Skip to main content
Log in

Helping Youth Immediately Following War Exposure: A Randomized Controlled Trial of a School-Based Intervention Program

  • Original Paper
  • Published:
The Journal of Primary Prevention Aims and scope Submit manuscript

Abstract

This study evaluates a school-based primary prevention intervention designed to promote adolescents’ coping in the immediate aftermath of war exposure in Operation Cast Lead. Participants were 179 adolescents from two demographically similar schools in Ashkelon in south Israel. The intervention incorporated two previously proven resilience factors—mobilization of support and self-efficacy. In a repeated measures design, the study assessed pre- to post-test changes in intervention (n = 94) and control (n = 85) conditions among adolescents exposed to high or low political life events (PLE). Findings showed significant pre-test differences in self-efficacy and psychological symptoms between participants with low and high PLE. For both PLE groups, the intervention strengthened support mobilization and self-efficacy and reduced psychological distress and emotional symptoms. Findings reinforce the importance of offering appropriate evidence-based interventions for school staff to restore security and well-being to adolescents in a crisis context immediately following war. Despite the apparent return to a school routine after war, school staff should be aware of the risk to youth for development of psychological symptoms and disorders, and the need for preventative intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1–26. doi:10.1146/annurev.psych.52.1.1.

    Article  PubMed  CAS  Google Scholar 

  • Benight, C. C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behavior Research and Therapy, 42, 1129–1148.

    Article  Google Scholar 

  • Berger, R., & Gelkopf, M. (2009). School-based intervention for the treatment of tsunami-related distress in children: A quasi-randomized controlled trial. Psychotherapy and Psychosomatics, 78, 364–371.

    Article  PubMed  CAS  Google Scholar 

  • Berger, R., Gelkopf, M., & Heineberg, Y. (2012). A teacher-delivered intervention for adolescents exposed to ongoing and intense traumatic war-related stress: A quasi-randomized controlled study. Journal of Adolescent Health, 51, 453–461.

    Article  PubMed  Google Scholar 

  • Berger, R., Pat-Horenczyk, R., & Gelkopf, M. (2007). School-based intervention for prevention and treatment of elementary-student’s terror related distress in Israel: A quasi-randomized controlled trial. Journal of Traumatic Stress, 20, 541–551.

    Article  PubMed  Google Scholar 

  • Betancourt, T. S., & Williams, T. (2008). Building an evidence base on mental health interventions for children affected by armed conflict. Psychosocial Work and Counseling in Areas of Armed Conflict, 6, 39–56.

    Google Scholar 

  • Brown, E. J., & Goodman, R. F. (2005). Childhood traumatic grief: An exploration of the construct in children bereaved on September 11. Journal of Clinical Child and Adolescent Psychology, 34, 248–259.

    Article  PubMed  Google Scholar 

  • Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press.

  • Canneti, L., Shalev, A. Y., & Kaplan de-Nour, A. (1994). Israeli adolescent norms of the Brief Symptom Inventory (BSI). Israeli Journal of Psychiatry and Related Science, 31, 13–18.

    Google Scholar 

  • Caplan, G. (1964). Principles of preventative psychiatry. New-York: Behavioral Sciences.

    Google Scholar 

  • Charles, C. B., Benight, C. C., Swift, E., Sanger, J., Smith, A., & Zeppelin, D. (1999). Coping self-efficacy as a mediator of distress following a natural disaster. Journal of Applied Social Psychology, 29, 2443–2464.

    Article  Google Scholar 

  • Cowen, E. L. (1983). Primary prevention in mental health: Past, present, and future. In R. D. Felner, A. Jason, J. N. Moritsugu, & S. S. Farber (Eds.), Preventive psychology: Theory, research, and practice (pp. 11–25). New York: Pergamon Press.

    Google Scholar 

  • De Berry, J. (2004). Community psychosocial support in Afghanistan. Psychosocial Work & Counseling in Areas of Armed Conflict, 2, 143–151.

    Google Scholar 

  • Derogatis, L. R., & Spencer, P. M. (1982). The Brief Symptom Inventory (BSI): Administration, and procedures manual-I. Baltimore, MD: Clinical Psychometric Research.

