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The war in former Yugoslavia (1991-95) exposedhundreds of thousands of children and adolescents tovery intensive, often multiple traumatic experiences,followed by a chain of chronic and increasing prob-lems in exile. This paper describes the theoreticalframework, implementation and evaluation ofYouth Clubs, a community-based psychosocial inter-vention implemented during the war years with theaim of supporting the psychosocial recovery andreintegration of young refugees in Serbia. The eval-uation study confirmed that Youth Clubs are an effi-cient intervention that reduces suffering and pre-vents a negative outcome of traumatic experience inthe majority of adolescent refugees. The author dis-cusses the hypothesis that the ‘healing’ effect of theYouth Clubs intervention might be due to provid-ing norms and context for the interpretation andunderstanding of traumatic events, offering youngpeople opportunities to master the reality and findsome new, meaningful goals that they can identifywith and fight for. Thus, their pre-existing “con-ceptual maps”, which were destroyed or profoundlyshaken by the traumatic events, could be replaced bynew ones enabling the young to give meaning topast and present experience and to pave the waytowards the future.

Keywords: war, traumatic experiences,adolescent refugees, psychosocial interven-tion, conceptual maps

Adolescents and the stresses ofwar To become a refugee and continue to growup in a community which is itself severelyaffected by war represents, no doubt, one ofthe most difficult experiences a young per-son could have. And that is exactly whathappened to hundreds of thousands ofchildren and young people as a result of thewar, armed conflicts and drastic socialchanges which went on for almost ten yearsin the former Yugoslavia (1991-1999).During that period about 3,2 million peoplefled their homes in the face of war and polit-ical violence and found shelter in otherparts of the world or, more often, in theother republics of the former Yugoslavia,which had become ‘new states’ in the mean-time. Nearly one half of that number werechildren and young people. Before exile, many of these children andyoung people had witnessed destruction,atrocities, and the torture and death of closepersons, or their own life was endangered,exposed to violence, deprivation and uncer-tainty. 41% of these young refugees experi-enced direct threat to their lives, and 14.4%witnessed the killing or wounding of a fam-ily member or other close person. Exposureto multiple traumas several months prior to

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Intervention 2003, Volume 1, Number 3, Page 38- 44Youth clubs: psychosocial intervention with young refugees

Youth clubs: psychosocial interven-tion with young refugees

Veronika Ispanovic-Radojkovic

seeking refuge was a frequent finding.(Ispanovic-Radojkovic et al. 1994).But the pain often continued after theyreached safety and found shelter. Worryabout those family members who stayedbehind in war zones, as well as the cares ofeveryday refugee life, diminished or non-existent opportunities for education, uncer-tainty about the future, continued to tor-ment and adversely affect the process ofgrowing up.Life in the shadow of war, under sanctions,in isolation, in the context of a drasticallyimpoverished society, in both a material anda spiritual sense, significantly affected themental health of young refugees in Serbia.According to our studies, the symptoms ofpsychological suffering were present in 65-81% of children and young people during thefirst months of their refugee life. After 1,5 - 2years, difficulties were present in 35,5% ofchildren, while 25,5% of children showedsymptoms of chronic reaction to stress evenafter 3 years (Ispanovic-Radojkovic et al,1994; Ispanovic-Radojkovic, 1996;Ispanovic-Radojkovic et al, 2002).Despite the concern the above data maycause, they also show at the same time thatmore than two thirds of young people whoexperienced serious traumatic events havenot developed psychopathology, but havebeen able to activate mechanisms for cop-ing with traumas and to develop new formsof adjustment. Beside the severity, nature and number ofthe traumatic events themselves, threegroups of factors influencing the outcomeof war-related traumatic experiences inchildhood and adolescence are being recog-nized nowadays. The first is related to theindividual characteristics of the child(maturity, cognitive style, self-esteem, quali-ty of previous life experience, and especial-ly the history of previous traumas and pre-

