Therapeutic workbook to facilitate healing process in Haitian children

Workshop at Massachusetts School of Professional Psychology on July 21 will train professionals and parents to help healing process

"When children can tell their stories about a traumatic event in their own words or pictures and at their own speed, healing can begin," says Dr. Jodie Kliman, psychologist and professor at the Massachusetts School of Professional Psychology (MSPP) in Boston.  That is why Kliman led MSPP's collaboration with the Children's Psychological Health Center (CPHC) in San Francisco and Ekol Akasya (Acacia School) in Haiti to create a workbook to facilitate that healing process in Haitian children and to identify those at greatest risk for long-term emotional problems.

On July 21, Kliman and her collaborators and coauthors will hold a workshop to help train the adults in these children's lives to use this therapeutic tool. The audience will include Boston public school staff, mental health professionals, graduate students, social workers and other human services professionals and parents.

Hundreds of thousands of Haitian children who survived the earthquake physically are still suffering great distress and need of support to help deal with what they witnessed and lost. The number of mental health professionals before the earthquake was already inadequate. "Even with an influx of international aid workers, the task of reaching all the children in emotional distress is daunting, if not impossible," says Kliman.

That is why Kliman and her father, Dr. Gilbert Kliman, founder of CPHC, and their Haitian colleagues decided to jointly create a tool that could be made easily accessible to anyone caring for Haiti's children—parents, teachers, social workers, aid workers and caretakers.  The workbook can be downloaded free from the Internet and distributed wherever it is needed throughout the country. If multiple copies are made, users should contact the copyright holder for free licensing at www.childrenspsychological.org.

The workbook, called My Own Story about the Earthquake in Haiti: A Guided Activity Textbook For Schools, Teachers, Children, Families, And Caregivers, is carefully crafted to gently lead children--with the guidance of a caring adult--through a series of activities to process fear, distress and anxiety, to hold onto the people and values they held dear, and to find hope for the future, says Kliman. The initial version for children who survived the earthquake, is in a bilingual form with Haitian Creole and French and can be used with children still in Haiti and with children who have come to the U.S. or Canada.  A second, English-language version for indirect victims of the disaster—children in the U.S. and Canada with family in the earthquake zone, has just been completed and will be an additional focus of the July 21 program. (The largest Haitian populations outside Haiti are in Miami, Montreal, Canada, New York, and Boston). The latest version is in English.

Initially, the workbook prompts children to give one word or phrase answers--"This is who I was with,"  "I don't know what happened to these people," or "before the earthquake I was doing this." The activities get more intense as the journey continues—"This is the scariest thing I saw." The ultimate goal is to help a child see that there is still hope—"This is someone who helped me." They also are encouraged to exercise mastery and resilience, for instance, in being asked to draw a picture of them helping someone else. And, that they themselves have a future—"This is how I can help now."

A checklist of feelings and symptoms of post-traumatic stress syndrome that is used at the beginning and after finishing the workbook can help determine the impact that the process has had on a child and also indicates where serious problems might exist and more treatment is necessary.

The Haitian version of the workbook is already being used in Haiti by several organizations, including the Aristide Foundation, the Love a Child Foundation, and AmurtHaiti, among others. The Love a Child Foundation works with and teaches children at the "Under the Tree Project," a makeshift school at the site of Quisqueya University, which was completely demolished by the earthquake, except for a large tree, under which students and staff gather.  

Says co-author Caroline Hudicourt, M.Ed., director of the Ekol Akasya, who also helped to translate and edit the workbook into Haitian Creole and French, "I am already receiving positive feedback from organizations, teachers and others using the workbook. Children also seem to be responding well to the process."  Hudicourt is also exploring distribution of the workbook to homeless shelters and camps.

In addition to Hudicourt's editing and translation, the team had the dedicated expertise of co-author Dorothie Ferdinand, M.A., an MSPP doctoral student, born in Haiti, who did the first translation into Creole, along with her mother, Antonine Ferdinand, and assessed the cultural appropriateness of the entire booklet.  According to Ferdinand, "As a person of Haitian background, I wanted to help alleviate some of the pain Haitian people are experiencing following the earthquake. This project offered me an opportunity to be of service."

Research has already shown that the use of such CPHC-originated workbooks, can improve the mental health of children. For instance, a research team from Tulane University found significant improvement in post-traumatic stress disorder symptoms in children involved in Hurricane Katrina when they were guided through a similar workbook.  U.S. foster children show a marked reduction in transfers among homes.  Children in Sichuan, China after the earthquake, terror and siege victims in Gaza and Israel, Indonesian Tsunami children, Central American mudslide victims,  and U.S. children in homeless shelters have also been helped by these workbooks. Nearly 60,000 children worldwide have been reached.

The therapeutic value of the workbook has a lot to do with its simplicity and the fact children can control the process and the time it takes to complete it, "unlike with some disaster interventions that can rip out the stitches before a wound is healed," says Kliman. "This workbook story process can take days, even weeks to complete, depending on the child, and it involves pleasurable activities like drawing and storytelling."

To see both versions of the workbook and learn more about the process, go to http://www.mspp.edu/community/events/haiti.asp .