Nip in the Bud® Podcast - The children's mental health health charity

Nip in the bud with Professor Dennis Ougrin: How can we create solutions for children affected by trauma?

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In this heartfelt conversation, Dennis Ougrin, a professor of child psychiatry, discusses his work in developing Intensive Community Care Services for children with mental health issues, particularly in the context of refugees and the ongoing war in Ukraine. 

He emphasises the importance of community support, routine, and honest communication with children about their experiences. Ougrin shares insights on recognising PTSD symptoms in children and the effectiveness of creative interventions like art therapy.

 He concludes with a call to action for listeners to consider how they can contribute to ending wars and supporting affected children.

Some key take aways from our conversation are:

  • Intensive Community Care Services can be more beneficial than inpatient care.
  • Community support is crucial for children's mental health recovery.
  • Routine and predictability are essential for children, especially those affected by trauma.
  • Honesty with children about traumatic events fosters trust and healing.
  • Art therapy can provide a non-threatening way for children to express themselves.
  • Teaching Recovery Techniques (TRT) helps children manage PTSD symptoms.
  • The power of community can significantly aid in the healing process.
  • Recognising specific PTSD symptoms in children is vital for effective support.
  • Parents and educators should create safe spaces for children to talk about their experiences.
  • Ending wars is essential for the well-being of children affected by conflict.

Some key words from this conversation are:

  • child psychiatry
  • community care
  • PTSD
  • refugees
  • Ukrainian children
  • mental health
  • art therapy
  • recovery techniques
  • support strategies
  • war impact

Our conversation contains references to some disturbing facts about war. Go carefully on here, some of the information that follows is very direct, so make sure you’re happy to keep listening – leave it and come back later if you need to.

If you are worried about the immediate well-being of yourself or someone else you can find more support in our “Where to go for Help” Section link below: 

Nip in the Bud - Where to get help

https://nipinthebud.org/where-to-get-help/



Alis  (00:05)

Welcome to the Nip in the Bud podcast. Nip in the Bud supports children's mental health by working with professionals to produce free online evidence-based short films, fact sheets and podcasts for educationalists, parents and others caring for children to recognise and respond to potential mental health and neurodivergent conditions.


Alis(00:30)

Today I'm in conversation with Denis Ougrin, who is Professor of Child and Adolescent Psychiatry and Global Mental Health at Queen Mary University of London. He's also a visiting professor at KCL. Professor Ougrin graduated from a medical school in Ukraine in 1998 and came to England to undertake his postgraduate training.


He completed his higher training in child and adolescent psychiatry at Guy's and Maudsley and is currently an honorary consultant child and adolescent psychiatrist at the Enhanced Treatment Service at South London and Maudsley NHS Foundation Trust. Professor Ugrun leads a programme of information exchange between the UK and Ukraine. He also developed and tested an intensive community care service model.


for young people with severe psychiatric disorders called Supported Discharge Service. In this episode, we talk about this model known as TRT or teaching recovery techniques and the impacts that this has had. We discuss the refugee experience and Dennis highlights the traumas children of war experience and how education professionals, parents or carers can identify signs of PTSD.


He shares some simple advice to help support in the journey of recovery. Our conversation contains references to some disturbing facts about war. Go carefully on here. Some of the information that follows is very direct, so make sure you're happy to keep listening. Leave it and come back later if you need to. If you're worried about the immediate well-being of yourself or someone else, you can find support in our Where to Go for Help section on the Nip in the Bud website.


Alis (02:25)

Welcome, Dennis, and thank you so much for your time today. Could we just start off by finding out a little bit about your background? What is it that you currently do and where do you work?


Dennis Ougrin (02:37)

As you say, I'm Dennis Ougrin. a professor of child psychiatry and I work primarily at Queen Mary University of London. And I'm a consultant psychiatrist at East London Foundation Trust, which covers some of the most deprived areas of the UK.


Alis (02:58)

Thank you. And what do you do to support children and their families and carers?


Dennis Ougrin (03:03)

Well, as part of my clinical role, I'm in charge of developing teams that are called Intensive Community Care Services. And I've done this in many different countries over many years, starting from 2011 in South London at the place called the Maudsley Hospital. And then...


