Communicating with Children in Crises

1. Communicating with Children in Crises Dr. Lynne Jones International Medical Corps Developmental psychiatry section Cambridge University

2. INTRODUCTION • Family approaches in Kosovo • Sexual abuse in Sierra Leone • Grief and loss in Aceh • Conclusions

3. Kosovo Spring 1999 • Longstanding conflict over Albanian desire for independence • NATO airstrikes • At least ¾ of population of 2 million Albanians flee province at gun point • Remainder trapped in province • Serb forces and para-militaries in control

4. Arlinda’s story

5. Drawing family trees • Collective act- engages extended family • Interesting and engaging for children • Allows for a collective naming of the dead • Allows for story telling under child’s control • Children included in collective narrative

6. Different children, different responses • Arlinda 14: symptomatic, talking and replaying • Jeton: talked to journalists, well • Mimosa: sad, did not want to talk • Arben: Overactive, did not want to talk • Dita: reconnect with father • Therapeutic activities • Identifying bodies • Funeral (only Arlinda went) • Play • Medical evacuation and treatment in UK • All children in school • Family support from social services

7. Mental health and justice • Interviews with war crimes tribunal 2001 • All the children talked at length and in detail • War crimes trial in Belgrade 2003 • All the children wanted to identify perpetrator and be witnesses • Changed attitudes to Serbs • All doing well at school

8. Post conflict Sierra Leone

9. Kailahun district, Eastern Sierra Leone • Conflict ended 2002 • Population c. 300,000 • 80% houses destroyed • > 80,000 displaced • > 8000 ex-combatants • 1 psychiatrist • 120 bed hospital(14 hours away)

10. Sexual abuse of a six year old girl Hysterical paralysis • HIV prophylaxis • Gentle mobilisation • Distraction techniques • Dream scripting • Protection issues - case conference • Prosecution and relocation • NB Local traditional approaches inadequate

11. Silent grief in Aceh • Tsunami 26 December 2005 • At least 155,000 died in one day • Landscape obliterated • Massive overwhelming loss

12. Elisa’s story

13. Using the story • Create a narrative that acknowledges her loss • Acknowledge and give permission for symptoms • Confirm her strength and courage • Let her know she is talented and loved • Give her the idea that pain will diminish over time

14. Some take home points • Cultural political literacy essential • Non psychological interventions protect mental health: • Address basic needs • Address protection and human rights issues • Reconnect children with families • Provide medical care • Re-establish normal routines activities—school family life • Access to justice

15. Take home points 2 • Assist mourning • Primary role to facilitate communication • Retelling trauma story not essential • Exposure can be helpful; timing up to child • Address sexual and gender based violence • Do not neglect children with preexisting problems (learning disability, epilepsy)

16. Guidelines for grieving children • Provide consistent, enduring appropriate care • Reunite children with their families or extended families as soon as possible • In the absence of family create enduring family type networks with a low ratio of caretaker to children. • Consistent care-giving by one or two caretakers, not multiple volunteers is essential to prevent attachment problems particularly in younger children • The more continuity with the child’s previous life the better. • Support the carers by attending to basic needs and their own mental states. • Facilitate normal grieving and mourning—with memorials for absent bodies, appropriate religious ceremonies • Don’t hide the truth • Children need clear, honest, consistent explanations appropriate to their level of development.

17. Guidelines for grieving children 2 • They need to accept the reality of the loss, not be protected from it. • Magical thinking should be explored and corrected. What is imagined may be worse than reality and children may be blaming themselves for events beyond their control. • Debriefing may not be therapeutic or appropriate. • Encourage a supportive atmosphere where open communication possible, difficult questions answered, and distressing feelings tolerated. • Allow children to express grief in manner they find appropriate to person they most trust, at a time of their own choosing, • Symptomatic relief: Help the family to cope with traumatic symptoms if they exist. Provide information as to what to expect and straightforward management advice. • Help the child maintain connection with the lost parents—find mementoes if possible or let the child draw pictures, make objects. Answer the child's questions about the dead relative. • Restart normal educational and play activities as soon as possible

18. Any Questions?