Towards novel methods of mental health care for refugees

Within the START project, an intervention for the initial stabilization of emotionally and psychologically severely stressed children and adolescents and underage refugees is being developed. The START training aims to help reduce stress and post-traumatic symptomatology, develop emotion regulation skills, and strengthen or even rebuild confidence in their own abilities.

Regardless of their country of origin, adolescent refugees can participate in this study if they are sufficiently fluent in one of the following languages:
German, English, Arabic, Dari, Somali.
Due to the current war in the Ukraine, adolescent refugees from Ukraine and neighboring countries can also participate in the study.

Location: Mainz

The integration of refugee families in the host country is also dependent on the successful integration of their children in the crèche. Within the framework of the START Childcare study, we would therefore like to investigate the effectiveness of a mentalization-based and attachment-oriented program for crèche children and their parents with a migration background and/or refugee experiences in the context of the familiarization phase in the crèches.

Location: Heidelberg

Subproject A3 realizes an 8-week group treatment targeting refugees with severe deficits in emotion regulation and management of everyday life. The START program covers training modules from different therapeutic approaches, including dialectic-behavioral therapy, trauma-focused cognitive behavioral therapy and biofeedback. A3 evaluates the feasibility of the START program in adolescents and young adults (18-25 years).

Location: Mainz

In our subproject B1, we use a smartphone app to investigate the effectiveness of the START A1 intervention as well as perceived stress in the daily life of adolescent refugees. Compared to other assessment methods, electronic diaries have the advantage of mapping everyday experiences unbiased, dynamically, and in the context of intrapsychological and social processes.

Ort: Karlsruhe

Within subproject B2, we want to test the effectiveness of the START A2 intervention in strengthening mentalization skills in the everyday working environment of childcare workers (see START A2). Mentalization refers to the ability to understand one’s own behavior or the behavior of other persons in a particular situation. Data will be collected in the everyday occupational life of childcare workers using e-diaries.

Location: Karlsruhe

A newly developed mobile app is being tested by means of a large clinical study. This is intended to make it possible to conduct a diagnostic interview with Arabic speakers (possibly with dialect). The results obtained using the app will be compared with results based on interviews with translators.

Locations: Mannheim, Karlsruhe

Despite high levels of psychological distress, it is difficult for asylum seekers to access psychological treatment. This is due to a lack of knowledge about psychotherapy as well as cultural and language barriers. The low-threshold, culturally sensitive psychoeducation "Health Tea Garden" aims to increase knowledge about mental health problems as well as available treatments and to improve mental resilience and self-care.

Location: Marburg

In subproject SP2 "ReTreat", a culturally sensitive, behavioral therapy group program for Afghan and Syrian refugees, respectively, will be adapted and studied. The culturally adapted intervention (CA CBT) is an already evaluated group program for refugees, which consists of psychoeducation, meditation and yoga/stretching. It discusses issues that preoccupy and stress many refugees in their daily lives: different fears, vivid memories of the past, and dealing with current stressors.

Location: Frankfurt

ReCAP SP3 (ReScript) investigates the effectiveness of Imagery Rescripting for the treatment of posttraumatic stress disorder in refugees. Post-traumatic stress disorder can occur after a traumatic event and cause symptoms such as intrusive memories or nightmares. Psychotherapy is the treatment of choice for posttraumatic stress disorder. Imagery Rescripting is a short, trauma-focused psychotherapeutic treatment that has shown promising results in previous studies and is well accepted by patients.

Locations: Frankfurt, München, Münster

In light of a lack of Data on substance related disorders among refugees this subproject aims to identify vulnerable groups and used substances, substance use related problems and factors that lead to substance use in seven major cities along with an adjacent rural area.

Furthermore „good practice“ strategies in addiction care for refugees in Germany will be identified. Finally, the addiction care facilities in Germany will be surveyed to what extent these strategies are already applied.

Location: Berlin

This working package intends to contributing to developing and evaluating a refugee and refuge sensitive assessment instrument.

Location: Emden

BePrepared covers the development and evaluation of a brief smartphone intervention for young refugees with hazardous use of alcohol and cannabis. The BePrepared App is free of charge, anonymous and available in five languages: Arabic, German, English, Farsi and Pashto. By offering a digital and culture-sensitive intervention the project contributes to addiction prevention in the hard-to-reach and underserved population of young refugees.

Orte: Köln, Berlin

Subproject 4 examines the effectiveness of an integrative group therapy (STARC) for refugees with post-traumatic symptoms and hazardous substance use or a substance use disorder. STARC is a culturally sensitive, transdiagnostic group therapy approach, which aims to improve affect regulation.

Ort: Hamburg

Parents with young children represent a particularly large group of refugees in Germany. The Improve Mental Health (IMPROVE-MH) project aims to improve the mental health of these refugee families. To this end, the parents' mental health and parenting skills are to be supported to promote their children's healthy development.

Location: Bochum, München

In order to compare the effectiveness of the IMPROVE intervention with the usual treatment, a so-called Ecological Momentary Assessment (EMA) is carried out in addition to the traditional survey methods. Participants will be surveyed daily for one week using a cell phone app. In this way, the behavior and experience of the participants will be recorded directly and without bias. In addition, the cultural sensitivity and quality of the traditional surveys will be investigated.

Location: Bochum

Hausärzt*innen sind bei Problemen oft die ersten Ansprechpartner*innen für Flüchtlingsfamilien. Da das Aufwachsen mit einem psychisch belasteten Elternteil ein großer Risikofaktor für die Entwicklung psychischer Probleme bei Kindern darstellt, werden im Rahmen der IMPROVE-MH-Studie Eltern mit Kleinkindern eine Intervention in Hausarztpraxen erhalten. So kann ein positiver Erziehungsstil vermittelt und ein gesundes Heranwachsen der Kinder gefördert werden. Teilstudie 2.2 evaluiert die Umsetzung dieser Intervention in den Hausarztpraxen.

