Theresa Betancourt, Associate Professor of Child Health and Human Rights at Harvard University, explains what challenges children from war zones encounter and how successful reintegration could look like.

Cathrin Jerie: Are children that come from war zones affected in their development?

Theresa Betancourt: You cannot put a label on war-affected children as all having mental health problems or other forms of dysregulation – it’s not that simple of an equation. But certainly we know that life brings an array of stress along a continuum. Some forms of stress are good – like having to give a public talk or perform in a concert – other forms can be toxic. Exposure to toxic stress such as bombings, shellings and the traumatic loss of loved ones in war situations can have lasting consequences for learning, behavior, and even health across the life course.

CJ: Can you give us an example?

TB: When war-affected populations resettle in a safe location or enter the post-conflict phase, we have observed difficulties in regulating strong emotional responses to stressors. Imagine a war-affected child who has been through tremendous trauma and loss. At school a teacher criticizes the child for not doing their homework correctly. How they manage that interaction is going to really matter in terms of their success at school.

There are ways to help war-affected children and families build the skills to manage one’s emotions and navigate challenging situations. Such interventions, with a focus on emotion regulation, interpersonal relationships, executive functions, problem solving, and priority setting, can help improve their day-to-day functioning and connect to life opportunities especially around education and employment.

In Boston, we helped through a student initiative to start a girls’ empowerment group for Somali Bantu refugee girls. They meet on the weekends and discuss issues of identity, navigating the school system and work on their homework. Models like that are important because they help to build a sense of community where there is a feeling of social isolation.

These are more classic support groups; but evidence-based curricula, especially adapted to context and culture, can be integrated into such support groups as well, especially if local facilitators can be trained and supervised with links to ongoing community mental health and other services.

CJ: What is important in the process of reintegration?

TB: Family-based prevention and family home visiting models are critical, especially when delivered by refugees, for refugees, in situations where English language skills are limited. Many of these families have to navigate complex issues of housing, jobs, and childrearing.

Beyond the family, community issues must also be a focus. In my numerous research projects on the reintegration of war-affected children, the issues of community relationships have played a crucial role. If children are stigmatized in the community, it greatly influences their psychosocial adjustment over time.

This can be evident in externalizing emotional and behavioral problems such as fighting and truancy or internalizing emotional and behavior problems such as social withdrawal, sadness and deficits in interpersonal behaviors and attitudes. Positive influences include community acceptance, contributing to community activities, and engaging in the lives of others.

CJ: What are the challenges for children to integrate into the school system?

TB: In the work we do with refugees resettling in the United States we focus on enabling the family to understand the new contexts in which they are operating, to give them better skills to navigate in the new context, and support them to navigate it well.

For instance, when our research group first started working with resettled refugees in Boston many years ago, there were tremendous misunderstandings between teachers and administrators in the public schools and refugee families. For example, the Somali Bantu children, many of whom had been born and were living in refugee camps in Kenya prior to resettlement, had been living in constant survival mode.

Children in the public school system in Boston were being told to line up because the supplies (such as art supplies) were going to be distributed. Refugee children would shove their way through the line in order to get to the front. The teachers saw these children as badly behaved, as fighting and not listening. However, these children were operating in the context they knew – that of a refugee camp. Teachers had no understanding of the background of many of these children and the hardships they endured.

CJ: What approach would you want to see?

TB: I think too often we leave out the family when we are thinking about refugee settlement and responding to the mental health needs of war-affected children and youth. Programs in schools and programs for individual children are very important but we can’t leave out the family. Those children depend on parents who have gone through tremendous trauma and loss. Those parents need support to regain their own sense of empowerment and get back in the driver’s seat in their children’s lives.

We do a lot of work preparing refugees for daily life such as how to take the bus, how to operate a dishwasher, how to find a job. But we don’t do a good job saying “here’s what is expected of you in the schools, here is how to navigate community and social relationships under resettlement, and here is how to enrich and improve communication and care for your children and yourself.“


Theresa Betancourt is an Associate Professor of Child Health and Human Rights at Harvard University T.H. Chan School of Public Health. She is Director of the Research Program on Children and Global Adversity at the Harvard T.H. Chan School of Public Health and an Affiliated Faculty member of the Harvard Center on the Developing Child. Her research interests include developmental and psychosocial consequences of concentrated adversity on children and families; resilience and protective processes in child development; child health and human rights; and applied cross-cultural mental health research. Theresa Betancourt is Principle Investigator of a project using community-based participatory research methods to study conceptualizations of mental health problems as well as attitudes about healing and help-seeking to design family-based preventive interventions for Somali Bantu and Bhutanese refugees in the Boston metropolitan area.

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