1. family and parenting
2. children

How to Help Children
Experiencing Traumatic Stress
An Evaluation of the Long-term Effects of
Psychosocial Intervention
and International Solidarity
Raija-Leena Punamäki
@STAKES National Research and Development Centre for Wellfare
and Health
ISBN 951-33-0838-3
Political violence and abuse of human rights are associated with images of horror: A child
witnessing how his father is harassed, a woman seeking for shelter, or blindfolded men in the
stadium of Santiago de Chile. In their eyes one can read disbelief in horrors caused by their
fellow humans. Witnessing injustice and cruelty evokes helplessness and rage in us. But it can
also evoke our activity and urgency to help suffering people.
Parasta Lapsille ( “The Best for the Children” ), a Finnish child welfare foundation,
understood the ordeal of persecuted Chilean families, and provided a concrete response to the
Finnish people’s sense of solidarity. It organised an assistance programme, ‘Help the Chilean
Child’, in co-operation with a Chilean child protection foundation, PIDEE (Protección a la
Infancia Dañada por los Estados de Emergencia). The Finnish foreign ministry further
sponsored the project that lasted for eleven years and assisted eight hundred children. The
project was unique in combining citizen’s voluntary action with governmental responsibility
to care for victims of human rights abuse. This report is an evaluation of this international
solidarity work, as seen through the eyes of the benefactors, who now are young adults.
I wish to express my gratitude first to my excellent fieldworkers, Roberto Coloma and Aquiles
Aroca. Without their devoted and courageous work I could never have succeed to meet ‘our
Chilean children’. And of course I extend my deepest gratitude to the Chilean families who
shared their painful experiences with us. I would also like to thank Parasta Lapsille
Foundation and The Finnish Ministry of Foreign for their support. Some employees in
Fundación PIDEE also shared their experiences with us and gave us access to the archives.
Finally, I would like to thank my man, Gideon Gitai, for his helping hand. We both recall the
warmth and hospitality that we enjoyed in Santiago de Chile, especially by Claudia MelnickLanzarotte, Viera Stein-Melnick, and Ana Melnick.
Contents
1 Conflicts and challenges....................................................................................5
2 How does political violence influence children? ............................................7
2.1 Nature and meaning of trauma ...................................................................7
2.2 Psychosocial well-being..............................................................................9
2.3 World-view and learning ..........................................................................10
2.4 Maturing and development .......................................................................11
3 What helps children to survive and prosper? ..............................................17
3.1 Resilience and coping strategies...............................................................17
3.2 Symbolic processing of trauma ................................................................18
3.3 Family relationships..................................................................................19
3.4 Social and community support .................................................................20
3.5 Intervention and therapy ...........................................................................22
4 Implications for organizing help....................................................................25
5 The Chilean case ..............................................................................................29
5.1 Political trauma .........................................................................................29
5.2 Finnish partners .........................................................................................31
5.3 Chilean partner ..........................................................................................32
5.4 Helping victims of human rights abuse....................................................35
6 Evaluation of organizational issues ...............................................................37
6.1 Relevancy and efficiency..........................................................................37
6.1.1 Initiatives and innovativeness ........................................................37
6.1.2 Shared principles ............................................................................39
6.1.3 Conflicts and problems...................................................................40
6.1.4. Problem solution .............................................................................43
6.2 Sustainability.............................................................................................44
7 Evaluation of the recipients’ viewpoints .......................................................47
7.1 Sample and field work ..............................................................................49
7.2 The assessment tools.................................................................................49
7.3 Meaning of childhood trauma...................................................................53
7.4 Current economic stand ............................................................................54
7.5 Education and learning experience...........................................................55
7.6 Family resources .......................................................................................58
7.7 Coping resources.......................................................................................58
7.8 Psychological well-being ..........................................................................59
7.9 The effectiveness of interventions............................................................60
7.10 Remembering PIDEE and Finnish sponsors ............................................64
7.11 Attitudes towards reconciliation ...............................................................66
8 Conclusions.......................................................................................................69
8.1 Criteria for effective psychosocial interventions .....................................69
8.2 Organizational aspect................................................................................70
8.3 Recipients' view ........................................................................................71
8.4 Premises for successful psychosocial intervention ..................................73
References ..............................................................................................................75
Appendixes:
Appendix 1. Content and dimensions of coping strategies....................................79
Appendix 2. Content and dimensions of mental health symptoms .......................81
Appendix 3. The Spanish language questionnaire ………………………………….?
Tables
Table 1. Adaptive and maladaptive responses to traumatic events in acute and long-term situation
Table 2. Child development, salient tasks and traumatic events.
Table 3. World-view: attitudes to the past, reconciliation and persecutors
Figures
Figure 1. The evaluation frame. How to help children in the context of Parasta lapsille and PIDEE
cooperation.
Figure 2. Economic Pressures and Adjustments in the PIDEE-group.
Figure 3. Learning Experiences in the PIDEE and comparison group.
Figure 4. Defensive Avoidance According to Gender and Childhood Trauma
Figure 5. Mental Health According to Gender and Childhood Trauma.
Figure 6. Use of PIDEE.servicesAamong Girls and Boys.
Figure 7. Childs’Age at the Initiation of Help and Coping Strategies.
Figure 8.Child’s Age at Initiation of Help and Mental Health.
Figure 9. Duration of the Assistance and Mental Health
Figure 10. Duration of the Assistance and Coping Strategies.
1
Conflicts and challenges
Typical of contemporary military conflicts is their long duration, high number of civilian victims
and disruption of family lives. While in the First World War, one in ten victims was a civilian, in
contemporary conflicts there are nine civilians in ten victims (Summerfield, 1996). Subsequently,
children and families suffer personally from violence, atrocities and humiliation. The main task of
the international community is to prevent conflicts and horrors from happening, but also to provide
effective help for the victims.
Mental health interventions among victims of political violence are a new
phenomenon, and have evoked considerable controversy. Some consider psychosocial interventions
to be luxury in conditions where the need for shelter, medical care, and economic and legal help are
highly imperative (Basogly, 1993). Others argue that military violence forms a serious risk
especially for psychological integrity and family relationships, and therefore comprehensive help is
morally legitimate. They also point out that political conflicts often last for generations, and
psychologically damaging effects thus accumulate. Effective psychosocial help can intervene in the
escalating suffering, and thus indirectly reduce a society’s future mental health costs. Finally,
psychosocial healing can be considered a means of enhancing reconciliation between enemies and
of rebuilding shattered communities (Punamäki, 1999; Taylor, 1998).
There is disagreement as to what extent humanitarian assistance should be
psychological or material in nature under military violence. Some people regard mental health
issues as irrelevant and argue that ‘violence is a natural part of life; people will endure pain and
recover easily’. Accordingly, economic compensation and legal assistance best serve the survivors’
needs. Others argue, however, that psychological problems are as pivotal as physical wounds, and
therefore victims should receive the best possible professional help. Fortunately, however, there is
an increasing consensus that both material and mental health assistance are important.
This report focuses on the effectiveness of a psychosocial assistance program for victims of
human rights abuse. The challenging issues are:
*
*
*
How can we translate knowledge of mental health and child development into practical help
for victims?
How can psychosocial help be organized so that it acknowledges the victims’ unique
experiences and integrates their natural ways of recovery with general scientific knowledge?
How can the long-term efficiency, institutional sustainability and relevance for a community of
psychosocial interventions be guaranteed?
These questions are discussed in evaluating a psychosocial project organized by Chilean and
Finnish child protection foundations1 and financed by Finnish volunteers and the Ministry of
Foreign Affairs. The recipients were Chilean families who were persecuted during the military
dictatorship in 1973-1989. The project provided educational and psychosocial assistance to families
who had lost a member due to execution, disappearance or incarceration, or who were expelled
from the country.
The report proceeds as follows. In the first chapter, I will discuss how war and
political violence influence children’s mental health, cognitive and emotional development and
social relationships. Next, I will discuss the factors that protect well-being and enhance optimal
child development in traumatic conditions. The Chilean-Finnish cooperative project is presented as
a case study. In the sixth chapter, the analysis focuses on organizational aspects concerning the
relevancy, effectiveness and sustainability of that cooperative project. Then, the project's success is
evaluated by examining the recipients’ experiences, psychosocial resources and mental health. The
evaluation shows that assistance can help children to endure and even blossom despite traumatic
events. Finally, I will present conclusions and suggestions for comprehensive psychosocial
interventions.
The report may serve professionals who are planning and implementing psychosocial
intervention programs for victims of war and political violence. This knowledge can also be applied
to refugees, asylum seekers and the families of torture victims. The evaluation results suggest that
timely and sufficient help for families facing military violence, war and human rights abuse may be
crucial to their children’s healthy development.
In Finland, the Parasta Lapsille Foundation and in Chile, PIDEE (Proteccion a la
Infancia Danada por los Estados de Emergencia).
1
2
How does political violence influence
children?
War and political violence intrude forcefully on children’s lives. Yet, the human mind is not a
reflection of the outside reality, however cruel it may be. Children are active participants in their
lives and always attempt to make sense of what is happening to them. A variety of psychosocial
issues protect their well-being and help them to endure and prosper. Planning of psychosocial
interventions should base on an understanding of both children’s vulnerabilities and strengths. They
include the children’s ways of responding to acute and chronic trauma, expressing their distress and
seeking help.
2.1 Nature and meaning of trauma
The scenes of war and violence seem utterly horrifying to an outsider. Therefore, it may be difficult
to realize that for a victim they present a unique set of associations, meanings, and feelings. The
same experience may, for instance, signify terror to one child and excitement to another. It is thus
imperative to be aware of and learn about each child’s personal experiences.
Certain characteristics of traumatic experiences form, however, a special risk for
children’s adjustment. They include danger to life, violence and humiliation targeted at family
members, horrifying visual scenes and auditive stimuli, unexpected losses and long-lasting
insecurity.
The source of children’s security is home. Witnessing atrocities and humiliation of
family members can be as disruptive as personal injury. Young children do not distinguish their
own security needs from that of their parents. Palestinian children expressed this by praying the
enemy soldiers: “You can take me, but please, spare my mother.” In the same vein, rescue workers
have observed that children tend to panic if they are saved before their parents.
Two issues seem important for children’s subsequent adjustment after trauma: how
they respond and how they remember the horrific scenes. Children vary considerably in their
behavior: some show amazing intactness and activity, while others panic and withdraw in traumatic
situations. Observations show that loss of consciousness and panic (“I didn't know where I was and
what I was doing”), and dissociative states (“I felt like I was somebody else”) form a risk of serious
symptoms. On the other hand, aim-oriented activity, such as helping others and belief, even
illusory, in one’s ability to control the traumatic situation leads to less severe consequences.
Horrifying and painful experiences tend to lead afterwards either to extremes of
retention or forgetting the event. Some children have very vivid, detailed and recurrent memories,
while others may totally deny the event and numb any related feelings and thoughts. Children
typically remember horrifying scenes as flashbacks, separated pictures, voices and body
movements, rather than as coherent stories (Wolfe, 1995; Ornstein, 1995). Wounded and abused
children have especially strong bodily memories but are often unable to verbalize them. The minds
of war victims are preoccupied by destructive scenes, frightening voices, and appalling smells.
Therefore adults’ attempts to console them verbally often turn out to be insufficient and ineffective.
Children’s traumatic memories are often distorted, and they can haunt them in dreams
and nightmares. Two kinds of distortion are common: children may remember themselves as
extremely helpless and victimized, and this self-image may generalize to safer conditions. On the
other end, children can perceive themselves as unrealistically omnipotent and responsible persons.
The imaginary notion that one could have helped or saved somebody causes a great burden and can
lead to severe guilt feelings.
Naturally, the accumulation of stress and harsh experiences is very harmful. Children
are amazingly capable and creative in dealing with one or two serious problems, but the risk of
emotional disturbances notably grows after four or more hardships (Garbarino & Kostelny, 1996;
Rutter, 1989). Children living on a war zone typically experience, besides military violence, also
parental distress, loss of home and friends, and disrupted schooling. The accumulation of loss and
trauma disturbs their everyday security and life rhythm. Psychosocial interventions should focus on
preventing that accumulation.
There is ample evidence that sudden and unexpected traumatic events make children
especially vulnerable. There have been some efforts to alleviate that negative trauma effect by
preparing children and adolescents to face extreme suffering (Dawes & de Villiers, 1987). In South
Africa and Palestine, psychologists have trained adolescents to face imprisonment by informing
them about the ways how human beings can endure isolation, sensory deprivation and other forms
of torture. The issue is naturally bewildering, because preparing children for horrors is antagonistic
to the adult’s role of advocating security and benevolence.
2.2 Psychosocial well-being
Much research focuses on symptoms and ill health and predicts pessimistic prospects for children
exposed to military violence. However, the evidence of the type and frequency of psychiatric
disorders is conflicting. Some argue that violence poses a serious risk to mental health, while others
maintain that children’s natural adaptive capacities profoundly counteract disturbances (Jensen &
Shaw, 1992).
Most children respond with distress to violent events, but a relatively small number
suffer from persistent symptoms. Symptoms may involve withdrawal from human contact, anxiety,
worry and intensive sadness, on the one hand, and aggression, hyperactivity, and concentration
problems, on the other. Somatic complaints, intensive fear, clinging to parents, and various sleeping
difficulties are also frequent (Macksound & Aber, 1996; Pynoos, Steinberg, & Goenjian, 1996).
Some children develop post-traumatic disorders (PTSD), characterized by oscillation between
avoidance and intrusive symptoms. Avoidance involves denial of traumatic memories and numbing
of feelings. Typical of intrusive symptoms is that children are overwhelmed by horrific memories
and experience uncontrollable thoughts, flashbacks, and nightmares.
Table 1. Adaptive and maladaptive responses to traumatic events in acute and long-term situation.
Children's responeses to traumatic experience
Adaptive in the acute stage
Maladaptive in the acute stage
*
*
*
*
*
*
*
*
* Loss of consciousness
* Severe disorientation and feeling of
detachment
* Loss of awareness of people around
* Irrational behavior
* Uncontrollable laughing
Feeling numb and withdrawal
Fearfull and easily startled
Anger and aggression
Clinging to adults
Sadness and crying
Sleeping difficulties
Nightmares
Repetitive playing of trauma scenes
Normal responses in the long-term
* Thinking and talking about the event
(6 months)
* Intensive mood changes
* Difficulties to concentrate
* Suspicion of strangers
* Intensive playing of events related to
trauma (funerals)
* Intensive analysing of salient issues such as
death, enemy and morality
* Preoccupation with safety: presence of
parents, strenght of adults
Abnormal responses in the long-term
*
*
*
*
*
*
*
*
Loss of weight
Loss of interest in life and depression
Excessive sleeping
Loss of ability to concentrate
Absent minded
Ritualitistic play
Inability to control imagination
Difficulty of controlling aggression to
others and onself
* Nightmares that disturb wakeful
state
It is important to differentiate the ‘normal’ from risking responses. Some examples of adaptive
versus maladaptive responses are presented in Table 1. Three issues are important in recognizing
the ways in which children express their distress after traumatic events.
First, the same symptom may be adaptive and healthy at the acute stage of trauma, but
turn out to be pathological if persisting. For instance, numbing of feelings and thoughts and
distractive activity may serve survival in the face of danger, but can later disturb family life and
become pathological.
Second, typical of abnormal expressions of distress is their repetitive and ritualized
nature, tendency to narrow and distort the child’s sense of reality. For instance, it is natural that
four-year-olds play funeral after somebody has died in the family. The play activity causes worry if
the same play becomes repetitious, ritualized and lacks thematic change. Engagement in this kind of
play hinders children’s realistic interaction with their environment.
Third, psychological symptoms may be only one expression of children’s distress.
Trauma often has a comprehensive impact on children's beliefs and attitudes, learning abilities, and
interpersonal relationships.
