psychosocial support for children in the republic of south sudan

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Eiling et al.

Psychosocial support for children inthe Republic of South Sudan:an evaluation outcome

Ellen Eiling, MarianneVan Diggele-Holtland,TomVanYperen &Frits Boer

This paper describes an exploratory outcome evalu-

ation ofWar Child Holland’s psychosocial support

intervention I DEAL, a life skills intervention

aimed at improving the ability of children and young

people a¡ected by armed con£ict in the Republic of

South Sudan to ‘deal’ with their daily lives. The

speci¢c objectives were to assess whether I DEAL

is consistent with local perceptions of wellbeing,

and to explore the outcomes, as well as the factors

that in£uence outcomes of this intervention. The

research was conducted using mixed methods,

with a focus on qualitative and participatory

methods: group exercises, individual goal setting

(N¼110)and interviews(N¼ 62).Totriangulate

¢ndings from children, interviews were held with

teachers (N¼ 7), facilitators (N¼ 5), and parents

(N¼11). It was found that the content of the inter-vention was consistent with children’s perceptions

of wellbeing. Speci¢c outcomes that were reported

by children and con¢rmed by facilitators, teachers

and parents included decreased ¢ghting and

improved relationshipswithpeers andparents. Find-

ings suggest that I DEAL positively a¡ect

children’s social coping skills and has the potential

to improve children’s emotional coping skills and

classroom performance.

Keywords: armed con£ict, children, parti-cipatory outcome evaluation, psychosocialsupport, Republic of South Sudan

IntroductionAn estimated one billion children andyoung people under the age of 18 live inareas a¡ected by armed con£ict (United

ht © War Trauma Foundation. Unautho

Nations Children’s Fund (UNICEF), 2009).Exposure to the disruption, loss andviolenceassociated with armed con£ict, and its after-math, negatively a¡ects the psychosocialwellbeing of children (Jordans et al., 2010;Tol et al., 2011a; Attanayake et al., 2009).At the individual and interpersonal levelspsychosocial support can rebuild brokenrelationships and promote nonviolence(Wessels & Monteiro, 2006). This articlefocuses on the evaluation of a psychosocialsupport intervention that can contribute tononviolent behaviours and other peace-building processes at the interpersonal levelin the Republic of South Sudan.Thirty-eight years of civil war, between theSudan and South Sudan, has displaced 4.9million people and killed more than 2million. The vital infrastructure of theRepublic of South Sudanhasbeen essentiallydestroyed, and there is an almost completelack of basic social services. The populationis estimated at 9million, withmore than halfliving below the poverty line, especially inrural areas (World Bank, 2013). The popu-lation below the age of 18 is around 51%(Central Bureau of Statistics, 2009). Thecountry is highly rural, and is characterisedby isolated and inaccessible communities.The high costs of primary education, thenecessity for children to contribute to thefamily income, as well as long distances toschools, all contribute to severely low schoolenrolment levels. At 8%, South Sudan’sfemale literacy rate is the lowest in the world(World Bank, 2012).

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Psychosocial support for children in the Republic of South Sudan: an evaluation outcome

Intervention 2014, Volume 12, Number 1, Page 61 - 75

After South Sudan’s independence in 2011,ongoing con£ict in some border regions,intercommunal con£icts, food insecurity,seasonal £ooding and internal displacementcontinue to a¡ect communities (UnitedNations, 2012). In addition, the presence ofseven armed groups, the recent outburst ofviolence, as well as more generalised vio-lence all continue to negatively impactthe psychosocial development of children.This is often demonstrated by violent beha-viour and weak social skills, as observedduring situation analyses and byWar Child’ssta¡.Eastern Equatoria State, where the evalu-ation of I DEAL was conducted, wasparticularly a¡ected by the civil war from1983^2005. Until today, the region experi-ences insecurity caused by landmines, manycivilians owning weapons, and shatteredsocial and community relations. Cattlerustling, armed robbery, and banditry areendemic. In many areas of the state there islittle security presence.Violent con£icts overcattle and land are common, which arefurther exacerbatedby the return of refugeesand the arrival of internally displaced civi-lians. In addition, Eastern Equatoria experi-ences chronic food insecurity, a lack ofbasic services, and few economic opportu-nities (United Nations Development Pro-gramme (UNDP), 2012). War Child hasworked in Eastern Equatoria since 2009,implementing child protection, educationand psychosocial support programming.The ongoing con£icts, generalised violenceand the recent outburst of ethnic violence callfor continued support in all three areas, aswell as e¡ective peacebuilding, to promotechildren’s rights and their healthy develop-ment.War Child follows an ecological approach(Bronfenbrenner,1979) to improve children’srights and healthy development, throughstrengthening protective factors at variouslevels in society (Betancourt & Kahn,2008). Therefore, War Child Holland’spsychosocial support intervention ‘I DEAL’1