From then on, I've been involved in one way or the other with a number of these teams in so many different countries. We published the first high quality study called Randomized Control Trial of this model in the UK. Then it was replicated in Germany with very similar outcomes too. And then...


These studies provided the research background for the development of these intensive community care services in the UK and in many other countries too. The essence of these services is that we know that admitting young people to inpatient hospitals is not always beneficial to them. Sometimes it's unavoidable, but sometimes especially if these admissions are long, then


outcomes may not be very good and in some cases young people could deteriorate. For example, one very powerful finding from the original randomized study that we published was that if you discharge young people early with the support of these intensive community care services and then if you compare those young people with early discharge with those young people who stay in hospital for a long time.


then you can see that the proportion of kids with significant and multiple self-harm is significantly higher in the actual hospital group. And there were a number of other outcomes that seemed to favor these intensive community care services. One of them, interestingly, was school reintegration. So the time it takes for people to go back to full-time education. The difference was actually quite large.


something like 50 % of the hospital group managed to return to school at six months versus 80 % with these intensive community care services. Other than that, most outcomes seem to be pretty similar between the two groups. And so we really concluded that at the very least, these teams are not harmful to young people and at best they probably provide some significant advantages.


Alis (05:37)

Could you elaborate on this model that you talk about?


Dennis Ougrin (05:41)

Yeah, so what it is is that we have a team of people that cover a particular geographical area and they essentially look very similar to what you would find on the inpatient unit. So you will have typically a consultant psychiatrist, quite often a psychologist, a number of nurses and other specialists such as psychological therapists of different kinds.


occupational therapists, physiotherapists, and depending on what the population you serve, could be some differences there. The backbone of the team is always nurses, the nursing team. And in fact, we found in different studies that it's actually nurses who deliver the majority of the care to these young people.


And they could also deliver psychological therapies, for example, and other specialist interventions as well, like autism diagnosis, if they are appropriately trained and supervised. Now, the difference between that team and the standard community team is that the team has a very small caseload. In the UK, we decided that...


really it should not exceed more than five families per full-time equivalent. So it's a very small in comparison to a standard community team. Except of course, young people that we look after are much, much, much more complex and they are at the complexity level that you would expect in an inpatient hospital. and then the other thing which is important is that the team like that could see the child and the family


as often as needed, perhaps every day, sometimes several times a day. And so the intensity and the small caseload and the 24-7, ideally, support that we provide makes it different from the standard community team. And of course, it also makes a difference that young people stay at home in their natural environment.


and very often family members benefit from this ongoing support. Occasionally, of course, cannot contain the risk that the young person poses in the community, and so sometimes inpatient admissions are necessary. But there is no doubt if you look at, say, six months involvement of a team like this, that the duration and the number of admissions are significantly lower.


with the support that a team like this provides.


Alis (08:12)

And this model and these teams work a lot with refugees. What are you noticing? What sort of behaviours or similarities in mental health concerns have you commonly come across with this cohort?


Dennis Ougrin (08:28)

Of course, we do work with refugees, although that is not the main focus of these teams. And in fact, I have to say that in the UK, we don't have good services that are specifically for refugees. There are some services that are for young people with trauma, for example, but not specifically for refugees. it's actually a service gap. It's a service opportunity development because...


I worked with refugees from Afghanistan and Syria and the former Soviet Union, and of course from Ukraine of late. Each individual child is very different, but they do share some interesting and quite complex needs that are not really found in the indigenous population. For example, the issue of acculturation, adaptation to a new language, often new culture.


that is especially pertinent for kids who are neurodivergent, say with autism and ADHD, who I think struggle the most when they are moved from one country to another. So it is something that could be an interesting service development opportunity. And we do of course come across refugee children in the course of our work quite often, but not


It's not the main focus of the team. But besides that sort of main work that I do for the NHS, obviously since the beginning of the war in Ukraine, we started seeing a lot of Ukrainian children who started coming after February 24th, 2022, when the full-scale invasion of Ukraine happened.


You know, these children, you they were, I started seeing them really literally almost from the first day of the war because the war started on Thursday and by Saturday I was already on the Polish Ukrainian border delivering some aid with my wife. And we started seeing kids crossing the border then literally it was still February 2022.


have some interesting pictures of these children. Some quite happy that they are away from bombardments and missiles. And some really quite lost and unsure what to do. Quite a few of them actually came with their pets, like with cats. And I have a beautiful picture of a boy with his rat in a sock.


