Hall, J. & Ahmad, A. (2022). Child Development and Resilience in War, Conflict and Displacement. Stockholm International Peace Research Institute (SIPRI). Retrieved from https://www.sipri.org/commentary/topical-backgrounder/2022/child-development-and-resilience-war-conflict-and-displacement

Child development and resilience in war, conflict and displacement

A five-week classroom-based group intervention designed by the HealthNet Transcultural Psychosocial Organisation (TPO). Aims to reduce distress and enhance resilience among children in conflict settings. Includes various concepts from creative, expressive and experiential therapy, cooperative play, parental support and CBT.

Michigan State University

When used with youth affected by war and conflict, CBT can help them better cope with the impact of traumatic experiences.
CBT for youth affected by war and conflict can be delivered in individual or group therapy sessions and can be adapted to the specific cultural, linguistic, and contextual needs of the youth and their community. The ultimate goal of CBT is to help youth develop skills and strategies to manage their symptoms and improve their overall quality of life.

Cognitive Behavioral Therapy for youth affected by war/conflict.

Interventions to reduce either distress and symptoms.

Treatment interventions for youth affected by war/conflict

A type of intervention with a multilevel ecological focus.

Multilevel 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

Ooi, C. S., Rooney, R. M., Roberts, C., Kane, R. T., Wright, B., & Chatzisarantis, N. (2016). The Efficacy of a Group Cognitive Behavioral Therapy for War-Affected Young Migrants Living in Australia: A Cluster Randomized Controlled Trial. Frontiers in psychology, 7, 1641. https://doi.org/10.3389/fpsyg.2016.01641

The Efficacy of a Group Cognitive Behavioral Therapy for War-Affected Young Migrants Living in Australia: A Cluster Randomized Controlled Trial

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

Psychosocial Care for Children in Conflict Areas (PCCCA)

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

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.

Narrative exposure therapy (KidNET)

In a randomized controlled trial (RCT) aimed at reducing depression symptoms among youth affected by war in northern Uganda, adolescents were divided into three groups: (1) those receiving an adapted group interpersonal psychotherapy, (2) a creative play intervention, and (3) a wait-list control group. The findings revealed that the adapted group interpersonal psychotherapy had positive effects on mood disorders that were locally relevant, particularly among young women. However, the creative play intervention did not lead to improvements in mental health or functioning.

Group interpersonal psychotherapy & creative play

The programs typically utilize a combination of Cognitive Behavioral Therapy (CBT), cooperative playgroup activities, and creative-expressive exercises (drama, art, dance, and music). These programs are implemented in structured sessions/phases and are usually led by teachers or volunteers with humanitarian experience instead of trained mental health professionals. While the effectiveness of these programs varies, they have shown moderate to significant short-term improvements in PTSD, behavioral, and emotional symptoms. However, no robust evidence yet for the long-term sustaining of these results post-intervention.

School-based programs for war-affected children exhibiting distress 

This type of intervention aims to build self-confidence, improve emotional regulation, and foster resilience and recovery by using culturally relevant designs. Although there is no published data on the long-term sustaining of the effects of DMT on outcomes such as aggressive behavior, depression, anxiety, intrusive recollections, and elevated arousal. There are qualitative reports indicating that DMT is highly feasible in a postwar context in terms of emphasizing group cohesion and preventive and reparative capacities.

Dance and movement therapy (DMT) for war-affected children in Sierra Leone and South Sudanese refugee in the US

An intervention that aims to reduce PTSD symptoms. Usually administered in schools by trained teachers (non-specialists). It incorporates a range of techniques including meditation, biofeedback, art therapy, autogenic training (a self-relaxation technique to produce a psychophysiologically determined relaxation response), guided imagery, genograms, physical movement, and specialized breathing exercises. The effectiveness of this intervention was examined through a randomized control trial involving high school students in Kosovo after the war (with a wait-list control group), as well as Kosovar refugees in Gaza (without a control group). The studies revealed significant reductions in PTSD symptoms among participants postintervention, and these improvements were sustained during the follow-up period.

Mind-body techniques for youth affected by war

A three-tiered intervention for youth affected by war in Bosnia post-war.
Tier 1: classroom-based psychoeducation and skills intervention.
Tier 2: school-based trauma- and grief-focused group treatment.
Tier 3: community-based mental health services for students at acute risk for harm.
Tier 1 and 2 interventions were implemented by local school counselors. A randomized control trial revealed significant reductions in PTSD and depressive symptoms, as well as improvements in maladaptive grief, among participants compared to controls. Effective for war-affected youths in low-resource settings.

