Developing Strategies to Deal with Trauma in Children (NATO Security Through Science Series. E: Human and Societal)

DEVELOPING STRATEGIES TO DEAL WITH TRAUMA IN CHILDREN

NATO Security through Science Series This Series presents the results of scientific meetings supported under the NATO Programme for Security through Science (STS). Meetings supported by the NATO STS Programme are in security-related priority areas of Defence Against Terrorism or Countering Other Threats to Security. The types of meeting supported are generally “Advanced Study Institutes” and “Advanced Research Workshops”. The NATO STS Series collects together the results of these meetings. The meetings are co-organized by scientists from NATO countries and scientists from NATO’s “Partner” or “Mediterranean Dialogue” countries. The observations and recommendations made at the meetings, as well as the contents of the volumes in the Series, reflect those of participants and contributors only; they should not necessarily be regarded as reflecting NATO views or policy. Advanced Study Institutes (ASI) are high-level tutorial courses to convey the latest developments in a subject to an advanced-level audience Advanced Research Workshops (ARW) are expert meetings where an intense but informal exchange of views at the frontiers of a subject aims at identifying directions for future action Following a transformation of the programme in 2004 the Series has been re-named and reorganised. Recent volumes on topics not related to security, which result from meetings supported under the programme earlier, may be found in the NATO Science Series. The Series is published by IOS Press, Amsterdam, and Springer Science and Business Media, Dordrecht, in conjunction with the NATO Public Diplomacy Division. Sub-Series A. B. C. D. E.

Chemistry and Biology Physics and Biophysics Environmental Security Information and Communication Security Human and Societal Dynamics

Springer Science and Business Media Springer Science and Business Media Springer Science and Business Media IOS Press IOS Press

http://www.nato.int/science http://www.springeronline.nl http://www.iospress.nl

Sub-Series E: Human and Societal Dynamics – Vol. 1

ISSN: 1574-5597

Developing Strategies to Deal with Trauma in Children A Means of Ensuring Conflict Prevention, Security and Social Stability. Case Study: 12–15-Year-Olds in Serbia Edited by

Jill Donnelly Mouvement Mondial des Mères/World Movement of Mothers, Paris, France

Anna Kovacova Klinika detskej psychiatrie, Detskej fakultnej nemocnice, Bratislava, Slovak Republic

Joy Osofsky Professor of Pediatrics, Psychiatry & Public Health, LSU Health Sciences Center, New Orleans, USA

Howard Osofsky Professor and Head, Department of Psychiatry, Louisiana State University, New Orleans, USA

Caroline Paskell Centre for Analysis of Social Exclusion, London School of Economics, United Kingdom

and

Josi Salem-Pickartz Clinical Psychologist Amman, Jordan Associate Professor of Psychology, University of Oldenburg, Germany

Amsterdam • Berlin • Oxford • Tokyo • Washington, DC Published in cooperation with NATO Public Diplomacy Division

Proceedings of the NATO Advanced Research Workshop on Developing Strategies to Deal with Post-Conflict Trauma in Children Bratislava, Slovak Republic 4–6 March 2004

© 2005 IOS Press. All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without prior written permission from the publisher. ISBN 1-58603-546-0 Library of Congress Control Number: 2005931630 Publisher IOS Press Nieuwe Hemweg 6B 1013 BG Amsterdam Netherlands fax: +31 20 687 0019 e-mail: [email protected] Distributor in the UK and Ireland IOS Press/Lavis Marketing 73 Lime Walk Headington Oxford OX3 7AD England fax: +44 1865 750079

Distributor in the USA and Canada IOS Press, Inc. 4502 Rachael Manor Drive Fairfax, VA 22032 USA fax: +1 703 323 3668 e-mail: [email protected]

LEGAL NOTICE The publisher is not responsible for the use which might be made of the following information. PRINTED IN THE NETHERLANDS

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

v

Foreword Slovakia is at the heart of the whirlpool of the communist past and a reunified Europe. I was delighted to welcome specialist particpants from so many different cultures and experiences to my country, both as a mother and as a doctor at the Child Psychiatry Hospital of Bratislava. This meeting identified ways of ensuring that a child would keep happy memories of childhood and would not allow traumatic experiences of war and terrorism to harm their adult life. It was held symbolically in the Slovak Academy of Sciences Castle of Smolenice – just the place where, in a child’s fairytale, the king and queen will live happily ever after in a perfect world when the forces of good have overcome the forces of evil... But can this ideal ever come true? A life at peace is the basis for the success of every human endeavor. Unfortunately, this peace is threatened by wars, ideological extremism, the class struggle, political conflict, terrorism, rape, murder, injustice... in Slovakia and many countires, by the sudden economic changes of transition ... and, everywhere in the world, man’s unbridled desire for power over other men... NATO was founded to maintain peace in Europe – and now beyond – at the same time as the Mouvement Mondial des Mères/World Movement of Mothers. The MMM helps mothers fulfil all their responsibilities, particularly building peace, in the family and outside the home. Thanks to these two organisations this meeting developed ways in which a child’s fairytale future might come true... Anna KOVACOVA, MuDr, NATO Partner Co-Director

Prevention of violence to children and the protection of their rights is the duty of every adult. But most adults do not know how to offer appropriate support. This meeting, which brought together for the first time scientists and lay people with practical experience, looked not only at practical measures to engage and train concerned adults and adolescents, but also at changing the attitudes which lead to the abuse of children. As a Belgian, trying to come to terms with the discovery of a paedophile network in the heart our society, I feel very strongly the need for coordinated local, national and international initiatives and guidelines to prevent and remedy trauma to children. Mia VANDERHASSELT NATO Co-Director

vi

NATO Advanced Research Workshop Smolenice Castle, Slovak Republic March 4–6th 2004

Preface and Acknowledgments No longer are threats to security and their impact on individuals a matter for the authorities alone – a holistic view is now essential. From grass roots to policy level all of us must be involved, take responsibility, make informed decisions and undertake appropriate actions. This is particularly important if we are to succeed in redressing the potential negative impact of the psychosocial consequences of trauma in children and adolescents in countries in transition, emerging from conflict or victim of terrorist incidents. There are many more young people who need appropriate help to come to terms with what they are suffering than there are mental health professionals. Many people could learn the skills to ensure that today’s young people realise their full potential as wellbalanced adults, willing and able not only to commit themselves to social development and security for their own country but also to focus on respect and understanding to ensure international peace and security. This Workshop sought to establish long-term and sustainable strategies of practical activities which mothers, fathers, teachers – any concerned member of the community – can be trained to undertake in order to complement the work of mental-health professionals to prevent trauma and to deal with its consequences in children and adolescents as victims, witnesses and perpetrators of the violence of the new security threats. As a first step, the 40 participants from 19 countries developed a Consensus Strategy to deal with the responses to trauma shown by 12–15 year old Serbian children, identifying the training required by non-professionals working alongside mental health professionals. Preliminary work was undertaken to develop international guidelines for implementing effective measures to help young people regain their well-being and become future actors for respect, understanding and Peace. We thank each participant for their most active and constructive involvement in every aspect of the Workshop: they each brought to our meeting total commitment, generosity of spirit and open-mindedness to succeed in our appointed task. The setting of Smolenice Castle allowed us all to complement the intense work of the sessions with very fruitful informal discussions. We should like to express thanks on behalf of NATO and the MMM to Dr Anna Kovacova, Barbora Maronkova and the direction and staff of the Castle for their unstinting efforts to ensure our comfort. I should like to give my sincerest thanks to Lucie Bratinkova and Diana Morato for their dedication and hard work throughout the meeting, to Caroline Paskell for recording and transcribing the proceedings, to all those who helped to translate and edit the manuscript and to Celia Clarke for copy-editing and proof reading. This spirit of solidarity and human concern in many people throughout the world far outweighs the atrocities committed by the few – this brings hope that the future can truly be secure and peaceful. Jill DONNELLY President, MMM International

vii

List of Participants AKHMEDOVA, Khapta BELAROUCCI, Latéfa BENHABYLES, Saïda BOKUN, Tanja

BRATINKOVA, Lucie DESPOTOVIC, Tija DONNELLY, Jill GASIC PAVISIC, Slobodanka GMUR KARAPETIAN, Armine IGNATIEVA, Anna JISHKARIANI, Mariam JOVANIC DUNJIC, Ivanka KOVACOVA, Anna

LETH, Ingrid KUTS, Linna DE MALHERBE, Angela MALKA, Shimon

MARONKOVA, Barbora MORATO, Diana NEUHAUSER, Linda

OZACKY Lazar, Sara

Psychologist dealing with refugees, Grozny, Chechnya Clinical psychologist, specialist in victims of terrorism, Algeria President of the International Federation of Victims of Terrorism Algeria NGO “Srce”, Centre for Emotional Support and Prevention of Suicide Novi Sad, Serbia and Montenegro Research Fellow Defence Academy of the United Kingdom Shrivenham UK (Czech) Psychoanalytical psychotherapist, psychiatrist Belgrade, Serbia President, MMM International Paris France (British) Professor Faculty of Education and Foundation Together Belgrade Serbia Center For Psychological Services, Armenia Union of Committees of Soldiers’ Mothers of Russia Moscow Russian Federation Psycho-rehabilitation Center For Victims Of Torture Centre “Empathy”, Tblisi Georgia Psychiatrist/psychotherapist, Belgrade Serbia Paediatric psychiatrist, Klinika detskej psychiatrie Detskej fakultnej nemocnice, Bratislava Slovak Republic Professor of Psychology, University of Copenhagen Denmark President, Democratic Union of Many Children Families Chernigov Ukraine Centre d’Education Pluridisciplinaire de la Personnalité Neuilly-sur-Seine France The Jewish Arab Center for Peace, Co-director ‘All for Peace’ joint Palestinian/Israeli radio station and Co-editor ‘Crossing Borders’ joint Palestinian/ Israeli/Jordanian youth magazine Givat Haviva Israel Centre for European and North Atlantic Affairs Bratislava Slovak Republic Universidad Pontificia Comillas (ICADE), Madrid, Spain Clinical Professor School of Public Health, University of California Health Sciences Center Berkeley, California, USA Academic Director, The Jewish Arab Center for Peace Givat Haviva Israel

viii

OSOFSKY, Howard OSOFSKY, Joy PASKELL, Caroline PETERS, Lilian DE RAMBUTEAU, Isabelle SALEM-PICKARTZ, Josi SKODA’CEK, I. SPECKARD, Anne

TKACHENKO, Dmytro VANDERHASSELT, Mia VLACHOVA, Marie

VULEVIC, Gordana

WIENTJES, Cornelis

YULE, William ZIVULOVIC, Jasna

Head of the Department of Psychiatry Louisiana State University, New Orleans USA Professor of Pediatrics, Psychiatry, & Public Health LSU Health Sciences Center, New Orleans USA Centre for Analysis of Social Exclusion, London School of Economics UK Consultant International Coalition to Stop the Use of Children as Soldiers President, MMM France Paris France Clinical psychologist, Amman Jordan (German) Head of the Klinika detskej psychiatrie Detskej fakultnej nemocnice, Bratislava Slovak Republic Associate Professor in Psychiatry Georgetown University, Professor of Psychology Vesalius College Free University of Brussels Belgium Youth section DUMF Chernigov Ukraine Liga voor het Kind, Ghent Belgium Centre for the Democratic Control of Armed Forces Women and Children in an Insecure World Programme Geneva Switzerland (Czech) Psychologist-Psychopathologist Faculty of Philosophy, Department for Psychology of Youth and Adolescence Belgrade Serbia Military psychologist, NATO Security-Related Civil Science & Technology Programme Brussels Belgium (Dutch) Professor of Applied Child Psychology, University of London Institute of Psychiatry UK President MMM Serbia, Belgrade Serbia

ix

Contents Foreword Anna Kovacova and Mia Vanderhasselt

v

Preface and Acknowledgments Jill Donnelly

vi

List of Participants

vii

Introduction Introduction I. The Essential Elements in Dealing with Trauma in Children and Adolescents in the Context of Conflict and Terrorist Incident Howard J. Osofsky Introduction II. Working in the Context of the New Security Environment and Threats to National and International Stability Jill Donnelly

1

7

Part I 1. Specific Causes of Trauma in Children and Adolescents as Victims, Witnesses and Perpetrators of the Violence of Conflict and Terrorism, and Activities Proved to Prevent, Reduce or Remedy the Consequences to the Individual and to Society as a Whole 1. Education Under Continuous Violent Conflict Sara Ozacky-Lazar 2. Brutalisation of Young Conscripts in the Russian Federation and the Long-Term Effects Anna Ignatieva

15

19

3. Terrorism in Algeria – The Impact on Children and Adolescents Saïda Benhabyles

23

4. Terrorist Violence: Attack on Community Attachments Latéfa Belarouci

25

5. Group Therapy with Traumatized Children in the Chechen Refugees Camps Khapta Akhmedova

32

6. Traumatic Stress Among Child War Victims and Problems of Rehabilitation in Georgia M. Jishkariani, V. Kenchadze and Z. Beria 7. Child Soldiers – Recruitment, Demobilization, Rehabilitation, Reintegration Lilian Peters

34 40

x

8. Negative Effects of the NATO Bombing on the Mental Health of Children in Serbia Slobodanka Gasic-Pavisic

53

9. Mechanisms of Generating Suicide Terrorism: Trauma and Bereavement as Psychological Vulnerabilities in Human Security – The Chechen Case Anne Speckhard and Khapta Akhmedova

59

2. A Comparative Study of Different Developmentally Grounded and Culturally Sensitive Mental Health Approaches Towards the Treatment of Trauma in Children and Adolescents – Round Table William Yule, Howard J. Osofsky, Igor Skodacek, Armine Gmur Karapetian, Latéfa Belarouci and I. Leth

65

3. Collaboration Between Mental Health Professionals and Non-Professionals Introduction William Yule

75

I. The Role of Non-Mental-Health Professionals – The Professional Viewpoint The Effects of Exposure to Violence on Children of Different Ages: Prevention and Intervention – Effective Collaboration with Police and Court Joy Osofsky The Role of Authoritative Parenting in Building Resilience Josi Salem-Pickartz II. The Role of Non-Mental-Health Professionals – The Non-Mental-Health Professional Viewpoint 1. Causes and Effects of Delinquent Behaviour and Social Exclusion Caroline Paskell

77 89

93

2. Dignity and Respect for Oneself and Others: A Practical Initiative with Adolescents Angela de Malherbe

107

3. Communication in the Family—A Means to Reduce Anti-Social Behaviour and Violence in the Community Isabelle de Rambuteau

110

4. Israel: Mechanisms to Help Youth Cope with the Current Situation and the Fear of Violence and Terror Shimon Malka

112

5. Working with Youth as Partners to Reduce the Effects of Trauma: Models from Belarus, Russia and the USA Linda Neuhauser

116

xi

Part II Identifying Scientifically-Grounded Specific Strategies to Deal with the Responses to Trauma Shown by 12–15 Year Old Serbian Children and the Training Required by Members of the Community, Working Alongside Mental-Health Professionals, to Implement Effective Measures to Ensure Well-Being and Well-Balanced Social Attitudes 1. Establishing the Context – The Impact of Post-Conflict Trauma on the Well-Being of Young People and the Future Development and Security of Fragile Societies: Bosnia, Kosovo, Serbia William Yule 2. Case Study: Specific Elements of the Post-Conflict Trauma of Serbian 12–15-Year-Old Children and Adolescents Tija Despotovic, Ivanka Jovanovic Dunjic, Gordana Vulevic and Jasna Zivulovic 3. Discussion 4. Effective Strategies Already in Place in Serbia 1. Psychosocial Programs for Teachers – A School-Based Model of Child Mental Health Protection Anica Mikuš Kos and Tatjana Bokun 2. Using Educational Institutions in Serbia for the Post-Conflict Recovery of Children Slobodanka Gasic Pavisic 5. “Serbia Maybe Could Forgive if NATO Apologised!” – NATO Response Cornelis Wientjes 6. Identifying the Obstacles and Local Resources for Implementation and the Training Required by Non-Professionals Working Alongside Mental Health Professionals to Implement Effective Measures to Ensure the Well-Being and Well-Balanced Social Attitudes of Young People in Serbia All Participants 7. Consensus Serbian Strategy. Action Plan Agreed by All Participants Part III Recognising Developmental Considerations and Cultural Sensitivities, First Steps in Developing a Strategy to be Applied Internationally for Preventing, Mitigating and Remedying Trauma in Children: Lessons Learned from the Development of the Strategy for Serbian Children – Relevance, Limitations and Opportunities Josi Salem-Pickartz, Jill Donnelly and Howard Osofsky

127

133

141

149

157

159

170 182

185

Unanimous Recommendations

198

Author Index

201

This page intentionally left blank

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

1

INTRODUCTION I The Essential Elements in dealing with trauma in children and adolescents in the context of conflict and terrorist incident. Howard J. OSOFSKY, M.D., PhD. NATO Country Co-Director Professor and Head Louisiana State University Health Sciences Center Department of Psychiatry New Orleans, USA The areas of relevance to the participants and the program objectives: First, how humans - children and their families - cope with ongoing threats, as well as the impact of long term threats, repeated exposure to trauma, and warfare and its aftermath. Second, the importance of cultural considerations and sensitivities related to the expression of symptoms, evaluation and treatment. Third, questions about whether there is a post warfare and terrorism mental syndrome. Fourth, issues of preparation/readiness including community preparedness, training of responders, development of family and school plans, and consideration of developmental needs. Fifth, response at the time of terrorist attacks and warfare including immediate needs, expectable reactions successful coping and worrisome reactions. Sixth, recovery including reduction, persistence or worsening of symptoms, as well as development of new symptoms. Seventh, when and how to carry out mental health evaluations and treatment taking into account developmental considerations, cultural values and resources. Eighth, resilience including the important components of successful coping and resilience, how resilience differs from resistance, and long term implications of resilience. Ninth, the needs of responders including respectful training of indigenous practitioners, compassionate reactions, counter transference and burnout, concerns about safety, family safety and family worries, and management of stress and personal difficulties. Tenth, issues of hope, altruism, spirituality and personal meaning with individual’s wishes to know where they are going - going forward to something - while knowing where they have been and integrating the traumas they have experienced.

Over the course of three days, key leaders, investigators, and clinicians from around the world focused on the needs of children, adolescents, and their families in the face of threats of violence, and ongoing current violence. The conference, a joint initiative of NATO and the World Movement of Mothers, represents the recognition of the importance of this topic not only for the European countries which will receive particular focus, but for the world at large. The World Movement of Mothers, representing millions of mothers and their concerns, plays a crucial role in emphasizing the key roles that parents, particularly mothers, play in fostering healthy development and in protecting their children, the young people and future of our society.

2

H.J. Osofsky / The Essential Elements in Dealing with Trauma in Children and Adolescents

NATO is taking the leadership in helping to bring together the best available scientific knowledge and in formulating specific action plans that can help high risk children and adolescents in their development, allowing them to achieve their potential, and minimize the threat of future violence. In the workshop, we focused both on current and ongoing threats and together with our Serbian colleagues, gave specific attention to programmatic efforts that can be of maximal help to young people in Serbia. We are well aware that most humans cope with reasonable success to various types of traumatic exposure including the complex emergencies related to warfare and other acts of mass violence. We know less about the impact of long term concerns about potential terrorist attacks or armed conflict in how these may affect children and adolescents’ behaviours and perceptions of others. During the workshop, a number of us presented data and our thoughts on outcomes related to repeated exposure to trauma and the aftermath of warfare. Within these presentations and the subsequent discussion, emphasis was placed on: - Losses — of loved ones, homes and income - Refugees, resettlement, immigrant problems - Injuries, rapes, torture, mutilations - Family and community stability - Parental strengths, difficulties - Roles of and for children and adolescents Through these presentations, it was considered important to deal thoughtfully with cultural considerations and sensitivities. These are crucial from a number of perspectives. The meaning and expression of symptoms clearly have commonalities across cultures; however, there are specific components that are culturally related and that will influence interventions that are designed to be of help in coping and recovery. Our approaches to treatment and the roles of treaters must similarly take into account these cultural considerations. In many areas of the world, skilled mental health professionals are either not available or available in very limited numbers. Other service providers and indigenous health practioners will play crucial roles in the delivery of services. Further, key responder groups, including spiritual leaders, teachers, community and agency first responders, and parents and children themselves play key roles, and we considered how to maximize their benefits in a respectful and thoughtful manner. As we continued in our discussions, we focused on a number of areas, which in English begin with the letter “R”: x Readiness — Preparation 1. Community preparedness 2. Training of responders 3. Development of family and school plans 4. Consideration of developmental needs x Response — Here we focused on the needs that are paramount at the time of terrorists’ attacks and active warfare. 1. Safety 2. Well being and availability of family 3. Nutrition 4. Shelter 5. Medications currently being prescribed 6. Crisis intervention services as needed.

H.J. Osofsky / The Essential Elements in Dealing with Trauma in Children and Adolescents

3

It was considered important to consider reactions that can be anticipated and expected at the time and shortly following terrorist attacks and those that occur during active warfare. As was noted throughout the workshop, as we address the needs of children and adolescents, we must give attention to such factors: x

Reactions 1. Age and developmentally related considerations for children and adolescents 2. Extent of Trauma 3. Proximity of Trauma 4. Losses 5. Prior experiences 6. Prior mental health symptoms 7. Family support 8. Community support This is obviously complex area for consideration. A number of key components include whether hostilities have ceased, the potential and real threats of future terrorism or renewal of hostilities, death, injury or torture of loved ones; economic loss, possible relocation and refugee status, perceived and real opportunities. Given the positive coping of most individuals, we can expect to observe a reduction of symptoms over time. However, we must be attuned to those who have a persistence of symptoms, a worsening of symptoms, or a development of new symptoms. Although specific mental syndromes have not been identified for these children and adolescents, rates of persistent mental health problems appear higher then those noted for non-traumatized community groups. Further, we must also be aware of and address behavioural and learning changes that are not traditionally associated with mental health diagnoses but that impact on school performance, peer relationships, and functioning within the family and community. For those of us who are involved in designing systems or clinically providing mental health evaluation and treatment, a number of key principles should receive focus “in our toolbox” or clinical approaches. These include: Identify Diagnose Treat Take into account developmental and age related considerations Be culturally attuned in diagnosing, communication, and prescribing Remember the importance of altruism, hope, cultural, and spiritual values Teach positive coping behaviours; reinforce reduction of risk behaviours x Resilience. It was considered very important for us to address the resilience of youth, how to promote their resilience, and how to allow it to serve them in developmentally appropriate and socially adaptive manners. Adolescents in particular should be included in the process and can be of help to their families, to younger children, and to the community during response and recovery. A number of participants at this workshop provided useful information concerning how resilience differs from resistance, factors that contribute to resilience, how we can support healthy resilience, and the long term implications of resilience.

4

H.J. Osofsky / The Essential Elements in Dealing with Trauma in Children and Adolescents

x Responders. Given the needs of countries and availability of resources, consideration must be given to the roles of local service providers and indigenous practitioners. Within this training, we addressed age and developmentally informed treatment, cultural questions, roles that are most helpful especially during response and recovery, and the respect that is required for local service providers and indigenous practitioners in their roles. Local practitioners and indigenous practitioners may be more attuned than consulting professionals to societal and cultural sensitivities and needs, and each can compliment the other. Any consideration of responders must include their reactions and those of their families. Responders may be called to deal with members of their community, with family members, or with individuals who remind them of family members. They may have compassionate reactions, especially when traumatized individuals are children. We need to consider when these compassionate reactions can be of help and when they interfere with responder effectiveness. Counter transference issues may also impact on the therapeutic process. When the patients’ problems awaken uncomfortable feelings in the therapist (and in these circumstances the therapist is dealing with these same issues) or when patients have been extremely traumatized, the therapist may either wish to make things better more quickly than is possible or feel hopelessness given the extent of the traumas experienced by the patient; either of these may interfere with treatment. Emphasis was put on issues related to responder burnout. The factors considered include: x Intensity and difficulty at work x Needs for time off, away from work x Increases in burnout over time—i. e. during hostilities or in refugee camps x Needs for colleagues/sharing/supervision x Worries about themselves, their safety x Worries about their families and their safety x Families’ worries about them and their safety It is necessary that we help responders, including those who are highly motivated, to recognize and deal with their reactions including, if and when their occur, stress reactions, physical complaints, post traumatic stress and mood symptoms, substance abuse in themselves or their families, and domestic problems. In conclusion, I would like to reflect on a component of our work and those of our colleagues with individuals who have experienced extreme trauma, including aspects related to terrorism and warfare. As they cope with and recover from their traumatic experiences, these individuals frequently describe the importance of hope, altruism, and spirituality as they address issues of personal need. We have been impressed with their wishes to move forward, to know where they are going and that they are going forward to something with realistic hope and expectations. At the same time when active engagement is possible, they often express the desire for greater understanding, knowing where they have been and wishing to integrate the traumas they have experienced. It is our obligation to help by thinking and developing plans to deal with the trauma experienced by children and adolescents of countries in the NATO periphery. We can have much hope for the future of our youth and their ability to meet their potential. This in turn will contribute to the social stability necessary for post conflict recovery and reconstruction.

H.J. Osofsky / The Essential Elements in Dealing with Trauma in Children and Adolescents

5

References Alexander, D. & Klein, S. (2001). Ambulance personnel and critical incidents. The British Journal of Psychiatry. 178, 76-81. Baker, A. & Shalhoub-Kevorkian (1999). Effects of political and military traumas on children: the Palestinian case. Clinical Psychology Review, 19(8), 935-950. Bell, C. (2001). Cultivating resiliency in youth. Journal of Adolescent Health, 29(5), 375381. Fazel, M., & Stein, A. (2002). The mental health of refugee children. Archives of Disease in Childhood, 87, 366-70. Gavrilovic, J., Lecic-Tosevski, D., Dimic, S., Pejovic-Milovancevic, M., Knezevic, G., & Priebe, S. (2003). Coping strategies in civilians during air attacks. Social Psychiatry and Psychiatric Epidemiology, 38(3), 128-133. Larsen, J. (2003). Stress and resilience in South African firefighters. SAMJ, 93(4), 36-38 Lipton, H. and Everly, G. (2002). Mental health needs for providers of emergency medical services for children (EMSC). Prehospital Emergency Care, 6(1), 15-21. Masten, A., Hubbard, J., Gest, S., Tellegan, A., Garmezy, N., & Ramirez, M. (1999). Competence in the context of adversity: pathways to resilience and maladaptation from childhood to late adolescence. Developmental Psychopathology, 11(1), 143169. Mollica, R., Osofsky, H., Osofsky, J., & Balaban, V. (In press). The mitigation and recovery of mental health problems in children and adolescents affected by terrorism. JOURNAL Mollica, R., Cardozo, B., Osofsky, H., Raphael, B., Ager, A., Salama, P. (In press). Scientific overview of the role of mental health in complex humanitarian emergencies. The Lancet. Osofsky, H.J., Osofsky, J.D.. (2002) Children’s Exposure to Community Violence: Psychoanalytic Perspectives on Evaluation and Treatment in Violence and Transmission of Trauma: Analytically Informed Interventions in the Community. B. Sklarew, S. Wilkinson and S. Twemlow. Eds. Analytic Press, New York. In Press Osofsky, H.J., Osofsky, J.D.(2001). Violent and Aggressive Behaviors in Youth: A Mental Health and Prevention Perspective, Psychiatry: Interpersonal and Biological Processes. Vol. 64, p. 285-295 Pynoos, R., Armen, K., & Steinberg, A. (1998). A Public Mental Health Approach to the Postdisaster Treatment of Children and Adolescents. Child and Adolescent Psychiatric Clinics of North America, 7(1), 195-210. Raphael, B., Sihgh, B., Bradbury, & Lambert, F. (1983). Who helps the helpers? The effects of a disaster on the rescue workers. OMEGA, 14(1), 9-20. Report of a Workshop of Institute of Medicine and National Research Council. The impact of war on child health in the countries of the former Yugoslavia. (March 27-30, 1994) Trieste, Italy. Salama, P., Spiegel, P., Van Dyke, M., Phelps, L., & Wilkinson, C. (2000). Mental health and nutritional status among the adult Serbian minority in Kosovo. Journal of the American Medical Association, 284(5), 578-584. Shaffer, D., Fisher, P., & Dulcan, M. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, Acceptability, Prevalence Rates, and

6

H.J. Osofsky / The Essential Elements in Dealing with Trauma in Children and Adolescents

Performance in the MECA Study. Journal of the American Academy of Child Adolescent Psychiatry 35 (7), 865-877. Walton, J., Nuttall, R., & Nuttall, E. (1997). The impact of war on the mental health of children: a Salvadoran study. Child Abuse and Neglect, 21(8), 737-749.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

7

INTRODUCTION II Working in the context of the new security environment and threats to national and international stability Jill DONNELLY, BA President of MMM International Mouvement Mondial des Mères – World Movement of Mothers Paris, France Today’s revolution - Impact of military activity on the fabric of social life leading to revolution - elements and causes of today’s revolution: social changes; shift in strategic focus; new threats to security - Why this is a personal problem and why we must respond - Why we are focusing on the well-being and needs of children and adolescents

Human history moves in cycles. Every 50 years or so there occurs a revolution in the way we think and react. Revolutions take time to happen. They differ from evolution in that the changes accumulate. Revolutions happen when several changes reach a high degree of intensity and simultaneity. The skill in negotiating a revolution is in recognising what will stay the same and what will change! In revolutions people are hurt because governments find they do not have the appropriate tools to deal with the new circumstances. I am speaking from a Western European perspective but this is – or probably soon will be – the experience of other parts of the world. The Impact of Military Activity on Social Life Military activity has a huge impact on the fabric of social life, and therefore, affects us all. Some examples from European history are x 1789-1815: the French Revolution to the battle of Waterloo saw the development of mass conscript armies. This meant the creation of a very large standing army, standardised and efficient. But it caused a social revolution in that now 20% of the active male population was exposed, not just to death in foreign lands, but to new ideas. This also caused the centralisation of states – France is a very good example. Napoleon was, therefore, able to enforce the legal system called the ‘Code Napoléon’ on every country of Europe he overran – and it is still in force today. x In the conflicts of the 1860´s came the rifle, rapid firing weapons, industrial mechanisation – but also the telegraph and the railways x The First World War, 1914 – 1918, saw the industrialisation of warfare and the fact it was a contributing factor to the revolution in Germany, Turkey and Russia and the

8

J. Donnelly / Working in the Context of the New Security Environment and Threats

x

formation of the Soviet Union. The loss of so many young men caused a huge impact on social customs and traditions. The Second World War: Nuclear armaments, modern medicine, such as antibiotics and the involvement in every aspect of the nation’s activities of women! For example, in 1947 the MMM – the World Movement of Mothers - was founded to give women a voice. While the men were mobilised, women, particularly mothers had kept alive not only their family but the nation as a whole, but they had had no say in the decision to go to war which had so overturned their lives. As an NGO with Consultative Status at the United Nations, the MMM can make the two-way link between grassroots and policy level. We are part of the rapid development since the Second World War of civil society.

Right now, we are in a revolution as profound as any of these – but because we are in it, we do not see it – and are, therefore, very vulnerable indeed. If you think the world has not changed so very much - just think about communication – How long have we all been able to use mobile phones, Internet, emails – and how lost we are without them when they do not work! Here are just a few of the compounding elements of our revolution: I shall mention just a few of the rapid and profound social changes. Globalisation and Western market-driven culture is overriding and even destroying national traditions and customs, particularly in countries with little state infrastructure where the role of mothers and fathers, clearly defined, but complementary, is the major source of well-being, support and social cohesion. In developed countries, where this traditional role is taken over more and more by the state, we are witnessing break up of family as the foundation of society – marriage is becoming rarer, divorce more prevalent, parental authority is challenged. In developed nations governments are struggling to find social policies to deal with the demographic trend of a non-replacement birth rate, single-person households, an ageing population: there are several causes, such as women in the workplace, professional women waiting to fulfil career goals before having children – and then finding they have left it too late to give birth, conflict, social and employment uncertainty and concerns about security. We are seeing increasingly individuals focusing on their rights – not their responsibilities. All of these – and more – are challenging tradition and are destabilising societies and nations. There has been a shift in strategic focus on the world military scene. Throughout the Cold War, strategic focus was in Central Europe - the East-West standoff – with Germany as the focal point. We can still see this today – all the major roads run East-West throughout Europe and the former Soviet Union, all heading towards Germany. It was the concentration of armies and armaments and the confrontation between the two. Now strategic focus has shifted to an arc stretching from Mauritania to Pakistan – with Turkey as the interface New threats to security bring new threats to our way of life. I shall deal with these later, but I shall mention two elements now. Firstly, we need to note the impact of the fact that defence and security are no longer synonymous. By this I mean that in the Cold War period, the stronger a country’s defence, the more secure its population felt. However, this is no longer true – Israel’s defences have never been stronger, but never have Israelis felt so insecure.

J. Donnelly / Working in the Context of the New Security Environment and Threats

9

The second, linked to the first, is terrorism. One contributory factor to the rise in terrorist activity is the fact that, during the Cold War, the great powers did not wage war in the conventional way in Europe and America, nothing showed the tension – the standoff – but the great powers were fighting their war using other actors – factions in fragile societies, such as those in the Middle East, Afghanistan, Africa. The aftermath is two-fold. There is legacy of resentment and discontent, particularly among young populations where their low economic opportunities and living standards make a stark contrast to the lifestyle images broadcast by the media and available on the Internet which give a false impression of life in developed countries. More insidious is the fact that there is in these countries a body of people trained in covert activities and agitational propaganda aimed at destabilisation.

What is this current revolution and why is it happening? There are many factors all intermeshed and interacting with one another, which bring great benefits but at the same time, truly terrifying vulnerabilities. We just need to look at two aspects of the growing gap between industrially developed – rich – nations and developing – poor – countries. Firstly economic: for example, exploitation, corruption, lack of capacity-building programmes for local administrators, absence of stable infrastructure and so on has led to slow economic growth-rates despite huge natural resources and inward investment. Secondly demographic: in industrially developed countries there is growth of the older population and very rapid decline in the birth rate. Despite wars, the AIDS pandemic, governmental mismanagement or corruption leading to the absence of the most basic needs of the population, epidemics and natural catastrophes, this is generally reversed in developing countries. Our lives have been changed by the rapid development and proliferation of technology military or otherwise – everything from thermal and satellite imaging, self-homing missiles, to robotic manufacturing, the internet and the mobile phone! This is linked to the information revolution. While we all think of the Internet and emails, we must not forget electronic banking. Many countries have reached a high level of sophistication but we are victims of our own efficiency – it leaves us very vulnerable. Almost all industrial enterprises - commercial or agricultural industries, hospitals, for example, now use the practice of “just in time delivery”, this keeps costs down, no stock is held in reserve. Whether it’s spare parts for your car factory in England or Japan, or fuel delivery for a hospital in Spain or Singapore, or feed for a chicken farm in Denmark, ‘just in time delivery’ is the system for economic efficiency. So why is this a potential problem? A breakdown of the delivery system could have truly a catastrophic effect on the socioeconomic cohesion of a country. And this system applies in electronic banking: no European country has enough cash in circulation to meet demand during peak times every week, particularly during Friday or Saturday. If the electronic system through which all transactions are channelled crashes on a Friday, in Britain, for example, by the following Thursday, farmers would have to start slaughtering cattle through lack of the delivery of fodder. And this all came to light, when in Britain two years ago, fuel delivery drivers went on strike to protest the tax on diesel fuel. If the strikes had continued for a further 36 hours,

10

J. Donnelly / Working in the Context of the New Security Environment and Threats

Britain would have faced social and economic collapse. Just think of one example: no fuel, no electricity for hospitals…. And this was a group exercising their legal right to make a peaceful protest. They were not aware of the repercussions – and it took the Government a week to 10 days to understand the gravity of the situation. Another example from Britain: in the 1990s, the IRA placed a large bomb in a lorry outside Canary Wharf, in the City of London – the heart of the British commercial and banking world – if it had been placed 10 meters to one side, it would have destroyed 60% of the U.K telephone communications, and it would have closed down the City. We are just not prepared for this kind of attack – we have no alternative back-up. To quote an example from another part of the world, just think of the Japanese cult leader who caused Sarin to be released in the Tokyo underground. It caused 11 deaths and 5,000 injuries – if he had been more technically competent, these figures would have been reversed. The 5,000 injured had been present in the underground - but the other 12,000 who were hospitalised had been nowhere near the incident. Most of them had seen it on TV! This was a clear example of the impact of psychological trauma. How could hospitals cope with a really successful terrorist incident? Professor Ahmed Baker’s research in Palestine confirms how the fear of danger is a powerful factor in provoking trauma – studying the reactions of children in three areas: a zone where bombs were dropping – where children were seeing family, friends and neighbours killed, their homes destroyed; within a five-kilometre radius – still a certain degree of danger and the noise of the attacks was loud; within a 20-kilometre radius – no danger at all, but the planes could be heard flying over. It was in this outside area that the evidence of trauma was greatest – in the danger zone, children dealt with day-to-day survival. It is not yet known what the situation will be in the future when the danger is past. Dr Anika Mikus Kos, president of Foundation Together, Slovenia, ran psychological tests on a visiting group of Serbian children – and on the Slovenian host children. The latter showed a higher degree of trauma than those who had actually been in the war zone. Again showing that fear and uncertainty are very strong factors in provoking trauma – which could impact negatively on the capacity of the rescue services and hospitals to cope with a serious incident. Lastly we have to face the new threats to security.

What are these New Threats to Security? x x x x x x x

Bad governance – Incompetent, corrupt, self-seeking governments Corruption at all levels of activity - from the State leader to the border guards Organised crime and its involvement in human trafficking and terrorism Insecure borders - illegal migration, leading too often to human trafficking for cheap labour, sexual exploitation and organ removal Refugees - the destabilising effect – just think about the influx of Palestinian refugees into Lebanon which led to 16 years of vicious civil war Ethnic and religious strife. The manipulation of natural resources – we all immediately think of oil, but water is more likely to cause conflict in the near future or to cause irreversible ecological damage. Turkey controls the water for Iraq and Syria and could hold them to ransom. Ethiopia controls the waters of the Blue Nile. If they were withheld then Egypt could become the desert wasteland that was the Aral Sea.

J. Donnelly / Working in the Context of the New Security Environment and Threats

x x

11

Proliferation of weapons, including weapons of mass destruction - the basic elements of which are available to the corrupt governments of the poorest countries, who could pose a serious threat to the major powers of the world. Terrorism. To repeat an earlier point, during the Cold War, the great powers did not wage war in the conventional way in Europe and America. Nothing showed the tension but the great powers were fighting their war using other actors – factions in fragile societies in the Middle East, Afghanistan and Africa. The aftermath is a legacy of resentment and discontent, particularly among young populations – and, particularly in those areas which came under the influence of the Soviet Union, groups of people well-trained and experienced in destabilising societies and nations by, for example, infiltration of national infrastructures. Many of these countries have a rapidly growing young population whose only chance of spiritual fulfilment, economic improvement for themselves or their family and enhanced self-image is offered by illicit income or membership of extreme groups. The fact that this is sustained and manipulated by corrupt governments and organised crime and that it facilitates terrorism and harms the social and economic fabric of nations is ignored by all concerned – including the beneficiaries in the so-called developed countries who benefit from cheap goods and labour. The situation is endangered further by the recruitment for suicide terrorism of well-educated young Muslims, often secondor third-generation, well-established in Western countries. A common factor is that they study or work in scientific or information technology fields and that they feel a lack in their life of spiritual values and purpose. This is a challenge for both the Western societies in which they live and for the Muslim communities of those countries.

Why is this a personal problem and why must we respond? Together with the foregoing factors, we must consider four more elements. They underline why we, as individuals working together, not the state, the “authorities” or whichever other actor we might like to be in charge, must take responsibility for and control of our present situation. The first is that in the past women and children were usually involved, injured or killed accidentally or incidentally in war. Today they are specifically targeted as a ‘normal’ feature and constitute 85% of the casualties in the conflicts of the last 10 years. The second is that no longer do massed armies face each other on a distant battlefield – now the conflict is close to our lives wherever we live - terrorism brings it into our workplace, our schools, our supermarket, our restaurants and our homes. Wherever we – and our children - are, we are now at risk. The third is more insidious - the power of the media – as uncontrollable – and potentially as dangerous - as the weather! It colours how we view current events and forms our attitude towards other people – particularly those from different backgrounds or cultures. The fourth returns to an earlier remark. In revolutions, states and international institutions do not have the right tools to tackle the new problems. The forces of law and order are almost powerless to stem the tide of illicit activity – because they act within the law and their adversaries act outside the law. Civil rights organisations persuade us that heightened security measures are an infringement of our privacy.

12

J. Donnelly / Working in the Context of the New Security Environment and Threats

What is more, the factional aspect of conflict is such that states and international organisations like NATO and the United Nations do not have the weapons to fight it – literally and metaphorically. Weapon procurement is a slow process – about 15 years from order to supply of new types of weaponry. Changing the mindset which still wants to spend the defence budget on new jet planes – at $220,000,000 each for a US F22 – and, no, I have not added a couple of extra zeros! - when we are facing a fast-moving ‘invisible’ enemy - is an equally slow process! Responsibility to act is now in the hand of individuals – and that is you and me! Whether we are mothers, fathers, teachers, concerned members of society – or mental health professionals - responsibility to act is ours. Few of the problems of our revolution are truly new – what is new is the immense scale, the vast numbers of people who have been hurt – or will be hurt physically and mentally. There are just not enough mental health professionals to deal with all of those who need help to recover. For this reason we were seeking to identify in this Workshop the necessary training and practical activities which, in collaboration with professionals, ordinary people can undertake. We found that certain activities have been proved to work to help children and adolescents cope with the consequences of the violence of conflict and terrorist incident activities such as discussion, art, music and theatre groups where traumatised children and adolescents can regain the trust and confidence necessary to begin the healing process – and where those who need individual help can be identified.

Why are we focusing on the well-being and needs of children and adolescents? Those children and adolescents who have suffered trauma – and those who, in this new security environment, run a real risk of suffering trauma in the near future - need our help. All of the clinicians and specialists at the Workshop from 19 different countries were united in a common concern for the well-being and happiness of children. A further dimension is that children represent the best investment for the future. The consequences for society of not helping them recover from the trauma caused by the violence of war and terrorism is all the greater because children are the future. The future safety of the world and the individual security of each one of us depend on children growing up into adults who are well-balanced, productive, committed to social development and nationhood - and who recognise diversity not as a threat to be eliminated, but as an enriching and shared human value. Our task in this Workshop was to develop measures to make this ideal a reality.

Part I 1. Specific Causes of Trauma in Children and Adolescents as Victims, Witnesses and Perpetrators of the Violence of Conflict and Terrorism, and Activities Proved to Prevent, Reduce or Remedy the Consequences to the Individual and to Society as a Whole The purpose of this session was to identify positive responses to traumatised children and adolescents - Speakers from several countries dealt with the kinds of extreme experiences which can cause their trauma – What are their symptoms? What is the impact on their community and on society as a whole?

Editors’ note: Issues raised in the discussion following the presentations have been incorporated into the texts

This page intentionally left blank

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

15

1. Education under Continuous Violent Conflict Sara OZACKY-LAZAR, PhD. Academic Director, The Jewish-Arab Center for Peace, Givat Haviva, Israel In Israel, the official school system hardly deals with the Israeli-Palestinian conflict and the way to cope with it. - Over the years, grassroots organizations and NGOs have developed various philosophies and methodologies to cope with the violent war-like reality. The oldest organization in this field is The Jewish-Arab Center for Peace at Givat Haviva, located at the heart of Wadi ‘Ara region. The area is characterized by its mosaic of population where Jews and Palestinians live side by side. - The Center integrates projects of instruction, education, research, and community involvement among diverse populations in Israel and Palestine. It helps design programs to different target groups and audiences. Its Department of Education runs programs for teachers, students, and trainers. Moreover, it develops creative techniques in an effort to highlight some key concepts: equality, tolerance, and acceptance of “the other.” Knowledge and information are essential, as well as creating a supportive environment for the children to talk and express their feelings.

In February 2003 Abigail, a 14-year-old girl and Adrian a 13 ½-year-old boy were killed – or murdered as I would say – in a suicide bombing of a bus on their way home from school. These two kids were part of one of our programmes for peace called ‘Children Teaching Children’. This is a project which we have been conducting at the Jewish Arab Center for Peace for the last 15 years. Their high school in Haifa was one of the first schools to try this programme. In Israel we have about 17% Palestinians who citizens of the state, they do not live under the Palestinian authorities or in the occupied territories; they are Arab, most of them Muslim, and some are Christian. One of their schools, paired with a school in Galilee, did not know what to do, how to react to the fact that their two Israeli friends had been killed in a suicide attack by a Palestinian, by someone of their nation, from their own people. A meeting had been planned for the week after the attack. The teachers got together to discuss if they should cancel the meeting. They did not know how the children would react. In the end they postponed it for one week. Two weeks after this traumatic happening, 50 kids got together, about half Jewish Israelis from the same class as Abigail and Adrian and half Palestinian kids. The teachers and the facilitators let go of the encounter. It was not structured – they just let the kids talk, express their feelings as they tried to overcome the trauma. It was very moving. We felt afterwards that this had been the right decision – to bring the kids together, let them mingle, talk together, crying on each others shoulders, drawing and writing letters for Abigail and Adrian – and they decided together to go ahead with the programme and not to stop the meetings, this alternative way of living as citizens in the same state.

16

S. Ozacky-Lazar / Education Under Continuous Violent Conflict

They wanted this new model: “We do not want to be like our fathers and the politicians” – “We want this new model which is Children Teaching Children. We are going to teach each other about ourselves about our culture, our religion, our life.” They invited each other to their homes. A year later in February 2004, Adrian’s father went to the Palestinian school for the first time and he met with the kids and teachers. He told the children how important the project was in the life of his 13-year-old son, and how he, his father, decided that his life’s mission now would be to follow his son’s footsteps and try to change the nature of the relationship between the two communities and the two peoples. This is just one story from many more – not all as tragic - from my personal experience in working in the Jewish Arab Center for Peace. This was the first NGO in Israel – it was in 1963 – to educate young people and adults for a better future, for mutual recognition, mutual respect and for future peace. In the course of 40 years you can imagine many, many changes have occurred – you could say there is never a dull moment in our country. You all see it in your headline news! Also, of course, there have been changes in the perception and the knowledge. But we have not changed one thing – I say “we” but I was not there 40 years ago, of course. The basics and the philosophy of the place can be defined in several ways: 1. Identity Self identity is very important. We try to strengthen and empower the identity of the kids and not just national identity. It is easy to understand the identity problems of Palestinian children in the Israeli state, but what are the identity problems of Israeli children? They are a majority in Israel, but a minority in the Arab world – so who are they? How are they able to cope with Palestinian children on an equal level when everything around them gives a different message? The question of identity is very complex. This is why the subject of identity is so significant and important in Israel, even among Israeli Jews – the religious, the secular, the settlers, the newcomers, different ethnic groups – Jews came from Europe, Eastern Europe, USA, North Africa, Yemen and other Muslim countries. What we try to do in the Jewish Arab Centre for Peace – and it was pioneering work in the 60s and 70s – is to give Palestinian Arabs the space to express themselves – What it is like to be a Palestinian citizen in a Jewish state. It is not a contradiction – Europe has its minority groups – and it will increasingly have to face problems because of the increasing power of Muslim groups. In Israel there is the additional element – the conflict. It is not just Palestinians inside the Jewish state, but outside, on the other side, the enemy – so we try and succeed in the framework of the Centre and this project - to give space and growth to the Palestinian kids to talk about themselves, to speak Arabic in front of their Jewish friends and show that different identities do not necessarily contradict, but is something that can bring moral value and moral richness to Israeli society. As for the identity of the Jewish kids – during these sessions they develop a sense of guilt towards the Palestinians because they find out things they did not know about: the state suppresses them, discriminates against them – so the first thing is they start defending themselves, going right back into Jewish history - and the Holocaust is everywhere in these discussions: ‘We were oppressed’. So they start arguing who is more victim. The victimisation of society is another topic. In both communities there is a deep sense of being a victim. The facilitators, by giving space, listening, respecting, can lead the kids towards what we think is right – they are equal citizens, despite the differences.

S. Ozacky-Lazar / Education Under Continuous Violent Conflict

17

2. The creation of equal conditions: A supportive environment for the kids is vital, especially when we talk about minority/majority relations of Israel. In Israel, of course, the Jews are the majority and the Arab Palestinians are the minority, but as we say, only half joking, “The Jews always feel as a minority”. Psychologically the Jews feel as though they are a minority and the Arabs psychologically feel they are the majority. This has to do with the historical and psychological background of the two communities but at the Center we try to create equal conditions, chairs in a circle and the children behaving together as equals. 3. Mutual respect: Respect for each others language is a very important thing in Israel, because the Arabs study Hebrew and speak Hebrew, but this is their second language. Most of the Jewish people do not study Arabic and they do not want to learn it – I am an Arabic teacher, so I know what I am talking about. They see it as the language of the enemy and even feel it is not legitimate to speak Arabic in public. People are afraid – if someone speaks Arabic behind you, immediately you think he is a terrorist. So we focus on legitimising the Arabic language. Of course they speak their language and practice their religion. The children teach each other about this. 4. Participation In this project and others, the children decide for themselves what they want to talk about, what they want to discuss, how they want to present their culture and background – not, as teachers, educators, facilitators tend to do, an imposed curriculum, their own methodology. I am not a psychologist; I do not see myself as someone who can treat an individual who has been through trauma. I would say the whole society in Israel is a traumatised society, as is the Palestinian society. There is recent research done in Israel, showing – which will be no news to you as mental health professionals - that sometimes trauma can be a trigger for empowerment and growth. This is in effect what we are trying to do. We take the situation, the reality as it is. We cannot change it right now. We try with the children to build ways of coping with this reality, to cope with the conflict and also give them the opportunity to express their ideas and their ways to resolve the conflict. Even if the conflict is not resolved – for the last 40 years, the conflict has not be resolved despite all sorts of efforts and initiatives – you know, every year there is a new peace initiative, which fails. So, even if the conflict is not resolved, we try to give the children the opportunity to grow despite the conflict and use the context of the conflict for their personal growth. For example, let them have hope and dreams, and also be engaged in an alternative project. Children Teaching Children is one project of several we have found to be effective in helping children cope with the trauma of living under continuous conflict. Face to Face is another project – meeting face to face with the enemy, so to speak, with the other side. Learning that the others side are human beings like themselves. They have the same dreams, eat the same food, wear the same clothes, like the same music and superstars. By experiencing this, they understand that the other side are like them and they have the opportunity to express themselves to the other side.

18

S. Ozacky-Lazar / Education Under Continuous Violent Conflict

From these two projects Children Teaching Children and Face to Face, we have developed another programme to empower the natural leaders amongst the children. We have in Israel what we call ‘Student Councils’, as in many other countries. These are made up of children elected by their friends to be the leaders of the school. So we have developed a special programme for these kids – for Israeli Jews and Palestinians to empower them, to train them and give them special skills as leaders and to work together. Another programme was developed 10 years ago. After working so many years with hundreds and thousands of kids, we decided to focus more on the teachers. Partly because of the budget and material problems and partly because of the mere fact one teacher meets in his or her career, thousands of kids. If we change the mentality of the teachers, hopefully we can change the kids’. So we have a programme called ‘Teachers Lounges’ – we work with the entire teaching staff of the schools: Arab schools paired with a Jewish school, to work together to develop methods, text books, techniques and projects for the kids. We have many projects, but to mention just two more - we have an Arts Centre where the kids create art together – There is a photography project, a beautiful project called ‘Through Others Eyes’, where kids form both communities are trained to be photographers and then they go and take pictures in each others houses and communities. Then they put together an exhibit. Sometimes we give the kids the task of first taking a picture of their own home, then invite the friend from the other community and let them take photos of it. It is interesting for them to see what he or she is focusing on. It is really interesting to compare what a kid thinks is important and worth photographing in his own home and what the guest from the other culture decides to photograph. Another successful initiative we did was a poem contest: ‘Children Write for Peace’. We did it with the local radio station and the kids were asked to write in Hebrew and in Arabic. There was a contest and the kids were invited to the radio studio to read their own poems. We put together a book in Arabic, English, German and Hebrew of selected poems. The two kids who won the contest were received by the President of the State and had a lot of media coverage. Good news for a change – not headline news, but it was very popular. In conclusion, I would like to read you one of the poems - it was very hard to choose – all the poems are very emotional and touching. A 13-year old girl, who is an Arab Druze wrote the poem in Arabic – here it is in English:

Peace: Yesterday I dreamed a dream That I was the queen of a great, broad land But in the morning when I woke, I was just a little girl Without a kingdom and a crown. Then I thought: Is peace just a dream Which can never be for real, for which we only hope, In which we must believe? Is it not possible To wake up one morning to a better world,

A world without war and hatred, Without enemies lying in wait around the corner? I really believe it can be so, That there is room for both Jews and Arabs, That both peoples move peacefully together, Like an king and a queen in their palace. Perhaps it’s only a small, foolish dream Of a girl not versed in worldly ways, But maybe from dreams like these We can build, not make believe real peace.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

19

2. Brutalisation of Young Conscripts in the Russian Federation and the Long-term Effects Anna IGNATIEVA Public Relations Officer and Information Technology Specialist Union of the Committees of Soldiers’ Mothers of Russia Moscow Russian Federation Brutal practices in the armed forces of the Russian Federation – suspension of human rights; poor living and working conditions, including deprivation of food and warmth; beatings; humiliations; torture; abuse – cause mental health damage to military personnel. Those most profoundly affected are the young conscripts, often straight from school who suffer this inhuman treatment for 2 years and then are released back into society with no vocational training, their sense of right and wrong destroyed and often suffering from Post Traumatic Stress Disorder. The authorities offer them no help to recover and settle into civilian life. In their desperation and traumatised state, they too often turn to criminality, drug abuse, even suicide. The Union of the Committees of Soldiers’ Mothers of Russia is the only organisation seeking practical ways to make the authorities acknowledge this situation, demanding military reform and the abolition of enforced conscription. However, those in power, too, have been through the military system and themselves show symptoms of the same mental damage. Justice for those who have suffered this mistreatment is a powerful tool in helping conscripts recover and their parents cope with their son’s aberrant behaviour.

