Elie G. Karam 1,2,3,4 , John Fayyad 1,2,3,4 , Mariana Salamoun 4 & Lynn Farah 1,3,4

1. Towards Psychosocial Interventions for Children and Adolescents in Lebanon 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

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

7. Age of Onset of Mental Disorders in LebanonNational Data from the WMH Study Median (years) ADHD 7- 9 Conduct disorder 9-14 ODD 7-15 Intermittent explosive disorder 13-21 Phobia and separation anxiety 7-14 Kessler at al (Karam) – World Psychiatry 2007

8. Age of Onset of Substance Usefrom RSA study High School Sample 2001 Mean (± SD) years Min-Max Cigarettes 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 Karam et al – LMJ 2010 in press; RSA Report IDRAAC 2003

9. Parenting Skills for Children with Behavioral Problems: Mothers’ Evaluations Before Training (%) After Training(% P-value Allocate time to converse and share interests with the child 53.2 93.8 <0.001 Reactions to the child’s difficult behavior: Shout 57.3 9.8 <0.001 Hit 40.2 6.1 <0.001 Punish 52.4 36.6 0.031 Give repetitive remarks 64.6 32.9 <0.001 Talk with him/her 50.0 90.2 <0.001 Scold 29.6 8.5 0.002 Ignore 17.1 69.5 <0.001 Fayyad et al- Eur Child Adolesc Psych 2010

10. Psychosocial Assessment after July 2006 War • A mapping of available resources and services related to psychosocial needs in South of Lebanon and Southern Suburbsof Beirut • A comprehensive assessmentof 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

11. 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

12. Themes of Recommendations • 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 • Awareness • Gender specific issues • Coping and Resilience • Child Abuse and Neglect • Parental Physical Abuse • School Violence • Underachieving students and school drop-out • Youth Empowerment

13. Example: Coping and Resilience 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.

14. Example: Child Abuse and Neglect • 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

15. 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

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