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October 10, 2017

9:00 A.M. - 12:00 P.M.

IntroductionsNeal M. Horen, PhD

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Welcome Phyllis Magrab, PhD

Syrian Refugees,2017

Rochelle Davis

Georgetown University

Artwork by Juan Zero, 2015

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End of 2016

http://www.unhcr.org/en-us/figures-at-a-glance.html

UNHCR: MENA October Update: Durable Solutions for Syrian Refugees 8 October 2017

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When I finally leave, be assured that I did everything I could to remain here. (Homs, Syria May 2014)

Imranovi

Hani Abbas, Palestinian artist from Syria

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http://data.unhcr.org/syrianrefugees/regional.php, 30 Sept 2017

Syrian Refugees in Camps

Syrian Refugees NOT in Camps

http://data.unhcr.org/syrianrefugees/regional.php, 30 Sept 2017

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UNHCR: MENA October Update: Durable Solutions for Syrian Refugees 8 October 2017

Syrian Refugees

http://data.unhcr.org/syrianrefugees/regional.php, 30 Sept 2017

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Nothing can cause me pain after such a departure [from our homes & homeland]

- created by the revolutionary Syrian artists’ collectiveThe Syrian People Know Their Way

Homeland Exile

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UNHCR: MENA October Update: Durable Solutions for Syrian Refugees 8 October 2017

Lebanon364,000 children enrolled in formal

education45,000 children benefiting from cash

grants for education

Iraq32,900 boys and girls enrolled in formal

primary education22,000 children participating in child protection

or psychosocial support programsJordan

195,000 children enrolled in formal education150,000 children participating in child protection or

psychosocial support programs

UNICEF No Lost Generation 2017 targets

Juan Zero

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How can our children study when our schools are destroyed and always threatened with mortars?

-- Bosra al-Sham, 2012

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Mouneer Alshaarani Facebook Page

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THE DEVELOPMENT OF SYRIAN REFUGEE CHILDREN

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The Syrian CrisisA Global Health Perspective

M. Zaher Sahloul, MD, FCCPSyrian American Medical Society

M. Zaher Sahloul, MD, FCCPSyrian American Medical Society,

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Global

Warming

& Drought

Poor

Governanc

e

Iraqi War

Islamism &

Jihadism

Lack of basic

freedoms

Social

Media

Young

population

Joblessnes

s

Quick

Urbanizatio

n

Assad

family reign

Uncontrolled

Population GrowthSectarianism

Obama

Speeches

DemocratizationGlobalizationArab Spring

The Syrian Conflict/Crisis/Revolution/Civil War/Genocide

Israel

HizbollahSaudia

Arabia

Iran

Kurds

TurkeyUSA

Israel

Russia

Qatar

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Annals ATS. First published online 19 Jan 2016 as DOI:

10.1513/AnnalsATS.201510-661PS

War is the Enemy of Health: Pulmonary,

Critical Care and Sleep Medicine in War-

torn Syria

Mohammed Z Sahloul, Jaber Monla-Hassan, Abdulghani Sankari, Mazen

Kherallah, Bassel Atassi, Safwan Badr, Aula Abbara, and Annie Sparrow

Read More: http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201510-

661PS#.VrN13ccd7R0

Healthcare in Syria Before

the conflict

• Middle Income Country withgood healthcare benchmarks

• Low spending on healthcare

• Hybrid system of Governmentrun hospitals and primary carefacilities

• Advanced medical care in majorcities– (Damascus and Aleppo)

• Rural areas– insufficient facilities and human

resources

• Ministry of Health is main player

• Gradual increase private sectorproviders and increase in public-private partnerships

• Change from communicable tonon-communicable diseases

• Highest smoking rates in theregion

• High morbidity and mortality dueto NCD

• High Vaccination rates

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Mental Health in Syria Before the

conflict

• Stigmata of mental illness

• Low number of psychiatrists• Low numbers of

psychologists, social workersand community mental healthworkers

• Shortage of newermedications

• Very low number of childpsychiatrists

• Inequity in distributions. Mostpsychiatrists are in majorurban areas

• Nonconventional treatment for mental illness (exorcism)