2.3 World-view and learning
Living under threat and danger shapes children’s attitudes to life, death and fellow men. Victims tell
that the most bewildering experience is to realize how devilish deeds fellow human beings can do.
The loss of trust in human virtue is harmful for children’s healthy development and world view.
Loss of future prospects is common among children who have witnessed violent death. Children
may be convinced that they will die soon or that they will not live until adulthood (Terr, 1991).
They seem to carry a death imprint with them. Children in war zones express patriotic attitudes,
support their own fighters and show willingness to join in the nationalistic struggle (Punamäki,
1996; Ziv & Israeli, 1973). It is not easy to understand why children who suffer from violence
actually support and glorify war. From a positive viewpoint, patriotic attitudes apparently protect
their integrity in the face of threat by providing an unquestionable belief in the invincibility of their
own fighters. Identification with their strength and bravery serves as a shield against fear and
despair. Also, in a nationalistic atmosphere, children can more easily make sense of violence and
feel free to express anger and frustration.
On the negative end, children may develop intensive hatred towards the enemy,
distorting their healthy development. First, dehumanizing and projecting all negative feelings
towards the enemy creates an unrealistic view on other people. This can lead to a generalized
rigidity and misinterpretation of other people’s motives and suspicion of them. Second, intensive
hatred for the enemy may restrict cognitive and, especially, moral development. Moral reasoning
proceeds normally from practical and concrete terms to a more symbolic processing of dilemmas
and conflicts. Also the subjective and self-concentrated views change to a more universal
understanding and consideration of other people’s point of view. An aggressive and violent
atmosphere interferes with this proceeding, children’s thinking becomes fragmented and their
empathy narrowly focuses on ‘our own people’.
Learning, concentration and memory problems are common among traumatized
children (Roussau, Drapeau & Corin, 1996; Qouta, Punamäki & El Sarraj, 1995). Children tend to
worry about their parents’ safety, fear for military reprisals and thus suffer from sleep disturbances
and nightmares. Subsequently they face difficulties in following teaching and instructions, and their
memory is burdened by other issues than learning tasks.
2.4 Maturing and development
Age greatly influences the ways how children experience and recover from traumatic events. Each
developmental period (infancy, preschool, school and adolescence) provides unique resources and
vulnerabilities. Capacity for abstract thought and memory go through fundamental changes. These
changes determine how children perceive the severity of threat, understand the causes of violence
and remember their own feelings, actions and thoughts during exposure. The age also influences the
ways how children express and regulate their emotions and interpret other people’s responses.
Finally, children’s coping strategies and imagination depend on their age. Young children typically
incorporate frightening scenes into their play, while older children attempt to understand their own
reactions to trauma and seek help from family and friends. (Punamäki & Puhakka, 1997; Shirk,
1988; Finkelhor, 1995). Table 2 summarizes the age-related developmental tasks and the impacts of
traumatic events.
Table 2. Child development, salient tasks and traumatic events.
Development stage
Infancy
Early childhood
Salient tasks
* Mutual parent-child
relationship
* Imitating and exploration of
environment
* Taking others' role
*
*
Middle childhood
*
*
*
Adolescence
*
*
*
*
Impact of trauma
* Insecure (avoiding or
ambivalent) ways of
attachment
* Overprotective parenting
* Human violence
incomprehensive
Effective problem solving and * Avoiding traumatic memories
memorizing
that may generalize
Expressing and controlling
* Loss of control and return to
emotions
earlier expression
Playing and imagining
* Fear of symbolic expression
Learning achievents and
* Intrusive thoughts interfere
sophisticated reasoning
learning, inability to
concentrate
Aware of one's own and
* Simplistic war propaganda
other's complex motives and
interferes empathy
emotions
development
* Complex issues become black
and white
Moral reasoning &
* Danger and threats are
hypothetical and abstract
concrete: underdevelopment
thinking
of reasoning potentials
Future planning
* Sense of defeat and lack of
future prospects
Intimate relationships
* Show reckless behaviour and
life-dangering acts
Omnipotent belief in one's
* Feeling immune to common
own capacity
dangers
Infancy
Babies are highly dependent on their mothers, and traumatic events thus may place a severe burden
on their relationship. Parents with traumatic memories may be less responsive to their infants’
nurturing and emotional needs. Their own suffering may hamper their ability to recognize the
infant’s distress or make them oversensitive to it. Traumatized parents tend to interpret any signs to
indicate danger and threat to their children’s security.
The early attachments form a basis for future interpersonal relationships and
emotional-cognitive integrity. We may assume that infants learn to adapt to their traumatized
parents in two insecure ways: they may avoid or become ambivalent about the parental bond
(Ainsworth, 1979; Bowlby, 1973). Evasive children habituate to satisfy and comfort their distress
by themselves and withdraw from maternal contact. Ambivalent children respond to the parents’
insensitivity by clinging to them or by developing various ‘difficult child’ characteristics. The
parent-child responses are reciprocal, and the infant’s early responses to the parents may thus either
complicate or facilitate mothering and fathering.
We lack research on how traumatic events influence the early parent-child
relationship. Mothering and fathering give a profound meaning to life in dangerous and traumatic
conditions, but involve also serious stress and fear for children’s security. Clinical observations in
Chile showed, on the one hand, that insecure attachment patterns are common among children of
imprisoned and tortured mothers. On the other hand, traumatized mothers aimed at compensating
for their children’s suffering by providing very good care for their family.
The infant-mother attachment is hardly ever used as a criterion for effective
intervention among traumatized families. There is, however, ample evidence that early attachment
influences emotional, social and cognitive development of children. Secure children learn easier,
form better peer relationships and are happier than insecure (Rutter, 1989). Insecure attachment can
make individuals vulnerable to unsatisfactory intimate relationships, poor parenting (van
IJzendoorn, 1995) and general distress (Fox, 1995; Mikulincer & Florian, 1995; Kanninen &
Punamäki, 2000) in adulthood.
Early childhood
Impressive cognitive, social and emotional developments happen during early childhood (2–6
years). Children learn effective problem-solving and memorizing, they are able to take the others’
role into account and engage in highly complex social and symbolic play. Emotionally, they learn to
solve conflicts between expressing and controlling negative feelings and enjoy their productivity
and competency (Berger & Thomphson, 1998, 299; Birch, 1997).
Preschool children are especially sensitive to expectations that adults are benevolent
and the world is a secure place to live in. Traumatic events compromise the feeling of personal
safety and trust in others. Children at this age may also feel powerless in dealing with their own
aggression and rage when their environment is violent. Therefore they may sometimes loose the
recently learned skills of mastery and regress to an earlier stage of development (Freud &
Burlingham, 1943). Parents reported, for instance, that their five-year-olds started to ‘behave like
babies’ after traumatic events: clinging to parents, biting their fingernails and wetting their beds.
In preschool years, playing, imagining, imitating and exploration are the dominant
mental activities. Play, imagination and fantasy are typically a two-edged sword in that they may
both protect children or make them more vulnerable in extreme stress. On the positive end, play
allows children to ventilate painful feelings and reconstruct their shattered world. Playing enables
them to change between different roles, create consoling as-if realities, and replay feelings of fear
and courage. Playing thus allows children to have access to emotions that otherwise would be too
provocative. Play enables them to integrate feelings of weakness and strength and increases their
affective repertoire. Trauma-related symptoms often block natural emotional and cognitive
experiencing, and play, as a multilevel expression, may be therefore crucial to recovery (Punamäki,
1997).
On the pathological end, children ritually repeat traumatic scenes in play, generalize
violent replaying into peer and adult relationships, and perceive also neutral scenes as threatening.
Preschool children tend to avoid traumatic memories and sometimes also suffer from a real memory
loss. Immersion into play can further enhance this denial and social withdrawal (Arroyo & Eth,
1997; Briere, 1992).
Middle childhood
Learning, achievement and peer relationships are important for school-age children. Their
knowledge expands, making new learning easier and reasoning more sophisticated. Exposure to
violence may result in intrusive thoughts, inability to concentrate and blurred memory.
Subsequently, children’s school performance may deteriorate, seriously compromising their future
possibilities. As school performance is socially important at this age, traumatized children may
loose their self-esteem and friends.
In middle childhood, children become more aware of the complex motives and
emotions that underlie other people’s behavior. They are keen to analyze what is morally right or
wrong. In war conditions, the existence of the enemy complicates this development. Children
concretely fear and hate the enemy because it has the power to destroy their home and deprive them
of their parents. The dehumanization of the enemy may be an effective defence against fear, but it
may also hinder children’s conceptual and moral development.
At this age, children become more conscious about their personalities, emotions and
abilities and build their self-identity and self-esteem by comparing themselves with others. Peer
groups often establish own subcultures with their own language, values and rules for controlling
aggressive behavior and solving conflicts.
Peer relations reflect political passions in war conditions. The peer status of politically
traumatized children is conflicting. Sometimes their peers bully or reject them at school (Finkelhor,
1995), while in another political atmosphere they treat them as national heroes. Both ways of
treating a trauma victim at school may cause distress. Heroic children feel a pressure to achieve,
without enjoying sufficient social support and an opportunity to show sorrow or fear.
Adolescence
Adolescence is the prime time of building a comprehensive world-view and deciding for one’s own
future. The expansion of hypothetical, abstract and logical thinking enhances more sophisticated
analysis and planning in adolescence. Young people analyze their role in the world and the meaning
of human life. They are able to transcend their ideas and do not accept things ‘in the way they have
always been’.
Traumatic experiences seem to have two opposing consequences at this age. On the
one hand, adolescents have an omnipotent belief in their capacity to save their suffering nation. On
the other hand, they may feel a deep sense of defeat and lack of future prospects. Related to the
first, adolescents consider it natural to join the army or freedom fighters. They believe in their
destiny for fame and great accomplishments and feel immune to common dangers.
Related to the second, prolonged traumatic conditions involving major losses may
lead to a foreshortened viewpoint of the future. The death imprint and the feeling that life will soon
end and holds few rewards ahead are especially devastating in adolescence. This hopelessness often
leads to poor career planning, dropping out from school, substance use and antisocial behavior
(Arroyo & Eth, 1997).
Adults greatly worry about the impact of military violence on adolescents. Their
violent and acting-out behavior is more visible and disturbing than, for instance, withdrawal and
ritualistic play of preschool children. Traumatized adolescents typically show reckless behavior and
life-endangering acts constituting re-enactment behavior. This disruptive behavior may later take
the form of self-blame and depression (Shirk, 1988). Furthermore, mood oscillations, typical to
adolescents, often intensify when a young person falls victim to violence and loss.
3
What helps children to survive and
prosper?
The main question is who are the children who manage to blossom despite painful experiences.
Research suggests that they are children who are capable of reconstructing their shattered worlds,
enjoy social and parental support and have cultural and ideological resources to build a coherent
identity on. Fostering these resilience factors is a useful criterion for effective psychosocial
interventions among traumatized children.
3.1 Resilience and coping strategies
Political history provides examples of children who have lived through intensive horrors and turned
out to be healthy and productive adults. The experiences of Jewish holocaust survivors, Indochinese
refugees and South African freedom fighters can teach us about the secrets of resiliency and
invulnerability. The resilient children seemed to have an ability (1) to maintain warm and safe
interpersonal relationships, (2) to create an internal fantasy world giving them condolence and
meaning in the midst of danger and (3) to cope with hardships in adaptive ways (Apfel & Simon,
1996; Garbarino, Kostelny, Dubrow, & Pardo, 1992).
A social network providing both intimate attachment relationships and practical help
is critical when children face traumatic events. Resilient children are able to seek and use adult
support. They, for instance, manage to get other adults to care about them if they fail to receive care
at home. Besides, resilient children enjoy helping others and are masters of promoting reciprocal
responses with adults. Meaningful relationships are a precondition to the fundamental feeling of
having goals to live for and a right to survive.
Internal resources of imagination, memory and fantasy are essential in balancing
between external horrors and psychological integrity. Resilient children show an ability to recall
images of good and supportive parents even if they have lost them e.g., through captivity or death.
They defend their well-being against anxiety and depression by postponing and rationing painful
memories until their environment is safe enough to allow expression of distress.
Faced with danger, human beings either tend to approach or avoid it. On a
psychological level, that corresponds to using either active, optimistic and reorienting coping
strategies, or passive, distracting and avoiding strategies (Carver, Scheier, & Weintraub, 1989;
Sorensen, 1993). The effectiveness of these strategies depends on the timing and circumstances of
trauma. For instance, passivity and detachment can be effective in extreme danger, whereas activity
and ventilation of feelings are beneficial in chronic stress. Children should therefore be encouraged
to use a broad repertoire of different coping strategies. A rich affective and cognitive repertoire
allows them to be in touch with painful feelings and reconstruct new meanings for them (Punamäki
& Puhakka, 1997).
3.2 Symbolic processing of trauma
Trauma typically overwhelms human capacity to regulate frightening emotions and images, and
comprehend what has happened. Therefore it is natural that traumatic memories occupy children’s
symbolic processes, such as playing and dreaming. Children also attempt to cope with trauma
through compensatory imagery, fantasy and day dreaming. A man, an African refugee, told about
his childhood by describing his recurrent compensatory fantasy.
“I’m sitting on a huge white horse with a golden leash. I am riding full of excitement, because I
have found a diamond. It is the lost diamond that, according to our heritage, was hiding deep in
the earth and on which our village was built. I am riding to bring the treasure to my mother. I
will return her and my whole tribe our lost dignity and prosperity.”
Evidence is definitive that traumatic experiences increase sleeping difficulties and bad dreams
among children (Pynoos et al., 1996; Qouta et al., 1995). Painful experiences also manifest in
nightmares, repetitive dreams, and flashbacks. The disturbed sleep and dream patterns are
characteristic of post-traumatic stress disorders (PTSD), and an alteration in sleep and dreams may
be central to initiating the PTSD (Wang, Wilson, & Mason, 1996).
Traumatic events thus hamper the symbolic processes involved in dreaming, playing
and imagination by narrowing their repertoire and candid expression. Research shows that the more
dreamlike, i.e., condensed, symbolic and bizarre the dreams are, the more effective healing potential
they involve (Punamäki, 1997). Characteristic of traumatic dreaming and nightmares is their
‘photolike’ correspondence with real events. Similarly, traumatic play has lost its healing potential
and closely reminds the reality. Traumatized children often refuse to play or choose repetitious play
themes. They are thus deprived of the beneficial influences of playing.
The core of the damaging impact of traumatic events may lie in the fact that exposure
prevents and disturbs the natural healing processes. War and political violence therefore constitute a
trap for child development: the more a child needs the healing potential of symbolic processes, the
more traumatic experiences disrupt their functioning.
3.3 Family relationships
The core parental tragedy is to witness one’s own children falling victim to military violence. The
scene disrupts the parents’ basic commitment to protecting their children and enhancing trust in
security and human virtues. Mothers tend to consider themselves a buffer between military violence
and family happiness. Their stories reveal guilt and pain when having to let their children witness
violence and humiliation. Here a Chilean mother remembers how she fled the country with her two
small children.
“... running to the Peruvian embassy, I carried my two kids and their toys and diapers only. I
had only one thought on my mind: to save them. When we were escorted to the airport in a
diplomatic car, the military raided us. They undressed my baby, thinking that I am hiding
something in his trousers. When we were finally safe..., the children were playing in a park on a
peaceful and sunny day. My son sees a police man. He is panicking, I had a hard time to calm
him down. I was thinking, what on earth am I doing to my children.”
Traumatic experiences may tighten but also complicate family ties. The parent-child relationship
becomes complex when mother is left alone, as often happens in war zones when men are killed or
imprisoned. Trauma creates unique family survival strategies that can either help or prevent healing
of its members. One phenomenon is the secrecy, ‘the conspiracy of silence’ around the traumatic
family history. Parents attempt to protect their children from horrifying scenes by not talking about
them. Children in turn tend to sense the painful meaning of the unexpressed family history and, in
the worse case, create their own fantasies of it.
