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Evaluation of a school-based, teacher-delivered psychological intervention group

program for trauma-affected Syrian refugee children in Istanbul, Turkey



The purpose of this study was to evaluate an innovative, protocol-based, groupcognitive behavioral therapy (CBT) program delivered by trained teachers to reduceemotional distress and improve psychological functioning among the war-traumatized Syrianrefugee students living in Istanbul.


A total of 32 participants, aged between 10 and 15 years (mean = 12.41, SD = 1.68)and mostly females (m/f = 12/20) were randomly selected from a sample of 113 refugeestudents based on their trauma-related psychopathology as reflected in the Child Post Traumatic Stress – Reaction Index (CPTS-RI) total score. The treatment program wasimplemented by the teachers trained by the study team to deliver a weekly, eight-session,protocol-based intervention in school setting. The degree of the fidelity to the originalprogram was tested via video-recordings and subsequent analyses of the sessions.Effectiveness of the intervention was evaluated by a pre-test/post-test comparison using theCPTS-RI, Spence Children’s Anxiety Scale (SCAS), and Strengths and Difficulties Questionnaire(SDQ).


All participants were accompanied minors. A significant proportion of them had eitherwitnessed or been personally exposed to traumatic events. Statistically significant reduction inpost-intervention evaluation was observed in the SCAS total score (t = 3.73, p = 0.001); CPTS-RItotal score (t = 2.72, p = 0.011) and in the intrusive (t = 3.88, p = 0.001) and arousal (t = 2.60, p =0.015) symptoms of the post-traumatic stress disorder (PTSD). In line with improvement inemotional problems as revealed in the anxiety and PTSD scales, the SDQ subcategory of theemotional problems was the only symptom area that showed a significant improvement (t =2.85, p = 0.008). No significant change was seen in the SDQ subcategories of conduct (t =1.01, p = 0.32), hyperactivity (t = 1.30, p = 0.20), peer problems (t = .66, p = 0.51), or inprosocial behavior (t = 2.15, p = 0.039). A significant proportion of the participants did nolonger meet the diagnostic threshold for anxiety (p = 0.001) and PTSD (p = 0.021) aftercompletion of the intervention. However, the post-intervention SDQ subcategories and thetotal SDQ score showed no significant difference as compared with the pre-intervention group.


Post-traumatic stressdisorder; cognitivebehavioral therapy; refugee;children; school-based

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