Bringing order out of chaos: A culturally competent approach to managing the problems of refugees and victims of organized violence (original) (raw)

A protocol for psychosocial intervention in refugee crisis; early experiences in Rwandan refugee camps

Journal of The American Society of Nephrology, 2004

This paper describes the conceptual framework and application of a working model ('EPSoCare') for psychosocial intervention for refugees living in camps in low income countries. The intervention's main objective is social re-integration of individuals with psychosocial problems. The model was applied in pilot programmes in camps with survivors of the 1994 genocide in Rwanda. The interventions aimed to cover 360.000 refugees in camps in Tanzania, and 230.000 in a camp in Zaire. The pilot programmes were heavily impacted by the prevalent insecurity in the camps and the atmosphere of mistrust resulting from it, as well as by the insufficiency of social services. The development of psycho-education material took more time than expected. Medical staff was not easily ready to be trained in psychosocial concepts. The course of the programmes showed the need for protocols with a well-defined target group and support offer, and a clear-cut working plan.

No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings

Conflict and Health

Background Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. Methods The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identifie...

Developing a Trauma-Informed Culturally-Based Intervention (TICBI) Approach for Refugee Resettlement Practices

Journal of International Social Work, 2023

Trauma-informed interventions have recently received more attention in the field of refugee resettlement and mental health. Although these interventions can be helpful to all trauma survivors, our model offers enhanced and cultural-based practice benefiting war-related trauma survivors, especially those from Post-Colonial nations. This model is based on needs identified by participants and collaboratively developed with the research team and the community. Our community-based participatory research (CBPR) began with three objectives. The first was to explore the current use of culturally-based, trauma-informed interventions and to assess service users' (SUs) and service providers (SPs) experiences. This was accopmlished by collaborating with a local community agency. The second objective was to identify service needs and gaps. The third objective involved working with the project's steering community members to develop a more effective model of interventions that can be used by resettlement and mental health agencies supporting refugees. During analysis, we examined the unique challenges identified by SUs and SPs to create a trauma-informed culturally-based intervention model (TICBI). We used a mixed-method study involving focus groups, individual interviews, and surveys with 23 service users (SUs) and 20 service providers (SPs). The barriers identified by the SUs included lack of access to needs-based assistance, cultural and linguistic misunderstandings, and marginalization. The barriers identified by the SPs included lack of structural/organizational support, lack of funding, large caseloads, and burnout risk.

Connecting cultures: A training model promoting evidence-based psychological services for refugees

Training and Education in Professional Psychology, 2014

Training clinical psychology graduate students in providing effective psychological services to refugees can be extremely complex. The training approach requires a culturally sensitive framework, potential modification of empirically validated techniques, and flexibility on the part of trainees and supervisors. Connecting Cultures is a program that creates a culturally sensitive context from which trainees can learn to effectively work with refugees within a social justice framework and the ecological model of human development. Connecting Cultures graduate students provide both community-based outreach and direct clinical services to meet the mental health needs of refugees in the Northeast region of the United States. The primary aim of this manuscript is to provide an overview of Connecting Cultures' training and supervision model, highlight the importance of working with cultural consultants, interpreters, and community elders, and discuss the impact this work has on clinical psychology graduate students. A secondary aim is to describe our method for evidence-based psychological assessment and to present preliminary outcome data from our graduate students. Strengths of the Connecting Cultures program include its clinical and research efforts with refugees from over 20 countries, and its ability to flexibly incorporate alternative therapeutic frameworks such as Acceptance and Commitment Therapy. Finally, the manuscript concludes by providing the implications of our work in attempting to meet the mental health needs of refugees after resettlement.

Task-shifting for refugee mental health and psychosocial support: A scoping review of services in humanitarian settings through the lens of RE-AIM

Implementation Research and Practice

Background: Decades of war, famines, natural disasters, and political upheaval have led to the largest number of displaced persons in human history. The refugee experience is fraught with obstacles from preflight to resettlement, leading to high rates of mental distress including post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of mental health services for refugees in transit. To meet the needs of this vulnerable population, researchers are experimenting with teaching lay community members basic tools for the delivery of mental health and psychosocial support services (MHPSS). However, there are research gaps about the use of implementation science to inform the delivery of applicable interventions, especially within low resource settings, and even less in the humanitarian context. Methods: This review utilizes an implementation science framework (RE-AIM) to assess the reach, effectiveness, adoption, implementation, and maintenance of these inter...

Integrative Mental Health and Psychosocial Support Interventions for Refugees in Humanitarian Crisis Settings

Refugees are often exposed to various interrelated stressors including the loss of resources and belongings, death of, or separation from, loved ones as well as direct exposure to armed conflict and violence. Psychological distress is common amongst refugees, with a substantial percentage developing mild to moderate mental disorders such as depression or anxiety disorders. A small percentage of people in refugee settings have severe mental disorders (often exacerbations of pre-existing disorders) and they are especially vulnerable. This chapter outlines complex challenges in addressing the mental health and psychosocial support (MHPSS) needs of refugees and describes key global guidelines, programmatic elements and recommendations in the areas of MHPSS including situational assessments, coordination of services and functional integration of mental health interventions within existing health systems. Various

Implementation of the national GBV policy in Uganda to address refugee survivors’ psychosocial needs

(MA Dissertation) Implementation of the national GBV policy in Uganda to address refugee survivors’ psychosocial needs, 2024

