Ecologies of care: mental health and psychosocial support for war-affected youth in the U.S

"Living their best life": PhotoVoice insights on well-being, inclusion, and access to public spaces among adolescent refugee girls in urban resettlement

PURPOSE

Newcomer adolescent girls from the Middle East and North Africa region face intersectional challenges and opportunities upon resettlement. This study employs PhotoVoice participatory research methodology to explore perspectives on well-being and belonging shared by six students who resettled to Chicago from Iraq and Syria.

METHODS

Two programme sessions consisted of participants reflecting on their photographic responses to four prompts in focus group discussions. The subsequent four sessions included qualitative analysis skill building, participant-led generation of thematic codes and diagrams using their data, and the creation of action plan posters to share back with the community. The research team then analysed all data using a grounded theory approach with constant comparative analysis.

RESULTS

Four major themes emerged: 1) public spaces served as a vehicle for exploring well-being and belonging; 2) intersectional inclusion in public spaces was deemed a vital priority; 3) schools held an important role in facilitating belonging and access to public spaces; and 4) language was a critical barrier and facilitator to access and inclusion.

CONCLUSIONS

Findings highlight the need for holistic approaches to support refugee youth in urban contexts and emphasize the role of schools in facilitating inclusive access to public spaces to strengthen newcomer students' well-being and belonging.

Resilience Mechanisms and Coping Strategies for Forcibly Displaced Youth: An Exploratory Rapid Review

Context: The global escalation of conflict, violence, and human rights violations sets a pressing backdrop for examining the resilience of forcibly displaced youth (FDY) in Canada. This study aims to unpack the multifaceted challenges and resilience mechanisms of FDY, focusing on their health, well-being, and integration into host communities. It seeks to identify current models of resilience, understand the factors within each model, and highlight gaps and limitations. Methodology: Using a university librarian-supported structured search strategy, this exploratory rapid review searched literature from Ovid Medline and open-source databases, published in English between January 2019 and January 2024, that fit specific inclusion criteria. The eligible articles (N = 12 out of 4096) were charted and analyzed by two student researchers with the Principal Investigator (PI). Charted data were analyzed thematically. Results: The selected studies captured diverse geographical perspectives, resilience models (such as Ungar's ecological perspective and Masten's resilience developmental models), as well as protective and promotive frameworks. Key findings indicate the complexity of resilience influenced by individual, familial, societal, and cultural factors. Each model offers insights into the dynamic interplay of these influences on FDY's resilience. However, these models often fall short of addressing the nuances of cultural specificity, the impact of trauma, and the intersectionality of FDY's identities. Conclusions: Recognizing the diverse and evolving nature of FDY's coping mechanisms, this study advocates for a culturally appropriate approach to resilience that integrates an intersectionality framework of individual attributes and culturally sensitive models.

Supporting social emotional learning and wellbeing of displaced adolescents from the middle east: a pilot evaluation of the 'forward with peers' intervention

BACKGROUND

A growing literature points to the critical role schools can play in promoting improved psychosocial wellbeing and resilience among first- and second-generation Arab immigrant and refugee adolescents, but few evaluations have examined the effectiveness of culturally adapted, school-based interventions.

METHODS

We conducted a pilot evaluation of a culturally adapted social and emotional learning and life skills program, Forward with Peers (FwP), and examined its potential effectiveness for this population. FwP was evaluated across three high schools in the Detroit Metropolitan Area. Within each school, one Arabic class was randomly assigned to receive FwP programming and another served as a control. The pilot evaluation sought to examine changes in several mental health and psychosocial outcomes of interest.

FINDINGS

Improvements in overall perceived social support (P = 0.045) and perceived social support from someone special in one's life (0.042) were statistically significant in the treatment as compared to the control group. Comparative improvements were also marginally significant for resilience (P = 0.095) and perceived social support from family (P = 0.074).

CONCLUSIONS

Findings highlight the potential of FwP and support the growing interest in establishing efficacy of school-based, culturally appropriate SEL programming to improve psychosocial wellbeing among Arab refugee and immigrant adolescents. FwP's demonstrated improvements in resilience and social support have the potential to prevent mental health disorders and bolster coping mechanisms to minimize adverse consequences in this vulnerable population. Employing a strengths-based approach, FwP offers an alternative intervention to traditional treatment-oriented supports for the proliferation of mental health disorders within this vulnerable population.

