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   Table of Contents - Current issue
Coverpage
July 2018
Volume 16 | Issue 2
Page Nos. 63-196

Online since Monday, July 30, 2018

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EDITORIAL  

From the editor: on deviation(s) p. 63
Marian Tankink
DOI:10.4103/INTV.INTV_49_18  
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CURRENT AFFAIRS Top

Children ‘disappeared’ at the United States/Mexico border: a symptom with consequences for the United States p. 66
Gerald Gray
DOI:10.4103/INTV.INTV_48_18  
‘Disappearing’ people as an act of torture has an ordinary language meaning, such that the United Nations could describe it and various torture treatment centres that address it as torture. The present United States policy of separating families into different prisons at its border with Mexico results in many such disappearances, and therefore is torture of both children and the families they are separated from. This article follows the United Nations description.
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ARTICLES Top

Integrating psychosocial support at Ebola treatment units in Sierra Leone and Liberia Highly accessed article p. 69
Inka Weissbecker, Reshma Roshania, Vanessa Cavallera, Michaela Mallow, Ashley Leichner, Jules Antigua, James Gao, Adam Carl Levine
DOI:10.4103/INTV.INTV_8_18  
The Ebola virus disease (EVD) epidemic killed almost 12,000 people across Sierra Leone, Liberia and Guinea, causing significant psychological distress and suffering. This paper describes International Medical Corps’ innovative and comprehensive model for integrating mental health and psychosocial support (MHPSS) considerations and activities into Ebola treatment units (ETUs) across Sierra Leone and Liberia. This includes staff capacity building as well as psychosocial considerations and activities to address needs and challenges at the ETUs. This model was aimed at reducing patient and family distress and promoting healthy behaviours and recovery. We also include data describing mental health-related symptoms reported by our ETU patients, as well as psychosocial support interventions utilised. We discuss recommendations and lessons learnt and conclude that in line with global guidelines, MHPSS considerations and activities should be integral to all aspects of EVD care. Key implications for practice
  • Patients admitted to ETUs face several stressors and challenges related to the ETU environment and procedures, separation from families and effects of EVD
  • Mental health and psychosocial support considerations should be an integral part of all aspects of care provided at the ETU
  • Paraprofessional psychosocial support workers can play a key role in meeting patient needs at the ETU in line with global mental health and psychosocial support guidelines.
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New targets for behaviour change in Ebola outbreaks: Ideas for future interventions p. 79
Tara Rava Zolnikov
DOI:10.4103/INTV.INTV_4_18  
Ebola virus disease (EVD) is an infectious disease with serious individual health and population consequences. While Ebola is extremely contagious, the 2014 outbreak in West Africa was the worst to date. Many strategies were implemented for the containment and treatment of the disease, although some were limited by a lack of focus on social and behavioural factors. These factors must be taken into consideration during intervention development at the levels of individuals, communities and international networks to address issues that could block intervention success. Projects in which social and behavioural understandings are embedded can have long-lasting results not only within affected communities, but also within institutions, with key players, and at a broader level. Ultimately, removing the barriers to outbreak response strengthens health and social systems and could help to prevent EVD infection and reduce transmission worldwide. Key implications for practice
  • Behaviour-based strategies should include communication through specific groups and subsets of people.
  • This type of communication embedded with social and behavioural understanding can have long-lasting results not only within the community, but also in institutions, key players, and other communities and levels of society.
  • Ultimately, removing the barriers to outbreak response strengthens health and social systems.
  • Being aware of cultural norms and traditions at various levels (individual, community and international) could ultimately help prevent EVD infection and reduce transmission.
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Developing a culturally sensitive mental health intervention for asylum seekers in the Netherlands: A pilot study p. 86
Ortal Slobodin, Samrad Ghane, Joop T.V.M De Jong
DOI:10.4103/INTV.INTV_2_18  
Introduction: This pilot study investigated asylum seekers’ needs and expectations in the mental health field to develop a culturally sensitive psychosocial intervention. Method: Participants were residents of a certain asylum-seekers centre in the Netherlands, with most of them from the Middle East crisis. Needs and expectations were identified using therapy expectations questionnaire (11 participants) and two focus groups (17 participants). Results: Participants associated mental health problems with post-migration stressors more often than with past traumatic experiences. Often, health problems were silenced due to shame, guilt, anxiety and the fear of negative stigma. Individuals and communities were limited in their ability to provide support for those suffering from psychosocial distress due to heavy stigma and the burden of multiple stressors. Conclusion: We underscore the importance of considering the local knowledge of mental health in developing emergency interventions and emphasise the need to reach beyond the trauma-focused approach to strengthen capacities within the community. Key implications for practice
  • Developing a culturally sensitive mental health intervention for asylum seekers requires local knowledge of mental health issues
  • Mental health interventions in emergencies should reach beyond the individualistic trauma-focused approach to address the whole context of forced displacement
  • Because armed conflict often leads to a disruption of the social ecology of a community, mental health interventions should build on existing local support and services and strengthen capacities within the community.
