INTRODUCTION:Eastern Congo has been affected by armed conflict for decades while the rampant use of sexual violence has left many women and girls dealing with a wide range of consequences of sexual violence. For adolescent victims the psychosocial impact of sexual violence is devastating. However, the role of avoidant/disengagement coping and family support on the mental health impact of sexual violence remains unclear. METHODS:The study design was a cross-sectional, population-based survey in which 1,305 school-going adolescent girls aged 11 to 23 participated. Mental health symptoms (IES-R and HSCL-37A), family support (MSPSS), avoidant/disengagement (Kidcope), war-related traumatic events (ACEES), experiences of sexual violence, daily stressors, and stigmatization (ACEDSS) were administered through self-report measures. Hierarchical multiple regression analysis was carried out with mental health outcomes as dependent variables for different types of sexual violence. Finally, several ANCOVA models were defined to explore possible interaction effects of avoidant/disengagement coping and family support with stigmatization, daily stressors and war-related traumatic exposure. RESULTS:For girls who did not report sexual violence, avoidant/disengagement coping has a direct negative effect on all psychological symptoms. For victims of sexual violence, when high levels of stigma were reported, avoidant/disengagement coping possibly served as a protective factor, as shown by the interaction effect between avoidance/disengagement coping and stigmatization on mental health outcomes. In victims of sexual violence however, high levels of daily stressors combined with avoidant/disengagement strategies showed a strong increase in posttraumatic stress symptoms. Interestingly, the mental health impact of sexual violence was not mitigated by support by family members. For girls who reported a nonconsensual sexual experience without labelling it as rape and at the same time testified to have a lot of family support, there was a positive association between stressors (daily stressors, stigma, and war-related trauma) and posttraumatic stress symptoms. CONCLUSIONS:These results of this study underwrite to the importance of looking beyond the straightforward negative impact of avoidant/disengagement coping strategies on mental health in adolescent victims of sexual violence. While avoidant/disengagement coping can have a negative impact on psychosocial well-being on adolescent victims of sexual violence, in case of high levels of stigmatization it can as well protect them from posttraumatic stress or anxiety. Furthermore these findings speak to the importance of exploring the diversified relationship between risk and protective factors, such as avoidant/disengagement coping strategies and family support, that shape the mental health impact of sexual violence in adolescent victims.

Inclusive citizenship is an important concept in today's mental health care. Still, persons with co-occurring substance use problems and psychiatric problems seem to fall through the cracks of existing (community) treatment services. At the same time, they are the persons least asked for their opinions as service users. This commentary sheds light on Villa Voortman, an innovative community-based outpatient treatment service for persons with dual diagnosis in Ghent (Belgium) that gives a central position to user perspectives in its daily practice.

Few studies on transnationalism have focused on migrants who return to their country of origin with insufficient resources and limited mobility. This study sheds light on the transnational connections of those who went back to Georgia and Armenia from Belgium on a voluntary assisted return and reintegration programme. Using Boccagni's (2012) analytical framework, we reveal the returnees' interpersonal, institutional and symbolic transnational ties. Although these ties were often limited and had little effect on their daily lives, and although the migrants' desire to participate in the transnational field rarely matched their ability to do so, they nonetheless attached great value to them symbolically and emotionally. Our findings question current conceptualizations of transnationalism and the focus on the home country as the sole context in which transnational ties should have an impact. We believe that there is a need to pay greater attention to the subjective and symbolic dimensions of the return–transnationalism field, including the relationship between integration and return migration policies.

