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

Abstract

ObjectivesThe 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.MethodsSpecial 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.ResultsThe 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.ConclusionThe 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 RegistrationClinicalTrials.gov NCT01426451

Review of the strengths and difficulties questionnaire translated into languages spoken by children and adolescents of refugee background

“…However, S‐SDQ impact or impairment ratings (viewed as primary outcomes) decreased significantly for Rousseau et al () and Rousseau et al (), and for first‐generation but not second‐generation youth (Rousseau et al, ). Control groups' S‐SDQ impact and T‐SDQ TDSs increased significantly (Rousseau et al, ; Rousseau et al, ), again possibly due to non‐intervention.…”

“…Three studies evaluated classroom‐based drama therapy workshops for refugee and immigrant youth in Canada (Rousseau, Armand, Laurin‐Lamothe, Gauthier, & Saboundjian, ; Rousseau et al, ; Rousseau et al, ). Students completed S‐SDQs in French, English, or students' (unspecified) native languages, supported by multilingual project staff (Rousseau et al, ); with interviewers (Rousseau et al, ); or requested translated versions (Rousseau et al, ). The three studies found no significant decreases in S‐ and T‐SDQ TDSs (viewed as secondary global measures by Rousseau et al, ).…”

“…Students completed S‐SDQs in French, English, or students' (unspecified) native languages, supported by multilingual project staff (Rousseau et al, ); with interviewers (Rousseau et al, ); or requested translated versions (Rousseau et al, ). The three studies found no significant decreases in S‐ and T‐SDQ TDSs (viewed as secondary global measures by Rousseau et al, ). However, S‐SDQ impact or impairment ratings (viewed as primary outcomes) decreased significantly for Rousseau et al () and Rousseau et al (), and for first‐generation but not second‐generation youth (Rousseau et al, ).…”

“…Of seven outcome studies with refugee and immigrant groups, only two showed statistically significant effects on SDQ TDSs. Three Canadian studies that found significant improvements in S‐SDQ impact but not TDSs, overlooked the lack of change in symptom scores by designating impact scores as primary and TDSs as secondary (Rousseau et al, ).…”

“…Three studies used the T-SDQ to evaluate a London school-based refugee mental health service for children referred by teachers In Canada creative expression sand-play workshops aimed to reduce emotional and behavioural problems of immigrant and refugee pre-schoolers (Rousseau, Benoit, Lacroix, & Gauthier, 2009 (Rousseau et al, 2007); with interviewers (Rousseau et al, 2012); or requested translated versions (Rousseau et al, 2014).…”