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‘This is not paranoia, this is real life’: Psychosocial interventions for refugee victims of torture in Athens p. 95
Gail Womersley, Laure Kloetzer
DOI:10.4103/INTV.INTV_5_18  
The need for culturally relevant treatment interventions for refugees focusing on post-migration factors is clearly of no small concern. To (i) explore culturally informed perspectives on trauma from an individual, qualitative perspective and (ii) track the trajectory of post-traumatic responses in relation to processes of social integration, we present the results of 12 months of research among asylum seekers and refugees in an NGO-run centre for victims of torture in Athens, Greece. This included an in-depth follow-up of 10 victims of torture, as well as interviews with 36 health professionals, seven cultural mediators and 21 refugee community leaders. A case study from the research project is presented to illustrate the substantial psychological impact of current material realities of refugee victims of torture as they adapt to their new environment. An interpersonal-social model is presented which examines various post-migration ‘feedback loops’ influencing post-traumatic symptomatology. Key implications for practice
  • Professionals working with refugee populations need to take into account the various cultural manifestations and understandings of trauma
  • Post-migration factors encountered in Europe, including delayed asylum trials and poor living conditions, have a substantial impact on post-traumatic symptoms
  • Psychosocial interventions need to include a focus on the current social, political and economic context.
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Trauma-related mental health problems and effectiveness of a stress management group in national humanitarian workers in the Central African Republic p. 103
Capucine de Fouchier, Marianne S Kedia
DOI:10.4103/INTV.INTV_9_18  
The aim of this study is to assess the levels of anxiety, depression and post-traumatic stress disorder (PTSD) in national aid workers in Central African Republic as well as to evaluate the effectiveness of a stress management group in reducing those symptoms. Twenty-seven stress management groups were evaluated in two international non-governmental organisations in which 197 national humanitarian aid workers took part. There was a significant decrease in the intensity of every psychopathological variable tested despite a decrease in the sample between the pre- and post-tests. At post-test, 8.1, 5.1 and 11.1% of the participants had scores indicating anxiety, depression and PTSD compared to 25, 18.9 and 26% at pre-test. The group intervention has demonstrated to be a realistic, effective and cost-effective way to respond to mental health problems in national aid workers living in a context of ongoing violence and where access to specialised services is extremely limited. Key implications for practice
  • Documenting the mental health of national humanitarian staff working in unsecure environment in Central African Republic
  • A one session stress management group protocol can reduce the levels of anxiety, depression and PTSD in this population and hence demonstrating that it is feasible and cost-effective for organizations to honour their duty of care towards national humanitarian workers
  • Further research is needed to confirm these preliminary results, especially in other cultural and humanitarian contexts.
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Dance movement strategies training to help rebuild social capital in Colombia p. 110
Natalia Quinones, Yvonne Gomez, Diana M Agudelo, Gabriela Martínez, María A López
DOI:10.4103/INTV.INTV_42_18  
Building social capital within a post-conflict scenario is key to achieving sustainable peace. The authors implemented an intervention consisting of a 120-h training programme in dance movement strategies in five violence-affected municipalities in Colombia (n = 150). The aim of the intervention was to assess any possible changes in the participants’ states of mindfulness, bodily connection, emotional intelligence, somatic complaints, aggressive reaction, empathy, agency, and subjective emotional experience. We selected the tested variables as conditions necessary to rebuild social capital within a community affected by violence. Post-test measures revealed statistically significant changes in mindfulness, bodily connection, emotional intelligence and regulation, somatic complaints, aggressive reaction, agency, perspective taking, sleep and appetite. Key implications for practice
  • Dance movement strategies help to create the necessary individual conditions for rebuilding social capital in regions heavily affected by an armed conflict
  • Training the community leaders in dance movement strategies positively impacts some aspects that are associated with better trust and reciprocity within communities
  • Community leaders trained in dance movement strategies should be encouraged to replicate these strategies within their own communities.