ht © War Trauma Foundation. Unautho62

is implemented in combination with inter-ventions promoting educationandchildpro-tection. I DEAL aims to support children(11^15 years of age) to deal better with theaftermath of armed con£ict, by strengthen-ing determinants of resilience and psycho-social wellbeing, such as self-con¢dence andsocial andemotional coping skills. Importantdeterminants for resilience include havingan internal locus of control and a sense ofself-e⁄cacy (Betancourt & Kahn, 2008). Toincrease children’s con¢dence that they canmake a di¡erence (internal locus of control)and to achieve their goals (self-e⁄cacy), theintervention uses participatory methods, tocreate opportunities for the children toexpress themselves and to reduce their fearof speaking within group situations.Other essential determinants of resilienceare social and emotional coping skills(Betancourt & Kahn, 2008), and supportivesocial relationships with peers, parents andother adults (Benzies & Mychasiuk, 2008).I DEAL’s aims of strengthening children’ssocial and emotional coping skills contrib-utes to improving social relationships,through group discussions and game basedactivities, focused on collaboration andcon£ict solving.The themes addressed in the six modules ofI DEAL (each consisting of 3^4 sessions),are identity, dealing with emotions, peerrelations, relationships with adults, con£ictand peace, and the future. Participantsactively contribute to the intervention byselecting the themes to be addressed, andthrough participatory monitoring andevaluation exercises (Claessens et al., 2012).The intervention consists of a maximum of19 sessions of 1.5 hours each, implementedover a period of 4 to 6 months, dependingon local circumstances and modulesselected. Each session combines creativeand participatory techniques, such as roleplay, drawing, games and group discussionsto stimulate active learning (Kalksma-vanLith, 2007). The groups have a maximumof 25 participants and are facilitated by

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Eiling et al.

community workers (hereafter facilitators)in schools, after school hours. Previouslypublished and non published evaluations inother countries have shown positive short-term outcomes of I DEAL; mitigating reac-tions to violence, such as aggression andimproving relations with adults and peers(Claessens et al., 2012).Despite growing evidence of the e¡ective-ness of psychosocial interventions for child-ren and young people (Flament et al., 2007;Jordans et al., 2010), there is an urgent needfor a stronger evidence base on the e¡ectiveapproaches for children a¡ected by armedcon£ict (Tol et al., 2011b). As complexpsychosocial interventions call for practicedriven research, process oriented and parti-cipatory approaches are required, beforemoving towards more rigorous researchdesigns (Claessens et al., 2012). Buildingon a pilot study conducted in Uganda(Claessens et al., 2012) in 2012, War ChildHolland, in collaboration with the Univer-sity of Amsterdam, the Netherlands YouthInstitute, and HealthNet TPO, conductedan exploratory outcome evaluation anda process evaluation of I DEAL in theRepublic of South Sudan.The primary purpose of this research isto further strengthen the intervention, inaddition to facilitating future e¡ect evalu-ations, by exploring locally relevant out-come measures. The study also aims tocontribute to current knowledge gaps inthe ¢eld of psychosocial support, throughaddressing three prioritised, internationalresearch areas for psychosocial supportinterventions (Tol et al., 2011b): e¡ectivenessof school based psychosocial support; localperceptions of psychosocial problems; andthe extent to which current interventionsaddress these needs. This paper addressesthe following questions:

1. D

ht ©

oes I DEAL ¢t with participants’ per-ceptions of wellbeing?

2. W
hat are the outcomes of I DEALregarding:
War Trauma Foundation. Unauthoriz

a. the achievement of participants’personal goals, and;

b. social and emotional coping skills

ed r

3. W
hat factors in£uence the outcomes ofthe interventions?
MethodsDesignThe exploratory evaluation followed amixed method, nonrandomised, pre andpost test design. As it was interventiondriven, the research included a conveniencesample in schools where the interventiontook place, and did not include a controlgroup. The pre test was conducted in April2012, the post test in November 2012. Theresearch is in line with international ethicalstandards and guidelines for the evaluationof psychosocial programming (UNICEF,2011; Inter-Agency Standing Committee(IASC), 2007). Respondents gave informedconsentverbally.Con¢dentialitywasensuredto all respondents, and it was explained thatall identity information was collected foranalysis only.To ensure data quality, nine communityworkers received three days of trainingand conducted the interviews in local lang-uages (Juba Arabic and Lotuho), withstructured topic lists. In order to build trust,the teacher introduced the researchers andthe research purpose to the children, andresearchers used child friendly approachesand games.

