KIDNET

OVERVIEW

KIDNET is a narrative exposure therapy program, aimed at treating refugee children suffering from post-traumatic stress disorder (PTSD).  Using techniques that encourage in depth descriptions of traumatic experiences, therapists guide children in building a chronological narrative that includes all of the significant trauma-related events in their lives.  An experimental evaluation of the treatment program found that there were significant reductions in PTSD, for those in the treatment group, at post-test and at a 6-month follow-up, which were sustained through a 12-month follow-up.  Significant improvements in non-verbal cognitive functioning were also found between the 6- and 12-month follow-ups.      

DESCRIPTION OF PROGRAM

Target Population: Traumatized refugee children and adolescents

The treatment consists of eight individual therapy sessions, 90 to 120 minutes in length, conducted weekly by trained clinical psychologists.  Focused on refugee children suffering from post-traumatic stress-disorder (PTSD) primarily related to war and other types of organized violence, the program is designed around the therapist helping the child build a chronological narrative of his/her entire life, with an emphasis on traumatic experiences.  When detailing these experiences, children are asked to describe sensory information, emotions, physical reactions, and thoughts, which are thoroughly recorded by the therapist; this written documentation is given to the child at the end of therapy.  While the therapist is meant to be supportive, the therapist also directs the child in guiding them forward with the narrative.  This method seeks to help children confront their traumatic pasts, while also working to provide complete details regarding each experience.  Techniques utilized by the therapist include active listening, unconditional positive regard, using empathy to identify with the child’s experiences, and helping the child match their feelings and emotions with how they express those emotions. 

Certain illustrative and creative tasks are also completed during the treatment program to aid the child in organizing his/her memories.  Prior to constructing the narrative, children participate in the lifeline exercise, during which they take different flowers and stones, representing positive and negative events, and place them along a rope to illustrate each of the most significant events in their lives.  Another exercise is re-enacting body positioning, during which children show therapists the ways they physically positioned their body during a traumatic experience (e.g., hiding in a crouched position during a bombing).  Drawings are also used to portray scenes and objects from traumatic experiences.  Each of these latter two exercises is utilized with the purpose of helping to bring about descriptions and language tied to these events.    

EVALUATION(S) OF PROGRAM

Evaluated population: Twenty-six refugee children (ages 7 to 16) were selected for the study.  In order to be included, children had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for PTSD, and could not be diagnosed with acute psychotic symptoms.  Participants had experienced an average of four traumatic event types, with the most common being violent attacks against parents or other family members.  Fifty-four percent of the sample was male; 31 percent originated from Turkey, 31 percent from the Balkans, 15 percent from Chechnya, 15 percent from Syria, and 8 percent from Georgia. 

Approach: Participants were randomly assigned to either the KIDNET therapy (N=13) or to the wait-list condition (N=13).  There were no significant differences between groups at baseline.  Children in the waitlist group were not offered treatment for the first 6 months after their initial screening interview.  After this waiting period, children were interviewed again and, if they still satisfied the diagnosis for PTSD, were then offered treatment.  To measure the effectiveness of the therapy program, data was collected on PTSD symptom severity through a questionnaire administered during diagnostic interviews.  For children who did not speak German, translators trained in PTSD issues provided literal translations during therapy.  Nonverbal cognitive functioning was also assessed.  Data were collected through interviews at baseline, 4 weeks post-treatment, and at 6- and 12-month follow-ups.  Assessors were blind to whether the children were in the treatment or control group. 

Results: At both the 4-week post-test and the 6-month follow-up, significant reductions in PTSD symptoms were found for the KIDNET therapy group.  Significant reductions were found for each of the individual symptom levels including intrusion, avoidance (all types), active avoidance, passive avoidance, hyperarousal, and functional impairment.  At the 12-month follow-up, it was found that these improvements were sustained, with an effect size of 1.8.  Significant improvements in nonverbal cognitive functioning were also found between the 6- and 12-month follow-ups.

SOURCES FOR MORE INFORMATION

References

Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23(4), 437-445

KEYWORDS: Children, Adolescents, Males and Females (Co-Ed), Clinic/Provider-Based, Counseling/Therapy, Other (Mental Health)

Program information last updated 9/26/11

© Child Trends 2003