Another phenomenon characteristic of traumatized families is ‘parentification’,
referring to reversed roles when children take over the caring and supporting role of the parents
(Levav, Kohn, & Schwartz, 1998). Children naturally feel sympathy for and worry about their
suffering parents, and, especially at certain age, they have an omnipotent feeling of compensating
for their suffering. Parents also attempt to provide compensating experiences for traumatized
children. In the negative case, it may lead to insecure parenting involving spoiling or overprotecting
children. That may encourage children’s passivity or dictatorial behavior that compromises their
developmental responsibilities.
There is evidence that good parenting, characterized by wise disciplining and love,
can protect children’s well-being. A Palestinian study established that when parents showed
intimacy, love and acceptance, traumatic events did not impair their children’s intellectual and
creative resources. These resiliency factors, in turn, predicted good mental health. When parents
were rejective, punishing and neglecting, children suffered more from poor psychological
adjustment (Punamäki, Qouta, & El Sarraj, 1997).
According to an Israeli study, maternal stress-buffering capacity was central to
protecting children’s mental health. Children were especially vulnerable when their mothers coped
with danger by withdrawal and avoidance. The mothers’ uncontrollable, fearful and horrific images
also predicted children’s poor adjustment (Laor et al., 1997). Evidently, mothers who are
emotionally available and provide consoling images, can manage to protect their children’s wellbeing.
These results tell about the secondary stress that a violent and dangerous environment
creates in parents. Parents would like to act as a buffer between the threatening world and their
children, which often turns out to be impossible. Assistance programs must therefore aim at helping
also the parents to cope with stress and horrors. Enhancing the parents’ resources by solving
feelings of guilt, improving marital relationships and soothing responsibility are essential for child
recovery.
3.4 Social and community support
Each war, military coup, and community violence has its unique historical roots and political goals.
The victims and perpetrators understand suffering, family roles and childhood resiliency according
to their cultural norms. The political atmosphere may vary from defeatist bitterness and collective
helplessness to activity, heroism and conviction that ‘we are on the right side of history’. Social
cohesion, leadership and communication style in turn shape the ways how people respond to loss,
violence and humiliation. Children encounter adversities in families that differ in their political
involvement, economic resources and social status. The family’s shared ideology apparently
influences how children understand their traumatic experiences. Conceptualization of trauma in turn
influences children’s well-being and potential for recovery.
The political atmosphere can either enhance or disturb children’s feeling of security
and meaning of life. Civilian endurance and mental health always become a weapon in a national
struggle and war. The enemy sides aim at destroying each other, and highly intimate issues such as
women’s honor and children’s innocence become a part of the struggle. Communities do their best
to protect people’s integrity, improve their resiliency and ease the suffering.
It is common that belligerent societies encourage fighting against the enemy and give
children ‘a hero status’ in this struggle (Punamäki, 1987; Ziv & Israeli, 1973). There is
disagreement about the benefits of ‘politicizing’ childhood. On the negative side, a heroic
atmosphere burdens children with adult-like responsibilities without providing them ageappropriate support (Punamäki, 1987). On the positive end, community can play a positive role in
helping children’s recovery by encouraging empowerment and creating an atmosphere of collective
hope. Psychosocial interventions should therefore involve also activation of community leaders and
other key persons and make them sensitive to children’s special needs.
The meanings and metaphors related to trauma influence the recovery process and
mental health. Man-made trauma of war and torture evokes different emotions and urges to act than
in natural disasters. The core experience of war and torture is coming face to face with the cruelty
of a fellow man. Losing trust in other people's benevolence and witnessing immoral acts is a
profound shock. Accidents and disasters in turn destroy the illusion that humans can predict and
control their environment. The question about safety and predictability of the world, and the moral
order of the good and the bad are essential for children and adolescents. They are constructing their
world view and incorporate political practices to their moral development.
There is an absolute split between ‘us and the enemy’, good and bad, villains and
heroes in war and political conflict. This split may be beneficial for mental health, because it brings
some order and reinforces cohesion in danger. However, in times of peace and national
reconciliation this black-and-white world view may turn out to be counter-productive. It narrows
children’s feeling and thinking repertoire and hinders mental flexibility and integration that are the
preconditions for developmental maturation.
A nationalistic and belligerent atmosphere does not cherish children’s benevolent
world-views. On the contrary, hatred towards the enemy and indifference towards the suffering of
‘the other side’ are fostered. To provide alternatives, several United Nations projects are advocating
peace education, conflict solution and reconciliation. They base on the philosophy that peace and
political stability can be achieved through forgiveness, empathy and creative problem-solving
among former enemies. Interventions for traumatized children must also base on awareness that
hostile and divided societies can handicap healthy and creative development.
3.5 Intervention and therapy
The review of protective factors among traumatized children revealed that war and political
violence form a trap for child development: paradoxically, the more a child needs healing resources
to survive and prosper, the more the traumatic events disrupt their functioning. The crux of the
damaging effect of war and military violence lies in their interfering with playing, imagination and
creative coping strategies and distorting good parenting and a benevolent moral atmosphere. The
task of intervention projects is to fill this trap.
Increasing knowledge of vulnerable versus protective factors in children’s lives has
resulted in more sophisticated psychosocial interventions, especially in the Balkans and Middle East
(Ajdukovic & Ajdukovic, 1993; 1998; Ayalon, 1998). They differ from earlier interventions in
involving explicit focus and aims, careful planning and using evidence-based tools. They aim at
integrating interventions of different domains (social, medical and building) and employing
multiprofessional teams and multisectorial cooperation.
Earlier communal interventions often expressed their aims in general terms. For
instance, the aim was simply to help suffering children or help them first to survive, then to
experience safety, and finally to flourish (Apfel & Simon, 1997). The help typically involved adult
supervising, strengthening family and peer relationships, and encouraging children’s imagination to
rework traumatic experiences.
Integrative interventions comprise social, psychological and pedagogic domains.
Psycho-educational approaches range from school system arrangements to curriculums providing
special education to enhance concentration and to heal learning difficulties. In catastrophic
situations, such as in Rwanda, UN projects supplied well-equipped classrooms on mobile buses to
maintain children’s schooling. Professionals in Israel and the Balkans have provided school-based
psychosocial assistance to ease children’s suffering from post-traumatic symptoms (Ayalon, 1998;
Gitai, Punamäki, & Sward, 1999). The Finnish project that is evaluated here gives a different
example of providing educational assistance combined with mental health services and
psychotherapy.
The planning of mental health services for trauma victims must be based on a careful
evaluation of their needs. The focus and timing of the intervention are important for a successful
recovery from trauma. It must be acknowledged that victims benefit from different kinds of help in
acute and chronic violence. There are observations that traumatized adults seldom seek
psychosocial help immediately after exposure. Bosnian women experiencing extreme atrocities
frequently refused psychotherapy immediately after trauma. They may have rejected the help
because they were in a phase of denial or depersonalization and therefore did not feel any need for
sharing their trauma (Kozaric-Kovacic et al., 1995). Our experiences further show that torture
victims tend to seek counselling or therapy because of marital conflicts and parenting problems,
rather than due to traumatic memories.
It is not always easy to make a connection between past trauma and current
physiological and psychological complaints. Chilean mental health workers told us that some of
their patients are still suffering from the consequences of political persecution that happened twenty
years ago. The victims’ mental health typically deteriorate when they face normative life crises,
such as a parent’s death or children leaving home. Also, remembrance days, such as the Holocaust
day and the ‘Jahrezeit’ for a military coup (in Chile, September 11) are critical to triggering
handicapping symptoms among victims. The symbolic recurrence of one's own trauma makes a
person continuously vulnerable. A political prisoner told that spitting on her face was one of the
most severe instances of humiliation in the concentration camp. In current normal social life, she
tended to interpret any indifferent or critical remarks as strongly emotionally provocative.
Suffering may thus occur long time after the actual trauma. It may also manifest itself
in masked forms, such as somatic symptoms and problems in intimate relationships. Interventions
to help trauma victims should therefore involve social support, counselling and debriefing
immediately after exposure, to be followed by more salient mental health services later. People who
deny their experiences and cope with distraction, depersonalization and avoidance are difficult to
help, and yet, they may desperately need help. Various psychotherapeutic means can be tailored to
fit to various acute and long-term needs of trauma victims.
4
Implications for organizing assistance
Psychosocial interventions should encourage children to survive and prosper, and should not focus narrowly
on symptoms and disorders. They should acknowledge children’s unique experiences, and be sensitive to
their age-related psychosocial activity and developmental potentials. The following issues are important in
planning of psychosocial assistance for victims of military violence and abuse of human rights.
a.
Age in relation to vulnerability and resources
Age influences the ways children appraise danger, remember traumatic events and cope with them. The
family relationships and social support also differ according to age. It is therefore important to explore
children’s critical or sensitive developmental periods. Young children, for instance, may cope effectively
because of their vivid imagination, but their improper use of causal explanations may make them especially
vulnerable. Assistance programmes therefore must be based on the knowledge of specific age-graded
vulnerability and resiliency characteristics.
b.
Behaviour durng traumatic experiences and their consequence
It is important to recognize that trauma is a very personal experience, even if it takes place in a collective
context. The way a child actually copes with it predicts the persistence of distress and symptoms. Loss of
consciousness, dissociation and uncontrollable visual, auditive, and kinaesthetic (bodily) memories form risk
for subsequent mental health.
The way children remember the traumatic events and how they attribute their causes
and consequences are important. Knowledge of them helps us to learn about the personal and
unique meanings that children give to their experiences. Understanding and dealing with trauma
seem more decisive for recovery than the trauma itself.
c.
The fate of parents, siblings and friends
Trauma creates unique family survival strategies that can either help or prevent children’s recovery.
Assistance programs must therefore consider the ways in which families share and communicate emotions,
and form parent-child relationships. A harmonious and supportive family life is very important in
safeguarding children’s mental health.
Assistance for traumatized families should also involve enhancing parental resources and
problem-solving skills, and alleviatiation of worry and guilt. We must be conscious of the heavy
burden that traumatic experiences place on marital relationship and parenting.
d.
Psychological first aid and long term assistance
It is necessary to separate “psychological first aid” from long-term assistance to traumatized children. Many
children suffer from severe symptoms immediately after traumatic events, but only a smaller number develop
persistent pathologies. The latter demand special care, while others can be helped in the schools and day care
centres through focused programmes.
It is crucial to note that some responses may be adaptive and healthy in the acute stage of
trauma, but turn out to be pathological if they persist. Psychological symptoms may be only one
expression of distress. Learning difficulties are common, and conflicts and aggression appear in
both school and home environments. Assistance programs must therefore involve also training of
intellectual capacity, group work and non-violent problem-solving skills.
e. Compensatory experiences to restore trust
War experiences not only disrupt physical security, but alter children’s world view. Victims lose trust in a
secure, benevolent and predictable world. Realization of the horrors that fellow-humans are capable of
inflicting each other is devastating for healthy development. Assistance programs should therefore provide
children other experiences. They may involve emotional caring, solidarity and friendship, on the one hand,
and problem solving and analysis of religious and nationalist philosophies, on the other.
Hostile and divided societies can fail in promoting children’s recovery from trauma. Portraying
the enemy as subhuman monsters can haunt children’s imagination and distort their belief in human
virtue. Interventions must therefore include also training for reconciliation and creative conflict
solution.
g.
Coping strategies and their enchantment
Children are not passive victims, but they aim at actively dealing with traumatic and violent events. In facing
trauma, they appraise how severe the danger is to their security and whether there are supports available.
Their core question is whether their parents are able to protect them. Based on these appraisals, children
employ coping strategies to endure and manage with hardship (Lazarus & Folkman, 1984; Punamäki &
Puhakka, 1997). Children must be encouraged to employ coping repertoires that match with their personality
and environmental demands. They may involve emotional regulation of traumatic memories, cognitive
processes of giving meaning and causal explanations to the trauma and behavioral activity to change its
traumatic reality. Assistance is effective if it takes these coping levels comprehensively into account.
h.
Reconstructing children’s natural social network
Children are conscious of the political conflicts and violence in their society. Violence forces them to face
enormous difficulties, but it also teaches them how to cope with dangers and protect oneself. The political
atmosphere, leadership and cultural norms shape children’s ways of responding to loss, violence and
humiliation. The existing support and social networks must therefore form a natural part of the intervention
programmes.
5 The Chilean case
5.1 Political trauma
On September 11, 1973, President Salvador Allende of Chile was shot dead by the military, led by
General Augusto Pinochet. Allende’s socialist government had won the historic multiparty elections
in 1970. Its governmental program involved extensive social and economic reforms, such as
comprehensive primary health care and free education for all.
The military rule was enforced, and emergency laws withheld all basic civil rights,
including freedom of expression and assembly, and forming political parties. The military forces
ruthlessly persecuted the supporters of the Allende government throughout the 16 years of
emergency rule. Approximately 40,000 persons were forced to leave the country after the military
coup and additional 200,000 became refugees later (CEDIAL, 1995), 2,920 were killed in
extrajudicial executions or by torture during 1973–1989. The number of detained, imprisoned and
tortured people remains unknown, being about 20,000 (Amnesty International, 1995; Human Rights
Watch, 1995). Several people disappeared in the hands of the military, estimated at 957 (Informee
Rettig, 1992).
The military government established several secret prison centers. Torture and illtreatment of detainees were frequently used to extract confessions and information. The military
used executions and torture also to warn against resistance activities and to spread fear and terror
among the former supporters of Allende. According to human rights monitors, torture and
‘interrogation’ included beating on the feet, electric torture and sexual violence. The methods of
both sensory ‘bombardment’ and deprivation were common. Detainees were exposed to extreme
hot and cold, and strong light and darkness. They spent long times in isolation with their heads
hooded (Amnesty International, 1995).
Similar to other repressive governments, the Chilean Secret Police frequently abused
the family members of prisoners. It directed violence at children to bribe and threaten their
politically active families. According to the Secret Police archives, 1,308 children under the age of
18 were imprisoned during the three-year period of 1986–1988 alone. Of them, 244 were accused of
being counter-revolutionaries and terrorists and were consequently tortured (Informee Rettig, 1992).
According to human rights records, of the 185 children who went missing during 1973–1989, a
third (N=59) were executed by the military, a quarter (N=42) disappeared as detainees and a quarter
were killed in demonstrations (CEDIAL, 1995).
Since the military coup in 1973 until the mid-1980s, the iron-fist policy harshly
suppressed any critical political or cultural expressions. The resistance activities continued despite
the harsh punishments, and in the 1980s more young people joined the clandestine organizations
working against the military rule. Underground activities to overthrow the military dictatorship
gained more momentum in 1986 when there was an attempt to assassinate General Pinochet. To
punish and frighten the opposition, extremely harsh collective reprisals were targeted almost
indiscriminately at families living in poor areas (poblaciones). Fear and terror of arbitrary torture,
interrogation and detention were widely speared.
Yet, contrary to what the military had planned, the reprisals increased the scope and
force of resistance against the military rule and repression. Finally, the emergency rule was lifted in
1989, and a referendum on the government was allowed. In the free elections, Chileans voted “no”
to Pinochet’s rule, and a center-party government led by President Alwin was formed. In the
coming years, at the beginning of the 1990s, tens of thousands of political refugees returned home.
A “Truth and Reconciliation” committee was established to inquire the extent of human rights
violations during the military era. It negotiated compensation for the families of murdered and
disappeared people. To the victims’ great disappointment, the committee declared general amnesty
for the perpetrators of the human rights crimes.
