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IV World Congress on Traumatic Stress. Qualitative research on the psychosocial impact of war on children in Burundi and Indonesia. “It never rains… it pours”. Wietse A. Tol-HealthNet TPO/ Vrije University Amsterdam Ria Reis-University of Amsterdam Dessy Susanty-CWS Indonesia

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IV World Congress on Traumatic Stress

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Iv world congress on traumatic stress

IV World Congress on Traumatic Stress

Qualitative research on the psychosocial impact of war on children in Burundi and Indonesia

“It never rains… it pours”

Wietse A. Tol-HealthNet TPO/ Vrije University Amsterdam

Ria Reis-University of Amsterdam

Dessy Susanty-CWS Indonesia

Adolphe Sururu-HealthNet TPO Burundi

Aline Ndayisaba-HealthNet TPO Burundi

Joop T.V.M. de Jong-HealthNet TPO/ Vrije University Amsterdam

Presentation contents

Presentation contents

  • Introduction

  • Research Objectives

  • Methodology

    • Setting & Procedures

  • Results

    • Summary of informants

    • Most relevant problems

    • Damage to the social fabric

    • Morality problems

  • Discussion/ Suggestions for psychosocial interventions

Introduction healthnet tpo

Introduction: HealthNet TPO

  • HealthNet TPO: a merger of HealthNet International (medical care in post-conflict settings) and the Transcultural Psychosocial Organization (psychosocial care in post-conflict settings)

  • HealthNet TPO is an international organization that works to develop research-informed (mental) health and psychosocial care systems in (post-) conflict and (post-) disaster areas, with the aim of increasing structural public (mental) health care

Introduction child thematic project

Introduction: Child Thematic Project

  • Psychosocial project for children affected by armed conflict in Burundi, Indonesia, Nepal, Sri Lanka, and Sudan

    • Public mental health approach; different types of interventions for differently affected children

    • Components: school-based group intervention, youth groups, awareness raising, psychosocial counseling

    • Integrated research component to come to evidence-based practices

      • Randomized Controlled Trial (RCT) on school-based group intervention

      • N = 1 study on psychosocial counseling

Research objectives

Research Objectives

  • Preparation for RCT on school-based group intervention [ISRCTN25172408, ISRCTN66249480, ISRCTN42284825]

    • “Cultural fit” of school-based intervention

    • Choice & adaptation of outcome instrumentation/ translation

  • Research questions

    • How do community members perceive the (psychosocial) impact of conflict?

    • What resources are available in the community to deal with this impact?

Methodology setting

Methodology: setting

  • Burundi:

    • Repeated cycles of killings and violence along ethnic lines since independence, between Hutu’s and Tutsi’s (250,000 to 300,000 killed, 880,000 displaced [Amnesty International, 2004])

    • Data collection in rural areas in two Northwestern provinces, heavily affected by violence

  • Central Sulawesi, Indonesia:

    • Periodic religious communal violence, since 1998 in Poso region. In 2002: 1,000 killed and 100,000 displaced [Human Rights Watch, 2002]

    • Data collected in mixed Muslim/ Christian areas in rural areas around Poso

Methodology procedures

Methodology: procedures

  • Key Informant Interviews with child experts in the community

  • Focus Group Discussions with children, teachers, parents

  • Semi-structured Interviews with children and parents/ caretakers of affected children

  • Informants identified through community meetings and subsequent snowball sampling

Methodology procedures cont

Methodology: procedures [cont.]

  • 4 local assessors with at least BA in social science

  • One-month training program, with a focus on interviewing skills and field-practice

  • Interviews were tape-recorded, transcribed and translated to English

  • Content analysis with grounded theory approach (Strauss & Corbin, 1996)

  • ATLAS.ti 5 qualitative data analysis software used

Results summary of informants

Results: Summary of informants

Results most important categories

Results: Most important categories

Results damaged social fabric

Results: Damaged social fabric

Results damaged social fabric1

Results: Damaged social fabric

Results damaged social fabric2

Results: Damaged social fabric

Results complaints of damaged morality

Results: complaints of damaged morality

Discussion the psycho social

Discussion: the psychosocial

  • Importance of looking at more than individual emotional complaints (cf. use of symptom checklists)

  • Importance of damage to morality

  • Differences in damaged social fabric in different armed conflicts, settings, need for different types of interventions

Suggestions for intervention

Suggestions for intervention

  • A Systems-approach rather then isolated psychosocial interventions:

    • Difficult to separate the effects of poverty and war

    • Illness experiences often include spiritual (Burundi: bewitchment, Indonesia: fate as decided by God), physical, social and psychological explanations

  • For example:

    • Community-based development approaches; income generation/ occupational training projects that build social connections between orphans and their communities in Burundi

    • Working on access to school of children, involving all religious groups

Suggestions for intervention1

Suggestions for intervention

  • Working with the damaged social fabric

  • Burundi:

    • Joining community efforts aimed at decreasing ethnic tensions; e.g. scouting, school-based efforts by teachers

  • Indonesia:

    • Reconciliation efforts at peer and community levels between ethnically different groups

    • Utilizing available initiatives; inter-religious meetings, school-based efforts, community sports games

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