Several studies and literature reviews have examined different strategies for address-ing individual early mental health interventions for refugee youth. A study by Grasser et al. (2021) suggests integrating mental health screening into the initial physical health screening protocols for newly arriving refugee youth, as early diag-nosis and treatment might reduce future disability and enhance rehabilitation. After screening, refugee youth with mental health issues should be treated at primary care settings, as they are considered the best place to conduct individual interventions (Ellis et al., 2010). Furthermore, receiving mental health services as part of routine care could also reduce the stigma associated with accessing services that exclu-sively treat psychological problems (Shim & Rust, 2013).
Several authors (Forrest-Bank et al., 2019; Hettich et al., 2020; Marshall et al., 2016) have found that building trust and relationships between youth and service providers during the early stages of therapy could be helpful in overcoming the stigma around mental health conditions and services; in particular, it could promote the feeling that youth have a safe space to talk about their lives. Ehntholt and Yule (2006) postulate that appropriate therapeutic interventions during this early stage could include providing psychoeducation regarding symptoms and treatment mod-els, normalizing trauma reactions, and supporting youth as they manage symptoms and develop coping strategies. However, these approaches need to consider cultural competency, with respect and awareness of cultural norms and attention to trauma- informed approaches, to ensure supportive post-migration environments that mini-mize re-traumatization (Forrest-Bank et al., 2019; Hettich et al., 2020; Marshall et al., 2016). Marshall et al. (2016) also recommend considering new and innovative online or mobile approaches to engage youth in their mental health support. Given that mobile approaches are often more anonymous, these could be helpful if youth have a history of mistrust of social services, government, or authorities.
Forrest-Bank et al. (2019) found that providers in the United States working with refugee children, youth, and families felt that certain early therapeutic interventions were helpful, such as cognitive behavioural therapy (CBT), play therapy, and eye movement desensitization and reprocessing therapy. Furthermore, Frounfelker et al. (2020) reported that individual psychotherapy with refugee youth using CBT was effective in reducing post-traumatic stress disorder (PTSD) symptoms: the study participants demonstrated significant improvements in their psychosocial function-ing and remained stable for 12 months for follow-up. Kankaanpaa et al. (2022) advocate for the use of CBT with a trauma-focused lens with refuge youth since it involves several therapeutic elements, such as learning to process past-traumatic events verbally, expressing painful emotions, and constructing a new narrative in a new and safe environment. However, Forrest-Bank et al. (2019) noted that these interventions might not be culturally relevant, and more research is needed to assess whether cultural adaptations are necessary for the therapeutic interventions to be effective. Additionally, von Werthern et al. (2019) examined the effects of trauma- focused therapeutic treatments (e.g., narrative exposure therapy; community- implemented trauma therapy; and culturally modified, trauma-focused CBT) and found them to be effective in reducing PTSD, depression, anxiety, suicidal ideation, and feelings of guilt, as well as increasing functioning and social behaviour among refugee youth. Integrating these therapeutic treatments also requires understanding of each youth’s region and the social context from which they have sought refugee status. For this reason, it is important to incorporate family interventions when car-ing for the mental health of refugee youth. The discussion that follows explores family interventions that engage parents and youth in treatment and examines how the family context contributes to the mental health and well-being of refugee youth.
Family Interventions
Family interventions are defined as social or psychological interventions with the goal of improving the mental health or psychosocial well-being of family members and their overall family functioning (Bunn et al., 2022). Frounfelker et al. (2020) assert that given the relationship between family functioning and youth mental health, interventions situated in families that target the well-being of the entire refu-gee family are needed. In their study with Bosnian refugee families in Chicago, Weine et al. (2008) focused on multiple family interventions known as Coffee and Family Education Support (CAFES). Interventions involved families of early and middle adolescents (age 11–15) with the goal of preventing high-risk behaviours and school dropout. Refugee families were provided with information on parenting, trauma, mental health, and available services. Support groups were also facilitated by refugees who were trained and supervised to conduct these groups in community settings. Further, these interventions included the development of a strength-oriented family narrative focusing on identifying and activating family strengths to increase family functioning and promote access to mental health ser-vices and resource navigation. The study findings indicated that multiple family group interventions were effective in increasing access to mental health services and family comfort when discussing trauma and mental health issues.