The Union of the Committees of Soldiers’ Mothers of Russia began its human rights work in 1989 in the time of the Soviet Union. Now it is the biggest female human rights organisation in Russia. One of our main focuses is human rights abuses connected with conscription – obligatory military service. 18-year-olds are deprived of their most basic human rights for two years. They are obliged to obey commands - or risk criminal charges. They cannot vote in elections. They cannot refuse to go to war or take part in the so-called ‘anti-terrorist’ action in Chechnya. There is the question “Are 18-year-old men children?” When our sons go into the military conscription they have just left school or university – we have brought them up too soft – they are not prepared for the reality of military service. So young lads at the age of 18 are children who need protection from the pressure – in military service they must obey every order otherwise they are punished; their human nature is broken; they cannot be a real human being when they grow up. Because of conscription, all men were damaged young by this military machine – and only women escaped the system and so want to help our men. Human rights’ organisations like the Soldiers’ Mothers have to protect their rights – this is a women’s organisation not protecting their own rights, but women protecting the rights of the men of our country! Every year the UCSMR office in Moscow registers approximately 4000 individual and 3000 written primary complaints. About 60 percent of complaints received by the UCSMR concern violations of human rights for life and human dignity. They include

20 A. Ignatieva / Brutalisation of Young Conscripts in the Russian Federation and the Long-Term Effects

beating, humiliations, tortures and other crimes. Around 20 percent of human rights violations’ complaints concern health and living conditions. Since 1989 every Monday the UCSMR holds Human Rights school for draftees and their parents. On average 200-300 people attend the courses in the school every week. In September 1998, the Committee called for the immediate abolition of involuntary conscription. The UCSMR demands military reform based on the establishing of professional military service From the start, the UCSMR was confronted with the problem of veterans returning from the Afghan War – these veterans, including those disabled in the conflict, were receiving no help from the authorities, neither vocational nor psychiatric. They were deprived of all their basic privileges. The Soldiers’ Mothers demanded that the State fulfil its responsibility towards these men, as was agreed and implemented after the Second World War. When we started our activities there was no connection between civil society and the authorities. Moreover, there was no civil society in Russia. The UCSMR has built up a system of mutual relations with authority and have forced the authorities to work with us in the legal field. We work with the President’s administration and regional authorities, with legislatures both on regional and at a federal level, military authorities, military justice, including military courts and Military Prosecutor. Currently every week the representative of the Military Prosecutor (whose duty is to observe the law) is on duty in our office to solve matters concerning Human Rights violations of draftees, soldiers and their parents. Achieving justice has a positive impact on the way they cope with their trauma. Now we are faced with a situation far worse than after the Afghan War. For 9 years our State has been waging war on its own territory, against our own citizens – the people of Chechnya. Our children – our young conscripts – are mutilated physically, morally and mentally in this war. They face death, injury, loss, brutal treatment, brainwashing and punishment outside the legal system. Young soldiers return home with this kind of experience. In the middle of the 1980s a new phenomenon was noticed in our country for the first time – organised criminal activity. The veterans of the Afghan war were the reason. Young men, conscripted at the age of 18, straight from school, suffer these two years of inhuman military service and then are released back into civilian society. It is very difficult for them to adapt. All they know is brutality and aggression. They have no experience of normal adult civilian life, no vocational training, working experience or profession. It is very difficult for them to find a job, because employers do not want to employ anyone who has been in the military and served in ‘hot’ places – they do not want to risk the problems, such as their spontaneous aggression and unpredictability – their mental state caused by their traumatic experiences and injuries, such as concussion, which have never received medical treatment. All this prevents them being accepted and reintegrated into normal society, which augments their trauma. There is no official programme for training and reinsertion into society after military service. There is no official recognition of Post Traumatic Stress Disorder, neither its causes nor consequences. In 1995 the Association of American Veterans made a proposal to our government: the setting up of a special psychological service in Russia for former military personnel – it was refused.

A. Ignatieva / Brutalisation of Young Conscripts in the Russian Federation and the Long-Term Effects 21

At present in Russia there is no State institution to deal with the consequences for military personnel of the Chechen war – the so-called ‘anti-terrorist’ action, the authorities ignore those illegally interned, such as conscientious objectors and prisoners of war – in contravention of international law. For this reason the Soldiers’ Mothers’ organisation focuses on the consequences of the Chechen War, by seeking to enforce legislation in favour of these prisoners, and in providing medical, social and psychological support for soldiers. But we meet resistance – in the summer of 1999 the Soldiers’ Mothers wanted to open their own rehabilitation centre in Sochi on the Black Sea, but the local government refused to grant planning permission. Despite this we did open a camp for this work – but the local government requisitioned it for other activities. Even according to official data the human rights situation in the armed forces is getting worse, which makes it even more difficult for young conscripts and former soldiers to reintegrate into normal society. Soldiers are dying of hunger, disease, accidents and suicide – every year more than 3,000. But soldiers cannot protect their constitutional rights. Commanders will not report violations of human rights. The soldiers have no possibility of defending their rights in court. The existing system of investigation makes a criminal of tortured, humiliated soldiers, particularly those who have deserted to protect their life and human dignity. The Military Prosecutor’s Office does not carry out objective investigations, even if there is evidence of brutal treatment, which judges describe a merely “officers exceeding their official authority”. The military court gives unconditional punishment to the soldier, but the officer accused of the abuse is left in command of his unit. We have to remember that these officers themselves are victims of the trauma of serving in the Chechen War. The Soldiers’ Mothers’ organisation presented a proposal to the Chief medical Officer of the Ministry of Defence to conduct medical tests and to provide psychological support for these officers. What was his response? Offended and angry, he screamed that the officers are “healthy” – and he ran away. We see this behaviour as a symptom of PTSD – and I think this is proved by the fact that he is an Afghan veteran! Even apart from military action, the injuries sustained during military service can be unfavourably compared with those suffered by survivors of natural disasters, torture, and abuse. In our country every year 400,000 people are drafted into military service. Each one of them, to a greater or lesser extent, suffers the after-effects of the abuse by officers and fellow soldiers which I have described. I shall give you one specific example. A crime occurred in December 2003 – it was a crime, not an accident. More than 70 soldiers were frozen on the way to military service. They were made to stand in the open without warm clothing in 30 degrees of frost – several died and all the rest were badly injured. How did we discover that this had happened? Not through official sources, but because a nurse working in the hospital where the injured were taken called the parents of these young guys to tell them their son was in hospital. The parents of one of them called our Moscow office to ask for advice. We contacted journalists and TV stations – and the incident was publicised. The State authorities cover up this kind of incident.

22 A. Ignatieva / Brutalisation of Young Conscripts in the Russian Federation and the Long-Term Effects

So this is just one example of the brutal mistreatment of young conscripts. After two years they are ejected and forgotten. Once they are back home they fall into criminality and drug addiction, and often become tramps or commit suicide. In the Russian Federation the causes of this behaviour is not acknowledged and there are insufficient mental health professionals. The only organisation which works with military reform and which works on soldiers’ human rights in the armed forces is the Soldiers’ Mothers organisation – we are the only specialists in soldiers’ rights. This is the reality unfortunately – several organisations speculate on military reform, but they do not deal with the real situation – they announce a programme – all very academic – but they do not want to work with soldiers, they do not want to know the real situation and they do not want to work with us! This situation will get worse – the war in Chechnya continues. President Putin does not want to abolish conscription. Using the expansion of NATO as an excuse, conscription is being increased. This is leading to more and more young men – our children – suffering from PTSD and its consequences which diminish our society. What kind of society will we have in the future?

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

23

3. Terrorism in Algeria – The Impact on Children and Adolescents Senator Saïda BENHABYLES President of the International Federation of Victims of Terrorism Algeria

In Algeria, children and adolescents are surrounded by terrorism and are targets of terrorism. These children have witnessed and escaped collective massacres. Schoolgirls have been killed because they were not wearing the chador or headscarf. We have seen the assassination of their teachers who refused to accept the ‘diktats’ of the terrorists. The children are also victims of the Fatwa, the religious authorisation which allows the massacre of a section of the population. The terrorist Muslim extremists declare this Fatwa which permits and incites the murder of babies, children, and adolescents so that they will not grow up in a society which the fundamentalists judge impious. School massacres have become commonplace, and terrorists have even been known to throw babies into ovens. Females, from little girls to women, must suffer the worst form of terrorism: rape. Rape is also authorised by the Fatwa which defines rape as a ‘pure act,’ a ‘marriage of pleasure’. These collective rapes are just the start of the most terrible suffering. If the females’ throats are not slit, the women and adolescents may become pregnant and subsequently rejected by society. In addition to the moral and physical abuse they have suffered, their own family insults and rejects them, which causes them to fall prey to depression, drug abuse, prostitution, and suicide. Children of the terrorists are victims of their fathers’ behaviour. Brought up in this atmosphere of violence, these children are far from thinking there is anything wrong with their father’s actions; rather, the children accept the actions as commonplace, and take them as a models for the future. The government is attempting reconciliation within society, but leaves these bad fathers unpunished. This political behaviour is very psychologically damaging for a child who sees the man who killed his or her family swaggering about the streets escorted by an official bodyguard. Recently, I asked a plumber to deal with a water leak. After we talked for a while, he said: “I know you – You’re the woman who helps families who have been victims of terrorism. I’m 18 now, but when I was 14 my father was killed right in front of me. Today the killer walks free with an official bodyguard and lives in a home provided by the State – but I’ve got nowhere to lay my head.” There is, therefore, total incomprehension on the part of these young witnesses. Our association fears that they are starting to have feelings of revenge. There is concern that they, too, will be become violent in adulthood due to feelings of revenge and hatred. We are concerned less with the consequences than with the problem of the violence. That is why

24

S.S. Benhabyles / Terrorism in Algeria – The Impact on Children and Adolescents

our association’s policy consists of exerting pressure on the government so that they do not encourage a policy of impunity. Please forgive my frankness, but I do not understand why we never hear from Palestinian victims in international conferences on terrorism. I was invited to an official conference in Spain – and I was astonished to see Israeli victims of terrorism represented – but no Palestinians. . Our Israeli friend, Dr Ozacky, described in her presentation the meeting between an Israeli father, who had lost his son in a Palestinian suicide attack, and a Palestinian child who did not understand why his son, her friend, was dead. I would have liked to know what would have been the reaction of an Israeli child to the Palestinian boy who has just had his hand crushed by Israeli soldiers. Inclusion is vital – we must not continue to allow exclusion. As far as I am concerned, exclusion is a form of terrorism As to the question of the coping mechanisms needed when dealing with children who have been the witness or subject of violence, I understand that there are two levels of dealing with the subject of violence and trauma: 1. information – the intellectual level 2. feelings – the emotional level It touches the basic human subjects of destruction and creation. Children are exposed to extremes of violence which deny them their existence, their integrity, their respect for their existence. How can one maintain a positive outlook and productivity – the children, the parents and the professionals? In Algeria there are two camps: those who want to plunge Algeria back into medieval obscurantism through terrorism and the rest of the population who resist the fundamentalists. We cope by drawing on sheer will-power and our determination so that the positive is not obscured. Each time you leave home you do not know if you will ever return – this is a constant fear, but strength of will does overcome fear and help us remain positive, everyone in their own sphere – children, teachers, psychologists – we are all afraid. But here is a concrete example: In 1997 the fundamentalists decreed a ‘white year’ – no education at all, no schools, no universities. Armed Islamists condemned to death school children, students, teachers to enforce their no education policy. But even after the mass killings in schools, pupils returned. Despite hands cut off, 825 schools and universities burnt down, school children, students and teachers assassinated, they went back to school – this is the triumph of will over fear, the desire for democracy over the negative obscurantism of the terrorists. You must realize that the people opposing the terrorist are not just the intellectuals, the politically aware, people seeking democracy – but also illiterate peasant women, the unemployed, young lads – it is everyone with one aim – to struggle against terrorism. This strength, this will-power has overcome the negative and transformed it into something positive.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

25

4. Terrorist Violence: Attack on Community Attachments Latéfa BELAROUCI M.D., PhD. Sidi M’Hamed Health Department, Algeria; Algerian Red Crescent Terrorism in Algeria aims principally at the destruction of the individual. In effect, however, the atrocities that are being committed target the entire community, because through the individual, the whole population lives in terror. This climate of terror is exacerbated by the fact that the assassinations and massacres are collective. Thus we are seeing the destruction of community ties, because of the assassinations, the destruction of homes, and the destruction of schools – places that symbolically represent a community. Their destruction means the destruction of the reference points that allow an individual to situate himself or herself in society.

Terrorism: attack on ties and confidence Terrorism targets the very fabric of society, particularly through the rape of women and girls. In the Arabo-muslim culture, the honour of the family and the community is enshrined in a woman’s body. An attack on the integrity of her body leads to the destruction of the family’s honour and ties of belonging and affiliation to the community. The terrorism is an attack on the community whose identity is destroyed and which must now bear the shame. Due to the fact that terrorism targets social ties and structures, communities are at risk of being unable to fulfil their usual role: being adaptive and providing for its members support and comfort. In effect, the climate of terror engenders a loss of confidence in oneself, in others, in the institutions and in the representatives of the State. This leads to a loss of perspective for the future and a generalised mistrust which weakens society as a whole. The psychological trauma caused by this violence originates in a brutal confrontation not only with death, but also with things that are unthinkable. Psychological trauma is therefore a result of the breakdown of ties with the world. It stems from exposure to a traumatic event of which the person was a victim or in which the person feared he or she was going to die or be seriously wounded, or in which he or she saw other people killed or injured. This is why so many families are affected by the violence and insecurity in which we have been living for over ten years in Algeria. This goes on to weaken the integrity of social groupings, particularly children and adolescents. In effect it is society as a whole that is the target of terrorism, because its impact is psychological. Furthermore, terrorism in Algeria is deliberate and intentional in nature – and it has been repetitive and ongoing for many years. The prime aims of terrorism are to physically destroy and psychologically annihilate because terrorist activities are aimed less at the victims than at the survivors. Faced with an intentional traumatic incident, the individual is hurt not only in his or her biological and psychological being, but also in his sense of

26

L. Belarouci / Terrorist Violence: Attack on Community Attachments

belonging to a sociocultural grouping. Also, if the social body is attacked and the individual has experienced trauma, then the problem is both on an individual and community level. A June 1999 study by the National Institute of Public Health analyzed the 348 children who had survived a collective massacre in their village 18 months earlier. The results were revealing: 94.4% talk about this experience. Amongst the traumatic incidents experienced by these children, 84.5% talk about the massacre, and 83.9% talk about friends or neighbours who were assassinated. Clinical indicators noted include: 69.8% experience flashbacks, 66.7% nightmares, 57.5% sleeping disorders, 51.1% difficulties with concentration, 73.9% - are easily startled. All of these are danger signs. The majority of the children began experiencing these effects in the first 6 months after the traumatic events. It is worth noting that 53.2% of the children had the feeling that the aggressors would return. These few facts show very well the distress of these children a year and half after the massacre. Moreover, this region is well known for having suffered several assassinations well before the massacre and to some extent since. While it was hard for these children to talk about their problems, their drawings speak volumes about the horror they experienced. Through their drawings, the children let us see and hear the all the horror of terrorist violence. This set of drawings reveals to us the persistence of the traumatising experience: violence that has not been exorcised, negative images, mourning that never took place. Their artwork does not consist of static images. Instead, it is more like snapshots of their psyche, of their inner turmoil, through dramatic scenes, aggressive people, and use of the colour red. Everything points to the existence of definite anxiety. These pictures are in effect raw, brutal documents of a thought process that is not masked by perspective or dissembling. Violence is depicted as it is. No one would doubt that these children are traumatised – violence and death appear in vivid detail. These pictures tell us about destruction and death, pain and suffering, and about unanswered questions. The children are the silent witnesses to barbarity. They remind us forcefully of the murdering madness of adults.

The traumatic effects are issues of generation and identity We pay particular attention to children, as they are especially vulnerable to the excessive violence being perpetrated around us: pillage, rape, arson, collective assassinations, and the destruction of homes and schools. In this situation, a child loses all of his or her points of reference since he or she is confronted by the breakdown of all he or she holds dear. In the case of collective assassinations, where the child has had to face death, there is the breakdown of the community. This means social breakdown since all social ties are broken, breakdown of the integrity of the human body when the child sees physical injuries, and spatial breakdown when houses are destroyed. For these children, adults are either murderous or powerless. It is these adults who are responsible for their pain and suffering. The adult world in which they believed and the laws that regulate it have been found lacking - powerless to stop the massacre. Furthermore, it is adults who have committed the atrocities. The child is thus forced to revise and take a new look at adult behaviour and attitudes. A desire for revenge is not far away. Therefore, we see uncharacteristic aggressiveness, and destructive behaviour – or on the contrary, extreme inhibition. Because their most basic beliefs have been deeply shattered, these children display serious personality changes. As the child develops, we see not only its basic personality modified

L. Belarouci / Terrorist Violence: Attack on Community Attachments

27

by the trauma, but also, in the words of L. Bailly, “when the event implies an attack on law, a child’s socialisation is put at risk. They discover human barbarity - committed by adults who should be protecting them. This discovery is profoundly traumatising. Terrorist violence thus introduces a cleavage in affiliation ties. In effect, belief in strong, powerful parents is fundamental for a child so that it can have faith not only in itself and its own abilities, but also so that it can build trusting relationships with other people and thus feel safe.” How are these children to build their identity? With which parental role model can they identify? How can a child build his or her identity when the only models are either an aggressor acting outside the law or a parent who is a victim, overcome by the aggression and unable to defend himself or herself and his or her family? When it is a choice between a violent dominating person or a weak person who has lost his or her dignity? Parents are dispossessed of their ability to be protectors since they let the horror take place. What is the basic question these children ask? Which law applies? The law imposed for many long years by the fundamentalists – their law which has deprived the children of their most basic rights –the right to education, the right to life itself...? It is true that the fundamentalists are in power, that they are the strongest – but does that make them the most just? Or what about the other law? Which law? The one that was found lacking? The one that let the terrorists get them? The law that is giving an amnesty to the assassins? These questions affect not only those children who were victims of terrorism, but also those whose parents are terrorists – except that for the latter the problem is much more complicated, and they are in an ambiguous position, with the stain of shame and the risk of social exclusion.

Which mechanisms for adapting are they going to develop in order to find a place in society? Having been present at scenes of violence, above all if they are repeated and committed by adults, can lead to profound changes in a child’s perception of his or her own safety and the safety of his or her emotional relationships. Additionally, the children will have difficulty in confronting the concept of the future. They will not make plans for the future, unlike children who have not experienced traumatic events. But we do see some who, after treatment, choose a career which we could call reparative, such as medicine, psychology, engineering, or mechanics. That applies to children who were victims of terrorism. What about those others – the ones whose parents were terrorists? Often they have no choice but to bear the burden of the place assigned to them by the family group or by society. The problem is even more accentuated for the children of those who have disappeared because they cannot mourn. The disappearance leaves a gaping hole in their lives around which settles pain, suffering, and above all, silence, because the label ‘disappeared’ implies ‘terrorist’ – someone who is guilty. These children live in an environment where there is no choice but secrecy, silence, things unsaid, and unanswered questions. Members of the family are torn between pride and shame that one of theirs is involved. How are these children going to develop with this label? How are they going to find their identity? With which paternal role model will they identify? This father is simultaneously called a hero, a martyr, an assassin, and a murderer. What adaptive

28

L. Belarouci / Terrorist Violence: Attack on Community Attachments

mechanisms are the children to develop in order to find their a place in the community, a place in society? Where do they fit in? In such a context, a child loses all points of reference – inner and external. The consequences resulting are mistrust, a feeling of insecurity, a loss of self-esteem, a general feeling of confusion, and most of all, a deep problem of identity.

The quest for meaning Children do not ask who did the killing. They know and call them ‘the cut-throats’. On the other hand, they often ask us this question: Why did they do it? No matter how old they are, they are trying to find a meaning. Finding the meaning of a traumatic event is part of therapy, but how can we give meaning to something which has no sense? What meaning can a psychologist give when the authorities not only do not give a meaning to the situation, but also show they are in denial when they say terrorism is over while the massacres are continuing? When they claim that “the terrorists are fools, mercenaries, definitely not Muslims,” while at the same time the terrorists use Islam to justify their actions? There is no worse aggression than something that does not make sense. Furthermore, the authorities themselves are guilty of violence – rejection of the needs of others, denial, attempts to make people forget, and the amnesty for terrorists – these are all violations. In the same way, forgetting and not recognising the facts reinforce suffering, worsen turmoil, foster hatred and lead to a revenge mindset.

Trauma Management The different mental health programmes proposed in conflict and/or post-conflict situations have three characteristics: - Importance given to post-traumatic syndrome - Aim of the public health system to prevent trauma based on epidemiological facts - Predominance of the individual therapy approach, such as support, counselling, debriefing... In effect these classic approaches to trauma all rely on an individual therapeutic model – and because of that they are all sure to fail. Why? A traumatic experience linked to a conflict situation or terrorist violence includes the breakdown of family, community and social ties which occur alongside the psychological disturbance. When intentional, repeated and collective destruction reaches the intensity, the seriousness and complexity that it has in our country, bandaging the wounds is just not enough. We must, therefore, find other kinds of approaches to the psycho-trauma in order for a procedure to have any chance of success. The procedure that seems the most suitable to this type of situation is one which allows collective treatment. We have to consider the individual in the global context of his or her relationships with society. This procedure should allow one to confront the traumatic events collectively. It aims above all at removing each victim from the spiral of despair and the inescapable nature of the trauma. Using a community approach makes it possible to avoid victims being too deeply stigmatised, since other factors intervene after conflict. These factors include: - financial difficulties

L. Belarouci / Terrorist Violence: Attack on Community Attachments

29

- social break-up due to separations, disappearances... - material and emotional losses - danger to oneself and to others - displacement, emigration, exile.... - uncertainty about the future In effect, the community approach can restore ties, community spaces, and social functioning. To paraphrase J. M. Lemaire:” if we consider that direct attacks on cultural, national, political and family ties are the focus of intentional destruction, we should also envisage that it is precisely these ties which should become the place where therapy can work. In this perspective, treating should not be limited to mental health professionals. The background, the social environment of the child, and family influence the psychosocial response to psychological disorders and recovery. A network of community help is fundamental for protecting children and meeting their needs. The active support of parents, neighbours, friends, religious leaders, medical authorities, teachers, social workers – plays a dynamic role in psychosocial well-being and in the resolutions of trauma.” Therefore, we can say that the psychological effects of trauma are very complex problems where the dimensions of subjectivity and social ties must be taken into account. The only potentially successful approaches in restoring meaning to the life of traumatised children are psychosocial and socio-political. Managing trauma, particularly when it is linked to armed conflict and terrorism, requires official recognition of the facts. Recognition by the relevant authorities of the violence and injustice suffered is a fundamental part of psychological recovery. If the evil is named, if the aggressors are brought to justice, if the prejudices suffered are recognised for what they are, then this will allow the ”community to rebuild its psychosocial points of reference and will avoid the spirit of revenge which leads to the violence being repeated.” Therefore, first the social and legal aspects must be dealt with before we begin psychological treatment. But how can we reform the justice system to admit the transgression and reestablish the rule of law? Verbalising and recognising the collective trauma and working on a collective memory are ways of allowing people to mourn. Children know this and they have started working through their memories in their drawings, songs and writings. Furthermore, a problem that confronts us currently and with which we must deal urgently is domestic violence. It is becoming more prevalent – and the ones that suffer are the children. What can we do to stop the culture of hatred and exclusion so that our children can know peace? Our duty as adults is to ensure that ‘culture of peace’ and ‘tolerance’ are not empty words. The child victims of violence call to us through their pictures, their poems, and even through silence. We do not have the right to remain silent – we must answer their questions. We have to find the words to help them – if we do not, they will develop pathologies which will lead them to their deaths.

Limits of clinical procedures Being a therapist who continually works with those who have suffered traumatic events is difficult because we have to accept things that we find morally offensive, to imagine things that are impossible to imagine, and to run the risk of being traumatised ourselves.

30

L. Belarouci / Terrorist Violence: Attack on Community Attachments

Many therapists find it difficult to work with children of terrorists or with terrorists themselves. You develop defence mechanisms, such as, for example, not asking about the circumstances in which the parent or parents died. The biggest difficulty is that you are immediately and emotionally involved because you are living through the same conflict situation as your patients. What makes us responders, then? It is being a professional, in touch with one’s emotions, and capable of knowing oneself, so that one can recognise in oneself something of the other person and recognise the other person, having the desire to put things right, to support. Also the emotions which the therapists feel must not be rejected. On the contrary, the emotions are an actual part of the work, as long as they are experienced as a developmental part of the therapy. This is why the framework, the plan of action, and a third party are so important in thinking through the psychological care which is essential to the inter- and intrapersonal restoration. In the same way as his or her patients, the therapist also has the experiences of pain and solitude. Very often he or she is alone, confronting the suffering of others. This isolation is difficult to communicate. For that reason, the therapist is tempted to say nothing. At the same time, his or her position makes him or her a witness under obligation to his or her patients. Furthermore, his or her position is uncomfortable because he or she has not only to bandage psychological injuries, but at the same time he or she has to think of the impact of his or her actions and treatment on the victims. The first obstacle which confronts the therapist relies on continually proving objectivity and neutrality in a context where the victim wants him or her to be subjective, where there are gaping wounds, and where there are many unanswered questions. Understandably, it is not rare for those who treat traumatised children to be beset by feelings of revolt in the face of atrocity, injustice, and abandonment. All therapists want to do something, want to bring their help and support to alleviate suffering. It is just like Francis Scott Fitzgerald says, “One has to understand that things are hopeless, but nevertheless decide to change them.” Seemingly hopeless barriers are often components of extreme situations like terrorism. However, our aim as therapists is to bring about a meaningful change. This necessitates a great deal of time and patience. What makes our task more difficult lies in the fact that we are working with children – and working with children is hard work because it requires us to be very energetic and active.

Why think? As underscored by F. Maqueda, it is precisely because “it is thought which is attacked in these situations where violence is overflowing with a cruelty which targets before physical death, a symbolic and social death. Coping with this is a difficult task as the therapists themselves are victims of stress, tensions, uncertainty, the difficulty of thinking and thinking through their own role. In effect as a result of rubbing shoulders with horror, the therapists reach the point where they cannot face the horror of thinking, engage in physical activity to avoid thinking, or limit themselves to their own certainties, procedures and techniques.” This is where the therapist

L. Belarouci / Terrorist Violence: Attack on Community Attachments

31

must use to good account his or her knowledge of the processes of individual and social change in order to effect the emergence of changes which make sense. This is possible through listening to, talking to, and focusing on the other person in distress in order to help the victim find his or her own place. For all those therapists who deal with children I offer these few lines of poetry: You say that it’s tiring to be with children. You’re right. You add because you have to get down to their level, crouch down, Stoop, bend over, and make yourself small. Well you’re wrong. That’s not what tires you out most. It’s rather the fact of being obliged to raise yourself up to the heights of their feelings To strain upwards, reach up, stretch up on tip-toe To avoid hurting them. Janusz Korczak, 1942 References Aiguesvives C. Situations de crise : prévention en santé mentale infantile, quels modèles. Anzieu A. Barbey L., Bernard-Nez J. Daymas S. Le travil du dessin en psychothérapie. Ed. Dunod, Paris, 1996. Baqué S. Jours après nuit. Voyage dans le dessin des enfants rwandais rescapés du génocide. Fondation Tumrere. Bailly L. et coll. Conséquences pour les enfants des crises familiales graces ou des événements traumatiques. In Nouveau traité de psychiatrie de l’enfants et de l’adolescent. P.2793-2805 Dubois V et coll. Catastrophes causées par l’homme : importance des programmes de santé mentale communautaire. In Méd. Catastrophes Urg. Collectives, 1999,2,106-110 Jacquet F. Séminaire « Approche communautaire, santé mentale et prévention », novembre 2000 Maqueda F. Carnets d’un psy dans l’humanitaire. Paysage de l’autre. Collection des Travaux et de Jours. Ed. Eres

32

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

5. Group Therapy with Traumatized Children in the Chechen Refugees Camps Khapta AKHMEDOVA, M.D., PhD Institute of Psychology Russian Academy of Sciences, Moscow Research Institute of Psychiatry, Russian Ministry of Health, Grozny, Chechnya

The tent camps for Chechen refugees in Ingoushetia were opened in 1999 and are now closing. During my four years of experience working with children’s and adolescents’ psychological well being in two of these camps, I had some interesting experiences. The first time, we carried out or work in the open groups. The open group included about 20-25 children. There was one group for children and another group for adolescents. Two psychologists worked with every group, which included many children who had been in active war zones immediately before their arrival at the camps. The children had acute stress reactions and needed help. Unfortunately, our team included only five psychologists and one psychiatrist, and we did not have the time for the individual investigation of every child. In the open group, we observed many children simultaneously and selected which children had symptoms of psychotrauma. Moreover, many children had tics and enuresis, signs of PTSD in children, and these symptoms first appeared during the course of the traumatic events. We also observed aggressive and elevated risk-taking behaviours in adolescents following traumatic exposure. We formed closed groups for those children and adolescents who had symptoms of PTSD and other disorders. In these groups, we used play therapy. The group therapeutic process included approximately sixteen meetings over two months. The traumatized children demonstrated repetitive, destructive, or interrupted playing. The playing showed that the children relived the trauma over and over because their styles of plays showed that the children could not surmount their feelings. When children seemed particularly frustrated, the psychologist would join the play and positively redirect it. Step by step, children learned to surmount their traumatic feelings not only in the play, but also in their everyday lives as well. We reached the positive changes of the children’s mental state in about 65% of children who completed the full two month schedule of meetings. The positive changes were somewhat dependent on several factors. First was the regular participation in the meetings. Second, family support, and particularly parental support, was also important. However, many troubled children’s families were also traumatized. When children left the group, they returned to their similarly troubled families, and it negatively influenced their progress. Therefore, we also began therapies for traumatized family members. One case with traumatized children involved a large family that included nine brothers, one sister, and two parents. They lived in a mountain village, but were separated most of the family came to the refugee camp, but the father remained at home. Over the

K. Akhmedova / Group Therapy with Traumatized Children in the Chechen Refugees Camps

33

first few days of the family’s life in the refugee camp, seven of the boys (from age 6 to age 14) made a security checkpoint near the aqueduct tap. The checkpoint was like an arms checkpoint in Chechnya, and they sat all day in the embankment they had dug. The brothers did not allow refugees to take water without paying for it, but many of the women who needed water did not want to pay. When the women did not comply, the boys began to stone them. When complaints reached the boys’ mother, she forbade her sons to continue their activities. The boys obeyed because she was a strong woman and they were afraid of her, but they soon built a similar checkpoint on the border of a neighbouring camp. The other children of the camps had nicknamed them pirates. We heard about these brothers and talked about them often. I visited their tent and talked with their mother about our centre and invited her sons to it. She did not even know what psychologists do. When I explained our profession to her, though, she agreed to tell her sons to come. The next day, seven brothers came to our tent, bringing two dogs with them. They were armed with sticks and stones, and asked who had invited them to the centre and why. I explained our groups to them, but they refused to be separated into groups by their ages. Instead, they wanted to stay together in one group with their siblings, the dogs, and the weapons. I negotiated with them for about half an hour. We agreed that all brothers could be included in an adolescents group if the dogs and equipment would be kept outside. It would have been inappropriate to separate them since they had been brought together by the trauma they had experienced, and they had to learn how to overcome the trauma together. In the group discussions, they discussed their experiences with war and how they had survived. They spoke of escaping soldiers’ gunfire as well as witnessing others being shot and killed. After our treatment, the boys’ behaviour changed. They did not demonstrate aggression, and actually began to make a business. The built a shop in front of their tent and sold food. They earned money and then constructed a video hall and play area that attracted many children who paid small fees for admission. Later, they bought a motorcycle for making food deliveries, and ultimately showed that they coped with trauma better than many of the adults in their community. In the process, the brothers became independent and each ran his own section of the business while still helping his siblings as well. After the group therapy, we observed their behaviour for two years, and they never repeated their previous negative behaviour. Sometimes, some of them even visited the centre and continued to speak about their feelings and their progress.

34

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

6. Traumatic Stress among Child War Victims and Problems of Rehabilitation in Georgia Dr. M. JISHKARIANI; Dr. V. KENCHADZE; Dr. Z. BERIA Psycho-Rehabilitation Center for Victims of Torture and Org. Violence "Empathy". M. Asatiani Research Institute of Psychiatry; Tbilisi State Med. University, Dep. Psychiatry and Med. Psychology;

In consequence of war conflicts on the territory of Georgia in 1992-1993, 1998 about 300,000 civilians become Internally Displaced Persons. The definition of IDP is widely used by the international organizations – UN etc, but from our opinion, that is question for suggestion: is this definition correct or not, because these persons, civilians are involuntary, forced displaced people. It is something different and is very important for appointment correct ways of rehabilitation. As well as there are amount 3 000 Chechen refugees in Georgia after the military conflicts in Chechnya (Russian federation). The several difficult problems have not only refugees or Internationally Displaced Persons, but the population living inside the military conflict zones, especially illegally repatriated IDPs in Abkhazia (Gali Region) and civilians that stay in this territory during and after military conflicts too. It must be indicated that unfortunately all their problems are unsettled up to now. In our opinion, investigation of the mental health and psycho – social problems in forced migrants is of special interest. In this case a number of etiological factors are involved in the development of post-stress disorders. A number of observations and study programmes were conducted in Georgia during the last 10 year period, among them in children population too. In this presentation we would like to represent some results and conclusions or questions for suggestion of several investigations that were provided in the dynamic. The analysis of the results of new, ongoing programme (by the financial support of the UNVFVT) of the Centre EMPATHY, including observations and medical and psycho – social rehabilitation for IDPs, Illegally repatriated IDPs in Military Conflict zone in Gali region and Refugees from Chechnya – Victims of Torture and their families have included in this presentation as well. First programme of investigation of the psycho – social problems of the children and as well as families involuntary migrants after the Abkhazian war conflict in Georgia was conducted in 1995 – 2 years after of migration. During this study program 400 children from 4 till 16 years old were investigated. The special prepared clinical questionnaire that include the several points (personal history, family psycho – social background, trauma history, character of the medical and psychological aid, psycho – social and physical condition in the dynamic, providing assistance and recommendations for rehabilitation have been included in this clinical card) was used for investigation, as well as the psychological tests: Lusher, PTSD, Hand test and Picture were used too for revealing the psychological problems of children involuntary migrants.

M. Jishkariani et al. / Traumatic Stress Among Child War Victims

35

During the study period, we identified several groups of psycho-traumatic factors causing PTSD, having some peculiarities of clinical manifestation and clinical course. 1. War Traumatic Stress Events, being a trigger for the development of the PTSD (Table 1, Program OXFAM/UK/) Table 1. N War Traumatic Stress Events Number of % children 1. Death of family members or close relatives 81 20 2. Being witness of death 82 21 3. Being in the area of bombing or under fire 275 69 4. Being among dead or mutilated wounded people 113 28 5. Being in captivity or hostage 17 4 6. Torture, violence, or being witness of the above 39 10 7. Physical trauma with the CNS disturbances 8 2 8. Home attack or home loss 389 90 9. Being at the occupied territory 10 2 10. Serious problems during evacuation (e.g. crossing mountain 81 20 pass in Svaneti) 11. Evacuation without parents, being unaware of their location 31 8 12. Conflict between family members on the basis of ethnic 3 1 differences

As we can see from the percent ratio in Table 1 there was combination of several traumatic stress events, which indicates intensity of the stress influence. 2. Additional stressors of the war and pre-war period, causing decrease of reactivity and creating the basis for the development of psychosocial disturbances (Table 2). Table 2. a) Additional stressors of war period 1. Starvation and shortage drinking water 2. Deficit of electricity and energy 3. Cold 4. Lack of sleep, insomnia 5. Unemployment b)”Global Changes” of pre-war period

1. Radical political changes in the former Soviet Union 2. Social-economic crisis

Above-mentioned combinations of stress factors caused high incidence of the PTSD symptoms (in 284 out of 400 – 71%, Program OXFAM /UK/). In all sufferers of the PTSD we observed symptoms of “Intrusive/Repetitive Phase” group and “Avoidance/Denial Phase” group of different intensity, depending of the personality features and age of the studied person. Children aged 6 - 11 years were found to be more susceptible to the PTSD. Second point or question for this study was: Is it only PTSD or something combination disorders - TSD?

36

M. Jishkariani et al. / Traumatic Stress Among Child War Victims

Symptoms of PTSD superimposed progressive asthenia (problems of the psycho – physical development) and other psychological or stress – related disturbances, caused by the prolongation and unsettlement of the stress situation and also by polymorphism of the etiological factors. Thus, we described stressors of the post-war period, which are decisive for the formation of some clinical features of the PTSD or TSD in children – war victims. These factors were defined as "Radical Social Changes" induced by the forced migration. Taking into consideration these peculiarities, we tried to single out following groups of disorders associated with the symptoms of the PTSD, according to the most typical structuraldynamic manifestations (as we defined Risk Groups for development of the behavioural or adjustment disorders) (Table 5). Table 5. Stress – Related Disorders among Children – War victims PTSD with somatization (with psychogenic enuresis) PTSD with neurotization 1. with teak disorders 2. with Obsessive - Phobic syndrome PTSD with behavioural disorders 1. Hyperkinetic disorders, children with hyperactive behaviour and with a lack of attention and concentration possibilities. 2. Opposite – Provocative brutal reactions Children with a tendency to chronic personality change after the traumatic stress event revealed in Social Grouping reactions PTSD with depressive disorders (prolonged grief reaction)

In 16 p. out of total 284 – 6%

1. In 12 p. out of total 284 – 4% 2. 36 ------------------------13 %

1. 15 – 5 % 2. 27 – 10 %

12 – 7 % (adolescents aged from 13 - 16)

8 – 3%

¾ In the first group (with enuresis) the main stress events were treated to be dead, to be in hostage, being in the captivity, torture, evacuation crossing Svanety Maintains. ¾ In the second group with neurotization the main stressors were the violence and torture of the family, to be under the bombing, death of the family members or parents etc. ¾ In the third group (with behavioural disturbances) were included the children mostly from 4 to 8 years older with severity trauma background in family, as well as secondary traumatized children, with hyper – control attitude from parents side. ¾ In the fourth group (with grouping reactions) were included mostly adolescents with hypo – control from parents side. ¾ Our special interest was fixed on the group with prolonged depression reaction. There were following groups of children included in this group: 1. "Children without mother" from the mix ethnic families. 2. Children those parents were dead during the military conflict (orphans). There were revealed severity problems of the psycho – social adaptation in these contingent that reveals in violation of the contacts, psychogenic autism and isolation, tendencies to be in friendship relations only with persons with same grief (life stress event), lack of interest outside to world, estrangement and feeling of abandonment etc. As well as it would be indicated that in accordance with our

M. Jishkariani et al. / Traumatic Stress Among Child War Victims

37

observations the particular trauma, especially for small children, was to leave (deprivation) domestic animals (dogs, cats etc), lovely toys or close relatives – grandmother or grandfather, on the occupied territory during the evacuation. It was reason for sever feelings of guilt, obsessive memories and dreams. Prospective study during 10 years revealed progressive changes of the personality with formation of the "image of enemy", hostility attitude to world and state, aggressive and self – aggressive reactions that become most obvious after the passing of years of involuntary migration. In this aspect it would be indicated that main problem of adaptation reveals in interpersonal relationships, in the difficulties of integration into the new society, intolerance of the contacts. They have close relationships only with IDP population, social actions, celebrations etc they provide only inside this population. Our observations revealed the important role of the mutual induction with the traumatic experiences inside the family in the children's wellbeing. As well as it must be indicated that the phenomenon of the trauma transmission into the generation is very clear too. That's revealed in the generation who was not remembering the war traumas or among the generation who was born after the migration. The same adaptation mechanisms and as well as intolerance in the contacts, close, circle, only refugees' community relations are revealed too. The important negative factor for psycho – social wellbeing of the children is the Collective Living Condition in the refugee's living centres. That causes the fixation of the community members on the war traumatic events and dissemination of the negative memories or feelings among the community and families, created of the close system of relationships and contacts. That caused among children population limitation of the world philosophy and system of values, limitation of their roles in the world and society. Ethnic – cultural factors influence on the psycho – social condition of the children and whole families. We divided the post-war stressors into several groups of ethnic-cultural features: 1. Self-Ethnic-cultural features: age-old traditions – phenomenon of the family house – residence of many generations for centuries. Loss of family house induces Nostalgia Phenomenon, becoming increasingly accentuated while hopes for repatriation fail. Another basic ethnic-cultural aspect is the traditional concern for the welfare of the yang generation with appropriate rituals, which is disturbed as a result of the radical social changes in the life of these people. 2. Deprivation of the religious traditions, associated with the family house and family crypts, interfering with the rituals of burial and rituals of religious feasts. 3. Social-cultural aspects, associated with the loss of social role of personality, as well as with the violation of the social traditions, caused by the change of the natural and climate conditions and alteration of biological rhythm. Above-mentioned ethnic-cultural characteristics play an important role in the complex succession of the etiological factors and cause prolongation and recurrence of the clinical course of the PTSD, alongside with the other stress-related disorders, with predominance and aggravation of the depressive affect. Frequent recurrence, associated with religious and traditional dates is an important ethnic-cultural peculiarity of these disorders in the present area. Mutual induction of traumatic experiences in family members and also in places of migrant’s collective dwelling, incorrect attitude of the society, mass media, and sometimes government officials, toward them also contribute to the recurrent clinical course of the disorder. Lack of a large-scale psychosocial rehabilitation and management actions, poor living conditions, imperfection of the mechanisms of legal protection, as well as public unawareness of those, uncertainty of future, alongside with the above-mentioned stressors,

38

M. Jishkariani et al. / Traumatic Stress Among Child War Victims

induce personality disadaptation, tendency to personality transformation and "Refugee" trauma transmission into the generation. Table 6. Stressors of the post-war period

I. a) b) c) d) e) f) g) h)

Radical social changes: Poor living conditions; Shortage of food; Deficit of electricity; Cold; Unemployment; Factor of mutual induction; Lack of medical assistance; Incorrect approach to the problem of refugees.

II. 1) a) b) c)

Ethnic-cultural factors: Ethnic-cultural factors proper: Loss of the traditional house; leaving relatives on the occupied territory; deprivation of the opportunity to concern for the welfare of the next generation; Change of social-cultural traditions; change of climate conditions; Violation of religious-cultural traditions: associated with burial ritual; associated with remembrance of the dead; associated with family house; associated with religious feasts.

2) 3) a) b) c) d) III. IV. V.

Uncertainty of future In case of the Chechnya Refugees language differences and problems of education. In case of uncontrolled military conflict zones civilian population (families) (example Gali region investigations) – Permanent fear and uncertainty waiting of torture and violence

Based on the above, we conclude that the complex combination of a number of etiological factors induce association of PTSD with the other stress-related disorders and result in chronic, recurrent clinical course of these disorders with marked affective liability – episodes of depression or euphoria /as a hyper-compensation/, deterioration of ability to estimate the real situation. Based on the above, we are dealing with a Complex Traumatic Stress Syndrome. Basic phenomenon of which is the affective liability, primary depression with a progressive asthenia and incorrect adaptation, circle "refugee and other world" relations that was increased by the incorrect system of the rehabilitation, especially for children IDP's and refugees population, such are: not having the state, comprehensive, national wide strategy of the children's rehabilitation after the war conflict, limited rehabilitation programs and

M. Jishkariani et al. / Traumatic Stress Among Child War Victims

39

educational yours centres only the refugee's communities, not having the plan of the repatriation of this contingent and protective strategy of their rights. For these reasons the main experiences are the fear of future, caused by its uncertainty, fear of threatening danger, destroy of the values systems and failure of the philosophy of life, the change of the attitude with: “I – another I”, “I – World”, “I – God”. It is important to note that behind these psycho - social manifestations is human being with his individual and collective existence philosophy. From this end the issues of interrelation of dramatic events and human’s mental equilibrium, being on crossroads of psychiatry, philosophy and human rights, become increasingly important. And that must be basis for creation of the correct strategy of the rehabilitation for families’ wellbeing and especially for psycho – social rehabilitation of the children after the war conflicts.

40

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

7. Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration Lilian PETERS, M.A. Middle East and North Africa NGO-network to Stop the Use of Children in Armed Conflict (affiliated to the International Coalition to Stop the Use of Children in Armed Conflict) Why children are recruited as soldiers; Reasons why children may become voluntary recruits; Who does the recruitment; Children who are vulnerable to recruitment; What can prevent underage recruitment; Key points for rehabilitation and reintegration of former child soldiers; A Framework for planning; The three stages of community involvement: Sensitisation Articulation and Reflection -Mobilisation of Resources; Initial steps for planning social reintegration of a former child soldier; Identifying factors which influence social re-integration Implementing programmes of rehabilitation within a therapeutic or medical framework - Issues affecting re-integration of child soldiers

Action for the Rights of Children (ARC) has worked extensively in the field of Child Soldiers and I am basing this paper on their work.1 Basic Principles 1. The factors that influence the participation of children in armed conflict are complex. No single model can either explain all the factors, or outline a uniform procedure that will prevent the recruitment of children, and enable procedures for their demobilization and social reintegration. 2. The recruitment and participation of under-age children in armed conflict constitute an abuse of their rights. 3. The rights perspective of the Convention on the Rights of the Child provides a framework for assessment of the impact of participation on children and informs a response to their situation. 4. Children, including adolescents, most at risk of recruitment in the particular situation, need to be specifically identified and planning needs to be undertaken to prevent their recruitment. 5. Responses to forced recruitment should be based on an understanding of the social, political and cultural factors which gave rise to the conflict. 6. Demobilization is the first step in the child’s return to a normal life and should be accompanied by initiatives to enable social reintegration. 7. Children and adolescents, their families and communities, need to be informed and empowered to enable them to resist recruitment, to effect demobilization and to participate fully in initiatives to secure the social reintegration of former child soldiers. 8. It is important to create an open and accepting environment and let children set the pace of their reintegration and rehabilitation, rather than focus on trauma and its consequences.

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

41

Overview and Definitions While many children fight in the frontline, others are used as spies, messengers, porters, servants and even sexual slaves; children are also often used to lay and clear landmines. The problem is most critical in Africa and Asia, though children are used as soldiers by governments and armed groups in many countries in the Americas, Europe and Middle East. While some children are recruited forcibly, others are driven into armed forces by poverty, alienation, patriotism and discrimination. Many children join armed groups because of their own experience of abuse at the hands of state authorities. The term child soldier has become widely adopted, and will, therefore, be used to cover any person less than 18 years of age who is part of any kind of regular or irregular armed force or armed group in any capacity other than purely as a family member. It does not, therefore, only refer to those carrying arms, but includes cooks, porters, messengers, and those accompanying such groups, including girls recruited as concubines or for forced marriage.1 Recruitment encompasses compulsory, forced and voluntary recruitment into any kind of regular or irregular armed force or armed group. Demobilization means the formal and controlled discharge of child soldiers from the army or from an armed group. The term psycho-social underlines the close relationship between the psychological and social effects of armed conflict, the one type of effect continually influencing the other.

Children who are vulnerable to recruitment It is important to recognize that certain children will be more vulnerable to underage recruitment, whether voluntary or forced. Research has shown that the overwhelming majority of child soldiers, in almost every conflict, are drawn from the poorest, least educated and most marginalized sections of society. Especially those separated from their families or with disrupted family backgrounds, are at risk. In general, children vulnerable to recruitment are: • Children from particular ethnic, racial or religious groups; • Children living in the conflict zones; • Children from unstable or disrupted backgrounds; • Children separated from their families and without the protection that the family can provide to prevent recruitment; • Unaccompanied children who initially became associated with an armed group for protective reasons, but who may progress to active participation; • Former child soldiers.

Why children are recruited Although children may be recruited predominantly because of shortages of adult soldiers, recent research suggests that they are often seen by commanders as having special qualities. Some of the main reasons why children are recruited, in addition to making up

42

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

numbers, have been identified as: easily used in battles; easily manipulated; adventurous; quick to learn fighting skills; no competition for the leadership role; less costly; pose a moral challenge for enemies. The longer a conflict continues the more likely it is that children will be recruited, and in increasing numbers.

How children are recruited, and by whom The manner in which children are recruited ranges from compulsory to voluntary recruitment, although in practice it is hard to ascertain the reality as they often merge into one another. The most distinct category is compulsory recruitment by conscription. This, by its nature, is a governmental prerogative. Many children, however, are conscripted under age. This may happen even where there is a legal minimum age of 18, because: • People are unaware of their rights; • Children lack documentation such as birth or identity records; • Voluntarily enlistment for compulsory conscription is sometimes a convenient loop-hole to mask conscription of children; • Children are caught up in “quota” enlistment which may be carried out by government agents, village headmen, local militias and others who are concerned to make up required numbers of conscripts; • The conscription system is flawed or outright ignored by the military particularly where there is a perceived need for an enlarged force, or the military is targeting certain groups. Forced recruitment is also practiced by armed opposition groups – sometimes justified as a requirement that all members of an ethnic group, for example to join the armed struggle. Armed groups may face shortfalls in numbers of recruits and therefore impose quotas on the populations in the areas under their control. The causes for voluntary recruitment are varied, and a number of factors may operate simultaneously to influence the child’s decision to volunteer. Some children make a positive choice to join, or are encouraged to volunteer by force of circumstance or because the family makes a choice on the child’s behalf.

Reasons for recruitment It is essential to understand how the problem is manifesting itself in a particular community, locality or country. This will include understanding of why and how children are recruited, forcibly or voluntarily, and enable steps to be taken which make such involvement less likely. Some responses require specific actions in the field, others longerterm programs as well as advocacy for changed laws and practices. In all cases, clear understanding is required of the social, cultural or economic reasons that may be contributing to recruitment, particularly when it is on a voluntary basis. However, the nature of how “voluntary” the decision may be depends a great deal on the circumstances. Some factors can be addressed through specific interventions; others require longer-term changes in society and in attitudes.

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

43

Cultural reasons: Participation in military or warlike activities is often glorified, and children are taught to revere military leaders. Value systems that endorse bearing arms as a mark of masculinity may draw or push youngsters into armed opposition groups. Some children may join as a result of peer pressure, particularly in urban areas or garrison towns, for the adventure or to escape boredom. Voluntary recruitment into armed opposition groups is significantly influenced by children's personal experiences of harassment by government armed forces, including torture, loss of home or family members, forced displacement or exile. Ideological Reasons: Some children volunteer for armed opposition groups because they believe in what they are fighting for: a holy war, religious freedom, ethnic or political liberty, a general desire for social justice. The children’s commitment to the opposition cause may have been instilled in them throughout their upbringing and be reinforced by the idealization of a culture of violence. Many may have witnessed abuses against their families or communities. Economic and Social Reasons: The motivation for volunteering may be to find a means of survival or support, particularly where the alternative is unemployment. Family may influence the child’s recruitment, because they need the income, as in some cases the child’s wages are paid to the family, or there are other incentives such as food or the provision of medicines. Economic motivation may be more than for pure survival, as the army may represent the only route to influence, or upward social mobility.

Demobilization and social reintegration The manner in which under-age recruits leave an army or armed group is varied, including: • They may escape from situations of abduction; • They may be spontaneously shed from armed factions and abandoned to their own resources; • They may be shed as such groups become aware of the disapproval that is associated with the practice, and political initiatives indicate that their aims and objectives in promoting the conflict may be reaching acceptance; • At the end of a conflict they may be grouped within a larger category of unaccompanied or separated children to avoid any acknowledgement of their participation, and thus be excluded from accessing any demobilization "benefits"; • They may return home with family members who occasioned their initial involvement; • They may be involved in organized procedures for demobilization of under-age recruits. Demobilization or release from an armed group should be considered as the first step in the normalization of the children's lives. Where possible, given the various circumstances, there should be a readiness to respond to children's needs immediately upon their release from the military, so that there is as smooth a progression as possible, and they are not left confused. Organizations concerned with the protection and welfare of children have an important role to play both in determining the criteria for child-oriented procedures of demobilization, and being involved in translating these into practice, so that children's needs and concerns are recognized and integrated into the process of demobilization. For some children, the prospects of life as a soldier, despite the hardships and dangers, may be more attractive than returning to one of oppression and destitution. Their

44

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

families may hold similar views and will influence the children accordingly. Demobilization and social reintegration programs should be rooted in this reality, and not digress into considerations of systems and procedures to “manage” the problem. There is a growing awareness not only of the particular needs of child soldiers, but of those of other children who are involved in fighting forces - children abducted or otherwise forcibly recruited not just as fighters but as “human shields”, porters and camp assistants, or for sexual purposes. One of the most challenging effects on children of such experiences is that they have spent a significant part of their childhood in a strictly hierarchical structure and have experienced a socialization process which serves the purposes of a military command. Clearly such experiences may make it difficult for children, upon release, to adjust and to re-learn new codes of behavior and how to develop relationships not based on power and fear. Children who have participated in violence and killing have probably been given messages about what such actions mean from the vantage point of armed forces. This may mean that children have to re-learn moral behavior and acquire the ability to make moral judgments appropriate to civilian life. Some children realize the terrible nature of their previous actions and may suffer greatly because of that realization and the guilt and shame associated with it. Some children - especially those who have had positions of responsibility in the fighting forces - may have particular difficulty in adjusting themselves to civilian life where their status is no longer recognized. Even young children may have taken on “adult” roles, responsibilities and authority: this may make it extremely difficult to return to the expectations associated with childhood - e.g. conforming to the norms and rules of school. Girls who have been on active duty may find particular difficulty in adjusting to expected ways of how girls should behave in their society, and this may affect marriage prospects as well as adjustment to the role of wife and mother. Girls are particularly at risk of rape and prolonged sexual abuse, and this may affect the normal development of ageadequate and culturally acceptable behavior: in turn this can pose a challenge for successful social integration. One aspect of life within fighting forces that is not always well recognised is that children may well have had some positive experiences, intermingled with many negative and brutalizing experiences. For example, they may have been part of a highly supportive group-living situation they may have had a strong sense of purpose, perhaps with in ideology which may have given a sense of meaning to their actions. They may also have had strong personal relationships with their commanders despite the potential for an exploitative and brutal aspect of this relationship. These more positive sides of their experience cannot always be replaced. Therefore, unless children do have opportunities for good adult and peer-group relationships, a sense of purpose and self-esteem, they are likely to experience difficulties in returning to more normal civilian life in the community. Integral to any concern to effect the demobilization and social reintegration of former child soldiers is the fact that all children in a community will to some degree have been affected by the conflict. Their circumstances and experiences have placed them also at special disadvantage. Under the provisions of the Convention on the Rights of the Child, they have the right to special protection and assistance. Families and communities who have experienced the various ways in which the conflict has impacted their daily existence, including the participation of some of their children, may be more concerned with establishing normal life and familiar routines. In other situations difficult and complex issues of “forgiveness" may have to be addressed

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

45

within the community as a whole because of serious acts of violence that have been perpetrated by the demobilized child soldiers. They may not initially be sympathetic to special initiatives on behalf of former child soldiers. The integration of vulnerable children such as child soldiers into overall programming for war-affected children will need to be carefully considered and monitored. Approaches which mobilise communities around key issues such as family impoverishment; education; skills training; health and disabilities; and reconciliation may be more likely to ease the return of the child soldiers. They entail a more sustainable, longterm perspective which also better meets the range of developmental needs experienced by former child soldiers. They can also be integrated into general programs of post-conflict reconstruction. The risk of marginalizing former child soldiers through the implementation of special programs should be balanced against such considerations. Special programs of rehabilitation and interim care may be necessary. At all stages children must be informed about their rights and details of the existing or planned programs. Dialogue, from the very earliest stages of any intervention, must allow the children to influence the demobilization and reintegration program and to determine a realistic "plan of action" for themselves. An essential aspect of rehabilitation is finding ways of promoting children’s selfesteem and a sense of hope and confidence in the future: this may be particularly difficult for children who have been recruited partly as a reflection of their own perceptions of the lack of opportunities available within their own community. Experience suggests that once these children reintegrate back into more normal life in the community, many struggle with poor self-esteem and a confused sense of who they are, and need long-term support from their families and community. It is not surprising that many remain vulnerable to rerecruitment.

