Prior research indicates that war-affected youth are at increased risk of mental health issues, and many humanitarian organizations have been implementing interventions to ameliorate these problems. Yet, few rigorous evaluations have been conducted and even fewer have implemented a randomized control design. Using a randomized control design, Bolton et al. (2007) examined the effectiveness of a group interpersonal psychotherapy intervention (IPT-G) and a creative play intervention (CP), as compared to a wait-list control group, in decreasing depression symptoms, anxiety symptoms, and conduct problems among war-affected adolescents. The authors first developed locally derived measures for depression, anxiety, conduct problems, and functioning to create the Acholi Psychosocial Assessment Instrument (APAI), which was found to have strong test-retest reliability and criterion validity. Stage one of the screening asked community leaders, teachers, community workers, and adolescents to create a list of 14 to 17-year-olds who exhibited at least one of the locally-derived depression symptoms. Stage two of the screening process administered the locally derived instrument to community-identified children to determine who should be included in the study. The study employed a pretest-posttest control group design, with participants randomly assigned to one of the three groups. The authors found that all three groups experienced decreased symptoms of depression. However, only girls experienced statistically significant reductions in their depressive symptoms after participating in IPT-G. Neither IPT-G nor CP were associated with improvement in anxiety, conduct problems, or functioning.
Based on previous RCTs in sub-Saharan populations, the authors recognized that attrition could pose a threat to the study’s validity by decreasing sample size and power and compromising the integrity of the random assignment. To address this, the authors employed intent-to-treat analysis, using pretreatment data from subjects who have dropped out as both pre- and post-test data. Intent-to-treat analysis also provided a conservative test of the hypothesis, making the effect of IPT-G all the more compelling. To decrease attrition further, the experimenters used a unique method of obtaining informed consent from the sample, both before the administration of the pre-intervention measure and after random assignment to one of the three groups. This study contributes to the growing knowledge base about ways to address the effects of war among adolescents, and proves that randomized control study designs can be implemented in difficult contexts with vulnerable populations.
Reference:
Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K.F., Neugebauer, R., Murray, L., and Verdeli, H. (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in Northern Uganda: A randomized control trial. Journal of the American Medical Association, 298(5), 519-527
Showing posts with label recovery. Show all posts
Showing posts with label recovery. Show all posts
Monday, October 5, 2009
Monday, September 28, 2009
Mind-Body Skills Intervention Decreases Symptoms of Post-Traumatic Stress Disorder in Postwar Kosovar Adolescents
Incidence of post-traumatic stress disorder (PTSD) has been reported among war-affected children and adolescents. Yet few studies have evaluated the effectiveness of PTSD treatment programs for this population. Gordon, et al. (2009) conducted a randomized control trial to determine the effectiveness of an intervention aimed at ameliorating the effects of PTSD in adolescents. All children in Jeta e Re (“New Life”) High School in Kosovo were screened to participate in the study. Eighty-two students met the criteria for PTSD and were randomly assigned to two groups: (a) intervention group and (b) delayed intervention group. The intervention group participated in a comprehensive mind-body skills group program, a 12-session program consisting of meditation, guided imagery, breathing exercises, relaxation activities, therapeutic discussion, and art therapy. The delayed intervention group received the same intervention once the intervention group had completed the program, approximately 6 weeks later. The study shows that students receiving the mind-body skills group program had significantly reduced levels of PTSD symptoms as compared to the delayed intervention control group.
This study is the first randomized control study to examine the effects of a therapeutic intervention on war-affected adolescents. The study design overcomes the ethical dilemma of withholding promising treatment from the control group by providing treatment to the control group after the intervention group has completed post-intervention interviews. Nevertheless, expectation bias poses a threat to the study’s internal validity, because the results of the improved outcomes may be due to the participants’ expectations that the intervention would be effective. This threat to internal validity is supported by the fact that the intervention was piloted in the school prior to the study, building even more anticipation, as students are bound to share their experiences with other students. This is also be related to the process of testing, which could be a threat to internal validity, because students may become familiar with the measures being used. Because teachers both facilitated the intervention and administered the measures, unintentional expectancy effects pose a threat to the study’s construct validity. In this case, teachers may have subconsciously expected students to show fewer PTSD symptoms in the post-test. Similarly, the students may have wanted to please the facilitators by showing improvements in the post-test. Despite the authors’ explanation that these students would only be comfortable speaking with a familiar adult, future studies should utilize external experimenters to administer the pre- and post-test, because they will be naïve to which students received the intervention and will have no vested interest in the outcome of the intervention.
Reference:
Gordon, J.S., Staples, J.K., Blyta, A., Bytyqi, M., and Wilson, A.T. (2008). Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: A randomized controlled trial. Journal of Clinical Psychiatry, 69(9), 1469-1476.
This study is the first randomized control study to examine the effects of a therapeutic intervention on war-affected adolescents. The study design overcomes the ethical dilemma of withholding promising treatment from the control group by providing treatment to the control group after the intervention group has completed post-intervention interviews. Nevertheless, expectation bias poses a threat to the study’s internal validity, because the results of the improved outcomes may be due to the participants’ expectations that the intervention would be effective. This threat to internal validity is supported by the fact that the intervention was piloted in the school prior to the study, building even more anticipation, as students are bound to share their experiences with other students. This is also be related to the process of testing, which could be a threat to internal validity, because students may become familiar with the measures being used. Because teachers both facilitated the intervention and administered the measures, unintentional expectancy effects pose a threat to the study’s construct validity. In this case, teachers may have subconsciously expected students to show fewer PTSD symptoms in the post-test. Similarly, the students may have wanted to please the facilitators by showing improvements in the post-test. Despite the authors’ explanation that these students would only be comfortable speaking with a familiar adult, future studies should utilize external experimenters to administer the pre- and post-test, because they will be naïve to which students received the intervention and will have no vested interest in the outcome of the intervention.
