Creating healing spaces

Preeti Jacob and Shekhar Seshadri

father-and-child
Child abuse is a violation of the basic human rights of a child and is a globally prevalent phenomenon. It encompasses psychological and physical abuse, neglect, cruelty, and sexual and emotional maltreatment. In the Indian context, acceptance of child rights as primary inviolable rights is fairly recent, as is the developing universal understanding of it. In the recent Study of Child Abuse: (India 2007, a study conducted by the Ministry of Women and Child Development, Government of India), 12,447 children between the ages of 5 and 12 years and 2,324 young adults were interviewed. Some of the major findings were that two out of every three children were physically abused; two out of three school going children were victims of corporal punishment; 53.22% children reported having faced one or more forms of sexual abuse; and every second child reported facing emotional abuse.

In the face of this often hidden problem of epidemic proportions, schools must equip themselves to identify and handle these problems.

Schools play a big part in a child’s life, and parents and caregivers often look to them to provide direction and support, especially in times of crisis.

Signs and symptoms of abuse
Traumatic events can have significant long-term consequences for students. Reactions to traumatic events vary, and may include anxiety, nervousness as well as sadness, or depression. At times, some students act out more in school, with peers, than at home. Some of these consequences directly interfere with performance in school.

Research has shown that exposure to violence leads to:

  • decreased performance
  • lower grade-point average
  • higher absenteeism
  • decreased rates of high school graduation
  • significant deficits in attention, abstract reasoning, long-term memory for verbal information

Academic performance can decline because of an inability to concentrate, flashbacks or preoccupation with the trauma, and a wish to avoid school or other places that might remind students of the trauma. Academic performance may also be affected by the development of other behavioural and emotional problems, including substance abuse, aggression, and depression.

Symptomatology varies with age and developmental level, for instance, preschool children may show regressive behaviour, and often re-enact the traumatic event in their make-believe play. Temper tantrums and withdrawn behaviour may also be seen. Physical symptoms, like stomach aches and headaches may be seen in primary school children. Anger outbursts, irritability, aggression towards other children or adults, sexualized behaviour, poor academic performance, absenteeism, and inability to concentrate may also be seen. Middle and high school students may be absent from school more often and may engage in more problem behaviours (such as substance abuse, fighting, reckless behaviour, and promiscuity). School performance may decline, and interpersonal relationships can be more difficult (National Child Traumatic Stress Network, 2006).

School mental health
School based mental health programmes are increasingly seen as ideal vehicles for addressing the mental health needs of children.

Successful school-based mental health programs are often the result of a careful process that includes needs assessment, resource mapping, and the dedicated and committed involvement of a number of people including:

  • students
  • class teachers
  • school counsellors
  • school nurse
  • school administrators
  • parents

Mental health programmes are broadly divided into:

  • universal
  • selected
  • indicated

Universal mental health programmes target the entire student population regardless of the presence or absence of psychological difficulties. Selected programmes target children specific groups and the indicated approach is for children showing signs and symptoms of abuse. Children requiring help can be identified in a variety of ways:

  • Teacher or Counsellor Nominated – School counsellors or teachers can be asked to nominate students perceived as needing the intervention program. This approach requires orienting the teachers and counsellors to the kinds of problems faced by children.
  • Parent Nominated – Schools may also describe the program to parents and ask them to nominate their own children if they feel it is appropriate.
  • Targeted School Screening – Students known to have been affected by a traumatic event can be assessed by a school counsellor.
  • General School Screening – Another option is to screen all students in the school, with parental permission. This approach is potentially less stigmatizing and may reveal high rates of trauma exposure that sometimes go undetected by parents, teachers, and counsellors.

