Enhancing Mental Health for Immigrant and Refugee Communities

1. Adapting Evidence-Based Practices to Meet the Mental Health Needs of Immigrant and Refugee Communities Olga Acosta Price, George Washington University Mark Sander, MN Public Schools/Hennepin County Joshua Kaufman, LA Unified School District

2. Presenter Disclosures 13th Annual Conference on Advancing School Mental Health There are no financial interests to disclose

3. Evidence-Based • Draws on theory • Undergone scientific evaluation • “…programs or practices that effectively integrate the best research evidence with clinical expertise, cultural competence and the values of the persons receiving the services.” Oregon Addiction and Mental Health Division, 2007

4. Implementation of EBP • Must include: • Assessment of the feasibility of particular approaches • Decisions about the quality of implementation efforts • Concerns of fidelity • Context • Compliance • Competence • Determinations of school, organization, and community readiness

5. What is different now? Dramatically changing demographics • In 2000, over 31 million individuals in the US were foreign-born (an increase of 57% since 1990) • According to the 2000 Census, 1 of every 5 children in the US is an immigrant or child of immigrants • Over 2 million refugees have resettled in the US in the past 30 years (large number being under 18 years old) • 19% of children 5-17 speak a foreign language at home and 5% of all children have difficulty speaking English

6. Cultural Competence • How do we know that our constructs around mental health mean the same thing to our clients? • Are we sure all aspects of service delivery are language accessible? • Are our evidence-based practices really appropriate for the families and children from other countries of origin? • What adaptations are necessary to make sure our treatment programs are effective?

7. Robert Wood Johnson FoundationCaring Across Communities Program • 15 grantees serving an immigrant or refugee-dense community • Building on the combined strengths of a community partnership • Utilizing a school base • Reducing barriers to care created by language and cultural difference

8. Case Examples Involving the community in the adaptation process to ensure cultural competence • Minneapolis Public School District • Building Cultural Connections and Competence in School Based Mental Health • LA Unified School District • Bienestar: Trauma Services for Immigrant Students

9. Building Cultural Connections and Competence in School-Based Mental Health Mark Sander, PsyD, LP and Minneapolis Robert Wood Johnson Partners

10. Partners • Minneapolis Public Schools • Jim Johnson • Hennepin County, Children’s Mental Health • Jamie Halpern • The Mental Health Collective • Martha Olsen • La Familia Guidance Center • Roberto Avina • African Aid • Karim Behi • Hennepin County - Office of Multicultural Services • Minneapolis Public School – Family Liaisons • University of Minnesota – Dr. Abigail Gewirtz “Support for this project was provided by a grant from Caring Across Communities, a national program of the Robert Wood Johnson Foundation.”

11. Demographics • Somali in MN - unofficial est. 10,000-70,000; 2000 Census – 11,164 in MN (7,316 in HC) • Oromo – 7,500 in MN • Latino – 175,000 in 2005; 76,981 in Minneapolis/St Paul; MN Latino population is relatively young: 1 in 3 is under 18; 1 in 4 Minnesotans overall • Minneapolis Public Schools • 76% Students of Color • 26% English Language Learners • Large African immigrant population • Largest Somali and Oromo communities in the nation • Growing Spanish speaking population

12. Cultural Competence and Adaptation • Delivering usual care and/or EBPs might not work for immigrants and refugees • Need for cultural connections to inform adaptations • How do we know that our constructs around mental health mean the same thing to our clients?

13. Building Cultural Competence:Cultural Knowledge To increase our knowledge of the community, we are: • Involving spiritual leaders from the African Community • Involving identified helpers from the Latino and African Communities (e.g., teacher assistants, other service providers, and community advocates) • Involving parents from the Latino and African Communities.

