Addressing the Mental Health Needs of Immigrant and Refugee Youth and their Families

1. Addressing the Mental Health Needs of Immigrant and Refugee Youth and their Families Olga Acosta Price, Ph.D. Mark Sander, Psy.D. Oct 18, 2007

2. Caring Across Communities Addressing Mental Health Needs of Diverse Children andYouth

3. Demographics • In 2000, 31.1 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 a child of immigrants • In the past 30 years, over 2 million refugees have resettled in the US, with a significant 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

4. Challenges Faced • Poverty rates are much higher for children in immigrant and refugee families than children in native-born families • Parents are more likely to perform low-wage work with no benefits (lack of health insurance) or limited benefits • Pre-migration, migration, and post-migration exposure to traumatic events creates vulnerabilities • People with limited English proficiency (LEP) are less likely to seek care and receive needed services (even when economic factors and ethnicity are accounted for)

5. Utilizing a School Base • Important resources at hand • ESL, student support services, special education, offices of multicultural services • Familiarity with translation and interpretation • Understand the value of community partnerships • Often less stigmatizing to receive services as part of support offered in school

6. Cultural Competence • How do we know that our constructs around mental health mean the same thing to our clients? • Do processes for obtaining informed consent need to be modified? • 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 National Program • Commitment to vulnerable populations and ending disparities in health care & outcomes • Expectations concerning CAC National Program • Developing models for assuring language access for children & their parents • Developing models for building cultural competence • Adapting evidence-based prevention and treatment interventions to effectively meet the needs of immigrant and refugee families and their children • Over 355 applications were received

8. Program Summary & Key Elements • 15 grantees identified and awarded up to $100,000 a year for three years (starting March 2007) • Serving an immigrant or refugee-dense community • Building on the combined strengths of a community partnership • Utilizing a school base • Understanding the target community & its most pressing mental health issues • Reducing barriers to care created by language and cultural difference

9. Program Monitoring and Evaluation • Program monitoring • Quarterly narrative • data reports • ‘success stories’ • Evaluation • Utilization • Satisfaction • Outcomes • Lessons learned- redefining best practices

10. School Mental Health: Building Cultural Connections and Competence Minneapolis Public Schools, Hennepin County, and Community Mental Health Agencies

11. Program Overview The Minneapolis Expanded School Mental Health (ESMH) Program provides a broad continuum of Mental Health services through public/private partnerships that are: • Universally accessible • Culturally competent • Effective • Sustainable • Compliant with data privacy requirements

12. Program Overview The Caring Across Communities Initiative allows us to enhance our Expanded School Mental Health Program by: • Improving language access • Enhancing service by training and adapting interventions • Providing culturally specific support services • Disseminating lessons learned to school staff, local providers and organizational leaders and policy makers

13. Program Overview The Continuum includes: • On site services for prevention, early intervention, screening, diagnostic evaluation and treatment (including individual, family and group) • Teacher consultation • Capacity Building – School staff training As needed: • Access to Targeted Mental Health Case Management • Day Treatment • Residential Treatment • Crisis Assessment and Intervention

14. Program Overview The ESMH Program is built on a partnership between: • Community Mental Health Providers • Hennepin County • Minneapolis Public Schools

15. Program Overview:Minneapolis Context Minneapolis is a culturally diverse city, The school district has: • 76% Students of Color • 26% ELL • Large African immigrant population • Largest Somali and Oromo communities in the nation • Growing Spanish speaking population

16. Program Overview:Need for Cultural Connections and Competence • Significant change in demographic of Minneapolis Public Schools in past 15 years • Large unmet need for mental health services for children and families, especially low income and immigrant and refugee students and families • Delivering usual care and/or evidence based interventions might not work for immigrant and refugee students and families

17. Project Plan:Overarching Goals • Goal 1: Improve access to mental health services for all students and families • Goal 2: Expand cultural competence of mental health clinicians and school staff • Goal 3: Build family and community connections and interventions • Goal 4: Capture lessons learned and disseminate knowledge and best practice

