Effectiveness of school-based counseling sessions





03/12/2014

Introduction
 

There has been increasing number of research on the effectiveness of specific psychological interventions for children living in war zones (Gupa, 2008). However, a number of studies have described or evaluated different models of interventions for PTSD among children who had suffered abuse, experienced natural disasters, or exposed to community violence. These predominantly adopt psychodynamic or cognitive therapeutic frameworks, and a variety of techniques, with the broad aim of enabling the child to make links between trauma, emotions and beliefs, which can subsequently be challenged and modified. Herman (1997) outlined three phases of treatment for traumatized clients: the establishment of safety, remembrance and mourning, and reconnection with ordinary life.

 Research on young people who had PTSD as a result of exposure to a disaster includes that by Chemtob, Nakashima, and Carlson (2002) examining adolescents with PTSD 2–3 years following exposure to a disaster, and that by Goenjian et al. (1997) in which CBT for PTSD began 1.5 years after exposure to a disaster. These studies both indicate that children who have significant PTSD symptoms benefit from CBT intervention for both the PTSD and related difficulties such as depression, social competence and behavioural problems. Three randomized, controlled psychosocial treatment studies of sexually abused children with acute PTSD symptoms also demonstrate the superiority of CBT compared with non-directive supportive therapy or usual treatment in the community (Cohen, 2003). A comprehensive review by Ramchandi and Jones (2003) on treatment available for children who have suffered sexual abuse concluded that, ‘cognitive behavior therapy for children who are symptomatic’ (including suffering from PTSD) ‘has the strongest research evidence for efficacy’. A randomized controlled study evaluating the effectiveness of a group CBT treatment package for a cohort of schoolchildren in Los Angeles, USA, who had PTSD symptoms as a result of living in a community with high levels of violence, found clinically significant improvements which were maintained at 6-month follow-up (Stein et al., 2003). In another study of Sierra Leone children to determine whether rapid education intervention reduced trauma symptoms found that intrusion and arousal symptoms decreased after such intervention, while avoidance reactions increase (Gupta and Zimmer, 2008).

The aim was to evaluate the school-based counseling sessions for children living in a zone of ongoing war conflict. The hypothesis was that, children receiving the intervention would have significantly reduced mental health  symptoms following the intervention.

 

Methods

Subjects

Children were selected from three public schools and one private school in the Gaza Strip. The sampled consisted of 240 children, age ranged from 10 - 16 years the average age (12.2 years). There were 186 boys (77.5%) and 54 girls (22.5%). Of the total children, 33.3% of children live Khan Younis, 35.4% live Deir el-Balah area, and 31.3% live in Gaza city. Children were selected as follow: from the total 4 schools, one class was selected randomly and children were introduced and consent from was send to parents asking for participation in the intervention study and asking permission for children also.

 

Procedure

Pre-test assessment was applied to children one week before starting the school-based sessions (children were involved in 8 sessions in two weeks time which consisted of providing a safe environment to share children traumatic experiences, providing accurate information about the trauma to clarify misunderstandings, drawing pictures about one of their worst memories, sharing their  drawing, story telling about experiences and discussion among themselves about the meaning and solutions, dream analysis, taking part in role-plays of similar traumatic events, and mentioning last dreams concerning the traumatic events . Each group consisted of 25 children. After one week of finishing the interventions sessions, the same assessment tools were used to find the effectiveness of such intervention on reducing children behavioural and emotional problems. The data collected during the time of Sept 2007- Jan 2008 by 8 psychologists and psychiatric nurses working the field of children victims of trauma and war.

Instruments

Sociodemographic data:

The children demographic data was collected by questionnaire include sex, age, class, and place of residence.

 

 

Children Behavioural and Emotional Scale

The scale consists of 34 items measures the emotional and behavioural problems of children. The score range from 0= not true, 1= sometimes, 2= true. 

The reliability test of the scale was Cronbach's alpha =   .

