International Society for Traumatic Stress Studies

Immigrant and Refugee Trauma


The ISTSS 34th Annual Meeting is the largest gathering of professionals dedicated to trauma treatment, education, research and prevention. There will be several workshops, symposia and expert trainings on trauma in immigrant and refugee populations. 

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Concurrent Session One: Panel Presentation

Thursday, November 8 | 9:45 AM to 11:00 AM


From Community Based Participatory Research (CBPR) to Policy: How Community Partnerships Lead to Systemic Change


Abdi, Saida, LICSW1; Agalab, Naima, BA2; Merchant, Abdul-Malik, MSW Candidate3; Cardeli, Emma, PhD4; Miller, Alisa, PhD4; Ellis, Heidi, PhD4

1Boston University/Children's Hospital Center for Refugee Trauma & Resilience/ Children's Hospital Boston, Boston, Massachusetts, USA
2Refugee & Immigrant Assistance Center/Children's Hospital Center for Refugee Trauma & Resilience/Children's Hospital Boston, Boston, Massachusetts, USA
3Boston University/Islamic Society of Boston Cultural Center, Roxbury Crossing, Massachusetts, USA
4Children's Hospital Center for Refugee Trauma & Resilience/Children's Hospital Boston, Boston, Massachusetts, USA


This panel will discuss ways in which community partnerships are instrumental to building trauma-informed, culturally-responsive systems of care for refugee youth and families in resettlement. Findings from the Somali Youth Longitudinal Study (SYLS) will be presented with a focus on risk and protective factors for this vulnerable population. SYLS is an unprecedented, multi-wave investigation of Somali refugee/immigrant youth (age 18-35) living in North America that is guided by a CBPR approach. Results illustrate the powerful role of social bonds and civic engagement in resilience building (Cardeli et al., under review; Ellis & Abdi, 2016; Ellis et al., under review). Experiences of adversity in resettlement (e.g., victimization) also emerge as significant predictors of high risk behaviors and psychological distress (Cardeli et al., in preparation; Ellis et al., in preparation). The panel (including perspectives of researchers, refugee resettlement, and faith-based leader) will provide different perspectives on the question “how can both the process and content of research inform practice and policy related to vulnerable populations”. Finally, strategies for translating science into practice will be discussed, highlighting Community Connect—an innovative, multi-disciplinary team approach to building resilience in refugee communities—as a model for producing systemic change. 


Concurrent Session Two: Symposium

Thursday, November 8 | 11:15 AM to 12:30 PM


Addressing Barriers to Scale: Innovations to Psychological Interventions in Refugee Crises and Humanitarian Settings
 

Chair: Kohrt, Brandon, MD, PhD

The world is currently experiencing the highest ever recorded number of refugees, most of whom reside in low- and middle income countries (LMIC). In addition to armed conflicts, populations in LMIC may face major stressors such as gender-based violence and chronic poverty. There is a significant body of research that documents the mental health risks associated with both conflict-related and other adversity in LMIC. At the same time, LMIC health systems are rarely equipped to provide mental health support to the large groups of people in need. The treatment gap in non-conflict affected LMIC is estimated to be higher than 90%. A critical challenge for the provision of mental health services for both governments and humanitarian agencies concerns the high-resource intensity of current evidence-based psychotherapeutic interventions in low-resource settings. Evidence-based psychological interventions are commonly characterized by a requirement for extensive training and ongoing supervision; large number of sessions; and their targeting of single mental disorders (when comorbidity is common) – collectively resulting in relatively few people reached at high cost. Innovative treatment models are required to ensure that mental health support can be brought to scale. This symposium provides an overview of these challenges, and presents the results of adaptations, piloting and randomized controlled trials from three different research teams in Kenya (women affected by gender-based violence), Uganda (South Sudanese refugees), and Zambia (violence-affected populations). Presentations highlight innovations in addressing barriers to scale through task-sharing, transdiagnostic approaches, alternative treatment formats (e.g., self-help), and the integration of mental health in other types of programming tested in randomized controlled trials.

A Common Elements Treatment Approach to Address Implementation and Scale-up Barriers in Low- and Middle-income Countries


Murray, Laura, PhD1; Kane, Jeremy, MPH1; Skavenski van Wyk, Stephanie, MPH, MSW1; Melendez, Flor, MPH1; Bolton, Paul, MB BS2

1Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
2Johns Hopkins University Bloomberg School of Public Health, Scituate, Massachusetts, USA

Despite high rates of anxiety and mood disorders in low- and middle-income countries (LMIC), a small percentage of individuals receive evidence-based treatment. Barriers to implementation and scale-up of effective interventions have been identified at various system levels. Modular, flexible transdiagnostic interventions were developed in part to ease dissemination, implementation, and scale-up efforts and have the potential to address several barriers, including the lack of trained mental health professionals in LMIC and the high rate of comorbidity among clients. This presentation provides data on a randomized trial of the common elements treatment approach (CETA) in Zambia. Baseline findings indicate high rates of comorbidity. Among male participants with hazardous alcohol use, 77% met symptom criteria for depression, 39% for post-traumatic stress, and 41% had other substance use. Among women who experienced violence, 65% met criteria for hazardous alcohol use, 86% met criteria for depression, 48% for trauma, and 24% had other substance use. Discussion will include data from the Zambia trial and other studies by our team on the utility of CETA to address known barriers to implementation, scale-up and sustainability. We will discuss adaptation of CETA, case studies, and implementation factors for sustaining and scaling-up CETA following study completion.


Evaluation of the Effectiveness and Implementation of a Brief Behavioral Intervention on Psychological Distress among Women with a History of Gender-based Violence in Kenya


Bryant, Richard, PhD1; Schafer, Alison, PhD2; Dawson, Katie, PhD3; Anjuri, Dorothy, BA4; Mulili, Caroline, BA4; Ndogoni, Lincoln, MSc5; Koyiet, Phiona, BA4; Sijbrandij, Marit, PhD6; Ulate, Jeanette, MD7; van Ommeren, Mark, PhD8

1University of New South Wales, Sydney, New South Wales, Australia
2World Health Organization, Geneva, Geneva, Switzerland
3University of New South Wales, Sydney, NSW, Australia
4World Vision Australia/International, Nairobi, Nairobi, Kenya
5Psychosocial Support Center, Nairobi, Nairobi, Kenya
6VU University, Amsterdam, Noord-Holland, Netherlands
7World Vision Australia/International, Montreal, Quebec, Canada
8World Health Organization, Geneva, Geneva 27, Switzerland


The aim of this study was to test the effectiveness of a new 5-session behavioral treatment called Problem Management Plus (PM+) that community lay workers can be taught to deliver for female survivors of gender-based violence. After community screening, 421 women who indicated distress were randomized to PM+ or enhanced usual care (EUC). At 3-months follow-up the difference between PM+ and EUC in the change from baseline to 3-month on the GHQ-12 was 3.33 [95% CI, 1.86 to 4.79], P = .001). This study demonstrated that among a community sample of women in urban Kenya with a history of GBV, a brief, lay-administered behavioral intervention resulted in moderate reductions in psychological distress. Following this, a collaboration with the local Ministry of Health and World Vision has implemented PM+, with over 1500 local practitioners trained and evaluations built in to all delivery. Data will be presented of the implementation phase with over 3,000 recipients of PM+ in this implementation evaluation. This program demonstrates that evidence-based interventions can be implemented in a scalable manner and can be integrated into local health systems.
 