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Stigma experienced by families with members with intellectual disabilities in Kinshasa, Democratic Republic of the Congo p. 119
Heather M Aldersey, Salome Kavira, Jeef Kiasimbua, Willy Lokako, Pelagie Miaka, Lucie Monte
DOI:10.4103/INTV.INTV_13_18  
Introduction: This article outlines the results of a participatory action research project to (a) understand stigma experienced by family members of people with intellectual disabilities (IDs) in Kinshasa, Democratic Republic of the Congo and (b) identify strategies used by these family members to mitigate or cope with stigma. Methods: We conducted 20 semi-structured interviews with family members of people with ID. Results: All participants in this study discussed experiencing stigma. This stigma was most commonly felt when people directed negative looks, used negative language and names, or refused to touch their family member with ID. Stigma was also directed at the family members as being the ’cause’ of the ID. Family members noted engaging a range of coping mechanisms or strategies to minimise the stigma. Conclusion: Insight from this study could be used to develop interventions benefiting families affected by ID. A sample of suggested interventions include creating opportunities for targeted, local contact with stigmatised persons; reducing or eliminating use of negative and stigmatising names (e.g. kizengi) for people with ID; and promoting self-help and self-advocacy groups for people with ID and their families. Key implications for practice
  • Families of people with intellectual disabilities in Kinshasa, Democratic Republic of the Congo experience personal and family-level stigma
  • Family members use a range of coping strategies, such as referencing religion; educating others; and participating in self-help associations
  • Future interventions might create opportunities for targeted, local contact with stigmatized persons; reduce or eliminate negative and stigmatizing names for people with ID; and promote self-help for people with ID and their families.
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Stigmatisation vécue par les familles de personnes ayant une déficience intellectuelle (DI) à Kinshasa, en République Démocratique du Congo.* p. 129
Heather M Aldersey, Salomé Kavira, Jeef Kiasimbua, Willy Lokako, Pélagie Miaka, Lucie Monté
DOI:10.4103/INTV.INTV_44_18  
Introduction: cet article expose les résultats d’un projet de recherche-action participative visant à : (a) comprendre la stigmatisation subie par les différents membres des familles vivant avec une personne ayant une déficience intellectuelle à Kinshasa, en République démocratique du Congo (RDC) et (b) identifier les stratégies utilisées par ces membres de la famille pour atténuer ou faire face à la stigmatisation, vécue dans leur société d’appartenance. Méthodes: nous avons mené vingt entretiens semi-structurés avec des membres des familles vivant avec une personne ayant une DI. Résultats: les participants à cette étude ont tous mentionné avoir vécu de la stigmatisation. Ils ont surtout ressenti cette stigmatisation lorsque les gens leurs lançaient des regards négatifs, utilisaient un langage ou des surnoms négatifs ou refusaient de toucher la personne ayant une DI. Les membres de la famille étaient eux-aussi visés par cette stigmatisation, car on les considérait comme « responsables » de cette déficience. Les membres des différentes familles ayant participé à l’étude ont mentionné avoir utilisé différents mécanismes ou stratégies de coping pour minimiser le stigma. Conclusion: les données de cette étude peuvent être mise à profit dans le développement d’interventions au profit des familles d’enfants ayant une DI. Les interventions suggérées comprennent la mise en place de lieu de contacts directs entre les personnes vivant la stigmatisation; la réduction ou l’arrêt de l’utilisation de surnoms négatifs et stigmatisants donnés aux personnes ayant une DI (par exemple : kizengi qui signifie idiot) ; et la promotion de groupes d’entraide et d’autodéfense des droits des personnes ayant une DI et de leurs familles. Principales implications pour la pratique
  • Les membres des familles de personnes ayant une DI à Kinshasa, en République démocratique du Congo (RDC) vivent différentes formes de stigmatisation sur les plans personnel et familial dans leur société d'appartenance
  • Elles utilisent un certain nombre de stratégies d'adaptation pour y faire face, comme par exemple la référence à la religion, l'éducation des autres et la participation à des activités organisées par des associations d'entraide
  • Les interventions suggérées comprennent la mise en place de lieu de contacts directs entre les personnes vivant la stigmatisation; la réduction ou l'arrêt de l'utilisation de surnoms négatifs et stigmatisants donnés aux personnes ayant une DI (par exemple : kizengi qui signifie idiot); et la promotion de groupes d'entraide et d'autodéfense des droits des personnes ayant une DI et de leurs familles.