This report tells about the children of the persecuted families. They lost their dear
ones as disappeared, executed and detainees, or were among refugees expelled from Chile. Chilean
and Finnish child protection foundations provided them with help during the violent years of the
military junta. The Finnish Parasta Lapsille Foundation organized the “Help the Chilean Child”
campaign to raise economic support, while PIDEE organized psychosocial services for the families.
The Finnish Ministry of Foreign Affairs, in turn, financed a part of these services. The project was
unique in combining both the citizen’s personal and governmental responsibility to care for victims
of human rights abuse.
5.2 Finnish partners
Parasta Lapsille (The Best for Children) is a Finnish child welfare foundation dedicated to
promoting children’s healthy development and family support. It focuses on the most vulnerable
families by providing recreational services in Finland and by participating in international solidarity
work. Its task is also to inform governmental organizations of children’s rights.
The sponsors were Finnish citizens who committed themselves to financing education
for a Chilean child for at least two years. The criterion for a child to receive sponsoring was that he
or she had lost a family member due to political imprisonment, execution or disappearance. Later,
children from exiled and returned families were also included. The sponsors took responsibility for
the finance, money transactions, and communicating with the family. They also implicitly
controlled the relevancy, effectiveness and transperency of the project: If they had any doubts, they
withdrew their monthly payments.
The Finnish Ministry of Foreign Affairs (Department for International Development
Cooperation, FINNIDA) financed the activities of PIDEE, which in turn provided psychosocial
services for persecuted Chilean families. Financing followed the principle of channelling foreign
aid through non-governmental organizations. The NGOs were eligible to apply support for their
foreign aid projects, if they themselves financed an agreed amount (60%) of the total budget. In the
case of the Parasta Lapsille Foundation, the sponsor money was accepted as this ‘NGO-capital’, and
Parasta Lapsille and PIDEE together applied for their projects, accounting for 40% of their total
costs. The preconditions for aid were that the project plans were relevant, realistic and financially
solid. They also had to fulfill the principles of empowerment of the participants, equality between
genders and sustainability.
FINNIDA’s aid was FIM 2.3 million in the years of 1987–1996. During the military
emergency rule, the aid was channelled to medical, dental, therapeutic and social services for
families who were victims of human rights abuse. This financial arrangement with PIDEE made it
possible that the persecuted families could use the Finnish sponsor money exclusively for
educational costs.
FINNIDA continued helping PIDEE also after the military emergency laws were
lifted in 1989. The rationale was that human suffering does not end the day that the hostilities cease.
Groups with special needs, such as orphaned, wounded and sick children, also received prolonged
assistance. The PIDEE gradually extended its services from victims of military violence to families
suffering from social adversities. Besides, FINNIDA’s financing was based on the condition that
PIDEE would participate in the constructing of a governmental child welfare and protection
organization in a new, more democratic Chile.
Accordingly, between 1991–1994, FINNIDA sponsored (1) a project on
’Consciousness rising and defending children’s rights’, (2) a psychosocial intervention project on
children and adolescents at risk, including domestic, criminal and political violence; (3) the data
bank on children’s well-being and protection in Latin America, and finally, (4) between 1991-1992
FINNIDA partly financed a comprehensive and multilevel repatriation program for families
returning from exile.
5.3 Chilean partner
PIDEE was established in 1979, in response to the suffering of persecuted families. Since the
military coup in 1973, Chilean professionals had established networks to help human rights victims.
They provided juridical, medical, social and psychological services for families with executed and
disappeared members, and developed special treatment for victims of torture. In this network,
PIDEE took the responsibility for the developmental needs of children and adolescents and tailored
therapies accordingly. The needs of the families and the share of work with other human rights
organizations dictated the aims of PIDEE. The director of the PIDEE remembers:
“Families just stormed into our institution to ask for help. They asked for all kind of help. There
was no other choice than to create mental health services. At the beginning, our problem was a
lack of professional knowledge of how to help a large number of children suffering from
political violence. The only references we could find were descriptions of the Holocaust
children.”
The objectives of PIDEE involved assistance, research and denunciation of the military emergency.
Assistance aimed at protecting children and adolescents from the negative consequences of military
violence. Research on child development in traumatic conditions was encouraged in order to
understand and help children’s recovery better. PIDEE struggled for democratic change and to
remove the military junta. Their agenda included demands for just juridical procedures,
condemnation of torture and ill-treatment, and reporting on human rights violations to the UN.
PIDEE offered children comprehensive care through a variety of programs and
interventions. They followed the principles of (a) multiprofessional teamwork, (b) empowerment of
the families, and (c) sensitivity to the victims’ needs in dangerous political conditions. The team
involved professionals with medical, social work, pedagogic and psychological backgrounds. They
evaluated the needs of the families and planned for interventions with them. The families’
participation was crucial to encouraging empowerment. The negotiations resulted in explicit sharing
of responsibilities and rights. It helped the family members to be conscious about their strengths
and vulnerabilities (PIDEE, 1992).
An example of the sensitivity to changing political conditions, the multiprofessional
team developed a curriculum for children returning from exile. The repatriating program had
ambitious aims to integrate pedagogic, mental health and economic aid. (1) Eight regional PIDEE
offices provided pedagogic workshops and training in the Spanish language, Chile’s geography and
history, scientific methods and vocational guidance. A multiprofessional team of teachers,
educational psychologists and counsellors evaluated a child’s educational needs through pedagogic
diagnosis. (2) Preventive mental health team organized workshops, in which the ex-patriots solved
their acute problems and examined their needs. Returning families could join group, family and
individual therapy and counselling, and adolescents had their own activity groups. (3) Economic aid
ranged from food aid to scholarships. The food aid was necessary to secure physical development
for returning children suffering from undernourishment. This help was necessary for about 200
minors.
The main tasks of the social work, physical and mental health, and educational units
were the following:
Social workers delivered concrete help and served as a diagnostic unit. When visiting
families, they recognized problems and analyzed them with the family. This resulted in an action
plan on how to develop family member’s skills to solve problems. It was important to find solutions
that would prevent dependency and paternalism.
The tasks of the social worker team changed according to the Chilean political
developments. In the early years, the help was concrete, involving food rations to families and milk
to children. Food deliveries were later replaced by lunch kitchens that provided food for poor
families at a low price and organized other activities.
Physical health programs included preventive medicine and health promotion. They
included, e.g., nutritional follow-up and check-ups for infants and underweight preschool children.
Individual treatment and rehabilitation was provided at ambulatory level and odontological services.
The Mental health team consisted of psychologists and psychiatrists. During the years,
it revised ideas of mental health and created new activities to meet the challenges of the increasing
repression and trauma. They used traditional methods, such as play sessions, and group, family and
individual therapies. Innovations included a community mental health program and prison
campaigns.
They created a community mental health project in response to the massive house-tohouse searches conducted by the military, causing severe fear and terror in the community and
badly disrupting family lives. The project employed local young people as volunteers to develop
recreational activities for children. It also encouraged young dwellers to create workshops and
occupational therapies, that could provide innovative solutions to their problems.
The mental health team developed their traditional working methods to meet the
changing political demands. For instance, children reacted intensely to the absence of their detained
or exiled fathers. They expressed their despair by acting out or numbing their feelings of loss. They
seemed either to be oversensitive or evasive to any hints that reminded them of the absent parent.
The team adopted the rule that the place of the absent parent must be kept “open” during the
separation. The parental contact had to remain as intact as possible. Children were encouraged to
make cards, presents and write letters to their detained or exiled parents. As the parent-child
attachment is especially salient in early years, the mental health team arranged children to visit their
parents in prisons. The interventions encouraged establishing, maintaining and developing
relationships between the child and parent, despite the military persecution.
The pedagogic unit cared for children’s school performance. Experiences of violence
and loss seriously interfered with schooling, and children failed to realize their learning capacity.
Many mothers had lost their partner as prisoner, dead or disappeared, and had therefore difficulties
to support their children’s learning and supervise their homework. PIDEE employed teachers to
provide complementary courses for pupils who faced difficulties in performing on the primary and
secondary school curricula. They also arranged preparation courses for university applicants.
Working methods included a plan on guidance, curriculum and individual support.
Children who suffered from reading, writing and calculus problems received treatment and training.
The aims were to correct the specific disorders and strengthen children’s general performance and
self-esteem.
Also the Pedagogic unit shaped their activities according to political development. As
the military emergency rule was lifted in 1989, the main focus was to integrate the former refugees
into Chilean society. Most of the school-age children were born in exile, and their Spanish language
and knowledge of Chilean society, history and geography was poor.
Children whose life was in acute danger could live in “Casa Hogar” (shelter home).
It provided a home for those whose parent was condemned to death and whose relatives were
unable to take care of them. The family members of political prisoners were at risk of being
kidnapped, abused and detained during the military rule. The secret police frequently bribed and
intimated the detainees by threatening their children and wives. Casa Hogar provided shelter for
these children and women. Casa Hogar was also used as a safe route to transfer children out of
Chile to reach the protection of international asylum organizations.
5.4 Helping victims of human rights abuse
Whom to help and how to organize assistance are crucial questions in politically repressive and
dangerous conditions. There is an obvious paradox in providing psychosocial assistance to
politically active people: even if the amount of suffering and persecution is excessive, only few
people seek help. The reasons may be the fear of military reprisals, generalized distrust and
suspicion, and social shame. Ideologically, mental health problems are often regarded as signs of
weakness, and therefore victims prefer economic help to its psychological counterpart.
PIDEE solved the contradiction in the following ways. First, it guaranteed a family’s
security by employing professionals who were ideologically committed and opposed the military
rule. They could show political sympathy to their clients and were aware of the everyday dangers
and threats in their lives. They were familiar with their clients’ legal rights and networks that could
protect them from military reprisals. In other words, the client and professional shared a common
understanding of events that caused the individual suffering. Help-seeking families could identify
with PIDEE’s aims of struggling for political freedom and denouncing human rights violations.
Chilean human rights organizations, for their part, had created a referral system that guarded the
security of the persecuted help seekers.
Second, PIDEE provided comprehensive assistance including shelter, economic
support, medical care and psychotherapies. The professionals decided with the families the nature
of the help, division of labor, duties and responsibilities. These working principles apparently
correspond with the world-view of politically and socially active clients.
The initial inclusion criteria for the Finnish educational sponsoring were the severity
of trauma and its consequences to family life. That was intelligible to the donors and was consistent
with PIDEE’s philosophy of helping victims of human rights abuse. However, the criterion turned
out to be insufficient due to the overwhelming needs for help. Subsequently, the child’s
performance in school, lack of alternative financial resources, and politically proper behavior were
also included as criteria for economic assistance.
The years 1985-1988 were characterized by overwhelming repression, and PIDEE’s
work was under surveillance. They experienced sporadic attacks to their offices in Santiago and the
provinces. When attacks on human rights and medical organizations continued, PIDEE built a fence
around its offices and insured its property. PIDEE was officially a humanitarian welfare office.
Horrifying news of losses, sorrow and violence often interrupted PIDEE’s work. An
extract from a letter to Helsinki and an interview with a former employee reveal the horrors behind
everyday work.
“Dear friends. This letter is badly incomplete because of the horrifying murder of a relative of
mine. He was kidnapped in the schoolyard in Santiago and was found next day in a ditch. He
had been badly tortured and his throat had been cut. Once again, we have four more orphans,
and I am unable to describe the pain and horror that his murder has caused to his family,
children and other relatives, also the whole population.” (Santiago, March 1985)
“The work was terribly hard, I never could have imagined that other people can do such
horrible things to a fellow human being. I hardly could prevent myself from crying when
listening to the children telling what had happened to their families.” (Interview with a former
PIDEE doctor).
6
Evaluation of organizational issues
In the following, the achievement of the objectives of the sponsor assistance program is analyzed. A
descriptive analysis aims at revealing its strong and weak points through archive material,
correspondence between the Parasta Lapsille and PIDEE Foundations and interviews with former
PIDEE employees.
6.1 Relevancy and efficiency
The project aims were on the ‘ sponsors level’ simply to help children, whose families were
suffering from human rights crimes, by financing their education. A shared understanding of the
Chilean socio-political situation and the purpose of assistance were crucial to the success of the
project. On an organizational level, effective sharing of work and responsibility between the
organizing partners was essential. Accordingly, I will analyze here (a) initiative and innovative
activities, (b) shared principles concerning assistance, (c) conflicts and problems, and (d) solution to
the problems between the Parasta Lapsille and PIDEE Foundations.
6.1.1
Initiatives and innovativeness
PIDEE, the Chilean counterpart, took most of the initiatives during 1981–1987. In the beginning
they involved practical proposals for money transfers, documenting children’s traumatic
experiences and solving familial problems. In the years of harsh military repression, PIDEE
extended its activities and developed several short-term projects to meet the increasing human
demands. Typical correspondence was as follows:
“Would it be possible for you to start a money-raising campaign to help and strengthen our
mental health program? The attached information bulletin illustrates why it is imperative to
continue psychological help for children.” (Santiago, December 1981)
PIDEE’s correspondence reflects worry about the increasing violence and repression in Chile. Their
interest was to guarantee permanent assistance to persecuted families and to expand their related
activities.
“In order to develop our services, we have until now trusted that your help will continue.
However, we need guarantees that it will enable our planning also towards the end of 1982. We
need your assistance to make our work known in the provinces (outside Santiago), where the
situation is very serious, due to the misery and marginalization of families.” (Santiago,
November 1981)
The main aim of the Parasta Lapsille Foundation, the Finnish counterpart, was to convince sponsors
to commit themselves to continuing their economic assistance to Chilean persecuted families. For
that purpose, they organized an extensive information campaign focusing on the human rights
crimes in Chile. “Help the Chilean Child” information campaign turned out to be very successful, as
indicated by the high number of sponsors ready to fulfill the needs expressed by PIDEE.
The information campaigns were essential to recruiting new sponsors. The decision to
commit to the program was based on the information concerning the political situation in Chile and
personal attitudes towards developmental aid. Koskinen (1992, 33) showed that two-thirds of
individual sponsors received their information about the project through the Parasta Lapsille media
campaign.
The number of interested sponsors grew steadily during the first years of the information
campaign (1981–1986). Occasionally there were more sponsors than children available to be
assisted. Organizing help and evaluating families’ needs was a highly complex task in politically
unstable conditions.
“Many people show interest in joining in our sponsor program. All the children whose names
you have sent to us have already received a sponsor. Please send us immediately 20 names of
children who need assistance, and at least 50 in April.” (Helsinki, March 1982)
The Parasta Lapsille Foundation applied various ideas to maintain and encourage the donors to
continue their commitment. They asked PIDEE to provide vivid information about the daily lives of
the persecuted children.
“Our project would greatly benefit from an article informing us about daily life in Chile. For
instance, what can 25–50 dollars buy in Chile today? How much are the school and day-care
fees today? How much do children’s clothes and daily food cost, on average? How much does a
family earn per month? This information would greatly help the Finnish donors to understand
why their support is needed. It would give a concrete picture of children’s daily life and reveal
the importance of assistance to Chilean children.” (Helsinki, January 1982).
6.1.2
Shared principles
The organizing partners agreed upon the general principles of helping the suffering children. It was
not always an easy task to translate the general aims into concrete criteria. The partners repeatedly
discussed who was eligible for economic assistance. In the beginning, the criterion for inclusion
was very general, referring to “children in need”.
“We would be extremely happy if you could find sponsors for 50 children in order to help them
to continue their school and nourish themselves”. (Santiago, November 1981).
Such a general criterion for the priority needs of assistance turned out to be impractical and
confusing. Therefore, PIDEE proposed more explicit criteria for inclusion in 1988:
(1) To guarantee schooling and education for children, whose parents or children themselves are
currently (politically) persecuted or who are suffering from the consequences of military
persecution. The persecution must be the principal reason for a family’s inability to pay for the
child’s education.
(2) Sometimes we ask the assistance to cover the costs for curing illness or other emergency costs.