The Effectiveness of a Guided Self-Help Intervention for South Sudanese Refugee Women: A Cluster Randomized Controlled Trial

Tol, Wietse, PhD1; Lakin, Daniel, MA1; Augustinavicius, Jura, Other1; Brown, Felicity, PhD2; Bryant, Richard, PhD3; Carswell, Kenneth, PhD4; Kogan, Cary, PhD5; Musci, Rashelle, PhD6; Ventevogel, Peter, MD7

1Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
2War Child Holland, Amsterdam, North Holland, Netherlands
3University of New South Wales, Sydney, New South Wales, Australia
4World Health Organization, Geneva, Geneva, Switzerland
5University of Ottawa, Ottawa, Ontario, Canada
6Johns Hopkins University, Baltimore, Maryland, USA
7United Nations High Commissioner for Refugees, Geneva, CH-1211 Geneve 2 Depot, Switzerland


Innovative interventions are needed to meet the vast mental health needs of refugees. WHO developed a potentially scalable intervention called Self-Help Plus (SH+). SH+ is a guided self-help intervention of 5 audio-recorded sessions and illustrated self-help manual provided to groups of 20-30 participants by lay helpers with minimal training.

We conducted a 2-arm, single-blind, cluster randomized trial with South Sudanese refugee women in northern Uganda. The primary outcome was psychological distress (Kessler-6). Outcomes were assessed 1 week before and after, and 3 months after intervention. Secondary outcomes included PTSD and depression, disability, self-defined psychosocial goals, feelings of anger, inter-ethnic relations, and subjective wellbeing.

Screening found 697 women eligible for inclusion. Data collection concluded in December 2017, preliminary analyses are reported here. Intent-to-treat analyses showed statistically significant effects on most outcomes. At immediate follow-up (n=659), we found moderate effect sizes on psychological distress (Cohen’s d = .65). At 3-month follow-up (n=625, attrition 8%) this effect was also significant (d = .27). Analyses of secondary outcomes showed a similar pattern.

An innovative multi-media guided self-help intervention was effective in reducing psychological distress in refugee women in a low-resource African setting. 
 

Concurrent Session Three: Workshop Presentation

Thursday, November 8 | 3:00 PM to 4:15 PM


“Will I be deported now?”: Navigating Destabilizing Immigration Policies and the many Roles of Clinicians


Iwata, Casie, MA, MSW; Hudak, Leora, MSW
Center for Victims of Torture, St. Paul, Minnesota, USA


We are living in a time of uncertainty for refugees and immigrants in the United States.  2017 brought the refugee ban, changes to DACA programming, and uncertainty for immigrants building a home in the United States. Refugee, immigrant, and asylum-seeking clients voice complex and destabilizing worries about the current US immigration system. As we sit with clients, we find ourselves in the roles of educator, policy interpreter, coordinator of legal services, advocate, supportive presence, and counselor in the span of a session.

This presentation will bring providers up to speed on recent changes to immigration policy.  It will present data from clients at the Center for Victims of Torture to illustrate the changes in asylum grants since 2012. It will also show data that suggests the power of legal status in predicting post-trauma symptoms of depression, anxiety and PTSD. It will utilize case vignettes to explore the role of the provider in navigating immigration issues in the clinical space and will provide concrete recommendations for incorporating advocacy in clinical work. Finally, the presentation will acknowledge the vulnerabilities that providers face when encountering oppressive structures and systems, and discuss self-care strategies for “endeavoring with” clients during uncertain political times.
 

Concurrent Session Four: Symposium

Thursday, November 8 | 4:30 PM to 5:45 PM


Improving Mental Health Outcomes in Low-resource Humanitarian Crises: Local Perspectives and Implementation Challenges


Chair: Kaysen, Debra, PhD, ABPP

Mental health symptoms associated with trauma exposure contribute greatly to the global burden of disease and are a public health challenge. However, the majority of intervention approaches tend to be individually-focused psychosocial interventions. This symposium will open with an overview of trauma-focused interventions, focusing on practical implementation challenges by the chair from her perspective as both a clinical trials researcher and clinician. Drawing on distinct trials of trauma interventions for conflict-affected women, three presentations by public health researchers will focus on holistic approaches to psychosocial interventions that incorporate respondent-driven mental health concerns and immediate needs.  The first presentation describes problems reported by South Sudanese refugees in Uganda as examples of self-reported needs among program beneficiaries as rationale for implementing integrated, sustainable interventions. The next presenter will discuss challenges and benefits of integrating psychosocial programming into other trauma initiatives, using an integrated safety planning and cognitive processing therapy-based intervention for intimate partner violence in Tanzania. This paper highlights the use of novel inter-sectoral interventions. The last presentation will focus on issues regarding program sustainability from three perspectives (i.e. client, provider, and system) based on qualitative data from a trial of cognitive processing therapy in the Democratic Republic of Congo and Uganda. Topics addressed include participant beliefs regarding treatment efficacy and desire to maintain care, provider opinions on institutionalization of interventions, and stakeholder perspectives on feasibility of sustainability. Overall the symposium will address larger issues regarding what types of interventions are implemented and larger scale factors that may influence uptake and sustainability.
 