Interestingly also, we never think about that, but I think these things are quite stressful for animals too. I have a picture of a really quite happy looking girl from Mariupol in the east of Ukraine with a very distressed looking cat. So it's obviously another interesting horrible effect of the war. And then of course,


Alis (11:04)

Yeah.


Dennis Ougrin (11:11)

We started seeing a fair number of kids from Ukraine, in the UK, in London especially. I don't know exactly the figures, but there'll be somewhere in the order of 20, maybe 25,000 kids at the moment. Of whom about 2,500 received some form of education from St. Mary's School, which is a well-established old Ukrainian school, Saturday school.


which had a few hundred children before the war and now has two and a half thousand.


Almost all of them came from Ukraine in the last two and half years. So again, when they started arriving in big numbers, then the school director, who is a wonderful, wonderful lady called Ina, who actually received an MBE this year. Congratulations, Ina, for her work. And it well deserved, well deserved, I have say.


Alis (12:06)

Wow. Yeah, fantastic.


Dennis Ougrin (12:12)

She reached out to me and my colleagues who are psychologists saying, look, we need to do something. Kids are suffering and especially teenagers. Because as you can imagine, little children seem to settle in relatively fast. And the younger the child is, the easier the process is. especially for teenagers that move.


was really quite a horrible thing and most of them missed their country and their friends and none of them wanted to stay in the UK. And they were really having fights with their parents about going back. So we had to do something about these children. And the first thing we did was something that they would really, really, really want to repeat at some point.


work together with local artists. So the main hub, the main school is in Holland Park. And it's been there for decades since the 60s, think, or 50s even. And not far from them, there is a wonderful sort of residential place where artists live and work. Literally, it may be like 500 meters from there. And, you know, so...


So one of the artists was of was walking by the past the Ukrainian center and she was saying well perhaps we could do some sort of collaboration so we found each other and they provided a wonderful space for children little children to come and we had I don't know five or six sessions where kids would come and the artist would provide these wonderful arts not art therapy just art.


groups for them, making t-shirts, doing some other activities, creating music with instruments. I have wonderful pictures of that stuff. And of course, wasn't a therapy of any kind. We were not talking about anything that would happen to them, but the kids enjoyed it so enormously. And actually, some will have a t-shirt that one of the children made for me, which was very nice of them.


Alis (14:05)

So, yeah.


Dennis Ougrin (14:07)

And so we did a bit of an evaluation of this intervention and one really cannot conclude very much because it wasn't the randomized study and with kids with significant PTSD symptoms, all of them had, the main factor is the passage of time. Typically these symptoms reduce over time, but at the very least it wasn't harmful.


we found significant improvement from before to after the intervention in the PTSD symptoms.


And then of course some kids need a bit more than just art. And so we started working with groups of children doing something called teaching recovery techniques. It's horrible name that no child can ever remember. I can hardly remember it myself. TRT, teaching recovery techniques. And that intervention is a...


Alis (14:51)

You


Dennis Ougrin (14:59)

is a group intervention for children based on a therapy called Cognitive Behaviour Therapy or CBT, developed by my wonderful late colleague called Bill Yule, who sadly passed away last year. He created the programme for the Bosnian wars in the 90s. And then we used it in Ukraine since 2014, which is when the actual first invasion.


of Russia happened.


So we did a number of these groups with kids. The intervention is basically we look at symptoms of PTSD of which there are also the three main clusters which is this intrusive remembering of what happened in all sensory modalities, hypervigilance, hyperarousal and then avoidance.


and we give children tools to manage all of these three clusters of symptoms. And so it's not sort of individual CBT for trauma. This is more like giving kids tools to manage these distressing symptoms. And we ran several of these groups. There's five groups for children and two for parents. I have to say


Parents were quite difficult to get together, significantly more difficult than kids. And in teenage children, so in the little ones, we had basically 50-50 boys and girls. With teenagers, it became really very heavily skewed towards girls. We hardly had any boys there.


But the groups were really well attended and again seemed to be quite beneficial for many children.


