Mental health support for refugee children
Promising results: early mental health support for refugee children
Can group conversations be a crucial first step in addressing post-traumatic stress (PTSD) in refugee children? Professor Anna Sarkadi of Uppsala University says yes.
In 2016, a shocking 76% of unaccompanied refugee children arriving in Sweden showed PTSD symptoms. Studies in Norway and Belgium confirm these symptoms can persist, highlighting a widespread mental health crisis.
A wave of 70,000 refugee children arrived in Sweden in 2015 and 2016, 35,000 of them unaccompanied. This surge of vulnerable young people exposed a critical gap: ”There weren’t enough psychologists to handle the widespread trauma these children had endured,” states Professor at the Uppsala University Department of Public Health and Nursing, Anna Sarkadi.
Her solution? ”Teaching Recovery Techniques Intervention” (TRT), a lowbarrier group conversation programme designed to equip refugee children ages 8-20 with the tools to cope, lessening their risk of developing full-blown PTSD.
First aid
Professor Sarkadi emphasises that TRT functions as a form of mental health first aid. “Unlike traditional therapy requiring psychologists, TRT utilises trained group leaders, making it a more readily available intervention. An additional benefit is its ability to identify individuals with more severe symptoms who require further specialist care within the healthcare system,” explains Sarkadi.
Kavli Trust has funded an evaluation of the programme by Sarkadi and her team at Uppsala University. In 2017, Sarkadi’s project was among the first to receive support from the Kavli Trust Programme on Health Research. This programme continues to prioritise research addressing critical evidence gaps in child and adolescent mental health.
Sarkadi’s project addresses the evidence gap: What is the effect of interventions for refugee and asylum seeking children?
”This allocation was crucial for my team and me,” said Sarkadi upon receiving Kavli Trust funding in 2017. Six years later, despite unexpected challenges, she reaffirms its impact. Though political changes and the pandemic forced a pivot from a largescale study, those shifts ultimately proved vital.
Professor at the Uppsala University Department of Public Health and Nursing, Anna Sarkadi
Adapting to change
Reduced refugee numbers in Sweden prompted recruitment within schools. The pandemic then spurred the development of a digital TRT app, which young people embraced. ”We discovered the school setting’s value for both delivering TRT and accessibility,” Sarkadi explains.
These adaptations led to numerous smaller studies, each yielding valuable insights about TRT as a method. Researchers explored its effectiveness when combined with parental support and its ability to uncover suicidal ideation.
”Since 2017, we’ve published multiple articles illuminating TRT,” says Sarkadi. The conclusion is clear: PTSD is a public health issue demanding preventative treatment. TRT offers a stigma-free, accessible tool for reducing PTSD symptoms in children and teenagers. Its ease of access within young people’s daily lives is a major strength. While a large-scale randomised trial wasn’t possible, the research team confirms TRT’s effectiveness.
”The group format is key,” emphasises Sarkadi, ”it combats isolation and fosters understanding.” TRT remains one vital component of a structured approach to treating trauma in this population.
User co-creation
User involvement and co-creation are fundamental principles of the Kavli Trust Programme on Health Research, ensuring that research is both relevant and impactful.
”The collaboration with Kavli Trust pushed us to prioritise co-creation,” Sarkadi emphasises. Collaborating with refugee children, families, and support networks throughout the research process has shaped and strengthened TRT. This collaborative model is now gaining broader adoption within the PTSD research community. ”From our very first meeting with Kavli Trust, they challenged us on how we would involve users in our research. We were committed to co-creation, but their questions – who we’d involve, what methods we’d use – showed us how seriously they took it. No other funder has been so focused on this aspect,” Sarkadi says.
”That push from Kavli Trust propelled us. Co-creation has become fundamental for those researching PTSD in children and youth. In fact, the Kavli funding has been directly responsible for this shift. This June, we have a PhD student defending a thesis entirely focused on co-creative research with refugee communities.”
TRT shows impact beyond initial research
The usefulness of TRT extends far beyond the initial research funded by Kavli Trust. Following the February 2022 attack on Ukraine, traumatised refugee children again sought sanctuary in Sweden. TRT has proven to be a valuable tool in addressing their mental health needs. Furthermore, the programme is being used to support children within Sweden who have been impacted by violence in their neighbourhoods, either witnessing traumatic events or experiencing heightened anxiety due to insecurity.
