How Effective are Sports and Play based initiatives at enhancing Psychosocial Wellbeing for Children that have been exposed to Conflict and Conflict-related stressors

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How Effective are Sports and Play based initiatives at

enhancing Psychosocial Wellbeing for Children that

have been exposed to Conflict and Conflict-related

stressors

This Thesis is submitted for obtaining the Joint Master’s Degree in International Humanitarian Action. By submitting the thesis, the author certifies that the text is from her own hand, does not include the work of someone else unless clearly indicated, and that the thesis has been produced in accordance with proper academic practises.

Juliette Nohlmans

MA International Humanitarian Action July 2019

Supervisors:

Dr. Saliha Metinsoy, University of Groningen Dr. Patrycja Grzebyk, University of Warsaw

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Abstract

Over the past two decades, the field of sport-for-development (S4D) has heightened its presence and legitimacy in the realm of international development. _{Using sport and play} (S&P) initiatives as a non-traditional approach _{to enhancing the psychosocial wellbeing of} children in conflict affected settings, _{is one subcategory of the S4D sector which has seen} significant growth since the start of the 21st century. _{This study therefore examines how} effective sports and play programs are as a psychosocial intervention tool in enhancing the wellbeing of children that have been exposed to conflict and conflict related stressors.

This thesis adopts a case study approach and analyzes three sport for development initiatives including: A capoeira program for refugees in Palestine, a Dance/Movement therapy program for former child soldiers in Sierra Leone, and a mixed sports program for children exposed to gang violence in Guatemala. _{Prior to conducting the comparative case study, it} was important to gain a solid foundation of knowledge on the current literature and research surrounding the use of S&P programs as a psychosocial intervention tool. The literature review explored (1) the concept of psychosocial wellbeing, (2) the theoretical basis of psychosocial interventions and examples of different approaches, (3) a review of the _mental health needs in conflict and post conflict conditions, (4) how sport and play programs are used as innovative instruments to promote psychosocial wellbeing, (5) the monitoring and evaluation methods used to measure effectiveness and impact and finally (6) the critical considerations of the S4D sector which are vital to uncover as they are relevant to the advancement of effective strategies in the S4D sector.

The study showed that S&P programs were effective in restoring and strengthening the psychosocial wellbeing of participating children exposed to conflict and conflict-related stressors. However, there was limited evidence to show whether the documented positive psychosocial change gained from the S&P programs was sustained over a longer period of time and whether it successfully encouraged ne _{w resilient life trajectories for conflict affected} children in the long run. Whilst S&P programs do not have the capability of solving complex social challenges, or replacing what children have lost as a result of conflict exposure, credible research demonstrates that S&P programs enable children to reclaim the joy of childhood through play, whilst incorporating structure, predictability and meaningful

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guidance into their lives. S&P programs further re-establish a feeling of safety and normalcy, enabling participating children to gain positive psychosocial competencies and helping them to process adversities, distress and trauma that has surfaced from exposure to conflict. This thesis argues that if S4D organisations _{want to make a positive impact on the} wellbeing of children, S&P programs should be implemented along with tangible strategies to achieve psychosocial goals whilst being based on the interests, needs and leadership of participants, and have a goal of mainstreaming the acquired psychosocial benefits into a participants day-to-day functioning.

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List of Acronyms

C4R- Capoeira4Refugees

DMT-Dance/Movement Therapy

GOF- Guatemalan Olympic Foundation IASC - Inter-Agency Standing Committee IOC- International Olympic Committee LSQ - Life Skill Questionnaire

M&E- Monitoring and Evaluation

MHPSS - Mental Health and Psychosocial Support NATO- The North Atlantic Treaty Organization NGO - Non Governmental Organisation

OVEP- Olympic Values Education Program OVEP PTSD- Post Traumatic Stress Disorder

RCT- Randomized Controlled Trial RUF- Revolutionary United Front S&P- Sport and Play

S4D- Sport for Development

SDP IWG- The Sport for Development and Peace International Working Group UNDP - United Nations Development Program

UNICEF- United Nations International Emergency Fund UNOSDP- UN Office on Sport for Development and Peace

UNRWA- United Nations Relief and Works Agency for Palestine Refugees UN - United Nations

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List of Figures

Figure 1: Wellbeing Flower………21 Figure 2: Curative vs Developmental approach………..22 Figure 3: Intervention Pyramid for Mental Health and Psychosocial Support in Aid

Interventions……….24 Figure 4: Do Good through Sport Diagram……….35 Figure 5: Capoeira for Refugees Theory of Change model……….48 Figure 6: The Hoodlinks program, Guatemala: Olympic values and coinciding virtues…55

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Chapter 1: Introduction

1.1 Background and problem statement

“Sport _{can play a role in improving the lives of individuals. Not only individuals, I might add} but whole communities. I am convinced that the time is right to build on that understanding, to encourage governments, development agencies and communities to think how sport can be included more systematically in the plans to help children, particularly those living in the midst of poverty, disease and conflict” - _{Kofi Annan, former UN Secretary General (Cited in} Maguire 2013:106).

Since _{the beginning of the 21st century, there has been significant growth in the emergence} of sport and play (S&P) initiatives being used as a strategic vehicle to address social, health, educational and economic issues in disadvantaged societies and communities around the world (Schulenkorf and Adair, 2013). Over the past two decades, the field of sport-for-development (S4D) has heightened its presence and legitimacy in the realm of national and international development work. In a nutshell S4D represents the “use of sport to exert a positive influence on public health, the socialization of children, youths and adults, the social inclusion of the disadvantaged, the economic development of regions and states, and on fostering intercultural exchange and conflict resolution” (Lyras & Peachey, 2011:311). A multitude of practitioners and academics working in the S4D field argue that well-constructed sport and play programs provide a safe, peaceful and predictable environment for children to process their fears, any trauma they have might have experienced, and to facilitate positive social interactions (Kunz 2009).

A pivotal moment in 2003 saw the United nations pass Resolution 58/5 which recognized the “role of sport and physical education as a means to promote education, health, development and peace” (Giulianotti 2014: 14). _{The S4D sector has continued to witness rapid growth} since the early 2000s in terms of the growing number of organisations and networks that are using the power of sport to achieve development goals, the volume of S4D activities, and the diversity of locations in which S4D organisations operate (Coalter 2010). To place this statement in context, Whitley et al (2019:1) _{states that “at this time [in 2016] over 950}

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organisations are listed on the International Platform on Sport for Development compared with 176 organisations in 2006.” _{Despite the various initiatives and claims surrounding the} efficacy of sport and play as a tool for development and positive social change, several academics convey their doubts regarding the assertion that sport can effectively fulfil development and peace-building goals in communities (Ley and Barrio, 2010; Coalter, 2007; Giulianotti, 2014; Kidd, 2008). It is crucial to uncover and explore these critiques, as they are relevant to the advancement of effective strategies in the sport for development sector (Darnell 2014).

