Immigration status microaggressions: A moderated mediation analysis of cultural stress, fear, internalization, and psychological stress among Latinx and Asian college students.

OBJECTIVES: Latinx and Asian people are experiencing an elevated rate of immigration status-related oppression-both systematically and individually-despite actual nationality, and this type of cultural stressor has seen a rampant increase recently in the United States. We aimed to assess the relation and effect of immigration status microaggressions on psychological stress and some mechanisms connected to these experiences. METHOD: Using a sample of Latinx and Asian college students (N = 776), we unpack the relationships between individual cultural stressors, such as immigration status microaggressions, and psychological stress, by exploring their mediating relation with internalized racism (Mediator 1), and fear of foreign objectification (Mediator 2), using Hayes's (2012) PROCESS Model 6-serial mediation. Furthermore, we expanded on this model, highlighting differences between Latinx and Asian participants (moderator) using a moderated mediation. RESULTS: Findings suggest a full serial mediation. Specifically, the psychological stress associated with immigration status microaggressions was mediated by internalized racism and fear of foreign objectification. Results also highlighted that Latinx participants, compared to Asian ones, showed a significant positive association between immigration status microaggressions with internalized racism and fear of foreign objectification. Furthermore, a significant interaction for Latinx who experience more fear of foreign objectification was positively associated with psychological stress. Indirect effects for each group are discussed. CONCLUSION: Our study is one of the first to explore cultural stress in the form of immigration status microaggressions in connection with more general forms of psychological stress and internalizing processes for two groups historically persecuted around immigration in the United States. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Avanzando Caminos (Leading Pathways): design and procedures of the Hispanic/Latino Cancer Survivorship Study.

Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Cohort Study aims to examine the influence of sociocultural, medical, stress-related, psychosocial, lifestyle, behavioral, and biological factors on symptom burden, health-related quality of life, and clinical outcomes among Hispanics/Latinos who have been previously treated for cancer. Avanzando Caminos is a prospective, cohort-based study of 3000 Hispanics/Latinos who completed primary cancer treatment within the past 5 years that is representative of the general Hispanic/Latino population in the United States. Participants will complete self-report measures at baseline (time [T] 1), 6 months (T2), 1 year (T3), 2 years (T4), 3 years (T5), 4 years (T6), and 5 years (T7). Blood samples drawn for assessment of leukocyte gene expression, cardiometabolic markers, and genetic admixture will be collected at baseline (T1), 1 year (T3), 3 years (T5), and 5 years (T7). Medical and cancer characteristics and clinical outcomes will be extracted from the electronic medical record and/or state cancer registry at each time point. Data analysis will include general latent variable modeling and latent growth modeling. Avanzando Caminos will fill critical gaps in knowledge in order to guide future secondary and tertiary prevention efforts to mitigate cancer disparities and optimize health-related quality of life among Hispanic/Latino cancer survivors.

You belong.

The author describes how she has earnestly struggled to find her fit in providing mental health services to Hispanic/Latino clients and the Latino communities that she belongs to. She wonders, if no one belongs, then who stands up for historically marginalized Latino communities? Personal and systemic biases and arbitrary criteria for being enough to serve Latino patients hurt providers and clients alike. Her work reminds her of the need to charge against stereotyping and racism to meet patients' needs regardless of skin color or linguistic abilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Collective good and individual choice: Perceptions on COVID-19 vaccine mandate among COVID-19 vaccinated individuals.

INTRODUCTION: Vaccine mandates are controversial, and people vary widely in their preferences to support or reject vaccine mandates. For some, vaccine mandates represent a commitment to reduce harm and support public health. For others, vaccine mandates are viewed as a threat to individual freedom and a violation of personal choice. This manuscript investigated support for a COVID-19 vaccine mandate among COVID-19-vaccinated individuals and identified differences by demographic characteristics and COVID-19 experience. METHODS: Cross-sectional surveys were given to COVID-19-vaccinated individuals at a vaccination clinic in South Texas in the U.S. with the goal of identifying attitudes, beliefs, and perceptions about COVID-19 vaccination and willingness to support a COVID-19 vaccination mandate. Associations of interest were analyzed using descriptive statistics. KEY RESULTS: Approximately half of the sample was of Hispanic or Latino origin (48 %); most respondents identified as White (59 %), followed by 12 % who identified as Asian. Overall, 59 % of participants supported the possibility for a COVID-19 vaccine mandate. Preliminary data showed significant racial differences in willingness to support a possible COVID-19 vaccine mandate (χ2 (1, n = 893) = 26.7, p < .001, phi = .17); 80 % of Asian people reported support for COVID-19 vaccination mandate compared to 50 % to 57 % for other racial groups. Significant differences also emerged by ethnicity (χ2 (4, n = 1033) = 7.12, p = .008, phi = .08) whereby a higher percentage of Latino participants (66 %) reported willingness to support a COVID-19 vaccine mandate. Similarly, significant differences were found by age (χ2 (4, n = 1045) = 20.92, p < .001, phi = .21), yet no significant differences were found by sex or previous COVID-19 diagnosis. CONCLUSION: Support for a COVID-19 vaccination mandate is controversial even among vaccinated people. Identifying and understanding cultural and contextual factors that underlie differences in attitudes and beliefs about COVID-19 vaccination mandates is essential to advance dialogue and inform educational health campaigns to increase COVID-19 vaccination rates.

