The goal of this study is to test an ecological/empowerment approach to reducing mental health disparities among socioeconomically disadvantaged Central African and Iraqi refugee adults by examining the effectiveness of a community-based advocacy, learning, and social support intervention (Refugee Well-being Project, RWP) that addresses social determinants of mental health and incorporates an evidence-based trauma treatment (Narrative Exposure Therapy, NET) for refugees with PTSD. The waitlist randomized controlled trial with 180 African and Iraqi refugee adults is innovative and significant because it will rigorously test the effectiveness of addressin social determinants of mental health (poverty, social and physical environments, access to services, marginalization) to reduce mental health disparities, as well as examine the impact of a community-based, mutual learning intervention on improving engagement and retention in evidence-based trauma-focused treatment for those who need it. The RWP intervention emphasizes a sustainable and replicable partnership model between refugee resettlement agencies and universities/colleges that involves refugee adults and undergraduate advocates working together to: a) increase refugees'abilities to navigate their new communities;b) improve refugees'access to community resources;c) enhance meaningful social roles by valuing refugees'culture, experiences, and knowledge;d) reduce refugees'social isolation;and e) increase communities'responsiveness to refugees. The RWP intervention is administered by university undergraduate students enrolled in a service learning course, and has two elements: 1) Learning Circles, which involve cultural exchange and one-on-one learning opportunities, and;2) Advocacy, which involves collaborative efforts to mobilize community resources related to health, housing, employment, education, and legal issues. Pilot testing of RWP demonstrated feasibility, appropriateness, acceptability, and preliminary evidence that the intervention decreased Hmong, Central African, and Iraqi participants'psychological distress and increased protective factors. A mixed methods strategy with data collected from each participant at four time points over a period of 14 months will be used to test the effectiveness of the 6- month intervention to reduce psychological distress (PTSD, depression, and culturally-specific distress), increase protective factors (access to resources, English proficiency, environmental mastery, mental health service use, and social support), and engage and retain refugee adults with PTSD in an evidence-based trauma treatment (NET). Mechanisms of intervention effectiveness will be explored by testing mediating relationships between protective factors and psychological distress. Qualitative components of interviews with refugee participants and paired qualitative interviews with refugees and undergraduates will explore participants'experiences in the intervention, inform interpretation of quantitative data, and investigate unexpected impacts.
This study tests the effectiveness of an innovative, community-based advocacy, learning, and social support intervention (Refugee Well-being Project) to reduce the mental health disparities experienced by low-income refugee adults by addressing several well-defined social determinants of mental health and increasing refugees'engagement in trauma treatment, when warranted. This is important not only for the large number of refugees in the United States and worldwide, but also because the intervention model has the potential to alleviate the disproportionate psychological distress experienced by other immigrant and minority populations throughout the United States who experience inequities in social and material resources and disproportionate exposure to trauma and stress and who are less likely to access formal mental health services because of lack of trust and concerns about culturally appropriateness. The intervention model is low in cost to implement, replicable, sustainable, and non-stigmatizing.