Abstract
With the growing worldwide refugee crisis, there is a need for evidence-based interventions that specifically deal with the consequences of cumulative trauma-exposure in refugee youth. Refugee children have unique service needs and differ from their non-refugee peers in terms of sociocultural trauma, language, culture, and educational barriers. This article explains the complexities associated with understanding refugee youth and presents a proposal for studying the possible benefits of Tree of Life therapy. At the present time, Tree of Life therapy has no evidence-base because the published studies of Tree of Life with refugee and/or immigrant youth have sample sizes of one, six, eight, and twenty-nine. As a culturally-grounded, strength-based group counseling approach, Tree of Life therapy addresses traumatic experiences, recognizes participants’ cultural differences, highlights individual skills, and aids in instilling both confidence and hope for the future. Ncazelo Ncube, the co-founder and main developer of Tree of Life, describes this therapy as a collective narrative practice that considers cultural beliefs and values (2006, 2010, 2018, 2019). The proposed research design is to study the effectiveness of the Tree of Life in Canada, the United States, the United Kingdom, and South Africa. The research plan is to use pragmatic, group-randomized controlled trials in the “real world” settings of schools and agencies in each of the four countries. In addition, the article describes the development of the Roots and Wings Questionnaire for Children and Youth, a culturally relevant, child-friendly questionnaire. The Tree of Life is a readily available therapy with great potential for helping traumatized refugee youth as well as other trauma-impacted young people worldwide.
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References
Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27(3), 379–387.
Adler, L. L., & Adler, B. S. (1977). The “fruit-tree experiment” as a cross-cultural measure of the variations in children’s drawings due to regional differences. Annals of New York Academy of Sciences, 227-281.
Betancourt, T. S., Newnham, E. A., Birman, D., Lee, R., Ellis, H., & Layne, C. M. (2017). Comparing trauma exposure, mental health needs, and service utilization across clinical samples of refugee, immigrant, and U.S.-origin children. Journal of Traumatic Stress, 30, 209–218.
Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5–20. https://doi.org/10.1007/s11020-005-1962-6.
Crespi, C. M. (2016). Improved designs for cluster randomized trials. Annual Review of Public Health, 37, 1–16.
Eruyar, S., Huemer, J., & Vostanis, P. (2018). Review: How should child mental health services respond to the refugee crisis? Child and Adolescent Mental Health, 23(4), 303–312.
Garoff, F., Kangaslampi, S., & Peltonen, K. (2019). Scandinavian Journal of Psychology, 60, 7–15.
German, M. (2013). Developing our cultural strengths: Using the ‘tree of life’ strength-based, narrative therapy intervention in schools, to enhance self-esteem, cultural understanding and to challenge racism. Educational & Child Psychology, 30(4), 75–99.
Goodman, A., & Goodman, R. (2009). Strengths and difficulties questionnaire as a dimensional measure of child mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 400–403. https://doi.org/10.1097/CHI.0b013e3181985068.
Haroz, E. E., Jordans, M., De Jong, J., Gross, A., Bass, J., & Tol, W. (2017). Measuring Hope among children affected by armed conflict: Cross-cultural construct validity of the Children’s Hope scale. Assessment, 24(4), 528–539. https://doi.org/10.1177/1073191115612924.
Helms, J. E., Nicolas, G., & Green, C. E. (2012). Racism and ethnoviolence as trauma: Enhancing professional and research training. Traumatology., 18(1), 65–74.
Ingraham, C., & Oka, E. (2006). Multicultural issues in evidence-based interventions. Journal of Applied School Psychology, 22(2), 127–149.
Isakson, B. L., Legerski, J. P., & Layne, C. M. (2015). Adapting and implementing evidence-based interventions for trauma-exposed refugee youth and families. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 45(4), 245–253.
Jacobs, S. F. (2018). Collective narrative practice with unaccompanied refugee minors: “The tree of life” as a response to hardship. Clinical Child Psychology and Psychiatry, 23(2), 279–293. https://doi.org/10.1177/1359104517744246.
Kangaslampi, S., Garoff, F., & Peltonen, K. (2015). Narrative exposure therapy for immigrant children traumatized by war: Study protocol for a randomized controlled trial of effectiveness and mechanisms of change. BioMed Central Psychiatry, 15, 1–14. https://doi.org/10.1186/s12888-015-0520-z.
Kowitt, S. D., Emmerling, D., Gavarkavich, D., Mershon, C., Linton, K., Rubesin, H., Agnew-Brune, C., & Eng, E. (2016). A pilot evaluation of an art therapy program for refugee youth from Burma. Art Therapy: Journal of the American Art Therapy Association, 33(1), 13–20. https://doi.org/10.1080/07421656.2015.1127739.
Kratochwill, T. R., & Stoiber, K. C. (2002). Evidence-based interventions in school psychology: Conceptual foundations of the procedural and coding manual of division 16 and the Society for the Study of school psychology task force. School Psychology Quarterly, 17, 341–389.