18. Improving access: 1st Year Progress • Bilingual providers on-site and/or culturally informed interpretation • Translating core documents (i.e., HIPAA, ROI, informed consent) • Translation of program brochures and agency inserts • Cross-training with OMS, family liaison, and clinicians

19. Expanding cultural competency: 1st Year Progress • Developed training plan for clinicians and administrators • Cross training with OMS and family liaison • Identification and Assessment of Trauma in Children • On-line TF-CBT offered through NCTSN • RWJF Web-based training • Discussions in Administrators’ and Clinicians’ meeting regarding current cultural issues • Initiated Community Advisory Group • September 25: 1st Meeting; November 8th next meeting

20. Building family and community: 1st Year Progress • Approximately 25% of clinicians’ contact are with the family • Clinicians can deliver services in home • Work with Community Advisory Group to develop additional outreach and engagement strategies

21. Capturing lessons learned and disseminating: 1st Year Progress • Disseminate internally within partner agencies • Disseminate externally to the local community of mental health providers

22. Challenges • Developing language access and cultural congruence of concept of mental health/wellness • Limited number of bi-cultural mental health professional, especially from African cultures • Potential concerns using interpreters • Confidentiality • Accurate interpretation of the questions and answers • Possible “intervention” by interpreter • Significantly different ideas of how one heals and the etiology of the issue or concern • Little research on what works for different cultures

23. Opportunities • Work with the African and Latino communities to develop better engagement and intervention strategies • Work with the African spiritual community (Imams) to develop better understanding of each other and do some cross-education • Develop and sustain strong partnership to develop a system of mental health care for immigrant and refugee students and their families • Learn what works with these students and families and disseminate the knowledge locally, regionally and nationally

24. Partners:District and School Staff • District wide coordination and alignment • Principals and student support staff • Teachers

25. Partners:Community Partners • Community mental health staff • The Mental Health Collective • Provide mental health services at Andersen Open, Andersen Elementary, and Sullivan schools • La Familia Guidance Center • Provide mental health services at Jefferson School Non-RWJF funded SMHP sites • Washburn Guidance Center • Provide mental health services at Tuttle and Longfellow Schools • NorthPoint Mental Health Center • Provide mental health services at Lucy Laney School

26. Partners:Community Partners • Culturally specific agencies • African Aid • Have strong relationships in cultural communities served • Mental health outreach and education to African Immigrants • Hennepin County Office of Multicultural Services • Have established trusting relationships with cultural communities served • Provide linguistically and culturally appropriate support assistance • Family Resource Centers: Parent Liaison • Have strong relationships with parents • Understand the needs of immigrant and refugee families • Provide support services in schools

27. Partners:Hennepin County Children’s Mental Health Area • Aligned county services and contracts to better integrate services in schools and increase access • Case Management • Day treatment • Residential Services • Contracts with community providers for students’ uninsured with serious emotional disturbance • Promoting cultural competence providers and systems

28. Partners:Consulting Partners • Abigail Gewirtz, Ph.D., L.P., University of Minnesota • Will assist in assessment and adaptation of child trauma protocols for immigrant and refugee communities • Director, Minnesota Child Response Center • Has a long history of partnering with MPS and Hennepin County Children’ Mental Health • Served as a consultant for program evaluation design for MPS ESMH program

29. Partners: State Partners • MN Department of Health • Ann O’Fallon, State Refugee Health Coordinator • MN Department of Human Services • Dr. Glenace Edwall, Director, Children’s Mental Health • MN Department of Education • Cindy Shevlin-Woodcock, School-based Mental Health Specialist

30. Contact Information • Olga Acosta Price, Ph.D. Co-Director, Center for Health and Health Care in Schools School of Public Health and Health Services, GWU • Email: oaprice@gwu.edu • Phone: 202-466-3396 • http://www.healthinschools.org • 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 • Phone: 612-668-5489