International Society for Traumatic Stress Studies

A Trauma-focused Intervention for Refugee Minors: A Pilot Study

10/11/2017
by Elisa Pfeiffer, M.Sc. and Lutz Goldbeck, Ph.D.

Background: a highly vulnerable population

As many other European countries, Germany has in the last years welcomed thousands of refugees from all over the world, among them about 64,000 unaccompanied refugee minors, most of them in the age range between 14 and 17 years. Before their arrival in Germany, they often had been exposed to severe stressors such as physical abuse, war and life-threatening flight conditions over months and years. Without having a close person with them, these adolescents are highly vulnerable for developing trauma-associated mental disorders such as posttraumatic stress disorder (PTSD), depression or anxiety (Jensen, Fjermestad, Granly, & Wilhelmsen, 2015). In accordance with the UN Convention on the Rights of the Child, the German child welfare system provides care for unaccompanied refugee minors. Beyond providing sufficient basic resources such as housing and education, trauma-informed care and appropriate acknowledgement of the young refugees special mental healthcare needs are extremely important challenges for the host country. This is especially true, as the refugees’ access to regular mental healthcare is limited due to cultural and language barriers and due to limited resources and readiness of the mental healthcare system to serve this population, even in a wealthy country such as Germany.

A collaborative intervention between child welfare and mental healthcare

The implementation of a trauma-focused intervention at the refugees’ group homes by their caretakers appeared as a chance to reach this population and provide basic trauma-focused mental healthcare within the limited time frame, before the young people have to make a living upon themselves. Based on promising findings regarding the feasibility and effectiveness cognitive-behavioral interventions for young refugees (Eberle-Sejari, Nocon, & Rosner, 2015, Ehntholt, Smith, & Yule, 2006), we developed a short-term trauma-focused group intervention, called “My Way”. The young refugees caretakers were trained and supervised by clinicians to empower them in performing the intervention. The intervention adapted core principles of cognitive trauma-focused treatment (psychoeducation, relaxation, trauma narrative and cognitive restructuring; Dorsey, Briggs, & Woods, 2011) to the cultural and language needs of the target group. 1-2 caretakers run a group with only 2-5 participants each, which then enables an individualized intervention adapted to the specific needs of the young refugees (participating in the group). The delivery of the intervention through the caretakers has several advantages such as the utilization of already established relations, a familiar atmosphere, less stigmatization as well as the immediacy of the intervention. The benefits of the group format included the opportunity to serve more refugees at the same time compared to individual therapy. Additionally, the group setting provides the young refugees a sense of shared experiences and belonging, group cohesion and destigmatization when working on their stress-related problems. Mutual support can be used to cope with individual difficulties, across the young peoples’ heterogeneous cultural and language backgrounds.

Results of a pilot study

29 young refugees from different countries, the majority from Afghanistan, completed six sessions of “My Way”. They were between 14 and 18 years old, all male and had experienced on average about eight different traumatic events, such as witnessing lethal violence or physical abuse. Participants reported significantly less posttraumatic stress symptoms (measured by the Child and Adolescent Trauma Screen CATS; Sachser et al., 2016) after participating in the intervention. They specifically improved in the PTSD DSM-5 clusters re-experiencing and negative alterations in cognitions and mood.

Hence, this study provides preliminary evidence for the effectiveness of a short-term trauma-focused intervention for young refugees with elevated posttraumatic stress symptoms. The uptake of our intervention by caretakers within the child welfare programs was enthusiastic, and the delivery of the trauma-focused intervention was feasible, with clinical background provided. The caretakers were found to be a great resource especially since they work with the young refugees every day and have great expertise to facilitate group processes. An ongoing randomized controlled trial is the next step to further investigate the efficacy of this intervention.

References

Dorsey, S., Briggs, E. C., & Woods, B. A. (2011). Cognitive-behavioral treatment for posttraumatic stress disorder in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 20, 255-269. doi: 10.1016/j.chc.2011.01.006

Eberle-Sejari, R., Nocon, A., & Rosner, R. (2015). Zur Wirksamkeit von psychotherapeutischen Interventionen bei jungen Fluechtlingen und Binnenvertriebenen mit posttraumatischen Symptomen. Kindheit und Entwicklung, 24 (3), 156-169. doi: 10.1026/0942-5403/a000171

Ehntholt, K. A., Smith, P. A., & Yule, W. (2005). School-based cognitive-behavioural therapy group intervention for refugee children who have experienced war-related trauma. Clinical Child Psychology and Psychiatry, 10, 235-250. doi: 10.1177/1359104505051214

Jensen, T. K., Fjermestad, K. W., Granly, L., & Wilhelmsen, N. H. (2015). Stressful life experiences and mental health problems among unaccompanied asylum-seeking children. Clinical Child Psychology and Psychiatry, 20(1), 106-116. doi:10.1177/1359104513499356

Sachser, C., Berliner, L., Holt, T., Jensen, T. K., Jungbluth, N., Risch, E., Rosner, R., & Goldbeck, L. (2017). International development and psychometric properties of the Child and Adolescent Trauma Screen (CATS). Journal of Affective Disorders, 210, 189–195. doi: 10.1016/j.jad.2016.12.040

Discussion Questions

  1. How can we further adapt and implement evidence-based principles of trauma-informed mental healthcare for young refugees, maybe in a stepped care approach?
  2. What are the implications of our findings for future collaborative care models, integrating resourses from the child welfare and child and adolescent mental healthcare systems?

Reference Article

Pfeiffer, E. and Goldbeck, L. (2017), Evaluation of a Trauma-Focused Group Intervention for Unaccompanied Young Refugees: A Pilot Study. JOURNAL OF TRAUMATIC STRESS. doi:10.1002/jts.22218

About the Authors

Elisa Pfeiffer, M.Sc., is a PhD student in the University Hospital Ulm who is also in training to become a clinical specialist for child and adolescent psychiatry/psychotherapy. Her PhD mainly focuses on trauma-focused treatments for refugee minors.

Lutz Goldbeck, PhD, is Professor for Child and Adolescent Psychiatry and Psychotherapy at the University of Ulm. His research and clinical work is dedicated to the development, evaluation and implementation of psychological interventions for traumatized children and adolescents and their families.
 


 

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