Child soldiering affects the well-being of thousands of young people globally and inflicts significant challenges on entire socio-ecological systems, confronting them with culminating stressful living conditions and immense loss. This study sought to explore how former child soldiers' transition trajectories are shaped by the dynamic interplay between these encountered challenges and available personal and communal resources. We conducted and analyzed in-depth interviews with 48 northern Ugandan former child soldiers using cluster analysis (K-means) and interpretative-phenomenological analysis. The results showed divergent post-child soldiering trajectories of stability, improvement, or decline across time. Regarding resources, the cases showed ongoing resource depletion, threat to remaining resources in the face of significant challenge, and loss of resources that could not be replenished. However, there was also evidence that halting the depletion of resources, utilizing existing resources, and valuing remaining resources could offset distress, especially when individual initiatives were environmentally scaffolded. This study calls for a comprehensive approach to the interconnected challenges and resources as well as the intersecting personal and communal responses to these challenges in the aftermath of child soldiering.

Although addiction is increasingly considered as a chronic problem, only a limited number of studies have addressed quality of life (QoL) in therapeutic communities (TCs) for addictions. This reflective conceptual article assesses the history, philosophy, and background of the TC movement as modern concept, with roots in existentialism and phenomenology, as well as the QoL approach as a "postmodern" concept, with a positive vision on wellbeing and happiness, grounded in Aristotelian rationalism. The exploration of the QoL concept situated in the context of TC values, facts, and subjects leads to the finding that both visions can go alternatively together and fertilize each other.

The return of migrants to their country of origin and the development of efficient return measures have become more prominent on the political agenda of many Western European countries. Since policymakers prefer voluntary' return, governmental programmes to support the return of migrants - Assisted Voluntary Return (AVR) programmes - were developed as far back as the 1970s and have played an increasingly important role in migration policy over the last three decades. At the same time, general migration policy and welfare systems have undergone profound change, including in the meanings and connotations attached to social welfare, return support and return policy. This raises questions about the implications of these broader societal and policy changes for the widely implemented AVR programmes. In this article, we discuss the interpretation and evolution of AVR programmes by analyzing how one particular European country, Belgium, has developed its AVR programme over time. We explore the evolution of the programme's content, target group and institutional positioning, which shed light on its changing goals and are closely linked to a broader shift towards a managerial' approach to migration policy and the welfare state. We argue that return support may become decontextualized when it adopts conditional entitlement' as a central principle. This leads to strong differentiation, based on personal responsibility, between deserving' and undeserving' migrants, the levelling down of the support given to returnees, and a more coercive voluntary return policy in which social support is linked to deportation.

AbstractDecades of armed conflict have left a devastating impact on the eastern Congolese population. The widespread use of sexual violence has made Congo home to many women and girls dealing with diverse sequelae of sexual violence. The impact of sexual violence, which is increasingly committed by civilian perpetrators, on the psychosocial well-being of adolescent victims is devastating. Little is known however on the role of avoidant/disengagement coping and family support in determining the mental health impact of sexual violence. These factors have been identified before as potentially protective to the mental health outcomes of trauma. This study therefore investigates the role of avoidant/disengagement coping and family support on the mental health outcomes of sexual violence in adolescent Congolese victims. MethodsA cross-sectional, population-based survey design was implemented in 22 secondary schools, randomly selected from a stratified sample, in Bunia, Eastern Congo, a region affected by war for a few decades. A total of 1,305 school-going adolescent girls aged 11 to 23 participated. Self-report measures of mental health symptoms, perceived family support, avoidant/disengagement, war-related traumatic events, and experiences of sexual violence (no sexual violence, rape, non-consensual sexual experience), daily stressors and stigmatization were administered. Chi square and ANOVA analysis were carried out to explore differences for in sociodemographic variables, types of sexual violence, family support, avoidant/disengagement coping, stigmatization, daily stressors, war-related traumatic exposure and mental health outcomes (HSCL-37A and IES-R). Hierarchical multiple regression analysis were carried out with mental health outcomes as dependent variables for different types of sexual violence. Finally, several ANCOVA models were defined to explore, besides the main effects and, possible interaction effects of avoidant/disengagement coping and family support with stigmatization, daily stressors and war-related traumatic exposure.ResultsAvoidant/disengagement coping has been shown to have a direct negative effect on all psychological symptoms in girls who didn’t report sexual violence. In victims of sexual violence, the interaction effect between avoidance coping and stigmatization on different mental health scales (in particular symptoms of posttraumatic stress and anxiety) showed that when high levels of stigma are reported, avoidant/disengagement coping possibly served as a protective factor. Interestingly, high levels of daily stressors combined with avoidant/disengagement strategies were associated with a strong increase in post-traumatic stress symptoms. Family support did in general not mitigate the mental health outcomes of sexual violence. For girls who reported sexual violence but didn’t label it as rape and had a high level of family support, there was a positive association between stressors (daily stressors, stigma and war-related trauma) and posttraumatic stress symptoms,ConclusionsThese findings speak to the importance of avoidant/disengagement coping strategies in adolescent victims of sexual violence and the impact it has on their mental health. Furthermore, it inspires further investigation on the role of family support in determining the mental health outcomes of sexual violence. This study also illustrates the complex relationship between risk and protective factors in determing the mental health outcomes of sexual violence. Finally important implications for addressing sexual violence and its consequences in war-affected contexts are discussed.

