Mental Health Screening and Promoting Positive Identity Development Among Youth Who Are Refugees: Program Development

By the summer of 2022, more than 100 million individuals had been forcibly displaced by war, persecution, and unrest across the world (United Nations High Commissioner for Refugees, 2022). the prevalence of mental health and psychosocial needs are well-documented among refugee youth and families, however, there exist many barriers to accessing appropriate services. Universal screening, low-intensity, and strengths-based programs are recommended as initial steps in overcoming some of these barriers. This study was conducted in partnership with the International Rescue Committee (IRC), a community organization that resettles individuals who are displaced by war or crisis. This partnership was established in 2018, when Phase One of the current project began with qualitative interviews that examined challenges refugee youth and families, from sub-Saharan Africa, face upon resettlement. Interviews expanded our understanding of the psychosocial needs of youth, and highlighted the vulnerability of girls (Woodford et al., in review), and the need to support positive ethnic and cultural identity development (Rial et al., 2021). During the second phase, findings from the interviews informed the development of parallel youth and parent group intervention programs, Culture Connection. These group programs could not be implemented as planned due to COVID. Alternatively, early discussions with the IRC Youth Program staff revealed the need for mental health screening and strategies to promote positive cultural identity. This offered an opportunity to adapt the original group manual into a briefer intervention, Positive Cultural Identity (PCI), which was delivered one-on-one within the IRC's existing Academic Coaching (AC) Program. Thus, the current study presents the modified Phase Two, which involved two primary aims. The first aim of the current project was to a) develop and implement a mental health screening program in the AC Program, b) determine the feasibility and acceptability of the program, c) examine the reliability of the selected screener, and d) explore differences in reported distress across students, particularly sex differences. The second aim was to adapt the original group manual to be a brief, low-intensity, intervention and integrate it into the existing structure of the AC Program. The feasibility and acceptability of the intervention was evaluated, as well as the reliability of the outcome measures. Analyses were also conducted to evaluate changes in positive ethnic identity between pre and posttest measures. Results: (Aim 1) Mental health (MH) screening was conducted with 54 participants (65% of those eligible). Although it was generally well-accepted and feasible to deliver, certain factors influenced feasibility and acceptability. Coaches noticed that responses to the screener, by both students and families, reflected a strong stigma around MH. The Refugee Health Screener (RHS-15) was found to be a reliable measure of distress. Lastly, girls endorsed more distress than boys. (Aim 2) Coaches delivered a five-lesson intervention promoting positive ethnic identity during individual meetings with students. Among 38 students (45% of those eligible) who completed a pretest scale, 55% completed at least one lesson and the posttest scale. Notable barriers impacted the feasibility and acceptability of the intervention, with few students completing all lessons, as designed. The measure of ethnic identity used (Multigroup Ethnic Identity Measure-Revised) was found to be reliable. Small, but not significant, changes in the expected direction were detected between pre and post measures of positive ethnic identity (n = 21). The IRC wishes to continue implementing both programs, with adjustments developed in collaboration with the Youth Program Leadership. Mental health screening offered opportunities to discuss sources of stress and well-being. The Positive Cultural Identity (PCI) intervention opened up valuable discussions around ethnicity and culture. For the intervention program, a hybrid of both group and individual format is being implemented in the summer term.