Understanding the needs of children returning from formerly ISIS-controlled territories through an emotional security theory lens: Implications for practice

BACKGROUND

Children who spent time in territories formerly controlled by the Islamic State of Iraq and Syria (ISIS) and who are now being reintegrated into their countries of origin have experienced significant trauma and may present with adjustment or mental health problems.

OBJECTIVE

In this paper we describe how Emotional Security Theory (EST; Davies & Cummings, 1994) and its more recent formulation, EST-reformulated (EST-R; Davies & Martin, 2013, 2014), provide a theoretical lens to aid in understanding the ways in which traumatic experiences under ISIS may have an enduring impact on a child's development and well-being.

METHODS & RESULTS

The core assumption of EST is that maintaining safety and security is a central goal for a child growing up in the context of conflict. Children living in conflict zones under ISIS rule may have developed emotional insecurity, which in turn is theorized to lead to developmental cascades across multiple domains of functioning and at times result in clinically significant distress. This theoretical understanding can guide intervention, as it suggests that the foci of intervention must (1) minimize social signals indicative of threat while also (2) reducing behavioral response patterns that limit opportunities for exploration and prosocial affiliation. Trauma Systems Therapy is a multidisciplinary child trauma treatment model that addresses both stressors in the social environment and related emotional dysregulation.

CONCLUSIONS

Challenges and considerations related to implementing such a comprehensive treatment approach in low- and middle-income countries are discussed.

Trauma Systems Therapy in Residential Settings: Improving Emotion Regulation and the Social Environment of Traumatized Children and Youth in Congregate Care

Although abundant evidence exists indicating the prevalence of trauma exposure among youth in residential care, few models exist for creating trauma-informed milieu treatment. This article outlines the problem and describes the implementation of Trauma Systems Therapy (TST) in three residential centers. TST is unique in emphasizing youth emotions and behaviors as well as the role a distressed or threatening social environment may play in keeping a traumatized youth in a dysregulated state. This dual emphasis makes TST specifically appropriate to implementation in congregate care, focusing assessment and intervention strategies on both clinical treatment and the functioning of the therapeutic milieu itself. Data are reported on incidents of the use of physical restraint; numbers of disrupted foster care placements following discharge from residential treatment; and scores on psychometric measures of children's functioning and emotion regulation capacity. Knowledge gained through TST implementation in these three residential centers has important implications for developing a model of trauma-informed congregate care.