How Theresa Betancourt fosters resilience and healing in ex-child soldiers

Episode transcript

[Music]

Theresa Betancourt: We have to think about the ecology of resilience and how we’re creating an enabling environment. I think when given an enabling environment, humans are ultimately quite resilient.

Dave Scott: That’s Theresa Betancourt, the director of the Research Program on Children and Adversity at Boston College. For the past 20 years, she’s been studying former child soldiers, a generation [of individuals] who were victims or witnesses of violence in the war zones of Sierra Leone, Uganda, Rwanda, and Chechnya. Some of those survivors fell into chronic depression and unemployment. Others became doctors, entrepreneurs, and humanitarian workers. She’s been researching why some children flourish after war and how to facilitate that recovery.

This is “People Making a Difference,” a podcast about people who are, step-by-step, making a better world.

Welcome, Dr. Betancourt.

Theresa Betancourt: Thank you so much for having me.

Dave Scott: So take us back to the beginning, if you would. Tell us about your original research of trauma and resilience.

Theresa Betancourt: We’ve worked all around the world in contexts affected by conflict, the Russian Federation with the Chechen conflict, on the Ethiopia-Eritrea border, also on the topic of child soldiers, both in Northern Uganda and Sierra Leone.

We also work with refugees resettling in the United States – with Somali Bantu and Bhutanese refugees – family-strengthening interventions that can be delivered for refugees by refugees. And, getting back to probably the study we’re best known for, is the intergenerational study of war, which has been running in Sierra Leone in West Africa for almost 20 years.

And in this research, we’ve been tracking the lives of a cohort of 529 girls and boys since the end of the 11-year civil war in Sierra Leone, when they were about 10 to 17, when they were children. And now we’ve continued to follow them as they’ve grown into young adults and are starting their own families.

And so that very early study [started] looking at what are the processes that shaped trajectories of more resilient outcomes or more risky outcomes over time? And from that, we’ve really been able to parlay our findings into thinking about evidence-based interventions that are scalable, feasible, and respectful of the culture and the context.

Dave Scott: Dr. Betancourt acknowledges that after a war, [there are] a lot of mental health issues relating to the violence, and often that’s what gets the immediate attention. But that focus, she says, is too narrow. And often temporary. Her research suggests that a more holistic approach, what she calls the social ecology of support, can change the arc of many young lives.

Theresa Betancourt: And so when I’m talking about the social ecology, imagine a drop of water in a still pool, and you have the rings shimmering around the center, those are the layers of influence on the life of the child that shaped their mental health, shaped their development, shaped their life trajectories.

And we do see that for a lot of the young people who are doing well over time, it’s because a virtuous cycle was kicked off. Maybe they were particularly motivated to continue in school and people around them noticed this and started to make investments in them and helped them remove barriers to attending school or to advancing themselves.

Dave Scott: So let’s bring it back down to maybe specific examples. Can you talk about a child or children, maybe in Sierra Leone, where you’ve seen a change by [way of] these interventions, by bringing support to bear?

Theresa Betancourt: I’ll start with a story that’s a less positive outcome, which is a young boy in our study. This is not his real name, but I’ll call him “Sar.” He was taken as a toddler from the arms of his grandmother because the rebel commander was looking for a young boy to be a house boy and a helper to his wife, who had a young child herself. And the grandmother pleaded and begged for them not to take such a small child. But nonetheless, he was taken and he spent four years with the rebels, experiencing countless exposures to violence, being forced to take drugs, being involved in raids on villages. And when he first was able to be released from the fighting force, four years later, they had a very hard time finding his family.

So by the time he got home, he’d spent time in many interim care centers around Sierra Leone. He came back to his family where his mother and grandmother loved him dearly. But the head of the household, the most powerful individual in the home, really saw him as shameful and didn’t advocate for him. So people in the community started to taunt him and tease him. He really didn’t have a lot of guidance on how to navigate those instances of provoking. And he would fight back.

