Circles of care: Supporting refugee families, children, and adolescents

Part 1. Refugee Families. In Chapter 2, we presented an overview of existing literature on the impact of Multiple Family Therapy (MFT) on mental health problems and/or family functioning, and a meta-analysis examining the efficacy of MFT. We found that MFT is associated with improvements in family functioning, with a small effect size. In addition, MFT is suggested to result in improvements in positive and negative symptoms of schizophrenia with a large effect size, although this effect was not statistically significant. Finally, MFT was not associated with changes in mood and conduct problems. Furthermore, we explored the feasibility of FAME, a preventive MFT program, adapted specifically for asylum seekers families in the Netherlands. Chapter 3 presented the study protocol for a FAME feasibility trial. The aim was to perform a pilot intervention trial in order to demonstrate program characteristics such as feasibility, acceptability, and potential effectiveness. The study protocol is followed by Chapter 4, describing the mixed-methods pilot trial assessing the feasibility of FAME. The study identified several challenges to program integrity, including constraints in time, attendance, and difficulties in organizing adequate rooms. A small group of participants completed all pre-and-post-FAME assessments measuring symptoms of depression and posttraumatic stress disorder (PTSD). Most participants noted they had appreciated gathering with multiple families. Some developed new coping strategies and more awareness of the impact of stress on their family. Although the quantitative results indicated that FAME might coincide with a decrease in anxiety and depression in parents, no change in family functioning was observed.Part 2. Unaccompanied Refugee MinorsTo map how URMs can be supported to improve their quality of life in the Netherlands, the perspectives of Eritrean minors and their guardians and mentors were explored using a focused ethnography study (Chapter 5). The study found the following themes to be crucial in the lives of Eritrean URMs in the Netherlands: relationships, psychological stress, preparation for independent living, spirituality, and leisure activities. The findings highlighted the need for more focused attention to their highly specialized mental health issues. Chapter 6 presented a pilot study of a short-term, multimodal trauma-focused treatment approach, evaluating the main request for help, treatment integrity, and the course of symptoms of PTSD and depression during the treatment. The results suggested that the trauma-focused treatment approach is partly feasible and that several barriers to mental health care were overcome. The added value of offering outreach care and collaboration with intercultural mediators (ICMs) was emphasized by the results. Finally, we aimed to evaluate the effectiveness of the multimodal treatment approach. In Chapter 7 we presented a mixed-methods study, combining a multiple baseline design and interviews assessing treatment satisfaction through triangulation. The quantitative results did not demonstrate that participants experienced a reduction in symptoms of PTSD and/or depression. Based on the qualitative evaluation, all but one minor found the treatment useful and thought the treatment had positively impacted their wellbeing. Both the quantitative and qualitative results reflect the impact of continuous stressors on the wellbeing of the participating URMs