​1. Title 

The effect of integrating cross-sectoral collaboration in psychosocial treatment of trauma-affected refugees; a randomised controlled trial. 

2. Project period 

2019-2022. 

3. Investigator(s) 

Maja Bruhn. 

4. Supervisors and collaborative partners 

Jessica Carlsson and Lene Eplov. 

5. Background 

Postmigration conditions in resettlement countries may moderate or exacerbate mental health outcomes in refugees (1). Ongoing stresses related to social problems may lead to difficulties focusing on the content and process of treatment for trauma-related mental health problems (2). This could reduce treatment outcomes. Cross-sectoral collaboration and coordination of municipal social interventions and regional psychiatric treatment are currently limited (3). 

6. Aim/s 

The aim of this study is to investigate the effect of integrating cross-sectoral collaboration with the municipality in psychosocial treatment of trauma-affected refugees. 

7. Methods 

7.1 Number of participants (N) 

230. 

7.2 Population 

Included in the study are refugees with post-traumatic stress disorder, who are unemployed and attending a municipal job centre or sickness-benefit unit in one of the five collaborating municipalities; Frederikssund, Gladsaxe, Hillerød, København, or Lyngby-Taarbæk. 

7.3 Description of data and data collection 

The randomised controlled trial is comparing treatment as usual comprising 10 sessions with a medical doctor (pharmacological treatment and psycho-education) and 16 sessions with a psychologist (cognitive behavioural therapy) with add-on of the cross-sectoral social intervention. The core of the intervention consists of three meetings between the patient, the municipal case counsellor and clinicians from CTP. The meetings are held at the beginning, half-way and end of an 8-10 months multidisciplinary treatment course. The patient’s self-perceived social stressors are addressed and a comprehensive action plan for handling the patient’s challenges is made. In-between the meetings the involved parties will be in ongoing contact. 

In addition, qualitative data will be collected for approximately 15 participants throughout the treatment period and 6 months after treatment has ended. The qualitative data collection will focus on how the participants have experienced the cross-sectoral collaboration, psychiatric recovery and treatment outcome, social recovery and whether the participants are left with a better plan and overview of life situation and circumstances. It will primarily consist of interviews and observations of the meetings. 

7.4 Application/acceptance from the Danish Data Protection Agency, the National Committee on Health Research Ethics 

Application has not yet been submitted. 

7.5 Analysis 

The primary outcome is WHODAS 2.0 together with a variety of secondary outcomes measuring psychiatric symptoms, quality of life and social factors (HTQ, HSCL-25, WHO-5, EQ6D, CHAI, HAM17- D+A, GAF-F+S). Different qualitative analysis will be carried out in accordance with the nature of the data material. 

8. Expected results 

We expect the integrated cross-sectoral intervention to enhance outcomes of treatment. 

9. Dissemination of results 

PhD thesis and 4-6 scientific publications. 

10. References 

1. Porter M, Haslam N. Predisplacement and postdisplacement of refugees and internally displaced persons: A meta-analysis. J Am Med Assoc. 2005; 

2. Bruhn M, Rees S, Mohsin M, Silove D, Carlsson J. The range and impact of postmigration stressors during treatment of trauma-affected refugees. J Nerv Ment Dis. 2018;206(1):61–8. 

3. Rigsrevisionen. Forløbet for flygtninge med traumer. 2018.