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

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. 

/pdf/multimodal-co-therapy-for-unaccompanied-minors-a-qualitative-20ea4ydv.pdf

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.

/pdf/trauma-focused-treatment-for-traumatic-stress-symptoms-in-1peo13e5.pdf

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

ABSTRACT Objective The number of forced migrants has been rising for years. Many forced migrants suffer from post‐traumatic stress disorder (PTSD), depression, and/or anxiety and need treatment. Here, we evaluate the effectiveness of psychological interventions (CBT, EMDR, expressive/art, mindfulness, mixed elements, NET and psychoeducation) in reducing symptoms of PTSD, depression, and anxiety in forced migrants. Design and Data Sources Systematic searches in PubMed and Web of Science and searches of preprint servers and grey literature were performed (final search date: 1 September 2023). Random‐effects frequentist and Bayesian meta‐analyses were used for data synthesis. Results We included 84 studies on treatment effects in adults (pooled N = 6302) and 32 on children and adolescents (pooled N = 1097). Our data show a reduction in symptoms of PTSD, depression and anxiety symptoms in both adults and child/adolescent forced migrants. Pooled pre‐ to post‐treatment effects (effect size Cohen's d ) ranged from −1.03 to −0.26 for PTSD, from −0.91 to −0.11 for depression and from −0.91 to −0.60 for anxiety, without there being differences in outcome per study design (i.e., RCT comparison vs. non‐RCT comparison vs. single arm treatment study). Treatment effects remained evident over follow‐up, and not a single type of treatment stood out as being superior to other treatment types. Structural differences in populations (e.g., regarding country of origin) over studies, however, could have hampered the validity of the comparisons between study characteristics such as treatment type. Conclusion Our findings support the effectiveness of psychological treatment in adult and child/adolescent forced migrants. 

Psychological Interventions for PTSD, Depression, and Anxiety in Child, Adolescent and Adult Forced Migrants: A Systematic Review and Frequentist and Bayesian Meta‐Analyses

Youth refugees and asylum seekers are vulnerable to mental health conditions. Although their mental health needs are well documented, evidence reveals that they are underutilizing mental health services. This integrative literature review aims to examine the evidence on barriers to mental health access experienced by youth refugees and asylum seekers, determine the literature gaps, and identify the future direction of research in the field. Academic databases, such as CINAHL, OVID MEDLINE (R), PsycINFO, EMBASE, and Web of Science, as well as grey literature, were used to identify eligible articles. A total of 29 articles were included in this review. Our findings revealed 5 major themes: (a) approachability and ability to perceive; (b) acceptability and ability to seek; (c) availability, accommodation, and ability to reach; (d) affordability and ability to pay; and (e) appropriateness and ability to engage. These findings can assist multiple stakeholders in improving mental health access, quality, and provision.

Barriers associated with inaccessible mental health services for youth refugees and asylum seekers: an integrative review

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
 .

/pdf/overcoming-barriers-to-mental-health-care-multimodal-trauma-5b5dvp2vi5.pdf

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

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