Psychosocial Support intervention for Improving Oral Health and the related quality of life of War Affected Children: A quasi randomized controlled trial

In the current study a short-term (6-week) integrative approach was designed. The aim was to promote oral health status in addition to mental health of war affected children. Targeted population was selected from 4 temporary accommodation centers (TACs) in four different cities in Damascus, Syria. Two TACs were randomly selected (using a simple coin toss technique) to obtain the intervention. The two other TACs had no intervention and served as controls. Therefore, children weren't randomly selected and the study followed a quasi-randomized trial design. Only children suffering from post-traumatic stress disorder and aged between 9-14 years were invited to participate. Post-traumatic stress disorder was diagnosed prior to the intervention using child post-traumatic stress disorder reaction index. Children were randomly assigned into two groups (intervention group and control group). Only children in the intervention group were enrolled in the program. The program included psychosocial support (PSS) integrated with an oral health education (OHE). The 12-session approach was carried out for 6 weeks. Children had attended 2 sessions weekly in terms of groups. The intervention group included 6 sub-groups, each sub-group had 18-20 children. For six weeks, the exact same session was conducted for two groups in the first three days of the week. In the following three days a new session was carried out including two groups daily. Every session took about 60-90 minutes. The program included 8 sessions of PSS and the last 4 sessions were integrated with OHE. A pediatric dentist (7 years of experience) held the oral health educational program, while two social workers (well-trained by a psychologist) conducted PSS part of the program. The same psychologist supervised the whole sessions and was always available in case any children had serious symptoms and needed urgent referral. Sessions had various integrated activities such as playing, drawing, and acting as well as relaxation methods. Educational materials about oral health included presentations, videos, illustration tools and storytelling. PSS focused in trauma healing, open discussions about social problems, friendly behavior and positive vision about the future. The educational program focused in oral and dental diseases and their consequences, prevention methods, treatment procedures and tools, stages of teething and dental appearance. Children were also informed about the importance of oral health to the whole body and how periodic checkups are necessary for their oral and dental health. Oral health evaluation included Plaque index (PI) and gingival index (GI). Oral health related Quality of life was evaluated using child perception questionnaire from 11-14 years (CPQ11-14). The investigator (pediatric dentist) conducted the clinical examination and supervised the questionnaire completion. The same dentist also monitored children's adherence to the intervention using session attendance checklist. Study variables were evaluated at baseline and after 6 weeks (end of the program) for both groups.