| 1. |
- Sarkadi, Anna, Professor, 1974-, et al.
(författare)
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Evaluation of the Teaching Recovery Techniques community-based intervention for unaccompanied refugee youth experiencing post-traumatic stress symptoms (Swedish UnaccomPanied yOuth Refugee Trial; SUPpORT) : study protocol for a randomised controlled trial
- 2020
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Ingår i: Trials. - : NLM (Medline). - 1745-6215. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In 2015, 162,877 persons sought asylum in Sweden, 35,369 of whom were unaccompanied refugee minors (URMs). Refugee children, especially URMs, have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue years after resettlement. The Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT) aims to evaluate a community-based intervention, called Teaching Recovery Techniques (TRT), for refugee youth experiencing PTSD symptoms.METHODS/DESIGN: A randomised controlled trial will be conducted in which participants will be randomly allocated to one of two possible arms: the intervention arm (n = 109) will be offered the TRT programme, and the waitlist-control arm (n = 109) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; about 8 weeks after randomisation) and follow-up (T3; about 20 weeks after randomisation).DISCUSSION: This study will provide knowledge about the effect and efficiency of a group intervention for URMs reporting symptoms of PTSD in Sweden. TRIAL REGISTRATION: ISRCTN, ISRCTN47820795. Prospectively registered on 20 December 2018.
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| 2. |
- Warner, Georgina, et al.
(författare)
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Evaluation of the teaching recovery techniques community-based intervention for accompanied refugee children experiencing post-traumatic stress symptoms (Accompanied refugeeS In Sweden Trial; ASsIST) : study protocol for a cluster randomised controlled trial
- 2020
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Refugee children have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue for years after resettlement. The Accompanied refugeeS In Sweden Trial (ASsIST) aims to evaluate a community-based intervention, called 'Teaching Recovery Techniques' (TRT), for accompanied refugee minors experiencing PTSD symptoms. METHODS/DESIGN: A cluster randomised controlled trial will be conducted in which participants will be randomly allocated to one of the two possible arms: the intervention arm (n=113) will be offered the TRT programme and the waitlist-control arm (n=113) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; c.8 weeks after randomisation) and follow-up (T3; c.20 weeks after randomisation). ETHICS AND DISSEMINATION: Ethical approval was granted by the Regional Ethical Review Board in Uppsala (Ref. 2018/382) (24th February 2019). Results will be published in scientific journals. TRIAL REGISTRATION DETAILS: ISRCTN17754931. Prospectively registered on 4th June 2019.
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| 3. |
- Dahlberg, Anton
(författare)
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Capturing and addressing preschool children’s emotional and behavioural problems : Using parents’, teachers’ and children’s perspectives
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Emotional and behavioural problems (EBP) are among the most common mental health problems in preschool children. EBP are also associated with poor parent mental health. Untreated, EBP can persist or worsen over time. In order to capture and address preschool children’s EBP, we need scientifically valid instruments that can access the perspectives of informants from different contexts of the child. We also need cut-off values for questionnaires assessing EBP that are representative of the population. Parenting support is a recommended intervention for addressing EBP in preschool children. Most parenting support programmes have a solid evidence-base and show positive effects on child EBP and parent wellbeing. However, we need a better understanding of the children’s emotional and relational experiences, especially in relation to their parents. Further, although the implementation of evidence-based interventions is a complex matter with substantial impact on intervention success, few studies assess the implementation process of parenting programmes. The studies constituting this thesis focused on preschool children. The Strengths and Difficulties Questionnaire (SDQ) was assessed for capturing EBP. Study I assessed the construct validity of the SDQ and its five subscales, when rated by fathers and preschool teachers. Confirmatory factor analysis was applied to evaluate construct validity. Results indicated that the SDQ can be used as an instrument to measure EBP in preschool children, rated by parents and preschool teachers. In study II, we established Swedish norms for the SDQ for preschool children. Results suggested lower SDQ cut-offs for Swedish preschool children compared with other countries, and higher cut-offs for boys compared with girls. In study III, preschool children whose parents participated in a parenting programme were interviewed regarding their emotional and relational experiences at home. Data were analysed using qualitative content analysis. The children provided accounts of negative and positive interactions with their parents, elaborately describing a coercive cycle with escalating conflicts and lack of problem resolution. In study IV, the implementation of the parenting programme Triple P in a preschool setting was assessed using the RE-AIM framework. Results indicated a successful implementation that relied on customisation of the programme; assessment of the process from parent, staff, and organisation levels; interdisciplinary collaboration; and continuous work on securing maintenance over time. This thesis provides pieces to a complex puzzle of understanding and addressing child mental health problems, particularly EBP. Assessing EBP from different perspectives and promoting children’s voices are essential, as well as actively working with the implementation of evidence-based programmes.