Alis (16:38)

What were the outcomes that you saw? What did you, have you got any anecdotes of success stories?


Dennis Ougrin (16:43)

Yeah, loads of stories. But in these sort of uncontrolled studies, one cannot conclude this is definitely the impact of the intervention. So when you see an effect from before the intervention to after the intervention, it may be that the intervention contributed, but it may be a number of other factors.


Alis (16:53)

Mmm.


Yeah.


Like you said earlier, time might be a factor.


Dennis Ougrin (17:09)

of which the passage of time and there were some interesting mathematical reasons for this regression to the mean and so on and so forth. at the very least we did not see any harm done to children and by the fact that they were actually quite keen to attend. In fact, some children went to these groups twice. There was a boy who lost his mum.


and had a father with significant mental health needs, then he went to these groups twice and loved both of these cycles. Now, and of course, there are some individual stories where children would report significant benefits, improvement. And also to remember is that


When you have a group of kids, one of the key therapeutic ingredients is the actual group. So when you have a, it applies to adults too, but if you have a group of people who share similar experiences and then you say, so somebody says, I have this particular symptoms like nightmares, then you say,


well, does anybody else have nightmares? And then all of a sudden this child understands that pretty much everybody in the group has the same issue. And that's very powerful because then you feel like you're not going crazy yourself. It's something that loads of other people experience. And then, you you feel supported by that group.


Alis (18:45)

So it's the power of community, isn't it?


Dennis Ougrin (18:48)

Exactly. It's the power of community and it's very powerful. Sometimes I wonder, know, what is more important, the tools that we give to kids or the actual group itself that support that they receive from other children. It's not that easy to disentangle, but we do sometimes occasionally work individually with kids using the same program. I remember working with two girls. We actually filmed on and is available on


as a sort of teaching film in Ukraine and on YouTube. Very interesting. So two girls from the same family, from, again, Mariupol in the East. And it's so interesting because you have two girls who went through the same horrible experiences, of which I have to say the most horrible was crossing the front line when they literally thought that the whole family will be killed. And that nearly happened.


So they then were working as a sort of a small group of just two children, an older sister and a younger sister. And it's so interesting that you had sort of one of the children who was very open about her experiences and her symptoms. And the other child, I think the youngest of the two,


was denying all symptoms, saying, I'm fine, there's nothing wrong, have none of this, none of this business. And then when you asked, when I asked the teachers, then teachers were saying that the child who was acknowledging the symptoms and working through the symptoms was really integrating very well with other kids in school. Whereas the child who denied all symptoms was really very poorly integrated and


was missing lots of classes, was aggressive to other children. And it's almost like a textbook case of, but you very rarely see this, like, so in this juxtaposition with two sisters. And of course, eventually, but it's so beneficial for the younger child to see her older sister open up and talk and work through what happened. It was actually...


I thought one of the key ingredients in her recovery that she saw that it's okay to speak about this. And she isn't going crazy and there is hope for recovery.


Alis (21:08)

Really interesting. And you talked there about the clusters of PTSD and recognising what they are and what support and how this TRT technique, this teaching recovery technique could help.


What sort of behaviours, I'm wondering if you can clarify what those behaviours would look like in a child. I'm thinking from the perspective of an education provider now or a carer who's looking out for refugees or anyone with PTSD. They might know what the symptoms are, but what might that look like in behaviours in a child?


Dennis Ougrin (21:46)

Well, one thing that every teacher will know about is hyper arousal. So when you have a child who went through horrible experiences like war experiences, then every educator will know that there will be specific triggers for this children to respond in this hyper aroused way. Interestingly, these triggers are quite specific to the actual war that kids experienced. For instance,


Children from Afghanistan that I saw very often were triggered by uniforms. There something about seeing a person in a uniform that made them very, very aroused and upset. But we never see this with Ukrainian children at all. It's really quite interesting how these triggers are quite different. And so, for instance, in the first summer,


after the beginning of the full scale invasion, we took... So I'm also a scout leader as well. So we took about 200 kids from Ukraine to a scout camp in Wales. We have a piece of land there. And, you know, in the scout camp, everybody, unfortunately, wears uniforms. so we thought, my God, this is going to be a nightmare. How are we going to manage this? But weirdly, none of the children at all, not one.


