Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach.
Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach.
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DOI：
10.1093/heapol/czx127
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发表时间：
2017-12-01
影响因子：
3.2
通讯作者：
Abu Hamad B
中科院分区：
文献类型：
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作者：
Samuels F;Jones N;Abu Hamad B
要在冲突后环境中取得良好的卫生成果，就必须建立适应性强、资源充足的卫生系统，但卫生系统以外的领域对确保更广泛的福祉也至关重要。本文着重于心理社会支持服务的重要性，在脆弱的环境中的少女。它的出发点是，青春期是生命历程中的一个关键时期，但考虑到青春期开始引发的身体、认知和情感变化，它也可能是一个对创伤、社会孤立、同伴欺凌、缺乏支持性成年人以及基于性别的暴力和性暴力高度敏感和脆弱的时期。我们的研究结果强调了为什么目前形式的人道主义和生物医学方法不足以解决这些复杂性。利用定性实地工作（包括深入和关键的知情人访谈以及在加沙，利比里亚和斯里兰卡的小组讨论，涉及三个国家的386名受访者），我们认为，超越生物医学方法并考虑健康的社会决定因素，包括解决歧视性性别规范和服务获取障碍的方法，对于实现更广泛的健康和福祉至关重要。虽然所有三个案例研究国家都被归类为冲突后国家，但政治经济动态各不相同，对社会心理脆弱性和服务环境的影响也各不相同。研究报告最后反思了为解决少女面临的心理社会脆弱性而采取的行动。其中包括：调整服务，确保对性别和年龄问题的敏感性;投资于服务提供者的能力建设，以促进服务的接受;加强战略，规范和协调提供心理健康和心理社会支助服务的行为者。
Adaptive and adequately resourced health systems are necessary to achieve good health outcomes in post-conflict settings, however domains beyond the health system are also critical to ensure broader wellbeing. This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. Our findings highlight why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork (consisting of in-depth and key informant interviews as well as group discussions in Gaza, Liberia and Sri Lanka involving a total of 386 respondents across the three countries), we argue that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls. These include: tailoring services to ensure gender and age-sensitivity; investing in capacity building of service providers to promote service uptake; and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services.