The increasing number of Australian cross-cultural and acculturation research projects over the past few years has served to advanced knowledge about the difficulties faced by non-English speaking background (NESB) children and teenagers who migrate to Australia. It has recently been highlighted that migrant groups vary in their experience of cultural adjustment, emotional distress, and coping ability. Although it is broadly recognised that acculturative-stress is a major cause of internalising problems, and that culturally diverse groups have specific needs, strengths, and weaknesses, little work has been undertaken to synergise existing research efforts. Culturally sensitive psychological-practice recommendations have been proposed in the cross-cultural literature, however, ethnically sensitive treatment programs for migrant groups, or even empirical trials of existing interventions for use with NESB youth, are virtually non-existent. To counter the NESB service paucity among Australian mental health professionals, Griffith University and QTMHC set out to develop anxiety prevention, emotional resiliency training (early intervention), and treatment programs that tap into the specific needs of migrant groups in culturally relevant ways.

Although considerable evidence purports that psychosocial treatments and prevention programs are effective in reducing a broad range of internalising problems (anxiety and depression) and promoting emotional resiliency in children and adolescents, the suitability of employing Anglo-Australian standardised therapeutic programs for use with NESB populations has been questioned. One of Australia’s leading family and peer group based cognitive behavioral early intervention and treatment programs (The FRIENDS program; see www.australianacademicpress.com.au) has recently been the centre of much attention with its application to participants of diverse cultures, both nationally and internationally (having been translated and used by therapists and researchers in Holland, Germany, Belgium, Portugal and the USA). Having been clinically validated, FRIENDS has satisfied Australian Federal Government guidelines for evidence-based research through national and international studies.

The program name ‘FRIENDS’ is an acronym for the strategies taught: F-Feeling Worried?, R-Relax and feel good, I- Inner thoughts, E-Explore plans, N-Nice work so reward yourself, D-Don’t forget to practice, and S-Stay cool and calm because you now know how to cope. FRIENDS is specifically designed for school age children, featuring two parallel programs for primary school and high school, each consisting of 10 weekly sessions. A group leaders manual clearly describes the activities that therapists need to implement in each session, and children work through their own personalised workbook detailing the strategies discussed in each session. Lessons include learning how to practice relaxation exercises, thinking helpful thoughts, changing negative thoughts to positive thoughts, graded exposure to difficult situations, problem-solving strategies, recognising feelings in yourself, recognising feelings in others, and helping both oneself and others to feel good. The manuals permit flexible implementation to allow for cultural individuality and the needs of any specific group.

The recent trial of the FRIENDS program in Australia with clinically anxious female refugees from former-Yugoslavia, revealed that while the program was effective in reducing clinical anxiety from pre- to post-intervention, the efficacy of the intervention may have been enhanced by tailoring the program to the specific migration issues presented by the participants. The authors concluded that there was not only a need to modify some of the existing activities to make them more culturally sensitive, practical to administer, and easier for NESB participants to understand, but also to allow for specific examples that addressed relevant migrant needs (e.g., cultural adjustment difficulties).

In order to evaluate the efficacy of FRIENDS in reducing anxiety and building emotional resiliency among NESB students, and gather practical suggestions on how FRIENDS activities could be culturally modified to better meet the needs culturally diverse youth, more than 200 NESB primary and high school students from Brisbane and the Gold Coast participated in a year long research program.

At different stages throughout 2000 and 2001, students of former-Yugoslavian, Chinese, and mixed ethnic backgrounds participated either in the FRIENDS program, or a parallel 10 week wait-list condition. All students were administered a comprehensive assessment package (differentiated by primary and high school) at pre-condition, post-condition, and at 6 months follow-up, using the same administration procedure for all school and cultural groups. Although participants could read and write basic-English, group assessments were conducted verbally in ESL classrooms, providing both an English and native cultural language (Mandarin, Cantonese, and former-Yugoslavian) interpretation of each question by trained bilingual Mental Health Professionals. Mixed-ethnic participants were administered the assessment package in English only (with the exclusion of Samoan and Arabic speaking students who also received interpretations).

