Abstract
Background
Schools are considered as natural environments to enhance students’ social-emotional skills in general and mental health and affiliation among students with refugee and immigrant background. A layered or tiered provision of services are recommended as they can be effective to meet the needs of war-affected adolescents’ who variably show posttraumatic stress disorder (PTSD). The current study tests the effectiveness of multi-layered interventions integrating targeted cognitive-behavioral treatment-based TRT (Teaching Recovery Techniques), a class-room focused preventive intervention PIER (Peer Integration and Enhancement Resources), and a whole school psychoeducative teacher-led intervention INSETT (In Service Teacher Training) in enhancing the wellbeing of children in their school environments. We analyze first, whether the interventions are effective in decreasing symptoms of PTSD and psychological distress and increasing positive resources i.e. prosocial behavior and resilience among refugees and immigrant students. Second, we analyze which student-, school- and parent-related factors mediate the possible beneficial changes, and third, we look at which groups benefit the interventions most.
Methods
A three-arm cluster RCT with parallel assignment, with approximately 1:1 allocation ratio, is applied among 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting-list control condition. Students, their parents, and teachers in intervention and control schools participate at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), executive functioning (AEFI) and prosocial behavior (SDQ). PTSD (CRIES-8) symptoms are used as outcome variable in one of the interventions (TRT).
Discussion
The current study provides a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among migrated students. Combination of promotive, preventive and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group.
Trial registration:
ISRCTN, identifier: ISRCTN64245549. Registered 10. June 2020. Retrospectively registered, http://www.isrctn.com/ISRCTN64245549