1. Elie G. Karam 1,2,3,4, John Fayyad 1,2,3,4, Mariana Salamoun 4 & Lynn Farah 1,3,4 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.orgidraac@idraac.org Tel/Fax: 961 1583583 Website: www.idraac.orgwww.idraac.org Towards Psychosocial Interventions for Children and Adolescents in Lebanon

2. 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”.

3. 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

4. Strategy at IDRAAC  Collect data  Research  Recommendations  Action planning www.idraac.org

5. 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. 6 WMH LEBANON Study Lifetime Prevalence of Mental Disorders Kessler et al – World Psychiatry 2007;6(3):168-176 Al Hasnawi et al- World Psychiatry 2009; 8:97-109 South Africa New Zealand United States Ukraine Colombia Lebanon Mexico Belgium Spain Germany Japan Italy Nigeria PR China Prevalence Iraq France Netherlands

7. Age of Onset of Mental Disorders in Lebanon National Data from the WMH Study Kessler at al (Karam) – World Psychiatry 2007 Median (years) ADHD7- 9 Conduct disorder9-14 ODD7-15 Intermittent explosive disorder13-21 Phobia and separation anxiety7-14

8. Age of Onset of Substance Use from RSA study Karam et al – LMJ 2010 in press; RSA Report IDRAAC 2003 High School Sample 2001 Mean (± SD) yearsMin-Max Cigarettes14.8 (2.0)7-19 Alcohol13.3 (2.8)2-20 Hashish/marijuana16.1 (1.5)9-19 Heroin15.2 (1.7)13-17 Cocaine15.0 (2.6)10-19 XTC16.0 (1.7)9-18 Amphetamines/stimulants15.6 (1.3)13-17 Tranquilizers15.7 (1.3)13-19 MO/Barbiturates15.7 (1.3)13-17 RECOMMENDATIONS to Ministries

9. Children Psychosocial Status Post-War 1996 MDD SAD PTSD Covariates*OR(95% CI)OR(95% CI)OR(95% CI) Disorders pre-war SAD11.6(3.7-36.6) PTSD11.5(1.1-121.0) Family Violence Family quarrels3.1(1.6-5.6)2.3(1.1-4.9) Fear of being beaten2.6(1.4-4.7)5.4(2.7-10.8)2.2(1.1-4.4) Financial problems3.2(1.5-6.7) War Exposure Witnessing any event2.1(1.1-4.1)2.9(1.4-6.1)2.2(1.0-4.7) * Only statistically significant relations reported Karam et al – World Psychiatry 2008

10. Parenting Skills for Children with Behavioral Problems: Mothers’ Evaluations <0.00169.517.1 Ignore 0.0028.529.6 Scold <0.00190.250.0 Talk with him/her <0.00132.964.6 Give repetitive remarks 0.03136.652.4 Punish <0.0016.140.2 Hit <0.0019.857.3 Shout Reactions to the child’s difficult behavior: <0.00193.853.2 Allocate time to converse and share interests with the child P-valueAfter Training(% Before Training (%) Fayyad et al- Eur Child Adolesc Psych 2010

11. 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

12. 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

13.  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

14. 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

15.  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

16. 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

17. Thank You!! For more information please visit: www.idraac.org