According to the United Nations, Russia’s invasion of Ukraine, which began on February 24, has led to a displacement of more than 14 million people, with over 6.5 million fleeing Ukraine. Poland has received the largest influx of Ukrainian refugees at about 3.5 million, and other neighboring countries (Romania, Russia, Hungary, Moldova, Slovakia, and Belarus) have received about 4.3 million combined. According to UNICEF USA President Michael Nyenhuis, 90% of displaced Ukranian refugees are women and children.
“The mental health needs of Ukrainian refugee children, youth, and families must be urgently addressed to help them deal with the multiple acute and potential long-term traumatic consequences of being victims of this war,” said Yale Child Study Center (YCSC) Professor James F. Leckman, MD, PhD, who was invited to present at a two-day international conference in Warsaw, Poland on May 27 and 28, on how to ensure and promote children’s mental health during war. Leckman, who served as YCSC Director of Research for more than 20 years, reflects on the conference and the mental health needs of displaced children and families traumatized by war.
What was the focus of the conference?
Leckman: The conference brought together experts including professionals, policymakers, international and civil society organizations, academia, and private sector to jointly and assertively, take steps to safeguard and improve the mental health of the children and youth of Ukraine, Europe and the rest of the world to discuss – How to ensure and promote mental health during war: Assessing and responding to the impact of trauma on child and adolescence development [video here]. There was a specific focus on the conflict in Ukraine, and how to best assess and respond to the impact of the trauma of war on children and youth. More than 20 mental health trauma experts from Poland, Ukraine, all across Europe, and the United States came together both virtually and in-person to decide on next steps.
What were your main takeaways from the conference?
The mental health needs of Ukrainian refugee children, youth, and families must be urgently addressed to help them deal with the multiple acute and potential long-term traumatic consequences of being victims of this war.
James F. Leckman, MD, PhD
Leckman: What first comes to mind are the tragic realities facing unaccompanied and separated children and youth that are fleeing the war in Ukraine. Many of them have not only had their lives completely disrupted, but they also been abused and trafficked. Sadly, those without parental care are at a heightened risk of violence, abuse, and exploitation. The experiences that all of these children and youth have had to endure as a consequence of the war are in stark contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. We need to take immediate action to address their needs.
What needs to be done?
Leckman: Mental health and psychosocial interventions for war-affected children and adolescents need to be multileveled, and specifically targeted towards their specific needs. Interventions need to be trauma-informed, and when possible, strength- and resilience-oriented. The first step is to screen and assess the mental health needs of each child and youth and decide what resources are indicated. Immediate supportive interventions need to focus on providing basic physical and emotional resources for these children and youth for them to regain a sense of being safe. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based interventions. Obviously, supporting these children and youth also entails enabling and supporting their parents and caretakers. (See Bürgin et al, 2022.)
Were specific action points identified at the conference?
Leckman: Yes, they included a joint commitment from the participants to continue to share their knowledge, experiences, and best practices to best serve these children and youth, and their families. We also decided to continue to reach out to our colleagues in the scientific, governmental, and non-governmental communities in order to put in place a joint strategy and a plan of action for victims of war, including long-term policies to build resilience and a culture of peace The trauma expert team, with the help of Fondazione Child and the World Health Organization will be making available the scientific psycho-educational material presented that was discussed at the conference. These materials focus on providing support to the children, parents, and care givers in coping with post-traumatic stress in a simple and user-friendly manner.
The international community needs to make mental health care more broadly accessible. This includes optimizing the use of innovative tools such as remote, on-line service delivery, via tablet, smartphone, and the web. As a result, we decided to engage with the tech and social media communities to maximize dissemination of these materials, both digitally and in printed form. When possible, we also agreed that it will be very important to use digital platforms used by children and youth.
Importantly, efforts are also underway to develop a scalable plan for high quality mental health training for medical professionals, including psychiatrists and psychologists, primary care family doctors, nurses, and social workers. This includes a broad dissemination of currently available, evidence-based prevention, assessment, early intervention and treatment services, and large-scale community-based screening for mental disorders.
Many of our faculty at the Child Study Center will be actively involved in training our colleagues in Ukraine, Poland and across Europe. These include Yale Center for Traumatic Stress and Recovery Co-director Dr. Steven Marans, Children's Psychiatric Inpatient Service at Yale-New Haven Children's Hospital Medical Director Dr. Andres S. Martin, and members of our adjunct faculty, Dr. Ernesto Caffo, and Dr. Andrea Danese, who are world experts on childhood trauma and trauma-related psychopathology.
Finally, given the fact that so many of the participants were from academia, we are agreed to work together to initiate high quality, innovative research programs to develop novel evidence-based individual and group interventions that are culturally sensitive and provided in multiple languages.
You are actively involved in several organizations that are focused on building a more peaceful world. How was this reflected in your participation?
Leckman: Although I was asked to speak about the impact of trauma on the first day of the conference, I was also asked to speak about Pathways to a More Peaceful and Sustainable World: The Transformative Power of Children and Families. I should mention that Prof. Caffo has been a good friend and colleague for more than two decades. In preparation for the conference, he specifically asked me to highlight our work together with colleagues in Israel and Palestine. I [typically] highlight the ongoing work of the Early Childhood Peace Consortium (ECPC). The ECPC is a global movement of United Nations agencies, non-governmental organizations, academia, practitioners, and the private sector focused on sharing scientific and practice-based evidence on how investment in early childhood development (ECD) can contribute to sustainable peace, social cohesion, and social justice.
Do you have any closing thoughts?
Leckman: Let me end with a couple of quotes:
“If we are to teach real peace in this world, and if we are to carry on a real war against war, we shall have to begin with the children …. You must be the change you wish to see in the world.” — Mahatma Ghandi
“There can be no keener revelation of a society’s soul than the way in which it treats its children.” — Nelson Mandela