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| 4. |
- Fängström, Karin, 1980-
(författare)
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‘I don’t even remember anything’ : Optimising the choice of method when interviewing preschoolers
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is increasing need and demand in various contexts to take children’s perspectives into account, including the views and opinions of the youngest children. However, listening to the voices of children is a challenging and complex task, and the field is normatively loaded. There is thus a growing need for valid and reliable methods and techniques that aid children to verbalise their experiences. The overall aim of this thesis was to examine the ability of the In My Shoes computer assisted interview and a Standard verbal interview to elicit accurate information and evaluative content, when used with preschool-aged children and determine their suitability in relation to situationally shy children.Our studies show that the two interview methods, in general, provided equally accurate and complete statements. In addition, the IMS interview can be a more useful and suitable tool during the rapport phase with situationally shy children compared to the Standard verbal method. For non-shy children, the interview methods were equally adequate. In relation to evaluative information, the recommended open-ended questions in the Standard verbal interview were insufficient. Children appeared to need evaluative questions in order to provide evaluative content. Examining the ability of IMS to elicit subjective experiences showed that using IMS aided children to provide detailed and varied descriptions of emotions, somatic experiences, and objects such as toys. Thus, when choosing the optimal child interview method, there are several aspects that need to be considered, including the degree to which children’s statements need to be accurate and complete and/or contain evaluative information and the child’s level of shyness. These studies have increased the number of evaluated methods for interviewing children and contributed to new knowledge about the challenging task of optimising the choice of method for interviewing preschoolers.
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| 5. |
- Johansen, Kine
(författare)
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Towards an evidence-based assessment of early motor performance in the child health services : Psychometric properties and clinical utility of the Structured Observation of Motor Performance in Infants
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish child health services (CHS) have a unique position in that they reach almost all children 0-6 years of age. The child health nurse has the main responsibility for developmental surveillance. Twelve scheduled visits with the nurse during the child’s first year of life make this an ideal setting to systematically identify infants with motor problems, ranging from asymmetric head positioning that may lead to plagiocephaly to more severe forms such as cerebral palsy (CP). However, the CHS lack evidence-based methods to assess motor development.The Structured Observation of Motor Performance in Infants (SOMP-I) assesses motor performance in two domains, i.e. level of motor development and quality of motor performance. SOMP-I is quick, non-invasive, requires minimal handling, and is suitable for a busy clinical setting when applied by physiotherapists. Given the importance of early detection, the increased likelihood of detecting motor problems when using evidence-based assessment methods and the key role of nurses within the CHS, the overall aim of this thesis was investigate the psychometric properties and clinical utility of SOMP-I when used by child health nurses. Furthermore, we aimed to establish the ability of SOMP-I to detect CP.Our results show that child health nurses can reliably assess the level of motor development in infants using SOMP-I. More variability was found when they assessed the infants’ quality of motor performance. Although the nurses expressed concern about introducing a more time-consuming assessment in an already tight schedule, they were able to integrate the SOMP-I assessment in routine care. The nurses reported that barriers to using SOMP-I were mostly logistic and practical in nature, and they pointed out the necessity of education and practice in order to become proficient assessors. Using SOMP-I appears to have supported the nurses in the decision-making process regarding motor performance in routine care. SOMP-I detected CP during the first months of life in neonatal intensive care recipients.To our knowledge, these studies are the first to evaluate child health nurses’ assessment of early motor performance using an evidence-based assessment method in routine care. The results are promising, but further research is warranted.
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| 6. |
- Rondung, Elisabet, 1980-, et al.
