Humanitarian curriculum and psychosocial interventions: An annotated bibliography

TREN DS/CASES

Humanitarian curriculum and psychosocialinterventions: An annotated bibliography

Gonzalo Retamal • Maria Low

Published online: 17 December 2010� UNESCO IBE 2010

Abstract This paper proposes an analytical description of the impact of violence and

natural disasters on schoolchildren. It attempts to explore the present state of the art in

psychosocial aspects of education and the curriculum in humanitarian settings. This is

carried out through a compilation and a brief annotated bibliography of existing literature

and research regarding psychosocial aspects/interventions in education or other settings in

humanitarian situations. It emphasizes some cases that are more useful for defining the

field of curriculum in humanitarian situations, rather than presenting important research of

purely psychological interest. This annotated bibliography is only a first attempt to explore

a constructive dialogue between educators and psychologists working in the humanitarian

field and to highlight important South–South contributions.

Keywords Humanitarian settings � Psychosocial interventions � Curriculum �Education in emergencies

Although research and intervention in the field of education in emergencies coupled with

psychosocial support has grown immensely over the past two decades, there still seems to

be a lack of systematic examples of good practice, with specific reference to curriculum

and education, more generally (Boothby and Melvin 2009; Pederson 2002).

This annotated bibliography aims to throw light on relevant past and current research on

psychosocial aspects of education in humanitarian settings, and to encourage greater

systematization of practice and evaluation. Based on a definition by the Psychosocial

Working Group (2003), ‘‘psychosocial well-being’’ refers to the connection between the

individual’s own psychological well-being (their emotions, thoughts and behaviours) and

their social world; in other words, their relationships (with family, friends, and

G. Retamal (&)74, route de Valavran, 1293 Bellevue, Geneva, Switzerlande-mail: [email protected]

M. Low53, chemin Pre des Fourneaux, 1293 Bellevue, Geneva, Switzerlande-mail: [email protected]

123

Prospects (2010) 40:535–557DOI 10.1007/s11125-010-9174-2

community), their culture and their traditions. ‘‘Psychosocial’’ is preferred as a term over

‘‘mental health’’ because the narrower term ‘‘mental health’’ adopts a purely curative

approach and threatens to disregard the resilience which is built within a social environ-

ment (Kalksma-Van Lith 2007). Psychosocial interventions can take many different forms.

Many interventions involve child-centred play and expressive art forms, during which

children can express themselves in a sheltered and safe environment (expression curricula).

Our main aim is to explore this concept in relation to humanitarian educational inter-

ventions and its possible impact on curriculum development in humanitarian settings. This

paper does not intend to be fully comprehensive; it underlines some cases that are more

useful for defining the field of curriculum in humanitarian situations, rather than important

research of a pure psychological interest. This annotated bibliography is only a first attempt

to explore a constructive dialogue between educators and psychologists working in the

humanitarian field and to highlight important South–South contributions.

The term ‘‘humanitarian settings’’ will be used interchangeably with ‘‘emergency set-

tings’’ and ‘‘complex emergencies’’ to mean an area where there has been or there is on-

going conflict or a natural disaster.

Background

The occurrence of violence has a pervasive psychosocial sequel for children and families.

The social, psychological, moral and emotional deprivations they suffer, forced migration,

the persistent fear of persecution, the actual loss of parents and caretakers, are as damaging

in the long term as being deprived of food, water and healthcare. As recommended in the

Machel Study, all phases of emergency and reconstruction assistance should take psy-

chosocial considerations into account. Opportunities for expression and structured activi-

ties, such as school, play and sport, should be a central part of the supporting role of the

agencies and governments (Machel 1996, p. 56). Specific research has also shown that

these activities in ‘‘normal’’ environments have a positive impact on the quality of edu-

cation (Amadio et al. 2006).

Play is an adaptive mechanism among children. One of the earliest signs of emotional

disturbance in a child is the inability to mix and play with contemporaries (Gil 1991;

Malchiodi 1998). ‘‘In contrast, psychiatrists learn that if a child has many friends of his/her

own age with whom he/she happily plays, it is unlikely that there is a great deal wrong with

him/her emotionally, even if the parents have many concerns about the child’’ (Aguilar and

Retamal 2008, p. 4). According to Landers, expression and play can be fundamental in

building resilience among children who are victims of organized violence (Landers 1998).

Resilient children have the capacity to make sense of stressful and traumatic events con-

fronting them. Assisting children to re-enact their traumatic experiences and express them is

a basic principle for the success of programmes for children under especially difficult

circumstances (Grotberg 1995). Time and again, it has been established that children who

have been traumatized will struggle to learn if they find themselves in a purely academic

environment (Ventura 2003). Consideration needs to be placed on creating an environment

in which children can express themselves through play, and artistic and corporal expression

(Case and Dalley 1992; Erikson 1963; Gallas 1994; Gil 1991; Malchiodi 1998; Rogers

1993). There is widespread agreement that, when incorporated into the school environment

in situations of humanitarian crisis, these activities have a healing effect and encourage

cognitive potential (Aguilar and Retamal 2008; Akhundov 1999; Betancourt et al. 2008;

Boothby and Melvin 2009; Gil 1991; Gupta and Zimmer 2008).

536 G. Retamal, M. Low

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Furthermore, it is believed that school-based interventions are the most efficient way of

reaching the greatest number of children within a structured and already existing envi-

ronment (Aguilar and Retamal 2008; Boothby and Melvin 2009; INEE 2004; Macksoud

1993). In addition to reaching a greater number of children, the school structure provides a

safe environment for children (Aguilar and Retamal 2008; Betancourt et al. 2008; Garcia

del Soto 2010; Macksoud 1993, UNICEF and University of Pittsburgh 2004), as well as

helping to normalize their lives post-crisis. Aguilar and Retamal (2008) state that education

in an emergency setting cannot simply be a ‘‘stop-gap’’ measure, hence resources are

needed to provide on-going post-disaster or post-conflict academic and healing education.

In fact, most of the literature refers to studies carried out on populations whose

schoolchildren are undergoing the ravaging effects of war and natural disasters, but does

not suggest systematic or other operational interventions to resolve the problem (Dyregrov

et al. 2002; Garbarino and Kostelny 1996; Punamaki et al. 2001; Quota and Odeh 2004;

Thabet et al. 2002; Thabet and Vostanis 2000). Although many non-governmental orga-

nizations (NGOs) and other bodies have developed guidelines and standards for how

education should be administered in a crisis (INEE 2004; Morgan 2010; UNICEF 2005;

Winthrop and Kirk 2006), they only refer in passing to the psychosocial problems involved

in the creation of curricula. Such guidelines theorize on the best way to proceed, yet do not

necessarily provide practical ideas when it comes to the psychosocial aspects involved

(Penson and Tomlinson 2009).

The International Rescue Committee [IRC] attempted to incorporate a more practical

aspect into their guidelines for ‘‘healing classrooms’’ by providing case studies of their

work in Ethiopia, Afghanistan and Guinea, which have all been tailored to the actual

situation in each of those places (Winthrop and Kirk 2006). However, very few elements

are provided on aspects concerning psychosocial approaches integrated into the curriculum

as such. Furthermore, the IRC clearly states that their guidelines are a work in progress.