Multi-sectoral Integration of Psychosocial Interventions in Low-resource Settings: Lessons Learned from the Implementation of an Integrated Mental Health and Protection Intervention for Refugees

 
Greene, Claire, MPH; Scognamiglio Pasini, Thea, MD; Tol, Wietse, PhD
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA

The bidirectional relationship between mental health and a variety of social and health outcomes (e.g. protection, livelihoods) underlines the need for a multi-sectoral strategy to promote wellbeing and mitigate consequences of poor mental health in low-resource settings.  Implementing integrated services across sectors is challenged by siloed operations. To examine the feasibility of implementing integrated psychosocial services we piloted a mental health treatment and violence prevention program for Congolese survivors of partner violence in Nyarugusu refugee camp. Upon completion of a randomized pilot trial, we conducted 29 interviews with beneficiaries, staff and partners to examine their perspectives on program implementation and analyzed the data using a thematic framework. Integrated psychosocial programming was relevant to refugee priorities and supported by stakeholders. Frequently reported challenges included stakeholder investment, resource allocation, coordination/communication and staff’s ability to manage multiple roles. Strengthening ownership and accountability was critical for implementation and may facilitate adoption of integrated programming. With adequate piloting and preparation it is possible to overcome the challenges identified through this qualitative research in order to implement an integrated, multi-sectoral intervention. 
 

Priority Problems and Impact on Well-being from the Perspective of Refugees: A Case Study among South Sudanese Refugees in Northern Uganda


Augustinavicius, Jura, Other1; Lakin, Daniel, MA1; Marx, Leku, Other2; Brown, Felicity, PhD3; White, Ross, Other4; Bryant, Richard, PhD5; Tol, Wietse, PhD1

1Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
2Peter C. Alderman Foundation, Kampala, Kampala District, Uganda
3War Child Holland, Amsterdam, North Holland, Netherlands
4University of Liverpool, Liverpool, Merseyside , United Kingdom
5University of New South Wales, Sydney, New South Wales, Australia


Priority problems in refugees’ own words are infrequently measured in trauma intervention research, but may impact uptake and effectiveness. We examined self-reported problems among 671 South Sudanese refugee women in Uganda using the Psychological Outcomes Profile in a trial of a self-help intervention. Women qualitatively described major problems and rated the effects of each problem on their well-being (0 (not affected) to 5 (severely affected)). Thematic analysis was used to summarize problem types and descriptive statistics were calculated for problem severity. Major problems pertained to basic needs (e.g. poor health (16%), lack of food (14%), depleted finances (10%)), isolation and loss (e.g. lack of support from others (10%), separation from or death of relatives (7%)), mental health (e.g. thinking too much (8%), stress (5%)), and interpersonal issues (e.g. marital (0.8%) and community (0.5%)). On average, problems were rated as strongly affecting well-being (mean=4.42, SD=0.98). Interpersonal problems (mean=5, SD=0), concerns related to isolation and loss (mean=4.75, SD=0.52), and mental health problems (mean=4.34, SD=1.05) were rated as having the strongest effects. Self-reported problems among trauma-affected populations can inform intervention implementation as direct intervention targets and by contextualizing mental health problems in low-resource settings. 


When Interventions End: Reflections on Sustainability and Responsibility from Client, Provider, and Organizational Perspectives


Lakin, Daniel, MA1; Murray, Sarah, PhD1; Kaysen, Debra, PhD, ABPP2; Matabaro, Amani, BS3; Bolton, Paul, MB BS4; Bass, Judith, PhD, MPH1

1Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
2University of Washington, Seattle, Washington, USA
3Action Kivu, Los Angeles, California, USA
4Johns Hopkins University Bloomberg School of Public Health, Scituate, Massachusetts, USA


Participant-centered psychotherapeutic interventions have shown clinical effectiveness for traumatic stress within low-income settings and humanitarian contexts. The sustainability of these programs – the continued use of these interventions following completion of research trials - has not been well explored. Results from a recent five-year follow-up of participants in a trial of group cognitive processing therapy suggest that not only are some effects on symptom severity sustained, but that skills learned in therapy were also retained. While this is a success from the researcher’s perspective, qualitative interviews with providers revealed a lack of organizational support, inability to continue meetings due to financial limitations, and strong desire to meet, and learn techniques. Interviews with providers and participant responses to open-ended items on follow-up questionnaires were used in a thematic analysis. The findings suggest micro and macro conceptualizations of sustainability – symptom improvements endure at scale, but feelings of empowerment, economic independence and financial support, and institutionalization were not affected. Providers reported feeling more valued in their communities and continued providing services beyond planned interventions despite lack of ongoing support. Strategies for reconciling these two components of sustainability will be discussed.

Current Approaches to Evidence-based Treatment for PTSD and Implications for Global Mental Health

Kaysen, Debra, PhD, ABPP
University of Washington, Seattle, Washington, USA

Disorders related to trauma exposure, such as anxiety, PTSD, and depression are major contributors to the global burden of disease. Clinical trials adapting and testing evidence-based interventions for these contexts have yielded truly promising results. These interventions are typically patient-focused and are delivered at the individual or group level. At the same time, in high income countries, there has been tremendous work on dissemination and implentation of evidence-based interventions. Despite these efforts, there are limitations in uptake and in increasing access to care and reach. This talk will provide an overview of the efficacy on trauma-focused interventions, along with a description of common elements across these interventions. The talk will also highlight the work on large scale dissemination and implementation efforts from high income countries, along with the challenges around long-term sustainability and uptake. The talk will use illustrative examples from Dr. Kaysen's own community-based clinical trials research as well. The rationale for public health and multi-systemic approaches to address mental health in response to trauma will be described.
 

Concurrent Session Five: Symposium


Friday, November 9 | 9:45 AM to 11:00 AM


Investigating the Psychological and Social Mechanisms Underlying Refugee Mental Health: Research Innovations


Chair: Liddell, Belinda, PhD;
Discussant: Schnyder, Ulrich, MD

There are currently over 65 million people who are forcibly displaced worldwide. Rates of psychological disorders are elevated amongst refugees, with refugees reporting high rates of posttraumatic stress disorder (PTSD) and depression. Understanding the impact of the trauma on refugee mental health to date has been limited by a lack of investigation of key psychological and social mechanisms underlying psychopathology. This symposium is comprised of four studies that implement innovative methodologies to investigate factors underlying refugee mental health. The first two studies investigate the role of psychological processes in influencing refugee mental health, and the final two studies examine the role of social and attachment factors in impacting psychopathology in both adult and child refugees. The first study investigates how justice sensitivity mediates the association between exposure to interpersonal trauma and mental health in Arabic and Farsi-speaking refugees. The second study distinguishes, for the first time, between different types of moral injury appraisals amongst refugees, and examines their differential relationship to mental health outcomes. The third presentation reports on the association between parental PTSD, parenting and child mental health in a representative sample of refugee parents and children in Australia. The fourth study investigates the mediating role of trust in influencing social engagement in a nationally-representative sample of 1894 refugees resettled in Australia. Findings will be considered in the context of current models of refugee mental health, and clinical implications will be discussed.
 

