Applications of mobile technology to address mental health needs in war torn areas
During the 2014 War in Gaza, called “Operation Pillars of Defense” in Israel, the Palestine Children’s Relief Fund (PCRF) mobilized efforts to address the expanding mental health needs of the children affected by the six-weeks of violence. As an initial step, the PCRF felt it was necessary to conduct a needs assessment to determine the nature of psychological symptoms impacting Gazan children exposed to the war. With the use of innovative technology, five PCRF social workers were trained to obtain data from 1072 children living in Gaza during the war, looking at both traumatic event exposure and mental health symptoms. This data was acquired as a first pass to launch a clinical intervention program within the organization with a goal of increasing mental health treatment for children suffering from intense trauma symptoms as a result of the war.
Two screening questionnaires were developed and administered by five social workers in the field. The first questionnaire was used to determine exposure to specific traumatic events during recent war (i.e. witnessing death/destruction, homelessness, etc.), the other to assess mental health symptoms. From this data, the total number of children with the diagnosis of PTSD, depression and anxiety symptoms can be determined, as well as correlations between symptoms, relationship between traumatic events exposure and symptoms as well as demographic and gender considerations. In addition, this data was used to identify the most severely affected children by symptom load for whom follow up and treatment planning are being provided while concurrently building mental health interventions within the PCRF.
Due to political, social and economic factors, the Gaza Strip is a difficult place to build any type of technical infrastructure. The war created additional friction and unreliable circumstances which made the PCRF’s efforts exponentially more challenging. The organization faced the following technical challenges in collecting data in the field:
- Lack of consistent electrical power
- No cellular data network and unreliable Wifi access
- No existing information system to collect and store data
Several tools were used by the PCRF staff to overcome these challenges in order to quickly collect information from 1072 children living in Gaza during the war. This included the use of mobile technology, as field workers used phones and cameras to document the data they obtained. By definition, mobile technology does not need to be physically connected to a power source to function. The devices utilized the power grid and Internet access when available but were not required for them to be useful tools.
In addition, the use of Open Source Software (ODK), provided two crucial features:
- The ability to quickly create a customized data collection application that could be downloaded to Android devices.
- The ability to collect and store data offline and upload it when Internet access became available.
ODK allowed the PCRF to build custom data collection forms using a spreadsheet instead of developing an application or hiring a 3rd party developer. In addition, the PCRF used the Google App Engine Platform to run its data collection application. The infrastructure was easy to build, easy to maintain, and easy to scale as traffic and data storage needs changed. There are no servers to maintain, the application runs in the cloud and data can be collected at anytime anywhere in the world.
The data was collected with the following security considerations:
- Mobile Device: Users are able to download forms to ODK Collect and submit data from ODK Collect to ODK Aggregate but must have ODK Aggregate accounts or AnonymousUser can be granted Data Collector rights which allows data to be uploaded without setting up specific accounts.
- Spreadsheets: Data can be published to Google Spreadsheets or Fusion Tables and are then controlled through Google Drive's security. Options for sharing are, Privately, To anyone with the link, or Publicly.
- Cloud Storage: Security is primarily controlled through ODK Aggregate, our server and data repository running on Google's Apps Engine. Access can be granted anonymously, through an Oauth 2.0 token (issued by Google) or directly via an ODK account, with a username and password specified by the IT Director.
The six-week war in Gaza left over 500 children dead and more than 2,000 injured, out of a total population of approximately 1.8 million people. For children eight years or older, this is the fourth war experienced in their young lives. The impact of witnessing or experiencing violence on children must be first measured before any concerted effort can be implemented as a solution. This initiative by the PCRF to use technology and data entry field-work is the first step in measuring the extent of the psychological damage done to Gaza’s children in the summer of 2014. The screening was designed to enable the PCRF and other actors to prepare an action plan to address the mental health needs of Gaza’s children in a way that will enable them to heal and overcome their plight.
We are in the process of analyzing this valuable information obtained by our dedicated staff and look forward to sharing these groundbreaking results within the organization and the broader international community.