SampleThe evaluation took place in Eastern Equa-toria State, where a total of 11 groups (152boys and 105 girls) participated in I DEAL.Out of the 11 groups, ¢ve (from di¡erentvillages) were selected to participate in theresearch. Teachers selected children fromgrades 3 and 4, and in some cases theyincludedgirls fromanother grade to improvegender balance. Consequently, the age ofparticipants ranged from 8 to 16 years old(see Table 1 for demographic information).

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Table 1. Demographic characteristics of participating children

School Mean age (SD) FemaleN MaleN TotalN

1 12.38 (1.69) 11 10 212 12.17 (1.09) 13 11 243 11.32 (1.72) 8 20 284 10.33 (1.04) 11 16 275 11.91 (1.44) 6 16 22



The selection of the research groups wasbased on the security and accessibility ofthe area, and the starting dates of the inter-vention. The ¢ve groups included a total of122 children: 73 boys and 49 girls.The total dropout rate of the interventionwas 32%, resulting in a smaller researchsample at the post test stage. SeeTable 2 foran overview of the sample sizes used for ¢nalanalysis, per research instrument. For eachinstrument, the selection of respondentswas based on presence during data collec-tion, age and gender. Each child (N¼122)participated in at least one of the researchmethods. From each location, at least oneteacher from grade three or four was inter-viewed. It was an aim to include parentsfrom each location through snowball


Table 2. Overview of sample per research

Researchinstruments

Baseline Wellbeing exercise 5 groupsof� 8

Personal goalsPost test Personal goals

Evaluation interviewGroup discussions 5 groups

of� 11Interview parents 2 locationInterview teachers 5 locationInterview facilitators

Two researchers had been facilitators in the past and also p

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sampling. However, due to practical con-straints, this resulted in a sample of 11parents from two locations.

Research instrumentsLocal perceptions of wellbeing

The participatory research tool, WellbeingExercise (Stark et al., 2012; Hart et al.,2007), was used as described by Stark et al.(2012) to compare the content of I DEALwith local perceptions of wellbeing, as wellas its relevance and cultural ¢t. Duringgroup exercises, children’s local perceptionsof wellbeing were explored through re£ec-tion of what determines the wellbeing of achild within their community, and whatbehaviours they associated with peers whoare ‘doing well’.


instrument

Meanage (SD)

FemaleN

MaleN

TotalN

12 (1.65) 15 26 41

11.6 (1.56) 44 66 11011.4 (1.59) 30 44 74

^ 26 36 62^ ^ ^ 56

s ^ 8 3 11s ^ 1 5 6

^ 1 2 3rovided input.

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Eiling et al.

Personal goals

Children set individual goals at thebeginning of the intervention, which isincluded as the ‘Personal Goal’ exercise in theintervention’s monitoring and evaluation2.Formulating child led and participatoryindicators of success supports facilitators toaddress the needs speci¢ed by the childrenthemselves. Further, children’s participationin planning, monitoring and evaluationcan, in itself, facilitate psychosocial growth(Karki, Kohrt & Jordans, 2009). To formu-late realistic and achievable goals, thepersonal goals were based on self-identi¢edstrengths and di⁄culties, and set withinthe themes of the intervention; personaltraits and relationships with peers andadults. Progress towards reaching personalgoals was measured on a visual analogueline of 10 cm, a continuous line withoutnumbers, using a smiling and a sad face toindicate the positive and negative ends,respectively (Baker & Hall,1994). In clinicalsettings, similar types of ‘Goal Attainment

Scoring’ have shown positive therapeuticvalue in encouraging patients to reach theirgoals (Durrant et al., 2007). There is grow-ing evidence that this way of measuringhas greater sensitivity over standardmeasures, potentially avoiding £oor andceiling e¡ects (Turner-Stokes et al., 2006).These e¡ects occur when respondentschoose the most positive or negative answeroption, which inhibits the measurement ofindividual di¡erences.

