Stepped-care Health Interventions after Exposure to Life-stress and Disaster

SHIELD will develop, adapt, and test digital tools for proactive follow‑up in frontline services (the SHIELD tool), combined with a parent‑led, trauma‑focused intervention (Stepping Together) delivered in frontline services, to strengthen evidence‑based support for children’s stress‑ and trauma‑related needs where the children are.

SHIELD aims to further develop, adapt and pilot clinical methodologies, digital case management tools and training approaches that will equip frontline providers, across health, education and social protection services, with the guidance, skills and supervision needed to:

• Identify, provide basic support and follow up children with stress‑ and trauma‑related needs
• Deliver low‑threshold, caregiver‑led, trauma‑focused, evidence‑based interventions, while reserving scarce specialists for supervision, consultation and step‑up treatment
• Generate aggregated frontline service data to guide evidence‑informed priority setting, resource allocation, and competency and capacity building, driving tailored service development, health emergency preparedness and response through crises and beyond.

Background: Why SHIELD?

Children and families in Ukraine and other war‑affected settings commonly face high unmet mental health needs, relating to cumulative trauma, displacement, bereavement and ongoing insecurity. While many children show resilience, large numbers develop significant stress‑ and trauma‑related difficulties affecting health, sleep, learning, social functioning and family relationships.Following such severe trauma, children’s coping, recovery and resilience depends heavily on their immediate access to adequate care, support, and, when needed, timely evidence-based trauma-focused interventions. In Ukraine as in other low to middle income countries torn by war, children’s access to these resilience-building resources is severely constrained, as the ability of families to support each other and availability of providers across health, education and social protection platforms typically erode in crises. International guidelines (UN, UNICEF, WHO) emphasise the need to:

• Extend early identification, basic support and proactive follow‑up of children’s and caregivers’ stress‑ and trauma‑related needs
• Ensure access to contextually adapted, trauma‑focused care at the lowest effective level of care (stepped care)
• Generate routine frontline data to guide needs‑based priorities and system strengthening

SHIELD responds directly to these needs by co‑developing and piloting a scalable, frontline‑anchored, trauma‑focused stepped‑care model in Ukraine. 

The SHIELD Model: Frontline‑Anchored Stepped Care

SHIELD is built around a stepped‑care “screen and treat” model that can be embedded in existing paediatric, school, community MHPSS and social protection services. The SHIELD Model is a frontline‑anchored, trauma‑focused approach that supports services in systematically identifying, following up and supporting children and caregivers with stress‑ and trauma‑related needs, while making best use of scarce specialist capacity. Building on a brief, semi‑structured clinical interview (the SHIELD tool, pre‑piloted as PAIR‑CA in Norwegian refugee health services with displaced Ukrainian families), the SHIELD stepped-care model is developed to help frontline providers integrate trauma‑informed assessment, basic support and structured follow‑up into everyday workflows, as well as providing low‑threshold, targeted trauma‑focused, evidence‑based caregiver‑led interventions (Stepping Together – continuous stress/war protocol), and secure referral to specialist care when needed. The SHIELD model is currently under development with Ukrainian and international partners, and preparations are underway to pilot an integrated, stepped approach in war‑affected child‑serving systems.

The SHIELD Tool and Stepping Together interventions

The SHIELD Tool is developed by the consortium as a frontline case management tool grounded in validated child trauma and mental health measures and best‑practice assessment domains, and early pilots indicate that it is feasible and clinically useful in routine frontline services. Stepping Together is a parent‑led, trauma‑focused intervention informed by Trauma‑Focused Cognitive Behavioural Therapy (TF‑CBT), with promising results from studies in the USA and Norway showing reductions in children’s post‑traumatic stress and depressive symptoms and improvements in caregiver wellbeing. Within SHIELD, these components are being adapted and combined to form a practical, scalable model that can strengthen everyday services for children affected by war and other crises.

The SHIELD Consortium

The SHIELD Consortium is a transdisciplinary collaboration headed by the Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), with core partners in:

• Ukraine – Kyiv (NaUKMA), Lutsk (Lesya Ukrainka Volyn National University), Zaporizhzhia (ZNU)
• Lithuania – Vilnius University, Center for Psychotraumatology
• Sweden – Karolinska Institutet
• Germany –  Catholic University of Eichstätt‑Ingolstadt (Ukrainian TF‑CBT network)
• United Kingdom – Exeter University
• United States – University of South Florida

The consortium brings together expertise in:

