Trauma-informed approach for unaccompanied refugee minors: A multiple baseline case series

Unaccompanied refugee minors (URMs) are at increased risk of developing mental health issues, such as symptoms of posttraumatic stress disorder (PTSD) and depression. However, few studies have evaluated trauma-informed interventions for URMs that address these issues. The current study evaluates a culturally-sensitive trauma-informed approach for URMs. The primary objective of this study is to establish whether symptoms of PTSD and depression change during the trauma-informed approach. The secondary objective is to explore how URMs define their request for help. The current study design concerns a non-concurrent multiple baseline design in which repeated assessments will be conducted during a randomized waiting period, during treatment, and during follow-up. Main study parameters are standardized questionnaires measuring symptoms of posttraumatic stress and depression. These measures will be employed during the waiting period, treatment and follow-up. Moreover, URMs will be asked to define their request for help.

URMs (N=10) between 13 and 19 years of age with posttraumatic stress symptoms will receive seven sessions of a culturally sensitive trauma-informed approach for URMs. The approach includes elements from KIDNET, EMDR and CBT - frequently used treatments for treating symptoms of PTSD and depression. For this study, participants will receive the trauma-informed approach with a randomized waiting period (4, 5, 6,7 or 8 weeks).

We hypothesize that the intervention results in a decrease of symptoms of PTSD and/or depression.

Weekly measurements during waiting period (4,5,6,7 or 8 weeks), intervention and follow-up (4 weeks).

The approach aims to address the specialized, individual needs of URMs and which corresponds with the daily practice of working with URMs. Based on our experience offering trauma-focused therapy to URMs, a culturally-sensitive, trauma-informed eclectic approach is offered by therapists from Centrum ‘45. Within this trauma-informed approach, cognitive behavioral oriented therapies, such as Narrative Exposure Therapy (NET), Cognitive Behavioral Therapy (CBT), and Eye Movement Desensitization and Reprocessing (EMDR) are conducted.

The culturally-sensitive, trauma-informed approach is:
Short term;
Performed on the living location of the minor;
Culturally sensitive, for example by collaborating with Intercultural Mediators (ICM’s). ICM’s are men and women close to the minors in experience, and familiar with Dutch as well as the minor’s native society and culture. They aid in translating as well as in bridging the cultural gap.

The trauma-informed approach aims to:
Foster resilience;
Help understand mental health responses to experiences ;
Be trauma-informed, prevent chronic difficulties;
Create clear expectancies about mental health care in the Netherlands.