Promoting Child and Adolescent Mental Health and Wellbeing Using an Evidenced-based Whole Family Mental Health Promotion Intervention for Resettling Afghans: Initial Lessons Learned

• In Event: Exploration of caregiver experiences and community-based interventions among refugee, internally-displaced, and war-impacted communities

Abstract

Introduction: Approximately 85,000 Afghan individuals have evacuated to the U.S., and 40% are minor-aged children. The mental health impacts of war, forced migration and resettlement on children and adolescents are well documented and include increased risk for depression, anxiety, PTSD, behavioral problems, and social difficulties. These traumatic and adverse life experiences also influence the family system. Parents and caregivers often struggle with their own psychological difficulties resulting from trauma and chronic stress, which can compromise family relationships, parenting abilities, parent-child attachment, and child well-being. Increasing access to culturally relevant, evidence-based whole family mental health promotion interventions can improve the mental health of children and adolescents, strengthen parenting skills and improve family functioning. Using the previously developed Family Strengthening Intervention for Refugees (FSI-R), the FSI-R was adapted to reflect Afghan culture and context and pilot tested. This current study discusses initial lessons learned from pilot-testing Afghan FSI-R with newly resettled Afghan families.

Study population: We aim to work with up to 30 newly resettled Afghan families with school-aged children (aged 7-17) living in one of the New England states. We hired Afghan community health workers (i.e., interventionists) from a partner resettlement organization, part of whom are also from newly resettling evacuees.

Methods: In this study, we use community-based participatory research methods and the ADAPT-ITT framework to iteratively adapt and further develop the evidence-based FSI-R to better reflect the Afghan culture. Also, through weekly supervision meetings with the interventionists, we are assisting in keeping fidelity to each module and helping develop cross-cutting competence through mutual learning. Also, we are learning about overarching themes to gain a deeper understanding of newly resettled Afghan families and communities.

Results: Several themes and initial lessons learned points have emerged. First, at the family level, we found several service needs for supporting parenting skills, especially in exploring the new environment of school systems and communities. For example, Afghani mothers reported a strong desire for English education, mainly to navigate the school systems and help find their children's English language education opportunities. Also, children in public school have difficulties adjusting to the U.S. school system with limited language abilities or education histories from their home country. Developmental concerns depending on the age of the children were frequently found—especially teenagers showing anxiety for significant school disruption due to the evacuation. Also, understanding the nuances of Afghan culture is essential for better acceptance of the program by the participating families, especially considering the diverse nature of Afghan ethnic groups. Gender, language, and ethnic group matching are critical for initial rapport building and helping develop parenting skills. Hiring female interventionists is vital, especially when Afghani mothers are the family's primary caregivers. Confidentiality and privacy concerns affect family mental health as families go through resettlement case trials. Participants were reluctant to share their experiences as they worried it might affect their ongoing asylum petition trials. Results from this project highlight a rigorous, community-driven adaptation process for family prevention services that can serve as a model for adapting other, evidence-based interventions for refugee families.

Authors

• Euijin Jung, Boston College
  Presenting Author

• Farhad Sharifi, Boston College

• Mary Bunn, University of Illinois at Chicago

• Theresa Stichick Betancourt, Boston College