Prisoner's Day in the West Bank

Last Tuesday, April 17th, 2012 was Prisoner's Day for Palestinians in the West Bank and Gaza. Israel arrests more than nine Palestinians (of all ages) per day on average. As of 2011, 4,489 Palestinians are being held as political prisoners. Of those, 320 Palestinians are being held in prison by Israel under administrative detention, which means that they are being held without trial. 183 prisoners are minors (under the age of 18). The people I interviewed in one village I visited yesterday said that 16 children were arrested or detained in a one week period in March, the vast majority on suspicion of stone throwing. In the same village last summer, a six-year-old was arrested and detained by Israeli forces; he was eventually released 24 hours later. As one father expressed, "Imagine if that was your child! What would you do?"

Detainees face an increased use of solitary confinement of prominent leaders, a ban on reading materials and television, a halt of transfer of funds from family members for prisoners to purchase many basic food products, and the discontinuation of academic studies for distance learning. To protest the prison conditions, 3,500 Palestinian prisoners in Israeli jails fasted last Tuesday as part of the Karameh (Dignity) Strike. 1,200 declared that they will continue to fast, joining several administrative detainees. Two detainees who have been on hunger strike for over 40 days--Bilal Diab (27) and Tha’ir Khekhle (34)--have been admitted to the hospital and their condition is deteriorating. Diad has been in detention for eight months, and Khlekhle has been in detention for more than two years. He has not yet seen his 22-month old baby, born after his detention. The two are examined regularly by doctors from Physicians for Human Rights doctors, and the NGO has expressed concern over their condition, calling for their immediate release.

There were several demonstrations throughout the West Bank to show solidarity with the prisoners and call for their release. En route to Al Azariyah, my research assistant and I stumbled upon a peaceful protest in Ramallah. Elderly mothers were holdings framed photos of their beloved sons who are being held in detention. Children of prisoners waved Palestinian political party flags. Fatah leader Abbas Zaki proclaimed, “There will be no peace and no safety without releasing all prisoners from Israeli jails.” After the central demonstration in Ramallah and after my assistant and I were on our way to Al Aazariya, hundreds of people went to protest near the Ofer military prison, were political prisoners are held. They were dispersed by the Israeli army with tear gas and the “skunk” water canon (a high-pressured hose that sprays foul smelling water).

Israeli's detention of Palestinians is not only punishment for the individual, but also collective punishment for Palestinian families, who face increased economic hardship and targeting by Israeli forces as a result of the imprisonment of their fathers, sons, and brothers. Due to the illegal transfer of prisoners outside the occupied territories, more than 3,000 prisoners cannot be visited by their families. This is a major challenge for Palestinian families. This week, I interviewed one family in a village near Bethlehem whose father has been imprisoned for the past ten years. The family is unable to visit their father, because of the recent Israeli restrictions on family visits. Even if they were allowed to visit, the journey would be nearly impossible considering the permits needed for Palestinians to cross into Israel as well as the travel costs that this family cannot afford. I asked the 11-year-old son to draw his dream place, and it was a picture of his mother, father, older sister, and younger brother going for a picnic in the park. His family responded by saying, Inshallah (God willing).

Parental Education Program Improves Mental Health and Adjustment in Parents of Children with Autism

Research indicates that parents of children with autism experience a high level of stress. Parent training interventions reflect an attempt to address this stress and improve parental mental health. In Tonge et al.’s (2006) study, parents of preschool children recently diagnosed with autism were sampled from four geographically separate metropolitan and rural regional assessment services for young children suspected of having autism. The sample was assigned to either the intervention group (n=70) or control group (n=35). Parents from the intervention group were further randomly assigned to a parent education and behavior management (PEBM) group (n=35) or a parent education and counseling (PEC) group (n=35). Subjects were administered a questionnaire at pre-intervention, post-intervention, and six-month follow-up. Parental health was determined using the General Health Questionnaire, a widely-used reliable, and valid self-administered adult screening test designed to detect mental health issues in community settings. Results showed that both interventions improved the mental health and well-being of parents with children recently diagnosed with autism, especially among parents who had preexisting mental health problems. There were no statistically significant results supporting the superiority of either PEBM or PEC.

The authors anticipate several potential threats to validity, and attempt to minimize these threats through the study design. First, by sampling populations in geographically distant rural and urban communities, the investigators attempted to control cross-contamination of groups as a threat to validity. Second, the investigators made attempts to control for any threats to internal or construct validity by training therapists to strictly follow guidelines for the specific interventions and providing supervision and training to therapists throughout the study. Therapists also administered both treatments and were rotated between therapies. The investigators videotaped a random 10% of the intervention group for content review and intervention adherence. Third, the authors address timing of measurement as a potential threat to external validity by testing all subjects six months after the study. Consequently, results showed that alleviation of symptoms became more apparent over the long-term, reflecting a possible cumulative effect of treatment. Nevertheless, the study also exhibits limitations. By selecting samples from rural and urban communities, access to services may have created notable differences between the groups. Because parents were included in the study based on their children’s diagnosis, the group may exhibit wide variation in regards to mental health. This diversity of subject characteristics made it difficult for the investigators to determine a difference between groups. Overall, the study reveals promising findings about the effectiveness of parent training as an important element of interventions for children with autism.