But without a strong advocate in the community, these instances of provoking continued. Sar eventually dropped out of school, was isolated. When we last interviewed him, he was living on the outskirts of a small village, working on a farm, just for room and board. He wasn’t even earning an income. 

And this was a life really taken off course by the many trauma exposures and the separation from family, but also the difficulties in reintegration and the inability of the family to truly advocate for him. And, the last time we went back to find Sar again, we learned that he had died at a young age, only in his twenties. This sort of captures the ways in which the social ecology can break down around a child.

Dave Scott: That’s tragic and probably all too common after some wars. What’s the flip side of that portrait?

Theresa Betancourt: There’s another girl in our study. I’ll call her “Musu,” again, that’s not her real name. She was abducted in a raid on her school when the rebels attacked.

She tried to run, but she and her sister were both captured. They were held together around the same amount of time as Sar. But what’s amazing about these two girls was the way they looked out for each other and protected each other. So again that family relationship was protective. Her young sister would even make sure to save food aside for her. They looked out for each other.

When they got out – and they experienced horrible traumas themselves – they were resettled into a foster family. But this girl desperately wanted to go to school because her burning desire was to continue her education. And so this foster family, it’s not always the case that a foster family would do this, but they began to see that the girl was very bright and they began to go the extra mile for her, like turning on the power generator at night so she could study, helping her secure the books and pay the fees for her to continue in school. 

And she decided she wanted to give back after all she’d been through and study medicine. And so she was admitted to medical school, because she was earning top grades all throughout her education. And some of the ways [that] she was able to do this is that her sister would do her chores for her, prepare meals so she could eat and didn’t have to spend a lot of time cooking, and doing other things around the house, so Musu could really dedicate herself to her studies.

So when she went on to medical school, people in the community – even some of the workers in the non-governmental organizations – saw the girl’s passion and her hard work and would take up a collection for her. This allowed her to continue in her studies and into medical school where she would borrow people’s books because she couldn’t afford to buy the textbooks.

And I recently was able to sit down with her and talk with her in Sierra Leone. She’s currently completing her residency and training to be one of the few female doctors in her country. And so that’s all from the same cohort of, 529 young people that you can have these lives that are totally taken off the rails by the breakdown in the social ecology – or a social ecology that’s extremely protective and interacts with that will, determination, and skill set from the individual to lead to more resilient outcomes.

Dave Scott: As I mentioned, Dr. Betancourt was taking her research findings and applying them to help others. She started an education study, working with local and international groups in Sierra Leone to help poor young people get into school and stay in school. One effort, called the Youth Readiness Intervention program, helped some 436 young people develop goals, manage their emotions, and foster relationships.

Theresa Betancourt: So we then tested this intervention – [which] we call the Youth Readiness Intervention – in a randomized controlled trial amongst 436 males and females, who are ages 15 to 24, living in very impoverished community settings in Sierra Leone. Not only did we see significant improvements in emotion regulation, interpersonal skills, and daily functioning, we also observed that youth who receive these interventions were six times more likely to persist in school.

Dave Scott: The success of that education program, Dr. Betancourt told me, led to a larger Youth Readiness Intervention program in Sierra Leone for more than a 1,000 young people, ages 15 to 25, to help them get jobs or start small businesses.

Theresa Betancourt: And that study is currently underway. We’ve just completed the pre-to-post data collection [and are] seeing some very exciting results on anxiety and depression, as well as labor market returns. We’re actually seeing that young people are shifting how they work, to work more efficiently and make more [money] when they get these sorts of interventions.

Dave Scott: That’s great. Can you take me down to the ground level a little bit more on the intervention. So what does that mean? If I’m a kid that is in a program that’s sponsored by the government, or the World Bank, to give me some training in how to become a welder (or a carpenter or something), do I get an hour of training once a week? And what [does] that training look like? Is that just anger management? Can you get it down to that level, a little bit?