 

Results of the study


Sociodemographic data  

 

The total number of children in the two stages were 240 children, age ranged from 10   -16 years with mean 12.2 years (SD=1.36).  According to sex, 77.5% were boys and 22.5% were females. According to place of residence, 33.3% of children live in the province of Khan Younis area, 35.4% live in Deir El-Balah, and 31.3% live Gaza city. According to grades, 19.6% were in the fifth grade, 31.3% were in the sixth grade, 13.8% were in the seventh grade, and 35.4% were in eighth grade.

 

Table 1

Demographic data for children in the sample

 

N

%

Sex

 

 

Male

186

77.5

Female

54

22.5

Level of study

 

 

Five

47

19.6

Sex

75

31.3

Seven

33

13.8

Eight

85

35.4

Place of residence

 

 

Khan Younis

80

33.3

Deir el-Balah

85

35.4

Gaza City

75

31.3

 

 

 

 

Second: test behavioral disorder of children:

 

Pretest assessment: the mean scores of behavioural and emotional problems was 15.25  (SD =degrees, 8.5 degrees variance criteria, and we have a team of healers work ( 8) sessions Archardi school and after school work sessions miscellaneous been applied measurement of behavioral disorders, the average degree of behavioral disorder in children and 13.45 degree of variance criteria of 8.07 degrees, which indicates that the degree of behavioral disorder in children said after the meetings.

Figure 1

Pre and Post assessment of  emotional and behavioral problems in  children

 

 

Third: the extent of the impact of the therapeutic sessions on reducing behavioral disorders in children:
Been applied measurement of behavioral disorders in children who are studying in the lower and middle schools to learn behavioral disorders suffer them, and then they work eight meetings healers school variety, and after the end of meetings has been the reintroduction of the measure behavioral disorders on children to determine the impact of the meetings were to reduce the degree of unrest Behavioral, it shows us that there is a moral statistically significant degrees of children before the application after application meetings and hearings in behavioral disorders ((Paired t-test = 3.1, P-value <0.05, the average degree of behavioral disorder in children before applying meetings 15.25 degree, while the average grades after applying meetings 13.45, as the average difference 1.80 a moral difference, and this shows that the meetings have had a clear impact in reducing behavioral disorders in children.

Table (2) results Paired t-test to study the impact on the conduct of meetings of school children

Ochas

Mean Diff

STD

T

P-value

After - Before

1.80

9.44

3.1

0.002 **

 

 

To ensure that this result was not the result of chance but came in a healthy test was done by Bootstrap to test value (t) through simulation, and after the application of this evidence noted that the value (t) were correctly, the value was close to the values that have been T. found through simulation, and this is reflected through the following format:

Form (2) clarifies the values (t), which came from the simulation method and compared with the value of the original (t)

 

 

 

• Differences between accommodation degrees behavioral disorders in children in the tribal distance measurement.
-- Measurement tribal noted the existence of fundamental differences statistically significant among children who live in the governorate of Khan Younis governorate and the Central Province Strip for behavioral disorders degrees (F = 8.5, P-Value <0.05), according to results of test comparisons of LSD Zuhr, has found that children who live in the governorate of Deir el-Balah suffer from behavioral disorders most of the children who live in the provinces of Khan Younis and Gaza, as the average children who live in the province of Gaza and 13.6 diversion standard 7.5, while the average grades of children who live in the province of Central 17.7 and 7.3 standard variance The average grades of children who live in the governorate of Khan Younis 13.0 and 8.8 variance criteria.
-- In telemetric have found substantial differences statistically significant between accommodation and various degrees of children with behavioral disorders ((F = 24.4, P-Value <0.05, according to the results of the test LSD comparisons Zuhr, has found that children who live in Khan Younis suffer less behavioral disorders of children who live in the provinces of Deir el-Balah and Gaza, as the average children who live in the province of Gaza and 13.2 diversion standard 8.7, while the average grades of children who live in the province of Central 17.3 and 8.3 standard variance, and the average degree of children who live in the province of Khan Younis 8.0 and 6.4 standard variance.
Table (3) shows the differences between the various possible accommodation and behavioral disorders in children in the tribal distance measurement

