Understanding mechanisms of change in a family-based preventive mental health intervention for refugees by refugees in New England

Abstract

Transnational migration of refugees is associated with poor mental health, particularly among children. We conducted a pilot trial of the Family Strengthening Intervention for Refugees (FSI-R), using a community-based participatory research (CBPR) approach to deliver a home-based intervention “for refugees by refugees” to improve family functioning and child mental health. N = 80 refugee families in the Greater Boston area participated in the study ( n = 40 Somali Bantu families; n = 40 Bhutanese families) with n = 41 families randomized to care-as-usual. Of the 39 families who received FSI-R, n = 36 caregivers and children completed qualitative exit interviews. We present findings from these interviews to identify the mechanisms through which a family-strengthening intervention for refugees can be acceptable, feasible, and effective at improving family functioning and children's mental health outcomes. Authors applied Grounded Theory to code interview transcripts and detailed field notes and used an iterative process to arrive at final codes, themes, and a theoretical framework. The greatest contributors to acceptability and feasibility included flexibility in scheduling intervention sessions, the interventionist being a community member, and improvements to family communication and time spent together. All of these factors were made possible by the CBPR approach. Our findings suggest that given the socio-political context within the U.S. and the economic challenges faced by refugee families, the successful implementation of such interventions hinges on culturally-grounding the intervention design process, drawing heavily on community input, and prioritizing community members as interventionists.

Investigating Outcomes of a Family Strengthening Intervention for Resettled Somali Bantu and Bhutanese Refugees: An Explanatory Sequential Mixed Methods Study

“…Data on intervention acceptability, feasibility, and family and child outcomes were collected using quantitative measures [47] and semi-structured qualitative interview guides [50], as described in prior publications.…”

“…The intervention also draws on the strengths-based perspective which views individuals holistically through the lens of their strengths and capacities and which are seen as important resources to be harnessed to address challenges and facilitate resilience [50]. A principal way that strengths are identified in the FSI-R is through the development of a family narrative that includes important life experiences prior to and since resettling in the U.S., challenges experienced and strengths and problem-solving capacities that the family utilized to overcome adversity.…”

“…A detailed account of our qualitative analysis processes has also been published elsewhere [50]. We employed Grounded Theory to analyze the interview transcripts and detailed field notes [58].…”

Promoting positive development among refugee adolescents

“…A multilevel intervention that targets stressors across the social ecology in a holistic manner can have optimal impact on improving outcomes for refugee adolescents (Hess et al, 2014). Importantly, interventions might need to address both belonging to the settlement community (building bridges) and staying connected to community of origin (bonding) while also linking refugees to the resources they need to rebuild their lives (DiClemente‐Bosco et al, 2022; Ellis & Abdi, 2017). Ideally, it would also address past trauma while promoting resilience against negative experiences such as discrimination.…”

“…An example of this approach can be seen in both TST‐R and FSI as they use community‐based participatory research and make building community capacity a central aspect of the partnerships. The FSI‐R use of refugee peers who received strong training and supervision opens up not only employment opportunities for local refugees but also community empowerment and career trajectories for refugee adolescents to enter the helping professions (DiClemente‐Bosco et al, 2022).…”