Impact case study database

Changing worldwide policies and support for traumatised children and carers

The World Health Organization (WHO) (2018) used [ R7, R8b] evidence—that displaced children often internalise MHD— to design targeted health care guidance for 1million asylum-seeking children registered in the EU, including 200,000 unaccompanied children (2015–2017) [ E1]. WHO (2016) drew on Vostanis et al.’s school mental-health models [ R5] to recommend targeted school programmes to improve literacy for displaced children [ E1].

Vostanis and Team’s evidence associating parent/carer support with PTSD reduction in war children and refugees [ R3, R6, R7, R8a,b] informed several UN and UNESCO recommendations. [ R3, R7] informed the UN’s Global study on children deprived of liberty (2019) and Occupied Palestinian Territory Report (2016), with both recommending law, policy and practice safeguards to reduce stigmatisation of displaced children and protect their human rights [ E2]. UNESCO (2015) implemented [ R6, R7, R8a,b] findings to recommend evidence-led training to reduce PTSD by embedding caretaker/family communication and activities with traumatised Palestinian children [ E3]. UNESCO’s Policy Papers (2019, 2015) directly drew upon [ R5, R8b] to recommend an integrated programme involving schools, healthcare, communities, teachers, and families, to holistically support traumatised children [ E3].

The NSPCC Priorities for Change (2015) [ E4] and the Department for Education (DOE) report (2015) [ E5] implemented the Team’s findings that carers may be unequipped to manage MHD in looked-after children [ R1 – R3], recommending carer/child interventions to prevent placement and attachment breakdown. The NSPCC (2016 ) Case for Change used [ R2] evidence to demand mental-health monitoring for infants in care to prevent later-life MHD [ E4]. The prevalence of unsupported refugee children with PTSD [ R4] informed the European Union Policy Report (2019) decision to devise a national committee for inclusive systems in EU Member States, integrating education, health and social services to support minority children – with refugees co-designing anti-bullying and anti-prejudice curricular resources [ E7]. The Migration Policy Institute Report (USA, 2015) used [ R4] to recommend multi-agency educational and mental health interventions for Syrian refugee children [ E6].

Transformed mental-health care in 14 countries

Building on [ R1 – R5], Vostanis and team collaborated with 29 NGOs, clinical services and community centres in 14 LMICs to design—often from nothing—sustainable service-delivery frameworks [ R8a,b]. The Team trained >1,200 service providers (SP) in health/social care, education, or the community (each with an average caseload of 50 children annually) to identify trauma and provide support for >44,000 children and young people who have experienced trauma in slums, orphanages, refugee camps, and care facilities. [ R8a,b, E8].

Professional and community practice

Practitioners in Asia (430); Latin America (210); and Africa (460) stated that WACIT training [ R8a,b] strengthened their strategic practices and improved relationships with children. WACIT’s three-year programme in South Africa “strengthened the relationship between me and the young people. And I’ve seen behaviour change.” – Care home manager. In Kenya, WACIT’s three-year interventions “gave me . . . impetus to continue. I have come up with various strategic plans in the church that target young people. I have now almost 100 kids and 50 young men and ladies . . . and every week we hold training for them”. - Pastor caring for slum and displaced children [ E8].

Government and NGO policy and practice

Eighteen Government and NGO managers (Turkey, Kenya, Rwanda, South Africa, Brazil) stated that [ R8a,b] raised practitioners’ child-mental-health awareness and directly changed their policy and practice, with a demonstrable effect on carers’ thinking, behaviours, and confidence. After WACIT’s four-year programme in Turkey, an NGO caring for >400 refugee and street children and families stated: “We improved our connection with other NGOs. We organised trainings for volunteers . . . and collaborated with municipalities. So, parents, children, government and NGOs worked together” [ E8].

The CEO of NGO disability care homes in Rwanda stated [ R8a,b] significantly improved care-workers’, knowledge, capabilities and confidence. Workers “feel that they have actually achieved something: most of our carers have had absolutely no training whatsoever. [M]any of them would struggle to write their own names – they have lived very desperate lives. [T]hey love the knowledge, and that someone is showing them respect and giving them the confidence that they lacked. [N]o one has ever done that before” [ E8].

The UK Department for International Development (DfID) Programme Manager in Syria stated [ R8a,b] raised DfiD’s awareness of psychosocial support “to break down stigma”, with [ R8a,b] now embedded into their strategic practice. “We started teacher training [and] implanting case work. [This is] new to the programme, and . . . within DfID. Now, these issues [are] looked at in the highest scale.” This increased traumatised children’s ability to share difficult experiences and emotions. “[W]e’re seeing results. Now children in Syria are more open to talk about and express their feelings. [WACIT is] being pushed a long way and . . . creating more safe space.” [ E8].

Transforming families

Vostanis’ attachment research [ R7, R8a,b] improved parenting skills and child-parent relationships, equipping children with trust in secure relationships. A care worker in South Africa stated: “I'm no longer [seen as] toxic, where the auntie or the mom who shout.” [ E8]. WACIT’s attachment-focused interventions [ R7] reduced PTSS and other MH symptoms by 50%, and improved attachment relationships for 15 refugee families in Turkey [ E8]. A child said: “All of the [interventions] were useful for me”. A parent said: “[My son] started to direct his excessive power to something positive.” [ E8].WACIT’s psychosocial interventions [ R8a,b] significantly improved families’ understanding of MHD, which reduced PTSD (effect size 0.79) for 27 displaced children and their families in Kenya [ E8]. A teacher stated: “The parents ignored him because he was a non-performer, but the parent was not aware that the child had a mental health problem. [W]e discussed with the parent [and] other teachers, giving motivation to the child. [F]inally the child performed very well.*” [ E8].Children described how WACIT’s interventions changed their lives : “I feel this is the best way I could express how I feel than talking to anyone”; “I feel like I have changed.”; and, *“Now I am free” [ E8].