Testing the effectiveness of the culturally adapted skills training START NOW to reduce mental health problems in adolescent refugees: study protocol for a randomized controlled trial.

Background: Adolescent refugees are particularly vulnerable to mental health problems, as they experience many risk factors associated with their resettlement at crucial stages of their physical and emotional development. However, despite having a greater healthcare needs than others, they face significant barriers to accessing healthcare services. Therefore, this study aims to test the effectiveness of a low-threshold, culturally adapted version of the skills training START NOW - START NOW Adapted - in reducing mental health problems among adolescent refugees. Methods: We will recruit 80 adolescent refugees (15-18 years) with symptoms of anxiety and depression or high perceived stress in Northwestern Switzerland. They will be randomly assigned to one of two study groups: an intervention group, receiving START NOW Adapted, and a control group, receiving treatment as usual (TAU). The intervention will last 10 weeks and will consist of one-hour sessions per week provided by a trained facilitator with the same cultural background, in the respective language. Assessments to collect depressive and anxious symptoms, perceived stress, social-ecological resilience, and emotion recognition abilities will be conducted pre-intervention, post-intervention (11 weeks later) and at the 3-month follow-up. Multilevel models will be computed with primary and secondary outcome measures as dependent variables. An effect of at least moderate size will be considered clinically relevant. Discussion: This randomized controlled trial aims to investigate the effectiveness of a culturally adapted version of START NOW, providing valuable insights to improve current health promotion for adolescent refugees in Switzerland (or rather lack thereof). Ultimately, the effects of START NOW may facilitate integration and promote healthy development while decreasing costs associated with treating migration- or conflict-related trauma.Clinical trial registration: ClinicalTrials.gov, identifier: NCT06324864.

START NOW WebApp-promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial.

BACKGROUND: Adolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled "Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions". METHODS: The study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups. DISCUSSION: This study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels. TRIAL REGISTRATION {2A AND 2B}: ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.

Addressing the mental health needs and burdens of children fleeing war: a field update from ongoing mental health and psychosocial support efforts at the Ukrainian border.

Background: The ongoing horrors of the war in Ukraine have led to enormous consequences: loss of life, severe injuries, and mass movements of civilians. Exposure to war, living in conflict zones, and forced displacement increase the risk of experiencing a broad spectrum of direct and indirect burdens towards physical and mental health, in particular among children. Objective: This letter to the editor aims to provide multiple clinical and 'mental health and psychosocial support' (MHPSS) systems' perspectives by experts working in ongoing aid efforts to bridge and disseminate their current observations towards child and adolescent mental health services involved in the mental health response to the current war in Ukraine. Results and Discussion: The diverse perspectives from three mental health professionals involved in the MHPSS response highlight the different burdens and needs of children being confronted with situations of an existential nature. Children live through transformed social situations, deteriorated life conditions, general uncertainty, and encounter numerous losses. As such, war is the ultimate non-normative and existential stressor. The four perspectives highlight the need to: (1) adjust help toward the needs of the beneficiary, (2) understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters, (3) recognise losses and embrace finding ways to facilitate grief, and (4) continue to address these needs in a coordinated way that follows inter-agency guidelines. Conclusion: Better understanding the needs of refugee children underlines the importance of investing in their future by providing resources for humanitarian aid and psychosocial interventions during sustained emergencies. The perspectives presented in this letter emphasise that psychosocial care is deeply rooted in intersubjective help-encounters and, therefore, a professionalisation of interventions should co-occur with their humanisation and be adapted to subjective needs, varying sociocultural backgrounds, and the individuals themselves with the goal of reducing suffering and fostering well-being. HIGHLIGHTS: The three expert humanitarian aid perspectives highlight the need to: adjust help toward the needs of the beneficiary,understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters,recognise losses and embrace finding ways to facilitate grief, andcontinue to address these needs in a coordinated way that follows inter-agency guidelines.

