Child Trauma Recovery in War Torn Contexts
Our research has transformed trauma recovery for children in situations of on-going violence
Until recent times, trauma recovery was provided post-conflict and was less successful. The trauma recovery programme research developed at Dundee and led by Dr. Barron has directly improved psycho-trauma assessment and intervention for over 6000 children in Palestine.
This has led to the development of a battery of screening measures and the delivery of culture-specific programmes into counsellor practice. These changes in psycho-trauma recovery have developed throughout Gaza (impacting on around 5,000 children), across the West Bank (around 1,000 children) and into other Middle East countries (Jordan and Egypt; around 200 children).
The research has led to the delivery of trauma recovery programmes for maltreated children in 30% of Scotland’s Secure Estate.
The impacts covered in this case study developed from child trauma recovery research conducted by Dr. Barron at the University of Dundee from 2008 to 2013. For the first time, research identified and quantified the different types of traumatic events children experience under military occupation in Palestine. Assessment of the consequences of these traumatic events included the development of a battery of screening measures covering the extent and nature of post-traumatic stress disorder (PTSD), depression, traumatic grief and the impact of trauma on familial/peer relationships and children’s school performance (Barron, Abdallah and Smith, 2012).
The design of the battery of screening measures for child trauma developed through an international partnership involving researchers at the University of Dundee; University College London; Kings College London; The Centre for Crisis Psychology, Bergen and the Centre for Applied Research in Education, Ramallah. The University of Dundee provided the core role of screening battery design, implementation and evaluation (Barron, Abdallah and Smith, 2012). Associated research at the University of Dundee, examining abuse/trauma prevention across the globe led to inclusion of screening for domestic as well as military violence (Topping and Barron, 2009).
Research at the University of Dundee exploring inter-cultural and ethical issues led to the adoption of a non-colonialist and empowerment framework underpinning trauma recovery programme delivery and research design (Barron and Abdallah, 2013). This guided the inclusion of Western and Middle East trauma recovery programmes; set the research within a socio-political-historical context (e.g. occupation, poverty, domestic violence, mental illness) and sought to understand children’s experiences of trauma and programme delivery in their ‘own’ words.
Previous associated research at the University in domestic violence/trauma prevention identified critical methodological gaps, i.e. control groups and randomisation, programme fidelity and exploration of children’s subjective experience (Topping and Barron, 2009; Barron and Topping, 2009, 2010). As these gaps were mirrored within the trauma recovery literature this led to a mixed methods approach utilising the gold standard of randomised control trials, the application of focus group methodology and implementation of programme fidelity measures.
Our research that explored school counsellors’ skills underpinning effective delivery of trauma recovery programmes led to the development of a phased model of training where counsellors are now required to develop effective listening and helping skills prior to training in trauma recovery specific programmes (Barron and Abdallah, 2012)
Related on-going research addresses (i) the development of a screening battery to include a measure of dissociation for complex trauma; (ii) the nature of supervision for effective trauma recovery programme delivery; (iii) evaluation of teachers’, parents’ and school principals’ perceptions of trauma seminars in Palestinian Schools and (iv) the identification and amelioration of complex trauma in young people in Scotland’s Secure Estate.
Details of the impact
As a direct consequence of our research a phased programme of training has developed across Palestine. To date, the phased programme has included training:
- 900 school counsellors in Gaza in the indigenous Healing Trauma Combating Hatred (HTCH) programme
- 50 school counsellors in the newly developed Arabic culture-specific version of the world leading Teaching Recovery Techniques programme (TRT)
- 20 school counsellors in Nablus have received the novel Listening Skills for Crisis intervention programme
The Centre for Applied Research in Ramallah has been monitoring the gains for counsellors over time. Benefits reported by counsellors include increased:
- knowledge and recognition of the nature of children’s trauma
- skills in listening and in the delivery of trauma recovery programmes
- confidence in responding to traumatic events
- networking between counsellors
- confidence in practice from access to external international expert consultation
As a direct consequence of the research involving counsellor training:
- 5000 children have received the HTCH programme in Gaza
- 1000 children have received the TRT programme in the West Bank
This has lead to substantial reductions in the rates of children meeting the criteria for:
- post traumatic stress disorder (down by 25%)
- depression (down by 50%);traumatic grief (down by 30%)
- other mental health concerns (down by 25%)
In addition children’s motivation and concentration in school has significantly increased (20% gains).
By the end of the rolling programme of training and programme delivery in Palestine more than 1 million children will have benefitted from this initiative.
Assessment of children’s subjective experience of programme delivery has led to longer term programmes and greater parental engagement and involvement. The research into children’s views has resulted in the development of:
- trauma-informed seminars delivered to teachers, parents and school principals; and,
- trauma awareness raising seminars have been delivered in Jericho to over 200 teachers, parents and school principals
Focus group evaluation of school staff and parental experience indicates a range of benefits: attitudinal shifts for teachers:
- head teachers and parents in being better able to recognise challenging behaviour as communication of traumatic stress
- knowledge gains in understanding the neurobiology of trauma
- skill gains in the supporting traumatised children
- emotional gains in feeling more confident in their handling of their children
School principals report the importance of embedding trauma-informed practices into the classroom context and ensuring traumatised children have access to trauma specific recovery programmes.
Impact has also occurred at national political level with the development of the first social policy in trauma recovery in Palestine. Ministry of Education policy now includes a rolling programme of trauma recovery training for counsellors and programme delivery for children and parents. Directly as a result of the Dundee research, this policy:
- incorporates a human rights lens on children’s traumatic experience
- challenges the cultural stigma of mental illness
- sets childhood trauma within wider public health concerns (e.g. unemployment and poverty, sanitation, medical services, utilities and domestic violence)
- identifies the nature and extent of traumatic exposure and resultant wide ranging symptoms; ensures key support adults’ trauma is addressed
- embeds effective trauma recovery programmes into the school curriculum.
The research has also contributed to increased economic capital for CARE, the no-governmental organisation responsible for coordinating the delivery of trauma recovery programmes throughout Palestine (£100,000). This funding has come through related trauma recovery projects.
The Dundee research has led to the application of trauma recovery programmes and the battery of measures to be developed into other conflict situations around the World:
- In Jordan and Egypt, CARE has delivered trauma recovery programmes to over 200 child refugees.
- In Scotland, for the first time, the research has led to the delivery of group trauma recovery programmes within Scotland’s Secure Estate. The two main secure accommodation services, Rossie and Kibble are now able to provide trauma recovery programmes to over one hundred children who are at risk of suicide and/or harm to others.
References to the research
Barron, I. and Abdallah, G. (2012) Evaluation of a group-based trauma recovery program in Gaza: Students’ subjective experience. Journal of Loss and Trauma: International Perspectives on Stress and Coping. 17(2), 187-199.
Barron, I., Abdallah, G. and Smith, P. (2013). Randomised control trial of a CBT trauma recovery program in Palestinian schools. Journal of Loss and Trauma. International Perspectives on Stress and Coping, 18(2), 306-321.
Barron, I. and Topping, K. (2010). Sexual abuse prevention programme integrity: video analysis of interactions, Child Abuse Review, 20(2), 134-151.
Barron, I. G. & Topping, K. J. (2009). School-based child sexual abuse prevention programs: The evidence on effectiveness. Journal of Children's Services 3(3), 31-53.
Topping, K. and Barron, I. (2009). School-based child sexual abuse prevention programs: A review of effectiveness. Review of Educational Research, 79(1), 431-463.