existing psychopathology), the second tothe strength and the cohesion of the familyand the third to the support of the socialenvironment in which the recovery is takingplace ( Macksoud, Dyregrov & Raundalen,1993; Jensen & Shaw, 1993; Ispanovic-Radojkovic, 2000). The significance of social framework for theoutcome of development after traumaticexperiences is especially great in adoles-cence. There is evidence that the attitude ofthe community, the belief that the war is jus-tifiable, and cohesion of political motivationof the community can mitigate the negativeeffects of war on young (Punamaki, 1983).How to understand these findings? Ibelieve that it has to do with the basic urgeof every human being, the ‘search formeaning’. Finding meaning and givingmeaning to the world, or creating one’sown ‘conceptual maps’ is an important driv-ing force of the developmental process, par-ticularly in adolescence. In a situation of war or any other form oforganised violence, a young person’s pre-existing ‘conceptual maps” are no longeradequate and even the mechanisms fordeveloping new ‘maps’ are often damagedor destroyed ( Garbarino, Kostelny &Dubrow, 1991). The breakdown of family,of connections with relatives and friends,the absence of school, work and othersocial institutions, in one word the break-down of a social network in the situation ofwar, represents in fact the destruction ofmechanisms which provide the adolescentwith the norms and context for the inter-pretation and understanding of traumaticevents.In order to facilitate the restoration of pre-vious ‘conceptual maps’ or the develop-ment of new ones, young people with trau-matic experiences should be helped toprocess and place their painful experiences

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in a more humane framework, and shouldbe given opportunities to cometo termswith reality and formulate meaningful goalsthat they can identify with and fight for. Such considerations led us to assume that apsychosocial intervention might be anappropriate way to assist a large number ofadolescent refugees who came to Serbiaduring the war years. Psychosocial inter-ventions after traumatic experiences shouldstrengthen the psychosocial protective fac-tors and reduce psychosocial stressors inthe effort to protect mental health and pro-mote human rights (Agger, 1994). In eachindividual case, the ‘protective’ or ‘support-ive’ value of each factor should be assessedin relation to the extent to which this willcontribute towards ‘giving meaning’ or inte-grating experience. The aim of this paper is to give a descriptionof the Youth Clubs; a community-based psy-chosocial intervention, as an innovativepractice which has had beneficial effects,according to the persons who implementedit and the young people themselves.An evaluation of the Youth Club interven-tion was done also in an attempt to under-stand better what was happening with theyoung people who took part in the inter-vention. The study took the form of empir-ical research rather than of a very strict sci-entific study, as it was hard to apply a strictscientific methodology in a war situation.

Youth ClubsThe implementation of Youth Clubs startedin Serbia in 1992 with the aim of addressingthe psychosocial needs of adolescentrefugees from Bosnia, Herzegovina andCroatia, and to aid their psychosocial recov-ery and reintegration. The aim of this inter-vention was to activate their strengths. Itwas expected that emerging from the pas-sive role of ‘victim in need of help’ and

starting to face daily practical challenges,would help young people to overcome theirpast difficult experiences and (re)gain con-trol over their lives. It was expected thatcreating meaningful goals, not only foreveryday life but also for the future, wouldhave the same effect.Since 1992, the Youth Clubs have beenimplemented in 8 boarding schools andyouth hostels in Belgrade, which house2400 students (aged l5-18 years), including400 refugees. During 1993-94 the Clubs’activities were supported by the Britishhumanitarian organization OXFAM andsince 1995 by INTERCARE, a Dutchhumanitarian organization. The Youth Club activities took place in theafternoons or evenings, after school hours,once or twice a week, in each of the board-ing schools. The Clubs were open to youngpeople attending the boarding school,refugees as well as local young people. Theactivities usually consisted of two parts: a‘creative-recreational’ one and a ‘talk shop’. The adolescents had complete jurisdictionin deciding the content of the creative andrecreational activities, which generally con-sisted of communal games, music, poetry,painting and drama or sporting activities.Club sessions were sometimes attended bypublic figures invited by the young people,with whom they held discussions anddebates about the subjects of interest tothem (Bojanin & Ispanovic-Radojkovic,1993; Bojanin, Ispanovic-Radojkovic &Lazic, 1994). The number of participants inthese activities ranged from 20 to as manyas 80. The first recreational part of Club activitieswas followed by a ‘talk shop’, lasting about90 minutes and supervised by young men-tal health professionals (psychologists,social workers, pedagogues), two of them ineach Club. Participation in the group was

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Intervention 2003, Volume 1, Number 3, 8- 44Youth clubs: psychosocial intervention with young refugees

open to all young people, but in practicethere was a core group of about 10-12 ado-lescents in each boarding school whoattended ‘talk shops’ regularly, while theothers did so occasionally.

