Introduction
Exposure to natural disasters has a devastating impact on the psychological
and social well-being of children, adolescents and adults. It is now
widely accepted that early psychosocial interventions that help to
mitigate the effect of trauma, alleviating psychological distress,
and strengthen resiliency must be an integral part of humanitarian
assistance. In the case of children and adolescents, psychosocial
interventions also aim to maintain or re-establish their normal development
process. The broad framework for planning and implementing psychosocial
programs is provided by a) the relevant Articles of the Convention
on the Rights of the Child, and b) UNHCR Guidelines on Protection
and Care of Refugee Children.
What do we mean by "psychosocial"?
For the purpose of this statement, "psychosocial" refers
to the dynamic relationship that exists between psychological and
social effects, each continually inter-acting with and influencing
the other.
"Psychological effects" are those which affect different
levels of functioning including cognitive (perceptions and memory
as a basis for thoughts and learning), affective (emotions), and behavioural.
"Social effects" pertain to altered relationships, family
and community networks, and economic status.
The following principles based on a body of evidence should guide
psychosocial programming
- Nearly all children and adolescents who have experienced catastrophic
situations will initially display symptoms of psychological distress,
including intrusive flashbacks of the stress event, nightmares,
withdrawal, inability to concentrate, and others.
- Most children and adolescents will regain normal functioning once
basic survival needs are met, safety and security have returned
and developmental opportunities are restored, within the social,
family and community context.
- Some children will require more specialized interventions to address
their suffering and help restore their flow of development. Immediately
after traumatic events, activities and opportunities which allow
children to talk about or otherwise express painful experiences
and feelings, such as physical and artistic expression, are most
beneficial if facilitated by people the children know and trust,
and have continued contact with.
- However, "trauma counselling", should never be the point
of departure for psychosocial programming, because structured, normalizing,
empowering activities within a safe environment will help the majority
of the children recover over time.
- Trauma counseling should never be provided unless an appropriate
and sustained follow-up mechanism is guaranteed. Defense mechanisms
exist for a reason and breaking them down before the child is ready
and in a safe physical and emotional environment leaves him/her
open and vulnerable to a re-traumatisation. There are serious risks
associated with trauma counseling carried out by nonprofessionals.
- Dramatic consequences for a child's life pathway can have more
damaging consequences for the individual's well-being than the traumatic
event itself (an example would be a child's loss of parents having
to grow up as an orphan, or destruction of school system leaving
children without education).
- The psychosocial well-being of adults, particularly parents and
caregivers has a direct impact on that of children, and should thus
be addressed through concurrent parent-focused psychosocial interventions.
- Children - and adults' - participation in decisions which affect
their lives has a positive effect on their mental health, empowers
them and helps them to regain control over their own lives.
- Grounding all psychosocial interventions in the culture, unless
it is not in the best interests of the child, is both ethical and
more likely to produce a sustained recovery.
Psychosocial interventions based on the above principles:
- Listen to children and adults before acting. Ensure that interventions
are based on consultation with the affected communities, reflect
what they need and take into consideration the age and stage of
development of the children involved.
- Understand and respect the culture and religion of the affected
population; give material and other support so that grieving and
mourning practices and rites can take place.
- Help children, family members, friends and neighbours find out
what happened to those who are missing, and find each other, and
let them know that efforts are underway.
- Set up "child-friendly" spaces as soon as possible and
activities that normalize the lives of children, give them a sense
of safety, structure and predictability through drawing, puppet-making
and playing, drama and songs, story-telling, sports, non-formal
education, etc. These activities also allow for the release of any
stored distress.
- Restore normal schooling as soon as possible.
- Encourage children to ask as many questions as they want, and
be ready to answer them truthfully.
- Focus and build on interventions that strengthen the population's
resiliency and resources, and current and traditional ways of coping
when they are in the best interests of the child.
- Involve youth in organizing activities for younger children: undertakings
that give an affected person a sense of accomplishment has a healing
effect.
- Involve children, their families and communities in the psychosocial
recovery process, discussing with them their perceptions, and how
they see their needs.
- Set up support group discussions, as much as possible accompanied
by involvement in concrete and meaningful activities that give a
sense of accomplishment and control over one's life: recreational
and non-formal education for children, common interest activities
for young people, sewing, gardening, building, leading children's
activities etc.
- Promote and support interventions which preserve and reinforce
the cohesion of the family, and discourage any which risks separating
children from their families.
- Promote activities and opportunities to allow children to express
their experiences and feelings so that they may make meaning from
and integrate them into their lives, as much as possible within
a familiar environment and only if:
- The child is ready for this expression - eliciting emotional
material too early can cause more distress and potential harm
to the child.
- We can ensure further, on-going comfort and help.
- Identify referral services for the small number of children and
adults who will need professional, medical assistance (some of these
people may have had pre-existing psychiatric illnesses).
- Assess the need and provide support to adults caring for children
for example provision of crèches or child focused activities
(e.g. child friendly spaces) which allow adults some time to recover
and re-energise them so that they can provide the support children
need.
- Provide training to those caring/responsible for children so that
they are comfortable dealing with children's natural distress and
recognise children who may need more specialised support.
These Guiding Principles represent the views of the following agencies:
the International Rescue Committee (IRC), Save the Children UK (SC
UK), the United Nations Children's Fund (UNICEF), the United Nations
High Commissioner for Refugees (UNHCR) and World Vision International
(WVI).
Organizations working on behalf of children are strongly encouraged
to endorse these priniciples.
Other References:
Promoting Psychosocial Well-Being Among Children Affected by Armed
Conflict and Displacement: Principles and Approaches, International
Save the Children Alliance, 1996.
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