Psychosocial response and trauma treatment for children and adolescents after the mass shootings in Serbia (2023–2026)
In May 2023, Serbia was struck by two mass shootings: at Vladislav Ribnikar Elementary School in Belgrade and in the Mladenovac area, where 18 people were killed, many of them children and adolescents. In response to a request from Serbian authorities, via the Norwegian Embassy and the United Nations Development Programme (UNDP), NKVTS has since 2023 collaborated with the Institute of Mental Health (IMH) in Belgrade to strengthen the country’s psychosocial response and build capacity for evidence-based trauma treatment for children and adolescents. This includes implementation of Psychological First Aid for schools, support for the establishment of a resilience and recovery centre for adolescents, and competence- and capacity-building in evidence-based trauma-focused treatment for children and adolescents.
Project Manager
Project Members
- Bækkelund, Harald
- Granly, Lene Beate
- Husebø, Gry
- Kjuus, Sigrid
- Knutsen, Marie Lindebø
- Løwgren, Ragnhild Holm
- Sigrid Kjuus
- Lise Tveter
- Knut Gythfeldt
- Mikael Zeiner
- Tore Indregard
- Geir Ove Kværk
- Cecilie Daae
Overall goal
The overall goal of the project is to strengthen the professional collaboration between NKVTS, IMH and the Serbian authorities, in order to ensure that children, adolescents and families affected by the May 2023 mass shootings have access to necessary psychosocial support and trauma treatment, while at the same time contributing to strengthening national preparedness and capacity to respond to future crises and disasters.
Specific aims
Aim 1 – Expert support for systematic follow-up
The collaboration aims to provide expert support to IMH and the Serbian authorities in planning and implementing systematic, evidence-based psychosocial follow-up of directly and indirectly affected individuals over time. A key objective has been to develop methods to identify and follow up affected children and adolescents, as well as their families’ stress- and trauma-related support needs, at the lowest effective level of care.
Aim 2 – Low-threshold interventions in schools
Another aim has been to help identify and implement appropriate low-threshold interventions, particularly in schools. In collaboration with IMH, a school-based intervention, Psychological First Aid (PFA) for Schools, developed by the National Child Traumatic Stress Network (NCTSN), was selected. NKVTS has assisted in establishing contact with the developers and facilitated translation, training and implementation of PFA for Schools in the affected schools.
Aim 3 – Youth resilience centre (CEZAM)
Based on needs identified by IMH and UNICEF for strengthened psychosocial support for adolescents in Belgrade, NKVTS has also provided expert support for the development of the youth resilience centre CEZAM. CEZAM combines a physical and digital meeting place with access to psychosocial low-threshold services and treatment.
Aim 4 – Capacity-building in trauma-focused treatment
Another important aim has been to build capacity and competence in trauma-focused treatment for children and adolescents in Serbia. This has been done through training, supervision and the initial implementation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in services, with the goal of establishing local therapist and supervisor competence.
Cross-cutting aim – International collaboration and knowledge exchange
Across all components, a cross-cutting aim has been to strengthen international collaboration and knowledge exchange on evidence-based psychosocial preparedness and response following terrorist attacks, mass shootings and other disasters, with particular emphasis on ensuring that affected children, adolescents and families receive the help they need in time.
Method
The collaboration is based on a combination of collegial support, expert advisory services, capacity-building and implementation support.
Phase 1: Expert advisory services and method development
In the first phase, NKVTS provided expert advice to the national mental health task force, IMH, health authorities and the education sector on the organisation and content of evidence-based psychosocial follow-up. The advisory work was based on international guidelines and experiences from crises and disasters in Norway and other countries and was delivered through digital meetings, a professional workshop in Belgrade hosted by the Norwegian Embassy, and contributions to conferences and professional meetings organized by IMH and UNICEF.
During this phase, NKVTS contributed to the development of methods and tools for identifying and following up affected children and adolescents and their families, with emphasis on tailored interventions at different levels of care.
Phase 2: Low-threshold services and youth resilience centre
In joint workshops, a need for a structured, school-based intervention for those affected was identified. IMH wished to implement Psychological First Aid for Schools, and NKVTS assisted in establishing contact with NCTSN and facilitated translation, training and implementation in affected schools.
Based on assessments and needs analyses conducted by IMH and UNICEF, NKVTS has also provided expert support for the development of CEZAM, a resilience and recovery centre for adolescents in Belgrade. CEZAM functions both as a social meeting place and as a psychosocial low-threshold service, and also provides access to more targeted treatment.
Phase 3: Capacity-building in trauma-focused treatment (TF-CBT)
Due to limited capacity and competence in trauma-focused treatment for children and adolescents in Serbia, IMH and UNDP called for a dedicated effort to strengthen evidence-based trauma-focused treatment for children and adolescents. Following a request from IMH and with funding from UNDP, and in agreement with the US developers, NKVTS has therefore provided training and supervision in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), with the long-term goal of systematic capacity-building in trauma-focused treatment for children and adolescents.
Specialists (psychologists and physicians in specialist training in child and adolescent psychiatry) were recruited to the training and supervision programme. The programme comprised a three-day TF-CBT course at IMH, followed by monthly supervision for one year in line with international guidelines. At final evaluation, the majority of participants were still active and had implemented TF-CBT in clinical practice. In response to requests from IMH and UNDP, the project is planned to continue, with the aim of consolidating implementation by identifying and training local supervisors, establishing local supervision groups under Serbian leadership, and providing monthly digital supervision from NKVTS to ensure sustained quality and fidelity to the model.
Ownership, funding and partners
On the Serbian side, the Institute of Mental Health (IMH) in Belgrade is the main collaboration partner and professional anchor institution, mandated by the Serbian authorities and the national task force for child and adolescent mental health, led by Professor Milica Pejović-Milovančević (child and adolescent psychiatry, MD, PhD). On the Norwegian side, NKVTS, represented by Principal Investigator Synne Øien Stensland (MD, PhD, paediatrician), is the professional partner. NKVTS Director Cecilie Daae is the project owner on the Norwegian side.
The initial phase in 2023 was carried out within the framework of a collaboration between IMH, the Serbian authorities, NKVTS and the Norwegian Embassy. The TF-CBT implementation in the period 2024–2025 is funded by the United Nations Development Programme (UNDP), and further consolidation in 2026 is contingent on continued funding from UNDP.
The extended professional collaboration also includes UNICEF Serbia, the Norwegian Embassy and several international experts, including from the University of Manchester, the NHS and the National Child Traumatic Stress Network (NCTSN) represented by Melissa Brymer, as well as TF-CBT developers Judith Cohen, Anthony Mannarino and Esther Deblinger.