Perceived Injustice: A Novel Mechanism Linking Trauma Exposure to Psychological Distress Among Refugees


Kashyap, Shraddha, PhD1; Nickerson, Angela, PhD2

1University of New South Wales, Kensignton, NSW, Australia
2University of New South Wales, Sydney, NSW, Australia


Objective: Interpersonal trauma, such as rape and torture; followed by psychological distress, are common features of the refugee experience. Understanding mechanisms which link trauma to psychological distress could help target intervention. One possible mechanism is how trauma-exposed individuals react to situations in which they perceive being treated unfairly, or perceive treating others unfairly (i.e. justice sensitivity).This study aimed to explore the relationship between trauma exposure, justice sensitivity and psychological distress among refugees. Method: 83 refugees from Arabic and Farsi speaking backgrounds, living in Australia completed self-report measures of justice sensitivity, trauma exposure, PTSD, depression, and anger. Results: Path analysis suggests that trauma exposure is significantly associated with sensitivity to treating others unfairly, but not being treated unfairly. Sensitivity to treating others unfairly predicted depression and PTSD; while sensitivity to being treated unfairly predicted anger. Finally, sensitivity to treating others unfairly mediated the relationship between trauma exposure and depression. Conclusion: This is the first study to show the relationship between justice sensitivity and psychological distress among refugees. Justice sensitivity may be worth exploring during interventions among such trauma exposed populations.
 

Cognitive Appraisals and Psychopathology in Refugees: A Latent Profile Analysis of Moral Injury Cognitions


Hoffman, Joel, PhD Candidate; Liddell, Belinda, PhD; Bryant, Richard, PhD; Nickerson, Angela, PhD
University of New South Wales, Sydney, New South Wales, Australia

There is emerging evidence that appraisals of traumatic events as violating deeply held moral beliefs (i.e., moral injury) impact negatively on refugee mental health. The Moral Injury Appraisals Scale (MIAS; adapted from Nickerson et al. 2015), captures whether these appraisals relate to transgressions committed by others, or by oneself. A latent profile analysis was conducted with 221 refugees and asylum seekers recently resettled in Australia, to classify participants across appraisal types, and to examine the association between class membership and key predictor (demographics, trauma exposure, living difficulties) and outcome (PTSD, depression, anger) variables. Results revealed a three-profile solution across MI appraisals: HIGH-ALL, HIGH-OTHERS/LOW-SELF and LOW-ALL. The HIGH-ALL class was associated with experiencing more interpersonal abuse and daily hardships, whereas the HIGH-OTHERS/LOW-SELF class was associated with more exposure to conflict and visa-related difficulties. Both the HIGH-ALL and the HIGH-OTHERS/LOW-SELF had significantly higher symptoms than the LOW-ALL group. The HIGH-ALL group also had significantly greater anger than the HIGH-OTHERS/LOW-SELF group. This was the first study to identify distinct profiles of moral injury appraisals in refugees, and to show their association with specific traumatic events, as well as non-traumatic stressors. 


Longitudinal Relationship between Trust, Psychological Symptoms and Community Engagement in Resettled Refugees


Nickerson, Angela, PhD1; Liddell, Belinda, PhD1; Keegan, David, MSW2; Edwards, Ben, PhD3; Felmingham, Kim, PhD4; Forbes, David, PhD5; Hadzi-Pavlovic, Dusan, MPsych6; McFarlane, Alexander, MD7; O'Donnell, Meaghan, PhD8; Silove, Derrick, MD PhD1; Steel, Zachary, PhD9; Van Hooff, Miranda, BA (Hons), PhD7; Bryant, Richard, PhD10

1University of New South Wales, Sydney, NSW, Australia
2HOST International, Sydney, NSW, Australia
3Australian National University, Canberra, ACT, Australia
4University of Melbourne, Melbourne, Victoria, Australia
5Phoenix Australia: Centre for Posttraumatic Mental Health: The University of Melbourne, Carlton, Victoria, Australia
6University of New South Wales, Randwick, NSW, Australia
7The University of Adelaide, Adelaide, South Australia, Australia
8Phoenix Australia: Centre for Posttraumatic Mental Health: The University of Melbourne, Melbourne, Victoria, Australia
9University of New South Wales, Randwick, NSW, Australia, Australia
10University of New South Wales, Sydney, New South Wales, Australia


The mental health and social functioning of refugees and asylum-seekers is a key public health priority for governments and non-government organizations. This presentation reports on the first longitudinal study with a representative sample to investigate the effects of interpersonal trust and psychological symptoms on community engagement in refugees. Participants were 1,894 resettled refugees who completed measures of trauma exposure, post-migration living difficulties, psychological symptoms, trust and community engagement within 6 months of receiving a permanent visa in Australia, and again two to three years later. A multilevel path analysis revealed that high levels of depression symptoms mediated the association between trauma exposure and living difficulties, and reduced subsequent engagement with refugees’ own communities. Conversely, low levels of interpersonal trust mediated the relationship between living difficulties and subsequent engagement with the host community. Findings indicate that there are differential pathways to social engagement after refugee resettlement, with depression/anxiety symptoms leading to reduced engagement with one’s own community, while interpersonal trust impacts on engagement with the broader community. These findings have important implications for policy and clinical practice.


The Impact of Posttraumatic Stress Disorder on Refugees’ Parenting and their Children’s Mental Health


Bryant, Richard, PhD1; Edwards, Ben, PhD2; Creamer, Mark, PhD3; O'Donnell, Meaghan, PhD4; Forbes, David, PhD5; Felmingham, Kim, PhD3; Silove, Derrick, MD PhD6; Steel, Zachary, PhD7; Nickerson, Angela, PhD6; McFarlane, Alexander, MD8; Van Hooff, Miranda, BA (Hons), PhD8; Hadzi-Pavlovic, Dusan, MPsych9

1University of New South Wales, Sydney, New South Wales, Australia
2Australian National University, Canberra, ACT, Australia
3University of Melbourne, Melbourne, Victoria, Australia
4Phoenix Australia: Centre for Posttraumatic Mental Health: The University of Melbourne, Melbourne, Victoria, Australia
5Phoenix Australia: Centre for Posttraumatic Mental Health: The University of Melbourne, Carlton, Victoria, Australia
6University of New South Wales, Sydney, NSW, Australia
7University of New South Wales, Randwick, NSW, Australia, Australia
8The University of Adelaide, Adelaide, South Australia, Australia
9University of New South Wales, Randwick, NSW, Australia