Impact of COVID-19 on Unaccompanied Immigrant Minors and Families: Perspectives from Clinical Experts and Providers.

The number of unaccompanied immigrant minors (UIMs) and families from Central America seeking asylum in the U.S. continues to rise. This growth, combined with restrictive government policies, led to crowded and suboptimal conditions in Customs and Border Patrol and non-governmental organization facilities. COVID-19 further taxed facilities and exacerbated uncertainty surrounding length of detention, basic human rights, and family reunification. The current project features testimonies from the authors who work as clinical experts and providers in Texas - a top destination for Central American immigrants. In collaboration with a deputy director of a not-for-profit human rights organization, volunteer psychologists, and the director of a humanitarian respite center, we describe challenges faced by administrators and clinical staff in addressing the mental health needs of immigrant children and families during the COVID-19 pandemic. The primary themes identified were anti-immigrant policies that occurred concurrently with COVID-19; difficulty implementing COVID-19 protocols alongside scarcity of supplies and volunteers; increased mental health needs among UIMs and immigrant families; and challenges in UIM placement upon release from custody. Strategies for addressing clinical challenges in the near- and long-term and opportunities for improvement in care systems to immigrant youth, including correcting anti-immigrant policies, addressing ongoing COVID-19 protocols and challenges, meeting mental and physical health needs, facilitating release and reunification for unaccompanied immigrant minors, and maximizing youth resilience through trauma-informed interventions, are presented.

Implications of Undocumented Status for Latinx Families During the COVID-19 Pandemic: A Call to Action.

BACKGROUND: A disproportionate number of COVID-19 cases and deaths have been reported among Latinxs in the U.S. Among those most affected by the pandemic are marginalized families, including those that are undocumented and mixed-status, in which some, but not all members are undocumented. Undocumented and mixed-status families face multiple and chronic daily stressors that compromised their health and wellbeing. Salient stressors faced by undocumented Latinx families include poverty, social disadvantage, discrimination, dangerous living and working conditions, and limited access to healthcare. These stressors are frequently compounded with trauma, fear of detention, deportation, and family separation. PURPOSE: Informed by the literature and insights from our community-based work to address the health needs of undocumented and mixed status Latinx families during the pandemic, this paper uses a social determinants of health lens to present a narrative summary that highlights four primary psychosocial stressors faced by these families and their implications for mental health. DISCUSSION: These include stressors pertaining to (a) anti-immigrant rhetoric and actions; (b) family stressors and disruptions in family dynamics; (c) economic changes and financial losses; and (c) limited access to healthcare. Implications of the aforesaid stressors on the mental health of undocumented families and youth are also discussed. In addition, recommendations are provided for the provision of mental health services, best practices, and resources from a strengths-based approach.

Family Separation at the US and Mexico Border Continues.

Record-breaking levels of asylum seeking by families with young children continue at the United States/Mexico border, particularly the Rio Grande Valley sector. In this Commentary, our aim is to increase awareness by providing child and adolescent mental health care providers with an update on current migrant conditions, bringing to light issues of family separation previously highlighted in the Journal.1 For context, our international group has collected data, via 3 large-scale studies funded by the National Institutes of Health, from more than 600 Latinx immigrants seeking asylum at the US/Mexico border in the last 4 years, during which levels of violence, climate disruption, and poverty in the Northern Triangle of Central America (ie, El Salvador, Guatemala, and Honduras) and Mexico have propelled high and sustained levels of asylum seeking in the United States. We contribute expertise in clinical psychology, Latinx psychology, attachment disruption, and public health, as well as this front-row perspective.

