Improving mental health care for unaccompanied young refugees through a stepped-care approach versus usual care+: study protocol of a cluster randomized controlled hybrid effectiveness implementation trial

Abstract

Background More than half of the unaccompanied young refugees (UYRs) resettled in Europe report elevated levels of posttraumatic stress symptoms (PTSS) and comorbid symptoms. Earlier studies have highlighted the effectiveness of the trauma-focused preventive group intervention “Mein Weg” (English “My Way”), and the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for UYRs. Both interventions are deemed to be empirically supported treatments (ESTs). However, UYRs seldom receive ESTs or, in fact, any treatment at all. In view of the high need and the limited treatment resources available, a stepped-care approach is indicated but has not been evaluated so far. The purpose of this trial is to compare the stepped-care approach BETTER CARE with usual care enhanced with screening and indication (usual care+). Methods In a cluster randomized controlled trial involving N = 540 UYRs living in up to N = 54 child and youth welfare service (CYWS) facilities, BETTER CARE will be compared with usual care+. We will randomize clusters comprising a CYWS facility with at least one eligible psychotherapist. BETTER CARE consists of step (1) screening and indication and either step (2) preventive trauma-focused group intervention “Mein Weg” delivered by trained CYWS staff or step (3) TF-CBT delivered by trained community therapists and supported by trained translators if necessary. Participants will be assessed 6 and 12 months after randomization. The primary outcome is the severity of PTSS after 12 months. Secondary outcomes are depressive and anxiety symptoms, quality of life, and proxy reported PTSS. Furthermore, drug use, health costs, benefits, and long-term effects on integration/acculturation will be assessed. Discussion The trial will directly integrate a stepped-care approach into existing structures of the German child welfare and (mental) health system. It could, therefore, serve as a blueprint for how to implement ESTs for UYRs. If successful, screening, prevention, and intervention will be sustainably implemented in CYWS in southern Germany. Trial registration German Clinical Trials Register DRKS00017453. Registered on 11 December 2019.

Online training for evidence-based child trauma treatment: evaluation of the German language TF-CBT-Web

“…However, it should be noted that the learning programme supports the implementation of TF-CBT in Germany. In two connected ongoing studies, the German TF-CBT-Web is used as a first step in training, and therapists participate in an additional workshop and a random selection of therapists will be assigned to supervision (Rosner et al, 2020a ; Rosner et al, 2020b ). This will allow to estimate the effectiveness of the various training modules in offering TF-CBT to patients with PTSD.…”

“…Between January 1, 2018 and December 31, 2020, 4,020 users signed up for the German language TF-CBT Web . The final study sample consisted of three different sub-samples: (1) any mental health professionals (licenced psychotherapists, psychotherapists in training, and psychiatrists) who enrolled independently, (2) German and Swiss university students who had to complete the programme as part of their psychology curriculum, (3) licenced psychotherapists who took part in two large German TF-CBT dissemination projects called BETTER CARE and BEST FOR CAN (Rosner et al, 2020 ; Rosner et al, 2020 ), who needed to complete the German language TF-CBT Web in order to participate in the study. A more detailed description of the sample characteristics is provided in the results section.…”

“Same same or adapted?” Therapists’ feedback on the implementation of trauma-focused cognitive behavioral therapy with unaccompanied young refugees

“…Nonetheless, URMs face numerous individual and structural barriers to receiving mental health care interventions tailored to their needs. Within the project “BETTER CARE – Improving mental health care for unaccompanied young refugees through a stepped-care approach” ( Rosner et al, 2020 ) we will implement TF-CBT according to the knowledge gained from the present study. Furthermore, the recommendations discussed can contribute to the implementation of TF-CBT in culturally diverse groups in future research and clinical practice and might help practitioners to overcome barriers in treating young refugees.…”

Thinking about young refugees’ mental health following the Russian invasion of Ukraine in 2022

“…Available studies suggest that for PTSD and related problems, trauma-informed CBT, narrative exposure therapy and eye movement desensitisation and reprocessing are effective (Brown et al, 2017;Bürgin et al, 2022). These therapies may also be offered to UASC (Pfeiffer et al, 2018;Rosner et al, 2020). In one study, the group CBT intervention for UASC was provided by trained social workers (Pfeiffer et al, 2018), significant given the shortage of CAMHS practitioners in the UK and many other countries.…”