Community Based Participatory Research: Lessons Learned from Family-Based Prevention Delivered By Refugees for Refugees

Background & Purpose: Refugee children and families who are resettled in the United States face dramatic disparities in the incidence and treatment of mental health disorders. Resettlement stressors and acculturative challenges exacerbate risks due to war-related trauma exposure, which often have intergenerational impacts. 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 responsive, flexible, interventions to promote healthy family functioning and child mental health and help prevent mental health disparities.

Methods: Guided by the ecological model of stress-adjustment, a collaborative research partnership with the Somali Bantu and Lhotshampa Bhutanese refugee community in the Greater Boston area has resulted in the adaptation and implementation of the Family Strengthening Intervention for Refugees (FSI-R) as a feasibility pilot with 80 refugee families. Content analysis of exit interviews with study interventionists and a triangulation of qualitative data from Community Advisory Board meetings and clinical supervision calls elucidate processes of community engagement and study implementation as it relates to the guiding CBPR framework.

Results: Basic sample descriptives and intervention impact on family functioning and child and caregiver mental health will be presented. Qualitative data analysis focused on innovations in community engagement, which are considered along two time axes: 1) the relatively linear process of the phases of research ranging from conducting community needs assessments, adapting an evidence-based intervention, and delivering services as part of an RCT, and 2) an ever-changing and unpredictable sociopolitical environment. Some innovations in community engagement specific to phases of research include training lay workers from refugee communities to collect both qualitative and quantitative data, working simultaneously with two culturally distinct refugee groups, and promoting research initiatives that respond to emerging needs identified by refugees themselves. Innovations in community engagement specific to the larger sociopolitical environment include adapting to new and emerging patterns of refugee resettlement and secondary migration, responding to the needs of service providers operating with increasingly unstable funding from the federal government, and developing strategies to ethically conduct research that acknowledges and responds to growing anti-immigration sentiment.

Conclusions & Implications: Family-based prevention can be used to address acculturative and resettlement stressors faced by refugees resettled in the United States. Given the nested nature of the FSI-R, where participants are nested within a specific cultural community, the lessons learned and insight gained are of particular use to community-based organizations that often serve multiple culturally diverse groups with limited capacity for tailoring services to address such cultural nuance. Through a layered approach, the integration of CBPR principles allowed for refugee community ownership in study implementation as interventionists, research assistants, and study advisors, resulting in a transformative research process. Finally, the FSI-R works with families as they navigate both formal and informal resources in their community, providing insight into the interactions and tensions between cultural and ecological systems.  Lessons learned from these processes, including the ways CBPR facilitated and challenged understanding of these tensions, will be critically examined.