• Child and family health and psychotraumatology across the lifespan
• Psychosocial outreach and MHPSS in war, disaster and crisis settings
• Development, adaptation and implementation of evidence‑based, trauma‑focused interventions for children (individual, caregiver‑led and group‑based)
• Health‑service utilisation and organisation in war‑affected settings
• Psycholinguistics and translation/adaptation of trauma tools and manuals

Together, the consortium and advisory board provide in‑depth knowledge of:

• Ukrainian service systems and wartime mental health challenges
• Ongoing research, training and implementation initiatives across Kyiv, Lutsk and Zaporizhzhia
• Global  best practice in scalable, trauma‑focused care for children and families in crises 

Core Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Norway

NKVTS is a cross sectoral research centre working towards the vision of “A better life for those affected by violence and trauma.” It has a multidisciplinary profile spanning medical, psychological, social, cultural, and legal perspectives. Primary funders include the Norwegian Ministries of Health and Care Services, Justice and Public Security, and Children and Families. Established on 1 January 2004, NKVTS is owned by the research organisation NORCE and has around 100 employees.

Key team members:

• Synne Øien Stensland – Principal Investigator (PI) for SHIELD; paediatrician and Research Professor heading the Section for Trauma, Disasters and Forced Migration – Children and Adolescents at NKVTS; President‑Elect of ISTSS; extensive experience leading major studies on mass violence, disasters and frontline personnel.
• Silje M. Ormhaug –  Co-PI for SHIELD and clinical child and adolescent psychologist; specialist in psychotherapy research and stepped‑care CBT for children after trauma; PI for the Norwegian Stepping Together trial.
• Else Merete Fagermoen – Child and adolescent psychologist; PhD on caregiver roles in Stepping Together; international TF‑CBT trainer; focus on implementation of evidence‑based treatments for traumatized children.
• Molly Carlyle – Researcher with a PhD in psychology; expertise in psychopharmacology, addiction, and how childhood adversity shapes vulnerability to substance use and mental health problems.
• Monica Baumann‑Larsen – Postdoctoral researcher and child psychiatry resident; research on childhood trauma, pain and early analgesic use; contributor to the Utøya Study.
• Eivor Indrebø Lægreid – PhD candidate on reintegration of extremely traumatised and indoctrinated children (e.g. Yezidi children after ISIS captivity).

National University of Kyiv‑Mohyla Academy (NaUKMA), Kyiv, Ukraine

NaUKMA is one of Ukraine’s leading public research universities, with a strong profile in social sciences, public health and psychology. The university hosts the Center for Mental Health and Psychosocial Support, which combines research, training and community‑based programmes to strengthen mental health and psychosocial wellbeing in conflict‑affected populations.

Key team members:

Sergiy Bogdanov – Site PI for SHIELD in the Kyiv region, clinical psychologist and psychotherapist, and Director of the Center for Mental Health and Psychosocial Support at NaUKMA. He leads the development, testing and implementation of psychosocial and clinical programmes for conflict‑affected groups, and was a key developer of SAFE SPACE, a multi‑layered school‑based psychosocial intervention in collaboration with UNICEF and the Ministry of Education and Science of Ukraine.

Oksana Basenko – Research Associate and Project Coordinator at the Center. She holds a PhD in Social Work from NaUKMA and works on projects on developmental psychology, trauma, resilience and youth wellbeing, with coordination experience across academic, NGO and diplomatic settings.

Kateryna Koss – PhD candidate affiliated with NaUKMA. She has been involved in international projects such as the CHANGE Trial with partners including the London School of Hygiene & Tropical Medicine and Harvard T.H. Chan School of Public Health.

Lesya Ukrainka Volyn National University, Lutsk, Ukraine

Lesya Ukrainka Volyn National University is a leading regional university with strong academic programmes in psychology, linguistics and social sciences. It hosts the Ukrainian Psychotrauma Center, a national hub for research, training and clinical innovation on trauma, resilience and mental health in populations affected by war, displacement and continuous traumatic stress.

Key team members:

Larysa Zasiekina – Site PI for SHIELD in the Lutsk region, Professor of Clinical Psychology and founder/director of the Ukrainian Psychotrauma Center. Her work covers PTSD, moral injury, continuous traumatic stress and intergenerational effects of genocidal trauma (including the Holodomor and the Holocaust). She is also a Senior Lecturer at the University of Exeter and leads the Innovations in Translational Mental Health research group.

Serhii Zasiekin – Professor of Applied Linguistics and Research Fellow at Lesya Ukrainka Volyn National University, and Editor‑in‑Chief of the East European Journal of Psycholinguistics. His research explores language and trauma‑related discourse in contexts of war, genocide and displacement, and he has extensive experience in translation and psycholinguistic adaptation of trauma‑related materials.