A decolonial and liberation lens to social justice research: Upholding promises for diverse, inclusive, and equitable psychological science.

In the face of harmful disparities and inequities, it is crucial for researchers to critically reflect on methodologies and research practices that can dismantle systems of oppression, accommodate pluralistic realities, and facilitate opportunities for all communities to thrive. Historically, knowledge production for the sciences has followed a colonial and colonizing approach that continues to silence and decontextualize the lived experiences of people of color. This article acknowledges the harm to people of color communities in the name of research and draws from decolonial and liberation frameworks to advance research practices and psychological science toward equity and social justice. In this article, we propose a lens rooted in decolonial and liberatory principles that researchers can use to rethink and guide their scientific endeavors and collaborations toward more ethical, equitable, inclusive, respectful, and pluralistic research practices. The proposed lens draws on literature from community psychology and our lessons learned from field studies with historically marginalized Latinx communities to highlight six interrelated tensions that are important to address in psychological research from a decolonizing and liberatory lens. These interrelated tensions involve conflicting issues of (a) power, (b) competence, (c) practices and theories, (d) rationale, (e) approach, and (f) trust. In addition, seven practical recommendations and examples for decolonial and liberatory research practices are outlined. The recommendations can assist researchers in identifying ways to ameliorate and address the interrelated tensions to give way to decolonial and liberatory research practices. Community and social justice scientists have the responsibility to decommission oppressive research practices and engage in decolonization and liberation toward a valid, ethical, equitable, and inclusive psychological science. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Liderando juntos y revueltos: A collectivistic leadership approach to address Latinx immigrant health and psychological needs.

Psychologists are positioned to help address societal and public health crises in beneficial ways, including collectively working with public sectors to serve marginalized communities. This article highlights the relevance of helping to address societal and public health crises with collectivistic psychological leadership approaches and uses Latinx psychology leaders for addressing the current immigrant needs among Latinx communities. We draw attention to the domains needed for collectivistic psychological leadership that are culturally nuanced and equity, diversity, and inclusion-focused to advance the well-being of historically marginalized immigrant communities. Finally, the article highlights how our collectivistic approach operates in the public sector by describing the creation of the Latinx Immigrant Health Alliance (LIHA) and targeted outcomes. Briefly, the LIHA informally started in 2017 and was founded in 2020 to fill a gap in Latinx immigrant health at the heart of systemic inequalities during the global pandemic, explicit anti-immigrant rhetoric, and anti-Latinx policies. The LIHA aims to collectively work with community organizations to promote Latinx immigration health research, policy, education, training, and effective interventions. We include future directions and opportunities for collectivistic psychological leadership to address today's complex social issues. In particular, we call for the translation of psychological methods and other skills (e.g., research, clinical skills, policy, quantitative and qualitative methodology) into public action for better wellness of our communities, as well as the advancement of social justice, health equity, and inclusion for historically marginalized communities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Exploratory Study of Healing Circles as a Strategy to Facilitate Resilience in an Undocumented Community.

Within the United States (U.S.), the COVID-19 pandemic highlighted critical inequalities affecting undocumented communities and resulting in particularly heightened stress for members of these communities. In addition to the stress associated to COVID-19, immigrants in the U.S. were more than ever subjected to a hostile anti-immigrant climate under Trump's administration. Given this compounded stress, the impact of the pandemic on mental health is likely to be disproportionately experienced by undocumented immigrants. In response, a group of psychologists partnered with a leading immigrant rights advocacy organization and formed a reciprocal collaboration to support undocumented communities. A major focus of the collaboration is to foster learning, supporting members of the immigrant community to contribute to their own well-being and others in the community. Accordingly, the collaborative developed and delivered a web-based mental health education session to the immigrant community and to practitioners serving this population. The session presented the use of healing circles as a strength-based approach to building resilience and also sought feedback regarding specific features of healing circles that can enhance their effectiveness in managing distress. Survey data and qualitative findings from this study show that those who participated in the web-based program perceived the session as validating and informative. Findings also underscored the need for creating safe spaces for community members to be vulnerable about their lived experiences while promoting ownership of their narratives. We discuss practical implications pertaining to the development and facilitation of social support groups for immigrants led by non-specialist community members trained for this role.