Community involvement The process of community involvement can be summarized in three phases: • Sensitization - to educate and raise awareness in the community; • Articulation and Reflection - based on dialogue with community members to enable an understanding of the root causes of child militarization; • Mobilization of Resources – both human and material to contribute to project implementation. The care and protection of children, and their social reintegration, will ultimately rest with their families and communities. Going beyond addressing the needs of children in difficult circumstances, to protecting and securing their rights requires the participation of their families and communities in order to take due account of the importance of the traditions and cultural values of each person for the protection and harmonious development of the child. There are practical considerations which dictate the necessity of encouraging community initiatives, which are usually low cost and have greater impact when aimed at building up local capacity to resolve their own problems through programs based on and managed by the communities themselves. Taking due account of these principles will involve: • Determining the attitude of the community towards the child soldiers; • The community’s perception of their roles and responsibilities; • The resources and capacities, both human and material, that are available to meet the

46

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

children’s needs; • The community's circumstances and realistic and sustainable objectives. Community involvement should not be seen as a simple solution to the social reintegration of former child soldiers. Time is needed to engage people in a dialogue in order to understand the risk factors within the family and community that can result in children being militarized. Often, there is an understandable focus on the worst consequences of the children's participation in the conflict, such as substance abuse, the atrocities they have committed, and their aggressive and violent behaviour. This is the aspect of the children's involvement that people have experienced, and risks placing the emphasis on the need to “de-traumatize” the children and to teach them to be good and moral citizens. This often goes along with the conviction that they are best kept away from people until they are ‘cured’.

An integrated community development model implies a range of partners, like international organizations and NGOs, local agencies and local NGOs, all contributing different skills and expertise. Agreement is needed amongst the various partners on what is an appropriate approach within a given situation. All concerned must be clear about their own roles and responsibilities. It may be necessary, for example, to identify a lead agency with responsibility for ensuring a co-coordinated response from the various organizations. Following conflict, the capacity of governments to respond to children's issues may be limited, which contributes to the risk that the government's role and responsibility towards its children is pre-empted by others. However, the involvement of appropriate ministries in program planning and implementation is important, in order that social reintegration develops from a shared perspective, and is implemented in a manner that allows for continuity and sustainability. Also, incorporating local partners and government departments at an early stage will enable a more effective response. Capacity building aimed at developing and strengthening human resources will be an important aspect of developing a framework to normalize the lives of child soldiers. Activities directed at the normalization of the children's lives will require outreach to their communities. Local partners can play a crucial role in assessing the situation of the children's families and communities, and in identifying factors that influence their social reintegration.

Community awareness Frequently, people’s attitudes and opinions about child soldiers indicate little awareness or sympathy for the view that the children themselves have suffered. When children are seen as the perpetrators of violence, introducing any consideration of abuse of children's rights is not easy, and may be considered irrelevant. An emphasis on the consequences for children of their participation in military activities, like: the loss of family life and normal developmental experiences, missed educational opportunities, social marginalization and increased risk of exploitation - can be a means of raising awareness, and thereby informing the process of demobilization, rehabilitation and social reintegration. In this manner the implementation of the CRC is promoted in a natural manner, not as a remote instrument of international law, as different activities are targeted at the range of children's needs occasioned by conflict.

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

47

As a result of their own experiences, people can be engaged in discussing how the conflict has affected children, including the fact that it has resulted in their children becoming soldiers. Here discussion can focus on "what was done to children" rather than "this is what the children did". Discussions such as these can enable people to take a longer term perspective about issues that influence their children, including strategies to assist child soldiers in what will be for many a long and difficult process of social reintegration.

Demobilization and social reintegration There are issues that are common to the experience of all children who have participated in conflict and which require consideration if they are to reintegrate with their families and communities. These issues are: • Separation from the family; • Family poverty and vulnerability; • Education and vocational training; • Participation of children; • Health; • Children in need of special care. 1. Separation from the family and community Child soldiers may have been separated from their families and communities for prolonged periods of time. This separation in itself can create a risk for children, but their situation is compounded by the experiences and conditions of their time as soldiers. These children need to be able to establish and maintain stable emotional relationships. This is of particular concern for children who have been "recruited", often abducted, at an early age. It will be important to re-establish continuity of care, nurture and support and to normalize their daily lives. A process of mediation may be required before communities can even accept child soldiers including perhaps, acknowledgement of inappropriate behavior, public apology, forgiveness, religious rituals or traditional procedures. This will be difficult and complex in situations where they are perceived to have committed atrocities against others and for communities to accept the limits of their responsibility as the children may be difficult. Family reunification and re-attachment to family and community can be considered as the most significant determinants of effective social reintegration. In the immediate term it will be necessary to trace families, arrange for family reunification and consider interim care arrangements, including substitute families or small group care within the communities for children who cannot be reunited with their own families. Some children may be unable or unwilling to return to their families and it will thus be necessary, as soon as possible after demobilization (preferably beforehand if sufficient time is available for planning), to determine the numbers of children to be reunified immediately; numbers for whom interim care is required during tracing; and the numbers requiring longer-term alternative care. Where options such as substitute family care or small group care under the supervision of the community are considerations, it will be necessary to work with the communities to establish criteria to ensure the protection and well-being of the children. Institutionalization is unlikely to meet the needs of these children and should be considered a "last resort" to be implemented in exceptional circumstances.

48

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

Children who are unable to reunite with their own families, or who choose not to return home, are especially vulnerable. Not only will they have no emotional or social reference points, but they will have no-one to represent their interests and secure their care and protection. Procedures for determining legal responsibility or guardianship for these children should therefore be considered. In theory, the role and responsibility of governments in such cases is defined by the provisions of the CRC. Organizations concerned with the rights and well-being of children must therefore acknowledge and respond to this issue, in particular the requirement for training and capacity building of government personnel in appropriate ministries, and local NGOs, in both legal and child welfare issues as they relate to these children. Monitoring of former child soldiers who are not reunited with their families is an essential aspect of long-term protection that requires consideration. 2. Family poverty and vulnerability The overall context for the children’s return may often be characterized by impoverishment of their families. The situation of the child soldiers' families and communities is a crucial factor for their social reintegration. Criteria should be developed to identify vulnerable families and to determine appropriate assistance, ideally delivered at the community level, to enable the reintegration of their children. Communities emerging from conflict often stress the linkage between education, employment opportunities and the economic security of the children’s families as the factors that would determine not only successful social reintegration, but also prevent rerecruitment. The requirement of children, of whatever age, to contribute to the family economy may constitute the most important factor in their re-attachment to their families, thereby defining effective social reintegration. During this process they will be valued for their contribution to the productive work of the family, and relearn the values, practices, and norms that regulate and give reason to family and community life. This must, however, be balanced against the requirement to address the overall needs and rights of the children occasioned by their participation in conflict. It will thus be important to identify those factors which create vulnerability in certain families and to direct assistance to their situation in order to prevent renewed risk to the children. Of particular importance for these children will be the prevention of further separations or abandonment. In some instances, the circumstances of the family may mean that it is unable to satisfy the needs of the child, ending up to push the child onto the streets, either through the child’s own initiative or by encouragement or forced by the family to provide for him/herself and even for the family. Life as a street child may not be the only consequence of such situations. Children from vulnerable families can also be at risk of sexual abuse and exploitation and child labor, or may find themselves again involved in violence by joining armed gangs. 3. Education and Vocational Training One factor which appears common to all child soldiers is that prior to their recruitment they have had limited or no access to education. The right of these children to education is selfevident, but how this right becomes a reality will again be a function of the circumstances confronting the children following demobilization, including the extent to which educational facilities have been destroyed, a situation which affects all children, not only the former child combatants. Experience with child soldiers indicates their desire for education. This poses

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

49

problems for older children in particular, as they will have lost the opportunity for normal education. Children will also be returning to impoverished families, and the need to contribute to the family's economy may outweigh any concern for their education. Consideration should be given to approaches that are appropriate to local circumstances, like: • Literacy and numeracy courses in parallel with vocational/skills training; • Traditional apprenticeship schemes; • Formal vocational training; • Opportunities for self-employment; • Ensuring the appropriateness and sustainability of skills training. 4. The Participation of Children A Child Rights approach to the social reintegration of child soldiers must incorporate their participation in procedures to facilitate their return to civilian life. Participation in any process requires access to reliable information. This is important in itself, but it is also a means of building trust and confidence in young people who may feel anxious and confused about their future. Thus, if demobilization is seen as a stage in social reintegration, efforts should be made to reach the children beforehand and to inform them that demobilization is planned, and how it is envisaged that they will be included in the planning. Without information, children may be prey to rumors and false expectations. Older children will likely have ideas for their own personal plans or situation, and a structure should be available to discuss personal or confidential concerns, and to make informed and realistic decisions that are appropriate to their age and circumstances. Further, children's participation should be actively promoted through strategies that enable the children to develop a sense of personal control and self-worth through contributing to and participating in the process of their social reintegration. 5. Health Children's experiences as soldiers indicate that many of them will have significant health problems. The effects of poor diet, unsanitary living conditions, untended injuries, and physical abuse will be immediately apparent. Not so obvious will be that some will have been affected by sexually transmitted diseases, with the risk of an elevated numbers of children being HIV positive. Girl soldiers may face added health complications associated with self-administered or incompetent abortions, unwanted pregnancies and miscarriages. Experiences of sexual abuse, both for girls and boys, can have significant social and cultural implications. This can have a negative impact on family reunification or social reintegration and means that related problems are often neither acknowledged nor addressed. Therefore, these issues must form a key aspect of planning of reintegration of former child soldiers. 6. Children in need of special care All former child soldiers could be considered as belonging to this category, but, given the children’s experiences, there will be some whose needs are particularly pressing. We need to consider what constitutes an appropriate response to children with special needs, but also what capacities are available to implement this response. This is of particular concern if children are not included in formal demobilization procedures, and planning includes emergency interim care.

50

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

The category of children in need of special care includes: • Children with disabilities; • Girl soldiers, in particular those returning with children of their own; • Children who remain separated from their families, including those separated at the time of recruitment; • Children whose families cannot be found; • Children who refuse to return to their families and communities of origin; • Children suffering from alcohol or drug dependency; • Children with psychological problems caused by, or exacerbated by, their experiences.

A return to normal life – key points • The involvement of government departments and local partners in program planning and implementation is vital. • Capacity building activities directed at developing and strengthening human resources can help to facilitate a return to normal life. • It is essential to establish criteria for protection and well-being of children in care of the community. • Daily routines help to normalize life, give children opportunities to learn skills, and build confidence and self-esteem. • Active participation of children, by involving them in planning and decision making, enables them to take responsibility for their own actions and future development. • It is important to create an open and accepting environment, and let the child set the pace, rather than focus on ‘trauma’ and its consequences. Although each situation is unique, and no one model can direct program responses, there are some issues that are likely to be common to efforts to re-establish normal life. These issues are: • Assessing child care needs: determining the numbers of children who will be immediately reunified with their families, the numbers for whom interim care is required during tracing, and the numbers requiring longer-term alternative care; • Establishing criteria to identify vulnerable families and to determine appropriate assistance to enable the reintegration of their children; • Identifying networks of social support at the community level, like: churches, mosques, schools, women's organizations, youth and community structures; • Identifying children with special needs, and paying particular attention to the situation of girl soldiers.

Re-establishing social and emotional bonds As they return to normal life, the impact of the children's experiences as soldiers may affect the re-establishment and development of social and emotional relationships. 1. The re-establishment of trust Children who have been exposed to violence and other traumatic experiences may over time lose their trust in others, and may have difficulty in differentiating between people who wish them well and others who do not. Re-establishing trust in others is a crucial task, upon which the possibility of successful recovery depends.

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

51

2. The re-establishment of self-esteem Normal family and community life enables the development of self-esteem. For child soldiers this can be endangered by separation from their families and the fact that they may no longer be valued by the community because of the acts of violence in which they have been involved. 3. Self-control Child soldiers have been encouraged or forced to continually activate and utilize their aggressive impulses. It is important to note that the aggression has also been sanctioned by those in command of the children. This can result in problems of self-control of aggression following return to normal, civilian life. Child soldiers have also been victims of aggression and humiliation, and this may similarly affect their capacity to control their aggression. 4. The re-establishment of identity The concept of identity is connected to one’s self-perception: the knowledge of who one is and how one experiences and defines oneself in a cultural, social, historical and spiritual sense. Included in our sense of identity is our set of values, skills, beliefs, and our role in the family. The losses that child soldiers have suffered and their experience of militarization pose particular problems for them as they seek to re-establish a sense of who they are and how they can fit into civil society. 5. The recognition of resources and strengths When working with and relating to children who have in some way been defined as “different” and “difficult”, attention is often drawn to problematic behavior, symptoms and signs of emotional disturbance and developmental deviancies. However, in order to assist children in achieving developmental tasks, it is necessary to recognize and encourage the development of children’s personal strengths and resources. They may have much to contribute and should not be seen only as recipients of any particular form of intervention. 6. The re-establishment of attachment Attachment describes a very close bond between persons. Children need close emotional attachment to feel secure, and to develop fully their potential as human beings. Close attachment is related to trust, the building of feelings of competence, and eventually a stable identity. Young persons and adults need close intimate relationships with at least a few others. Thus a very important task will be to help child soldiers develop the capacity for good relationships with others. Assistance in finding lost parents or other family members is crucial as well as helping the children to build friendships again, and to develop behaviors which favor positive interaction with others is equally important.

Rehabilitation Whether children are able to reunite immediately with their families, or are cared for within some form of interim care program, the term rehabilitation is frequently used to describe program responses directed to their needs. It can have many different meanings, from educational projects to clinical approaches to deal with the consequences of traumatic events. Those engaged with the development of projects and activities to normalize the child soldiers' lives should use the term carefully. Consideration should be given to its meaning within the social and cultural reality of the lives of the children, their families and communities, and its appropriateness within this context. One common use of rehabilitation emphasizes the need to “rehabilitate” children

52

L. Peters / Child Soldiers - Recruitment, Demobilization, Rehabilitation, Reintegration

because of the behavioural consequences of their participation in conflict. These are understood as the psychological effects of the traumatic events the children have experienced. Specific programs of rehabilitation within a therapeutic or medical framework In the development of therapeutic rehabilitation programs, thought should be given to points like: • Is the concept appropriate to the experience and conditions of life of the children, and the families and communities to whom they will return? • Who will make the decision to implement a rehabilitation program, and who will be involved in the process of implementation? • Which children will benefit from the program, and what criteria will be used to select them? • What will be the aim of the program, and how will this be explained to the children and their families? • Has any consideration been given to alternative strategies, incorporating, for example, skills and knowledge from within the community? The children themselves will have many worries and concerns, some of a practical nature, both about their past experiences and what the future will hold in store for them. The setting in which they can express such concerns requires careful consideration. Counseling the children could wait until their environment has been normalized and they have been assessed and are ready to talk about their experiences. It might be necessary to “unpack” the term trauma and talk instead about issues of suffering, loss, loneliness, terror and anxiety. Also the term trauma counseling can stigmatize the children and more neutral words could be used which focus on issues that may be troubling the children. Community members could be trained to hold supportive conversations in order that the children feel their concerns are accepted, and that someone is available to listen and to help them resolve their problems. Enabling children to reflect on their experiences and their implications is important. This is best conducted, however, with some practical goal in mind. For example, a child may have a particular problem controlling aggression. Practical strategies can be discussed with the child, setting particular goals, perhaps on a daily or weekly basis. The idea is to help the child to gain gradual control of the problem, to accept personal responsibility and ultimately to experience a sense of achievement that they have mastered a problem through their own efforts. Children can assist each other in achieving these goals, and their participation in this process should be encouraged. Traditional ceremonies and practices to heal or cleanse children can be important components in this process, and should be incorporated where appropriate. References 1 ARC is developed by OHCHR, UNHCR, UNICEF and Save the Children. For more information, please contact David Nosworthy, ARC-Project coordinator, [email protected], Phone: +41-22-919 2003 2 Cape Town Principles, 1997

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

53

8. Negative Effects of the NATO Bombing on the Mental Health of Children in Serbia Slobodanka GASIC-PAVISIC, PhD Faculty of Defectology, University of Belgrade, Beograd, Serbia

Yugoslavia was bombed by NATO during 1999. The bombing lasted permanently for 79 days. The flights of the warplanes were so frequent that the air emergency warning lasted for two or three days continuously, and emergency air warnings were repeated everyday. According to NATO official statements the bombing was directed just to the military targets, but many civil objects were struck (so called collateral damage) and actually the only safe places were the shelters. Since the parents had to work, day care for children was a particular problem. The preschools worked but some of them were damaged by bombing and moved to cellars and private houses. Through the help of humanitarian organisations, different kind of creative activities and psychological support was organised in order to help the children overcome the feeling of fear and uncertainty.1 Approximately 3,000,000 children lived under these traumatic circumstances. However, the consequences of the NATO bombing to the children’s mental health attracted only small attention from the experts and public. The bombing and its consequences are not a subject to talk about in Serbia. Is it all forgotten or just put away in the subconscious in order to save strength for the everyday hard life lasting for decades with a sombre perspective for the future? (“Is the memory bombed as well”, was the title of the comment published on the Internet in March 2005). However, it is possible that the silence has other causes besides the psychological.

Research – Findings on Level of Trauma in Children Looking for data about the posttraumatic effects of the NATO bombing on the children of Serbia I found only a few unconnected investigations, most of them not fully published. I will state here their main findings chronologically. N. Kapor-Stanulovic (Stanulovic, 2001) conducted research concerning the disturbance of the mental health of adolescents and adults during the bombing. By the end of last two weeks of bombing she had tested 368 subjects from the two cities in Vojvodina

54

S. Gasic-Pavisic / Negative Effects of the NATO Bombing on the Mental Health of Children

(Zrenjanin and Novi Sad in North of Serbia). The main finding was that more than 60% of subjects had expressed symptoms of posttraumatic stress, while the presence of depression and anxiety was significantly less observed. Marija Zotovic (Zotovic, 2001) investigated the frequency of PTSD symptoms in the children 2 months after bombing. The sample was 333 children from Novi Sad, 11, 14, and 15 years old. This research has shown as well that over 60% of subjects showed the signs of PTSD symptoms significantly present. One year after bombing, M. Zotovic (Zotovic, 2004) conducted research into details concerning the state connected with PTSD of male and female adolescents of 12, 15 and 18 years old (629 subjects in total). The object of the research was: (1) What is the level of posttraumatic stress disorder (PTSD) and depressive symptoms in children and adolescents a year after the NATO bombing of Yugoslavia?; and (2) What factors correlate with PTSD and depression level, in a way that they present risk factors for development of higher levels of symptoms? The main findings of the research are: - A year after the bombing, significant extent of PTSD symptoms (moderate and severe levels of disorder) exists in almost 60% of children and adolescents (59.6%). This result shows that the consequences persisted a year after the bombing, and that they could not disappear easily and quickly. - The symptoms of depression were significantly less frequent. They were registered in 18.5% of subjects. - Girls had greater number of symptoms comparing to boys. - The highest level of PTSD symptoms was revealed in the youngest group of subjects (12 years old), while the oldest group of subject (18 years old) had the highest number of depressive symptoms. Questioned about what was the most terrible experience for them during bombing the majority of them answered that it was the first day (59%) and after followed: the worry for the family members or other close persons (48%): when some particular target was struck ( a bridge, TV tower etc): the sound of the explosion and the ground shaking (40%). The research also revealed risk factors for development of PTSD and depression.’’For the prediction of PTSD level, a usage of specific coping strategies seemed especially important. The best predictor for higher levels of PTSD was a tendency for using social coping strategies – the need to talk with other people, to share the company of other people. It is assumed that more anxious subjects used social coping strategies, and later developed higher levels of PTSD, as the result of the anxiety. Likewise, it is possible that the subjects who sought social support were not satisfied with a response from their social network (because everybody was distressed), and therefore suffered more and had more symptoms. In contrast to social, usage of avoidant coping style was the predictor of lower levels of PTSD symptoms. This finding is in accordance with the results of previous studies, as well as theoretical statements in the field (Lazarus & Folkman, 1984; Folkman et al., 1986). Among personal characteristics, higher neuroticism appeared to be a risk factor for developing higher levels of PTSD.’’(Zotoviü,2004). M. Zotovic warns that is difficult to measure the psychological effects of bombing since that is a complex and multidimensional experience.

S. Gasic-Pavisic / Negative Effects of the NATO Bombing on the Mental Health of Children

55

In another research study, R. Marusic-Gasic (Marusic-Gasic, 2000) investigated the PTSD in preschool children one year after bombing. The research carried out at the Department for child’s health at VMA in Belgrade during 2000 year. The sample consisted of the parents of 128 children. The children were about 6 years old by the time of bombing. Since their fathers were engaged in military service, most of the subjects (32%) were used to live without them during bombing and just the small number of subjects (12%)had had their fathers with them. That fact increased the effect of anxiety and the feeling of uncertainty since they were worried about their fathers. Mothers were mostly with their children (76%) but some of them had to work (24%) and there children had to stay with neighbours or their relatives. One boy, 12 years old, from Belgrade, wrote: “Every night I was woken up by the sounds of the warplanes and missiles. Since my father was a soldier, I was the only male at home. Yet, my heart was trembling with fear and I was crouched all the time in the doorway with my mother and sister where we were waiting, clinging to each other, for the sounds of warplanes and explosions to stop”. During the air emergency, most of the parents (48%) did not go with their children into the shelters, only 9% were regular in their going into a shelter and the rest only went occasionally (43%). This kind of behaviour certainly was not safe but psychologically it was less traumatic for children, since they were able to sleep in their own bed, to be fed more regularly, to play with their own playthings and to be surrounded with people they knew. According to the parents’ statements, the children’s reactions to the air emergency signal and the sounds and detonations of warplanes and missiles were the following: 5% of subjects did not answer to the question, 49% showed signs of fear and uneasiness, 46% requested explanations or just continued with their activity. The manner of the children’s reaction was determined by the parent’s behaviour at that moment, depending as well on the part of the city or on the kind of apartment where they were living ( uneasiness was greater for the children in multystorey buildings). The findings showed that a year after the bombing more than half of the examined children had at least one symptom of psychotrauma and for 46.37% of children the parents had not observed any of the mentioned symptoms. 15.7% of children showed 3 or more PT symptoms as a sign of their moderate or difficult state of mental health. Among the children’s psychotrauma symptoms, generated during the bombing and observed at preschool children one year after bombing, were: -

Enforced fear of the separation from the parents (the child does not want to stay alone in the room and prefers sleeping in the parents’ bed ) - 35.5% Disturbed biological cycle– sleeping, nutrition (scared to sleep, waking up in the night and crying, refusing to eat, eating too much) - 15.94% Fear and shaking at any strong sound - 10.86% Disturbed behaviour (aggressiveness, irritation) - 5.07% Regressive symptoms – enuresis, tics, baby talk - 3.62% Three or more symptoms together -10.86%.

56

S. Gasic-Pavisic / Negative Effects of the NATO Bombing on the Mental Health of Children

A year after the bombing 33.3% of children (129 examined) talk often about the bombing, have the need for questioning , talk and mention the events connected with bombing, which means that the event is intensively present in their memory. Also, about one third of the children (32.5%) have been playing war games and bombing games (‘’ the post-war games’’). Four year after bombing , 30 of these children were tested again (Bejatoviü, 2003) and 60% of them still have the same symptoms of psychotrauma. The number of children having the group of symptoms (increased feeling of fear, disturbance of sleeping and appetite, over-exciting, enuresis, disturbance in speaking, tics) has increased (23.3%).

Protective Factors The two most important protective factors concerning the trauma caused to the children during the bombing were: 1. Staying in their homes instead going to the shelter which psychologically gave them the illusion of safety and keeping their every day schedule undisturbed (sleeping, resting and nutrition) 2. Parent’s presence near the child, what was not possible in many cases since the parents had to work or do military service. The author of the research R. Marusic, stressed the needs for implementing psychosocial programmes for children’s mental health protection in Serbia, particularly giving care to vulnerable children. However, very few of these necessary programmes have been implemented. Some of the actions were directed to in-service training of teachers in order to prepare them for giving psychosocial help to traumatised children. One such very successful psychosocial programs for teachers is being organised and implemented in Serbia by Foundation “Together” from Ljubljana, Slovenia. The effects of the NATO bombing on handicapped children During the bombing, handicapped children and their parents were particularly affected. The effects of the NATO bombing on handicapped children were direct and indirect. The direct effects of the NATO bombing comprise slow and/or regressive psychomotor development of the children and some additional disorders like epilepsy, stammering, etc. not existing before the bombing. The indirect effects of the NATO bombing include the disturbed psychodynamics of children’s' family life, suddenly impoverished families, and worsening quality of the institutional care for rehabilitation of the population (Stosljeviü, 2000). The negative influences of bombing on these children are multifold and appeared very quickly, according to a study carried out by Stosljevic (Stosljevic, 2005) the effects of which were observed already after 20 days. Stosljevic began to observe 72 moderately mentally retarded children two years before the bombing. The objective of the research was to follow up the effects of their rehabilitation on their psychomotor development for a long period of time. We have been assessing their

S. Gasic-Pavisic / Negative Effects of the NATO Bombing on the Mental Health of Children

57

development every six months, the last being organized with 43 available subjects twenty days after the beginning of NATO's aggression on Yugoslavia. The obtained results showed that their psychomotor development index have constantly been increasing till the beginning of NATO's aggression when, only 20 days later, it has gone down to the value recorded in March 1998. There are at least two reasons for the results obtained: the negative psychological effect of the bombing on the handicapped children and the understandable break in their treatment. The second direct effect of the NATO bombing was the occurrence of new, repeated additional disorders of the subjects researched. In the last controlled measurement the following disorders can be singled out: the majority of disorders (99.47 %) were from the domain of the motor activity expressed through their motor unrest, their changed behaviour (83.80 %), neurosis (83.80 %) and their vigilant attention (66.64 %). However, more drastic disorders like enuresis (30.08 %), facial jerks (30.08 %), and epilepsy (28.56 %) are more alarming. The author points out that ‘’ Epilepsy was particularly great problem due to the shortage of antiepileptic and a dramatic clinical picture that upsets in an already upsetting environment. The problem is exceptionally difficult if the attack takes place in a bomb shelter, during the air-raid danger, or to the sound of air-raid sirens announcing the danger.... Disturbed psychodynamics of children’s' family life seems to be among the worst. When you dislocate handicapped children from their own social milieu and put them in a bomb shelter to the sound of air-raid sirens with rules to regulate the behavior there which the children do not understand, they are obligatorily traumatized. That indirectly affects their families and the people in bomb shelters.’’ (Ibidem). To end, I shall recount a personal memory: During the bombing, I was working as a professor at the Preschool Teachers’ College in Belgrade. One of my girl students had the oral part of her graduate exam. During the exam we heard the sound of the emergency signal. I asked her if she wished us to stop the examination and go to a shelter. She wanted to finish the examination and we proceeded in spite of the sounds of explosions. After the exam was finished, I approached her and we shook hands. Then, I noticed that her hand was icy cold and her face totally bloodless. I will never forget that.

Final comment In this comprehensive and certainly not completely encompassing overview of the researches accomplished about the consequences of NATO bombing to the mental health of children in Serbia, I wanted to present the facts which can be useful for developing the strategy for helping those children. Theoretical interpretation of the researches presented here was already given by the authors themselves, and interested readers can find it in the references. The common finding of all of those research studies is that the great number of children in Serbia had two or three of the symptoms of stress related to disorders as a consequence of the NATO bombing. This makes the children’s mental health susceptible to future disturbing life circumstances - and those are the conditions in which children live in Serbia nowadays. However, it has to be kept in mind that the psychotraumatic consequences are not the only ones which affected the children in Serbia and affect them further in connection with the NATO bombing. Since the child’s resistive mechanism was weakened by the

58

S. Gasic-Pavisic / Negative Effects of the NATO Bombing on the Mental Health of Children

stress during the bombing, children are exposed to the increasing risk of malignant disease whose number increased significantly in Serbia after the bombing (Stanimirovic 2005). Meanwhile all the authors mentioned showed that the consequences of the traumatic experience to the children are long-lasting and that is necessary to give to those children psychosocial help and support – but to date very little has been done in that field. I hope that the warm understanding, compassion and good will of the World Movement of Mothers will contribute to the fact that children all over the world stricken by war will more easily overcome their traumas. Note 1

For example, there were organized youth gatherings – birthday parties and amateur theatre performances in the shelters, professional theatres worked free of charge during the air strikes and every day in the city plazas were organized lunch-time concerts. There was a totally unrealistic - and unforgettable - sight of thousands of young people (and not only youth) in the plaza singing and dancing with the warplanes flying over their heads. The purpose of those concerts was certainly political but it was also one of the strategies for coping with stress and for relaxation.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

59

9. Editor’s Note: Dr. Speckard and Dr. Akhmedova’s work provides thought-provoking insight into some of the possible factors contributing to a traumatized adolescent’s descent into terrorism and martyrdom. Its narrative style encourages future examination of their findings in more detailed research studies.

Mechanisms of Generating Suicide Terrorism: Trauma and Bereavement as Psychological Vulnerabilities in Human Security - The Chechen Case Anne SPECKHARD, PhD. Adjunct Associate Professor of Psychiatry, Georgetown University Medical Center, Professor of Psychology, Vesalius College, Free University of Brussels and psychological consultant of Advances in Health & Khapta AKHMEDOVA, PhD. Institute of Psychology Russian Academy of Sciences, Moscow Research Institute of Psychiatry, Russian Ministry of Health Since the dissolution of the Soviet Union, Chechnya has unsuccessfully sought independence from Russia in two wars on Chechen territory. The first occurred in 19941996, and the ongoing war started in 1999. Russian military forces currently occupy the area, with numerous and well-documented war atrocities and human rights violations by both sides. Indeed one Russian policy analyst commented privately that the Russian forces currently in Chechnya are poorly controlled, chaotically operating there, and attracting to their ranks the lowest level criminals who wish to operate in an arena of widespread impunity. Terrorism, particularly suicide terrorism, as a strategic tactic has been introduced into the Russian/Chechen conflict over the past decade, imported through Al Qaeda and other terrorist networks. The idea of tempered revenge has a strong foundation in Chechen culture. When a family member is harmed or killed it is the responsibility of the family members to seek out the evil-doer and make him or her pay accordingly. However, this ideology of revenge is strictly codified and does not normally spread beyond seeking out the harm’s originator and repaying his or her evil deed. With widespread war traumatization, bereavement, and the importation of a terrorist mentality, this mindset is changing. Rather than being limited, in the minds of many revenge is becoming generalized. Indeed, Akhmedova found in her

60

A. Speckhard and K. Akhmedova / Mechanisms of Generating Suicide Terrorism

study of over 600 clinical subjects who had undergone war traumas that those who had the highest levels of posttraumatic effects had undergone a transformation in this regard. They no longer regarded revenge as a duty to find and repay in kind the person who had harmed their families. Instead, the subjects broadened their desire for revenge to wishing to hold an ethnicity responsible for the actions of some of its members. Retribution against members of this ethnicity (i.e. the Russians military or civilians) was both sufficient and acceptable. 2 War-harmed youth appear the most vulnerable to the fusion of revenge and terrorist ideology spreading through the region. This paper draws on clinical case examples from the practice and research interviews of the authors, and examines the vulnerabilities in youth who are drawn to terrorist activities. The paper focuses on prospective suicide terrorists and makes recommendations regarding preventative actions. Trauma and Grief Traumatic loss is common during war. Nearly everyone in Chechnya has witnessed and been subjected to traumatic events. However when the trauma hits close to home, these events are riveting and life changing. Researcher Janof-Bulman posits that in normal times and given nurturing upbringings most individuals hold what she calls world assumptions. Three fundamental assumptions that according to Janof-Bulman3 generally go unquestioned and unchallenged are: benevolence, meaningfulness of the world, and a sense of self worth. The experience of psychological trauma (i.e. an inescapable, horrifying and terrifying experience which is life threatening or threatens serious injury, or in which a person witnesses or learns of the death or serious injury of another), however, often so challenges these assumptions that they are completely shattered, and unable to be rebuilt. Indeed reparative psychological work with trauma victims often involves rebuilding a cognitive frame capable of “holding” the emotional and cognitive aspects of the traumatic event. At age 23, S journeyed to Moscow as part of the Chechen terrorist group that overtook the Dubrovka theatre. The group held more than 800 people hostage for fiftyeight hours. S was in Grozny in 1995 during the onset of the second Russian offensive against the Chechens. Without money and transport to flee, he and his family hid in a cellar during the bombings. At some point during the onslaught, S’s mother left the shelter to retrieve water for her family. Though she was mortally wounded, she was able to return to the family’s shelter. At age 17, S sat powerless for four days, witnessing his mother’s death. Because of the ongoing violence, his family could not even bury their mother properly for some time after her death. Eventually, they dug a grave for her in the courtyard of their apartment block. S was deeply traumatized by the death of his mother. He began to isolate himself from the family. This only worsened when his father shockingly remarried in a rather short amount of time. Traumatic events are by definition individually defined, but they are overwhelmingly horrifying, terrifying, and fraught with death and/or the threat of death for the person experiencing them. When a person is severely traumatized, it is normal that he or she cannot take in the enormity of the experience he has undergone at once. His or her view of the world is dramatically altered; normalcy no longer exists. Frequently, his or her mind is unable to allow the full impact of the event into consciousness and the traumatic

A. Speckhard and K. Akhmedova / Mechanisms of Generating Suicide Terrorism

61

memory exists in a highly charged sensory state triggered in flashbacks, nightmares, and arousal states that occur with reminders of the original event. Part of healing from a traumatic event is finding a way to allow this highly charged memory to be processed into normal memory in a manner that creates new meanings, behaviours, and outlooks that are able to process the highly charged and painful emotions that were experienced. For some, healing occurs in fits and spurts as avoidance strategies are enacted to keep the traumatic memory at bay until little by little it is accepted into the conscious narrative of one’s life story. For others, an active seeking occurs, in which the individual searches for a new frame in which to place the traumatic memory in context of one’s life that gives it meaning which is acceptable versus overwhelming in grief, shame, fear and sorrow. For these seekers of a new cognitive frame, the terrorist recruiters are a grave danger. Seeking Meaning after Trauma Nearly every trauma survivor seeks to place his or her traumatic experience within the context of his or her past, present and future. For some, the shame, fear, guilt and danger that the event posed make this a very difficult thing to do. For instance, sexual abuse survivors are often so terrified by the sexual advances of adults toward them that they will construct a reality in which they blame themselves for having “seduced” their abuser. By placing this negative label upon themselves, they are able to gain a sense of control over what happened to them. For a survivor, it is often far more acceptable to believe that one was “evil” or “seductive” as a child than to believe that it can happen at random, unpredictably, outside of one’s willing or desire. It is always possible once reform this selfcognition or to block out these unacceptable sides of the self, but to accept a random, unpredictable, and terrifying world is a much worse alternative. The same is true with victims of war. When S’s mother returned mortally wounded, he was powerless to help her. He couldn’t even bury her without a shameful delay. Later, his father seemed to forget her, marrying again. S had to find some way to deal with his grief, guilt, anger, and shock over these events. He found himself drawn to a mosque espousing radical and violent ideologies. There he found other father figures who guided and taught him. He was drawn to Allah, the ultimate father figure, one who neither abandons nor forgets. S lived with the traumatic recollection that he could not save his mother and that his needs may have contributed to her death. However, he learned there was a way to come to peace with these painful emotions. He could avenge her death. At the mosque, he was taught jihad martyrdom was a way he could find to right the world and to regain a sense of control by enacting social justice. He could go to Moscow and do there what had been done to his family. He would have to give his life to achieve this goal, but it was a small price to pay for the peace it would give him. It is likely he found a way to rebuild his inner narrative, and in this life narrative, his mother and all the others beside her would not have died in vain. He would ensure it. Her death and his would be meaningful. He and the other suicide terrorists would take the death they experienced in Grozny to Moscow and make sure the Russians had a taste of it.4 Maybe then his people would be freed, and maybe then the Russians would withdraw their forces. If there were enough brave men and women, they could give their lives for their country and fight back for justice. In doing so, they would gain a sense of control and wash the shame of powerless witnessing off themselves. Even in their dependent states, they could

62

A. Speckhard and K. Akhmedova / Mechanisms of Generating Suicide Terrorism

do something that would make their lives honourable and meaningful. S had found a way out of the traumatic cellar where he had watched his mother die. The Tasks of Adolescence and Terrorism Recruitment The tasks of adolescence are difficult in normal times, and more so in times of war. During the stage when an adolescent is often still seeing things in formal operations versus abstract thinking, the experience of war can complicate things greatly. Traumatic events often engender a primitive thinking process in which perceptions are narrowed to a concentration on the threat and, if possible, fighting back or escaping it; all else often recedes from conscious awareness with a great enough threat. Likewise, teens typically go through a process of alternating between dependency on and rejection of their parents. While moving away from the family and toward independence, the young person typically begins to see the weaknesses of his or her parents and turn to peers and others in attempt to distance themselves. When war weakens, threatens, and renders parents powerless, these normative tasks are intensified in their difficulty for adolescents. When there is no clear path to adulthood and little to hope for in the future other than to avoid death, fears coupled with the need to achieve developmental tasks can be overwhelming. Terrorist recruiters typically understand this struggle and offer a powerful family for the confused and frightened adolescent. Bonds of loyalty are forged in the form of Muslim “brotherhood.” This often achieves the developmental task of leaving parents, although in a unfinished manner, as dependencies are transferred from one to the next “family”. Then, escalating tests of adulthood are offered, one of which might be placing a mine where Russian armoured trucks typically drive and exploding the mine. For those who successfully ascend the ladder of commitment and violence, the opportunity to go to a jihad training centre is offered next. In this case, the teen typically separates himself completely from his family of kin, and joins the family of “Muslim brotherhood”. He learns to carry out a terrorist act, and trains in the mission of martyrdom. He is shown pictures and films of atrocities toward children, women and elderly men. His anger and his longing to enact justice are kindled, while the “family” ties are cemented through singing about Jihad and training with other recruits. In many ways, this experience differs only slightly from typical military “boot camp” training in which military recruits are completely removed from their own families the brotherhood of the military is forged by group experiences, and the values of loyalty and self sacrifice are instilled. Many young U.S. military recruits will openly admit that the service functioned as a family for them when they left troubled homes and were in need of guidance to grow into responsible adults. Recruitment of Bereaved Children In Chechnya, militant madrassahs often recruited young children from families in which the father has been killed. A mother having trouble supporting her children is often quite grateful that her children can receive education and at first may not understand the price her child will pay to receive such an education. In this case, it is relatively simple to play upon the vulnerabilities of the mother and the child. Without a father, the child is

A. Speckhard and K. Akhmedova / Mechanisms of Generating Suicide Terrorism

63

eager for a father figure. Likewise, when sympathy is extended for their loss, strong bonds are forged. Then, it is relatively easy to steer the child beyond traditional views of the duty to avenge the death of one’s parents into generalized views of revenge, and from there into the tactics of terrorism. Terrorism Recruitment and Traumatic Stress Responses Victims of traumatic stress generally feel very alienated. Realizing that their experience is personally overwhelming and incomprehensible, they know not to expect others to be able to be able to listen, understand, or bear their pain with them. When surrounded by other trauma victims, they often learn that to speak of their own pain only triggers reactions of hyperarousal, flashbacks, anger, avoidance and fear in others similarly traumatized. In attempts to calm their flashbacks and hyperarousal, they will often avoid things that previously brought pleasure and isolate themselves from people and activities that may trigger negative emotional states. They are typically searching for meaning and means to weave the traumatic event into their life narratives. They search for a way to understand and accept what happened, and what it means about the world, the self, and one’s place in the future. Trauma victims often feel a sense of a foreshortened future. They no longer believe the world is benevolent or predictable, or that they deserve not to have chaotic evil events befall them. They know that, no matter how much self esteem they previously had, no matter how much control they thought they had, and no matter how good the world seemed, it can all come crashing down in a dreadful moment. Trauma victims often suffer survivor guilt. They cannot make meaning out of the idea that others died when they did not. They are pained by their powerlessness to keep their loved ones alive, by their inability to act in frozen terror, or the failure of their actions to make a positive effect. Some are depressed and welcome death. All are seeking ways to find an acceptable meaning to assign to their experiences that allows them to re-enter life in a way that makes it possible to live without a constant state of emotional pain. L is likely such a person. When L was 12, her father was killed in the war. Her teacher reports that L immediately went into mourning, withdrawing from the others. She seldom smiled and never laughed. In time, she was drawn to the Whabbit beliefs and began to dress modestly in the hijab. For three years this girl withdrew from her normal school girl life, dutifully but robotically performing her school tasks while searching for a way out of her pain. On her last day of life, she went to school and told her classmates and teachers goodbye. She came to her teacher and begged forgiveness for everything bad she had done, making it clear in retrospect that leaving this life cleansed of guilt was very important to her. That day she left with a terrorist peer – another girl – to drive a lorry into the courtyard of the local Russian commandant’s office, break through the concrete barriers, blow up the office, and martyr themselves. L appears to have been propelled by the terrorist organization to embrace what she came to see as a meaningful death, which to her was more acceptable than the pain of her traumatically bereaved adolescence. While her teachers had noticed her withdrawal, isolation and changed behaviours, they had not realized what was occurring in her foreshortened life.

64

A. Speckhard and K. Akhmedova / Mechanisms of Generating Suicide Terrorism

Combating Suicide Terrorism Recruitment in Vulnerable Populations Recognizing the general, trauma-related, and bereavement-related vulnerabilities in adolescents, treatment professionals can be equipped to make programs to combat the influence of individuals who prey upon adolescents to steer them toward terrorism. Indeed, it is possible to combat terrorism recruitment, but it requires outreach and support on the community level. Unfortunately, the militant mosques are currently superior to any governmental or nongovernmental group in terms of community connectedness. While war atrocities, human rights violations and suppressed struggles for independence are all very real stressors, terrorist jihadists who prey upon vulnerable populations can be deterred. Alternatives to turning to militant religious organizations to find meaning, solace, and community following traumatic bereavement should be offered. While religion is the means by which most individuals assess life and death, militant fundamentalism is not the only religious answer. Likewise, recognizing the normal profile of traumatic stress through community wide education, parents and peers can be taught to help identify those individuals unable to move through the normal posttraumatic phase of avoidance, isolation, and alienation. With this knowledge, they may be able to identify individuals vulnerable to terrorist recruitment. Schools and clinics can offer treatment to traumatized individuals to help them find meanings other than offering one’s life in martyrdom. In the after-effects of a war torn and conflict ridden environment, programs should be introduced into schools and medical clinics that funnel troubled traumatized youth into group and individual psychological treatment. Naturally the programs would be expensive, but so is doing nothing. As long as youth continue to be vulnerable to terrorist recruitment and terrorist organizations continue to desire to wage war, these youth will be drawn to and selected into martyrdom. They see it as the only current treatment available for them to overcome their traumatic bereavement experiences. Certainly we can do better than that. References I Akhmedova, K. (2004) Unpublished doctoral thesis. 2 Janoff-bulman, R(1992) Shattered Assumptions: Towards a New Psychology of Trauma. New York free Press 3 For various descriptions from the point of view of the hostages of the Chechen terrorist takeover of the Moscow Dubrovka theatre in which this individual participated, see: 4 Speckhard, A., Tarabrina, N., Krasnov, V. & Akhmedova, K. (2003) Observations of suicidal terrorists in action: The psychology of suicidal terrorism. Journal of Terrorism and Political Violence. (In press). 5 Speckhard, A., Tarabrina, N., Krasnov, V. & Mufel, N. (2003) Stockholm effects and psychological responses to captivity in hostages held by suicidal terrorists. Unpublished Manuscript 6 Speckhard, A., Tarabrina, N., Krasnov, V. & Mufel, N. (2003) Posttraumatic and acute stress responses in hostages held by suicidal terrorists in the takeover of a Moscow theatre. Journal of Traumatology (In press).

7 Speckhard, A. Soldiers for God: A Study of the Suicide Terrorists in the Moscow Hostage Taking Siege (2004) in Mcternan, O.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

65

2. A Comparative Study of Different Developmentally Grounded and Culturally Sensitive Mental Health Approaches towards the Treatment of Trauma in Children and Adolescents Roundtable Identifying and analysing the mental health indicators of trauma - including emotional, relationship, behavioural, somatic and cognitive components - Different approaches towards the professional treatment of trauma in children and adolescents

William YULE MD, PhD Professor of Applied Child Psychology University of London Institute of Psychiatry UK

My experience in refugee camps on the Pakistan border, leads me to make this point: - We need to differentiate between a single traumatic event occurring in a normal settled life, and incidences of multiple stresses. The latter given the context of terrorism and conflict is the subject of this Workshop. I stress this because the literature tends to relate to single traumas. The reactions of children, when they have been subjected to violence, are many and varied. These are the sort of thing children told me about in the camps. The problem is that these reactions do not fit into the diagnosis of PTSD – individual behaviours and emotions such as anxiety, depression. We know quite a lot about children over the age of 8, because they can fill in questionnaires and so on – it is quick and cheap to do. But it is a lot more work to observe and interview younger children. Methods of diagnosis tend to be adult-centric and can overlook key aspects of a child’s behaviour, avoidance. We need, therefore, much more research on how children react in these stressful situations. We must pay close attention to the role of parental stress. Children are very sensitive to their parents’ distress. If a child and parent are involved in the same incident and the child starts talking about it, the parent gets upset – this often enough to stop the child ever mentioning it again, because the child does not want to upset the parent. It is worth remembering this, because so many studies of child trauma use the parents and teachers as informants; they do not ask the children themselves about their reactions.

66

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

It is our job to listen to the children. A recent study on disasters concentrates on the mother’s distress – a lot in it did not make sense to me, but it took me a while to spot what the problem was: Avoid using the mother as a judge of her child’s state of mental health – it can distort the validity of the evaluation. Upset mothers saw their children more upset than they really were, got more upset, made the child more upset and so on – it just extends the impact of trauma. When we repeated this study in Bosnia only using the children, it was possible to be far more accurate. Direct exposure to the traumatic event is also a major factor. PTSD is not a temporary problem. This came out very recently in a study of people involved in the Aberfan disaster 33 years ago where a slag heap collapsed onto a school in Wales. 29% of those traumatized still met the criteria for PTSD – It is not a transient thing – which is why we must take it seriously. When I first worked in Bosnia 4 years ago we were told to gather information from parents etc. When doing our assessment we encountered a lot of resistance from people working with the children – How would we gather the information? What would happen to the information? Is it just for a PhD? There was a lot of suspicion. There were many hundreds of well-meaning NGOs working with groups of children, but they were not evaluating what was said to them at all. UNICEF said we had to have evaluation. We trained 20 teachers in a 2-day seminar. Each teacher worked with 60 kids. The plan was that over 10 years, 600 children could be assessed. What we still need is more information about how the children’s adjustment is changed by psychological intervention. Not everyone agrees that it is appropriate to make a diagnosis of what is after all a very human response. Not only one discipline is involved in describing very clearly what is happening, how children are behaving. When we consider crisis intervention, we have to consider it in the context of the large groups we work with - we hear very moving descriptions, but only two interventions have a reasonable evidence base: 1. Behaviour therapy, including prolonged exposure and 2. EMDR Observation and assessing. These two treatments can be offered to many people because non-mental-healthprofessionals can be trained for this treatment.

Howard J. OSOFSKY, MD., PhD Professor and Head Louisiana State University Health Sciences Center Department of Psychiatry New Orleans, USA I should like to raise other issues of treatment: Close studies at every step of the way are vital – sometimes what seems to make common sense often does not. When we look at the literature on critical stress de-briefing, which is a popular intervention, there are serious questions about the validity because despite seeming logical and being popular, people were not gaining significant benefit – some improved, but some worsened due to the intervention. So I would be suspicious about recommending EMDR.

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

67

We need to look more closely at the benefit derived from different methods and timing of intervention. After 9/11 it was not appropriate to go straight in after the traumatic event applying cognitive behaviour therapy – victims needed a more supportive, community approach in the therapy than when we were treating a more discreet group of symptoms. It is a question of symptoms v. the diagnosis. When we look at parents’ reactions, there is a tendency to find parents reporting fewer symptoms in their children than do the children themselves... How much of this is the normal parental reaction in wanting to see our children performing better in difficulties? How much is it children protecting the parents and identifying with the parents’ trauma and not wanting to add to it? Children being ‘brave soldiers’ and reporting fewer traumas to their parents. How much is the parents’ own anxiety or depression related to their own difficulties in how they view the children even as good parents? How much are other societal concerns in play? – Is it safe to talk to people? – This is one of the things that often comes up in conflict situations, such as in Afghanistan where there have been deaths and loss of limbs as reprisals. So there is concern that if you say something then something will happen to you, you are putting your family group or community at risk. People are wary of speaking to strangers. We as therapists must be aware of this as we come into complex situations. One of the other issues is the prior history: Not only people who have experience of prior trauma will be in some ways more protective and predisposed to a re-awakening of symptoms, but also those who have a prior history of mental health problems will be more prone to develop problems after a traumatic episode. Some of the other issues were brought up earlier: After hostilities are over, what is the state of the community? What is the issue of refugees and immigrants? What is the issue of trusty in the government? How is the leadership of the government functioning? Do people have confidence in what is going on in their community, in their personal world? Another issue came up in the thoughtful and profound presentation on child soldiers – how difficult it is in countries, such as Mozambique, where the children are taken as soldiers and forced to kill family members, then when they get older and rebellious they will be crippled or blinded before they go back into their communities – those who survive. How different it is from the countries where the children of a somewhat similar age are ideologically a close part of the movement. These are issues of which we must be aware in our work. I would stress also that there are age-specific reactions. In my work with close colleagues in Israel - and other developed countries – they say that the initial immediate response is good – they talk about the excellent hospital response, the mobilization of the people to get on with their lives, the hope, the courage, the altruism, but the response to the long-term symptoms is less good. Studies are being done on the long-term effects – one sees higher incidence of mood and anxiety symptoms in school-age children – which would be expected in people living in an on-going assault of incidents. I stress that because there are things that each of us within our own culture would not look at in the same way. Being mindful of protecting the population and the culture may not always give us a clinical picture of the variety of experiences. For this reason therapists must be aware of cultural considerations – for example, what may be expressed and what may not.

68

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

Finally there is the issue of medication in the cultural context – when medication is appropriate, how to make sure that the practioners have an adequate knowledge of the cultural base model of the use of medication which could relate to levels of dosage.

Igor SKODACEK Mudr, PhD Klinika detskej psychiatrie Detskej fakultnej nemocnice, Bratislava, Slovak Republic

The phenomenon of group violence has been presented throughout history and is an important aspect of the last century. Violent behaviour presents a risk phenomenon for the entire human society. The natural base of society is family life; for this reason, it is the most important element of education. Family relations are the first ones and contribute to individuals’ formation of basic manifestations, habits, language, and moral habitude. Hereby we can find a possibility for deformity of personality, the natural development of a child, his or her morality, conscience, and justice. The signs of hostility and animosity together with all forms of violence may occur within the family, from typical psychic tyrannical maltreatment up to lethal physical violence. Home violence is more often an issue than we suppose. If this violence occurs, it has the tendency to graduate. The relationship exists between trauma related factors in children experienced not only during domestic violence, but also during war and so called PTSD reactions. The current denomination posttraumatic stress disorder (PTSD) points to our belief in stress as a cause of mental disorders. PTSD is pervasive anxiety disorder that follows exposure to stressful events. PTSD has three cardinal sets of symptoms. First, those suffering from PTSD re-experience the trauma (including memories, nightmares and/or flashbacks). Second, they avoid internal or external cues associated with the trauma. Finally, they experience increased arousal (including insomnia, irritability, impaired concentration and hyper vigilance). The duration of disturbances must exceed 1 month, and it should be associated with significant distress or impairment. Recovery from PTSD regularly occurs during the first year. However, approximately 20-25% of the survivors of severe traumatic events may suffer from chronic PTSD. We can specify causes of PTSD that range in duration and intensity, from traffic accidents to war exposure or holocaust. In the Child Faculty Hospital in Bratislava sixty maltreated children were registered over a five year span. From seven outpatient pedopsychiatric departments, we received the questionnaires on CAN syndrome and we have identified 374 children with this syndrome in a ten-year period. However, forty-one casualty wards exist in Slovakia, meaning that the sample could predict 1770 affected children. Only one thirtieth of cases are pedopsychiatrically examined, suggesting that 53,100 of Slovakia’s 1.4 million children (or approximately 4 %) could be affected by CAN syndrome. Some biological features associate PTSD with other mental disorders. Comorbid panic disorder was found in 13 to 19% of PTSD patients. Anxiety, dissociation and flashbacks can be elicited in PTSD patients by experimental procedures (such as administering yohimbine or lactate) that provoke panic attacks in patients with panic disorder. For this reason, we can assume a role of the locus coeruleus-norepinephrine “alarm” system and predict a positive effect of anti-panic medication on PTSD symptoms. In many cases, major depression in PTSD patients is diagnosed. It resembles depressive symptoms listed in the DSM-IV as “diminished interest,” “restricted range of affect” or

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

69

“sense of foreshortened future.” We can apply similar treatment with antidepressants and MAO inhibitors. The specific view on PTSD is the “opioid” model, which is based on the recognition that opioid neuromodulation is responsible for phenomena such as stress-induced analgesia and amnesia. Traumatic remembrances (‘spomienky’) usually consist of sensory and emotional states. After stressful situations, we may find higher levels of corticosteroids on receptors of hippocampal neurocytes. They change normal functions of the hippocampus and coding of time and space. Traumatic remembrances are in the form of sensory events such as flashbacks (van der Kolk 1997). Here is the low correlation between the content of traumatic remembrances and reality of physical, psychic sexual experiences or punishment. In emotional memory, the acquisition of fear conditioning is mediated by the subcortical path. This includes the sensory thalamus and the lateral and central nuclei of the anmygdala and thalamocortical pathway. Emotional memories may be stored “forever” at subcortical levels of the brain. Successful treatment of PTSD may not involve an eradication of traumatic memories but rather an enhanced control over previously acquired fear responses. Also, repeated processing of distressful recollections decreases the threshold for neuronal transmission of similar signals up to an irreversible cycle of spontaneous repetitions with gene expression, new protein synthesis, and neuronal spreading. This leads to the irreversible modifications of synaptic conductivity. These neuronal changes may be later expressed as PTSD. It is the kindling theory of PTSD. Studies of the hypothalamuspituitary adrenal axis have shown a decreased epinephrine/cortisol ratio, elevated urinary catecholamines and increased dexamethasone suppression in PTSD. Findings of increased serotonin receptor affinity imply that serotonergic neurotransmission may play a role in PTSD. Therefore, the therapy with SSRI is effective to some extent. Studies on antidepressants suggest that these drugs sometimes improve intrusion and avoidance as well as depression, insomnia, and anxiety. No study has presented the full remission of PTSD symptoms yet. In PTSD the dopaminergic brain systems are also involved. Yehuda et al. (1992) found an elevated urinary excretion of dopamine in Vietnam veterans which correlated with PTSD symptom severity. In some cases, therapy with neuroleptics is also effective. Studies on benzodiazepines have produced different results. Several investigations described a specific effect of alprazolam on intrusion and avoidance, despite a modest effect on anxiety. Clonazepam and buspirone improved sleep and reduce nightmares, flashbacks and panic attacks. Open trials indicated that the mood stabilizers such as lithium, sodium valproate, and carbamazepine reduce irritability and improve impulse control. The pharmacological treatments require a prolonged period, approximately between four and eight weeks, to become effective. Pharmacotherapy alone is rarely sufficient to cure PTSD. Therefore, the psychotherapeutical approach is applied. The various psychotherapeutical advances in child psychiatry are in the form of play therapy. The core behavioral conceptualization of PTSD identifies classic conditioning as the mechanism linking the symptoms of PTSD to the precipitating trauma. Increased responses to cues reminiscent of the trauma are followed by operant conditioning. Perception of controllability and predictability and the subsequent attribution of threat are central to the development of the conditioned responses involved in PTSD. Such perceptions of trauma should be addressed in therapy along with desensitization (gradual re-exposure to the conditioned stimuli-cues or flooding what is massive re-exposure to the cues). Prolonged exposure to cues had greater efficacy in reducing PTSD symptoms. Maginal

70

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

desensitization was better in children; it was associated with reduction in nightmares, flashbacks, muscle tension and readmission rates. Also, brief dynamic therapy, hypnosis, produced measurable improvement. Desensitization of one traumatic incident does not extend to the other traumatic incidents from the same event. From the psychodynamic point of view, the therapy should include ego-supportive maneuvers, address vulnerability in character structure, and involve the therapist in the role of participants rather than neutral observer. Based on our experiences, empathy is crucial in the psychotherapy of children. This we can apply in group therapy and family therapy. PTSD patients often perceive their life experiences as fundamentally different from nonvictims. Alienation, isolation, helplessness and mistrust reduce PTSD patients´ interpersonal and social competence. Therefore group therapies have a major role in the comprehensive psychiatric treatment of PTSD. Expression of violence, fear, suspiciousness, or tension within families of PTSD patients may extend to future generations. Family members’ reactions may reciprocally exacerbate the patient’s condition. Hypnotic induction and other suggestive techniques are used especially in the treatment of combat stress reactions because they improve avoidance and distress. Hypnosis for adolescents must be used carefully due to possible development of severe dissociative states. In Slovakia, we prefer to hospitalize children with PTSD symptomatology, often in response to depression, substance dependence, suicidal behaviour and violence. We use a variety of interventions such as group and milieu therapy, individual therapy, counseling sociotherapy or pharmacotherapy. The length of hospitalization varies and is up to 2 months. After hospitalization, rehabilitation is necessary for concentration to work, to learn, or rehabilitate the sports skills, and so on. To draw conclusions, we can say that it is necessary to support the superior effectiveness of early treatment, whether pharmacotherapy or cognitive-behavioral therapy. Every treatment modality which has had success can often be of great significance for the patient. Evidence of synergetic effects of pharmacotherapy and psychotherapy has been reported in up to 70% of the patients (Bleich, Siegel 1986). Patients with PTSD can expect to receive substantial help from therapists but probably not a definite cure. This is also the problem for self-help, religious organizations, non-governmental institutions and municipal authorities.