Evaluation interviews

Based on a client satisfaction questionnaire(Healthnet TPO & Centre for TraumaPsychology,2010), structured interviewswereheld at the end of the intervention to assesschildren’s satisfaction with the intervention.Usingboth closed and open ended questions,the interviews assessed motivation to parti-cipate, reasons for missing one or moresessions, level of enjoyment and children’sperceptions of the bene¢ts of the interven-tion. To explore outcomes, children were


asked: ‘has there been any change (positive/nega-

tive) after ¢nishing I DEAL, for you personally?’Answer options were: a) deterioration, b)no change, c) some improvement, or d)much improvement, followed by an openquestion to obtain an explanation.

Group discussions

Agroup discussionwas held in each locationin order to evaluate the modules. During agroup exercise, based on a structured topiclist, each child used a sticker to indicate themodule they liked most (green), the onethey liked least (red) and the module wherethey learned the most (orange). In addition,children were asked, within small groups,to formulate suggestions regarding time, set-ting, themes and facilitation.

Interviews with teachers, facilitators, project sta¡

and parents

To triangulate the ¢ndings, structured inter-views with teachers, facilitators, project sta¡and parents were held using structured topiclists, including both closed and open endedquestions. Respondents were, for example,asked if they had observed any changesin children’s behaviour over the past sixmonths, and what they thought had causedthese changes. Interviews with facilitatorsand War Child sta¡ included questions onthe quality of implementation, and otherfactors that could have in£uenced the inter-vention’s outcomes.

AnalysisQuantitative data was entered and analysedusing Excel and SPSS 20 software. Tocompare the di¡erence between the meanscores at pre and at post test in relation tothe variation in the data, t-tests wereused to assess progress towards achievingchildren’s personal goals. Qualitative datawas analysed, combining grounded theoryand content analysis. The combination waschosen to allow for new insights providedby the data, while keeping general theoreticthemes in mind. First, intensive case levelanalysis was done, followed by extensive


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Intervention 2014, Volume 12, Number 1, 1 - 75

analysis combining and comparing types ofinformants, topics and crosscutting themes,in order to discover patterns emerging fromthe data (Russell Bernard, 2002; Silverman,2011). Two researchers separately conductedthe coding, in order to increase the objecti-vity of data analysis. Consensus was reachedwhere needed.

ResultsParticipants’ perceptions of wellbeingParticipants’ perspectives of what deter-mines a child’s wellbeing canbe summarisedin ¢ve main categories (in the order offrequency): material welfare; access to edu-cation; good relations with peers and adults;religious beliefs; and a safe environment.When discussing behaviours associatedwithwellbeing, most responses were related to:behaviour towards peers, behaviour towardsadults, general conduct, expressing emotionsand behaviour motivated by future goals.Participants strongly associated wellbeingwith being friendly and not ¢ghting, listen-ing well to adults, and being respectful. SeeTable 3 for the complete overview of speci¢cbehaviours mentioned.

Outcomes of I DEALDuring evaluation interviews (N¼ 62),48% of the respondents stated that theynoticed signi¢cant personal improvement,while 30% noticed some improvement.The main types of improvement are listedinTable 4. None of the participants reportednegative changes, and 14 (22%) childrendid not report any changes during the inter-view. Two of them also showed very littleprogress towards their personal goals.Theyindicated that they did not like the gamesand thought that I DEAL was too di⁄cult.Four children dropped out of the inter-vention, and therefore missed a signi¢cantamount of sessions. The other eight didreport positive improvement regardingtheir personal goals.


Personal goal scoresAtotal of 110 personal goals were formulatedin the ¢ve locations. Most children (45%)formulated goals to improve their pro socialbehaviour, including ‘sharing’, ‘helping’, ‘beingforgiving’ and ‘having respect for others’. Thirtyfour percent stated goals relating to relation-ships with others: to improve friendships ormake more friends,‘socialise’and ‘play together’with peers. Nearly 1/5 of the children (19%)wanted to improve on‘workinghard’andbeing‘disciplined’. Half of them mentioned this inrelation to their parents or home environ-ment.Two percent of the children’s personalgoals combined discipline and pro socialbehaviour. One child wanted to improveself-esteem and become more courageous,which was categorised as ‘emotional wellbeing’.Before I DEAL, the average score was3.0 (SD¼1.757, N¼ 74), in relation to achiev-ing their personal goals. None of the child-ren showed lower scores at post test. Posttest scores within the same group weresigni¢cantly higher (t(73)¼ 16.26, p¼ 0.00),resulting in an average score of 6.9(SD¼1.914). No signi¢cant di¡erences werefoundbetween locations, age or gender. Boysshowed slightly more improvement thangirls, with their average improvement ratesat 4.2 and 3.5, respectively. These di¡er-ences were not statistically signi¢cant(t(72)¼�1.548, p¼ 0.126). Quotes belowprovide examples of personal goals and theprogress towards achieving them.A 13 year-old girl’s personal goal stated‘I would like to improve playing with my friends’.She indicated that she progressed from 4 to6 on the visual scale (0^10), and explained:‘I was afraid of playing with my peers, but now at