Dentro de los Estados Unidos (EE. UU.), la pandemia de COVID-19 acentuó desigualdades críticas que afectan a las comunidades indocumentadas, provocando un nivel de estrés particularmente alto entre los miembros de estas comunidades. Además del estrés asociado con el COVID-19, los inmigrantes en los EE. UU. estuvieron más que nunca sujetos a un clima antiinmigrante y hostil bajo la administración de Trump. Dado este estrés agravado, es probable que los inmigrantes indocumentados experimenten el impacto de la pandemia en su salud mental de manera desproporcionada. En respuesta, un grupo de psicólogos se unió a una organización líder en defensa de los derechos de los inmigrantes y formó una colaboración recíproca para apoyar a las comunidades indocumentadas. Un enfoque central de esta colaboración ha sido fomentar el aprendizaje, apoyando así a los miembros de la comunidad inmigrante para que contribuyan a su propio bienestar y al de los demás en la comunidad. Por consiguiente y a través de esta colaboración, se desarrolló y presentó una sesión de educación en línea sobre salud mental a la comunidad de inmigrantes, así como a los profesionales que sirven a esta comunidad. La sesión presentó el uso de círculos curativos como una estrategia basada en las capacidades para desarrollar la resiliencia y buscó también obtener retroalimentación sobre características específicas de estos círculos que puedan aumentar su efectividad en el manejo de la angustia. Los hallazgos de la encuesta y cualitativos de este estudio muestran que los participantes percibieron la sesión como validante e informativa. Los hallazgos también destacaron la necesidad de crear espacios seguros para que los miembros de la comunidad puedan ser vulnerables sobre sus experiencias vividas mientras se promueve la propiedad de sus narrativas. Discutimos las implicaciones prácticas relacionadas al desarrollo y la facilitación de grupos de apoyo social para inmigrantes dirigidos por miembros de la comunidad capacitados para asumir dicho rol.

Buscando la Calma Dentro de la Tormenta: A Brief Review of the Recent Literature on the Impact of Anti-Immigrant Rhetoric and Policies on Stress Among Latinx Immigrants.

The mental health burden associated with anti-immigrant rhetoric and ever-changing immigration policies is undeniable, though the psychological and emotional sequalae may remain invisible for years to come. Exclusionary immigration policies, as a form of structural racism, have also led to an epidemic of stress-related health within the Latinx community, particularly the Latinx immigrant community, across the United States. Recent examples of anti-Latinx and anti-immigrant rhetoric and policies include the 45th President's implementation of the Zero Tolerance policy, Migrant Protection Protocols, and Title 42. The recognition of previous and existing anti-immigrant policies, and the impact on Latinx immigrants, is critical in understanding the manifestation of psychological stress to prevent it from becoming chronic. For mental health providers, attention to existing policies that can be detrimental to the Latinx immigrant community is essential to understanding their mental health trajectory and applying frameworks that honor an individual's psychological stress to prevent pathologizing the immigrant experience and negative health outcomes. The objective of the present brief review is to shed light on recent research and offer recommendations for practice (eg, educating the Latinx community about the link between the immigrant experience and psychological stress) and policy (eg, drafting of legislation aimed at rescinding harmful immigration policies) regarding the relation between aggressive anti-immigration rhetoric and psychological stress among Latinx immigrants in the United States.

Cuento de nunca acabar [never-ending story]: Compounding trauma and mental health among undocumented Latinx immigrants.

Research examining the effects of traumatic events on undocumented Latinx immigrants often focuses on assessing posttraumatic stress disorder or general psychological distress, which may obscure the field's understanding of how trauma exposure impacts other common mental health disorders (e.g., anxiety, depression). This study sought to assess the cumulative, individual, and timing effects of immigration-related traumatic events on anxiety and depressive symptoms among undocumented Latinx immigrants. Participants were 253 undocumented Latinx immigrants recruited using respondent-driven sampling who reported their history of immigration-related trauma exposure and symptoms of depression and anxiety. Results suggest that cumulative immigration-related trauma was significantly associated with increases in anxiety and depressive symptoms, τ = .26. Significant positive correlations were found for cumulative trauma at each point in the immigration process (i.e., before immigration, while in transit to the United States, and while living in the United States) such that increases in the number of events were associated with higher anxiety and depressive symptom levels, τ = .11-.29. Trauma frequency differed throughout the immigration process such that some events more commonly occurred before immigration or during transit to the United States, whereas others occurred while an individual resided in the United States. Random forest algorithms uncovered differences in the relative importance of individual traumatic events in explaining the variance of depressive, R2 = .13, and anxiety symptoms, R2 = .14. The findings highlight the importance of providing trauma-informed care when treating anxiety and depression among undocumented Latinx immigrants and considering multidimensional epidemiological approaches in assessing immigration-related trauma.

