Promoting positive development among refugee adolescents.

Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suárez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suárez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.

Discrimination and mental health of Somali immigrants in North America: a longitudinal study from 2013 to 2019.

PURPOSE: Immigrant mental health is closely linked to the context of reception in the receiving society, including discrimination; past research has examined this relationship only cross-sectionally. This longitudinal study examines the relationships between discrimination and mental health among Somali immigrants living in North America from 2013 to 2019. METHODS: Data for 395 participants (mean age 21 years at Time 1) were collected through the four-wave Somali Youth Longitudinal Study in four cities: Boston, MA, Minneapolis, MN, Lewiston/Portland, ME, and Toronto, ON. Latent linear and quadratic growth models were used to predict mental health symptoms over time and discrimination's role in these changes. RESULTS: PTSD and anxiety symptoms decreased from 2013 to 2015 and subsequently increased. Depression was static from 2013 to 2015, worsening thereafter. Increases in discrimination predicted increases in mental health symptomatology at all timepoints. CONCLUSION: This study provides support for discrimination's toxic impact on mental health and suggests that recent increases in discrimination may have contributed to worsening mental health among Somali immigrants living in North America.

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).

Civic development and antisocial attitudes/behaviors among Somali immigrants: Change over one year.

Objectives: Understanding how immigrant young adults engage with civic society over time is critical to understanding and fostering healthy development and healthy democracies. The present study examines how civic engagement and antisocial attitudes/behavior of Somali young adult immigrants (ages 18-30, N = 498) in four North American regions co-occur, and change over time. Method: Using latent transition analyses, we examine latent classes of young adult males and females in relation to political and nonpolitical civic engagement and dimensions of antisocial attitudes/behavior and stability of these classes over 1 year. Results: Distinct latent classes were identified that remained consistent over time. Rates and patterns in latent class transitions varied along civically engaged/antisocial dimensions and also by gender. Conclusions: Antisocial attitudes/behavior can coexist with civic engagement. For males, sense of belonging to both Somali and American/Canadian communities was associated with lower levels of antisocial attitudes/behavior. Movement away from, or into, antisocial attitudes/behavior differs by gender and can happen either in the presence or absence of civic engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Comparing Trauma Exposure, Mental Health Needs, and Service Utilization Across Clinical Samples of Refugee, Immigrant, and U.S.-Origin Children.

Most mental health services for trauma-exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee-origin, immigrant-origin, and U.S.-origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee-origin youth (n = 60, 48.3% female, mean age = 13.07 years) and propensity-matched samples of immigrant-origin youth (n = 143, 60.8% female, mean age = 13.26 years), and U.S.-origin youth (n = 140, 56.1% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth than either U.S.-origin youth (p < .001) or immigrant youth (p ≤ .001). Compared with U.S.-origin youth, refugee youth had higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder.  In contrast, the refugee group had comparably lower rates of substance abuse and oppositional defiant disorder (ps ranging from .030 to < .001).This clinic-referred sample of refugee-origin youth presented with distinct patterns of trauma exposure, distress symptoms, and service needs that merit consideration in services planning.

Supporting Women and Children Returning from Violent Extremist Contexts: Proposing a 5R Framework to Inform Program and Policy Development.

Women and children returning from areas formerly controlled by the Islamic State typically have experienced high levels of trauma and indoctrination, further complicating politically fraught efforts at reintegration and resettlement. Consequently, countries around the world are grappling with how best to manage the return of these women and children. To help better understand which types of programming can contribute to the successful, non-violent reintegration of these individuals, we incorporated ideas from existing Repatriation and Rehabilitation (R&R) literature, field practitioners, R&R subject matter experts, and literature from adjacent fields (e.g., refugee resettlement, criminal justice, psychological resilience) into a recommended best practice approach to supporting returning women and children. We propose a shift from "R&R" programming to what we call the "5R" framework: Repatriation/ Resettlement, Reintegration, Rehabilitation, and Resilience. This shift provides conceptual clarity related to how different program elements target proximal goals (e.g., wellbeing and personal safety, belonging and opportunity, non-violence, and dignity), and how programming can shift from more centrally- and government-held services to informal and community-based supports.

Rehabilitation and Reintegration of Women and Children Returning from Violent Extremist Contexts: A Rapid Review to Inform Program and Policy Development.

This rapid review used a systematic approach to examine the available literature on rehabilitation and reintegration (R&R) programs for women and children returning from contexts of violent extremism, examining common assumptions, inputs, activities and outcomes across diverse settings. Fifty-one documents including peer reviewed articles and grey literature were included in the analysis. The most common program activities identified included mental health services, community level social programs, promoting school and vocational enrollment, regular health services, and parenting training & education, though there was a lack of consensus around core program components. The analysis points to the need for a robust set of inputs and resources to implement R&R programs including government officials, child welfare, mental health professionals, teachers, law enforcement, healthcare, community leaders, and extended family. The review also uncovered a number of gaps. This includes the need to create clear and analytically distinct definitions of rehabilitation and reintegration that are applicable and relevant to key stakeholders, delineating age-appropriate activities and outcomes for young children, youth, and adults, defining frameworks for service delivery and coordination of stakeholders, and placing R&R programs within existing domains of public safety and restorative justice.

The role of discrimination, assimilation, and gender in the mental health of resettled Somali young adults: A longitudinal, moderated mediation analysis.

Acculturation styles have important associations with future adjustment among immigrants and refugees, yet less is known about the individual and interpersonal factors that influence the strategy an individual adopts. High rates of discrimination may signal the receiving community's rejection of one's ethnic group, increasing pressure to assimilate and suppress one's heritage identity. Within a sample of Somali young adults (18-30, N = 185) resettled in North America, this study tested whether two acculturation styles (assimilation and integration) longitudinally mediate the relation between discrimination and three mental health outcomes (i.e., anxiety, depression, and posttraumatic stress disorder), and whether gender moderated these relations. Discrimination had a direct, positive relation with future mental health symptoms for females, which was not mediated by acculturation strategy. By contrast, the association between discrimination and mental health outcomes for males was fully mediated by increased endorsement of assimilation, but not integration. Experiences of marginalization may erode connections to both the Somali community and to the nation of resettlement, which have been identified as particularly strong protective forces within this community. Interventions targeted at the receiving community to reduce the rates of discrimination toward immigrants and refugees and interventions to strengthen youth's sense of belonging in both the predominant culture and their culture of origin may improve transdiagnostic mental health outcomes.

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.

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).

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.

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).

Residential mobility, mental health, and community violence exposure among Somali refugees and immigrants in North America.

Refugees and immigrants resettled in high income countries often later experience a new phase of residential uncertainty in search of safe and secure housing. This study investigated the effect of past year housing stability on symptoms of posttraumatic stress disorder (PTSD) and exposure to neighborhood violence among a sample of 1st and 2nd generation Somali young adults (N = 198) living in urban areas in North America. In one year, 8.1% of the sample experienced a forced move and 20.7% of the sample moved voluntarily. Discrimination, neighborhood violence, economic insecurity, and interpersonal conflict precipitated forced moves. Forced moves were associated with worsening PTSD symptomology over one year, while voluntary moves were associated with improvements in symptoms. The current study provides evidence of the importance of safe, stable housing for the mental health of young adult immigrants.

Factor structure and concurrent validity of the Cognitive Fusion Questionnaire (CFQ) in a sample of Somali immigrants living in North America.

The process of resettlement in a new country and culture is commonly one of intense stress. Somali immigrants and refugees living in North America represent a large ethnocultural group navigating the complexities of forced displacement and resettlement. Despite the immense resilience exhibited by Somali communities in resettlement, the behavioral health needs of these communities require effective and culturally appropriate psychological assessment tools that can be used across service and research sectors. Given this need, we sought to examine the psychometric properties and concurrent validity of the Cognitive Fusion Questionnaire (CFQ), a transdiagnostic measure of cognitive fusion, in a sample of 233 (M age = 25.35; female = 45%) Somali young adults living in North America. Results using confirmatory factor analysis demonstrated that the one-factor structure of the CFQ previously found in other diverse populations held in the present sample. The structure and related item loadings were invariant across three key variables: gender, age, and location of resettlement in North America. Importantly, cognitive fusion was meaningfully associated with aspects of clinical and psychosocial functioning thought to be highly relevant to this population, including posttraumatic stress, anxiety, and depression symptoms, thwarted belongingness and perceived burdensomeness, and experiences of discrimination. Building upon the growing body of evidence supporting the CFQ's strong psychometric properties across cultural groups, researchers, and clinicians should have an added degree of confidence and enthusiasm in utilizing this measure to support immigrant and refugee communities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Understanding the needs of children returning from formerly ISIS-controlled territories through an emotional security theory lens: Implications for practice.

BACKGROUND: Children who spent time in territories formerly controlled by the Islamic State of Iraq and Syria (ISIS) and who are now being reintegrated into their countries of origin have experienced significant trauma and may present with adjustment or mental health problems. OBJECTIVE: In this paper we describe how Emotional Security Theory (EST; Davies & Cummings, 1994) and its more recent formulation, EST-reformulated (EST-R; Davies & Martin, 2013, 2014), provide a theoretical lens to aid in understanding the ways in which traumatic experiences under ISIS may have an enduring impact on a child's development and well-being. METHODS & RESULTS: The core assumption of EST is that maintaining safety and security is a central goal for a child growing up in the context of conflict. Children living in conflict zones under ISIS rule may have developed emotional insecurity, which in turn is theorized to lead to developmental cascades across multiple domains of functioning and at times result in clinically significant distress. This theoretical understanding can guide intervention, as it suggests that the foci of intervention must (1) minimize social signals indicative of threat while also (2) reducing behavioral response patterns that limit opportunities for exploration and prosocial affiliation. Trauma Systems Therapy is a multidisciplinary child trauma treatment model that addresses both stressors in the social environment and related emotional dysregulation. CONCLUSIONS: Challenges and considerations related to implementing such a comprehensive treatment approach in low- and middle-income countries are discussed.