Reference:
Gordon, J.S., Staples, J.K., Blyta, A., Bytyqi, M., and Wilson, A.T. (2008). Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: A randomized controlled trial. Journal of Clinical Psychiatry, 69(9), 1469-1476.
Thursday, September 10, 2009
Historical Roots of Community Engagement and Mobilization
Programs for disadvantaged populations risk encouraging passivity and creating dependency, which are adverse to recovery and sustainability. Social settlements, one of the cornerstones of modern social work, were founded on the tenet of collective action built on a basis of trust and cooperation with community members and local institutions to improve community life. The first settlement house was developed in late 19th-century London as a response to growing numbers of people living in poverty, especially immigrants. Soon thereafter, Jane Adams developed a settlement house in the United States, Chicago’s Hull House, which quickly took on several vital roles within the community – a center for social activity and learning, with youth clubs, women’s clubs, athletic classes, and college extension classes, as well as community advocacy. Though Adams’ settlement house movement did not only target vulnerable populations but rather “all sides of neighborhood life”, it is regarded as the starting point of social services to address the needs of the vulnerable within the community. Adams (1892) essay “The Objective Value of a Social Settlement” focuses on the tenets behind the settlement model, most importantly providing people with opportunities so they can help themselves, rather than relying on charity. Likewise, Agnew’s (2004) chapter on Mary Richmond, tells of her discouraging begging and handouts and focusing on educational and employment opportunities for the needy. Both emphasize that drawing upon all the resources that social programs offer as well as the resources of the community allows for collective strength and cooperation.
In the field of international child protection, community engagement and mobilization around the needs of children has always been key to creating a protective environment for children. For example, Richmond engaged with the community to safeguard children’s interests around regulating child labor. When a community is engaged to identify the needs of children in their community, children are prioritized. Collective planning facilitates the empowerment of adults and creates a sense of autonomy in uncertain and disempowering circumstances. Even in emergencies, communities still maintain structures and capacities for coping, aligned with their ideals, values, and relationships. Although pre-crisis coping mechanisms may be undermined during times of crisis, the community does not lose its capacity for developing solutions and rebuilding community life. Wessells and Monteiro (2008) suggest using an empowerment model rather than a service model to connect with the community in a front-line response to create a protective environment for young children and aid in their own recovery. Psychologically, part of community recovery is a reinstatement of collective efficacy and action to help monitor and reduce risks and prevent abuse and exploitation. In this way, caregiving structures for children in the community are strengthened. When the capacity of communities to recovery from crisis is recognized, feelings of hope and autonomy are increased. As Adams (1893) says, “They require only that their aspirations be recognized and stimulated, and the means of attaining them put at their disposal” (p. 61).
References:
Adams, J. (1893). The objective value of social settlement. In C. Lasch (1982), The Social Thought of Jane Adams. New York, NY: Irvington Publishers, p.44-61.
Adams, J. (1915). Subjective necessity for social settlements. In Twenty Years at Hull House. New York, NY: The Macmillan Company, p. 113-127.
Agnew, E. (2004). Families and the circle of reform. In From Charity to Social Work: Mary E.
Richmond and the Creation of an American Profession. Ubana, IL: University of Illinois Press,
p. 95-131.
Wessells, M. and Monterio, C. (2008). Supporting young children in conflict and postconflict
situations: Child protection and psychosocial well-being in Angola. In M. Garcia, A. Pence, and
J. Evans (Eds.), Africa’s future, Africa’s challenge: Early childhood care and development in
sub-Saharan Africa (pp.317-329). Washington, DC: World Bank.
In the field of international child protection, community engagement and mobilization around the needs of children has always been key to creating a protective environment for children. For example, Richmond engaged with the community to safeguard children’s interests around regulating child labor. When a community is engaged to identify the needs of children in their community, children are prioritized. Collective planning facilitates the empowerment of adults and creates a sense of autonomy in uncertain and disempowering circumstances. Even in emergencies, communities still maintain structures and capacities for coping, aligned with their ideals, values, and relationships. Although pre-crisis coping mechanisms may be undermined during times of crisis, the community does not lose its capacity for developing solutions and rebuilding community life. Wessells and Monteiro (2008) suggest using an empowerment model rather than a service model to connect with the community in a front-line response to create a protective environment for young children and aid in their own recovery. Psychologically, part of community recovery is a reinstatement of collective efficacy and action to help monitor and reduce risks and prevent abuse and exploitation. In this way, caregiving structures for children in the community are strengthened. When the capacity of communities to recovery from crisis is recognized, feelings of hope and autonomy are increased. As Adams (1893) says, “They require only that their aspirations be recognized and stimulated, and the means of attaining them put at their disposal” (p. 61).
References:
Adams, J. (1893). The objective value of social settlement. In C. Lasch (1982), The Social Thought of Jane Adams. New York, NY: Irvington Publishers, p.44-61.
Adams, J. (1915). Subjective necessity for social settlements. In Twenty Years at Hull House. New York, NY: The Macmillan Company, p. 113-127.
Agnew, E. (2004). Families and the circle of reform. In From Charity to Social Work: Mary E.
Richmond and the Creation of an American Profession. Ubana, IL: University of Illinois Press,
p. 95-131.
Wessells, M. and Monterio, C. (2008). Supporting young children in conflict and postconflict
situations: Child protection and psychosocial well-being in Angola. In M. Garcia, A. Pence, and
J. Evans (Eds.), Africa’s future, Africa’s challenge: Early childhood care and development in
sub-Saharan Africa (pp.317-329). Washington, DC: World Bank.
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