Summary of the impact

Research by the UoA has transformed trauma recovery for children in situations of on-going violence. Hitherto, trauma recovery was provided post-conflict. Trauma recovery programme research developed at Dundee and led by Dr. Barron has directly improved psycho-trauma assessment and intervention for over 6000 children in Palestine. The UoA has led the development of a battery of screening measures and the delivery of culture-specific programmes into counsellor practice (N=200). These changes in psycho-trauma recovery have developed throughout Gaza (N=5000 children), across the West Bank (N=1000) and into other Middle East countries (Jordan and Egypt; N=200). The research has led to the delivery of trauma recovery programmes for maltreated children in 30% of Scotland's Secure Estate (N=50).

Underpinning research

The impacts covered in this case study developed from child trauma recovery research conducted by Dr. Barron at the University of Dundee from 2008 to 2013. For the first time, research identified and quantified the different types of traumatic events children experience under military occupation in Palestine. Assessment of the consequences of these traumatic events included the development of a battery of screening measures covering the extent and nature of post-traumatic stress disorder (PTSD), depression, traumatic grief and the impact of trauma on familial/peer relationships and children's school performance (Barron, Abdullah and Smith, 2012).

The design of the battery of screening measures for child trauma developed through an international partnership involving researchers at the University of Dundee; University College London; Kings College London; The Centre for Crisis Psychology, Bergen and the Centre for Applied Research in Education, Ramallah. The University of Dundee provided the core role of screening battery design, implementation and evaluation (Barron, Abdullah and Smith, 2012). Associated research at the University of Dundee, examining abuse/trauma prevention across the globe led to inclusion of screening for domestic as well as military violence (Topping and Barron, 2009).

Research at the University of Dundee exploring inter-cultural and ethical issues led to the adoption of a non-colonialist and empowerment framework underpinning trauma recovery programme delivery and research design (Barron and Abdullah, 2013). This guided the inclusion of Western and Middle East trauma recovery programmes; set the research within a socio-political-historical context (e.g. occupation, poverty, domestic violence, mental illness) and sought to understand children's experiences of trauma and programme delivery in their `own' words.

Previous associated research at the University in domestic violence/trauma prevention identified critical methodological gaps, i.e. control groups and randomisation, programme fidelity and exploration of children's subjective experience (Topping and Barron, 2009; Barron and Topping, 2008, 2011). As these gaps were mirrored within the trauma recovery literature this led to a mixed methods approach utilising the gold standard of randomised control trials, the application of focus group methodology and implementation of programme fidelity measures.

University of Dundee research that explored school counsellors' skills underpinning effective delivery of trauma recovery programmes led to the development of a phased model of training where counsellors are now required to develop effective listening and helping skills prior to training in trauma recovery specific programmes (Barron and Abdullah, 2012).

Related on-going research addresses (i) the development of a screening battery to include a measure of dissociation for complex trauma; (ii) the nature of supervision for effective trauma recovery programme delivery; (iii) evaluation of teachers', parents' and school principals' perceptions of trauma seminars in Palestinian Schools and (iv) the identification and amelioration of complex trauma in young people in Scotland's Secure Estate.

References to the research

Details of the impact

Research by the University of Dundee has transformed trauma recovery for children in situations of on-going military violence. Hitherto trauma recovery was provided post-conflict. As a direct consequence of the Dundee research a phased programme of training has developed across Palestine. To date, the phased programme has included training nine hundred school counsellors in Gaza in the indigenous Healing Trauma Combatting Hatred (HTCH) programme; 50 school counsellors have been trained in the newly developed Arabic culture-specific version of the world leading Teaching Recovery Techniques programme (TRT) and twenty school counsellors in Nablus have received the novel Listening Skills for Crisis intervention programme (C1 & C5). The Centre for Applied Research in Ramallah has been monitoring the gains for counsellors over time. Benefits reported by counsellors include: increased knowledge and recognition of the nature of children's trauma, increased skills in listening and in the delivery of trauma recovery programmes and increased confidence in responding to traumatic events. School counsellors also report increased networking between counsellors and increased confidence in practice from access to external international expert consultation (C5).

As a direct consequence of the research involving counsellor training, 5000 children have received the HTCH programme in Gaza and 1000 children have received the TRT programme in the West Bank. This has lead to substantial reductions in the rates of children meeting the criteria for post traumatic stress disorder (down by 25%), depression (down by 50%), traumatic grief (down by 30%) and other mental health concerns (down by 25%). In addition, children's motivation and concentration in school has significantly increased (20% gains). By the end of the rolling programme of training and programme delivery in Palestine more than 1 million children will have benefitted from this initiative (C3, C4, C5).

Assessment of children's subjective experience of programme delivery has led to longer term programmes and greater parental engagement and involvement. The research into children's views has resulted in the development of trauma-informed seminars delivered to teachers, parents and school principals. Five trauma awareness raising seminars have been delivered in Jericho to over 200 teachers, parents and school principals. Focus group evaluation of school staff and parental experience indicates a range of benefits: attitudinal shifts for teachers, head teachers and parents in being better able to recognise challenging behaviour as communication of traumatic stress; knowledge gains in understanding the neurobiology of trauma, skill gains in supporting traumatised children and emotional gains in feeling more confident in their handling of their children. School principals report the importance of embedding trauma-informed practices into the classroom context and ensuring traumatised children have access to trauma specific recovery programmes (C5).

Impact has also occurred at national political level with the development of the first social policy in trauma recovery in Palestine (C1 & C2). Ministry of Education policy now includes a rolling programme of trauma recovery training for counsellors and programme delivery for children and parents. Directly as a result of the Dundee research, this policy incorporates a human rights lens on children's traumatic experience; challenges the cultural stigma of mental illness; sets childhood trauma within wider public health concerns (e.g. unemployment and poverty, sanitation, medical services, utilities and domestic violence); identifies the nature and extent of traumatic exposure and resultant wide ranging symptoms; ensures key support adults' trauma is addressed; and embeds effective trauma recovery programmes into the school curriculum (C1 & C2). The research has also contributed to increased economic capital for CARE, the non-governmental organisation responsible for coordinating the delivery of trauma recovery programmes throughout Palestine (£100,000). This funding has come through related trauma recovery projects (C5).

The Dundee research has led to the application of trauma recovery programmes and the battery of measures to be developed into other conflict situations around the World. In Jordan and Egypt, CARE has delivered trauma recovery programmes to over 200 child refugees. In Scotland, for the first time, the research has led to the delivery of group trauma recovery programmes within Scotland's Secure Estate. The two main secure accommodation services, Rossie and Kibble are now able to provide trauma recovery programmes to over one hundred children who are at risk of suicide and/or harm to others (C3, C4, C6, C7).

Sources to corroborate the impact

C1. Head of Counselling Department, General Directorate of Counselling and Special Education, Palestinian Ministry of Education, Ramallah (policy development and trauma recovery programmes in Palestinian schools).

C2. Member of the Palestinian Parliament, Palestinian Authority.

C3. Emeritus Professor of Applied Child Psychology, King's College, London and a Director of the Children and War Foundation.

C4. Lecturer, King's College, London and Chair of the Board of Directors, Children and War Foundation.

C5. Report on the development of trauma recovery training in Gaza and the West Bank. Centre for Applied Research in Education: Ramallah. http://www.care-palestine.com/trauma-recovery-projects-.html

C6. Children and War Website — Evaluation of the Recovery Manual across Palestinian Schools. http://www.childrenandwar.org/gaza/

C7. Rossie Young People's Trust. http://www.rossie.org.uk/index.php/news/69-trauma-recovery-training.html