Antecedentes: Los horrores que están ocurriendo en la guerra en Ucrania han conducido a consecuencias tremendas en términos de pérdidas de vidas, heridas graves, y de movimientos masivos de ciudadanos. Vivir en zonas de conflicto, estar expuestos a la guerra y ser forzados a desplazarse, aumenta el riesgo de experimentar un amplio espectro de consecuencias directas e indirectas sobre la salud física y mental de las poblaciones afectadas, especialmente en los niños.Objetivo: Esta carta al director busca proveer múltiples perspectivas clínicas y de sistemas de apoyo psicosocial y de salud mental en servicios de urgencia (MHPSS, por sus siglas en inglés) en relación a los esfuerzos de ayuda que se están realizando, y discutirlos con una perspectiva de asistencia informada sobre el trauma, para conectar y diseminar las actuales observaciones de las prácticas clínicas y MHPSS involucradas en la respuesta de salud mental actual.Resultados y discusión: Las diversas perspectivas de tres profesionales de la salud mental involucrados en la respuesta de los MHPSS destacan las diferentes cargas y necesidades de niños que han sido confrontados con situaciones de naturaleza existencial. Los niños viviendo situaciones sociales en transformación, condiciones de vida deterioradas y la incertidumbre general al encontrarse con numerosas pérdidas. Como tal, la guerra es el máximo estresor existencial no normativo. Los cuatro puntos de vista destacan la necesidad de: (1) ajustar la ayuda según las necesidades del beneficiario, (2) comprender los esfuerzos de ayuda como encuentros humanos intersubjetivos e incluir en ellos a los padres y cuidadores, (3) reconocer las pérdidas y adoptar la búsqueda de maneras para facilitar el duelo, y (4) continuar abordando estas necesidades de una forma coordinada que siga guías clínicas interinstitucionales.Conclusión: Una mejor comprensión de las necesidades de los niños refugiados subraya la importancia de invertir en su futuro proveyéndolos de recursos de ayuda humanitaria e intervenciones psicosociales durante emergencias prolongadas. Estas perspectivas presentadas en esta carta enfatizan que el cuidado psicosocial está profundamente arraigado en encuentros de ayuda intersubjetivos y, por lo tanto, debería ocurrir una profesionalización de las intervenciones junto con su humanización, y ser adaptados a las necesidades subjetivas, a los trasfondos socioculturales variados, y a los individuos mismos con el objetivo de disminuir el sufrimiento y fomentando el bienestar.

Feasibility and relatability of cultural adaptation amongst conflict-affected populations.

Cultural aspects, such as cultural values and specific stressors, need to be considered in intervention development of care. One study looked at the relevance and necessity of cultural adaptation in mental health interventions, and the results were conclusive. They found that for populations the intervention was not designed for, treatment was less effective than for the target population. Existing mental health programs well established in developed countries, with a low-threshold for quality care and a flexible delivery of the care, have shown to be less effective for marginalized populations and refugees, where linguistic and cultural barriers still exist. These barriers include limited understanding of treatment, a lack of knowledge on the healthcare systems in host countries, and the lack of interpreters or programs available in their native language. A promising approach for culturally-informed treatment are short skills-training interventions, designed to help participants better cope with stress and build up resilience to successfully deal with new challenges. START NOW is an evidence-based integrative skills training program and an effective treatment for vulnerable adolescents in demanding situations. We designed a total of eleven characters and fifthteen storylines that reflect the negative experiences commonly experienced by the target beneficiaries, and then conducted content testing to identify the most relatable among them. By conducting content testing, we can culturally adapt the START NOW program to meet the needs of Persian and Afghans migrants, informed by the very community that the program seeks to help. The results identified the six most relatable characters and twelve most relatable storylines, which will go on to feature in START NOW intervention sessions, and improve outcomes in testing the adapted program's efficacy with participants in Switzerland. This study provided a greater understanding of the challenges and emotions experienced by Persian and Afghan migrants, and enables us to design an effective, culturally-relevant treatment to address symptoms of poor mental health amongst this population. We can now replicate this process when adapting evidence-based treatments for other populations in need.