of the 200 had any particular triggers to do with uniforms. But unlike many other children, Ukrainian kids very often are triggered by specific noises. So you will see kids who jump when they hear the noise of a helicopter or an airplane. And also quite interestingly, many Ukrainian children


will respond badly to the sound of trains. And I thought for a while that it may have had something to do with the fact that Russians were targeting civilian trains as they were fleeing from the east. And maybe there was some sort of an association in their mind. But I don't think so, because it also applies to kids who were never targeted in their trains. And there might be something about the pitch of the


of the train that reminds them of rockets or some other missiles that the Russians throw at them. Sometimes these triggers could be almost subconscious, so the child is not aware of what it actually is that triggers them. For instance, smells. You would sometimes see a child who would respond very badly and they don't know what it is that


triggered them. And it may be something like, for example, petrol, like a car exhaust, or sometimes something that reminds them of gunpowder, or some sort of smell that reminds them of rotting corpses and bodies that they were exposed to. Like maybe some of the shops.


And it's quite interesting and you have to almost do some detective work around what it is that triggers the child. And that will be quite specific to what actually happened to this individual child.


Alis (24:41)

Yeah, yeah, yeah. So I'm hearing you say that that detective work, if you like, is around relationships and teachers or parents or carers spending time building that relationship and having those conversations so that they get to understand the individual triggers for that child.


Dennis Ougrin (25:03)

Indeed, We might come back later on if that's part of your sort of line of questions to what, know, how best to support children, you know, for parents and for teachers. But just going back to your question around, you know, what are the symptoms and how they might present to a teacher or a parent, then, you so all of these symptoms were to do with hyperarousal. So it's


Alis (25:12)

Hmm.


Yeah.


Dennis Ougrin (25:28)

very obvious when the child becomes suddenly very upset, very aroused. Sometimes they would run away from the classroom or from somewhere. And of course, part of this hyper arousal is also poor sleep. So the child may find it very difficult to fall asleep and that's something that parents will detect and teachers could detect first thing in the morning when the child is sleeping in their class.


Alis (25:52)

Yeah.


Dennis Ougrin (25:53)

Now, the intrusions, the flashbacks and re-experiencing of what happened, that's less obvious to anybody. I you could see the child daydreaming and perhaps not concentrating when they experience these flashbacks. And sometimes they also could be quite upset by them as well.


It's almost like a dissociative experience where the child literally feels that they're back in that moment. So, when it comes to those symptoms, then the visual flashbacks are the most common. And the difference between the flashback and the normal memory is that flashbacks are not under the child's control. The child cannot control this. It just happens.


may be triggered by one of the triggers that I mentioned before. And then auditory flashbacks also happen. They're a bit less common than visual, but could be quite upsetting to the child. And then you have interesting flashbacks which are to do with smells. So the child suddenly smells the same horrible smell that they did before.


Alis (26:42)

Yeah.


Dennis Ougrin (27:09)

Sometimes they can have a taste that's really quite rare. I don't see a lot of children, but sometimes they report, for example, the taste of blood in their mouth or some other substance. And then you have tactile flashbacks too, so that's to do with being touched, that's especially to do with children who've been raped, for example, by soldiers, or other sort of horrible experiences they had during the war.


And then probably the least common flashbacks are to do with, they're called kinesthetic, they're really quite rare. And that is to do with the child who had an explosion nearby and they were thrown by this wave far away. And occasionally the child has this sort of re-experiencing of this being thrown by the...


explosion. That's really quite rare and we have very little knowledge about what to do with these flashbacks. One other thing that somebody told me, I don't know if it's true or not, is that when the child experiences this blast, this explosion nearby and is thrown by this wave, is that they very often urinate themselves. There's something sort of mechanical that happens.


And then children often think that they're sort of cowards, but it has nothing to do with being a coward. It's just the physical pressure that they experience. I'm not entirely sure if it's true or not. And it's actually quite a rare phenomenon. And then, course, avoidance. Avoidance is something that teachers might also come across. And there are two types of avoidance. There is the physical avoidance, where the child


Alis (28:17)

Hmm.