Inadequate policy implementation exacerbates Gender-Based Violence (GBV) and GBV-related psychosocial needs of survivors. In Uganda, the National Policy on Elimination of GBV (2016) and the National Guidelines on Provision of Psychosocial Support to GBV Survivors (2017) are core policy frameworks for the redress of GBV-related psychosocial needs. However, GBV remains high at 51% of women and 52% of men nationwide. In refugee hosting areas like Yumbe, refugee GBV survivors report increased low social functioning, poor community relations, alcoholism and suicide ideation. This explanatory qualitative study investigates implementation of the National GBV policy to address refugee survivors’ psychosocial needs. Data was collected from survivors, community actors, and national experts on access, appropriateness and quality of psychosocial support. The findings show policy implementation milestones like functional multi-stakeholder coordination mechanisms, referral structures, and survivor wellness. However, the policy and psychosocial guidelines are poorly disseminated and less known to community-based populations. They also offer a one-size fits all minimum package that ignores intersectionality and the unique systemic multilayered vulnerabilities of refugee survivors of GBV. The study argues for a context-specific minimum package that integrates specialised mental health into what is homogenously provided for survivors nationwide. Psychosocial support to refugee survivors ought to address pre-existing trauma, broken social supports in settlements, alcoholism and daily stressors that simultaneously compound to increase risk and vulnerability to fresh GBV incidents and protracted survivor psychosocial needs. The study recommends formulation of specific Guidelines for GBV-related Psychosocial Support that center intersectionality to address the multilayered vulnerabilities of refugee survivors.

The Role of Mental Health Counselors in International Human Rights: Reflections on Counseling Services with Urban Refugees at the Refugee Law Project in Kampala, Uganda

International Journal for the Advancement of Counselling

Drawing on the experiences of a Mental Health Counselor trainee in the Anti-Torture and Mental Health Unit of the Legal and Psychosocial Department of the Refugee Law Project in Kampala, Uganda, this article provides an overview of the refugee population and services in sub-Saharan Africa, specifically in East Africa. Using case examples, this paper highlights the challenges of and opportunities for providing effective mental health services to this population within this context, while reflecting on the first author's experience. The article concludes with considerations for ethical and culturally competent practices for mental health counselors in the early stage of their professional careers who are new to the field of human rights and social justice. concern^, with a total number of displaced and stateless people in the continent doubling from approximately 10.2 million in 2011 to 20 million in 2016 (UNHCR 2016). By the end of 2016, Africa hosted 5.6 million refugees and asylum seekers, almost 13.2 million internally displaced persons (IDPs) and returnees (refugees who returned to their home countries), and 715,000 stateless people (UNHCR 2016). Emergency situations and security incidents were registered in the countries of Burundi, Nigeria, South Sudan, the Democratic Republic of Congo (DRC), Chad, the Central African Republic (CAR), Mali, and Somalia (UNHCR 2016). Due to the number of refugees, lack of resources, and fears of assuming responsibilities related to real or perceived threats to national security, in many African countries the work of refugee protection is conducted by non-state actors (UNHCR 2003). Non-state actors include the UNHCR and other non-governmental organizations (NGOs) that work on building a culture of support and collaboration, while strengthening the protection of refugees and IDPs (UNHCR 2003). The UNHCR provides the bulk of resources for the protection and integration of refugees in sub-Saharan Africa through humanitarian aid and emergency relief, planning and constructing refugee settlement camps and, within the settlements, providing food, household and basic items, organizing agricultural and other income-generating activities, taking measures regarding health and education, and promoting community development (UNHCR 2003). The UNHCR's operational role also includes working with refugees in relatively stable situations after the initial emergency phase by continuing to provide basic needs (shelter, food, health, and basic education), as well as vocational Uganda is situated in the Great Lakes region of East Africa. In 2017, the UNHCR calculated a total of 1,014,119 refugees and 39,045 asylum seekers residing in Uganda, making up a total Bpopulation of concern^of 1,277,476 (UNHCR 2017). The three largest populations of forced migrants were from the DRC, Burundi and Eritrea (UNHCR 2017). In Uganda and the Great Lakes region of East Africa, NGOs work to research the causes and consequences of forced migration, and to promote political, economic, and social well-being and justice for this population. They work on law reform and the protection and promotion of human rights through monitoring, reporting and denunciating human rights violations and lack of assistance, through press releases, reports and media broadcasts. NGOs work on evaluating refugee programs on the basis of successful integration and access to education, healthcare, shelter, psychosocial assistance, and income generating activities. NGOs also educate refugees on their individual legal rights and provide direct legal assistance, representation and guidance in the process of regularization. They also train refugees on the topics of health and sanitation, rape, violence against women, gender-based violence, and trauma, with the aim of instilling knowledge and skills for self-reliance. Some organizations focus on the important work of dialogue and reconciliation within marginalized and war-affected communities (2014, February 10th. Retrieved from http://www.refugeerights.org). All these activities are crucial for the well-being of refugees all over the world, due to the environmental stressors they face and the overwhelming and powerful effects these produce. 366 Int J Adv Counselling (2018) 40:365-386 training, income-generating activities and livelihood projects for economic self-sufficiency (UNHCR 2003). In sub-Saharan Africa, the UNHCR also focuses on access to territorial protection along borders, voluntary repatriation and fundamental rights and freedoms of returnees, local integration, and resettlement in third countries for reasons of safety or family reunification (UNHCR 2012). The UNHCR performs its activities both directly and through implementing partners (UNHCR 2003).