The transmission of trauma in refugee families: associations between intra-family trauma communication style, children's attachment security and psychosocial adjustment.

This study explores the transmission of trauma in 30 Middle Eastern refugee families in Denmark, where one or both parents were referred for treatment of PTSD symptoms and had non-traumatized children aged 4-9 years. The aim of the study was to explore potential risk and protective factors by examining the association between intra-family communication style regarding the parents' traumatic experiences from the past, children's psychosocial adjustment and attachment security. A negative impact of parental trauma on children might be indicated, as children's Total Difficulties Scores on the Strengths and Difficulties Questionnaire (SDQ) were significantly higher than the Danish norms. A negative association between children's attachment security as measured by the Attachment and Traumatization Story Task and higher scores on the SDQ Total Difficulties Scale approached significance, suggesting that the transmission of trauma may be associated with disruptions in children's attachment representations. Furthermore a significant association between parental trauma communication and children's attachment style was found.

Protocol: Interventions aimed at preventing out-of-home placement of children: A systematic review.

This is the protocol for a Campbell systematic review. The objectives are as follows. The aim of the present review is to synthesize evidence on the effectiveness of interventions for at-risk families aimed at preventing the out-of-home placement of children or increasing the likelihood that children are reunited with their birth families following temporary care arrangements. The review has two objectives: (1) To assess the effectiveness of interventions for at-risk families with children aged between 0 and 17 years old on measures of out-of-home placement and on secondary outcomes. (2) To identify factors that modify intervention effectiveness (e.g., prior placements, parental risk factors such as substance abuse, mental health issues, age, minority status, child risk factors such as disabilities, age, and gender).

Attachment narratives in refugee children: interrater reliability and qualitative analysis in pilot findings from a two-site study.

Although forced migration research on refugee family functioning clearly points to the potential breakdown of parental availability and responsiveness in the context of cumulative migration stressors, studies exploring attachment security in refugee children are surprisingly lacking so far. The authors report their findings from a 2-site, small-scale administration of an attachment measure, adapted for use with refugee children aged between 4 and 9 years from a reliable and validated doll-play procedure. We evaluated interrater reliability and conducted a qualitative analysis of refugee children's narrative response to identify migration-specific representational markers of attachment quality. The level of agreement among 3 independent coders ranged between .54 to 1.00 for both study samples, providing initial psychometric evidence of the measure's value in assessing child attachment security in this population. The exploratory analysis of migration-related narrative markers pointed to specific parameters to be used in parent-child observational assessments in future validation of the attachment measure, such as parental withdrawal or trauma-communication within the parent-child dyad.

The effects of small class sizes on students' academic achievement, socioemotional development and well-being in special education: A systematic review.