Reference:
Tonge, B., Brereton, A., Kiomall, M., Mackinnon, A., King, N., and Rinehart, N. (2006). Effects of parental mental health of an education and skills training program for parents of young children with autism: A randomized control trial. Journal of the American Academy of Child and Adoelscent Psychiatry, 45(5), 561-569.

Study in Afghanistan Finds Trauma Exposure and Caregiver Mental Health Predict Risk of Negative Mental Health Outcomes in War-Affected Youth

Research conducted in war-affected situations has found an association between exposure to traumatic events and mental health outcomes. However, there have been few studies focusing on the mental health outcomes of children and adolescents affected by war. Panter-Brick, et al. (2009) conducted a study aimed at determining a causal relationship between war and mental health problems, specifically looking at associations related to gender, traumatic events, caregiver mental health, and socio-demographic characteristics. The sample targeted children ages 11 to 16, who were randomly drawn from randomly selected schools in three purposively chosen regions of Afghanistan. Data were gathered from three informants (children, caregivers, and teachers), who were interviewed with a variety of brief measures. Measures were chosen because they had high reliability in other contexts of instability. To increase instrument diagnostic validity, measures were translated, back-translated, and reviewed by a multi-disciplinary team. The research found that the variables of exposure to multiple trauma and caregiver mental health were predictive of psychopathology for in-school Afghan adolescents. Previous research corroborates this finding and adds to the study’s external validity. Furthermore, the study found that girls were more likely than boys to develop poor mental health outcomes, such as depression.

The authors explore the quality of traumatic events to include not just war-related events, but accidents, corporal punishment, illness, death of a relative. The quality of the particular incident is not indicative of predicting poor mental health, but rather the accumulation of traumatic events contribute to risk factors for mental health problems. The study includes a few threats to validity. By only sampling school children, the study neglects out-of-school youth, who may be at high risk of developing psychopathology. Furthermore, even though the sample of in-school youth was stratified to include accurate proportions of boys and girls, the focus on in-school youth disproportionately excludes girls, because boys are more likely to attend school than girls. The school samples were restricted to three urban areas, affecting external validity and indicating that future research might consider including a sample from a rural setting. Despite its limitations, this study indicates the value of working within the school system to assess children’s mental health needs and proves the value of school-based mental health services. Furthermore, the findings contribute to the small but much needed knowledge base about the mental health of war-affected children.

Reference:
Panter-Brick, C., Eggerman, M., Gonzalez, V., and Safdar, S. (2009). Violence, suffering, and mental health in Afghanistan: a school-based survey. The Lancet, 374, 807-816.

Quality of Parental Involvement More Relevant Than Use of Child Corporal Punishment in Development of Negative Adolescent Outcomes

Child development researchers have long suggested that corporal punishment is a predictor of negative behavioral outcomes in children. However, because they suffer from serious methodological limitations, studies on the effects of corporal punishment have yet to definitively determine if corporal punishment is causally related to negative adolescent outcomes. In this study, the authors attempt to determine the extent that quality of parental involvement and corporal punishment independently predict adolescent maladjustment, specifically adolescent aggressiveness, delinquency, and psychological well-being. The authors used a prospective study design, interviewing 332 families annually over a three-year period. Interviews consisted of parent self-reports, adolescent reports, and observed ratings of family interaction tasks. Corporal punishment was determined by time (i.e., consistent use of physical discipline over the three-year study period), age-appropriateness (i.e., continuing during adolescence, indicating harsh discipline), and type (i.e., use of object, being shoved or pushed.) Quality of parental involvement was determined by display of warmth and affection, monitoring and supervision, consistency of discipline, and use of inductive reasoning to explain rules and expectations. The authors found that once other dimensions of parenting are controlled for, there exists a significant relationship between quality of parental involvement and adolescent outcomes. Contrary to past research on this topic, the study found no significant relationship between corporal punishment and the adolescent outcomes.

This study’s main strength lies in its design aimed at isolating other parenting behaviors to determine that quality of parental involvement, rather than corporal punishment, was a predictor of maladaptive behavior among adolescents. The study’s use of self-reports from parents and adolescents, combined with observation of family interactions, created a more comprehensive depiction of family interaction. However, the sample selection presents some limitations to the study. Firstly, the sample represents a rural population, highlighting the need for the study to be replicated in an urban setting. Furthermore, though 451 families were recruited for the study, only 404 families completed all four waves, 19 families were not eligible after divorcing during the study period, and there was incomplete data for 53 of the families. Secondly, the authors emphasize that corporal punishment should not be confused with physical abuse, for in this study, the corporal punishment wasn’t extreme enough to be considered physical abuse; therefore, additional studies should be conducted to examine the effects of physical abuse on adolescent outcomes, independent of other parental behaviors. Thirdly, there might be other adolescent dimensions not addressed in this study that would be important indicators of maladjustment; the authors suggest looking at autonomy, self-reliance, and creativity in future research.