    Google Scholar 

  • Dyregrov, A., Gupta, L., Gjestad, R., & Mukanoheli, E. (2000). Trauma exposure and psychological reactions to genocide among Rwandan children. Journal of Traumatic Stress, 13(1), 3–21.

    Article  PubMed  CAS  Google Scholar 

  • Ehntholt, K. A., Smith, P. A., & Yule, W. (2005). School-based cognitive-behavioural therapy group intervention for refugee children who have experienced war-related trauma. Clinical Child Psychology and Psychiatry, 10, 235–250.

    Article  Google Scholar 

  • El Zein, H. L., & Ammar, D. F. (2011). Assessing Lebanese children’s reactions to war-related stress. Journal of Loss and Trauma, 16(3), 195–204.

    Article  Google Scholar 

  • Finzi-Dottan, R., Dekel, R., Lavi, T., & Su’ali, T. (2006). Posttraumatic stress disorder reactions among children with learning disabilities exposed to terror attacks. Comprehensive Psychiatry, 47, 144–151.

    Article  PubMed  Google Scholar 

  • Fogle, L., Huebner, E. S., & Laughlin, J. E. (2002). The relationship between temperament and life satisfaction in early adolescence: Cognitive vs. behavioral mediation models. Journal of Happiness Studies, 3, 373–392.

    Article  Google Scholar 

  • Fremont, W. P. (2004). Childhood reactions to terrorism-induced trauma: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 381–392.

    Article  PubMed  Google Scholar 

  • Gelkopf, M., & Berger, R. (2009). A school-based, teacher-mediated prevention program (ERASE-Stress) for reducing terror-related traumatic reactions in Israeli youth: A quasi-randomized controlled trial. The Journal of Child Psychology and Psychiatry, 50(8), 962–971.

    Article  Google Scholar 

  • Goodman, R., Meltzer, H., & Bailey, V. (1998). The Strengths and Difficulties Questionnaire: A pilot study on the validity of the self-report version. European Child and Adolescent Psychiatry, 7, 125–130.

    Article  PubMed  CAS  Google Scholar 

  • Gupta, L., & Zimmer, C. (2008). Psychosocial intervention for war-affected children in Sierra Leone. British Journal of Psychiatry, 192(3), 212–216.

    Article  PubMed  Google Scholar 

  • Guttmann-Steinmetz, S., Shoshani, A., Farhan, K., Aliman, M., & Hirschberger, G. (2012). Living in the crossfire: Effects of exposure to political violence on Palestinian and Israeli mothers and children. International Journal of Behavioral Development, 36, 71–78.

    Article  Google Scholar 

  • Hollifield, M., Eckert, V., Warner, T. D., Jenkins, J., Krakow, B., Ruiz, J., et al. (2005). Development of an inventory for measuring war-related events in refugees. Comprehensive Psychiatry, 46, 67–80.

    Article  PubMed  Google Scholar 

  • Jones, L., & Kafetsios, K. (2005). Exposure to political violence and psychological well-being in Bosnian adolescents: A mixed method approach. Clinical Child Psychology & Psychiatry, 10, 157–176.

    Article  Google Scholar 

  • Jordans, M. J. D., Komproe, I. H., Tol, W. A., Kohrt, B. A., Luitel, N. P., Macy, R. D., et al. (2010). Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: A cluster randomized controlled trial. Journal of Child Psychology and Psychiatry and Allied Disciplines, 51(7), 818–826.

    Article  Google Scholar 

  • Jordans, M. J. D., Tol, W. A., Komproe, I. H., & De Jong, J. T. V. M. (2009). Systematic review of evidence and treatment approaches: Psychosocial and mental health care for children in war. Child and Adolescent Mental Health, 14, 2–14.

    Article  Google Scholar 

  • Joshi, P. T., & O’Donnel, D. A. (2003). Consequences of child exposure to war and terrorism. Clinical Child and Family Psychology Review, 6, 275–292.