Background: Class size reductions in general education are some of the most researched educational interventions in social science, yet researchers have not reached any final conclusions regarding their effects. While research on the relationship between general education class size and student achievement is plentiful, research on class size in special education is scarce, even though class size issues must be considered particularly important to students with special educational needs. These students compose a highly diverse group in terms of diagnoses, functional levels, and support needs, but they share a common need for special educational accommodations, which often entails additional instructional support in smaller units than what is normally provided in general education. At this point, there is however a lack of clarity as to the effects of special education class sizes on student academic achievement and socioemotional development. Inevitably, such lack of clarity is an obstacle for special educators and policymakers trying to make informed decisions. This highlights the policy relevance of the current systematic review, in which we sought to examine the effects of small class sizes in special education on the academic achievement, socioemotional development, and well-being of children with special educational needs. Objectives: The objective of this systematic review was to uncover and synthesise data from studies to assess the impact of small class sizes on the academic achievement, socioemotional development, and well-being of students with special educational needs. We also aimed to investigate the extent to which the effects differed among subgroups of students. Finally, we planned to perform a qualitative exploration of the experiences of children, teachers, and parents with class size issues in special education. Search Methods: Relevant studies were identified through electronic searches in bibliographic databases, searches in grey literature resources, searches using Internet search engines, hand-searches of specific targeted journals, and citation-tracking. The following bibliographic databases were searched in April 2021: ERIC (EBSCO-host), Academic Search Premier (EBSCO-host), EconLit (EBSCO-host), APA PsycINFO (EBSCO-host), SocINDEX (EBSCO-host), International Bibliography of the Social Sciences (ProQuest), Sociological Abstracts (ProQuest), and Web of Science (Clarivate, Science Citation Index Expanded & Social Sciences Citation Index). EBSCO OPEN Dissertations was also searched in April 2021, while the remaining searches for grey literature, hand-searches in key journals, and citation-tracking took place between January and May 2022. Selection Criteria: The intervention in this review was a small special education class size. Eligible quantitative study designs were studies that used a well-defined control or comparison group, that is, studies where there was a comparison between students in smaller classes and students in larger classes. Children with special educational needs in grades K-12 (or the equivalent in European countries) in special education were eligible. In addition to exploring the effects of small class sizes in special education from a quantitative perspective, we aimed to gain insight into the lived experiences of children, teachers, and parents with class size issues in special education contexts, as they are presented in the qualitative research literature. The review therefore also included all types of empirical qualitative studies that collected primary data and provided descriptions of main methodological issues such as selection of informants, data collection procedures, and type of data analysis. Eligible qualitative study designs included but were not limited to studies using ethnographic observation or field work formats, or qualitative interview techniques applied to individual or focus group conversations. Data Collection and Analysis: The literature search yielded a total of 26,141 records which were screened for eligibility based on title and abstract. From these, 262 potentially relevant records were retrieved and screened in full text, resulting in seven studies being included: three quantitative and five qualitative studies (one study contained both eligible quantitative and qualitative data). Two of the quantitative studies could not be used in the data synthesis as they were judged to have a critical risk of bias and, in accordance with the protocol, were excluded from the meta-analysis on the basis that they would be more likely to mislead than inform. The third quantitative study did not provide enough information enabling us to calculate an effect size and standard error. Meta-analysis was therefore not possible. Following quality appraisal of the qualitative studies, three qualitative studies were judged to be of sufficient methodological quality. It was not possible to perform a qualitative thematic synthesis since in two of these studies, findings particular to special education class size were scarce. Therefore, only descriptive data extraction could be performed. Main Results: Despite the comprehensive searches, the present review only included seven studies published between 1926 and 2020. Two studies were purely quantitative (Forness, 1985; Metzner, 1926) and from the U.S. Four studies used qualitative methodology (Gottlieb, 1997; Huang, 2020; Keith, 1993; Prunty, 2012) and were from the US (2), China (1), and Ireland (1). One study, MAGI Educational Services (1995), contained both eligible quantitative and qualitative data and was from the U.S. Authors' Conclusions: The major finding of the present review was that there were virtually no contemporary quantitative studies exploring the effects of small class sizes in special education, thus making it impossible to perform a meta-analysis. More research is therefore thoroughly needed. Findings from the summary of included qualitative studies reflected that to the special education students and staff members participating in these studies, smaller class sizes were the preferred option because they allowed for more individualised instruction time and increased teacher attention to students' diverse needs. It should be noted that these studies were few in number and took place in very diverse contexts and across a large time span. There is a need for more qualitative research into the views and experiences of teachers, parents, and school administrators with special education class sizes in different local contexts and across various provision models. But most importantly, future research should strive to represent the voices of children and young people with special needs since they are the experts when it comes to matters concerning their own lives.

Holding a foster child's mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families.

BACKGROUND: Children in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent-child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being. METHODS: This is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4-17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists. DISCUSSION: This trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children. Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022.

Twenty seven years of treating survivors of torture and organized violence - associations between torture, gender and ethnic minority status among refugees referred for treatment of PTSD.

Background: Victims of torture and organized violence are among the most vulnerable refugees. The nature of torture promotes shame, secrecy and silencing of the survivors, and there is a need for studies to provide a testimony to the experiences of survivors. Objective: To contribute to the global knowledge base by exploring the nature and frequency of different types of torture as reported by survivors and to explore potential associations between basic sociodemographic variables and the likelihood of reporting different kinds of torture and of attending treatment for PTSD. Method: This study is based on archival data from 27 years of clinical practice treating survivors of torture and organized violence (N = 1249) in a specialist outpatient clinic. Data was coded from patient files by two research assistants. Statistical analysis included independent samples t-tests, Pearson Chi Square tests and regression. Results: The study found strong associations between gender of survivors and the reporting of different kinds of torture, most strongly with respect to sexual torture. Furthermore, the study found significant differences between survivors belonging to an ethnic minority and survivors who belonged to the majority populations within their countries of origin with regards to the extent of the torture, they report being subjected to. Patients who received treatment reported more torture experiences than those who did not. Conclusions: Findings from the present study document the experiences of different torture methods as reported by survivors, and suggest that belonging to an ethnic minority population is associated with an increased risk of being subjected to more severe torture, which has implications for both research and interventions aimed at treating survivors of torture.

