Promoting Asylum-seeking and Refugee Children's Coping With Trauma

Implementation and Evaluation of Teaching Recovery Techniques (TRT) Among Asylum-seeking and Refugee Children

A short term trauma-focused cognitive- behavioral program to reduce trauma-related mental health problems among asylum-seeking and refugee children.

The main hypothesis of the study is that the TRT program significantly improves mental health (i.e. reduces symptoms of post-traumatic symptoms, depression and generalized anxiety and increases perceived quality of life (Qol) in the intervention group compared to the waiting-list control group.

Study Overview

• Status: Completed
• Conditions: Depression; Mental Health Disorder; Social Anxiety; Post-Traumatic Stress Disorder in Adolescence
• Intervention / Treatment: Behavioral: Teaching Recovery Techniques, TRT

Detailed Description

Teaching Recovery Techniques (TRT) was developed by Children and War Foundation (www.childrenandwarfoundation.org ) as a tool to support children in coping with their mental reactions to being exposed to war and catastrophes. TRT has proven to be effective in reducing trauma-related mental health symptoms in such contexts. However, it has never been used with children experiencing all the uncertainties and stress of an asylum-seeking context, or with refugee children in high-income countries. The main aim of the present study is therefore to implement and evaluate the TRT among asylum-seeking and refugee children in the context of four different care conditions: 1)asylum-seeking children who arrived accompanied by a legal care-taker 2) asylum-seeking children less than 15 years in care centers administered by the Child Welfare Services 3) asylum-seeking children 15 years and older living in asylum centers regulated by the Directorate of Immigration 4) Former unaccompanied asylum-seeking children who have been granted residence (refugees) and are resettled in a municipality in Norway.

Based on Power analyses, the target group is 40 children in each care condition (total n = 160) > 9 years speaking Arabic, Tigrinya, Somali, Dari, or Pashto.

The study employs a randomized clustered experimental design that includes a waiting list control group, which will receive the TRT when the intervention group has completed the program.

• Study Type: Interventional
• Enrollment (Actual): 170
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Norway
  • Bergen, Norway
    • Bergen Municipality
  • Dokka, Norway
    • Nordre Land municipality
  • Drammen, Norway
    • Drammen Municipality
  • Drevsjø, Norway
    • Engerdal Municipality
  • Fredrikstad, Norway
    • Fredrikstad municipality
  • Gjøvik, Norway
    • Gjøvik municipality
  • Hønefoss, Norway
    • Ringerike Municipality
  • Kirkenær, Norway
    • Grue municipality
  • Leira, Norway
    • Levanger municipality
  • Lyng, Norway
    • Lyngdal municipality
  • Lyngdal, Norway
    • Lyngdal municipality
  • Rud, Norway
    • Bærum municipality
  • Sjøvegan, Norway
    • Salten municipality
  • Stavanger, Norway
    • Stavanger municipality
  • Trondheim, Norway
    • Trondheim Municipality
  • Vadsø, Norway
    • Vadsø municipality

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 years to 20 years (ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Accompanied asylum-seeking children living in reception centers,
• Unaccompanied asylum-seeking children living in reception centers
• Unaccompanied refugee minors who have been granted residence

Children in the target Groups reported symptoms of post-traumatic stress above clinical cut-off on Children's Revised Impact of Event Scale, 8 items

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Exclusion Criteria:

• Psychosis,
• Mental disabilities

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NON_RANDOMIZED
• Interventional Model: SEQUENTIAL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Intervention group; Teaching Recovery Techniques implemented 1- 3 weeks after recruitment	Behavioral: Teaching Recovery Techniques, TRT; TRT is a , low-threshold, group based, manual driven short term intervention to reduce trauma-related mental health problems. The program is based on principles from trauma-focused cognitive-behavioral therapy
ACTIVE_COMPARATOR: Wait-list control group; Delayed implementation of Teaching Recovery Techniques (after the experimental group has completed the program)	Behavioral: Teaching Recovery Techniques, TRT; TRT is a , low-threshold, group based, manual driven short term intervention to reduce trauma-related mental health problems. The program is based on principles from trauma-focused cognitive-behavioral therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Children's Revised Impact of Event Scale (CRIES-13)	Self-reported symptoms of intrusion, hyperarousal and avoidance. ' The participants check how often during the last week they had each symptom from "never" (0); "rarely" (1) "sometimes" (3) and "frequently" (5)	Change in CRIES-13 scores from baseline (T1) to two weeks (T2) and two months after intervention is completed.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Screen for Child Anxiety Related Disorders (SCARED). 9 items tapping symptoms of generalized anxiety disorder, and 7 items tapping symptoms of social anxiety	Measures if children have perceived each anxiety symptom over the last three months from "not true, or hardly ever true" (0), "somewhat true or sometimes true" (1) "very true or often true" (2)	Change in SCARED-scores from baseline (T1) to two weeks (T2) and two months after intervention is completed.
Cantril Ladder	Measures current subjective well-being on a ladder With 11 steps from "worst possible life" (0) to "best possible life" (10)	Change in scores from baseline (T1) to two weeks (T2) and two months after intervention is completed.
Montgomery-Aasberg Depression Scale, MADRS	9 items assessing patients' mood, feelings of unease, sleep, appetite, ability to concentrate, initiative, emotional involvement, pessimism and zest for life over the last three days. Each item is scored between 0 (not a problem for me) and 3 (affects me very much), with three intermediate levels (0.5, 1.5, 2.5).	Change in MADRS-scores from baseline (T1) to two weeks (T2) and two months after intervention is completed.

Collaborators and Investigators

• Sponsor: Norwegian Institute of Public Health
• Collaborators: University of Bergen; University of Tromso; Norwegian Directorate of Children, Youth, and Family Affairs; Norwegian Directorate of Immigration; Norwegian Directorate of Integration and Diversity

Study record dates

Study Major Dates

• Study Start (ACTUAL): June 20, 2017
• Primary Completion (ACTUAL): May 31, 2018
• Study Completion (ACTUAL): June 30, 2018

Study Registration Dates

• First Submitted: January 21, 2019
• First Submitted That Met QC Criteria: January 28, 2019
• First Posted (ACTUAL): January 30, 2019

Study Record Updates

• Last Update Posted (ACTUAL): January 30, 2019
• Last Update Submitted That Met QC Criteria: January 28, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Keywords: Teaching Recovery Techniques; Asylum-seeking children; Refugee children; Low-threshold intervention
• Additional Relevant MeSH Terms: Pathologic Processes; Trauma and Stressor Related Disorders; Disease; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Mental Disorders
• Other Study ID Numbers: 16/54571

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: It is not yet known if there will be a plan to make Individual Patient Data (IPD) available. If IPD are to be shared, we follow the regulations of the Norwegian Institute of Public Health

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No