Leveraging community-based mental health services to reduce inequities for children and families living in United States who have experienced migration-related trauma.

OBJECTIVE: Trauma systems therapy for refugees (TST-R) is a trauma-focused, culturally responsive mental health prevention and intervention model designed to meet the needs of children and families who are fleeing their home countries and seeking humanitarian refuge. TST-R provides trauma-focused mental health treatment and addresses problems in part exacerbated by harsh U.S. immigration policies (e.g., poor mental health, stigma, fear) that have implications for the psychosocial well-being of immigrant children and families, especially those who have experienced migration-related trauma. METHOD: Informed by a community-based participatory research approach, TST-R was developed as an adaptation of trauma systems therapy to address common barriers to care experienced by those of refugee and immigrant backgrounds, including mental health stigma, distrust of service systems, and cultural and linguistic barriers. RESULTS: TST-R is a multitiered and phase-based intervention that strategically addresses stressors and needs across levels of the social ecology. Most TST-R services are delivered in easily accessible, nonstigmatizing settings (e.g., school) by a cultural broker and a clinician who work in partnership. TST-R has been disseminated and implemented with multiple cultural groups (e.g., Somali, Bhutanese) across the United States and Canada. CONCLUSIONS: Given the unique stressors, strengths, and needs of immigrant children and their families, mental health services must be equitable, community based, and sustainable. TST-R demonstrates promise as a prevention and intervention model especially for those experiencing immigration policy-related stressors and may serve as a guide for developing child mental health policies and immigration policies that promote mental well-being for immigrant families. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Qualitative Examination of How Somali Young Adults Think About and Understand Violence in Their Communities.

Violence prevention efforts must take into consideration the potentially stigmatizing labels associated with violence, and how youth perceive different types of violence in their communities. Somali communities and individuals in North America have at times been labeled as at-risk for violence, with two notable examples being gang violence and ideologically motivated violence, or violent radicalization. Little is known, however, about how the youth themselves think about and understand these types of violence in their communities. In this article, we seek to answer the following questions: How do Somali immigrants think about violence in their communities, and the stigma related to this violence? and What are the implications of these perceptions/beliefs for violence prevention? Data are drawn from two qualitative studies conducted as part of an ongoing community-based participatory research (CBPR) collaboration between academic partners and Somali communities in three cities in North America. Study 1 consists of nine focus groups (n = 36, male only), and Study 2 consists of in-depth interviews (n = 40, male and female). All participants are Somali young adults living in North America. Overall, radicalization to violence is seen as a remote and irrelevant issue in the Somali community. Participants distance themselves from the idea of radicalization to violence and from those who participate in radical acts or held such beliefs. In contrast, gang involvement is characterized as a major problem for Somali communities, and a product of the marginalization associated with being a refugee in Canada or the United States. Findings suggest that prevention efforts focused on gangs are more likely to be acceptable to communities than those focused on violent extremism.

Partnering with refugee communities to improve mental health access: Going from "why are they not coming" to "what can I (we) do differently?".

Refugees are disproportionally impacted by trauma and its negative sequelae. Even after being resettled in the United States, refugees face disparities in accessing services due to the stigma attached to mental health symptoms and the paucity of culturally and linguistically accessible services. Thus, there is a great need to develop methods that facilitate the engagement of refugee communities. Community-Based Participatory Research recommends the forming of equal and equitable partnerships with communities and stakeholders to enhance community capacity and ownership of the research process and outcomes (Israel et al., 1998). The present article shares one approach to operationalizing these principles with the Somali refugee community. It provides a road map of best practices in collaborating with communities and the importance of colearning and cultural humility to a successful partnership. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Risk and Protective Factors Associated With Support of Violent Radicalization: Variations by Geographic Location.

Objectives: We examine the association between perceived discrimination, mental health, social support, and support for violent radicalization (VR) in young adults from three locations across two countries: Montréal and Toronto, Canada, and Boston, United States. A secondary goal is to test the moderating role of location. Methods: A total of 791 young adults between the ages of 18 and 30, drawn from the Somali Youth longitudinal study and a Canada-based study of college students, participated in the study. We used multivariate linear regression to assess the association between scores on the Radical Intentions Scale (RIS) with demographic characteristics, anxiety, depression, social support, and discrimination. Results: In the full sample, discrimination, age, and gender were associated with RIS scores. When we examined moderation effects by location, RIS scores were associated with depression only in Montréal, and with social support (negatively) and discrimination in Toronto. None of the variables were significant in Boston. Conclusion: These findings suggest that an understanding of risk and protective factors for support of VR may be context-dependent. Further research should take into consideration local/regional differences.

Developing Advisory Boards within Community-based Participatory Approaches to Improve Mental Health among Refugee Communities.