• Poor inpatient psychiatric treatments

• Somatization

• Denial and refusal to accept treatment

Shouldn’t We Care About the

Syria?1.The worst humanitarian crisis in

our lifetime and since WWII

2.Global Refugee crisis

3.Systematic attack on healthcareundermining medical neutrality

4.Destruction of public healthcareinfrastructure

5.Flight of healthcare workers

6.Frequent use of ChemicalWeapons

7.Terrorism

8.Use of siege as a weapon(starve to surrender)

9.Lost generation of children

10.Anti-refugee sentiment andXenophobia

11.War Crimes, Crimes against humanity, ethnic cleansing and Genocide

12.The Syrianzation of the world

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• 350,000- 500,000 killed• 1.9 million injured• 13.8 million in urgent need for

humanitarian assistance• 5.1 million registered refugees• 7.8 million IDPs• 4.7 million in hard to reach areas• 1.2 million in besieged areas• 5.5 million children affected by the crisis• 4/5 are jobless• 80% below poverty line• 3.5 million children without education• 185 Chemical Weapon attack• 10,000 died under torture• Average life expectancy dropped from 76

years to 55 years• 50-65% refugees with mental heath

problems• 30% Syrian patients with severe emotional

problems• Human Devestation Syndrome

“Every time we use a new figure in relation to the Syrian crisis, we say it is unprecedented”

Valerie Amos, Past UN Chief for Humanitarian Affairs

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Reference❖ https:/ / www.huffingtonpost.com/ entry/ in -syrias-war-mental-health-

is-the-last-priority_us_59b316f9e4b0dfaafcf810f7

❖ https:/ / www.ncbi.nlm.nih.gov/ pubmed/ 26784922

❖ http:/ / foreignpolicy.com/ 2014/ 03/ 04/ the-corridor-of-death/

❖ https:/ / www.theguard ian.com/ world / 2016/ aug/ 18/ treating-aleppos-child -casualties-we-see-many-like-omran-daqneesh

❖ http:/ / blogs.plos.org/ speakingofmedicine/ 2016/ 05/ 26/ health-in-flight-medicine-and-migration-at-the-msf-scientific-days/

❖ http:/ / www.scidev.net/ global/ conflict/ multimedia/ cave-hospitals-syria-front-line.html

❖ https:/ / medicalxpress.com/ news/ 2016-01-medical-society-syrian-health-crisis.html

❖ https:/ / beta.theglobeandmail.com/ opinion/ will-syrias-child ren-ever-be-able-to-breathe/ article34641371/ ?ref=http:/ / www.theglobeandmail.com&

❖ https:/ / newrepublic.com/ article/ 119087/ aleppo-hospital-photos-inside-syrias-civil-war

❖ https:/ / www.ncbi.nlm.nih.gov/ pmc/ articles/ PMC3697421/

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Toxic Stress and Syrian’s ChildrenAlexandra Chen, MA

QUESTIONS

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REFUGEE CHILDREN AND HOST COUNTRIES: AVAILABILITY AND ACCESS TO SERVICES

Presented by Maliha El Sadr, Ed Psy

ECIL Founder & Director

"Syrian Refugee Children:

Assessing and Addressing Developmental and Mental Health Issues"

The status of young Syrian refugees children (0-5)with disabilities living in Lebanon

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The Impact of the Syrian Displacement Crisis on the Lebanese Economy

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“Syria is the worst humanitarian crisis in our history” (The United Nations)

In its latest report published on February 26, 2016 the United Nations High

Commission for Refugees (UNHCR) revealed that Lebanon (4.4 million citizen) is

hosting:

• more than 1 million registered Syrian refugees,• 31 000 Palestinian refugees from Syria,• 6 000 Iraqi refugees,• 280 000 refugees from Palestine.

79% of the displaced persons are women and children

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According to UNHCR, close to 417,000 Syrian refugee children in Lebanon are aged between three and 14 years old.250,000 Syrian Children are Out of School

The Impact of the Syrian Displacement Crisis on the Lebanese Economy

The Impact of the Syrian Displacement Crisis on the Lebanese Economy

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Lebanese and international officials concerned with the response to the Syrian crisis agree that the number of displaced Syrians is so large that they now make up a third of the Lebanese population, incurring a huge burden on such a small country.

“This is equivalent to 80 million Mexicans arriving in the United States over a span of 18 months”.