Armine GMUR KARAPETIAN., PhD Center for Psychological Services, Yerevan, Armenia My experience with traumatized children dates from the devastating earthquake of 1988 in Armenia. 5,000 died, 500,000 were made homeless. The first psychological centres in Armenia date from that time – we did not have any psychological centres or hospitals. It was a very difficult period and it needed great courage to create psychological centres in Armenia at that time. The earthquake was a natural disaster, but only 18months – 2 years later Armenia was involved in war with Nagorni Karabakh. It was also the period when the Soviet Union collapsed – the whole system collapsed. ‘Big Brother’ Russia could not give any help because Armenia wanted to be independent. So, different socio-economic factors made the situation even more difficult.

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

71

The earthquake caused mass traumatisation. There was a general sense of insecurity and helplessness. There were several elements: 1. Feelings went back to the history of our nation, particularly the genocide – this came up in all the therapy sessions – “We are a punished nation”; “We are helpless”; “Worse will happen” – there was a real expectation of future incidents. From a cultural and political viewpoint it was difficult to help. There was little trust towards the foreign professionals who came to help – “How can they help us if we have such a traumatic history?” 2. The role of the child in the family – Armenians think families are child-centered, but the paradox was that adults were not sensitive enough to a child’s trauma. Adults were too occupied with problems and their own trauma – the children’s pain was ignored. They did not help inside families – it was usual to hear from mother, father, grandparents that if a child is showing certain symptoms, they were not identifying them as the symptoms of a traumatized child, but rather as the normal behaviour of a child whose mother has died and so on. It was rather sad, and made artificial difficulties to helping children. 3. The strong role of the mother – another paradox. In our culture, the mother’s role is strong, but in the family the father wields the power – so this created more difficulties. 4. Young children (under 7 years) were not told the truth about the death of their parents – “They have gone to Russia”; “They are working in Georgia” So two or three years after the earthquake, children were still living the nightmare – “Is it true? Is it not?” Children want to see the grave of their parents. Their need to live out their grief was denied them. 5. We still had the Soviet ideological heritage. We know very well that religious belief – in our case Christian – helps overcome the grief and losses, but at that time the Church was not exactly forgotten, but the values were absent. We were still in the old Soviet tradition. Armenia suffered the multi-traumatisation of earthquake, war and the collapse of the political, social and economic system. Psychologists who came there shortly afterwards noticed that the latter seemed to be creating a sense of depression and helplessness, particularly amongst the male population. We love our children very much, but it was significant that after the earthquake there was no respect for the feelings of children. The country was at war, and there was no respect for a child as a human being, a social, emotional human being. It was not considered that a child was part of life, experiencing everyday life’s influence on him.

Latéfa BELAROUCI., PhD Sidi M’Hamed Health Department, Algeria; Algerian Red Crescent Contrary to the compartmentalized Slovak approach, in Algeria we use a more global, psychodynamic approach to psychotrauma. When a traumatic event happens, whatever its cause, there is a breakdown of ties – the traumatic event causes a rupture. These might be community ties, where houses are destroyed, schools and mosques burnt – these are the reference points for an individual’s identity which have been attacked.

72

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

There is a rupture in family ties, when a parent or family member is killed or reported missing – there is the question “What happened to him?” “When will he come back?” When there are earthquakes, floods, mass murders lots of parents fled abandoning their children. The purpose of our approach is to the rebuild the ties – the tie of the child with its community, the ties of the child to its family. Identifying local resource people On the community level, the first step is to find resource people with whom we can work – whatever the profile of that person may be – mayor, teacher, social worker, imam from the mosque….We have put together a network, based on the principle that a psychologist or psychiatrist treating a traumatized child cannot work alone, because it is not the child alone who is affected – there is the effect on the individual, the family, the community. So, through this work in a network having key resource people. It is necessary to put in place an action plan involving all of them – because the way to approach psychotrauma is not just the work of mental health professionals. There also the social, religious, legal context, so we identify resource people on a local and regional level who can take part in this plan – all the possible therapists in a district or a region, establish links with these people, get ourselves known, because psychologists are not always well-thought-of! Then we start working towards our goal. Why group therapy works Here are some examples of work we have initiated in the different kind of traumatic events I have mentioned. The common factor is group therapy – why? The traumatic event, no matter what it was, was experienced by a group of people, if they are treated together and talk through the event together this helps them overcome the trauma – this is particularly true of children. For example, for traumatized children, we organize art workshops – this is not art therapy – pictures are used as a mediator in the relationship between the children and between the children and the therapists. Generally we work in a team of teachers and psychologists together. Why a group with children? A group has its own internal dynamics – it allows a child to speak out, and if one child starts talking others are stimulated to speak. Equally the group reduces the feeling of loneliness, because very often after a person has been very deeply traumatized, he has the feeling that he is alone in his distress – the fact of sharing it with his peers – children in the same group who have been through the same experience – can reduce the feeling of isolation. The final objective of the workshop is simple: it is to allow, through drawing as a medium for building relationships, to work on the traumatic event. This works well for young children. With adolescents, or older children who can verbalise, we organize discussion groups. I remember a group in a village where there had been a mass murder, one boy pointing to a classmate and telling me “His uncle killed my uncle”. You can imagine that my first reaction was panic – What would happen to the group now? Then I asked the boy “Who is he?” “He’s my friend”. So I asked “Who is he really?” “He’s my friend”. “What about his uncle?” “He is the uncle of my friend.” That is why I say that group therapy also can work with adolescents, giving the opportunity to talk through the traumatic event and put things into context – “He’s my friend”.

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

73

We also organize discussion groups with parents and children. I said earlier that very often in catastrophic or traumatic events, parents flee, leaving their children behind. Many children have told us this– I am thinking again of the village where there was the mass murder. Terrorists had held sway there for 5 years. The little girls were obliged to wear the headscarf, and those who did not were dragged through the streets by their hair. The fathers fearful of the consequences of disobedience would say to their daughters “Wear the headscarf”. So in relation to this parental image, we organized a discussion group between the parents and children, so that they could say what they wanted and be listened to. The children felt before that they could never say what they thought openly. It was the same for the parents – they could say “Wear the headscarf” or “Don’t go to school”, but did not dare explain that if they disobeyed, the parent would be killed, and maybe the child, too. This group helped to reweave the ties in the heart of the family. Using cultural practices to overcome trauma What we also have tried to do, taking into account our cultural practices is to use the mourning ritual. A concrete example: After the last earthquake, I went to the site of the disaster, to a village where a little girl had been killed by falling masonry. All the children I met – in fact all my information came direct from the children – did a certain kind of drawing. This helped me choose the best way to help them. The pictures depicted their neighbour, the little girl on roller skates or a bike, often her name, Naserine, appeared, and also the little girl dead. Shortly afterwards came the ‘40th Day’ which in our culture marks the end of mourning – in fact I do not know if it is cultural or religious. There is a ritual where the tomb of the dead person is built, a meal is offered, and imams read verses from the Koran. So with the agreement of the parents we organized the very active participation of the children in the ceremony. I thought the children’s pictures were wonderful, so we organized an exhibition. An artist friend did a portrait of Naserine which was put on show with the children’s pictures – so that we could get away from the idea of death, they had done some of the village after the earthquake. We invited to the exhibition the parents of the little girl, the local authorities who had helped us materially; flowers were placed at place she died with readings from the Koran, and then we accompanied the children to the cemetery where they could see where their little friend was buried. This was very effective in dealing with their trauma. This implies that the psychologist must agree to leave his usual workplace, waiting behind his safe desk for patients to come to him – but traumatized people often do not seek help. So it is up to the therapist to go out to meet them and make them part of their own healing.

Round the table comments from each participant and discussion following these presentations, underlined further issues: 1. 2. 3. 4.

The historical background is important Ideology and religion play an important role in how people deal with trauma There are pronounced similarities between different cultures However, there are surprising differences in approach concerning children

74

Different Approaches towards the Treatment of Trauma in Children and Adolescents – Round Table

5. On the subject of the benefit of group v. individual therapy - If the trauma was experienced as a group, then group therapy has been found to be very effective – the symbiotic effect is beneficial. Group therapy helps in identifying those who need individual therapy 6. Family and friends are powerful factors in overcoming trauma. Examples: During the bombing in Sarajevo, the most popular strategy to reduce stress was being together with family and friends. Young people were on the streets playing basket ball and dancing during the air-raid sirens. 7. The most important factor for helping children cope with trauma was staying in their own home despite danger during the bombing rather than going to the shelters – half of the people decided to risk staying at home. 8. It is essential to take care of the parents before you can start to take care of the children. 9. When there is a national disaster it is vital to raise awareness on a national level. 10. On the question of the evaluation of very young children, it was underlined that there are accurate ways of assessing very young children and treating them. Follow-up as children grow up and begin to verbalise confirms this. 11. Many European conferences are from the Western viewpoint and ignore the situation in countries like Ukraine, where there are not enough well-trained therapists, a great lack of any kind of information – not just for psychologists but for all the medical profession. There is a lack of modern information, up-to-date research, so the follow-up from this meeting, spreading information will be very welcome. 12. The therapy that has been the most studied is cognitive behavioural therapy. Others do not have the scientific basis, such as play therapy with children and child/parent therapy. CBT has been shown to be effective for some people. 13. Depending on the individual, a combination of therapy and medication may also help. 14. Use of medication in children can actually produce symptoms of PTSD. Therapists need to be made aware of this. 15. Even with professional treatment of many different therapies, people still have lingering symptoms of trauma. I LETH MD, PhD Professor of Psychology University of Copenhagen, Denmark Summing Up Mental health professionals from several countries have shown that there are very many different approaches and views on the treatment of traumatised children and adolescents. The following issues must be addressed by us all: Identifying children’s needs Identifying the assessment tools Being able to distinguish between the trauma of the child and the trauma of the parents Making a diagnosis Selecting appropriate treatment But we still need much more scientific research and information about who needs to be treated, by whom and with what kind of treatment.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

75

3. Collaboration between mental health professionals and non-professionals The aim of this session was to identify potential resources – people, places, infrastructures, agencies - by examining practical activities in the family and in the community to mitigate and deal with trauma in children and adolescents. Introduction – Trauma in Young children - Working with the police and judiciary – Building resilience in the family -

Introduction William YULE MD, PhD Professor of Applied Child Psychology University of London Institute of Psychiatry UK

When mental health professionals work with non-professionals there is a great need to raise awareness of the effect of conflict, terrorist incident and disasters on children. When I worked with UNICEF in Yugoslavia, a large part of the work was in raising awareness. We tried a meeting at which all the local politicians were present as well as the local TV cameras. While the cameras were on them they looked interested, but soon left – and we got on with the real work! Media coverage and political will are very important but are they truly interested? I was charged with collaboration within the community in Mostar to help build local capacity in a way that is sustainable. Group therapy can help to identify those individuals with whom it is necessary to do intensive individual work. The needs of the local infrastructure must be considered. The role of the school is important. In Mostar we spent a long time with the people who work with kids – teachers and officials, many of whom had been affected by the war. And we took account of that. The local people wanted training seminars for teachers and parents, so that they could work as counselors. We looked at the role of the schools. Then we identified a new syndrome – “Post-Training Stress Disorder” – people started recognizing their own symptoms! We also worked with specialist teachers already in the schools and gave them additional skills. We did a survey of refugee children in the UK – there was a high level of PTSD, so there is a role for trained members of the community in the destination countries as well as in the country of origin. A group of Western psychologists who had worked together and separately in Yugoslavia got together and said ”What have we learned there that could be used for large numbers of children in a future disaster or war?”

76

W. Yule / Introduction

- Training seminars for non-professionals work. - What is very clearly evidence-based is that there is a use for people, not necessarily trained therapists, but people who like children and could work with minimal supervision with a group of 20-30 kids. These measures are being used in the foundation we have set up in Norway: www.childrenatwar.org In the Greek earthquake this method was used and the children’s symptoms were reduced. So there is evidence that this technique is useful. It has since been used to good effect after the earthquakes in Turkey and India.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

77

I. The role of non-mental-health professionals - the professional viewpoint The Effects of Exposure to Violence on Children of Different Ages: Prevention and Intervention – effective collaboration with police and court Joy OSOFSKY, MD, PhD Professor of Pediatrics and Psychiatry, Louisiana State University Medical Center, New Orleans, Louisiana USA Children are traumatized by community and domestic violence exposure as victims and witnesses. Information on the effects of violence exposure on children will be presented including developmental implications, resultant behaviors, and the most extreme reaction, posttraumatic stress disorder. Parental and caregiver traumatization will also be discussed. Prevention and early intervention is very important both to reduce exposure to violence and to reach children shortly after exposure. Therefore, the role of the mental health professional as an interventionist with first responders such as law enforcement will be discussed as a way to reach traumatized children earlier. A model for mental health professionals to develop collaborations with judges and lawyers who work in juvenile court will be presented. The conclusion will describe ways to provide education and relevant information to police and the court on how to help traumatized children.

Violence exposure affects all children, even the very youngest infants who usually expect to be protected in their homes and communities. Children are impacted by their exposure to domestic and community violence as well as war, terrorism, and natural disasters. Yet many people have difficulty thinking about children, especially infants and toddlers, being affected as victims and or even witnesses to violence; many think they are too young to be impacted by the violence that they see, hear, or feel. The situation may be further complicated by the fact that often children, especially very young children, who are exposed to violence have no voice and have to depend on adults to take care of them and to speak for them. Young children are sometimes victimized by violence, and, if they are exposed to too much violence, there is a risk they may become immune and lose the ability to empathize with other victims. While young children may not always understand the experience of violence exposure, they do remember it. Therefore, it is important that we pay attention to their feelings and behaviours. Caregivers have a responsibility to help all children, particularly infants and young children, comprehend the meaning of violence,

78

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

especially since they do not have language to help them organize their experience and express their feelings. While we often cannot prevent infants and toddlers from being exposed to violence either in violent neighbourhoods or in their homes, we can certainly help protect them, nurture them, keep their hopes alive, and care for them. In this chapter, I will discuss what is known about the effects of violence exposure on young children and then discuss prevention, intervention and treatment strategies. The effects of violence exposure on young children Violence is defined as the use of physical force so as to damage or injure. (Webster’s Unabridged Dictionary). Trauma is an event out of the normal range of normal experience. Children are affected by violence exposure at all ages: however, less is known about the consequences of exposure at younger ages, especially about the long term effects of such exposure. Many people assume that very young children are not affected at all, erroneously believing that they are too young to know or remember what has happened. However, even in the earliest phases of infant and toddler development, clear associations have been found between exposure to violence and emotional and behaviour problems. Infants and toddlers who witness violence show increased irritability, immature behaviour, sleep disturbances, emotional distress, fears of being alone, and regression in toileting and language (Bell, l995; Drell et al., l993; Jaffe et al., l990; Osofsky, 2004; Osofsky & Fenichel, l996; Pynoos, 1993, Pynoos, et al, 1997). Exposure to trauma interferes with their normal development of trust and later exploratory behaviours (Osofsky & Fenichel, l994). Consistent reports have even noted the presence of symptoms in these young children very similar to post-traumatic stress disorder in adults, including repeated re-experiencing of the traumatic event, avoidance, numbing of responsiveness, and increased arousal (Drell et al., 1993; Osofsky, 2004; Osofsky & Fenichel, 1994). In addition to the trauma that young children may experience, it is also important to consider that their parents or caregivers may be numbed, frightened, and depressed when they are exposed to trauma. For the children, it is especially difficult when they cannot depend on the trust and security that comes from caregivers who are emotionally available; consequently, children at any age may withdraw and show disorganized behaviours. Older school age children often experience increases in anxiety and sleep disturbances with exposure to violence (Pynoos, l993). They have difficulty paying attention and concentrating since they frequently experience intrusive thoughts. They are likely to understand more about the intentionality of the violence and worry about what they could have done to prevent or stop it (Drell et al., 1993; Pynoos, 1993). In extreme cases, they may exhibit symptoms akin to post-traumatic stress disorder. Both school age children and preschoolers exposed to violence are less likely to explore and play freely, showing less motivation to master their environment. Studies related to clinical work with children and their families who have been traumatized, show that it is not unusual for the parents to be unaware of their children’s difficulty with concentration and school problems that frequently follow traumatization from violence exposure. Some studies (Bell, 1995; Bell & Jenkins, 1997) have reported that school-aged children who witness domestic violence often show a greater frequency of externalizing (aggressive, delinquent) and internalizing (withdrawn, anxious) behaviour problems in comparison to children from nonviolent families. Overall functioning, attitudes, social competence, and school performance are often affected negatively.

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

79

Much more is known and symptoms recognized in adolescents who have experienced violence exposure throughout their lives. They are more likely than non-exposed adolescents to show high levels of aggression and acting out, accompanied by anxiety, behaviour problems, school problems, truancy, and revenge seeking. Although some adolescents who witness community and domestic violence may be able to overcome the experience, many others suffer considerable scars. Some report giving up hope, expecting that they may not live through adolescence or early adulthood. Such chronically traumatized youth, often appear deadened to feelings and pain, with resultant constrictions in emotional development. Alternatively, they may attach themselves to peer groups and gangs as substitute family incorporating and accepting violence as a way of coping and dealing with frustration (Bell & Jenkins, 1997; Pynoos, 1993). Understanding the effects of violence exposure on children The impact of exposure to community and domestic violence on a child depends on many factors, including the age of the child, frequency and type of violence exposure, characteristics of the neighbourhood (including degree of community resources), amount and quality of support provided by caregivers and other significant adults, experience of previous trauma, proximity to the violent event, and familiarity with the victim or perpetrator (Pynoos, l993). How much a child perceives or remembers a violent experience affects the presence or absence of symptoms and the circumstances under which they are likely to occur (Drell, Siegel, & Gaensbauer, l993). Adolescent problems related to violence exposure have been most visible, both in the research and clinical literature and in the media. Less well-known are the problems that are frequently seen in younger children who may be exposed to violence as witnesses or victims. As mentioned above, a common assumption is that young children are too young to know or remember what has happened and that exposure violence has little impact on them. In fact, this assumption is far from the reality in that young children are impacted greatly even by hearing their parents or caregivers fighting through closed doors. The issue of the effects of exposure to violence on children is a topic that has been sorely neglected. Exposed children frequently show signs of posttraumatic stress disorder similar to those seen in war veterans who have been traumatized by violence. Although very young children may be partially protected from exposure to a traumatic incident because they do not fully appreciate the potential danger (Drell, et al, l993; Pynoos, l993), it is crucial to pay attention to their reactions to violence. Even the youngest of children are likely to show emotional distress, immature behaviour, somatic complaints, and regressions in toileting and language (Bell, 1995; Drell et al, l993; Jaffe, Wilson, & Wolfe, l990; Margolin, l998; Osofsky & Fenichel, l994; Osofsky, l995a; Pynoos, l993). As mentioned, in the most extreme cases, the presence of symptoms very similar to post-traumatic stress disorder in adults have been noted, including repeated re-experiencing of the traumatic event, avoidance, numbing of responsiveness, and increased arousal (Drell, et al, l993; Osofsky, 2004; Osofsky & Fenichel, l994). With exposure to violence at an early age, the child’s view of him or herself, the world and people in it will be impacted significantly. Because the child is so young, the rapid and complex changes that are part of normal development in the earliest years of life influence the infant or toddler’s perceptions, understanding, and experience of violence. The very young child’s capacity for perceiving and remembering the experience of violence will affect the

80

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

symptoms that result from exposure. If the victim or perpetrator is very close to the child, he or she may wonder whether relationships are trustworthy and dependable. If the child is exposed to violence repeatedly, the effects are likely to be more significant and/or severe as the child grows older. He or she will come to expect violence in everyday life, not be aware of other ways to respond, and, over time, may become immune and unfeeling about such exposure. It must be remembered that infants have very few ways of expressing their feelings and distress since they do not have language. Yet, the exposure to violence has special meaning for very young children. Thus, with violence exposure, frequent responses include difficulty sleeping, clingy behaviour, withdrawal, aggression, crying and irritability, eating problems, anxiety and fearfulness. Regression in both toileting and language is common. For toddlers, it is often possible to help them use words, play or drawings to express how they are feeling; however, the symptoms described above for infants are also seen commonly. Recent clinical data regarding interventions and treatment of young children exposed to violence indicate that early interventions can be quite effective in alleviating symptoms and that the symptom manifestations may be intensified if a child does not receive treatment shortly after experiencing the trauma. The impact of violence exposure on parents, other adults, and the relationship For some parents and children, the stress associated with violence exposure and the necessary coping with violence as an everyday event affect both the parent’s ability to parent and the child's capacity to form healthy attachment relationships (Osofsky & Fenichel, l994). Since early relationships form the basis for all later relationship experiences, such difficult early interactions may be problematic for the child's later development. Poverty, job and family instability, and violence in the environment add immeasurably to the inherent difficulties. Although systematic research has not yet been conducted concerning the effects of violence exposure on parenting and the caregiving environment, anecdotal reports indicate that parents who live with violence frequently describe a sense of helplessness and frustration about their inability to protect their children and keep them safe, even in their own neighbourhoods (Garbarino, Dubrow, Kostelny, & Pardo, l992; Osofsky & Fenichel, 1994; Richters, l993). While some parents will maintain their strength creatively finding ways to cope with violent environments, for others, the constant barrage of violence may lead adults to communicate helplessness and hopelessness to their children. Protecting children and facilitating their development is a family’s most basic function. Regardless of their composition, families are uniquely structured to provide the attention, nurturance, and safety that children need to grow and develop. An important psychological aspect of parenting an infant or toddler is being able to provide a “holding environment” (Winnicott, 1965) in which a parent can both protect a child and allow and encourage appropriate independence. Parents who are aware that they may not be able to protect their children from violence are likely to feel frustrated and helpless. In addition, when parents witness violence or are themselves victims of violence, they are likely to have difficulty being emotionally available, sensitive, and responsive to their children (Osofsky & Thompson, 2000; Osofsky, 2004). In trying to help children and parents who have been traumatized by violence exposure, it is important to offer support to the parents as they cope with their own trauma in order to help enable them to deal with their children’s needs. When parents live in constant fear, their children

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

81

often lack the sense of basic trust and security that is the foundation of healthy emotional development. Another burden, rather than support for parents may result from the traditional societal protectors of children, including schools, community centres, and churches, also being overwhelmed and unable to assure safe environments for their children. Several surveys done in urban cities in the United States designed to identify issues of trust and safety among a group of African American parents and children living a high rate of community violence according to police homicide statistics indicated that many parents believed their children were not safe in their neighbourhoods or walking to school. Thirty-five percent of the parents reported that they did not feel their children were safe walking to school and 54% did not feel they were safe playing in their neighbourhood. Only 17% of these parents felt that the children were very safe doing these activities. However, the majority (62%) felt that the children were very safe at home and 30% felt they were very safe at school (Fick, Osofsky, & Lewis, 1997). These data are consistent with the responses of their elementary school children, ages 8-12, from the same neighbourhoods, who reported that they felt much safer at home and in school than walking to school or playing in their neighbourhood. In clinical work with traumatized young children and their families, one of the first issues that must be dealt with before any treatment can begin is whether the child and the family feel safe. There is a dual problem, however, in dealing with community violence: 1) the continued physical reality of the violent environment; and 2) the continued post-traumatic reality for the young child and caregivers. Exposure to violence may interfere with normal developmental transitions for both parents and children. On the one hand, violence exposure may divert the child from his or her normal developmental trajectory. On the other hand, in violent neighbourhoods, parents may become overprotective, hardly allowing their children out of their sight. Yet, encouragement of autonomy is important for development and comes with trust in the safety of the environment (Erikson, l950). For families living with violence, children's growing independence and normal exploration may be anything but safe and, therefore, not allowed. Parents who are exposed to chronic violence may also become depressed and unable to provide for their young children’s needs. Even with heroic efforts, if the parent is sad and anxious, it will be more difficult for her to respond positively to the smiles and lively facial expressions of her young child. Depressed parents may be more irritable and may talk less often and with less intensity. All of these factors, although understandable, may influence young children to be less responsive themselves and feel that they may have done something “bad” to contribute to this state of affairs. Thus, supports outside of the family are very important for parents and children exposed to violence. Supporting strengths in young children exposed to violence An important, but little understood, area concerns the issue of invulnerability or resilience, that is, which children will experience fewer negative effects in response to exposure to community or other violence. Results from many studies of resilient infants, young children and youth consistently identify a small number of crucial protective factors for development (Masten, 1997; Masten, 2001; Masten, et al 1990; Rutter, 1993; Werner, et al, 1994). The most important protective resource is a strong relationship with a competent, caring, positive adult, most often a parent. The most important personal quality is average or above average intellectual development with good attention and interpersonal skills. While catastrophic stressors such as

82

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

premature birth, war, trauma, and loss can threaten the integrity of a child’s ability to think and solve problems, good parenting by either a parent or other significant adult that supports both cognitive ability and positive development and relationships will proceed positively even with adversity. For children living in high violence areas, having a protected place in the neighbourhood provides a "safe haven" from violence exposure. Additional protective factors include positive role models, feelings of self esteem and self efficacy, attractiveness to others in both personality and appearance, some individual talents, religious affiliations, socioeconomic advantage, opportunities for good schooling and employment, and ability to seek out people and environments that are positive for development. It is crucial to recognize that adult behaviour, especially “good enough” parenting plays a central role in a child’s risks, resources, opportunities, and, therefore, his/her resilience. Several studies have focused on resilience, a factor that has been emphasized which may improve conditions directly affecting a child’s coping ability is effective parenting. Werner’s (1984) landmark study on resilience describes this phenomenon as the ability to recover from or adjust easily to misfortune or sustained life stress. Resilience is often used to describe the following outcomes in children (Werner, 1994): 1) Good outcomes despite risk status; 2) sustained competence under stress; 3) recovery from trauma. Many studies, including those of Werner (1984) and Masten (2001) define a resilient child as one who is more likely to have an adaptable easy temperament and be more intelligent. A resilient child is also more likely to have a supportive person, often a parent or care giver, in his/her environment -- a person with whom the child has a trusting relationship. Werner (1984) found in her longitudinal study that resilient children who adapted successfully to adult life had the following protective factors: 1) An adaptable temperament that allowed them to elicit positive responses from caring adults; 2) skills and values that allowed for an assessment of the child’s abilities in order to develop realistic educational and vocational goals; 3) parents or care- givers who reflected competence and fostered self-esteem in their children or other supportive adults who fostered trust. Further, resilient children sought out environments that reinforced and rewarded their competencies and helped them successfully handle life’s transitions. Much can be learned from Werner’s remarkable longitudinal study. Regarding concerns about adaptive parenting, it is important to note that in her study of 698 babies born on the Hawaiian island of Kauai, resilient youth (about a third of the group) at the time of high school graduation had developed a positive self-concept and an internal locus of control. They displayed a more nurturant, responsible, and achievement oriented attitude toward life than did their high risk peers who had developed problems in their teens. These boys and girls had grown up in families where they had not experienced prolonged separations from their primary caregivers during the first year of life. All had the chance to establish a close bond with at least one caregiver from whom they received much positive attention when they were infants. Some of this nurturance came from substitute parents, such as grandparents or older siblings, or other members of their extended family. Both parents and substitute parents served as important role models for identification for the children. Masten and her colleagues (1997) research and studies of resilience were carried out as part of Project Competence, a careful longitudinal study following the pioneering work in this area by Garmezy. This study includes competent children growing up with little adversity, resilient children growing up with high levels of adversity, and maladaptive children who have

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

83

not been able to successfully overcome adversity. Again, they found that the role of a good enough parent is crucial for positive outcomes in these children. Successful children whether low or high risk have a history of more resources than maladaptive children. Important factors for good outcomes appear to be better intellectual skills and good parenting. Resilience in children and youth is not created in a vacuum, even with good enough parenting. Promoting positive development depends on creating healthy systems for youth in addition to healthy individuals. Thus, parents need support from the broader society and environment for parenting, educating, and socializing their children. Further, study by Masten and colleagues (2001), suggest that future understanding of the impact of factors such as parenting on developmental outcomes could benefit from disaggregating global resources such as “parenting quality” into meaningful components such as dimensions like structure, warmth, and expectations that may relate to conduct, achievement and social functioning with peers under different conditions. The development of both resilience and protective factors begins in infancy and longitudinal studies have pointed consistently to factors in very young children that contribute to such strengths. Werner (1994) reported that 10 percent of their Asian and Polynesian cohort who had experienced four or more risk factors including perinatal complications, parental psychopathology, family instability, and chronic poverty before the age of 2 years developed into competent, confident, caring adults. These resilient young children were described by their caretakers as active, affectionate, cuddly, easy infants with few problematic early behaviours. Similar observations on resilient infants were part of the Coping Project carried out many years ago at the Menninger Foundation (Murphy and Moriarity, 1987). Clinical assessments of 32 Caucasian infants revealed an active, easy-going nature and few feeding and sleep problems. These babies were also notably responsive to people and objects in their environment. Resilient babies are often characterized by responsiveness and warmth as well as an ability to seek out and relate to others in their environment. In our studies of infants of teenage mothers who did better as they developed, we observed similar positive behaviours (Osofsky, 1998). Rutter (1993) has clarified the issue of resilience further as it relates to parenting. He cites evidence from behavioural genetics indicating that in many circumstances, nonshared environmental influences tend to have a greater effect than shared ones. Thus, features that impact equally on all children in a family may be less important than those that impact differentially so that one child may be affected more than others. Therefore, it is not uncommon to see a family which is relatively organized, but where one child in the family is scapegoated – or favoured – over others. How does a child manage to be resilient under such circumstances? He/she may distance him or herself from what is going on, i.e., in some families, quarrels and fights occur and one child may be drawn into the disagreement or dispute and others remain uninvolved. In a home with parental mental illness, a less vulnerable child may manage to find emotional support outside of the home. Children, even very young children, can do a great deal to influence what happens to them. Rutter (1993) indicated that protective effects may result from people actively planning how they deal with what happens to them, thus feeling like they have more control of their lives. Younger children may protect themselves by withdrawing and finding support outside of the family. Older children may be able to actively plan in ways that are helpful to them and make them feel less vulnerable.

84

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

Thus, results from many studies of resilient infants, young children and youth identify consistently a small number of crucial protective factors for development (Masten, 2001; Masten, et al 1990; Masten, 1997). The most important protective resource is a strong relationship with a competent, caring, positive adult, most often a parent. The most important personal quality is average or above average intellectual development with good attention and interpersonal skills. While catastrophic stressors such as premature birth, war, trauma, and loss can threaten the integrity of a child’s ability to think and solve problems, good parenting by either a parent or other significant adult that supports both cognitive ability and positive development and relationships will proceed positively even with adversity. Additional protective factors across many studies of risk include additional positive role models, feelings of self esteem and self efficacy, attractiveness to others in both personality and appearance, some individual talents, religious affiliations, socioeconomic advantage, opportunities for good schooling and employment, and ability to seek out people and environments that are positive for development. It is crucial to emphasize, however, that adult behaviour, especially “good enough” parenting plays a central role in a child’s risks, resources, opportunities, and, therefore, his/her resilience. A community based violence intervention programme (VIP) In 1992, the Violence Intervention Program for Children and Families (VIP) was initiated in New Orleans (Osofsky, 1997; Osofsky, et al, 2004) in response to the crisis of rising violence in New Orleans (paralleling that in the United States as a whole) and the fact that ever increasing numbers of children were being exposed to violence as victims or witnesses. Establishing the program was challenging as the city of New Orleans at that time was experiencing a high level of violence, there were continual changes in the police force, and much community organizing was ongoing with realistic scepticism about the potential effectiveness of establishing a communitybased effort involving outside agencies. The program evolved from collaborative discussions and work with mental health professionals, resident council leaders, police, and community agency representatives who first developed trust in each other and then decided what type of program would be most helpful for the infants, children, and families. What has evolved over time is a level of trust and confidence that has permitted the program to grow gaining an understanding from the police, residents, community schools, and parents about the importance of prevention and early intervention for children exposed to violence as well as support for parents and caregivers. At all times, the goal has been to help build strength within the groups and to be available to provide advice, guidance, and services. The VIP program uses a systems approach designed to work with the whole community to address the problem of violence among our youth and to develop meaningful prevention and intervention efforts. It is startling that homicide is the third leading cause of death for children between the ages of 5 and 14 in the United States. In some areas of our inner cities throughout the United States, neighbourhoods have become like war zones with children carrying guns and other weapons to school in order to feel safe. Mothers teach their children to watch television lying below the window sills in order to avoid random bullets. The project aims to decrease violence through a combination of early intervention, counselling, and services to victims as well as education and prevention forums directed at police, parents, and children. A key component of the program is education of police officers about the effects of violence on children and families to increase their knowledge and sensitivity

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

85

when dealing with violent incidents. Over the years of the program, evaluations have been done of the effectiveness of education for police have indicated increased sensitivity to the needs of the traumatized children as well as increased knowledge about resources for referral. In an effort to reach traumatized children and families as quickly as possible, a 24-hour Hotline was established to provide the needed communication through which children and families touched by violence could seek immediate referral, counselling, and guidance. It is available to police officers and families to obtain advice or information at the scene of community or domestic violence. The police distribute VIP cards with the hotline number to families so that they can seek help if needed. About 60% of the calls are for referrals of children 12 years old or younger (with some children as young as one to two years of age) and approximately 50% of the calls become referrals for mental health services. Funds are raised to support the program in order to provide mental health services to children and families who could not otherwise afford such services. The VIP program has seen an increase during the past few years in the numbers of children exposed to domestic violence and sexual abuse in addition to community violence and other violence exposure. The use of the 24-hour Hotline appears to reflect the level of violence in the city with calls increasing as more violence occurs in the city. Children and families receive services in the child clinic at LSU Medical Center’s Department of Psychiatry in addition to ongoing consultations and services provided in the schools and in the community. The program has been developed as a multidisciplinary effort to build relationships between community, police, mental health professionals, schools, and day care centres to address issues of prevention and services for referred children who witness violence and suffer from symptoms related to their exposure such as nightmares, disruptive behaviour in school, and, in the most extreme cases, post traumatic stress disorder. The staff of the programme meet with police to develop strategies that might work better for the child witnesses when they investigate violent incidents, such as homicides. Parents are also supported in finding ways they can protect their children, keep them safe, and away from violent scenes because of the potentially traumatizing impact on both them and their children. They are also helped if they are in domestic violence situations with their own issues and in ways to protect their children. VIP works to build strength in communities to help both parents and children. The VIP program has continued to evolve and grow. Evaluation of the effectiveness of the work has been built into the intervention program from its inception to learn about what works and what does not and determine the changes that are needed to make the program more effective. Materials that have been developed for training and intervention include a Police Education Manual, a Children’s Safety Booklet, a Parenting Booklet, a Newsletter about activities of the program, and a Community Resource Directory for use by police and others for referrals. Over the years, additional funding has been obtained to expand work with younger children in child care centres and with child welfare.

Directions for the future All children are affected by violence exposure in their homes, communities, and neighbourhoods. Further, it is no longer possible to assume that even very young children, including infants and toddlers are too young to comprehend and react when they are

86

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

exposed to violence. Alternatively, more education is needed about the effects of violence exposure on children so that health care, mental health care, child care professionals, teachers, and traditional and non-traditional first responders recognize the signs and symptoms and know what can be done. In this way, infants and young children will no longer be silent victims. To be able to understand and help traumatized children, it would be very important to study the long term effects of exposure to violence on children. Studies have been hampered by several factors: 1) difficulties in carrying out randomized trials with samples that are often at very high psychosocial risk; 2) the absence of reliability and validity for many of the measures frequently used to study violence exposure (at least some of the standardized measures that are available to study outcomes and validate the violence exposure measures have been developed on populations coming from different racial and socioeconomic groups than most children exposed to violence); 3) resistance to carrying out research that may enhance science but not necessarily help the affected children; 4) experiences of violence exposure are often difficult for adults to hear, and, therefore it may take time and effort to communicate. Further, there may be a tendency at times to hide or distort the facts and in order to avoid dealing with the emotions and upset that may accompany the children’s traumatic experiences. To date, more is still from retrospective rather than prospective reports and research about processes that lead to violent behaviour. However, some prospective studies have been enlightening (Widom, 1989). Carefully designed evaluation research studies are needed to understand the causes of violent behaviour and to learn more about factors that mitigate against violence in high risk situations. Studies should include prospective longitudinal designs to investigate the long term psychological effects of exposure to violence on children with children of different ages, socioeconomic backgrounds, and ethnic and cultural backgrounds. Evaluation is needed of the cumulative effects of repeated exposure and the differential effects of severity of exposure, especially when the child may be familiar with the victim and/or perpetrator. Research is needed on factors that support the resilience of children and buffer them against adverse effects of violence exposure. Significant longitudinal research has been done on determinants of resilience and conditions that serve as protective factors (see Werner et al, 1982; Masten, 2001; Rutter, et al, 1998). However, careful longitudinal studies within primarily high risk inner city populations where much of the violence in the United States occurs have yet to be done Broad based epidemiologic studies are needed to determine the differential effects of witnessing violence, being victimized by violence, the severity of the exposure, and the differential effects of being exposed to an acute trauma as compared with chronic ongoing violence. If possible, the epidemiological work should attempt to sort out the differential impact of community versus domestic violence exposure on children, exposure to terrorism and war. Samples should include children of different ages, socioeconomic backgrounds, and ethnic or cultural backgrounds. The inclusion of information about violence exposure would be useful to include in national surveys. This information would be helpful in relation to the training of professionals who work with children as well as planning prevention and intervention strategies.

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

87

References Bell, C. (1995). Exposure to violence distresses children and may lead to their becoming violent. Psychiatric News, 6-18. Drell, M., Siegel, C., & Gaensbauer, T. (1993). Post-traumatic stress disorder. In C. H. Zeanah (Ed.), Handbook of infant mental health (pp. 291-304). New York: Wiley. Fick, A. C., Osofsky, J. D., & Lewis, M. L. (1997). Perceptions of violence: Children, parents, and police officers. In J. D. Osofsky (Ed.), Children in a violent society. New York: Guilford Press. Erikson, E. H. (1950). Childhood and society. New York: Norton. Garbarino, J., Dubrow, N., Kostelny, K., & Pardo, C. (1992). Children in danger: Coping with the consequence of community violence. San Francisco: Jossey-Bass. Jaffe, P. G., Wolfe, D. A., & Wilson, S. K. (1990). Children of battered women. Newbury Park, CA: Sage. Jenkins, E. J., & Bell, C. C. (1997). Exposure and response to community violence among children and adolescents. In J. D. Osofsky (Ed.), Children in a violent society (pp. 9-31). New York: Guilford. Margolin, G. (1998). Effects of witnessing violence on children. In P. K. Trickett & C. J. Schellenbach (Eds.), Violence against children in the family and the community. Washington, DC: American Psychological Association.

Masten, A.S., Best, K.M., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and Psychopathology, 2, 425-444. Masten, A. (1997). Resilience in children at risk. In Research/Practice: A Publication from the Center for Applied Research and Educational Improvement. Minneapolis: College of Education and Human Development, University of Minnesota Masten, A.S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227-238. Murphy, L. & Moriarity, A. (1987). Vulnerability, coping, and growth from infancy to adolescence. New Haven, CT: Yale University Press. Osofsky, J. D. (1997). Children in a violent society. New York: Guilford. Osofsky, J.D. (1998) Psychosocial Risks for Adolescent Parents and Infants: Clinical Implications. In J. Noshpitz (Ed.) Handbook of Child and Adolescent Psychiatry, New York: Wiley.

Osofsky, J.D. (2004). Young children and trauma: Intervention and treatment. New York: Guilford. Osofsky, J.D. & Fenichel, E. (Eds) (1996). Islands of Safety: Assessing and Treating Young Victims of Violence, Washington, D.C: Zero to Three/National Center for Infants, Toddlers, and Families.

Osofsky, J. D., & Fenichel, E. (1994). Hurt, healing, and hope: Caring for infants and toddlers in violent environments. Zero to Three Bulletin, Vol. 14. Arlington, VA: National Center for Clinical Infant Programs.

Osofsky, J.D. & Thompson, D. (2000). Adaptive and maladaptive parenting. In J.P. Shonkoff & S. J. Meisels (Eds). Handbook of Early Childhood Intervention, 2nd Edition, (pp. 54-75), New York: Cambridge University Press.

88

J. Osofsky / The Effects of Exposure to Violence on Children of Different Ages

Osofsky, J. D., Hammer, J.H., Freeman, N., & Rovaris, M. (2004). How law enforcement and mental health professionals can partner to help traumatized. In J.D. Osofsky (Ed). Young children and trauma: Intervention and treatment. New York: Guilford Publishers. Osofsky, J.D. (1995) The Effects of Violence Exposure on Young Children, American Psychologist, 50, 782-788.(Reprinted in The Evolution of Psychology: Fifty years of the American Psychologist, 1998, American Psychological Association).

Pynoos, R. S. (1993). Traumatic stress and developmental psychopathology in children and adolescents. In J. M. Oldham, M. B. Riba & A. Tasman (Eds.), American Psychiatric Press Review of Psychiatry (pp. 205-238). Washington, DC: American Psychiatric Press. Richters, J.E. (1993). Community violence and children's development: Toward a research agenda for the 1990's. Psychiatry, 56, 3-16. Rutter, M. (1993). Resilience: Some conceptual considerations. Contemporary Pediatrics, 11, 36-48. Werner, E.E. (1984). Resilient children. Young Children, 40, 68-72 Werner, E.E. (1994) Overcoming the odds. Developmental and Behavioral Pediatrics, 15, 13136. Werner, E.E. & Smith R.S. (1982). Vulnerable but invincible: A study of resilient children. New York: McGraw-Hill. Widom, C.S. 1989. The cycle of violence. Science 244(4901),160–166 Winnicott, D. (1965). The maturational processes and the facilitating environment. Madison, CT: International Universities Press.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

89

The Role of Authoritative Parenting in building Resilience Josi SALEM-PICKARTZ MD, PhD Clinical Psychologist Amman, Jordan Associate Professor of Psychology, University of Oldenburg, Germany

The context The following reflections are based on my year-long work with families and children who live in comparatively peaceful societies such as Germany and Jordan and Palestinian and Israeli refugee families. The reflections also build on the experience I gained through my involvement with NGOs and international organizations that assist in the protection and recovery of populations after catastrophic social change, as they have occurred in Iraq, Palestine, and Armenia in the last fifteen to twenty years. Building resilience is important because children’s living conditions are rapidly changing worldwide and creating much insecurity. Growing numbers of children are exposed to serious threats to their physical and mental well-being and development through the challenges that are inherent in many modern societies. Whether the societies are at war or peace, they may not be able to offer sufficient protection and nurturing for youth. Mental health professionals and educators have started to consider building resilience as an important measure to strengthen children against distress and trauma and to equip them with the capabilities and skills to build their future. This is a step that overcomes the traditional deficit- and rehabilitation oriented “clinical model” of intervention following high degrees of distress and trauma. Until quite recently, the standard model has prevailed in large-scale international responses to catastrophic social change. There is no doubt that our clinical knowledge about the impact of stress and trauma on children’s well being complements our attempts to respond sensitively to their needs. However, most postconflict situations do not provide sufficient security and protection for adequate therapeutic interventions. Very often the number of professionals who are available to provide counselling and therapeutic support is lower than necessitated by the severity of the trauma experienced. On the other hand, though, by far not all children are in need of professional assistance. However, children and their parents have to go on with and master their lives on a daily basis. We agree that equipping them with the necessary personal qualities, knowledge, and skills to achieve will significantly contribute to their recovery. Building resilience is, therefore, both a preventative and rehabilitative intervention that enables children to master current and future challenges. Parents play a pivotal role in building the capacity for resilience, and it is argued that they can be taught how to foster resilience from the very beginning of a child’s life.

90

J. Salem-Pickartz / The Role of Authoritative Parenting in Building Resilience

What is resilience? In her famous diary, Anne Frank describes the resilient spirit of a child under persecution when she writes, “I have lots of courage, I always feel so strong and as if I can bear a great deal, I feel so free and young! I was glad when I first realized it, because I don’t think I shall easily bow down to the blows that inevitably come to everyone” (1993, p. 260).3 The concept has evolved since the 1970s, particularly Aaron Antonovsky’s study of female survivors of Nazi concentration camps who managed to maintain good physical and psychological health throughout their lives despite their horrific experiences. Antonovsky introduces the sense of coherence as a central construct that explains why resilient people pull through adversities and gain from challenges instead of succumbing to them. He defines the sense of coherence as a “…feeling of confidence that one’s internal and external environment are predictable and that there is a high probability that things will work out as well as can reasonably be expected.” 3 The term “resilience” has also become known through Emily Werner’s 1970s and 1980s work on influences on healthy growth of adolescents and adults despite unfavourable developmental conditions.4 Werner discovered that, at least during sensitive periods of their development, these children had been supported by a charismatic adult who was empathic and caring. However, this adult was often not a family member. These important persons in children’s lives not only cared, but also preached principles, asked children to assume responsibilities according to their age, and asked children to be of help to others. Another working definition describes resilience as “the capacity to do well when faced with difficult circumstances.” 3 According to Vanistendael (1995), resilience consists of two components: resistance against destruction (as a person’s capacity to protect his or her integrity under pressure) and the ability to construct a positive life in spite of difficult circumstances. Resilience manifests as good development outcomes in spite of high risks, such as a person’s capability to sustain competence under threat and his or her capacity to recover from trauma. Another more detailed current working definition speaks of resilience as “the ability of a child to deal…effectively with stress and pressure, to cope with everyday challenges, to bounce back from disappointments, adversity and trauma, to develop clear and realistic goals, to solve problems, to relate comfortably with others, and to treat oneself and others with respect. Resilient children feel special and appreciated.” 3

Building resilience through authoritative parenting Early ideas about building resilience through proper parenting are evident in the authoritative education style concept. Based on their research on preschoolers and the parenting styles that contribute to developmental maturity and balanced personality development, Maccoby e.a. (1983) identified four parenting styles along the two variables: controlling/demanding, low in control/undemanding, low in control/undemanding and responsive/child-centred -unresponsive/parent-centred.8 The researchers found that parents of mature preschoolers differed sharply from others by using a set of child-rearing practices that they described as authoritative. They were controlling and demanding, had high expectations for mature behavior, and firmly reinforced them by using commands and consequences for disobedience when necessary. At the same time, they were warm and nurturing, listened patiently and sensitively to their youngsters’ points of view, and encouraged children’s input in family decision making. These authoritative

J. Salem-Pickartz / The Role of Authoritative Parenting in Building Resilience

91

parents used a rational, democratic approach to child rearing in which the rights of both parents and children were recognized and respected. Baumrind has emphasized that it is not the exercise of firm control per se, but rather the rational and reasonable use of firm control that makes authoritative child rearing effective in producing positive consequences for children’s development.3 Children have a tendency to comply with and internalize such fair parental control strategies. Nurturing, non-permissive parents who are secure in the standards that they hold for their youngsters provide children with models of caring and concern for others as well as for confident, assertive behavior. Their demands also tend to be sensitive and responsive to their children’s developing capacities. By adjusting expectations to fit with children’s abilities to take responsibility for their own behavior, such parents communicate to children that they are competent beings who can successfully do things for themselves. As a result, high self-esteem and mature, autonomous functioning are fostered. Brooks and Goldstein recently formulated ten guiding principles for parents who want to raise resilient children.3 They are as follows: 1. Teach and convey empathy 2. Make children feel special and appreciated 3. Listen, learn, and communicate effectively 4. Help children set realistic expectations and goals 5. Nurture islands of competence 6. Consider mistakes important opportunities for learning 7. Help your child develop responsibility, compassion, and social consciousness 8. Teach the importance of solving problems and making choices and decisions 9. Promote self-discipline and self-worth 10. Rewrite your “negative scripts” by changing words and strategies that do not work

Teaching parents as you want them to teach your children It is often rightly argued that parents in post-conflict situations do not have the energy and personal capacity to attend to their children in the desired way, as parents themselves are distressed, traumatized, burnt out, and barely able to take care of themselves. Here lies the challenge for helpful professional individuals, groups, and organizations. As much as they want parents to commit themselves to their children’s recovery and development, professionals and organizations working in post-conflict situations need to first build resilience in the parents. In order to achieve this, the same guidelines that were outlined before should be followed, but with the understanding that success will take time. Commitment over time appears to be one of the prime measures of the honesty and seriousness of people who care for others.

References 1 Brooks, R. & Goldstein, S.: Raising resilient children. Fostering strength, hope, and optimism in your child. New York: McGraw-Hill, 2001. 2 Antonovsky, A.: Health, stress, and coping: New perspectives on mental and physical well-being. San Francisco: Jossey-Brass, 1979. 3Werner, E.E. 7 Smith, R.S.: Vulnerable but invincible. A study of resilient children. New York: McGraw-Hill 1982.

92

J. Salem-Pickartz / The Role of Authoritative Parenting in Building Resilience

4Vanistendael, S.: Growing up in the muddle of life. Resilience: Building on people’s strength. Geneva: ICCB, 1995. 5Brooks & Goldstein, ibidem, p.p. xiii ff. 6 E.E. Maccoby and J.A. Martin: “Socialization in the Context of the Family: Parent – Child Interaction” in E.M. Hetherington (ed.): Handbook of Child Psychology: Vol. 4 Socialization, Personality, and Social Development (4th ed., p.p. 1-101). New York: Wiley, 1983. 7 Baumrind, D. (1983): Rejoinder to Lewis’s reinterpretation of parental firm control effects. Are authoritative families really harmonious? Psychological Bulletin, 94, 132-42. 8 Brooks & Goldstein, ibidem, p. 295.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

93

II The role of non-mental-health professionals - the non-mental-health professional viewpoint 1. Editors’ note: The following presentation offers an understanding of the issues of delinquent behaviour and social exclusion as one of the potential consequences of the trauma suffered by children and adolescents exposed to the violence of conflict and terrorism.

Causes and Effects of Delinquent Behaviour and Social Exclusion Caroline PASKELL Centre for Analysis of Social Exclusion, London School of Economics, UK Delinquent behaviour by young people is a long-standing subject of public and governmental concern. Although ‘delinquency’ is hard to define, widespread understanding of its core characteristics, main causes, and effects exists. The concept of ‘social exclusion’ is new and is not widely understood, but the problems it refers to are extensive. This paper provides an overview of both delinquency and social exclusion, and discusses how they relate to one another. The paper focuses on neighbourhoods in order to explain how delinquency can both follow from and add to social exclusion at the local level. Drawing on the author’s research in Britain and America, the paper details how attending to the local links between delinquency and social exclusion can be central to addressing both problems.

1.Introduction This paper discusses the problems of delinquency and social exclusion. It describes them separately at first and then shows how they relate to one another. The problem of delinquency is long-established; the problem of social exclusion has been more recently identified. Considering the problems together, how they emanate from and impact on one another, points to ways in which their negative impacts can be addressed. Focusing on the neighbourhood, the paper argues that there is potential for significant reduction of delinquency where young people’s sense of local inclusion is promoted. Drawing on my PhD study - Community action around youth crime, drug-use and anti-social behaviour: who benefits? – and other research, this paper details

94

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

encouraging examples of such action. I conclude by discussing what can be generalised about how to minimise both delinquency and social exclusion. 1.i

Scope of the paper The paper focuses on Britain and also refers to America. This focus could be considered a limitation in restricting the discussion to relatively stable and wealthy societies, overlooking less settled and more deprived contexts. However, the narrower scope does serve to highlight ‘residual problems,’ those that exist in the context of comparative wealth and stability. The benefit of considering such residual problems is that this analysis can offer a guide to realistic expectations of improvements to delinquency and social exclusion, both in advantaged and developing or less settled nations. 2.

Effects and definitions The discussion starts by defining the problems of delinquency and social exclusion. This section shows that both are defined primarily by their effects, rather than by specific characteristics. The discussion also shows that they can be understood as having two parts or operating on two levels. Delinquency is characterised as having a core of behaviour that is restricted by statute and a fringe of behaviour that is subjectively defined as negative. Social exclusion is characterised as operating at the societal level (affecting people’s engagement with society as a whole) and at the local level (affecting local activity).