14. Identifying an EBP • Having input from numerous informants • Mental Health Professionals with experience working with target populations • Community Workers with experience working with target populations (African Aid and Office Multicultural Services) • University Researcher (developer of EBP) • Mental Health Supervisors • Identifying need for both population and clinicians gap in experience • Identified: Trauma and parent-child interaction (relationship)

15. Trauma Focused Parent Coaching • Adaptation of Parenting Through Change – SAMHSA National Registry Evidence Base Practice and Programs (Patterson & Forgatch) • Adaptation adds content specific for trauma – emotional regulation and self-care • Skill focused (more acceptable for Somali culture), not “therapy” focused • Assessing need for further adaptations for cultural “fit” with Somali population

16. Trauma Focused Parent Coaching • Advantages • Not diagnosis driven for parent • Use group format (better cultural fit) • Skill focused • Active learning – role plays, mid-week check in calls, home work • Challenges • Intensive training for staff (9 full days; 1 ½ hr coaching weekly) • Child care, incentives, food, logistics, etc. • Making sure it works for our cultural populations

17. Lessons Learned:To be effective we need to Work with children in the context of the family and larger community Provide community resources for children and families Focus on practical solutions; De-emphasize traditional mental health jargon Listen, explore new ways of looking at things, and adapt our model as needed Collaborate with parents, community leaders, and religious leaders

18. Bienestar: Trauma Services for Immigrant StudentsA Project of the Robert Wood Johnson Foundation’s Caring Across Communities program Joshua Kaufman, L.C.S.W. LAUSD/RAND/UCLA Trauma Services Adaptation Center for Schools and Communities School Mental Health Services Los Angeles Unified School District

19. Welcome to LAUSD • Current student population total: • 877,010 • Includes k-12 enrollment, community adult schools, and early education centers • The total area of LAUSD is 710 square miles. The district serves many cities and several unincorporated areas of LA County. • 45% ELLs • 78% Title 1 eligible • 90% of students in Downtown schools are from Mexico and Central America

20. CBITS as Recommended Practice • U.S. Department of Education: CBITS meets standards of the No Child Left Behind policy • Recognized as evidence-based program by: • National Child Traumatic Stress Network • National Registry of Evidence-based Programs and Practices (NREPP) • Promising Practices Network • Office of Juvenile Justice and Delinquency Prevention (OJJDP)

21. Bienestar Program Adapting Evidence-Based services to meet the unmet needs of newly arrived immigrant students: • All services provided in Spanish by bilingual/bicultural clinicians. • All treatment documents translated into Spanish • Addressing traumatic immigration experience, additional attachment issues of separation and reunion, and adjustment to “new life” • Tailoring intervention to older students • Weekly reflective supervision to provide support and monitor fidelity

22. LAUSD Immigrant Center: Key Language Groups

23. Belmont High School’s Newcomer Center

24. Belmont Newcomer HS Teachers 2007 (N=13) Do teachers feel they need more training about trauma and students? Is trauma a relevant issue for students in Your classroom? Not relevant (15%) Very relevant (85%)

25. Violence Exposure & SymptomatologyBelmont Newcomer Students (n=90) September 2007 Experienced multiple traumatic events Gun or knife violence Trauma symptoms in clinical range

26. Services - Year 1 • Rec’d Bienestar CBITS: 9 • Rec’d other adjustment groups: 13 • Rec’d indiv/family support: 38 • Teacher trainings: • Trauma Awareness • Psychological First Aid

27. Opportunities Provide leadership in developing a coordinated system of care with schools as a cornerstone Collaboratively develop culturally specific interventions that are effective by meaningfully involving the community Promote cross-cultural awareness/understanding and be willing to share power Improve community health within immigrant communities and in the larger community Explore additional partnerships and opportunities for collaboration

28. Olga Acosta Price, PhD Co-Director, Center for Health and Health Care in Schools Associate Research Professor, GWU Email: oaprice@gwu.edu Phone: 202-466-3396 Joshua Kaufman, LCSW LAUSD/RAND/UCLA Trauma Services Adaptation Center for Schools and Communities School Mental Health Services Los Angeles Unified School District Email: joshua.kaufman@lausd.net Phone: 213-241-2173 Mark Sander, PsyD, LP Minneapolis Public Schools/Hennepin County Project Director, RWJF Initiative Coordinator, Expanded School Mental Health Program Email: mark.sander@mpls.k12.mn.us or mark.sander@co.hennepin.mnus Phone: 612-668-5489 Contact Information