Best Practices for Meeting Mental Health Needs of Resettled Refugee Youth

Background and Purpose:

Refugee youth arrive in the United States after enduring considerable violence and trauma. During resettlement, they are exposed to additional stressors (e.g., linguistic and cultural barriers and acculturative stress) that increase risk of poor mental health status while integrating into U.S. society. Despite the need for mental health services to address the impacts of trauma exposure, limited information is available on serving refugee youth in a manner that aligns with their cultural norms or perceptions of mental health. Toward identifying evidence-based interventions and research priorities for working with this population, two studies were conducted. The first involved qualitative interviews with providers serving refugee youth, and the second a systematic review of research on the mental health of resettled refugee youth. The current study's focus is to present resulting best practice recommendations for research and service provision.   

Methods:

Study 1: Individual interviews were conducted with providers (N = 14) who work in the system of care serving refugee youth. Participants were recruited through purposive and snowball until data saturation was achieved. All interviews were recorded and transcribed verbatim. Analysis applied grounded theory strategies for inductive thematic analysis. Transcriptions were coded using NVivo 12 by the two principal investigators and code lists were incrementally merged into a codebook. Codes were grouped into categories and sorted until consensus was reached and distinct themes were determined.

Study 2: The systematic review included peer-reviewed articles between 2000- 2016 that focused on mental health of resettled refugee youth through age 25 in the U.S. The search included five social science databases. A total of 49 articles fit the study criteria. Data extraction was conducted through several stages and each article was read by at least two researchers.

Results:

Best practices for addressing mental health concerns were found to center on four key areas: (1) location of services. School settings, existing social service programs that are already utilized by resettled refugee youth, and religious entities can be both accessible and safe for refugee youth (2) intervention delivery formats. Findings from both studies emphasized the importance of group, as opposed to individual, treatment delivery. The value of parental education and involvement in treatment also emerged as a best practice.  (3) key measurement considerations. Best practices included language and cultural appropriateness, consideration of family, school, community, and social/cultural contexts, and having non-Westernized assessment tools, and (4) general recommendations. Included in this area are practice recommendations for program design, service delivery, and understanding of client situations.

Conclusions and Implications:

Traditional mental health services are often ineffective for serving refugee youth during resettlement. Best practices are available in the literature and supported by qualitative interviews with providers engaged with this population. Utilization of these best practices can guide micro-centered strategies for improved engagement and retention in treatment by delivering services in culturally informed and responsive ways. Additionally, best practices are valuable for informing program design that aligns with cultural lenses to help seeking and mental health. Future research should evaluate refugee youth and parent perceptions of best practices.