ABSTRACT
Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect Abstract. Background: As part of a multicenter study evaluating measures to improve access to evidenced-based treatment for children and adolescents following child abuse and neglect, we introduced and evaluated migration-adapted services, including a one-day intercultural training. Key issues were the dissemination of information concerning migration and acculturation, trauma and mental health to immigrant families as well as the development of exercises on intercultural competence and culturally sensitive work. Method: Near the end of the research project we gathered experiences and opinions concerning the work with immigrant families using an online survey in a subgroup of case managers working in the project (professionals in child-welfare services). This article presents two case report illustrating the practical relevance of the training's content. Results: Overall, the training was rated positively. In the opinion of the case managers, especially language barriers and cultural diversity should be considered while working with immigrant families. The case reports show that the training sensitized and supported the case managers supported the case managers when dealing with differing illness concepts, differing illness concepts, culture-sensitive assessment, or work with language mediators. Conclusions: The case management work also demonstrated the limitations of the psychosocial care system; the further dissemination of intercultural knowledge is important.
Subject(s)
Child Abuse/psychology , Child Welfare , Communication Barriers , Cultural Competency/education , Emigrants and Immigrants/psychology , Adolescent , Child , Cultural Diversity , HumansABSTRACT
Background: The United Nations reported that in 2016 over 65 million people worldwide have forcibly left home. Over 50% are children and adolescents; a substantial number has been traumatized and displaced by war. Objective: To provide an overview of the effectiveness of psychosocial interventions in this group we conducted a narrative review and a meta-analysis of intervention studies providing data on posttraumatic stress symptoms (PTSS), depression, anxiety, grief, and general distress. Method: We searched PILOTS, MEDLINE, WoS, Embase, CENTRAL, LILACS, PsycINFO, ASSIA, CSA, and SA for studies on treatment outcomes for war-traumatized displaced children and adolescents. Between-group effect sizes (ES) and pre-post ES were reconstructed for each trial. Overall pre-post ES were calculated using a random effects model. Results: The narrative review covers 23 studies with a variety of treatments. Out of the 35 calculated between-group ES, only six were significant, all compared to untreated controls. Two of them indicated significant adverse effects on symptoms of general distress or depression. When calculating pre-post effect sizes, the positive between-group results of cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) were reproduced and singular other treatments showed significant positive effects. However, the mean pre-post effects for PTSS and depression could not be interpreted due to the high heterogeneity of the included studies (PTSS: ES = 0.78; I2 = 88.6%; depression: ES = 0.35; I2 = 93.1%). Only the mean pre-post effect for seven active CBT treatment groups for depression (ES = 0.30, 95% CI [0.18, 0.43]) was interpretable (Q = 3.3, df = 6, p = .77). Conclusion: Given the large number of children and adolescents displaced by war there were regrettably few treatment studies available, and many of them were of low methodological quality. The effect sizes lagged behind the effects observed in traumatized minors in general, and often were small or non-significant. However, CBT and IPT showed promising results that need further replication.