Ort: Bochum

To examine the cost-effectiveness of the IMPROVE intervention program compared, parents are invited to take part in interviews on mental health outcomes and fill in questionnaires prior, during and after the treatment. The aim is to investigate, if the Improve intervention shows a favorable and acceptable incremental cost-effectiveness ratio compared to treatment as usual.

Location: Hamburg

Reliable and culturally adjusted psychodiagnostic instruments (e.g. questionnaires, standardised interviews) are urgently needed in the psychosocial care of and research with refugees. Therefore, subproject 1 develops and evaluates a modular, online-based tool providing free and open source psychodiagnostics instruments in the languages most relevant to the current refugee population.

Location: Leipzig

This subproject comprises the cultural adaptation of a transdiagnostic treatment program for Arabic-speaking refugees in Germany. The „Common Elements Treatment Approach“ (short: CETA) addresses psychological problems that are particularly common in refugees (e.g. anxiety, trauma-related symptoms). Next, a digital equivalent of the CETA intervention will be developed in cooperation with refugees and other relevant stakeholders: the ALMAMAR-App.

Location: Berlin

The subproject I-REACH SP3 investigates the effectiveness of a psychotherapeutic treatment for Arabic-speaking refugees and migrants, which is being applied for the first time in the German context. The intervention called ALMAMAR is either delivered internet-based or face-to-face. In the study we want to find out whether this intervention helps Arabic-speaking people who suffer from psychological stress.

Location: Berlin

The subproject I-REACH SP4 investigates the implementation of a blended-care approach in inpatient psychiatric-psychotherapeutic care of refugees with mental illness. With blended-care we describe the combination of face-to-face treatment and parallel use of internet-based therapeutic elements. For this purpose, internet-based psychotherapeutic elements in the mother tongue are offered in addition to treatment as usual in the participating psychiatric clinics for Arabic and Farsi speaking patients (intervention group). Acceptance and satisfaction are evaluated with the offered treatment and treatment results are compared to a control group (treatment as usual).

Location: Cologne

In the care of refugees, a number of specific factors (e.g. language and cultural barriers) lead to a particularly high risk of dropout. The project PrevDrop supports the research network in planning and implementing measures to prevent dropout. In addition, predictors and subjective reasons for dropout in refugees will be investigated by a combination of quantitative and qualitative methods across the studies of the research network.

Location: München

The cross-sectional project CUMI accompanies all subprojects of the research network in the cultural adaptation of their respective planned interventions. The aim is to increase the expertise on cultural adaptations, to bundle and expand the know-how of the individual consortia and to improve the cultural sensitivity of the applied interventions. In this way, the effectiveness of the interventions can be improved.

Locations: Berlin, Zürich

The cross-sectional project KS-Diagnostik aims to bundle expertise and experience in culturally sensitive diagnostics across the research associations, formulate common standards and enable exchange of diagnostic instruments. Furthermore, an open access platform will be established to make existing instruments available for researchers and clinicians.

Location: Leipzig

The Digital Assessment Tools Task Force (DATTF) is a cross-sectional project that supports the consortia in planning and implementing IT-related requirements (e.g., data collection using smartphones, tablets, or PCs; data protection). In this way, common barriers in the use of digital tools are to be eliminated as early as possible. The project is also responsible for creating and maintaining the cross-network website.

Location: Berlin

The subproject addresses treatment barriers for unaccompanied young refugees (e.g. . limited number of therapy places for trauma-focused, evidence-based psychotherapy for young refugees in Germany). The project aims to improve the psychotherapeutic care of young refugees through the dissemination and implementation of trauma-focused cognitive behavioral therapy (TF-CBT). Within the subproject, interpreters will be prepared for the specific challenges of translating psychotherapies via a certified online workshop.

Location: Eichstätt

This subproject is concerned with the health economic evaluation of BETTER CARE interventions from the societal perspective. For this purpose, the health and psychosocial care services used by the study participants in the will be completely recorded and valued in monetary terms, the participants’ subjective quality of life will be assessed and quality-adjusted life years (QALYs) will be generated. These data form the basis for an incremental cost-utility analysis to determine the necessary maximum willingness to pay for one year of life in full health by the BETTER CARE intervention in addition to routine care.

Location: Ulm

In order to meet the needs of distressed UYR, collaboration between child and youth welfare system (CYWS) and mental health services is crucial. The aim of SP5 is to find out more about existing structures and collaborations between the relevant actors in the field. Collaboration is especially important in the proposed stepped care approach BETTER CARE, therefore we will assess conditions and motivation in CYWS residential care facilities to successfully implement mental health services for unaccompanied young refugees.

Location: Munich

With the joint project "BETTER CARE" we want to contribute to the improvement of psychotherapeutic care for unaccompanied young refugees in Germany. Within the project, a stepped care approach will be developed, implemented and compared with the standard care in Germany with regard to its effectiveness. In SP1, the recruitment of youth welfare institutions that are interested in implementing the stepped care approach in their residential groups will be promoted.

"BETTER CARE" develops a stepped care approach to improve psychotherapeutic care for unaccompanied young refugees in Germany. In the sub-project SP2, screenings are conducted together with SP1, which serve as a basis for the stepped care approach. In addition, SP2 is responsible for the subsequent implementation of the preventive group program "My Way".