Boothby and Melvin (2009) review various approaches to ‘‘best-practice’’ for school-

based psychosocial initiatives for traumatized children. They review six different

approaches and conclude that, although positive initiatives and programmes have been

implemented by various groups, the research into and provision of such interventions is

still in its infancy, especially with regard to providing consistent psychosocial support for

children affected by a crisis. It is also important to note that examples and evaluations of

school-based psychosocial support in non-emergency settings and in developed countries

can also be of great value (Adelman et al. 1997; Case and Dalley 1992; Chemtob et al.

2002; Gallas 1994; Kataoka et al. 2003; Malchiodi 1998; Wolfe and Nayak 2003).

Some grey literature exists as a sub-product of the implementation of educational

emergency activities by UNICEF and other agencies with specific teacher guides for the

management of cognitive and psychosocial aspects of curricula (Retamal 2000; UNICEF

and MOE Haiti 2010; UNICEF and MOE Liberia 2003; Centre des Jeunes Gatenga 1996).

In addition, found within this grey literature are the instruments produced by the ‘‘Return

to Happiness’’ programme originally developed in Mozambique in 1992. This initiative was

an improved and established version of a systematic protocol to train youth in areas of

psychosocial support and play therapy for schoolchildren in areas of war and displacement in

Colombia in 1995 (UNICEF Colombia 1997). Adolescent volunteers supervized by teachers

are the key to the programme. Young volunteers are trained in play therapy and taught how

to encourage the trust and hope among younger children in primary schools through games,

art, puppetry, song and storytelling (Quiroz 2002; Romero 2003; Siegrist 2003).

Also in Colombia, one of the most systematic interventions was the one developed by the

Ministry of Education and the Escuela Nueva Foundation, in which the active curriculum of

Humanitarian curriculum and psychosocial interventions 537

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Escuela Nueva was adapted to support the needs and integration of children of internally

displaced persons (IDPs); it was entitled Circulos de Aprendizaje [Learning Circles]. Aside

from the actual materials in the Escuela Nueva curriculum, two basic and efficient manuals

have been developed to replicate the learning units with reference to the community, the

local authorities, the logistics of the curriculum and parent participation, etc. Even more

relevant is the manual for training the teachers/tutors, which includes a series of training

modules and planned activities. These manuals probably represent one of the best instru-

ments for the development of humanitarian curricula and psychosocial support for children

(Ministerio de Educacion Nacional and Fundacion Escuela Nueva 2006a, b).

According to several evaluations (Bakhshi 2008; Schiefelbein et al. 1996; Siegrist 2003;

UNICEF and University of Pittsburgh 2004), Escuela Nueva improves the learning skills of

its students thanks to the active participation of parents in the learning and socialization

process. The school offers opportunities for parents and the community to participate in the

debate about the on-going educational process, so that they feel that they ‘‘generate cul-

ture’’ in the sense of Freire’s ideas. The community feels that their culture is valuable and

could be integrated into the daily activity of the school through the many options being

offered in the open and active curriculum. For example, the ‘‘show and tell’’ offered by the

local artisan in the preparation of clay and the teaching of how to use it for the devel-

opment of utensils and even the modelling of the first letters and numbers creates this dual

communication.

Nonetheless, limited research exists at this practical level about curriculum develop-

ment and classroom intervention and there are few reported examples of good practice in

the field. This is partly to do with ethical concerns related to carrying out a study in

emergency settings, such as having a control group that does not receive any interven-

tion—which, in fact, would mean leaving those children without any support (Gupta and

Zimmer 2008). Another explanation for the lack of reported examples of good practice is

the fact that, because an emergency situation is a sudden and unexpected event, researchers

are not prepared to implement evaluation instruments within a psychosocial intervention.

Thus, there is a future need for incorporating such instruments in the planning and pre-

paredness of the educational emergency response. However, UNICEF (2007) created a

guide for the evaluation of psychosocial interventions in humanitarian settings in an effort

to consolidate and systematize the work being carried out in the field, but this guide is not

available for general circulation.

Psychosocial interventions have taken many shapes and forms: (a) some are distinctly

school-based (Berger et al. 2007; Gupta and Zimmer 2008; Houinato and Maclure 2002;

Retamal 2000; Tol et al. 2008); (b) others are out-of-school or centre based (Colliard and

Baggio 2007); (c) some are all-encompassing or, for example, deal with the demobilization

of child soldiers (Betancourt et al. 2008); and (d) others concern individual or small-group

counselling sessions (Chemtob et al. 2002). Emphasis should be placed on examples of

good practice that have effectively introduced the psychosocial approach as an integral part

of the educational humanitarian response.

The dominant tendency in the last decades has been to develop temporary structures or

projects that deal with the problem of psychosocial support as a stop-gap intervention,

without integrating the psychosocial support into the more stable, long-term environment

and development of school curricula. In some cases the results can be disappointing for the

psychosocial practitioners themselves. They see all the effort that they have expended on

the temporary structure of a play group or other arrangements/centres disappear once the

first signs of the emergency assistance evolve into the following stages of rehabilitation

and reconstruction.


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A pioneering example of the need to make an effort to provide psychosocial support to

child victims of humanitarian crises through the school curriculum was Mona Macksoud’s

Helping Children Cope With Stresses of War: A Manual for Parents and Teachers. She

wrote:

However inadequate the buildings and however inexperienced the people appointed

to act as teachers, schools are the main community institution where most, if not all,children can be reached. Hence, there is need for appropriate training of the teachers

to recognize signs of distress in the children and to be able to provide first aid as well

as to know when and whom to refer children on for more experienced help

(Macksoud 1993, p. 4).

The second, overriding issue is the need to integrate ‘‘healing activities’’ into the main

frame of the emergency curriculum. Quality education in complex emergencies in

developing and transition societies requires a different emphasis on aspects related to

‘‘classroom climate’’.1 The protective milieu that education can provide in unstable

environments requires a special response that refers to this aspect of curricula. The main

aim of the curricula is then providing children with the possibility of dealing with their

distressing experiences through: re-creation of habits; re-establishment of relational

behaviours; and having access to creative expression, play and humour (Aguilar and

Retamal 2008; Bloom 1997).

Some systematic evaluation exists that examines, in empirical terms, the assertions that

play and expression are valuable instruments for healing traumatized children in human-

itarian environments. The evaluation of the particular role that the school curriculum can

play in this direction is limited. No reference is developed in Boothby and Melvin’s (2009)

classification along these lines. Perhaps a unique experience is that of Plan International in

Sierra Leone (Plan International 2000). This experience demonstrates that providing an

opportunity for war-affected children to express their bad memories and painful feelings in

an active curriculum environment giving priority to play and expression does reduce the

prevalence of traumatic symptoms, while restoring a sense of hopefulness about the future

(Gupta and Zimmer 2008). The integration of a dual system of evaluation/assessment for

the cognitive and especially the psychosocial domain in the humanitarian curriculum has

helped to foresee the real impact of play, recreation and expression on cognitive devel-

opment and achievement (Gupta and Zimmer 2008; Retamal 2000). Gupta and Zimmer’s

application of a pre- and post-test to assess trauma among the RapidEd displaced camp

school in and around Freetown, Sierra Leone, is significant.

