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Van Es CM, Velu ME, Sleijpen M, van der Aa N, Boelen PA, Mooren T. Trauma-focused treatment for traumatic stress symptoms in unaccompanied refugee minors: a multiple baseline case series. Front Psychol 2023; 14:1125740. [PMID: 37325732 PMCID: PMC10268033 DOI: 10.3389/fpsyg.2023.1125740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Unaccompanied refugee minors (URMs) are at increased risk of developing mental health problems, such as symptoms of posttraumatic stress disorder (PTSD) and depression. In addition, URMs face several barriers to mental health care. Few studies have evaluated trauma-focused interventions for URMs that target these issues. The current study evaluated a multimodal trauma-focused treatment approach for URMs. It aimed to provide an initial indication of the effectiveness of this treatment approach and to provide a qualitative evaluation assessing treatment satisfaction of the participating URMs. Methods A mixed-methods study was conducted among ten URMs, combining quantitative data with qualitative data through triangulation. Quantitative data were collected using a non-concurrent multiple baseline design in which repeated, weekly assessments were carried out during a randomized baseline period, during treatment, and during a 4-week follow-up period. Questionnaires assessing PTSD (Children's Revised Impact of Event Scale) and symptoms of depression (The Patient Health Questionnaire-9, modified for adolescents) were used. In addition, treatment satisfaction was measured post-treatment using a semi-structured interview. Results During the qualitative evaluation, all but one URM noted they found the trauma-focused treatment approach useful and felt the treatment had positively impacted their wellbeing. However, the results of the quantitative evaluation did not show clinically reliable symptom reductions at posttest or follow-up. Implications for clinical practice and research are discussed. Discussion The current study presents our search in developing a treatment approach for URMs. It adds to the current knowledge about methodological considerations in evaluating treatments for URMs, the potential effects of trauma-focused treatments on URMs, and the implementation of treatments for URMs.Clinical trial registration: The study was registered in the Netherlands Trial Register (NL8519), 10 April 2020.
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Affiliation(s)
- Carlijn Maria Van Es
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Merel E. Velu
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Marieke Sleijpen
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Niels van der Aa
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Paul A. Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Trudy Mooren
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
- ARQ Centrum’45, ARQ National Psychotrauma Centre, Diemen, Netherlands
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Moutsou I, Georgaca E, Varaklis T. Psychotherapeutic and Psychosocial Interventions with Unaccompanied Minors: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11060918. [PMID: 36981575 PMCID: PMC10048295 DOI: 10.3390/healthcare11060918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Unaccompanied minors (UAMs) are considered a particularly vulnerable population, facing severe threats regarding their physical and mental health. As their number has increased in recent years worldwide, research on mental health interventions has become necessary. The implementation of psychotherapeutic interventions has been documented, but psychosocial interventions seem to not have been consistently studied. In this review, we summarize the psychotherapeutic and psychosocial interventions with UAMs that have been studied up to now. Following the PRISMA guidelines for scoping reviews, we searched four databases and included studies and practice papers; there were no restrictions on publication date, geographical region, language, or method. We identified 46 studies on psychotherapeutic interventions and 16 studies on psychosocial interventions that met the inclusion criteria. Psychotherapeutic interventions were mainly based on cognitive behavioural, psychodynamic, narrative, art and transcultural approaches and aimed at improving UAMs' trauma, mental health and wellbeing, as well as professionals' skills and therapeutic protocols. Several studies showed promising results, with the cognitive behavioural approaches being the most researched. However, more research is needed in order to draw conclusions in terms of effectiveness. Psychosocial interventions followed various approaches and aimed at UAMs' empowerment, wellbeing, support and integration, as well as at improving caregivers' skills. Nonetheless, they seem not only very heterogeneous but also understudied, and we believe that a focus on them would be very useful. Methodological limitations and their implications for future research are discussed.
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Affiliation(s)
- Irene Moutsou
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Theofilos Varaklis
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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Guessoum SB, Minassian S, de Staël P, Touhami F, DiGiovanni M, Radjack R, Moro MR, Benoit L. Multimodal co-therapy for unaccompanied minors: a qualitative study. Child Adolesc Psychiatry Ment Health 2022; 16:81. [PMID: 36344979 PMCID: PMC9641960 DOI: 10.1186/s13034-022-00518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Unaccompanied refugee minors-or unaccompanied minors-are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients' experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care. METHODS MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). RESULTS Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one's story can "set us free" if guided carefully by care providers. CONCLUSION This study suggests that MUCTUM therapy may efficiently support unaccompanied minors' mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.
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Affiliation(s)
- Sélim Benjamin Guessoum
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014, Paris, France. .,Université Paris Cité, PCPP, Paris, France. .,Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France.
| | - Sevan Minassian
- grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France
| | - Pauline de Staël
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France
| | - Fatima Touhami
- grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France
| | - Madeline DiGiovanni
- grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, USA
| | - Rahmeth Radjack
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Laelia Benoit
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France ,grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, USA
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