2.i

Delinquency ‘Delinquency’ is ostensibly a simple concept, referring to unacceptable behaviour, and most commonly to unacceptable behaviour by young people (i.e. 8/10-20/25)2. However, while it is widely understood in general terms, there is little clarity over exactly what it entails. Firstly, it is not exclusively about the behaviour of young people, as the occasional prefix of ‘juvenile’ shows. Secondly, it is sometimes used to refer to law-breaking, and sometimes to legal behaviours that are perceived as ‘unacceptable’: the word delinquent ... is even more imprecise [than ‘criminal’]. Firstly, it may be used to designate a young criminal. ... [But] it is also frequently used to denote a young person who performs acts which some members of society find unacceptable, but which have not been criminalized. It has to be said that theorists are not always clear how they are using the term, and this causes even greater problems. (Williams, 1994: 27) Such observations – that ‘delinquency’ is “a product of the ideas which people have of one another” (Downes and Rock, 1998: 190) – also hold for concepts more commonly used in Britain to refer to problematic youth behaviour (Pitts, 1999): disorder, anti-social behaviour and nuisance behaviour (also incivility and problem behaviour, with yobbish, thuggish and ned-like occasionally used by politicians3). These refer to illegal or illicit behaviours but also reflect subjective evaluations of behaviour as ‘unacceptable’ (Girling, Loader and Sparks, 2000; Sampson, 1999; Pearson, 1994, 1983; Griffin, 1993). Even the statutory definition of anti-social behaviour is premised on this subjectivity, defined as acting: 2

See May, 2002 for discussion of the origins of ‘delinquency’ as a concept. ‘Ned’ is Scottish slang meaning ‘a non-educated delinquent’. See the Sunday Herald (13/04/03), the Edinburgh Evening News (03/05/03) and BBC News Online (06/05/03) for politicians’ use of the phrase. See BBC News Online (12/03/03) and the Sunday Herald (13/04/03) for politicians’ references to ‘thugs’

3

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

95

in a manner that caused or was likely to cause harassment, alarm or distress to one or more persons not of the same household (HMSO, 1998; Section 1(1)a)4 2.i.i

Defined by its effects This paper argues that the defining characteristic of delinquency and related concepts is that they refer to behaviour that causes or is seen as causing harm (Muncie, Hughes and McLaughlin, 2001: Matthews and Pitts, 2001). For example, 83% of respondents to the 2001 British Crime Survey stated that ‘youth nuisance’ (which was left undefined) had a negative effect on their lives (Youth Justice Trust, 2002: 35). Therefore these terms are defined by their effects (harm or concern over harm) rather than by specific behaviours. As such, however, they encompass not only illegal behaviour but also legal behaviours which cause some people concern. The Home Office Working Party on Community Safety has noted: [such problems] are not necessarily related exclusively to law-breaking but may also be just as concerned with what one might call incivility – action that may not have a malicious intent but which serve to intimidate large sections of the community. (cited in NIF, 1998: 13) This paper views delinquency and related concepts as broad and variable categories of behaviour that are defined partly by the objective standards of statute and partly by individuals’ subjective evaluations. It characterises these two bases of definition as the core of the problem (behaviour restricted by law) and the problem’s fringe (behaviour that is legal but perceived as unacceptable). 2.i.ii

Core of delinquency This paper categorises crime and drug use as being at the core of the problem of delinquency. Not all drug use is criminal per se, but all is illegal if conducted by young people under a certain age and most is also illegal thereafter. Both youth crime in general and drug use by young people are prevalent in Britain (Pudney, 2002). Police records underestimate the incidence of crime and drug use, so victim and self-report surveys are used to provide a more accurate picture6 (Maguire, 1994). These consistently show young people as disproportionately involved in crime and drug use. In Britain, around a quarter of under-25s offend any year (FloodPage et al, 2000) and just under a third (28%) of 16-24 year-olds take drugs (Condon and Smith, 2003: 5). Young people account for approximately 40% of recorded crime and a third of drug offenders (Corkery, 2002: 32-33). The proportion of young people involved with crime or drug use varies, however, with gender, age, socio-economic background and geographical location – factors that will be returned to in discussion of causes (Section 3). 2.i.iii Fringe of delinquency Crime and drug use are readily identifiable by reference to statute but beyond them is a wider fringe of delinquency that cannot be so consistently defined because it is premised on personal interpretation:

4

The Act also made ‘anti-social behaviour’ a civil offence in Scottish law (HMSO, 1998; Section 19(1)a) See also MVA (2002) for similar results from the Scottish Crime Survey 6 Although these also have limitations; see summary in Simmons et al (2002: 6-11) and discussion in Farrington (1989) 5

96

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

Deviance is not a quality that lies in behaviour itself, but in the interaction between the person who commits an act and those who respond to it. (Becker, 1963: 14) This is not simply a semantic argument. Behaviours such as vandalism or graffiti might be identified as delinquent by the majority of people, but neutral behaviors may also be seen as delinquent by some, as research shows. In Pain and Williams’ study, a young girl observes that neighbours treat young people as if they are causing trouble when they are “only sitting on the wall” (2000: 11). This observation that apparently neutral behaviour can be seen as problematic is borne out in Power and Mumford’s study, in which a policeman states that: The younger generation – kids running around the streets, causing nuisance – has the biggest effect on people. (Power and Mumford, 1999: 62) Young people sitting on walls or running around the streets are not inherently problematic, and even this policeman’s comment that these ones were ‘causing nuisance’ does little to clarify what is going on, and what is going wrong. The difficulty is not that the behaviours are imagined, or exaggerated, but that their categorisation as problematic can vary so much – so that what is seen as ‘delinquent’ in one case may not be seen as delinquent in others. In academic terms, these categorisations are constructed rather than given (Christie, 2004), and therefore vary with the ideas of those judging behaviour (Downes and Rock, 1998: 190) and with location (Cresswell, 1996) or other contextual factors: political, socio-economic, and temporal. These onlooker or context-related factors will be considered again in the discussion of what causes delinquency (Section 3). 2.ii

Social exclusion The problem of social exclusion has been the subject of much discussion in West Europe, most notably in the European Commission, in Britain and especially in France, which initiated the concept. However, it is not widely used in other contexts (in the USA, for example) and there is disagreement even where it is used (Hills, LeGrand and Piachaud, 2002 have outlined its complexity) with accompanying concerns expressed that it is used to avoid addressing poverty itself (Levitas, 1998), that it overlooks voluntary exclusion (Le Grand, 2003) and that it is focused on adults, failing to allow sufficiently for the particular interests, opportunities and constraints of young people. Despite these reservations, it is widely used in British policy and academia. This paper discusses social exclusion as it is understood in this context, showing how it is defined by its effects, and arguing that it operates at both the societal and local levels. 2.ii.i

Defined by its effects As with delinquency and related concepts, social exclusion is most readily defined not by its parts but by its effects on people’s quality of life and engagement with society. The UK government defines it as: A shorthand term for what can happen when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown. (SEU, 2001: 10)

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

97

The Scottish government has also adopted the concept, although it uses the more positive terminology of social inclusion7. Both governments view inclusion as a combination of interlinked factors that affect people’s local quality of life and their ability to participate in what society offers, factors that relate to but extend beyond poverty. Tony Blair has described social exclusion as “not hav[ing] the means, material and otherwise, to participate in social, economic, political and cultural life” (cited by Goodlad, 2001: 5). British academia has been more circumspect about the nature and validity of the concept but has nevertheless sought to engage with it (Burchardt, Le Grand and Piachaud, 2002) and has likewise defined the problem in terms of its effects on people’s quality of life and opportunity for engagement. It can be understood as affecting people’s ability to participate both in wider society and their local area. 2.ii.ii Wider social exclusion There is no standard academic definition of social exclusion but the concept is most commonly taken to refer to engagement with society as a whole. A comprehensive depiction has been given by academics at the Centre for Analysis of Social Exclusion8, who have asserted that: An individual is socially excluded if (a) he or she is geographically resident in a society, (b) he or she cannot participate in the normal activities of citizens in that society, and (c) he or she would like to so participate, but is prevented from doing so by factors beyond his or her control. (Burchardt, Le Grand and Piachaud, 1999; 227) The paper follows this understanding of social exclusion as factors that limit wider social engagement, but it also asserts that social exclusion and social inclusion operate at the level of the local area, too. It also argues that this local level is the more significant for understanding and addressing delinquency. 2.ii.iii Local social exclusion Social exclusion is understood as a problem that not only affects individuals but also areas. It is seen as such by government – which has defined it as “what can happen when people or areas suffer from a combination of linked problems” (SEU, 2001: 10, italics in original) – and also by academics: Social exclusion ... is about the tendency to push vulnerable and difficult individuals into the least popular places, furthest away from our common aspirations. ... For a long time this has meant that inner city areas, and some large outlying council estates, increasingly vacated by people who can find an alternative, became a receptacle for problems. (Power, 2000: 1) Concern with such ‘local social exclusion’ typically focuses on areas as being disengaged from wider society (Sibley, 1995; Shields, 1991), but this paper focuses on dynamics of inclusion ^

G“There was broad agreement with the [UK] Government’s wide definition of social exclusion. However, concern was expressed about the use of negative terminology (for example, ‘tackling social exclusion’), and the suggestion made that the more positive ‘promoting social inclusion’ was preferable.” (Responses to the Consultation Paper, “Social Exclusion In Scotland” – Scottish Office, 1999b: 4) 8 CASE, my research unit at the London School of Economics – see http://sticerd.lse.ac.uk/case/ for further information

98

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

and exclusion within local areas, which can affect people’s local opportunities and their local ‘quality of life’ (see Hagerty, Vogel and Møller, 2002; Audit Commission, 2002; European Foundation online9 for discussion). People in such areas can experience limits on local involvement, limits that usually follow from how people interact. While it is important not to pathologise such areas, it should be noted that their distance from mainstream society does not necessarily promote positive local dynamics. Support mechanisms can exist, and indeed they are often prevalent (Mumford and Power, 2003; Bowman, 2001) but they can exist alongside dynamics of constraint and conflict. For example, areas deemed to be socially excluded not only have higher crime rates (Dodd et al, 2004: 87102), but also disproportionate fear of crime (Grieve and Howard, 2004) and anti-grassing cultures which inhibit people from calling the police (Graef, 2004). Thus, although local relations can facilitate social inclusion (Richardson and Mumford, 2002), they can also contribute to social exclusion if they serve to limit residents’ engagement with their area (Field, 2003; Lupton and Power, 2002), impede their sense of local safety or comfort (Brand and Price, 2000; Pain and Williams, 2000) or their local autonomy (Graef, 2004; Sampson, 1997). 3.

Understanding the causes This third section brings the two problems together to discuss how their causes relate to one another. It shows that core and fringe forms of delinquency are more likely in contexts of local social exclusion, and that local social exclusion is, in turn, fostered by delinquency. Identifying these links also reveals a way of addressing the incidence and harm of both problems.

3.i

Risk factors for delinquency Factors which promote young people’s involvement in crime, drugs, and legal but antisocial behaviour (such as loud behaviour or public drinking, YJB, 2003; Rutter, Giller and Hagell, 1998; Farrington, 1995) are termed ‘risk factors’, not ‘causes,’ since apparent causes do not always lead to delinquency (false positives) and seemingly innocuous factors may actually do so (false negatives). Such cases are found in all longitudinal studies of delinquency (Farrington, 1996). There are two sets of risk factors: individual and contextual. Box 1. Risk factors associated with crime and drug-use10 Individual risk factors Gender Nature Age Hyperactivity/high impulsivity Personal Low self-esteem Contextual risk factors

9

The Audit Commission produced a set of quality of life indicators in 2002 to aid local authorities in promoting the social, economic and environmental well-being of their area, as required by the Local Government Act 2000 (HMSO, 2000). See also the 28-country 'Quality of life in Europe' survey by the European Foundation: www.eurofound.ie/living/qual_life/ 10 Numerous studies have established that these risk factors are among the most significant (Flood-Page et al., 2000; Rutter, Giller, and Hagell, 1998; Utting, 1996; Graham and Bowling, 1995; Rutter, 1995; West and Farrington, 1990).

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

Family

Peer

School

Area

99

Low-income household Social housing Poor parental supervision Harsh or erratic discipline Conflict between parents Separation from a biological parent Parent/older sibling with criminal record Peers with a criminal record Peers who use drugs and alcohol Socialising with peers on the street Low attainment in school Aggressive behaviour/trouble in school Truanting from school Exclusion from school Deprived neighbourhood High turnover and lack of attachment ‘Socially disorganised community’

The figures over the page show (for young UK males11) the different levels of risk these factors carry (Table 1) and how their accumulation, in any combination, has an exponential impact (Chart 1). Table 1. Risk factors for serious or persistent offending Chart 1. Relationship between number of risk by males aged 12 to 30 (Campbell and Harrington, 2000: 5) factors and serious or persistent offending by males (Flood-Page et al., 2000: 46) Risk factor

Used drugs in the last year Used drugs at least once a month Drinks at least five times a week Disaffected with school Truanted from school at least monthly Temporary/permanent school exclusion No qualifications on leaving school Delinquent friends or acquaintances Parents rarely/never know whereabouts Hangs around in public

Age 1217 3

Age 1830 3 3

3 3 3 3

3 3

3 3

11 The study from which this data are drawn – the 1998/9 Youth Lifestyles Survey (Flood-Page et al, 2000) – included up to age 30 to investigate ongoing criminal involvement. The much lower numbers of young females who admit to involvement in crime and drugs means that there is not sufficient data from which to extrapolate confidently about female involvement.

100

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

Gender is the most significant of the individual factors. Young males are more likely to be involved in crime and drug-use than young females: most young offenders and most young people who admit to offending are male (Flood-Page et al, 2000: 17) and proportions of males using drugs exceed those of females at all ages over 15 (ibid. 10). Age is the second most significant risk factor: peak ages for offending are 18 for males and 15 for females (East and Campbell, 2000: 11), although it should be noted that males remain involved in crime for considerably longer than females. The 1998/9 Youth Lifestyles Survey showed that men do not tend to grow out of crime until their mid-20s (Campbell and Harrington, 2000). The third most significant of the individual factors are personal characteristics such as hyperactivity, high impulsivity, and low self-esteem (Rutter, Giller and Hagell, 1998: 127-167). Individual factors vary in significance, however, depending on a person’s socio-economic background, status and geographical setting. Studies show that young people of either sex, any age or personality type are all more likely to be involved with crime or drugs if they come from a disadvantaged home or live in a low-income area (YJB, 2001: 15-18). The area-level factors are of particular significance for this paper, since this is the context of local social exclusion. The most significant area-level factors (shown in Box 1) are: multiple deprivation (DETR, 2000; SDRC, 2003); rapid residential turnover; little attachment among residents for area and neighbours (Sampson, 1997); and weak social infrastructure (Power and Tunstall, 1997). It is important to note that these factors also affect local social exclusion. The next section outlines the causes of local and wider social exclusion before the discussion assesses the interaction between the two problems of delinquency and social exclusion. 3.ii

Causes of social exclusion Social exclusion is a compound problem and so has diverse causes. Exclusion from the wider society is generally understood as primarily being caused by poverty (Levitas, 1998), and compounded by other inequalities of opportunity and outcome (SEU: 2001), especially relating to education, employment, health and relationships (see Chamberlayne et al, 2002 for personal experiences of social exclusion). There are various views on what has caused these inequalities, but the problem of social exclusion as a whole can be understood as following from advanced capitalism, historical structural inequalities, and individuals’ own actions (or lack of them), as argued by Burchardt, Le Grand and Piachaud (2002). At the local level, it is typically understood as a geographical concentration of inequalities (Power, 2000) but it also entails local dynamics of exclusion, and these have other causes than societal inequalities. Primarily, the dynamics are based on residents’ perceptions of and relations with each other (Phillipson et al, 2004). People’s interest in and uptake of local association are influenced by how they feel about others who may be involved, either directly or in passing. Concern at the behaviour of others may discourage people from engaging, and so undermine their local social inclusion. This relates directly to delinquency. 3.iii

Delinquency and social exclusion – mutually reinforcing problems Delinquency and social exclusion can follow from and impact on one another, especially in local areas. Box 2 sets out ways in which this can happen, and the following sub-sections discuss these processes.

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

101

Box 2. Ways in which delinquency and social exclusion can compound each other Being delinquent – fosters negative groupings – enhancing risk of social exclusion

Fractured social relations – foster delinquency – undermining positive local interaction

Feeling excluded – creates sense of vulnerability – increasing perception of delinquency

Experiencing social exclusion – undermines self-esteem – enhancing risk of delinquency

3.iii.i Delinquency as a cause of social exclusion Delinquency can contribute to social exclusion at the wider level, by undermining links between areas, and at the local level, by inhibiting residents’ association with others and with local facilities or activity. The most significant impacts come from the core of delinquency. Crime and drug use are recognised as prompting area-wide social exclusion through companies and residents avoiding locating in areas with high crime rates. Moreover, they promote individual social exclusion because living in high-crime areas can lead people to avoid the public domain, limiting their association with local facilities or services (Mumford and Power, 2002). Similar consequences can also follow from perceptions of delinquency, with employers choosing not to employ people from areas with reputations for problematic behaviour, and with residents avoiding those they see as delinquent (Bramley et al, 2000), which again can have negative repercussions on their local social inclusion. For example, if someone is intimidated by groups of young people (regardless of what they are doing) then that person may avoid the public domain in order to avoid them, and so limit their own inclusion. Alternatively, if their concerns led to young people being inhibited from gathering on the street, then those young people could experience local social exclusion (Pain and Williams, 2000). Thus, directly or indirectly, actual and perceived delinquency can contribute to social exclusion. 3.iii.i Social exclusion as a cause of delinquency By the same token, however, dynamics of social exclusion can enhance the risk of delinquency. People who experience exclusion from the wider society are more likely to become involved with crime, drugs, or anti-social behaviour since they are more likely to be exposed to or experience the contextual risk factors outlined above. At the local level, too, dynamics of social exclusion can encourage delinquency. Residents who feel disengaged from positive local relations are more prone to see others as a threat to their local quality of life (Mumford and Power, 2003: 197-228), and so are more likely to perceive the neutral behaviour of young people as ‘delinquency’. In treating young people’s behaviour as a problem, residents and local workers can also unintentionally encourage delinquency by limiting young people’s access to local facilities and services. Young people may respond to this by ‘acting up,’ either to prove a point by fitting into other people’s image of them or to compensate for this limit on their activities. It is not all bad news, however; identifying the links between delinquency and social exclusion provides insights into ways that both can be addressed at the local level, where delinquency is most problematic.

102

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

4.

Addressing the problems – encouraging examples Establishing that the two problems play into one another suggests that there could be a common way to address them. It must be recognised that both are complex and prevalent problems, and as such cannot be removed altogether, but my research and other studies show that there are opportunities to tackle the problems simultaneously. The challenge is to engage young people in positive local opportunities that foster their own sense of social inclusion, thereby diminishing their exclusionary impacts on others. Research conducted for my doctorate – Community action around youth crime, drug-use and anti-social behaviour: who benefits? – indicates ways of addressing both problems. My study focused on resident-initiated youth projects working with disadvantaged young people in low-income areas of Britain and the United States. Among the wide range of organisations that I studied were a number that had made significant and sustained contributions to addressing delinquent youth behaviour. Box 3 outlines six of these which achieved this specifically by improving young people’s sense of local social inclusion. Box 3. Community organisations that addressed delinquency and social exclusion

UK: Bristol crime

sports-based initiative aimed at addressing drug-use and

Newcastle vandalism

broad youth project established to address crime and

Edinburgh drug-use

arts and education project focused on tackling crime and

USA: Harlem, NY crime

sports-based project set up to deter youths from gangs and

Philadelphia

arts project founded to detract young people from crime and

Bronx, NY

youth-led mediation project and campaign on youth justice

drugs

issues

None of these were large organisations, but all were ambitious in their approach to the work, aiming not simply to ‘keep kids busy,’ but to address delinquency (actual, perceived, potential) by engaging young people in positive action. Each of the projects recognised that there is common ground between most young people’s aspirations and interests and those of other residents. Young people typically have the same longer-term aspirations as adults (family, job, house) and are rarely inclined towards a life of crime per se. Furthermore, as these projects were aware, the vast majority of young people want to feel valued by their local area, not constrained by it. This common ground and the underlying affinity that young people have for their areas can be used as a basis for ambitious (even if small-scale) local youth work. The fact that residents had founded these projects was in itself a bonus for their engagement with young people, showing the importance that had been attached within the community itself to the needs of young people. This original emphasis on youth in the community was maintained through the work itself which, despite the different methods used, had a constant sense of young people as being central to the future of the community.

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

103

5.

Conclusion Encouraging young people to see their place in the neighbourhood as a positive one enhances their local social inclusion and can also address delinquency and so reduce exclusionary impacts on others; this finding is substantiated out by other studies. Research in America by the Forum for Youth Investment offers diverse examples of such work (Tolman and Pittman, 2001) and a comprehensive explanation of what lies behind the success (Irby, Ferber and Pittman, 2001). The Forum for Youth Investment states: What is needed? Two things: clear expectations that all young people can and should make a difference – expectations conveyed and reinforced by parents, peers, teachers, faith leaders, public officials and business owners – and visible pathways for young people to do so. (Irby, Ferber and Pittman, 2001: 29)

This insistence that young people should be expected to engage in positive ways and be given clear routes to do so supports my arguments regarding the importance of enhancing young people’s positive sense of place in their community and facilitating their positive engagement with it. The same positive cycle has been observed within areas that use Communities that Care programmes. CTC is a multi-faceted strategy for youth and community development that has been successful in the United States and in Britain (France and Crow, 2001). It aims to mobilise whole neighbourhoods “so that prevention [of delinquency] ceases to be the responsibility of a few specialist organisations.” Its underlying principle is that by enhancing young people’s sense of inclusion and value, the local area as a whole will benefit – “building safer neighbourhoods where children and young people are valued, respected and encouraged to achieve their potential” (Communities that Care, 1999: 1). Such programmes and the projects researched in my study and by the Forum for Youth Investment are evidence that both social exclusion and delinquency can be diminished to some extent by action that engages young people in positive local activity. Overviews of youth policy and practice observe the same (Lewis: 2003). The ways in which the problems relate to one another (impacting on or following from the other, especially at the local level) makes them amenable to efforts focused on developing positive local links – from young people to their community, and from other residents towards young people. Not only do such relations build local social inclusion, but they also detract young people from delinquency, creating a sustainable positive cycle in local areas. References Audit Commission (2002) Using Quality of Life Indicators. (Audit Commission: London) Also available online: www.audit-commission.gov.uk/pis/quality-of-life-indicators.shtml BBC News Online (2003a) ‘Blunkett’s yob culture purge’ (12/03/03) http://news.bbc.co.uk/1/hi/uk_politics/2841481.stm BBC News Online (2003) ‘Holyrood urged to protect ‘neds’’ (05/06/03) http://news.bbc.co.uk/1/hi/scotland/2964378.stm Becker, H.S. (1963) Outsiders: Studies in the Sociology of Deviance (Collier-McMillan: London) Bowman, H. (2001) Talking To Families In Leeds And Sheffield: A Report On The First Stage Of The Research. CASEreport 18 (Centre for Analysis of Social Exclusion, LSE: London) Bramley, G., Pawson, H. and Third, H. with Parker, J., Hague, C. and McIntosh, S. (2000) Low Demand Housing and Unpopular Neighbourhoods. (DETR: London) Brand, S. and Price, R. (2000) The Economic and Social Costs of Crime. Home Office Research Study 217 (Research Development and Statistics Directorate, Home Office: London)

104

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

Burchardt, T., Le Grand, J. and Piachaud, D. (1999) ‘Social exclusion in Britain: 1991-1995’, in Social Policy and Administration, Vol. 33 (3) 227-244 Burchardt, T., Le Grand, J. and Piachaud, D. (2002) ‘Degrees of exclusion: developing a dynamic, multi-dimensional measure’, in Hills J., Le Grand, J. and Piachaud, D. (eds) Understanding Social Exclusion. (Oxford University Press: Oxford) Campbell, S and Harrington, V. (2000) Youth Crime: Findings from the 1998/1999 Youth Lifestyles Survey. Home Office Research Findings No. 126 (Home Office: London) Chamberlayne, P., Rustin, M. and Wengraf, T. (2002) Biography and Social Exclusion in Europe: Experiences and Life Journeys (Policy Press: Bristol) Christie, N. (2004) A Suitable Amount of Crime. (Routledge: London) Communities that Care (1999) A Guide to Promising Approaches (JRF: York) Condon, J. and Smith, N. (2003) Prevalence of Drug Use: Key Findings from the 2002/2003 British Crime Survey. Findings 229 (Research Development and Statistics Directorate, Home Office: London) Corkery, J. (2002) Drug Seizure and Offender Statistics, United Kingdom, 2000. Home Office Statistical Bulletin, 04/02 (Research Development and Statistics Directorate, Home Office: London) Cresswell, T. (1996) In Place/Out of Place: Geography, Ideology and Transgression. (University of Minnesota Press: Minneapolis) DETR (Department of the Environment, Transport and the Regions) (2000) Regeneration Research Summary, Number 31: Indices of Deprivation 2000. (DETR: London) Dodd, T., Nicholas, S., Povey, D. and Walker, A. (2004) Crime in England and Wales 2003/2004 (Home Office: London) Downes, D. & Rock, P. (1998) Understanding Deviance: A Guide to the Sociology of Crime and Rule-Breaking. (Third Edition. Oxford University Press, Oxford) East, K. and Campbell, S. (2002) Aspects of Crime: Young Offenders 1999 (Home Office: London) Online only: www.homeoffice.gov.uk/rds/pdfs/aspects-youngoffs.pdf Edinburgh Evening News (2003) ‘Labour vows to tackle city’s ned culture’ (03/05/03) Farrington, D. P. (1989) ‘Self-reported and official offending from adolescence to adulthood’, in M.W. Klein (ed.) Cross National Research in Self-Reported Crime and Delinquency. (Kluewer: Dordecht) Farrington, D.P. (1995) ‘Teenage antisocial behaviour’, in M. Rutter (ed.) Psychosocial Disturbances in Young People. Challenges for Prevention. (Cambridge University Press: Cambridge) Farrington, D.P. (1996) Understanding and Preventing Youth Crime (Joseph Rowntree Foundation: York) Field, F. (2003) Neighbours from Hell: The Politics of Behaviour (Politico’s: London) Flood-Page, C., Campbell, S., Harrington, V. and Miller, J. (2000) Youth Crime: Findings from the 1998/99 Youth Lifestyles Survey. (Home Office: London) France, A. and Crow, I. (2001) CTC- the story so far: an interim evaluation of Communities That Care (Joseph Rowntree Foundation: York) Girling, E., Loader, I. and Sparks, R. (2000) Crime and Social Change in Middle England: Questions of Order in an English Town. (Routledge; London) Goodlad, R. (2001) From Poverty to Social Justice www.wtltnet.org.uk/wtltnewsite2/training/m1frpovsocjus.htm Graef, R. (2004) ‘Hope, not fear, is the key’, in J. Grieve and R. Howard (eds.) Communities, Social Exclusion and Crime. (The Smith Institute: London)

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

105

Graham, J. and Bowling, B (1995) Young People and Crime. Home Office Research Study 145 (Research Development and Statistics Directorate, Home Office: London) Grieve, J and Howard, R (eds) (2004) Communities, social exclusion and crime (Smith Institute: London) Griffin, S. (1993) Representations of Youth: The Study of Youth and Adolescence in Britain and America (Polity: Cambridge) Hagerty, M.R., Vogel, J. and Møller, V. (2002) Assessing Quality of Life and Living Conditions to Guide National Policy: The State of the Art. (Kluwer Academic Publishers: Boston) Hills, J., Le Grand, J. and Piachaud, D. (eds.) (2002) Understanding Social Exclusion (Oxford University Press: Oxford) HMSO (1998) Crime and Disorder Act 1998 (HMSO: London) HMSO (2000) Local Government Act 2000 (HMSO: London) Irby, M., Ferber, T. and Pittman, K. (2001) Youth Action: Youth Contributing to Communities, Communities Supporting Youth (The Forum for Youth Investment: Takoma Park, Maryland) Le Grand, J. (2003) Individual Choice and Social Exclusion CASEpaper 75 (Centre for Analysis of Social Exclusion, LSE: London) Levitas, R. (1998) The Inclusive Society? Social Exclusion and New Labour. (Macmillan Press: London) Lewis, A. (2003) Shaping the Future of American Youth: Youth Policy in the 21st Century (American Youth Policy Forum: Washington, DC) Lupton, R. and Power, A. (2002) ‘Social exclusion and neighbourhoods’, in Hills, J., Le Grand, J. and Piachaud, D. (eds.) Understanding Social Exclusion. (Oxford University Press: Oxford) Maguire, M. (1994) ‘Crime statistics, patterns and trends: Changing perceptions and their implications’, in M. Maguire, R. Morgan and R. Reiner (eds.) The Oxford Handbook of Criminology. (Oxford University Press: Oxford) Matthews, R. and Pitts, J. (eds.) (2001) Crime, Disorder and Community Safety. (Routledge: London) May, M. (2002) ‘Innocence and experience: the evolution of the concept of juvenile delinquency in the mid-Nineteenth Century’, in J. Muncie et al (eds) Youth Justice: Critical Readings. (Sage: London) Mumford, K. and Power, A. (2002) Boom or Abandonment: Resolving Housing Conflicts in Cities. (Chartered Institute of Housing: Coventry) Mumford, K. and Power, A. (2003) East Enders: Family and Community in East London. (Policy Press: Bristol) Muncie, J., Hughes, G. and McLaughlin, E. (eds) (2002) Youth Justice: Critical Readings. (Sage: London) MVA (2002) The 2000 Scottish Crime Survey: Overview Report (Scottish Executive: Edinburgh) NIF (Neighbourhood Initiatives Foundation) (1998) Planning for Real Safety: Community Safety and the Work of the Neighbourhood Initiatives Foundation. (Neighbourhood Initiatives Foundation: Telford) Pain, R. and Williams, S. (2000) ‘Young people and fear of violence in North Tyneside: The exclusionary tensions of ‘community safety’’, Geographies of Fear and Violence conference, 4-7/1/00 RGS London Pearson, G. (1983) Hooligan: A History of Respectable Fears. (Macmillan: London) Pearson, G. (1994) ‘Youth, crime and society’, in M. Maguire, R. Morgan and R. Reiner (eds.) The Oxford Handbook of Criminology. (Oxford University Press: Oxford)

106

C. Paskell / Causes and Effects of Delinquent Behaviour and Social Exclusion

Phillipson, C., Alan, G. and Morgan, D. (2004) Social Networks and Social Exclusion: Sociological and Policy Perspectives (Ashgate: Aldershot) Pitts, J. (2001) The New Politics of Youth Crime: Discipline or Solidarity? (Palgrave: Basingstoke) Power, A. (2000) ‘Poor Areas and Social Exclusion’, in Power, A. & Wilson, W.J. Social Exclusion and the Future of Cities. (CASEpaper 35, LSE, London) Power, A. and Mumford, K. (1999) The Slow Death of Great Cities? Urban Abandonment or Urban Renaissance. (Joseph Rowntree Foundation: York) Power, A. and Tunstall, R. (1997) Dangerous Disorder: Riots and Violent Disturbances in Thirteen Areas of Britain, 1991-92 (Joseph Rowntree Foundation: York) Pudney, S. (2002) The Road to Ruin? Sequences of Initiation into Drug Use and Offending by Young People in Britain. Research Study 253 (Home Office: London) Richardson, L. and Mumford, K. (2002) ‘Community, neighbourhood and social infrastructure’, in Hills, J., Le Grand, J. and Piachaud, D. Understanding Social Exclusion (Oxford University Press, Oxford) Rutter, M., Giller, H. and Hagell, A. (1998) Antisocial Behaviour by Young People (Cambridge University Press: Cambridge) Rutter, M. (ed.) Psychosocial Disturbances in Young People: Challenges for Prevention (Cambridge University Press: Cambridge) Sampson, R.J. (1999) ‘Systematic social observation of public spaces: a new look at disorder in urban neighbourhoods’, in American Journal of Sociology, Vol.105, No.3, pp.603-51 Sampson, R.J. (1997) ‘Collective regulation of adolescent misbehaviour: Validation results from eight Chicago neighbourhoods, in Journal of Adolescent Research, Vol.12, pp.227-244 Scottish Office (1999) Responses To The Consultation Paper, “Social Exclusion In Scotland”: A Summary (Scottish Office, Edinburgh) SDRC (Social Disadvantage Research Centre) (2003) Scottish Indices of Deprivation 2003 (Department of Social Policy and Social Work, University of Oxford: Oxford) SEU (2001) Preventing Social Exclusion: Report by the Social Exclusion Unit. (HMSO: London) Shields, R. (1991) Places on the Margins: Alternative Geographies of Modernity. (Routledge: London) Sibley, D. (1995) Geographies of Exclusion. (Routledge: London) Sunday Herald (2003) ‘Ned, n: 1. A delinquent; 2. A ‘threat to Scotland’; 3. A wee lost boy’, 13/04/03 Tolman, J. and Pittman, K. (2001) Youth Acts, Community Impacts: Stories of Youth Engagement with Real Results (The Forum for Youth Investment: Takoma Park, Maryland) Utting, (1996) Reducing Criminality Among Young People: A Sample of Relevant Programmes in the United Kingdom. Home Office Research Study 161 (Home Office: London) West, D.J. and Farrington, D.P. (1990) ‘The Cambridge Study in delinquent development: a long term follow up of 411 males’, in H.J. Kerner and G. Kaiser (eds.) Criminality, Personality, Behaviour, Life History. (Springer-Verlag: Berlin) Williams, K.S. (1994) Textbook on Criminology: Second Edition. (Blackstone Press: London) YJB (Youth Justice Board for England and Wales) (2001) Risk and Protective Factors Associated with Youth Crime and Effective Interventions to Prevent It. Research Note No. 5 (YJB: London) Youth Justice Trust (2002) Young People and Crime in Greater Manchester: Perceptions and Evidence. (Youth Justice Trust; Manchester)

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

107

2. Dignity and Respect for Oneself and Others: A Practical Initiative with Adolescents Angela DE MALHERBE President, Centre d’Education Pluridisciplinaire de la Personnalité Neuilly-sur-Seine France Adolescence is a time for discovery, and puberty introduces an explosion of questions about the self. Everything that happens to an adolescent is important, but young people will no longer receive parental advice as they had before. In order to adjust to their evolving self-images, they feel they must assert their egos very strongly to be considered important by their parents or by adults in charge. It is as though they were sticking a pin into a large balloon. Adolescents assert themselves by taking a 180 degree turn away from the values that their parents or adults around them have always proposed. For example, youth from very religious families may decide against going to services or may join another religion. If the parents are very conservative, the adolescents may assert liberal views. This is all normal in terms of growing up. What is also interesting is that while the adolescent wishes to be recognized as unique, he or she will conform to peer-pressure and want to wear the same clothes and listen to the same music as his or her contemporaries. Youth culture is universal. Immediate communication from one side of the globe to the other has made this possible. It is also normal at this time, whether life is difficult or not, for young people to ask themselves probing questions about themselves and their future focusing on self-definition, career possibilities, and romantic commitments. There is no doubt that family breakdown has created new difficulties for young people. Numerous scientific studies show that children from broken homes are the ones who easily fall into delinquency, drug abuse, vandalism, and crime. Their schoolwork and studies are not what they should be, and they have difficulties in adjusting to society. In France, suicide among people under 25 years of age is the second leading cause of mortality. Therefore, families are very important in building balanced and responsible individuals. In French opinion polls, adolescents have two values that come first: family and the desire to build a happy married life. But how are young people to be helped to achieve these goals in a world where divorce is encouraged by law, where violence and insecurity, poverty, and intense competition make it increasingly difficult for adolescents to find the meaningful lifestyle that they would wish to adopt? We must also recognize the fact that human life has become something that one can destroy at will—in wars and conflict where women and children become the prime target, and through genetic engineering and procreation that have made men and women objects to be disposed of or produced at will. Today, an animal used as a “guinea pig” in a laboratory is more expensive than a human embryo. In France, if someone runs over a dog with his or her car, he or she will be prosecuted. However, if someone causes an accident that kills a child in its mother’s womb, the baby’s right to live is not recognized by law. In this kind of

108

A. de Malherbe / Dignity and Respect for Oneself and Others

setting, how can we give adolescents a sense of self-worth and a desire to live a constructive life in the human community? As sexuality is our capacity to love, it is the most fundamental component of the human being. In 1980, an interesting and efficient programme of sex education began in the United States. TeenSTAR (Sexuality Teaching in the context of Adult Responsibility) has been very successful in helping adolescent boys and girls to “find themselves” as human beings by guiding them toward integrating all the components of sexuality. The programme covers the five major aspects in human sexuality (represented by the five branches of the star in the TeenSTAR logo): physiological, emotional, social, intellectual, and spiritual. Once these are understood and integrated, the adolescent becomes a star! He or she is now in control of his or her person, and has achieved self-respect. Therefore, the adolescent is capable of self-control, and directing his or her goals toward the lifestyle he or she has chosen with regard to personal values and talents. This programme invites parent participation, and builds bridges between generations. It includes curricula for early, middle, and late adolescents. It is taught in an interactive manner, with teachers asking many questions of their students in order to help them find the significance of basic human realities. Young people need to understand the meanings and objectives of human actions and their own sexuality in terms of its different aspects in order to make informed, free choices for the future. At puberty, the teenage girl is ready to become a mother, and the boy a father. This power is very important to them, even though they are not yet ready to use it. They are at the centre of their world, are at the point in their psychological development where they think concretely, and think that nothing that happens to them is unimportant. They tend to “telescope” many things. For example, when the “all powerful” doctor gives a girl contraceptive pills, she may understand that her fertility is an illness since she has to take a medicine for it. As her fertility is at the centre of her ego-identity, she, in her mind, has been deemed sick. She does not want to accept this negative denial of her parental capacities, so she forgets to take her pill and becomes pregnant. This psychological reaction has been identified by other social psychiatrists, including Professor Tony Anatrella in France. Thus, girls become pregnant in order to assert their womanhood in the face of contraceptive constraints imposed on them by society. Dr. Hanna Klaus implemented the TeenSTAR programme in 1980. She is a gynaecologist who has worked with unwed mothers in addition to practicing her profession in developing countries. She has also taught medicine in the United States, where she directs the Natural Family Planning Centre of Washington, D.C., Inc., and TeenSTAR International. In the late 1970s, Dr. Klaus was working in an American hospital where she was asked to care for pregnant teenagers. In spite of widespread contraception, there were 400,000 teenage abortions per year. Dr. Klaus could not understand how there could be so many teenage pregnancies. She believed that if girls could learn about the meaning and the significance of their fertility, maybe they would behave differently and avoid pregnancy before adulthood. This is indeed what happened: by learning to recognize the signs of fertility, the girls began to value their womanhood and their behaviour changed. Very few began to experiment sexually. In the pilot group, half of those who were already sexually active stopped the activity. This has been consistently true in groups following the curriculum wherever it is taught. Each year, statistics are kept from the anonymous exit questionnaires answered by the students and follow-up on behavioural outcomes. The personal value derived from knowledge stemming from the programme helps to make young people responsible not only as adolescents, but also in terms of their family lives, careers, associations, and community involvement as well. The

A. de Malherbe / Dignity and Respect for Oneself and Others

109

message from the programme is received as good news that brings peace to adolescents. They then communicate the message to their friends. TeenSTAR exists in 29 countries and is directed to and taught in different socioeconomic backgrounds. Courses taught in the Eastern European countries, and Poland in particular, often receive support from the government. TeenSTAR was recently introduced in Korea, Cameroon, Russia, and Burkina Faso. Presently, the curriculum is being translated into Mandarin, and teacher training workshops are scheduled in China as soon as the translation is complete. I introduced TeenSTAR to France ten years ago, and it is developing very well. School principals, teachers, parents, and the adolescents themselves continue to send us testimonies of great satisfaction with the outcomes. Furthermore, more schools and youth groups are requesting teacher training workshops throughout the country. Teaching adolescents to value themselves in all aspects of their sexuality and therefore their personhood helps adolescents acquire a sense of responsibility toward themselves and others. This can have a very positive impact on individual societies as well as on participating countries as a whole.

110

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

3. Communication in the Family—A Means to Reduce Anti-Social Behaviour and Violence in the Community Isabelle DE RAMBUTEAU President, Mouvement Mondial des Mères France, Paris France

In France, the MMM is implementing a simple and concrete plan to assist mothers in the fulfilment of their family and social roles. Local and national government support for our programme has been strong, and the current initiatives have been very successful. The plan can work anywhere in the world through bringing peace into the home, the community, and society as a whole.

MMM France: Who we are MMM France is a feminine, family organization founded in 1993. Like its parent organization, MMM International, it is non-political, interdenominational, and committed to promoting the role of mothers in building and maintaining peace at home and beyond. Our objectives are twofold: 1. to help mothers, working closely with fathers, understand the importance of their role, and 2. to make the mother’s viewpoint heard in local and national decision making. MMM France is a working group for designing and implementing practical projects on issues of concern to mothers, such as making policy-makers understand the needs of mothers and the family, preventing their children use and abuse drugs and alcohol, or helping children to deal with the pornographic images and violence in films and television. MMM France is currently working on practical schemes to promote social inclusion and thus reduce frustrations and violence in the community – the pilot scheme in Colombes, a borough of Paris, has been very successful. This has led to the French government inviting MMMM France to present their results and become a consultant to government in this field. Its members are individuals and local associations, and its partners are larger associations, sponsors, and town councils.

What we do and how we do it MMM France supports mothers in their roles as the pivotal force of family life, coeducators with fathers of the next generation, and actors for the active prevention of violence among young people in the family and outside the home. We do this through discussion groups encouraging the exchange of know-how and experience with education in the family.

I. de Rambuteau / Communication in the Family

111

Our discussion groups bring together 8-12 mothers with children in the same age range for a few hours. They may meet in a variety of places, from a town hall to someone’s home, and cover a number of topics relevant to parenting, including authoritative interaction with, sharing with, and listening to children. First, the discussion leader shows Let’s Dare to be Parents, our video of real-life situations in five families that gives ideas about dealing with everyday problems of raising children. Next, using the manual, the leader asks mothers to discuss issues raised in the video and to exchange experiences and solutions that work for them. At the end of the session, in addition to the new ideas she has learned, each participant takes home the following items: 1. A “charter” of sharing to use at home (listen to each other, respect differences, etc.) 2. Simple guide to children’s needs 3. List of books, courses, other discussion groups, associations, and centres, and 4. Details of a free course to become a group leader. Our group leader training is open to mothers who have been training groups as participants. Group leader training is open to ten mothers per session, and is led by professional consultants. Training sessions are also held in places accessible and acceptable to all participants. The training courses give mothers the opportunity to run discussion groups in an informal social setting in hopes of building a network of well-informed and active parents who are willing and able to share their experiences of good parenting.

Goals of the discussion groups: We aim for the discussion groups to assist mothers in their crucial functions of caregiving to children. We also hope to help mothers feel less isolated in dealing with the problems of motherhood through connecting them to other women within their own culture and across other cultures who are struggling with the same issues. Additionally, we want these discussions to help the women communicate with fathers about the importance of partnership in raising children, and to learn the importance of instilling values in their children so that they do not turn to dysfunctional and dangerous behaviours such as drug abuse, violence, suicide, and anti-social behaviour. Through the support of the network, it is also our hope that mothers will be better able to raise their children without the help of professional counsellors. We see these discussion groups as a cost-effective way to improve the quality of family life for many and, therefore, beneficial to society as a whole.

112

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

4. Israel: Mechanisms to Help Youth Cope With the Current Situation and the Fear of Violence and Terror Shimon MALKA The Jewish Arab Center for Peace, Givat Haviva Israel Co-director ‘All for Peace’ joint Palestinian/Israeli radio station and Co-editor ‘Crossing Borders’ joint Palestinian/ Israeli/Jordanian youth magazine

Workshops for Educational Institutes: Rationale: Political violence and Terrorism, for its own sake, aims to disseminate death and fear over a population of civilians. Terrorism is a violent, manipulative method intended to accomplish interests and achieve goals which, allegedly, are unattainable using other means. The greatest influence terrorism can attain is in channels that are completely emotional, the foremost of which is fear. It is true that feelings of fear are also caused due to realistic and logical situations, however the most common effect of terrorism on the general public is that it has on the emotional aspect, in addition, of course, to the actual physical injury incurred by people who are directly involved. The main goal in coping with these feelings is to try and transfer how one relates to terrorism from the emotional region to the rational, as much as possible. This process requires taking action in several channels: 1. Expressing and processing feelings. 2. Understanding the roots of terrorism and its goals. 3. Recognizing the broader picture of the reality in the region. 4. Presenting possible scenarios – positive and negative developments.

Methodology: 1. Expressing feelings This involves procedural work that will enable the expression and processing of feelings by the participants. All of the feelings and relevant associations are supposed to surface in the form of description of these, without being required to explain [or being ashamed of, or apologizing for having these feelings]: fear, hate, anger, anxiety, and helplessness, loss of control, pain, and weakness. All of these, and others, will come to the surface in the course of discussions in a familiar forum and in an atmosphere of encouragement and cooperation and one that grants legitimacy to almost anything. Some of the fears will become better understood and for many of

S. Malka / Israel: Mechanisms to Help Youth Cope with the Current Situation

113

the group this will hopefully enable them to descend to a more conscious and therefore more controlled level. Nonetheless, it is important that one is careful not to grant legitimacy to racist statements. In these situations it is reasonable that angers will surge and feelings of hate or proposals for collective punishment will surface (death to all Arabs/ an atom bomb/ transfer and such). The tools for this activity are based on experts’ knowledge in the field of psychology and will be imparted by moderators especially trained in this field.

2.

What is terrorism? Where do its roots lie? What are its goals? What are its methods of action? To establish a proportional picture, it is important to present and relate to terrorism as an international phenomenon that emerges all over the world and that the Palestinians most definitely were not its originators. A general review of world terrorism can help youth understand that even if they are presently residing in a living hell, and are afraid of the terrorism in their country, this phenomenon has a long history all over the world and in various countries there are examples of coping with the phenomena of terrorism and arriving at solutions, whether by methods of war or with agreements. One must bring forth examples of countries that in the past were in continuous states of war, similar to that of Israel in the Jewish – Arab conflict, and that resolved the conflict. Understanding these issues touches, in fact, on the main point for which terrorism is activated – intimidation and creating intense emotional stress on civilians, so that the latter will put pressure on their political leaders. One must assume that the fear will not disappear following this activity, but in a certain way it will be possible to transfer the fear from a place in which it is totally uncontrollable (due to lack of knowledge) to a more rational and conscious place, in which it is, therefore, more limited and easier to cope with.

3. Case study: Recognition of the Jewish – Arab conflict in which terrorism operates: The broad context To succeed in locating the fear in a more rational aspect, it has to be linked with the rest of the details in the picture: Terrorism is part of a long and continuous confrontation between two nations and one must become familiar with the conflict’s historical details and the narratives of both sides, the Israeli and the Palestinian. This chapter will provide a historical review of the national conflict in Israel; the positive stages and processes of the Arab Israeli reality will also be described: peace agreements, peace discussions and political and cultural achievements that have been reached throughout the course of years. These will constitute a vital, positive factor in understanding the comprehensive picture and will make possible an opening for hope.

4. Possible scenarios – what can happen? Along with the information that is to be imparted through lectures, historical reviews, simulations and workshops, it is important to add two more levels that are also to be based on understanding and knowledge:

114

S. Malka / Israel: Mechanisms to Help Youth Cope with the Current Situation

a. Possible scenarios for radicalisation of the situation Where can this continuous confrontation lead to? War and all its repercussions, results of the war and then what? It is possible that an additional component of the fear of terrorism is the fear of war. Therefore, it would only be right, at this point, to also portray a scenario of possible war that would be short and limited due to the immediate external, international intervention that would strive to prevent deterioration of the entire area into a state of war. b. Scenarios that reveal a light at the end of the tunnel It is important to present an alternative picture as well, one that will present possible solutions to the existing situation, such as both sides going back to the table of negotiations, after a phase without any terrorist acts that will lead to the return of trust between the two parties. Or, perhaps, the discussions will then be renewed, those that supposedly, in the end, are to lead to a permanent arrangement with the Palestinians and maybe even to the end of the conflict. Just as in any field, it is important that youth be aware of and understands the chance for a positive change, even if it seems to have poor and almost impossible chances in the current reality. Belief in a positive change that will be based on understanding and recognition of all the variations of possibilities and interests of both sides will enable hope and belief in the existence of another reality, one that is positive and totally different from the present period of terrorism. The workshops take place in schools. The length of the activity is six hours. The workshops are conducted by professional mediators from the various fields.

Coping With the “Situation” A day of activity that is to take place in schools and that will carry on for about four to five hours. There are two workshops, one for raising and treatment of youths’ feelings and the second, as a body of knowledge on “what is terrorism”. Both of the workshops can take place simultaneously, with two halves of a class. It is not necessary to first work on feelings and then on terrorism. It is worthwhile to find a way that both workshops will take up the same amount of time. It is preferable that each one will take two hours. It is important that the part dealing with feelings should be given by a professional mediator from the familiar staff. One workshop will work on youths’ feelings, raising issues such as: ‘What do I feel towards whom/ what am I angry about?’ ‘What am I afraid of?’ ‘What can I do with these feelings?’ Angers and expressions of hate that will be raised by the students towards the Palestinians will constitute the basis for discussion of the conflict. Most of the workshop can and should be conducted according to the directions of discussion that develop in the class, while the mediators set themselves a goal, not to leave any slogans or ideas for solving the “situation” untreated (transfer, an atom bomb, death to all Arabs and such). To conclude, it will be possible to go back and again enable the youths to raise their feelings, which may have changed from the beginning of the workshop. The second workshop will be conducted as a lecture – discussion that will explain the idea and effect behind terrorism. The claim is that the more one understands the “rules of the game”

S. Malka / Israel: Mechanisms to Help Youth Cope with the Current Situation

115

and the participants, hence he/ she will be able to transfer fears to a more conscious place and perhaps less uncontrolled. Examples of appropriate subjects: Understanding the components and character of the phenomenon The limits of the phenomenon The goals of terrorism The psychological battle against the soul of the public The connection between the media and terrorism Military activity as terrorism. It is reasonable to assume that here too things will develop into dealing with the conflict. Here it is possible to lead to the roots of the conflict, to proposed methods of solution, international aspects of the conflict, etc. In order to inspire independent thought, even following the day of activity, it is important to close the discussion by drawing a broader picture of legitimacy and understanding of fears and apprehensions (1), of the “phenomenon” – terrorism (2), whose motives, tools and implications on our lives are now clear. Using common interests to build understanding Young people like similar pursuits – sport, pop music, magazines. These are very effective ways in bringing young people to understand each other. We have two activities which work very well: ‘All for Peace’ - joint Palestinian/Israeli radio station ‘Crossing Borders’ - joint Palestinian/ Israeli/Jordanian youth magazine By recognising their common interests we lead the young people to build up an understanding of the others’ viewpoint and of peaceful ways to resolve conflicting interests.

116

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

5. Working with Youth as Partners to Reduce the Effects of Trauma: Models from Belarus, Russia and the USA Linda NEUHAUSER, PhD University of California, Berkeley, USA Trauma from conflicts, terrorism and societal instability can cause serious problems for young people and hinder their healthy development and future success. Unresolved childhood trauma is linked to a wide range of problems including poor growth, difficulty in forming relationships with adults and peers, violent behaviour, poor school attendance, hopelessness about the future, substance abuse and many psychiatric conditions such as depression and anxiety (Silove, 1999; Cohen, et al., 2002; Pfefferbaum et al., 1999; Pynoos, 1992; Black, Emanuel & Mendelsohn, 1997; Monohon, 1997; Veenema & Schroeder-Bruce, 2002). Psychosocial consequences of trauma in youth can also increase conflict and insecurity in families and communities (Barber, 1997; Harvey, 1996; Cairns & Dawes, 1992). The International Society for Traumatic Stress Studies (ISTSS) is a useful resource for information about worldwide research on the effects of childhood trauma and professional, community and political approaches to prevent and reduce these consequences (http://www.istss.org).

The challenge to understand youth trauma It is difficult to find effective ways to prevent, identify and respond to trauma in youth. Young people and their families may be powerless to stop serious conflicts and ongoing threats to their security. Although many youth are exposed to intensely traumatic situations, researchers and practitioners cannot identify with any certainty the youth who are at highest risk for poor psychosocial outcomes, especially over the long-term (Cairns & Dawes, 1996). Fundamentally, trauma is paradoxical. The symptoms that result from traumatic stress, such as heightened responses and anxiety, may be viewed either as pathological signs of mental dysfunction or as instinctual defence mechanisms needed to adapt to and survive extreme situations. Symptoms of stress may be perceived positively as “stimulating activity” that helps a person reconstruct their world, or negatively, as evidence of an individual’s inability to cope (Pupavac, 1999). The paradox arises from a lack of agreement about how to frame the issue of trauma. The traditional “medical model” emphasizes individual reactions to trauma and recovery (Harvey, 1996) and focuses on individual counselling to manage short-term symptoms and reduce longerterm negative effects. The presumption is that psychological intervention is important, especially for children who might otherwise suffer lifelong consequences. This model has come under increasing criticism in part because of the lack of solid clinical evidence that improved outcomes necessarily result from trauma counselling (Scott & Stradling, 2001). For example, according to a NATO workshop on the social and psychological

L. Neuhauser / Working with Youth as Partners to Reduce the Effects of Trauma

117

consequences of terrorism, evidence does not support the routine use of early intervention such as critical incident stress debriefing (NATO, 2002). Such approaches may tend to over professionalize stress and intrude on natural networks of coping. A more pointed criticism is that labelling populations as “traumatized” and in need of external psychological assistance may be disempowering and invalidate their rights to selfdetermination (Pupavac, 2001). Such an approach may be seen as using a Western therapeutic model to incautiously project “dysfunctionalism” on people who have experienced trauma with the conclusion that Western-type psychosocial interventions are also needed and effective in other cultural settings (Summerfield, 2000). Indeed, such psychosocial interventions have now become an integral component of international aid in post-conflict areas. Ironically, the accumulating evidence shows that the vast majority of children exposed to ethnic and political violence ultimately demonstrate good physical and psychological functioning in the absence of clinical care (Cairns & Dawes, 1996). Moreover, the differences between the children who do well and those who don’t are not well explained by individual factors. The Task Force on International Trauma Training of the International Society for Traumatic Stress Studies concluded that international training in mental health and psychosocial interventions for populations exposed to trauma is a new, developing field, and that there has been little consensus on the best approaches and standards (Belgrad & Nachmias, 1997; Weine, 2000).