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Highlighting the gender disparities in mental health among Syrian refugees in Jordan Highly accessed article p. 140
Anita L Kisilu, Lina Darras
DOI:10.4103/INTV.INTV_18_18  
Jordan has been a host country to many refugees from neighbouring countries for many years and has recently become a place of refuge for thousands of Syrians. The Syrian crisis has resulted in millions of Syrians fleeing their homes, uncertain of When they will return. Most of those seeking refuge have witnessed and/or experienced traumatic events that have affected their mental well-being in addition to starting over as refugees. Despite the large number of non-profit organizations providing free mental health services to refugees, not everyone has equal access to these services. This report, based on a literature review and a focus group discussion, highlights the different gender dimensions of mental health among Syrian refugees in Jordan. These risk factors include access to and use of mental health services, manifestation of mental health and psychosocial problems, treatment by mental-health workers and the socio-economic outcomes of living with someone suffering from mental health. Key implications for practice
  • To highlight the gender disparities in mental health among Syrian refugees residing in Jordan
  • To highlight the gender differences in mental health needs and services among Syrian refugees in Jordan
  • To provide insight about the level of mental health services provided for Syrian refugees in Jordan.
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FIELD REPORTS Top

Psychosocial support to foster social cohesion between refugee and host communities in Jordan p. 147
Paulina Acosta, Nuria Chica
DOI:10.4103/INTV.INTV_40_18  
The internal conflict in Syria has displaced large numbers of the population into neighbouring countries since the uprising in 2011. The large influx of displaced people into Jordan poses great challenges to the international community as well as local authorities, with increasing competition for already scarce resources and services creating rising tensions between refugee and host communities. In this context, the non-governmental organisation, Action Contre la Faim, implemented a programme aimed at improving psychosocial well-being, fostering resilience and promoting positive interactions between the members of both communities. Through the participation of support groups within community-based organisations, dialogue was facilitated, and interactions took place in a safe and therapeutic environment. Participants reported improved perception of well-being and self confidence, as well as improved mutual understanding and communication, reduced isolation and the extension of social support, enhanced empathy and reduce prejudice.
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Resilience building through alternative intervention: ‘STARTTS “Project Bantu Capoeira Angola”’; On the road to recovery p. 154
Shakeh Momartin, Edielson da Silva Miranda, Jorge Aroche, Mariano Coello
DOI:10.4103/INTV.INTV_6_18  
As a consequence of prolonged exposure to the high levels of cumulative trauma such as war, gross human rights violations and traumatic loss, refugee adolescents are at significant risk of developing psychological and behavioural complications. During resettlement in Australia, they are often faced with social challenges. It is vital to provide support at this vulnerable stage to reduce future setbacks. In response to the high rates of truancy, challenging behaviour in school and negative relationship with teachers and peers, Capoeira Angola programme was implemented to help them better settle in school life, build resilience, using individual strengths and kinesthetic movement for personal growth and recovery. The main aim of this qualitative evaluation was to establish efficacy and ascertain the impact attributable to the programme on psychological and social issues. Positive changes were observed by participant and teacher’s accounts, demonstrating improvements in resilience, self-esteem, interpersonal relationships and school attendance. The significance and benefits of the programme was established and was endorsed its continuation.
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SPECIAL SECTION: PSYCHOSOCIAL SUPPORT AND CONFL ICT TRANSFORMATION: A NECESSARY DIALOGUE Top

Introduction to Special Section on: Psychosocial support, conflict transformation and creative approaches in response to the needs of Syrian refugees in Turkey p. 161
Guglielmo Schinina, Marian Tankink
DOI:10.4103/INTV.INTV_36_18  
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Enhancing the awareness of emotions through art and drama among crisis-affected Syrian refugee children in southeast Turkey p. 164
Necile S Gurle
DOI:10.4103/INTV.INTV_41_18  
By learning to identify feelings and express emotions, children can better cope with the difficulties they face, as well as increase their personal resilience. As the Syrian crisis has entered its seventh year, it has had a negative effect on vulnerable populations, especially children. It should be noted that while not all children have been traumatised, many have experienced conflict and crisis, and in turn face challenges expressing and regulating their emotions and behaviour. The aim of the small study, described in this field report, is to explore the power of using drama and art as tools for Syrian children to help them learn to identify their emotions. The qualitative study was conducted at an informal education centre in southeast Turkey, with 10 children, over the course of five workshops. Basic drama and creative art skills were used to raise awareness about emotions as the first phase of emotion regulation.
