Children and War

To evaluate the comparative effectiveness of a classroom-based psychoeducation and skills intervention (tier 1) and a school-based trauma- and grief-focused group treatment (tier 2) of a three-tiered mental health program for adolescents exposed to severe war-related trauma, traumatic bereavement, and postwar adversity.

Alors qu'ils sont brigadistes pendant la guerre d'Espagne, le couple Françoise et Alfred Brauner collecte des dessins d'enfants espagnols, qui donnent lieu à quatre publications d'Alfred Brauner, de 1938 à 1991. Cet article propose de reparcourir l’histoire des représentations de l’enfance en guerre au XXe siècle, à travers la manière dont les Brauner réinterprètent constamment ces mêmes sources, qu’ils ont eux-mêmes contribué à produire. En effet, les enfants-héros de la guerre d’Espagne, mobilisés dans l’antifascisme en 1938, sont dépeints, en 1991, comme des enfants-victimes, traumatisés par la guerre. Comme leur vision de l’enfance, l’usage que font les Brauner des dessins d’enfants évolue avec leurs combats politiques – de l’antifascisme militant des années 1930 au pacifisme antinucléaire à partir des années 1970. Le contraste radical entre les commentaires proposés entre 1938 et 1991 sur les mêmes dessins, signale la labilité des sources historiques, qui sont toujours construites par leurs usagers successifs – voire, ici, par les interprétations changeantes des deux mêmes personnes au cours de leur vie.

Ongoing wars and conflicts in many countries in the world resulted in various problems effecting Men and societies, especially children. This situation requires serious professional interventions, especially in dealing with children affected by political violence. At the same time they are the most important group in social work interventions which aimed to protect, prevent and treat them. School is actually the best source to reach the children and their parents in such crises, as well it is a best source because it is where social work can help children and provide them with supporting services. Direct and indirect exposure to violence affects their behavior and growth requiring direct work with the child and his family. Undoubtedly that social work intervention with children in times of war and conflict requires sufficient skills and information about the difficulties they suffer. This article discusses the impact of living in an environment of war and conflict on children and the importance of school social work intervention. Impact of violence caused by war and conflict on children at school Living in an environment of war and conflict causes children to lose their rights as well involves the emergence of behavioral problems affecting their physical, moral, social and psychological development. Consequently and negatively this affects the participation of children within the school environment. A symptom of post-traumatic stress disorder often appears in children who have been exposed to or witnessed violence. These negative effects establish peer relationships and peer school performance. Besides the impact of violence on children, there are other things created by an environment of war and conflicts that have a direct impact on the mental health of children for instance poverty, malnutrition, family relations and violence emergin from environment. Generally children still under the influence of the conflicts they see in public, television and environment can apply the pattern of violent behavior against each other in school. Exposing or witnessing the violence affects the children's concentration and participation in class and in other activities in school (Snoubar, 2010; Snoubar & Duman, 2015). Psychological hazards to children includes, terrible events observation and threats against loved ones, show the terrible events in the media, torture, threats and self-blame. Moreover, children from an early age can be danger-measured by reading concerns of their parents. This phenomenon is called social referencing (Masten et al. 1990; Masten and Narayan, 2012). Therefore it is necessary to include the presence of parents in any intervention made to the children. School Social Work in Conflict Community School is one of the most important places where could be managed the case in dealing with children in the times of crisis. Accessing to children in times of distress through the school and providing them with psychological and social support is a crucial step in the field of child protection in a risked environment. In fact, school facilitates the work of social workers in determining the risk factors and problems suffered by children and affecting their development and school performance. Activities that can be done inside the school include large numbers of students and split them to individuals, groups and society. At the same time work can be done with teachers and all school staff in order to support and assist children within the activities, programs or seminars.

Objective: To evaluate the comparative effectiveness of a classroom-based psychoeducation and skills intervention (Tier 1) and a school-based trauma- and grief-focused group treatment (Tier 2) of a three-tiered mental health program for adolescents exposed to severe war-related trauma, traumatic bereavement, and postwar adversity. Method: A total of 127 war-exposed and predominantly ethnic Muslim secondary school students attending 10 schools in central Bosnia who reported severe symptoms of posttraumatic stress disorder (PTSD), depression, or maladaptive grief and significant impairment in school or relationships were randomly assigned to one of two experimental conditions. These included either an active-treatment comparison condition (tier 1), consisting of a classroom-based psychoeducation and skills intervention alone (n = 61, 66% girls, mean age 16.0 years, SD 1.13) or a treatment condition composed of both the classroom-based intervention and a 17-session manual-based group therapy intervention (tier 2), trauma and grief component therapy for adolescents (n = 66, 63% girls, mean age 15.9 years, SD 1.11). Both interventions were implemented throughout the school year. Distressed students who were excluded from the study due to acute risk for harm (n = 9) were referred for community-based mental health services (tier 3). Results: Program  effectiveness was measured via reductions in symptoms of PTSD, depression, and maladaptive grief assessed at pretreatment, posttreatment, and 4-month follow-up. Analysis of mean-level treatment effects showed significant pre- to posttreatment and posttreatment to 4-month follow-up reductions in PTSD and depression symptoms in both the treatment and comparison conditions. Significant pre- to posttreatment reductions in maladaptive grief reactions were found only in the treatment condition. Analyzed at the individual case level, the percentages of students in the treatment condition who reported significant (p < .05) pre- to posttreatment reductions in PTSD symptoms (58% at posttreatment, 81% at 4-month follow-up) compare favorably to those reported in controlled treatment efficacy trials, whereas the percentages who reported significant reductions in depression symptoms (23% at posttreatment, 61% at follow-up) are comparable to, or higher than, those found in community treatment settings. Lower but substantial percentages of significant symptom reduction were found for PTSD (33% at posttreatment, 48% at follow-up) and depression symptoms (13% at posttreatment; 47% at follow-up) in students in the comparison condition. The odds of significant symptom reduction were higher for PTSD symptoms at both posttreatment and 4-month follow-up and for maladaptive grief at posttreatment (no follow-up was conducted on maladaptive grief). Rates of significantly worsened cases were generally rare in both the treatment and comparison conditions. Conclusions: A three-tiered, integrative mental health program composed of schoolwide dissemination of psychoeducation and coping skills (tier 1), specialized trauma- and grief-focused intervention for severely traumatized and traumatically bereaved youths (tier 2), and referral of youths at acute risk for community-based mental health services (Tier 3) constitutes an effective and efficient method for promoting adolescent recovery in postwar settings.

J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(9):1048Y1062. Key Words: posttraumatic stress disorder, depression, grief, school-based intervention.

Clinical trial registration information Randomized Controlled Trial of the Effectiveness of Group Treatment with War-Exposed Bosnian Adolescents. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00480480.