Using sport and play initiatives as mental health and psychosocial intervention, is one subcategory of the S4D sector that is an especially hotly debated topic (Hamilton et al 2016) _. There is a growing body of work that highlights the positive effects of sport and play initiatives on the psychosocial wellbeing of children that have grown up in conflict affected settings (Hamilton et al 2016). The term psychosocial refers to the dynamic relationship between the psychological and social aspects of an individual, where both influence one another (Wiedemann et al, 2014). In summary, the claimed benefits of sport and play participation in adverse conditions include the following (Coalter 2007: 19):

(1) “Improved mental health and psychological well being, resulting in the decrease of anxiety and stress

(2) Socio-psychological gains including empathy, integrity, tolerance, cooperation, trustworthiness and the development of social skills;

(3)Wider sociological impacts including increased community identity, social cohesiveness and integration (collectively known as social capital)”

Why it is so crucial to consider the mental health and psychosocial needs of children amidst conflict and post-conflict conditions? Exposure to conflict and conflict related stressors, such as the experience of violence, abuse, neglect, displacement, social isolation, and lack of access to basic needs are major risk factors for increased levels of poor mental health (Kadir et al 2019). Conflict not only exposes the individual to violent and traumatic experiences, making them more susceptible to mental health problems, but it can simultaneously radically alter the social and economic circumstances in the affected community. This can further aggravate psychosocial wellbeing in addition to disrupting the social cohesion of communities

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(Kadir et al 2019; Hamilton et al 2016). Children can be left with a myriad of psychosocial consequences which can include: feelings of anxiety and fear; feelings of hopelessness for the future, emotional numbness, withdrawal from family and peers, depression and post traumatic stress symptoms _{(Williams and Drury, 2010).}

It is also important to note that psychosocial problems stemming from exposure to conflict and community violence can result in a negative attitude towards the ‘other’ or rival group, which can result in hostility amongst affected children and community members (Lavi and Solomon, 2005). In psychosocial healing, the learning of empathy for an individual's former enemies is broadly comprehended as an important step toward community reconciliation (Harris, 2007). Sport and play programs are often depicted by policymakers as an unconventional yet perfect tool to enhance community cohesion and encouraging intercultural awareness and mutual respect between and within communities (Dorokhina et al 2011). According t _{o IASC (2007), a subgroup that requires particular consideration in relation to} mental health and psychosocial wellbeing are children and adolescents. In the past two decades, the negative impacts of conflict on the psychosocial wellbeing of children and the responsibility to protect children from these negative implications have become universally acknowledged within the international humanitarian field. _{Children are especially at risk to} the detrimental impact of conflict due to their lack of experience and resources to independently fulfil their developmental, social, emotional and behavioural needs (Schonfeld and Demaria 2015). During challenging times and unstable conditions induced by conflict additional support is required to help children in coping with adversity, retrieve a sense of control and the ability to function as before (UNICEF, 2009). Ultimately children are the foundation of the future and for a peace generation, and therefore the focus of this thesis is on child-centred approaches that promote healthy psychosocial development.

Despite the fact that many S4D implementing organisations make a wide range of positive psychosocial health claims, Hamilton et al (2016:44) argues that there is currently a “fragmented evidence base” for these claims. Hamilton et al (2016) isn’t the only one that asserts this viewpoint, as many scholars from various disciplines postulate that S4D organisations make exaggerated and often idealistic claims in achieving development goals, and in response, critics request empirical justifications for investments into S4D programs

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(Kidd 2008). This explains that in the last decade a lot of attention and resources have been put into cultivating monitoring and evaluation mechanisms in order to assess the effectiveness, impact and sustainability of S4D programs (Kidd 2008). Despite the fact that outcomes and impact in the psychosocial sport for development field are notoriously difficult to measure and evaluate, there have been a number of research case studies that have used qualitative and quantitative measures to demonstrate how sport can restore psychological health and social wellbeing for conflict affected children; three of which will be examined in chapter 4. As postulated by Henley (2007), the challenge remains to validate the true efficacy of sport and play programs beyond anecdotal evaluations. This paper will critically analyse the efficacy of using sport and play as a mechanism in psychosocial intervention, and whether S4D programs are truly able to stimulate new resilient life trajectories for conflict affected children through enhancing their psychosocial competencies.

1.2 Significance of the study

This _{research paper is relevant for a couple of reasons. The field of psychosocial assistance is} vast in both program implementation and academia, however, there are not many research papers that explicitly focus on the utilization of sport and play (S&P) in providing specifically psychosocial assistance. Hence why it is important for the relation between these two to be further investigated, which is the main focus on the study (Hamilton, 2016). Research in the sport for development realm- and affiliated scholarly work- has been growing for over 15 years, however, it has received minimal attention from development scholars. Even though the S4D sector sits at the margins of international development research, S&P programs are increasingly becoming more acknowledged and endorsed by nation-states, NGOs, corporations and activists as a means of addressing global issues (Chawanksy et al 2017). Kidd (2011:603) further ascertains Chawansky’s point as he observes that whilst development researchers have mostly overlooked S4D, 'it has become a recognized strategy of social intervention in disadvantaged communities throughout the world'.

Betancourt and Tanveer Khan (2008) argue that there has been plenty of research on the ways in which exposure to armed conflict and violence contributes to psychosocial distress, and in some cases, longer-term psychopathology in children and adolescents. However, there has been insufficient attention on how psychosocial interventions can build on protective processes i.e. reinforcing social supports and connectedness amongst conflict -affected youths

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and their caregivers, peers and community, in addition to building upon the naturally occurring strengths within conflict affected children, to achieve resilient mental health outcomes. Since the majority of research on psychosocial consequences of conflict affected children has focused on risk factors, whilst less research has been directed to the factors that pave way to resilient and positive outcomes in the face of armed conflict, one of the main focal points of this research paper will explore how S&P programs can help strengthen the psychosocial coping mechanisms of affected children.