Yuliia Rozmyrska – Associate Professor in the Department of Educational and Developmental Psychology. Her work focuses on communication and speech‑related aspects of interpersonal interaction, ambiguous loss and the psychological impacts of continuous traumatic stress. She contributes to national research on mental health and quality of life among displaced populations, military personnel and their families.

Zaporizhzhia National University (ZNU), Zaporizhzhia, Ukraine

Zaporizhzhia National University (ZNU) is a major public university in southeastern Ukraine with strong programmes in psychology, education, social sciences and applied research. ZNU collaborates closely with paediatric hospitals, resilience centres, community‑based NGOs and social services that provide integrated somatic, mental health and psychosocial support to children and families in one of Ukraine’s most heavily affected frontline regions.

Key team members:

Natalya Mosol – Site PI for SHIELD in Zaporizhzhia, Associate Professor of Psychology, Deputy Dean for International Affairs and site PI for SHIELD in Zaporizhzhia. Professor Mosol is a clinical child and adolescent psychologist, currently leading the Ukrainian TF-CBT network. She has over 20 years of experience in higher education and professional training, more than a decade of international project management, and extensive applied work in NGO‑based and community mental health initiatives, including wartime psychological assistance for children and families.

Marianna Tkalych – Professor, Doctor of Psychology and CEO of the Research Laboratory “Rating Lab”. She has over 20 years of experience in higher education and academic leadership and leads large‑scale mental health and sociological research, including surveys, qualitative studies and in‑depth interviews, ensuring high‑quality research design and analysis within SHIELD.

Natalya Guba – Head of the Department of Psychology, Associate Professor and PhD in Psychology, with over 35 years of experience in higher education leadership and practitioner training. She has led the design and implementation of numerous psychological training programmes and curricula.

Anastasiia Nemanezhyna – PhD candidate and Assistant at the Department of Psychology, serving as Early‑Career Research and Digital Support Lead. She contributes to digital learning development, online educational components, data collection and integration of digital tools in project‑related research.

Vilnius University, Center for Psychotraumatology, Lithuania

Vilnius University is the leading university in Lithuania with a strong international research profile. The Center for Psychotraumatology conducts multidisciplinary research on trauma and disseminates evidence‑based, trauma‑informed care. The team has particular expertise in resilience and risk factors for trauma‑ and stress‑related disorders, development and implementation of psychosocial interventions, and e‑health solutions.

Key team members:

Professor Evaldas Kazlauskas – Professor of Clinical Psychology, Head of the Center for Psychotraumatology and Vice‑Dean of Research at the Faculty of Philosophy. A pioneer of psychotraumatology in Lithuania, he is a former President of the European Society for Traumatic Stress Studies (ESTSS) and current ISTSS Board member, with more than 100 scientific publications.

Dr Paulina Želvienė – Associate Professor and Senior Researcher at Vilnius University, where she leads the Research Group on Child and Adolescent Psychotraumatology. A clinical psychologist, she is Board Member of the Lithuanian Trauma Psychology Association, President of EMDR Lithuania and member of the EMDR Europe Scientific Committee, with a research focus on child and adolescent trauma, evidence‑based interventions and large‑scale projects such as HACHI and STARA.

Karolinska Institutet, Sweden

Karolinska Institutet is one of Europe’s leading medical universities with a strong focus on psychiatric and trauma research. The Department of Clinical Neuroscience and Centre for Psychiatry Research contribute expertise on child and adolescent trauma, forced migration and scalable trauma‑focused interventions.

Key team members:

Dr Erica Mattelin is a clinical psychologist and postdoctoral researcher at Karolinska Institutet. Her work focuses on trauma, forced migration, PTSD and child and adolescent mental health. She has extensive clinical experience from Save the Children Sweden, where she provided support to children affected by violence, war and displacement, and has contributed to the development and evaluation of digital trauma treatments and low‑intensity psychological support for young people. Dr. Mattelin is a licenced TFCBT trainer, and has contributed to the TF-CBT trainings in the Ukrainian TF-CBT network. 

Michael Larsson is a clinical child and adolescent psychologist and licensed psychotherapist with decades of experience in child and adolescent trauma work. He has provided TF‑CBT training and supervision since 2010 and has been actively involved in two Ukrainian TF‑CBT projects, contributing to capacity building and supervision within the Ukrainian child trauma network.