Dennis Ougrin (28:40)

will not leave the safety of their house for example. Or they will not go to a particular place that reminds them of what happened. Or they would not for example watch a movie that reminds them of what happened. So that may apply to certain maybe school trips or experiences in school where the child actually would not go.


But there's also an even more interesting type of avoidance, which is cognitive, which is inside the child's mind. And that is to do with refusing to remember or think and or suppress any reminders of what happened to them. And that is actually something that is not very obvious at all. but it's very central in fact to the...


mechanism of how PTSD works because the more you suppress memories and thoughts and images inside your brain, the more they become active and the more they control you. In fact, the basic sort of theory and mechanism of any therapy that's effective for PTSD is how to teach the child and how to work with the child to make sure that they can actually


Alis (29:34)

Okay.


Dennis Ougrin (29:49)

talk about what happened in a coherent way. this sort of disjointed memory becomes just a narrative that they can explain. And the best thing in therapy with the child is when they become bored, not scared. So when the child is bored with the story by retelling it many times, then I love it. It's the getting the child bored is what I really like. It's a very good sign.


Alis (30:13)

That's a good sign. Yeah.


Dennis Ougrin (30:17)

when they're no longer scared, just bored. So that's just what it might look like to a teacher or a parent.


Alis (30:25)

Yeah, so I wonder, I mean that's really useful, I wonder if you could go on to talk about how, if you do recognise any of those signs, what sort of support you could put in place if you're not trained or you haven't been part of the TRT intervention, what would you suggest?


Dennis Ougrin (30:46)

Yes, well there are loads of things that all of us can do. The first thing I would say is to be honest with the child. I have come across many, families that chose to be somewhat economical with the truth when it comes to what happened. For instance, I worked with a family very early in the full-scale invasion when


There was a father who lost his wife and one of his children literally in the first two or three days of the war. And then he remained alive by chance and one of his kids, a daughter, remained alive but very severely damaged by the shrapnel. In fact, that family's story is very interesting because...


It was in a small town not far from Kiev and the father you can imagine was in this incredibly this short state and so he grabbed this alive daughter, it tiny, and ran to the hospital with really no help that any help could be provided. And purely by chance there was a neurosurgeon from Kiev in that hospital consulting on some difficult case and he got stuck because of the war.


And so he actually operated on the child and saved her life. It an extraordinary story. She then had her rehabilitation in Italy and I think it doing quite well. She was visited by the Pope, was in the newspapers. I actually have a picture of the Pope giving her a rosary. They're quite sweet. Anyway, so what then happened was that the father decided, perhaps understandably so,


Alis (32:00)

Amazing, yeah, amazing.


Wow.


Yeah, wow.


Dennis Ougrin (32:20)

not to reveal to the child that her mother was dead. And that really created a lot of problems later on. So one thing to say to parents, especially to parents, is that it's very tempting to maybe hide things from the child. And in the short term, seems like a very good solution to say that mum is asleep or she went somewhere else.


But in the long term it creates a lot more problems. The problem of basic trust and grief, grieving and all of this stuff. So I would really not recommend it. And of course one has to adjust the information to the child's level and make sure that it doesn't traumatize the child excessively with gruesome details and so on and so forth. But it's very important to be honest with the child about what happened.


It will save a lot of trouble down the line. The second thing to say is that children really need routine more than anything else, especially when they're displaced by the war. And so we quite often see families who think that because kids went through horrible experiences that


They need to be excited by things. So they try to take them to some exciting places all the time and play with them until late at night.


Alis (33:41)

Almost like a distraction. Yeah. Trying to help them to forget. Yeah.


Dennis Ougrin (33:44)

almost like a distraction or some sort of a... Exactly. And that's something that again, may be a nice thing in moderation, but we know that the thing that is most important, especially little children, is predictability and routine. And that's something that we really encourage parents to do. So especially when it comes to...


Alis (33:56)

Mm.


Dennis Ougrin (34:09)

late evening, early night routines. have to say fathers are especially guilty of disrupting that. Especially if they work late. They to come and they suddenly decide to play football with the child or do something exciting. And when that happens, we just say, let's just examine what the routine is. For example, it could be like dinner, then a bath, a story.


pray if the family is religious, a cup of milk and then sleep. So if the father really wants to play when he comes, we say, look, why don't you read the book to the child or do some other part of this routine so that the child has got predictability. And that's the most important, by far the most important thing for them. Then...