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The impact of crisis on children health and development

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The experience of war in Syria hasresulted in a significant increase ofchildren with mental illnessesincluding anxiety disorders,depression, post-traumatic stressdisorders, and developmentalproblems.

These children are impacted by symptoms of phobia, hysteria, night terrors and regression in development.

Estimated number of Syrian Children with specific disorders in Lebanon

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An assessment conducted by UNHCR during the second half of the year 2012 showed that the potential number of people with disabilities (PWDs) reaches ~15% of the children refugeepopulation

The generally accepted proportion is of 10-15% of PWDs in a given population.

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Estimated number of Syrian Children with specific disorders in Lebanon

Estimated number ofSyrian Children withspecific disorders inLebanon according tointernationalStatistics on childrenwithspecialneeds

Response to the crisis: Health care and Education

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The Lebanese public sector has, since the civil war, been suffering from weak, costly, and fragmented service provision, with facilities that are under-equipped, and unable to adequately deal with structural shortcomings.

Access to EducationThe RACE 2 response plan, adopted by the Ministry of Education and HigherEducation (MEHE) aims to increase the number of Syrian children enrolled informal education.Despite these efforts over 50% of Syrian refugee children (250,000) remainoutside school

As long as wars and disasters happen, the international mental health community needs to prepare positively to meet the predictable, but usually unexpected needs.

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Response to the crisis: Health care and Education

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Access to HealthcareThe gross mismanagement of the refugee crisis in Lebanon has, since the startof the crisis, deprived many refugees and asylum seekers from accessingproper services; and shortages in funding have depleted aid agencies’capacities to provide adequate access to services.

Barriers to accessing healthcare• Cost of provision• Limited scope of UNHCR provision• Weak referral system• Restricted freedom of movement and transportation

Response to the crisis: Health care and Education

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The main Health and education providers:• Professionals from Lebanese MOH and MEHE• UNHCR• UNICEF• NGOs

NGOs are the main health and education providers for Syrian special needs children

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Status of coverage and services provided by 4 NGOs in Lebanon

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THE UNION OF RELIEF AND DEVELOPMENT ASSOCIATIONS (URDA)

Al-Awda camp has 350 tents, sheltering 350 families, with anaverage of 875 children under the age of 14. It is considered to bethe largest in Lebanon.

There are currently at least 400 suspected cases of disabilitiesamong children under ten years of age in the Al-Awda camp.

No services are provided for children under 5 years old, except forthe primary medical health issues.

Status of coverage and services provided by 4 NGOs in Lebanon

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RESTART CENTER FOR REHABILITATION OF VICTIMS OF TORTURE AND VIOLENCE (RESTART)

RESTART’s capacity to receive is limited to the funding from the UNHCR, and therefore they can service an average of 1800 cases of Syrian refugees including all ages and services, while the need is estimated to be much higher. It is not clear how many children are included in this number.

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Status of coverage and services provided by 4 NGOs in Lebanon

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ARCENCIEL (AEC)

Aec project covered an average of 3000 Syrian children in two years (2015-2017), before it was stopped. They are waiting for funding to renew the project in January 2018.

Since the beginning of the Syrian crisis, aec provided various therapeutic services for Syrian children of all ages up to 18 years, in addition to the required medical services.

Status of coverage and services provided by 4 NGOs in Lebanon

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BEIT ATFAL ASSUMOUD (BAS)

Currently, they weren’t able to receive any Syrian children, since they already are servicing a great number of Palestinians.

The Family Guidance Center, in the Mental Health Care department of the BAS stated that 84% of their Syrian clients are children with complex health, education and psychosocial needs.

BAS accept Syrian refugees’ children referred by all organizations, and they have a large waiting list.

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Conclusion

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This applies to all the Syrian children aged belowfive years, who suffer from any type of mentalhealth illness or developmental difficulties.

“The most important impediment that hinders the implementation of appropriateintervention to the Syrian children with ASD is the lack of accurate data on their numberand locations.”

“In addition to lack of data, the shortage of fund and financial resources imposes a seriousimpact on providing special treatment, appropriate intervention, recruiting professional,and creating special placement in school for children with difficulties” (United Nation,2013).