least I talk and play with them’.A 9 year-old boy’s personal goal stated:‘I would like to try to be more forgiving when

someone has done something wrong’. After IDEAL he progressed from 3 to 7: ‘I no longer¢ght in revenge, but I controlmy temperand take time

to decide. For example, someone slapped me and I

did not react. But after a day, I asked him [about

it] and he asked for forgiveness from me, and I


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Table 3. Behaviour associated with well being by participants

CategoryBehaviour of childthat is doing well N

Behaviour of childthat is not doing well N

Behaviour towardspeers

Friendly to others 7 Lonely and isolated(no friends)

5

Sharing / helping others 5 Bullying 2Playing peacefully 4 In£uences others

negatively1

Playing with friends 3Behaviour towards

parents/caregiversListens / does what

is told10 Disobedient 8

Respectful 5 Lack of respect 8Helps at home 3 Doesn’t help at home 3Loving relationship 3 Runs away / wanders

around3

Other� 3 Does not acceptpunishment

2

General conduct No ¢ghting 8 Fighting 8No stealing or being

greedy3 Rude and insulting 4

Humble / graceful 2 Greedy/doesn’t share 3Other�� 2 Steals and makes trouble 2Prays a lot 1 Not loved/beaten by others 2

Doesn’t go to church 1Emotional

wellbeingAlways happy 6 Short tempered / restless 3

Noworries 1 Unhappy 1Future goals Tries to achieve good

results in school4 Doesn’t go to school 6

Hard working 1 Lazy 4Doesn’t care for himself 1

�Accepts punishments/appreciates gifts/does not go out of home without permission.��Not using badwords/visiting people.

Eiling et al.

did. [But] when someone has seriously hurt me, it

takes time to forgive’.

Social coping skillsDuring the evaluation interviews, most chil-dren reported changes regarding social skillsand relationships. The following changesare described in more detail below: reduced


conduct problems, improved pro socialbehaviour, relationships with peers, andrelationships with adults. Thirty-nine per-cent (N¼ 24) of children interviewedreported that they ¢ght less and are lessaggressive after having participated in IDEAL. As one 11 year-old boy stated: ‘I havenoticed some changes in me. For example, I used

to ¢ght a lot, but since I was taught about dealing


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Table 4. General changes reported in evaluation interviews

Type of change % Total (N) Girls (N) Boys (N)

Less ¢ghting and less aggressive 39 24 10 14Improved friendships and social skills 32 20 8 12Improved relationwith parents and

other adults19 12 4 8

Improved sharing / helping / respectingothers

11 7 4 3

Less worries and better control overown emotions

6 4 3 1

Nomore stealing 3 2 1 1Participant described one type of change 39 24 10 14Participant described more than one

type of change39 24 10 14

Participant could not mention anyrelevant changes

22 14 5 9

Total 100 62 25 37



with emotions I could forgive [others] and control

my emotions’. Also, two children said they usedto steal, but no longer do so.Teachers in threelocations and a facilitator con¢rmed adecrease in ¢ghting, bullying and otheraggressive behaviour.Eleven percent (N¼ 7) described more gen-eral improvements in sharing, helping andrespecting others (pro social behaviour).Thiswas also observedby four teachers, whostated that some children started helpingtheir peers with their schoolwork and wereshowing more respect for others. Accordingto three teachers in two locations, girls andyoung children in particular displayedimprovement in their general behaviourafter I DEAL. One facilitator mentionedthat participants became better at sharingduring I DEAL.One-third (N¼ 20) of the children indicatedthat they strengthened their friendships andimproved their social skills, learning how tomake friends and ‘play well’ together. Thischange was also described by two teacherswho observed childrenworkingwell together,helping each other, behaving more sociallyand becoming more united as a group.