Alis (34:53)

Yeah


Dennis Ougrin (35:00)

slightly more clinically, especially in the beginning of the war, were these calls for psychologists and psychiatrists to go urgently and intervene and do something with these children. And again, we know that debriefing is such, it's probably harmful to children and to adults for that matter. And especially if there are children who went through horrific experiences like rape and being kidnapped and


nearly killed, witnessing their parents being killed. Some of them are really almost mute. They don't speak at all. these children, they just need to be looked after. They need to be looked after in a quiet, predictable, supporting, loving way. One of my tasks in the beginning of the war with some of the more traumatized children was how to keep ourselves away from them.


psychologists and psychiatrists away from them. there may be that some children will require our input, perhaps even the majority of the children, but not in the first few days after it happened. They need to be settled in a safe, loving environment. And there's no research, particularly evidence to this, but my anecdotal experience is that the heavier the trauma,


the more they need this basic support before any therapy. Then there is a very important issue which is to do with allowing the child to talk about what happened. Now typically parents fall into one of two big groups. One group says let's not talk about the war at all.


Alis (36:22)

Thanks.


Dennis Ougrin (36:37)

It re-traumatizes the child, let's just not even mention anything about the war. And whenever the child wants to speak, they say, just don't do this, let's talk about something else. And then you have another group of parents who think that they have to force the child to speak because it's good for them. So they actually really torture the child by saying, no, you must speak about it. And the thing that, and then of course there are parents who not like that.


But we think that both of these extreme groups are probably unhelpful to children. What is true is that every child I've come across will want to speak about what happened at some point. And it is important for parents not to be scared to talk about this and to really find the time to sit down with the child.


And when they do want to talk about this, to listen very carefully without problem solving initially. Again, especially fathers are guilty of this because they say, if you have this, then you should do that. It's a very father, of which I'm guilty to have to say. They want to fix the thing immediately. And that comes, I'm sure, from a very good place.


Alis (37:38)

Yeah, yeah, yeah. I want to, they want to fix the, yeah. Yeah, yeah. Yeah, of course.


Dennis Ougrin (37:50)

But kids don't need that, at least in the short, that they need to be listened to carefully. And then children will have questions about what happened. And as I said before, you need to be honest with them within their level of understanding. And then parents need to find the time to speak to their children about what happened and listen to them very carefully, answer their questions.


And that probably is the most important preventative thing that anybody could do, including if teachers have some knowledge and ability to listen, then it applies to teachers as well, but especially it applies to parents, the surviving parents. And the very good place, I find, anecdotally, to do this is when they drive. So when you have...


When you sort of face each other, it's more difficult to speak. But when you look straight ahead, both of you, then children tend to speak a lot more. And that's a very nice place, I think, when you drive, when the child is...


Alis (38:50)

And I suppose walking as well if you're out, just walking and you're both looking forward.


Dennis Ougrin (38:53)

Yes, walking is a good way of talking too. But my point is that there will be a point when every child will want to speak about what happened. And that is like golden opportunity to prevent PTSD and it's really important to help the child organize their experience.


right from the very beginning, even before the horrible events, through these horrible events, up until the place of safety where they are, say in the UK. So that narrative that the child has in their mind is coherent with no major gaps and inaccuracies. So I would really encourage that.


Alis (39:41)

That's fantastic. I'm just gonna sort of sum those up just so that anyone listening can hear them in a batch. So the first one you said was to be honest with the child and not try and hide things because that doesn't pay out in the long run. Routine is key alongside predictability. Giving them time where they just feel that they've got that basic support and feeling loved and safe.


before you start to do therapy, allowing them to talk when they're ready on their terms rather than on ours and allowing and listening without trying to fix or solve. And then just seeing that time to talk as a really golden opportunity to help them create that coherent narrative. And I think they're really clear tips actually that we wouldn't necessarily need to be fully trained up in order to be able to do them. We just need to.


know them and I think that that notion of having time, making sure you put time aside to get to know the child and get to approach the child in this manner.