ABSTRACT Despite more than 40 years of research, limited evidence is available for the effectiveness of drug-free therapeutic communities (TCs). Worldwide, TCs have attempted succesfully to integrate innovative and evidence-based interventions, while adhering to the “community as method” (De Leon, 2000). This article is a case study of scientific research on practice and innovations in a TC, De Kiem (Belgium), over the past 40 years, illustrating how research and innovative approaches have shaped the TC into its current practice. From the start, scientific research was used to develop and adapt the TC program. International collaboration introduced new ideas, instruments, and methods and promoted a culture of inquiry. Several interventions that were implemented have contributed successfully to increased program retention, like the introduction of a welcome house phase, social network support, and a mother and child program.

Migrants' post-return experiences are influenced by different elements. Cassarino has proposed that differences in post-return experiences can be explained by migrants' 'return preparedness', composed of two elements: first, the free choice of migrants to return, or their willingness to return; and second, their readiness to return, above all their abilities to collect those resources that are needed to return. This chapter explores how migrants experience their return trajectories and how their wellbeing is shaped throughout the return migration process. It examines the first two years in the return process of four migrants who were returning from Belgium to Armenia. The respondents were selected out of a larger study, in which a longitudinal follow-up of 65 migrants who were returning to Georgia and Armenia with support from the Belgian assisted voluntary return and reintegration (AVRR) programme as provided by the non-governmental organisation (NGO) Caritas International.

The objective of the current study is to investigate the association between time in treatment and participants' perceptions of the treatment process in therapeutic communities (TCs) for addictions. Using a linear mixed effect model, we assessed whether the rate of participant change was related to motivation, cluster B personality traits, and psychological distress. Longitudinal data were gathered among 155 adults in 4 traditional TCs for addictions in Belgium. The results provide evidence that with time in treatment participants develop more profound perceptions regarding the TC concepts and processes of self-change, which denotes the theoretical assumption of identity change and right living in TC treatment.