1.3 Aim and research objectives

The previous subchapters have provided a brief overview of the use of sport and play initiatives in being powerful and effective tools in fostering psychological and social wellbeing in children that have been exposed to adverse conditions as a result of armed conflict. The paper also briefly touched upon the current challenges within the S4D sector. This has lead to the following research aim: _{How effective are sports and play programs as} a psychosocial intervention tool in enhancing the wellbeing of children that have been exposed to conflict and conflict related stressors? In order to fulfill this aim, this study can be subdivided into four objectives:

I. Examining the theoretical underpinnings and various approaches of mental health and psychosocial interventions.

II. Evaluating the potentials and challenges on the use of S&P initiatives as professional tools of psychosocial interventions.

III. Presenting the key findings of case studies on S&P interventions used as a mechanism for psychosocial assistance in three different conflict affected countries namely Palestine, Sierra Leone and Guatemala. These case studies will connect theoretical underpinnings with empirical observations and aim to shed light on the measured effectiveness and impact of initiatives on the psychosocial wellbeing of participating children.

IV. Establishing _{key practises for practitioners in the S4D sector to consider when striving} for effective psychosocial S&P interventions.

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programs that promote psychosocial development through S&P initiatives in the varying conflict affected geographic regions of Palestine, Sierra Leone and Guatemala. The study aims to identify some of the strengths and areas of improvement of different psychosocial sport programs in order to contribute to the sector's growth and development. It is crucial to explore critical considerations on the claims that sport can serve as a positive developmental influence for children exposed to adverse conditions, as this evaluation will allow for progressive advancement in designing more effective psychosocial programs. Theoretical and empirical knowledge gathered throughout this paper will help formulate a set of key practises for practitioners in the S4D field to implement effective S&P programs that promote individual and collective psychosocial wellbeing amongst conflict affected children.

1.4 Conceptual Framework of the study

In order to gain a detailed understanding of the research question and aim of this study, it is necessary to define four key concepts which will be fleshed out in chapter two and three. The first concept that will be addressed is the idea of ‘psychosocial wellbeing’. To understand the meaning of psychosocial wellbeing this study will employ the following definition:

“The term psychosocial refers to the dynamic relationship between the psychological and social dimension of a person, where each one influences the other. The psychological dimension includes internal, emotional and thought processes, feelings and reactions. The social dimension includes relationships, family and community networks, social values and cultural practices. Psychosocial wellbeing describes the positive state of being when an individual thrives. It is influenced by the interplay of both psychological and social factors” (Wiedemann et al, 2014:25).

As outlined by Henley (2007) there has been a recent evolution in the conceptual framework underpinning humanitarian interventions in mental health care and psychosocial support. The focus is much more targeted towards the affected population's strengths and resiliencies, and ability to bounce back from the impact of a crisis, which is the lens through which this paper will be viewed.

The second concept is the notion of ‘conflict affected settings’, which in most cases are environments of intense stress and adversity. As postulated by Betancourt and Tanveer Khan

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(2008) conflict is a condition that is characterized by insecurity, the disintegration of civil and social networks, loss of structure of daily life and unpredictability. This paper will focus on sport initiatives working with individuals and populations living in conflict or post conflict settings with case studies exploring S&P initiatives implemented in Palestine, Sierra Leone and Guatemala. Since the nature of conflict is perpetually evolving and can take a diversity of forms, this paper will include children living in adverse conditions as a result of exposure to structural armed violence and/or community violence in non-war contexts.

The third concept of using S&P programs as a psychosocial intervention tool undoubtedly forms an important component of the research question. The main aim of psychosocial S&P programs is to ‘restore social wellbeing and psychological health through group-focused practices, tailored to fit the context of local culture, traditions, needs and resources’ (Henley et al, 2007:52). There are a handful of compelling research studies that explore the connection between sport and play initiatives, and their ability to assist conflict affected societies in healing from severe stress and adversity, which will be further explored in chapter four. The last and fourth important concept of this study is the notion of ‘effectiveness’ as an evaluation criteria, which essentially refers “to the extent to which the various aspects of the program are contributing to the achievement of the desired aims and outcomes” (Coalter, 2008:17). Effectiveness is considered as one of the five evaluation criteria from the Development Assistance Committee (DAC). The five criteria to evaluate development interventions namely, relevance, effectiveness, efficiency, impact, and sustainability, are the most notable and universally adopted evaluation criteria by NGOs (Chianca 2008). Effectiveness was chosen as the main evaluation criteria, as it focuses on determining to what degree sport and play interventions meet its goal of promoting psychosocial wellbeing. However, as argued by Chianca (2008), the definition of effectiveness focuses on determining the degree to which the intervention met its _{goals, and not necessarily the needs of the}

beneficiaries. Hence why in the case studies in Chapter 4, effectiveness and impact; defined as “the positive and negative changes produced by a development intervention, directly or indirectly, intended or unintended” (Chianca 2008: 43), are both used as an evaluation criteria.

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1.5 Methodology

This study will adopt a qualitative research method, namely a comparative case study. The comparative case study will involve the analysis and synthesis of the commonalities, differences and trends across three existing research studies on S4D initiatives implemented in Palestine, Sierra Leone and Guatemala. Gerring (2004:342) defines a case study as “an intensive study of a single unit for the purpose of understanding a larger set of units”. As argued by Heale and Twycross (2018) using a multiple-case research study approach as opposed to a single-case study, allows for a more comprehensive exploration of the research question, and is often argued to be a more reliable source of data collection, providing a more in depth understanding of the phenomenon/intervention studied. Additionally when findings are rooted in multiple case studies, it can potentially provide the related literature with more convincing evidence for desired outcomes, and can facilitate rich conceptual/theoretical development (Heale and Twycross 2018). As postulated by Hodkinson (2001) through case study research “existing theories can be brought up against complex realities, and the very richness of the data can help generate new thinking and new ideas”. Gerring (2004) further argues that when selecting case studies to analyse, random sampling is not a suitable option and instead careful consideration when selecting case studies is required. Nevertheless, Hodinkson (2001) argues that there is no simplified checklist of criteria, against which the validity and quality of a case study can be assessed. Instead the worth of case study research demands some understanding and careful evaluating by the reader, who has a solid foundation of knowledge of the topic being investigated. The rationale for selecting the three specific S4D case studies is further elaborated in chapter 4.1.