 

OCHAS

Address

N

M

STD

F

P-value

Before

 

 

Khan-youns

79

13.0

8.8

8.5

**0.001

Der-elbalh

83

17.7

7.3

Gaza

72

13.6

7.5

After

 

 

Khan-youns

65

8.0

6.4

24.4

**0.001

Der-elbalh

75

17.3

8.3

Gaza

46

13.2

8.7

 

 

 

Form (3) shows the differences between the various possible residence in the measurement of the distance tribal behavioral disorders of children

 

 

 

 

 

 

 

 

* The impact of outreach meetings to reduce behavioural disorders in children who live in the governorate of Khan Younis.
  Shows us that there is a moral statistically significant degrees of children who live in the governorate of Khan Younis before the application after application meetings and hearings in behavioral disorders ((Paired t-test = 3.18, P-value <0.05, the average degrees of behavioral disorder have before applying MEETINGS 12.5 degrees, while the average grades after applying meetings 8.7, with an average difference 3.75 a moral difference, and this shows that the meetings have had a clear impact in reducing behavioral disorders in children who live in the governorate of Khan Younis.

Table (4) results Paired t-test to study the impact on the conduct of meetings of school children who live in Khan Younis

Ochas

Mean Diff

STD

T

P-value

After - Before

3.75

9.5

3.18

0.002 دالة

 

 

* The impact of outreach meetings to reduce behavioral disorders in children who live in the governorate of Deir Al-Balah
  Shows us that there is a moral statistically significant degrees of children who live in the governorate of Deir el-Balah before the application after application meetings and hearings in behavioral disorders ((Paired t-test = 0.68, P-value> 0.05, the average degrees of behavioral disorder have before applying MEETINGS 18.01 degrees, while the average grades after applying 17.2 hearings, as the average variance 0.80, which is the differential non-moral, and this shows that the meetings did not have a clear impact in reducing behavioral disorders in children who live in the governorate of Deir el-Balah.

Table (5) results Paired t-test to study the impact on the conduct of meetings of school children who live in the governorate of Deir Al-Balah

Ochas

Mean Diff

STD

T

P-value

After - Before

0.80

10.07

0.68

0.49 غير دالة

 

 

 

 

 

 

 

 

 

 

 

 

 

* The impact of outreach meetings to reduce behavioural disorders in children who live in the province of Gaza
  Shows us that there is a moral statistically significant degrees of children who live in the province of Gaza before the application after application meetings and hearings in behavioral disorders ((Paired t-test = 0.56, P-value> 0.05, the average degrees of behavioral disorder have before applying meetings 14.8 degrees, while the average grades after applying 14.2 hearings, as the average variance 0.63, which is the differential non-moral, and this shows that the meetings did not have a clear impact in reducing behavioral disorders in children who live in the province of Gaza.

Table (6) the results Paired t-test to study the impact on the conduct of meetings of school children who live in the province of Gaza

 

Ochas

Mean Diff

STD

T

P-value

After - Before

0.63

7.8

0.56

0.57 غير دالة

 

 

 

• Differences between males and females in grades behavioral disorders in children in the tribal distance measurement:
  - Measurement tribal noted that there are statistically significant differences between male children and female children for degrees behavioral disorders (t = 2.35, P-Value <0.05), the differences were for males, and this shows that the male children suffer from behavioral disorders more than female children .
- In telemetric noted substantial differences statistically significant between male children and female children for degrees behavioral disorders (t = 7.4, P-Value <0.05), the differences were for males, and this shows that the male children suffer from behavioral disorders more than female children , which means that meetings that have been submitted to them had a significant impact in reducing behavioral disorders in children.

