Associations between social factors and school belonging among newcomer and non-newcomer youth in Sweden.

Feeling a sense of belonging at school is associated with important positive outcomes for youth and requires youth to engage in positive social relationships. Yet there is a limited understanding of the social factors most associated with youths' school belonging and limited evidence about whether correlates of school belonging vary for marginalized groups like newcomers compared to majority groups. Sweden provides an important context for investigation of these issues because, over the past two decades, the country has experienced an influx of asylum seekers and educational reforms that have altered the composition and functioning of Swedish secondary schools. This study addresses these gaps by (1) investigating which of eight social factors are associated with school belonging among diverse Swedish youth, and (2) examining whether newcomer status moderates the relationship between social factors and school belonging. Hierarchical regression and moderation analyses were used to analyze data from 14 to 19 year-old (n = 233) newcomers and non-newcomers in Sweden. An exploratory factor analysis revealed that the school belonging measure contained two factors: positive perceptions and negative perceptions (reverse coded). For both, stronger school belonging was associated with lower perceived ethnic discrimination. Positive perceptions of school belonging were also associated with more prosocial behaviours and lower emotional problems. Negative perceptions of school belonging were associated with more peer problems. Notably, quantity and quality of peer relationships were not associated with school belonging. There was no consistent evidence of newcomer status moderating the relationship between social factors and school belonging. These results highlight factors associated with school belonging which are modifiable and amenable to intervention or impact by policy-ethnic discrimination, prosocial behaviour, and emotional and peer problems. The absence of moderation by newcomer status suggests that school belonging interventions or related policies are likely to affect newcomer and non-newcomer students similarly.

Schools' and teachers' roles and challenges in supporting the mental wellbeing of refugee youths: a qualitative study with Swedish teachers.

PURPOSE: Resettled refugee youths are increasingly entering host-country school systems and are at risk of poor mental wellbeing. Schools and teachers are often expected to provide psychosocial support to youths with refugee backgrounds, but the teachers' views on this expectation are poorly understood. We investigated the question: What do Swedish teachers believe is the role of (1) schools and (2) teachers in supporting refugee youths' mental wellbeing? METHOD: Four semi-structured focus groups were conducted with 30 Swedish educators from five schools. Interview transcripts were analysed and themes reflecting the key concepts were constructed using reflexive thematic analysis. RESULTS: Seven themes were constructed. Three addressed the role of schools in supporting refugee youths' mental wellbeing: Promoting Belonging, Offering Refuge, and Instilling Civic Literacy. Four addressed the role of teachers: Building Relationships with Students, Maintaining a Non-therapeutic Relationship, Connecting to Professionals, and Instructing in the Classroom. CONCLUSION: Teachers believe that both schools and teachers play an important role in supporting refugee youths' mental wellbeing and each contributes in unique ways. However, schools and teachers are not always successful in supporting refugee youth and teachers reported facing challenges such as unclear roles and a lack of resources.

Giving schools a nudge: can behavioural insights improve recruitment of schools to randomised controlled trials?

OBJECTIVE: It is widely acknowledged that recruitment to randomised controlled trials (RCTs) is challenging, particularly trials that operate across multiple sites. A research area in need of further high-quality evaluation, including RCTs, is school-based mental health interventions for refugee children and adolescents. However, engaging schools with interventions and associated evaluations can be challenging. This paper explores the application of behavioural insights, i.e. evidence-based understanding of how people behave and make decisions, to RCT recruitment at the school level via email communications. A pilot study of applying behavioural insights to mail outs attempting to recruit schools to a RCT of a trauma-focused group intervention for refugee children and adolescents experiencing symptoms of post-traumatic stress is reported. Rates of school involvement between the behavioural insights approach (n = 31) and a standard outreach approach (n = 65) are compared. RESULTS: Schools were more likely to give a positive response to the mail out designed using the behavioural insights framework than standard outreach. Accounts of recruitment strategies such as this are valuable additions to the literature on RCT methodology given the potential for recruitment issues to affect trial operations.

Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial): study protocol for a cluster randomized controlled trial.

BACKGROUND: Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools. METHODS: This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI). DISCUSSION: This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools. TRIAL REGISTRATION: ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.

Extramedullary Waldenström macroglobulinemia.

Disease assessment in Waldenstrom Macroglobulinemia (WM) is dependent on the percent involvement of B-cell neoplasm in the bone marrow and IgM paraprotein in the serum. A subset of patients also demonstrates extramedullary involvement, which is infrequently examined. The role of extramedullary involvement in the diagnosis and prognosis of WM is poorly understood. The purpose of this study is to report the characteristics of WM patients with extramedullary disease (EMD). Nine hundred and eight-five patients with WM were evaluated at one academic center and the presence of EMD was assessed in these patients. Forty-three (4.4%) patients were identified to have EMD. Nine (21%) patients presented with involvement at WM diagnosis, while 34 (79%) developed EMD post-therapy for WM. Most frequent EMD sites involved were pulmonary (30%), soft tissue (21%), cerebrospinal fluid (23%), renal (8%), and bone (9%). The median overall survival at 10 years was 79% (95% CI: 57-90%). This is the first study to describe the clinical characteristics, response and overall survival in patients with extramedullary WM. Further studies to define the molecular characteristics of this entity and mechanisms of its development are warranted.