The Effectiveness of Group Interventions for Trauma Among Refugee and Immigrant Children: A Systematic Review

Background and Purpose: Group work has been recognized as useful in working with adolescents and young adults. Immigrant and refugee children and adolescents are a population at risk for developing mental health problems including post-traumatic stress disorder, anxiety, and/or depression. The literature describes a range of group interventions designed to reduce psychopathologies and improve the well-being of displaced children. This study provides a critical review of psychosocial group interventions for trauma among refugee and immigrant children and adolescents in reducing trauma

Methods: A systematic search following the Cochrane Handbook for Systematic Reviews of Interventions was conducted to identify group-based intervention studies. The PICO (population, intervention, control, outcome) framework was applied to examine relevant characteristics of the studies. Each study was reviewed for risk of bias by two reviewers. Between-group effect sizes for controlled clinical trials and pre-post effect sizes for all the included studies were calculated.

Results: The search yielded fifteen studies utilizing ten interventions involving 1,078 participants. The studies varied in targeted population (immigrants, refugees, asylees), design (randomized and non-randomized controlled trials, and single group pretest posttest), the interventions (cognitive behavioral therapy based therapies, writing for recovery, mindfulness based intervention, teaching recovery techniques, sand play, art therapy, and crisis management), and setting (urban, refugee settlements, and institutions). Boys were overrepresented in most of the studies. Between-group effect sizes varied from medium adverse effect to large positive effect. A large effect was found for a study using CBT on PTSD compared to untreated comparison (d= 0.88). Within-group effect sizes showed improvement in posttraumatic stress disorder, anxiety, and general distress symptoms in all studies. Six studies reported large within group effect sizes (d > 0.80) on PTSD, depression, and general distress. A small negative effect was found on depression in one study utilizing crisis management (d= - 0.16). A major limitation of all the studies was the lack of reporting on group treatment factors. Most studies did not provide adequate information on group composition, process, and leadership.

Conclusions and Implications: Given the large number of displaced children and adolescents, there were few intervention studies with strong methodological designs. Overall, the positive effect of the majority of interventions provides sufficient evidence of the short-term benefit of group work for refugee and immigrant children. Cognitive behavioral interventions showed promising results that need further replication, with longer posttests. It is recommended that future group work studies consider including description and analyses of group factors such as those mentioned above.