Skills, psychoeducation, and trauma/grief-focused group treatment  intervention for war-affected youths

An intervention that aims to provide vocational training and offer psychosocial assistance to youth who exhibit significant distress. The psychosocial support encompassed counseling on coping strategies, cognitive and behavioral techniques, and facilitating referrals for those requiring further assistance. It addresses sleep problems, psychosomatic symptoms, and concerns about family, future, and income. The intervention is implemented by counselors with a wide range of training backgrounds. A study in Uganda evaluated the intervention using qualitative research methods and found that the majority of participants' psychological distress was alleviated.

Vocational training and psychosocial support intervention for war-affected youths

An intervention that aimed to reduce psychosocial trauma and promote social healing in war-affected youths From Croatia through a school-based curriculum. Trained teachers implemented trauma/grief-focused psychotherapy. Post-intervention and follow-up after a year revealed small but significant positive outcomes in terms of stress reduction and ethnic bias in participants compared to the 2 control groups. A few confounding variables pose limitations to the study and can be controlled for by future research. 

Teacher-led trauma/grief psychotherapy intervention for war-affected youths

An intervention that addresses both educational needs and psychological distress among displaced youths in post-conflict settings by combining basic non-formal education (e.g., literacy and numeracy) with trauma healing activities (e.g., group sharing about past war experiences). Trauma healing activities focused on reducing levels of emotional distress and post-traumatic stress reactions that often interfere with learning. A noncontrolled pilot study in Sierra Leone examined the effectiveness of the intervention and found that participants had decreased intrusion and arousal symptoms and greater optimism about the future, but increased avoidance symptoms. However, future studies with control groups are still needed. 

Rapid-Ed: Nonformal education and trauma healing intervention for war-affected youth

A trial conducted in Bosnia over a five-month period investigated the impact of a short-term, group-based psychosocial intervention on mother-child dyads compared to a control group that received only free medical care. The intervention, developed by the International Child Development Programme, incorporated successful techniques previously used with the Bosnian population and theory-driven treatments from other settings. The results of the pre/post-intervention assessment showed a slight positive impact on maternal mental health, children's weight gain, and their psychosocial functioning and mental health. However, the study's limitations included a small intervention sample size (n=87 dyads), lack of involvement of male caregivers, and challenging environmental conditions that made intervention delivery difficult.

Dyad psychosocial support/treatment for war-affected children

A pilot study was conducted with 30 families in postwar Kosovo who were living with severe mental illness, using a multiple-family group intervention that also included individual home visits. Led by a local psychiatrist and nurse and supervised by trained local service teams and American study consultants, the intervention comprised seven sessions of psychoeducation on chronic mental illness. The objective was to enhance compliance with psychiatric medication for war-affected individuals undergoing treatment and improve mental health service use among families. The group sessions covered several topics, such as psychoeducation, medication use and side effects, psychosocial causes and effects of relapse, responding to symptoms, crisis response, accessing professional mental health services, and building resilience. Positive outcomes were reported on both measures, but including information on child mental health outcomes would have made the study design more robust. The study employed a collaborative approach to delivery, working closely with Kosovar partners.

Multiple-family group intervention for war-affected children/families

The intervention comprises five levels: mental health promotion for the general population, preventive group activities, classroom-based interventions for specific subgroups, counseling by paraprofessionals for targeted subgroups, and specialized individual psychiatric treatment. A comprehensive monitoring and evaluation framework was utilized to assess the care package in four war-affected countries (Burundi, Indonesia, Sri Lanka, and Sudan). The evaluation yielded positive feedback from nearly 30,000 child beneficiaries across all settings.

Multilevel community-based package intervention for war-affected youth

An intervention involving a unique combination of activities at individual, group, and family levels. Laypersons were involved in delivering the intervention, which was evaluated in a pilot study with Kosovan refugee children and adolescents in Germany. The treatment addressed both past traumatic experiences and post-migration stressors, incorporating creative techniques and psychoeducation. Post-intervention results showed significant reductions in symptoms of PTSD, depression, and anxiety, with participants demonstrating improved psychosocial functioning. However, the study lacked a control group.

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