Welcome back. It is really important that we learn what makes a difference for children and youth who are exposed to war, terror, and political conflict. What have we learned from research that can inform our efforts to intervene more effectively with this young, with these young people? There are very good studies on intervention but they are rare because it's very difficult to do this kind of work. The most informative studies for learning whether an intervention works have to meet what's called the gold standard. And the key to a gold standard study is that the treatment group is compared to another group and the, those who are receiving the treatment are randomly assigned just by chance to one group or the other. And this helps you know whether it's the intervention that made a difference or not. When these investigators, Peltonen and Punamaki, tried to find all the evidence of experimental studies that met the gold standard out there in the research. They only found four studies that had randomized comparison groups or control groups in their review. And there are more now than there were in, in 2010, but there're still very few of these gold standard efforts. But I do want to take a look at several examples that do meet these gold standard criteria. One classic study by Dybdahl was done, published in 2001. This is a very important early example of an experiment to try to learn whether they could help young families who've been exposed to the war in Bosnia, and their focus in this study was to promote the quality of interaction in mothers and young children. The average age of the children in their study was five years old. So these were young children and they were trying to see if providing support and, and education for these mothers to help them with the quality of their interaction with their children would make a difference, both for the mother and for the child. And they did, have a comparison group, where they randomly assigned the families, and the comparison group just received medical care, and the treatment group received the medical care plus the other parts of the intervention. And this did show good effects. Not only did the mother's mental health improve from the treatment they received, but also the child's physical health was better. This was a very well done study some time ago that demonstrated that you, there are interventions that can support families and young children in the wake of a disastrous war, as we saw when former Yugoslavian countries were at war with each other. There's been, was another study, study in Bosnia. With older youth, that also demonstrates good results. This was done by Chris Layne and colleagues. And they did a comparison of two kinds of treatment for adolescent students. These were group-based treatments, and one group received specialized trauma and grief-focused treatment, and the other group received psychoeducational training and skills about how to cope and so forth. And, interestingly enough, both groups improved. So there's something probably about being in a group that is supportive that probably provides help to students, and both groups improved in terms if both their post-traumatic symptoms and their symptoms of depression. But the specialized treatment group that was focused on trauma and grief, did show more improvement in grief reactions. There have been other school-based interventions with randomized control groups or waiting lists control groups that meet high standards for experiments. Some have been done with Indonesia children, others with Israeli children, and a number of these have used manuals and have taken an approach called, under the umbrella of cognitive behavioral therapy, or CBT. Which train young people in what they can do to try to cope with any issues they're having after trauma. The report here by Tol et al in 2008 on Indonesian children is important because this one was focused particularly on positive targets, and they were looking to improve coping, hope and supportiveness of peers to each other. And their intervention was effective in that way. So these are just demonstrations that you can do interventions in the school context that can be helpful to students of various ages. There's also been experiments to try to help former child soldiers. Just a couple of examples here. We've encountered NET before, that's NET. NET stands for Narrative Exposure Therapy. Sometime called Kid NET when it's used with young people. This kind of intervention combines telling your story, your autobiographical account of your experiences, with desensitization that is presumed to come from exposing yourself to memories. And this, I put the ropes, and rocks, and flowers here to remind you of this strategy. What they do is lay out a timeline with a real, you know, they lay out a rope, and then the young person lays down flowers and either large stones or small stones to represent difficult challenges in their life. And then they talk about, gradually, over time, talk about some of these experiences. Narrative exposure therapy has been implemented in Uganda with former child soldiers and appeared to be effective. They, the treatment group had lower post traumatic symptoms than two other comparison groups. One was a weightless control and the other was a different kind of active treatment. Betancourt, who we've heard about recently, also has implemented an experimental design to test whether interpersonal group therapy would be effective for former child soldiers. And that work which you can read more about, was most effective for girls, abducted girls who were depressed. So, they had been abducted to be child soldiers and they were depressed. And this inter, interpersonal group therapy, which focuses heavily on relationships and connection, did appear to make a difference for these young women. The final example I want to talk about here today is, Stress Inoculation Training. And this particular study is interesting because it's an example of a natural exp, experiment. In this study a group in Israel was training schools, and children in schools, what to do in the event of you know, terror attacks or bombing and shelling, that sort of thing. They were trying to prepare children for traumatic experiences in the same way that some school children are trained in how to respond to tornadoes and hurricanes. And they were trained in how to cope with this kind of traumatic experience and how to manage stress. So a number of schools, were trained in this Stress Inoculation Training Method based on manualized treatment and this, this was done with schools with eight to 12 year old children. Well, about three months after this training was done there was a period of shelling in this region of Israel which was called operation Cast Lead. So there was a surge in shelling in the area, so the bombs were falling, and some of the schools that had received this intervention were in the shelling region, and some schools that were in the shelling region had not had this training yet. So they were able to compare the schools that had been trained in advance before this shelling began to happen with schools that had not been trained. And their analysis of the data showed that children who'd receive this kind of preparation of how to handle stress and cope with traumatic situations had fewer trauma symptoms than kids who had not been involved in this training as yet. So this was very good evidence that this kind of advance preparation may make a difference for children who live in war zones or areas where there's a high risk for exposure to traumatic events such as bombing or terror attacks. I want to close though this segment by saying that almost all reviewers agree that there's a striking lack of evidence, really high-quality evidence, of what works to intervene with children who are exposed to war and terror given the millions and millions of children around the world that are exposed to this kind of situation every year. And we clearly need more intervention re, research to find out what works and what can we do to promote the resilience and recovery of these chil, children and adolescents who are survivors of war and terror. [SOUND]
