RefugeesWellSchool (Sweden): teaching recovery techniques and in-service teacher training program

INTERVENTION: The trial has two arms (i.e., an intervention arm and a control arm) and the cluster is assigned by school and in an allocation ratio of 1:1. The researchers used an online randomisation tool named sealed envelope (https://www.sealedenvelope.com/) Youth in the intervention arm will participate in data collection and will be screened to determine whether they receive the Swedish translation of the Teaching Recovery Techniques (TRT) programme. Youth in the intervention arm will be offered TRT if they meet the following TRT inclusion criteria: 1. CRIES‐8 score = 17 2. Time spent in Sweden = 6 years 3. Therapist does not advise against intervention The TRT programme is a group‐based cognitive‐behavioural programme that includes 2 parent/guardian sessions and 7 youth sessions. It is delivered to qualifying youth in the intervention schools and may also be delivered to their parent/guardian, though adolescents do not need to have a participating guardian to take part in TRT. Parent/guardian sessions focus on psychoeducation. One session is delivered prior to the commencement of the youth sessions and the other is delivered between the second and fourth youth session. Youth sessions focus on psychoeducation, intrusion, arousal, avoidance, and coping strategies. The first session is a ‘getting to know each other session’ and the final session is a ‘follow‐up session’ which consolidates learning and enables participants to talk about their experience of taking part in the programme. Sessions will be delivered over 7 consecutive weeks and each session will last 2 hours (including a break). TRT facilitators will receive 3 days of training in programme delivery. Adolescents who receiv CONDITION: Symptoms of post‐traumatic stress ; Mental and Behavioural Disorders ; Post‐traumatic stress disorder PRIMARY OUTCOME: ; The following outcomes are measured at baseline, post‐intervention, and at three months follow‐up:; ; Adolescents who receive TRT:; Measures of mental health problems including:; PTSD symptoms, measured using the Children’s Revised Impact of Event Scale (CRIES‐8); ; Parents who attend TRT as guardians:; Measures of mental health problems including:; Mental health, measured by the General Health Questionnaire (GHQ12); ; Teachers who receive INSETT:; 1. Measure of supportive parent‐teacher interrelationships, including:; Teacher‐parent collaboration, measured by the Trust Scale (TS); 2. Measure of cultural competence, including:; Multicultural awareness and understanding, measured by the Teacher Multicultural Attitude Scale (TMAS); ; Adolescents who do not receive TRT:; Measures of social support and school belonging including:; Feelings of belonging at school, measured by the Psychological Sense of School Membership Scale; SECONDARY OUTCOME: ; The following outcomes are measured at baseline (except the adolescent PHQ‐9 and teacher classroom atmosphere measure), post‐intervention, and at three months follow‐up:; ; Adolescents who receive TRT:; 1. Other measures of mental health problems and wellbeing including:; 1.1. Internalizing and externalizing problems, measured using the Strengths and Difficulties Questionnaire (SDQ); 1.2. Depression severity, measured using the Patient Health Questionnaire‐9 (PHQ‐9); 1.3. Experience of the amount of stressors in daily life, measured by the Daily Stressors questionnaire (DSSYR); 1.4. Positive development and resilience, measured by the Child and Youth Resilience measure (CYR‐12); 1.5. Wellbeing, measured by one item developed for this study; 2. Measures of social support and school belonging including:; 2.1. Social support, measured by a Multidimensional Scale of Perceived Social Support; 2.2. Existence of interethnic friendships and friendship satisfaction, measured by questions developed for this study; 2.3. Experience of discrimination, measured by The Perceived Ethnic Discrimination Questionnaire; 2.4. Feelings of belonging at school, measured by the Psychological Sense of School Membership Scale; 3. Measure of cognitive functioning, including:; Perception of one’s own executive functions, measured by the Amsterdam Executive Function Inventory (AEFI); ; Parents who attend TRT as guardians:; 1. Other measures of mental health problems including:; 1.1. Self‐reported health, measured by one item on the SF‐36; 1.2. PTSD symptoms in the parent, measured by the PTSD‐8 questionnaire; 2. Measures of social support and school belonging including:; 2.1. Teacher‐parent collaboration, measured by the Trust Scale (TS); 2.2. Experience of discrimination, measured by The Perceived Ethnic Discrimination Questionnaire; 2.3. Social support, measured by the Social Support Instrument (ESSI); ; Teachers who receive INSETT:; 1. Measures of teachers’ self‐efficacy and experiences with work, including:; 1.1. Stress symptoms, measured by the Single Item Stress Index (SISI); 1.2. Work exhaustion/burnout, as measured by the Bergen Burnout Inventory (BBI); 1.3. Work engagement including vigor, dedication, and absorption, measured by the Utrecht Work Engagement Scale (UWES); 1.4. Self‐Efficacy, measured by the Teachers’ Sense of Efficacy Scale (TSES); 2. Measure of school climate, including:; 2.1. Classroom atmosphere, measured using a scale developed in a psychosocial school intervention study; ; Adolescents who do not receive TRT:; 1. Other measures of social support and school belonging including:; 1.1. Social support, measured by a Multidimensional Scale of Perceived Social Support; 1.2. Existence of interethnic friendships and friendship satisfaction, measured by questions developed for this study; 1.3. Experience of discrimination, measured by The Perceived Ethnic Discrimination Questionnaire; INCLUSION CRITERIA: Inclusion criteria for schools: 1. Must be multi‐ethnic secondary schools that have grades 7–8 and/or introduction classes for newcomer adolescents, including at upper secondary schools 2. Must have an interest in participating in the school‐based interventions. Inclusion criteria for adolescents who receive TRT: 1. Legal guardian consents to participation if the adolescent is <15 years 2. Adolescent self‐consents to participate if they are ?15 years 3. Time spent in Sweden less than or equal to 6 years 4. Screen positive on the Children’s Revised Impact of Event Scale‐8 (CRIES‐ 8) PTSD screening tool (=17 points) 5. Therapist does not advises against intervention Inclusion criteria for parents/guardians: 1. Parent/guardian consents to participatio