University of South Florida (USF), USA

The University of South Florida is a major public research university with strong programmes in social work and child mental health. Within SHIELD, USF contributes expertise in stepped‑care trauma‑focused interventions for children.

Key team member:

Professor Alison Salloum – Professor in the School of Social Work. Her research focuses on evidence‑based treatments for childhood trauma, including interventions for children, adolescents and families affected by violence, disaster and loss. She developed Stepping Together, the parent‑led, therapist‑assisted programme used as the basis for SHIELD’s caregiver‑led component, as well as the Grief and Trauma Intervention (GTI), which is included on national evidence‑based registries. She is also a national TF‑CBT trainer.

University of Oslo (UiO) and Oslo University Hospital (OUS), Norway

The University of Oslo and Oslo University Hospital are longstanding partners of NKVTS with shared programmes in child and adolescent psychiatry, paediatrics and psychotraumatology. UiO/OUS and NKVTS collaborate on large cohort and registry studies such as the Covid Hospital Cohort, PATHWAYS and the Utøya terror research projects.

Selected collaborators:

Professor Grete Dyb – Vice Dean at the Medical Faculty, UiO, child and adolescent psychiatrist, and senior researcher at NKVTS, with extensive experience from leading major terror, disasters and child mental health studies. Past president of the International Society for Traumatic Stress Studies, ISTSS.

Professor Tine Jensen – Child and adolescent psychologist, and senior researcher at NKVTS, with extensive experience from leading the implementation of major studies of evidence-based trauma-focused interventions for children in Norway. 

Professor Randi Ulberg – Professor of Psychiatry at UiO with expertise in youth mental health and psychotherapy research.

Professor Frank Becker – Professor of Physical Medicine and rehabilitation, Head of Department Sunnaas rehabilitation hospital, with extensive experience from the NorDoc Norway-Ukraine collaboration.

Professor Ketil Størdal – Paediatrician and Professor at UiO, with expertise in paediatrics and global child health.

Professor John‑Anker Zwart – Professor of Neurology at UiO/OUS, Head of Research and Innovation, at the Neuroclinic Oslo University Hospital.

Maren Karoline Frogner – MD and postdoctoral researcher in the PATHWAYS project at OUS and NKVTS, focusing on adverse outcomes and health pathways following childhood trauma, with additional experience in project management and child‑focused humanitarian work.

User and Practitioner Involvement

User and practitioner involvement is central to SHIELD.

• Norwegian municipal services have piloted the first edition of the semi‑structured SHIELD clinical interview for case management (PAIR‑CA) in refugee health services, providing essential practice‑based input to the digital SHIELD Tool. In this work Ukrainian user and practitioner panels contribute to:
  • Co‑design and adaptation of the SHIELD Tool 
  • Feedback on feasibility, acceptability and relevance in frontline practice

User involvement is integrated throughout the project, with frontline providers informing:

• The wording and structure of assessment tools
• The practical organisation of stepped care and referral pathways
• Recommendations for sustainable scale‑up in service systems

Funding

SHIELD has received funding from:

• The University of Oslo (three consecutive allocations in 2023, 2024 and 2025) supporting the development, piloting and refinement of the SHIELD Tool and stepped‑care model
• Additional institutional and in‑kind contributions from NKVTS and partner institutions

Outputs, Publications and Dissemination

Tools and Protocols

• The Pre-SHIELD Tool – piloted in Norwegian community-based refugee health services:
  • The Psychosocial assessment of refugees in reception phase, child and adolescent version (PAIR-CA): https://www.nkvts.no/ressurser-og-verktoy/kartleggingsverktoy/kartleggingsverktoy-barn-pair/
• Basic Frontline Package (Step 0) – Training materials, supervision manuals and digital decision‑support tools for frontline providers
  • Kunnskapsstatus barn, unge og familier  
  • Kunnskapsstatus voksne  
  • https://www.nkvts.no/ressurser-og-verktoy/flyktning/  
  • Webinar: På flukt fra krigen i Ukraina, hvordan kan vi hjelpe flyktningene i Norge? 

Scientific and Practice‑Oriented Outputs

• Practice briefs and Norwegian‑language articles and reports, including:
  • National guidance and commentary on trauma‑focused stepped care for children Publications Stensland et al 202, Tidsskrift for Den norske legeforening, https://tidsskriftet.no/en/2023/12/specialties/follow-those-affected-war-and-disasters
  • NKVTS-Report “Skal vi snakke om psykisk helse“: A pilot study of perceived help‑seeking needs and       attitudes toward mental health among Ukrainian refugees.
• Conference presentations and invited talks (ISTSS, ESTSS and other professional societies)