political aspects of trauma. Studies on the use of this therapy with Sudanese refugees suggest that it could be a helpful alternative to traditional psychotherapy, which may not be culturally relevant or accessible to certain populations. However, there is no evidence yet on how effective this therapy is for children affected by war. Before implementing this therapy, focus groups were consulted to ensure its feasibility and their feedback was incorporated into the intervention protocol.

Testimonial psychotherapy

an intervention developed to address PTSD, depression, anxiety symptoms, and distorted perceptions related to self-blame, safety, and trustworthiness of others. However, the limited resources available for one-on-one treatment make CBT trauma-focused treatments rare. In high-income countries, individual trauma-focused cognitive-behavioral therapy is recommended due to its sufficient evidence base. However, in war zones, the lack of resources, specialized professionals, and stigma associated with mental health problems make it difficult to implement such individualized treatments.

Trauma-focused Individual CBT

a short-term individual treatment for PTSD delivered by experienced mental health clinicians. It involves constructing a narrative about the patient's whole life, focusing on traumatic experiences and memories. KidNET is a version of narrative exposure therapy adapted for war-affected adolescents and children aged 12 to 17 years, and studies have shown it to be effective in reducing PTSD symptoms in various settings. However, further research is needed on the long-term efficacy of KidNET and maintenance interventions that involve ongoing treatment.

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