Other studies by Weine et al. (2003) and El-Khani et al. (2018) used multiple family groups to support refugee youth mental health. The interventions included family members from multiple families who were experiencing similar culturally mediated family stressors, such as trauma, displacement, and resettlement. The interventions were delivered in community and school settings and focused on interfamilial discussions of stressors affecting family relationships, development of coping strategies to improve family functioning, and identification of family strengths. These studies also incorporated psychoeducation interventions to help families understand and work on the impact of trauma and family communication skills, family goal setting, and social skills training (including rebuilding social sup-port during resettlement). In a study with Somali and Bhutanese refugees, Betancourt et al. (2020) used home visit interventions to promote youth mental health and rela-tionships within their families. The study interventions included psychoeducation on diverse resettlement stressors, navigating the American education system, par-enting skills, and communication skills. These interventions were delivered by lay workers from refugee communities who were trained and supervised to deliver mental health interventions to peers. The study outcomes demonstrated improve-ment in relationships between caregivers and their children, parenting skills, and children’s functioning and mental health.
School-Based Interventions
While individual and family interventions are ideal for responding to the mental health needs of refugee youth, the public health framework calls for an examination of a person’s environment as their social and cultural milieus do influence their trajectory in life. Schools play an integral role in the lives of children and youth as they spend a considerably amount of time in this setting. Their visibility as refugees at school can lead to the identification of their presenting mental health challenges and struggles. Hence, school-based intervention is a necessary step to meet the youth where they are at. Burbage and Walker (2018) posited that addressing the mental health concerns of refugee youth in school settings increased opportunities for early interventions in this group. Schools are often the first places refugee youth begin socializing and building relationships with peers and adults. Further, refugee youth take their initial steps navigating a new culture in the school systems where they are settled. Therefore, school-based mental health programs could provide an outlet for youth to address adverse childhood experiences and overcome barriers they might encoun-ter during and after resettlement. Ellis et al. (2010) suggested that schools tend to be trusted systems and seen by parents as “helpers” for their children. As a result, refu-gee parents are receptive to the idea that mental health support can help refugee youth succeed, particularly when services are available through the school.
Refugee youth have also identified school as a natural place to seek support. Ellis et al. (2010) found that most study participants valued school and family as sources of support. In an evaluation of several school-based mental health services in Britain with adolescent refugees from diverse backgrounds, Fazel et al. (2016) found that participants preferred seeking mental health support at school over other options. Many youth reported feeling safe and familiar at school, making it feasible and comfortable to meet with a therapist during scheduled appointments and on an as- needed basis. Beehler et al. (2012) assessed the effectiveness of providing school- based mental health programs for traumatized immigrants youth in the United States; in this study, all students were provided with clinical services, including CBT, supportive therapy, and coordinating services. The study found that CBT and supportive therapy were associated with increased psychosocial functioning; greater service coordination was associated with decreased PTSD symptoms.
Other researchers recommend school-based interventions that integrate creative techniques (e.g., drama, music, and art therapy) within the classroom, as well as interactions with peers. For instance, Rousseau et al. (2005) developed a program which used drama workshops in a school to support immigrants and refugee youth going through multiple transitional and adverse experiences associated with adoles-cence and migration. The evaluation of this program revealed that the workshops were a safe place for youth to express themselves, supported by the team and the dramatic nature of the play. Youth in the program were able to use stories to explore a wide range of values representing their hybrid world. These stories allowed them to construct meaning and grieve some of the losses associated with migration, a process which ultimately reduced their stress and led to improved academic performance.
Art therapy has also been used to address the mental health of youth who have encountered traumatic experiences. Orr (2007) used content analysis in her review of art therapy with youth who had experienced disaster. She found that art therapy offered youth a way to communicate grief and loss and could be used as a long-term coping resource. Similarly, Eaton et al. (2007) conducted a literature review on the efficacy of 12 peer reviewed art therapy studies with youth who had experienced trauma. Data from these studies indicated that art therapy could be an effective treat-ment to address the negative psychosocial consequences of childhood trauma. Although the studies by Orr and Eaton et al. were not conducted with refugee youth, they examined the potential application of art therapy with youth who had experi-enced trauma, grief, and loss—all issues refugees encounter. A study with Syrian refugee youth demonstrated that art therapy interventions reduced stress and increased coping skills, such as problem solving and social sup-port (Feen-Calligan et al., 2020). Kankaanpaa et al. (2022) asserted that interven-tions with creative writing and drawing were found to be effective for immigrants and refugee youth in decreasing mental health problems and increasing positive resources, such as effective coping and hope. Further, Kankaanpaa et al. (2022) and Burbage and Walker (2018) suggested that training teachers, school counsellors, and administrators to understand and support this group of students in their aca-demic and mental well-being are critical. The training could integrate cultural com-petence to increase educators’ awareness of the impact of trauma on student learning. Furthermore, teachers and school counsellors have a pivotal role in help-ing refugee students improve their mental health.