Preventing Trauma Symptoms in the Aftermath of Sexual Abuse in Children and Adolescents in Burundi
Condition: Posttraumatic Stress Disorder; Mental Health Issue; Family Dynamics
MeSH terms: Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Survivors of sexual violence are particularly vulnerable to develop psychological as well as
      physical health problems, Burundian children and adolescents being at elevated risk.
      Psychosocial care, and trauma-focused interventions, nevertheless, are near absent in
      Burundi.

      The purpose of this project is to ameliorate psychosocial care for survivors of sexual
      violence in strengthening health care competencies by implementing evidence-based
      intervention strategies. We intend to develop an approach identifying particularly vulnerable
      children and adolescents and testing a preventive family-oriented psychotherapeutic approach.
      The latter aims at reducing stigmatization and at promoting the processing of the event
      within families. The project involves two cohorts, which are assessed enrolling them in the
      study, during a three-months and a 12-months follow-up.
    

Detailed description: 
      Survivors of sexual violence are particularly vulnerable to develop psychological as well as
      physical health problems, children and adolescents being at particular risk. Residing in
      conflict zones with disrupted community structures and social norms, substantially increases
      the risk for interpersonal violence, especially sexual abuse. The post-war country Burundi
      shows high prevalence rates for childhood sexual abuse. Adequate psychosocial care and
      trauma-focused interventions, however, are near absent, especially in rural areas.

      Furthermore, talking about sexual activities remains a taboo-topic in Burundi, and
      particularly talking about sexual abuse. Survivors often suffer from stigmatization and
      therefore conceal their abusive experience. Recent studies, however, accentuate the
      importance of social support, notably parental acceptance, in the aftermath of sexual abuse.
      Parental acceptance shows buffering effects of sequelae following sexual abuse. Conversely,
      parental rejection, especially coming from the father, lowers the self-esteem and leads to
      emotional unresponsiveness and negative self-cognitions. Rejection thus risks to exacerbate
      feelings of shame and the internalization of stigma. Hence, the implementation of
      family-oriented interventions is crucial for effective treatment outcomes.

      The purpose of this project is thus to ameliorate psychosocial care for survivors of sexual
      violence in strengthening health care competencies by implementing evidence-based
      intervention strategies. Combining insights from the aforementioned research, cognitive
      behavioural strategies, and cultural aspects we developed a preventive treatment approach
      aiming to address (1) the building block effect using trauma-therapeutic methods, (2) social
      exclusion by family members and society, and (3) communication about the incident and
      associated emotions within the family. The intervention consisted of three sessions. The
      first cohort included in the study does not receive the intervention in order to establish a
      baseline assessment of the course of mental health symptoms in the aftermath of sexual
      violence, and to help identify those in need of psychosocial assistance. The second cohort is
      offered the family intervention.

      Follow-up assessments are planned at 3 and 12 months.
    

Intervention name(s): Preventive Narrative Exposure Therapy (PreNET) family intervention
Intervention type(s): Behavioral
Intervention description(s): Sessions: (1) Participants are invited to narrate the event in detail, in line with the protocol of the trauma-focused intervention NET. Furthermore, participants and caregiver(s) will receive a brief psychoeducation about expected symptoms and supportive behaviour in the aftermath of sexual violence.
(2) Two weeks after session 1, the second session focuses on caregiver only and their emotions. The narration of the event is read to the caregiver(s). Caregiver(s) receive assistance regulating their emotions. They receive psychoeducation on how to support their child.
(3) Two weeks after the second session, the children assisted by their caregivers lay a chronological lifeline of their most important life experiences. The chronology and the context of the traumatic events is reinforced. The narration of the sexual abuse is read again to the child and the caregiver(s). The caregiver(s) are encouraged to support emotionally their child during the renarration.
Allocation: Non-Randomized
Intervention model: Sequential Assignment
Intervention model description: Two cohorts. The first cohort receiving treatment as usual in Burundi, mostly a waiting control group, the second cohort receiving a three session family focused intervention.
Masking: None (Open Label)
Primary purpose: Prevention