Applying an Antiracist Approach to Promoting Health Equity and Psychological Well-Being in Unaccompanied Immigrant Minors.

Unaccompanied immigrant minors (UIMs) are a fast-growing demographic in the United States, doubling in population since 2014.1 According to the Office of Refugee Resettlement, a UIM is someone under the age of 18 years who enters the United States without lawful status and an accompanying guardian.2 Most UIMs in the United States originate from the Central American northern triangle (ie, El Salvador, Guatemala, Honduras), with violence, extreme poverty, and family re-unification as the top 3 reasons for migration.1,3 Repeated exposure to stressful and/or traumatic events at home, during migration, and upon arrival increases UIMs' risk for psychological distress and mental disorders.3 UIMs' repeated encounters with race-based trauma (eg, racism, discrimination) further heightens this risk.3 The repercussions of these events are compounded by the fact that UIMs lack the adversity buffering effect that is traditionally associated with the presence of a caregiver.3 Furthermore, UIMs' mental health risk is augmented by their interaction with US systems (eg, legal, immigration, child welfare, educational, healthcare) with policies and practices that are discriminatory, are exclusionary, propagate the view of UIMs as racialized threats to society, and fail to consider their developmental context.3,4 Considering these risks, it is imperative to the well-being and positive development of UIMs that they have access to quality mental health services (MHS).

Anti-immigration policy and mental health: Risk of distress and trauma among deferred action for childhood arrivals recipients in the United States.

OBJECTIVE: This study examined the association between immigration legal status and distress from the announcement of the termination of the Deferred Action for Childhood Arrivals (DACA) program among individuals affected by this potentially traumatic event (PTE), along with identifying relevant risk factors. METHOD: Participants (N = 233) affected by the termination announcement provided cross-sectional self-reports on distress from the announcement that was measured using the Impact of Events Scale-Revised. RESULTS: Of the participants, 40.7% met the clinical cutoff for distress from the PTE indicative of posttraumatic stress disorder. DACA recipients had significantly higher levels of distress from the PTE compared with non-DACA undocumented immigrants and documented counterparts, χ²(2, N = 233) = 23.25, p < .001. After controlling for covariates, being a DACA recipient (OR = 4.11, 95% confidence interval [1.99, 8.50], p < .001), being male (OR = 2.06, [1.05, 4.03], p = .035), and having lower financial security (OR = .54, [.38, .75], p < .001) were significantly associated with distress. CONCLUSION: The future of DACA recipients is uncertain, which can be trauma inducing. The field of psychology needs to make space for this kind of experience as potentially traumatic. Advocacy efforts to shift immigration policies can be strengthened to alter the negative effects of the potential termination of DACA on those affected by it. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Increasing diversity in developmental cognitive neuroscience: A roadmap for increasing representation in pediatric neuroimaging research.

Understanding of human brain development has advanced rapidly as the field of developmental cognitive neuroscience (DCN) has matured into an established scientific discipline. Despite substantial progress, DCN lags behind other related disciplines in terms of diverse representation, standardized reporting requirements for socio-demographic characteristics of participants in pediatric neuroimaging studies, and use of intentional sampling strategies to more accurately represent the socio-demographic, ethnic, and racial composition of the populations from which participants are sampled. Additional efforts are needed to shift DCN towards a more inclusive field that facilitates the study of individual differences across a variety of cultural and contextual experiences. In this commentary, we outline and discuss barriers within our current scientific practice (e.g., research methods) and beliefs (i.e., what constitutes good science, good scientists, and good research questions) that contribute to under-representation and limited diversity within pediatric neuroimaging studies and propose strategies to overcome those barriers. We discuss strategies to address barriers at intrapersonal, interpersonal, community, systemic, and structural levels. Highlighting strength-based models of inclusion and recognition of the value of diversity in DCN research, along with acknowledgement of the support needed to diversify the field is critical for advancing understanding of neurodevelopment and reducing health inequities.

Vaccination for COVID-19 among historically underserved Latino communities in the United States: Perspectives of community health workers.