The research study is qualitative in character, as studies and data will be interpreted, and perceptions will be examined allowing for the development of insights into the efficacy of using sport and play programs as a psychosocial intervention tool. Prior to conducting the comparative case study, it is important to gain an initial understanding of the current literature surrounding the use of sports and play programs as a psychosocial intervention tool in enhancing the wellbeing of conflict affected children. The literature review will explore (1) the concept of psychosocial wellbeing, (2) the theoretical basis of psychosocial interventions and examples of different approaches, (3) a review of the _{mental health needs in conflict and} post conflict conditions, (4) how sport and play are used as innovative instruments to promote

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psychosocial wellbeing, (5) the monitoring and evaluation methods used to measure effectiveness and impact and finally, (6) the critical considerations of the S4D sector.

Regarding both the comparative case study and literature review, this paper will rely on the collection of relevant data from secondary sources, _{including scholarly journals, books,} empirical research studies, organisational impact reports, peer-reviewed articles, handbooks and training manuals and reports from UN agencies and NGOs. The newly established, Journal of Sport for Development (https://jsfd.org/- launched in 2012) developed with the purpose of examining and disseminating evidence and best practices in the S4D field, was highly valuable for sourcing credible peer reviewed research in this field. The literature, case studies and reports are largely collected through trusted data engines: Google Scholar, PubMed, PsychINFO, and Science Direct.

Finally, _{the case studies and literature review will help to identify a number of key practises} for practitioners in the S4D sector to consider when striving for effective psychosocial sport and play interventions in conflict affected settings.

1.6 Limitations

Similar t _{o most research in the field of humanitarian action and development, it is challenging} to examine certain practices in their effectiveness without going into the field and collecting primary data. Due to geographical, financial and time constraints, it is beyond the scope of this study to collect either qualitative or quantitative primary data from individuals who partake in psychosocial sport programs. A further limitation is the fact that reporting on findings from multiple-case research is challenging firstly because the sheer volume of data can be difficult to organise in a succinct manner (Heale and Twycross 2018). Despite the fact that case study research can bring to the forefront unexpected findings that were not anticipated when the research began, the risk is that the researcher can veer away from the research focus. Moreover, since the sample with case study based research is relatively small and the data is primarily non-numerical, it is difficult to establish the probability that the data is representative of a larger population (Hodkinson 2001).

One of _{the most important considerations for the researcher is to reflect upon their “social} positioning” within the study. _{Social positioning draws on the insider/outsider binary, which} is important to consider when undertaking ethical research and to validate knowledge.

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Schulenkorf et al (2016:2) reiterates the importance of social positioning in the S4D field by stating that “though the majority of S4D projects are carried out in Africa, Asia, and Latin America, 90% of S4D authors are based in North America, Europe, and Australia”. This demonstrates that there is a distinct practitioner and scholarly divide in the S4D sector with minimal representation from individuals from developing countries. Sarah Cummings (2014, cited in Piotrowski 2014) _{argues that as a result of this under-representation from the research} community, developing countries become the target of research and not active players in it. These findings mean that it is crucial to be aware of my own social position in this field (i.e having a global North identity and researching a global South context) and therefore be receptive of the biases and assumptions when interpreting research papers.

Despite the fact that these limitations are regarded as being acceptable given the nature of the thesis and the method used, these limitations should be taken into consideration by the reviewer.

1.7 Structure of the thesis

The structure of this research paper is organized into five chapters. The second chapter of this paper will explore the current theories and approaches within psychosocial interventions, as well as the psychosocial implications for children that have been exposed to armed conflict and violence. Chapter three will delve into the current research and documentation on how sport and play activities are used as a vehicle for psychosocial intervention for children that have been exposed to conflict and conflict related stressors. This chapter will explore both the potential positive outcomes and limitations of utilizing sport and play initiatives as a tool in promoting psychosocial well being. After reviewing and analysing relevant literature and theoretical frameworks, the fourth chapter will draw upon case studies in Palestine, Sierra Leone and Guatemala to gain an increased understanding of the measured positive psychosocial impact and any lessons learned regarding the effectiveness of their programs. A summary of the study will be provided in the fifth and final chapter which will contain concluding remarks regarding the effectiveness and impact of sport and play programs in enhancing the psychosocial wellbeing of children exposed to conflict. Based upon the theoretical frameworks, related literature and case studies, this chapter will include a set of

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key practises for S4D professionals to consider and reflect upon in the development and implementation of psychosocial sports programs.

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Chapter 2: Psychosocial Interventions- Theories and

Approaches

2.1 Introduction

In recent years in development and humanitarian aid, there has been a lack of consensus in relation to what entails psychosocial assistance. _{The varying interpretations of psychosocial} assistance amongst aid workers and their agencies has resulted in diverse implementation strategies _{(Loughry and Eyber, 2003). Williamson and Robinson (2006) postulate that there} are a wide variety of approaches have been utilized to address the psychosocial implications of conflict and conflict related stressors. Some of the approaches have included the following: “psychiatric and psychological, clinical interventions, training local paraprofessional counsellors, community-based social suppor_{t and integration, cultural activities, sports, play} opportunities, educational activities (formal and non-formal), support for traditional cleansing and healing” and many more (Williamson and Robinson, 2006: 5). _{It is critically important} that psychosocial interventions are intentionally designed, and backed up by empirical and reliable research and theory, hence why this chapter identifies and explores the theories and approaches to understand the different components of psychosocial wellbeing and psychosocial interventions.

2.2 Concept of ‘Psychosocial wellbeing’

As articulated by a UNICEF report (2009) on ‘Psychosocial Support of Children in Emergencies’, how we conceptualize the notion of psychosocial wellbeing may not always seem so clear cut. Whilst the focus may appear to be on the individual child, they are in fact affiliated to different social groupings including familial, community and societal support structures, each of which has a direct impact on the individual's wellbeing. As outlined earlier in Chapter 1.5, the following definition was employed to describe psychosocial wellbeing:

‘The term psychosocial refers to the dynamic relationship between the psychological and social dimension of a person, where each one influences the other. The psychological dimension includes internal, emotional and thought processes, feelings and reactions. The social dimension includes relationships, family and community networks, social values and cultural practices. Psychosocial wellbeing describes the

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positive state of being when an individual thrives. It is influenced by the interplay of both psychological and social factors. ’ (Wiedemann et al, 2014:25)

This idea is reaffirmed by the Psychosocial Working Group (2003; cited in Hamber and Gallagher, 2016), who define the concept of “psychosocial” as the close correlation between psychological aspects of an individual (behaviour, thoughts and emotions ) and external social experience (relationships, traditions, norms and culture). Through this lens, psychosocial can be comprehended as an element of relations between individuals, groups and communities, as opposed to merely being an individual state (Hamber and Gallagher, 2016).