Theresa Betancourt: Yes, sure. You’re right, those are the sorts of entrepreneurship programs that you might see out there. They do a lot of problem-solving around what could be an entrepreneurial enterprise that the young person could pursue. And then the readiness intervention was layered into those entrepreneurship programs. And so the readiness intervention is done in 90-minute, same-gender group sessions. They’re led by well-trained and well-supervised lay facilitators or nonspecialists. 

The themes and issues discussed: We’re making links to livelihoods. And so the sessions are really about developing emotion-regulation skills to promote coping and also interpersonal skills and how you present yourself and get along with others. And sometimes when we talk about this in youth entrepreneurship, youth employment, we call these 21st century skills or soft skills: working in teams, getting along with others, very important for the workplace. 

We also, as I mentioned, engage in problem-solving skills to assist them in achieving life goals. [That is], setting a goal for themselves and using the group to talk about that goal and problem solve and moving towards it. 

For young people who’ve lived through armed conflict, developing those emotion-regulation and relaxation skills [can be critical]. If you look at a typical cognitive behavioral therapy manual that might be used in the West, they might talk about emotion regulation as a car speeding out of control, or a television set turned up too loud. But those sorts of metaphors, in rural Sierra Leone, don’t translate very well.

So in working with the young people, we came up with the metaphor of a pot of boiling water to talk about emotion regulation. So, a pot of water doesn’t come to boiling immediately. As you start to build a fire under it, it starts to bubble and percolate and the water starts to heat.

And those are the signs that you’re starting to move towards boiling. And as you start to move towards boiling, you can take sticks out from underneath the pot to cool it down. And what are those things for you? What helps you to cool down? And so in that group, that youth might express different things they try out: taking a walk, talking to a friend, taking a timeout and listening to music, and sharing some of those ideas. And so that they start to use the group to develop those skills, to identify what triggers you, what might get you upset and also what you can do to keep your cool and to manage strong emotions.

Then, once we’ve established some of those stabilization and coping skills, we start to move more into challenging negative views about yourself and the world around you.

They walk around, and everyone puts a rock in their shoe and they’re asked to concentrate on the rock. When you concentrate on the negative thing, what is the result? OK, so now what if I give you all a sweet piece of a biscuit and you put that in your mouth and walk around. You concentrate on the sweetness. What does that do to your perspective? And so we use just really simple techniques to help people shift some of their negativity bias towards also appreciating the positive things in their lives and the strengths they have.

Dave Scott: I asked Dr. Betancourt to give us an example of how those classes and training programs produce practical results for the young adults.

Theresa Betancourt: I’m thinking of an example actually from Northern Uganda that happened in some of our interpersonal therapy groups where young people were despairing that they couldn’t pay their school fees. And then they got the idea of “what if I asked my uncle if I could use some of his land to plant groundnuts. And would he let me, if I planted some small crops there, keep the earnings, if I sold them?” They found that by that little bit of problem-solving they were actually able to turn a profit and to make enough money to pay these nominal fees. And then they feel a sense of empowerment too, rather than hopelessness.

I think there are lots of examples like that of young people and how they’ve got inherent resourcefulness, but they need these sorts of settings to unlock it.

Dave Scott: That’s awesome. So can you talk a little bit about your work with refugees? Is [your work] similar with [the] refugees in the U.S.?

Theresa Betancourt: Back in 2005, we were contacted by a local public school district because there were a large amount of Somali-Bantu refugees resettling in New England. As families were resettling in Massachusetts and other states, they were getting complaints from the schools for things like – these kids are pushing and shoving. They’ve got behavior problems and their parents don’t show up to parent teacher night. These parents are very disengaged. 

And so we reached out to community leaders and we learned that, in a refugee camp, when there’s something being distributed, usually food supplies, you need the shove and push to get to the front of the line or your family may not eat. And there were lots of misunderstandings that [these] kids were exhibiting behaviors that weren’t bad behaviors, they were learned coping skills that fit in one context, but didn’t fit anymore, now upon resettlement in the United States.

