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It is estimated that over one billion children and adolescents live in regions affected by armed conflict Oacob et al., 2007). Whereas access to mental health care is already very limited in low- and middle-income countries (LAMIC}-the World Health Organization (WHO) estimates the level of untreated mental disorders among adults in low- and middleincome countries may be as high as 78 percent (Kohn, Saxena, Levav & Saraceno, 2004)-the gap between the need for services and their limited availability is accentuated in regions affected by armed conflict (Betancourt, McBain, Newnham & Brennan, 2013; IASC, 2007; Walker et al., 2011). Among adolescents and youth exposed to war, psychological distress may be expressed in higher rates of internalizing problems such as PTSD, depression, withdrawal, and social isolation as well as externalizing problems (e.g., aggression, hostility) (Betancourt et al ., 2013; Bryant, 2006; Johnson et al., 2008). Although many war-affected youth demonstrate great resilience, those who continue to suffer elevated levels of distress and impairment in the post-conflict environment are at risk for poor health and development, low rates of school completion, and poor economic self-sufficiency (Bayer, Klasen & Adam, 2007; Betancourt et al., 2008; Derluyn, Broekaert, Schuvten & De Temmerman, 2004). Few evidence-based i~terventions exist to. address mental health problems in war-affected youth (To! et al., 2011), and even fewer interventions focus on helping war-affected youth struggling with distress and impairment to navigate successful transitions to school and employment programs.
Given years of sustained exposure to violence and subsequent polyvictimization and loss among young people in war zones, it is important that the scope of interventions be broadened beyond models targeting a singular disorder such as depression or PTSD to anticipate comorbidity and diverse manifestations of complex trauma (Cloitre, 2009; Lanktree et al., in press; Peltonen & Punamaki, 2010). The present study used a multiphase mixed methods design (see figure 7.1) to inform the development of a feasible and acceptable intervention for war-affected youth. In this design, results of a prior longitudinal study and new qualitative data were integrated to identify the focal points for intervention development. The quantitative data investigated the longitudinal trajectories of psychological distress in the post-conflict setting, and qualitative data were collected to assess specific areas of priority per the opinions of stakeholders on ongoing emotional and behavioral problems that pose obstacles to successful functioning among some war-affected youth. These findings were used to identify important intervention components and modalities for treatment delivery.