2.2.1 Wellbeing Flower Concept

Some academics argue that the concept of wellbeing of an individual and the surrounding community is dependent on a multitude of factors such as making sure that the biological, material, social, spiritual, cultural, mental, and emotional needs are met (Williamson and Robinson 2006). By recognizing that all these needs are in fact interconnected in the goals of most programs, the wellbeing of the targeted populations have the opportunity to be enhanced to an even greater degree.

Safety, participation, and development are three contextual issues which are essential to address in promoting the wellbeing of individuals affected by armed conflict. Safety can refer to physical, emotional or political safety; participation implies the importance of conflict affected populations playing an active role in building their own capacities to meet their psychosocial needs; and development implies that wellbeing should be considered as a process and not an end point, whereby participants can learn, adapt and grow in healthy manners over time (Williamson and Robinson 2006). Within these three contextual issues there are seven interrelated aspects of wellbeing that are also vital for practitioners to take into account when implementing programs for those affected by disaster/conflict.

(1) _{Biological: Ensuring a healthy functioning of an individual's body including hydration,} nutritional uptake, respiration.

(2) _{Material: Provision of structures where populations live and work including shelter,} transport, roads, equipment etc.

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(3) _{Social: Participating in a social group is essential to the identity and daily activity of most} people and can include social gatherings, activities and communication between individuals and groups of people.

(4) _{Spiritual: It is necessary for aid practitioners to be perceptive to a population's spiritual} beliefs and religious customs as these can correlate directly to the social functioning of individuals and communities ability to handle adverse conditions. Allowing the targeted population to continue their religious and spiritual practise is a crucial element in their recovery.

(5) _{Cultural: Culture involves cultivated patterns of belief, thought and social behaviour of an} individual or community. Those working with conflict affected populations must have a comprehensive knowledge of what the cultural norm was and the current practises, as well as their opportunities and restrictions. It is also crucial to know if there are any cultural beliefs that mean that some individuals are more susceptible to stigma and discrimination.

(6) Mental: Mental elements of wellbeing refer to cognitive and other functions of the mind, including ‘learning how to learn, acquiring information and being able to use it’ (Williamson and Robinson 2006:16). For instance, for children, the opportunity of going to school is very critical in a conflict related setting. In fact, education is a key activity that demonstrates the interconnectedness of mental, social and emotional requirements. As well as promoting cognitive growth, attending school on a regular basis creates an aspect of normalcy and dependability in a context that is jeopardized by conflict.

(7) _Emotional: _{Even though wellbeing is reliant upon the tangible circumstances in which} individuals live, they must also feel well so that they can genuinely be well. A substantial amount of emotional and mental functioning is necessary to make efficient use of material resources and opportunities presented. For example, alleviating emotions of fear and anger, which are often stimulated in a conflict setting are essential to wellbeing and building peace.

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The concept of the wellbeing flower is developed by Williamson and Robinson (2006) and is visualized below in figure 1.

Figure 1: Wellbeing flower (Arnborg 2017:42) based on Williamson and Robinson’s concept (2006)

Ultimately, segregating psychosocial needs from physical needs and other needs mentioned above is not effective since these needs are interconnected and their fulfilment is dependent on one another. All in all, attempting to formulate psychosocial wellbeing as a distinctive realm is a “ conceptual blind alley and is ultimately not helpful, either to those addressing psychosocial issues or as part of the broader set of programmatic responses to conflict generally” (Williamson and Robinson 2006:5).

2.3 Curative vs De_{velopmental Approach}

In the realm of psychosocial assistance, _{Kalksma-Van Lith (2007) argues that the main type} of interventions can be categorized into two different and broach approaches: the curative and developmental approach. As demonstrated below (figure 2), at one end of the spectrum we have the curative approach which is largely focused on the treatment of individuals through either psychotherapy or small group counselling. This type of intervention is strongly trauma focused. At the other end, we find the developmental approach which is more preventative in nature. As opposed to concentrating on past experiences, developmental approaches focus on the repercussions of conflict and their current challenges. They additionally focus on the healthy development of children within their socially fragmented context to ensure that children are protected from the development of future mental or social disorders. It is crucial

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to point out that some programs are not necessarily archetypes of either the curative or the development approach, but instead are moderate varieties that can be found anywhere along the spectrum. Many implementing organisations use elements of both approaches (Kalksma-Van Lith, 2007).

Figure 2: Curative vs Developmental approach (Loughry and Eyber 2003)

To delve a bit deeper into the key differences between the two, the intervention from a curative perspective is predominantly rooted in psychotherapeutic approaches that are correlated to Western health concepts, for example Post Traumatic Stress Disorder or PTSD (Loughry and Eyber 2003) _{where individuals or small groups are singled out to confront the} difficulties faced as a means of processing adverse conditions. This approach generally speaking, necessitates the engagement of mental health specialists, such as psychiatrists, psychologists and creative therapists. This intervention is more treatment focused and can be operationalized from local treatment centers or work towards building the capacity of service providers to provide therapy sessions to conflict affected children. Therapists are usually involved in longer term targeted relations with their clients to process adversity. The last key characteristic of curative programs is that they ‘often have a clearly demarcated ending’ despite the fact that the long-term nature of these programs is at times challenging to match within a tight framework (Kalksma-van Lith 2007:8).

The developmental approach toward supporting children in conflict affected contexts views children from an ecological perspective, namely as part of a wider social fabric of communities, relationships and structures (Dorokhina, 2011). There is always an interplay and exchange between the individuals internal, psychological characteristics and their external and social environment. The developmental approach operates beyond the traumatic experience, and instead focussing on understanding the daily problems of children and how they can cope

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with stressful situations. Family, friends and community members are seen as crucial elements that enhance child coping mechanisms _{(Stichick, 2001; Loughry & Eyber, 2003).} This approach additionally acknowledges children's capacity to take the lead in the design of programs that would benefit them (Kalksma-van Lith 2007).