Also in Somalia, it’s considered very respectful to turn your child over to mentorship from the teacher and to stay out of their hair. So the thought of going and meeting with the parents and the teachers together, and asking certain things of the teacher, was very foreign to a lot of parents. 

So we started to co-create a family strengthening intervention that would improve the overall parent-child relationship for school-aged kids and help parents navigate better. We have actually also published an initial pilot with 80 families, where we enrolled 40 Bhutanese families and 40 Somali Bantu. We saw that there was actually a reduction in children’s traumatic stress reactions, fewer symptoms of child depression, as reported by caregivers. And in Bhutanese parents, [we saw] fewer conduct problems, but we didn’t see the same thing on a Somali Bantu side. We, on the Bhutanese side, saw reduced instances of family arguing.

From that pilot, we – through the last few years – have been doing a larger, better-powered study with over 100 families, again, using the community participatory process. [But] that was interrupted with COVID-19. So, we didn’t get entirely the sample size we would have liked to have gotten, but we were able to innovate and pivot and actually started to work on a digital version of the intervention, using tablets to engage household members when you can’t go and do home visiting. The peer counselor could connect on FaceTime or other web platforms to meet with the family.

Dave Scott: I wanted to note here that her refugee work in New England is taking on new relevance. Dr. Betancourt told me that she’s been talking to U.S. officials about the recent surge in Afghan refugees, and what lessons might be applied to their resettlement in the U. S. Now, let’s get back to our conversation.

Dave Scott: As I listened to how you do this, it strikes me that family and community are pretty key to nurturing resilience. And forgive me if I’m going in a direction that sounds like it’s not very academic, but to me, that sounds like an expression of a kind of love. The Greeks had many different names for love and one of the terms was “storge,” which is “family love” – family empathy, and compassion. It sounds like part of what you’re doing is creating support systems that are essentially loving: Bringing love into these people’s lives – or these children’s lives or these refugees lives – in more systematic ways. Is that accurate? How would you describe it?

Theresa Betancourt: Yes, that’s really beautiful. I hadn’t thought of it in that way, but I would say certainly our interventions are grounded in the natural, organic empathy, compassion, and love that exists in families and communities. And sometimes it’s just a matter of finding the platform to allow it to flourish.

And, this is not just my work. This is the work of a huge team of collaborators in every one of the settings. Community partners, community advisory boards, people that we’ve worked with in Sierra Leone for now going on 20 years, in Rwanda for 14 years, and in the refugee communities since 2005.

So this takes a village in so many ways and community is important. We also see in our research that community can be a source of great harm. The stigma I talked about in our child soldiers research: When there’s rejection, when there’s community stigma, we see time and time again in our research that it’s one of the most enduring and harmful risk factors that can really shape negative outcomes in the life of a young person.

And so, belonging to a community and having that love, that investment, that attachment relationship, is a massive protective factor. And building a sense of community and social ties are part and parcel of the process of healing from trauma and other forms of adversity. And so I do agree: I think it’s about unleashing the inherent empathy and compassion that lies in individuals and in communities.

Dave Scott: I’ve heard you speak about the need for education as almost … that’s the hope for the future. You need a sense of hope and that sense of hope is manifested either through education or a path to employment. Can you talk a little bit about that?

Theresa Betancourt: Yes, actually we, a few years ago, published this model that we call the S.A.F.E. model of child protection. And so the model of SAFE is the interaction between “S” which is safety, security, freedom from harm; “A,” which is the access to physiological needs (food, shelter, a standard of medical care, including mental health). And then the “F” in a SAFE model is family and connection to others. I think we’ve been talking a lot about that. And then the “E” is the hope for the future component that you’re talking about: Education and economic security, livelihoods, a sense that you can move towards a brighter future.

And when it comes to hopes for the future, we see a lot of ways in which if kids aren’t safe at home, if they are experiencing violence or neglect, even that bright view of going on to continue one’s education or to have a livelihood, it’s really hard to secure. Same thing, if you don’t have your basic needs met for food or for shelter. The same thing if you don’t have the family and the attachment relationships to give you guidance, to help you pay your school fees, to help you navigate when you hit a roadblock or a difficult teacher.