These interventions considerably reduced the majority of children’s post-traumatic

stress (PTS) symptoms. The reduction in PTS symptoms, which included an improvement

in concentration ability amongst 98% of the children, may have also contributed to their

1 This factor of quality education has been demonstrated to be far more relevant than other aspects, such asphysical conditions of the school, multi-classrooms compared to ‘‘normal’’ classrooms, systematic use ofevaluation, or distribution of children by ability. Additionally, the same findings have become the basis forreformulation of educational practices and reform in industrialized countries. What can schools do to make adifference? ‘‘Classroom and school climate’’ are definitively related to better student performance indeveloped countries where teacher/student relations are positive. There is a creative and disciplinary climatein the classroom. Teachers emphasize academic performance and place high demands on students. Thisemphasis should be essentially orientated towards the support of the psychosocial situation of children inhumanitarian settings (LLECE and UNESCO 2002; OECD 2000).


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improved academic performance, whereby 97% of the sample who enrolled for the

national exams passed them 4 months after participating in the RapidEd programme.2

The present review of literature intends to fulfil the purpose of bringing to the forefront

examples of practice of psychosocial integration into the activities and planning of

emergency curricula. In spite of a limited number of examples found, the review also

shows that most of the experiences refer to special out-of-school or centre-based, as well as

community-based and ‘‘stop-gap’’ programmes, such as child-soldier demobilization. Most

of the readily-accessible literature takes the form of theoretical or secondary research.

Annotated bibliography

The following annotated references are divided into four sections. The first is a general

section on education in humanitarian settings, including particular reviews of psychosocial

interventions. The second section includes guides and manuals that have been created by

various NGOs and United Nations agencies, making particular reference to psychosocial

issues within education. The third section includes studies of experiences of psychosocial

support in formal and non-formal educational humanitarian settings. The final section

discusses the use of psychological instruments, providing a table with the instruments used

in the studies mentioned in this article.

Education in humanitarian settings (General aspects concerning psychosocial

interventions and quality of education)

Aguilar, P., & Retamal, G. (2008). Protective environments and quality education in

humanitarian contexts. International Journal of Educational Development, 29, 3–16.

This article engages the reader in a discussion of the need to have protective environments

and quality education in emergency settings and argues the need for more research in the

field to ensure examples of good practice. The authors begin by stating that restoring

community bonds is the starting point to healing and learning. Therefore, school atten-

dance needs to be a protective and healing environment for children, and education needs

to be a priority in emergency settings. From an educational perspective, there is enough

evidence to support recreation and play as part of the psychosocial healing process in

humanitarian settings. Such education cannot be a mere ‘‘stop-gap’’. Resources need to be

made available to ensure that such healing education can continue after the conflict or

disaster. The authors present examples of interventions: in Sierra Leone’s RapidEd study

(Gupta and Zimmer 2008); in Colombia’s Return to Happiness and Friendly Schools—

where emergency interventions fitted well into the existing infrastructure; the Child

Friendly Spaces in the Northern Caucasus (various informal educational activities took

place, with the Ministry of Education on board); in Gujarat, India (support came through

families and villagers, psychosocial activities set up in schools and teachers awareness was

raised, the government recognized the importance). Strategies to improve psychosocial

well-being are beneficial not only for emergency situations, but also for socially margin-

alized people in any society. The authors note that the impact that conflict or natural

disaster can have on a child in an emergency situation does not allow much time to be

spent on building a curriculum. The curriculum (e.g. School-in-a-Box and the Recreation

2 Personal communication with Gupta, 7 September 2010.


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Kit) has to be ready to be put in place to normalize the experiences of children as soon as

possible and avoid future psychosocial problems. It is important that these emergency

interventions leave behind a sustainable curriculum which can be integrated when the

international aid stops. The authors conclude that humanitarian education could be the tool

needed to stop the cycle of ‘‘human destructiveness at a social generational level’’. In

addition, they conclude that more research is needed at a hands-on level to evaluate

whether interventions are effective and sustainable.

Betancourt, T. S., et al. (2008). High hopes, grim reality: Reintegration and the edu-

cation of former child soldiers in Sierra Leone. Comparative Education Review, 52(4),

565–587.

This qualitative study looks at the effects that continuous civil war has had on education in

Sierra Leone, which, prior to the conflict, was already inadequate. Specifically, the study

focuses on the improvement of education for former child soldiers, who have not only

witnessed violent war, but have also often taken part in it, mostly against their will.

Various educational programmes were attempted in Sierra Leone, such as Complementary

Rapid Education for Primary Schools (CREPS) and the Rapid Response Education

Programme (RREP) to accelerate the educational process for children and adolescents who

were older and had not had much education before the war started. However, such

programmes were shown to be of a not-particularly-high quality when compared to

standard programmes. In addition to the aforementioned programmes, NGOs and donor

governments contributed to education through short-term education programmes. How-

ever, these were not sufficiently focused on the reintegration of former child soldiers, but

rather on providing them with basic skills. On the other hand, the Youth Reintegration

Training and Education Peace Programme (YRTEP), funded by USAID, focused heavily

on the reintegration of the former child soldiers into society. The authors, using Ajdukovic

(1998) as an example of such practices, place emphasis on the fact that former child

soldiers who are suffering from ‘‘war trauma’’ are likely to have difficulties in benefiting

from education and that this could lead to problems in the school environment—as well as

drop-out. The study involved a mixed-methods design, which is presented in an incomplete

form in this paper. Data were collected at three different time points from 2002 to 2008.

All interviews were carried out by local research assistants who were trained by the

researchers. The authors conclude that, although there have been steps towards improving

the educational situation in Sierra Leone, ‘‘serious barriers to education remain’’ (p. 13).

They suggest that integrating psychosocial services into schools should be made a priority,

so as to enable the screening of children who are in need of support, in addition to family

and community involvement.

Boothby, N., & Melvin, C. H. (2009). Towards best practice in school-based psycho-

social programming: A survey of current approaches. In R. Mollica (Ed.), Refugeemental health. Nashville, TN: Vanderbilt University Press.

This article reviews six different approaches to psychosocial support provision within

schools for war-affected children. The authors point out that psychologists in the past have

focused too heavily on trauma with the implementation of trauma centres and treatment

programmes. However, they argue that such centres do not reach all children who are in

need. Therefore, ‘‘public health approaches’’ need to be put in place ‘‘through schools,

parent support groups, religious institutions, youth clubs and other community mecha-

nisms’’ (p. 4). Schools and other institutions existing prior to the conflict provide a form of

stability and normalcy for the children, and are hence the best places to implement


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psychosocial healing. Unlike special trauma centres, the school provides an environment

which is accessible to all children. Nonetheless, in war-affected areas, it is difficult to keep

schools open and accessible. Although no comparative controlled studies have been carried

out to show the efficacy of psychosocial interventions in schools, case studies, programme

evaluations, impact studies and field studies have all shown the positive effects of such

interventions. Six approaches—Schools First, Safe Spaces, Teacher Sensitization,

Psychosocial Structured Activities Programmes, Peer-to-Peer Dialogue and School-Based

Counsellors—are reviewed individually with a comparison of advantages ‘‘in terms of

feasibility, scale and results’’ (p. 9). The authors conclude that efforts have been made to

provide psychosocial support to children affected by conflict or disaster. However, this

field is in its infancy in terms of providing consistent psychosocial support. More

systematic studies are required to evaluate and provide evidence of good practice.