When it comes to the results from research with conflict affected children, Kalksma van Lith (2007) argues that the research is in many cases coloured by the theoretical lens of the researchers, perhaps explaining why often these research studies produce glaringly different results in conflict affected contexts. In some cases, the prevalence of psychological distress (trauma, PTSD) is observed and reported to be very high, whilst other studies illustrate that intense psychological distress amidst conflict-affected children tends to be rare. Given the nature of the research focus, the S4D case studies analysed in chapter 4 focus on two interventions that lean more towards the developmental side of the spectrum (Palestine and Guatemala case study), whilst the Sierra Leone case study focuses slightly more on a curative approach.

2.4 MHPSS Intervention Pyramid

Armed conflict and community violence can trigger significant psychological and social suffering to affected individuals and communities. The psychological and social effects of conflict can be acute in the short term, however, can additionally weaken long term mental health and psychosocial wellbeing of affected individuals and populations. Hence why one of the key priorities in the aftermath of conflict is to protect and strengthen individuals mental health and psychosocial wellbeing (MHPSS) (IASC, 2007). In 1996, the Machel Study f _irst suggested that mental health and psychosocial support for children that have been exposed to conflict should be integrated in humanitarian interventions, acknowledging the interdependence between a child's biological and psychological state as well as their social environment (Betancourt and Tanveer Khan 2008). This suggestion was consolidated in 2007 in the Inter-Agency Standing Committee Guidelines: IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings to support practitioners to implement MHPSS. These guidelines were established after a long history of disharmony between various international agencies on the provision of this kind of support _{(Ommeren and Wessells 2007).} According to the guidelines, _{MHPSS is any form of local or outside assistance that strives to}

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protect or promote psychosocial wellbeing and/or prevent or treat mental disorder. It is commonly represented in the IASC pyramid illustrated below:

Figure 3: Intervention Pyramid for Mental Health and psychosocial support for aid interventions (War Child (2018:9 )adapted from IASC Guidelines (2007:12-13))

At each level of the intervention pyramid (Figure 3) key tasks are outlined to identify and strengthen the psychosocial capacities and skills of individuals, families, and communities (IASC 2007). The first level reflects all individuals affected by the emergency who will need to be protected and have access to basic services (food, shelter, water, health, hygiene). Security should be re-established to prevent further psychosocial deterioration (Save the Children 2009). The second level exemplifies a smaller but still significant portion of the affected community. Individuals who have experienced the loss of loved ones, disrupted community networks, displacement, or loss of livelihood opportunities will need support to reestablish the protective factors that these structures provided for example:family tracing and reunification, healing practises for reconciliation, parenting programs etc (Allden et al 2015). The third level reflects a still smaller portion of the affected community who necessitate more focused individual, or group interventions from trained community workers (who may not need years of specialized training to provide support). This group can include survivors of gender based violence who may require a combination of livelihood and mental health support from community workers. The top of the pyramid represents the most vulnerable individuals from the affected population. Despite receiving previous support, these individuals continue to suffer and experience challenges in day-to-day functioning. These

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individuals need specialized psychological or psychiatric interventions provided by trained specialists.

As outlined in the _{War Child (2018) research paper on ‘Reclaiming Dreams: Prioritising the} Mental Health and Psychosocial Wellbeing of Children in Conflict’, the bulk of NGO interventions address level 1-3 of the pyramid. The reason being is because most children affected by conflict do not develop a severe mental health disorder and manage adversity without the need for a professional clinical intervention. However, the War Child study (2018) also argues that in some cases, clinical psychological interventions are required as some children do suffer from enduring and severe symptoms of anxiety, depression and/or psychological trauma. Where there is active conflict or moving populations, it can, however, be challenging to begin a clinical intervention due to a grave lack of resources and professionals.

As outlined by the Ommeren and Wessells (2007) poor coordination of mental health and psychosocial support has been noticeable in many program implementations, largely due to institutionalized divisions in the humanitarian and development world. In other words in most interventions of this kind, two broad approaches materialize: one concentrates on clinical assistance through the health sector, whilst the other concentrates on providing community self-help and social support activities. In many cases, these two integral approaches develop into separate types of activities that compete for influence and funding and do not communicate effectively with one another.

2.5 War Child’s intervention approach

To take a more concrete example of a specific type of psychosocial approach for conflict- affected children, War Child’s core psychosocial interventions, known as DEALS programs are based around structured activities that enhance children’s resilience and innate strengths through fortifying their family and peer relationships, increasing their confidence and skills to cope with distress (War Child 2018). The underlying assumption of the DEALS programs is the belief that creative and participatory methods that encourage ‘learning by doing’ are effective activities for war affected children to attain physical, emotional and social life skills, and can help them to express their emotions, communicate more efficiently and build strong relationships. Throughout creative play in child friendly spaces, children come to better

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comprehend social rules, the possibilities and constraints of their own bodies, the ability to tackle problems, becoming empathetic towards others and learning how to confront and manage challenging situations _{( Kalksma van Lith et al, 2007). Griede and Speelman (2007)} assert this by postulating that play and creative expression drive healthy child development. Children find it easier to express themselves through play and creative activities, both verbally and non-verbally. When observing meticulously how children play, practitioners can learn a lot about the participants ‘feelings, problems, wishes, needs, and (developmental) situation’ (Griede and Speelman 2007: 9).

War Child (2018) believes that in isolation, psychosocial support will not be able to enhance a child’s wellbeing. Assessments of child friendly spaces have demonstrated that simply attending child-friendly spaces had only a moderate positive impact on the individual’s psychosocial wellbeing, therefore suggesting that psychosocial interventions should be mainstreamed into all sectors of the child's life. Their interventions therefore seek to be integrated into community systems and into participating children's education and recreation institutions so as to ensure that interventions can be sustained whilst simultaneously helping to bring some normalcy into the situation via the provision of routine (War Child 2018). 2.6 Psychosocial implications of conflict and conflict related stressors

Individuals and communities affected by conflict are in many cases exposed to traumatic and distressing events, such as violence, loss of loved ones, abuses of human rights, exploitation, forced recruitment into fighting forces and so on _{(Miller and Rasmussen, 2010). These} distressing and traumatic events are all catalysts for heightened psychosocial distress and the development of long-term psychological problems. For affected children, conflict often results in a drastic change in their social ecology and infrastructure, which would otherwise support their normal child development. Rehabilitation of a damaged social infrastructure is imperative to improving interventions for war-affected children.