Nineteen percent (N¼12) of the childreninterviewed reported improvement in theirrelationshipwith adults.The type of changeschildrendescribed in their relationshipswiththeir parents related mostly to respect andobedience, as illustrated in these quotes:

‘Whatever my parent tells me to do Ialways do

in time’. (Girl,11years old)‘I always apologise to my parents for the badthings I do to them’. (Girl,13 years old)

Seven parents also described these changes.One 14-year-old boy described a di¡erentformof improvement in his relationshipwithhis parents, saying ‘I can go for advice to my

parents now’.Two teachers also reported that childrenbecamemore obedient, with girls in particu-lar showing more respect towards teachersafter the intervention. See Table 4 for anoverview of changes reported by children.

Emotional coping skillsIn the evaluation interviews, four out of 62children reported that theyworried less thanbefore, or could control their fears better.


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One boy implicitly mentioned emotionalcoping skills as his reason for participatingin I DEAL:

‘I wanted to participate in IDEAL because of

playing games likeboom-chika.Theymakeme

stronger and physically fit in the mind, as well

as making me learn to let go of other problems,

like the memories of bad things like death,

poverty, lack of food’.

One teacher commented that I DEALreduces children’s problems because ‘playingmakes them no longer think of it’.Two facilitators observed that childrenbecame more con¢dent and active during IDEAL sessions over time. Teachers (N¼ 4)also reported that children in I DEAL hadbecome more con¢dent in class and parti-cipated more. However, both a facilitatorand a teacher mentioned that improvedself-con¢dence sometimes resulted in de¢antand disruptive behaviour from a few child-ren.The male facilitator stated:

‘[. . .]some children can also become morestubborn, they start making fun of it [the

activity], because when you learn to express

yourself you get this freedom, you’re free at

heart and free in your mind’.

Another facilitator noted that some childrenremained very shy, hardly participating inthe group. Only two children mentionedchanges in con¢dence, related to theirpersonal goal.

Academic performanceAll teachers interviewed (N¼ 7) reportedpositive changes in their pupil’s academicperformance after participating in I DEAL.‘Some children started studying together in groups,even without being told’, explained one teacher.Another teacher explained that the increaseof respect and increased concentration hascontributed to the children’s academic per-formance:


‘I DEAL children are performing better than

those who [did not participate]. In the way

they behave, for example they have learned

about respecting one another and their parents

and teachers. Such improvement has prevented

their learning being interrupted because of

psychological issues’.

According to another teacher, some childrenperformed better because they were moreattentive, and others because they hadbecome more con¢dent and participatoryin class: ‘It has also empowered some children to

actively participate in the class, they have now

realised their right to talk in public or class’.

Factors contributing to interventionoutcomesIn order to identify factors in£uencingthe outcomes, a process evaluation wasconducted to assess: appreciation of theintervention; attendance; the quality ofimplementation; characteristics of facilita-tors; and contextual factors (security,illnesses, and accessibility of locations). Asappreciation and attendance may have hadthe more direct in£uence on the individualoutcomes, these are described below.

AppreciationFindings from the group discussion indicatethat children liked the module addressingsocial relationships with peers most. Themodule on solving con£icts was the leastliked by the children, who also consideredit, and themodule on dealing with emotions,to be the most useful. None of the parti-cipants thought that any of the modulesor sessions should be removed, however.Participants provided suggestions on howto improve certain exercises, and recom-mended including local games in the ses-sions. The majority (84%) of the childrenthat were interviewed (N¼ 62) stated thatthey ‘enjoyed the programme a lot’, 15%responded ‘quite a bit’ and 1% ‘a little’. Mostchildren indicated that they felt good in thegroup during sessions, with the exception of


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nine childrenwho stated they did not alwaysenjoy being in the sessions, as illustrated bythe following quotes:

‘For me, I did not want to participate becauseI do not want to be embarrassed by friends,

for example, during the introduction I do not

speak Arabic language verywell. [. . .] some-times I feel bad to be in the group when I am

embarrassed’. (Girl, 9 years old)‘I did not feel good most of the time, because thegames are hard to understand’. (Girl,11yearsold)

A signi¢cant positive relationshipwas foundbetween the level of enjoyment in I DEALand changes reported by children in theevaluation interviews (Kendall’s t¼ 0.269,p¼ 0.025).The children who enjoyed the session less(16%)were also those who reported the leastimprovement at the end of the intervention.