A total of 10 FRIENDS intervention groups were run in six different schools. All participating schools were recruited from analogous socio-demographic regions. Both primary and high schools were of similar size, and were all operating under the Queensland state education system. Four high school treatment groups were run (n=50), comprising one former-Yugoslavian group (n=12), two Chinese groups (n=22), and one Mixed-Ethnic group (n=15). Six primary school treatment groups were run (n=71), comprising three former-Yugoslavian Groups (n=28) and three Chinese groups (n=37). Each FRIENDS group featured between 6 and 17 students. All remaining participants (matched for school level, gender, and cultural background) participated in the three assessment phases of the program, without having participated in FRIENDS.

The outcome of the project was overwhelmingly positive, with School Principals, Deputy Principals, ESL coordinators, and Bilingual teacher aids, acknowledging positive in-class and playground behaviour change among NESB students who participated in FRIENDS. Based on pre-post quantitative measures, students who participated in the FRIENDS program showed significantly greater improvement on self-esteem (primary students only), level of anxiety, and future-outlook, than NESB control students (matched for culture, gender, and age) who did not participants in the program.

The program itself received considerable feedback from group leaders, NESB student-participants, ESL teachers, ethnic community members, project management staff, and independent psychologists, which directly contributed to the development of a culturally sensitive resource specifically targeted for NESB migrant students. Social validity data and independent interviews with participants and program facilitators aided this process by gathering valuable information on the strengths and weaknesses of administering existing activities to NESB participants.

The general consensus from facilitators and participants was that the program would benefit from flexible open forums for group discussion on topics of cultural concern and interest, as well as the incorporation of music, art, and creative stories that are personally relevant to young NESB migrants. Over a series of months, changes were made to existing activities featured in the FRIENDS program, culminating in a brand new Group Leader’s Universal NESB Supplement to FRIENDS (UNSF) Manual. The new supplement follows the same 10 sessions of the original FRIENDS program, providing both detailed process instructions for facilitators and alternative culturally sensitive/acculturative-relevant activities. Although now ready for administration, the UNSF Manual will continue to evolve and be modified over the coming months following eventual validation trials with NESB students around Australia.

For more information about this research project or the FRIENDS program, please contact:
Dr. Paula Barrett, Griffith University
(07) 38753375
p.barrett@mailbox.gu.edu.au
Stephen May, Australian Academic Press
(07) 32571176
stephen@australianacademicpress.com.au

References
Barrett, P. M., Sonderegger, R., & Sonderegger, N. L. (in press). Assessment of child and adolescent migrants to Australia: A cross-cultural comparison. British Journal of Clinical Psychology.
Sonderegger, N. L., Barrett, P. M., & Sonderegger, R. (in press). Therapeutic considerations for working with children from non-English speaking backgrounds in the school setting. The Australian Educational and Developmental Psychologist.
Verhulst, F. C., & Archenbach, T. M. (1995). Empirically based assessment and taxonomy of psychopathology: Cross-cultural applications. European Child and Adolescent Psychiatry, 4, 61-76.
Barrett, P.M., Dadds, M.R., & Rapee, R.M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64, 333-342.
Barrett, P.M., Lowry-Webster, H., & Turner, C. (2000c). FRIENDS program for youth: Group leaders manual. Brisbane: Australian Academic Press.
Barrett, P. M., Moore, A. F., & Sonderegger, R. (2000). The Friends Program for Young Former-Yugoslavian Refugees in Australia: A Pilot Study. Behaviour Change, 17, 124-133.
Barrett, P. M., Sonderegger, R., & Sonderegger, N. L., (in press). Evaluation of an anxiety prevention and positive-coping program (FRIENDS) for children and adolescents of non-English speaking background. Behaviour Change.
Barrett, P. M., Sonderegger, R., & Sondereger, N. L. (2001). Universal Supplement to FRIENDS for Youth Group Leader’s Manual: For Participants from Non-English Speaking Backgrounds. Griffith University & QTCMHC.