Brilliant, thank you. Okay, is there any, I mean, those I hope are the key takeaways from our conversation today that anyone could take. Is there anything that we've not covered? Is there anything that, if you think our listeners might be educational professionals, they might be people that are caring for refugees, they might be parents who have found themselves as refugees.


Anything that you feel that we've not touched on that you'd really like to.


Dennis Ougrin (41:23)

One thing I wanted to mention is that we now have some evidence unpublished, but hopefully published later this year, maybe early next year, about the impact of some of the psychological interventions in Ukraine and with Ukrainian children outside of Ukraine. Now, a very striking finding from these studies is that it appears that


when kids are in a place of safety, in this case in Poland, the effect of these interventions is present. So you can actually see the difference between kids who had them and didn't have them. Whereas in Ukraine, in that case it was sort of brief intervention. So we can't talk about many others, but these very brief interventions did not appear to make a difference to children. And we...


Alis (42:03)

Yeah.


Dennis Ougrin (42:11)

We don't know why this is. One possibility is that it may be to do with just kids having this sort of chronic stress to do with the war. That these brief interventions doesn't particularly reduce or cannot particularly reduce them. But we don't quite know fully why this is the case.


And the prevalence of PTSD, significant PTSD symptoms is very high in Ukraine. Even in the Western cities, you'll get about 40 % of kids who have significant symptoms. And so one thing that is clear to me is that no matter what we do, we need to stop the war. Because, you know, we can do all kinds of interventions and maybe they could make a little bit of a difference.


to some kids, but when you have this sort of chronic everyday experience of being a target of Russian missiles and bombs and you have to go into shelters every day and having everything disrupted with your friendships and your school, you know, that I think is such an incredibly powerful and heavy thing to counteract that I can't imagine that we could make


Alis (43:22)

Absolutely.


Dennis Ougrin (43:25)

make a huge difference to these kids. And so if you have the listeners who think about these things, you know, I would just ask them to think about how they can stop Russia. Maybe they can, I don't know, donate something to the Ukrainian cause of some kind. Maybe they can look for some


Alis (43:26)

Yeah.


Dennis Ougrin (43:49)

medical supplies for our soldiers or children or whatever. But I think if everybody does something small, we really hope that we can stop Russia and stop the war. And it's something that not one person can resolve.


Even very powerful people cannot resolve this, but I think if everybody sort of joins together, then there is a better hope for this horrible war to stop. And that applies to any war. I can imagine that exactly the same considerations will be true about any war in the world. We just have to realize that these things have a very, very heavy...


Alis (44:18)

Yeah. Yeah.


Dennis Ougrin (44:35)

impact on kids and maybe politicians before they start these wars, they have to really think about what they're doing. Even, you you sometimes listen to Vladimir Putin who says, look, we're not targeting civilians, which of course is a lie, but he says that. But even if it is true, even if there is a relatively sensible leader that actually doesn't want to,


target civilians, that doesn't matter. That still causes incredible suffering to children because they have their lives disrupted for years to come. So I would like to thank, first of all, all British listeners around the world who helped enormously by accommodating


our kids, something that probably hasn't happened since the Second World War with Jewish children who were accommodated in Britain. But also to think that the key here is how we can stop Russia and stop the war.


Alis (45:37)

Yeah, yeah, thank you. And I think you hit on it there, you know, it's all wars, it's recognizing what's happening across the globe at the moment and thinking about what's happening in the Middle East as well and in Palestine and recognizing the fallout of all of this is often the children, often the children in all of it. And then where does that lead? So it is, I think.


Dennis Ougrin (45:46)

Yes.


Exactly.


Alis (46:02)

It's fantastic to talk about the symptoms and what we can do to support, ultimately without the war we wouldn't be having this conversation.


Dennis Ougrin (46:11)

In Exactly


Alis (46:11)

That's where it starts. So, Dennis, thank you. You've shared some really difficult stories with us today, but some really useful tips and really useful ideas on how we can support and things that we need to do. And a really good takeaway, I think, is to consider how we can ensure more peaceful times ahead. Thank you.


Dennis Ougrin (46:34)

Thank you so much for this opportunity and I hope your listeners find it useful.


Alis (46:39)

I'm sure they will. Thank you so much.


Dennis Ougrin (46:41)

All right, Bye