Lange, S., Sauerland, S., Lauterberg, J., & Windeler, J. (2017). The range and scientific value of randomized trials—Part 24 of a series on evaluation of scientific publications. Deutsches Ärzteblatt International, 114, 635–640. https://doi.org/10.3238/arztebl.2017.0635.
Le Corff, Y. L., Tivendell, J., & LeBlanc, C. (2014). The tree test: A parsimonious projective drawing technique. In L. Handler & A. D. Thomas (Eds.), Drawings in assessment and psychotherapy: Research and application. New York: Routledge.
Lyon, A. R., Lau, A. S., McCauley, E., Vander Stoep, A., & Chorpita, B. F. (2014). A case for modular design: Implications for implementing evidence-based interventions with culturally-diverse youth. Professional Psychology: Research and Practice, 45, 57–66. https://doi.org/10.1037/a0035301
Masten, A. S., & Osofsky, J. (2010). Disasters and their impact on child development. Introduction to the special section. Child Development, 81(4), 1029–1039.
Mustafa, S., & Byrne, A. (2016). Faith in recovery: Adapting the tree of life to include Islamic ideas of well-being. Context., 146, 10–15.
Nastasi, B. (2006). Multicultural issues in school psychology practice: Introduction. Journal of Applied School Psychology, 22(2), 1–11.
Ncube, N. (2006). The tree of life project: Using narrative ideas in work with vulnerable children in southern Africa. International Journal of Narrative Therapy and Community Work, 1, 3–16.
Ncube, N. (2010). The journey of healing: Using narrative therapy and map-making to respond to child abuse in South Africa. The International Journal of Narrative Therapy and Community Work. No. 1 www.dulwichcentre.com.au
Ncube, N. (2018) Cited in Tibbles, P. (2018). Editorial by Paul Tibbles in dialogue with Ncazelo Ncube. Clinical Child Psychology and Psychiatry. 23(2). 179–185.
Ncube, N. (2019). Tree of life practitioners guide. Available during Tree of Life training. Information about Tree of Life training can be found at Phola.org.
Nicolas, G. & Schwartz, B. (2012). Culture first: Lessons learned about the importance of the cultural adaptation of cognitive behavior treatment interventions for black Caribbean youth. In G. Bernal & M. M. Domenech Rodríguez (Eds.), Cultural adaptations: Tools for evidence-based practice with diverse populations (pp. 71–90). Washington, D.C.: American Psychological Association. https://doi.org/10.1037/13752-004.
Panter-Brick, C., Dajani, R., Eggerman, M., Hermosilla, S., Sancilio, A., & Ager, A. (2017). Insecurity, distress and mental health: experimental and randomized controlled trials of a psychosocial intervention for youth affected by the Syrian crisis. Journal of Child Psychology and Psychiatry, Ncbi.nlm.nih.gov. Retrieved 23 July 2018, from https://www.ncbi.nlm.nih.gov/pubmed/28967980 doi: https://doi.org/10.1111/jcpp.12832
Panter-Brick, C., Dajani, R., Ager, A., Hadfield, K., Eggerman, M., & Ungar, M. (2018). Resilience in context: A brief and culturally-grounded measure for Syrian refugee and Jordanian host-community adolescents. Child Development, 1-18. https://doi.org/10.1111/cdev.12868.
Pejovic-Milovancevic, M., Klasen, H., & Anagnostopoulos, D. (2018). ESCAP for the mental health of child and adolescent refugees: Facing the challenge together, reducing risk, and promoting healthy development. European Child & Adolescent Psychiatry., 27(2), 253, 5p–257. https://doi.org/10.1007/s00787-017-1064-1.
Peltonen, K., & Kangaslampi, S. (2019). Treating children and adolescents with multiple traumas: a randomized clinical trial of narrative exposure therapy. European Journal of Psychotraumatology, 10(1), 1–13. 1558708. https://doi.org/10.1080/20008198.2018.1558708.
Pieloch, K., McCullough, M. B., & Marks, A. K. (2016). Resilience of children with refugee statuses: A research review. Canadian Psychology / Psychologie canadienne, 57(4), 330–339. https://doi.org/10.1037/cap0000073.
Shernoff, E. S., Bearman, S.K., & Kratochwill, T. R. (2017). Training the next generation of school psychologists to deliver evidence-based mental health practices: Current challenges and future directions. School Psychology Review, 46(2), 219–232. https://doi.org/10.17105/SPR-2015-0118.V46.2.
Schottelkorb, A. A., Doumas, D. M., & Garcia, R. (2012). Treatment for childhood refugee trauma: A randomized, controlled trial. International Journal of Play Therapy, 21, 57–73.
Senehi, J. (2015). Our tree of life in the field: Locating ourselves in the peace and conflict studies field through the tree of life experience. Peace Research: The Canadian journal of Peace and Conflict Studies. 47(−2), 10–28.
Seymour, K. L. (2014). An integrated approach to the assessment of the refugee student. In A.B. Clinton, Assessing bilingual children in context: An integrated approach. Washington, DC: American Psychological Association.
