Palestinian and Norwegian Kindergarten Teachers' Perspectives on Psychosocial Support: A Qualitative Study.

The current qualitative case study aims to explore and map the concepts and the conditions for providing psychosocial support in kindergarten across two vastly different countries, Palestine and Norway. The global challenge of providing psychosocial support toward children is increasingly acknowledged. Although education is described as crucial for psychosocial support from the health sector, studies dealing with the educational perspective on this topic are rare. Data from 26 participants (10 from Gaza, 10 from Hebron and 6 from Norway) were collected in qualitative semi-structured interviews. Despite vastly different contexts, the analysis showed some important common features. Kindergarten teachers in both countries link psychosocial support conceptually to psychological and emotional knowledge. The teachers in both countries are concerned about the psychosocial support being performed repeatedly in everyday situations, such as establishing routines, paying extra attention, and calming children and creating everyday safe spaces. They give detailed descriptions of the quality of their long-term, yet professional relations with the child. Time and space are crucial challenges in both countries, and they call for more knowledge on mental health. A main difference between the two countries was the role of the community and relation to parents. The Palestinian teachers defined psychosocial support as a "set of community services," the teachers were frustrated with the lack of parental collaboration. The Norwegian teachers downscaled or overlooked the importance of community or parents and community. The findings give overall presentations of the concepts and the conditions for providing psychosocial support in education Palestine and Norway. We argue that education not only represents sites for conducting health-directed interventions but represents important resources for developing the field of psychosocial support in collaboration with community services. Education - and especially kindergarten provides other values, knowledge, and structural resources for the development programs and knowledge on psychosocial support.

Traumatic Events and PTSD Among Palestinian Children and Adolescents: The Effect of Demographic and Socioeconomic Factors.

BACKGROUND: The situation in the Gaza Strip is uncommon in the frequency with which children are exposed to war-related traumatic events on a daily basis and because of the long-term nature of the conflict. The prevalence of posttraumatic stress disorder (PTSD) among children and adolescents in the Gaza Strip increased after the recent wars. The aims of the study are: To investigate the prevalence and nature of war traumatic events and PTSD; and to investigate how these traumatic events predict PTSD when taking into account demographic and socioeconomic status factors amongst Palestinian children and adolescents in the Gaza Strip. METHODS: The sample consists of 1,029 school pupils (11-17 years old): 533 (51.8%) were female and 496 (48.2%) were male. War-Traumatic Events Checklist (W-TECh) Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS) were used. RESULTS: The majority of children and adolescents experienced personal trauma (N: 909; 88.4%), witnessed trauma to others (N: 861; 83.7%) and observed demolition of property (N: 908; 88.3%) during the war. Compared to girls, boys showed significantly more exposure to all three event types as well as overall traumatic events. Results also demonstrated that the prevalence of DSM-V PTSD diagnosis was 53.5% (N = 549). Further, children who had experienced personal trauma, trauma to others, and the demolition of property were significantly more likely to be diagnosed with PTSD compared to those who had not, even when adjusting for demographic and socioeconomic factors. The strongest war trauma for PTSD is personal trauma followed by witnessing trauma and then observing demolition of properties. CONCLUSIONS: The study provides valuable evidence that demographic and socioeconomic factors mediate the relationship between different war traumatic events and PTSD. Interventions should take into account the children's background including their gender, age, where they live, and their socioeconomic status (e.g., family income, parents' educational level, family size) to alleviate the psychological symptoms and to enhance their resilience.

The relationship between multiple exposures to violence and war trauma, and mental health and behavioural problems among Palestinian children and adolescents.

The current study aims to investigate the effect of cumulative exposure to violence on mental health amongst children and adolescents living in the Gaza Strip. The sample consists of 1029 children and adolescents aged 11-17 years. Of them, 533 (51.8%) were female and 496 (48.2%) were male. War-traumatic events were measured using the War-Traumatic Events Checklist (W-TECh). Violence was derived from the Multicultural Events Schedule for Adolescents (M.E.S.A.) containing three domains: violence at home, violence in the neighbourhood, and violence at school. Emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ). Posttraumatic Stress Disorder was measured using the Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS). Finally, depression symptoms were measured by the Depression scale. Around two thirds of the children (64.5%, N = 665) reported that they were exposed to violence at home, 48.2% (N = 497) to violence in the neighbourhood, 78.2% (N = 806) to violence at school. In addition, boys significantly showed more exposure to violence compared to girls. Moreover, the prevalence of PTSD according to DSM-5 is 53.5% (N = 549). The results also showed that cumulative effect of exposure to violence in more contexts (political war trauma, violence at home, neighbourhood and/or school) predicted higher levels of PTSD, social and emotional problems, depression, and overall mental health problems amongst children. Cumulative exposure to violence may increase the propensity of developing mental health problems such as PTSD, emotional and behavioural problems, and depression symptoms and thus interventions should be targeted to these populations.

Effectiveness of a School-Based Intervention on the Students' Mental Health After Exposure to War-Related Trauma.

BACKGROUND: After the war, which was conducted against Palestinian civilians in the Gaza Strip, the prevalence of posttraumatic stress disorder (PTSD) among children and adolescents has increased. The counselling department at the Ministry of Education in the Gaza Strip applied a counselling program in schools in order to alleviate the effect of exposure to war. The aim of the study is to investigate the effectiveness of the counselling program after exposure to war-traumatic events among Palestinian children and adolescents in the Gaza Strip. METHODS: The sample consists of 572 students aged 12-18 years old. Of them, 331 (57.9%) were female and 241 (42.1%) were male. Traumatic events were measured by War-Traumatic Events Checklist (W-TECh). PTSD was measured by the Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS). Anxiety symptoms were adapted from The Anxiety Symptoms Scale, and depression symptoms were measured by Child Depression Inventory. Repeated measures design was employed as the counselling program was applied in all the schools at the same time. Specifically, the data were collected from the participants before the application of the counselling program and 2 months later. RESULTS: After applying the school-based counselling program, the prevalence of PTSD (according to DSM-V) decreased from 57.5% to 45.6% among the children and adolescents who were exposed to war-traumatic events. In addition, PTSD symptoms, and emotional, somatic and cognitive functional impairment symptoms has decreased after the implementation of the counselling program especially amongst girls. CONCLUSIONS: The school-based counselling program was effective in decreasing the PTSD symptoms among children and adolescents after the exposure to war-traumatic events.