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New Directions in Refugee Youth Mental Health Services: Overcoming Barriers to Engagement

  • Ecological Factors and Trauma
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Abstract

Mental health outcomes in refugee youth are diverse, ranging from prolonged difficulties to resiliency. Refugee communities rarely access services, even for those youth who are in need. Barriers include (a) distrust of authority and/or systems, (b) stigma of mental health services, (c) linguistic and cultural barriers, and (d) primacy and prioritization of resettlement stressors. Mental health promotion among refugee youth requires an integrated response to these barriers. This article includes a description of how the previously mentioned barriers may prevent refugee youth from receiving mental health services; approaches to addressing them; and a detailed description of Supporting the Health of Immigrant Families and Adolescents (Project SHIFA), a program developed in collaboration with the Somali community in Boston, Massachusetts.

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References

  • Alvarez, M. (1999). The experience of migration: A relational approach in therapy. Journal of Feminist Therapy, 11, 1–29.

    Article  Google Scholar 

  • Becker, D. F., Weine, S. M., Vojvoda, D., & McGlashan, T. H. (1999). PTSD symptoms in adolescent survivors of “ethnic cleansing”: Results from a one-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 775–781.

    Article  PubMed  Google Scholar 

  • Benson, M. (2004). Survey of National Refugee Working Group Sites 2004: Summary report. Boston, MA: National Child Traumatic Stress Network, Refugee Working Group.

    Google Scholar 

  • Birman, D., Beehler, S., Harris, E. M., Everson, M. L., Batia, K., Liautaud, J., et al. (2008). International Family, Adult, and Child Enhancement Services (FACES): A community-based comprehensive services model for refugee children in resettlement. American Journal of Orthopsychiatry, 78(1), 121–132.

    Article  PubMed  Google Scholar 

  • Birman, D., & Espino, S. R. (2007). The relationship of parental practices and knowledge to school adaptation for immigrant and non-immigrant high school students. Canadian Journal of School Psychology, 22, 152–166.

    Article  Google Scholar 

  • Birman, D., Ho, J., Pulley, E., Batia, K., Everson, M. L., Ellis, H., et al. (2005). Mental health interventions for refugee children in resettlement. [White Paper II]. Chicago, IL: Refugee Trauma Task Force, National Child Traumatic Stress Network.

    Google Scholar 

  • Burns, B. J., & Costello, E. J. (1995). Children’s mental health service use across service sectors. Health Affairs, 14(3), 147.

    Article  PubMed  Google Scholar 

  • Children’s Hospital Center for Refugee Trauma and Resilience. (2010). Project SHIFA partners. Retrieved from http://www.childrenshospital.org/clinicalservices/Site2813/mainpageS2813P5sublevel9.html

    Google Scholar 

  • Chen, C. T., Kyle, D. W., & McIntyre, E. (2008). Helping teachers work effectively with English language learners and their families. School Community Journal, 18(1), 7–19.

    Google Scholar 

  • Coard, S. I., & Holden, E. W. (1998). The effect of racial and ethnic diversity on the delivery of mental health services in pediatric primary care. Journal of Clinical Psychology in Medical Settings, 5, 275–294.

    Article  Google Scholar 

  • Collier, V. P. (1995). Acquiring a second language for school. Directions in Language & Education National Clearinghouse for Bilingual Education, 1(4), 3–14.

    Google Scholar 

  • Daniel, E. V., & Knudsen, J. C. (Eds.). (1995). Mistrusting refugees. Berkeley, CA: University of California Press.

    Google Scholar 

  • Delgado, M., Jones, K., & Rohani, M. (2005). Social work practice with refugee and immigrant youth. Boston, MA: Pearson.

    Google Scholar 

  • Ehntholt, K. A., & Yule, W. (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma. Journal of Child Psychology and Psychiatry, 47, 1197–1210.

    Article  PubMed  Google Scholar 

  • Ellis, B. H., Lincoln, A., Charney, M., Ford-Paz, R., Benson, M., & Strunin, L. (2010). Mental health service utilization of Somali adolescents: Religion, community, and school as gateways to healing. Journal of Transcultural Psychiatry, 47(5), 789–811.

    Article  Google Scholar 

  • Ellis, B. H., MacDonald, H. Z., Lincoln, A. K., & Cabral, H. J. (2008). Mental health of Somali adolescent refugees: The role of trauma, stress, and perceived discrimination. Journal of Consulting and Clinical Psychology, 76, 184–193.

