Program

Nov 20, 2012

OVERVIEW

The Teaching Recovery Techniques intervention is a group psycho-social skills training that aims to strengthen coping abilities in war- or disaster-affected children through a variety of evidence-based techniques.  An experimental evaluation of this program with war-affected children in Palestine found that the intervention significantly decreased the rate of clinical posttraumatic stress in boys when compared with boys in a control group.  A similar effect was seen for girls with low baseline peritraumatic dissociation.  These benefits were not maintained at 6-month follow-up, and no other mental health measures showed significant impacts.

DESCRIPTION OF PROGRAM

Target Population:  War- or disaster-affected children aged 8 and older.

The Teaching Recovery Techniques intervention is a group psycho-social skills training designed to help children cope with current difficulties and prepare for future difficulties.  Teaching Recovery Techniques aims to create feelings of safety and mastery through trauma-related psychoeducation, cognitive behavioral therapy methods, coping skills training, and creative expressive elements.  The intervention is typically conducted in five 1.5 hour sessions with groups of 15 children or fewer.  In these sessions, children develop problem-solving skills, practice imagery techniques, learn relaxation exercises, develop coping self-statements, and draw, write, and talk about their experiences.  A parent component includes two parallel sessions that describe the intervention and suggest methods to help children cope with war or disaster.  This program was intentionally designed to be implemented with minimal training or supervision, to enable its utilization by individuals already working with children affected by war and disaster.

A manual is available from the website listed below. There are unique versions of the manual for war and disaster, and the manual is available in Arabic, Bahasa Malaysian, Chinese, English, French, and Japanese.

EVALUATION OF PROGRAM

Qouta, S. R., Palosaari, E., Diab, M., & Punamaki, R. (2012). Intervention effectiveness among war-affected children: A cluster randomized controlled trial on improving mental health. Journal of Traumatic Stress, 25, 1-11. doi:10.1002/jts.21707

Evaluated Population:  The sample consisted of 482 Palestinian children aged 10 to 13 years.  Children were recruited from 5th and 6th grade classrooms in two areas of Gaza that were shelled during the 2008-2009 war in Gaza.  The participants were 51 percent male and had an average age of 11.3 years.

Approach:  In each of the two areas in Gaza, two schools were randomly selected for participation.  Then, four classrooms (two boys’ classes and two girls’ classes) were randomly selected from each school.  From those four classrooms in each school, one class of each gender was randomly assigned to the intervention, and one class of each gender was assigned to the waitlist control condition.  This resulted in a total of 16 classrooms participating, with eight in the intervention group (n=242) and eight in the waitlist control group (n=240).  The intervention was conducted as an extra-curricular activity on school grounds, and included eight 2-hour sessions over 4 weeks.  Parents were involved through homework assignments, but it is unclear whether the separate parent sessions were included in the intervention.  Children completed baseline, post-intervention, and 6-month follow-up assessments of posttraumatic stress symptoms, depressive symptoms, and psychological distress.  Peritraumatic dissociation (depersonalization, derealization, and disorientation) was assessed at baseline only.  The analyses were adjusted for clustering. The only significant difference between the groups at baseline was a higher rate of posttraumatic stress symptoms in the intervention group.

Results:  Analysis of the full sample did not find any significant impacts of this intervention.  Subgroup analyses found a significant impact on posttraumatic stress symptoms in boys.  Specifically, boys in the intervention group were less likely to have posttraumatic stress symptoms above the clinical cut-off at post-intervention when compared with boys in the control group.  This impact was not maintained at 6-month follow-up.  No other significant impacts were seen in boys.

In girls, those in the intervention group with low peritraumatic dissociation at baseline showed significantly less posttraumatic stress symptoms at post-intervention than those with low peritraumatic dissociation in the control group.  The same effect was not seen for those with medium or high levels of peritraumatic dissociation.  This effect was not maintained at 6-month follow-up.  No other significant impacts were seen in girls.

SOURCES FOR MORE INFORMATION

References

Qouta, S. R., Palosaari, E., Diab, M., & Punamaki, R. (2012). Intervention effectiveness among war-affected children: A cluster randomized controlled trial on improving mental health. Journal of Traumatic Stress, 25, 1-11. doi:10.1002/jts.21707

Website: http://www.childrenandwar.org/resources/teaching-recovery-techniques-trt/

Contact Information

Children and War Foundation at Kluge Law Firm

Postboks 394 Sentrum

N-5805 Bergen, Norway

E-mail: contact@childrenandwar.org

Raija-Leena Punamaki

School of Social Sciences and Humanities/Psychology

Kalevankatu 5, Linna 4krs, FIM-33014

University of Tampere

Tampere, Finland

Email: raija-leena.punamaki@uta.fi

KEYWORDS:  Children (3-11), Adolescents (12-17), Elementary, Middle School, Males and Females (Co-ed), School-based, Manual, Parent or Family Component, Counseling/Therapy, Skills Training, After-School Program, Anxiety Disorders/Symptoms, Depressive/Mood Disorders, Mental Health Other

Program information last updated on 11/20/12.