A cluster randomized-controlled trial of a classroom-based drama workshop program to improve mental health outcomes among immigrant and refugee youth in special classes

Cécile Rousseau, Caroline Beauregard, Katherine Daignault, Harriet Petrakos, Brett D Thombs, Russell Steele, Helen-Maria Vasiliadis, Lily Hechtman, Cécile Rousseau, Caroline Beauregard, Katherine Daignault, Harriet Petrakos, Brett D Thombs, Russell Steele, Helen-Maria Vasiliadis, Lily Hechtman

Abstract

Objectives: The aim of this cluster randomized trial was to evaluate the effectiveness of a school-based theatre intervention program for immigrant and refugee youth in special classes for improving mental health and academic outcomes. The primary hypothesis was that students in the theatre intervention group would report a greater reduction in impairment from symptoms compared to students in the control and tutoring groups.

Methods: Special classrooms in five multiethnic high schools were randomly assigned to theater intervention (n = 10), tutoring (n = 10) or control status (n = 9), for a total of 477 participants. Students and teachers were non-blinded to group assignment. The primary outcome was impairment from emotional and behavioural symptoms assessed by the Impact Supplement of the Strengths and Difficulties Questionnaire (SDQ) completed by the adolescents. The secondary outcomes were the SDQ global scores (teacher and youth reports), impairment assessed by teachers and school performance. The effect of the interventions was assessed through linear mixed effect models which incorporate the correlation between students in the same class, due to the nature of the randomization of the interventions by classroom.

Results: The theatre intervention was not associated with a greater reduction in self-reported impairment and symptoms in youth placed in special class because of learning, emotional and behavioural difficulties than a tutoring intervention or a non-active control group. The estimates of the different models show a non-significant decrease in both self-reported and impairment scores in the theatre intervention group for the overall group, but the impairment score decreased significantly for first generation adolescents while it increased for second generation adolescents.

Conclusion: The difference between the population of immigrant and refugee youth newcomers studied previously and the sample of this trial may explain some of the differences in the observed impact of the theatre intervention.

Trial registration: ClinicalTrials.gov NCT01426451.

Conflict of interest statement

Competing Interests: Brett Thombs is a PLOS ONE Editorial Board member and this does not alter the authors' adherence to PLOS ONE Editorial policies and criteria.

Figures

Figure 1. Participant Flow Diagram.
Figure 1. Participant Flow Diagram.

