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About this paper symposium
| Panel information |
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| Panel 1. Context: Cross-Cultural, Neighborhood, and Social |
| Paper #1 | |
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| School-based Intervention to Promote Resilience Among Newcomer Youth | |
| Author information | Role |
| Rebecca Ford-Paz, Lurie's Children's Hospital, United States | Presenting author |
| Bianca Ramos, LCSW, United States, Lurie's Children's Hospital | Non-presenting author |
| Abstract | |
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Refugee and asylum-seeking youth have significantly higher rates of PTSD, depression, and anxiety compared to the general population (Frounfelker et al., 2020), but few forcibly displaced youth receive mental healthcare in traditional clinical settings due to a variety of barriers, including high rates of mental health stigma in their countries of origin, lack of familiarity with the U.S. healthcare system, as well as financial, language, and cultural barriers (Sim et al., 2023). In addition to migration-related distress, many newcomer children experience a hostile reception in the U.S. in the form of structural violence and discrimination (Beiser & Hou, 2016; Fazel et al., 2012). With more than 43 million children forcibly displaced globally in 2022 (UNHCR, 2023) and increasing numbers of children coming to the U.S. seeking safety every year (U.S. Customs & Border Patrol, 2023), it has never been more important to ensure access to mental healthcare in healing-centered environments for this growing, yet vastly underserved population. School-based interventions for newcomers have been put forward as a potential strategy to decrease stigma related to mental health help-seeking and reduce mental health inequities (Fazel et al., 2016; Sullivan and Simonson, 2016). Using an example of a collaboration between a school district and an academic medical center in a large Midwest urban center, this presentation will offer real-world clinical perspectives on best practices for translating and disseminating research-based interventions to schools and ensuring uptake by trained clinicians. First, this presentation will describe the essential district-level partnerships and coordination with existing professional development structures. Second, tier 1 and tier 2 training offered in schools multi-tiered systems of support will be discussed. Tier 1 trainings focused on the creation of welcoming environments for newcomer students, enhancing understanding and empathy for students and families seeking immigration relief for all school personnel, building trauma-informed classrooms and instruction for newcomers, connecting with and engaging caregivers, and sharing local resources. Tier 2 trainings equipped school-based clinicians and English language learner teachers to partner in offering Supporting Transition Resilience of Newcomer Groups (STRONG; Hoover, et al., 2019), a school-based, strengths-focused group intervention designed specifically for newcomers to build social connections, develop adaptive coping skills to buffer them from the impact of migration-related stressors, and screen for trauma-related distress. Research support for STRONG is growing and demonstrates promise (Crooks et al, 2019; Crooks et al., 2020). Third, the presentation will provide an overview of ongoing supported implementation meetings that are designed to facilitate and encourage implementation. STRONG trainers schedule four follow-up meetings to offer technical assistance to overcome challenges to implementation, refresh training content, enhance fidelity, and reduce implementers’ anxiety about implementing for the first time. Dissemination and implementation of research-based interventions need to center sustainability and cultural responsiveness. Close partnerships between academic and community/school partners are essential to ensure that evidence-based treatments that benefit newcomer youth successfully reach their intended target population. |
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| Paper #2 | |
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| Identifying Facilitators and Barriers in the Implementation of Trauma-informed, School-based Program for Refugee and Immigrant Youth | |
| Author information | Role |
| Andrea Donis, Loyola University Chicago, United States | Presenting author |
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Dr. Sungha Kang, United States, Loyola University Chicago Roxanna Flores, United States, Loyola University Chicago Susana Sosa, United States, Loyola Universtiy Chicago |
Non-presenting author |
| Abstract | |
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Introduction Refugee and immigrant youth in the United States are tasked with navigating the challenges that come with resettlement (Santiago et al., 2018) Resettlement, which refers to the process of adapting to the host country’s language, culture, societal norms, and environment, is marked as a stressful period as refugee and immigrant children are often forced to navigate acculturation, discrimination, and poverty, among other stressful experiences. These stressors place these youth at an increased risk for mental health difficulties and, due to the systemic barriers they face to accessible and culturally responsive mental health care, may have long-term consequences (e.g., depression, anxiety, and behavioral problems). (Santiago et al., 2018) For these youth, schools have emerged as an accessible and welcoming setting to receive necessary support during resettlement, which is imperative for their well-being. While schools can ameliorate some of the key systemic barriers (e.g., lack of health insurance) preventing these youth from receiving care, the literature demonstrates that the implementation process of school-based services can be challenging (Santiago et al., 2018) Therefore, the goal of this presentation is to analyze the implementation process of a school-based intervention for refugee and immigrant youth. Methods The Supporting Transition Resilience of Newcomer Groups (STRONG; Hoover, et al., 2019) program is a trauma-informed school-based program developed for immigrant and refugee youth. STRONG was designed with a strengths-based approach aimed at fostering resilience, strengthening adaptive coping, and promoting school connectedness. For this study, STRONG was implemented in six public schools in a Midwestern urban city with high rates of immigrant and refugee student population for two academic school years. To better understand the implementation process of STRONG, qualitative interviews and focus groups were conducted with teachers and clinicians to identify facilitators and barriers to implementation of STRONG in these schools. The proposed presentation will present