Annual Research Review: Breaking cycles of violence - a systematic review and common practice elements analysis of psychosocial interventions for children and youth affected by armed conflict

Felicity L. Brown, Anne M. de Graaff, Jeannie Annan, Theresa S. Betancourt

Research output: Contribution to JournalArticleAcademicpeer-review


Background: Globally, one in 10 children live in regions affected by armed conflict. Children exposed to armed conflict are vulnerable to social and emotional difficulties, along with disrupted educational and occupational opportunities. Most armed conflicts occur in low- and middle-income countries (LMICs), where mental health systems are limited and can be further weakened by the context of war. Research is needed to determine feasible and cost-effective psychosocial interventions that can be delivered safely by available mental health workforces (including nonspecialists). A vital first step toward achieving this is to examine evidence-based psychosocial interventions and
identify the common therapeutic techniques being used across these treatments.
Methods: A systematic review of psychosocial interventions for conflict-affected children and youth living in LMICs was performed. Studies were identified through database searches (PsycINFO, PubMed, Cochrane Central Register of Controlled Trials, PILOTS and Web of Science Core Collection), hand-searching of reference lists, and contacting expert researchers. The PracticeWise coding system was used to distill the practice elements within clinical protocols.
Results: Twenty-eight randomized controlled trials and controlled trials conducted in conflict-affected settings, and 25 efficacious treatments were identified. Several practice elements were found across more than 50% of the intervention protocols of these treatments. These were access promotion, psychoeducation for children and parents, insight building, rapport building techniques, cognitive strategies, use of narratives, exposure techniques, and relapse prevention.
Conclusions: Identification of the common practice elements of effective interventions for conflict-affected children and youth can inform essential future treatment development, implementation, and evaluation for this vulnerable
population. To further advance the field, research should focus on identifying which of these elements are the active ingredients for clinical change, along with attention to costs of delivery, training, supervision and how to sustain quality implementation over time.
Original languageEnglish
Pages (from-to)507–524
Number of pages18
JournalJournal of Child Psychology and Psychiatry
Issue number4
Publication statusPublished - 2017
Externally publishedYes


Funding support was received from an Endeavour Queen Elizabeth II Diamond Jubilee Fellowship under grant number 4764_2015 (FB); and the National Institute of Health under grant number 5R01HD073349-04 (TB) and the kNOw Violence in Childhood Initiative (FB, JA, TB). This paper was prepared under the Know Violence in Childhood: Global Learning Initiative ( The authors acknowledge the support and internal review provided by the Initiative and its funders. They thank the Harvard T.H. Chan School of Public Health and the International Rescue Committee, for supporting this work. The authors have declared that they have no potential or competing conflicts of interest. This review was invited by the Editors of this journal, who offered a small honorarium to cover expenses. This work has undergone full, external peer review. For his input in the early stages, we thank John Weiss. We also thank Bruce Chorpita and Eric Daleiden and PracticeWise for sharing the coding manual and for their valuable input. The authors acknowledge the many researchers globally who shared their intervention protocols to make analysis possible. This work would not be possible without the research staff in Boston, including Robert Brennan, Lori Holleran, Setsoakae Thipe, and Grace Lilienthal.

FundersFunder number
Endeavour Queen Elizabeth II Diamond Jubilee Fellowship4764_2015
International Rescue Committee
National Institutes of Health5R01HD073349-04
Harvard T.H. Chan School of Public Health


    • Adolescents
    • Armed conflict
    • Children
    • Developing countries
    • Mental health
    • Psychosocial treatment
    • Systematic review
    • Violence
    • War
    • Well-being
    • Youth


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