START – Entwicklung einer Intervention zur Erststabilisierung und Arousal-Modulation für stark belastete minderjährige Flüchtlinge

Abstract

START - Development of an Intervention for a First Stabilization and Arousal-modulation for Highly Stressed Minor Refugees This article focuses on the development of an intervention called "Stress-Traumasymptoms- Arousal-Regulation-Treatment" (START), through the process of working with refugeed minors in acute stress during the clearing process immediately on arrival in Germany. START is a short manualized structured intervention for crisis intervention and stabiliziation of children and adolescents suffering from intense stress and acute tension or desperation. It consists of five sessions preferred for group or also single treatment. For easy and widespread applicability we translated the START-Manual in Dari, Arab and English. The language is simple and easily understandable and illustrated by picture material. For children incapable of reading there is also an audio version in the different languages. Some compounds of START are derived from elements of dialectic behavioral therapy (Linehan, 2015; Rathus u. Miller, 2015; Bohus u. Wolf, 2011) and traumafocused cognitive behavioral therapy for children (Cohen, Mannarino, Deblinger, 2009). The manual can be used by psychotherapists, social workers, physicians, school psychologists as well as qualified caretakers, given the highly self-instructive character of the instrument. In clinical settings, children of all cultural backgrounds can and should be included in the group treatment. START was very readily accepted by the refugeed children and adolescents and observed to reduce stress in children and supervising professionals. Its efficacy and effectiveness is currently target of a standardized pre-post evaluation. Clinical implications as well as limitations of the concept are discussed.

Feasibility and Effectiveness of a New Short-Term Psychotherapy Concept for Adolescents With Emotional Dysregulation

“…Central characteristic are many colorful illustrations—therefore, the language and attention span requirements are very low. The program has been described in more detail in the START-manual and articles of the authors Dixius and Möhler ( 66 , 70 ). The treatment does explicitly not contain a narrative approach or exposition-based therapy as this would not be appropriate as a first step for adolescents in highly unstable emotional or psychosocial situations.…”

“…However, the intellectual and motivational requirements of dialectic behavioral therapy exclude a patient population with shorter attention span and/or more unstable therapy commitment, as frequently presenting in acute child psychiatric clinics ( 66 ). Therefore, a low threshold program was designed to meet the acute treatment needs of emotionally highly unstable adolescents.…”

“…The intervention designed and evaluated in this study places special emphasis on the use of adaptive regulation strategies for acute crisis management and ED ( 69 ). In the first step, the short therapeutic program START was developed by Dixius and Möhler ( 70 , 71 ) and originally conceived for the work with refugee minors only. Minor refugees appear to be a particularly vulnerable group for the development of mental disorders with a range from 20 to 82% ( 23 , 72 ).…”

START adolescents: study protocol of a randomised controlled trial to investigate the efficacy of a low-threshold group treatment programme in traumatised adolescent refugees

“…The manualised Stress-Traumasymptoms-Arousal-Regulation-Treatment (START) programme was developed from clinical work with traumatised unaccompanied refugee minors in Germany to promote coping with traumatic distress and emotional irritability. [18][19][20] An uncontrolled pilot study in 22 traumatised refugee minors showed positive effects on emotion regulation, adaptive strategies, self-control, distress and good feasibility. 18 A subsequent study confirmed the positive effects on adaptive emotion regulation strategies.…”

“…[18][19][20] An uncontrolled pilot study in 22 traumatised refugee minors showed positive effects on emotion regulation, adaptive strategies, self-control, distress and good feasibility. 18 A subsequent study confirmed the positive effects on adaptive emotion regulation strategies. 21 The primary aim of this RCT is to evaluate the efficacy of the START programme in reducing psychological distress and trauma symptoms in traumatised adolescent refugees compared with a waiting-list control group (WL).…”