qualitative data from seven individual interviews (one principal interview and six teacher interviews) and two focus groups with clinicians who led STRONG in each school. Results The qualitative data will be coded by the research team through the Exploration, Preparation, Implementation, and Sustainment (EPIS; Moulin et al., 2018) framework to identify facilitators and barriers within and outside the school context that impacted the implementation of STRONG. The EPIS framework, shown in Figure 1, is a widely used implementation framework that defines the implementation process by identifying outer and inner organizational contexts and their associated factors, innovation factors related to the characteristics of the implemented program, and bridging factors involved in the complex interplay of the outer and inner contexts. Using a hybrid coding approach, the codebook was developed deductively within the EPIS framework and inductively informed by the interview transcripts. A preliminary examination of codes indicated that support from leadership from the school and the district may be an important facilitator in the implementation of STRONG. Some barriers may include scheduling difficulties, lack of teacher-clinician communication, and difficulty finding space to deliver STRONG. Further analyses will extract specific themes from these transcripts to identify key facilitators and barriers at play in the implementation of STRONG. Understanding the implementation process of STRONG is an important component of providing immigrant and refugee youth with high-quality, accessible, and culturally responsive support during resettlement. The findings from this study will be used to discuss critical systems-level changes (e.g., education and mental health policy) needed to support the implementation of STRONG and other school-based mental health programs for immigrant and refugee youth. |
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| Paper #3 | |
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| Created by the Community, for the Community: Implementation Outcomes of a Community-Based Intervention | |
| Author information | Role |
| Emilia Roman, Unviersity of Illinois Chicago, United States | Presenting author |
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Stephanie Torres, United States, UIC Jillian L. Garcia,United States, UIC |
Non-presenting author |
| Abstract | |
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Introduction During the last decade, the Latinx population accounted for over half of the U.S. population growth (Noe-Bustamante et al., 2020), yet they continue to face striking health disparities, including disproportionate rates of stress and access to behavioral health services. Structural racism is a key driver of disparities among Latinx communities. Structural racism is defined as discriminatory policies, practices, stereotypes, and norms that fuel and perpetuate inequities for historically marginalized communities (Braveman, 2022). For Latinx immigrant families, stress caused by structural racism can drive immigration fears, discrimination, and linguistic isolation, exacerbating risk of mental health problems and further deepening health disparities (Misra et al., 2021). Immigrant stress reverberates across the family unit, leading to impaired parent-adolescent relationships, adolescent mental health distress, heightened family conflict, and diminished capacity to cope with stress (López-Zerón et al., 2020). The multilevel impact of structural racism demands interventions that integrate multilevel strategies to help families reduce stress and improve mental health, but few interventions exist that integrate multiple components. Interventions to address structural racism must fit within the context they are delivered. Dissemination and implementation (D&I) science is well-positioned to guide how best to translate evidence-based practices into real-world settings. The current study assesses the acceptability, appropriateness, feasibility, and sustainability of a novel intervention called FIESTA (Familias Inmigrantes Empoderándose contra Estrés Tomando Acción). Methods Led by community health workers (CHWs), FIESTA focuses on reducing stress due to structural racism among Latinx immigrant mothers and their children through 10-group sessions focused on topics such as stress and coping, family communication, and advocacy. FIESTA was developed in partnership with five CHWs harnessing community-engaged approaches and emphasizing real-world effectiveness and sustainability. Using intervention mapping (IM); Fernandez et al., 2019), we identified three targets for stress reduction consistent with prior research: community navigation; family coping and communication skills; and individual stress management techniques. Protocols and materials were reviewed in four iterative cycles using semi-structured focus groups and feedback was incorporated into the final manual. The pilot study recruited 12 mother-adolescent dyads (n = 24 participants) who identified as a Latinx immigrant mother or caregiver or a child of a Latina immigrant, respectively. Mother-adolescent dyads were randomized to the treatment arm (immediate start) or waitlist-control arm (delayed start after 3 months) using block randomization. Participants and facilitators will complete quantitative measures of acceptability, appropriateness, and feasibility after each session of FIESTA. After the intervention (Time 2 for the treatment arm and Time 3 for the waitlist-control arm), participants will be asked a series of questions about the FIESTA intervention to assess for appropriateness, acceptability, feasibility, and sustainability. This portion will be facilitated by trained bilingual research assistants and will be audio-recorded. Facilitators of the FIESTA group will be asked similar questions and will complete the following quantitative measures: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Results The pilot study is ongoing. The research team will conduct content analyses with inductive and deductive approaches to analyze the qualitative data. Quantitative measures (AIM, IAM, and FIM) will be used to complement the qualitative data. Preliminary results collected after each session show that FIESTA is acceptable, appropriate, and feasible for both participants and facilitators. This study highlights the utility of developing a community-based intervention through engaging multiple stakeholders with lived experiences. |
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School- and Community-Based Trauma-Informed Interventions: Implementation and Dissemination from Clinical and Research Perspectives
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| Session Title | School- and Community-Based Trauma-Informed Interventions: Implementation and Dissemination from Clinical and Research Perspectives |