"Hope for a better tomorrow": Using photovoice to understand how Arab adolescents enact critical consciousness

We explore how Arab adolescents enact critical consciousness to improve their lives and better their community. Eleven first- and second-generation Arab adolescents participated in a Photovoice study and were asked to reflect on and take photos that represented their well-being, daily life, and sense of belonging and community. The participants discussed their photos over multiple group reflection sessions. Thematic analysis highlights how Arab adolescents make positive change in their community, aided by their connections to community, their awareness of structural challenges they and their communities face, and their sense of agency to make positive change. We contribute to the literature by offering a window into the lived experiences of critical consciousness among Arab adolescents, an underrepresented group in the critical consciousness literature. We also add to the growing body of evidence that highlights the importance of "everyday activism" when considering social change actions.

Cultural idioms of distress among displaced populations: A scoping review

BACKGROUND

Armed conflicts and natural disasters can cause significant psychological and social challenges for affected populations. Displaced populations are extremely heterogeneous in terms of culture, language, and experiences of crises. Current diagnostic criteria is insufficient when evaluating the symptoms and treatment of mental health issues across contexts.

AIM

This scoping review presents information about cultural idioms of distress across displaced populations. The review includes aspects of etiology, symptomology, and proposed intervention methods.

METHODS

I conducted a Boolean search of academic and grey literature for studies that described cultural idioms of distress among displaced populations. Results were analyzed using thematic analysis and grounded theory.

RESULTS

A shared sense of injustice, spirit possession, and karma are common etiologies for mental distress among displaced populations. Symptoms include somatic complaints, 'thinking a lot', and interpersonal challenges such as social isolation and a fear of others. Potential interventions are likely on a community-level, including the generation of community mechanisms for conflict-resolution, reconciliation, and culturally grounded healing rituals.

CONCLUSIONS

It is vital to understand the ways displaced communities conceptualize their mental health in order to develop appropriate culturally grounded interventions. Understanding the etiology, symptoms, and proposed interventions can inform and improve humanitarian aid delivery of mental health and psychosocial support services.

Inter-Organisational Entanglements in Migrant Support Ecologies: Action and Collaboration Supporting Labour Market Integration

This paper examines inter-organisational behaviours in what we call ‘migrant support ecologies’ – shared physical and abstract spaces where multiple organisations work to help migrants access and transition within the labour market. Drawing on composite data generated through studies conducted in the UK and Brazil, we argue that actors and organisations in such environments operate in ‘common goal domains’, in which objectives are related but not necessarily integrated or coordinated, and they consequently adopt diverse interactional practices. We distinguish between four ideal types of migrant support organisation based on their activity scope and stakeholder focus before outlining how different organisations and their constituent actors engage in tactical and strategic coupling practices, reflecting shorter and more episodic interactions alongside complex, multithreaded ones. The findings show how different forms of cooperative arrangements may be pursued based on organisations’ capacities, focus and the types of value they seek to create for organisations, migrants and wider societies.

A University and Community-Based Partnership: After-School Mentoring Activities to Support Positive Mental Health for Children Who Are Refugees

The objective of this study was to examine mentors’ perceptions of a pilot service-learning program designed to provide activities to promote the self-esteem and positive development of elementary school-age children who were refugees. Activities were designed to promote self-esteem, self-confidence, social skills development, and problem-solving. College students completed reflection journals to record their perceptions of mentoring and what the children were learning and experiencing. The results indicated that mentors believed the children were learning ideas to improve their self-esteem and social development. Mentors’ impressions were corroborated by reports about the program from staff who worked with the children daily. Involving parents in programming, may have extended the reach of program efforts. Some children may have benefited from evaluations to determine if counseling would benefit them, given the trauma history they and their family members were potentially facing. This was a pilot program implementation study, and a limitation is that data from youth and parents about mental health outcomes were lacking. In the future, assessing perceptions of children, involving their caregivers in programming, and then assessing their caregivers’ perceptions of the impact of the program on children’s self-esteem and social and emotional functioning will provide critical information about program success and information for program development.