The term ‘conflict’ can be interpreted in various different ways, however, this research paper will focus on children that are living in adverse conditions as a result of exposure to structural armed violence and/or community violence in non-war contexts. _{The case studies selected} operate in various and vastly different conflict or post conflict settings. The common denominator is that the implemented programs operate in contexts where children have been

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exposed to adverse childhood events including structural violence, neglect, abuse etc, and where there is inadequate access to psychosocial and mental health based support and initiatives.

When analysing the social, psychological and behavioural responses of young people to conflict and/or mass violence, NATO’s (2009; cited in Williams and Drury, 2010) review of research evidence demonstrates that many more young people suffer from distress as opposed to psychiatric disorders. According to a range of estimates in the literature, NATO’s TENTS (The European Network on Traumatic Stress) guidelines suggests that “up to 80% of people of all ages who are directly or indirectly affected by disasters and major incidents may experience at least short-term mild distress, 15 to 40% medium-term, moderate or more severe distress, 20 to 40% a psychiatric disorder or other psychological morbidity associated with dysfunction in the medium-term, and 0.5 to 5% a long-term disorder”(Williams and Drury, 2010:9). This research demonstrates that the majority of children and young people experience distress as a result of conflict, but does not necessarily imply that they have insufficient resilience to prevent the distress from turning into a long term mental disorders (Williams and Drury, 2010).

Miller and Rasmussen (2010) argue that when it comes to comprehending mental health needs in conflict and post conflict conditions, many practitioners tend to place too much emphasis on the impact of direct conflict exposure, whilst not adequately considering the negative implications of stressful social and material conditioners, namely daily stressors. _Conflict related stressors, refer to the social, psychological and material challenges caused or worsened by conflict, violence and political instability (Newnham et al 2015). Newnham et al (2015) further argue that the negative implication of daily conflict related stressors propose that in spite of exposure to distressing and chronic violence, economic and interpersonal stressors encountered in conflict situations seem to play a considerable role in young people’s psychological and social impairment. Therefore, including a focus on daily stressors is imperative when addressing the needs of children in conflict affected settings. The following table lists some of the most common conflict related stressors outlined by various scholars:

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Social marginalisation and isolation (Hamber and Gallagher, 2016)

Prolonged displacement (Hamilton et al, 2016)

Direct exposure to violence (Henley et al, 2008)

Destruction of social and community structures (Miller and Rasmussen, 2010)

Disappearance or death of a loved one (Miller and Rasmussen, 2010)

Displacement into overcrowded and impoverished refugee camps

(Miller and Rasmussen, 2010)

Poverty (Miller and Rasmussen,

2010)

Child abuse and inter-parental violence (Miller and Rasmussen, 2010)

Reduced opportunities to access school and work (Miller and Rasmussen, 2010)

Lacking money for basic necessities (Newnham et al, 2015)

Unemployment of the household’s main wage earner (Newnham et al, 2015)

Member of the household experiencing depression (Newnham et al, 2015)

Suffering from war injury and/or illness (Santa Barbara, 2006)

Table 1

Below, table 2, depicts some of the most common psychosocial implications for children exposed to conflict outlined by various researchers and practitioners. It is important to note that table 2 does not attempt to encompass all the psychosocial consequences of conflict and violence on children as this realm is too vast.

Psychosocial implications of exposure to conflict and conflict related stressors

References

Upsurge of aggressive behaviour (Newnham et al, 2015)

Lack of empathy and remorse towards others (Hamilton et al, 2016)

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Experiencing stages of grief including denial, anger, resentment and depression

(Lauff, 2008)

Externalizing behaviours, such as delinquency, bullying, and drug and alcohol use

(Liu, 2017)

A large sense of burden of responsibility (Prytherch and Kraft, 2015)

Post-traumatic stress symptoms which can include the following:

- Distressing memories about a traumatic event - Feeling distant from others and become socially

withdrawn.

- Emotional numbness

- Irritable and angry outbursts

- Reckless or self-destructive behaviour - Difficulty concentrating

- Persistent fear

(Schonfeld and Demaria 2015)

Sadness or depression- can cause a reluctance to engage in previously enjoyed activities

(Schonfeld and Demaria, 2015)

Withdrawal from peers and loved ones (Schonfeld and Demaria, 2015)

Anxiety, worries, or fears: children may become anxious about a repetition of the traumatic event

(Schonfeld and Demaria 2015)

Diminished hope and optimism for future prospects (Williams and Drury, 2010)

Loss of trust (Williams and Drury, 2010)

Table 2

As outlined above conflict affected environments and related daily stressors can have severe implications on the psychosocial wellbeing of children. The efficacy of utilizing sport and play programs to negate some of these implications, and have positive impacts on the physical, mental and social wellbeing of affected young people will be explored in subsequent chapters.

2.7 Implications for children

According to IASC (2007), a subgroup that necessitates particular attention in relation to mental health and psychosocial wellbeing are children and adolescents. In the past decades,

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responsibility to protect children from these negative consequences have become widely acknowledged within the international humanitarian field. _{Children are especially at risk to} the negative implications of conflict due to their lack of experience and resources to independently fulfil their developmental, social, emotional and behavioural needs (Schonfeld and Demaria 2015).

On the contrary, Loughry and Eyber (2003) argue that there is a heightened belief that only a small portion of conflict-affected children and communities develop serious psychological issues that necessitate specialised care. It is therefore much more important for implementing programs to focus on the stress resilience and coping mechanisms of affected children. This idea is supported by Cortes & Buchanan (2007) who performed a study of six Colombian child soldiers who did not display trauma related symptoms after being recruited and exploited by armed groups. They aimed to comprehend the mechanisms and characteristics that the ‘resilient former child soldiers’ utilized to buffer the negative impacts of conflict related trauma. They identified six varying themes which that appeared to enable the ability of these young people to overcome the trauma of conflict. These themes include: ‘a sense of agency; social intelligence, empathy, and affect regulation; shared experience, caregiving features, and community connection; a sense of future, hope and growth; a connection to spirituality; and morality’ (Cited in Betancourt and Tanveer Khan, 2008:3).