This study tested the impact of refugee caregivers’ prior trauma and levels of ongoing stressors on current PTSD, and in turn how this influences parenting behaviour and consequent child psychological health. This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia. The current data comprised 411 primary caregivers who provided responses in relation to at least one child (n = 660 children). Primary caregiver PTSD and postmigration difficulties were assessed at Wave 1 (in 2013), and caregiver PTSD was re-assessed at Wave 2 (2014). At Wave 3 (2015-2016), primary caregivers repeated measures of trauma history, post-migration difficulties, and probable PTSD, as well as harsh and warm parenting style, and also a parental report of the Strengths and Difficulties Questionnaire for their child. Path analyses revealed that caregivers’ trauma history and postmigration difficulties were associated with greater subsequent PTSD, which in turn was associated with greater harsh parenting and in turn, higher levels of child conduct problems, hyperactivity, emotional symptoms, and peer problems. Refugee children’s mental health is adversely affected by how their caregiver’s PTSD contributes to harsh parenting.


Concurrent Session Six: Symposium

Friday, November 9 | 11:15 AM to 12:30 PM


International Perspectives on the Impact of Ongoing Threat and Daily Stressors on the Mental Health of Refugees and Asylum Seekers


Chair: Higson-Smith, Craig, PhD Candidate

The research on therapeutic outcomes with refugees and survivors of war or torture has been summarized in at least 15 systematic reviews or meta-analyses in the last decade. These reviews consistently critique the narrow set of outcomes considered in this body of research. Most particularly, reviewers have questioned whether studies focused exclusively on PTSD, anxiety and depression symptoms can address the full range of mental health needs of these extremely vulnerable populations. The role of ongoing threat and overwhelming daily stressors in the origin and maintenance of emotional suffering is not well understood. Nor have researchers and practitioners identified the most effective approaches for addressing these issues in the care of refugees. What is known is that much of the suffering of refugees is contextually determined and that practitioners around the world have been reluctant to adopt the evidence-based treatments identified in the literature. This symposium will present the empirical research of four researchers who are exploring a broader range of mental health outcomes (including continuous traumatic stress, traumatic bereavement, and social cohesion) using a range of methodologies (including case file review; in-depth interviews, and population-based surveys). The studies included in this symposium have been conducted with refugees in urban and camp settings in countries in sub-Saharan Africa and the Middle East, as well as asylum seekers in a resettlement context. By including studies with such varied methodologies, refugee populations, and contexts the presenters will draw attention to common mental health challenges experienced by refugees that are inadequately addressed by existing evidence-based practice. In so doing we will advocate for increased research on a broader range of mental health interventions and considering a more complex set of treatment outcomes.


The Prospective Association of Torture, Postmigration Stress, PTSD and Depression amongst Farsi and Dari Speaking Asylum Seekers in Sydney Australia


Steel, Zachary, PhD1; Wells, Ruth, BSc Hons Psychology2; Rostami, Reza, PGDip Psych1; Hadzi-Pavlovic, Dusan, MPsych3; Abedy, Haleh, MPsych1; Silove, Derrick, MD PhD4; Solaimani, Jila, Other4; Berle, David, PhD5

1University of New South Wales, Randwick, NSW, Australia, Australia
2University of Sydney, Camperdown , NSW, Australia
3University of New South Wales, Randwick, NSW, Australia
4University of New South Wales, Sydney, NSW, Australia
5University of Technology Sydney, Ultimo, NSW, Australia, Australia


A large percentage of refugees and asylum seekers report exposure to torture prior to arrival in a host country. Exposure to torture is associated with high rates of depression and PTSD. Little focus has been given to how such torture exposure interacts with harsh asylum procedures. The aim of the current presentation is to examine the prospective association of torture, depression, PTSD and visa status. A multi-stage representative community sampling frame was applied to recruit 408 Farsi- and Dari-speaking asylum seekers, refugees and immigrants that had arrived in Australia since 2010. Respondents completed translated versions of the HSCL Depression Scale and PTSD and trauma exposure sections of the Harvard Trauma Questionnaire at baseline, 2-, 4- and 6- months. Results: 172 respondents reported that they had been exposed to physical (n=70) and/or psychological (n=166) acts of torture. Exposure to torture was associated with higher PTS and Depression symptoms at all time points controlling for visa status, gender, and lifetime trauma exposure count (P.001). Prospective linear mixed models identified a time by torture effect for PTSD with torture survivors (p=.02) showing greater sensitivity to asylum stresses prospectively. Findings demonstrate the heighted vulnerability of torture survivors to asylum seeker stressors.


“A Balm for the Soul”- Relational Processes and Experiences in Group-based Treatment for Syrian Refugees in Jordan


Bunn, MA, LCSW, Mary, PhD Student
University of Chicago, Chicago, Illinois, USA

Group treatment has been described as a useful format for repairing social consequences of torture, war and displacement. Yet, there has been very limited scientific evaluation of social and interpersonal processes and outcomes in treatment. Using a phenomenological approach, this study sought to understand the nature and quality of relationships that develop in group treatment for survivors of torture and war, and how participants perceive their social resources following participation. In-depth interviews were conducted with Syrian refugees in Jordan who participated in an interdisciplinary, phase-oriented and trauma focused group intervention (n = 31). Multi-lingual thematic analysis revealed several themes including restoring a sense of trust and dignity resulting from new friendships, sharing pain and receiving and giving support in the group. Some participants described positive changes in themselves, their family and broader perceptions of support resulting from these experiences. Others emphasized the challenges of sustaining social gains given ongoing stressors of material deprivation, discrimination and the uncertain nature of their future in Jordan.  This is one of few empirical studies on group treatment for survivors of war and torture and among the first to uncover underlying relational processes. Implications for programming and evaluation will be discussed.


Daily Stressors and Mental Health Symptoms among Refugees: Evidence from Surveys in Kenya and Ethiopia

Golden, Shannon
The Center for Victims of Torture, Saint Paul, Minnesota, USA

This study identifies predictors of mental health problems among populations in humanitarian emergencies. Refugees can exhibit severe psychological effects from loss of loved ones, torture or other abuse, or experiencing and witnessing atrocities. They also experience negative effects from ongoing threats and daily stressors from life in refuge. These factors can impair functioning and lead to an inability to effectively meet challenges of daily life. The data are from representative surveys (N=1504) in Kalobeyei refugee settlement and Turkana host community (Kenya) in 2016 and 2018 and in Mai Ayni and Adi Harush refugee camps (Ethiopia) in 2017. There is little representative data about refugee mental health; these datasets identify patterns of need and prevalence of symptoms across entire populations, including vulnerable segments. This analysis predicts mental health symptoms using measures of stressors and ongoing threats, controlling for demographic factors (age, gender, education, country of origin). Length of time since migration, reported torture, attitudes about mental health, access to services, and coping strategies are mediating factors that can affect the predictive model. This paper advances the central argument that daily stressors have a powerful effect on mental health, but understanding this relationship requires accounting for multi-level contextual factors. 