Correlates of Suicide Ideation and Resilience Among Native- and Foreign-Born Adolescents in the United States

PURPOSE

Nearly 20% of U.S. adolescents have considered suicide. Yet, gaps remain in understanding correlates of resilience and suicide risk, especially among populations born outside the United States who may face unique migration- and acculturation-related stressors. This study adds to the literature by exploring correlates of suicide ideation among a diverse population.

METHODS

This study analyzes quantitative data (N = 357) from the Study of Adolescent Lives after Migration to America, in Detroit and Harrisonburg. More than 40% of the sample was born outside the United States, with the majority born in the Middle East and North Africa. Path analysis was used to model dual outcomes of resilience and suicide ideation using measures of hope, school belonging, stressful life events, and being born outside the United States.

RESULTS

Suicide ideation and resilience were negatively correlated (ß = -.236[.069]; p < .001). Adolescents with greater hope (ß = .367; p < .001) and school belonging (ß = .407; p < .001) reported higher resilience, while lower levels of school belonging correlated with higher levels of suicide ideation (ß = -.248; p = .009). More stressful life events were associated with suicide ideation (ß = .243; p < .001), while fewer were correlated with resilience (ß = -.106; p = .003). Being born outside the United States was associated with suicide ideation (ß = .186; P-.015), with this finding driven by those from the Middle East and North Africa region, who faced significantly increased risk of suicide ideation (ß = .169; p = .036).

CONCLUSIONS

Findings suggest that adolescents born in the Middle East and North Africa region may represent a vulnerable group needing targeted and culturally responsive interventions to destigmatize mental health and psychosocial well-being, boost existing sources of resilience, and encourage help-seeking behaviors.

Stressful Life Events and Their Unique Associations with Psychosocial Outcomes: a Gendered Analysis Among High School Adolescents

INTRODUCTION

There is substantial evidence linking stressful life events (SLEs) in childhood to poor mental health later in life, but few studies explore how various types of SLEs differentially impact mental health. The purpose of this study is to assess associations between SLEs and psychosocial outcomes in a diverse adolescent population in the USA and to examine whether and how these relationships are gendered.

METHODS

The sample comprises 181 high school students ages 13-21 years in Harrisonburg, Virginia. This study analyzed associations between 12 SLEs and eight psychosocial outcomes using ordinary least-squares and logistic regressions. Relationships were estimated for the full sample and for males and females, separately.

RESULTS

For boys, having ever been forced to leave one's family was associated with declines in resilience (B = - 4.646; 95% CI (- 8.79, - 0.50)) and increases in externalizing symptoms (B = 0.392; 95% CI (0.15, 0.63)). Furthermore, boys who experienced a drastic change in their family reported lower levels of school belonging (B = - 9.272; 95% CI (- 17.45, - 1.09)). For girls, having ever been forced to leave one's family was associated with decreases in depressive (B = - 0.961; 95% CI (- 1.88, - 0.05)) and anxiety symptomology (B = - 0.868; 95% CI (- 1.68, - 0.06)). Overall, students who experienced a life-threatening emergency exhibited greater depressive (B = 0.445; 95% CI (0.15, 0.74)) and anxiety symptoms (B = 0.287; 95% CI (0.05, 0.52)), and depressive symptomology was also associated with having ever been physically hurt by someone (B = 0.224; 95% CI (0.01, 0.44)).

CONCLUSIONS

Findings provide insights into how exposures might engender different mental health processes and outcomes, and how these processes may manifest differently across gender.

Supporting mental health and psychosocial wellbeing through social and emotional learning: A participatory study of conflict-affected youth resettled to the U.S

BACKGROUND

A growing literature has drawn attention to the central role that schools play in supporting the adjustment of resettled refugee youth and promoting their mental health and psychosocial wellbeing. In particular, the recent proliferation of school-based social and emotional learning (SEL) initiatives presents an opportunity to strengthen supports for resettled adolescents. This participatory research study aims to understand how high school students resettled from countries in the Middle East and North Africa region are experiencing the challenges and opportunities of acculturation and the ways in which they believe schools can better support them in this process.

METHODS

We analyzed primary data collected during focus group discussions as part of the SALaMA study. During these discussions, we used participatory ranking methodology to elicit adolescents' suggestions on how high schools can better support students both academically and psychosocially after resettlement. Fourteen focus group discussions were held with male (n = 38) and female (n = 31) adolescents aged 14-20 years, who were selected purposively across six public high schools in Harrisonburg, Virginia, Austin, Texas, and Detroit, Michigan. Participants offered suggestions and then ranked them in order of importance using consensus ranking.

