Cultural Adaptations of Evidence-Based Mental Health Interventions for Refugees: Implications for Clinical Social Work

Abstract

As the number of refugees worldwide reaches unprecedented levels, social workers’ ability to provide effective and appropriate mental healthcare to this population is as critical as ever. This article provides a review of contemporary debates revolving around the cultural adaptation (CA) of mental health interventions—when it is warranted, what approach should be taken and what components of an intervention should be adapted. CA is presented as a promising and pragmatic approach to service delivery, one that can assist clinical social workers in designing and implementing interventions that reflect refugees’ local needs and knowledge without neglecting important advances in research evidence and clinical expertise. However, it is not without its challenges. By drawing on literature related to the integration of cultural and contextual factors in mental health interventions and services, the article addresses critical issues in the CA approach and asks: is it possible to strike a balance between fidelity to evidence-based interventions and culturally compatible care?

Interpreters working in mental health settings with refugees: An interdisciplinary scoping review.

“…There are also broad generic practice guidelines that detail issues practitioners need to take under consideration when working with interpreters (The British Psychological Society, 2017; Victorian Transcultural Psychiatry Unit, 2006). However, the scholarship on language barriers among refugees remains scarce (Health Canada, 2001), and specific guidelines detailing how interventions may be adapted for this population have not been explicitly outlined and are severely lacking (Fennig, 2020). The dearth of information and official best-practice guidelines has meant that practitioners and interpreters have few resources to help them navigate this complex terrain (Leanza et al, 2015).…”

Cultural consideration for cognitive‐behavioural therapy for sexual minority young people in Chinese societies: Perspectives from practitioners and target users

“…To this end, Lau (2006) highlighted the importance of collecting data from multiple stakeholders to identify target problems and guide the adaptation process. Researchers have also suggested making a clear distinction between consideration at a surface structural level (e.g., translation of materials, use of clients' preferred language, inclusion of culturally appropriate greetings and rituals, or matching race or ethnicity between clients and therapists) versus a deep structural level (e.g., addressing the core values and norms pertinent to the context and population or incorporating clients' explanatory models for the problems they present) (Backer, 2001;Fennig, 2020;Kumpfer et al, 2002;Resnicow et al, 2000). Chowdhary et al's (2014) review shows that most cultural adaptations only attended to surface structural level changes.…”

Mirrored Social Representations of Canadian Caseworkers with Migratory Paths Intervening with Refugees in the Host Country

“…Bouquet and Jaeger pointed out that refugee-integration professionals, like any other professional working with disadvantaged people, are confronted with permanent contradictions between public order, professional ethics and the need to take into account the daily reality of migrants' journeys [23]. These professionals are also challenged in their relationships with refugees by institutional norms and social policies over which they have little control [84].…”

“…The caseworkers, listeners to the refugees' life stories, experience a dilemma. They have to choose between "a normalizing function and a contribution to social change" [85], with this change being a mission of public (or political) interest [23] but also in the interest of the refugees. The complexity of refugee identity is that it integrates in an intersecting way all the identities borrowed and absorbed during the refugees' life trajectory.…”

“…Research has revealed the importance of cultural-competence assets and sensibilities in working with refugees [20]. In this context, M. Fennig considers the cultural adaptation of mental health interventions as a promising and pragmatic approach to service delivery [23]. To help address the cultural needs of refugees, the majority of caseworkers recruited in 2015-2016 to work with Syrian refugees were themselves former migrants or refugees [24].…”