In recent decades, return migration has received increased attention in migration policy and research (Black and Gent 2006; Cassarino 2004; Matrix Insight 2012). Despite previous approaches to return migration as an ‘easy’, ‘natural’ or ‘unproblematic’ homecoming, it is now well recognised that return migration is a multi-phased, multi-layered, long-lasting and complex process and experience, which is sometimes even experienced as more difficult than the initial migration (Black et al. 2004; Ghanem 2003; Markowitz and Stefansson 2004). Migrants’ postreturn experiences are influenced by different elements. Cassarino (2004, 2008) has proposed that differences in post-return experiences can be explained by migrants’ ‘return preparedness’, composed of two elements: first, the free choice of migrants to return, or their willingness to return; and second, their readiness to return, above all their abilities to collect those resources that are needed to return. Both elements are, according to Cassarino, strongly influenced by circumstances in both the host and the home country. With respect to the first element, the ‘willingness’ of migrants to return, it is widely recognised that the voluntary or forced nature of migration (in general, not only related to return migration) may influence migrants’ psychosocial wellbeing (Bhugra 2004). With regard to return migration in particular, different authors have stressed the importance and centrality of migrants’ motives to return, and their agency in the process of deciding whether to return or not – thus, their ‘voluntariness’ to return, since this may influence returnees’ range of options and their rate of success after return (Cassarino 2004), their possibilities of embedding themselves in the society of the country of origin (Ruben et al. 2009), and their possibilities of creating feelings of belonging post return (De Bree et al. 2010). Yet, researchers have also indicated that there is no strict distinction between forced and voluntary migration; the decision to migrate, or to return, is often ‘mixed’, and a response to a complex set of factors of both compulsion and choice (Turton 2003; Van Hear et al. 2009). Therefore, it is a false assumption that voluntary migration would be a ‘safe’ form of migration in terms of its consequences for migrants’ psychosocial wellbeing (Vathi and Duci 2016).

The reintegration of formerly recruited youth typically engenders a range of relational and social challenges, affecting both formerly recruited youth and the communities to which they return. Yet, research rarely studies the perspectives of community members, hampering the design of muchneeded community-based interventions. This study aimed to understand how communities in northern Uganda experience and deal with relational and social challenges during the reintegration of youths who were formerly recruited into the Lord's resistance army (LRA). The study was undertaken in 2012 in Lira district. Participatory Ranking Methodology (PRM) was conducted with 267 participants, of whom 49 were formerly recruited youths. The results show five themes that give insight into how communities experience and handle relational and social challenges in the reintegration of formerly recruited youth: (i) letting go of fear, (ii) getting used to life after captivity, (iii) resentment and forgiveness, (iv) reducing insults and nicknaming and (v) coping with ongoing relational and social challenges. We discuss how formerly recruited youths and other community members frame relational and social challenges differently, and value similar resources for different reasons. The results of this study suggest that multiple experiences of and perspectives on relational and social challenges following child soldiering should be taken into account to develop interventions that are supported and valued by the community. Furthermore, interventions should draw upon the strategies that communities have already developed in response to relational and social challenges. Copyright (C) 2015 John Wiley & Sons, Ltd.

Introduction: In Belgium, offenders who are deemed criminally irresponsible for their criminal actions because of mental illness or intellectual disability are subject to a specific safety measure with the dual objective of protecting society and providing mandated care to the offender. While Belgian law requires that offenders who are deemed criminally irresponsible should be in a hospital, clinic or other appropriate institution outside of prison, in practice, about one-third of all such offenders still reside in prison. Whether imprisoned or living in settings outside prison, there is a dearth of knowledge on the characteristics of the aging population among the criminally irresponsible offenders.Objective: This paper aimed to explore the characteristics of older offenders categorized as criminally irresponsible in Flanders (northern Belgium) with a focus on the differences between imprisoned older offenders deemed criminally irresponsible and their peers who are residing outside prison.Method: A retrospective case note study of all offenders deemed criminally irresponsible, >60 years of age (n = 174), was conducted in the four Commissions of Social Defense, which implement the procedure in the case of those deemed criminally irresponsible in Flanders. The files were screened for (1) demographic characteristics, (2) criminal history as well as (3) mental and physical health issues.Results: One-fourth of the population were >70 years of age. A total of 30.5% were in prison. Compared to their non-imprisoned peers, the imprisoned offenders had a history of having committed more serious violent crimes towards persons, such as homicides and sexual crimes. In addition, imprisoned older offenders categorized as criminally irresponsible are characterized more explicitly by personality traits that are likely to reduce their chances of being transferred to more appropriate settings in the community.Implications: A comprehensive and systematic screening of all older offenders deemed criminally irresponsible with regard to health needs and social functioning, including age-related deterioration, alcoholism, and other causes of social disadvantages, is warranted to detect potentially hidden problems. (C) 2016 Elsevier Ltd. All rights reserved.

