Communicating with

Children in Crises

Communicating with

Children in Crises

Dr. Lynne JonesInternational Medical CorpsDevelopmental psychiatry section Cambridge University

Dr. Lynne JonesInternational Medical CorpsDevelopmental psychiatry section Cambridge University

INTRODUCTION

Family approaches in Kosovo

Sexual abuse in Sierra Leone

Grief and loss in Aceh Conclusions

Kosovo Spring 1999

Longstanding conflict over Albanian desire for independence

NATO airstrikes At least ¾ of population of 2

million Albanians flee province at gun point

Remainder trapped in province Serb forces and para-militaries in

control

Arlinda’s story

Drawing family trees

Collective act- engages extended family Interesting and engaging for children Allows for a collective naming of the dead Allows for story telling under child’s

control Children included in collective narrative

Different children, different responses

Arlinda 14: symptomatic, talking and replaying Jeton: talked to journalists, well Mimosa: sad, did not want to talk Arben: Overactive, did not want to talk Dita: reconnect with father Therapeutic activities

Identifying bodies Funeral (only Arlinda went) Play Medical evacuation and treatment in UK All children in school Family support from social services

Mental health and justice

Interviews with war crimes tribunal 2001 All the children talked at length and in detail War crimes trial in Belgrade 2003 All the children wanted to identify

perpetrator and be witnesses Changed attitudes to Serbs All doing well at school

Post conflict Sierra Leone

Kailahun district, Eastern Sierra Leone

Conflict ended 2002 Population c. 300,000 80% houses destroyed > 80,000 displaced > 8000 ex-combatants 1 psychiatrist 120 bed hospital

(14 hours away)

Sexual abuse of a six year old girl

Hysterical paralysis HIV prophylaxis Gentle mobilisation Distraction techniques Dream scripting Protection issues -

case conference Prosecution and

relocation NB Local traditional

approaches inadequate

Silent grief in Aceh

Tsunami 26 December 2005 At least 155,000 died in one

day Landscape obliterated Massive overwhelming loss

Elisa’s story

Using the story

Create a narrative that acknowledges her loss

Acknowledge and give permission for symptoms

Confirm her strength and courage Let her know she is talented and loved Give her the idea that pain will diminish

over time

Some take home points

Cultural political literacy essential Non psychological interventions protect

mental health: Address basic needs Address protection and human rights issues Reconnect children with families Provide medical care Re-establish normal routines activities—

school family life Access to justice

Take home points 2

Assist mourning Primary role to facilitate communication Retelling trauma story not essential Exposure can be helpful; timing up to

child Address sexual and gender based violence Do not neglect children with preexisting

problems (learning disability, epilepsy)

Guidelines for grieving children Provide consistent, enduring appropriate care Reunite children with their families or extended families as

soon as possible In the absence of family create enduring family type

networks with a low ratio of caretaker to children. Consistent care-giving by one or two caretakers, not

multiple volunteers is essential to prevent attachment problems particularly in younger children

The more continuity with the child’s previous life the better. Support the carers by attending to basic needs and their

own mental states. Facilitate normal grieving and mourning—with memorials

for absent bodies, appropriate religious ceremonies Don’t hide the truth Children need clear, honest, consistent explanations

appropriate to their level of development.

They need to accept the reality of the loss, not be protected from it.

Magical thinking should be explored and corrected. What is imagined may be worse than reality and children may be blaming themselves for events beyond their control.

Debriefing may not be therapeutic or appropriate. Encourage a supportive atmosphere where open communication

possible, difficult questions answered, and distressing feelings tolerated.

Allow children to express grief in manner they find appropriate to person they most trust, at a time of their own choosing,

Symptomatic relief: Help the family to cope with traumatic symptoms if they exist. Provide information as to what to expect and straightforward management advice.

Help the child maintain connection with the lost parents—find mementoes if possible or let the child draw pictures, make objects. Answer the child's questions about the dead relative.

Restart normal educational and play activities as soon as possible

Guidelines for grieving children 2

Any Questions?