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The FRIENDS Program for Young


Former-Yugoslavian Refugees in Australia:
A Pilot Study
Paula M. Barrett, Alan F. Moore, and Robi Sonderegger
Griffith University

Young immigrants frequently experience anxiety as a consequence of the stress associated with
migration. Despite being at high risk for the development of psychopathology, culturally sensi-
tive assessment and intervention procedures for use with ethnic minority groups residing in
Australia have yet to be developed and validated. The aims of the current study were to (a)
investigate the level of anxiety in a sample of former-Yugoslavian teenage refugees; (b)
appraise the efficacy of the FRIENDS program, a validated Anglo-Austra1ian anxiety-preven-
tion program, for use with this high-risk group; and (c) obtain information from both the pro-
gram participants and facilitators regarding how the intervention could be modified to better
meet the needs of this growing refugee population· in Australia. Twenty female former-
Yugoslavian youths completed standardised measures of internalising symptoms. Participants
were allocated to either an intervention (n = 9) or a waiting list (n = II) condition. In spite of
the small sample size, post-assessment indicated that participants in the intervention condition
reported significantly less internalising symptoms than participants in the waiting list condi-
tion. Social Validity data indicated that, overall, participants were highly satisfied with the
intervention. Suggestions for assessment and treatment program modifications are discussed.

T he experience of becoming a refugee or


migrating to a foreign culture is increas-
Involuntary migration and resettlement
places massive demands on the ability of young
refugees to cope. Young refugees have been
ingly recognised to place young people at great
risk for the development of psychopathology observed to react to such stress through the
(Lavik, Hauff, Skrondal, & Solberg, 1996; development of separation fears, social anxiety
and withdrawal, eating disorders, sleeping
Ying, 1999). Factors contributing to the psycho-
problems, cultural identity confusion, and inter-
logical maladjustment of young refugees
familial conflict (Ajdukovic & Ajdukovic,
include the emotional experience of war stress
1993; Ymg, 1999). The risk of symtomatology
(Zivcic, 1993), exposure to traumatic events amongst refugees increases when parents
(Weine, Kulenovic, Pavkovic, & Gibbons, become physically absent or emotionally
1998), and factors associated with the process unavailable to their children as a direct conse-
of involuntary migration and resettlement, quence of their own psychological distress,
including family separation and acculturation often associated with trauma and adjustment
problems (Baker,1999; Magwaza,1992). issues (Grunbaum, 1997). At the upper spec-

The authors gratefully acknowledge the staff and studenJS ofthe Milpera School, Queensland, Australia.for their
involvemenJ in this study.
Addressfor correspondence: Paula M. Barrett, School ofApplied Psyclwlogy, Griffith University, Mr. Gravan Campus,
Mr. Gravan QW 4111, Australia. Email: P.Barrett@mailbox.gu.edu.JU4