Dyregrov, A., & Raundalen, M. (1996). Children and war in the contemporary world.

International Child Health, 7, 45–52.

This article brings to light the atrocious effects of war on children. The authors use two

case studies to emphasize this—Rwanda and Iraq—where they were involved in research

using the Impact of Events Scale (Horowitz et al. 1979). They suggest strategies which

include: raising awareness of the importance of supporting and listening to children in

emergency situations; creating mass outreach programmes (as individual therapy is a

luxury that most cannot afford); ensuring parents and/or caretakers are equally supported

and informed (so that they, in turn, can support their children); giving ‘‘trauma first-aid’’

(i.e. allowing children to express themselves through writing or drawing); using prayer and

religious rituals; and, finally, communicating with children so that they may understand the

situation they are in. All these strategies are explained as theoretical ideas, based on

previous research, which indicate that they might help children overcome their trauma. The

authors conclude that interventions must take place in order to stop the cycle of violence

and hatred. However, the authors do not point towards the need for further practical

systematic research, hence making this paper only theoretical.

Kalksma-Van Lith, B. (2007). Psychosocial interventions for children in war-affected

areas: The state of the art. Intervention, 5(1), 3–17.

This article reviews two approaches to psychosocial interventions in conflict zones: a

curative approach and a developmental approach. The curative approach is one that focuses

on psychosocial and psychological help/treatment at an individual or small group level and

is very much trauma oriented. It uses psychotherapeutic approaches from Western mental

health practice and, hence, involves psychiatrists, psychologists and creative therapists.

Often curative programmes are only implemented over a short time-span. The develop-

mental (community-based) approach has a preventative scope, which does not focus on past

experiences, but rather on the consequences of war and the challenges that arise from it. This

approach endeavours to protect children from future mental and social disorders. It views

child development as something which includes the family and community or the child’s

social environment. This approach does not focus on the symptoms of traumatic

experiences, but rather focuses on coping mechanisms for future protection and resiliency.

Additionally, it nurtures stable emotional relationships with parents/caregivers and social

support, as well as a positive educational climate. The author documents a move towards the

developmental approach, even though some interventions are still curative in nature.

UNICEF, UNHCR, Save the Children and IRC all agree that a psychosocial intervention

which provides stability in the school environment and nurtures family and community


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relationships for all children is more effective than attempting to help each child

individually through specialized psychological counselling. Furthermore, western-style

psychological counselling might not be beneficial to children of different cultures.

Kalksma-Van Lith refers to work by Loughry and Eyber (2003), which suggests that

perhaps both approaches are valid, depending on the context. The author goes on to describe

specific programmes employing each approach and examples of where they have been used.

Although all programmes evaluated using either the curative or developmental approach

show positive results, the research is limited, not systematic and not necessarily

transferrable across countries and cultures (p. 13). Finally, the author notes that, although

curative programmes are simpler to evaluate, developmental approaches are viewed as the

more appropriate approach.

UNICEF and University of Pittsburgh (2004). Child friendly spaces/environments (CFS/

E): An integrated services response for emergencies and their aftermath. Pittsburgh, PA:

UNICEF/University of Pittsburgh.

The authors begin by noting that the CFS/E, which were launched in 1999 by UNICEF, are

continuously adapted to fit the needs of each emergency situation, yet there are no

systematic evaluations of these experiences. Therefore, this paper starts with a case study

analysis of the work done in Albania, Colombia, Liberia, India, Turkey and the Northern

Caucasus. Each case study focuses on the background of the emergency, the key contextual

considerations, results and an analysis of lessons that have been learned for the future. The

theory behind CFS/E is that the spaces need to provide protection to children through

education, health and hygiene, psychological support and recreation. The CFS/E are also

spaces in which the family and community come together to protect the child and be part of

a healing process. The authors emphasize the important ‘‘preventive and rehabilitative’’ (p.

5) role that education has in the protection of children and the fact that education plays a

much broader role in a humanitarian crisis than just cognitive development. The six

situations reported are quite distinct but, in each case, UNICEF assumed the role of co-

ordinator by helping NGOs in delivering services adequately, as well as co-ordinating with

the each country’s ministry of education.

Manuals and guidelines for education in emergency situations (with special reference

to psychosocial environments)

Inter-Agency Network for Education in Emergencies [INEE] (2004). Minimum stan-dards for education in emergencies, chronic crises and early reconstruction. London:

DS Print/Redesign.

These guidelines offer a small section in the form of a checklist on psychosocial aspects in

emergencies. The checklist provides questions on three areas: general conditions; parents;

and children. INEE refers to ‘‘protection and well-being’’ of the child as one of its three

standards, which encompass the promotion of security, protection and mental and emotional

well-being of the students/children. These guidelines provide a very basic description of the

minimum standards for such protection, such as the school’s physical environment, class-

room management and the understanding of emotional and mental well-being.

Macksoud, M. (1993). Helping children cope with the stresses of war: A manual forparents and teachers. New York, NY: UNICEF.


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This manual is presented in a very user-friendly manner. The effects of stress on children

in conflict is dealt with by age-group and advice for both parents and teachers is given on

specific reactions that children might have, such as anxiety, aggression and bed-wetting.

It is divided into six chapters. The first describes war experiences which can affect

children, such as parent loss, war-caused poverty, exposure to combat and becoming a

refugee. This is followed by a chapter on understanding children’s reactions—whether they

are normal or severe, and trying to identify their causes. The next chapter describes age-

appropriate normal reactions to wartime stresses. The fourth chapter embarks on a

discussion of ‘‘home and school’’ support for children and adolescents and relevant

guidelines. Chapter five looks at ten specific behaviours which might occur due to wartime

stress. The final chapter deals with those who need special care, due to severe reactions and

problems. The fourth chapter brings to light practical techniques which can be used to help

the child, such as re-establishing normalcy through activities and schooling, as well as

encouraging the child to express their feelings, supporting realistic hopes for the future and

encouraging expressive play. Macksoud emphasizes the need for the school to provide an

environment in which children can express their feelings and share their experiences, while

still maintaining a level of normalcy through standard classroom teaching. This innovative

publication, for its time, also includes drawings of children who have been affected by war.

These provide a useful insight into how a child might express their experiences.

Ministerio de Educacion Nacional and Fundacion Escuela Nueva (2006a). Manual paratutores y tutoras del modelo de atencion de aprendizaje—Escuela Nueva Activa. Bo-

gota: Fundacion Escuela Nueva.

Ministerio de Educacion Nacional and Fundacion Escuela Nueva (2006b). Documentode Apoyo a la Replicabilidad del Modelo, Cırculos de Aprendizaje—Escuela NuevaActiva (CA-ENA). Bogota: Fundacion Escuela Nueva.

These manuals (Tutors’ manual and Support manual), both created by the Escuela Nueva

(New School) Foundation, go hand-in-hand and for this reason are included here together.