    Article  PubMed  Google Scholar 

  • Fang, S. S., & Wark, L. (1998). Developing cross-cultural competence with traditional Chinese Americans in family therapy: Background information and the initial therapeutic contact. Contemporary Family Therapy, 20, 59–77.

    Article  Google Scholar 

  • Fazel, M., & Stein, A. (2002). The mental health of refugee children. Archives of Disease in Childhood, 87, 366–370.

    Article  PubMed  Google Scholar 

  • Gong-Guy, E., Cravens, R. B., & Patterson, T. E. (1991). Clinical issues in mental health service delivery to refugees. American Psychologist, 49, 642–648.

    Article  Google Scholar 

  • Guerin, B., Guerin, P., Diiriye, R. O., & Yates, S. (2004). Somali conceptions and expectations concerning mental health: Some guidelines for mental health professionals. New Zealand Journal of Psychology, 33, 59–67.

    Google Scholar 

  • Hess, J. Z., Barr, S. C., & Hunt, G. D. (2009). The practice of family mentoring and advocacy: A theoretical investigation of critical issues. Families in Society: The Journal of Contemporary Social Services, 90, 189–195.

    Article  Google Scholar 

  • Hollifield, M. (2004). Building new bridges in primary care. General Hospital Psychiatry, 26, 253–255.

    Article  PubMed  Google Scholar 

  • Hou, F., & Beiser, M. (2006). Learning the language of a new country: A ten year study of English acquisition by Southeast Asian refugees in Canada. International Migration, 44, 135–165.

    Article  Google Scholar 

  • Huang, Z. J., Yu, S. M., & Ledsky, R. (2006). Health status and health service access and use among children in U.S. immigrant families. American Journal of Public Health, 96, 634–640.

    Article  PubMed  Google Scholar 

  • Hundley, G., & Lambie, G. W. (2007). Russian speaking immigrants from the commonwealth of independent states in the United States: Implications for mental health counselors. Journal of Mental Health Counseling, 29(3), 242–258.

    Google Scholar 

  • Jaycox, L. (2004). Cognitive behavioral intervention for trauma in schools (CBITS). Longmont, CO: SoprisWest.

    Google Scholar 

  • Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., et al. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 311–318.

    Article  PubMed  Google Scholar 

  • Kataoka, S. L., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.

    Article  PubMed  Google Scholar 

  • Kia-Keating, M., & Ellis, B. H. (2007). Belonging and connection to school in resettlement: Young refugees, school belonging, and psychosocial adjustment. Clinical Child Psychology and Psychiatry, 12, 29–43.

    Article  PubMed  Google Scholar 

  • Kinzie, J. D., Sack, W. H., Angell, R. H., Manson, S., & Rath, B. (1986). The psychiatric effects of massive trauma on Cambodian children: I. The children. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 370–376.

    Google Scholar 

  • Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley, CA: University of California Press.

    Google Scholar 

  • Kugler, E. G. (2009). Partnering with parents and families to support immigrant and refugee children at school. Washington, DC: Center for Health and Health Care in Schools, School of Public Health and Health Services, George Washington University. Retrieved from http://www.rwjf.org/files/research/partneringwithparentsandfamiliesimmigrants.pdf

    Google Scholar 

  • Lawrence, J., & Kearns, R. (2005). Exploring the ‘fit’ between people and providers: Refugee health needs and health care services in Mt Roskill, Auckland, New Zealand. Health & Social Care in the Community, 13, 451–461.

    Article  Google Scholar 

  • Layne, C. M., Pynoos, R. S., Saltzman, W. R., Arslanagi, B., Black, M., Savjak, N., et al. (2001). Trauma/grief-focused group psychotherapy: school-based postwar intervention with traumatized Bosnian adolescents. Group Dynamics: Theory, Research, and Practice, 5, 277–290.

    Article  Google Scholar 

  • Lustig, S. L., Kia-Keating, M., Knight, W. G., Geltman, P., Ellis, H., Kinzie, J. D., et al. (2004). Review of child and adolescent refugee mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 24–36.

    Google Scholar 

  • Mann, C. M., & Fazil, Q. (2006). Mental illness in asylum seekers and refugees. Primary Care Mental Health, 4, 57–66.

    Google Scholar 

  • Measham, T., Rousseau, C. C., & Nadeau, L. (2005). The development and therapeutic modalities of a transcultural child psychiatry service. Canadian Child and Adolescent Psychiatry Review, 14, 68–72.