(3) The assistance can be stopped if the child is not studying without a good reason, if the family is
not persecuted any more, or if the child has already received support for many years.
Later, more implicit criteria for continuation of assistance were developed. They included the
child’s successful school performance and the family’s compliance with the PIDEE’s principles.
“We ask you to continue the sponsoring of “M”, even though he is already sixteen. He has been
responsible for the well-being of the whole family since his both parents were killed. He has
done exceptionally well at school. (Santiago, April 1988).
The most uncompromising criterion for the inclusion was the family’s continuous persecution and
its negative consequences.
“We visited the family of “C”, and the mother told that the sponsors are sending money directly
to them. We estimated the family’s condition and concluded once again that the family is not
persecuted any more. Even if they have economic difficulties, they do not fulfill the PIDEE
criteria, and for this reason we cannot agree with the sponsors to continue sending money to
them. (Santiago, April 1988).
The institutional correspondence involved a great amount of confusion and unclear payment issues.
Until 1987, it was up to the sponsors to decide the amount of money that they sent to the families.
The variation of assistance caused problems for both PIDEE and families. To harmonize the
practice, PIDEE proposed a scheme of assistance that aimed at covering the child’s education. The
amount of monthly assistance was 25 USD for children in primary school, 50 USD in secondary
school and 75 USD at the university level.
The project was based on individual people’s motivation and commitment to help the suffering
children. Information about the children’s needs and living conditions was essential for the
continuation of assistance. PIDEE proposed several improvements in their monthly reporting,
including the following rule in 1987:
(1) Annual reports on the socio-economic situation of the families whose children are receiving
assistance. This will guarantee your understanding why we want the assistance to continue.
(2) List of the families who have not received their assistance for over a month. We ask you to
inform us about the reason why the donor has not sent the money.
(3) Reports about children who are no more in need of assistance, and whom we have decided to
replace by others. We will inform you about the reasons for stopping the assistance.
6.1.3
Conflicts and problems
Problems concerned both practical issues of money transfer and principles of assisting human rights
victims. Sending money to individual families through the international banking system was not an
easy task. The families’ addresses changed and money was lost. PIDEE could not be mentioned as a
recipient organization in the money transfers. The project dedicated considerable efforts to finding
the most rational ways of transferring money.
“We would like to suggest that the money would be sent as a lump sum. The total sum would
be collected in Finland and sent once in six months in bulk. This suggestion would replace our
earlier agreement of sending money monthly.” (Santiago, January 1982).
“Most of our sponsors are common working people, who despite their own difficulties are
ready to give from their modest income. It is not possible for them to donate big sums of money
to cover a few months of children’s education.” (Helsinki, February 1982)
The Finnish and Chilean families created close relationships and friendships. PIDEE reminded, time
and again, that the sponsors must follow the principles of the assistance program:
“We like to remind the sponsors that the purpose of the assistance is to cover children’s
educational costs. In some cases, the payments have considerably exceeded the amount that we
have recommended. We ask you to follow the rules, as we have agreed upon, and hope that
there would not be such a great variation in the money that children receive. It creates envy,
suspicion and confusion.” (Santiago, May 1988)
A great amount of correspondence focused on the relationships between individual sponsors and
children. The sponsors claimed that they had not received letters from ‘their Chilean child’. They
also expressed deep concerns about the safety of the child and felt uneasy about the dangers that
their assistance may cause to the family. Others doubted whether families received their money
transfers, and if the family used the money properly.
“The sponsors are very worried about the child, because they have not received any messages
from him. They ask about his well-being and his health.” (Helsinki, June 1984)
Commitment to help a child for two years had both negative and positive consequences. The
termination of assistance seemed to cause enormous organizational work and lots of disagreements
between the sponsors and PIDEE. Both agreed that stable education and sufficient financial support
are beneficial for children. Yet, the harsh Chilean realities forced PIDEE to adopt a strict policy of
focusing help on the families who were in the greatest need. They aimed at helping many children
and maintained that a limited assistance prevents dependency and enhances empowerment. The
ongoing persecution of the family was the most uncompromised criterion for assistance, but
personal sympathies between the Finnish and Chilean families sometimes contradicted PIDEE’s
objective evaluation. PIDEE constantly reminded the sponsors that the aim is to assist people in
poverty caused by political repression and not by general economic hardships.
“Concerning the extra assistance of 500 USD to help the ‘C’ family, I have to tell you,
unfortunately, that the family has not told us of having suffered any losses. We would like to
ask you, again, to consult us for any extra assistance. As a Chilean proverb tells: “La necessidad
tiene care de hereje” (Want has the face of heretics”). That happens also sometimes to us,
though fortunately, very seldom.” (Santiago, June 1985)
“The amount of money received by ‘M’ is so meager that at this moment she suffers from
undernourishment (Santiago, January 1984); ...We understand that the assistance cannot
continue for ever, but the situation of our children is simply so bad.” (Santiago, June 1984)
Several problems occurred due to the different understanding of social and political situation in
Chile, the purpose of economic assistance and children’s personal aspirations. There were
disagreements about what is proper behavior for the children of human rights victims. For instance,
some Finnish sponsors claimed that aerobics is not an acceptable hobby for victims and recipients
of economic aid. Others regarded university studies as luxury. Many Finnish students finance their
studies by working themselves, but the situation in Chile is different.
“We hope that assistance to ‘A’ can continue, because he is able to continue his university
studies only if the sponsors help him. Otherwise, he has to stop, which would be a great pity,
because he is a very good student and has worked enormously for his success.” (Santiago,
September 1994)
The situation in Finland was very different from Chile concerning freedom of expression. The
Parasta Lapsille Foundation regularly informed sponsors about Chilean political hardships and
atrocities committed against human rights activists and their families. Finnish sponsors had,
however, difficulties to imagine the real meaning of constant presence of a military threat.
The Parasta Lapsille Foundation needed information and personal accounts of the political
repression to recruit more sponsors. Yet, PIDEE had to be very cautious, because reporting on
human rights crimes to a foreign partner caused a risk of military reprisals. Persecuted people were
not free to tell about what was happening under the military emergency rule. The political situation
was hardly ever explicitly present in the correspondence, but it was revealed in the laconic reports
on children’s lives.
“The family of ‘V’ had to flee the country. They were harassed and their house was raided. The
children were in Casa Hogar (shelter provided by PIDEE) until they could leave the country.”
(Santiago, March 1987)
“We ask you to continue assisting ‘G’. Her family has again suffered hardships, the girl’s elder
brother was murdered last month. The girl was forced to leave the country, but she still needs
assistance in order to continue her studies.” (Santiago, March 1986).
6.1.4
Problem solution
PIDEE solved problems by (a) redefining the rules and reminding the partners about the aims of the
project, (b) following the principles of empowerment and activation of the assisted families, (c)
initiating new projects to meet new challenges, and (d) constantly evaluating their own and the
families’ activities.
The rules were highly transparent. PIDEE took a clear position on each disputable case and
explained the reasons for its decisions.
“Our sponsoring agreement and contract are signed for two years, and after that our foundation
has the right to evaluate whether the family still needs assistance. We have plenty of children
living in very painful conditions. Many of them are in a very serious need of help. That is why
we hope that the Finnish sponsors can also accept assisting other children. We are sorry for the
many misunderstandings concerning the needs of the families. Neither you nor we are to blame,
but we feel that it is important to emphasize that we are not a social welfare office. We are a
foundation with a highly professional personnel, and we are very able to evaluate the needs of
the families and comprehend the Chilean situation.” (Santiago, October 1986)
Empowerment is often ‘cream cake talk’ in foreign aid projects. PIDEE provides some good
examples of how to translate it into daily problems. They were conscious of the risk of regular
assistance creating dependency problems. Also, being poor, unemployed and politically persecuted
often negatively affected the families’ motivation to improve their living conditions. The question
of empowerment was especially salient among single-parent families. Women were forced to take
responsibility for their children alone in very traumatic circumstances and often without any prior
warning. PIDEE observed that dramatic changes could lead either to helplessness or activation and
social participation. PIDEE workers saw their role as encouraging initiatives, optimism and
endurance among single parents.
Empowerment encouraged families to participate in planning their lives and creating
community interventions.
“We are of the opinion that the ‘X’ family should not be assisted any more, because they have
not given any information about their whereabouts. We think that they lack respect for our
principles and mutual plans.” (Santiago, March 1984)
“...Here is a list of families whose assistance should be stopped. The reason is that the families
have either received help for a long time or they do not do anything themselves to overcome
their difficulties. They have become passive and have gotten used to receiving assistance.”
(Santiago, July 1986)
The policy that every assistance case had to be negotiated can be considered a tool for empowering,
on the one hand. The food aid, for example, was only for two months, and the Finnish educational
assistance, principally, for two years. The idea was that the families should be helped to overcome
their difficulties at the early stage of traumatization. PIDEE disapproved of any sings of
dependency, misuse of aid and passivity.
On the other hand, great transparency created much bureaucratic work and
correspondence. There seemed to be negotiations about every single case. PIDEE, for instance,
always asked what to do with the money that the sponsors had sent to families who did not need it
any more. It is imperative to have mutual agreements with changes and decisions concerning ending
or interrupting the support. However, it may have been more convenient to develop a system for
using the extra money.
6.2 Sustainability
The democratically elected Chilean government made a suggestion for national reconciliation in
1989. It included the possibility of economic compensation for persecuted families who had lost a
member due to disappearance or execution. Subsequently, a few children supported by PIDEE
received compensation, and the Finnish sponsoring subsequently stopped. Some Chilean families
were too afraid to report to the commission and could not trust that their persecution was over.
PIDEE continued to help them because they were psychologically in a difficult situation.
“They are not considered victims of military repression and yet, they have lived in a situation
where they had to hide their political activity. Assistance is crucial to us to maintain their social
well-being.” (Santiago, July 1991)
All PIDEE’s activities were financed by foreign aid during the years of military emergency. In
1991, for instance, seven European states supported it financially. The Finnish share was 11%
excluding sponsoring, and 38% including it (Koskinen, 1992). The foreign aid apparently made it
possible to work among human rights victims during the military dictatorship. However, it made
PIDEE very dependent and vulnerable when the political situation changed. Chile was considered a
democratic society and a promising economic power. Projects helping human rights victims were
regarded as outdated and politically incorrect.
The PIDEE administration made great efforts to reorganize its activities to correspond
to the new political reality. Nevertheless, all foreign projects gradually stopped, and after 1997
PIDEE’s activity comprised only a documentation center employing two persons.
PIDEE had committed itself to participating in building democratic Chilean society in
the 1990s and to cooperating with other institutions in establishing a national child welfare
organization. They could have provided knowledge (data bank) and expertise on children’s
problems, resources and developmental needs. PIDEE’s activities were restricted to the
documenting of human rights abuses from the time of military dictatorship. The motive was the
failure of the Rettig committee to investigate and compensate for all the families who had been the
target of systematic persecution during the dictatorship.
PIDEE was highly successful in providing help during the military junta. They healed
and documented consequences of human rights violations with the utmost objective of putting an
end to military violence. Once this aim was achieved, PIDEE became professionally paralyzed. The
cessation of its psychosocial activities is a great loss. PIDEE had developed excellent professional
practice through substantial human and financial efforts. Their expertise could have benefited many
more Chilean families suffering from hardships. In all fairness, the project was created to meet
children’s needs in emergency, but PIDEE had also committed to sustainability.
Preconditions for a successful foreign aid project are the employment and
development of local expertise. It can guarantee the continuation of activities also after foreign
financing has stopped. PIDEE’s programs provide a good example of using highly trained local
experts and developing new professional skills. Yet, its sustainability failed. Finnish foreign aid
assisted PIDEE for 15 years. It would have required more explicit and concrete plans and strategies
as to ‘how to survive peace’.
7
Evaluation from the recipients’ viewpoint
Sponsorship is based on the idea that when you help one of your fellow men, you are serving the
whole of mankind. Humanitarian assistance offered through the project combined concrete financial
support for education and affective ties between the Finnish families and the Chilean recipients. The
aim of the sponsoring, together with the PIDEE services, was to promote children’s well-being and
empower their families.
If the project was successful, the benefits should be visible in the recipients’ current
educational and economic standing, and their coping and family resources, mental health, learning
experiences and political attitudes. The criteria for well-being and empowerment were the
following:
Education. The children constantly experienced military violence and harassment at home. They
lived in one-parent families and had lost a parent and sometimes siblings under very traumatic
circumstances. Subsequently, they often had difficulties concentrating on schoolwork. Their
thoughts were distracted as they worried about the reprisals of the military regime. Their peers
sometimes bullied or intimidated them in the Chilean political atmosphere, where their families
were portrayed as national enemies.
Educational sponsoring, together with PIDEE’s psycho-pedagogical services, was
aimed at helping children’s educational performance, despite all these obstacles. Accordingly, we
evaluated the recipients’ current educational and professional achievements, as well as their
experiencies as students.
Family atmosphere. Military violence seriously interferes with children’s experience of home as a
secure place. Chilean children routinely experienced night raids at home and had lost their fathers as
prisoners or dead. Their mothers were often overwhelmed by the loss and by their worry about the
family’s security. The military regime reinstated expensive school fees (contrary to free education
during the Allende regime), which further caused severe stress.
Sponsoring children’s education lifted a part of the economic burden. In addition, the
Finnish sponsors expressed solidarity, respect and support for the families, and PIDEE provided
support in the form of family therapy and legal assistance. We therefore expect that the help has
created a positive family atmosphere by increasing coherence and problem-solving skills.
Coping resources. The Chilean children had faced severely traumatizing events in their young
lives. Some had lost their parents when they were detained, disappeared or executed, and others had
experienced expulsion from their homeland. One aim of the sponsorship program was to help
children to endure these family tragedies. Psychosocial treatments by PIDEE aimed at encouraging
development of their strengths and their resilience. An examination of the children’s coping
resources enabled us to estimate how successful this support had been.
Psychosocial adjustment. PIDEE, together with the Finnish sponsors, provided the persecuted
children with a possibility of normal and healthy development. We were curious to learn about their
current mental health and social well-being. We wanted to learn about the protective factors that
helped children to maintain good mental health.
The evaluation study examines how childhood trauma is associated with long-term
psychosocial adjustment, and whether the psychosocial assistance provided by PIDEE was
beneficial. Figure 1 presents the study setting. As criterion variables, the economic standing,
educational level, learning experience, coping strategies, family atmosphere and mental health were
assessed. We examined the effectiveness of psychosocial, pedagogic, medical and economic
assistance in a retrospective setting.
7.1 Sample and field work
The participants were 125 former recipients of the Finnish and PIDEE assistance from Santiago and
two provincial towns in Chile. About half (52.5%) of them were boys and 47.5% were girls, and
their ages varied between 13 and 28 years, the mean age being 23 years. They are called here the
PIDEE group. The control group of 28 young adults was living in the same areas (poblaciones) and
had suffered from military violence, but had not received assistance. The groups were similar as
regards gender (X^2(1,151)=1.92, p=ns) and age ((X^2(1,151)=1.64, p=ns).
The study population was the 6001 Chilean children who had received economic
assistance from Finland and used P.I.D.E.E. services during the emergency years. Their names were
available from the P.I.D.E.E. and the Finnish NGO (Parasta lapsille) archives. Sampling was done in
two stages, applying random and systematic sampling procedures to take the nature of childhood
trauma into account. First, every second child was chosen thus resulting in 300 names. Second, the
archive information was arranged according to the nature of trauma: children of executed, disappeared,
detained and exiled parents.