The first one trains the teachers/tutors on the use of the curriculum, classroom management

and evaluation, as well as community relations. The latter manual provides guidelines and

instructions to train the local authorities, headmasters from regular schools, local NGOs,

etc., in making a co-ordinated effort in favour of the educational support for IDP children

participating in the Circulos de Aprendizaje (learning circles).

The Escuela Nueva curriculum comprises guides for students and manuals for teachers

and supervisors. The activities proposed in the guides are supported by study corners, a

small library, as well as by peer or mastery learning, where more advanced or older

children support other children having academic/emotional difficulties. Children work on

small tables where they interact and also work individually under the supervision of the

teacher, who provides feedback.

An adaptation of the mainstream curriculum has been the integrated approach used in

the learning circles. Each guide integrates mathematics, language, science and social

science skills around a theme that is related to the problems of IDP children. Escuela

Nueva places a high degree of importance on school governance, the organizational system

of the students, which attempts to involve children and parents in a responsible way in

school management. It introduces children into an active ‘‘civic and democratic life’’

within the school, developing attitudes of co-operation, solidarity and involvement.

Psychosocial support is a fundamental element provided by learning circles. Self-esteem

and positive, collaborative behaviour is an indicator for measuring the success of the

programme. Three types of instruments have been developed and applied:


123

• Cognitive tests—mathematics and language.

• Verbal and non-verbal ability tests to evaluate children’s basic capacities and aptitudes.

• Self-esteem test (TAE). The application of these TAE tests showed that the self-esteem

of children increased by 18.5% at the end of the process. Furthermore, more than 98%

of children achieved a score demonstrating a normal self-esteem and the need for

external psychological support was no longer necessary (Marchand et al. 2005).

In the case of learning circles, the work of this rather non-formal approach in supporting

internally displaced children is linked from the beginning to the local official school. IDP

children will be incorporated into the regular school after the process of remediation and

upgrading is completed. Local organizations and local social workers provide specialized

services, which include protection and psychological support, with the help of precise

guidelines for affiliation and training. The study guides also incorporate messages pro-

moting special understanding of the social condition of IDP families. The highly developed

and systematic Tutors’ manual covers all aspects concerning teaching methodology and the

creation of a sympathetic environment. Teachers and parents are trained to assess the

psychosocial condition of children following guidelines inspired in Macksoud’s manual

(see below, Macksoud 1993).

Morgan, J. (Ed.). (2010). Trainer’s guide for training teachers in conflict and emergencysettings. Johannesburg: REPSSI and Transcultural Psychosocial Organisation (Psycho-

social Wellbeing Series).

An edited anthology of global teacher-training materials to facilitate the integration of

mental health and psychosocial support into education in conflict and emergency settings.

The guide describes techniques for planning and provides links to various existing tool-

kits, handbooks, manuals and guidelines on teacher training, bringing together various

sources of information and past experiences in the field. It provides checklists and material

lists, as well as emphasizing the need for psychosocial support in order to provide a good

education in emergency situations. Above all, this document categorizes and simplifies the

search for specific guidelines on issues concerning education in emergency situations.

UNICEF (2005). Emergency field handbook: A guide for UNICEF staff. New York, NY:

UNICEF.

UNICEF produced this handbook to encompass all aspects of an emergency response.

Section 5.4 deals specifically with the educational response, comprising all aspects of

education, such as first response, assessment, UNICEF’s role, partner roles, use of kits,

rehabilitating schools, temporary learning spaces, training teachers, re-introducing the

curriculum, working with local authorities and communities, incorporating recreational

activities into the curriculum and creating child-friendly spaces. Psychosocial support is

dealt with throughout the publication (including the Education Section), but has its own

segment in the Child Protection section (5.3), which refers to the need to incorporate/ such

support into the education programme/curriculum. This guide is very detailed and can be

of great use in the field.

UNICEF (2007). Guide to the evaluation of psychosocial programming in emergencies(Field Testing Draft). New York, NY: UNICEF.

This manual, unlike the other manuals described in this section, is intended to guide the

evaluation of psychosocial programming in emergency situations in order to systematize

efforts in this field. UNICEF recognizes that psychosocial interventions in emergencies,

which have been growing in number and importance in recent years, have varied


123

immensely in approaches to the activities provided. Consequently, this has created

inconsistency in the field, as well as discord among professionals on what represents best

practice. UNICEF emphasizes the need for higher quality evaluations and research to

‘‘develop a better understanding of what approaches to psychosocial support are the most

effective, in what situations’’ (p. 2).

Conducting their review of existing evaluations of psychosocial interventions, the

researchers encountered various problems, such as: the lack of ‘‘clear and appropriate

objectives’’ (p. 2); methodological limitations; and the lack of appropriate scales and tools

for evaluating and assessing psychosocial well-being. These problems have been attributed

to the lack of guidance, lack of agreement on objectives of psychosocial interventions and

lack of capacity to address such difficulties. Therefore, the aim of this handbook is to

provide UNICEF and other organizations with basic guidance in the field of psychosocial

interventions. However, the guide does not provide ‘‘detailed guidance on specific skills or

techniques required to conduct psychosocial evaluations’’ (p. 3), but rather makes reference

to appropriate guidelines and tools.

UNICEF (1997). El Retorno a la Alegrıa: Programa de recuperacion psico—afectivamateriales y evaluaciones. Bogota: UNICEF.

These guidelines describe and evaluate the programme of Return to Happiness. The crucial

component of the programme is enabling families and communities to take part in the

psychosocial recovery process. Adolescent volunteers are trained in ‘‘play therapy’’ and

taught how to build the trust and hope of younger children through games, art, puppetry,

song and story-telling.

The programme broke with the Western clinical model of psychosocial therapy by

offering a community-based participatory approach. The youth-to-child relationship, which

is the foundation of the ‘‘Return to Happiness’’ programme, helps rebuild the children’s

trust. Through their work as ‘‘play therapists’’ the adolescent volunteers come to serve as

role models in their communities. There is a set of training protocols developed for the

adolescents that upgrades their capacity as playground leaders/healers and establishes links

between families, schools and communities, forming a network of reconstructive peace-

building. The simplicity of the programme is its cornerstone: the children’s right to play.

Each volunteer receives a ‘‘knapsack of dreams’’ with rag dolls, puppets, wooden toys,

music CDs, books and a manual for the volunteer. The provision of instruments and

materials provided to the volunteer costs about US$198, including a ‘‘boom-box’’ and a

megaphone. This comprises the local production of the knapsack, with all its training

materials, generating income for the community.

The programme has demonstrated its success because it led to improved relationships

between teachers and children, and among the children themselves. This has contributed to

the quality and relevance of the education curriculum. This is especially true of co-

ordination with the other basic component of the IDP UNICEF strategy, the EscuelasAmigas de la Ninez (child-friendly schools).

Winthrop, R., & Kirk, J. (2006). Creating healing classrooms: Tools for teachers andteacher educators. New York, NY: International Rescue Committee, Child and Youth

Protection and Development Unit.

These guidelines by the IRC employ case studies to demonstrate the different ways of

creating healing classrooms. For creating such environments, emphasis is placed on the

training of teachers and creating a support network. Each case study describes a different

innovation that has been successful in a particular place: promoting teacher development in


123

Ethiopia; supporting home-based teachers in Afghanistan; and promoting gender equality

and the protection of girls through teacher and classroom assistant development in Guinea.