Shadlow, J. O., Boles, R. E., Roberts, M. C., & Winston, L. (2014). Native American children and their reports of Hope: Construct validation of the Children’s Hope scale. Journal of Child and Family Studies, 24(6), 1707–1714.
Sleijpen, M., Ter Heide, F. J. J., Mooren, T., Boeije, H. R., & Kleber, R. J. (2013). Bouncing forward of young refugees: A perspective on resilience research directions. European Journal of Psychotraumatology, 4, 20124. https://doi.org/10.3402/ejpt.v4i0.20124.
Sleijpen, M., Boeije, H. R., Kleber, R. J., & Mooren, T. (2016a). Between power and powerlessness: A metaethnography of sources of resilience in young refugees. Ethnicity & Health, 21, 158–180. https://doi.org/10.1080/13557858.2015.1080484.
Sleijpen, M., Haagen, J., Mooren, T., & Kleber, R.J. (2016b). Growing from experience: An exploratory study of posttraumatic growth in adolescent refugees: European Journal of Psychotraumatology,7, https://doi.org/10.3402/ejpt.v7.28698.
Sleijpen, M., Mooren, T., Kleber, R. J., & Boeije, H. R. (2017). Lives on hold: A qualitative study of young refugees’ resilience strategies. Childhood, 24(3), 348–365. https://doi.org/10.1177/0907568217690031.
Snyder, C. R., Hoza, B., Pelham, W. E., Rapoff, M., Ware, L., Danovsky, M.,et al. (1997). The development and validation of the Children’s Hope scale. Journal of Pediatric Psychology, 22, 399–421.
Stiles, D.A., (2019). Refugee youth consult about a research project on Tree of Life therapy. Poster presented at the 77th annual conference of the International Council of Psychologists: Human Rights, Dignity, and Justice: From Knowledge to Action. Cadiz, Spain.
Stiles, D. A., Schulze, J. M., Unger, R. G., Moore, A. L. & Blake, N. L. (2014). Incorporating international children’s rights into a graduate course: Children, Culture, and Violence (Tree of Life). Poster presented at the 36th annual conference of the International School Psychology Association, Kaunas, Lithuania.
Stiles, D.A., Wilkinson, L.R., Ritchie, K.L. & Alaraudanjoki, E.A. (2018). The value of storytelling and art for traumatized refugees. Poster presented at the 76th annual conference of the International Council of Psychologists: Human Rights, Dignity, and Justice. Montreal, Canada.
Suarez-Morales, L., Dillon, F. R., & Szapocznik, J. (2007a). Acculturative Stress Inventory for Children [Database record]. Retrieved from PsycTESTS. https://doi.org/10.1037/t00023-000.
Suarez-Morales, L., Dillon, F. R., & Szapocznik, J. (2007b). Validation of the acculturative stress inventory for children. Cultural Diversity and Ethnic Minority Psychology., 13(3), 216–224. https://doi.org/10.1037/1099-9809.13.3.216.
Task Force on Evidence-Based Interventions in School Psychology. (2009). Procedural and coding manual for review of evidence-based interventions (2nd ed.). Retrieved from Indiana University website http://www.indiana.edu/~ebi/documents/_workingfiles/EBImanual1.pdf.
Toussaint, L. L., Kalayjian, A., Herman, K., Hein, A., & Diakonova-Curtis, D. (2016). Traumatic stress symptoms, forgiveness, and meaning in life in four traumatized regions of the world. International Perspectives in Psychology: Research, Practice, Consultation., 6(1), 5–16.
Tyrer, R. A., & Fazel, M. (2014). School and community-based interventions for refugee and asylum-seeking children: A systematic review. PLoS One, 9(2), e89359. https://doi.org/10.1371/journal.pone.0089359.
UNICEF. (2016). Uprooted: The growing crisis for refugee and migrant children. New York: United Nations Children’s Fund.
United Nations (1989). Convention on the Rights of the Child. Retrieved from http://www2.ohchr.org/english/law/crc.htm.
United Nations High Commissioner for Refugees: The UN Refugee Agency. (2017). Global trends: Forced displacement in, 2017.
Van Widenfelt, B. M., Goedhart, A. W., Treffers, P. D. A., & Goodman, R. (2003). Dutch version of the strengths and difficulties questionnaire (SDQ). European Child & Adolescent Psychiatry., 12, 281–289. https://doi.org/10.1007/s00787-003-0341-3.
Yates, S. L., Morley, S., Eccleston, C., & de C. Williams, A. C. (2005). Quality rating scale [database record]. Retrieved from PsycTESTS. https://doi.org/10.1037/t11779-000.
Zwarenstein, M., et al. (2008). Improving the reporting of pragmatic trials: An extension of the CONSORT statement. BMJ, 337, a2390.
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Stiles, D.A., Alaraudanjoki, E., Wilkinson, L.R. et al. Researching the Effectiveness of Tree of Life: an Imbeleko Approach to Counseling Refugee Youth. Journ Child Adol Trauma 14, 123–139 (2021). https://doi.org/10.1007/s40653-019-00286-w
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DOI: https://doi.org/10.1007/s40653-019-00286-w