BEHAVIOUR CHANGE
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ANXIETY PREVENTION FOR ETHNIC YOUTH

trum of severity, stress-related reactions have settings. It is reasoned that culturally diverse
the potential to develop into internalising prob- clients become empowered through the con-
lems such as anxiety. Such psychopathology struction of a therapeutic se~ng that encour-
may take the form of generalised anxiety disor- ages mutual explorative dialogue in the context
der, adjustment disorder, and/or posttraumatic of self-discovery and social learning.
stress disorder. It is concerning to note that, This study explores the efficacy of an
despite the growing awareness of psychological Australian standardised anxiety-prevention pro-
distress in migrant and refugee populations, gram that combines cognitive and behavioural
little clinical or research anention has focused techniques. Specifically, the program addresses
on the adjustment of Australian migrants and anxiety and stress by focusing on physiological
refugees. reactions, thought processes, and coping skills
As a consequence of the civil war in the (for a detailed program review, see Barrett,
former Yugoslavia and other countries (i.e., 1999). While the necessity and considerations
most recently, East Timor), Australia has for a culturally adaptive intervention to be
received a large number of refugee families. developed and evaluated in Australia have been
However, it is unknown to what extent immi- outlined (Barren, Turner, & Sonderegger, 2000;
grants and refugees to Australia experience psy- Sonderegger, Barren, & Sonderegger, in press),
chological distress, or how the experience of culturally sensitive interventions have not been
forced migration may contribute to such stress. operationalised in the broader context of clini-
Despite Australia's multicultural diversity, cal practice prior to this study.
assessment and treatment protocols for non-
Anglo Australian population groups are yet to The Present Study
be developed. Given the likelihood of signifi- There exists an obvious need to develop a better
cant psychological distress among refugee understanding of the experience of young
migrants, there is great demand on mental refugees entering Australia. Given the extent to
health agencies and government departments to which this group is at risk for the development
increase the attention devoted to this issue. of psychological problems, there is also a need
to determine the effectiveness of "mainstream"
Qinicallssues for Culturally Sensitive interventions for use with refugees from non-
Interventions English-speaking backgrounds (NESB). This
Gong-Guy, Cravens, and Patterson (1991) information may then be used to modify inter-
reported that refugees in the United States who ventions to ensure that they are culturally sensi-
require mental health services are confronted tive, appropriate, and as effective as possible.
with numerous challenges, including frequent The aims of the current study were twofold:
misdiagnosis, inappropriate use of interpreters (a) to assess the effectiveness of a group-based,
and paraprofessionals, and inappropriate treat- anxiety intervention previously validated only
ment methods. Moreover, migrants whose cul- with Anglo-Celtic participants and (b) to obtain
tural identity and values differ significantly information from the participants and facilita-
from Anglo-Western society have pronounced tors regarding how the intervention could be
difficulty accessing mental health services improved to best cater for the needs of this spe-
(Ymg, 1999). According to Greene, lensen, and cific group.
lones (1996), to overcome such cultural barri- In keeping with past findings, with regard to
ers, awareness of cultural self-identity becomes the efficacy of the intervention, it was hypothe-
especially important for clinicians working with sised that participants receiving the treatment
populations who are ethnically distinct. These program would report significantly fewer anxi-
authors advocate a constructivist approach to ety symptoms at post-treatment compared to
therapy, where existing therapeutic models are pre-treatment. It was also expected that anxiety
tailored to encourage "collaborative empower- symptoms in the wait list group would remain
ment" in suitably applied crosscultural clinical stable over time. Finally, it was predicted that