Developing a new framework for youth trauma Clearly, a better model is needed to predict which youth are likely to be most adversely affected by trauma and which interventions will be most beneficial. Studies increasingly show that youth outcomes from trauma are most closely related to children’s interactions with their family and community. For example, Barber (1997) found that, among Palestinian children and adolescents exposed to high levels of stress during the Intifada, those who were well integrated into family, educational, and social institutions appeared to survive without major negative consequences. Conversely, youth who reported that they had poor relationships with their parents and community institutions were much more likely to show poor psychological and social outcomes. Garbarino and Kostelny (1996) also studied outcomes for Palestinian children exposed to violence. They concluded that outcomes were reasonably positive unless the children had been exposed to extreme violence on multiple occasions without adequate family and community supports. Similarly, in examining the impact of state terrorism on Guatemalan refugee children, Miller (1996) pointed out that coping with these circumstances required collective, rather than individual, support. The understanding that trauma outcomes are intricately linked to multiple dimensions in a child’s environment has promoted interest in an ecological perspective. In the same way that the “ecological model” is now considered the preferred framework to guide development of public health interventions (Emmons, 2000), effective responses to trauma must be viewed within multiple levels of interaction in communities (Harvey, 1996; Weine et al., 2002). In this regard, the ecological approach advanced by the study of community psychology places the issue of trauma within the resources and interrelationships that exist in communities (Trickett, 1984). Community psychology considers trauma a threat to individual youth as well as to the security of the community as a whole. Therefore, in order to deal with trauma, a child’s reaction must be understood within the context of community strengths, values, and behaviours (Koss & Harvey,

118

L. Neuhauser / Working with Youth as Partners to Reduce the Effects of Trauma

1991). The efficacy of both psychological and community interventions depends on how well they fit within the relationships between youth, their families and communities. These complex interactions may help explain some of the current confusion about how to improve children’s outcomes after trauma. According to the ecological model, it is critical to understand the youth’s environment and the positive or negative factors involved, rather than to assume that a standard psychological interpretation or intervention will be effective. Because trauma outcomes are multi-dimensional, clinical psychological approaches alone are insufficient to address the other critical family, school, and community supports youth need to succeed under adverse conditions.

Resilience and youth trauma Although the ecological framework emphasizes the need to explore youth trauma in a multi-dimensional environment, it does not obviously explain why some youth do well after trauma, and others do not. The past three decades of longitudinal research on healthy human development suggests an important answer: that successful emotional, social, cognitive, physical and spiritual outcomes depend on critical developmental supports and opportunities during childhood (Benard & Constantine, 2000). Resilience research—long-term, international studies of positive human development in the face of adversity--provides strong evidence about family and community factors that promote good outcomes for youth (Werner & Smith, 1992). This research has catalyzed a focus on “resilience” to help understand how children overcome traumatic experiences. Resilience is described as “a phenomenon whereby individuals show positive adaptation in spite of significant life adversities” (Luthar, Cicchetti & Becker, 2000). It is considered a universal developmental capacity in every human being (Benard, 2004). Although resilient children may experience extreme distress and hardships, they are able to adapt and function well socially and psychologically. Resilience is closely related to the concept of “empowerment.” Resilient youth are considered empowered youth. They are active participants in their environments, rather than passive victims of events, as is sometimes presumed by traditional psychological models. Resilience studies have identified three major protective factors that help youth shift their lives from “risk to resilience.” They are 1) caring relationships, 2) messages of high expectations, and 3) opportunities for engagement and contribution (Werner & Smith, 1992). These factors help youth meet their needs for love, belonging, respect, mastery and meaning. A striking finding of the research is that the protective factors have a more profound impact on the life course of children than do specific risk factors or stressful life events (Benard, 2004). These competencies and strengths appear to transcend ethnicity, culture, gender, geography and time (Werner & Smith, 1992). And, long-term studies of positive development show that these supports and opportunities are precisely those that predict the best outcomes for all youth, not just those thought to be “at-risk.” In all, resilience work represents a dramatically different perspective about youth who have experienced trauma or other significant adversity. Unlike previously dominant “deficit models” that have concentrated primarily on risk factors, resilience models advocate a shift to creating communities with rich developmental support for all children (Benard & Constantine, 2000).

L. Neuhauser / Working with Youth as Partners to Reduce the Effects of Trauma

119

Promoting resilience through participation How can we incorporate these protective factors into successful strategies to foster resilience in children and adolescents? During the past two decades there have been many promising efforts to develop resilience and “positive youth development” interventions that address the complex issues of childhood adversity (Pittman, 1996; Vernberg & Vogel, 1993). These strategies seek to build underlying resilience, empowerment, and hope in the face of difficult challenges. There is growing evidence that such interventions help youth become more secure and competent during adolescence and as adults. Strategies that incorporate high levels of participation are especially effective. Participatory approaches are grounded in the pioneering work Brazilian philosopher and empowerment educator, Paolo Freire, who argued that only the people directly affected by complex social and health problems can develop effective solutions (Freire, 1970). Although there are as yet few studies about youth-designed interventions, initial results are promising (Minkler & Wallerstein, 2003; Cheatham & Shen, 2003). When youth are involved as partners in programs intended to help them, they form stronger relationships, take on bigger challenges, and make important contributions to their communities. In this way, they directly affect the factors that promote their own resiliency. Participatory strategies have another advantage—they draw upon the resources of both youth and adults in communities. This approach recognizes the important role of non-professionals. However, the participatory model is a radical change from the traditional approach in which adults are the leaders and typically make choices for youth. Interventions with youth as partners Participatory interventions with youth have been developed in many countries affected by violence and disasters as presented elsewhere in this NATO Workshop Report. This section describes programs designed by youth who have experienced trauma or significant adversity. Our Center for Community Wellness at the University of California, Berkeley (USA), in partnership with other US and international collaborators, played a facilitating role to support the work of these youth. Our Center’s approach is based on a philosophy of empowerment. In our US programs with schools and communities, we have worked with youth as partners over the past ten years. In particular, we collaborate with low-income youth in areas affected by violence and high levels of insecurity. We provide students with training to become leaders (“health promoters”), reach out to their peers, and choose direct action projects to improve their schools and communities. We also train parents to become leaders and get involved with schools and support students (Aalborg, 1998). This dual approach taps the unused power of both youth and parents to foster resilience, empowerment and hope. Our evaluations have found that youth involved in these participatory programs increase their self-confidence, strengthen relationships with their parents, improve academic success, and are more likely to avoid violence, drug use and other risky behaviours (for further information, visit: http://www.ucwellness.org). In 1995, we were invited to share this model with people from villages in Southern Belarus that had been affected by the 1986 Chernobyl nuclear disaster. While there was already a professionally run community psychology program in the area, the Byelorussians were interested

120

L. Neuhauser / Working with Youth as Partners to Reduce the Effects of Trauma

in adding a participatory action approach. They identified two main project goals: to help families avoid contamination with radioactive food, and to instil a sense of hopefulness in their children and adolescents. Many of the youth had little hope in their future, feared cancer, and had little trust in civic and political organizations. We worked in partnership with community leaders and youth to hold focus groups with people in the local villages. This collaborative inquiry led to the decision to develop a guide to safe food and local health services to address the concerns raised in the villages about radioactive contamination. Secondary school youth took the lead to distribute this information to people in the villages and to advise them on healthy practices. Their distribution strategies included education at dances and community dinners. Feedback was highly positive; youth felt engaged with adults and their peers, more challenged and more positive about their future because of their important leadership roles in their communities. In 1999, we began another project with youth in Snezhinsk, a “closed city” in the Southern Urals in Russia. With the dissolution of the Soviet Union and the subsequent instability, health professionals were concerned about the rapidly increasing rates of HIV/AIDS and drug addiction among youth. The traditional technique of having health professionals give youth advice at government clinics was not successful, and there was interest in trying a more participatory approach. Working together, we linked Snezhinsk to a city near our University. Health professionals from the two “sister cities” visited each other to exchange ideas. A delegation of health professionals from Snezhinsk visited us to learn about our youth-designed strategies. Then, a Russian psychologist who specializes in youth development led the initial design of the program. In this model, adolescents were recruited from secondary schools or from the streets to join a “youth action group.” They received leadership and health issues training. Then, they defined strategies to educate other youth and to develop the program. The youth leaders were highly innovative: they created rock videos and jazz programs, and incorporated curricula and ideas they found on the Internet. Over time, youth identified the need to have more focus on psychological issues resulting from instability in their families. The adolescents naturally gravitated toward the actions that support resilience: better relationships with their families, highly challenging and creative projects, and community service.

Lessons learned and potential for adapting the model elsewhere While these examples are drawn from vastly different places in the world, they demonstrate a common participatory approach to empower youth to define their own issues, actions and future. They incorporate the three principles required to promote healthy youth development and resilience: strong caring relationships among youth and adults, high expectations for youth achievements, and meaningful contributions to the community. An added benefit is that these strategies are thought to be beneficial to all youth involved, whether they have been affected by significant trauma and adversity or not. Although these models are still experimental, we have learned that the following seven practical steps are important for success: 1. At the beginning, bring together officials, community leaders and youth to obtain broad agreement about the program. 2. Identify an adult leader who is committed to participatory work.

L. Neuhauser / Working with Youth as Partners to Reduce the Effects of Trauma

121

3. Select youth participants from existing positive and politically neutral organizations like schools. 4. Give youth training on practical leadership skills such as organizing meetings, outreach, analyzing problems, and designing programs. 5. Involve parents or other adults to support the program; also give them training on leadership skills. 6. Ensure that youth truly take the lead in designing and implementing their own programs; support their connections with other youth internationally. 7. Include a component of meaningful community action and a way for youth to publicly demonstrate their achievements. The positive experiences with these and other similar interventions suggest that the participatory youth development model has potential to reduce the effects of trauma and foster resilience, empowerment, and hope for Serbian and other youth. A proposed initial step would be to convene a work group of adults and youth involved with such participatory projects to identify goals, international resources, and a preliminary action plan.

References Aalborg, A. E. (1998). Parental participation and healthy adolescent development: An empowerment approach for inner-city schools. Dissertation. University of California, Berkeley. Baker, A. (1990). The Psychological impact of the Intifada on Palestinian children in the occupied West Bank and Gaza: An exploratory study. American Journal of Orthopsychiatry, 60, 496-505. Barber, B. K. (1997). Palestinian children and adolescents during and after the Intifada. Palestine-Israel Journal, IV (1): 23-33. Belgrad, E. A., & Nachmias, N. The Politics of International Humanitarian Aid Operations. Praeger, 1997. Benard, B. (2004). Resiliency: What we have learned. San Francisco: WestEd. Benard, B. & Constantine, N. (2000). Supporting positive youth development in our schools. Report. American Association of School Administrators and WestEd. Report dated February 10, 2000. Black, D., Emanuel, R., & Mendelsohn, A. Children and adolescents. (1997). In D. Black & M. Newman (Eds.). Psychological trauma: A developmental approach, (pp 281-193). Arlington, VA: American Psychiatric Press. Cairns, E., & Dawes, A. (1996). Children: Ethnic and political violence—a commentary. Child Development, 67: 129-139. Cheatham, A., & Shen, Eveline (2003). Community-based participatory research with Cambodian Girls in Long Beach, California. In: M. Minkler & N. Wallerstein (Eds.). Community-Based Participatory Research for Health. San Francisco: Jossey-Bass.

122

L. Neuhauser / Working with Youth as Partners to Reduce the Effects of Trauma

Cohen, J. A., Mannarino, A. P., Greenberg, T., Padio, S. & Shipley, C. (2002). Childhood traumatic grief: Concepts and controversies. Trauma, Violence & Abuse, 3 (4), 307-327. Emmons, K. M. (2000). Behavioral and Social Science Contributions to the Health of Adults in the United States. In Smedley, B.D. & Syme, S.L. (Eds.). Promoting Health: Intervention Strategies for Social and Behavioral Research. Washington, DC: National Academy Press. Freire, P. (1970). Pedagogy of the oppressed. New York: Seabury Press. Garbarino, J. & Kostelny, K. (1996). The effects of political violence on Palestinian children’s behavior problems: a risk accumulation model. Child Development, 67, 33-45. Harvey, M. R. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Traumatic Stress, 9 (1): 3-22. Koss, M. P. & Harvey, M. R. (1991). The Rape Victim: Clinical and community interventions. Newbury Park, CA: Sage. Luthar, S. S., Cicchetti, D. & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. New York: W.W. Norton & Company, Inc. Miller, K. E. (1996). The effects of state terrorism and exile on indigenous Guatemalan refugee children: A mental health assessment and an analysis of children’s narratives. 89-106. Minkler, M. & Wallerstein, N. (2003). Introduction to community based participatory research. In: M. Minkler & N. Wallerstein (Eds). Community-Based Participatory Research for Health. San Francisco: Jossey-Bass. Monahon, C. (1997). Children and Trauma: A Guide for Parents and Professionals. San Francisco: Jossey Bass NAT0 (2002). NATO-Russia Advanced Research Workshop on Social and Psychological consequences of Chemical Biological and Radiological Terrorism. 25-27, March 2002. NATO headquarters. Online report at: http://www.allied-co.com/arw/final.htm. Pfefferbaum, B., Nixon, S., Tucker, P., Tivis, R., Moore, V., Gurwitch, R., Pynoos, R., & Geis, H. (1999). Posttraumatic stress response in bereaved children after Oklahoma City bombing. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1372-1379. Pittman, K. (1996). Community, youth, development: Three goals in search of connection. New Designs for Youth Development, 12 (2), 4-8. Pupavac, V. Post-conflict reconstruction: Political, social and economic. Paper presented at the 51st Political Studies Association Conference, 10-12 April 2001, Manchester, United Kingdom. Pynoos, R. (1992). Grief and trauma in children and adolescents. Bereavement Care, 11(1), 2-10. Scott, M. J. & Stradling, S. G. (2001). Counseling for post traumatic stress disorder. London, Thousand Oaks, New Delhi, p. 126. Silove, D. (1999). The psychological effects of torture, mass human rights violations and refugee trauma: Towards an integrated conceptual framework. Journal of Nervous and Mental Disease, 187(4), 200-207. Summerfield, D. (2000). Childhood, war, refugeedom and “trauma”: Three core questions for mental health professionals. Transcultural Psychiatry, 37, 3, 417-433. Trickett, E. (1984). Toward a distinctive community psychology: An ecological metaphor for the conduct of community research and the nature of training. American Journal of Community Psychology, 12, 262-279. Veenema, T. G., & Schroeder-Bruce, K. (2002). The aftermath of violence: Children, disaster and posttraumatic stress disorder. Journal of Pediatric Health Care, 16, 235-244. Vernberg, E., & Vogel, J. (1993). Part 2: Interventions with children after disasters. Journal of Clinical Child Psychology, 22, 485-498.

L. Neuhauser / Working with Youth as Partners to Reduce the Effects of Trauma

123

Weine, S., M. (2000). International trauma training: Report on the task force. Stresspoints 14:3-4. Weine, S. M., Danieli, Y., Silove, D., Van Ommeren, M., Fairbank, J. A., Saul, J. (2002). Guidelines for international training in mental health and psychosocial interventions for trauma exposed populations in clinical and community settings. Psychiatry 65(2), 156-164. Werner, E. & Smith, R. (1992). Overcoming the odds: High–risk children from birth to adulthood. New York: Cornell University.

This page intentionally left blank

Part II

Identifying scientifically-grounded specific strategies to deal with the responses to trauma shown by 12-15 year old Serbian children and the training required by members of the community, working alongside mental-health professionals, to implement effective measures to ensure well-being and well-balanced social attitudes.

This page intentionally left blank

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

127

1. Establishing the context – the impact of postconflict trauma on the well-being of young people and the future development and security of fragile societies: Bosnia, Kosovo, Serbia William YULE MD, Ph.D Professor of Applied Child Psychology University of London Institute of Psychiatry UK

Peace of mind is one of our most precious resources and the UN and its agencies are there to try and protect that peace of mind. To establish the context of the Serbian Case Study, I shall briefly mention the UN attitude, then focus on some of the factors which have been proved to rebuild the well-being of children and adolescents and reduce the impact of post-conflict trauma on the future development and security of fragile societies, such as the countries which I know in former Yugoslavia. We all know the framework in which we mainly work, that is the UN Convention on the Rights of the Child, and within this context it is important to remember, too, that children have the right not to be separated from their parents. But in times of war, in times of ethnic cleansing, they do get separated. Not all people cross international borders, so they’re not officially asylum seekers, they are nonetheless displaced. To a child there is not that much difference between being a refugee and being displaced; they’ve lost touch with all that is familiar. Children who are traumatised have separation from things and people that are familiar; they are plunged into a new environment. At the same time they are experiencing loss, and that is a tremendous amount for young children to deal with. We must also remember the right of access to healthcare and the right of access to education, and that Article 39 puts a duty on all the states to recognise that children are, or may be, badly affected by war and – and this is the important part for our deliberations – that there is a duty on us to do something to mitigate those effects - to do some-thing to help the children to overcome the effects of conflict. That is sometimes forgotten even within UN organisations who argue that we should not be providing therapies of any sort, that this is a natural reaction.

The impact of armed conflict on children – the UN report of Dr Graca Machel Now I want you to reflect on the work of Dr Graca Machel, appointed in 1994 by the previous Secretary General, Dr Boutros Boutros Ghali, to report on the impact of armed conflict on children. She was a very wise lady, and she knew that the report that she did could be wellreceived, put in nice journals and then be put on a shelf. So she decided to go back five years

128

W. Yule / Establishing the Context – The Impact of Post-Conflict Trauma

later to see what progress had been made. So the whole issue of making recommendations, but then following up to see, is really quite important. What she found was not very encouraging. In the late 1990s there had been more than 2 million children worldwide killed in armed conflict, that 20 million children at that point in time were currently displaced from their homes, and that at any one point in time something like a third of a million children are being used as child soldiers - they are used and then discarded, so that there are many in the community who were child soldiers until they were no longer needed. In our previous presentations and discussions here we seemed to be comfortable about talking about trauma and its effects. Not everyone within our community or within the United Nations is comfortable with this conceptualisation. So she pointed out that it was an attempt to talk about individually-focused programmes and she rightly says that any programme must take account of the child’s needs within the society and community in which they live, to avoid institutionalisation. But she then went further and said that workers and practitioners should protect children from the pain that may result from inappropriate intervention. Now I think that you can agree with that sentiment, but by that she meant talking about traumatic events. So this is where I disagree with her. Now we know from the work that has been done, that in the appropriate context, talking about and reliving what happened is a very important therapeutic step. But it is quite right that not everyone should be asking the child to relive their worst moments. So what has grown up around this in the last 15 years has been an anti-trauma position which leads people to say: “PTSD is a Western concept, it should not be used in other countries, it is an act of Western imperialism, the intervention should only be community-based so that it doesn’t stigmatise, that you should pay attention to cultural issues, that more attention should be placed on traditional healing.” I have yet to find out what people mean by ‘traditional healing’ but it comes up like a mantra in most of the politically-correct discussions. My partial riposte to this is that PSTD is not just a Western concept. It was argued through the WHO, which is not an easy thing to do with representatives from all countries of the world and they came to a certain conclusion – slightly different from PTSD, but nonetheless they recognised that it can be found worldwide. Indeed in our own work it has been found that you can identify stress reactions in virtually every war-torn country and there is more similarity than there is dissimilarity. And we need to consider this. It is all very well saying that we need to pay attention to culture, of course we must, but we have got to ask ourselves, is the culture always right? Just because a practice is culturally acceptable, such a female genital mutilation, does that mean that we can support it? Just because the Taliban decided in Afghanistan to stop women being educated, do we support that? So we have got to challenge some of the cultural beliefs, and not just assume that because they are there, that they are right. And my position is that most of these contentious positions can be addressed by attempting to evaluate what we are doing. Evaluation is vital. We know that there are risk and protective factors. We need to identify that some of them at least can be manipulated, and we know that we can bolster our children to be more resilient, to be more able to withstand extreme experiences. But within all of this we know that if children suffer from the deliberate acts of other people there are more likely to be bad effects.

W. Yule / Establishing the Context – The Impact of Post-Conflict Trauma

129

Reconciliation Here is a different approach - some social psychologists have begun to look at the psychology of reconciliation. The Foreword to the Good Friday Agreement in Northern Ireland tried to do what everyone thought was impossible, to get the opposing sides, basically two religious factions, the Catholics and Protestants, to come together and to move forward together rather than reigniting the battles of the past – by recognising that yes, we should not forget the people who have been injured and the dead, we should not forget them. But that is only the start. It is what you do next. How do you start afresh, how do you move forward, how do you achieve some kind of reconciliation? And the recently published work of these social psychologists tries to pull out from social psychology and from human experience that, in order to approach forgiveness, you have got to give up the right to remember. Now try telling that to people in the middle of a conflict, or very shortly thereafter. The need for revenge, that human feeling, is very strong, yet unless we give it up you can’t move forward very far. So how do we then foster the compassion, generosity and love that is necessary for doing that?

Respect We have to recognise that it requires changes in our affect and our emotion, going from resentment to compassion and understanding, going cognitively to stop condemnation and build respect – respect for the adolescent, respect for the parents, respect for people who previously were the enemy – and move from resentment and revenge to caring and love. This starts with an apology.

Apology, Remorse, Forgiveness Saying sorry really is very hard to do. What the survivors need is someone to stand there and say “I am sorry – it’s happened, we can’t undo it, we really regret it, but…..”, and the but is “now we have to move on”. And that is hard. It was hard in the former Yugoslavia when I was there. As a Scot I know some of the awful things that the English did to us way, way back, but somehow we have moved on with life. When I was hearing about the battles in former Yugoslavia, as if they had happened the day before, young people, kids were reliving it. It’s one thing to learn about history, it is another thing to take it in and believe that it is still there. So you need an apology that is sincere, and that is to the group. It is a lot easier to forgive an individual in front of you than the large group. And we know now, from all the work on forgiveness, that it’s a lot easier if the perpetrator shows remorse. So the indicators are that we know, collectively and individually, it’s the way people interpret what happens that can determine the level of distress that they experience.

130

W. Yule / Establishing the Context – The Impact of Post-Conflict Trauma

And we also now know that in individual therapy, in group therapy, in less structured interventions, the way in which people misinterpret things needs to be challenged. They need to be told to reconstrue what is happening and then to reclaim their lives and move on. That takes them through acknowledging that there is a past, which is important, but we need to take control of the present and do things in a sensible way. So it’s about greater equality of opportunity, less segregation, as well as proper respect to cultural values.

The right to grieve The things that I learned working in Mostar, which I did for quite a long time, were some very simple, practical things that you always need to address in the post-conflict era. One of those things we found in the Former Yugoslavian Republic of Macedonia, visiting a refugee camp there. The guy who was in charge of the camp there saw us coming in our white vans and said “You must do something about it, you must stop the radios broadcasting about how many have been killed in battles.” Why? “Because the women and children in the refugee camp when they heard that their loved ones had been killed got very upset and we didn’t have enough strong medication to knock them out.” I can tell you that was what they were trying to do. Not recognising that people have a right to know about what is happening, have the right to grieve. When I went to Slovenia and did a seminar there, there were marvellous people working there. A teacher said to me: “What do I do about this problem?” Now I have been around long enough to tell that people throw the most difficult thing at you to challenge you to see if you really know what you’re on about, so I threw it back to the group. The problem was this – he had a 10-year-old boy in his class, he knew that the boy’s father had been killed but the boy’s mother had said “You mustn’t tell him that his father was killed” and the teacher did not know what to do. So I asked how many other people in the room who were teaching had faced the same problem. And a lot of them had. We’re not talking about an individual crisis; we’re talking about a policy of what to do. They all agreed that the best thing was to be open and honest with the child, so I suggested that they say that their school policy was to be open and honest and that if the parent didn’t agree with that then they had to do something else. And the reason for that is very simple: the child had the right to grieve.

Rebuilding trust Furthermore if you lie to children then they will not trust that adult, they will not trust their parent - the trust goes. So there are a lot of things that happen in the war and post-war that can challenge the trust that children and adolescents put in adults. Being honest with children is very difficult for even a therapist to do. But not being honest breeds a situation for the child where they will often imagine things that are even worse than the reality as it is.

The right to education We have underlined that schooling is one of the most important structures. But of course the school in the immediate post-conflict era for a time may well be run-down - broken buildings, many of the teachers unqualified – someone has to do it – and yet what we found in Bosnia, for

W. Yule / Establishing the Context – The Impact of Post-Conflict Trauma

131

example, was that quote: “As normality returned, so did the bureaucrats.” So what happened was that offialdom would say “Well you haven’t completed the curriculum for whatever it is, you will have to start all over again.” A child could have been out of the country for over three years and would be not allowed to go back in with its normal peers because he had missed out on the curriculum. The need for flexibility in the curriculum and in examinations and so on is really quite important. What we also found was that the teachers required a lot of advice and support in dealing with things that they’d never dealt with before, not just the direct stress reactions but classroom misbehaviour. I am told that in schools in Mostar children had been very, very well behaved; now they misbehaved, they showed no respect to the teachers, they came in late, they were smoking in the classroom. The issue was that, before the conflict, the teachers knew that the children would behave well - they didn’t have to do anything about it. Now they needed strategies to deal with children misbehaving

The right to leisure pursuits. There is a need, particularly for the adolescents we are talking about, to make sure that there are adequate leisure facilities, that there are adequate sporting facilities. In Mostar, for example, there were no recreational facilities at all, and people were saying that they wanted football teams and music. I went back home thinking about this – I was totally naive then – so I went back the UNICEF headquarters in London and I said “Please can you help me to get some footballs and football kit – all you need to do is to ring around the football teams and I’m sure they’ll let you have some. And can you get me some second-hand musical instruments because there are none left in Mostar.” I was told by UNICEF “That is not our job – UNICEF’s job is to raise tens of thousands of pounds and dollars, not to get musical instruments. You want them, you do it.” I did bring back one mouth organ but that was all I could carry. But it is often very simple things like that which make a huge difference. So leisure activities are important, as an outlet for their energy and as a way of ensuring the social education of the young people - they need to know about, not only the immediate effects of trauma, but also about the longer effects: the reminders - they need to know that they will be remembering and re-living what has happened for many, many years to come.

The returners And finally, we must consider the returners - people who have been out of the country, for all sorts of reasons, now they are coming back to help rebuild the country. They often expect to be welcomed back with open arms – they are coming back to their old family, their old friends. And what they are often met with is enormous hatred, enormous resentment – “They got out, they saved themselves, they didn’t experience the siege of Sarajevo, or the bombing of Belgrade, or whatever”. So they need to be prepared for what they are going to be facing, and we need to think about how we are going to integrate them. None of this is straightforward, but I remain an optimist.

132

W. Yule / Establishing the Context – The Impact of Post-Conflict Trauma

Editors’ note: We include this pertinent response from the floor as Josi Salem-Pickartz’s work as a clinical psychologist over the last 25 years in, for example, Jordan, Iraq, Palestine has given her a deep insight into the cultural sensitivities of psychosocial assessment and treatment. Josi Salem-Pickartz: With regard to PTSD and the issues of cultural sensitivity, there are three issues: In the first place partly the resistance to the clinical help that has been offered by Western professionals is based on the short-term perspective of interventions because we know from therapy that people can only open up if there is trust and a commitment to care from the psychotherapists and that takes time. Secondly people need to have some sense of security in order to open up and very often the programme offered to them has not been sufficiently secure. Thirdly, also in regard to being culturally sensitive, I think that is something to be negotiated; in the end you can only trust psychosocial assessment and treatment by finding out how they work in practice. That means that in talking of PTSD, in talking of stress reactions, it has to be absorbed into the local way of thinking. There must be in all concerned readiness to listen and to absorb. Both sides need to be willing to listen to each other and build bridges. Not giving due attention to this can create resentment and suspicion.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

133

2. Case Study: Specific Elements of the Post-Conflict Trauma of Serbian 12-15-year-old Children and Adolescents Serbian Team: Tija DESPOTOVIC, MD, PhD; Ivanka JOVANOVIC DUNJIC, MD, PhD; Gordana VULEVIC, MA; Jasna ZIVULOVIC, MA

Brief definition of the elements that are specific for the Post-Conflict Trauma of Serbian children and adolescents who are 12-15 years old. Serbian children were exposed to chronic, long term flooding with uncertainty and anxiety caused by both external events and through their parents who were going through life, health, and financially threatening experiences. As a consequence of a long lasting crisis, the parents, as well as the other institutions of society, failed to provide enough containment and support for children and adolescents in this very vulnerable developmental period.

Crisis in Serbia The political and nationalistic tensions that started to grow in the late 1980s culminated in disintegration of Yugoslavia. It was a traumatic event for many people, who lost what they believed their country was overnight. Though there was no armed conflict on the Serbian territory until 1999, people were jeopardised by political, economic and social crisis. The fears were increased by sanction-based economic isolation and a totalitarian regime producing a paranoid and xenophobic atmosphere. That was followed by increased poverty and the highest rate of inflation known in history. Male populations were exposed to life threatening situations through mobilisation or hiding from it. Many families were faced with losses and separations. An enormous number of refugees came with their difficult experiences and losses of members of their families, homes and other goods. The functioning of vital institutions of society (schools, health service, police, law administration, justice, psycho- social service) was disturbed, corrupted and criminalized. The crisis lasted more than ten years. The crisis in Serbia deeply affected and disturbed all parts of the society, ruined the existing value system, and interfered with very psychological functioning of every individual. The turmoil influenced functioning of all families by exhausting their internal recourses to cope with normal developmental needs of the children who are very demanding during early adolescent period. We will briefly summarize some developmental characteristics of early adolescence and the pressure it puts on their parents.

134

T. Despotovic et al. / Case Study: Specific Elements of the Post-Conflict Trauma

Developmental characteristics of early the adolescent period Youngsters 12-15 years olds are at the beginning of adolescent period, puberty chaos. This period starts with somatic transformations through which the infantile body is transformed into a sexually mature one, and is followed by psychological and behavioural changes. This process hopefully leads to the establishment of a healthy, mature, autonomous and self-confident personality. During this time, the immature ego of the adolescent is exposed to strong pressure, from inside as well as from outside. Internal struggles are expressed through conflicts about sexuality, between dependency and autonomy needs, and between guilt and anxiety charged necessity to abandon internal idealised parental pictures from infancy in order to establish a new value system of one's own. The external pressures are expressed through demands of establishing new and progressively more complex social roles outside from secure family boundaries. Those changes are often confusing and anxiety provoking for parents. Their children who were previously nice and obedient have suddenly become difficult, negative and rejecting. At the same time, the rebellious attitude expressed through opposing and questioning of parental authority is a developmentally normal manifestation of the separation process. For the majority of families, the period of adolescence is the most difficult and demanding developmental task, comparable with the stress of having a newborn baby. The whole family has to contain the adolescent's rage, anxiety, chaotic, contradictory and intensive feelings of love, hate and devaluation, and to sustain permanent attacks on their boundaries and values. It is very important for an adolescent to have experience with self-confident, stable parents who are able to provide stability in this difficult time.

Crisis and Families in Serbia It is obvious that having an adolescent child is stressful to a certain extent for every family. In the situation of prolonged external pressure, the capability of the family to deal successfully with new demands is lessened. Under the prolonged stress, the family loses its protective function for their children. During the crisis in our country, important conditions for successful coping with stress within the family failed. Those important conditions were: parental physical and mental health, financial stability, professional satisfaction, and external support. Because of the turmoil, the majority of Serbian parents were exhausted, discouraged and had ruined health. There are some epidemiological evidences of increase in cordial diseases in young adults, malignant diseases, and shortening of women’s lives. Also, the frequency of prescription of anxiolytic drugs augmented ten times. The incidence of psychosomatic disease increased. The adults were flooded by great financial uncertainties concerning daily survival. Many of them lost their jobs, worked for very low salaries, or without salaries. Some of them reacted with complete withdrawal and paralysis, and others worked several jobs for 60 or 70 hours per week. Due to these circumstances, parents lost their capacities to be mentally present and emotionally available for their children. Violent and impulsive parental behaviour increased the level of aggression within families. The number of murders in families also increased, with children and women as the usual victims. (There is no valid epidemiological data concerning violence in families, and until recently the victims of family violence were not protected by law).

T. Despotovic et al. / Case Study: Specific Elements of the Post-Conflict Trauma

135

To conclude, many parents failed to provide the containing function for their children’s anxieties; in addition, the children were flooded, through verbal and nonverbal communication, with parents’ own fears and anxieties. The result was the secondary traumatisation of children through the parental helplessness. External supporting systems and the effect of crisis The families are an inseparable part of social context and dependent on its support. As we have already mentioned, almost all social institutions and organisations were affected by crisis. The most relevant institutions and organizations for the population we are concerned with are the school system and social care system. All employees working in those institutions were exposed to the difficult conditions. The middle class of Serbian society disappeared, and the highly-educated professionals were also faced with poverty. Those bad conditions influenced their working capacities, produced a lack of motivation, and a high incidence of burnout syndromes. At the same time, the educational programs continued to be highly demanding and difficult. For several years, school hours were shortened from the usual 45 minutes to 30 minutes because of teachers’ protests, and the school year was often shortened or disrupted because of political demonstrations or bombing. There were many difficulties in relationships between teachers and pupils, and atmospheres at school were filled with misunderstanding and explosiveness. Those obvious difficulties were not recognised or acknowledged by teachers or school authorities as an expression of tension provoked by the external threat. Instead, the developments were viewed narrowly as teacher incompetence or student disobedience. Complex feelings of frustration and anger were acted out through unacceptable behaviour on both sides, between teachers and children, or among children themselves. The relationship between teachers and children was analogous to the relationship between parents and children. The conflicts and anxieties were not contained, but were acted out in a hostile atmosphere. The research concerning empathic capacities of the teachers (Radovanovic, 1993) found that the majority of high school teachers in comparison to administrative workers showed the same or even less emotional responsiveness and empathy. Both male and female teachers were more prone to emotional contagion from the pupils’ negative feelings, and showed general emotional instability. Consequently, they were not able to give psychological support to children and reacted with withdrawal or aggression.

Consequences Those unfavourable circumstances had many consequences for the children’s emotional development because their personalities are still developing and their coping mechanisms for overcoming stress are still fragile and incomplete. Unfortunately, the available data about prevalence of relevant disorders in adolescent children in last 15 years is limited and poorly organized. We are now going to present a brief overview of existing studies on relevant subjects that we obtained through cooperation with the Belgrade UNICEF, through personal contacts with colleagues working in children’s and adolescent care units, and researchers from the University.

136

T. Despotovic et al. / Case Study: Specific Elements of the Post-Conflict Trauma

School achievement One 1997 research study in 28 Belgrade primary schools concerned with reasons of poor school achievement indicated that only 13% of learning failures could be attributed to specific reasons such as: mild mental retardation 3%, speech disorders 3%, sensorial and somatic problems 1%, or mental disorders 6%. For 87% of others, etiological reasons could not be identified. Results of another study conducted from 2000-2001 indicated that 59.37% of boys and 40.63% of girls of normal intelligence had some poor school achievement. Although these results may be explained by emotional factors destroying children’s attention spans, more comprehensive research is needed. There are also some indicators that the number of children included in pre-school education decreased, as well as the number of children attending secondary school. There was also an increase of the drop out rate in primary and secondary school.

Increased aggression and juvenile delinquency While the statistics do not show a marked increase in juvenile crime in the last two years, the accuracy of this data is suspect. Professionals who work in juvenile crime are definitely seeing a change. Data obtained from UNICEF’s study (Assessment of the Juvenile Justice System) showed that while actual criminal incidents were not increasing in significant numbers, the types of crimes were more serious and that the nature of the juvenile offender was changing. Both the professionals from the Centre for Social Work in Krusevac and the head of the juvenile police division in Belgrade found that there was an increase in more serious crimes, armed robberies, and drug trafficking. It was also found that many of today’s juvenile delinquents are from "functional" families: no abuse, no neglect, and nothing dramatic in psychosocial profile. This Assessment also revealed that an increasing number of children below age 14 are breaking the law and that the age of criminally active children has dropped to about six years old. (Those children were ordered by their parents to commit petty crimes and robbery). It has also been noticed that children act destructively, damaging school property and inventory. During school breaks, their behaviour is violent and causes bodily injuries to other children.

Substance Use and Abuse Many young people in FRY smoke tobacco. Among 15 - 24 year olds, 57 percent of young women and 64 percent of young boys smoke daily. Even one in four youths aged 11, 13, and 15 smoke, twice as many as in Canada and France, countries at the top of the list for young smokers. A survey of secondary school pupils concerning alcohol consumption found that two thirds of 15 year olds had tried alcohol and 20 percent reported that they have been drunk more than once. Before the massive changes of the 1990s, the use of narcotics was rare and largely limited to a few urban affluent. However, drug trafficking has risen dramatically. As borders opened, economic hardship increased the allure of “easy money,” and young people lived in

T. Despotovic et al. / Case Study: Specific Elements of the Post-Conflict Trauma

137

time of great uncertainty and stress. Today young people in trouble with drugs come from all parts of society. Up to 10 percent of adolescents aged 13-15 have experimented with some kind of psychoactive substance. This compares to the middle range of industrialized countries. Marijuana is the most commonly drug used among children 11-15 years old. Next are hashish, sedatives, and Ecstasy. 1.6 percent are using heroin. Serbian doctors report that young people use a wide range of intoxicants that include glue, acetone, asthma spray and tranquillisers, and that these intoxicants are very often combined with alcohol.

Suicide During the 1990s, suicide rates among young people increased as it did in many transition countries. The increase was particularly evidence in young men. According to UNICEF’s data, the youth suicide rate in Serbia remains one of the lower rates in the transition countries. However, its increase needs serious attention and intervention.

Homicide Homicide rates among youth in Serbia doubled at the beginning of the 1990s and were elevated throughout the decade. Guns were the most frequently used weapon in homicides for all age groups, and the availability of arms increased enormously during the conflicts of the 1990s.

Accidents Deaths from accidents increased dramatically in 1991. Typically, traffic accidents are the leading cause of death from accidents. Young men had three times more vehicle accidents than young women. The main causes cited are bad weather, fast driving and alcohol consumption.

Depressiveness A research project conducted among 11-15 years old in Belgrade and the surrounding area in 1999 showed that less then 10 percent of young adolescents say they feel depressed once or several times a week. This rate, according to UNICEF, is the lowest in 29 European countries where the same survey was used. However, this relatively low level of reported depression should not be taken as entirely accurate since the research was held in a time of external threat. It is well known that during war, incidences of mental illnesses decreases, while there are increases in psychosomatic disorders. After the war or crisis there is an increase of depressiveness and other mental disorders in that is now a problem in Serbia.

138

T. Despotovic et al. / Case Study: Specific Elements of the Post-Conflict Trauma

Conclusion All research indicates that there are increases in anxiety, destructiveness, depression, delinquency, substance abuse, suicide and accident proneness among adolescents in Serbia that are similar to other countries in transition. There is also worrying data about an earlier beginning of all those difficulties. We think that it is very important to stress that during adolescence, there is a low tolerance of depressive moods and the depression is acted out through different kinds of impulsive behaviour or relieved through substance abuse. We also think that we need more carefully designed research instruments to obtain valid data concerning the problems of depression and anxiety in adolescents.

What has been offered already The majority of projects and activities concerning psychosocial support for children and adolescents, both in governmental and in the NGO sector, were directed to refugees, children without parental care, or children with special needs.

Strategies If we think about strategies that would adequately be addressed to the early adolescent age group and their needs, in our opinion they should be directed to 3 groups: adolescents, parents, and school staff and other professionals who are in close contact with children. The activities in direct contact with adolescents should not be intrusive and should be easily available. There is a great need for central counselling services outside of psychiatric and health institutions or schools, with no charge, no obligation for users to be registered, or no danger of being labelled as "cases." These objectives could be achieved through open clubs with many activities or internet-based services. Parents should receive counselling services, and school staff and professionals should have seminars and professional development sessions.

Appendix UNICEF Programmes in Serbia and Montenegro 1. Access to Quality Education Programme The objective of this programme was to contribute to universal quality education for all children, especially for the children excluded due to ethnic background, disability, poverty, violence, abuse or exploitation. This program was designed to encourage participation, creativity and self-esteem, as well as to utilize structured child-centered curriculum and participatory learning and teaching methods. Achievements of this programme were: evaluation of the Civic Education program; support for the optimization of the school network; expansion and mainstreaming of active learning methodology into the primary education system; expansion of the Community-Based Rehabilitation program bringing together parents of children with disabilities, professionals and community members to support children with special needs; support to Roma education

T. Despotovic et al. / Case Study: Specific Elements of the Post-Conflict Trauma

139

and social integration; and reparation of schools and Education for Peace and tolerance implemented in 40 primary and secondary schools in Montenegro. 2. Young People’s Health, Development and Participation Programme The aim of this program was to help develop young people into active and responsible citizens by providing them with the necessary skills to cope with adulthood and lead a healthy life. The program was focused on the promotion of peace and tolerance, the development of youth-friendly social and health services, and the advocacy of the healthy life styles. Counseling and outreach services have been developed to provide relevant information and skills for healthy life styles, family planning, prevention of sexually transmitted infections, and substance abuse. Within this program, about 1,400 young people were trained as peer educators on HIV/AIDS and substance abuse. Additionally, 700 young people and 200 health and education professionals in Serbia were trained to provide youth-friendly reproductive health services. Multi-ethnic Youth Clubs were established in Bujanovac and Prijepolje in order to foster dialogue between youths and to provide them with possibilities for self-development and improvement of the quality of their lives, etc. 3. Child Protection Programme The objective of this program was the development of policies, legislation and practices that provide optimal care for children in need of special protection measures, encouraging careful de-institutionalization and the introduction of family-based care. This program, supporting an integrating approach to child protection policy reform, addresses child rights violations, lack of due process for children in conflict with the law and placement in institutions This program also promotes foster care and placement of children in families to provide more opportunities for social integration. An important part of this program was promotion of the partnership between national/local governments and non-governmental organizations. The achievements of this program were support for the disabled children through establishment child-friendly day care centers, assistance for 169 foster families, education for social workers, comprehensive assessment of the juvenile justice system, etc. 4. Advocacy for Children’s and Women’s Rights The aim of this program was to help to ensure that rights of women and children were placed high on the political agenda in the country. The Council on Child Rights of the Republic of Serbia was established in 2002 to develop a national strategy for all children and young people. The strategy was based on the Convention on the Rights of the Children, and harmonized with the legislation of the European Union and other international standards.

5. SAVE THE CHILDREN and NGO FAMILLIA A. A project named Safe House was concerned with emotional problems and the needs of adolescents in foster families. Within this project, research about emotional disturbances of children in foster care was conducted and a database was established. Also, counselling service for foster children and foster parents had been formed.

140

T. Despotovic et al. / Case Study: Specific Elements of the Post-Conflict Trauma

There have been many education programs for professionals in working in centres for social work. B. The objective of the project Step Forward was to give psychological and social support to adolescents who, at the age of 18, have to leave foster families and are no longer under the protection of social care. 6. Ministry of Education A. A programme concerning prevention of drug abuse was started two years ago. Unfortunately, we could not obtain more information about this project. B. A programme aimed to educate professionals, teachers and adolescents in high school to intervene in time of crisis such as suicide or other accidents at school was also initiated.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

141

3. Discussion All present: Round-the-table comments and open discussion Anne Speckhard: I should just like to comment on the controversy over treating PTSD v. “traditional healing”. I think it is a really important thing to address in this group of mostly women and being organised by mothers of the world. In the West we are experts on defining typologies and defining trauma. But there is also the other axis of feeling and the para-sympathetic axis: one of the best examples in the body where both of these are activated is in traumatic childbirth experience. Women have difficult childbirth experience all over the world but most women remember it as not the worst thing in the world and that is because the oxytocin system is immediately activated – it is activated in the birth and it is activated by breast-feeding. As the specialist Mary Sharpe says: “Practicing the attributes of motherhood – whether you are a woman or a man - produces healthy body chemistry in ourselves and in others. They produce a cocktail of beneficial hormones such as the feel good serotonin, pain killing endorphins and in particular it produces oxytocin, known as the bonding hormone, which nursing mothers produce in abundance to bond with their babies.” Women in certain cultures instinctively are aware of this. They know the importance of touching, they know that attachment activates this system and I think that that is what they are trying to say by natural healing methods, that trauma is something that disturbs attachments. Some cultures are more respectful of attachments than we are in cultures where we easily break them. Marie Vlachova: In relation to the Serbian presentation, have I understood correctly that most of this psychological trauma was possibly a result of transition with its attendant social and economic disorder? I would like to know if there has been any transnational research comparing countries where the transition was accompanied by war and those, like the Czech Republic and Slovakia, where it was just transition. Tija Despotivic: UNICEF has done some research on Romania, Russia and I think on other countries in transition and the same results were found: increase in alcohol abuse, increase in suicide rate and so on - indicators that our research found. So it is obvious that unstable societies promote some emotional reactions, not only in adolescents but also in adults. Ivanka Jovanic Dunjc: I want to comment on how transition might impact, how war might impact. Even during the crisis, which lasted about 10 to 12 years, we did not have much war on our territory, only during three months of bombing, but on the other hand, we were surrounded by war, by pictures of wars, by mobilisation. We do not have, as we pointed out, problems with acute PTSD symptoms because there was not acute traumatisation. It was a more chronic kind of

142

Discussion

traumatisation which has undermined parents’ ability to meet their children’s needs in this fragile period. Slobodanka Gasic Pavisic: I am also from Serbia and I agree these changes in mood are connected with the transition. But I would like to say that the situation is not so dark as can be believed from this report because although it is all true, using of drugs is up, and the school problem is up, but if you compare our research results with results from other countries, for example from the USA or Germany, you can see that our youth are not doing so badly. For example, you just need to compare research on the discipline problem in our schools with research in Britain. I think that the research on youth life finds this all around the world; the situation is worse now everywhere. Saïda Benhabyles: Does the fact of asking forgiveness reduce trauma? Turning the page, closing your eyes to the suffering caused – does it really help? I should also like to draw your attention to those children who have had to abandon childhood and take on adult responsibilities. What are the effects of the limitation of such an important phase of human development? Then there are the children in societies like Serbia and Algeria who have never known a ‘normal’ childhood, a normal quality of life. William Yule: About forgiveness - No-one is arguing that you should close your eyes to the atrocities. The atrocities need to be labelled as such. They are wrong, wrong, wrong. And the children as well as the adults need to know that. But having set that in the context of peace, which of course does not occur immediately after conflict, then there is the question of saying “That was wrong but now we must decide to forgive and move on.” That is a different point. We’re not arguing just to say “I forgive” is enough. Ivanka Jovanic Dunjc: On the subject of children deprived of their childhood - We can speak about it in two ways. The first is a very dramatic way. Helping with children from refugee families we had the example of a 9-year-old boy, a Serbian from Croatia, who had to drive the truck several hundred kilometres with the rest of his brothers and sisters because he was the oldest in this group. The second way that children are deprived of their childhood is more insidious - in Serbia through the loss of parental compassion to contain their children’s problems. It is more discrete but it is always present. Latéfa Belarouci: I should like to come back to the question of forgiveness – it is very important for me as an Algerian and as a therapist. What about the situation where the aggressor does not say sorry, where the law pardons assassins, where the government does not admit the suffering caused to the whole population? Surely recognition of the status of victim could help the victims rebuild their lives? I believe that not asking stressful questions or not helping a child ask those questions is wrong. A child is always seeking answers – well before birth, a child can perceive and understand. After suffering violence, a child continues to wonder and question. Sometimes a child cannot question the parents directly, for fear of hurting them. Perhaps at that moment, if the

Discussion

143

therapist is sufficiently attentive, the child might ask them questions and the therapist might bring the child to ask questions and to try to find answers. William Yule: I think that the tension is between working as an individual therapist and considering the needs of the victim, and having the perpetrator apologise does not always happen; as opposed to the societal level where the representatives of the different groups of aggressors are being asked to be forgiving, to apologise and the groups must be generous and magnanimous in accepting the apologies, not to continue to demonise the former enemy. And this is the problem in many of the very bitter civil wars. It isn’t always good to have a very accurate memory because that maintains the conflict in front of you. Ivanka Jovanic Dunjc: I think that our case study pointed to one issue you raised – what should we say to children? It has been mentioned several times that the mourning process is very important - only the mourning process can bring immersion into reality. It can help to deal with the things that happened 10 years ago, and for our country it’s very important that it can also help to cope with the things that happened 50 years ago, in the Second World War – it is important that the ghosts from the past should be mourned. They were not mourned; they were hushed up by our former regime. And so we think that in the true psychological approach it is very important to bring this mourning process of painful things and losses active and to bring it to the fore. Isabelle de Rambuteau: I should like to give you a concrete example: A young adult one day came to realise that as a child he had been raped. He realized, too, that he had been hard on his aggressor, violent and aggressive without thinking through his anger. He found the rapist and asked for the forgiveness of this man who had raped him. The act of forgiveness brought peace to him. A year later the rapist died. The young man had found peace and could begin to rebuild his life. Anna Kovacova: Listening to the exposé of the symptoms of trauma in Serbian children, I find the same indicators here in Slovakia in my work as a pediatric psychiatrist. We, too, are a country in transition, but we have not experienced war. Transition is a huge economic and psychological upheaval. It involves the destruction of the infrastructure which existed under socialism: for example, social benefits, such as family allowances have been cut – which means that the poorest families, such as the gypsies, are starving and this has led to riots. Unemployment is a major issue, with areas of Slovakia with 30% unemployment, some places rising to 50% - this leads to many mental health problems which we see in our psychiatric unit – far more than before ‘transformation’. Tija Despotivic: I just want to add something that was maybe not so obvious in our presentation. This is not measured because nobody has done any research about it but in our society we became crueler in the functioning of society and all institutions. Parents and teachers being so much overwhelmed with anxiety actually became crueler towards the children. It permeates the whole atmosphere. And also when you go somewhere abroad you can see people are different, smiling. But this chronic situation is very important and I think we would be wrong not to acknowledge

144

Discussion

that our children are suffering just for the sake of giving a good picture of our country and ourselves as parents. Joy Osofsky: This is the ecological environment of stress. You are talking about stress within the society, not just stress within the individual, that impacts on everybody in the situation. William Yule: Visiting Belgrade in1994, the very weekend that NATO was threatening to bomb Serbia unless the Serbians withdrew the emplacements around Sarajevo, I picked up a difficult situation: although there was no fighting on Serbian soil at that time you had many, many refugees. And because of the culture and the tradition, refugees were welcomed into Serbian homes, but then as visitors they were expected to do no domestic work, not to help and so on. Now it is one thing to have a visitor for two days, but to have ten visitors in your house for three years who do not do any work, well the stress of that is part of the stress of the conflict, of the war. You then had, a short time after, the impact of the sanctions. And we know the same as in Iraq that the people who suffered most were not the rulers but were the children. In Iraq there was an increase in the infant mortality rate, the decrease in birth weight, the increase, therefore, of brain damage in young children, and there were similar things beginning to happen in Serbia. Finally, in terms of the fighting - Serbian men were away fighting, so although it was true that there was no fighting in the land, it meant that there were many families of young children growing up without fathers around, with relatives or non-relatives sharing their houses, with even the everyday goods disappearing – a huge change, and it lasted for 10 years. Gordana Vulevic: Just on that issue of Serbian men fighting: they were forcibly mobilised and sent to fight but officially they were labelled as volunteers. William Yule: But a child doesn’t know that [general agreement from others] Sara Ozacky Lazar: I would like to make a comment on what Professor Yule mentioned, the problem or dilemma of culture, whether we can import models from one culture to another. I want to give you a brief example. I think we should all learn from the South African experience of the Truth and Reconciliation Committee. In fact we got together a group of Israelis and Palestinians and brought some South African experts, to learn from them, and then we realised that it does not fit our culture. The whole concept of pardon and asking forgiveness is based on the Christian culture and it does not fit the Middle Eastern, Jewish, Muslim culture. [Disagreement from Muslim participants] A comment for the Serbian team: I don’t know much about your political structure and government but what I have seen in our work in Israel as an NGO, and there are dozens of NGOs in Israel who are engaged in peace education and education for tolerance and democracy, but unless it is built into the official school curriculum we are like some drop in a stormy ocean. Although we succeeded in integrating this concept into the official school system, very varied levels of support from different Ministers for Education has been important to its success or failure.

Discussion

145

Howard Osofsky: I remembered, when we were in Ireland recently, the words of Jonathan Swift in the Cathedral in Dublin, when he wrote in 1728 “We have just enough religion to make us hate, but not enough to make us love one another” and I was very struck by that. I have been reminded of that now as the Irish example comes to mind. When there are so many generations of conflict and misunderstanding based on religious and cultural traditions, when a conflict or troubles end it does not go away, and one does see increased difficulty ongoing in a society that in some ways is less stable, and in some ways more forbidding, there may be more concerns about what it means to show forgiveness or remorse or looking as though one is aligning with other groups which would be seen as unacceptable. And this is exacerbated when there has been economic destruction, or there are other types of dysfunction - In the case of Serbia, for example, the international community saying that aid would be dependent on turning over former leaders, or renouncing aspects of the past, this feeling of being scapegoated. These sorts of factors make it hard to talk through anger at times of grief, especially when there is a more ambivalent situation where there are aspects that are complex and difficult to resolve. Tija Despotivic: I think it is extremely difficult to reach that point of feeling sorry. I really do. And one day I think that we will face that, but I do not know when. I agree that, everything points to the fact that the traumatised are those that are making trauma for the others. It is so difficult because the experience of our history, the history of the Balkans repeats itself. It was very important for us when our president in Sarajevo said sorry. But I know, talking about real, true feeling sorry, that is a completely different thing from politically correct behaviour. Linna Kuts: I want to make the point that we are living in the time when there is a shift in consciousness, not just on the political level, but also on other levels, such as cultural. First of all it touches adults, and then through them it goes to children. That is why our organisation, in spite of the fact that it is a family organisation, does a great deal in our locality and in Ukraine for young people. We were the first to start a volunteer European children’s school. And in that school our motto is that first of all we are living on the planet Earth, and that is why we are Earth men, in the second place we are European because we live in Europe, and only on the third place we are Ukrainians who live in Ukraine as part of their Earth humanity. And from that platform, we say to our children the truth, the real truth, for example the Serbian case - it is not only the case of Serbia it is the case of our people too. The last few years showed that we are heading in the right direction, because when we exclude ourselves from what is going on in the world then we exclude ourselves from reality. Very often the trauma, post-traumatic cases, they can have very, very deep roots. Now trauma is defined by specialists, and a child and even a family of people who are living in that state do not accept that this is trauma, because trauma is to do with specialists, but for them their mental state is reality, it is everyday life and that is why they do not know that they are in that state which specialists call “trauma”. And so proving to them that they are in trauma means making an additional abuse against them, because nobody wants to feel that he is ill or has some kind of disease, even if it is psychological, that is why Dr Speckhard’s reference to natural methods was so relevant. If you would like to know more, I can tell you about some natural methods that are used in our organisation.