Towards a Contextually Appropriate Framework to Guide Counseling of Torture Survivors in Sub-Saharan Africa


Higson-Smith, Craig, PhD Candidate
Center for Victims of Torture, St Paul, Minnesota, USA

If the right to rehabilitation is to become a meaningful reality for torture survivors in sub-Saharan Africa, it is necessary that counseling practice be responsive to the contextual and cultural demands of the region. The results of a mixed methods study of ongoing torture rehabilitation work are reported. This study incorporated a review of 85 randomly selected case files of work with torture survivors treated at torture rehabilitation centers in three countries in sub-Saharan Africa. Additional in depth interviews with fifteen counsellors and fourteen clients at those same centers elaborate the findings. Help-seeking torture survivors in this region are a diverse and highly symptomatic group, often struggling to survive with their families in precarious circumstances and under ongoing threat. In addition to incorporating key aspects of existing evidence-based practice, counselors also use a range of psychosocial approaches to assist torture survivors to protect and support their families in the face of seemingly overwhelming life challenges. We propose that more systematic methodologies that facilitate the inclusion of the voices of clients and clinicians in ongoing international debates relating to evidence-based practice with torture survivors will enhance the application of such practices in diverse contexts.


Concurrent Session Seven: Workshop Presentation

Friday, November 9 | 3:00 PM to 04:15 PM


Advocating for Asylum Seekers in a Time of Record Forced Displacement: a Collaborative, Inter-Disciplinary Approach
 

McQuaid, PhD, Jennifer, PhD1; McKenzie, MD, Katherine, MD2; Pyati, JD, Archi, JD3

1Sanctuary for Families, New York, New York, USA
2Yale School of Medicine, New Haven, Connecticut, USA
3Tahirih Justice Center, Falls Church, Virginia, USA


This workshop presents an inter-disciplinary model in which a (1) human rights lawyer, (2) an internist, and (3) a clinical psychologist collaborate in support of asylum seekers.  The UN defines an asylum seeker as “someone who claims to be a refugee without those claims being verified.” The building of a legal case for asylum hinges on the applicant’s ability to relay their own history of persecution.  Studies show the rate of PTSD in asylum seekers ranges from 30% - 82% (Steel et. al., 2009; Teodorescu et al., 2012).  An overview of existing research on the mental and physical health of asylum seekers will be presented, to anchor participants’ understanding of the ways in which trauma complicates the asylum process, and how clinicians can contribute by documenting harm and emotional suffering.  

Guidelines for evaluating asylum applicants and documenting clinical findings will be presented, including discussion around integrating standardized assessments.  Case material will be shared that highlights a model in which clinical evaluations: (1) elucidate applicants’ claims, (2) support the lawyer-client relationship, (3) scaffold the applicant’s testimony, (4) educate courtroom officials on effects of trauma, and (5) empower applicants with psycho-education.  Audience discussion will be encouraged as a means of increasing participants’ confidence in conducting this work.
 

Concurrent Session Eight: Symposium

Friday, November 9 | 4:30 PM to 05:45 PM


Trauma Research as Social Activism and Creating a Just World
 

Chair: Hobfoll, Stevan, PhD;
Discussant: Benight, Charles, PhD

Trauma research and intervention is often social activism.  The populations we seek to protect are often the most disenfranchised, prejudiced against, victimized, vulnerable and least-resourced in our societies. They are often the exploited, and those who cannot protect themselves.  Rape and sexual abuse victims, victims of domestic violence, child soldiers, refugees, women sold into sexual slavery, migrant laborers, are so often the participants of our studies and those who we seek to develop more successful treatments for following their victimization.  People of color, children living in poverty, ethnic minority populations are not helpless, but they often lack access to the levers that exert control over large landscapes of their fate.  Even the victims of disaster, seemingly random acts of God, are known to disproportionally impact those who already have a tenuous grip on economic survival and social equity.
Although we are aware of this, and write our proposals and articles couched in careful science and advanced statistical models, our motivation is often liberal social ideals of fairness, rights to live in a just society, and our desire to stand together with those who have been victimized to be part of their story of strength, resilience, true empowerment, and gaining political and social voice.
This group of researchers will discuss their work and the populations with whom they have worked, discussing our motivations to be part of repairing a broken world and standing up to oppression, both microsocial and macrosocially. We will share what has inspired us, how the populations with whom we have worked have influenced our thinking, and how we have designed our work to be part of social action, social change, and social justice.
 

Seeking to Repair Broken Bits of Our World

Hobfoll, Stevan, PhD
Rush Medical College, Chicago, Illinois, USA

We will illustrate through several research examples with inner city women of color and civilian victims of political conflict how we have sought to  repair parts of a world where others have been victimized, disenfranchised, and subjected to circumstances that too often are drawn from a repertoire of the world’s evils.  Violence and trauma in inner-city women’s lives and in regions of intensive conflict do not occur randomly to individuals, and are more likely to be directed at and deeply effect those with the least capacity to protect themselves, their families, or their community.  We do not come as saviors, but as co-travelers, who have resources to share and wish to aid in telling the stories of those with limited voice.  We will illustrate how our research endeavors to be part of solutions.  Our research has been based on Conservation of Resources (COR) theory, whose basis is that personal, social, and material resources are not equitably distributed and that the protection of those resources from loss is more challenging for those with fewer resources.  COR theory has further posited and illustrated that psychology’s focus on individual appraisal denies the reality of the traumatic events that people experience.  Too often appraisal implies a lack of objective veracity for the violence and tragedy that the less well-resourced in our world are subjugated too.
 