125
PAULA BARRETT. ALAN F. MOORE, AND ROBI SONDEREGGER

the post-treatment intemalising scores of the depressed), and two of the subscales combine to
treatment group would be significantly lower produce an adjustment score on the extemalis·
than the corresponding scores for the waiting- ing dimension (delinquent, aggressive). The
list control group. remaining three subscales (social problems,
thought problems. attention problems) provide
Method an indication of current social and occupa-
tional/academic performance. To determine the
Participants extent of participants' affective/anxious con-
Twenty female teenagers, ranging in age from cerns, only those items contained within the
14 to 19 years (M = 16.3 years) participated in intemalising dimension were utilised in the pre-
the study. All participants were from the former sent study. So as to be sensitive to potential
Yugoslavia; 11 identified their nationality as trauma that participating refugees may have
Bosnian,6 as Croatian, 1 as Serbian. and 2 as experienced during the war in their country of
Yugoslavian. Participants had arrived in origin, one item regarding suicidal ideation ("I
Australia on average 2 months prior to their deliberately try to hurt or kill myself') was
involvement in the study, and all had been omitted, leaving a total of 30 items.
granted refugee status. All participants attended
a transitional school for NESB children. The
The Spence Children's Anxiety Scale. (SCAS;
Spence, 1998). This is a measure of anxiety
government-funded school provides short-term
used with children aged 8 to 12 years. The
assistance for students to aid them in their tran-
SCAS consists of 44 items, 38 of which aim to
sition to "mainstream" high school.
assess six specific groups of anxiety symptoms
Acculturation into the Australian community is
(e.g., social phobia, separation anxiety, panic
also fostered by simultaneously providing gen-
attack, and agoraphobia). The remaining six
eral education and training in the English lan-
items are "filler items", included as a means of
guage. On average, students attend the school
reducing negative response bias. The SCAS
for a period of 26 weeks. Students who
was employed to determine the specificity of
appeared worried, sad, or stressed in class were anxiety problems that may be experienced by
referred by teachers to participate in the pro- refugees.
gram. Students were recruited for intemalising Spence (1998), using a standardisation
difficulties, not extemalising or behaviour prob- sample of 2,052 children aged between 8 and
lems. Despite the participants receiving English 12 years, investigated the psychometric proper-
language tuition, all preferred to converse ties of the SCAS. The SCAS achieved high
throughout the program in their native tongue. levels of reliability, with a Guttman split-half
Before commencing the program, prior English reliability of 0.90 and an alpha coefficient of
tuition of participants varied greatly from 0 to 0.92. A test-retest correlation of 0.51 (period
=
1,092 hours (M 395). All demographic infor- between administrations was 6 months) was
mation was obtained through the school's also obtained using 120 children from the stan-
administration. dardisation sample. Spence (1997) found the
SCAS to be acceptably correlated at .71 and .52
Measures with the Revised Children's Manifest Anxiety
The Youth Self-report Form. (YSR; Scale (RCMAS; Reynolds & Richmond, 1978)
Achenbach, 1991). This aims to provide a mea- and the Children's Depression Inventory (CD!;
sure of internalising and externalising Kovacs, 1983) respectively.
behavioural symptoms in children aged 11 to 18 Although the age range of the present
years. The checklist contains 112 items, which sample falls outside the range of the standardis-
collapse to produce eight subscale scores. Three ation sample used by Spence (1998), the scale
of these subscales combine to produce an was employed for its simplistic use of language,
adjustment score on the intemalising dimension offering NESB students greater understanding
(withdrawn, somatic complaints, anxiousl of the terms and concepts in .questions being