146

Discussion

Slobodanka Gasic Pavisic: I think it is important that we mention handicapped children in the situation of bombing. We have not spoken about this group of children, the handicapped children, but in that situation it was far worse for them. The psycho-dynamics of these children’s family lives seems to be among the worst. When you dislocate handicapped children from their own social milieu and you put them in a bomb shelter with the sound of air-raid sirens, the child does not understand and they are automatically traumatised. In my research I observed one year later – it was on the so-called normal population of children in a primary school, 35% of the children did not want to be in school because they wanted to be with their parents. In 15% there was disturbance of the biological cycle, sleeping, etc and fear and shaking at any loud noises. There was disturbed behaviour and aggressiveness in 5%, and three or more symptoms together in 10%. It was one year after the bombing. Four years after bombing, 30 of the children are still aggressive and 60 of them carried the same symptoms of psycho-traumatism. The number of children with symptoms has increased since the bombing. Ivanka Jovanic Dunjc: We did not forget about the handicapped children, we just wanted in our study to focus on so-called ‘normal’ children. Because we think that the children with special needs do get some kind of attention, but those children who just live in our country are not very covered by any kind of research or interventions.

Ingrid Leth: I want to thank Sara Ozacky Lazar for reminding us of the South African Truth and Reconciliation process. There are very many, many problems and we have just heard from our friends here about the problems in Serbia. Of course it is important to look at all the factors that have brought the country and the community into this situation but you have to see your youth as indicators of the problems, not to get desperate and depressed, but to see that they are telling us what should be done. Armine Gmur Karapetian: I just want to say that Serbia has passed through real sufferings and pains and it is not so easy to implement initiatives very sensitively in such situations. But I wish you courage and success. Lillian Peters: I was thinking about substance abuse and alcoholism or alcohol abuse as self-medication, and I was wondering why are the young people doing this kind of medication, what is their reason? Ivanka Jovanic Dunjc: It is known that in the adolescent period there is not the mental capacity to contain the feelings inside and the adolescent has such a need of quick relief of their sufferings so one of the ways is the substance abuse.

Discussion

147

Gordana Vulevic: I want to comment about the uncertain future - Our country is perceived by young people as a black hole. When we were younger it was a stable society, maybe not democratic but the institutions and infrastructure were there, but now everything has changed. Why are they taking drugs? I give you an example of a rap song: a 17- or 18-year-old is singing that “he would say to his exhausted mother…..” – I think they cannot cope with the feeling of their parents’ inadequacy, so they take more drugs. Josi Salem-Pickartz: Saïda and Slobadanka raised the issue of making sure that all children are considered. In this context I would really like to come back to the resilience concept - I think a lot of support to troubled children, but also to all children, can be given if we take into account the knowledge that has been developed on this. Let me connect it with another aspect. I was a bit surprised by the disintegration of relationships between teachers and students and parents and children in Serbia. The Palestinian example, just for contrast, is different; here the situation has actually led to a better understanding between students and teachers. The situation is a bit different because all of them are at risk and so it is very important to maintain the communication system and to inform each other, using education as a form of resistance against the Israeli occupation, so it means that there are complications. I think that the definition of a common interest can be very important in generating support for the future, however, and this is for the strategy, it might be good to start with teachers first as such and with students first, because these have common interests because they all suffer a specific suffering in this situation. Now let me come to my third point, dealing with this issue of reconciliation within trauma therapy, and again I go back to torture survivors for whom it is very difficult to forgive. In the tradition of torture therapy it is very important to reconstruct what happened. We prefer to do this in a group because a group has a better common memory. And this is a very important stage, you have to acknowledge what happened before you can actually overcome it. Of course there is the aspect of anger. One of the important ways to channel anger into more productive ways is to ask what you can actually do to take revenge. And realistically very often there is nothing you can effectively do, so you reach the point of acknowledging that it is better to channel your anger into productive action for yourself and your community. And this often is quite an important turning point. Once you have thought through your anger, what you would like to do and what you can do, and what also your ethics tell you you should do or not do, then eventually you find an alternative. You concentrate on channelling anger into productive action. And I would like to say that, in whatever situation, people are always making outlets for themselves and so it is about finding outlets. Tija Despotivic: I would like to comment on the relationship between parents and children and teachers and children. Some recent research showed that children do not find figures for identification among their parents who they see as very fragile person, for example maybe very educated but with no money or the ‘exhausted mother’– not an attractive role-model. So they do not look to the future but back to the past to find role models. During the bombing the families did stick together – external forces like being in danger or having enemies gives you a common interest and a sense of cohesion but that lasts for a short time.

148

Discussion

Gordana Vulevic: I would like to add that there is also research about family ties between adolescents and parents in the war area and their ties were much closer. Those adolescents believed in the support of the family and it became very important for them. So it seems that in situation of war or external threat, families became closer. Saïda Benhabyles: I apologise for returning again to the issue of remorse and forgiveness, but it very important. In a desire for reconciliation our government closed its eyes to the guilt – How can you expect a child to understand right and wrong or forgiveness when he sees his father’s killer walking free in society? We cannot defend human rights without justice, and we cannot have justice without repentance, atonement and forgiveness. Joy Osofsky: Obviously that issue of saying sorry is a very complex one. In one of my cases a mother had abused and neglected her child, she said she was sorry and really did show some remorse which was unexpected, but she also did not get her child back. So there is that dimension, too. Does forgiveness always follow saying sorry? There are many dimensions and complexities: true repentance or empty words, different cultural attitudes… William Yule: Warfare in the 21st century is small, vicious, aimed at women and children and rape is as much an instrument of war as the weapons. So who then do you blame, do you blame the conscripts and volunteers who did the rape, which was wrong but was part of a political strategy in terms of the war? So what we are talking about is trying to understand from the victim’s perspective that this was an act of war and whoever was politically in charge and who initiated it is not acknowledging it was wrong and that they are sorry. But that is very different from personal violence from one individual to another. I’m just pointing out that there are different levels at which it has got to be taken. You can then link that to the child soldiers. These children of the wars in Uganda and so on, are we going to say that they should all be treated as criminals, punished, locked away as we would an adult burglar? Or do we take the point of view that they are the victims as much as the people whom they killed? These are the complexities. I wasn’t saying all you have to do is say sorry. There is punishment; there is atonement and all sorts of other things, which all cross different cultures. Howard Osofsky: Listening to the very sensitive and complex questions that have been raised, I am reminded that military people returning home who have been in conflicts where either they feel they have let their buddies down, their unit hasn’t functioned that well, or there has not been support for what they were doing tend to have some difficulties when they return home. And I am thinking, in particular, of the Serbian fathers who have also come home from a war in which they been branded and scapegoated by the international community, even if at times unfairly. We have been considering the children and the mothers, but we must not forget what it may mean to these men and what it means for adolescents and children growing up in aftermath of this difficult and complex situation in Serbia.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

149

4. Effective strategies already in place in Serbia . Psychosocial Programs for Teachers A School-based Model of Child Mental Health Protection 1

Anica MIKUŠ KOS, MD, PhD Program Director, Foundation “TOGETHER”, Regional Centre of the Psychosocial Well-being of Children, Ljubljana, Slovenia Tatjana BOKUN MD, PhD NGO “Srce”, Centre for Emotional Support and Prevention of Suicide Novi Sad, Serbia and Montenegro

Children affected by armed conflicts and post conflict adversities Children who have experienced armed conflicts and post conflict social adversities are certainly facing more risk factors concerning their psychosocial development. The international community provides numerous psychosocial support programs and mental health protection for these children. Programs and interventions certainly differ for therapists of refugee children in a mental health center in Western Europe and therapists who work in regions affected by armed conflicts and poverty. For those areas, community and school based models of psychosocial protection of children are of crucial importance. The institutional system of child mental health protection is poorly developed. For people living in rural areas, mental health services are difficult to reach and often parents are often too poor to pay bus ticket fares. Furthermore, the culture and habit of looking for psychological and psychiatric help is not adequately developed. The majority of parents do not know what they can expect from mental health services or are even scared to be stigmatized in their surroundings. In such circumstances, community based programs are needed. These activities are integrated in basic structures like schools, primary health care services, groups of civil society (NGOs, volunteers), etc. The other implications of the term community based are that an important number of children can benefit from psychosocial activities and that those activities have an impact on the mental health of the community.

150

A. Mikuš Kos and T. Bokun / Psychosocial Programs for Teachers - A School-Based Model

The psychosocial program for teachers in Serbia will be described. This program is run by the Foundation “TOGETHER” in partnership with two regional NGOs from Serbia and Montenegro: “SRCE”- Center for Emotional Support and Prevention of Suicide and “DUGA”Center for Voluntary Work and Help to Children. The Foundation “TOGETHER” “TOGETHER” was established in 2002 by the Slovene Government, the City of Ljubljana and the NGO Slovene Philanthropy with the aim to mobilize Slovenia's and Western Europe’s capacities for providing psychosocial assistance to children from countries of Southeastern Europe. “TOGETHER” has the following objectives: x To develop comprehensive inter-sectorial and inter-disciplinary models of psychosocial protection of children: x To mobilize civil society resources on behalf of the well-being of children; x To allow for exchange of concepts and models of good practice; x To develop cross-border networks and facilitate cooperation in the region. The goals are achieved through following programs: x Psychosocial training for teachers aimed at strengthening their capacities to help special needs, traumatized, and otherwise emotionally affected children and to improve the overall psychosocial climate of schools; x Training for medical workers to help them provide psychological assistance to children and parents as part of primary health care services; x Development of volunteer work as a means of activation of community resources for psychosocial support to children; x Development of volunteer work of children and youth as a means of their empowerment, developing social responsibility and preventing psychosocial disorders; x Development and support of child mental health institutions; x Organization of conferences and seminars for the exchange of experiences between different countries and the presentation of different models of good practice and development of common projects; x Publishing literature on psychosocial subjects. The basic philosophy and strategies of “TOGETHER” are: - Mental health for all children - Community and school based programs - Holistic approaches to child mental health protection - Inter-sectorial cooperation - Linkage to existing local structures - Critical mass of included persons / institutions - Building the pyramid of mental health protection for the served population by starting from basic systems (school, primary health care, volunteers) - Based on local human, professional, institutional, civil society resources - Working in partnership with local organizations and institutions - Developing continuous and sustainable programs - Linking different regions, building cross cultural bridges “TOGETHER” is active in regions of former Yugoslavia (Bosnia, Kosovo, Macedonia, Serbia and Vojvodina) and recently in Iraq.

A. Mikuš Kos and T. Bokun / Psychosocial Programs for Teachers - A School-Based Model

151

The school as a protective factor The leading theoretical concept on which the activities are based is the concept of protective factors and processes acting as counterweights to traumatic experiences, losses, and other adversities. Psychosocial programs are conceived as empowering processes that help children develop coping factors within their everyday lives. The impact of protective factors is presented in the scheme:

TRAUMAS LOSSES POST-WAR ADVERSITIES

ADDITIONAL ADVERSITIES RISK FACTORS

SUFFERING

PROTECTIVE FACTORS/ PROCESSES

VIEW ON THE WORLD HUMANITY

ADDITIONAL ADVERSITIES RISK FACTORS

SOCIAL CONSTRUCTION OF REALITY

PROTECTIVE FACTORS/ PROCESSES

ATTITUDES

PSYCHOSOCIAL PROBLEMS PSYCHOSOCIAL DISORDERS

MENTAL HEALTH GOOD PSYCHOSOCIAL FUNCTIONING

152

A. Mikuš Kos and T. Bokun / Psychosocial Programs for Teachers - A School-Based Model

Protective factors can be inherent to the child (temperament, biochemical reactions to stress and traumatic events, previous experience). Important protective factors can also stem from the family environment, but in situations of armed conflict or of social adversity, the supportive capacity of parents is often affected by the mentioned circumstances. Many research findings and practical experience are showing that the school can be an important protective factor for many children experiencing armed conflicts or adverse family situations. Good school achievement through supportive relationships with teachers and peers, being successful in endeavors such as sports and art, and showing talent in other activities, is nowadays recognized as important protective factor in children burdened with manifold risk factors. Many traumatized or otherwise psychosocially affected children who will never receive any professional mental health assistance can be helped by their teachers in school. Therefore, empowering and educating teachers to create positive psychosocial climates in schools and provide psychosocial support to children in need are valuable interventions from which all children can benefit. Psychosocial program for teachers The program is aimed to improve the psychosocial functioning of the school, to create a safe, supportive and motivating environment for all students, and to provide some basic psychological and psychosocial assistance to children with special needs and those with psychosocial problems. The goal is to protect and promote children's well being by facilitating quality functioning of the primary school, involving all children aged around 6 to 16. The basic idea of the program is that the school and the teachers have important psychosocially protective influences on the present psychosocial well- being, mental health condition, psychosocial functioning, and future development of children experiencing traumatic events, losses or chronic adversities. Raising awareness about teachers’ protective role is an important empowering process which stimulates their pedagogic involvement and psychosocial support to children. The comprehensive program emphasizes the positive aspects: coping, resiliency, protective factors and processes. It is based on a systemic approach to the psychosocial functioning of the school, focusing on its protective role and empowerment of children. It integrates psychosocial contents and psycho-educational approaches. The program should provide teachers with skills for: -

-

Integrating psychosocial and psycho-pedagogic components in their regular work with the class (i. e. in lessons) and in other job related activities (class meetings, excursions, cultural and social events) Organizing special activities for groups of children in need or for groups of interested children (children with learning disorders, social skills training, etc.) Providing individual support to children in need Working with parents Activation of support in the community.

Being aware that few children with psychosocial problems will visit mental health services and be helped by mental health professionals, the intention of the program is to equip teachers with

A. Mikuš Kos and T. Bokun / Psychosocial Programs for Teachers - A School-Based Model

153

some school-appropriate skills to help children. Those approaches and skills could be applied on the individual level, small group level, or on the class-wide level. The theoretical frames of the program are derived from psychology, developmental psychiatry, pedagogy, cognitive-behavioral theory, system theory, psychodynamic theory and group dynamics with a strong psycho-pedagogic orientation. The components of the program: - Training of trainers - Seminars for teachers - Implementation of new ideas and skills in the every day work of teachers - Continuous support to teachers (in knowledge, counseling, crisis intervention, job related problems, in helping teachers to implement acquired skills and knowledge, to realize their own initiatives and to give them motivation for future action) - Monitoring the implementation of the program - Replication of the initial or adapted programs in the region (without international experts). SCHEME OF THE ACTIVITIES

SEMINARS FOR TEACHERS

Module 1 Implementation in schools

Lectures workshops in schools

Training of trainers

Module 2 Implementation in schools Module 3

Implementation in schools Module 4

Implementation in schools

154

A. Mikuš Kos and T. Bokun / Psychosocial Programs for Teachers - A School-Based Model

Training of trainers Local professionals (10–20 physicians, psychologists, social workers, pedagogues) are recruited as trainers and lecturers. They are prepared for the role in a three-day training for trainers before the first module of the course for teachers. Trainers should empower and motivate the teachers for their pedagogic work and for their roles as psychosocial helpers. As teachers have considerable experience in dealing with children in distress and with special needs, and in managing critical situations in the classrooms, they should be given enough opportunities to present and demonstrate their own philosophies and strategies and share examples of good practice with their colleagues. Trainers are free to adapt the themes, group work topics, and exercises to local circumstances, needs of the participating teachers, and to their own skills and capacities. The program should be flexible and adapted to the social reality of the targeted schools and communities. After each day of the seminar, reflection and group analysis of the activities are performed by the group of trainers and international experts. This is an excellent opportunity for learning, improving teaching, and enhancing trainers’ group management skills. This procedure facilitates the development of durable knowledge and know-how of local professionals who will run further programs in the region without international experts. Trainers are also visiting schools and giving workshops and lectures for teachers on the most interesting and needed topics from the seminars. Seminars for teachers Each program is organized for 50 to 100 teachers from different schools. The programs are primarily targeted at village schools, which have little opportunity for additional education. Two or three teachers from each school participate because it would be difficult for one teacher to introduce innovations and spread the new knowledge on his or her own. The course of seminars for teachers consists of four three day modules with implementation of knowledge gained in between modules. Seminars for teachers are interactive, using group work, role paying, and expressive techniques as much as possible. Teachers are given enough time and opportunity to speak about their own problems and job-related burdens. Attention is paid to distress, difficulties and to the facilitation of their coping. The topics of the program could be divided into four main areas: -

-

The psychosocial climate of the school (relationship between teachers, pupils and parents, the protective role of the school and teachers, working with groups of children, etc.), Helping children with special psychological, learning, or other needs (approaches which can be performed in the classroom, mobilization of resources outside of the school), The psychological burdens of the teaching profession and preventing burnout (how to cope with everyday working problems, how to cope with social adversities, with their own trauma, losses, and post war disappointments) and

A. Mikuš Kos and T. Bokun / Psychosocial Programs for Teachers - A School-Based Model

-

155

The cooperation of the school with the community (developing voluntary work in schools, activating volunteers and raising material resources from the community for the benefit of the school and pupils, engaging parents for the benefit of the school, etc.).

Among important goals of the program for teachers are linking the school with the community and development of pro-active behavior of teachers in mobilizing local and international resources (material and human) in order to improve the quality of the school. Implementation The most important component is the implementation of acquired knowledge and know-how in participating schools, which is monitored through visits of trainers in schools. Modules of seminars include the overview of implemented activities by participants in included schools. Another output of the program is building networks among teachers from different schools, school workers, medical workers, social workers and other professionals acting as trainers. This network facilitates the development of various activities from which the school system and individual children can benefit. Conclusion So far, approximately 2000 teachers have been trained through programs in Bosnia, Macedonia, Serbia and Montenegro, and Kosovo. The program was replicated by Care International in the North Caucasus and recently in Iraq. The program proved to be of great interest for teachers, and space limitations necessitate that some must be turned down for participation. The monitoring of the program shows that numerous ideas and practical activities are implemented in the every day functioning of the school. Teachers from Vojvodina and Serbia included in the program: -

-

“Higher number of teachers should be included in the seminars; a lot of seminars should be organized.” “Thanks to great trainers, the group work was organized very well, unbelievably well lead, educational, interesting, nice, full of suggestions, which shows us different ways of solving problems and ways of behavior in certain situations.” “I felt extremely nice, fulfilled and because of that I thank all who participated in the organization of this seminar.” “I felt relaxed, nice and energized, because I have exchanged experiences with my colleagues and created a new experience.” “The lectures were educational and interesting, very useful for improvement and development of teachers' work with children.”

The valuation of community based psychosocial programs is extremely demanding because the methodology is very complicated and the procedure is expensive. Besides, many ethical questions could be raised, such as the ethics of using questionnaires on consequences of traumatic experience with a large number of children. The conclusion that large numbers of children and a community as a whole can benefit is based on following:

156

-

-

-

A. Mikuš Kos and T. Bokun / Psychosocial Programs for Teachers - A School-Based Model

quantitative indicators of direct and indirect beneficiaries (teachers, children, parents); indicators showing the activated resources in the community (number of volunteers, number of working hours by volunteers, other raised resources for related psychosocial programs, etc); monitoring of implemented changes and innovative activities in schools and communities covered by the program evaluation by teachers of the quality and applicability of acquired know-how behavior of teachers in the frame of the program (regular attendance of the program, proactive behavior, high level of participation, etc) popularity of the program in the regions and requests by other teachers to be included in the program, who cannot be included due to the financial limits (it should be stressed that in spite of the fact that their participation in the seminars does not bring them financial or promotional benefits in school, teachers are willing to give their time during weekends to attend seminars); the estimation by international experts of acquired knowledge and developed and know-how in local professionals, teachers and volunteers; number and quality of public and promotional activities, first of all in media aimed to raising awareness and informing the public about psychosocial issues and children’s mental health.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

2

157

.

Using educational institutions in Serbia for the post-conflict recovery of children Slobodanka GASIC PAVISIC Professor, Faculty of Defectology, University of Belgrade, Belgrade, Serbia and Foundation Together It is vital to use every level of the educational infrastructure to raise awareness of trauma in children and to implement effective measures to reduce or remedy trauma. We have initiated programmes in the University Education Faculty, Teachers’ Training Colleges and schools. There are many facets to this complex issue and we have created a centre to deal with these: for example, improving the communication skills in parents, improving the interpersonal and professional skills of teachers themselves. This empowering of the teaching profession has led to an increase in self-confidence and preparedness to initiate activities. There has been an improvement in school-work and motivation in the students: for example, looking after school garden, organising school sports, organising volunteer support for helping other children. We know a lot about teachers’ knowledge dissemination between colleagues. Cooperation with professional services is also very important. Co-operation with professional services in the local area: health centres; centres for social work; and police. Professor Osofsky spoke about co-operation with the police, and in our centre and in our school in Serbia in the last few years we have worked also with the police. It is important to improve personal contact with all of these local resources. We encourage mutual interconnections, making networks to build co-operation and communication between staff and other participants at the centre. For example, students from a city school organised a school party for students from a small mountain village and they made a connection. We have identified the need for organising a professional consulting team in the local community for helping people to solve their problems where they are not able to cope alone. And there is a need for inter-institutional co-operation in the local community, in the area of social care for making a contribution to long-term sustainability and established goals for ensuring the children’s well-being. I would like to say something about our other project. It is voluntary work with students and in the school. These volunteers help children who are in fourth grade; they help them in learning their subjects and also they speak with them about personal problems and they are something like friends. We started it very recently, but I cannot stress enough that it is very important to organise this voluntary work. Here is just one example of why this works so well: One student who had learning problems and poor academic success said to his volunteer that he was very anxious in the class. Nobody in the school knew about this situation and so he had been

158

S. Gasic Pavisic / Using Educational Institutions in Serbia for the Post-Conflict Recovery

receiving no special help. His volunteer was able to bring his problem to the attention of the staff so that it could be addressed. I would like to recommend this kind of voluntary work for helping young people with resilience. Voluntary work helps to get better self image and self esteem, to do something for others, to develop life skills, to be a member of the social group, to get respect from others. And we have had very, very good experience with this organised voluntary work. I would like to mention another project we initiated in 1995-6 with the co-operation of UNESCO. And I would like to say to Professor Yule that UNESCO, in this project, did buy balls and musical instrument for children! It was action-research in five very big schools only, where they had many traumatised children. The results from this project showed that the most efficient model for working with children is within the framework of existing extra-curricular activities. In our schools there are many forms of extra-curricular activities: in meeting between class teacher and parents; in classes devoted to social work; and cultural activities; school branches of social and charitable organisations; school excursions; and outdoor learning activities. But I would like to say one more important thing, a sentence from a Serbian girl, aged eight, who said “When the war stops, we will still be the children of the war”.

And so, I feel obliged to say that we have spoken in this meeting a great deal about a true apology and remorse leading to forgiveness – My personal opinion is that maybe we Serbs can forgive NATO for bombing if NATO can apologise to us for bombing.

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

159

5. “Serbia maybe could forgive if NATO apologised!” - NATO Response Cornelis WIENTJES NATO Security-Related Civil Science & Technology Programme, Brussels Belgium What NATO is – NATO as a science facilitator and generator – ARW on social and psychological consequences of terrorism – NATO-Serbia relationship

I would like to deal with four issues. First I would like to speak about NATO, about what NATO is, how NATO works, what kind of development NATO has gone through in the last decade. Then I would like to speak about NATO as a facilitator and science generator, about the mechanism that we have, what types of activities we undertake. Thirdly, I would like to go into a little bit more detail into the results of an ARW that was held over two years ago on the social and psychological consequences of terrorism because I think that a number of the findings of that Workshop are relevant to this Workshop. And fourthly, I would like to do the most problematic part of my presentation, I would like to go into the relationship between NATO and Serbia; and explore with you, and with your help, how NATO can play a role, a positive role hopefully, in helping to resolve a number of the problems that Serbia is coping with right now, including the problem that we are focusing on in this ARW.

Misconceptions about NATO Just a few words because I think it might be useful to explain a little bit about what NATO is. I know that there are many misconceptions about what NATO is and how NATO works. I frequently encounter these misconceptions when I travel, and I travel a lot in what we call the Partner Nations, that is the nations that are not NATO members but are associated with NATO through various treaties. Of course, primarily NATO is a political military alliance, with very important Article 5 which postulates that if one of the NATO member nations is attacked, that this will be perceived as an attack on all NATO nations - that is one of the bases of the alliance. The alliance was very much designed in order to meet the situation that was relevant in the Cold War. A very important principle in NATO is, and I have to emphasise that, NATO is not a hierarchical organisation that dictates to the nations. On the contrary, it is the nations that tell NATO what to do, and NATO can only act when all the member nations are in consensus, are agreeing. If one nation, even a very small nation, does not agree with the proposal that has been brought up in the North Atlantic Council, it will not happen. And this is a way of organising and a way of decision-making that is completely and essentially different from what was the case in the Warsaw Pact, which was very much a top-down structure. NATO is not a top-down type of organisation.

160

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

But what I very frequently encounter, when I travel, is that people say “Well, NATO has done this” or “NATO is now doing that”. It is true, but what really should say is “NATO nations have decided to do this or that, and NATO is carrying out those procedures”. As I said, NATO was very much set up as a Cold War instrument, to defend the NATO nations against the threat that was posed by the Warsaw Pact. But obviously since the early 1990s there is an enormous evolution of the roles that NATO has been taking on. Rather than an organisation that was focused on defence, it is now very much an organisation that is focused on promoting and maintaining stability and security. And this in practical terms, in terms of the operation of NATO, means that the types of operations that NATO is undertaking is very much peace keeping, peace enforcement and other interventions that are associated with that. Also increasingly what you see is a tendency for NATO to operate out of its traditional area, because of course traditionally it was the North Atlantic area, the area covered by the NATO member states. That was the operational area. Now NATO is moving more and more out of that area. Also it has become clear that NATO is very important and a relevant instrument in order to keep up the dialogue across the Atlantic Ocean. Everybody knows that the US and Europe have steered different courses in the last couple of years, and, especially since the breakdown of a number of discussions in the United Nations, there is very little in terms of instrument, that enables the Europeans to speak with people in the US. And NATO is one of the few of these instruments that enable us to maintain dialogue across the Atlantic. And of course, since the 11th of September, 2001, NATO is increasingly taking up roles associated with defence against terrorism. Also NATO is expanding. When the Kosovo war was fought, or initiated, there were 16 NATO members. Very shortly after that, three members joined NATO – the Czech Republic, Poland and Hungary, now there are 26 members. In addition to the roles that I have mentioned, what you can see is that NATO is not only addressing the hard security issues, but also increasingly soft security issues. And I cannot go into this deeply but what I mean by that are issues to do with the environment, to societal questions, to illicit trafficking of persons and drugs etc. All kinds of issues that were not traditionally addressed by NATO, but that are increasingly seen as being very relevant for security and stability. Of course traumatised children, due to conflict, terrorism or war, is an issue that is very relevant in this context.

NATO as a science generator. Basically, there are two organisations in NATO that are involved in science. The Research and Technology Organisation is working in the area of defence research and technology and the NATO Science Committee, which is the body that is sponsoring this ARW, is working in the area of civil science and technology. These two organisations have completely different modes of operation. Most NATO nations have defence research facilities or establishments or have laboratories or universities where part-time defence research is being conducted. The RTO has the primary role of bringing people from these institutions together in order to co-ordinate as much as possible, and in order to enhance co-operation as much as possible between these professional resources. The Science Committee works in a completely different fashion. It brings individual scientists together – from NATO nations and from Partner nations, because that is one of the requirements nowadays, that there should be parity in the involvement of participants in Science

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

161

Committee activities between NATO members and Partner members. And the initiative for activities that are proposed for sponsorship by the Science Committee comes from the individual scientists. What happens with these applications is that they go through a peer review process, there are a number of panels in the Science Committee with experts from NATO nations as well as Partner nations, and these panels review the proposals that are being submitted. And if they think that the quality is high enough, then they provide the funding as part of the science programmes. The Science Committee has gone recently through an evolution or a revolution. Traditionally the Science Committee was very much focused on civil science and technology, basic science; what they have changed is that they have now very explicitly put the focus on what they call “new threats and challenges”, and that includes terrorism and other security threats. We also have Explosives Protection Working Group that is looking into new technologies that can hopefully be used to detect where there are explosives hidden under clothing or in luggage or in cars. And we do that with Russia, with Israel and the Ukraine. We have in 2003 and in 2004 done five Workshops on different technology areas. A Workshop in Prague on contemporary threats very much focused on cultural issues and on dialogue between Americans, Europeans, people from Israel and Arabs. In June 2004 there was a Workshop on suicide terrorism, which focused on three issues: protection and mitigation - and by protection I mean all the factors and protective methods that you can take; pre-emption, which is much more intelligence business, where you are trying to infiltrate into suicide terrorist networks, trying to destroy them from the inside; and the root causes, and in particular the recruitment mechanisms and the popular support on which suicide terrorism thrives. Later in 2004 there was also an important Workshop on non-lethal weapons as counterterrorism weapons. This is interesting because it is a direct consequence of what has gone wrong in the way Russian security troops have dealt with the hostage-taking in the theatre in Moscow. This workshop will try to develop both procedures and technologies that will hopefully enable security forces to use these kinds of developments in a way that is effective but not so harmful for the hostages.

Advanced Research Workshop on Social and Psychological Consequences of Terrorism. This Workshop was co-directed by Simon Wesseley from the UK and Valery Krasnov from Russia. It was the first NATO-Russian activity undertaken in response to a call from President Putin and Lord Robertson in the fall of 2001, after the attacks in New York and Washington for co-operation between NATO and Russia in the area of defence against terrorism. The rationale was that although it is conceivable that very catastrophic attacks using chemical or biological or radiological weapons take place with thousands and thousands of casualties, it is much more likely that it will be small-scale attacks, if there will be attacks at all. But the point is that even if there are very small-scale attacks, with very limited numbers of casualties, the effects, the psychological and social effects, and the long-term effects, can be very serious. Furthermore, and this may be the most important point, that there are various societal, psychological mediators that may serve to amplify the consequences of such attacks. And these mediators were one of the prime topics of the workshop. The other subjects of the workshop were typical social and psychological reactions, postdisaster behaviours, intervention techniques, communication between authorities and the public, mis-communication in terms of rumours and myths, the role of the media and the press, some

162

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

scenarios were worked through, cross-national perspectives were explored, in particular in terms of comparing how response in Russia would be compared to the response of NATO nations. We did very thorough analysis of events like the Three Mile Island incident, Chernobyl, events in Brazil, attacks in Israel, the Sarin attack in Tokyo, and the Oklahoma City bombing. And in all cases - it was a very common phenomenon - there is an overwhelming response in terms of people who report complaints or symptoms which they ascribe to the consequences of these events. And as it turns out later only a very small minority of these complaints and symptoms are actually related to exposure to dangers here, so there is a very strong psychological component. Some of the main findings of the Workshop were that authorities very strongly tend to underestimate the resilience of the public; there are numerous examples of catastrophic or nearcatastrophic incidents where people, because the authorities were not there at the point in time when the disaster took place, where people began to organise themselves in a very effective way, began to take care of the wounded, began to act as first responders, and were very effective. Also it was concluded that panic is not a very likely response in the case of a terrorist attack. Only under very specific circumstances, if people are in a confined space, with doors that do not open or insufficient air then they begin to panic. So distress is very powerful obviously but it was a very powerful conclusion that it is only a very small minority that will suffer from long-term psychological and psychiatric problems. This should not be exaggerated, this issue of the longterm consequences. It was also emphasised that there is a very strong need for people to speak with each other about what has happened, and by ‘people-to-people’ communication I mean people-to-ordinary people, not specifically people-to-therapists. On the contrary there is strong evidence that immediate interventions like stress counselling may be counter-productive in terms of exacerbating the trauma rather than providing relief. Communication in particular from authorities about the event, rapidly and reliably, is very important as a protective factor against anxiety and stress. Failures to communicate, because there are discrepancies between what different authorities say, or because there are maverick scientists who come up and say “What the authorities have told you is a lie and in reality it is much worse”, lead to rumours and myths and these in turn lead to implications for the consequences, and in particular are instrumental in creating these unexplained symptoms that you see after these catastrophes.

Recommendations of this ARW: 1. Communication and trust First, and most importantly, adequate and reliable communication; and this is something that authorities should prepare for at national level, maybe at regional level, city level. There should be somebody who will be perceived as the trusted communicator. Also authorities have a tendency to mistrust the responses of the public and to very much under-estimate the ability and capability of the public to maintain order and to respond in a sensible way and to organise themselves in an effective way. So the message from the Workshop was that authorities should make the public allies rather than alienate them. 2. Risk communication Very importantly, there is an urgent need for authorities to understand the principles of risk communication. How do you communicate about things that might affect the public negatively,

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

163

their health or their future or whatever? It is necessary to develop communication strategies for this because it is essential and it is a most important long-term objective to maintain the public confidence in the authorities. 3. Interventions And also it was suggested, although it might practically be very difficult, that if there is an affected group, that has been exposed to some sort of agent, that this group is very carefully monitored and it would ideally be excellent to have a control group that is matched in all its respects but that has not been exposed, but that might be somewhat idealistic. As I mentioned people talking with people seems to be a much better idea, much more effective, than people talking with professionals. And that is also relevant for what we are discussing here today. Because this is a very normal and healthy response of people, that if there is something wrong they speak with each other and that is a help. On the issue of immediate versus delayed interventions, it was agreed that there might be some need for further research there. 4. Resilience Resilience is an issue that we have also discussed here. Making society more resilient was identified as a crucial problem. One of the things that was concluded was that there is this very strong tendency nowadays in our societies to be very concerned about everything, to be very concerned about being exposed to somebody smoking in the room and to be very concerned about whether you live too close to a highway or not, to be very concerned about almost anything that might potentially affect you. And there was a general consensus that this tendency to minimise risks is in the end counterproductive, as far as resilience is concerned. It undermines resilience. Resilience is also based on a willingness to face certain risks and not to run away from them, and in this respect the precautionary principle is a bit exaggerated and there are some examples, for example in the United States many subway stations in cities in the United States are equipped with detectors in order to detect biological agents or chemical agents, and one of the US people involved in this workshop, who is in the Pentagon working in this area, told me that they have a full-time job dealing with all these false alarms. It is an exaggerated response and it may lead to social disruption and undermine resilience.

Public confidence and the crisis-management process The long-term maintenance of confidence is of course related to this, but it is important that we very carefully study how authorities manage the crisis-management process. Maybe communicators should be specifically selected and trained. What they should learn in particular is to be able to handle uncertainty in a confident manner, because uncertainty will inevitably be there. When there is terrorism, nobody will know for sure what has happened exactly. So communicators should be able to deal with this uncertainty. And of course there are cultural differences there. It is so important for NATO and for the NATO nations to very carefully look at these issues and to continue looking at these issues, so an Advisory Committee and an Advisory Panel were set up that would continue to work on this: there are members from NATO nations, from a number of NATO bodies, and from Russia

164

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

because this is the NATO-Russia Science Committee. The panel meets regularly, and the themes of these meetings are: - Risk communication, using concrete examples, such as the Moscow Theatre hostagetaking. Strong recommendations concerning how authorities should communicate about risk with the public were presented to the NATO-Russia Council in November 2003. I think that is a very important event, and it shows you also that a Workshop like ours can, in principle if it makes recommendations that are hard and relevant, go to the highest level immediately. It is possible to get important recommendations at the right place because NATO has those mechanisms. - Psychological consequence management and the early intervention issue. - Suicide terrorism, and as I mentioned there is a workshop planned on resilience. - Working techniques in management of psycho-social interventions in crisis situations.

NATO and Serbia Now I would like to say a few words about NATO and Serbia. And I think it is fair to say that the relationship between NATO and Serbia is a deeply traumatic one, for a number of reasons - in particular, of course, associated with the war in Kosovo. And it is very obvious that very different perceptions, concerning the intervention of NATO exist in Serbia and in NATO nations. I have to emphasise that in NATO nations this decision to do this intervention was taken on a consensus basis, because that is how NATO works. So there was agreement across all 16 NATO nations that this was a very painful but necessary measure. It was certainly a decision that was taken with a very deep appreciation of the risks that were involved to the Serbian population and there was a genuine intention from the NATO side to avoid creating causalities among the Serbian population as much as possible. I am convinced of that. But unfortunately that has not always been successful of course. It will be down to history as to whether this was a correct or wrong decision. But it is obvious that this part of history is among the many other traumatising events for the Serbian population, and I fully recognise that. However, I would also like to emphasise that this is certainly not the only traumatising fact in Serbian society. And during our discussion we have probed more extensively and reviewed a number of events. And there is in the history of Serbia - a whole series of factors that have contributed to this trauma. And what concerns me very much - and I would like to bring this up although I find it very difficult to phrase it in a way that expresses exactly what I would like to say - is that there might be mechanisms in Serbia, in terms of the attitudes of the authorities, in terms of the press, in terms of all kinds of societal mechanisms, that serve to not alleviate the trauma that is associated with the NATO bombardments as well as with other unfortunate events in Serbian history, but to the contrary are still serving to keep the trauma acute and even to increase the degree of trauma. And I am very concerned about this because we have just been speaking about effective strategies for dealing with traumatised children and adolescents in Serbia, and I have heard some excellent proposals, but I am very concerned that there might be a societal force at work in Serbia that serves as an obstacle to really resolving much of the trauma that is there.

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

165

Because my feeling is, and if I am wrong I would be very happy to hear it, but my fear is that there are still mechanisms at work in Serbia that serve to keep this trauma alive, then that is a very major obstacle. And if that is the case then what is needed is a healing process and that is a very complicated and difficult affair. But I would like to explore with you is how NATO and the assets NATO has – and I think in particular here of the mechanisms we have for setting up workshops, funding exchanges, a whole series of mechanisms – how we can use these assets and mechanisms to be part of the solution to the problem, rather than part of the problem. So this is what I would very much like to further explore.

Discussion Jill Donnelly - Moderator: The last presentation from Dr Wientjes, and some of the earlier remarks, makes me realise that over these last two days - until now - we have all found that we have many things in common and we have developed a very good working relationship and I think I can dare to say some very good friendships. Now this issue of NATO and its relationship with countries that traditionally saw the member nations of NATO as their enemy has brought out a slightly divisive feel to our meeting, and I think it is very important that we air that now. So if you feel very strongly about an issue, please state it frankly. Response from participants : I Jovanovic (Serbia): I agree with you that there is a very painful relationship between Serbia and NATO. I am sure that if you ask any citizen of Serbia to say very quickly their first association to NATO, it would be the bombing of 1999. So this painful experience is very rich soil to build some misperceptions and to maintain them. But the only way to fight against misconceptions, all kind of misconceptions, is to provide information and communication. So if the people can learn about NATO as an organisation that promotes better activities, which is concerned with security issues and fighting against terrorism, then this picture could be maybe changed – but through time, not very quickly. My second point is that we were all born – I apologise to those who are younger here – in the split world, the world which was split by the Iron Curtain, and with split pictures, black and white pictures, of the world in our heads. It would be a major objective, of our project to help our young people not to maintain these black and white pictures, but to negotiate more complex and integrated picture of the external world they live in. Anna Ignatieva (Russia): I understand that NATO is currently restructuring its activities; but in spite of that, the fact is that NATO up to now has been based on military force. This is a real problem for the Union of the Committee of Soldiers’ Mothers of Russia. We are a human rights organisation and for our activity it is very dangerous that NATO still exists. Why? Because you see NATO was developed as an organisation to counterbalance the Warsaw Pact. However the Warsaw Pact no longer exists. And for our military this is a good reason to say “Look at the West. The West still has lots of military organisation. All Western countries have military forces and are tied in to NATO – and you, they told us, you human rights organisation insists on cutting the number of military forces in Russia? Look around the world. Next to our Western border

166

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

there are so many countries which are a member of NATO. Look to the South border, there are lots of former Soviet republics which allows US forces to base their military on it”. They use the excuse of NATO expansion – which means NATO member states are getting nearer to Russia – to stop military reform in our country. C Wientjes: What you say is, of course, not new to me because I very, very frequently go to Russia and I have spoken with many people who say very similar things. But there are still a number of misconceptions in what you say. Just to mention a few. It’s not the military who are in power in NATO; it’s the heads of government in the NATO nations. The military have to do what the heads of government decide. NATO is, rather than building up military presence, reducing its military presence enormously. The role of NATO in the new NATO nations has been and will be to enormously reduce their military equipment and potential. Demilitarisation, in particular of the former Soviet republics, in terms of finding solutions in terms of jobs for the enormous amounts of military personnel, in terms of finding solutions to dispose of the enormous quantities of ammunition, the enormous arsenals and armaments, in an environmentally-safe way, are very prominent and very high among the priorities of NATO. It is one of the main issues that we are involved in. Of course, NATO is a political-military organisation, but if you look at the day-to-day business of NATO, in particular at the day-to-day business directed towards what we call the ‘partner nations’, what you will see is that there is very strong efforts towards reduction of the military arsenals, very strong efforts towards the reduction of political tension potential, very strong efforts in a positive sense towards the development of impartial and fair systems where minorities are given their proper rights – their human rights. So I know that we will continue to differ in opinion, but I can assure you that NATO is a stabilising organisation, that is serving peace rather than war. Jill Donnelly: Several participants have said in informal discussions that NATO has an interest perhaps in communicating what it has become, and to try and get rid of some of these misconceptions - some kind of public awareness campaign in many different countries to communicate what NATO really is. Latéfa Belarouci : You said that serious trauma is only found in a minority of people – I disagree entirely. I shall explain why. It is true that if a person is exposed to one single traumatic experience, they will not usually suffer deep, long-term psychological or psychiatric effects. But I know from my experience of psychotrauma, that, depending on the individual, a person traumatised does not present the symptoms immediately. It could be two months, ten months – years before they show the effect of the trauma. In Algeria the traumatic events linked to war and terrorism are repetitive. In those circumstances the whole population has been affected: There are the direct victims, that is those who have been hurt or who have witnessed the torture or death of loved-ones. Then there are the indirect victims, that is, people affected by living in this climate of insecurity – and this is a very important traumatic factor. My concern is that if politicians and policy-makers hear you say that only a minority will suffer, they will not see the point in setting up mechanisms to deal with trauma, to train psychologists, psychiatrists, social workers, counsellors. That is my fear, based on what has

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

167

happened in Algeria. It was only 4 years ago in 2000 – 10 years after terrorism began - that they have begun to train psychologists. The second point is that you said that it is preferable for people to talk to ordinary people not to therapists. Again, I disagree. I think that communicating is hard. Mental health professionals, journalists, specialists in communication, because they know how communication works, can help the population. The big problem today is communication. Furthermore, mental health professionals have a profound knowledge of the human psyche. They understand the process of change, of removing the blocks to communication. They can, therefore, re-establish communication which re-establishes normal attachments. I believe, therefore, that the role of mental health professionals – whatever their speciality – is fundamental in rebuilding communication. Lack of communication is why people kill each other, why there is violence, aggression, anger – and if that is not managed it turns into mass murder like we have had in Algeria. The fact of re-establishing attachments and communication means that all that violence and the problem of communication, the problems of intolerance and anger, can be managed - but to reach that stage, we need professionals. C Wientjes: Thank you very much for this very valuable comment. It is absolutely true what you are saying. Of course there are, in events like this, people who not only suffer acutely very much but also in the long term. It is also true that not always people who are affected find the right ways to treatment. And I think this in many countries now is changing for the better because the authorities are becoming more and more aware of the need to take adequate measures in order to screen people for potential trauma and in order to offer treatment opportunities for them. My main issue was that when you look at the figures - and there is a lot of research that has been done in this area - when you look at the figures, for example, on the Tokyo sarin attack, you see two very interesting things. First of all the psychological mechanism of people who are very concerned that they might have been affected and who are very anxious, and who report to hospital because they think that there is something wrong with them. In Tokyo that was 80% of the people who presented with symptoms to hospitals turned out to be not contaminated. So that is one mechanism – there is a tendency of people in events like this to be very concerned, to respond to their concerns although there is not always cause for concern. Another mechanism, the second effect that you see in these situations is that there is a group of people who have very long-term, very disabling effects. You also see that in the Oklahoma City bombing one-third of the people who survived that attack showed criteria for Post-Traumatic Stress Disorder, which is a substantial number of people, although it is a minority. And even after one year, when there was a reassessment, numbers of people affected with PTSD symptoms were high. So there is a group of people, albeit the minority, that suffers very serious long-term effects. So I did not mean in any way to belittle this problem. I only wanted to say that the overwhelming majority in many cases of people who think that they have been affected and who think that there is something wrong with them, fortunately after careful assessment turn out to be not affected. And that is what I meant, but you are quite right that there is quite a number of people who have very serious problems and that have to cope with very serious consequences and they should be adequately dealt with and treated.

168

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

S Ozacky-Lazar: I find it fascinating that NATO is changing, and has come to believe that security is not just a matter of military force, but has a broader meaning. And I too, like Anna, attended the Workshop in Prague and there were many issues, but three issues were raised very strongly. The Workshop was about the religious roots of terrorism. One consensus that we arrived at was that terrorism cannot be defeated only by force, and by military force. There are other dimensions that should be investigated in order to cope with terrorism. Another thing that was raised very strongly by an Egyptian professor was the lack of understanding between the West and the East, that is, the Arab and Muslim world. And we spoke a lot about the urgent need to have some kind of dialogue between these two cultures before it is too late. Maybe it is not too late, but before it is any later. The other thing is that Shimon Malka has mentioned several times during the last two days is the role of the media. And in that case the role of the media is stimulating the effect of terror, and sometimes terrorists use and manipulate the media in order to achieve more effect. For example, in France a media alert about a possible attack on the railway system by terrorists, put the whole country in hysteria. So even before they placed one bomb, everyone in France is in a state of emergency. So I really want to thank NATO for making this dialogue possible, with all the criticism that you heard – maybe you, as a representative of the organisation, deserve a complement. J Salem-Pickartz: I would like to make a personal and a professional statement. The personal statement: I think your presentation highlighted the fact that NATO is an organisation that in the past has made forceful decisions, the decision to implement force, to be aggressive if I might say so, and at the same time it is searching for more peaceful ways of avoiding, minimising conflicts, and increasing stability and security. And for me personally, as somebody born in peaceful times, after the Second World War, in the West, I think it is time to say goodbye to the illusion that there can be something like a comprehensive peace, a lasting one. This is a psychological process and I am just realising that I am going through it, and coming to terms with it – and this Workshop helps. So thank you. Now two comments to what was said with regard to healing the wounds of war between NATO and Serbia. What came to my attention also when we worked yesterday in the community group – designing projects, having in mind community conditions – I had in mind very strongly that there is a rift between the people’s representatives, the government, and civil society. We also talked about the need for truth and reconciliation and I think that something like this might be necessary between NATO and Serbia. However, I would like to underline very much the necessity to conduct this process with the population and not to forget the people by reducing it to dialogue between, at best, NATO and government. I can give you the really bad example of Jordan. Jordan signed a peace treaty with Israel in 1994, and this peace treaty was never discussed with the population. Actually the parliament was denied the right to debate it – forget even about discussing it in the press. Now this peace treaty is there, but as in my dialogue with my Israeli colleagues, we both agreed – and I think it is the lack of communication within the population, the population that has led to a very strong resistance on the Jordanian side to even want to know anything about what is going on in Israel and the wider context. It leads to blacklisting of people who ever dare to have any contact, professionally, personally, with Israelis – so it has created strict rejection of contact, and it has fostered unfortunately blunt ignorance.

C. Wientjes / “Serbia Maybe Could Forgive if NATO Apologised!” - NATO Response

169

And ignorance can be very dangerous ground for taking action that is completely unjustified. And in this context I think that what you are doing is so extremely important - This meeting together and communicating across the borders. Now another point, concerning the human factor in security and stability considerations: Much of the scientific reflections as I understand them focused on traumatised people, and how to minimise the impact of trauma on people, what kind of immediate intervention to take and so on. But I think that maybe NATO needs to look a bit beyond this. There is a question that has come up several times here and I think it is a question that needs very careful consideration. It is the question “How do these conditions of insecurity and instability also impact on people’s long-term development?” – on children’s development over time. I was talking with Shimon Malka and we both know Israel and Palestine well - the mere fact that you do not know what will have happened until the end of the day; if you move through Palestine you do not know if you can pass the next road block and if you pass it whether you will come back or not. I would just claim from the perspective of children, it will deprive children of development chances if they just restrain themselves to a very narrow, secure, controllable environment. Or it makes you careless, you just enjoy the day, you go even for high-risk situations because you don’t know if you will still be alive tomorrow. So I think that what you are doing in the long term must consider these aspects: what the situation means for healthy development of children into adults, what it means for their quality of life – and they are the future decision-makers of our society.

L Peters: I agree with Dr Salem-Pickartz. Truth and reconciliation is a bit of a fashion nowadays. In my view it is the end of a process that starts with confidence-building measures. And I missed that in your presentation as one of the activities that NATO is focusing on. I am sure you are doing it in a human security concept, but it might be worthwhile to explain it a bit more, and make it an issue by itself, and not something that is implied in other things. Because I think it is extremely important, in your relationship with Serbia for example, what kind of confidencebuilding measures you could take as an organisation to rebuild the relationship between you and Serbia.

170

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

6. Identifying the obstacles and local resources for implementation and the training required by non-professionals working alongside mental health professionals to implement effective measures to ensure the well-being and wellbalanced social attitudes of young people in Serbia Task Group Reports: 1. School Strategies Ingrid Leth, Linda Neuhauser, Joy Osofsky Slobadanka Gasic Pavisic (Rapporteur): We would want to gain information about the incidence of traumatisation following bombing. What did you do during the bombing, how were you and your family protected, what was and would be helpful to help your children and adolescents affected by bombing? We think this question is important for the research on victims of bombs and also could be helpful for other people to know how, to share in our experience. Education and training for teachers related to signs and parameters of trauma and how to help children and adolescents who are traumatised that will be integrating in ongoing teacher training on psycho-social development and victims’ self-esteem, then developing individual attention to children and adolescents affected by trauma in different ways. To develop group teaching methods. It means I say that in Serbia we have a new school record, started in the last two years, and this individual approach and the group work in class is easier now in normal schools. Of course these are only some of other more general topics which are important in education and training for teachers. It is useful to have youth peer groups as a way to integrate especially through developing activities. Training is needed to facilitate this work, how to convey a group plan or project, and how to do it – we liked Linda Neuhauser’s most useful suggestion of participatory methods. Life skills training for leadership and organisation with peers, action club in local community. I said a special bad condition for development and for life is in big cities, and Belgrade has 2 million inhabitants and in a new part of this big city there are no possibilities for young people to be included in constructive activities. And this action for young people needs support, of course, both financial and of other kinds. Support could be from the local community or from government, or from a humanitarian organisation. Workshops for teachers to help them problem-solve, understand, and deal with their own trauma. It is very, very important question, and in our seminars in Serbia we talk about it and the teachers are very glad. Organise work with volunteers to help in classrooms, with homework and in other activities. For example, young people and students volunteer in a faculty which works with children, in Belgrade, a teacher faculty or a

Identifying the Obstacles and Local Resources for Implementation and the Training

171

faculty of psychology or medical faculty also. And then these points need more explanation but it is only short here because the forms of help of volunteer could be very different. But it has inner motivation for learning and education. There is a negative relationship between higher education and earnings and being willing to support family. We didn’t mention this more today, but it is a big problem for our young generation and I think in young in other countries in transition, because young people do not have motivation for learning and for education, they can see all around them that the people that are uneducated have a better life plan, a better lifestyle than them. One problem with our young people here is that they have a habit to go out during the night time and to sleep during the day, and we have no idea how to solve it. Develop family clubs in schools, especially to learn more about the teenagers and the better co-operation with school and parents. Try to find role models and/or mentors for adolescents who are feeling helpless and hopeless. 2. Using the Resources of the Community Latéfa Belarouci, Tanja Bokun, Caroline Paskell, Isabelle de Rambuteau, Josi Salem-Pickartz, Jasna Zivulovic Armine Gmur Karaptian (Rapporteur): Our main goal is developing strategies for programmes to deal with trauma in 12-15 year-old children. What is the current situation in the community? We realised that there is a very big gap between civil society and local authorities. And for that we think it would be important to organise awareness-raising campaigns for local authorities, so that they are more interested in youth problems and especially in traumatised children and their treatment. We agreed that NGOs can generally best represent youth problems, and we had representatives of NGOs like MMM Serbia, Jasna Zivulovic, who knows the situation very well and who can see very big problems in organising certain activities for youth – there are problems providing for even basic children’s activities such as painting and drawing, because of lack of resources. And it would be important in such a situation to organise certain activities on different levels, like activating the role of church or youth organisations, such as the Scouting movement, if they exist, educational and health-care structures and other services. For local NGO leaders, whom we had in our team, it would be very important to create youth service centres as social service centres because the young do not have any place to go in and to have their leisure time and after school they are either in cafes or on the street. So this youth service centres would help them to organise their leisure time in better ways. And we focused our attention on mental health problems because we are talking about traumatised children, so it would be important to involve the public health services to organise psycho-social services together. So finally it would be clever to have two different directions here, and to try to create community-based psycho-social services and community-based social service or youth centres. It would be very important to involve as much as possible volunteers and youngsters in organising such things. And, as far as we could understand, NGOs who are interested to create such structures themselves they need certain capacity-building and strengthening to be able to organise the future centres in a better way. Anna Kovacova: discussion of cultural and societal institutions [in French]

172

Identifying the Obstacles and Local Resources for Implementation and the Training

3. Family Tija Despotovic, Anna Ignatieva, Linna Kuts, Dmytro Tkachenko, Mia Vanderhasselt Lucie Bratinkova (Rapporteur): Our group came back to a line that Jill Donnelly took yesterday in her defence presentation, so the motto of our report could be “strong and healthy families, as a response to the new security threat”. The threats which we are facing in our north western hemisphere, for example terrorism and organised crime, are disruptive challenges. And in those conditions we think that the family has necessarily to be viewed as the most important educator in society and therefore should be supported in this role because through the families children learn individual responsibility and the ability to be socially aware and this is the most important platform then for a society which is resilient to new security threats which always target local communities. So the most important thing is promoting family values, which starts with recognition of this role of the family. It leads us to the role of the family in building economic health which is especially important in the transitional economies where the old mechanisms have collapsed and the new ones are not yet installed. And the other one which is important all over Europe is support of education in families, for example in transitional economies there is this mis-understanding between generations – our grandparents were used to different systems than we are, they don’t understand what other problems we have to face and therefore it’s difficult for them to pass their own life experience on to new generation which is facing completely different problems than they used to. So it is important to establish counselling centres which would work locally for parents and families especially young parents. Dmytro Tkachenko said that the most important is the spiritual source of the family, and he underlined a problem in Ukraine, where there are many young people who are parents themselves, but they are not shaped by their parents, nor are they not adult yet, and there is nobody to give them help. Linna Kuts and Dmytro said their organisation has set up in Ukraine small centres to help mothers with motherhood and parenting skills, to teach them what it means. We agreed that the education should be not only inter-generational consultation, but also inter-cultural exchange, which is more important maybe for Western Europe where the economy is fine but they have lots of immigrants from different cultures. They have large Muslim communities and I remember what Isabelle de Rambuteau was saying about Colombes, a part of Paris which is divided by a train track, and on each side there are two different cultural communities who do not talk to each other. That might become a big security issue – for example in the UK, where it is actually the third generation of Muslims who are turning if not into terrorists but certainly into extremists. So it is not their parents or grandparents who came from Muslim countries, but it is the third generation which somehow feels de-rooted in the new society and is searching for different values which can be either religious extremisms or nationalism or any other form of aggressive ideologies which can be eroding not only local communities but also then whole societies.