(författare)
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Feasibility of a randomised trial of Teaching Recovery Techniques (TRT) with refugee youth : results from a pilot of the Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT)
- 2022
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Ingår i: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although post-traumatic stress is prevalent among unaccompanied refugee minors (URM), there are few evidence-based psychological interventions for this group. Teaching Recovery Techniques (TRT) is a brief, manualised intervention for trauma-exposed youth, which has shown promising results in exploratory studies. The aim of the present study was to assess the feasibility of conducting a randomised controlled trial (RCT) evaluating the use of TRT among URM by investigating key uncertainties relating to recruitment, randomisation, intervention delivery and data collection. Methods: A 3-month long non-blinded internal randomised pilot trial with a parallel-group design assessed the feasibility of a planned nationwide multi-site RCT. URM with or without granted asylum were eligible if they were 14 to 20 years old, had arrived in Sweden within the last 5 years and had screened positive for symptoms of post-traumatic stress disorder (PTSD). Quantitative data were collected pre- and post-intervention, and 18 weeks after randomisation. On-site individual randomisation (1:1) followed directly after pre-intervention assessment. Participants allocated to the intervention were offered seven weekly group-based TRT sessions. Quantitative pilot outcomes were analysed using descriptive statistics. Qualitative information was gathered through on-site observations and follow-up dialogue with group facilitators. A process for Decision-making after Pilot and feasibility Trials (ADePT) was used to support systematic decision-making in moving forward with the trial. Results: Fifteen URM (mean age 17.73 years) with PTSD symptoms were recruited at two sites. Three of the youths were successfully randomised to either TRT or waitlist control (TRT n = 2, waitlist n = 1). Fourteen participants were offered TRT for ethical reasons, despite not being randomised. Six (43%) attended ≥ 4 of the seven sessions. Seventy-three percent of the participants completed at least two assessments, with a response rate of 53% at both post-intervention and follow-up. Conclusions: The findings demonstrated a need for amendments to the protocol, especially with regard to the procedures for recruitment and randomisation. Upon refinement of the study protocol and strategies, an adequately powered RCT was pursued, with data from this pilot study excluded. Trial registration: ISRCTN47820795, prospectively registered on 20 December 2018
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| 7. |
- Sarkadi, Anna, Professor, 1974-, et al.
(författare)
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Are We Ready to Really Hear the Voices of Those Concerned? : Lessons Learned from Listening to and Involving Children in Child and Family Psychology Research
- 2023
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Ingår i: Clinical Child and Family Psychology Review. - : Springer Nature. - 1096-4037 .- 1573-2827.
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Tidskriftsartikel (refereegranskat)abstract
- A changing view of children, accelerated by the Convention of the Rights of the Child (UN in Convention on the rights of the child, UN Doc. A/RES/44/25, 1989, http://www2.ohchr.org/english/law/pdf/crc.pdf) has shifted the landscape of child and family research over the last few decades. Once viewed with low credibility and operating outside the interpretive framework of adult researchers, the rights-bearing child is increasingly recognized not only as having the capacity but also the right to participate in research. More recently, this movement has transitioned from the direct engagement of children as research participants—now considered commonplace, although less so for those who are structurally vulnerable—to the involvement of children in research design, review, conduct, and dissemination. Yet, both practical and ethical challenges remain. While children have the right to participation, they also have the right to protection. In this commentary, we set out to: (i) lay forth epistemic, child rights, and child sociology arguments for doing research about, with and by children and youth; (ii) recount our own journey of including children and youth in research to demonstrate the unique knowledge and insights gained through these approaches; and (iii) offer lessons learned on how to engage children and youth in research, including the involvement of structurally vulnerable groups.
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| 8. |
- Sarkadi, Anna, Professor, 1974-, et al.
(författare)
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Is the refugee health screener a useful tool when screening 14-18 year old refugee adolescents for emotional distress?
- 2019
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Ingår i: The Journal of Refugee Studies. - Oxford, UK : Oxford Academic. - 0951-6328 .- 1471-6925. ; 32:Special_Issue_1, s. i141-i150
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Tidskriftsartikel (refereegranskat)abstract
- The high number of asylum seekers in Sweden has highlighted the need for structured assessment tools to screen for refugee mental health problems in clinical services. We examined the utility of the Refugee Health Screener (RHS) in refugee adolescents, aged 14-18, attending routine clinical examinations or staying in group homes/refugee centres (N=29). Participants completed a survey, including the RHS, administered through iPads in their native language. The RHS showed excellent internal consistency (α = .96) and correlated moderately with symptoms of PTSD (r=0.41, p=.025). Mean scores and prevalence rates were comparable to a study of adult refugees in Sweden. Unaccompanied refugee minors (URM) scored significantly higher (M=32.0, SD=12.9) compared to youth staying with their families (M=7.5, SD=8.2, p<.001, d=2.27). Our findings confirm that the RHS can be used in the adolescent population in Sweden. These findings moreover suggest that URMs are a particularly vulnerable group with a large burden of mental health problems.
