Building Community Capacity for Refugee Mental Health Care in Resettlement: Towards Culture-Informed and Trauma-Informed Care

Background: Refugees endure tremendous trauma during migration and resettlement, which likely leads to a wide range of mental health needs. Refugee newcomers in the U.S., however, face numerous challenges in accessing adequate services and appropriate care in part due to a lack of capacity for culturally responsive services and the absence of partnership among service providers. Few training programs and intervention models are directly relevant to unique refugee mental health issues and culturally competent trauma-informed care is scarce in refugee resettlement services. in, In order to address such gaps, we developed, implemented, and assessed an interactive training program, called Cross-Cultural Trauma-Informed Care (CC-TIC), based on Herman’s (1997) trauma recovery model and the core principles of trauma-informed care designed by Substance Abuse and Mental Health Services Administration (SAMHSA).

Methods: A series of CC-TIC training sessions were delivered to refugee-serving mental health/health care professionals, resettlement staff, community leaders, and interpreters in collaboration with two state-wide refugee health promotion programs. This study assessed the needs and gaps in refugee mental health care and evaluated the effect of CC-TIC, using mixed methods including free listing and semi-structured retrospective pre- and post-training surveys. Key service providers (N=175) in five localities across two states participated in the CC-TIC training over two years, completing the free listing exercise (N=140) and evaluation surveys (N=120).

Results: Content analysis of free listing data and open-ended questions revealed six overarching themes of the community priorities for refugee mental health, including refugee-specific intervention models, provider networking, and trauma-informed care tailored to refugees. The post-training evaluation showed significant improvement in providers’ knowledge of trauma impacts, cultural expressions of trauma/stress-related symptoms, and culturally responsive trauma-informed care. Trauma-informed care specific to the refugee resettlement program was regarded as the most helpful topic, and community partnership building was the most requested area for future steps. The areas of competencies showing the most improvement included: mental health terminology (t[118]=2.917, p=0.004), common mental health issues in refugees (t[119]=2.055, p=0.042), psychoeducational skills (t[119]=4.438, p<0.001), the multi-tiered approach (t[118]=2.556, p=0.012), and trauma-informed care (t[119]=2.577, p=0.011.). A series of ANOVAs revealed that the training effect was significantly different for mental health providers compared to refugee resettlement workers and other professions for most core competency items.

Discussion: Culturally responsive trauma-informed approaches can help bridge gaps between mental health care and resettlement services and promote exchanges of knowledge and expertise to build collaborative care and community partnership. Mental health professionals reported low baseline scores on culturally competent trauma-informed care in refugee resettlement and improved scores following the training, indicating that work experiences alone do not build competencies in how to respond to refugee mental health needs. This implies significant gaps in currently available training for refugee-serving professionals and a lack of culturally responsive and relevant mental health trainings not only for those without mental health backgrounds but also for mental health professionals with formal training and direct practice experience.