BACKGROUND: Community-based participatory approaches to research and intervention with ethnically and racially diverse minority groups demonstrate great promise to address health disparities. Refugees as a group have experienced a disproportionate amount of trauma, experience on-going resettlement and acculturative stressors, and have been shown to be at a heightened risk for psychological distress. OBJECTIVE: This article aims to extend current knowledge by examining best practices for use of community advisory boards (CABs) and youth advisory boards (YABs) to achieve mental health equity among refugee communities. METHODS: In order to improve outcomes in refugee communities, public health and mental health research and interventions should aim to engage refugees as active partners on advisory boards. Employing trauma-informed care principles through cultural humility, authentic engagement and power-sharing, recognition of the stigma of mental illness and mental health care, respect for community norms and preferences, and acknowledgement of acculturative and generational differences within refugee communities epitomize best practices in establishing and maintaining meaningful community advisory boards. CONCLUSIONS: Inclusion of trauma-informed CABs community adult and YABs in refugee mental health research and interventions ensures that the work is relevant and meaningful to those who are intended to benefit from these efforts.

Discrimination, marginalization, belonging, and mental health among Somali immigrants in North America.

In this study, we examined the relationships among discrimination and mental health for Somali young adults, a group at risk for an unfavorable context of reception, and the way in which individual- and community-level factors explain these associations. The present study drew upon data collected during the first wave of the Somali Youth Longitudinal Study, a community-based participatory research project focused on understanding and supporting the healthy development of Somali young adults in four different regions in North America: Boston, MA, Minneapolis, MN, and Portland/Lewiston, ME in the United States and Toronto, Canada. Somali men and women aged 18-30 participated in quantitative interviews that included questions about their health, their neighborhoods, and their thoughts and feelings about their resettlement communities (N = 439). Results indicate that discrimination has a direct effect on worse mental health; this effect was mediated through both individual (marginalized acculturation style) and community-level (sense of belonging) factors. These findings suggest that factors associated with a receiving society's attitudes and behaviors, in addition to its structural supports and constraints, may be particularly important in understanding immigrant mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior.

Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressors such as illiteracy, family conflict, and being separated from family members were more associated. IPTS holds promise in understanding suicide in the resettled Bhutanese community.

Multi-tier mental health program for refugee youth.

OBJECTIVE: We sought to establish that refugee youths who receive a multi-tiered approach to services, Project SHIFA, would show high levels of engagement in treatment appropriate to their level of mental health distress, improvements in mental health symptoms, and a decrease in resource hardships. METHOD: Study participants were 30 Somali and Somali Bantu refugee youths in the English language learner classroom in a middle school in New England. Project SHIFA is a multi-tiered program including prevention and community resilience building for the community at large, school-based early intervention groups for at-risk students, and direct intervention using an established trauma model (trauma systems therapy) for those with significant psychological distress. Data were collected from students at time of enrollment, 6-month follow-up, and 12-month follow-up. Measures used were the War Trauma Screening Scale, Adolescent Post-War Adversities Scale-Somali version, UCLA PTSD Reaction Index for DSM-IV (Revision 1), and the Depression Self-Rating Scale. RESULTS: Students across all tiers of the program demonstrated improvements in mental health and resources. Resource hardships were significantly associated with symptoms of posttraumatic stress disorder over time, and the stabilization of resource hardships coincided with significant improvements in symptoms of depression and posttraumatic stress disorder for the top tier of participants. CONCLUSIONS: Project SHIFA is a promising model of treatment for young refugees.

Interpersonal complementarity in the mental health intake: a mixed-methods study.

The study examined which socio-demographic differences between clients and providers influenced interpersonal complementarity during an initial intake session; that is, behaviors that facilitate harmonious interactions between client and provider. Complementarity was assessed using blinded ratings of 114 videotaped intake sessions by trained observers. Hierarchical linear models were used to examine how match between client and provider in race/ethnicity, sex, and age were associated with levels of complementarity. A qualitative analysis investigated potential mechanisms that accounted for overall complementarity beyond match by examining client-provider dyads in the top and bottom quartiles of the complementarity measure. Results indicated significant interactions between client's race/ethnicity (Black) and provider's race/ethnicity (Latino) (p = .036) and client's age and provider's age (p = .044) on the Affiliation axis. The qualitative investigation revealed that client-provider interactions in the upper quartile of complementarity were characterized by consistent descriptions between the client and provider of concerns and expectations as well as depictions of what was important during the meeting. Results suggest that differences in social identities, although important, may be overcome by interpersonal variables early in the therapeutic relationship. Implications for both clinical practice and future research are discussed, as are factors relevant to working across cultures.

Ethnicity in child maltreatment research: a replication of Behl et al.'s content analysis.

This study examines the use of ethnicity in 489 empirical research articles published in three major child maltreatment specialty journals from 1999 to 2002. Of the American samples, 12.5% focus on ethnicity, 76.2% report the ethnic composition of participants, and 33.8% use ethnicity of participants in analyses. Ethnicity has a significant effect in 52.3% of articles in which it was used in analyses, suggesting its importance as a variable in a wide range of studies. African Americans and Native Americans are underrepresented in research samples. These findings indicate more attention to ethnicity in American research than Behl, Crouch, May, Valente, and Conyngham's 2001 study might suggest but also highlight the need for continued expansion in focusing on, reporting, and using ethnicity in research.