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.

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.

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.

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).

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.

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.

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).

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 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.

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).

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.

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.

The Dilemma of Predicting Violent Radicalization.

Parents, educators, law enforcement officials, and health professionals are all concerned about the violent radicalization of adolescents. Health professionals may be called on to assess teenagers regarding the risk that they will become dangerous. We present a case in which a psychiatrist is asked to do a forensic evaluation of a young adolescent who said troubling things and had some concerning posts on his Facebook page. The evaluation reveals things about both the young boy and his community.

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.

Building community resilience to violent extremism through genuine partnerships.

What is community resilience in relation to violent extremism, and how can we build it? This article explores strategies to harness community assets that may contribute to preventing youth from embracing violent extremism, drawing from models of community resilience as defined in relation to disaster preparedness. Research suggests that social connection is at the heart of resilient communities and any strategy to increase community resilience must both harness and enhance existing social connections, and endeavor to not damage or diminish them. First, the role of social connection within and between communities is explored. Specifically, the ways in which social bonding and social bridging can diminish risk for violence, including violent extremism, is examined. Second, research on the role of social connection between communities and institutions or governing bodies (termed social linking) is described. This research is discussed in terms of how the process of government partnering with community members can both provide systems for early intervention for violent extremism, as well as strengthen bonding and bridging social networks and in this way contribute broadly to building community resilience. Finally, community-based participatory research, a model of community engagement and partnership in research, is presented as a road map for building true partnerships and community engagement. (PsycINFO Database Record

Culturally adapting a physical activity intervention for Somali women: the need for theory and innovation to promote equity.

There is pressing need for innovation in clinical research to more effectively recruit, engage, retain, and promote health among diverse populations overburdened by health disparities. The purpose of this study is to provide a detailed illustration of the cultural adaptation of an evidence-based intervention to bolster translational research with currently underserved communities. The cultural adaptation heuristic framework described by Barrera and colleagues is applied to the adaptation of a physical activity evidence-based intervention with adult Somali women. Widespread changes were required to ensure program feasibility and acceptability, including the reduction of assessment protocols and changes discordant with current trends in physical activity research. The cultural adaptation of evidence-based interventions offers an important mechanism for reducing health disparities. Improved reporting standards, assessment of features relevant to underserved communities, and greater funding requirements to ensure better representation are needed to promote more widespread access for all people.

The Impact of Acculturation Style and Acculturative Hassles on the Mental Health of Somali Adolescent Refugees.

Refugee adolescents often immigrate to a new society because of experiences of persecution and trauma, which can have profound effects on their mental health. Once they immigrate, many refugees experience stressors related to resettlement and acculturation in the new society. The current study examined relationships among acculturation styles and hassles and the well-being of young refugees as well as the role of gender. Data were collected from 135 young refugees (M age = 15.39, SD = 2.2; 62 % male) from Somalia resettled in the United States The findings from our study indicate that in addition to trauma history, acculturative hassles and acculturation style impact the wellbeing of Somali refugee adolescents. These findings indicate the need to understand both past experiences as well as current challenges. Potential areas for intervention are discussed.