Elie G. Karam1,2,3,4, John Fayyad1,2,3,4 , Mariana Salamoun4 & Lynn Farah1,3,4

1 Department of Psychiatry & Clinical Psychology, St George Hospital University Medical Center

2 Faculty of Medicine, Balamand University, 3 Medical Institute for Neuropsychological Disorders (MIND)

4 Institute for Development, Research, Advocacy & Applied Care (IDRAAC)

Beirut, Lebanon.Email: idraac@idraac.org

Tel/Fax: 961 1583583 Website: www.idraac.org

Towards Psychosocial Interventions for Children and Adolescents in Lebanon

The Psychosocial Concept

The “psychosocial” concept refers to a comprehensive response to psychological and social needs of the community.

There is a broad overlap between the terms “Psychosocial” and “Mental Health”.

Epidemiological Research

Epidemiological data are essential for setting priorities within health and within mental health, and for designing and evaluating public health interventions …..

Epidemiology, amongst other things, is also an important tool for advocacy, but the fact remains that many countries lack data to support advocacy ….

WHO. The world health report 2001 - Mental Health:

New Understanding, New Hope

Strategy at IDRAAC

Collect data Research Recommendations Action planning

www.idraac.org

Findings from Research

Examples of assessment studies for psychosocial needs:

The World Mental Health (WMH) LEBANON study (ongoing):- National database for psychosocial data: Prevalence, age of onset ….

Rapid Situation Assessment (RSA) (2001) - Supported by UNODC

Children and War (1996):- Supported by Ministry of Interior and UNICEF

Assessment Study of Psychosocial Status (SSS) (after July 06 war):- Commissioned by HCC and supported by Handicap International /Echo/EU

6

WMH LEBANON Study Lifetime Prevalence of Mental Disorders

Kessler et al – World Psychiatry 2007;6(3):168-176Al Hasnawi et al- World Psychiatry 2009; 8:97-109

25.8%

0% 4% 8% 12% 16% 20% 24% 28% 32% 36% 40% 44% 48%

South Africa

New ZealandUnited States

Ukraine

Colombia

LebanonMexico

Belgium

SpainGermany

JapanItaly

NigeriaPR China

Prevalence

Iraq

France

Netherlands

Age of Onset of Mental Disorders in LebanonNational Data from the WMH Study

Kessler at al (Karam) – World Psychiatry 2007

Median (years)ADHD

7- 9 Conduct disorder

9-14

ODD

7-15Intermittent explosive disorder

13-21Phobia and separation anxiety

7-14

Age of Onset of Substance Usefrom RSA study

Karam et al – LMJ 2010 in press; RSA Report IDRAAC 2003

High School Sample 2001

Mean (± SD) years

Min-MaxCigarettes

14.8 (2.0)

7-19

Alcohol

13.3 (2.8)

2-20

Hashish/marijuana

16.1 (1.5)

9-19

Heroin

15.2 (1.7)

13-17

Cocaine

15.0 (2.6)

10-19

XTC

16.0 (1.7)

9-18

Amphetamines/stimulants

15.6 (1.3)

13-17

Tranquilizers

15.7 (1.3)

13-19

MO/Barbiturates

15.7 (1.3)

13-17

RECOMMENDATIONS to Ministries

Parenting Skills for Children with Behavioral Problems: Mothers’ Evaluations

<0.00169.517.1Ignore

0.0028.529.6Scold

<0.00190.250.0Talk with him/her

<0.00132.964.6Give repetitive remarks

0.03136.652.4Punish

<0.0016.140.2Hit

<0.0019.857.3Shout

Reactions to the child’s difficult behavior:

<0.00193.853.2Allocate time to converse and share interests with the child

P-valueAfter Training(%

Before Training (%)

Fayyad et al- Eur Child Adolesc Psych 2010

Psychosocial Assessment after July 2006 War

A mapping of available resources and services related to psychosocial needs in South of Lebanon and Southern Suburbs of Beirut

A comprehensive assessment of the psychosocial and mental health needs of Lebanese children and adolescents in South of Lebanon and Southern Suburbs of Beirut

Recommendations to meet the needs identified in the mapping and assessment phases

Divisions of Recommendations

By age group By themes By target group: school, parents, NGO’s Research based vs. general Relevant to specific Ministries (Ministry of Education,

Information, Interior, Public Health, Social Affairs)

Available upon request idraac@idraac.org

Awareness Gender specific issues Coping and Resilience Child Abuse and Neglect Parental Physical Abuse School Violence Underachieving students and school drop-out Youth Empowerment

Teacher’s training Leisure Activities Television and Media Availability of Services War and Disasters Mental Health Effectiveness of Interventions Policy Makers Need for ongoing Research

Themes of Recommendations

Life skills training programs (such as: teaching the importance of sharing feelings, constructive ways of expressing feelings, problem solving skills, how to seek social support, using cognitive and behavioral distraction strategies…).

IDRAAC with partial support of the EU is starting a new project aiming to contribute to the mental wellbeing of school children, to enhance coping and resilience among these children in response to their daily stressors.

Example: Coping and Resilience

Higher Council of Childhood National Action Plan for Violence Against Children (draft):

- revision of laws

- capacity building

- awareness and education

- children participation

- hotlines

- reporting, monitoring and referral system

Example: Child Abuse and Neglect

Example: Need for Ongoing Research

Evaluation of effectiveness of psychosocial interventions Set up guidelines and scientific standards for psychosocial

interventions Additional studies on psychosocial needs and mental health of

children and adolescents