 
Table (7) illustrates the differences between males and females of behavioral disorders in children in the tribal distance measurement

Ochas

Sex

N

M

STD

T-test

P-value

Before

 

 

Male

183

15.8

8.3

2.35

0.02**

Female

54

12.8

8.4

After

 

 

Male

139

15.5

9.0

7.4

0.001 **

Female

50

7.2

5.8

 

 

 

 

 

 

Form (4) clarifies the differences between males and females in the measurement of the distance tribal behavioral disorders of children

 

 

* The impact of outreach meetings to reduce behavioural disorders in females.
  Shows us that there is a moral statistically significant degrees of female children before the application after application meetings and hearings in behavioral disorders ((Paired t-test = 5.17, P-value <0.05, the average degree of behavioral disorder in children before applying meetings 12.9 degrees, While the average grades after applying meetings 7.2, with an average difference 5.72 a moral difference, and this shows that the meetings have had a clear impact in reducing behavioral disorders in children female.

Table (8) results Paired t-test to study the impact on the conduct of meetings of school girl child

Ochas

Mean Diff

STD

T

P-value

After - Before

5.72

7.81

5.17

0.001 دالة

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* The impact of outreach meetings to reduce behavioral disorders in children males.
  Shows us that there is no difference moral statistically significant degrees of male children before the application after application meetings and hearings in behavioral disorders ((Paired t-test = 0.46, P-value> 0.05, the average degree of behavioral disorder in children before applying meetings 16.15 degrees , while the average grades after applying meetings 15.77, as the average variance 0.37, which is the differential non-moral, and this shows that the meetings did not have a clear impact in reducing behavioral disorders in children males.
Table (9) results Paired t-test to study the impact on the conduct of meetings of school boys

Ochas

Mean Diff

STD

T

P-value

After - Before

0.37

9.5

0.46

0.64

غير دالة

 

 

Differences between levels in the atmosphere degrees behavioral disorders in children in the tribal distance measurement.

 - Measurement tribal observed statistically significant differences between the children who are studying at different levels for the extra degrees of behavioral disorders (F = 6.9, P-Value <0.05), according to results of test comparisons of LSD Zuhr, has found that children who are studying in class VIII suffer more behavioral disorders of children who are studying at the school the following levels (V, VI and VII), while not noted any differences between other groups.
-- While in telemetric and found statistically significant differences between candidates of different levels and degrees of behavioral disorders, (F = 17.0, P-Value <0.05), according to results of test comparisons of LSD Zuhr, has found that children who are studying in class VIII suffer from behavioral disorders most of the children who are studying at school the following levels (V, VI and VII), also found that children who are studying in the sixth grade suffer from behavioral disorders most of the children who are studying in the seventh grade, and while not to notice any differences between the other groups.

 
Table (10) clarify the differences between the levels in the atmosphere behavioral disorders in children in the tribal distance measurement

Ochas

Level

N

M

STD

F

P-value

Before

Five

46

12.7

9.8

6.9

 0.001**

Sex

72

13.6

7.5

Seven

31

12.2

5.6

Eight

83

17.7

7.3

After

Five

32

10.1

7.3

17.0

 0.001**

Sex

46

13.2

8.7

Seven

31

6.2

4.8

Eight

75

17.3

8.3

 

 

Form (5) clarifies the differences between different levels of credit in the measurement of the distance tribal behavioral disorders of children

 

• the impact of outreach meetings to reduce behavioral disorders in children as classroom level.
To answer this question were used test Paired t-test comparison between tribal and measurement degrees telemetric behavioral disorders in children for various levels of candidates, we will be talking about every level descriptive basis n and reflected by the following:

Table (11) results Paired t-test to study the impact of outreach meetings in reducing behavioral disorders in children as extra levels

 

Ochas

levels

Mean Diff

STD

T

P-value

After - Before

Five

0.15

10.2

0.08

0.93 غير دالة

After - Before

Sex

0.63

7.85

0.56

0.57 غير دالة

After - Before

Seven

7.36

7.4

5.6

0.001 دالة

After - Before

Eight

0.80

10.07

0.68

0.49 غير دالة

 

 

Clear from the above table:
-- There is no moral difference statistically significant degrees of children who are studying in the classroom following levels (V, VI, VIII) before the application after application meetings and hearings to reduce behavioral disorders have, this shows that the meetings did not have a clear impact in reducing behavioral disorders when children who are studying in the classroom following (V, VI, VIII).
-- Noted that there is a moral statistically significant degrees of children who are studying in the seventh grade before the application after application meetings and hearings in behavioral disorders ((Paired t-test = 5.6, P-value <0.05, with an average difference 7.36 a moral difference, and this shows that the meetings have had a clear impact in reducing behavioral disorders in children, who are studying in the seventh grade.

