Task-Shifting to Reimagine Migrant Mental Health Support: A Hybrid Implementation-Preliminary Effectiveness Study

Background and Purpose: Between 2022 and 2024, many cities struggled to meet the mental health needs of unprecedented numbers of displaced migrants arriving in the United States seeking safety. The aim of this hybrid implementation-effectiveness study was to examine the feasibility, acceptability, and preliminary effectiveness/utility of the Reimagining Mental Health Supports for Migrants task-shifting, community capacity-building intervention. Developed as a rapid response in a Midwestern "welcoming city," the intervention trained five cohorts of front-line workers (n = 499) on trauma-informed care, healing-centered engagement, psychological first aid, and mental health crisis prevention. Methods: Participants completed post-training surveys assessing satisfaction, acceptability, competence, confidence in implementing strategies learned, and perceived knowledge change (retrospective pre-/post-assessment). Results: Over 97% of participants reported satisfaction with the trainings, with 98% reporting learning new information about universal supports, 99% reporting learning how to facilitate small group interventions, and 96% reporting increased confidence implementing strategies learned. Perceived knowledge change showed significant improvements in a variety of content areas including migrant mental health needs (t(456) = -25.63, p <.001), how to avoid retraumatization (t(456) = -27.97, p < .001), and strategies to prevent compassion fatigue (t(456) = -1.26). Additionally, over 87% of participants received at least an 80% accuracy score on items assessing content knowledge. Qualitative results demonstrated that participants intended to implement numerous strategies they learned to promote physical and psychological safety, teach emotion regulation, build a sense of belongingness and community within and without the shelter, and preserve staff well-being. Participants also noted that language-congruent instruction enhanced pragmatic competence, highlighting the importance of culturally and linguistically responsive training. Conclusion and Implications: The increasing number of forcibly displaced populations seeking safety in the United States presents unique mental health challenges that the current workforce cannot fully address. Task-shifting interventions, popular in the global health literature, offer a cost-effective solution by training front-line workers to manage mild to moderate psychological distress and reduce referrals to acute care. This study provides an important first step in demonstrating the feasibility, acceptability, and preliminary effectiveness of this approach that offers an innovative and culturally attuned model of addressing migrant mental health needs in U.S. communities and emergency humanitarian contexts with a limited mental health workforce.