Trauma alleviation treatment for unaccompanied children after the Rwandan Genocide : a cautionary tale

Tens of thousands of children were orphaned or separated from their parents by the 1994 Rwandan Genocide. Following an all too familiar practice in post-conflict societies, these children were placed in unaccompanied children’s centres (UCCs) referred to as orphanages. Staff in a proportion of these centres received training in simple trauma alleviation methods as part of a program instituted by the United Nations Children’s Fund (UNICEF) with Rwandan governmental ministries. This study examines whether children in UCCs with staff trained in these methods had lower levels of post-traumatic stress symptoms (PTSS) than children in UCCs staffed by individuals who, to the best of our knowledge, lacked any formal mental health training. Data for these analyses derived from a National Trauma Survey conducted by UNICEF (1995) that included sampling of children from UCCs. Ordinary least squares multiple regression analysis was used to evaluate the effect of staff training on levels of PTSS among children, controlling for relevant covariates. Overall PTSS scores did not differ between children in UCCs with and without staff training. However, avoidance/numbing and hypervigilance symptoms were significantly elevated among females in UCCs with trained staff as compared with UCCs with staff lacking this training. Whereas these findings might result from unmeasured confounding variables, they nonetheless underscore the importance of formal assessment of treatment safety and effectiveness before implementing interventions.

KEY IMPLICATIONS FOR PRACTICE 

Community-based approaches using a training of trainers approach may not always be effective when treating severe psychopathology after large scale violence 

Humanitarian agencies must include rigorous monitoring and evaluation protocols as part of their intervention efforts 

Mental health interventions should be adapted to address gender differences in child responses to interventions