School-based interventions for minors in war-exposed countries: a review of targeted and general programmes

Lately, there has been a call to develop and assess efficacious mental health interventions for minors who have witnessed organized violence. This review outlines what is currently known about targeted and general school-based interventions for children and adolescents in war exposed countries. Seven empirical outcome studies were identified from a PubMed and PsychINFO search; four targeted and three general programmes. Despite the paucity of published evidence, some promising findings were noted. School-based interventions implemented by locally trained paraprofessionals in organized violence settings appear to be a feasible and low cost sustainable alternative to individualized therapy for distressed children in low and middle income countries. However, the reported outcomes for treatment effectiveness were mixed and suggest that school-based group crisis interventions for traumatized war exposed minors may not be sufficient to reduce mental distress and may sometimes even increase it. Several limitations in the published literature were observed. Although studies reported changes in symptoms associated with interventions, most did not report on the degree of functional impairment. Further, there may be a need to develop interventions targeting other dimensions of organized violence than post-traumatic distress, for example, depression and maladaptive grief. At this point in time it is difficult to compare targeted versus general interventions. There may be risks associated with screening minors, and studies should weigh the cost benefit of targeted versus broader treatment approaches. Future research should aim to determine which therapeutic ingredients, which could be professional-specific, such as manualized cognitive-behavioural therapy, culture-specific, or a combination, significantly contribute to positive outcomes.