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Non-violent communication and theatre of the oppressed: A case study with Syrian refugee women from the Kareemat Centre in Turkey p. 170
Usama Alshughry
DOI:10.4103/INTV.INTV_45_18  
This field report describes a case study on the applicability of non-violent communication (NVC) within the Syrian refugee context, and the usefulness of theatre of the oppressed techniques in practicing NVC. The intervention was applied to refugee women working or attending activities in a livelihood centre in Turkey. Through the work, NVC was explained and discussed with participants, who brought real-life themes and scenarios to practice learnt skills using theatre of the oppressed techniques. Participants reported improved self-compassion, compassion, communication and collaboration with others. They also reported that such activities changed their view of conflict. Theatre of the oppressed helped participants achieves more empathy and understanding and to try different solutions to scenarios in which they faced conflict.
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Dealing with stress using social theatre techniques with young Syrian students adapting to a new educational system in Turkey: A case study p. 175
Cafer Yuksek
DOI:10.4103/INTV.INTV_38_18  
After a migration process, people begin to yearn for the settledness of their previous lives; this includes those in the education process. After the crisis in Syria, millions of refugees came to Turkey, in that, many of whom were students. The students started to enrol and although the schools’ curricula are in Arabic, students of these schools must pass a university entrance exam in the Turkish language to apply. There is also a quota limitation imposed on foreign students in universities. As these obstacles evoke extra-migratory stress among young refugees, the psychosocial support (PSS) needs become even more pronounced. The PSS workshop series outlined in this field report was conducted for Syrian students as they prepare for university admission. The series aimed to support participants to deal with this stressful process through six sessions using art and creativity methods and social theatre tools, including drama therapy games and forum theatre techniques. Through such techniques, the participants were encouraged to express their fears and future anxieties as well as find solutions for self-defined obstacles.
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Creating existential spaces: what do oral history interviews held with Syrian refugee men tell us? p. 181
Isinsu Koc
DOI:10.4103/INTV.INTV_47_18  
The dominant narratives on refugees evolve around vulnerability and trauma discourse that homogenizes a whole group of individuals as traumatized, therefore, vulnerable, as they exposed to an adversity. It is the self-narratives of refugees that reveal the complexity, uniqueness and totality of each person’s experience that can object to this passivation. Oral history in this respect stands as a crucial tool as it creates spaces of existence where refugees can speak freely about their own life stories to the extent and content she/he desires. This small research is a naïve attempt to apply life history approach, and oral history as one of its methodological tool, to psycho-social support at the intersection with refugee studies. Although evolved in different paradigms, this research aims to demonstrate that oral history can also empower refugees since their self-narratives stand as valid sources of reality to challenge the above mentioned discourses, now and then.
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Using art tools with older Syrian refugee women to explore activated development p. 187
Bayan Hakki
DOI:10.4103/INTV.INTV_46_18  
The case study this field report is based on used creative art activities and a systematic approach through the framework of the complex circle. Its aim was to aid Syrian refugee women between the ages of 55–65 to explore changes in their roles and their adversity-activated development after fleeing Syria due to the current conflict. Five psychosocial sessions were conducted, twice a week, with a group of three Syrian refugee women living in Kilis, Turkey. A simplified version of the qualitative ‘adversity-activated development’ grid was used as a pre- and post-intervention assessment and results were analysed qualitatively. Findings showed that at the end of sessions women were expressing more positive feelings and realising positive role changes as well as continued sadness in terms of the separation of their families.
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BOOK REVIEW Top

War Torn: Stories of Courage, Love and Resilience by Kenneth E. Miller. Burdett, New York: Larson Publications. 2016 (295 pages) ISBN-13: 978-1-936012-78-7,eISBN: 978-1-936012-79-4 p. 195
Leslie Snider
DOI:10.1097/WTF.0000000000000155  
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