The authors reason that a teacher is the first point of entry into creating an environment in

which children who have been exposed to war or natural disaster can feel safe. An

untrained teacher can make the trauma situation worse by marginalizing children and not

allowing them to express themselves. The IRC recognizes that teacher training goes hand-

in-hand with teacher support, and that to enable teachers to provide the support children

needed on a psychosocial and academic level the teachers themselves need a strong

supportive network. These guidelines provide a practical guide to the innovations which

the IRC has used to create a healing classroom environment.

Experiences and studies of psychosocial support in formal and non-formal educational

humanitarian settings

Amston, L. (2001). Review of the former Soviet Embassy Compound IDP Camp psy-chosocial support activities: Kabul, Afghanistan. Kabul: Save the Children.

This report presents the a review of psychosocial support activities that were implemented

by Save the Children, funded by UNICEF, in Kabul IDP camps for 14 months. The

programme was carried out with three specific goals: (a) to build or re-establish ‘‘social

support networks for children and women’’ (p. 17); (b) to increase access to health ser-

vices, education and information; and (c) to encourage long-term or future planning in the

child, youth and mother/care-giver populations. More specifically, the goals of primary

education, other than academic, were to increase self-worth, belonging, empowerment,

initiative, active participation, responsibility within family, development of goals and

future aspirations, etc.

The activities included use of safe age-appropriate playgrounds, various sports and arts

and crafts skill-building (specifically for girls), such as embroidery, beadwork and crochet.

To evaluate the effects of these activities, voluntary focus groups were created with a

variety of community members, so that the entire camp community could take part in the

process. However, many restrictions were placed on the programme, such as the fact that

the Taliban did not allow the depiction of animals or humans in the school textbooks

provided by UNICEF, that girls were not allowed to be educated and that girls could not be

employed, except in the health sector, which forced the skill-building sessions to focus

solely on health education. Furthermore, the programme could not be evaluated as a whole,

due to the restrictions on various camp activities.

The author concludes that lessons learned throughout this programme can be replicated

with adaptations for differing situations. She brings to light ideas for improving psycho-

social support programming, such as involving fathers and brothers actively through

mobilizing them to carry out various activities, such as the upkeep of the school grounds

and training them in education and peaceful conflict resolution skills.

Betancourt, T. S. (2005). Stressors, supports and the social ecology of displacement:

Psychosocial dimensions of an emergency education program for Chechen adolescents

displaced in Ingushetia, Russia. Culture, medicine and psychiatry, 29, 309–340.

In the abstract of this study, Betancourt points out that, although psychosocial interventions

help adolescents, these interventions are initially a temporary replacement of ‘‘normalcy’’ in

the children’s lives, and that what adolescents yearn for is the environment of formal

education. Betancourt also mentions that although NGOs and UN agencies are available,


123

they have ‘‘very few professional and financial resources to provide culturally and context-

appropriate mental health services’’ (p. 310). This study consisted of interviewing fifty-

seven adolescents on their experiences and opinion of psychosocial support through an

emergency education programme. Some were part of the IRC’s emergency education

programme, others had just started in the education programme, and some had not had any

exposure to the education programme. This programme has a particular focus on

strengthening a community support network for children and adolescents and, through this,

providing psychosocial support. Through the interviews, the study found that these

adolescents placed importance on their education for the future and saw it as a safe space to

go and take part in activities with other young people, making new friends and finding social

support. Betancourt concedes that, although this is not a direct link to improved mental

health, the education programme aids the ‘‘social and emotional development’’ of these

adolescents (p. 332). Through the use of the adolescents’ own words, Betancourt provides

an interesting perspective on the situation that displaced adolescents face, rather than using

scales and instruments which do not necessarily encompass how the children feel about

educational and psychosocial interventions.

Colliard, C., & Baggio, S. (2007). Well-being and resilience after the Tsunami: Eval-uation of Terre des Hommes psychosocial programme in Sri Lanka: Final report.Lausanne, Switzerland: Terre des Hommes.

This study involved psychosocial interventions outside a school setting in the Tsunami

region (2004, Sri Lanka), where various interventions have already taken place.

‘‘Empowerment’’ and ‘‘capacity building’’ have been coined by the authors as the aims

of psychosocial programmes. Also, an emphasis on psychosocial support, rather than

mental health, is important so as not to portray post-traumatic stress symptoms as an

abnormality. The aim of this research was to gauge the effect that structured recreational

activities within the Terre des Hommes centres (eighteen in total) had on the children’s

psychosocial well-being, as well as evaluating the mental health of the parents/caregivers.

The study encompassed two field surveys within a 13-month period. Due to ethical and

circumstantial problems, the researchers did not have a control group; however, the data of

both surveys were compared. The first survey was carried out prior to the commencement

of the activity programme. The research team spent a week training animators, supervisors

and social supporters. One year later the same process was carried out. The initial survey

included 417 children, but the second sample, due to drop out, closing of camps and return

to their community of origin, consisted of only 242 children. The survey included the use

of three scales. The first was the Impact of Events Scale (IES) (Horowitz et al. 1979), but

this was only given to the parents/caregivers of the children. The second measure was the

Strength and Difficulties Questionnaire (SDQ), which was administered to parent/care-

givers, as well as to children over 11. Finally, the third questionnaire was the Resiliency

Scale Questionnaire, which was specifically created for this study and was administered to

children, parents/caregivers and selected animators.

The researchers engage in a very detailed analysis of all the factors that could affect

children in disasters, as well as their parents/caregivers. Although, the study unfortunately

does not focus on ‘‘the curriculum’’ of the recreational programme and activities, the

instruments used before and after the implementation of the programme seem to establish a

correlation between recreation/play-group activities and an improvement of psychosocial

well-being and resilience.


123

Goenjian, A. K., et al. (1997). Outcome of psychotherapy among early adolescents after

trauma. American Journal of Psychiatry, 154, 536–542.

The authors undertook a study of a school-based psychotherapy intervention for young

adolescents who had been affected by the Armenian Earthquake of 1988. They measured

post-traumatic stress and depressive reactions among a group of participants and a control

group—pre-intervention and post-intervention. The evaluation included the use of the

Child Post-Traumatic Stress Disorder Reaction Index and the Depression Self-Rating

Scale. The treatment period was short, lasting only 6 weeks, and it was carried out one-

and-a-half years after the earthquake. The intervention took a direct approach to trauma-

healing, whereby different aspects of trauma were dealt with in the sessions, with verbal

expressions of experiences, as well as some drawing. Focus was also placed on building a

better future. However, only sixty-four young adolescents participated, of whom thirty-five

participated in the intervention and twenty-nine formed part of the control group. The

results showed that symptoms of post-traumatic stress decreased significantly over time,

but the symptoms of those in the control group increased over time. However, no change

was found in depression symptoms among participants, but the control group’s depressive

symptoms increased over time. The authors conclude that untreated, symptoms of PTSD

and depression can significantly increase, hence the efficacy of the broad school-based

psychotherapy intervention. Furthermore, they conclude that, due to their success, there is

a justification in using Western-based psychotherapeutic approaches cross-culturally.