”We’re grateful for Kavli Trust’s unique approach,” says Sarkadi. ”Unlike some funders, they haven’t just provided funding and waited for results. Their ongoing communication and support have been invaluable.”
Spinoff projects
Sarkadi’s team, with backing from various funders, is embarking on new projects to expand TRT’s reach and effectiveness. These ”spinoffs” will delve deeper into the method’s potential through app development and real-world testing.
”We’re actively refining the app based on user feedback,” explains Sarkadi. ”Young people made it clear they want exercises led by peers, not ‘oldies’.” This feedback is guiding the app’s development and upcoming trials in schools and vulnerable areas where children may have witnessed gang violence.
Sarkadi’s team champions open communication about TRT. They actively present their research to researchers, practitioners and even politicians. This dedication to user involvement extends beyond research.
”Whenever possible,” says Sarkadi, ”we include young people themselves.
Recently, two joined us for a presentation at the Swedish Medical Association, and two others took part asking video questions to politicians at Almedalsveckan (Almedalen Week, a political festival),” says Sarkadi.
”This project exemplifies the spirit of the Kavli Trust Programme on Health Research,” says Programme Manager at Dam Foundation and head of the research programme, Jan-Ole Hesselberg.
”We prioritise projects where end-users are actively involved. TRT is a shining example.”
In 2022-2024, Kavli Trust supported the Swedish children’s rights organisation Bris with NOK three million for their rollout of the TRT method in a venture for children and young people with a refugee background in Sweden.
Large research group
Mikael Wallerstedt
“Working with scientists was fun, so inspiring. You had to learn new things. It was powerful. Now when I tell my friends about it, they’re all curious and want to get involved too. At job interviews, when recruiters see my CV, it is the first thing they ask me about!”
Kalid Ibrahim (21)
“I first encountered TRT at school, and it was honestly a lot of fun. Those weekly sessions, talking and sharing ideas. Then the pandemic hit, and we couldn’t meet in person anymore. They tried taking things online, but it wasn’t the same. Even though I’d only been online once, they reached out because they wanted my feedback on how to make the virtual experience better. There were about eight of us, a couple of people were more quiet. The researchers were listening and taking notes. I loved sharing ideas with the others about how to improve TRT for online settings. It was such a positive experience because everyone respected each other. We all wanted to be there, and that good energy made it really fun!”
Reem Aljeshy (22)
Excerpt from article, where the two youngsters are co-authors: Inge, E., Pérez-Aronsson, A., Ibrahim, K., Aljeshy, R., Sarkadi, A., & Warner, G. (2023). Ameliorating epistemic injustice in practice: Communication strategies in a research project with refugee youth co-researchers. Health Expectations, 27(1), e13926. https://doi.org/10.1111/hex.13926
Advice to researchers from Reem and Kalid
How can researchers and young people work best together? These are the recommendations of Reem Aljeshy and Kalid Ibrahim.
- Respect our time: Researchers should respect young people’s time and commitments. Please be flexible and understanding if we have other stuff going on.
- Positive atmosphere: Make it welcoming and fun! That way we’ll actually want to be there and contribute.
- Having other young people involved is key. It helps combat shyness.
- Honesty and trustworthiness: Researchers should be reliable and follow through on promises.
- Prepare for participation: Send meeting details and questions a couple of days beforehand, giving young people time to think and prepare to contribute comfortably. Consider how we prefer to receive information: WhatsApp might work better than email.
- Create a comfortable environment where we feel safe expressing ideas. If you have to wait a long time for your turn to speak, it is easy to forget what you wanted to say. Young people aren’t comfortable interrupting adults.
- Provide snacks and refreshments for longer meetings to maintain energy.
- If meeting in person at an unfamiliar location such as a university, a friendly introductory call (phone or video) can reduce anxiety and nervousness.
- Incorporate fun warm-up activities in the first meeting to build rapport and get everyone comfortable. Let us help plan these icebreakers!