Practitioners' Perspectives on Barriers and Benefits of Telemental Health Services: The Unique Impact of COVID-19 on Resettled U.S. Refugees and Asylees.

The COVID-19 pandemic and associated sequelae have disproportionately exacerbated refugee mental health due to health disparities, poverty, and unique risk factors. In response to the pandemic, most mental health providers have shifted to virtual platforms. Given the high need for services in this population, it is essential to understand the effectiveness and potential barriers to serving refugees via telehealth. This study is one of the first to examine the extent that socio-cultural and structural barriers impact telemental health services received by resettled refugees during the COVID-19 pandemic. This study also addresses the potential benefits of telemental health service delivery to refugees. We surveyed 85 providers serving refugee and non-refugee clients in the United States. Statistical analyses revealed that more significant socio-cultural and structural barriers, including access to technology, linguistic challenges, and privacy limitations, exist for refugees compared to non-refugee clients. Potential benefits of telemental health for refugees during the pandemic included fewer cancellations, fewer transportation concerns, and better access to childcare. These results highlight the need to address the disparity in telemental health service delivery to refugees to limit inequities for this population.

Identifying resilience-promoting factors for refugee survivors of torture.

INTRODUCTION: There are 1.3 million refugee survivors of torture living in the United States today. An existing body of research with refugees has largely examined mental health, but few of these studies focused on resilience. OBJECTIVE: Using a clinical sample of refugee survivors of torture, we tested the resiliencepromoting factors of community engagement, employment, English fluency, and psychological flexibility. We conducted moderation and mediation analyses to investigate how these resilience-promoting factors impact the torture-mental health relationship. RESULTS: Torture severity had significant positive associations with all mental health symptoms including PTSD (post-traumatic stress disorder), depression, and anxiety. Conversely, psychological flexibility had significant negative associations with all mental health symptoms. Additionally, psychological flexibility was a significant mediator of the torture-mental health relationship, highlighting its potential as a causal mechanism between torture and mental health. This evidence suggested that experiencing greater torture severity led to greater mental health problems in part via difficulties in psychological flexibility. Separately, English fluency and employment status were negatively correlated with mental health symptoms. CONCLUSION: The findings from this study identified potentially resilience-promoting factors for refugee survivors of torture and contributed to both research and clinical insights in better serving this vulnerable population.

Emotional responding: Integration of multiple constructs and association with psychological health.

OBJECTIVE: Numerous psychological constructs exist to describe different facets of emotional responding, but they have rarely been examined together. We empirically modeled the associations between four psychological constructs (mindfulness, emotional nonacceptance, experiential avoidance, and anxiety sensitivity) of individuals' responses to their affective experience, hypothesizing that a bifactor model would fit the data best. METHOD: We used exploratory structural equation modeling, a novel latent variable modeling framework, to compare five measurement models of emotional responding in an online community sample (N = 307). RESULTS: A bifactor model including a general emotional responding factor had substantial factor loadings from nearly all items, with mixed results for specific factors. Exploratory analyses supported the significant association of avoidant emotional responding and psychopathology/well-being. CONCLUSION: The general avoidant emotional responding factor appears to overlap most directly with experiential avoidance and may be a transtheoretical construct relevant to mental health.

A house is not a home: Modeling the effects of social support and connection within resettled refugee populations.

AIM: The U.S. resettlement program currently resettles refugees in communities of similar or the same ethnic background known as like-ethnic communities. This practice provides resettled refugees with a familiar community who may be able to provide support through the difficult resettlement process. However, by associating with a like-ethnic community, resettled refugees may limit interaction with the host community, which may have subsequent adverse effects on well-being. METHODS: This study examined whether satisfaction with community support is moderated by a premigration factor (trauma history) or a postmigration factor (English fluency) in predicting depressive symptoms in a resettled refugee community (N = 179). Four moderation models were analyzed and compared. RESULTS: The model in which English fluency moderated the relationship between satisfaction with community support and depressive symptoms had the best overall model fit. In addition, trauma history was found to also be a meaningful but secondary moderator within this relationship. English fluency and trauma history within this study did not significantly interact. CONCLUSION: These results highlight the importance of early English language lessons and community support during resettlement. Further, they emphasize the need to integrate refugees with individuals from similar backgrounds, as well as with host communities throughout resettlement.

Suicide and Suicide-related Behavior among Bhutanese Refugees Resettled in the United States.

Suicidal behavior and death by suicide are significant and pressing problems in the Bhutanese refugee community. Currently, Bhutanese refugees are dying by suicide at a rate nearly two times that of the general U.S. population. Proper identification of risk factors for suicide saves lives; however, if risk is underestimated due to culturally inflexible risk assessments, preventable deaths may continue to occur. In this review, we examine specific cultural factors related to psychopathology and suicide among Bhutanese refugees. To contextualize the current suicide crisis among Bhutanese refugees, we propose an integration of the interpersonal psychological theory of suicide (Joiner, 2005) and the cultural model of suicide (Chu, Goldblum, Floyd, & Bongar, 2010). We provide recommendations for preventing suicide from a systems framework and discuss practical lessons from a preliminary study designed to test a culturally-responsive model of suicide in Bhutanese refugees.

The Chronic Traumatic Stress Framework: A conceptual model to guide empirical investigation and mental health treatment for refugees and survivors of torture.

An increasing number of refugees and survivors of torture resettled in the United States are presenting to clinics for treatment related to trauma and postmigration difficulties. Although clinicians experienced in treating trauma with diverse populations may recognize the limitations of a PTSD diagnosis, one of the primary diagnoses received by refugees and survivors of torture remains post-traumatic stress disorder (PTSD). A variety of interventions exist (e.g., supportive, trauma specific, interdisciplinary including physical, social and psychological) for survivors of torture and trauma that move beyond this diagnosis, however, a unifying conceptual model is needed to guide treatment and further the empirical investigation and evidence base in this growing field. In this paper, we propose a broader biopsychosocial framework of the impact of traumatic war events including the measurement of stress related to post migration living difficulties, and daily hassles while highlighting the importance of protective and risk factors. Intervention outcomes emphasize resilience, physical well-being, and mental well-being, along with traumatic stress symptoms. We describe Chronic Traumatic Stress (CTS) as an integrated and unifying framework which provides guidance for the growing number of providers conducting assessment and intervention with refugees and survivors of torture. We also highlight that this model is specifically designed for empirical testing.

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

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.