fear How teachers can help

  • Teachers are potentially helpful resource persons for a large number of children who may have difficulty disclosing the abuse to a family member. Sensitized and trained teachers are able to identify behavioural indicators of abuse and suggest interventions. For some children, teachers may represent their most, or only positive relationship.
  • The teacher should be approachable and the child should feel comfortable enough to confide in him/her. While confidentiality should be maintained, any abuse needs to be reported to the parents or the authorities after the child’s permission has been taken. Avenues to prevent further abuse and protect the child need to be explored, with sensitivity to the child’s perceptions and needs.
  • Traumatic experiences are unpredictable and hence, a teacher should be consistent and predictable in her/his relationship with the child, as it promotes a feeling of security. Structure and routine decrease their anxiety, as they know what to expect.
  • The teacher can help the child identify emotions and express them appropriately. Flash cards with different emotions can be used to facilitate this process.
  • The teacher needs to be patient, reassuring, and a positive role model for the child.
  • The school counsellor or teacher can also impart problem-solving strategies, anger management skills, life skills training, and abuse prevention strategies in an individual or group setting.
  • Children who are severely affected must be referred to a mental health professional for detailed evaluation and management.

Creating healing spaces

  • Setting aside a place in the classroom or school for children to “gather themselves together” or calm down may help a child who is feeling overwhelmed. Some teachers call it a “cool down” place. However, the measure should not be portrayed as punitive.
  • Putting the child’s name on his/her desk would encourage a sense of belonging to the group. Displaying the child’s work, making sure that there is a place for their belongings, and facilitating involvement in group activities are other measures that would promote this sense of belonging.
  • Providing creative opportunities to express emotions through art, drama, music, and play can help build a sense of safety, thus offering the possibility of cathartic processes for children.
  • “Speak out sessions”, where children can freely discuss their difficulties may provide much needed avenues to access help.
  • Awareness programmes on safety issues, how to tackle abuse, and seek help can be conducted in interactive and engaging formats keeping in mind the developmental stage and understanding of the target audience.
  • Providing “drop boxes” in schools where children can write to a counsellor/teacher may reduce the risk of being stigmatized in their peer groups.

In conclusion, schools and teachers play a central role in the lives of children. Every aspect of a child’s life impacts his/her learning. School mental health programmes are an important way to identify, rehabilitate, prevent and protect our children from the harmful effects of abuse. Teachers need training to be empowered to facilitate child mental health in every school. Schools must, therefore, not just be centres of learning, but must transform themselves into spaces of understanding, sensitivity, and of healing.

School as a sanctuary

Child-Abuse Exposure to traumatic experiences can have devastating and long lasting effects on a child’s development and psyche. The world is then viewed as a dangerous and unpredictable place. Schools have a role in preventing and protecting children from these experiences, as well as mitigating their short and long-term consequences. Hence, schools must aspire to be safe and nurturing and their physical environs should reflect these qualities. Factors such as good ambient lighting, adequate ventilation and seating, and bright colours help create an oasis of comfort in their lives. Architecture that incorporates green spaces can uplift mood and facilitate learning.

Stability and consistency are required to bring about a sense of normalcy to a young person faced with adverse life events. Schools help provide this by establishing daily rhythms and routines that the child or adolescent can participate in. Centres that limit their vision to narrow definitions of academic success lose out on opportunities to help children cope with crises and can inadvertently neglect the development of essential life skills.

Exploring the entire range of a child’s potential and promoting a sense of competency in areas of strength can be therapeutic, and serves as positive reinforcement. It also provides a sense of accomplishment and control over one’s life. Creating time in an otherwise hectic academic curriculum, and building infrastructure dedicated exclusively to sports, recreation, theatre activities, and the arts allow children to express themselves as individuals; and can inculcate a sense of belonging. Facilitating such normative peer group experiences can help with development and healing.

Child friendly areas, where children and adolescents can share their feelings and access adult or peer mentors, need to be integrated into the more conventional elements of school infrastructure. Aspects involving the physical safety of children such as railings for balconies, and limiting access to relatively isolated areas where supervision is difficult, help deal with children who are at risk for, or prone to, harmful behaviours. Appropriate physical spaces set the stage for cathartic and corrective emotional experiences for children and adolescents. Schools must adapt themselves to meet the varying challenges that confront students and teachers.

Dr.Preeti Jacob is Senior Resident and Post-doctoral Fellow at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. She can be reached at [email protected].

Dr.Shekhar Seshadri is Professor of Psychiatry, Child and Adolescent Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. He can be reached at [email protected].

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