The Effectiveness of Community and Family-Based Programs on Promoting Refugee Child Mental Health and Development: A Systematic Review and Meta-Analysis

Background: There are over 11 million refugee children worldwide as a result of ongoing global conflicts and violence. After families resettle, they may receive services to address or prevent mental health problems, promote family acculturation, or promote children’s positive development. Some programs offered to refugee families have been evaluated for their effects on parent or child outcomes. However, the different types of programs have not been systematically reviewed or analyzed to determine the most effective types of programs for parent and child outcomes. The purpose of this study was to conduct a systematic review to examine the outcomes of community and family-based programs on promoting refugee child mental health and development. Additionally, we examined whether programs that included or targeted caregivers were more effective than programs that only included children.

Methods: This systematic review included evaluations of interventions that broadly targeted refugees, asylum seekers, or displaced persons as a result of political violence, with a focus on contemporary crises. The following databases were searched: PsychINFO, Pubmed, Web of Science, CINAHL, Eric, as well as the grey literature (e.g., think tank and NGO evaluation reports). Articles were included if they meet the following criteria: 1) experimental or quasi-experimental study design, 2) assessed child mental health and developmental outcomes, including socio-emotional, cognitive, and language outcomes, 3) were published since 2001. Studies were excluded if they did not include a control group or used an individual psychotherapy approach to treating children or their families. PRISMA procedures were followed; two reviewers independently screened all titles and abstracts for inclusion and exclusion criteria, followed by a full text review. Programs were assessed for their overall effectiveness on child outcomes, and comparisons were made between community (e.g., school-based) and parenting programs.

Results: Studies were categorized by type of intervention and delivery target. Results were categorized under eight main categories at three levels: 1) at the child level: mental health outcomes (e.g., depression, anxiety, ptsd), socio-emotional development (e.g., behavioral problems), and cognitive development; 2) at the parent level: mental health outcomes, psychosocial wellbeing (stress, coping), and parenting (e.g., harsh punishment, responsiveness, and stimulation); and 3) at the family level: family functioning and support. The quality of each study was assessed for risk of bias using the Cochrane Risk of Bias Assessment tool for Non-randomized Studies (RoBANS).

Conclusions and Implications: Programs that treat the whole family may be better suited to address mental health problems and the intergenerational effects of trauma. Community and family programs alone, however, may not be intense enough to address the complex issues refugees and their families face. Further research is needed to understand multi-system solutions to address mental health problems in refugee children, and to make up for educational disruptions. Furthermore, research on preventive interventions for children who do not yet display mental health symptoms is warranted.