Addressing Mental Health Disparities in Refugee ChildrenL A CBPR Collaboration

描述（由申请人提供）：在美国，难民儿童和家庭在心理健康障碍的发病率和治疗方面面临着巨大的差异。重新安置的压力因素（贫困、获得护理的机会有限）和非文化适应的挑战（文化规范的差异、歧视）往往会加剧与战争有关的创伤暴露所带来的风险。通常，难民的心理健康服务是有限的——通常只专注于创伤后应激障碍的临床治疗——很少回应难民社区的整体需求；尽管美国的难民人口统计数据在迅速变化，但很少有干预措施被设计用于跨文化和难民群体。基于社区的参与性研究（CBPR）方法的跨文化应用可以增加对难民社区风险和保护因素的了解，并有助于制定灵活的心理健康干预措施，以解决差异。这个CBPR项目建立在与大波士顿地区索马里班图难民社区现有的合作研究关系的基础上。初步研究已经确定了许多文化和社区优势，以及家庭冲突，亲子沟通不良等持续存在的问题，这些问题与持续的压力因素相互作用，增加了儿童情绪和行为问题的风险。以家庭为基础的干预模式经当地投入调整，并由受过培训的社区成员提供，在美国的这些和其他难民群体中大有希望。本研究将使用CBPR混合方法（定性和定量数据收集）进行需求评估，并设计和评估核心家庭干预措施。项目活动将强调在大波士顿地区重新安置的两个难民社区（索马里班图人和不丹人）的能力建设，积极动员难民社区成员、社区咨询委员会、服务提供者和其他利益攸关方。具体目标是：(1)通过共同领导、能力建设和知识共享，深化与索马里班图人和不丹人社区的伙伴关系；(2)收集和应用定性数据，以便(a)就儿童和青少年的心理健康、获得护理的障碍和每个目标难民群体的服务偏好编制需求评估；(b)为难民照顾者和儿童开展心理健康/社会心理评估；(c)调整以家庭为基础的加强干预的核心组成部分，以便用于难民；(3)对80个家庭进行试点研究，以检验干预的可接受性和可持续性。主要成果将是改善照料者与儿童之间的关系、获得精神卫生服务、增强功能以及减少儿童和青少年的精神卫生症状。

DESCRIPTION (provided by applicant): In the US, refugee children and families face dramatic disparities in the incidence and treatment of mental health disorders. Resettlement stressors (poverty, limited access to care) and acculturative challenges (differences in cultural norms, discrimination) often exacerbate risks due to war-related trauma exposure. Commonly, refugee mental health services are limited-usually with a narrow focus on clinical treatment of PTSD-and rarely respond to the holistic needs of refugee communities; few interventions are designed to be used across cultures and refugee groups, despite rapidly evolving refugee demographics in the US. The cross-cultural application of community-based participatory research (CBPR) methods can increase understanding of risk and protective factors in refugee communities and contribute to development of flexible mental health interventions to address disparities. This CBPR project builds on an existing collaborative research relationships with the Somali Bantu refugee community in Greater Boston. Preliminary research has identified numerous cultural and community strengths as well as ongoing problems of family conflict, poor parent-child communication which interact with ongoing stressors to increase risks for child emotional and behavioral problems. Family-based intervention models adapted via local input and delivered by trained members of the community hold great promise for use among these and other refugee groups in the US. This study will use CBPR mixed methods (qualitative and quantitative data collection) to conduct needs assessments and design and evaluate a core family-based intervention. Project activities will emphasize capacity building in two refugee communities resettled in Greater Boston-the Somali Bantu and the Bhutanese-actively engaging refugee community members, community advisory boards, services providers, and other stakeholders. Specific Aims are to: (1) deepen partnerships with the Somali Bantu and Bhutanese communities through co-leadership, capacity-building, and knowledge sharing; (2) collect and apply qualitative data to (a) prepare a needs assessment of mental health in children and adolescents, barriers to care, and services preferences with each target refugee group; (b) develop mental health/psychosocial assessments for refugee caregivers and children; (c) adapt the core components of a family-based strengthening intervention for use with refugees; and (3) conduct an 80-family pilot study to examine acceptability and sustainability of the intervention. Key outcomes will be improvements in caregiver-child relationships, mental health services access, increased functioning, and reduced mental health symptoms in children and adolescents. RELEVANCE (See instructions): The proposed study will employ cross-cultural CBPR methods to develop a family-based intervention grounded in needs assessments on contributors to mental health disparities among refugee children and families. The mixed methods research approach to selecting, adapting and implementing culturally-informed assessments and intervention models has the potential to contribute to feasible, acceptable and sustainable intervention models of mental health services for diverse groups of refugee children and families.