Henley et al (2007) argues that when considering the operalization of any psychosocial sports intervention program for children the variation in responses between age, gender and culture must be incorporated into the design of the program. Children react differently to conflict situations or stressful events depending on their age or developmental phase. Younger children tend to display symptoms of severe stress through behavioral unrest or 'somatic complaints' whilst older children display symptoms that manifest more in a social setting. Similarly, S&P programs should be implemented in a gender sensitive manner, as psychosocial needs may differ between girls and boys affected by conflict (Betancourt and Tanveer Khan, 2008). Diverse cultures may have different perspectives on the capacities of girls and boys and about what implemented programs will be valuable to them and not. In some cultures, girls are prohibited from participating in S&P programs due to expectations to fit certain gender stereotypes or socio-cultural norms. Hence psychosocial sports initiatives have to alter their coaching and treatment of children depending on the various factors

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mentioned above (Hamilton et al, 2016). Ultimately children are the foundation of the future and for a peace generation, and therefore the focus of this thesis is on child-centred approaches and the healthy psychosocial development of children.

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Chapter 3: Using Sport and Play initiatives as Psychosocial

Interventions

3.1 _{Realm of Sport for Development (S4D)}

Since the late 1990’s there has been rapid growth in the number of sport and play based initiatives that are used as a catalyst to create social, health and economic change at the local, national or international levels ( _{Giulianotti, 2014). Definitions of the term ‘sport and play’} may vary, however, in the development context it usually includes a wide spectrum of inclusive activities with a strong emphasis on the positive values of sport. The UN Inter-Agency Task Force on sport for development and peace outlines “sport and play” in the context of development as: “all forms of physical activity that contribute to physical fitness, mental wellbeing and social interaction, such as play, recreation, organized or competitive sport, and indigenous sports and games” (Sport for Development and Peace International Working Group 2008: 5 , henceforth SDP IWG).

Sport for development has emerged as a significant new development field, demonstrating growing momentum around the globe. It is frequently argued by practitioners operating in the field of sport for development (S4D) that the universal popularity of S&P transcends national, socio-economic, cultural and political barriers and can be implemented successfully in various contexts (SDP IWG 2008). There are a multitude of definitions of S4D but the following is the most holistic and all-encompassing view, namely: “the use of sport to exert a positive influence on public health, the socialisation of children, youths and adults, the social inclusion of the disadvantaged, the economic development of regions and states, and on fostering intercultural exchange and conflict resolution” (Lyras and Peachey, 2011:311). This definition emphasizes that from an S4D angle, sport can be used as a means of achieving wider beneficial ‘non-sport’ development goals for disadvantaged individuals or populations, as opposed to being an end itself (Spaaij et al 2018). These non-sport development goals can include the following: promoting physical and mental health; combating disease; fostering education; building employment skills; reducing violent behaviour and crime; empowering marginalized social groups such as females, ethnic minorities and people living with a disability; human rights advocacy; establishing peaceful relations in fragmented societies; and

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raising awareness of a range of other social problems ( _{Giulianotti 2014). This exhaustive list} of ‘non-sport’ goals and the belief in potentially beneficial outcomes has resulted in the creation of hundreds of S4D initiatives implemented by non-governmental organisations (NGO’s), government entities, sport associations, aid organisations and even corporate institutions (Spaaij et al 2018).

Practitioners and academics that support the use of sport to achieve development goals are quick to emphasize its positive qualities. Nevertheless, the traditional field of development is taking longer to fully accept the notion that sport could be an engine that drives development practises forward, explaining as to why sport for development literature is mostly overlooked in social sciences academia (Levermore 2008). To put this into context, Levermore (2008:184) stated that of “the 70,000+ entries in the last 15 years of international development abstracts, only 12 mentioned sport”. The idea that sport still sits in the margins of development literature was reiterated by the UN as is stated in one of their policy documents that ‘sport is seen as a by-product of development, not as an engine’, demonstrating that the potential of using sport as a tool for development has yet to be fully realized (Levermore, 2008: 184). It is however, necessary to recognize that S4D initiatives are not a recent trend. International entities such as the United Nations as well as the International Olympic Committee (IOC) already began in the 1920s to use sport as a means of reaching development related goals. From the 2000s onwards, the UN Millennium Development goals and in more recent times the Sustainable Development Goals (SDG's) of 2015 have acted as pillars to expand the range of S4D practices (Chawanksy et al 2017).

The following subchapters will firstly touch upon the range of thematic areas that are broadly incorporated under the S4D umbrella. Secondly, the study will delve into the anticipated positive psychosocial outcomes of S4D initiatives, with a special focus on the creation of ‘safe spaces’ as this is a fundamental element of enhancing both psychological and social wellbeing for children living in conflict affected societies. Thirdly, the focus will be placed on how practitioners and researchers alike seek to measure the effectiveness and impact of psychosocial sport interventions. Lastly, this chapter will offer insights and stimulate reflection on the pitfalls of the S4D sector in achieving development outcomes.

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3.2 Thematic areas of S4D

As outlined above, sport for development initiatives use sport as a mechanism for social intervention to attain non-sport goals. The Journal of Sport for Development has developed seven different classifications to distinguish between various non-sport thematic areas that S4D organisations strive towards (Svensson and Woods 2017). These thematic areas are used to methodically examine the focus of different S4D organisation and include the following:

(1) S4D and Disability_{- Promoting the inclusion of people living with a disability in sports} and play activities and ensure participation and equal access of people from various disability groups.

(2) S4D and Education_{- Use of sport to provide equitable quality education to children,} helping them to develop life long skills such as communication, decision-making, team building and problem solving.

(3) S4D and Gender_{- Use of sport to work towards gender equity through challenging} gender norms and empowering girls/women to acquire leadership experience, and life skills.

(4) S4D and Health_{- Use of sport to address communicable or non-communicable} diseases including health awareness. Organisations utilize the positive impact sport has on the physical, mental and emotional health of participants to achieve a vast range of health outcomes.

(5) S4D and Livelihoods_{- Use of sport to enhance livelihoods for underserved and/or} impoverished participants and communities through jobs skills training, enhanced employment opportunities and economic development in combination with sport. (6) S4D and Peace_{- Use of sport as a tool for reconciliation and peace-building in conflict}

affected countries and divided communities, promoting the ideals of solidarity, non-violence, tolerance and justice.

(7) S4D and Social cohesion-_{Use of sport to promote community empowerment, social} inclusion and strengthening_{dialogue amongst individuals and communities from} diverse backgrounds_.

The following chapters will focus on sport for development initiatives that are working towards: (1) Health, (2) Peace and (3) Social cohesion as these thematic areas combined are the most relevant when it comes to examining how effective sport and play initiatives are in

How Effective are Sports and Play based initiatives at enhancing Psychosocial Wellbeing for Children that have been exposed to Conflict and Conflict-related stressors