Addressing Gender-Based Violence through Trauma Research in an LMIC

(Commun, Cul Div-Depr-Fam/Int-Global, Adult, I, C & E Europe & Indep)
Weine, Stevan, MD1; Pirova, Gulya, MD2

1University of Illinois Chicago, Chicago, Illinois, USA
2Tajik State Medical University, Dushanbe, Tajikistan, Tajikistan

This presentation describes the development and implementation of research which addresses gender-based violence through a trauma-focused intervention in a patriarchy.  In Tajikistan, many women are exposed to separation from their migrant husbands, violence both within and outside of the home, STIs transmitted by their spouses, and common mental disorders (including PTSD), as well as high mental illness stigma, restricted service access, and severely limited treatment resources. Lifting this burden in low- and middle-income countries (LMICs) requires new services based upon task sharing, which uses non-specialists and laypersons to deliver mental health care.  Our ongoing research has found that in Tajikistan, peers and primary care nurses have played major but largely informal roles in helping women with trauma and mental health problems.  To build new services with them, we adapted two existing interventions (BRIDGES and Interpersonal Psychotherapy) as part of a novel stepped care model.  This involved challenging gender attitudes, promoting new values and practices, and socio-culturally tailoring the interventions and assessment strategies.  This investigation will provide evidence that can impact mental health policy and develop new evidence-based public health services, as well as strengthen the research capabilities of the Tajikistan partners.


Community Based Participatory Research with Somali Immigrants: Seeking to Understand the Negative Impact of Stigma and Discrimination without Contributing to the Problem


Ellis, Heidi, PhD1; Abdi, Saida, LICSW2

1Children's Hospital Center for Refugee Trauma & Resilience/Children's Hospital Boston, Boston, Massachusetts, USA
2Boston University/Children's Hospital Center for Refugee Trauma & Resilience/ Children's Hospital Boston, Boston, Massachusetts, USA

In 2007-2008, 24 Somali immigrants living in Minneapolis travelled overseas to join Al-Shabab, a foreign terrorist organization.  This raised questions in the national security and academic spheres related to what factors contribute to radicalization to violence, and how it can be prevented.  For our Community Based Participatory Research (CBPR) team with a decade-long Somali community-academic partnership, however, it also raised a conundrum: How could we conduct research to understand (and ultimately prevent) radicalization to violence within this group without contributing to the stigma and misperception that Somalis, other refugees and/or Muslims were at heightened risk for violent extremism? We will present both our process of conducting a longitudinal multi-site study with Somali immigrant young adults, as well as findings related to civic development and antisocial attitudes/behavior.  We will discuss how CBPR can build social bonds, bridges and linkages which are key to building more resilient communities.  We will then share Latent Class Analysis findings illustrating the importance of broadening beyond single/pathological outcomes.  Finally, we will discuss the role of trauma and social bonds in civic developmental outcomes, and how the process of CBPR can contribute not only to better research but also community resilience.    


Research for Social Justice, Social Justice within Research


Rasmussen, Andrew, PhD
Fordham University, Bronx, New York, USA

Trauma researchers who work with populations defined by human rights concerns (e.g., refugees) often find themselves faced with dilemmas that force them to rethink several traditional clinical research paradigms. Although theory has been developed for social justice research in some branches of psychology (e.g., Fassinger & Morrow, 2013), as of yet there is no consensus on a framework for thinking about trauma in social justice. This presentation uses two examples of social justice in a trauma research career, one supporting human rights litigation and one a community-based participatory research (CBPR) project. Two inter-related and fundamental issues delineate the two projects’ designs: “Whose conceptualizations of trauma are included?” and, “Who are the audiences for the research?” Human rights research is in many ways simpler, as there are usually well-defined, well-delineated research questions and audiences. CBPR attempts to work with participants to describe their own conceptualizations of trauma in ways that capture culturally-related meanings and response styles as well. This necessitates prolonged engagement with communities, some version of sequential exploratory mixed methods (Hanson et al., 2005), and not infrequently questioning one’s own definition of trauma.

 

Concurrent Session Nine: Workshop Presentation

Saturday, November 10 | 9:45 AM to 11:00 AM


Narratives from the Field: Development, Training and Implementation of a Refugee Transit Camp Psychosocial Support Group in Uganda

Murakami, Nancy, LCSW
New York University Silver School of Social Work, New York, New York, USA

It is well documented that mental health and psychosocial wellbeing are negatively affected by persecution, forced migration and post-migration stressors (Porter & Haslam, 2005; Siriwardhana, Ali, Roberts, & Stewart, 2014; Slobodin & de Jong, 2015; Turrini, 2017). Psychosocial services in humanitarian emergency settings may help mitigate the chronic psychosocial struggles endorsed by resettled refugees. In 2017, a Ugandan community-based organization initiated a psychosocial support program in a UNHCR refugee transit camp on the border of the Democratic Republic of the Congo, which has one of the most protracted humanitarian emergencies in the world. The program is launching a Refugee Transit Camp Psychosocial Support Group (RTC-PSSG) for refugees exhibiting signs of acute stress and trauma following their flight from war and persecution. This intervention's objectives are to enhance refugees' awareness of psychosocial well-being, expand distress management skills, and reduce isolation. RTC-PSSG may be the first effort to bring a manualized, psychoeducational and supportive, adult, group intervention into a transit camp to address mental health and psychosocial needs. In this workshop, the psychosocial program manager will discuss psychosocial needs of acutely displaced refugees and describe the development, training and implementation of RTC-PSSG in Uganda. 


Concurrent Session Ten: Symposium

Saturday, November 10 | 11:15 AM to 12:30 PM

 


Parenting in the Face of Trauma: Addressing Violent Discipline in Contexts of Conflict, Post-Conflict and Displacement


Chair: Romano, Elisa, PhD, Cpsych

Political conflict and its aftermath place children at risk for violent discipline by parents whose fear, grief, and trauma challenge their capacity to regulate their behaviour. Programs are needed to empower parents to respond in a way that strengthens familial bonds and promotes children’s coping. Positive Discipline in Everyday Parenting (PDEP), an 8-week program delivered through community agencies, has been successfully introduced in settings of conflict, post-conflict, and displacement through careful adaptation and delivery.  Its aims are to help parents manage their stress, understand their children's emotional needs, and respond in a way that helps the child learn and keeps the child safe. This symposium will first present quantitative findings of two teams that have delivered and assessed PDEP in: 1) Gaza and the West Bank, where violence is the norm and parents live in constant fear for their children’s safety; and 2) Kosovo, where most adults parenting today survived the genocide of 1998-1999.  Next, a qualitative paper will be presented that will describe PDEP’s adaptation and delivery in a squalid, crowded Rohingya refugee camp in Bangladesh where parents and children struggle daily to survive. Finally, a fourth team will present findings of a qualitative study conducted in Canada to learn what PDEP's most effective components are, as well as how it could be further strengthened. Discussion will focus on issues involved in adapting programs for situations of trauma, stress and loss.
 

