COPYRIGHT © 2022 Costanza, Amerio, Aguglia, Magnani, Huguelet, Serafini, Pompili and Amore. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Meaning-centered therapy in Ukraine’s war refugees: An attempt to cope with the absurd?

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Meaning-centered therapy in Ukraine's war refugees: An attempt to cope with the absurd?

The effectiveness of trauma treatment approaches in refugee children and adolescents: A systematic review

The present paper attempts to provide preliminary support for the use of narrative exposure therapy (NET) in a child protection context. The prevalence of violence, abuse and neglect (VAN) within New South Wales is outlined as well as the current perspectives in trauma definition and symptomology, and the prevalence of trauma symptomology among birthparents and young people within child protection services. NET is introduced including its theoretical background, methodology, applications and research. Four applications of NET within a child protection context are presented, including lifelines and narrative excerpts. Specific themes presented included experiences of physical abuse, domestic and family violence, parental drug use, suicidal ideation and child removal. Statistical analysis including reliable change, clinical and statistical significance of pre- and post-PCL-5 outcomes measures are presented to infer preliminary support for NET within a child protection context. Limitations and future considerations for future research are discussed. 

Preliminary support for the use of narrative exposure therapy in a child protection context: Collective case‐study narratives

Abstract Background Unaccompanied refugee minors—or unaccompanied minors—are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients’ experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative &amp; institutional approaches to care. Methods MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). Results Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one’s story can “set us free” if guided carefully by care providers. Conclusion This study suggests that MUCTUM therapy may efficiently support unaccompanied minors’ mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted. 

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Multimodal co-therapy for unaccompanied minors: a qualitative study

Introduction Unaccompanied refugee minors (URMs) are at increased risk of developing mental health problems, such as symptoms of posttraumatic stress disorder (PTSD) and depression. In addition, URMs face several barriers to mental health care. Few studies have evaluated trauma-focused interventions for URMs that target these issues. The current study evaluated a multimodal trauma-focused treatment approach for URMs. It aimed to provide an initial indication of the effectiveness of this treatment approach and to provide a qualitative evaluation assessing treatment satisfaction of the participating URMs. Methods A mixed-methods study was conducted among ten URMs, combining quantitative data with qualitative data through triangulation. Quantitative data were collected using a non-concurrent multiple baseline design in which repeated, weekly assessments were carried out during a randomized baseline period, during treatment, and during a 4-week follow-up period. Questionnaires assessing PTSD (Children’s Revised Impact of Event Scale) and symptoms of depression (The Patient Health Questionnaire-9, modified for adolescents) were used. In addition, treatment satisfaction was measured post-treatment using a semi-structured interview. Results During the qualitative evaluation, all but one URM noted they found the trauma-focused treatment approach useful and felt the treatment had positively impacted their wellbeing. However, the results of the quantitative evaluation did not show clinically reliable symptom reductions at posttest or follow-up. Implications for clinical practice and research are discussed. Discussion The current study presents our search in developing a treatment approach for URMs. It adds to the current knowledge about methodological considerations in evaluating treatments for URMs, the potential effects of trauma-focused treatments on URMs, and the implementation of treatments for URMs. Clinical trial registration: The study was registered in the Netherlands Trial Register (NL8519), 10 April 2020.

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Trauma-focused treatment for traumatic stress symptoms in unaccompanied refugee minors: a multiple baseline case series

This study evaluated the feasibility of a short-term, multimodal trauma-focused treatment approach adapted specifically for unaccompanied refugee minors (URMs) in the Netherlands. This approach aims to overcome barriers to mental health care and to reduce symptoms of posttraumatic stress disorder (PTSD) and depression. An uncontrolled study was conducted, evaluating the main request for help, treatment integrity and feasibility, and the course of symptoms of PTSD (Children's Revised Impact of Event Scale-13) and depression (Patient Health Questionnaire modified for Adolescents). In total, 41 minors were included in the study. Most participants were male (n = 27), predominately from Eritrea (75.6%) with a mean age of 16.5 (SD = 1.5). Minors mostly reported psychological problems, such as problems sleeping, and psychosocial problems, including worries about family reunification. Deviations from the approach were made to meet the current needs of the minors. Factors limiting the feasibility of the approach were often related to continuous stressors, such as news concerning asylum status. The results provide a first indication that this approach partly overcomes barriers to mental health care and emphasize the added value of collaborating with intercultural mediators and offering outreach care. Trial registration: The study was registered in the Netherlands Trial Register (NL8585), 10 April 2020, Retrospectively registered, https://www.trialregister.nl/trial/8585
 .

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Overcoming barriers to mental health care: multimodal trauma-focused treatment approach for unaccompanied refugee minors.