Bhutanese Refugee Youth: The Importance of Assessing and Addressing Psychosocial Needs in a School Setting.

BACKGROUND: Traumatic exposure combined with significant stressors in resettlement place Bhutanese refugees at risk for mental health problems. Despite this, refugee youth often are reluctant to seek mental health services. Psychosocial support services, such as school-based groups, offer one solution to this barrier to care. We had 2 aims in this study: (1) to describe the psychosocial needs of resettled Bhutanese refugee students; and (2) to evaluate the impact of skills-based groups on these students' sense of school belonging and mental health. METHODS: Bhutanese refugee students in middle school (N = 34) participated in the 12-week group curriculum (a component of Trauma Systems Therapy for Refugees) and the associated preevaluation/postevaluation. RESULTS: Baseline descriptive analyses indicated high levels of mental health symptoms; approximately, 49% of students met partial or full criteria for posttraumatic stress disorder. In addition, sense of school belonging was significantly inversely associated with depressive and posttraumatic stress symptoms at baseline. Paired sample t tests indicate that students' avoidance symptoms significantly decreased postintervention. CONCLUSIONS: Findings suggest that skills-based groups may be an effective way to engage students in supportive services and address psychosocial needs. Results further highlight the potential protective role of school belonging in reducing refugee students' vulnerability to psychological distress.

Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination.

The primary purpose of this study was to examine relations between trauma exposure, post-resettlement stressors, perceived discrimination, and mental health symptoms in Somali adolescent refugees resettled in the U.S. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135) who had resettled in the U.S. Participants were administered an interview battery comprising self-report instruments that included the UCLA Posttraumatic Stress Disorder (PTSD) Index, the War Trauma Screening Scale, the Every Day Discrimination scale, the Adolescent Post-War Adversities Scale, and the Acculturative Hassles Inventory. Results indicated that cumulative trauma was related to PTSD and depression symptoms. Further, post-resettlement stressors, acculturative stressors, and perceived discrimination were also associated with greater PTSD symptoms after accounting for trauma, demographic, and immigration variables. Number of years since resettlement in the US and perceived discrimination were significantly related to depressive symptoms, after accounting for trauma, demographic, and immigration variables. Further research elucidating the relations between post-resettlement stressors, discrimination, and mental health of refugee adolescents may inform intervention development.

Cognitive behavioral therapy for symptoms of trauma and traumatic grief in refugee youth.

The diverse clinical presentation of refugee children and adolescents after their traumatic experiences requires a treatment model that can mitigate a number of internalizing and externalizing symptoms. Refugee populations also require interventions that can adjust to the wide-ranging experiences likely encountered during preflight, flight, and resettlement. There is some evidence that immigration stressors or social stressors, such as discrimination, are associated with symptoms of posttraumatic stress disorder in refugee youth. Therefore refugee youth may benefit from multiple levels of services, ideally integrated. This article focuses on the mental and behavioral health component of services for refugee youth.

Ethical research in refugee communities and the use of community participatory methods.

This article describes the distinct challenges associated with conducting ethical research with refugees. A case example of an ongoing study of stigma and access to mental health treatment among Somali refugee adolescents resettled in the USA is presented. In developing the study, standard research paradigms were critically examined in order to take account of the unique aspects of Somali culture and experience. Community participatory methods were adopted to uphold both ethical and methodological rigor in the research. A participatory approach for developing ethical protocols within different refugee communities is recommended.

Belonging and connection to school in resettlement: young refugees, school belonging, and psychosocial adjustment.

Schools are one of the first and most influential service systems for young refugees. There is a burgeoning interest in developing school-based refugee mental health services, in part to reduce stigma and increase treatment access for this population. Despite the relevance of gaining a better understanding of how refugee students experience schools in resettlement and how this relates to psychosocial adjustment, belonging and connection to school have not been previously investigated among a population of resettled refugees. This study examines school belonging and psychosocial adjustment among a sample of 76 Somali adolescents resettled in the United States. A greater sense of school belonging was associated with lower depression and higher self-efficacy, regardless of the level of past exposure to adversities. Notably, more than one-quarter of the variation in self-efficacy was explained uniquely by a sense of school belonging. School belonging was not significantly associated with posttraumatic stress symptom severity and did not moderate the effect of exposure to adversities on psychological adjustment. These results suggest that investigating ways of improving school experiences would be particularly useful in the effort towards continued development of school-based mental health programs for young refugees.