126
ANXIETY PREVENTION FOR ETHNIC YOUTH

asked. Considering that the norms obtained by interpretation bias and rates of avoidance
the SCAS, using non-ethnic children, are con- response (Barrett, Dadds, & Rapee, 1996).
sidered to be non-comparable with NESB stu-
Treatment protocol. The FRIENDS Program for
dents, the scale was adopted to reveal general
Youth (Barrett, Lowry-Webster, & Holmes,
trends of anxiety.
1999) is a IO-week, cognitive-behavioural,
The Ambiguous Situations Protocol. (Barrett, group-based anxiety intervention for youth aged
Rapee, Dadds, & Ryan, 1996) This aims to between 12 and 17. The program can be used as
assess the cognitive styles of school-aged chil- a treatment for anxiety, or as a preventative
dren. The protocol consists of seven ambiguous intervention for the development of intemalising
social situations that are read to participants. disorders. The program aims to build resilience
Participants then record whether they interpret and to develop skills in participants that have
the situation as being neutral or threatening. been shown to help in the management of anxi-
The development of the protocol was based on ety (e.g., problem solving, relaxation).
the premise that cognitive biases found in chil- The FRIENDS program has a long develop-
dren with various mental health problems mental history, evolving from the Coping Cat
would result in their interpreting ambiguous (Kendall, 1990) and Coping Koala (Barrett,
stimuli in a corresponding fashion. Scenario 1995) workbooks. The intervention focuses on
responses are coded according to whether the group discussions about strategies for combat-
child interprets the situation in a threatening or ing anxiety through experiential learning and
nonthreatening way (nonthreatening scores peer learning models. The practical elements of
ranging from 0 to 7), and whether they would the program include identifying the relationship
respond to the situation in an avoidant or posi- between thoughts and feelings, learning to cope
tive manner (positive scores ranging from 0 to with worries, encouraging positive behaviours,
7). This device was used to assess the degree to and promoting positive family skills.
which ethnic children would interpret ambigu- This model of therapy has been validated
ous situations as threatening, and therefore be at several times in Australia (Barrett, 1998). The
risk for anxiety problems. FRIENDS program has been used successfully
To determine the validity of the protocol, in several cognitive-behavioural based interven-
Barrett, Rappee, et a1. (1996) compared the tion programs for children and youth (e.g.,
interpretations and responses of anxious, oppo- Barrett, Dadds, et al., 1996; Barrett & Thrner, in
sitional, and nonclinical children. Results indi- press; Dadds, Spence, Holland, & Barrett, 1997;
cated that, compared to the non-clinical Lowry-Webster & Barrett, in preparation).
= =
children sample (n 27), the anxious (n 152) However, the intervention has not previously
=
and oppositional (n 26) children were more been applied to NESB populations. The present
facilitation of the FRIENDS program incorpo-
likely to interpret situations in a threatening
manner. However, clinical groups differed in rated the use of one clinical psychologist, and
their responses to the situations. Anxious chil- one bilingual public health administrator.
dren demonstrated a tendency for avoidant Treatment integrity. Group facilitators received
behaviour, whereas oppositional children training and supervision throughout implemen-
tended to respond aggressively, offering tenta- tation of the program. Each group facilitator
tive support for the protocol's validity. completed the Program Integrity Checklist
In addition to self-report measures, which (Barrett, Lowry-Webster, & Thrner, 1999). This
are often criticised for their questionable valid- checklist lists session-by-session content areas,
ity among NESB populations, the Ambiguous and asks trainers to rate the overall effective-
Situations Protocol is considered particularly ness of their implementation. For each session,
valuable as it also offers experimental evidence. trainers check the items they feel they success-
The protocol's sensitivity to change makes it an fully completed during the implementation of
excellent pre/post evaluation task, and allows each session, and provide overall Likert ratings
for the discrimination between rates of threat- on a number of dimensions of group-process

127
PAULA BARREn. ALAN F. MOORE, AND ROBI SONDEREGGER
-----------------------------------
skills (e.g., listening, including children, use of after the first administration of questionnaires,
positive reinforcement, setting home tasks, these participants once again completed the
implementation of group problem-solving tasks, YSR, SCAS, and Ambiguous Situations
and completion of activities as outlined in the Protocol. Ten participants in total completed
manual). both assessment administrations.
The second group of students was com"
Social validity (Barrett, 1999). Additional rat-
prised of 9 individuals (mean age = 15.8) who
ings were collected at the end of the interven-
were also accessed from the transitional
tion in order to further assess the social
school's care class. This group, who had spent
acceptability of the intervention for participants.
an average of 1.94 months in Australia, was
Participants were assessed using 15 items, such
assigned to the treatment condition. As with the
as "How satisfied were you with the group?"
waiting list condition, participants were admin-
and "How much do you feel you learnt from the
istered the YSR, SCAS, and Ambiguous
groUp?". Ratings were made on a 5-point Likert
Situations Protocol 1 week prior to the com-
scale ranging from 1 (not at all) to 5 (very
mencement of treatment. Participant responses
much).
were obtained in parallel fashion to the waiting-
list control group.
Procedure The participants in the treatment condition
Owing to the small percentage of former- were administered the FRIENDS program over
Yugoslavian students enrolled with the transi- 10 consecutive weeks, by the clinical psycholo-
tional school at any given time, the treatment gist and former-Yugoslavian public health pro-
and waiting list conditions were not undertaken fessional. Each session was conducted in both
simultaneously. At the outset of the study, II English and the native language of the partici-
students (mean age = 16.6) were accessed from pants. At the conclusion of each session, partici-
their "care" program, which is a weekly class pants were asked to complete the social validity
where students of uniform ethnic background scale (Barrett, Lowry-Webster, & Turner, 1999),
typically meet and hold discussions together which provided a record of the extent to which
with a teacher who speaks the same language. they enjoyed the session, and the extent to
This group, who on average had arrived in which they believed the material in the session
Australia 3 months prior, was assigned to the would be useful in helping them to cope with
waiting list condition. stressful, anxiety-provoking situations. Based
With the assistance of a bilingual member on in-session observations, the two facilitators
of the school staff, an experienced clinical psy- of the group also recorded ways in which the
chologist administered the YSR, SCAS, and program could be improved and tailored to
Ambiguous Situations Protocol to these partici- better suit participants from this ethnic minority
pants. Prior to the administration of assessment group. The facilitators also completed the
and intervention, facilitators received training Program Integrity Checklist (Barrett, Lowry-
over 3 days in the administration of assessment Webster, & Turner, 1999), a record of how well
devices, implementation of the FRIENDS pro- they considered they implemented the session.
gram, and a follow-up evaluation. The assess- One week following the program's conclu-
ment devices featured standard written English, sion, participants were again required to com-
so they were administered in a group format to plete the YSR, the SeAS, and the Ambiguous
ensure a complete understanding of each item. Situations Protocol. Participants were also
Questions were read aloud to the class and were required to provide overall ratings of how much
subsequently interpreted by the trained bilin- they enjoyed the program, and how useful they
gual staff member. Participants were instructed believed it to be. A total of 7 participants com-
to tick the answer that best described them, and pleted the post-treatment tasks, as 2 participants
were given the opportunity to ask questions if had graduated from the transitional school and
they had interpretation difficulties. Ten weeks went on to attend mainstream high school.

