Why do some child soldiers heal and not others? What one scholar found.

To Ishmeal Alfred Charles, his time as a child recruit in Sierra Leone’s brutal civil war was part of what he calls “the making.”

At some point between 12 and 14 years old, Mr. Charles was kidnapped by the Revolutionary United Front, an army that waged a failed rebellion in the country from 1991 to 2002. He escaped twice – once while waiting to have his hand amputated after being recaptured – only to be seized a third time by a pro-government militia that threatened to shoot him for being a rebel. They released him only after a complete stranger identified him as a student, and he was eventually reunited with his mother.   

Mr. Charles witnessed extreme trauma as a youth, yet he says his adulthood has largely been fulfilling. Today he works as a program director with Healey International Relief Foundation/Caritas Freetown in Sierra Leone. 

“I feel very fortunate in what I do today,” he says. “It brings me a lot of joy.”

Sierra Leone’s civil war spawned a generation of former child recruits and other war-affected youth. Some fell into chronic depression and unemployment, researchers found, while others became lawyers, doctors, entrepreneurs, and, like Mr. Charles, humanitarian workers. 

Why did some recover while others succumbed to trauma? That’s one of the questions Theresa Betancourt set out to answer in Sierra Leone in 2002. Dr. Betancourt is the Salem Professor in Global Practice at the Boston College School of Social Work and director of the Research Program on Children and Adversity. 

Her research is today considered one of the most exhaustive academic studies of the aftermath of child soldiering. With help from Mr. Charles and many others, Dr. Betancourt and her colleagues developed Youth Readiness Intervention, an evidence-based approach that views childhood trauma through a collective frame, one that includes family, community, and culture.

“A lot of the trauma of violence is interpersonal,” says Dr. Betancourt. “The recovery from the trauma of violence is one that takes a lot of social structures into account.”

Healing takes a village

Dr. Betancourt arrived by helicopter in Kono in 2002, just months after the war had ended. A diamond-rich district in Sierra Leone’s east, Kono had been hit particularly hard by the war, with 9 out of every 10 of the district’s buildings destroyed. 

Yet she took the challenging conditions mostly in stride, an adaptability honed growing up in Bethel, Alaska, a remote city of 6,500, the majority of whom are Yup’ik.

“We were minorities out there,” she says. “Growing up in a place like that, I had always been sensitized to the importance of listening to and respecting the dominant culture.”

Bethel’s isolation instilled Dr. Betancourt with a strong sense of the importance of social bonds. “We all had to pull together to make it through,” she says. “I learned to really appreciate collectivity.”

In Sierra Leone, she used this appreciation to frame her research.

“A lot of programs focus on just the child soldiers themselves and not the community systems and family systems,” she says. 

Dr. Betancourt and her colleagues recruited more than 500 war-affected youth for the study, and they’ve been following their lives ever since, conducting follow-up interviews in 2004 and 2008 and again from 2016 to 2017.

They found that the young peoples’ wartime experiences did not necessarily dictate their lives’ trajectories. The degree to which their families and communities accepted or stigmatized them played a major role in shaping their outcomes.

“Healing from trauma is about collectivity,” she says. “One of our greatest strengths is our connection to each other.”

Putting knowledge to work 

Dr. Betancourt and her colleagues’ scholarship was revealing complex patterns of trauma and resilience, but over time they became uneasy with their role as disinterested observers. 

“We started to feel ethically troubled by just watching and not trying to roll up our sleeves,” she says. “Couldn’t we learn something about what we were observing to inform intervention development?”

“Theresa being Theresa, she became really interested in how she could take these findings and use them in an applied manner,” says Adeyinka Akinsulure-Smith, a psychology professor at the City College of New York. 

The two began developing Youth Readiness Intervention (YRI), a collaborative mental health approach that combined research developed by Dr. Betancourt and other social scientists with an understanding of Sierra Leone’s cultural norms and the local mental health infrastructure. 

“She brought in her research,” says Dr. Akinsulure-Smith, who was born in Sierra Leone. “I brought in the psychological piece.”

With Mr. Charles’ help, the program paired with researchers at Caritas Freetown, a Catholic charitable group, in 2010. 

Their study of more than 400 young people found that those who took part in the YRI program were six times more likely to remain in school than those who did not. 

Their model recognizes that mental health resources in Sierra Leone are scarce, so it relies on intensive training of lay workers in conducting group-based cognitive behavioral therapy centered on local cultural concepts. The main goals of the YRIs are to build emotional, interpersonal, and
problem-solving skills with the aim of helping youth excel in school or work.

When participants in the program would feel emotionally overwhelmed, for instance, “we talk about your pot boiling,” says Dr. Akinsulure-Smith. “We talk about maybe you want to remove some of the firewood.”

In contrast to some Western clinical models, the YRI takes a collaborative approach. “The Sierra Leone culture, it’s not just about ‘I, me, myself,’” Dr. Akinsulure-Smith says. “You have an individual who is located in a family who is located in a community. 

In 2016, the National Institute of Mental Health awarded Dr. Betancourt and her colleagues nearly $3 million to launch an expanded YRI study. She and her colleagues are currently conducting a YRI-style entrepreneurship study of 1,200 participants.  

This study is assessing whether and how a YRI approach can be integrated into a national employment program partly funded by the World Bank. So far, participants in a pilot study showed improved interpersonal skills and better emotional regulation.

Paying it forward 

Dr. Betancourt and her research team found that the Youth Readiness Interventions were not only having a positive impact on the participants, but they were also prompting them to share their coping strategies with others.

“Every time we deliver this intervention,” Dr. Betancourt says of the YRI, “the young people feel compelled to help others around them and to share their skills.”

To Mr. Charles, helping others is a way of expressing thanks. “I have been in circumstances where I didn’t believe that things would change,” he says. “When things really changed, I have been really grateful.”

“To survive being captured so many times and yet to be able to live through the difficulties of everyday life in Sierra Leone and those realities are just part of the making,” he says.