Antecedentes: Las víctimas de la tortura y de la violencia organizada se encuentran entre los refugiados más vulnerables. La tortura por naturaleza promueve la vergüenza, el secretismo y el silenciamiento de los sobrevivientes, existiendo la necesidad de estudios que sirvan como un testimonio de las experiencias de los sobrevivientes.Objetivo: Contribuir a la base del conocimiento global explorando la naturaleza y la frecuencia de los diferentes tipos de tortura reportados por los sobrevivientes; así como, explorar las asociaciones potenciales entre las variables sociodemográficas básicas y la probabilidad de reportar diferentes tipos de tortura y de acudir a tratamiento para el trastorno de estrés postraumático (TEPT).Métodos: Este estudio se basó sobre la información de los archivos de 27 años de práctica clínica en el tratamiento de los sobrevivientes a la tortura y a la violencia organizada (N = 1249) en la atención ambulatoria de una clínica especializada. La información fue codificada de los archivos de los pacientes por dos asistentes de investigación. Los análisis estadísticos incluyeron pruebas t para muestras independientes, pruebas Chi cuadrado de Pearson, así como de regresión.Resultados: El estudio encontró asociaciones fuertes entre el género de los sobrevivientes y el reportar los diferentes tipos de tortura, con más fuerza en relación con la tortura sexual. Asimismo, el estudio encontró diferencias significativas entre los sobrevivientes que pertenecían a una minoría étnica y aquellos sobrevivientes que pertenecían a las poblaciones mayoritarias dentro de sus países de origen en relación con la extensión de la tortura que refirieron padecer. Los pacientes que recibieron tratamiento reportaron mayores experiencias de tortura que aquellos que no.Conclusiones: Los hallazgos del presente estudio documentan las experiencias de diferentes métodos de tortura reportadas por los sobrevivientes y sugieren que el pertenecer a una minoría étnica está asociado a un riesgo mayor de padecer una tortura de mayor severidad, lo que tiene implicaciones tanto para la investigación como para las intervenciones que tienen por objetivo el tratar a los sobrevivientes de tortura.

PROTOCOL: Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

This is the protocol for a Campbell review. The objectives are as follows: 1.To assess the efficacy of attachment-based interventions on measures of favourable parent/child outcomes (attachment security, dyadic interaction, parent/child psychosocial adjustment, behavioural and mental health problems and placement breakdown) within foster and adoptive families with children aged between 0 and 17 years.2.To identify factors that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (for example, age of the child at placement and at intervention start, programme duration, programme focus).

Is silence about trauma harmful for children? Transgenerational communication in Palestinian families.

Style of family communication is considered important in the transgenerational transmission of trauma. This study had three aims: first, to identify the contents of family communication about past national trauma; second, to examine how parents' current war trauma is associated with transgenerational communication; and third, to analyze the associations between transgenerational communication and children's mental health, measured as posttraumatic stress disorder (PTSD), depression and psychological distress. The study sample consisted of 170 Palestinian families in Gaza Strip, in which both mothers (n = 170) and fathers (n = 170) participated, each with their 11-13-year-old child. Mothers and fathers responded separately to three questions: 1) what did their own parents tell them about the War of 1948, Nakba?; 2) what did they tell their own children about the Nakba?; and 3) What did they tell their own children about the 1967 Arab-Israeli War and military occupation? Current war trauma, as reported separately by mothers, fathers and their children, refers to the Gaza War 2008/09. Children reported their symptoms of PTSD, depression, and psychological distress. Results revealed seven communication content categories and one category indicating maintaining silence about the traumas. Fathers' high exposure to current war trauma was associated with a higher level of communicating facts, reasons, and meanings regarding the1948 and 1967 wars, and mothers' high exposure to current war trauma was associated with a lower level of maintaining silence. Family communication about facts, reasons, and meanings was significantly associated with children not showing PTSD and marginally with not showing psychological distress, while maintaining silence was not associated with children's mental health.

A systematic review of risk and protective factors associated with family related violence in refugee families.

The current systematic review summarizes the evidence from studies examining the risk and protective factors associated with family related violence in refugee families. Data included 15 peer-reviewed qualitative and quantitative studies. In order to gain an overview of the identified risk and protective factors an ecological model was used to structure the findings. At the individual level, parental trauma experiences/mental illness, substance abuse and history of child abuse were found to be risk factors. Family level risk factors included parent-child interaction, family structure and family acculturation stress. At the societal level low socioeconomic status was identified as a risk factor. Cultural level risk factors included patriarchal beliefs. Positive parental coping strategies were a protective factor. An ecological analysis of the results suggests that family related violence in refugee families is a result of accumulating, multiple risk factors on the individual, familial, societal and cultural level. The findings suggest that individual trauma and exile related stress do not only affect the individual but have consequences at a family level. Thus, interventions targeting family related violence should not only include the individual, but the family.

Disclosure and silencing: A systematic review of the literature on patterns of trauma communication in refugee families.

This systematic review aimed to explore the effects of different degrees of parental disclosure of traumatic material from the past on the psychological well-being of children in refugee families. A majority of studies emphasize the importance of the timing of disclosure and the manner in which it takes place, rather than the effects of open communication or silencing strategies per se. A pattern emerged in which the level of parental disclosure that promotes psychological adjustment in refugee children depends on whether the children themselves have been directly exposed to traumatic experiences, and whether the children are prepubescent or older. The process of trauma disclosure is highly culturally embedded. Future research needs to address the culturally shaped variations in modulated disclosure and further explore how modulated disclosure can be facilitated in family therapy with traumatized refugee families.