In these ‘talk shops’, young people coulddebate on anything without fear of rejectionor condemnation. In the first months afterthe traumatic experiences they most oftentalked about injustice, national intoler-ance, hatred and the desire they often feltfor revenge on ‘enemies’ who had causedthem pain and loss. Such aggressive rea-soning and fantasies were not condemnedby the facilitators; they encouraged youngpeople to view them as a natural and justi-fied strategy for coping under extreme dan-gers. However, little by little, the facilitatorsintroduced the idea that the same strategythat gives meaningfulness to life in warzones may lead to dehumanisation, which,on its own behalf, deepens the conflict,decreases the ability to compromise andforces the young to continue the war andthus to expose themselves and future gener-ations to unnecessary suffering and death.By this time, some of the young people’sstories and memories of positive experi-ences of their past life with ‘enemies’, neigh-bours, and friends started to emerge in the‘talk shops’, and they were encouraged bythe facilitators. It was gradually explainedthat when people find themselves undergreat stress it may frequently happen thatthe image of the other gets split into a goodand bad part, so that others are seen asexclusively bad or exclusively good. In awar situation, under immediate threat tolife, it is dangerous to bear in mind thememories of positive aspects of the past, oftimes when living side by side was possible.Therefore, under war conditions the enemyas a whole is seen as bad, while one’s own

people, the members of one’s own group,are seen exclusively as good; this only leadstowards further deepening of the conflict(Agger, 1994).It was important that the young started tounderstand that one of the prerequisites forovercoming the hatred and fear they feltdeep inside themselves was to allow posi-tive memories of the past to resurface andbe expressed. According to the observation of the groupfacilitators, the emphasis on current positivepersonal experience of empathy, toleranceand support provided by the group itselfwas also an important tool in the healingprocess. It helped young people to developbetter self-perception, to obtain better con-trol over their present life and to directthem towards the future. Adolescent refugees stated that they foundthe Clubs a very pleasant and effectivemeans of integrating themselves into newsurroundings. ‘The most important thing isthe constant contact between Club mem-bers; talking, arguing, competing, falling inlove, having fun together…We were nolonger labelled as refugees. We became peo-ple with real values and had influentialmoral figures as role models’, wrote oneyoung person (P., 15 year-old refugee boy).

Evaluation study of the YouthClub In order to evaluate the effects of the above-mentioned Youth Clubs, an evaluationstudy was done in the school year 1995-96by comparing the changes seen in theexperimental and control group of adoles-cents before and after intervention. The sample was made up of 1.106 students(813 boys, 293 girls) from boarding highschools in Belgrade, aged 15-18 years, 158of whom were refugees. Adolescents(N=128) who had taken part in Youth Club

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activities for at least 6 months formed theexperimental group, while the rest (N=978)formed the control group. The evaluation of the effects of Youth Clubactivities was done by computing the differ-ences between the first and second meas-urements in both groups and comparingthem (Ispanovic-Radojkovic, 1996;Ispanovic-Radojkovic et al., 2002).The hypothesis of the study was that theapplied psychosocial intervention signifi-cantly decreases symptoms of psychologicalsuffering (anxiety, withdrawal and aggres-sive behaviour) and levels of trauma, andincreases the self-respect of adolescents withwar traumatic experiences.The main instruments used in the studywere:• The Youth Self Report, for ages 11-18 (T.

Achenbach et al, 1991), • Adolescent Self-Esteem Measure (B.

Wolf, H. Davis et al. 1996) • War Trauma Questionnaire (B. Wolf,

1994);• Impact of Event Scale (Horowitz et al

1979) –We are presenting here the main findings ofthe study while more details on the study’sdesign, methods and results can be foundelsewhere (Ispanovic-Radojkovic, 1996,Ispanovic-Radojkovic et al., 2002).Traumatic experiences were more commonin girls (66,8%) than in boys (56,2%). Thedifference was even bigger in refugeeswhere 88% of girls and 74,1% of boys hadtraumatic experiences, mostly related towar, while in non-refugees 63,3% girls and53,2% boys had ‘peace-time’ traumaticexperiences. . The level of trauma of young people fromour sample was between medium-high andhigh. Refugees, especially the girls,expressed a significantly higher level oftrauma, according to the Impact of Event