Abstract Background Prevalence of posttraumatic stress disorder (PTSD) in refugees is reportedly higher in comparison to the general population. Refugee children specifically are often coping with trauma and loss and are at risk for mental health difficulties. With staggering numbers of people seeking refuge around the world and 50% being 18 years or younger, research examining the effects of trauma-focused therapies for refugee children with PTSD is highly needed. Both Eye Movement Desensitization and Reprocessing (EMDR) therapy and the child version of Narrative Exposure Therapy (KIDNET) have been used for refugees, although these treatment methods have not been systematically compared. The aim of the current study is to investigate the effectiveness of EMDR and KIDNET, compared to a waitlist control group and with each other, offered to refugee children. Methods A randomized controlled three-arm trial has been designed. The primary outcome is PTSD diagnosis and symptom severity assessed with the Clinician-Administered PTSD Scale for Children DSM5 (CAPS-CA-5) at baseline (T1), 1 month post-treatment, or after 8 weeks of waiting (T2) and 3 months follow-up (T3). Additionally, instruments to assess posttraumatic stress symptoms, behavioral and emotional problems, and quality of life perception in children aged 8–18 are conducted at T1, T2, and T3. Discussion This is the first RCT that examines the effectiveness of EMDR and KIDNET in refugee children aged 8–18 years specifically, compared to a waitlist control group intended to reduce PTSD diagnosis and severity of posttraumatic stress symptoms and comorbid complaints in a growing and challenging population. Trial registration Dutch Trial Register NL40769 . Retrospectively registered on June 16, 2021. 

https://trialsjournal.biomedcentral.com/track/pdf/10.1186/s13063-022-06178-z

Trauma-focused treatments for refugee children: study protocol for a randomized controlled trial of the effectiveness of KIDNET versus EMDR therapy versus a waitlist control group (KIEM)

ABSTRACT Background: Prevalence of posttraumatic stress disorder (PTSD) in refugees is higher compared to the general population, and barriers in accessing mental health care are often experienced. With staggering numbers of people seeking refuge around the world, and 40% being 18 years or younger, effective trauma-focused therapies for refugee children with PTSD are highly needed. Objective: A systematic review and meta-analyses were conducted to provide an overview of, and to analyse, intervention studies using PTSD measures in young refugees, assessing treatment effectiveness and addressing efforts to mitigate barriers to mental health care. Method: Eleven databases were searched for studies evaluating trauma-focused treatments (TFT) for refugee children (0–18). Meta-analyses were conducted for all included studies grouped together; and second, per intervention type, using posttreatment measures and follow-up measures. Pooled between-group effect sizes (ESs) and pre–post ESs, using a random-effects model were calculated. Results: A total of 47 studies was retrieved, with 32 included in the meta-analyses. The narrative review highlighted positive outcomes in reducing posttraumatic stress symptoms for CBT-based interventions, EMDR therapy, KIDNET, and other treatments such as art therapy. Meta-analyses revealed medium pooled pre–post ESs for CBT-based interventions (ES = −.55) and large for EMDR therapy (ES = −1.63). RCT and CT studies using follow-up measures showed promising outcomes for KIDNET (ES = −.49). High heterogeneity of the included studies limited interpretation of several other combined effects. Results should be interpreted with caution due to the generally low quality of the included studies. All studies addressed efforts to minimize treatment barriers. Conclusion: More high-quality studies are urgently needed to inform treatment recommendations. Evidence-based therapies, such as CBT-based interventions, EMDR therapy, and KIDNET, demonstrate promising findings but need further replication. Strategies to overcome barriers to treatment may be necessary to reach this population. HIGHLIGHTS A systematic review and meta-analysis evaluated intervention studies targeting PTSD in young refugees, analysing treatment effectiveness and barriers to mental health care. Meta-analyses revealed medium to large pre–post effect sizes for CBT-based interventions and EMDR therapy. Medium between-group effect sizes where shown for KIDNET when using follow-up measures, suggesting effectiveness over time. All studies addressed efforts to minimize treatment barriers. Due to high heterogeneity and generally low study quality, additional high-quality research is needed to inform treatment recommendations. Implementing strategies to overcome treatment barriers may be essential for effectively reaching this population.

Effectiveness of trauma-focused treatments for refugee children: a systematic review and meta-analyses.

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Overcoming barriers to mental health care: multimodal trauma-focused treatment approach for unaccompanied refugee minors.

Trauma-focused treatments for refugee children: study protocol for a randomized controlled trial of the effectiveness of KIDNET versus EMDR therapy versus a waitlist control group (KIEM)

Effectiveness of trauma-focused treatments for refugee children: a systematic review and meta-analyses.

Trauma-focused treatment for traumatic stress symptoms in unaccompanied refugee minors: a multiple baseline case series