AttendanceOf the 122 participating children, 24%attended all19 sessions,38%missed1^3 ses-sions, and 6% missed 4^7 sessions. Themain reasons for missing a session were ill-ness or domestic chores, such as work in thegarden or cleaning. Thirty-two percent ofthe children completely dropped out, ofwhich 29 (75%) dropped out during the lastmodule, predominantly in the two locationsthat had postponed the last sessions untilafter the Christmas holidays. Sometimes ses-sions were cancelled or postponed due tonational holidays or festivities, or becausecommunity meetings were held in the samelocation. In a few locations, children missedsessions for security reasons related to inter-communal con£ict. One teacher indicatedthat some parents did not support their chil-dren’s participation because they perceivedthe sessions as playtime.

DiscussionFirstly, local perceptions of wellbeingwere explored to assess to what extent the


interventionwas culturally relevant. Resultsshowed that the sessions address most ofthe locally de¢ned determinants of well-being; having positive social relationshipswith peers and adults, through beingrespectful, being friendly, preventing con-£icts, and being able to cope with negativeemotions. The factors that children associ-ated with wellbeing that the interventiondidnot addresswere: religious practices; welldisciplined behaviour; education; safety;and material welfare. Other War ChildHolland programme components addresssafe environments and access to education.Material welfare and religion are currentlynot addressed in War Child’s work. Anassessment of local resources and copingmechanisms would further increase theintervention’s relevance and cultural accep-tance. Further tailoring the interventionto the context and target group could berealised through an assessment and con-sultation phase, as described by Jordansand colleagues (2013).Secondly, the outcomes of the interventionwere explored. Findings showeda signi¢cantimprovement towards achieving personalgoals. It can be argued that these ¢ndingsmay be biased, due to the subjective natureof the self assessment. However, the resultsindicate that children seemed to score theirprogress realistically, not scoring too highat either the start, or the end.The main changes reported by children, aswell as by facilitators, teachers and parents,were decreased ¢ghting and improvedrelationships with peers and parents.These outcomes are in line with previousunpublished evaluations conducted in othercountries using I DEAL. The reporteddecrease in ¢ghting suggests improve-ment in the ability to copewith the emotionsleading to aggressive behaviour. Facilitatorsand teachers observed changes in con¢-dence and participation, which also suggestincreased emotional coping skills. The factthat very few children mentioned copingwith emotions as a di⁄cultyor changemight


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be caused by cultural or linguistic factors,or a di⁄culty in re£ecting on emotions.These ¢ndings suggest that the interventionstrengthens essential components of children’sresilience: social and emotional coping skills,and supportive relationships (Betancourt &Kahn,2008).However,whenadoptingamoreecological conceptualisation of resilience,the in£uence of children’s family and com-munity lifehas tobe taken intoaccountaswell(Tol et al., 2009). In addition, by reducingviolence and strengthening relationships, IDEAL potentially contributes to peacebuild-ing processes (Wessels & Monteiro, 2001).Furthermore, I DEAL seemed to have posi-tively a¡ected pupils’ academic perform-ance, in line with studies inWestern settings(Gavala & Flett, 2005; Van der Merwe,2005), as well as earlier ¢ndings fromWarChild Holland in Uganda (Claessens et al.,2012). This may be explained by the socialand emotional coping skills gained, whichhave shown to positively a¡ect school per-formance (Lam & Kirby, 2002; Zins et al.,2004).Additionally, factors that could in£uence theoutcomes of the intervention were analysed.The ¢ndings indicate that the participantswho enjoyed I DEAL less than the others,reported less improvement. Attendancecould notbe identi¢edas a factor in£uencingindividual outcomes. However, enhancedattendance and continuity of implementa-tion could signi¢cantly improve outcomes.Further, the quality of implementation,characteristics of facilitators, and contextualfactors (security, illnesses, and accessibility oflocations) may have in£uenced the outcomes.In addition, although no signi¢cant di¡er-ences were found in outcomes of younger orolder participants, the wide age range mighthave negatively in£uenced the outcomes,as this can a¡ect the group dynamics (forexample, younger children may not have feltcomfortable and learn at a di¡erent pace).As not every child experiences behavioural,social or emotional problems as a result ofbeing exposed to con£ict, it can be argued


that participants of psychosocial supportinterventions should be selected based onpsychosocial distress screening (Jordanset al., 2008). Although this may furtherimprove the outcomes,War Child Holland,aims to enhance social integrationby includ-ing all children within an existing group(i.e. class), in order to prevent stigmatisationof those selected, or jealousy among thoseexcluded.To gain more insight into other contextuallyrelevant factors a¡ecting children’s psycho-social wellbeing, as well as broader peacebuilding processes, it is essential to assesscommunity needs and build on availableresources. Addressing these factors of ‘ecologi-cal resilience’ can contribute to preventingre-occurrence of violent con£ict (Tol et al.,2009).