THANK YOU FOR YOUR ATTENTION

The presentation material and white paper are available by emailing malihaelsadr@ecilcenter.com

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Slide 2

Raed H.Charafeddine, First Vice-Governor, Banque du Liban. Fouad El Zein- Banque du Liban.

Graduate Institute of International and Development Studies, Maison de le Paix,10 Mai 2016/ Geneva, Switzerland.

Slide 4

Statement by UN Resident and humanitarian Coordinator in Lebanon Ross Mountain

Slide 5

Shaheen, Kareem, “Lebanon ill-equipped to handle mental-health issues of Syrian refugee children,” The Washington Post, September 27, 2014.

The Consequences of Untreated Trauma: Syrian Refugee Children in Lebanon- Maria Hawilo, JD

Slide 7

United Nations High Commissioner for Refugees, 2014

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References

Ms. Huda MuasherDirector, Iman Early Learning Center

October , 2017 76

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1948: the first wave of Palestinian refugees

1967: the second major wave of Palestinian refugees

mid-1970’s: the civil war in Lebanon brought yet morerefugees

1993: the first Gulf war brought Kuwait’s & Iraqi’sinto Jordan

2003: the second gulf war we welcomed the Iraqi’s

2011: to present we have hosted our neighbors to theNorth the Syrian’s

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2015 National Census Jordan As the national census indicates there are over 184, 932 Syrians living

in the capital of Amman in Irbid there are 136,606 in Zarqa, there 48, 126 Syrians Actual number of refugees in Jordan, according to the 2015 national

census is 1, 265, 514 and presently that number continues to grow. Total Syrian Refugees registered with the UNHCR in Jordan is: 659,125

UNHCR Indicates that 78.7% of Syrian refugees live in urban settings. They

move about freely and are integrating into the mainstream The remaining 21.3% are distributed across three refugee camps:

Zaatari, Zarqa and Emiratt Half of refugees are children:

15.5% are children under 4 (8% male and 7.5 female) 1 in 3 Syrian children has grown up knowing only crisis

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80% of human brain development occurs in the first 3 years of a child’s life.

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Adverse childhood experiences

Source: Adverse Childhood Experiences (ACE) Study Shonkoff, J. P., et al. (2012). An integrated scientific framework for child survival and early childhood development.

Pediatrics, 129, e460-e472.

The biology of adversity and resilience demonstrates thatsignificant stressors, beginning in utero and continuing inearly childhood, can produce long-lasting impacts on brainarchitecture and function, and affect health, learning and

behavior for life.

.

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-TAKE ADVANTAGE OF MALLEABILITY

-BUILD STRONG FOUNDATIONS FOR FURTHER

LEARNING

-PREVENT EARLY DAMAGE / AVOID

LOSS OF POTENTIAL

WHICH CANNOT BE REMEDIATED

INVEST STRONGLY IN EARLY CHILDHOOD PROGRAMS, EVEN IF PAYOFF IS ONLY 20+ YEARS FROM TODAY

Source: Pedro Carneiro, 2008

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Over 60% of active 2016 humanitarian response plans, flash appeals and refugee response plans do not includecomprehensive ECD services or ECE within education sector responses.

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Country Based Pooled Funds:Specific to development, and

Fund projects in 3 -5 year cycles

Central Emergency Response Funds, Exclusively for emergency and humanitarian interventions, and

Projects must be completed in 6-18 months.

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The economic argument proves it

The social emotional arguments proves it

The brain science proves it

The harsh reality of the refugees begs it

Our ethical responsibility obliges us, even commands us to do

it.

It can be done…let’s do it !

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Anyangwe, Eliza. (2015). Is it time to rethink the divide between humanitarian and development funding? The Guardian: December 4, 2015. https://www.theguardian.com/global-development-professionals-network/2015/dec/04/funding-humanitarian-assistance-development-aid

Betancourt, T. S., Newnham, E. A., Layne, C. M., Kim, S., Steinberg, A. M., Ellis, H. and Birman, D. (2012), Trauma History and Psychopathology in War-Affected Refugee Children Referred for Trauma-Related Mental Health Services in the United States. JOURNAL OF TRAUMATIC STRESS, 25: 682–690. doi:10.1002/jts.21749.

Dickinson, Elisabeth. (2017). New push for funding for education in emergencies. https://www.devex.com/news/new-push-for-funding-for-education-in-emergencies-91113.