References

    1. Reddy LA, Newman E, De Thomas CA, Chun V (2009) Effectiveness of school-based prevention and intervention programs for children and adolescents with emotional disturbance: A meta-analysis. Journal of School Psychology 47: 77–99.
    1. Wilson SJ, Lipsey MW (2007) School-based interventions for aggressive and disruptive behavior: Update of a meta-analysis. American journal of preventive medicine 33: S130–S143.
    1. Glick JE, White MJ (2003) The academic trajectories of immigrant youths: Analysis within and across cohorts. Demography 40: 759–783.
    1. Rumbaut R, Portes A (2001) Ethnicities: Children of immigrants in America. New York: University of California Press. Russell Sage Foundation. 334 p.
    1. Van Hook J, Stamper Balistreri K (2002) Diversity and change in the institutional context of immigrant adaptation: California schools 1985–2000. Demography 39: 639–654.
    1. Bibeau G, Chan-Yip AM, Lock M, Rousseau C, Sterlin C, et al... (1992) La santé mentale et ses visages: Un Québec pluriethnique au quotidien. Boucherville: Gaëtan Morin. 289 p.
    1. Rousseau C, Drapeau A, Corin E (1996) School performance and emotional problems in refugee children. American Journal of Orthopsychiatry 66: 239–251.
    1. Kanouté F (2002) Les profils d'acculturation d'élèves issus de l'immigration récente à Montréal. Revue des sciences de l'éducation 28: 171–190.
    1. Rasco LM, Miller KE (2004) Innovations, challenges, and critical issues in the development of ecological mental health interventions with refugees. In: Miller KE, Rasco LM, editors.The mental health of refugees: Ecological approaches to healing and adaptation.New Jersey: Lawrence Erlbaum Associates. pp. 375–416.
    1. Hodes M (2000) Psychologically distressed refugee children in the United Kingdom. Child Psychology & Psychiatry Review 5: 57–68.
    1. Rousseau C, Guzder J (2008) School-based prevention programs for refugee children. Child and Adolescent Psychiatric Clinics of North America 17: 533–549.
    1. Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, et al. (2003) A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial. The Journal of the American Medical Association 290: 603–611.
    1. Tol WA, Komproe IH, Susanty D, Jordans MJD, Macy RD, et al. (2008) School-based mental health intervention for children affected by political violence in Indonesia. JAMA 300: 655–662.
    1. Jordans MJ, Komproe IH, Tol WA, Kohrt BA, Luitel NP, et al. (2010) Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial. Journal of Child Psychology and Psychiatry 51: 818–826.
    1. Tol WA, Komproe IH, Jordans MJ, Vallipuram A, Sipsma H, et al. (2012) Outcomes and moderators of a preventive school based mental health intervention for children affected by war in Sri Lanka: a cluster randomized trial. World Psychiatry 11: 114–122.
    1. Akhundov N (1999) Psychosocial rehabilitation of IDP children: Using theatre, art, music and sport. Forced Migration Review December 1999: 20–21.
    1. Danev M (1998) Library project “Step by step to recovery”. In: D Dokter, editor.Art therapists, refugees and migrants: Reaching accross borders. London: Jessica Kingsley.
    1. Lopez A, Saenz I (1992) Nuestro origen, nuestro exilio: de niño a niño. Mexico: Comité del Distrito Federal de Ayuda a Refugiados Guatemaltecos.
    1. Miller KE, Billings DL (1994) Playing to grow: A primary mental health intervention with Guatemalan refugee children. American Journal of Orthopsychiatry 64: 346–356.
    1. Nylund BV, Legrand JC, Holtsberg P (1999) The role of art in psychosocial care and protection for displaced children. Forced Migration Review December 1999: 16–19.
    1. Rousseau C, Drapeau A, Lacroix L, Bagilishya D, Heusch N (2005) Evaluation of a classroom program of creative expression workshops for refugee and immigrant children. Journal of Child Psychology and Psychiatry 46: 180–185.
    1. Rousseau C, Benoit M, Gauthier M-F, Lacroix L, Alain N, et al. (2007) Classroom drama therapy program for immigrant and refugee adolescents: A pilot study. Clinical Child Psychology and Psychiatry 12: 451–465.
    1. Rousseau C, Armand F, Laurin-Lamothe A, Gauthier MF, Saboundjian R (2012) Innovations in Practice: a pilot project of school based intervention integrating drama and language awareness. Child and Adolescent Mental Health 17: 187–190.
    1. Moneta I, Rousseau C (2008) Emotional expression and regulation in a school-based drama workshop for immigrant adolescents with behavioral and learning difficulties. The Arts in Psychotherapy 35: 329–340.
    1. Manassis K, Wilansky Traynor P, Farzan N, Kleiman V, Parker K, et al... (2010) The feelings club: randomized controlled evaluation of school based CBT for anxious or depressive symptoms. Depression and Anxiety.
    1. National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research Unit (2005) Post-traumatic stress disorder. The management of PTSD in adults and children in primary and secondary care; Excellence NIfC, editor. London: Gaskell and the British Psychological Society.
    1. Layne CM, Saltzman WR, Poppleton L, Burlingame GM, Pasalic A, et al. (2008) Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial.[see comment]. Journal of the American Academy of Child & Adolescent Psychiatry 47: 1048–1062.
    1. Everitt BS, Wessely S (2008) Clinical trials in psychiatry. West Sussex: Wiley.
    1. Lane KL, Wehby JH, Little MA, Cooley C (2005) Academic, social, and behavioral profiles of students with emotional and behavioral disorders educated in self-contained classrooms and self-contained schools: Part I—are they more alike than different?. Behavior Disorders 30: 349–361.
    1. Anderson JA, Kutash K, Duchnowski AJ (2001) A comparison of the academic progress of students with EBD and students with LD. Journal of Emotional and Behavioral Disorders 9: 106–115.
    1. Lane KL, Wehby JH, Little MA, Cooley C (2005) Students educated in self-contained classes and self-contained schools: Part II – How do they progress over time? Behavior Disorders 30: 363–374.
    1. Goodman R (1999) The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry 40: 791–801.
    1. Bourdon KH, Goodman R, Rae DS, Simpson G, Koretz DS (2005) The strenghts and difficulties questionnaire: U.S. normative data and psychometric properties. Journal of American Academy Child & Adolescent Psychiatry 44: 557–564.
    1. Goodman A, Patel V, Leon DA (2008) Child mental health differences amongst ethnic groups in Britain: a systematic review. BMC Public Health 8: 258.
    1. Goodman R, Renfrew D, Mullick M (2000) Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. European Child & Adolescent Psychiatry 9: 129–134.
    1. Goodman R (2001) Psychometric properties of the Strengths and Difficulties Questionnaire (SDQ). Journal of the American Academy of Child & Adolescent Psychiatry 40: 1337–1345.
    1. Tucker CM, Zayco RA, Herman KC, Reinke WM, Trujillo M, et al. (2002) Teacher and child variables as predictors of academic engagement among low-income African American children. Psychology in the Schools 39: 477–488.
    1. Suarez-Orozco C, Pimentel A, Martin M (2009) The significance of relationships: Academic engagement and achievement among newcomer immigrant youth. The Teachers College Record 111: 712–749.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren