Advertisement

Journal of Contemporary Psychotherapy

, Volume 45, Issue 4, pp 245–253 | Cite as

Adapting and Implementing Evidence-Based Interventions for Trauma-Exposed Refugee Youth and Families

  • Brian L. IsaksonEmail author
  • John-Paul Legerski
  • Christopher M. Layne
Original Paper

Abstract

Refugee youth routinely encounter difficult challenges related to past trauma, loss, and resettlement stressors. The recent surge in refugees resettling in the United States has made it increasingly likely that mental health service providers will receive referrals to work with refugee youth. It is thus essential to prepare the national mental health workforce to provide the best care possible. Although the current evidence base regarding the use of empirically-supported treatments with refugee youth living in Western countries is insufficiently developed to provide authoritative standards for evidence-based practice (EBP), sufficient advances have nevertheless been made to offer evidence-informed suggestions and guidance to practitioners who work with this unique population. We thus focus on three primary considerations for adapting and implementing evidence-based interventions with refugee youth by drawing on the American Psychological Association’s (Am Psychol 61:271–285, 2006) framework for EBP, which integrates (1) the best research available, (2) client characteristics, culture, and preferences; and (3) clinical expertise. We use this framework as a lens to selectively review research pertaining to the refugee youth experience and identify sound therapeutic practices. We recommend key factors to consider when seeking to provide culturally sensitive, developmentally appropriate trauma interventions to this at-risk yet underserved population in real-world settings. We discuss the promise of modularized interventions that integrate both common elements of evidence-based trauma interventions and common therapeutic factors, while also underscoring the importance of addressing extra-therapeutic factors within the broader ecology that can powerfully influence the well-being and functioning of refugee youth and their families.

Keywords

Refugees Youth Evidence-based practice Trauma Cultural competency Ecological framework 

References

  1. Al-Sabah, R., Legerski, J. P., Layne, C. M., Isakson, B., Katalinski, R., Pasalic, H., et al. (2015). Adolescent adjustment, caregiver-adolescent relationships, and outlook towards the future in the long-term aftermath of the Bosnian war. Journal of Child and Adolescent Trauma, 8, 45–60.CrossRefGoogle Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  3. American Psychological Association. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271–285. doi: 10.1037/0003-066X.61.4.271.CrossRefGoogle Scholar
  4. Aroche, J., & Coello, M. J. (2004). Ethnocultural considerations in the treatment of refugees and asylum seekers. In J. P. Wilson & B. Drožðek (Eds.), Broken spirits: The treatment of traumatized asylum seekers, refugees, war and torture victims (pp. 53–80). NY: Routledge.Google Scholar
  5. Barth, R.P., Lee, B.R., Lindsey, M.A., Collins, K.S., Strieder, F., Chorpita, B.F.,… Sparks, J.A. (2012). Evidence-based practice at a crossroads: The timely emergence of common elements and common factors. Research on Social Work Practice, 22, 108–119.Google Scholar
  6. Betancourt, T. S., Meyers-Ohki, S., Charrow, A. P., & Tol, W. A. (2013). Interventions for children affected by war: An ecological perspective on psychosocial support and mental health care. Harvard Review of Psychiatry, 21, 70–91. doi: 10.1097/HRP.0b013e318283bf8f.PubMedCentralCrossRefPubMedGoogle Scholar
  7. Birman, D., Beehler, S., Harris, E.M., Everson, M.L., Batia, K., Liautaud, J.,… Cappella, E. (2008). International family, adult, and child enhancement services (FACES): A community-based comprehensive services model for refugee children in resettlement. American Journal of Orthopsychiatry, 78, 121–132. doi:  10.1037/0002-9432.78.1.121.
  8. Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York: Guilford.Google Scholar
  9. Briere, J., & Lanktree, C. (2012). Treating complex trauma in adolescents and young adults. Thousand Oaks, CA: Sage.Google Scholar
  10. Briere, J. N., & Scott, C. (2013). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
  11. Bronstein, I., & Montgomery, P. (2011). Psychological distress in refugee children: A systematic review. Clinical Child and Family Psychology Review, 14, 44–56.CrossRefPubMedGoogle Scholar
  12. Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  13. Bruno, A. (2014). Refugee admissions and resettlement policy (CRS Report No. RL31269) (pp. 1–16). Washington, DC: Congressional Research Service.Google Scholar
  14. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685–716.CrossRefPubMedGoogle Scholar
  15. Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press.Google Scholar
  16. DeRosa, R. R., Amaya-Jackson, L., & Layne, C. M. (2013). From rifts to riffs: Evidence-based principles to guide critical thinking about next-generation child trauma treatments and training. Training and Education in Professional Psychology, 7, 195–204.CrossRefGoogle Scholar
  17. Dyregrov, A., Gjestad, R., & Raundalen, M. (2002). Children exposed to warfare: A longitudinal study. Journal of Trauma Stress, 15, 59–68. doi: 10.1023/A:1014335312219.CrossRefGoogle Scholar
  18. Ehntholt, K. A., & Yule, W. (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma. Journal of Child Psychology and Psychiatry, 47, 1197–1210. doi: 10.1111/j.1469-7610.2006.01638.x.CrossRefPubMedGoogle Scholar
  19. Ellis, B. H., Kia-Keating, M., Yusuf, S. A., Lincoln, A., & Nur, A. (2007). Ethical research in refugee communities and the use of community participatory methods. Transcultural Psychiatry, 44, 459–481. doi: 10.1177/1363461507081642.CrossRefPubMedGoogle Scholar
  20. Ellis, B. H., Miller, A. B., Abdi, S., Barrett, C., Blood, E. A., & Betancourt, T. S. (2013). Multi-tier mental health program for refugee youth. Journal of Consulting and Clinical Psychology, 81, 129–140. doi: 10.1037/a0029844.CrossRefPubMedGoogle Scholar
  21. Ellis, B. H., Miller, A. B., Baldwin, H., & Abdi, S. (2011). New directions in refugee youth mental health services: Overcoming barriers to engagement. Journal of Child and Adolescent Trauma, 4, 69–85. doi: 10.1080/19361521.2011.545047.CrossRefGoogle Scholar
  22. Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors. The Lancet, 379, 266–282. doi: 10.1016/S0140-6736(11)60051-2.CrossRefGoogle Scholar
  23. Friedman, M. J., Cohen, J. A., Foa, E. B., & Keane, T. M. (2009). Integration and summary. In E. B. Foa, T. M. Keane, M. J. Friedman, & J. A. Cohen (Eds.), Effective treatments for PTSD: Practice guidelines from the international society for traumatic stress studies (2nd ed., pp. 617–642). New York: Guilford Press.Google Scholar
  24. Goodkind, J. R., Githinji, A., & Isakson, B. L. (2011). Reducing health disparities experienced by refugees resettled in urban areas: A community-based transdisciplinary intervention model. In N. Schafer-McDaniel (Ed.), Converging disciplines: A transdisciplinary research approach (pp. 41–55). New York: Springer.CrossRefGoogle Scholar
  25. Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy: Theory, Research, Practice Training, 43(4), 531–548.CrossRefGoogle Scholar
  26. Harris, M., & Fallot, R. D. (2001). In M. Harris & R. D. Fallot (Eds.), Using trauma theory to design service systems. San Francisco, CA: Jossey-Bass.Google Scholar
  27. Hinton, D. E., & Otto, M. W. (2006). Symptom presentation and symptom meaning among traumatized Cambodian refugees: Relevance to a somatically focused cognitive-behavior therapy. Cognitive and Behavioral Practice, 13, 249–260. doi: 10.1016/j.cbpra.2006.04.006.PubMedCentralCrossRefPubMedGoogle Scholar
  28. Hinton, D. E., Rivera, E. I., Hofmann, S. G., Barlow, D. H., & Otto, M. W. (2012). Adapting CBT for traumatized refugees and ethnic minority patients: Examples from culturally adapted CBT (CA-CBT). Transcultural Psychiatry, 49, 340–365. doi: 10.1177/1363461512441595.CrossRefPubMedGoogle Scholar
  29. Hobfoll, S. E., Horsey, K. J., & Lamoureux, B. E. (2009). Resiliency and resource loss in times of terrorism and disaster: Lessons learned for children and families and those left untaught. In D. Brom, R. Pat-Horenczyk, & J. D. Ford (Eds.), Treating traumatized children: Risk, resilience and recovery (pp. 150–163). NY: Routledge/Taylor & Francis Group.Google Scholar
  30. Holmbeck, G. N., Devine, K. A., & Bruno, E. F. (2010). Developmental issues and considerations in research and practice. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 28–39). NY, NY: Guilford Press.Google Scholar
  31. Jenmorri, K. (2006). Of rainbows and tears: Exploring hope and despair in trauma therapy. Child & Youth Care Forum, 35, 41–55. doi: 10.1007/s10566-005-9002-7.CrossRefGoogle Scholar
  32. Kaplow, J. B., Layne, C. M., Pynoos, R. S., Cohen, J. A., & Lieberman, A. (2012). DSM-V diagnostic criteria for bereavement-related disorders in children and adolescents: Developmental considerations. Psychiatry & Biological Processes, 75, 243–266.Google Scholar
  33. Kazak, A. E., Hoagwood, K., Weisz, J. R., Hood, K., Kratochwill, T. R., Vargas, L. A., & Banez, G. (2010). A meta-systems approach to evidence-based practice for children and adolescents. American Psychologist, 65, 85–97. doi: 10.1037/a0017784.CrossRefPubMedGoogle Scholar
  34. Kazdin, A. E. (2006). Arbitrary metrics: Implications for identifying evidence-based treatments. American Psychologist, 61, 42–49. doi: 10.1037/0003-066X.61.1.42.CrossRefPubMedGoogle Scholar
  35. Kirmayer, L. J., Lemelson, R., & Barad, M. (2007). In L. J. Kirmayer, R. Lemelson, & M. Barad (Eds.), Understanding trauma: Integrating biological, clinical, and cultural perspectives. New York: Cambridge University Press.CrossRefGoogle Scholar
  36. Kirmayer, L.J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A.G., Guzder, J.,… Pottie, K. (2011). Common mental health problems in immigrants and refugees: General approach in primary care. Canadian Medical Association Journal, 183, e959–e967.Google Scholar
  37. Layne, C. M., Beck, C. J., Rimmasch, H., Southwick, J. S., Moreno, M. A., & Hobfoll, S. E. (2009). Promoting ‘resilient’ posttraumatic adjustment in childhood and beyond: ‘unpacking’ life events, adjustment trajectories, resources, and interventions. In D. Brom, R. Pat-Horenczyk, & J. D. Ford (Eds.), Treating traumatized children: Risk, resilience and recovery (pp. 13–47). NY: Routledge.Google Scholar
  38. Layne, C.M., Ippen, C.G., Strand, V., Stuber, M., Abramovitz, R., Reyes, G.,… Pynoos, R. (2011). The core curriculum on childhood trauma: A tool for training a trauma-informed workforce. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 243–252.Google Scholar
  39. Layne, C., Olsen, J.A., Baker, A., Legerski, J., Isakson, B., Pasalic, A.,… Pynoos, R.S. (2010). Unpacking trauma exposure risk factors and differential pathways of influence: Predicting postwar mental distress in Bosnian adolescents. Child Development, 81, 1053–1076.Google Scholar
  40. Layne, C. M., Steinberg, J. R., & Steinberg, A. M. (2014a). Causal reasoning skills training for mental health practitioners: Promoting sound clinical judgment in evidence-based practice. Training and Education in Professional Psychology, 8, 292–302. doi: 10.1037/tep0000037.CrossRefGoogle Scholar
  41. Layne, C., Strand, V., Popescu, M., Kaplow, J., Abramovitz, R., Stuber, M., & Pynoos, R. (2014b). Using the core curriculum on childhood trauma to strengthen clinical knowledge in evidence-based practitioners. Journal of Clinical Child & Adolescent Psychology, 43, 286–300.CrossRefGoogle Scholar
  42. Layne, C.M., Stuvland, R., Saltzman, W.R., Djapo, N., & Pynoos, R.S. (1999). War Trauma Exposure Index. Unpublished psychological test. Los Angeles: University of California.Google Scholar
  43. Lustig, S.L., Kia-Keating, M., Knight, W.G., Geltman, P., Ellis, H., Kinzie, J.D.,… Saxe, G.N. (2004). Review of child and adolescent refugee mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 24–36.Google Scholar
  44. Macksoud, M. S., & Aber, J. L. (1996). The war experiences and psychosocial development of children in Lebanon. Child Development, 67, 70–88. doi: 10.2307/1131687.CrossRefPubMedGoogle Scholar
  45. Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science and Medicine, 70, 7–16.CrossRefPubMedGoogle Scholar
  46. Nickerson, A., Bryant, R. A., Brooks, R., Steel, Z., Silove, D., & Chen, J. (2011). The familial influence of loss and trauma on refugee mental health: A multilevel path analysis. Journal of Traumatic Stress, 24, 25–33. doi: 10.1002/jts.20608.CrossRefPubMedGoogle Scholar
  47. Rousseau, C., Measham, T., & Nadeau, L. (2012). Addressing trauma in collaborative mental health care for refugee children. Clinical Child Psychology and Psychiatry, 18(1), 121–136.CrossRefPubMedGoogle Scholar
  48. Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23, 437–445. doi: 10.1002/jts.20548.CrossRefPubMedGoogle Scholar
  49. Sack, W. H., Clarke, G. N., & Seeley, J. (1996). Multiple forms of stress in Cambodian adolescent refugees. Child Development, 67, 107–116. doi: 10.2307/1131689.CrossRefPubMedGoogle Scholar
  50. Saltzman, W. R., Layne, C. M., Pynoos, R. S., Olafson, E., Kaplow, J. B., & Boat, B. (2015). Trauma and grief component therapy for adolescents: A modular approach to treating traumatized and bereaved youth. Los Angeles, CA: University of California, Los Angeles.Google Scholar
  51. Samuels, J., Schudrich, W., & Altschul, D. (2009). Toolkit for modifying evidence-based practice to increase cultural competence. Orangeburg, NY: Research Foundation for Mental Health.Google Scholar
  52. Shirk, S. R., Karver, M. S., & Brown, R. (2011). The alliance in child and adolescent psychotherapy. Psychotherapy, 48(1), 17–24. doi: 10.1037/a0022181.CrossRefPubMedGoogle Scholar
  53. Spring, B. (2007). Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know. Journal of Clinical Psychology, 63, 611–631.CrossRefPubMedGoogle Scholar
  54. Summerfield, D. (1999). A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Social Science and Medicine, 48, 1449.CrossRefPubMedGoogle Scholar
  55. Tol, W.A., Barbui, C., Galappatti, A., Silove, D., Betancourt, T. S., Souza, R.,… van Ommeren, M. (2011). Mental health and psychosocial support in humanitarian settings: Linking practice and research. Lancet, 378, 1581–1591. doi: 10.1016/S0140-6736(11)61094-5.
  56. Tribe, R. (2002). Mental health of refugees and asylum-seekers. Advances in Psychiatric Treatment, 8, 240–248.CrossRefGoogle Scholar
  57. UNHCR. (2014). UNHCR statistical yearbook 2013. http://www.unhcr.org/54cf9bd69.html. Retrieved 2 March 2015.
  58. Williams, M. E., & Thompson, S. C. (2011). The use of community-based interventions in reducing morbidity from the psychological impact of conflict-related trauma among refugee populations: A systematic review of the literature. Journal of Immigrant and Minority Health, 13, 780–794. doi: 10.1007/s10903-010-9417-6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Brian L. Isakson
    • 1
    Email author
  • John-Paul Legerski
    • 2
  • Christopher M. Layne
    • 3
  1. 1.Department of Psychiatry and Behavioral Sciences, MSC09 5030, 1 UNMUniversity of New MexicoAlbuquerqueUSA
  2. 2.Department of PsychologyUniversity of North DakotaGrand ForksUSA
  3. 3.UCLA-Duke University National Center for Child Traumatic Stress, and Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations