In the US, refugee children and families face dramatic disparities in the incidence and treatment of mental health disorders. Resettlement stressors (poverty, limited access to care) and acculturative challenges (differences in cultural norms, discrimination) often exacerbate risks due to war-related trauma exposure. Commonly, refugee mental health services are limited-usually with a narrow focus on clinical treatment of PTSD-and rarely respond to the holistic needs of refugee communities;few interventions are designed to be used across cultures and refugee groups, despite rapidly evolving refugee demographics in the US. The cross-cultural application of community-based participatory research (CBPR) methods can increase understanding of risk and protective factors in refugee communities and contribute to development of flexible mental health interventions to address disparities. This CBPR project builds on an existing collaborative research relationships with the Somali Bantu refugee community in Greater Boston. Preliminary research has identified numerous cultural and community strengths as well as ongoing problems of family conflict, poor parent-child communication which interact with ongoing stressors to increase risks for child emotional and behavioral problems. Family-based intervention models adapted via local input and delivered by trained members of the community hold great promise for use among these and other refugee groups in the US. This study will use CBPR mixed methods (qualitative and quantitative data collection) to conduct needs assessments and design and evaluate a core family-based intervention. Project activities will emphasize capacity building in two refugee communities resettled in Greater Boston-the Somali Bantu and the Bhutanese-actively engaging refugee community members, community advisory boards, services providers, and other stakeholders.
Specific Aims are to: (1) deepen partnerships with the Somali Bantu and Bhutanese communities through co-leadership, capacity-building, and knowledge sharing;(2) collect and apply qualitative data to (a) prepare a needs assessment of mental health in children and adolescents, barriers to care, and services preferences with each target refugee group;(b) develop mental health/psychosocial assessments for refugee caregivers and children;(c) adapt the core components of a family-based strengthening intervention for use with refugees;and (3) conduct an 80-family pilot study to examine acceptability and sustainability of the intervention. Key outcomes will be improvements in caregiver-child relationships, mental health services access, increased functioning, and reduced mental health symptoms in children and adolescents.

Public Health Relevance

The proposed study will employ cross-cultural CBPR methods to develop a family-based intervention grounded in needs assessments on contributors to mental health disparities among refugee children and families. The mixed methods research approach to selecting, adapting and implementing culturally-informed assessments and intervention models has the potential to contribute to feasible, acceptable and sustainable intervention models of mental health services for diverse groups of refugee children and families.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Resource-Related Research Projects (R24)
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Special Emphasis Panel (ZMD1-RN (07))
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Dankwa-Mullan, Irene
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Harvard University
Public Health & Prev Medicine
Schools of Public Health
United States
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Frounfelker, Rochelle L; Assefa, Mehret T; Smith, Emily et al. (2017) ""We would never forget who we are"": resettlement, cultural negotiation, and family relationships among Somali Bantu refugees. Eur Child Adolesc Psychiatry 26:1387-1400
Betancourt, Theresa S; Newnham, Elizabeth A; Birman, Dina et al. (2017) Comparing Trauma Exposure, Mental Health Needs, and Service Utilization Across Clinical Samples of Refugee, Immigrant, and U.S.-Origin Children. J Trauma Stress 30:209-218
Betancourt, Theresa S; Abdi, Saida; Ito, Brandon S et al. (2015) We left one war and came to another: resource loss, acculturative stress, and caregiver-child relationships in Somali refugee families. Cultur Divers Ethnic Minor Psychol 21:114-25
Betancourt, Theresa S; Frounfelker, Rochelle; Mishra, Tej et al. (2015) Addressing health disparities in the mental health of refugee children and adolescents through community-based participatory research: a study in 2 communities. Am J Public Health 105 Suppl 3:S475-82