128
ANXIETY PREVENTION FOR ETHNIC YOUTH

Results post- (M =5.86, SD = .69) being higher than at


pre-treatment (M = 5.29, SD = .951). Although
In an attempt to reduce the likelihood of a Type
pre/post measures on these sc~es reveal signifi-
I error occurring, only total scores and the gen-
cant differences, they should be interpreted with
eral anxiety subscale scores of the YSR and
caution as the variance of some participants'
SCAS were considered in analyses. Before scores within groups (i.e., select participants
undertaking analyses to test specific hypothe- reporting a substantial reduction in anxiety
ses, the data were checked to determine whether symptoms and interpretation of threat) was on
the waiting list and treatment groups were com- occasion greater than the difference between
patible, that is, both groups being representative pre- and post-intervention means.
of the same general sample, considering that A final series of I tests was calculated to
they were assessed at different times. For the assess whether differences existed between the
first assessment phase, I tests were conducted post-assessment scores of the waiting list and
for both waiting list and treatment groups on all treatment groups. Results indicated that the
internalising measures, number of hours of mean score of the waiting list group was signifi-
former English tuition, and length of time in cantly higher than that of the treatment group at
Australia. Results indicated that there were no post-assessment on the AnxiouslDepressed sub-
significant differences between the waiting list
and treatment groups.
=
scale of the YSR, 1(6) 3.29,p < .05.
In order to determine whether the partici-
A series of paired samples I tests was subse- pants' length of time in Australia and amount of
quently calculated for both the waiting list and previous English language study had an effect
treatment conditions to determine whether on the scores on the dependent variables, analy-
group means on the anxiety dimensions of the ses of variance (ANOVA) for each of these
YSR, SCAS, and Ambiguous Situations independent variables were calculated. No sig-
Protocol had changed significantly from pre- nificant effects were found for these indepen-
treatment to post-treatment assessment. Table 1 dent variables.
presents means for the waiting-list control and With respect to the intervention's social
treatment groups over the two assessment validity, the quantitative and qualitative
phases. Results of the contrast analysis for anxi- responses of the participants from the treatment
ety symptoms, as measured by the internalising group were examined. Based on the social vali-
dimension of the YSR, revealed a significant dation scale ranging from I (nol al all) to 5
increase over time for the waiting list group, (very much), the average response across weeks
1(9) = -4.10, P < .05, scoring higher at post- regarding how much participants enjoyed the
treatment (M = 17.2, SD = 3.60) than the pre- session was 4.5, with the average rating of the
= =
assessment phase (M 10.82, SD 6.00). concluded program being 5. The average
For the treatment group, total anxiety, as response across sessions for how useful the
measured by the SCAS, decreased significantly intervention was in helping participants build
over time, 1(6) = 2.68, P < .05, with scores resilience ranged from 425 to 5, with the aver-
being lower at post- (M = 30.43, SD = 11.37) age overall rating of the program's usefulness
than pre-treatment (M = 39.89, SD = 13.22). being 5.
Accordingly, the Generalised Anxiety scale Qualitatively, the participants' translated
revealed a similar decrease over time for the responses gave suggestions for improvement of
treatment group, 1(6) = 2.52, P < .05, partici- the program related to the content of group ses-
=
pants scoring lower at post- (M 4.86, SD = sions as well as the process for its administra-
=
2.34) than the pre-treatment (M 7.22, SD = tion. In terms of the program content, 85% of
1.79). Additionally, the mean number of participants indicated that the program helped
ambiguous items interpreted in a nonthreaten- them deal with stress- and anxiety-provoking
ing manner on the Ambiguous Situations situations both at home and at school. The most
Protocol was found to significantly increase frequent suggestions for improvement involved
=
over time, 1(6) -2.82, p < .05, with scores at more emphasis on family support and relation-