A critical step to reduce the spread of COVID-19 is vaccination. We conducted a mixed methods project that used online surveys and focus groups with 64 Community Health Workers and Promotor/as (CHW/Ps) located near the U.S.-Mexico border to identify barriers and facilitators to COVID-19 vaccination among Latino communities that have been historically underrepresented and medically underserved. Overall, personal barriers to vaccination included mistrust of manufacturers and administrators as well as fear of: becoming infected from the vaccine, discrimination/stigmatization from healthcare professionals administering the vaccine, exploitation/manipulation by the government or health authorities, and having personal information mishandled. Environmental and community barriers included being undocumented and fear-inducing myths and beliefs. Additional barriers included limited information and logistics pertaining to vaccination access. Targeted efforts are needed to overcome barriers in a culturally and contextually sensitive manner to prevent harm and reduce risk of infection among communities that have been historically underrepresented.

Trauma in the American asylum process: Experiences of immigrant families under the migrant protection protocols.

OBJECTIVE: Latinx asylum-seeking families report posttraumatic distress that is 161-204% higher than in nonimmigrants, with adverse consequences for health and well-being. Recent U.S. policies have further embedded trauma in the asylum-seeking process by forcing families to remain in Mexico, enduring dire living conditions in tent encampments near the border while awaiting processing. These families are now entering the United States in large numbers. This article sheds light on their recent experiences and mental health needs, using a mixed methods-grounded theory design, presenting quantitative and qualitative data to describe the experiences of six asylum-seeking families who waited for 1-2 years in the refugee camp in Mexico. METHOD: Quantitative data was obtained from the Brief Symptom Inventory-18 and the Harvard Trauma Questionnaire while qualitative interviews provided insight into reasons for migration and trauma at different stages of the migration process. RESULTS: All participants experienced multiple traumas and endorsed trauma related symptoms. Important themes of psychological distress and trauma emerged, including unending suffering, hunger, and worry for the safety of their children while living in the refugee camp. Asylum-seeking families experienced substantial distress and trauma secondary to their stay in Mexico and COVID-19. CONCLUSION: Families arriving to the United States have experienced significant trauma, separation, and loss before and during their journey. Interactions with an unprepared and overwhelmed immigration system further compromises their psychological well-being. It is imperative that first-person narratives inform policy that addresses their complex needs and protects their human rights. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mind the gap: Identifying training needs of community health workers to address mental health in U.S. Latino communities during and beyond the COVID-19 pandemic.

Addressing mental health is an important part of the COVID-19 response among historically underserved communities, which have been disproportionately affected. Community Health Workers (CHWs) are well placed to offer insights about barriers to mental health service use in their communities, and they are well positioned to address mental health gaps by providing education, resources, and assistance to bridging the gap for the use of more traditional mental health services. Using the perspectives of CHWs, this project identified barriers faced by CHWs in assisting community members with their mental health needs, along with relevant training needs to more effectively deliver mental health resources, referrals, and recommendations to community members. Survey data along with data from focus groups were collected among 43 CHWs in communities that have been historically underserved near the U.S.-Mexico border region. Quantitative data were analyzed using descriptive statistics whereas qualitative data were analyzed through systematic methods. Identified barriers to assisting community members with their mental health needs exist at the personal, community, environmental and organizational levels, and ranged from fear and mistrust to limited services, resources, funding and training opportunities. To help address the aforementioned barriers and facilitate access to mental health service use in their communities, CHWs identified and described opportunities for training in core areas including communication, mental illness symptom identification, trauma, self-care and stress reduction, and cultural awareness and sensitivity. Needs-based training programs that incorporate the insights of CHWs are a crucial part of promoting community-based mental health to address existing mental health disparities in access to and use of mental health services.

"No one left behind": A social determinant of health lens to the wellbeing of undocumented immigrants.

Undocumented and mixed-status families, in which some, but not all members have an undocumented immigration legal status, often face multiple and chronic stressors that influence their health. Compounded by trauma and limited opportunities, the aforementioned stressors negatively impact the physical and mental health of the undocumented and mixed-status population. This article uses a social determinants of health (SDOH) framework, examining five key domains--economic stability, education, healthcare, the social and community context, and the neighborhood and built environment. Undocumented immigrants face challenging living, social and work environments, have less economic stability, and have restricted access to opportunities. The aforesaid challenges place undocumented and mixed-status families at risk. Strategies are discussed to improve the health outcomes of this vulnerable population.