Sandra Löfving Gupta: Implementation of a community-based trauma recovery intervention for youth who have sought refuge in Sweden

Abstract

Young people exposed to trauma may face substantial mental health challenges that require accessible, evidence-based interventions. Originally developed to address trauma symptoms among children affected by war and conflict, Teaching Recovery Techniques (TRT) is a structured, group-based intervention grounded in Trauma-Focused Cognitive Behavioural Therapy and includes caregiver involvement. TRT is delivered by non-specialist professionals after brief training, and was introduced to address the needs of young people seeking refuge in Sweden in 2016 as part of a stepped-care model. Although endorsed by UNICEF and supported by an international evidence base, knowledge gaps remain regarding how it functions in the Swedish context. This thesis examines the implementation of TRT in Sweden with a focus on safety, parental engagement, online delivery, and research feasibility.

Study I explored TRT leaders’ experiences of safety procedures when participating refugee youth disclosed suicidal ideation, revealing that TRT leaders felt ill-prepared to deal with suicidality, found trauma-focused components challenging, and lacked functioning referral pathways, leaving some TRT leaders burdened with responsibility. Study II investigated caregiver sessions, highlighting youths’ reluctance to involve parents, TRT leaders’ limited preparedness to address practical issues related to caregiver sessions and concerns regarding parental readiness, while parents expressed willingness to participate. Study III examined online delivery of TRT. Although feasible and acceptable, digital delivery was constrained by technological difficulties, screen fatigue, privacy challenges, and reduced group cohesion. Youth recognised benefits but expressed a preference for in-person delivery. Study IV evaluated the feasibility of a randomised controlled trial (RCT) to strengthen the evidence base for TRT in Sweden. The RCT proved unfeasible due to contextual disruptions, including the COVID-19 pandemic and shifts in immigration policy affecting recruitment and implementation.

This thesis underscores the complexity of trauma interventions and the need for stronger support for TRT leaders, particularly in addressing suicidality, delivering trauma-focused modules, and enabling inter-agency collaboration. It advocates for culturally responsive training, strength-based communication, and careful ethical practice when conducting research with refugee youth in school settings. Findings highlight the importance of adapting caregiver components, strengthening group cohesion and ensuring meaningful involvement of refugee youth in both intervention development and research design.