    Article  PubMed  Google Scholar 

  • Klingman, A. (2002) Children under stress of war. In A. La Greca, W. K. Silverman, E. Vernberg, & M. C. Roberts (Eds.), Helping children cope with disasters and terrorism (pp. 359–380.(Washington, DC: American Psychological Association.

  • Klingman, A., & Ben Eli, A. (1981). A school community in disaster: Primary and secondary prevention in situational crisis. Professional Psychology, 12, 523–532.

    Article  Google Scholar 

  • Layne, C. M., Saltzman, W. R., Poppleton, L., Burlingame, G. M., Pasalić, A., Duraković, E., et al. (2008). Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1048–1062.

    Article  PubMed  Google Scholar 

  • Lonigan, C. J., Phillips, M., & Richey, J. A. (2003). Posttraumatic stress disorder in children: Diagnosis, assessment, and associated features. Child and Adolescent Psychiatric Clinics of North America, 12, 171–194.

    Article  PubMed  Google Scholar 

  • Mansbach-Kleinfeld, I., Apter, A., Farbstein, I., Levine, S. Z., & Ponizovsky, A. M. (2010). A population-based psychometric validation study of the strengths and difficulties questionnaire—Hebrew version. Frontiers in Psychiatry, 1, 151.

    Article  PubMed  Google Scholar 

  • Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227–238.

    Article  PubMed  CAS  Google Scholar 

  • Masten, A. S., & Coatsworth, J. D. (1998). The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53(2), 205–220.

    Article  PubMed  CAS  Google Scholar 

  • McDermott, M., Duffy, M., & McGuiness, D. (2004). Addressing the psychological needs of children and young people in the aftermath of the Omagh Bomb. Child Care in Practice, 10, 141–154.

    Article  Google Scholar 

  • Moore, K. W., & Varela, R. E. (2010). Correlates of long-term posttraumatic stress symptoms in children following Hurricane Katrina. Child Psychiatry and Human Development, 41, 239–250.

    Article  PubMed  Google Scholar 

  • Muris, P. (2001). A brief questionnaire for measuring self-efficacy in youths. Journal of Psychopathology and Behavior Assessment, 23, 145–149.

    Article  Google Scholar 

  • Offord, D. R. (2000). Selection of levels of prevention. Addictive Behaviors, 25, 833–842.

    Article  PubMed  CAS  Google Scholar 

  • Paardekooper, B. (2002). Children of the Forgotten War: A comparison of two intervention programs for the promotion of well-being of Sudanese refugee children. Amsterdam: Vrije Universiteit.

    Google Scholar 

  • Pat-Horenczyk, R., Qasrawi, R., Lesack, R., Haj-Yahia, M. M., Peled, O., Shaheen, M., et al. (2009). Posttraumatic symptoms, functional impairment, and coping among adolescents on both sides of the Israeli–Palestinian conflict: A cross-cultural approach. Applied Psychology: An International Review, 58, 688–708.

    Article  Google Scholar 

  • Paykel, E. S., Prusoff, B. A., & Uhlenhuth, E. H. (1971). Scaling of life events. Archives of General Psychiatry, 25, 340–347.

    Article  PubMed  CAS  Google Scholar 

  • Pina, A. A., Villalta, I. K., Ortiz, C. D., Gottschall, A. C., Costa, N. M., & Weems, C. F. (2008). Social support, discrimination, and coping as predictors of posttraumatic stress reactions in youth survivors of Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology, 37, 564–574.

    Article  PubMed  Google Scholar 

  • Rose, S., & Bisson, J. (1998). Brief early psychological interventions following trauma: A systematic review of the literature. Journal of Traumatic Stress, 11, 697–711.

    Article  PubMed  CAS  Google Scholar 

  • Rosner, R., Powell, S., & Buttollo, W. (2003). Posttraumatic stress disorder three years after the siege of Sarajevo. Journal of Clinical Psychology, 59, 42–57.

    Google Scholar 

  • Rutter, M. (2000). Resilience reconsidered: Conceptual considerations, empirical findings, and policy implications. In J. P. Shonkoff & S. J. Meisels (Eds.), Handbook of early childhood intervention (2nd ed., pp. 651–682). New York, NY: Cambridge University Press.