Planteamiento: Las Naciones Unidas informaron de que en 2016 más de 65 millones de personas en todo el mundo han tenido que abandonar a la fuerza sus hogares. Más del 50% son niños y adolescentes. Muchos de ellos han sido traumatizados y desplazados por la guerra. Objetivo: Con el fin de proporcionar una visión general de la eficacia de las intervenciones psicosociales en este grupo, se realizó una revisión narrativa y un metanálisis de los estudios de intervención que proporcionaban datos sobre síntomas de estrés postraumático (SEPT), depresión, ansiedad, duelo y malestar general. Método: Buscamos en PILOTS, MEDLINE, WoS, Embase, CENTRAL, LILACS, PsycINFO, ASSIA, CSA y SA estudios sobre resultados de tratamiento para niños y adolescentes traumatizados y desplazados por la guerra. Se reconstruyeron los tamaños del efecto (TE) entre los grupos y los TE pre-post para cada ensayo. Los TE generales pre-post fueron calculados usando un modelo de efectos aleatorios. Resultados: La revisión narrativa consta de 23 estudios con una amplia variedad de tratamientos. De los 35 TE entre grupos calculados, sólo 6 fueron significativos, todos en comparación con controles no tratados. Dos de ellos indicaban efectos adversos significativos en los síntomas de malestar general o en los síntomas de depresión. Al calcular los TE pre-post, se reprodujeron los TE entre grupos positivos de la terapia cognitivo-conductual (TCC) y la terapia interpersonal (TIP) y otros tratamientos singulares mostraron efectos positivos significativos. Sin embargo, los efectos promedio pre-post para SEPT y depresión no pudieron interpretarse debido a la alta heterogeneidad de los estudios incluidos (SEPT: TE = 0.78, I2 = 88.6%, depresión: TE = 0.35; I2 = 93.1%). Sólo se pudo interpretar el efecto promedio pre-post para 7 grupos activos de tratamiento con TCC para la depresión, TE = 0.30, IC del 95% [0.18, 0.43] (Q = 3.3, df = 6, p = 0.77). Conclusión: Dado el gran número de niños y adolescentes desplazados por la guerra, lamentablemente existen pocos estudios de tratamiento disponibles y muchos de ellos de baja calidad metodológica. Los tamaños del efecto se quedaron a la zaga de los efectos observados en los menores traumatizados en general, y a menudo eran pequeños o no significativos. Sin embargo, la TCC y la TIP mostraron resultados prometedores que necesitan replicarse más.
ABSTRACT
BACKGROUND: Unaccompanied refugee minors (URMs) are a group who are vulnerable to developing posttraumatic stress symptoms (PTSS). However, they rarely receive the treatment that is indicated and there are no treatment studies focusing exclusively on this group of adolescents. This case study evaluates the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for URMs with PTSS. METHOD: A health care utilization sample of N = 6 was assessed prior to and after treatment with TF-CBT. Therapists were asked to report differences in treatment application and content in comparison to TF-CBT standard protocol. RESULTS: We found moderate to high levels of PTSS at baseline and a clinically significant decrease in symptoms at posttest. Some modifications to the TF-CBT protocol were made with regard to affective modulation which required more sessions than usual whereas fewer caregiver sessions were conducted. CONCLUSION: TF-CBT is feasible in reducing PTSS in severely traumatized URMs. Further research with controlled trials is necessary. TRIAL REGISTRATION: The trial registration: ClinicalTrials.gov Identifier NCT01516827. Registered 13 December 2011.
Subject(s)
Cognitive Behavioral Therapy/methods , Minors , Refugees , Stress Disorders, Post-Traumatic/therapy , Adolescent , Feasibility Studies , Female , Humans , Male , Research Design , Stress Disorders, Post-Traumatic/psychology , Treatment OutcomeABSTRACT
PURPOSE: This study evaluates a newly developed information booklet about depression among adolescents. The aim was to examine the enhancement of knowledge through the booklet with the objective of reducing stigma and facilitating awareness of own treatment needs. METHODS: 628 German ninth graders were enrolled in a pre-post-follow-up study using study-specific questionnaires to investigate knowledge enhancement in seven depression-related topics. Exploratively, knowledge enhancement was calculated with respect to education level and gender. Additionally, the students assessed the booklet's layout, content and utility. Knowledge enhancement was analyzed using repeated measures ANOVA for index values of the booklet's topics. The effect size partial eta square (η²) was computed. RESULTS: The pre-post-follow-up comparison yielded significant knowledge enhancement for all seven index values (p < 0.001). The associated effect sizes were medium to large. The strongest effects were achieved for the categories "Antidepressants" (η² = 0.56), "Symptoms" (η² = 0.45) and "Treatment" (η² = 0.17) of depression as well as for "Suicidality" (η² = 0.36). Although baseline knowledge was high in all students, knowledge enhancement was greater in better educated than in less educated students. Overall assessment of the booklet was good (mean = 2.15 on a rating scale from "very good" (1) to "fail" (6)). CONCLUSIONS: The information booklet as a low-threshold educational approach can significantly enhance depression-specific knowledge in students. Hence, it helps adolescents to acknowledge their own symptoms and treatment needs as well as to recognize these specific mental health problems in their peers. Thus, the booklet can contribute to the reduction of stigma and treatment barriers in adolescents.
