ARTICLE REVIEW

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University of Central Florida

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ARTICLE REVIEW 2

This paper will be critiquing the article “Psychosocial Intervention for War-Affected

Children in Sierra Leone” found in the British Journal of Psychiatry. The research was

conducted by Gupta and Zimmer (2008) who studied the efficacy of Rapid-Ed Intervention on

decreasing trauma symptoms in war-displaced children.

Research Problem, Hypothesis, and Questions

The researchers’ problem statement is clearly stated at the beginning of the article in the

first paragraph. The research problem addressed in this article is described by the narrative of the

1999 Revolutionary United Front attack on the capital city of Sierra Leone and its effect on the

war-displaced children. There is no clear research question neither is there a clear hypothesis in

this article. Instead, the researcher plainly states the objectives of the study that include assessing

the psychological status of children displaced by war in Sierra Leone and determining the

efficacy of the Rapid-Ed intervention at decreasing Post-Traumatic Stress Disorder (PTSD)

symptoms that cause difficulties in learning. These objectives are very clearly connected with the

research problem, considering that these children who are being researched have indeed

experienced high levels of trauma and are plagued by PTSD symptoms and also considering that

Rapid-Ed is an intervention made to decrease PTSD symptoms. Considering the sparse amount

of literature regarding PTSD symptoms in refugees, conducting a pilot test to determine the

efficacy of an intervention is quite reasonable.

Variables

The dependent variable in this study is the trauma symptoms of the children that provide

challenges to academic success. Trauma symptoms are defined as intrusive images, avoidance of

reminders, arousal symptoms, and associated post-traumatic stress reactions. I found this

definition to be too broad and exclusive, as PTSD results in more manifestations than just the

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ones listed in the article. To ameliorate the conceptualization, the researcher could have defined

trauma symptoms as “the negative physical and emotional manifestation of traumatic war events

including sleeplessness, irritability, lack of focus, nightmares, anxiety, depression, experiencing

terrifying memories, and other related symptoms.” Trauma symptoms were measured using a 15-

item Impact of Events Scale (IES) that assessed the frequency of trauma symptoms using a 4-

point scale. Also included was a questionnaire asking children to describe the activities they

participated in during the intervention and their feelings before and after participating. This

measure seemed quite appropriate although I may have included symptom severity in the

questionnaire as many children may continue to experience frequent symptoms, but their severity

may decrease over the course of the intervention.

The independent variable in this study was Rapid-Ed Intervention. The intervention is

defined in the first paragraph as a “psychosocial pilot project aimed at normalizing displaced

children’s lives and alleviating psychological distress by participating in nonformal education,

trauma healing, and recreational activities.” The intervention also integrated a revised Trauma

Healing Module. This concept is well-defined yet the phrasing does not match the phrasing of

the dependent variable, which uses the phrase “trauma symptoms” as opposed to “psychological

distress.” This can be confusing to the reader, as “psychological distress” is more of a broad term

and is not defined. The dependent variable is operationalized as an intervention taking place over

the course of eight sixty-minute interventions completed twice per week during four weeks. The

intervention focused on reducing psychological distress through encouraging the children to

share their traumatic stories in groups and artistically express their memories and feelings about

the trauma.

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Sampling

The population of interest in this study includes children who have been displaced from

their homes because of war. The sampling frame includes those war-displaced children who

attend the Grafton and Trade Center Camps aged 8-17. Children who are not a part of camps

Grafton and Trade Center, who have not been displaced from their homes due to war, and who

are not from Sierra Leone are excluded from this study. The researcher did not state that children

who were displaced by the war but did not have PTSD were excluded. It is therefore implied that

even those children who do not exhibit symptoms of PTSD will be included in the sampling

frame of the study. The researcher uses a stratified probability sampling approach. The subjects

used in this study do not fully represent displaced children from other cultures who have been

displaced because of war. Because the sample was taken solely from one ethnic group, the

results of the study are less generalizable. Also, the results of the study are less generalizable

because of the fact that every war is different—there are different types of warfare used and the

war trauma will vary in intensity and in duration depending on the war. The fact that the children

were randomly selected from a list by the Ministry of Education does increase the

generalizability of the results. The results therefore are representative of the children of Sierra

Leone whose homes were attacked by the Revolutionary United Front in 1999, but are not truly

representatives of children from other cultures who have experienced a different war.

In order to obtain a more representative sample, the researchers could have chosen a

sampling frame that included children of many different races and cultures who had been

displaced from their homes because of different wars. For an example, Syrian refugees and

Iranian refugees could have been added to the sampling frame, increasing the generalizability of

the sample.

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Study Design and Data Collection Procedures

The research design for this study is One Group Pretest-Posttest Design. One potential

problem with this design is that there is no control group, which would have given the researcher

reliable baseline data with which the researcher could have compared the experimental group.

Also, the posttest data was collected four to six weeks after the intervention, which means data

could have been affected by the children returning to their everyday lives. I did not see any

problems with the way the data was collected. My only suggestion was that the researcher

include a section in the questionnaire to ask about the severity of PTSD symptoms, instead of

only frequency. I did not see any aspects of the research that would have created an opportunity

for bias. Threats to internal validity would include events that occurred after the intervention and

before the posttest, not having a control group, and testing effects on the posttest from having

taken the pretest. These threat to internal validity could mean that the results are less likely to

produce valid conclusions. In order to reverse these negative effects, the researchers could have

tested the children immediately after the intervention and had a control group in their study.

Threats to external validity include whether the children have been exposed to therapy before,

using only children from Sierra Leone, and the fact that the children knew that they are being

tested. These threats to external validity could mean that the results of the study are not

generalizable. In order to reverse these effects, researchers could have asked the children

whether or not they have received therapy before on the questionnaire and they could have

included children from many countries and wars. Problems with generalizability are simply that

the sample is small and it does not include children of different ethnicities or from different wars.

These problems to generalizability could mean that the results are not generalizable to any

population other than children who were displaced by war in Sierra Leone.

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Human Diversity

This research does not apply to diverse groups of people because it only includes children

who have been affected by war trauma in Sierra Leone. However, the research did focus on a

vulnerable population who is highly at risk for suffering from PTSD and has fallen victim to

violence. The methods used were very ethical and sensitive to the population. One example of

their following good ethics is exemplified in them not including a control group to prevent a

group of children from not receiving the needed intervention. Children were asked whether they

wanted to participate and were allowed to leave. Parents were also required to authorize their

children’s participation. In addition, the researcher provided a statement on the purpose of the

research and on confidentiality.

Conclusions and Applications

After the study, the researcher concludes that combining education and intervention to

treat trauma symptoms is effective. The researcher also concludes that the Rapid-Ed intervention

is an effective method of treatment for children who have been displaced from their homes

because of by war. The researchers emphasize the fact that children who have experienced

trauma desperately need a safe place to express their feelings and to share their painful memories

as part of their therapy. Although the author does not directly discuss implications for social

work practice, a social worker may be encouraged by reading this study to engage in trauma-

informed care with their child clients who have experienced trauma. Participating in trauma-

informed care could include adopting a few of the parts of this intervention by normalizing the

child’s reactions to trauma, renewing a child’s sense of hope for the future, and encouraging the

child to partake in structure play and drawing about their painful memories.

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Reference

Gupta, L., & Zimmer, C. (2008). Psychosocial intervention for war-affected children in Sierra

Leone. British Journal of Psychiatry, 192(3), 212-216.