RESULTS

Thematic analysis of the PRM results across sites produced a wealth of suggestions centered around three broad themes, namely: skills related to navigating social and academic challenges, culturally responsive teaching, and socially and culturally equitable learning environments.

CONCLUSIONS

Findings reported illustrate limitations of the conventional, universal SEL model and shed light on how schools can adapt transformative SEL strategies to serve their students better, especially newcomers from conflict-affected countries.

The role of culturally responsive social and emotional learning in supporting refugee inclusion and belonging: A thematic analysis of service provider perspectives

Young refugees resettled to the U.S. from the Middle East and North Africa (MENA) region face significant acculturative stressors, including language barriers, unfamiliar norms and practices, new institutional environments, and discrimination. While schools may ease newcomer adjustment and inclusion, they also risk exacerbating acculturative stress and social exclusion. This study seeks to understand the opportunities and challenges that schoolwide social and emotional learning (SEL) efforts may present for supporting refugee incorporation, belonging, and wellbeing. We completed semi-structured interviews with a purposive sample of 40 educators and other service providers in Austin, Texas, Harrisonburg, Virginia, and Detroit Metropolitan Area, Michigan as part of the SALaMA project. We conducted a thematic analysis with transcripts from these interviews guided by the framework of culturally responsive pedagogy. The findings revealed that students and providers struggled with acculturative stressors and structural barriers to meaningful engagement. Schoolwide SEL also provided several mechanisms through which schools could facilitate newcomer adjustment and belonging, which included promoting adult SEL competencies that center equity and inclusion, cultivating more meaningfully inclusive school climates, and engaging families through school liaisons from the newcomer community. We discuss the implications of these findings for systemwide efforts to deliver culturally responsive SEL, emphasize the importance of distinguishing between cultural and structural sources of inequality, and consider how these lessons extend across sectors and disciplinary traditions.

Psychosocial Well-Being, Mental Health, and Available Supports in an Arab Enclave: Exploring Outcomes for Foreign-Born and U.S.-Born Adolescents

Introduction: Few studies have assessed the impact of displacement, resettlement, and discrimination on well-being outcomes for adolescent refugees resettled within the U.S. Conducted in three charter schools in the intergenerational Arab enclave of the Detroit Metropolitan Area, this mixed-methods study assessed the mental health and psychosocial support for both U.S.- and foreign-born adolescents from the Middle East and North Africa region. Methods: A quantitative survey was used to collect data on 176 students. Key outcomes included hope, prosocial behaviors, resilience, depressive, anxiety, externalizing symptoms, stressful life events, perceived social support, and sense of school belonging. Differences in outcomes between U.S.- and foreign-born students were compared using T-tests. Regression analysis explored whether outcomes were gendered and correlated with years in the U.S. for foreign-born students. Qualitative data collection included key informant interviews with school staff and community service providers, student focus group discussions, and caregiver interviews. Interview transcripts were analyzed using thematic analysis and the constant comparative method. Results: No statistically significant differences between the foreign-born and U.S.-born groups were observed. However, analysis revealed that resilience decreased for male students with time spent in the U.S. Qualitative themes illuminated these results; shared cultural heritage allowed newcomer students to access relevant language and psychosocial support, while inter- and intra-group peer relationships strengthened students' dual language skills and identity formation. However, shifting gender expectations and role hierarchies for newcomer students revealed boys' increased stressors in the family domain and girls' better accessed support in the school context. Conclusion: The existence of an immigrant paradox in this enclave setting was not supported. Instead, findings highlight the reciprocal value of peer-based mentorships and friendships between U.S.- and foreign-born students with similar cultural backgrounds, the importance of social and emotional curricula and cultural competency training within schools, and the gendered effects of acculturation.

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

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 identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts.

RESULTS

The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols.

CONCLUSION

The proposed four-step process offers a useful guide for how to adapt low-intensity psychological intervention within humanitarian settings. Despite some limitations, we show that even when time and resources are scarce it is possible and necessary to culturally adapt psychological interventions. We invite further testing, replication, and improvements to this methodology.