129
PAULA BARREn: ALAN F. MOORE, AND ROBI SONDEREGGER

TABLE 1
Means (and Standard Deviations) of Participant Self-report Measures for the Waiting-list Control and Treatment
Conditions

Waiting list" Interventionb


Scale Pre Post Pre Post
.._----_.-.--_._.-_.- .._.-._--_.
Youth Self-report
Totallntemalising
M 10.82 ·17.20 15.44 13.57
SO A.71 3.A3 A.50 A.28
Anxious/Depressed
M 6.27 9.80 7.44 5.29
SO 3.17 3.08 2.83 2.93
Spence Chilclren's Anxiety Scale
Total
M 30.M 34.20 39.89 °30.A3
SO 13.54 8.A8 13.22 11.37
Generalised Anxiety
M 5.55 6.AO 7.22 °A.86
SO 2.50 2.22 1.79 2.3A
Ambiguous Situations Protocol
Non-threat Perception
M 5.00 A.50 5.29 ·5.86
SO .81 1.18 .95 .69
Positive ResfXInse
M A.20 3.90 A.29 5.00
SO 1.23 1.10 .75 1.29
• Pre-treatment n =11, post-treatment n =1O. b Prlt'treatment n =9, post-treatment n = 7.
• Post-treatment measures si9ni~cantly differ from pre-treatment measures at p < .OS.

ships. more discussions and activities on nor- deemed culturally acceptable by participants.
malisation of cultural differences, and a greater However, the efficacy of the intervention
focus on the adjustment difficulties associated should be interpreted with caution, as the sensi-
with migration. In terms of the process of the tive nature of the pilot study has ensured the
group, the majority of participants desired a recruitment of few participants. Consequently,
greater opportunity for large-group discussion the statistical power for analysis is weak, and
as opposed to talking with one other person or apparent post-treatment reductions in anxiety
individually recording ideas. Analysis of the and threat interpretation should only viewed as
treatment integrity checklists indicated that pro- intervention trends. The broad deviation in
tocol adherence was high across al112 sessions. select participants' self-report measures may
suggest that the intervention requires further
Discussion adaptation to the cultural needs of former-
The main findings from this study indicate that, Yugoslavian refugees to ensure maximum bene-
despite the small sample size, the efficacy of fits from the program.
the FRIENDS program as measured by pre/post The aim of the study was to evaluate the
assessment appears to be adequate in reducing effectiveness of an Australian standardised anx-
levels of anxiety in young NESB refugees, and iety-intervention program with refugees from

