title: A cluster randomized-controlled trial of a classroom-based drama workshop program to improve mental health outcomes among immigrant and refugee youth in special classes.
abstract: OBJECTIVE
  The aim of this cluster randomized trial was to evaluate the effectiveness of a school-based theatre intervention program for immigrant and refugee youth in special classes for improving mental health and academic outcomes. The primary hypothesis was that students in the theatre intervention group would report a greater reduction in impairment from symptoms compared to students in the control and tutoring groups.
  
  
  METHODS
  Special classrooms in five multiethnic high schools were randomly assigned to theater intervention (n = 10), tutoring (n = 10) or control status (n = 9), for a total of 477 participants. Students and teachers were non-blinded to group assignment. The primary outcome was impairment from emotional and behavioural symptoms assessed by the Impact Supplement of the Strengths and Difficulties Questionnaire (SDQ) completed by the adolescents. The secondary outcomes were the SDQ global scores (teacher and youth reports), impairment assessed by teachers and school performance. The effect of the interventions was assessed through linear mixed effect models which incorporate the correlation between students in the same class, due to the nature of the randomization of the interventions by classroom.
  
  
  RESULTS
  The theatre intervention was not associated with a greater reduction in self-reported impairment and symptoms in youth placed in special class because of learning, emotional and behavioural difficulties than a tutoring intervention or a non-active control group. The estimates of the different models show a non-significant decrease in both self-reported and impairment scores in the theatre intervention group for the overall group, but the impairment score decreased significantly for first generation adolescents while it increased for second generation adolescents.
  
  
  CONCLUSIONS
  The difference between the population of immigrant and refugee youth newcomers studied previously and the sample of this trial may explain some of the differences in the observed impact of the theatre intervention.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01426451.
authors.affiliation: Division of Social and Cultural Psychiatry, McGill University, Montreal, Quebec, Canada.
authors.forename: Cécile
authors.initials: C
authors.lastname: Rousseau
authors.affiliation: Department of Educational Psychology and Adult Education, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Beauregard
authors.affiliation: Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Daignault
authors.affiliation: Department of Education, Concordia University, Montreal, Quebec, Canada.
authors.forename: Harriet
authors.initials: H
authors.lastname: Petrakos
authors.affiliation: Department of Psychiatry -Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Thombs
authors.affiliation: Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Russell
authors.initials: R
authors.lastname: Steele
authors.affiliation: Department of Community Health Sciences, Sherbrooke University, Sherbrooke, Quebec, Canada.
authors.forename: Helen-Maria
authors.initials: HM
authors.lastname: Vasiliadis
authors.affiliation: Division of Child Psychiatry, McGill University, Montreal, Quebec, Canada.
authors.forename: Lily
authors.initials: L
authors.lastname: Hechtman
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy; D004324:Drama; D004519:Education, Special / Q000379:methods*; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D017063:Outcome Assessment, Health Care; D011577:Psychodrama / Q000379:methods*; D012036:Refugees / Q000523:psychology*; D012574:Schools; D013334:Students; D011795:Surveys and Questionnaires