Heckman, James. (2017). The Lifecycle Benefits of Influential Early Childhood Program. https://heckmanequation.org/resource/research-summary-lifecycle-benefits-influential-early-childhood-program/

International Committee of the Red Cross. (2009). Children in War. Geneva: ICRC. https://www.icrc.org/eng/assets/files/other/icrc_002_4015.pdf

Martin, Ben. https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/?all=1

Murad, I., Gordon, H. (2002). Psychiatry and the Palestinian population. Royal College of Psychiatrists. Vol. 26, Issue 1. DOI: 10.1192/pb.26.1.28.

Pridmore, S. Iqbal, M. (2004). Psychiatry & Islam. Australasian Psychiatry. Vol 12., Issue 4. P380-385. DOI: 10.1111/j.1440-1665.2004.02131.x

Save the Children (2017) Invisible Wounds. https://www.savethechildren.net/article/syrian-children-face-growing-mental-health-crisis-new-report-reveals

United Nations High Commission for Refugees (UNHCR). 18 September, 2017. Syrian Regional Refugee Response: Inter-Agency Information Sharing Portal. http://data.unhcr.org/syrianrefugees/regional.php

United Nations Office for the Coordination of Humanitarian Affairs (OCHA). http://www.unocha.org/syrian-arab-republic/syria-country-profile/jordan-country-profile

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Thank you

nurturing hearts and minds

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EVIDENCE BASED AND INNOVATIVE PROGRAMMING

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Pyramid Model to Promote Social Emotional Competence and Address Challenging

Behavior In Young Children

Rob Corso, PhDrob.corso@pyramidmodel.org

October 10, 2017

A public health, tiered model of Promotion, Prevention,Intervention– Developed by 2 federal centers (CSEFEL & TACSEI)

Intended to support the development of all children

It is both:– Collection of evidence-based practices based on supporting

diverse learners– Conceptual framework for a comprehensive array of

interventions and approaches

The Pyramid Model

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Tertiary Intervention: Few Children

Secondary Prevention:

Some Children

Universal Promotion:

All Children

The Pyramid Model:

Promoting Social and Emotional Competence and Addressing

Challenging Behavior

Creating an environment where EVERY child feelsincluded.

Designing an environment that promotes child andfamily engagement.

Focusing on teaching children what TO DO! Teach expectations and routines. Teach skills that children can use in place of

challenging behaviors.

The Goal of the Pyramid is to Promote Children’s Success by:

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Key Social Emotional Skills Children Need as They Enter School

• Confidence

• Capacity to developgood relationshipswith peers and adults

• Concentration andpersistence onchallenging tasks

• Ability to effectivelycommunicate emotions

• Ability to listen toinstructions and beattentive

• Ability to solve socialproblems

Pyramid Training Materials (Free/Public Domain)

Infant/Toddler Training Modules

Preschool Training Modules

Practice Based Coaching Modules

Family Coaching (home visiting) Modules

Parents Interacting with Infants (PIWI)

Positive Solutions for Families

Targeted Strategies to Support Children withDisabilities

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Research and

Evidence of Best

Practices =Teaching and

Learning

1. What is adopted is not used with fidelity

2. What is used with fidelity is not sustained

3. What is used with fidelity is not used to scale

Research to Practice Gap: Implementation

Statewide Implementation

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Tracking Pyramid Model work Across the Globe

Argentina

Australia

Belize

Burundi

Canada

Chile

China

Colombia

Costa Rica

Dominican Republic

Finland

Gambia

Ghana

Greece

Guatemala

India

Iceland

Ireland

Israel

Jamaica

Japan

Jordan

Kazakhstan

Malaysia

Mexico

Nepal

New Zealand

Philippines

Pakistan

Samoa

Saudi Arabia

South Africa

South Korea

Spain

Taiwan

Thailand

Trinidad & Tobago

Turkey

Uganda

United Kingdom

USA

Venezuela

Vietnam

Formula for Success

Effective and Socially Valid Practices

x

Effective Implementation Methods

x

Implementation Supports

Meaningful Outcomes

Adapted from Fixsen & Blase, 2012

Pyramid Model Practices

Coaching/Intervention Fidelity

State, Community & Program Systems for Implementation Fidelity

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System Components107

State/Commun. Leadership Team

State/Community Coordinator

Implementation SitesProgram Leadership Team:

administrator, internal coach, data coordinator, others

DataProgram Leadership Team:

administrator, internal coach, data coordinator, others

Master Cadre

external coach to sites; state T/TA

Program Leadership Team

Family Engagement

Program-Wide Expectations

Supports for Pyramid Model Practice Implementation

Systems to Identify and Respond to Individual

Child Needs

Continuous Professional

Development

Data Decision-Making Examining Implementation and Outcomes

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Implementation TeamNo Implementation Team