Gupta, L., & Zimmer, C. (2008). Psychosocial intervention for war-affected children in

Sierra Leone. The British Journal of Psychiatry, 192, 212–216.

The aim of this study was to determine the psychological status of displaced children prior

to their enrolment in the Plan International/UIE ‘‘RapidEd’’ intervention in Sierra Leone

and to re-assess these children post-intervention to see whether such a programme could

ease traumatic stress symptoms. For this study, 315 children aged 8–18 in two camps for

displaced people in Sierra Leone were interviewed about their war experiences and

reactions to it. Following this, the children took part in a first 4-week ‘‘RapidEd’’

intervention. ‘‘RapidEd’’ involves the amalgamation of basic education and trauma healing

activities which focus on the children’s ability to express themselves. Activities included:

sharing stories of experiences; drawing pictures of worst memories; writing; performing

role-plays; performing traditional dances; and playing musical instruments. The children

also took part in recreational activities, such as volleyball, skipping, athletics, football and

ball-throwing. Sixteen hours per week used for trauma healing activities and 20-min

sessions 4 days per week were unstructured recreation. The main instrument used for

assessing trauma was the Impact of Events Scale (IES) (Horowitz et al. 1979). However,

demographics, exposure to war events and the child’s world view and future perspectives

were all measured. Results showed the positive effect of the programme through

statistically significant decreases in intrusion and arousal symptoms and greater optimism

about the future. On the other hand, there was a slight increase in avoidance reactions,

which the authors suggest could be due to the fact that in post-war situations, a child might

need to use avoidance as a defence mechanism. Although the intervention was successful,

it is difficult to judge how beneficial it is compared with traditional emergency basic

education, due to the lack of a control group. However, in such a situation, the authors note

that ‘‘it seemed unethical to deny a certain group of survivors an opportunity to potentially

alleviate some of their distress by participating in the intervention’’ (p. 215). However,

there is strong correlational support for this finding, as indicated by the post-test IES scores


123

and subjective assessment reports (where 98% of the children stated that their ‘‘ability to

concentrate was better or much better’’ after participating in the writing, drawing, story-

telling, music, dance, drama, and recreational activities) during the first 4 weeks of the

RapidEd intervention.

Houinato, B., & Maclure, R. (2002). The importance of education in disaster rehabili-

tation: Plan’s rapid education programme in Sierra Leone. In A. Jabrey (Ed.), Childrenin disasters: After all the cameras have gone (pp. 25–33). London: Plan UK.

This chapter is a review of the Rapid Education Programme (RapidEd, see Gupta and

Zimmer 2008), which was implemented in Sierra Leone. The authors begin by describing

the unstable history of Sierra Leone and the detrimental effects that this has had on

children’s well-being. The RapidEd programme, which was originally created in Liberia,

Rwanda and Somalia, was taken to Sierra Leonean camps with the agreement of the

Ministry of Education. The aim of RapidEd is to provide basic literacy and numeracy,

structured recreational and reflective activities, which encourage the ‘‘trauma healing’’

process and ‘‘peace education’’. The second aim of the programme is to provide ‘‘the

foundations of a fully formed rapid education methodology that could be widely adopted

by the government and other developmental agencies in Sierra Leone’’ (p. 28). The

RapidEd programme in Sierra Leone was initiated through the creation of a specific

teachers’ guide drawn from previous experiences. The curriculum had two clear domains:

(a) literacy and numeracy, which had the goal of re-integrating children into a formal

education system when possible; and (b) the expression domain, which comprised all the

structured activities to aid trauma healing and personal expression, such as counselling,

physical and health education, drawing, drama, songs, story-telling and peace education.

The programme was supported by ‘‘School in a Box’’ and a ‘‘Recreation Kit’’ as developed

by UNICEF and UNESCO/PEER in Rwanda and Somalia. The RapidEd programme was

fully implemented in four camps in 2001, which was 7 months after the Freetown rebel

attack. Initially, there were workshops for teacher training and how to use the materials

provided. Furthermore, they gave specific training on how to recognize trauma in children

and how to deal with it. RapidEd was shown to be effective through its reliance on

international and national expertise in curriculum development, trauma healing and teacher

training, as well as collaboration with the Ministry of Education and donor agencies.

Furthermore, the speed with which the programme was designed and put into place, the

regular supervision and support for teachers and the flexibility of the programme also made

the RapidEd programme a success. However, some problems arose, such as a dependency

on the programme and external aid, which pinpointed the need for emergency education

response programmes to be able to extend into long-term initiatives when necessary.

Loughry, M., et al. (2006). The impact of structured activities among Palestinian chil-

dren in a time of conflict. Journal of Child Psychology and Psychiatry, 47(12),

1211–1218.

This study aims to see if there is a positive impact from child-focused structured activities on

Palestinian children, who have been continuously exposed to political conflict. The

programme took the form of recreational, non-formal and cultural activities, which were

aimed at ‘‘supporting the development of resilience’’ (p. 1211). The authors hypothesized that

children would benefit from social and emotional well-being, relationships with parents and

future orientation. The methodology involved 250 children from the West Bank and 150

children from Gaza, of whom 300 were part of the intervention group and the other 100

comprised the control group. The measures used were the Child Behaviour Checklist


123

(CBCL), the Parental Support Scale and the Hopefulness Scale–Youth Version. These scales

were used prior to the intervention and 12 months after the intervention. Prior to the

intervention there were no significant differences between the participant group and the

control group. However, 12 months after the intervention, those in the structured activities

had lower CBCL scores and the children in Gaza reported increased parental support. No

significant difference was found between the participants and control group in hopefulness.

The authors mention, however, that perhaps these results cannot be attributed entirely to their

intervention, as there were other humanitarian works occurring simultaneously. Furthermore,

data were collected solely on the basis that the children had enrolled in the programme, but no

data were collected throughout the programme and on specific programme elements.

Retamal, G. (2000). Sierra Leone: Building a rapid educational response, a preliminarydescription. Hamburg: UNESCO Institute for Education/PLAN International Project.

This report describes the process of building and implementing the RapidEd response in

Sierra Leone. In addition, the report provides a clear diagram of the 24 week programme

divided into phases, as well as tables on the time-line and sessions. Three tracks of non-

formal education were developed for the IDP children: (a) basic literacy, with emphasis on

trauma healing and education for peace, particularly for children who were not in schools

and had not had any previous schooling; (b) basic skills, trauma healing and education for

peace for children who had some primary schooling; (c) the third track was focused on

young adults, offering them basic literacy, sports, recreation and peace and reconciliation

education. An emphasis was placed on structured expression and play activities as a means

of relieving trauma, grief and improving stress management (Gupta and Zimmer 2008).

These activities were agreed upon with a Ministry of Youth, Education and Sports’

(MOYES) specialist on counselling. The report also includes brief results of a

questionnaire administered 1–4 weeks after participation in the 24 week programme,

showing an improvement in how the children’s feelings compared to when the programme

began.

Tol, W. A., et al. (2008). School-based mental health intervention for children affected

by political violence in Indonesia: A cluster randomized trial. Journal of the AmericanMedical Association, 300(6), 655–662.