    PubMed  Google Scholar 

  • Miller, K. E., Weine, S. M., Ramic, A., Brkic, N., Bjedic, Z. D., Smajkic, A., et al. (2002). The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. Journal of Traumatic Stress, 15, 377–387.

    Article  PubMed  Google Scholar 

  • Munroe-Blum, H., Boyle, M. H., Offord, D. R., & Kates, N. (1989). Immigrant children: Psychiatric disorder, school performance, and service utilization. American Journal of Orthopsychiatry, 59, 510–519.

    Article  PubMed  Google Scholar 

  • Murphy, D., Ndegwa, D., Kanani, A., Rojas-Jaimes, C., & Webster, A. (2002). Mental health of refugees in inner-London. Psychiatric Bulletin, 26, 222–224.

    Article  Google Scholar 

  • Nadeau, L., & Measham, T. (2005). Immigrants and mental health services: Increasing collaboration with other service providers. Canadian Child and Adolescent Psychiatry Review, 14(3), 73–76.

    PubMed  Google Scholar 

  • Osterman, J. E., & de Jong, J. T. V. M. (2007). Cultural issues in trauma. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 425–446). New York, NY: Guilford.

    Google Scholar 

  • Palmer, D. (2006). Imperfect prescription: Mental health perceptions, experiences and challenges faced by the Somali community in the London Borough of Camden and service responses to them. Primary Care Mental Health, 4, 45–56.

    Google Scholar 

  • Papadopoulos, R. K. (2001). Refugee families: Issues of systemic supervision. Journal of Family Therapy, 23, 405–422.

    Article  Google Scholar 

  • Pumariega, A. J., Rothe, E., & Pumariega, J. G. (2005). Mental health of immigrants and refugees. Community Mental Health Journal, 41, 581–598.

    Article  PubMed  Google Scholar 

  • Rothe, E., Lewis, J., Castillo-Matos, H., Martinez, O., Busquets, R., & Martinez, I. (2002). Posttraumatic stress disorder among Cuban children and adolescents after release from a refugee camp. Psychiatric Services, 53, 970–976.

    Article  PubMed  Google Scholar 

  • Rothe, E. M., Castillo-Matos, H., & Busquets, R. (2002). Posttraumatic symptomatology in Cuban adolescent refugees during camp confinement. Adolescent Psychiatry, 26, 97–124.

    Google Scholar 

  • Rousseau, C., & Guzder, J. (2008). School-based prevention programs for refugee children. Child and Adolescent Psychiatric Clinics of North America, 17, 533–549.

    Article  PubMed  Google Scholar 

  • Sack, W. H., Him, C., & Dickason, D. (1999). Twelve-year follow-up study of Khmer youths who suffered massive war trauma as children. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1173–1179.

    Article  Google Scholar 

  • Saunders, S. M., Resnick, M. D., Hoberman, H. M., & Blum, R. W., (1994). Formal help-seeking behavior of adolescents identifying themselves as having mental health problems. Journal of the American Academy of Child & Adolescent Psychiatry, 33, 718.

    Article  Google Scholar 

  • Saxe, G. N., Ellis, B. H., & Kaplow, J. (2006). Collaborative treatment of traumatized children and teens: The trauma systems therapy approach. New York, NY: Guilford.

    Google Scholar 

  • Schwab-Stone, M., Ruchkin, V., Vermeiren, R, & Leckman, P. (2001). Cultural considerations in the treatment of children and adolescents: Operationalizing the importance of culture in treatment. Child and Adolescent Psychiatric Clinics of North America, 10, 729–743.

    PubMed  Google Scholar 

  • Scuglik, D. L., Alarcon, R. D., Lapeyre, A. C., III, Williams, M. D., & Logan, K. M. (2007). When the poetry no longer rhymes: Mental health issues among Somali immigrants in the USA. Transcultural Psychiatry, 44, 581–595.

    Article  PubMed  Google Scholar 

  • Singh, N. N., McKay, J. D., & Singh, A. N. (1999). The need for cultural brokers in mental health services. Journal of Child and Family Studies, 8, 1–10.

    Article  Google Scholar 

  • Sobel, A., & Kugler, E. G. (2007). Building partnerships with immigrant parents. Educational Leadership, 64(6), 62–66.

    Google Scholar 

  • Stein, B. D., Kataoka, S., Jaycox, L. H., Steiger, E. M., Wong, M., Fink, A., et al. (2003). The mental health for immigrants project: Program design and participatory research in the real world. In M. D. Weist, S. W. Evans, & N. A. Lever (Eds.), Handbook of school mental health advancing practice and research (pp. 179–190). New York, NY: Kluwer Academic/Plenum.