4. Societal and Cultural Issues – dealing with psychosocial interventions with cultural sensitivity Ivanka Jovanic Dunjic, Cornelis Wientjes, William Yule Lilian Peters (Rapporteur) We started with a brief situation analysis, Population: 7 million persons, including refugees from Kosovo. Capital: Belgrade, 1-1.5 million persons.

Identifying the Obstacles and Local Resources for Implementation and the Training

173

Many people in Serbia have an “ethnical fragmented” identity. It is mainly a Christian Orthodox society. The Orthodox Church plays a more significant role than during the communist era, when the church was invisible. The succeeding socialist regime misused nationalistic and religious themes so that the Church and certainly religions became an ethnic attribute. Now some young people begin to practice religion without knowing the tradition and background. The clergy, therefore, is playing an important role when it comes to the formation of the values of young people, so they are guiding young people in the search for values. However, the clergy tend currently to play a negative role but they could play a positive and guiding role. So far there have been very few examples of a priest that gave this positive role but it is a possibility, it is a potential to be explored further. Mental health workers should make contact with the clergy and try to make them more sensitive to training for guiding young people in their search for values. Foreign aid-workers should be briefed and study the history of a place before entering a situation: foreigners should be aware of cultural sensitivities, rules, customs, human and economic resources. This is true, of course, of outside intervention in all countries. They need to do thorough needs assessment and situation analysis: for example in Serbia one should know how NATO might be perceived. Then there is the question of how a NATO-backed initiative would be perceived in Serbia. In any intervention it is important to be sensitive to vested interests, which might cause resistance at first. Interventions should be long-term, permanent and include local resources. It is vital to avoid “hit and run” interventions – there must be a permanent presence and frequent seminars for both sides to understand the situation and to build trust, developing a relationship in which useful intervention can actually be accomplished. We were given an example of different approaches: a foreign aid-worker was confronted with the question “Can you please identify the handicapped children with special needs so we can send them off to institutions for special care?” In the West people are trained to integrate children with special needs into the general system, not to separate them. So that is a completely different approach and it created some dilemmas for aid workers. A reason for that might be that the local community does not have the cultural tradition or human and financial resources for integrating children with special needs into the general school system. So it is important to act sensitively, knowing the circumstances, the cultural specificity in areas such as how Serbian culture treats weaker members of society, such as handicapped children. Otherwise as a donor or foreign agency you run the risk of being met with the attitude “Give us the money and disappear” and that is usually not what you want when you enter as a foreign organisation. Young people in Serbia seek idols. Parents struggling to come to terms with the complex situation in Serbia do not provide appealing role models. Young people listen to folk music more than their parents, who used to listen more to the Beatles and to Western music. They look to the past as the future looks bleak. The societal and economic changes of transition exacerbate intergenerational incomprehension. Active participation in voluntary work with committed adults could provide sense of worth and self-esteem. What our Serbian colleagues found interesting was the concept that professional health workers can train non-professional people to be mental health workers. This might be a completely different phenomena or a change of cultural attitude, so it might be advisable to identify all the issues first. Then, if this method seems appropriate, train the professionals how to train the people, the first responders, such as the priest who was mentioned at the start of this report. So the concept of training and learning is something that should be taken seriously but

174

Identifying the Obstacles and Local Resources for Implementation and the Training

be culturally-specific. And there might be in the beginning resistance against this communitybased approach because of the vested interests in human beings, but on the other hand if you can convince people that there is a lot of potential, especially in young un-employed people to become part of their society and to contribute to their society, then it might work very well. Suggestions: Thorough and sensitive briefing of foreign personnel Empower the local community, particularly young people and care-givers, to be voluntary mental health workers Enlist the support of local resources such as clergy Create peer groups (parents; school psychologists; teachers; children; adolescents) 5. Adolescents’ needs

Khapta Akhmedova, Angela de Malherbe, Howard Osofsky, Gordana Vulevic Anne Speckhard (Rapporteur,) Discussion in our group began with Dr Gordana Vulevic explaining one of the problems in Serbian schools which is that adolescents are showing up in school with learning difficulties, up to 40% of the kids are having trouble, and it seems that they are trauma-related learning difficulties – unpredictability, emotional problems and short attention span. In addition to this there is a high prevalence of drug use – mostly of marijuana and hash. She believes that the root problems are trauma, social deterioration, and family stress. Angela de Malherbe added that often teens have no-one to talk to and, of course, in this Serbian situation, the parents themselves are over-stressed. We were informed that school psychologists are available in every school but teens do not like to use those services because of the lack of confidentiality. Many of the psychologists need better training. The mental health system in Serbia is over-whelmed, many mental health professionals have gone into private practice but a normal teen cannot afford to go because the cost of one therapy session is one sixth of an average to high monthly income of their parents. So we discussed, given these constraints, what would be some good solutions? We agreed that it must be group intervention because there are not enough professionals. Gordana suggested people who are studying psycho-therapy, especially the ones who have experience of group analysis, could possibly run groups. And the primary thing was to be in groups, but we remembered Linda Neuhauser’s suggestions to have it be participatory and Dr Khapta Akhmedova told us that in the teen sessions that she runs she has a suggestion box on the outside of the door so that teens are able to make their suggestions. Also Khapta told us about making use of peers and when you have the peers that are not using drugs and not in trouble come into these groups – and we were saying of course these groups must have a positive name and a positive draw, so you’ve got to draw the good kids up first – but you can ask them “Can you bring your peers that are having trouble, the ones that are using drugs and the ones that are having trouble in school or perhaps have been kicked out of school”, but at the same time Howard reminded us that we must be careful and protect the good kids so that they are not being adversely affected when they start bringing the kids that are having troubles. And we said one of our goals in this group would be not to have diagnosis, not to criticise, and not to label the kids and I realise I already did and I did not mean to do that – so that is something to beware of. And we also remembered some of the things that Professor Yule said, such as that we must make assessments at the beginning. Gordana suggested that she could assess the kids when

Identifying the Obstacles and Local Resources for Implementation and the Training

175

they came to the group. Khapta told us that her groups are successful after 16 sessions so perhaps after 16 sessions to make another assessment and see if there really is an improvement because we remembered what Professor Yule told us, that we must be able to prove effects. Howard stressed the importance of these pre- and post-assessments not only to see how they are working but the possibility that the sensitivity of these Serbian professionals, of the work that they were going to be doing, could be published and also translated, made available to help other groups and other communities. We thought that it was very important to collaborate with the school psychologist, not to offer this as a competitive programme, but to support them. Also sometime along the line we would recommend a meeting of mothers or parents. In this case the group would be supportive, to teach them how to detect drug problems and how to respond to depression in their kids, or aggression, and not to be over-whelmed by this, but to give them good suggestions and to support them in helping their children. Jill Donnelly and Anna Kovacova had some ideas for training the mothers so that, if they learn some of these skills, they can help their loved-ones and themselves overcome trauma and actually go out and teach many other mothers so it can have a wide impact. Howard underlined that parent groups could be very supportive to parents as well, because they then are taking a productive role, to involve the parents in dealing with substance abuse and the mood and behaviour problems of their children. It links in very much with the importance of the mothers and the importance of the parents and also their wish to help their children. Carrying on that point and because the group was looking at the needs of adolescents Jill raised the point that one of the main needs of an adolescent is a parent who can cope and that was part of the logic – that the parents would be in a group to learn how to help their adolescents and by doing that would be able themselves to overcome their own trauma.

Serbian Team Howard Osofsky: I have been impressed with the extreme sensitivity and ability of our Serbian colleagues. And even the openness to sit with other colleagues and think through ideas together, with a great deal of expertise, as we heard in their Case Study. Recognising these strengths, strengths at a very difficult time, at a time when there is much dedication to children, to the community, we hope that ideas or collaborations from other parts of the world may be of assistance in their goals. No one intends to impose anyone else’s system of views, it is to try and work within the traditions and the strengths with this collaborative method as colleagues and as friends in this very difficult time. It would be useful to hear comments from the Serbian group with regard to how useful these presentations and discussions had been so far for their own project. Ivanka Jovanovic: First, I want to thank you for according to us so much time, everybody has helped to give us such a helpful exchange of experiences. The idea that was new for me was to think about how to make a healthy marriage between this professional approach which we have a lot of experience with, and the participatory system of non-professional inclusion of which we did not have so much experience. We have also a lot of experience of training professionals and nonprofessionals, but the ideas of this conference about how non-professionals were participating in different kinds of ways were new and helpful to us.

176

Identifying the Obstacles and Local Resources for Implementation and the Training

Tija Despotovic: The exchange of different experiences and ideas, of uniting all those different activities, has been enriching. We are moving towards founding a counselling service for adolescents who have various difficulties; and those who would work there would be professionals or people studying psycho-therapy. Both group and individual work would be offered, but beside that counselling service for adolescents with difficulties, to recognise their own difficulties, we thought to establish clubs with various activities which would give structure to adolescents because we think that they very much need structure in their lives. They would focus on the interests of the youngsters, such as a film section, art and design section, lectures or discussion groups with different themes of interest to them. Then also non-professionals with different skills in these areas could work together to develop these various things. Also we thought about Internet clubs where they can find information and advice on the Internet, that is anonymous and that is the way maybe that they can find out what they want. Those clubs can be developed very much, in various ways: also with parents or adults, both parents or one parent, to make some kind of counselling service that would work on a group or individual approach. Something that would be spread in schools is education for school psychology about youngsters and that can also be education where they can express their own feelings and find relief. Gordana Vulevic: We thought that education of school psychologists is maybe the best way to get into the school. And we thought about a tri-partite model, about giving a lecture on the developmental periods of children, and then about their relationships with parents, and to give them some skills to improve communication between children and teachers, and also between children and parents. So the knowledge they would get in that seminar would be spread to all ages. That may be the easiest way to get into the schools. School psychologists are very lonely: they do not have much occasion for exchange and support with other professionals, such as the teaching staff, and so it would be so would be useful experience for them. Jasna Zivulovic: MMMSerbia could be a connection between local authorities and local communities. In contact with media, proper organisation of the work of our organisation, and members and mothers could be educated with other women and mothers and they could connect schools, parents and communities. Tatjana Bokun: Although I am not part of the Serbian team I wanted to offer services of my NGO. Because we have been working for 13 years now, we have quite a lot of experience in the area of education, so I thought it might be a good idea to share some of those experiences with the team from Belgrade. So if you need any help, or support, with training, whatever, I would be very happy to offer it on behalf of my NGO. And also speaking about the Internet and e-mails, I just wanted to tell you that for two years we have been doing interaction through the Internet and we have found it very useful because there are a lot of people, not just in Serbia but also abroad like in the States and Canada, who have psychological problems – good access to e-mail of course – and they are quite lonely and they like to talk about their problems in their own

Identifying the Obstacles and Local Resources for Implementation and the Training

177

language, so they e-mail us and I think it works very well. So if you need any help then I will be very glad to help you. Slobadanka Gasic Pavisic: I would like to underline the importance of the role of school in community life in Serbia. I think the school would be the centre of community activities. Half the population of Serbia lives in villages and small towns, where often there is no health centre, no medical doctor, maybe no police - there is only a school. Such a school is personal, and for that reason we should give to school an important role in this strategy.

General discussion – main points Linda Neuhauser: I wanted to comment on your idea about the Internet, because this is an area that I have been very interested in in working with youth in various programmes that use the Internet, and what I have found is that youth, of course, really like the Internet and they do go there for psychological help as well as to communicate with other young people and learn things. I know a lot of adults are worried about youth and the Internet and whether that can hurt them, and what the research has been showing is that the Internet is usually a good influence because of the reason you said, that it is anonymous and that young people can go there when they want to. I wanted to mention one more thing about the Internet: we found – in a participatory programme in Russia working with youth – that they decided to go on the Internet and find curricula for their schools, to improve the way that the teachers and the youth talked about problems, like Aids and smoking and violence and drugs, and they were able to bring that new curriculum into the school and into their clubs, and educate each other. One thing that came out of working with the Internet was that they decided as a group that what they wanted to work on next was psychological problems that they had because of unstable families, so that was what surprised and pleased me the most – that they decided to work on psychological problems themselves. And it surprised their teachers and parents. So I think it’s a very good idea and a good resource. Lilian Peters: We very much have a needs-based approach here and what I would like to see in the conversation is building strengths. We could think in terms of rights, and instead of having a needs-based approach, you could have a rights-based approach in your work: young people are not only desperately in need of care and love but also young people have rights, rights to the future, the rights to participate, the right to be heard, the right to be in control of their lives. So my suggestion would be to work with the teachers and work with the parents from that concept. It might become a more active and maybe a more equal approach – put the child in the middle, the child is the one with the rights and the Convention of the Rights of the Child explains all those rights in great detail. Then identify who are the duty-bearers, who are responsible for making it possible for a child to have these rights implemented. Work on that and then you also address the question of the local community, the donor community, the government, the clergy, everybody who is part of that structure, that society that the child is in, that makes the child a whole human being.

178

Identifying the Obstacles and Local Resources for Implementation and the Training

Sara Ozacky Lazar: There is a lot to learn from the structure and the organisation of kibbutz life, which in its classical model, took the responsibility for the children from the family and moved it to the community. The whole community organised itself to fulfil its responsibility to raise a better generation, a generation of kids who are happy, and get all their needs equally, the best education, the best health-care, equal, and the focus is on equality. Different kinds of kibbutz do it differently but in the kind that I belong to, classes educate the kids from early childhood to run their own lives, take decisions, set the rules for their small community of 6 or 10 kids who live together and create what we call a ‘community of the youth’, and there is very rich literature about it, both theoretical and practical. Even though it is changing, it was maybe too open to the outside world and was influenced by that, there is a lot to learn. The school that I have been working in for many years is a junior high and high school, so 12-18-year-olds. They had their own organisation, they elected their own democratically, they had their committees for socialising and for culture and for sport, everything. And they took the decisions and they decided what was good for them. The only thing that was decided for them was the studying and attending classes, but after school, what we call informal education was completely in their hands and still is. So I would think maybe we could organise a visit for you in Israel, we would be glad to host you there. The institute where I am working – the Jewish-Arab Centre for Peace – is affiliated to the kibbutz movement in Israel and we also take some of these models and implement them in our work with Jewish and Arab kids. I am a great believer in the community. We were talking the last two days about cultural issues, about how we cannot imitate a model from one community and implement it in another because of the cultural gap, and differences, but I think that if you are – and you are – intent to help the youth, then the entire community should be recruited to feel responsible for it. It can start with maybe a small committee of local leadership, from different walks of life – it could be business people. Businesses should also be responsible for the youth; it is in their interest not to have crime and drugs and to have higher education. Of course educators, women, mothers, fathers. But local leaders who will meet every now and then and feel their responsibility for what you are doing. It is not only a matter of the teachers, of the principals of the school, it is a matter of the entire community – start with the mayor and the local council. Try to have a permanent body that has as its main goal to secure the welfare of the young people of the community. S Malka: A powerful way to improve the community is through using the media and also working with the media. There are many, many ways to have the media on our side, if we know what to give them. To raise awareness to the needs of the society is the goal and I do not see a more powerful tool than the media today. And the Internet, but it is not accessible to everyone. There are some ways to let the media and other powerful actors become part of the goal. I mean if the media will promote, and powerful companies all over the world recognise that the more society will be healthier and stronger, the next generation will be able to hold more prosperous, and the economy will be stronger and so the goal is yours, you are sharing the goal with everybody. This way you can have actually free campaigns: Find, for example, a computer company to become your sponsor, and they know, of course, that the people using computers in the coming future are the youth of today. Convince them that you have a mutual interest.

Identifying the Obstacles and Local Resources for Implementation and the Training

179

Another way to reach media is by news. But what you are dealing with here are weighty issues and the media does not deal with heavy issues – on the whole they need to see either blood or sport or sex. But there is still a way to reach the media with very, very sensitive issues and emotional stories and through these stories to bring out the information, the numbers involved, the need, how serious the issue is. So yes, the community is very powerful, but to reach the community the media is the most powerful tool.

Obstacles and Resources Resources J. Salem-Pickartz: I hear two resources: there is a good Serbian resource of an organisation that has quite some experience in dealing with communities and addressing the needs and rights of all age-groups; and there is also an intellectual resource. I Leth: This is very dear to my heart, having worked with local organisations since 1990 in this process of transforming an idea into a project. We have all sorts of ideas and images and energy from this, but now we must be more concrete: Define your precise objective, so that the relevant resources can be identified. G Vulevic: Yes, we want to help the young people to reach mature adulthood, because their maturing process was jeopardised by many difficult factors, external and internal. J. Salem-Pickartz: What do you see as resources for the realisation of this project that you start to envisage now more clearly, and maybe the group can help identify even more of those? Gordana Vulevic: First of all, there are the human resources: - Very experienced mental health professionals; then young colleagues who are still studying or nearly finishing education or just finished education and who are young and with a lot of ability to work on this. - Teachers - Maybe as a first step – we can develop it later – we can reach the teachers through group psychologists who will apply their knowledge about group dynamics and situation, in working with teachers and with children. It could be a first step and later we can develop something for the teachers themselves. - MMM members - we will together organise a network, an MMM network. Media - We have good connections with the media - Government - Our generation in government is now more approachable because they actually listen, so we have good connections there and this project will be accepted. Ivanka Jovanovic: Another very important resource is our group approach. We are not the professionals only sitting in our room, because one very important part of our activities is the group approach, conducting groups and apply a kind of group training, team functioning and institution functioning. So I think this kind of experience could be used very much through this community approach in linking all kind of groups and institutions. Marie Vlachova: Another source is security organisations: NATO is a very good example, as here we are backed and supported by NATO. Where I work, the Centre for Democratic Control of Armed Forces, is another example. And it is not mere chance. The security community is heading towards the broader concept of security – the protection of vulnerable groups. But there is a lot of confusion over how to cope with these issues. At the same time, these security institutions have practical programmes and most of these men – soldiers and civilians - are fathers. They are not really inclined to hear about these issues, because they do not know how to

180

Identifying the Obstacles and Local Resources for Implementation and the Training

cope with them. You have to present your project for traumatised children as a security issue. I suggest you put in a request for support to DCAF immediately with some practical project, but also to security international institutions, agencies operating in your region. And I would do it just now because just now is the time. Obstacles J Zivulovic: The first obstacle I think of is that all kinds of people in all institutions in the community are burnt out, by those 10 or 15 years of difficult living. This is a major obstacle. T Bokun: I think we could spend two days thinking about obstacles of course because there are a lot of obstacles. The first important issue is the lack of system, which is the system generally speaking is in chaos. From a political point of view, from social point of view, from educational point of view. Serbia is not the most open country where you know the role of everybody - no concept of transparency. This is a big obstacle because you do not know whom you should address, or how it works, or if it works at all. The next obstacle, of course, is the country is poor – generally speaking – so whatever you want to do you do need money; not necessarily a lot I agree, but sometimes you do need more money. I agree that burnout symptoms are present everywhere – we are all a bit exhausted. And also the consequences of isolation are present, which means that it is obvious that we have been closed to the rest of the world for a certain period of time, 10 or 12 years. We are speaking about knowledge, about technology, about the way people think. We do need time to catch up with the rest of the world. Joy Osofsky: The obstacles being discussed now are very clear, and I am sure there are more. But we must confront them and not give in to a sense of helplessness and the hopelessness Faced with difficulties or obstacles I immediately think “Well, how can we think about dealing with that?” I was resonating particularly with the burnout issue – we can all identify with that. In facing the obstacles, NATO might play a role – to build in ongoing consultation, workshops, bringing people in from the outside to your country, not as experts to tell you what to do but as people to support what you are doing. Because one of the things that we have found and I have heard it in the discussion a great deal, is that in dealing with trauma, in dealing with very difficult situations, sometimes it is hard to talk about some of those things, to get the support from colleagues. It is helpful to build up trust on a consistent basis with people coming in from the outside, providing training, workshops, working with you, providing an audience, a way to talk about issues of burnout and compassion, fatigue and vicarious traumatisation so that you can feel renewed, and have energy in terms of dealing with the work. Tija Despotovic: You know, we are very, very happy that you mentioned that issue. We have been aware for a long time of working that it is very important to have that approach and sometimes to look from the outside. All the time we are inside and we have built all different strengths but still we are inside. Slobadanka Gasic Pavisic: It would be a more realistic approach if the Serbian team did one pilot project in a community in Belgrade or other part of Serbia for some years and then maybe after that they would have enough experience for a national general strategy. As a Serbian colleague, I think that it is important to know what we want, what the Serbian team wants. My NGO has very much experience of voluntary work and helping children in Belgrade. We work jointly with the local authority in one part of Belgrade and another project is a medical centre for child health, and third part is two schools in Belgrade, and fourth is working with an NGO, an English funding organisation to realise these ideas.

Identifying the Obstacles and Local Resources for Implementation and the Training

181

Anne Speckhard: I would just like to echo Joy’s comment about burnout. It is good to have reliable colleagues coming in from the outside, but you need to get out and you will go back refreshed. Josi Salem-Pickartz: So a word to the Serbian group: I know it requires some courage to expose yourself, your ideas and your situation to such an extent to such a large audience. It is not a common exercise, so all of us want to say thank you very much for listening. Now work on your project proposal in more detail, based on these reflections and then present its final shape.

182

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

7. Consensus Serbian Strategy Action Plan agreed by all participants March 6 2003, Smolenice Castle, Slovak Republic Introductory Statements Chronic trauma is potentially damaging for healthy development of children, adolescents, and adults. The program in Serbia should address adolescents, families, schools, and community. Adolescence is not an illness, but a vulnerable period of development. In order to develop a stable society, the proposed program has significant benefits for security and stability in Europe and the world.

Adolescents

Help for traumatized adolescents must be readily available and not intrusive. Youth centres need to be established where clubs, peer groups addressing special interests, and counselling, if needed, will be available. Youth centres will be places for adolescents to be able to communicate with many different groups including other youth, associations, and authorities. In these centres, they can exchange experiences with youth from different schools and regions. Professionals in these youth centres would lead and conduct counselling services. Training will be available for paraprofessionals to develop skills to work with and communicate with the adolescents. Their work will be supervised by professionals. Contact with other professionals and paraprofessionals from abroad will be used to establish and develop the different activities in the youth centres. At the centre, a person needs to be available for advice. These advisors will include adults and experienced older youth. At the youth centre, materials will be available for the youth such as computers, books, pamphlets, music, films, theatre, art, magazines, and materials for drawing, painting and sculpting, and magazines from other countries. At the centre, there needs to be space for a café with video availability as a place to share in a relaxed atmosphere. Youth within the centre will publish a monthly newsletter about activities in the centre and important concerns.

Action steps: 1. Establish one comprehensive youth centre in Belgrade with materials listed above within one year

Consensus Serbian Strategy

183

2. Identify individuals who will staff the centre and recruit professional and paraprofessionals to assist in the work 3. Obtain consultation from abroad to assist in the development of the youth centre. 4. Popularization of the ideas through media including television, radio and pamphlets 5. Inform children about their rights 6. Use this youth centre as a model to develop youth centre in different areas of Serbia 7. Adolescents in the youth centres will publish a monthly newsletter.

Family

Counselling services for traumatized, exhausted, and burned-out parents need to established and readily available to fill the gap between the medical institutions and private practice. These services can be made available according to a certain schedule in a different location at the same youth centres. This counselling should be conducted by professionals and trained paraprofessionals. Parents groups should also be available led by trained professionals and paraprofessionals. Education related to how to parent and manage adolescents will be made available at these centres. The educational topics should include information about substance abuse, dealing with violence, recognizing trauma, sexuality in adolescents, and setting boundaries and applying discipline among other areas. Parents will be provided information about normal adolescent behaviour. Parents will have the opportunity to be in groups with other parents and competent professionals. Opportunities should be made available to have adolescents and parents in groups together with a professional to discuss problems and issues of concern. Action steps: 1. 2. 3. 4. 5.

Establish parent activities within youth centre Identify staff for family activities and participation Obtain books and other materials for the centre for parents Include Parent Column in Youth Magazine Provide information to parents about their rights.

Schools

Training is needed for school psychologists and pedagogists on trauma and normal adolescent developmental periods and problems. The training will include issues of their burnout and frustration. Experiential groups are needed about adolescents’ problems and ways to respond. Training is needed for crisis intervention including how to handle fights, violence, and unpredictable and uncontrolled behaviour. Enable school psychologists to improve communication between teachers and children. Consultation should be available to help psychologists and teachers in dealing with traumatized and difficult adolescents. Establish

184

Consensus Serbian Strategy

extracurricular activities, especially sports in school. Help communication between and parents and school staff. Preparation for entrance exams need to be available at schools.

Action steps: 1. 2. 3. 4. 5.

Contact school authorities about training Motivate school psychologists for training Obtain funding to establish consultation for school psychologists and teachers in schools. Develop program training Identify staff to do training

Community

The main problem in community is lack of communication between adolescents, parents and schools. There is also a lack of communication between the community the rest of the world. It will be important to communicate to adolescents that people in the rest of the world are caring individuals who can communicate at a normal level. By exchanging ideas with the outside community, they will be helped in overcoming feelings of isolation. This will be the main objective related to work in the community.

Action Steps 1. Make connections between local authorities, adolescents, and parents. 2. Identify other helpful resources in the community 3. Make contacts with individuals who are abroad and provide adolescents with the information obtained and answers. 4. Spread ideas, programs, information about lectures and training to media

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

Part III Recognising Developmental Considerations and Cultural Sensitivities, First Steps in Developing a Strategy to be Applied Internationally for Preventing, Mitigating and Remedying Trauma in Children: Lessons Learned from the Development of the Strategy for Serbian Children – Relevance, Limitations and Opportunities 1. Introduction Josi Salem-Pickartz Based on the reflections of the Serbian experience, is it possible, desirable, relevant to generate a general strategy? Guidelines which could be applied internationally to help people, particularly children and adolescents, cope with current and new threats to security? We need to analyse the limitations and opportunities for a general integrated strategy based on all our professional, personal and voluntary experience, on what we developed for the situation in Serbia. To face these new challenges, which bring the violence of war and terrorism into our lives wherever we live in the world, we need to be well-informed, trained and resilient. We can draw on the experience and expertise of all the participants at this meeting and base our suggestions on what we have learned in developing the strategy for Serbia. And we have to pay attention to the issues of obstacles and resources, with regard to official attitudes, funding, training, reporting back and using the experience of already-conducted projects and methods. Common issues came up across the Task Groups as we prepared suggestions for the consideration of the Serbian Team. Youth developmental needs have a lot to do with finishing school, young people need leisure facilities, there is the issue of employment and youth is very much concerned with finding their identity and working out the perspective for their future. However, these normal development needs and challenges are at stake in the situation of Serbia – and many other places in the world. We talked about learning difficulties; many students have a lack of concentration, they have nobody to talk to in order to clarify their mind and to develop a concept of self and to develop a perspective on the future, and really many, the great majority I understand, are distressed, traumatised, and in need of special help.

186

Recognising Developmental Considerations and Cultural Sensitivities

The strategies that different groups proposed emphasised the point of view of a group approach and peer approach. Youth among themselves, parents among themselves, teachers among themselves, mental health professionals among themselves. Then there was agreement that the family needs strengthening as a basic security for society and that it is important for youth to find role models, as idols again, for the future. And across the different subjects what I heard was that there is a need to raise awareness, a need to educate, a need to provide guidance and support, therapy to both adolescents and their parents, and there is a need for training, of mental health professionals, training of teachers and we mentioned also adolescents and parents when we think about peer support. Is something like a general integrated strategy possible at all? If so, to what extent; and where does it need differentiating?

2. Rationale Jill Donnelly This is the logic for looking at the possibility of devising a set of guidelines which could be adopted internationally for use in many different countries: We have looked at Serbia, and we have looked at other countries like Algeria and Israel where there are ongoing conflicts and people are traumatised already. But in the brief outline I gave at the beginning of the Workshop on the current security environment, I indicated that every single one of us elsewhere, who is not at the moment exposed to the violence of conflict or terrorism, runs a very clear risk of imminent traumatisation, as more and more frequently the threats of the new security environment reach out into our everyday lives. We are considering the possibility of a strategy of practical activities which could be used in different countries, in different circumstances to provide support by people who are not mental-health professionals, for the great bulk of the population, children and adolescents, who need help but actually get nothing. Those who are extremely disturbed get the help they need from the small number of professionals and there is a very small number who have extraordinary resilience and coping abilities and so need no support. But there is a huge bulk of the population who do need some help and at the moment gets none. Every country has the resource people, that is, mothers, fathers, parents, children, teachers…., who would like – and could be trained - to provide that support. So the rationale behind a general strategy is: Can we bring together everything we have discussed in these two days’ work – your in-depth experience and knowledge and all the useful, very practical activities that you have seen work? In this brief time we can only hope to begin to formulate a set of guidelines that could offer to adolescents and children the kind of support that is lacking - and we have heard from Dr Speckhard and Dr Akhmedova what happens when it is lacking: they have to go elsewhere for that kind of support and are at risk of coming under the influence of extremist groups. We seek to identify a strategy to prevent the long-term consequences of trauma, and if not, at least to mitigate and remedy trauma suffered by young people, so that it does not carry on into their adult life. I am using the word ‘strategy’ to convey a global view - structured, co-ordinated, integrated, long-term, sustainable activities. At the moment there are very many effective, but isolated, activities taking place throughout the world – tactical activities. How do we make this, not small associations dotted all over the world doing wonderful things, how do we make this something that is cohesive, something that by the critical mass of those small examples becomes something of a world-wide policy? So we are suggesting a strategic view.

Recognising Developmental Considerations and Cultural Sensitivities

187

The logic of seeking to identify a workable general strategy is to help develop the concept of national and also international resources working together, sharing expertise in a proactive way. At the moment this happens as a reaction to individual incidents. We would like you to analyse the issue of putting measures in place before an incident arises. We have all had to deal with children who suffer the long-term consequences of traumatisation - we do not want this pain to happen to others if we can do something to avoid it. We have seen, too, that if people – young and old, know what to do, how to react sensitively and appropriately, in extreme situations, they can achieve a great deal to help others and at the same time contribute to their own recovery. Research, for example, on the trauma of soldiers in the first Gulf War, showed that everyone exposed to the same violence suffers the same level of psychological trauma, but the differences between individuals become apparent subsequently – those from happy, stable home backgrounds recover more quickly than those from unstable backgrounds – and many of these never recover. So developing stability and resilience in the family is vital. Can we develop measures to prepare parents and children for what they are going to be experiencing? If so, we need to do it quickly. No country in the world is adequately preparing for this. What you do in Israel or Chechnya or in other countries is so important that you should share this. And this is what we have done here, and we have all understood it, but we need to convince the people who have got the power. We need mechanisms for conveying the importance of this strategy to those concerned, including to the decision-makers and policy-makers who can actually make this happen. Without this our proposals will not become a strategy they will remain wishful thinking. Is a general strategy or a set of international guidelines possible, is it advisable? We do not know yet. This is an Advanced Research Workshop, we have not come with answers, we have come together to analyse all the factors in order to reach innovative solutions and innovative recommendations for policymakers, and that is policymakers in NATO, in all the international organisations, in business, in NGOs, in national government, everybody who has responsibility to make policies for the future.

3. Issues Howard Osofsky The strength of this meeting is that we do have a group of experts, with experiences of working in past and current conflict. We add the dimension now of preparing for potential conflict or serious incident. We must first analyse the components of preparation, how to have community strength and resilience, and how to use the collective wisdom and practical aspects of preparation, very much involving the children and adolescents, the families, the strength of the families, and other resources. Then we need to examine the area of response, which is different, where one should still be sensitive to the needs that go on, to the panic, to the concerns, to the families, to the many issues, but in a way where one needs to be so well prepared that one is on auto-pilot at that point in dealing with the initial response. And then we must plan the period of recovery – effectively what we have been talking about in relation to Serbia. Although there is still trauma, recovery has begun: we need to recognise what one does to intervene, what one does to improve health and resilience and build on the coping strengths of children and adolescents. This is where each one of us brings different perspectives to build up a whole picture.

188

Recognising Developmental Considerations and Cultural Sensitivities

Working towards a General Strategy 4. Discussion – main points and proposals Shimon Malka: Two years ago there was a storm of terror attacks in Israel. We felt in the JewishArab Centre “OK, we cannot reach the schools with the material of co-existence, just let me see existence, leave the co-existence!” So we wrote a plan of four steps, an immediate four steps for eight hours – I know it sounds short and not professional at all but it was a kind of emergency kit that we developed and we are happy to share that knowledge and information: 1. Hold some accurate information about what is going on outside, what you should expect or what are the risks of what is happening outside, not just what you see on the TV. 2. Consume the media in a different way - take from the media the kernel of truth, avoid the media ‘spin’ 3. Ventilation. I mean kids need to speak, they want to shout their fears, they want to say “my god, I’m not going on buses anymore, I will walk”. They need to talk, and sometimes back home they can talk, but in some homes they cannot. 4. Ways to be able to meet up outside, even for two or three hours to share the fears, because in the Jewish-Arab Centre we have Arabs and Jews from Israel, and they are sharing the same fears because they are going on the same streets and the same buses and the same everything and so their fears are common. That was a kind of four stage programme that we gave to schools and it was free because it was very easy to raise funds for this programme and we reached about 20,000 students during the year, which is a lot. And it is not that big a programme. I know it is not the level of the problem that others here are dealing with, but for an emergency kit it was good – and we had very good feedback. Linna Kuts: For the strategy to work it must be based on the acceptance of reality. It must be able to be used by everybody, for example, in my country, Ukraine, traumatised not only by postwar conflicts but in everyday life. The next thing is that, knowledge, simple knowledge like ABC or psychological knowledge – has to be passed on to common people, to grassroots. And when that knowledge is passed on, then it will be accepted. And one last thing, that it is very important to train positive thought, positive reactions, and positive feelings. If a person thinks: “Oh my god, something awful has happened, I will die” he will give up. But if he tells himself: “Something awful has happened, but I want to survive” then he will survive”. These kinds of strategies are empowering and bring good results. A de Malherbe: Adolescents need a certain structure, and our Serbian friends referred to the fact that this means learning who they are. We need to help adolescents address their needs to become mature adults. Lilian said that the young have a right to be in control of their lives. Lilian also said “make the child a whole human being.” Josie said “give the young a hope for the future”. And somebody asked the question: what are the risks in the different countries, what are the resources to help these kids? Where is the message of love and commitment that young people are seeking? We have found, in the TeenStar programme, that fertility awareness helps young people to have self-esteem, to respect themselves and others, they can direct their

Recognising Developmental Considerations and Cultural Sensitivities

189

own fertility without outside coercion. This is an empowerment for them to create healthy, loving families, and to contribute to creating positive and peaceful communities. L Neuhauser: We need to talk about national policy, or even regional or municipal policy related to these issues. It would be helpful, perhaps, to have, incorporated in the strategy national meetings to invite political officials, community leaders, all kinds of people, psychologists, teachers…, to talk about issues in the country and to see if a national policy, adapted to national specificity, could be developed from a set of basic guidelines. Many of you talked about the issue of disorganisation and lack of information in Serbia, Ukraine and in many other countries. L Peters: Should we not first do a risk mapping? What are the risks that a certain community is possibly facing, because every community is different, with different situations? You cannot compare the Netherlands with Israel. J Salem-Pickartz: Having worked with peace and conflict situations now for 25 years, as a spontaneous idea with regard to the strategy to prepare people to deal with possible prospects of difficult situations, I would say maybe there is something like indeed a kit one can put together, but it would need to be applied sensitively to each and every specific situation. The most important ingredient for me would be raising resilient children. There are a lot of ingredients to parenting strategies that create resilient kids – and I would suggest that this is rather cross-cultural – kids who have self-confidence, who know their resources, who know how to look at problems, identify goals, work together with others, work with resources and maintain a sense of hope for the future. I think this is very important to lay confidence and resilience as a basis for the children. You can do the same as you do with adults; there are certain approaches of education, of working together on projects that also give a sense of strength and resilience in adults, as they would in children. Secondly, certainly people should have, in my point of view, knowledge about stress and crisis, understanding the mechanism and preparing themselves how to deal with it, both on a level of action and on a level of dealing with their own reaction as such. They need the same information about trauma. But at the same time as a fourth ingredient, I would say giving them knowledge of context. When we talk about dealing with crisis and dealing with rapid changes, dealing with catastrophes, I think people also need to be aware what is their circle of influence and what are other levels where influence need to take place, where they have to organise – for instance civil society – in order to prevent or to remedy the situations following a crisis. Give them social, economic knowledge and empower them.

190

Recognising Developmental Considerations and Cultural Sensitivities

5. Preliminary Conclusions It was informally agreed that a Strategy of General Guidelines should be adopted internationally in order to prepare the population for current and future political violence, focussing on the needs of children and adolescents, but encompassing the needs of the ‘responders’ – such as, parents, teachers, mental health professionals. National implementation should take into account cultural specificity and sensitivities. The preliminary conclusions were very much in line with those of the Advanced Research Workshop on Social and Psychological Consequences of Terrorism. Key elements Communication

Responsibility

Resilience

Response

These elements all interrelate and interact Communication - Accurate information Education, such as on the potential impact of trauma on the individual Training in simple coping activities, including an understanding of building resilience Media: Accurate reporting of current situation and realistic analysis of progress Reminders about how to cope with this situation The effectiveness of the authorities’ responses Internet: Dedicated interactive website with email communication - Interpersonal – peer groups (children with children of similar age-group; adolescents with adolescents; parents with parents; teachers with teachers; police with police…..) - Intergenerational – adolescents, in particular, need role models: ideally strong, coping parents - Intercultural – equitable balance - Between the authorities and the people Commitment, support, trust Responsibility - for one’s own actions - for the actions of family members - for the actions of your societal group When things go wrong: Remorse, saying sorry, forgiveness and atonement lead to recovery - Community responsibility for each member, particularly young people - Media responsibility to provide accurate objective information - Voluntary work – taking responsibility to help others, particularly the involvement of adolescents

Recognising Developmental Considerations and Cultural Sensitivities

191

Resilience The family is the prime source of resilience - Specific policies at all levels are necessary to strengthen the family unit - Training in authoritative parenting - Training in communication within the family - Adolescents prepared for parenthood Resilience for all the population can be built up by providing - Effective communication of accurate information - Set of simple, but effective responses to use in time of need - Trust in local and national government to respond appropriately - Sense of security – uncertainty exacerbates trauma Response Responses must be appropriate – if not they could prove counterproductive both to the situation and to the level of trauma in the individual. It was generally agreed that an isolated traumatic event, if dealt with appropriately would be unlikely to result in long-term trauma, except in certain vulnerable individuals. Repetitive and ongoing violence does cause profound trauma, the recovery rate of which depends on the individual’s own response to trauma, such as resilience. It was agreed that further scientific analysis is required to evaluate and plan suitable responses. Adolescents It became clear that adolescents must be the focus of all these activities whether or not they have been part of past and current traumatic events caused by conflict or terrorism or will become involved in the future At this developmental stage of finding their identity, adolescents are particularly vulnerable to the impact of uncertainty and traumatic events. As they seek to identify their place in society, they have a strong need for self-esteem and to be valued by others: voluntary work for adolescents was agreed to be very effective. Risks involved in neglecting adolescents: - Disruptive, antisocial behaviour – distressing for individuals, expensive for society - Involvement in extreme groups – a serious security issue, potentially fatal for the adolescents and their victims - Lack of a committed civil population in the future – the waste of ‘human capital’ - Lack of suitable candidates for the armed forces, police, security agencies, fire service …… - Lack of competent decision makers and policy makers for the nation’s future These risks are serious issues for the international community, and national and local government. Social and security policies are necessary to prevent further disintegration of social cohesion which could be accelerated in the event of conflict or a serious terrorist incident.

192

Recognising Developmental Considerations and Cultural Sensitivities

6. Identifying Mechanisms for Promoting the Concept of an Action Plan to Prevent, Mitigate and Remedy Trauma in Children and Adolescents in the Event of Conflict or Terrorist Incident : on the international and national policy level, to the civil population with emphasis on families and to adolescents specifically. It was agreed that at least one further Advanced Research Workshop would be required for the group to devise a realistic Action Plan for a ‘General Strategy’. However, as knowing how to gain commitment to such a strategy is vital to achieving its successful implementation, Task Groups examined methods for engaging groups of society whose support would be vital to this initiative.

Task Group Reports: Shimon Malka presented to each group the role of the media in each context.

1. International – diplomatic/military/political Marie Vlachova, Khapta Akhmedova Anne Speckhard (Rapporteur) We must reach politicians and diplomats with a clear message to encourage them to support and implement strategies like this set of guidelines we are working to develop and also to uphold the ones that already exist. In the UN, for example, there are policies that already exist, but nationally they do not get supported or implemented: In times of conflict when other issues take priority, the Belgrade bombing is a good example, the needs of children are put aside because of the imminent security needs in another sphere. Each government has different priorities, sometimes overlooking the needs of children For example in Israel, right now the army is given very high priority and security situation is given priority sometimes over the needs of children and the needs of seeing the future of security. How to influence security organizations and governments - Simple message - Use the United Nations, NATO and other international alliances - Use international non-governmental organizations, such as the MMM - Use the media - Use influential people who hold informal power in society: sports figures, entertainment personalities, musicians, the Pope….. The way the guidelines are presented will depend on the interests of the audience – the message should be clear, simple and pertinent and focus on the specific needs of each beneficiary. The major international organisations already have mechanisms for promoting initiatives. If you can say, for example, that millions of mothers support this initiative, then that is something that diplomats and politicians and military organisations and the media will have to listen to because mothers are a force to be reckoned with everywhere in the world and mothers are prepared to work actively to ensure a happy future for their children.

Recognising Developmental Considerations and Cultural Sensitivities

193

Media support is vital, particularly for politicians and ‘personalities’. Many ‘personalities’ act as role models, particularly for young people, their commitment to the initiative could be a very powerful tool 1. How to justify the investment - It is an issue of current and future security Children who are traumatised in war or conflicts belong to the generation of those who will establish the institutions of society after the war and they need good mental health to think in a democratic way, a healthy person will be more tolerant, will be able to deal with differences, have less fear of strangers, be less xenophobic, will have a tolerance of conflict, normal conflict in groups, and of religion, and be much better about negotiating and over-coming differences. Mature well-balanced persons are much more able to tolerate frustrations and difficulties, and are more socially functional. If we do not deal with the traumas of today, and the children of today, we can expect that traumatising conflict and incidents will be repeated in the future. The security community is heading towards the broader concept of security – the protection of vulnerable groups. These security institutions have practical programmes and most of these men – soldiers and civilians - are fathers. They are not inclined to hear about these issues, because they do not know how to cope with them. It is important to present the project for traumatised children as a security issue. 2. How to balance the priorities of society There must be a mechanism to check, especially after crises, the priorities of society. If one day the security is the first priority and the well-being of children the second, it does not have to stay like this. Allocating the budget in this way must be regularly reconsidered. Also there must be awareness-raising mechanisms to show the changes in priorities to the population and opinion-formers. 2. Policy-makers and Decision Makers Tanja Bokun, Anna Ignatieva, Sara Ozacky-Lazar, Lilian Peters, Howard Osofsky, Cornelis Wientjes Armine Gmur Karapetian (Rapporteur) 1. Use all available resources we have including national and local governance, such as: - Specific days (e.g. International Women’s Day or Mothers’ Day) - Specific events – elections, important conferences - Media is important tool, and must know how to use it – it means that messages have to be very precise and they have to be given together with sensitive examples. Useful for campaigns - Church has a big influence and therefore should be used - Curriculum of basic training of teachers in teacher training colleges. 2. Involve prominent people, such as, political leaders, entertainment personalities, respected opinion-formers 3. Activate the role of the internet specifically the NATO website and the MMM website – open the site in their office and prove to them what can be done

194

Recognising Developmental Considerations and Cultural Sensitivities

4. Explore the possibility of finding a NATO nation that would be willing to adopt this issue and sponsor it, and would be willing to bring this issue up in the international forum whenever this would be appropriate. 5. It is important to address people in the level that they can actually do something – do not over-ask people, and do not under-ask people 6. Address women who are in the political and decision-making structure: This is very important in transitional countries because those women made it through a very vague and unstable environment and they know how to deliver the message. 7. Every message should be cost oriented: Whenever we talk to politicians and diplomats and decision-makers, every message should be cost-oriented, we should collect information on how costly it is to deal with the aftermath of violence and to promote the idea that prevention is much, much cheaper. 8. Certain countries have special needs, for example: - Strengthening the NGO sector - Organising actions, such as public awareness campaigns, focussing on overcoming uncertainties 9. Ensure that presentations of needs assessment and researches reach the policy-maker at the proper time and in the right way, because if you get it wrong, there will be no real outcome. 10. Create coalitions, networks of organisations working together to have more impact. 3.Civil Population Josi Salem-Pickartz, William Yule, Diana Morato, Linna Kuts, Dmytro Tkachenko Ingrid Leth (Rapporteur) 1. NATO Advisory Panel on Preventing Trauma in Children and Adolescents to coordinate activities in member and partner countries: - Need for assessment: It is difficult to give a strategy for the whole population. Find out who is affected, who is concerned and who needs to be involved. Aiming at. x all professionals in the health sector, including mental health professionals x all schools x police x trade unions x politicians x parents’ organisations x relevant NGOs x religious organisations x ideological leaders These different groups should be addressed in different ways according to their function or what they are doing - Need for risk analysis – Who is responsible? - Information should be combined with building up competence so people are ready to deal with catastrophes - Need for training. It is necessary to build up competence to be prepared

Recognising Developmental Considerations and Cultural Sensitivities

195

A voice for parents Training in building resilience 2. - Develop a good web site based on evaluation of similar pages, such as one organised by American Pediatricians. People should have access to a website that would not only inform and educate the general public, but would also publish evaluation of the different programmes that are running at the moment. Members of the public could have easy access to relevant information about a particular situation and to be prepared before the event instead of being prepared after the event. Some of the associations represented here could each evaluate one of the programmes. During the meetings of the Advisory Panel, the participants could give information on their experience in putting the programmes into practice. As a result of the Advisory Panel Meetings, the website would be updated. As one of the main points of this ARW was to use the expertise and resources that exist already, it would be useful to link to very good information on the websites related to this that exist in, for example, the United States and which could at least give supplementary or complementary information. 3. The media should be involved in order to promote the good messages and to make them aware of the consequences of their actions: There are progressive steps in this process (from formal realistic information to confrontation). - Sensitising the media - Work together with the media in order to promote good messages and accurate, pertinent information. - illustrate the consequences of programmes in the media - Raise awareness in the media that the wrong messages may have a damaging impact - Convey the understanding that these are sensitive, complex issues - there are no easy, ‘quick-fix’ answers - Use the media to build up competence, to be prepared for situations of small-scale or bigger catastrophes.

4. Engaging Children, Adolescents and Parents in Self-help and Outreach. Latefa Belarouci, Anna Kovacova, Angela de Malherbe, Linda Neuhauser Caroline Paskell (Rapporteur) 1. Parents Our interest in them is as parents, but we thought that it was important always to bear in mind that under stressful situations and even under the day-to-day difficulties of bringing up children, these parents come with their own personal needs as well. They have their own difficulties, their own frustrations, and their own trauma in many cases. So we need to approach them in two ways, to approach them as parents, and to approach them as individuals. So in dealing with parents, you can use extant resources, resources which already exist in the nation, in the community, and these can be in different forms. They could be institutions, international like the Red Cross or faith-based, the church or the mosque. Or they could be networks that have been around for sometime, either small-scale groups of mothers meeting already, or school-based groups.

196

Recognising Developmental Considerations and Cultural Sensitivities

And also not to forget the role of the media which is already there, is very comprehensive, and needs to be used to promote positives. We can build on these existing organisations with new organisations – they may be small, they may just link in on the side of the organisations that are already there, but we needn’t think that we are limited by using only what already exists, you can build by starting small and building up. It is important to bear in mind that we are not only talking about mothers, and not only were we about mothers and fathers, but we are talking about grandparents, uncles, aunts, about other people who are in the family in general. This also brought us to the consideration of inter-generational work, of the benefits that come from having grandparents alongside children and taking some of the burden from parents, but also allowing the children to learn some more about ways that people have dealt with these situations before, because there is a lot to be learnt and a lot of benefit obviously to the adults involved. Inter-cultural activities are important: in lots of troubled places, and lots of non-troubled places like Britain, there are very large refugee populations, who have their own needs but the key thing obviously is to integrate them and to learn what they do in terms of parenting their children and to start, as we have already said, as being parents is such a common issue – it’s not a societal issue, it’s not a national issue, so we can all share from that – and there are practical ways of learning from the Red Cross who in your community is in this position, and how you can go about engaging them in these groups that you are establishing, or the groups that already exist. When we talk about groups, we were not talking about groups as analysis, not as psychoanalytical groups, but as groups for sharing experiences, groups for building on each other’s understanding and sharing common experiences. 2. Adolescents and children. We wanted to start by making it very clear that this is built around an aspiration for young people and for the children. And that is why we are here – because of young people’s current problems, not hopefully continuing into their positive futures, we want to build for them a positive future. It is important to make it clear to them that they are being given the opportunity to build on their own potential - and recognise the positive things that they bring, their skills. It is important to build their self-esteem, their esteem among their peers, within their community and their family, but also broader than that and so we thought that we could use the media to promote people who had been successful in different arenas of youth activity – not only because for those young people it’s beneficial, but because for young people who have never seen them it sets up positive ideas about what young people can do within their own society. There are practical ways of actually giving young people things to be engaged with, and there are a range of these obviously. Some of them are slightly distant from the young person, so they can see positive things in the media, they can get information from diverse sources, or they can use the Internet, or they can hear of it – we had an example of people witnessing on the radio about how they had overcome obstacles in their own life. And this means that young people are not necessarily meeting, but at some distance they are learning positive experiences.

Recognising Developmental Considerations and Cultural Sensitivities

197

Active participation of the young people is vital, when you are actually dealing with young people themselves, when you are bringing them into groups. It is really important, whatever strategy you take, to make it clear that the young people and the children have as much control as they can of the way in which the group activity is designed and conducted and what comes out of it, what time period it is over, all the different dimensions of decision-making must engage the young people and the children – we mustn’t assume that only adolescents are possible decision-makers, we should also consider children to have an aptitude for decisionmaking and give them the greatest degree that we can. Here are some particular ways of doing it: art, drama, writing groups where young people were able to talk about their dreams or their experiences and publish this as a kind of community newspaper or a school-based newspaper, debates and discussion groups, and then there are slightly more structured groups, like Scouts and Guides; in Serbia there is the Mountain Club for example, not Scouts exactly but the same kind of outward-bound, adventurebased work. We underline the importance of volunteering, not only because obviously young people are an immense resource for their community and their society, and should be made to feel that they are a resource and not a burden and not a constraint, but also because in volunteering young people can take a positive role in relation to one another. In Algeria they have a first aid group where you learn how to save life, and thereby limit how much interest you take in taking life, building your own sense of personality and your respect for other people. Peer education is a key issue. We know that often at the moment there are many great limitations in linking through to the authorities and in finding resources for this, but what we wanted to convey is that starting is the important thing. But bearing in mind from the start how you are going to sustain this is key because you need to be practical, you need to be realistic, but you do not need to be limited and afraid, you can be positive about it and take it forward. Whatever it is that we put together at the end of the day, we felt as a group that it is really important to get young people to comment on our contribution – we are making suggestions here, we think they are quite good, but we don’t know because we have not yet tested them against young people’s views, so we would also like to put that forward as something we should do.

The results of this brainstorming highlight areas of research to be undertaken in preparation for further Advanced Research Workshops.

198

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

Unanimous Recommendations Serbia 1. Serbia needs external help to rebuild its infrastructure – economic, political, social, educational and technological (the isolation of 10-12 years of conflict has led to an information gap) 2. Implementation of the Consensus Strategy of Activities for Serbia – initially in Belgrade - Funding; training for therapists, families, police, judiciary and individuals - International and national policy commitment to the scheme (Use the NATO framework to ensure that this information reaches the governments of NATO member nations and other international institutions) - Monitoring and analytical evaluation of the implementation and its impact on reducing trauma

NATO and Serbia Further Advanced Research Workshops are needed to: x identify the ways in which the international community and the security community can work together with Serbia to overcome obstacles and bring Serbia into mainstream Europe x evaluate the progress of the Serbian model and to explore the possibility of developing it for use elsewhere in countries within NATO’s responsibility x explore ways of improving NATO-Serbian relations with emphasis on raising the awareness of the population in Serbia about the nature and functioning of NATO and why the member states made the decision to intervene in the civil war in the former Yugoslavia, followed by a NATO public relations campaign in Serbia aimed at reducing the resentments and lack of understanding about NATO’s role.

NATO

Creation of a NATO Advisory Group specialising in responses to trauma in children and adolescents caused by conflict or terrorist incidents Further Advanced Research Workshops

To develop a detailed Action Plan for policy makers at all levels of national and international organisations and the civil population: Adolescents, families and teachers Adolescents, families and teachers must be actively engaged in, for example: - Participatory projects - Peer groups - Using the media to publicise positive actions – not all news needs to be ‘bad’ - Exploring the possibility of a ‘popular’ book on this topic - Creation of a dedicated website

Unanimous Recommendations

199

Policy makers Further Advanced Research Workshop to develop further the general guidelines and simple affordable strategies for policy makers with mechanisms for implementation and evaluation to prevent and reduce the impact of trauma on children and adolescents, such as: - Training in building resilience in the family and in school - Inclusion in teachers’ training establishment curricula of courses for recognising the indicators of trauma, responding appropriately, running participatory groups for young people - Training for police, judiciary, community personnel to recognise and deal appropriately with traumatised youth - Training for concerned members of the public, particularly young people, to run support groups for traumatised children and adolescents

It is important that these recommendations be conveyed effectively to international and national policy makers as this is an issue, not only of the well-being of vulnerable young people, but also of the current and future security and stability of NATO Member States and Partners, and nations throughout the world.

This page intentionally left blank

201

Developing Strategies to Deal with Trauma in Children J. Donnelly et al. (Eds.) IOS Press, 2005 © 2005 IOS Press. All rights reserved.

Author Index Akhmedova, K. Belarouci, L. Benhabyles, S. Beria, Z. Bokun, T. de Malherbe, A. de Rambuteau, I. Despotovic, T. Donnelly, J. Gasic Pavisic, S. Gmur Karapetian, A. Ignatieva, A. Jishkariani, M. Jovanovic Dunjic, I. Kenchadze, V. Kovacova, A. Leth, I.

32, 59 25, 65 23 34 149 107 110 133 vi, 7, 185 53, 157 65 19 34 133 34 v 65

Malka, S. Mikuš Kos, A. Neuhauser, L. Osofsky, H.J. Osofsky, J. Ozacky-Lazar, S. Paskell, C. Peters, L. Salem-Pickartz, J. Skodacek, I. Speckhard, A. Vanderhasselt, M. Vulevic, G. Wientjes, C. Yule, W. Zivulovic, J.

112 149 116 1, 65, 185 77 15 93 40 89, 185 65 59 v 133 159 65, 75, 127 133

This page intentionally left blank

This page intentionally left blank

This page intentionally left blank