This study aims to gauge the efficacy of a mental health intervention within the school

setting created for children exposed to conflict and who originated from low-income

settings. The study enlists a control group which consisted of those on the waiting list for

the intervention. There were 495 participants with a mean age of 9.9 years in communities

in Poso, Indonesia, where there has been political violence since 1998 between

communities of Muslim and Christian backgrounds. The children received fifteen sessions

over a 5-week period of intervention, such as: trauma-processing activities; co-operative

play; and creative-expressive elements (drama, dance and music). These activities were

carried out by locally-trained (2-week programme) para-professionals (some experience in

humanitarian programmes, but no formal mental-health training). The intervention

followed a cognitive behaviour therapy (CBT) technique and used a structured programme,

focusing on information, safety and control, stabilization, awareness and self-esteem,

trauma narrative and ‘‘reconnecting the child and group to his/her social context using

resiliency based activities’’. The outcome measures included, the Child Post-Traumatic

Stress Scale, Depression Self-Rating Scale, Self-Report for Anxiety Related Disorders (the

five-item version), the Children’s Hope Scale, as well as locally developed rating scales.

Post-test measures were taken at 1 week and then 6 months after the intervention. The


123

study showed that children in the intervention group had less post-traumatic stress

symptoms and maintained hope, compared to those in the control group. However, there

were no significant differences between the groups in traumatic-stress related symptoms,

depressive symptoms, anxiety symptoms or functional impairment. The authors conclude

that school-based psychosocial interventions might not be enough to ‘‘reverse the

challenges to psychosocial well-being presented by chronic poverty and political

instability’’. They suggest that a psychosocial intervention coupled with poverty reduction

and conflict resolution might be more efficient.

Evaluation instruments and conclusions

Although this literature review is not exhaustive, the results show that the correlation

between psychosocial issues within the curriculum and cognitive outcomes were evaluated

in only a few cases. The central aim of this research was to draw attention to the need to

incorporate these evaluation instruments into the psychosocial domain of school curricula

in complex humanitarian emergencies. In this way, the positive impact of the therapeutic or

healing value of the school in these situations could be made clear.

This review presents only two cases where the psychosocial instruments were incor-

porated into the curriculum planning process, its input and outcome assessment. In both

cases the psychological instruments were able to indicate that curriculum intervention had

a positive impact on the psychological well-being of children. In other words, it supported

the concept of the healing value of a given humanitarian curricula. One was the case of the

Sierra Leone experience of RapidEd (Gupta and Zimmer 2008; Houinato and Maclure

2002; Retamal 2000)3 and the on-going experience of Circulos de Aprendizaje from the

Colombian Escuela Nueva (Ministerio de Educacion Nacional and Fundacion Escuela

Nueva 2006a, b).4

The reference to the different psychological instruments, shown in Table 1, presents the

type of instruments that have been used to measure and evaluate the traumatic impact of

war and catastrophic events on children of school age. These instruments have been used in

a variety of ways to gauge the levels of PTSD symptoms, depression, anxiety and resil-

iency. However, except for the two cases mentioned in the previous paragraph, these

instruments have not been integrated into an on-going curriculum as tools to assess the

positive impact that incorporating psychosocial activities/support within the curricula can

have. Although the short-term interventions resulted in positive effects on the well-being of

children, they merely used the tools to evaluate the effects, without necessarily having the

intention of building sustainable, long-term educational and psychosocial programmes.

Furthermore, as can be seen in Table 1, most of the scales used in these studies are not

readily accessible to the public, resulting in limited replication, validation and use of these

instruments by humanitarian educational practitioners, especially in developing countries.

In addition to Table 1, we decided to include the following two annotations in this

section, as we consider them to be valuable. The first provides a psychometric review of

3 Although these three documents all deal with the same intervention—RapidEd—they each take on adifferent focus, providing insight into the details of the programme, which offered IDP children a basiceducation, as well as psychosocial support.4 This data is extracted directly from the manuals of the Escuela Nueva, not from a study per se. It is,however, one of the best examples, as the psychosocial support has been fully integrated into the curriculumthrough the Learning Circles.


123

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trauma youth scales; the second is a study of trauma in war-affected Angolan youth, which

incorporates the use of trauma scales, as well as cognitive measures.

Ohan, J. L., Myers, K., & Collett, B. R. (2002). Ten-year review of rating scales. IV:

Scales assessing trauma and its effects. Journal of the American Academy of Child andAdolescent Psychiatry, 41(12), 1401–1422.

The authors engage in a review of youth trauma scales over the past 25 years, but focus on

the most recent decade. They note that many of these scales are moderately new, which

demonstrates the fact that the field of study of youth trauma is only recent. However, this

signifies that these scales have not been tested to the same degree as in other areas and,

hence, lack the ‘‘depth of psychometric examination’’ (p. 1401) and the ‘‘breadth of

applications’’ (p. 1401). Due to the variety of scales which have been created measuring

different facets of youth trauma, there is a need for future research to stress exactly what

the goal of the study is in order to use an appropriate scale.

Ventura, M. (2003). O stress traumatico e suas sequelas nos adolescentes do sul deAngola. Luanda: Editorial Nzila.

This book is a published doctoral thesis from the University of Minho, Portugal. This

publication is of particular interest for the trauma, anxiety, self-esteem and other scales

which it contains. The author describes each scale in terms of its sub-scales, construction,

validity within the target population and reliability. This in-depth and systematic treatment

of these scales provides a justification as to why they were used instead of other scales. The

measures used in this study were: the PTSD scale for adolescents; the Piers-Harris

Children’s Self-concept Scale; the Manifest Anxiety Scale; the Child Depression

Inventory; Teachers’ Report Form; the Wechsler Intelligence Scale for Children—Revised

Scale; and, finally, the Roberts Appreciation Test for Children.

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Author Biographies

Gonzalo Retamal (Chile) is senior researcher on education in emergencies and post-conflict at UNESCOIBE in Geneva. He was a visiting research fellow at the University of Pittsburgh and the Woodrow WilsonSchool, University of Princeton. Until 2007, he was senior research specialist in the UNESCO Institute forEducation, Hamburg, developing education systems for displaced children in Sierra Leone and youth inKosovo. In the 1990s, he was the UNESCO representative in Iraq for the ‘‘Food for Oil’’ programme. Heworked with UNESCO in Eastern Africa, where he created the PEER Programme in refugee camps inSomalia, Rwanda, Djibouti and Ethiopia. He has been involved in non-formal and formal educationprogrammes in Angola, Belize, Bosnia, Colombia, Honduras, Peru, Southern Africa, Sudan, etc. Retamalholds a Ph.D. from the University of Hull, UK. His publications have been influential in the area of refugeeand humanitarian education.

Maria Low (Spain) is a research fellow at UNESCO IBE. She has a B.A. (Hons) in Applied Psychologyand an M.Sc. in Applied Social Psychology, both from Sussex University. Her graduate research focused onsexual health education in secondary schools in England. Before coming to UNESCO IBE, she worked on avoluntary basis in three NGOs in the UK and Uganda, focusing on HIV/AIDS education and prevention.


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Humanitarian curriculum and psychosocial interventions: An annotated bibliography

Documents