The Karen Chemical Dependency Task Force: Developing an Intervention for Harmful Alcohol Use with a New Refugee Community

Background and Purpose: Many refugees who resettle in the United States experience traumatic events during conflict and displacement. Exposure to traumatic events can lead to harmful alcohol use as a coping mechanism. Harmful alcohol use has been identified as a concern among refugee communities in both camp and third country resettlement settings. Despite growing awareness of the risks for harmful alcohol use in refugee communities, there are gaps in research-based knowledge and few evidence-based models to reduce harmful alcohol use in refugee communities.

The Karen are an ethnic minority group in Burma who have experienced widespread human rights abuses at the hands of the Burmese government. In recent years the Karen have been one of largest refugee ethnic groups to resettle in the U.S. The Karen community in St. Paul, MN has identified harmful alcohol use and the lack of culturally relevant prevention or treatment as one of the primary crises facing the community.

Community based participatory research (CBPR) is increasingly used to engage communities experiencing health disparities in developing and implementing behavioral health interventions. In 2013 leaders in the Karen community joined behavioral health, medical, law enforcement, and social service professionals to form the Karen Chemical Dependency Task Force (KCDTF) to explore the issue of harmful alcohol use in the Karen community and to develop systemic interventions. The KCDTF has used CBPR methods to develop a range of individual and community-level interventions.

This paper reports the results of a case study process evaluation of the task force. The evaluation had three goals to evaluate: 1) the value of the Task Force to the individual members, 2) members’ perceptions of the impact of the Task Force in meeting goals, and 3) elements of the Task Force that were essential to its success.

Methods: Eleven in-depth, semi structured interviews were conducted with members of the KCDTF. Participants were asked about the strengths and challenges in the functioning of the task force, personal and professional gains from participation, cross-cultural and cross-professional communication. Interviews were recorded and transcribed and transcripts were analyzed using an inductive thematic analysis.

Findings: Data analysis revealed unique characteristics that contributed to successful development, implementation, and sustainability of interventions. Key tactics and strategies were collected into a toolkit for CBPR with new refugee groups including provision of a protected and reliable space for mutual education across ethnic and professional boundaries; a sense of “mutual action and responsibility” to address problems, and a concrete framework for cultural adaptation. Analysis also uncovered barriers to success including long periods of inaction, poor communication between meetings, and lack of support for Karen task force members. Solutions to these barriers were also suggested.

Conclusion and Implications: Resulting themes were collected into a toolkit for successful cross-cultural and cross-professional collaboration with new refugee communities to intervene with health disparity issues. These themes suggest the central importance of finding a more culturally relevant process to integrate refugees’ indigenous problem solving strategies with mainstream social service systems.