Shifting Attitudes toward Violent Discipline among Parents in the Chronic Conflict Zone of Gaza and the West Bank


Stewart-Tufescu, Ashley, PhD Candidate1; Aljawi, Rania2

1University of Manitoba, Winnipeg, Manitoba, Canada
2Save the Children occupied Palestinian Territories, Ramahallah, West Bank, Israel

Families in Gaza and the West Bank have endured decades of political violence with little access to mental health services, resulting in high trauma rates among parents and children. High levels of stress and worries about safety make violent discipline of children common.  A 2010 regional survey found that 92% of children aged 1-14 years had experienced violent discipline by household members in the previous month. We piloted Positive Discipline in Everyday Parenting in this region to assess whether it could reduce parents’ acceptance of violent discipline.  The 8-week program was delivered to 216 parents (63 mothers and 148 fathers) through community-based organizations. Of these parents, 54% had high school education or less, and 63% had three or more children. Paper-and-pencil questionnaires adapted for parents with low education levels were administered at pre- and post-test to assess change. Over the course of the program, parents’ support for violent discipline significantly decreased (p < .001). Virtually all parents (98.4%) were ‘mostly’ or ‘very’ satisfied with the program. These results suggest that the program may be effective in promoting attitudinal change in parents living in a chronic conflict zone with high rates of war trauma. 


Addressing Violent Discipline by Parents in Post-war Kosovo


Tolaj, Cyma, BA (Hons)
University of Manitoba, Winnipeg, Manitoba, Canada

The 1998-1999 genocide committed against Albanian Kosovars in Kosovo resulted in major social disruptions and high rates of trauma among survivors. Parents who have been exposed to traumatic events throughout their lives have an increased likelihood of using harsh and punitive discipline with their children. UNICEF’s 2013-14 Multiple Indicators Cluster Survey found that 61.4% of Kosovar children younger than 15 had experienced physically or psychologically aggressive discipline by caregivers in the previous month. We assessed the impact of Positive Discipline in Everyday Parenting among a sample of 121 parents (94% mothers; 6% fathers) in Kosovo. The program aims to increase parents’ knowledge of child development, empathy, and skills in resolving conflict with their children non-punitively. At post-test, most parents reported that the program will help them to: use less physical punishment (81.9%); understand their children’s development (90.7%); communicate better with their children (95.9%); understand their children’s feelings (92.4%); control their anger (91.9%); and build stronger relationships with their children (96.7%). Most (90.7%) were satisfied with the program and their support for physical punishment decreased significantly from pre- to post-test. The results suggest that the program may be helpful in reducing violence among parents deeply affected by trauma. 


Adapting a Parenting Program to Reduce Violent Discipline in the World’s Largest Refugee Camp


Bamgbose, Angie
Save the Children, Stockholm, Stockholm, Sweden

The Rohingya crisis is also called the children’s disaster. Since August 2017 more than 600,000 Rohingyas have crossed the border to Bangladesh to seek protection in the refugee camps of Cox’s Bazar. In Northern Rakine State in Burma the villages of the Rohingya communities have been razed to the ground, people have experienced brutal violence, and many have witnessed family members being killed. The refugee camps have become an overcrowded and an unsafe place for children.  The living conditions in the refugee camp are difficult. People live in mud and rain, without access to clean water or health care.

Traumatized by their experiences and stressed by the constant effort required to meet their basic needs, parents are prone to responding violently to their children.  The shouting, screaming and beating of children amplifies their trauma and compromises their coping ability.  Positive Discipline in Everyday Parenting was adapted for this setting and delivered to parents with the aim of strengthening their own coping skills, reducing violence against children, and promoting family cohesion.  This paper describes the many barriers to delivering the program in this context, the approach taken to program adaptation, the many successes, and the remaining challenges


Positive Discipline in Everyday Parenting: What Parents and Facilitators Tell Us about their Experience

Stenason, Lauren, PhD Student; Moorman, Jessie, MA PhD Student; Romano, Elisa, PhD, Cpsych
University of Ottawa, Ottawa, Ontario, Canada

Positive Discipline in Everyday Parenting has potential for adaptation and delivery in a wide variety of contexts.  The process of adaptation raises the question of how to maintain program integrity while optimizing the program’s relevance to diverse and challenging settings.  In this qualitative study, we aimed to identify the factors that facilitate change and should therefore be kept constant across adaptations.  Focus groups were conducted using semi-structured interviews with parents who have taken PDEP and facilitators who deliver it. Parents and facilitators indicated that PDEP contributed to overall changes in parenting approaches and that parents learned new ways of thinking about parenting, including finding more balance and gaining self-efficacy. Key program aspects identified were: coherence and continuity among program modules; discovering new ways of thinking about parenting; the use of concrete examples to demonstrate key concepts; supportive facilitators and fellow group members; and childcare provision. Suggestions for program improvement included: additional concrete examples of concepts; longer program duration; and greater flexibility in program delivery. These findings can help guide PDEP’s further development and future adaptations for diverse situations.

 

Concurrent Session Eleven: Workshop Presentation

Saturday, November 10 | 2:00 PM to 03:15 PM


Treating Refugee and Immigrant Families Using Health Navigators Trained in Strengthening Family Coping Resources - Peer-to-Peer


Kiser, Laurel, PhD MBA1; McArthur, Laura, PhD2; Perez, Ana, BS2

1University of Maryland School of Medicine, Baltimore, Maryland, USA
2Aurora Mental Health Center, Aurora, Colorado, USA


Families affected by political, historical and intergenerational trauma and who are living in traumatic contexts endure multi-layered challenges that require innovative clinical service models. Strengthening Family Coping Resources-Peer-to-Peer (SFCR-P2P) is a peer-driven parent treatment model focused on improving intergenerational relationships and especially on trans-generational trauma, violence, substance abuse and mental illness. The Trauma Resilience Youth Program (TRYP) is a program at Aurora Mental Health Center serving clients (ages 3-24) who are first or second-generation refugees or immigrants and their families. One of the unique components of TRYP includes Health Navigator Case Managers who have been trained to provide culturally and linguistically appropriate SFCR-P2P to different refugee and immigrant communities (Spanish, Arabic, French, Sango, Swahili, Nepali, Burmese and Karen). This workshop will review the structure and content of SFCR-P2P as adapted for refugee families providing short session vignettes and experiential role-plays in each of the 5 conceptual areas covered: Family, Traditions, Routines, Safety, and Connections. The workshop concludes with discussion of training/implementation guidelines along with illustration of successes and challenges of SFCR-P2P with refugee and immigrant communities.