Knowledge Gap

What is the effect of trauma treatment for refugee children and adolescents?

Children and young people with refugee backgrounds are at high risk of mental health challenges such as anxiety, depression, and post-traumatic stress disorder (PTSD).

Teaching Recovery Techniques (TRT) is a group-based, trauma-focused programme grounded in cognitive behavioural therapy, and has previously shown promising results.

What did we still lack knowledge about?

• Has TRT demonstrated documented effects in larger, controlled studies
• How does the intervention work in real-world settings — not only under controlled conditions?
• How can the intervention be implemented in systems undergoing change?

Where does the project fit in?

The project aimed to provide clear evidence of effectiveness through a randomised controlled trial (RCT), while also contributing knowledge about implementation in real-world practice.

Executive Summary

The study examined the effects of the group intervention Teaching Recovery Techniques (TRT) on the mental health of refugee children and adolescents. The project was initiated in response to a significant need for interventions that are both evidence-based and scalable.

The project was originally designed as a randomised controlled trial, with participants recruited through refugee reception centres and healthcare services. During the course of the study, however, the framework conditions changed: structural changes in the follow-up system for young refugees made it necessary to move both recruitment and implementation into schools. Once this transition had been completed, the Covid-19 pandemic struck, and school closures made it impossible to carry out the intervention as planned.

As a result, the project was adapted, including the development and testing of a digital version of the intervention. Although the main study could not be completed as originally intended, the project generated valuable insights into both barriers and enabling factors for implementation, as well as how interventions can be adapted to unpredictable circumstances. The findings therefore provide important knowledge about how such interventions may function in real-world practice — within a target group and context characterised by continuous change.

Methodology

The study applied a mixed-methods design, combining a planned quantitative randomised controlled trial (RCT) with qualitative studies and pilot testing of digital solutions. The sample included refugee and asylum-seeking children and adolescents, as well as group facilitators (professionals and school staff), parents, and user representatives.

Data collection drew on several sources:

• mental health questionnaires
• interviews and focus groups
• pilot data from digital TRT
• experiences from implementation in real-world settings

The analyses included quantitative analyses where feasible, thematic analysis of qualitative data, and assessments of feasibility and usability.

The study had several important limitations. The planned RCT was not completed, meaning that no clear effect measures are available. In addition, major structural changes in the field, the Covid-19 pandemic, and recruitment challenges affected implementation. Taken together, this means that the findings provide greater insight into how interventions can be implemented in practice than into the magnitude of their effects.

Results

Main Finding: Implementation was the greatest challenge

It was not possible to evaluate the intervention’s effectiveness as originally planned. The project’s most important insight therefore concerns not whether the intervention works, but what is actually required to make it accessible to the children who need it.

Secondary Findings

Schools emerged as a key arena for reaching large numbers of children, but also as a vulnerable setting dependent on capacity, structure, and opening hours. At the same time, the project demonstrated that digital TRT is feasible, with good usability and suitability for both training and delivery. This points to a clear potential for increased flexibility and scalability.

Recruitment proved to be a recurring challenge and required proactive outreach efforts and close collaboration between stakeholders. The study also showed that group facilitators need more support, particularly when dealing with difficult topics such as trauma and suicidal thoughts. This highlights the need for stronger supervision, practical training, and collaboration with local support services.

Furthermore, the findings suggest that interpreters can play an important role as active contributors during implementation, helping to strengthen both the quality of the intervention and participants’ sense of safety. Parental involvement also appears to generate positive ripple effects, both for the children themselves and for the broader anchoring of the intervention.

Conclusion

The findings show that the greatest challenge is not necessarily identifying what works, but how interventions can actually be implemented in practice. The project provides important insights into implementation in a complex and unpredictable context, demonstrates that digital solutions are feasible, and highlights key barriers to scaling. For practitioners, this points to the need to design interventions around settings where children already are — such as schools and local communities — to prioritise flexible and digital solutions, and to ensure adequate support for group facilitators. For policymakers, the findings underline the importance of stable frameworks and long-term funding, as well as the need for interventions that can withstand changes in systems and context.

Further Research

The findings point to the need for more robust and flexible study designs, larger studies testing the effectiveness of digital interventions, and greater knowledge about how implementation can be strengthened over time.