Evaluation of a Collaborative Virtual Continuing Education Partnership with Refugee-Serving Mental Health Providers Working in Malaysia

Background and Purpose: Malaysia is the largest recipient of refugees in Southeast Asia hosting 326,490 displaced newcomers (Yunus et al., 2021; UNHCR 2024). Kaur et al. (2020) have identified high rates of violence exposure, posttraumatic stress, anxiety, and suicide among Rohingya refugees, who account for 108,310 of the refugees currently living in Malaysia (UNHCR, 2024). A dearth of culturally relevant trauma-focused capacity building collaborations creates barriers to care for refugee trauma survivors and limits local mental health providers’ ability to provide care. This paper presents the implementation and evaluation of a 30-hour continuing education (CEU) course co-developed with Malaysian colleagues to provide needed trauma education.

Methods: Course content includes managing secondary trauma, principles of assessment and treatment of posttraumatic stress with refugees, a culturally adapted integration of Narrative Exposure Therapy, and local psychopharmacology. The CEU course was delivered live, over an online platform to 14 mental health professionals practicing throughout Malaysia. Cultural adaptation was tracked using Bernal’s (1995) framework for adaptation and session-to-session feedback. Pre- and post-course ratings of knowledge, comfort, and confidence working with refugees, treating posttraumatic stress, and working with trauma narratives were reported on a 5-point Likert scale and analyzed using paired t-tests. Qualitative data was gathered from session-to-session and pre-post feedback, and mid-course interviews. Content analysis was utilized to code feedback for utility and novelty, and to identify barriers and facilitators to participants’ implementation in their practice.

Results: Participants included clinical psychologists (7), licensed counselors (3), social workers (2), and others (2). The majority had a master’s degree (10), 2 had a bachelor’s, and 2 had doctorates. Three participants had been in practice <1 year, 5 for 1-4 years, and 6 for 5 or more years. Five participants had <1 year of experience working with refugees, 2 had 1-4 years, and 7 had more than 5 years of experience working with refugees. Results indicate statistically significant changes in participants’ self-ratings of their ability to provide treatment for traumatic stress generally (t(14)=3.21, p < .01) and in refugee populations (t(14)=4.52, p < .01), as well as their comfort working with refugees (t(14)=2.65, p < .02) and their confidence discussing survivors’ trauma histories during treatment (t(14)=2.17, p <.05). Results further indicate a high degree of acceptability, appeal, and accessibility of training content, with 93% of participants indicating intent to use what they learned in their practice. Qualitative feedback indicated the importance of experiential practice and discussions related to culture. Post-course feedback affirmed the relevance of specific, evidence-based education in trauma treatment. Five participants indicated interest in becoming teachers in a future train-the-trainer expansion of this partnership.

Conclusions and implications: These findings highlight the potential of online learning platforms to improve international access to evidence-based continuing education. The high degree of local acceptability for the training suggests that successful online continuing education requires fostering true collaboration that is focused on co-creating knowledge and prioritizing cultural adaptation. Initial feasibility indicates further potential for a train-the-trainer regional scale up of this project, and the viability of similar international capacity building collaborations.