Two local male fieldworkers contacted the families in their homes in
November–December 1997. The fieldwork turned out to be demanding, delicate and sometimes
dangerous. Even though the military rule was over, suspicion and fear were common among people,
who had suffered extensively and continued to live in poor housing areas. The visits would not have
been possible without the two excellent fieldworkers. They were motivated, socially gifted and very
informed about Chile’s cultural and political history. Their communication with the families was
easy, because they shared common experiences of military persecution. The families warmly
welcomed the visitors. The interviews provided the families with an occasion to ventilate their
feelings, remember ‘the hard old days’ and exchange some information and ideas. Most of the
families were pleased to hear that “the Finns still showed interest in our lives.” All families except
one agreed to participate, but the whereabouts of 25 families could not be found. They were
replaced by other persons in the list who were similar in their age and nature of trauma.
7.2 The assessment tools
1
The Finnish sponsorship program involved approximately 800 children, but the archives provided
sufficient information only of 600.
The data were collected by using questionnaires which the participants filled in themselves. The
questionnaires concerning economic situation and coping strategies were translated and backtranslated from Finnish into Spanish by the fieldworkers and the author. A Chilean psychologist
checked the language. Other questionnaires were available in Spanish, and they were validated in
Chile (mental health, learning experiences) or other American countries (family atmosphere). The
Spanish-language questionnaire is inclueded in Appendix I.
Demographic variables included gender, age, marital status, number of household
members and working status (student, steady or temporary job, unemployed).
Economic situation was assessed by the levels of general and specific economic
pressures (Elder, Nguyen, & Gaspi, 1985; Solantaus, Punamäki, & Leinonen, 1999). The
participants were asked to report whether their family had difficulties in paying monthly bills (1=no
difficulties at all, 5=great difficulties) and whether their family had money left over at the end of
month (1=more than enough money, 4=not enough money to make ends meet). The scores were
summed up to indicate general economic pressures.
Specific economic pressures refer to economic adjustments that the family had to
make in everyday life. Participants reported if they had to make any of the 14 cutbacks in
expenditures on a scale (1) never, (2) sometimes, or (3) often during the last months. The cutbacks
involved buying cheaper food, postponing holidays, saving on clothing and hobbies, and reducing
medical expenditure.
Education was assessed in terms of school achievement and learning experiences.
Achievement was measured by three questions about (1) years in school, (2) level of education and
(3) dropping out and interruptions in schooling.
Learning experiences were measured by using a modified tool originally developed by
Gesten (1976). The participants were asked to describe themselves as students by estimating on a
5-point scale how well the 28 descriptions fit them. Conceptually, the items measured work
motivation, task-performance styles, social competence and communication skills. Three subscales
were formed according to the factor solution. They describe the student predominantly as: I
Creative and initiative, II Successful in peer relationships, and III Conscientious and taskorientated.
Coping strategies were assessed to indicate personal and social resources in facing
stress and trauma. The participants were first asked to describe the most painful event in their life,
and were thereafter given a 28-item coping questionnaire (Julkunen, 1996). They were asked to
indicate on a 4-point scale how well each description fit their ways of responding to that painful
event: (1) not at all, (2) to some extent, (3) rather well, (4) completely. Conceptually, the tool
captures two basic dimensions of coping responses: resignation versus optimism, and an avoidance
versus reorientation. Four averaged sum variables of resignation, reorientation, defensive avoidance
and optimistic approach were formed accordingly (see Appendix II).
Family atmosphere was assessed by a shortened version by Moos-FES (Moos & Moos,
1981; Spanish translation by Rojas & Zambrano, 1988) family environment assessment tool. Only
three scales of the original 10 were used, the questionnaire consisting only of 26 descriptions of family
life. (Excluded scales were Achievement, Active-Recreational, Intellectual-Cultural, Moral-Religious,
Organization, Expressiveness, and Independence). The participants were asked to estimate the 26
descriptions as either true (1) or false (2) in regard to their own family. Three subscores of family
atmosphere are averaged sum variables of 11 items measuring Coherence (Cronbach's reliability .82),
nine items measuring Conflict (Cronbach’s reliability .76) and five items indicating Control
(Cronbach’s reliability .50). Family atmosphere was assessed by a shortened version of the Moos
and Moos (1981; Spanish translation: Rojas & Zambrano, 1988) family environment assessment
tool. The excluded scales were moral and religious orientation and cultural and recreational
activities. The participants were asked to estimate 26 sentences as either true (1) or false (2) in
regard to their own family. Three subscores of family atmosphere were formed according to the
factor solution: Loving harmony, Conflicting tension and Tolerant cohesion.
The mental health was assessed by a shortened questionnaire by Zegers, Manzi, Florenzano, Ramon
and Acle (1987). The original questionnaire (56 items) includes selected symptoms based on DSM-III
(Diagnostic and Statistical Manual of Mental Disorders) and General Health Questionnaire (Goldberg
& Hiller, 1979). ). Our scale consists of 44 items, excluding the eating disorders -scale and ten
repetitious and highly pathological items. The shortening was imperative in order to keep the
questionnaire reasonably short and avoiding severe pathological items.
Fife averaged sum variables were constructed accord to Zegers et al. (1987), and that factor
structure was investigated using confirmatory factor analysis (CFA). The five-factor solution produced
only a reasonable fit (The Goodness of fit index (GFI) .77, GFI Adjusted for the degrees of freedom
.73, the Comparative fit index (CFI) .89). All manifest variables loaded significantly (t > 2.00) to the
following factors: The scales are posttraumatic disorders (15 symptoms; Cronbach's reliability .90),
depressiveness (11 symptoms; Cronbach's reliability .86), and anxiety and somatic symptoms (eight
symptoms; Cronbach's reliability.73), aggressiveness (five symptoms; Cronbach's reliability .74) and
sleeping difficulties (four symptoms; Cronbach's reliability .73).
Descriptive material. Archives gave us some descriptions about the trauma that the participants
had endured. Because the fieldwork consisted predominantly of one-time visits, we decided not to ‘talk
about the tragedies’. However, many participants wanted to tell about their experiences, apparently
because the fieldworkers shared the same experiences, and because at that time (before the house arrest
of Augusto Pinochet in Great Britain) the victims of human right abuse seldom had the opportunity to
reflect on their familiar experiences. The participants were also asked to report about the happiest and
the most painful experience in their life, which often referred to the military persecution. Furthermore
they were asked to remember the P.I.D.E.E: and their contacts with the Finnish sponsors.
Political attitudes were assessed by four open-ended questions concerning human
rights violations, the democratization and reconciliation process in Chile. We also inquired the
participants’ attitudes of forgiveness versus revenge towards the persecutors of the family. A
descriptive analysis was applied to reveal the respondents’ world-view and political thinking.
Type of assistance: The PIDEE archives provided information about the recipients’ use of
(a) mental health services, such as individual or family therapy, (b) pedagogical assistance such as
therapy for speech and learning problems, and (c) social services (number of visits to the family).
The participants were also asked to tell about their experiences of using services and reveal
memories about PIDEE and the Finnish sponsors. All participants in the PIDEE group received
economic assistance from the Finnish sponsors. The archives provided information about the length
of assistance and the age of the child when he or she received help for the first time.
Figure 1. The evaluation frame. How to help children in the context of Parasta lapsille and PIDEE cooperation.
ChildhoodtraumaAssistancetionsin childhoodPast and presentresourcesAdulthoodwell-beingLoss of parent asEconomicParental supportPsychological
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•
•
•
•
•
•
•
•
7.3 Meaning of childhood trauma
About a half of the PIDEE grpup (n=62) had lost one or more family members as prisoners, and ten percent
(n=12) had lost the father was executed. The share of exiled and returned children was 18%, and 14% of the
participants had lost a family member as disappeared. The distribution of childhood trauma corresponds with
the official figures (Grossi, & Villar, 1992; Informee Rettig, 1992) and PIDEE archive information.
Let’s listen to some participants’ own memories of their childhood trauma. First, a 24-year old
woman tells what her father’s imprisonment meant for her.
“Really, I do not want to recall these experiences and what I went through during these years...Most
painful was that I learnt that my father was detained, and the most painful thing was that I learnt about it
from a television report: to see my dad suffering, not knowing what I can do for him, thinking that he is
hurt and humiliated, that he is being tortured there, inside the prison...”.
The following recollection is from a 26-year-old woman whose father was executed when she was four years
old. It succinctly shows how an early trauma strongly shapes a person’s life.
“The most painful memory is the death of my dad and some friends of mine. In my mind there is only a
blurred memory of how I lost my childhood innocence. I remember my inability to understand anything
that had happened to my dad. As far as the killing of my friends is concerned, all I can remember is
weeping and much sufferings, my great grief at losing a dear person. I still remember the pain in my
chest, and a lot, a lot of weeping. The security forces murdered all of them... on the pretext of restoring
public order.”
The father of this young man disappeared when he was seven. He was imprisoned himself during his
adolescence, and is now 25 years old.
“It was approximately at 00.30. I was walking home with my brother when we were approached by a
white Chevrolet in which three people were sitting. Two of them pointed at us with a sub-machine gun
and detained us. They took us to the investigation quarters, undressed and blindfolded us, took us to a
room, separated us from each other and moved us to another place in order to continue torturing us,
without giving any reason for our detention. I was handed over to the Fiscalia Militar very rapidly, and
later put in jail.”
It is noteworthy that painful childhood memories organize and give meaning also to many happy events, as
the following memories reveal. The father of this young man (25 years old) was detained and severely
tortured. Later his family was forced to flee Chile and settle as refugees in Europe.
“The most painful memory in my life was when the ‘security forces’ of the military dictatorship came in
the early morning, entered our house by force, arms in their hands. They messed up the house in order to
show their supremacy, and were looking for something that we never had in our home - weapons and
arms. They took our dad, and we felt a terrifying feeling of insecurity and doubted that we would ever
see him again”.
“The happy events... My life was marked by the years when my dad was in jail. But I recall with joy the
two times when they set him free, after his unjust imprisonment. The day when my son was born was
unforgettable. He is now four.”
Finally, we listen to a woman of 27, who had lost her father in prison.
“I recall the day when they took my dad, and, even if we did not know it then, how they returned him to
us only many years later. I knew that he was in “internal exile” in Chacabuco and Dos Alamos
(concentration camps). Years later, when he returned home, I understood why I didn’t have a normal
childhood, as others did.
My childhood was a testimony of the sufferings of my mam and my brothers, after the police had
broken into our house whenever they liked, night and day. The raids always ended with the detention of
some of my family members. In total, all the repression that the military directed against my family is
too much... Now they want me to forget these events, but how can I forget what happened, how can one
forget all those who died?”
7.4 Current economic stand
The PIDEE group suffered more from general economic stress than the comparison group
(t(148)=2.29,p=.03). They also experienced more specific daily economic pressures than controls (Figure 2),
which suggests that they still had to save and cut down their everyday maintenance expenses. For instance,
about 80% had to put off purchases, buy cheap food, and save in clothes and holiday expenses. About a half
tried to eat fewer meals in order to save money.
Figure 2. Economic Pressures and Adjustments in the PIDEE-group.
0 %10 %20 %30 %40 %50 %60 %70 %80 %90 %100 %Live on savingsLive in cheap areasPostpone purchasesBuy on creditTake out loansPut off paymentsUse fewer medical services
Save on med
7.5 Education and learning experience
The results show that the PIDEE sample had about twelve (11.8) years of education on average. The older
recipients had naturally more schooling. For instance, the 25-year-olds had 15 years as compared to 17-yearolds with 10 years of education. The length of education did not differ according to gender, but according to
the nature of childhood trauma (F(4,145)=8.92, p=.0001). Participants who had lost a parent through
disappearance or execution were more educated than those whose parent had been imprisoned or exiled (Post
hoc tests; Tukey’s-b, p<.05). When the age was controlled, the difference still remained.
The Finnish sponsor project focused primarily on education. It provided a child full
economic support for schooling for at least for two years. Many sponsors continued their support
and some committed themselves to finance the completion of the primary education. Persecuted
families were highly appreciative of education, because education symbolizes hopes for the future
and prospects for a better life. Therefore, the economic assistance was wellcome, as the interviews
reveal:
“Economically PIDEE helped us, we got school uniforms and note books, which were all very important
for us...” (Man, 20)
“The help was crucial, because otherwise my mother could not have paid for my education. PIDEE took
me as a family member, even though they know what kind of difficulties I had. I was only six or seven
years old, when the Finns started to pay my school fees. Now I am a young man of seventeen. I try to be
a good human being and contribute to my community, even if my country does not appreciate us. My
mother fights every day for her children’s better future, and she is able to do that because she got help
from PIDEE in that very critical moment. Without PIDEE, we would never have survived, there were so
many problems: emotional... I also had difficulties to learn. I am very grateful for the encouragement. I
learned that health and education are everybody’s human right.” (Man, 17)
The children who received assistance had relatively high educational and working status as adults. Of them
21% studied at a university, 11% had a permanent and 14% a temporary job. The youngest, 45%, were still
in school (20% professional school and 25% gymnasium). Currently 9% were unemployed. Nevertheless, the
PIDEE group did not differ from the comparison group in their working status.
Of the employed (N=52) participants, 15% had a university degree, and 6% had
completed gymnasium and 5% professional school. Only 3% had only basic school education. The
participants worked in variety of fields as carpenters, computer specialists, journalists, researchers
and teachers.
A third (33%) of the PIDEE children had had to interrupt their education or drop out
from school, in which they did not differ from the comparison group. The groups differed, however,
in the reasons for drop-out (X^2(4,149)=9.20,P<.05). Almost a half (46%) of the PIDEE group had
left school because of economic difficulties, while 50% of the comparison group reported having
had family problems. A fifth (22%) of the PIDEE drop-outs were due to political reasons. For
example, children had to work because their father was imprisoned. An other 19.5% reported
problems with authority as the reason for dropping out.
Figure 3. Learning Experiences in the PIDEE and comparison group.
2,612,882,882,9332,982,22,42,62,833,2Conscientious &task-orientedPopular among peersCreative & showsInitiativeSTUDENTCHARACTERISTICSPIDEEgroupComparisongroup
Helping children in the midst of military violence was, to some extent, successful. The assistance positively
influenced their later learning experiences. Figure 3 shows that the PIDEE group was more conscientious
and task-orientated than the comparison group (t(148)=2.05,p<.04). They typically followed instructions,
meticulously completed their homework, accepted critics constructively, and were seldom punished.
Participants whose fathers were missing were especially conscientious and task-oriented in their work and
studies (F(4, 140)=4.33,p<.002; age as a control variable was non-significant). No differences were found
between groups showing creativity and initiative, or success in peer relationships.
The results concerning Chilean children’s current learning experiences are somewhat
contrary to the general assumption that childhood trauma compromises academic achievement and
learning ability. On the contrary, the traumatized children had reached a relatively high educational
level and described themselves as successful performers.
7.6 Family resources
Receiving assistance and support from Finnish sponsors and PIDEE positively influenced family
relationships. The PIDEE group perceived their families as more tolerantly cohesive than the comparison
group (t(148)=2.00,p<.05). Their family members cared for each other, enjoyed discussions and felt highly
united.
The nature of the childhood trauma was associated with the family atmosphere, with
the families with imprisoned members being the most cohesive (F(4,145) =3.50,p=.009).
The size of the family ranged from 2 to 16, with 28% one-parent families in the
PIDEE group, 10% living without mother and 18% without father. Participants who had their
mother at home described their family atmosphere as more tolerantly cohesive (t(136)=2.45, p<.02)
and less conflicting and tense (t(136)=-1.89, p=.06) than those without mothers. The presence of the
father in the family did not affect family atmosphere.
Traumatic experiences often distort family relationships. Overwhelmed parents face
difficulties in providing emotional support for their children and feel guilty when witnessing their
children’s suffering. Children in turn tend to shoulder adult-like responsibilities and burden
themselves by worries. Our results show that receiving assistance can keep family life relatively
intact. Cohesion, warmth and tolerance were characteristic of traumatized families who had
received help.
7.7 Coping resources
One may expect that traumatic childhood experiences invite problematic and ineffective coping strategies.