80%

3

Years

14%

17

Year

s

To “Making it Happen”From “Letting it Happen”

Sources:

Fixsen, Blase, Timbers, & Wolf, 2001

Balas & Boren, 2000

Green & Seifert, 2005

Saldana & Chamberlain, 2012

Improvement in Outcomes

Why an Implementation Team?

Effective

Teaching

Practices

Practice-Based Coaching• Focused on effective

teaching practices

• Based oncollaborative

partnerships.

• Guided by goals anda plan for refinementand action.

• Assessed throughfocused observation.

• Supportive of teachergrowth throughreflection andfeedback.

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ESTIMATED COACHING IMPACTS

*Note: Adapted from “Student Achievement Through Staff Development,” by B. Joyce and B. Showers, 2002, p.78. Copyright 2002 by the American Society for

Curriculum and Development.

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Pyramid Model – Gold Standard Research

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http://www.pyramidmodel.org/

rob.corso@pyramidmodel.org

217-390-0403

MEETING THE NEEDS OFCHILDREN WITHDISABILITIES

Rachel Brady, PT, DPT, MS

Center for Child and Human Development

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10 %

2 Million

700,00 children

Most at risk

Not identified

Added trauma

Focus on physical disabilities

18%-22%

Estimates and Challenges

Before Conflict

After Conflict

Displacement

In what ways can we support displaced children with complex disabilities and

their families?

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Models of support

Community-based

Integration

Supports

Person centered

Collaboration

Family centered

Capacity building

Context centered

Community Based Rehabilitation Routines Based Supports

Provide supports that are….

Family centered and culturally and linguistically competent

Developmentally supportive, strengths based, and promote children’s participation in their natural environments

Based on community-based resources and supports

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Community-Based

• Identify

– People

– Services

– Resources

• Training

– ID disabilities in young

children

• Awareness

Family Centered Care

• Identification of need

• Strengths of family and child

• Daily routines

• Problem solving

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Natural Environments

• Enhance relationship

to caregivers

• Model and support

families

• Within the belief and

values of the family

• Identify disability and needs

• Use existing models to provide supports

• Build capacity of family and community

Summary

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• Chatterjee, S. Naik, S., John, S. et al (2014). Effectiveness of community-based interention forpeople with schizohrenia and their caregivers in India (COPSO): a randomized control trial, TheLancet, 9926(383), 1385-1394.

• Dunst, C.J., Raab, M., Trivette, C.M., & Swanson (2010). Community-based everyday childlearning opportunities. In R.A.McWilliam (Ed, )Working with families of young children withspecial needs. New York: Guilford Press

• Hwang, A., Chaie, M., & Lui, S. (2014). A randomized control trial of routines-based earlyintervention for children with or at-risk for developmental delay, Research in DevelopmentalDisabilities, 34(10), 3112-3123.

• Iemmi, V., Gibson, L., Blanchet, K., Suresh K. et al, (2015). Community-based rehabilitation forpeople with disabilities in low- and middle-income countries: a systematic review. CampbellSystematic Reviews, 15 . DOI: 10.4073/csr.2015.15

• Roberts, M. & Kaiser, A.P. (2011). The effectiveness of parent-implemented languageinterventions: a meta-analysis. American Journal of Speech-Language Pathology,doi10.1044/1058-0360(2011/10-0055)

• Standnick, N.A., Stahamer, A., &Brookman-Frazee, L. (2015). Preliminary effectiveness of projectImPACT: a parent-mediated intervention for children with autism spectrum disorder delivered in acommunity program. Journal of Autism and Developmental Disorders, 45(7) 2092-2104.

References

DISCUSSION

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