Scale, than non-refugees. Significant connections were found betweenthe psychological problems of young peopleas measured by the Achenbach Scale, andsex, refugee status, and traumatic experi-ence. Girls had higher results than boys onall scales except on the scale of Social prob-lems and delinquency. Male refugees hadsignificantly higher scores than male non-refugees on the scales Withdrawal, Somaticdifficulties, Anxiety-depression and Cog-nitive problems, which indicates that malerefugees tend to internalise their problems.Self-respect was lower in refugees, more soin girls than in boys.Here are some of the most significantchanges in the young people who partici-pated in Club activities.78% of the adolescents said that theirunderstanding of themselves had improved;63% reported an improvement in theirunderstanding of others; and 60% said thatit was also much easier for them to makecontact with their peers.A significant increase of self-respect was reg-istered in all adolescents.The psychological problems of young peo-ple, especially refugees, were significantlydecreased. Significant decreases of symp-toms following the Achenbach Scale wereregistered: Withdrawal and Anxiety-Depression (for male refugees), andWithdrawal and Social Problems (forfemale refugees). The level of traumatic stress of young non-refugees decreased; however, this positiveeffect did not happen with refugees –although a slight but insignificant increasein IES scores was registered.

Discussion How can we explain what seems to be acontradictory result: refugees who tookpart in Youth Club activities felt better, their

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psychological problems, measured by theAchenbach instrument, decreased, theirself-esteem increased, but their trauma-related symptoms, as measured by the IESScale of Intrusion and Avoidance, actuallyshowed a slight increase? There are several possible explanations.The answer may be found in the nature ofthe intervention itself. The Youth Club is apsychosocial intervention focused on theactivation and strengthening of the person-ality. It is possible that participation in Clubactivities helped adolescents to feel stronger,‘allowing’ them to face their hitherto sup-pressed painful memories more easily, in anattempt to integrate these into their person-al concept of the world and their position inthat world. Considering the fact that the dominant psy-chological mechanism of young refugees,especially males, before the interventionswas internalisation, we can presume thattheir participation in Club activities helpedthem to ‘open up’, to reject the passive role‘of a victim that needs help’ and to gaincontrol over their lives, thoughts and feel-ings. This explanation is confirmed by thefact that young people felt better after theintervention, regardless of the fact that theywere thinking about traumatic events evenmore. The other explanation could be related tothe instrument which was used in the study,namely to the Impact of Event Scale. After10 years of experience with people trauma-tized by war in former Yugoslavia, I amconvinced that it is not the most appropri-ate instrument to measure the internalprocesses of young adolescents who arerecovering from difficult war-related experi-ences. It certainly does not measure, norwas it originally intended to measure, theprocess of ‘giving meaning to the world, tothe past, present and future’ which is, in my

view, the central theme of the healingprocess. As to the effects of the Youth Clubs inter-vention, research confirms that such clubsconstitute an efficient psychosocial inter-vention, capable of reducing suffering andpreventing negative outcomes of traumaticexperience for the majority of adolescentrefugees. The question is whether the healing processthat was strengthened by this interventioncould be successfully brought about with alladolescents, and whether some adolescentsneed a more extensive psychotherapeuticintervention. A long-term study of refugeeadolescents who took part in this interven-tion could give an answer to this question.According to our experience a classical ther-apeutic intervention is not obligatory aftertraumatic experience, but is justified in situ-ations where other supportive mechanismsare absent, or in cases where the giving ofmeaning, integration of experiences is verycomplex or delicate in view of the social oremotional state of the young person.In practice, it is essential to help young peo-ple with difficult life experiences to createnew ‘conceptual maps’ untainted by vio-lence, but in which the conceptions of peaceand positive human and social values pre-vail, which will make it possible for youngpeople to emerge from their isolation, toopen up towards others and to respect theirdiversity.

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Veronika Ispanovic-Radojkovic, MD,PhD. is professor of Child and AdolescentPsychiatry and Head of the Department. OfResearch in Child Psychiatry, at the Institute forMental Health, 37 Palmoticeva, 11 000Belgrade, Serbia and Montenegro, tel. /fax.381 11 3236 353, e-mail: [email protected]

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