Reference:
Simons, R.L., Johnson, C., and Conger, R.D. (1994). Harsh corporal punishment versus quality of parental involvement as an explanation of adolescent maladjustment. Journal of Marriage and the Family, 56(August 1994), 591-607.

Preventive Interventions Help Secure Attachment in Maltreated Infants

Child maltreatment presents threats to child developmental processes, including long-term maladjustment and development of psychopathology. Cicchetti, Rogosch, and Toth’s (2006) study examines the effectiveness of two preventive interventions: psychosocial parenting education (PPI) and infant-parent psychotherapy (IPP). Based on the theory that secure attachment is derived from parental knowledge and skills, PPI involves a series of psychoeducation-focused home visits with mothers to improve parenting skills, increase mothers’ knowledge of child development, and enhance coping and social support skills. IPP is based on attachment theory and includes an exploration of the parent-child relationship through therapy. The hypothesis that PPI or IPP interventions will be most effective for ameliorating the effects of maltreatment of infants is explored in this study. The study sampled mothers and their infants in maltreating families (n=137). Subjects were randomly assigned to one of three cohorts: (1) psychosocial parenting education (PPI), (2) infant-parent psychotherapy (IPP), or (3) community standard (CS). A normative comparison (NC) group of non-maltreated infants and their mothers (n=52), with similar demographics to the intervention group, was also included. Using validity tested measures, the authors found that mothers and children in the PPI and IPP groups showed greater increases in secure attachment than mothers and children in the CS and control groups. This study supports evidence that preventive intervention programs can alter attachment organization and ameliorate the negative developmental consequences of maltreatment.

As compared to results from the CS group, the authors provide evidence that the PPI and IPP interventions result in greater increases of secure attachment in maltreating families. However, the non-maltreating control group varied greatly from the maltreating group, with maltreating mothers reporting higher rates of maltreatment in their own childhoods, more insecure relationships with their mothers, more maladaptive parenting attitudes, more parenting stress, and lower family support. Similarly, despite trying to maintain uniform adherence to the therapeutic intervention, the therapy was not completely standardized, because the intervention used different therapists. Lastly, the intervention groups were actively pursued to follow the therapy schedule, which is not commonly done in treatment modalities such as the CS group.
The authors attempt to eliminate any self-selection bias, by seeking out maltreating families rather than the families seeking to be enrolled in the study.

Reference:
Cicchetti, D., Rogosch, F.A., and Toth, S.L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623-649.

Child-Centered Spaces are Beneficial to Young Children Affected by War in Northern Uganda

A widely used approach to aid children and their families in emergencies is the implementation of child-centered spaces (CCSs), which are physical spaces providing structured activities and support for children and their caregivers in emergencies. Despite the prevalence of CCSs, there has been little systematic research to assess their impact. Kostelny and Wessell’s (2008) evaluation of safe spaces in an internally displaced persons (IDP) camp in northern Ugandan is the first of its kind. The study uses both qualitative and quantitative methods to determine if CCSs protect young children (3-6) from risks and threats in their environment, improve children’s psychosocial well-being, and increase children’s knowledge and life-skills levels. Qualitative data were collected from focus group discussions with 92 caregivers and community members. Qualitative data informed development of a tool based on locally-derived indicators of child well-being in the northern Uganda context. Using the locally derived indicators and a Western developed screening tool for emotional and behavioral difficulties, quantitative data were collected from interviews with caregivers. The study randomly selected 176 caregivers of children attending CCS program and 118 caregivers randomly selected from a nearby IDP camp where there were no CCS services available. Significant benefits for children in the CCSs occurred within the domains of protection, psychosocial well-being, and life skills. The authors conclude that if positive effects can occur in as challenging an environment as northern Uganda, then the implementation of CCSs might have similar positive effects in other difficult settings.

This study uses locally appropriate measures to bypass questions of validity inherent in Western measures’ application to non-Western settings. Furthermore, the study focuses on outcomes versus process indicators, which rarely describe the actual benefits of a program in regards to child development, protection, and well-being. Nevertheless, the authors recognize limitations to their study. First, intervention and control groups weren’t systematically matched. Secondly, because the data rely on self-reports, the study may have experienced self-preservation bias with the intervention group reporting more favorable outcomes. Lastly, the external validity of the findings should be considered with caution, since this evaluation only addresses one specific context. In order to gain support that child-centered spaces are beneficial for children in crisis settings, more research must be conducted in other contexts.

Reference:
Kostelny, K. and Wessells, M. (2008). The protection and psychosocial well-being of young children following armed conflict: outcome research on child-centered spaces in northern Uganda. The Journal of Developmental Processes, 3(2), 13-25.