Our results did not, however, support that expectation. On the contrary, the most common ways of mastering
painful experience in the PIDEE group were optimism and reorientation. They tried to find new resources in
themselves and their social relationships. They typically believed that hardships had strengthened them and
allowed them to learn what is really important in life.
Receiving assistance was not, however, associated with more effective coping
strategies. Compared with the control group, the PIDEE group relied more on defensive avoidance
in facing stress and trauma (t(148)=2.08,p<.04). They were deserved in expressing their emotions,
controlled their feelings, and relied on rational thinking and withdrawal. The nature of childhood
trauma was associated with coping strategies in adulthood. Figure 4 shows that defensive avoidance
was especially common among boys whose father had disappeared or had been political prisoner
(F(4,140)=3.84,p<.05).
Figure 4. Defensive Avoidance According to Gender and Childhood Trauma.
2,532,312,62,422,252,312,132,232,12,671,92,12,32,52,7DisappearedExecutedPrisonersExiledControlsFamily memberBoysGirls
7.8 Psychological well-being
Figure 5 reveals, first, that the PIDEE group suffered most frequently from somatic and anxiety symptoms
involving diverse pains, fears and insecurity. Second, it shows that girls were more vulnerable to
psychosocial symptoms when experiencing childhood trauma than boys. Girls whose father was missing,
were especially vulnerable, as indicated by elevated levels of intrusive memories, depression, anxiety and
somatic symptoms later in life. No differences were found between the PIDEE and the comparison group in
mental health. Thus the help given to children did not influence their mental health in adulthood.
Figure 5. Mental Health According to Gender and Childhood Trauma.
Figure 5. Mental Health According to Gender and Childhood Trauma2,132,22,562,242,371,881,982,071,821,72,292,062,622,242,252,232,022,262,152,052,652,332,722,542,392,141,822,342,222,0711,522,53Sleeping pro
7.9 The effectiveness of assistance
The participants had used PIDEE services relatively frequently. For instance, 64% had been treated by
psychotherapists and 60% by medical doctors. Almost a half had received help in overcoming learning
problems and participated in special educational groups. Social workers had visited families regularly a few
times a year across the assistance period. Figure 6. summarizes the use of PIDEE services.
Figure 6. Use of PIDEE.servicesAamong Girls and Boys.
5365,732,244,167,255,901020304050607080Mental healthServicesPsychoeducationalMedical ServicesServices%BoysGirls
We were interested in finding out whether PIDEE services and receiving Finnish assistance had a positive
effect on recipients’ later family resources, coping strategies, learning experiences and mental health. We
found that the age of the child at the beginning of the assistance and the length of the assistance were
important in predicting coping and family resources, educational achievements and mental health in
adulthood. The early initiation of help predicted favourable outcomes.
Figure 7 shows that if children received help at an early age (eight years or less), they
later used more effective coping strategies such as reorientation (t(121)=1.60, p<.08), and fewer
ineffective coping strategies such as resignation (t(121)=-1.96, p<.05).
Figure 7. Childs’Age at the Initiation of Help and Coping Strategies.
s2,442,442,192,652,422,782,92,8322,22,42,62,83Eight or youngerNine or olderAge of the ChildAvoidanceResignationOptimismReorientation
Figure 8 shows a strong association between the timing of assistance and the recipients’ subsequent mental
health. If children were helped early (eight or less), they suffered less from intrusive, depressive, anxiety,
somatic and especially aggressive symptoms in adulthood.
Figure 8.Child’s Age at Initiation of Help and Mental Health.
1,992,32,112,332,222,322,362,571,972,181,822,22,42,6Eight or lessNine or olderAge of the ChildIntrusive memoriesDepressive symptomsSomatic and anxietysymptp,sAggressive symptomsSleeping problems
Furthermore, when children were assisted in early age, they experienced their families as cohesive in
adulthood (t(121)=-2.80, p<.006). Finally, the earlier the children received help, the higher educational level
they reached (t(121)=3.30, p<.001). In the group that was assisted early, the average years of education was
13 and among those helped later, 11 years. Age as a covariance did not challenge this result.
Substantial duration of assistance in childhood was associated with good mental
health and effective coping strategies in adulthood. Children who had received assistance more than
two years showed better mental health than those who received it less (total sum of symptoms:
t(122)=2.38, p=.019). Figure 9 specifies that children with a longer sponsorship showed less
aggressive and intrusive symptoms when they were adults. Furthermore, results indicate that longterm educational assistance decreased the use of ineffective coping strategies in adulthood. Figure
10 shows that participants who had received assistance more than two years used less avoidance
and resignation when coping with trauma.
Figure 9. Duration of the Assistance and Mental Health.
2,212,12,282,22,492,422,21,932,282,221,822,22,42,6Two years or lessMore than two yearsDuration ofAssistanceIntrusive memoriesDepressive symptomsSomatic and anxietyAggressive symptomsSleeping p
Figure 10. Duration of the Assistance and Coping Strategies.
2,562,342,392,252,852,852,762,7122,22,42,62,83Two years or lessMore than two yearsDuration of the AssistanceAvoidanceResignationOptimismReorientation
The extent to which PIDEE services were used was not associated with the psychological adjustment and
coping strategies later in life, but their use improved the family atmosphere. The more recipients had
received help, the less conflicting and tense family atmosphere they had (t(123)=-1.98, p<.05). PIDEE
interventions thus enhanced warmth, unity and feeling of security in families and improved the members’
ability to solve conflicts.
7.10 Remembering PIDEE and Finnish sponsors
We asked the participants to tell about their memories and experiences of PIDEE and Finnish sponsors. They
had both negative and positive experiences. The main criticism was the fact that the asssistance was not long
enough. Some psychosocial services were criticized as ineffective and non-professional: “We entered the
therapy and there were psychology students without proper knowledge trying to help us.” There were also
ethical accusations: “Only if you were a member of the right political party, were you considered worth
helping”. Some participants remembered that some PIDEE workers showed ‘from-up-to-down attitudes’
towards the families: “They were talking to us, but now I realize that they did not have any idea how we
lived; They saw as only as statistical numbers”. The participants typically balanced their positive and
negative comments, as in the case of the daughter of a political prisoner. She received assistance for two
years.
“PIDEE, it means good memories, especially when we took part in summer holiday camps: Beach, trees,
swimming pool. I learnt to play guitar and developed myself in our theatre workshops. We gave several
street performances. These experiences have had a good impact on my life. I think that PIDEE was an
extraordinary institution. But I am sorry to say that it was not always in good hands... The economic
help was very efficient in that very difficult time. Also I highly appreciate the help in learning, because I
had difficulties to learn in class, but with the ‘aunts’, learning was so easy. Altogether, visiting PIDEE,
the doctors, when I was sick, dental care, and affectionate psychologists gave us emotional security. I
felt a permanent solidarity that helped me.” (Woman, 22)
The memories of PIDEE reveal that it was important for persecuted children to feel safety, appreciation and
normality in their burdened lives. They could share their experiences with other children who had a similar
fate. Friendships, rituals and play provided with opportunities to ventilate their feelings and obtain relief
from a threatening and violent reality.
“I remember when I came to our lessons and we gathered in the yard to sing and play the guitar. In the
class they taught us real stories. I remember people who were good, such as the lady with the cookies
and milk. When we were hungry we fought for them at breakfast time. I made friends whom I still meet
sometimes and I learned to know what solidarity is. I also remember the cops when we went to
Mampato (prison), I remember when we used to go to the psychologist and I always ended up weeping
because I felt that the questions were very hard.” (Man, 24)
The participants were eager to remember their Finnish sponsors. Their stories revealed that the money
occasionally meant the survival of the family. In addition to the economic importance, the sponsors’ caring
and showing interest in the children’s lives were crucial under the extremely painful conditions. Some
children considered their sponsors as family members and developed emotional ties with them.
“They regularly sent letters and gifts to us. Once I got a book about all the wonderful trees of Finland.
Some friends wrote me from Helsinki when my sponsor died after suffering heart problems... Generally,
my life was full of pain. That what haunted my mind most, was the persecution against my family. My
dad, uncle and grandparents. I suffered when my dad’s parents died and when my sponsor died. Even if
I never knew him, he was a man with great human warmth. Other painful things, when we were children
we suffered and hoped, then we saw that all our expectations were frustrated when democracy came. We
thought that, as the song said, “La alegría ya viene -- joy is coming.” Yet, the change towards happiness
never reached our family.” (Man, 25).
“They were very friendly, and they took care of us. They even learned Spanish in order to communicate
with us. They wrote continuously, sent photos and gifts. The best thing for me was that they showed
their love to me. We knew each other only through letters, but it was a joyous and beautiful friendship.”
(Woman, 24)
“I remember when the first aid came (letters, money), it allowed us to satisfy our basic needs of food,
cloths and travelling by bus. The regularity of the letters gave us a feeling of security. They gave us an
almost normal life. My memories are good and beautiful from that time. My childhood was beautiful
and I am grateful.” (Man, 24)
“I have lots memories of him, my sponsor. I still have his letters and gifts. And many times I had to hide
them because the Pinochet militia raided my home. The most important thing for me was that my ‘uncle’
was always interested in me, everything in my life, even if he did not know me. For him, it was not so
important how I used his assistance, but I was important, as a person. He always wrote with tenderness
and I felt like having a relative abroad. I can sense this tenderness still today.” (Woman, 22).
7.11 Attitudes towards reconciliation
Violence, persecution, and loss of family members loomed over the childhood of our participants. We were
interested in finding out how they perceive their own future and prospects of Chilean democracy. Because
they themselves were victims of human right crimes, we wanted to learn what they feel and think about the
prospects of reconciliation, forgetting and forgiving.
My and their future
The participants were asked to imagine their life in ten years’ time. Results show that they tended to view
their personal future in optimistic, happy and promising terms, while, when referring to Chile’s future, the
tone was more pessimistic, helpless and desperate. The following examples reveal the general tendency of “I
will build my life, while Chile struggles with her unhealed wounds from the past.”
“I will be working in my profession as a social worker in the community or in some human rights
organization. I will still have my boy friend, and we will have a son or a daughter. We will still be
living in the same Chile of today, elitist, individualistic and even more submerged in the free market,
poorer and with a higher degree of inequalities than before.” (Woman, 23)
“I will be teacher, a man completely fulfilled and happy. I’ll live on a meagre salary but with a big heart,
just as I’ve always done. Chile of 2007 will still be a country divided by huge furrows. Poverty,
inequality and repression will still exist. But I see how people become more united every day and how
they are less and less willing to accept the injustice.” (Man, 23)
To remember or to forget
Chileans have written two different histories of the military era. Some support Allende’s ideology and
cherish values of social equality and brotherhood, while others emphasize individualism and the positive
aspects of military order. Chileans also disagree in their attitudes towards their past. According to some
people the bad times should be forgotten, while others think that the shameful past should be remembered in
order to avoid its repetition.
We wished to find out what the PIDEE participants thought about these issues, and Table 3
summarizes their opinions. It reveals that a majority maintained that it is not possible to forget the
past and that one cannot help remembering the crimes committed against their families. Both
remembering and forgetting were emotionally loaded solutions.
“We can never forget. We must remember so that it shall never recur. The crimes of the torturers will
always live in our memory. Our lives were imprinted by persecution and humiliation, imprisonment,
torture and death, in the most pure Nazi style.” (Woman, 24).
“It is something much deeper than these two alternatives, because unfortunately in this country
you cannot do anything concrete, anything that change things. We live in the middle of what one
tries to forget and what one remembers is in fact the same situation: we continue to live with
injustice, and those who have the power, have all the living guarantees.” (Man, 21).
Reconciliation
We reguested the participants’ opinions about the possibility of reconciliation and forgiveness in Chile after
the military regime. Table 3 reveals a general feeling of disbelief, defeat and scepticism. Many considered
the reconciliation process a hypocracy, because their suffering was not recognized and the persecutors were
not punished. Others maintained that reconciliation can be achieved only if justice prevails. Only few held
the opinion that reconciliation had been beneficial to their country and argued that forgiving the enemy is the
only way to enhance healthy societal development. The personal experience of persecution and trauma
overwhelmingly influenced the analysis.
“Neither reconciliation nor justice has taken place, because the truth still lies in the darkness, and justice
has failed. Dictatorship destroyed our family and left my dad without work. We have not yet overcome
the physical and psychological pain in ourselves. Dad was imprisoned, tortured and persecuted, and we
continue to suffer.” (Woman, 20).
“I believe, feel and think, that it is impossible to forget anything; terrible things have happened
here, and not only those of us who suffered repression in a direct way. Rather the shocks here was
so great for all of us that nobody remained alien to the terror. I think that to forget means to remain
deaf and dumb in regard to the suffering of so many human beings, of too many of them. It means
to generate a space for impunity and for the possibility that the same kind of deeds can happen all
over again; I do not want forgetfulness, I think forgetfulness is a symbol of death.” (Woman, 22).
My enemies
An amnesty law was applied in Chile after military law was abolished. Accordingly, the military officers and
suspects of human right abuse were freed from any responsibility. Our Chilean hosts told us that they
sometimes meet the person who had tortured them in the street, and many knew the names of their
‘interrogators’. We asked the participants, the children of the victims, how they felt towards people who
had persecuted their family. Table 3 shows that feelings of hate, indifference, pain, sadness, empathy and
confusion were all present. Again, justice was the core issue: forgiveness can be possible only if proper
justice is done and those who committed crimes against humanity are brought to court.
“I feel a profound disgust and pity for them, and think they should be imprisoned, and not walk freely on
the streets as if these terrible deeds had never occurred.” (Woman, 19).
“A terrible hatred. I m extremely phobic against the military, whatever their branch (Navy,
Police, and so on). And I feel a distasteful disgust regarding all those polititians who cover up for
the assasins.” (Woman, 22).
Table 3. World-view: attitudes to the past, reconciliation and persecutors
Questions I. People have different opinions about the Military era. Some think that bad times should be forgotten, and others think they should
be remembered. To remember or to forget....What do you think?
Active: One has to remember
Passive: You cannot forget
It is better to forget
I've always thought that it's good to
remember the past and the history of your
country, because without past you wouldn´t
be anybody.
How can you be able to forget and not feel
resentment in view of so much pain and so
much spilled blood? Each time I see or
remember something I feel a great
impotence and great pain; it hurts very
much, I can´t forget, they destroyed so
many families, I don´t know, it´s
something very difficult to forget and to
explain.
To forget. They did wrong, but to remind
them of it only increases hatred, revenge
and grudge among us. This country will
never agree to write her common history,
there will not be a time when all agree and
all is cleared. You simply have to forget.
We have to remember because if the
catastrophe happens again, we must defend
ourselves and fight for our rights. Otherwise
they will step over us again.
I think that anyway you have to remember,
because he or those who did this have to pay
for it one way or another. So, you have to
remember.
Well, in my case and in the case of other
youngsters who lived the same thing, the
absence of a relative...I´ll always
remember this and I´ll never forget
because this is a wound that does not heal
and will be healed only when I find his
rests and the culprits, something that won´t
happen.
I think it is difficult to forget, especially
people who was closer to all that happened.
Yet, personally I also think that it doesn´t do
you any good to remember, because that only
leads to feelings of hatred and to the ideas of
revenge.
I think Chileans should forget a bit, because
some have very ugly experiences
Question II. Tell about your thoughts and feelings concerning the reconciliation process that is going on in our country.
It is a good development
It is a lie and hypocrisy
Reconciliation and forgiving are the basic
values in life. If you are angry with
somebody, it is better to make peace and to
compromise.
It is not what I had hoped for. I think that
people who did those crimes will lie again.
If there is justice, the assassins should be
brought to justice. There are many who
have to pay for what they have done.