    Chapter  Google Scholar 

  • Seeman, T. E. (1996). Social ties and health. Annals of Epidemiology, 6, 442–451.

    Article  PubMed  CAS  Google Scholar 

  • Shaw, J. A. (2003). Children exposed to war/terrorism. Clinical Child and Family Psychology Review, 6, 237–246.

    Article  PubMed  Google Scholar 

  • Slone, M. (2006). Promoting children’s coping in politically violent environments: Suggestions for education. In C. Greenbaum, P. Veerman, & N. Bacon-Shnoor (Eds.), Protection of children during armed political conflict: A multidisciplinary perspective (pp. 169–195). Antwerp: Intersentia.

    Google Scholar 

  • Slone, M., & Shechner, T. (2009). Psychiatric consequences for Israeli adolescents of protracted political violence: 1998–2004. Journal of Child Psychology and Psychiatry, 50(3), 280–289.

    Article  PubMed  Google Scholar 

  • Slone, M., & Shoshani, A. (2008). Efficacy of a school-based primary prevention program for coping with exposure to political violence. International Journal of Behavior Development, 32, 348–358.

    Article  Google Scholar 

  • Slone, M., Shoshani, A., & Paltieli, T. (2009). The psychiatric burden of forced evacuation on children: Contextual and family risk and protective factors. Journal of Traumatic Stress, 22, 340–343.

    Article  PubMed  Google Scholar 

  • Smith, P., Perrin, S., Yule, W., Hacam, B., & Stuvland, R. (2002). War exposure among children from Bosnia-Herzegovina: Psychological adjustment in community sample. Journal of Traumatic Stress, 15, 147–156.

    Article  PubMed  Google Scholar 

  • Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J. D., Macy, R. D., & De Jong, J. (2008). School-based mental health intervention for children affected by political violence in Indonesia—A cluster randomized trial. JAMA—Journal of the American Medical Association, 300, 655–662.

    Article  CAS  Google Scholar 

  • Udwin, O., Boyle, S., Yule, W., Bolton, D., & O’Ryan, D. (2000). Risk factors for long-term psychological effects of a disaster experienced in adolescence: Predictors of post-traumatic stress disorder. Journal of Child Psychology and Psychiatry, 41, 969–979.

    Article  PubMed  CAS  Google Scholar 

  • Werner, E. E. (2000). Protective factors and individual resilience. In J. P. Shonkoff & J. Samuel (Eds.), Handbook of early childhood intervention (pp. 115–132). Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Wessells, M., & Monteiro, C. (2004). Healing the wounds following protracted conflict in Angola: A community-based approach to assisting war-affected children. In U. P. Gielen, J. Fish, & J. G. Draguns (Eds.), Handbook of culture, therapy, and healing (pp. 321–341). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Wolmer, L., Hamiel, D., Barchas, J. D., Slone, M., & Laor, N. (2011a). Teacher-delivered resilience-focused intervention in schools with traumatized children following the second Lebanon war. Journal of Traumatic Stress, 24(3), 309–316.

    Article  PubMed  Google Scholar 

  • Wolmer, L., Hamiel, D., & Laor, N. (2011b). Preventing children’s prosttaumatic stress after disaster with teacher-based intervention: A controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 340–348.

    Article  PubMed  Google Scholar 

  • Wolmer, L., Laor, N., & Yazgan, Y. (2003). School reactivation programs after disaster: Could teachers serve as clinical mediators? Child and Adolescent Psychiatric Clinics of North America, 12, 363–381.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was generously supported by a Grant from the French Friends of Tel Aviv University.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michelle Slone.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Slone, M., Shoshani, A. & Lobel, T. Helping Youth Immediately Following War Exposure: A Randomized Controlled Trial of a School-Based Intervention Program. J Primary Prevent 34, 293–307 (2013). https://doi.org/10.1007/s10935-013-0314-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10935-013-0314-3

Keywords

Navigation