Building Multi-Tier Mental Health and Psychosocial Supports in the Community: Towards Trauma-Informed and Culture-Informed Care for Refugees in the U.S

Background and Purpose: Trauma and forced migration often impede refugee coping and deteriorate support systems, impacting resilience and social care. Despite refugees’ multifarious challenges, previous studies on refugee mental health have focused heavily on clinical treatment of pre-migration trauma, which likely leads to stigmatization of common emotional distress and negligence of psychosocial supports that are critical to mental health. To provide stratified interventions for diverse needs in the refugee community during resettlement, this study applied a multi-tier mental health and psychosocial support (MHPSS) model with a two-pillar approach, trauma-informed and culture-informed care, as a holistic care framework. The current study explored the process and impact of a series of community workshops aimed to promote refugee empowerment and community resilience, while enhancing capacity and partnerships among mental health professionals and refugee community leaders.

Methods: We conducted a participatory evaluation study to explore gaps in wellness promotion during resettlement and the impact of community-based interventions to build capacity and partnership. We developed and provided cross-cultural trauma-informed care (CC-TIC) workshops to 54 service providers (n=28) and community leaders (n=26) from various refugee/immigrant communities (Afghanistan, Bhutan, Colombia, Congo, Iraq, Mexico, Nepal, Somalia), followed by a series of peer-led or agency-based community wellness workshops held between 2016 and 2019. We gathered participants’ self-assessment using two focus group interviews and conducted follow-up interviews with seven facilitators and 18 participants of CC-TIC. A thematic analysis was adopted to analyze the data.

Results: The findings revealed significant gaps as well as improvement in providers’ knowledge of refugee experiences, cultural expressions of trauma/stress-related symptoms, and culturally-relevant coping resources. In addition to general competences related to trauma-informed care, participants gained a deeper understanding of the intersection between trauma and culture, in which trauma sequelae are experienced and expressed through different languages and cultural beliefs (e.g., cultural concepts of distress). Participants expressed appreciation for the group diversity, which allowed for cross-cultural learning and made the training “rich and deep” while also enhancing cultural humility in ways that resettlement programs and mental health services may fail to accommodate.

Community leaders reported how the communities have to exert resources to exercise cultural practice and manage the participation in both American and native cultures. This reinforced the need for balanced integration and culturally-relevant practices for collective coping and community resilience. Participants commented that the workshops built a sense of community, both among participants and in the broader community, and helped build a healing partnership that extended cross-culturally and expanded inter-community networks.

Conclusions and Implications: This study highlights the importance of building capacity and partnerships for culturally-responsive mental health supports through engagement across communities and empowerment of refugee community leaders. Findings shows that a culturally-responsive trauma-informed approach can help bridge gaps between mental health and psychosocial services and that systemic barriers (e.g., service availability and relevancy, language access, etc.) require community-level advocacy and collective action. Trauma-informed and culture-informed MHPSS programs require relational, organizational, and community-wide collaboration, as well as individual competences, to strengthen the refugee community and sustain collective efforts for refugee wellness promotion.