I do not want any revenge, even if I justify
it. I only want justice and a wish for
reconsiliation (allthough I know that it has
been only partly fulfilled). In Chile
democracy faces serious obstacles and we
have to be vigilant to keep its progress. But I
think that in the last time, important advances
have been made regarding human rights
(trials against former officers from the army
and the police).
To me reconciliation is very important
because I don´t like it to be angry at people.
And thinking of those days of repression, the
thoughts are joyful and sorrowful at the same
time.
It is important, but not possible without
justice
I think, reconciliation means that you can
have back the corpse of dear one whom they
killed, to be able to hold a wake, to bury
him and to know whom do I forgive; as long
as we don´t know where our dead are, I do
not forgive; only if justice is done can there
Not very favorable in fact. I honestly feel that be reconciliation.
it amounts to something done just to be able
to say that something was done, but in truth, The reconciliation process is very important
it doesn´t have a reconciliatory effect, to give more unity to the families; but it is
because we keep on living in a world, in a difficult, because what happened can never
country where the “good guys” and the “bad be forgotten. Impunity for the things that
guys” still exist. What is imposed here is happened in the past can never be imposed.
impunity, forgetfulness, a reconciliation that
sometimes looks like a “putting the
conscience at rest”.
Question III. How do you feel towards people who persecuted your family?
Hatred, anger, bitterness
& revenge
Indifference, efforts to
forget & denial
Forgiveness, empathy &
sharing justice
Sadness, helplessness
& feeling of defeat
Confusion and conflicting
emotions
I feel a great deal of
resentment and rage, so it
would be very difficult for
me to forgive them.
Because, first they took my
father without my being
able to know him and
second, we are
psychologically marked and
still in a bad shape. In times
when we would have
needed protection, they
murdered and persecuted. If
I had my fathers’ murderer
in front of me I would make
justice with my own hand,
for all the pain we have
suffered.
I don’t use to think of those
persons, although in my
case they are perfectly
identified and sheltered by
the Amnesty Act, I believe
that to think about them
means to awaken
resentments which I don’t
think are good for the
normal development of my
life.
I only want that justice be
made; I do not want any
more impunity; I’m tired of
seeing how we live in a
country where the real
criminals walk freely on the
streets; I want justice and
not revenge; I want us to be
acknowledged as human
beings and I do not want
any more leftovers...I want
them to be able to look at
me in the face and that they
speak the truth, nothing
else. You do not feel
hatred, but I search and
struggle for the whole truth.
I don’t feel anything,
whether good or bad;
sometimes I think that
maybe if my parents hadn’t
gone to Argentina my
family would be all
together and their fates
would had been different.
Now we’ll never know.
The harm is not directly
evident, since in this
generation we were not
subject to 'direct' violence,
but I feel there is a hidden
story, the story of a man I
still miss (my grandfather)
and Y would like to have a
certainty about his
situation. There is no
answer and it appears that
nobody cares. Sometimes I
feel anger, helplessness.
Then I forget.
Hatred, can I feel that? It’s
odd to think that you feel
hatred, but, yes, I can feel it
against those, who
recklessly threatened us,
chased us, against those
who tortured my father,
against those who killed
and made people disappear.
It is not worth while
thinking. It would be too
much for those persons; just
the fact of thinking about
them is a waste of time.
I don´t feel anything,
whether good or bad;
sometimes I think that
maybe if my parents hadn´t
gone to Argentina my family
would be all together and
their fates would had been
different. Now we’ll never
know.
I think that every person
does something evil when
he is enraged, but I don’t
feel anything evil against
anybody.
I want them to be able to
look at me in the face and
that they speak the truth,
nothing else. I do not feel
hatred, but I search and
struggle for the whole truth.
I feel much resentment, but
I think that here we will
never be able to do justice
to the people who truly
worked to achieve
democracy.
I always think that
everything is paid for in
this life, but sometimes I
see that those who hurt me
most are walking around
free, I feel so enraged, I feel
terribly helpless and I can’t
do anything about it.
In fact in regard to what I
feel vis a vis these persons,
I do not have it clear. Yes, I
am confused and do not
know whether to feel rage
or hatred against them or
pity for the way they
achieved their goals.
8
Conclusions
8.1 Criteria for effective psychosocial interventions
Feeling safe and enjoying security are foundations for healthy child development. The seriousness of
childhood trauma lies in its comprehensive developmental influences on emotional, cognitive and social
domains of life. Success and happiness in later life depend on how children manage to cope with traumatic
conditions. Psychosocial interventions aim at helping them to maintain their coping capacities. Their crucial
task is to restore the feelings of competence and safety in the minds of war and violence.
Psychosocial assistance projects are often based on a general good-hearted desire to
help suffering children. Their intervention methods are based on more intuition than knowledge
about developmental vulnerabilities and strengths of children. Children are encouraged to play
because they like it, or they are provided festvities because adults consider them compensatory
experiences. On the other hand, there are controversies and disagreements about the usefulness of
psychosocial projects. For instance, Maryanne Loughry (1999) argues that `life is healing the
wounds´, and providing physical shelters `is the best kind of psychological help for children´. One
reason for the controversy may lie in the fact that psychosocial assistance is not based on
knowledge about underlying mechanisms of recovery.
It is naturally unfair to evaluate the Chilean experience according to the criteria based
on our current knowledge about children’s recovery from traumatic events. When PIDEE and the
Finnish Parasta Lapsille Foundation started their cooperation, the main sources of information were
Anna Freud’s insightful observations of children during the London bombardment and documents
about the resiliency and vulnerability of Holocaust child survivors. Nevertheless, enthusiasm, a
feeling of solidarity and high quality professionalism seem to have brought about positive results.
More explicit criteria of the effectiveness of the assistance are needed for future
planning and evaluation. Assistance projects should start early in childhood, continue for a
substantial period of time, and combine material, social and psychological help. It would be
preferable to integrate them into the general health care system. If the political situation prevents
that, there should be realistic plans to continue the activity once military emergency over. Projects
should be based on sound local professional expertise and they should recognize the special local
resources and vulnerabilities. Trauma is an emotionally loaded experience, and it tends to lead to
conflicts both among family members and professionals. Therefore knowledge and support are
important for professionals who work with such families and children.
The aims of intervention should be specific, explicit and concrete. They should be
based on the knowledge about how children response to trauma in acute, chronic and long-term
phases. Age is a decisive determinant of how children perceive, understand and cope with trauma
and expresses distress. Subsequently, the intervention programmes must be tailored to meet their
developmental needs.
‘
8.2 Organizational aspects
It is problematic to apply general evaluation criteria of foreign aid projects for psychosocial and solidarity
work. Here I have tried to ‘translate’ the criteria of efficiency and sustainability by analyzing the negotiation
process between donor and recipient organizations. We may conclude that PIDEE was effective in providing
comprehensive help for traumatized children in emergencies, but failed to continue its activities in less
dangerous conditions.
FINNIDA accepted very general aims for its foreign aid for PIDEE: providing
services for suffering children. The agreements did not include explicit criteria for efficiency and
sustainability of the activities. Even if PIDEE translated its aims professionally and effectively into
practice, FINNIDA, as donor organization, should have developed tools to estimate out-dated
versus effective intervention methods.
PIDEE provides a good example of developing teamwork and comprehensive
services. Their experiences suggest that psychosocial interventions should not be isolated from legal
and economic help. Traumatized families also need physical shelter and protection from human
rights violations. The organizational cooperation should base on agreements about specialization,
share of work and responsibility.
PIDEE responded flexibly to the changing needs of persecuted children. Tailoring
interventions according to their specific needs was based on close cooperation with their families.
Research or surveys were not used. Yet, they could provide an effective tool for comprehensive
planning of treatments. They can give information about both the subjective and objective degree
of traumatization, children’s strengths and weaknesses, perceptions and explanatory models for
traumatic events and problems. Surveys can bring insights and information for both professionals
and families.
PIDEE was successful in protecting children and adolescents from the negative effects
of military repression during the state of emergency from 1973 to 1989. It was less successful in
transforming its activities into the new challenges of more peaceful and normal times. Lack of
sustainability was evident in PIDEE’s inability to cooperate in establishing and developing child
well-fare organizations in the more democratic Chile. PIDEE played a crucial role in providing
child well-fare in emergency, but was paralysed in building the new society after the military
dictatorship came to an end.
The paralysis is attributed to the lack of foreign financing and the hostile political
reality. Total dependency on foreign aid cannot therefore be recommended, and alternative
financing should be an integral part of project planning. Continuation of psychosocial activities is
essential for two reasons: First, it is well known that traumatic experiences may cause social,
psychological and somatic problems long afterwards. People may feel free in expressing their
distress only when external dangers disappear. Second, professional expertise developed during the
emergency can be used to help children with other traumatic experiences such as family violence or
social adversities. The preparation for future changes involves innovation and constant evaluation
of current activities.
8.3 Recipients view
On the individual level, the criteria for successful help were to (1) improve the potential for good education
and enjoyable learning, (2) enhance effective coping resources and family support, (3) protect mental health
and psychosocial well-being, and (4) encourage positive attitudes to reconciliation and effective conflict
resolution. The results give evidence that the interventions were successful in promoting education and
psychosocial and family resources.
The educational level was high in the PIDEE group that had received help. They had
twelve years of education in average, 20% had a university degree, and 11% had a permanent job.
The younger ones were still at school. According to national statistics, 12 years of education is a
minimum to guarantee a decent life in contemporary Chilean society. The participants belonged to
the poorest people in the society and lived in problaciones. Their educational achievement can
therefore be considered extraordinary.
Helping children in traumatic conditions had beneficial impacts on their coping and
family resources and learning experiences still in adulthood. The PIDEE group showed more
effective coping strategies in facing stress and enjoyed a more coherent and nurturing family
atmosphere than the controls. (The controls had experienced similar trauma, but had not received
psychosocial help). The PIDEE group was also more task-oriented and conscientious in its studies.
The timing and duration of help for traumatized Chilean children turned out to be
crucial. The earlier children had received help, the more effective coping strategies, characterized
by optimism and constructiveness, they used and the better mental health they enjoyed as adults.
Those who had received help early also enjoyed a good and harmonious family life and had reached
a high level of education. Children who had received assistance for more than two years used more
effective coping strategies and enjoyed better mental health as adults, as compared to those who
received assistance for a shorter period.
It is agreed that young children have their unique ways of perceiving severity of
threat, understanding the causes of violence, expressing their distress and seeking consolation.
Young children may thus be more sensitive to both negative and positive influences. Processing
traumatic experiences in childhood is still flexible, constantly changing and receptive to new images and
impressions. Maybe that is why compensatory experiences can have a comprehensively positive impact.
Sponsoring and PIDEE services provided them security and caring which may explain the
effectiveness of early help
Interesting enough, substantial duration of assistance protected participants from
developing symptoms, especially posttraumatic images (intrusive recollections) and aggressive
behaviour. Aggressiveness among individuals traumatised in a military context often derive from
feelings of betrayal and injustice, frustration, cynicism and lack of future prospects. The P.I.D.E.E’s
psychosocial interventions together with international solidarity were based on sharing, supporting
and ideologically strengthening the victims. The aim was to balance and compensate children’s
horrifying experiences, and to help them to reconstruct their shattered world view. The confirmation
about the existence of good and caring people was important for children whose experiences of the
fellow-humans showed the opposite. The P.I.D.E.E.'s interventions provided the children a sense of
security, recognition for their suffering and prospects for future. Many participants emphasised the
importance of sharing experiences with other children whose parent also was killed or detained.
It is thus worthwhile to help children in the midst of military persecution. One tends to
emphasize that childhood trauma strongly shapes a person’s life. Our result in turn suggest that
early and long-term interventions may positively shape a victim’s later psychosocial adjustment.
The benefits of the Finnish sponsor project were relevant to the recipients even as adults. PIDEE’s
comprehensive assistance included economic, mental and physical health, and pedagogic and social
services. The participants remembered them very vividly and were still moved about being helped.
They showed high appreciation and gratefulness for PIDEE and the Finnish sponsors. Attention,
love, support and recreation activities had a high experiential value, and had subsequently
comprehensively influenced the development of young trauma victims.
We may conclude that in addition to shelter and material (here money) help, the
experience of people caring for each other, showing interest and sharing pain are crucial for
children’s healthy development. The vivid memories of toys, play and fiestas and loving ‘uncles
and aunts’ indicate that rather simple services can be effective when children are in danger. The
programme allowed children to survive, feel safe and protected. PIDEE services allowed children
to flourish, encouraged their imagination to rework trauma memories, and strengthened their family
and peer relationships.
The world view of the victims of political persecution determines how post-war
societies recover and flourish. Declarations for democracy are empty if the subjective reality of
former enemies is ignored. Our results revealed deep pessimism and helplessness among the
children of victims of human right abuses. Only few were willing to forgive the persecutors of
their family. Most of them demanded justice and real reconciliation.
In Chile, former victims and persecutors have normalized their relationships on the
governmental level. Our results suggest that personal suffering and painful memories underlie the
attitudes towards reconciliation and forgiveness. Trauma involves a profound sense of injustice and
of the evil nature of fellow humans. The participants suggested that open confrontation, genuine
dialogue and legal responsibility for human rights crimes are the preconditions for healing that
trauma.
8.4 Premises for successful psycho-social
intervention
We know relatively much about children’s psychosocial suffering and resiliency in traumatic conditions. Our
challenge is to translate that knowledge into practical assistance. Interventions should be based on the
evidence of (a) the help-seeking behaviour of trauma victims, (b) the specific needs of victims of acute and
long-term suffering, and (c) developmental aspects and family dynamics of the children involved.
Even if most people in war conditions face losses, humiliation and danger to life, only
a relatively small number seek psychological help. Adults tend to seek help for the more distant
consequences of trauma, such as difficulties in intimate and social relationships, and parenting. The
unvillingness to seek psychological help among victims of military violence is sometimes
interpreted as fear of being ’stigmatized’. Professionals should not, however, readily accept that
kind of generalized statements. The attitude is based on stereotypic ‘war hero’ images and notions
that “people who fight for their legitimate right should not be treated as clients or victims”
(Summerfield, 1996). The real reason may be that the treatments and services do not conform to the
state of mind of trauma victims. People who deny the trauma and cope with distraction,
depersonalization and avoidance, for instance, can also be helped through psychotherapy. They
may even be in a especially urgent need for assistance.
The timing of help seems to be crucial. While economic and medical help are
necessary immediately after trauma, the need for psychological healing appears later. Effective
assistance programmes should there include differentiated services that meet the varying needs of a
wide range of victims.
Taking account of a variety of needs could be understood in terms of ‘an iceberg’
model’. On the top clinical services are provided to children and parents who have endured severe
trauma and/or suffer severely. These can be given through primary health-care services, including
(a) intensive trauma treatment for children, exceptionally vulnerable children (separated from their
families, orphans, wounded and children who have witnessed atrocities) and (b) family
consultations, medication, and specialized treatment for victims of torture and abuse.
On the secondary level, psychosocial interventions are planned for families and
children in their natural surrounding, such as schools and kindergartens. They may include, (a)
surveying for psychological, somatic and social problems and the children´s need of assistance; (a)
special education services to remedy learning disabilities; (c) organizing group activities to support
mental recovery, encouraging social skills, conflict-resolution and anger regulation; (d)
Consultation possibilities for parents.
On the third level, information is provided to families about how to master and
understand consequences of trauma and psychosocial hardships. Training and support for school
and kindergarten teachers are essential. The focus is to (a) increase awareness of the special needs
of children and families who were exposed to violence and persecution; (b) to achieve better
understanding of children’s experience of loss, bereavement, grief and violence in various ages and
development stages. (c) to distinguish between normal and abnormal patterns of behaviour; (d) to
introduce ideas, programmes and educational tools with which to alleviate children’s problems and
to prevent trauma experiences from becoming chronical symptoms or social problems;(e) to
strengthen parents´ and teachers´ own resilience and prevent burn-out in the work-group.
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