 

 

Results of the study

The number of members of the 240 children who are studying in phases basic minimum and higher, ranging between the ages (10-16) years and the average age (12.2 and diversion standard 1.36) years, with males in the sample rate of 77.5%, while the proportion of females constituted 22.5 %. And 33.3% of children live in the province of Khan Younis, and 35.4% in the governorate of Deir el-Balah, and 31.3% in the province of Gaza.

Final results:
1 - measurement tribal average degrees of behavioral disorder in children (15.25 variance and standard 8.5) degree, while in telemetric average grades in the behavioral disorder (13.45 variance and standard 8.07) degree, and this shows that the meetings have had an impact in reducing behavioral disorders When children.

2 - moral differences found statistically significant degrees of behavioral disorders in children before and after the application of therapeutic sessions Paired t-test = 3.1, P-value <0.05)), with an average 1.80 degrees difference, and this shows that the meetings have had a clear impact in reducing behavioral disorders in children.

3 - noted the existence of fundamental differences statistically significant among children who live in the governorate of Khan Younis governorate and the Central Province Strip degrees for behavioral disorders in tribal Measurement (F = 8.5, P-Value <0.05), according to results of test comparisons of LSD Zuhr, has been found to be Children who live in the governorate of Deir el-Balah suffer from behavioral disorders most of the children who live in the provinces of Khan Younis and Gaza, as the average children who live in the province of Gaza and 13.6 diversion standard 7.5, while the average grades of children who live in the province of Central 17.7 and diversion standard The average 7.3 degrees children who live in the governorate of Khan Younis 13.0 and 8.8 variance criteria. While it was observed after the application of therapeutic sessions there fundamental differences statistically significant between accommodation and various degrees of children with behavioral disorders ((F = 24.4, P-Value <0.05, according to the results of the test LSD comparisons Zuhr, has found that children who live in Khan Younis suffer less behavioral disorders of children who live in the provinces of Deir el-Balah and Gaza, as the average children who live in the province of Gaza and 13.2 diversion standard 8.7, while the average grades of children who live in the province of Central 17.3 and 8.3 standard variance, and the average degree of children who live in the province of Khan Younis 8.0 and 6.4 standard variance.
  4 - show a statistically significant difference between male children and female children for behavioral disorders degrees before applying therapeutic sessions (t = 2.35, P-Value <0.05), the differences were for males, and this shows that the male children suffer from behavioral disorders more than female children, and after the application of therapeutic sessions observed statistically significant differences between male children and female children for degrees behavioral disorders (t = 7.4, P-Value <0.05), the differences were for males, and this shows that the male children suffer from behavioral disorders more than female children, which means that meetings that have been submitted to them had a significant impact in reducing behavioral disorders in children.
5 - show a statistically significant difference between the children who are studying at different levels for the extra degrees of behavioral disturbances in the tribal Measurement (F = 6.9, P-Value <0.05), according to results of test comparisons of LSD Zuhr, has found that children who are studying in class VIII suffer from behavioral disorders most of the children who are studying at school the following levels (V, VI and VII), while not noted any differences between other groups, and after the application of therapeutic sessions observed a statistically significant difference between the candidates of different levels and degrees of behavioral disorders, ( F = 17.0, P-Value <0.05), according to results of test comparisons of LSD Zuhr, has found that children who are studying in class VIII suffer from behavioral disorders most of the children who are studying at school the following levels (V, VI and VII), also found that children studying in the sixth grade suffer from behavioral disorders most of the children who are studying in the seventh grade, and while not to notice any differences between the other groups.

 










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