    Google Scholar 

  • Stein, B. D., Kataoka, S., Jaycox, L., Wong, M., Fink, A., Escudero, P., et al. (2002). Theoretical basis and program design of a school-based mental health intervention for traumatized immigrant children: A collaborative research partnership. Journal of Behavioral Health Services & Research, 29, 318–326.

    Article  Google Scholar 

  • Stiffman, A. R., Pescosolido, B., & Cabassa, L. J. (2004). Building a model to understand youth service access: The gateway provider model. Mental Health Services Research, 6, 189–198.

    Article  PubMed Central  PubMed  Google Scholar 

  • Takeuchi, D. T., Bui, K. V. T., & Kim, L. (1993). The referral of minority adolescents to community mental health centers. Journal of Health & Social Behavior, 34, 153–164.

    Article  Google Scholar 

  • Tribe, R. (2002). Mental health of refugees and asylum-seekers. Advances in Psychiatric Treatment, 8, 240–248.

    Article  Google Scholar 

  • United Nations High Commission for Refugees. (UNHCR). (2008). 2007 global refugee trends: Refugees, asylum-seekers, returnees, internally displaced and stateless persons. Geneva, Switzerland: UNHCR Geneva.

    Google Scholar 

  • United Nations High Commission for Refugees. (UNHCR). (2009). 2008 global refugee trends: Refugees, asylum-seekers, returnees, internally displaced and stateless persons. Geneva, Switzerland: UNHCR Geneva.

    Google Scholar 

  • Watters, C. (2001). Emerging paradigms in the mental health care of refugees. Social Science Medicine, 52, 1709–1718.

    Article  PubMed  Google Scholar 

  • Watters, C., & Ingleby, D. (2004). Locations of care: Meeting the mental health and social care needs of refugees in Europe. International Journal of Law and Psychiatry, 27, 549–570.

    Article  PubMed  Google Scholar 

  • Weine, S. M., Becker, D. F., McGlashan, T. H., Vojvoda, D., Hartman, S., & Robbins, J. P. (1995). Adolescent survivors of ‘ethnic cleansing’: Observations on the first year in America. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1153–1159.

    Article  PubMed  Google Scholar 

  • Weine, S. M., Knafl, K., Feetham, S., Kulauzovic, Y., Besic, S., Lezic, A., et al. (2005). A mixed-methods study of refugee families engaging in multi-family groups. Family Relations, 54, 558–568.

    Article  Google Scholar 

  • Weine, S. M., Kulauzovic, Y., Besic, S., Lezic, A., Mujagic, A., Muzurovic, J., et al. (2006). A family beliefs framework for developing socially and culturally specific preventive interventions for refugee families and youth. American Journal of Orthopsychiatry, 76, 1–9.

    Article  PubMed  Google Scholar 

  • Weine, S., Kulauzovic, Y., Klebic, A., Besic, S., Mujagic, A., Muzurovic, J., et al. (2008). Evaluating a multiple-family group access intervention for refugees with PTSD. Journal of Marital and Family Therapy, 34(2), 149–164.

    Article  PubMed  Google Scholar 

  • Weine, S. M., Raijna, D., Zhubi, M., Delisi, M., Huseni, D., Feetham, S., et al. (2003). The TAFES multi-family group intervention for Kosovar refugees: A descriptive study. Journal of Nervous and Mental Diseases, 191(2), 100–107.

    Google Scholar 

  • Weine, S. M., Ware, N., & Klebic, A. (2004). Converting cultural capital among teen refugees and their families from Bosnia-Herzegovina. Psychiatric Services, 55, 923–927.

    Article  PubMed  Google Scholar 

  • Weiss, M. (1997). Explanatory Model Interview Catalogue (EMIC): Framework for comparative study of illness. Transcultural Psychiatry, 34, 235–263.

    Article  Google Scholar 

  • Wong, E. C., Marshall, G. N., Schell, T. L., Elliott, M. N., Hambarsoomians, K., Chun, C., et al. (2006). Barriers to mental health care utilization for U.S. Cambodian refugees. Journal of Consulting and Clinical Psychology, 74, 1116–1120.

    Article  PubMed  Google Scholar 

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Heidi, B., Miller, A.B., Baldwin, H. et al. New Directions in Refugee Youth Mental Health Services: Overcoming Barriers to Engagement. Journ Child Adol Trauma 4, 69–85 (2011). https://doi.org/10.1080/19361521.2011.545047

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