These things are interrelated and interdependent, and I think that sense of hope for a future is a really important part of that overall picture.

Dave Scott: So there are many in academia that don’t take their work to the next level, yet you have. Can you tell me what motivates you? What makes you want to scale up your work – not just to study trauma and resilience, but to find ways to heal lives?

Theresa Betancourt: Yes, I think for me it became a turning point where we couldn’t continue to simply observe such tragedy, but also the potential in so many young lives thwarted by trauma and loss. To just observe and do observational research felt inadequate, if not unethical.

And so if you really want to learn about something, try and change it. And so we decided to roll up our sleeves. We started to think about parenting interventions and family based prevention as well.

And I think that’s very challenging work. It takes a lot of partnerships. It takes long-lasting commitment and really working on your relationships with government, with key stakeholders, with donors. But it’s ultimately much more satisfying in a way too, because in these sorts of low-resource settings (and I’m originally from Alaska, I grew up in a low resource part of the United States in a small village where we didn’t have paved roads or plumbing), but in situations that are so low resource, a little bit of quality can go a very long way. And that’s really satisfying and exciting.

Dave Scott: There’s a lot of your research – and other research and history – that suggests that humans are remarkably resilient in the face of adversity. Do you agree? If so, why?

Theresa Betancourt: Yes, I do agree. I think what’s important when talking about resilience is not to see it as a trait inherent to individuals, but as a process. And I think overall, our study underscores how reintegration of young people, who’ve been through some of the worst trauma imaginable, is shaped by not just their individual factors, but what goes on around them. So, we have to think about the ecology of resilience and how we’re creating an enabling environment. I think when given an enabling environment, humans are ultimately quite resilient.

Dave Scott: I like to give a homework assignment to our podcast listeners. What steps could they take to help themselves or others dealing with adversity?

Theresa Betancourt: I think if you just go back to your immediate community, and we’re all going to have a chance here in the United States with the upcoming resettlement of Afghan refugees all over the United States. It’s a real time for people to allow their compassion and their empathy to be unleashed, and to remember the importance of those social ties, those small gestures, those little opportunities to remove a barrier for someone. It can be as small as donating your volunteer time to help with logistics, for finding housing or securing clothing, for resettling populations. Or, volunteering for kids facing disadvantage in your own community. We know from the research that we’ve done all over the world in war-affected populations, that empathy and compassion and serving others is tremendously healing.

To engage in giving back, and acts of altruism and compassion for other people, who may come from a different background than yourself, can be extremely rewarding and ultimately will help us all move towards a better world.

Dave Scott: What I find compelling about Dr. Betancourt’s work is how she challenges the assumption that when children face violence or trauma or war, it doesn’t mean they’ll automatically become broken adults. Remember the “F” in her S.A.F.E. formula? Healing comes when family, and/or members of the community, give love and support to a child or teenager. And the “E” in her S.A.F.E formula is for education and employment. Those are the ingredients of hope. 

Those children from Afghanistan, Africa, or the house next door, don’t have to make their way in the world alone. She has shown how our support can make a huge difference in their lives.

This week’s challenge? Dr. Betancourt gave us one: Help Afghan refugees fleeing the Taliban. Your house of worship may already be doing work with refugees. If not, here are three websites that may help you connect with that effort in the United States.

The International Rescue Committee: www.rescue.org. 

No One Left Behind: www.nooneleft.org. 

Lutheran Immigration and Refugee Services: www.lirs.org.

Tell me how it goes. Call me at (617) 450-2410. And leave me a voice message about your experience helping Afghan refugees. That’s (617) 450-2410. 

Thanks for listening to “People Making a Difference,” a podcast about people who are, step-by-step, making the world a better place.

Produced by The Christian Science Monitor, copyright 2021. 

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