TRT – Teaching recovery techniques

Summary

Introduction

TRT is a group intervention based on cognitive behavioural therapy and has several elements in common with Trauma-Focused Behavioural Therapy (TF-CBT). It has been developed to support the coping and recovery of children exposed to trauma following war or armed conflict, natural disasters or who arrive in the country unaccompanied.

Objective and research question

This systematic literature review assesses the effectiveness of the Teaching Recovery Techniques (TRT) intervention on the basis of research literature. The review answers the following question: Does the TRT intervention have evidence-based effectiveness, applicable to Finland, in increasing the coping methods of children and adolescents and reducing the symptoms of trauma and stress?     

Data and research methods

This study used the Population, Concept and Context (PCC) strategy to systematically search for literature, which is a typical strategy in exploratory literature reviews. The search targeted the following question: What research has been done on the TRT (Teaching Recovery Techniques) intervention?  The following keywords were used: P = Children, adolescents and their parents, C = Teaching recovery techniques (TRT). Context (C) was omitted to avoid an excessive restriction of the results of the search. The primary area of interest in the search was effectiveness studies carried out on the intervention, although studies carried out using different frameworks were also included. A systematic literature search was carried out for the following six reference databases: MEDLINE, APA PsycInfo, CINAHL, ERIC, Web of Science and Scopus. In addition, a search for publications in Finnish was performed on the Finna.fi service, and the search was supplemented by a manual search. In Finland, too, the TRT intervention is aimed at children and adolescents from war, conflict and disaster areas, which is why no regional country delimitation was used in this review. 

Results

Based on the literature search, twelve effectiveness studies were selected for a systematic review. Two of these studies were Nordic, four were from high-income countries as classified by the World Bank and six were from low- or middle-income countries. Most of the studies examined the effectiveness of the TRT intervention in war and conflict situations (k = 7). Of these studies, two were conducted in high-income countries and five in low- or middle-income countries. Four studies examined the effectiveness of the intervention in unaccompanied children in high-income countries, and one study examined the effectiveness in post-natural disaster situations. The results of the studies of effectiveness show that the TRT intervention has an impact on the reduction of trauma and stress symptoms in children and adolescents and on the increase in coping mechanisms when the children and adolescents have been exposed to war or a natural disaster or are unaccompanied refugees. The impact would appear to be strongest in situations where the traumatic situation no longer persists (e.g. the war has ended, or the adolescent has been granted a residence permit). The intervention has been described in detail and comprehensively in the manuals, and they have been updated as necessary. The implementation support for the intervention is fulfilled in five out of seven areas, which supports successful implementation of the TRT intervention. The quality of the studies varied from poor to good. The intervention description and implementation support were assessed as good. The limitation of the review is that there are no Finnish studies of effectiveness and there was no control group in the Nordic studies. In the evaluated studies, the implementation of the intervention was also not fully consistent with the manual. Based on the review, it was assessed that the TRT intervention is suitable for use in a Finnish context, even though some elements, such as meeting times or their duration, had been reduced in most studies. In the future, effectiveness and implementation research carried out in Finland will be needed.

Methodology evaluation

TRT is an intervention with proven effectiveness (4/5) and is very applicable in a Finnish context. The results of the studies of effectiveness show that the TRT intervention has an impact on the reduction of trauma and stress symptoms in children and adolescents and on the increase in coping mechanisms when the children and adolescents have been exposed to war or a natural disaster or are unaccompanied refugees.