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| 9. |
- Fäldt, Anna, 1975-, et al.
(författare)
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Experiences of children with disabilities during the COVID-19 pandemic in Sweden : a qualitative interview study
- 2022
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Ingår i: BMJ Paediatrics Open. - : BMJ Publishing Group Ltd. - 2399-9772. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The impact of the COVID-19 pandemic on people with disabilities has been described as a 'triple jeopardy'. Not only have they experienced the negative social impacts of disease control measures, but access to required health services has been affected, and, not least, they are at increased risk of severe outcomes from COVID-19. This study aimed to determine how children with disabilities have experienced the pandemic in Sweden and its impact on their lives.METHODS: Six children (5-13 years) were interviewed via video conferencing. An interview guide was adapted based on the children's communicative abilities and included augmentative and alternative communication support. Reflective field notes were included in the analysis. The data were analysed using qualitative content analysis.RESULTS: Two themes were identified: The child's knowledge of Corona raises anxiety and fear; and Boring Corona makes the child even lonelier. The children had knowledge about and were worried about COVID-19, primarily about illness and death of their grandparents. The children longed for their grandparents and other social contacts at school, and life was described as boring and lonely. Many families lacked adequate tools to communicate with their children about the pandemic.CONCLUSION: Given adequate support, children with disabilities and communication difficulties can give insights to their unique life situations. The interviewed children reported significant impact on their life and school life. Children were worried about their grandparents based on their knowledge about the virus. The enthusiasm with which the children engaged in the interviews is testament to the need and right of all children, regardless of communicative competence, to voice their experiences.
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| 10. |
- Fält, Elisabet
(författare)
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A cross-service approach to identify mental health problems in 3–5-year-old children using the Strengths and Difficulties Questionnaire
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Child Healthcare Services (CHS) in Sweden offer regular health check-ups and reach almost all 0–5-year-old children. Although one of the objectives of the CHS is to detect mental health problems, evidence-based methods are not used for this purpose at the Child Health Clinics (CHCs). Therefore, an evidence-based instrument to assess children’s emotional and behavioural problems through parent and teacher reports, the Strengths and Difficulties Questionnaire (SDQ), was introduced, as part of the Children and Parents in Focus trial, run between 2013 and 2017 in Uppsala, Sweden. The overall aim of this thesis was to evaluate the introduction of the procedure, including the facilitation strategies provided to support implementation, and to provide inter-rater correlations and norms for the SDQ in this population.Data were collected through individual interviews with nurses, parents and preschool teachers; group interviews with nurses; and a survey performed at the end of the trial to evaluate nurses’ experiences of the SDQ-procedure and the implementation process. In addition, delivery, response rate and population coverage of the questionnaires were calculated. Quantitative data were analysed using descriptive statistics, Pearson correlations and Intraclass Correlation Coefficients (ICC), and qualitative data using Grounded Theory and content analysis.Results showed that nurses found it useful for their assessment to have access to preschool teachers’ SDQ-ratings. Parents were also positive to the procedure but had concerns regarding confidentiality of the responses. Preschool teachers were least positive, fearing labelling of children and negative parental reactions. Significant, albeit poor, agreement (ICC) was found between parent and teacher ratings and good agreement between parents’ ratings. Teachers were found to report lower levels of problems compared to parents. Cut-off values differed for age and were somewhat higher for boys (lower for prosocial), suggesting that boys display more behaviour problems. Nurses perceived facilitation strategies used by the research team useful to support implementation and delivered the procedure, essentially, as intended. However, response rate remained lower than expected, around 50%.The findings suggest that implementing the SDQ to aid CHC-nurses’ assessment of 3-5-year-olds’ mental health is feasible, but requires further effort in regular services to reach all children.
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