From Rupture to Reconstruction: A Systematic Review on Trauma and Loss Interventions for Children in Displacement and Welfare System

Abstract

Children and adolescents exposed to adoption processes, displacement, or child welfare involvement often experience relational rupture, instability, and trauma and/or grief symptoms. Although psychological interventions for childhood trauma have been widely studied, less is known about how they address the intersection between trauma, grief, and retraumatization in these vulnerable populations. This systematic review analyzed empirical studies on psychological interventions for trauma and/or grief in adopted, displaced, or alternative-care children and adolescents, aiming to identify therapeutic strategies to inform a future intervention for children in residential care with trauma or complicated grief symptoms. A PICO question was formulated, and the review followed PRISMA guidelines, using Covidence software for study screening and selection. From the initial 1,052 articles identified, twelve studies met the inclusion criteria, including quantitative and qualitative designs. The interventions included Narrative Exposure Therapy, Trauma-Focused Cognitive Behavioral Therapy, and other trauma-focused approaches. Most studies focused on refugees, unaccompanied minors, and children in the child welfare system, with no adoption-specific studies identified. Several interventions were associated with reductions in PTSD (Post-traumatic stress disorder) or traumatic stress symptoms, although grief and retraumatization were not directly assessed. Recurrent components across those interventions included psychoeducation, stabilization and emotional regulation, narrative and autobiographical work, cognitive restructuring, gradual exposure, expressive techniques, and relational components focused on safety, belonging, peer support, identity continuity, and future-oriented work. Overall, this review maps clinical strategies for vulnerable youth and highlights the need for stronger designs, direct assessment of grief and retraumatization, and studies examining mediators and moderators of outcomes.