Development and Piloting the MMMM Ecological Interactive Open Systems Model: A Prospective One-Year Treatment Outcome of Children of Tortured Refugees

Abstract

Children of refugee torture survivors present a compelling case of cumulative and continuous chronic past and current traumas and complex post-cumulative trauma symptoms. Traditional models of interventions with victims of single past traumas may not be effective with such victims. The goal is to develop and initially test a new open multi-systemic, multi-component and multimodal intervention model (MMMM) as applied in the context of Summer Day Treatment and AfterSchool (SDTAS) program, and to determine its potential effectiveness as well as the feasibility of a larger study with more rigorous experimental design. A total of 27 secondary torture survivor Iraqi refugee children (13 males and 14 females, age between 11-16), living in the US, who suffered from serious symptoms and were non-responsive to treatment as usual for at least the previous six months, completed the planned interventions and three times follow-up assessments of five domains: PTSD, complex PTSD, anxiety, depression, and global level of functioning (GAF). Repeated measure analysis of variance was used to analyze changes over the three time points. Results indicated significant decrease in symptoms, and increased GAF with high effect sized (Partial Eta Squared ranged between 0.85 -0.93). The amount of change displayed by the treated individuals was large enough to be clinically meaningful. Current study provides evidence of potential effectiveness of this novel intervention and of the feasibility of more rigorous and larger future controlled clinical trials to help develop evidence-based treatments for the multiply traumatized children who suffer past and present ongoing adversities. We suggest that the model is cost effective, and can be conducted with children of torture survivors and refugees in different settings world-wide by professionals or by trained supervised para-professionals.

The central role of social identity in oppression, discrimination and social-structural violence: Collective identity stressors and traumas, their dynamics and mental health impact.

“…One implication of the study is the importance of a paradigm shift in intervention with victims of CISTs focusing more on identity work within a multisystemic interventions (e.g., Kira, Ashby, Omidy, & Lewandowski, 2015; Kira, Lewandowski, et al, 2014; Kira, Lewandowski, Ashby, & Omidy, 2015; Kira, & Tummala-Narra, 2015; Kira & Wroble, 2015). Another implication of the study is the importance of social justice intervention to reduce inequality and enhance systemic fairness.…”

What are the personality and trauma dynamics that contribute to posttraumatic growth?

“…Furthermore, the results suggest that it is important to analyze the trauma profiles of individuals and groups, as well as the internal valuation dynamics and self-discrepancies, to better understand and design targeted interventions to enhance their growth after traumas. New paradigms of intervention along this line are emerging (e.g., Kira, Ashby, Omidy, & Lewandowski, 2015; Kira, Lewandowski, Ashby & Omidy, 2015; Kira & Tummala-Narra, 2015; Kira & Wroble, 2016).…”

The health effect of the Syrian conflict on IDPs and refugees.

“…Initial work in this direction that addresses victims of identity traumas (Kira, Ashby, Omidy, & Lewandowski, 2015) starts and need to be more developed and tested. New paradigms of multisystemic wraparound interventions with refugees (Kira, Amer, et al, 2014; Kira, Lewandowski, Ashby, & Omidy, 2015; Kira, & Tummala-Narra, 2015; Kira & Wroble, 2015), are emerging. For treating PTSD, narrative exposure therapy (Nakeyar & Frewen, 2016; Palic & Elklit, 2011), and eye movement desensitization and reprocessing EMDR (Acarturk et al, 2015) proved to be effective in treating PTSD in Syrian refugees.…”