130
ANXlffi PREVENTION FOR ETHNIC '(QUTH

the former Yugoslavia. It was predicted that that of the waiting list group at post-interven-
those participating in the FRIENDS program tion. Considering that the intervention was not
would exhibit a reduction of anxiety symptoms tailored to account for the specific cultural
from pre- to post-treatment. Although statistical needs of this ethnic group, and that it did not
power was evidently poor, this hypothesis was account for the migration issues or intergenera-
generally supported by the data trends. As antic- tional family conflict that often accompanies
ipated, anxiety measures in the waiting-list con- acculturation difficulties, it is likely that the
trol group did not decrease over time, but the previously Australian-validated intervention
internalising dimension of the YSR actually was not as effective as it could have been. In
increased over the IO-week period between order for culture-specific therapeutic interven-
assessment intervals. Given the very recent tions to be effective, ethnically appropriate and
migration experience of these participants and sensitive procedures need to take into account
their families, and that the acculturation process multilayer contexts that account not only for
often develops from initial idealisation of the anxiety, but also for family, acculturation, and
new culture into disillusionment (Merrel, 1999), self-identity issues (Baker, 1999; Westermeyer,
this finding is not surprising. Although the 1989).
impact of migration, in terms of stressful life An additional aim of the study was to obtain
events, was not assessed in this study, it is an information regarding how the intervention may
obvious factor that would contribute to the
be improved to best cater to the needs of this
maintenance or advancing of anxiety symptoms
specific group. One example for modifying the
over the lO-week period between assessment
FRIENDS program to be more culturally sensi-
administrations.
tive for this population relates to the process of
Participants receiving treatment exhibited
the group. Participants indicated a desire for
considerable pre- to post-treatment changes on
more opportunities to discuss issues as a large
the SCAS total score and the Generalised
group (rather than with only one person next to
Anxiety subscale. Moreover, participants inter-
them) and to verbalise responses in preference
preted significantly more situations as being
nonthreatening on the Ambiguous Situations to writing them down. The observations of
Protocol at post-treatment than they did before facilitators and reports from school staff con-
the intervention. No significant change for the firmed that this particular population have a
intervention group, however, occurred on the tendency for a greater degree of expression and
YSR. This rmding is perhaps related to the dis- general disclosure than Anglo-Celtic groups,
criminant validity of the scale. It is important to despite the presence of intemalising problems.
note that the participants' scores on the internal- In the design of the FRIENDS program for gen-
ising measures of the YSR were within the eral use in Australian schools, it was considered
"normal" range at pre-treatment, thereby undesirable to require group members to dis-
explaining why there were only moderate close and participate almost exclusively in a
changes from pre- to post-treatment. Previous large-group format, as this may be anxiety pro-
studies have also shown a weakness in the ducing for some participants.
YSR's ability to discriminate between clinical One of the most frequently received recom·
and nonclinical levels of anxiety (Johnson, mendations regarding the content of the inter-
Barrett, Dadds, Fox, & Shortt, 1999). vention related to the need to incorporate
While the FRIENDS program appeared to cultural and migration issues (e.g., adjustment
be effective in reducing level of anxiety from difficulties) into examples and activities in the
pre- to post-intervention, comparisons of program. This feedback confirms the impor-
change in level of anxiety between the waiting- tance of this issue for refugees, and indicates
list control and treatment groups were less con- that there was a corresponding desire to discuss
vincing. Findings indicated that only the mean not only traumatic or stressful events, but also
AnxiouslDepressed score of the YSR for the participants' migration and post-migration
treatment group was significantly lower than experiences.

131
PAULA BARRETT, ALAN F. MOORE. AND ROBI SONDEREGGER

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