Abstract
Few psychosocial and mental health care systems have been reported for children affected by political violence in low- and middle income settings and there is a paucity of research-supported recommendations. This paper describes a field tested multi-layered psychosocial care system for children (focus age between 8-14 years), aiming to translate common principles and guidelines into a comprehensive support package. This community-based approach includes different overlapping levels of interventions to address varying needs for support. These levels provide assessment and management of problems that range from the social-pedagogic domain to the psychosocial, the psychological and the psychiatric domains. Specific intervention methodologies and their rationale are described within the context of a four-country program (Burundi, Sri Lanka, Indonesia and Sudan). The paper aims to contribute to bridge the divide in the literature between guidelines, consensus & research and clinical practice in the field of psychosocial and mental health care in low- and middle-income countries.
Highlights
There is ample literature available to demonstrate the impact of perpetual political violence on child mental health [1,2]
A broad spectrum of consequences have been reported, including disruption of normal developmental pathways [3], breakdown of social structures such as family and school systems [4,5], increased psychopathology such as depression, post traumatic stress disorder and anxiety [6,7], as well as literature stressing the nonpathological nature of children's reactions, such as increased aggression, withdrawal, pre-occupation with negative thoughts [8]
Model presentation To provide mental health and psychosocial support to children in areas affected by political violence we developed a multi-layered care package (See Figure 1; Table 1)
Summary
There is ample literature available to demonstrate the impact of perpetual political violence on child mental health [1,2]. CBI implementation included the following subsequent steps; (a) initial target area selection based on public health criteria [18]; (b) obtaining permission for care provision from local authorities; (c), review and adaptation of intervention within the give context; (d) skill-based capacity building of the facilitators; (e) coordination with school principals, teachers and parents for practical arrangements; (f ) pre-intervention community awareness raising (see above); (g) 1-2 hours sessions, spread out over 5 weeks, within the school premises; (h) post-intervention follow-up and referral when indicated and structural monitoring and evaluation. Upon prescreening briefing of parents, teachers and children, groups of children were selected to undergo the brief screening procedure to allocate services, the Classroom Based Intervention; child resilience groups, counselling or referral to existing resources or specialized mental health care. Parallel and ongoing attention was given to issues of quality control, including continued capacity building of service providers, clinical supervision, structured monitoring and evaluation, and efficacy research [30,31]
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