Whether post-conflict reconciliation programmes are able to change hostile behaviours is not known. This study sought to assess the influence of reconciliation programmes on the reconciliation attitudes of war-affected adolescents in two communities in Northern Uganda. Four hundred and forty five adolescents within two communities, one with and the other without interventions were assessed for exposure to war-related and daily stressors and place of residence using hierar- chical regression analysis to predict reconciliation attitudes. Adolescents in the non-intervention community recorded more positive and also more negative reconciliation attitudes; exposure to daily and war-related stressors was more positively associated with increasing reconciliation attitudes among adolescents in the non-intervention than those in the intervention community. Overall the programmes recorded limited impact on reconciliation attitudes, perhaps due to the pervasive adverse social situation of the people. Conclusion: there is a need for multi-pronged, collaborative programme efforts targeting holistic recovery programmes with focus on changing negative reconciliation attitudes. Key words: reconciliation attitudes, reconciliation programmes, war-affected adolescents, Northern Uganda

The recent focus on extending risk assessment and treatment in forensic mental health with protective factors relates to the increasing interest in strengths-based approaches in various professional disciplines: law (e.g. human rights), criminology (e.g. desistance), mental health care (e.g. recovery), forensic psychology (e.g. the Good Lives Model), special needs education (e.g. Quality of Life) and family studies (e.g. family recovery). In this article, we will discuss the available knowledge with regard to strengths-based approaches for offenders with mental illness, in relation to these different disciplines. Several dilemmas are observed across these disciplines: (1) “Living apart together”: the integration of different disciplines; (2) “Beyond Babylonian confusion and towards more theoretical research”: conceptualization of strengths-based practices in different fields; (3) “No agency without autonomy”: the individual in context; and (4) “Risks, strengths and capabilities”: the search for an integrated paradigm. In our view, these different disciplines share a shift in how humankind is viewed, respecting agency in the interaction with people who have offended. Yet, differences apply to the objectives that the disciplines strive for, which warrants not to eclectically consider strengths-based working in each of the disciplines as ‘being small variations of the same theme’.

Purpose – Influenced by evolutions in mental health, a meeting house, “Villa Voortman”, was recently developed. It is based on an integration of therapeutic community (TC) and psychoanalytical Lacanian thinking. The purpose of this paper is to investigate the position of Villa Voortman in the treatment continuum for dually diagnosed clients. Two research questions are addressed: how does Villa Voortman operate ? and how do clients perceive the Villa? Design/methodology/approach – The first question was tackled by a personal account of the founders of Villa Voortman. The second question was addressed by a qualitative study using video-material of 19 visitors’ personal accounts. Findings – The visitors mentioned three themes: social inclusion, personal development and equality. These aspects are further refined into sub-themes including the provision of “asylum”; the instalment of a warm and welcoming atmosphere; the focus on real human encounter; a permissive, supportive and “waiting” environment; a minimal but “good enough” structure; the necessity of a place where persons can develop themselves; the striving for social inclusion and future perspectives; and the support in becoming inclusive citizens again. Originality/value – The value of the paper lies in disclosing the visitors’ lived experience. This is an essential part of shedding light on the “active ingredients” of support, In reference to the title, visitors nor treatment staff have “carte blanche” with regard to how support develops, as this is driven by the dialectal course of everything that occurs during the support process.

Research articles about unaccompanied refugee minors (UM) have rarely addressed ethical issues. This is remarkable, given UM's specific, marginalized and vulnerable position within society, and the growing interest and developments in research ethics in refugee research. This article poses the question whether studies involving UM raise specific ethical issues compared to research on other refugee groups. We formulate personal reflections on ethical issues in a particular research project-a longitudinal study of UM in Belgium-and connect them to the existing body of literature on research ethics in qualitative and refugee research. We conclude that research ethics in studies with UM need to be multilayered because of researchers' obligation to take ethical responsibility at both the micro and socio-political levels.