LimitationsConclusions regarding attribution of out-comes have to be drawn with care, due tothe non randomised sampling, and the lackof a control group. Demographic infor-mation, except gender and age, was notcollected; therefore conclusions about repre-sentativeness cannot be drawn. Despitee¡orts made to balance gender in both theintervention, as well as in the research, thisturned out to be challenging due to lowschool attendance of girls in the region.The dropout rate for personal goal measure-ments was 33%, which may have biased theresults to some extent. However, the inter-vention driven evaluation provides strongqualitative evidence for outcomes, as thesample size was substantial, and responsesfrom children were triangulated with thoseof parents, teachers and facilitators.

ConclusionContributing to current gaps in knowledgeon psychosocial support (Tol, et al., 2011b),this study indicates that the psychosocialsupport intervention I DEAL is consistentwith local perceptions of wellbeing, posi-tively a¡ects children’s social coping skills


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and potentially improves children’s emotio-nal coping skills and classroom perform-ance. Through reducing violence andstrengthening relationships, I DEAL alsohas the potential to contribute to peacebuild-ing processes. Findings indicate that enjoy-ment of participation in the interventionpositively in£uences the outcomes of theintervention.

RecommendationsFindings from this study should be used tofurther improve the e¡ectiveness of the psy-chosocial support intervention and informfurther research. The results lead towardsthe following recommendations:

� T

ht72

o e¡ectively promote children’s psycho-social wellbeing and healthy develop-ment, psychosocial interventions shouldbecombinedwithother interventionsthataddress material wellbeing, health, edu-cation, and protection, and that build onlocal resources and coping mechanisms.

� T
o foster consistent participation and sus-tainability of outcomes, community sup-port for the intervention needs to beincreased.
� B
uilding on this exploratory outcomestudy, future evaluations should measureoutcomes by de¢ning more speci¢c andculturally relevant indicators of psycho-social wellbeing.
� F
uture research is needed to analyse therelation between speci¢c interventioncomponents andoutcomes using (waitinglist) control groups, to be able to drawconclusions about e¡ectiveness. Futurestudies should also analyse to what extentpsychosocial characteristics, age rangeand gender balance within the group,attendance, quality of implementationandcontextual factors in£uence the e¡ec-tiveness of the intervention.
� M
ore research is needed to explore thelonger term e¡ects (including on aca-demic performance) of IDEALandotherpsychosocial interventions.
© War Trauma Foundation. Unautho

AcknowledgmentsWewould like to express our deepest appreciationto all who made the research possible: in the ¢rstplace all participating children, head teachersand teachers, parents and caregivers, the facilita-tors from partner organisations Sarra andYopas,and allWar Child Holland sta¡ in South Sudan.We would also like to acknowledge the crucialrole of the core research team in South Sudan(Grace Abalo, Umba Peter Bosco, Grace John,Joyce Katala, Jane Mindraa, Stephen Lokol,and Paul Tongi), especially Umba Peter Bosco,Joyce Katala and Mindraa Jane Silver. Muchthanks also go to Frits Boer, Mark Jordans andTom van Yperen for their guidance throughoutthe research. Our thanks also go to all colleagueswho provided input and support in completingthis paper: Annette van Andel, Elise Griede,Lasu Joseph, Jessie Kolkman, Laura Miller,Arjen Mulder, Esther Obdam and MartenSchoonman. Furthermore, we would like tothank Adessium Foundation for ¢nancially sup-porting this research, and enabling War ChildHolland to conduct in depth evaluations andlearn about how to further improve the psycho-social support provided to children a¡ected byarmed con£ict.

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1 The I DEAL methodology can be found on theWCH open-source platform www.warchildlear-ning.org.2 See Monitoring and Evaluation Toolkit atwww.warchildlearning.org/trainingtools/evaluation.


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Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.

Ellen Eiling, Drs, is Research, Monitoring and Evaluation Specialist at War Child Holland, the

Netherlands.

email: [email protected]

MarianneVan Diggele-Holtland,MSc, isJunior Researcher atWar Child Holland, the Netherlands.

TomvanYperen,PhD, isanExpert atYouthCareof theNetherlandsYouth Institute.He isalsoProfessorof

Monitoring and InnovationYouth Care at the State University, Groningen, the Netherlands.

Frits Boer,MDPhD, is an Emeritus Professor of Child and Adolescent Psychiatry at the University of

Amsterdam, the Netherlands.

Eiling et al.

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mailto:[email protected]