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This study examines the factors influencing physical health status, specifically focusing on the gender differences in risk and promotive factors affecting health outcomes among Somali refugee youth displaced in Nairobi, Kenya (n = 227). A survey was used to assess participants' physical health along with psychosocial factors, somatic symptoms, and demographic characteristics. The study shows that religious belief and somatic symptoms among the total sample were significant predictors in influencing the outcome of physical health. A moderated mediation analysis and logistic regression analyses also revealed gender differences in associated factors as well as health status; female participants reported higher somatic symptoms, associated with a decline in physical health, whereas the protective effect of social support and religious belief promote was found only among male counterparts. Future studies and interventions would be benefited from a gender-specific approach to health promotion and coping mechanisms in this population. [ABSTRACT FROM AUTHOR]

Refugee newcomers resettled in the United States face numerous challenges impacting their mental health and overall well-being. Despite extensive research on clinical interventions, multimodal interventions with peer-based group models in resettlement contexts remain scarce. Adopting a realist evaluation approach, this study aims to conduct a comprehensive implementation evaluation of a complex community-based mental health and psychosocial support (CB-MHPSS) group intervention, examining its mechanisms and processes while considering the interplay among context, implementing agents, and community settings. Qualitative and quantitative data on the implementation process were collected from 11 refugee agencies, involving trained resettlement staffers (n = 32) and refugee community facilitators (n = 31) who implemented the 31 CB-MHPSS psychosocial groups in 2021. The analysis included fidelity reports, process reflections, and follow-up survey responses, utilizing a structured template based on the CB-MHPSS Theory of Change (ToC) and Medical Research Council (MRC) guidance. Results of an in-depth exploration of complex relations between context and implementation processes reveal the vital role that adaptability to socio-ecological circumstances during the global coronavirus pandemic played in achieving successful implementation of psychosocial group interventions. Striking a balance between fidelity and refinement of intervention of the intervention curriculum emerged as crucial factors for aligning facilitation goals with newcomer needs. This approach maintained the integrity and appropriateness of the intervention, requiring implementers to utilize local knowledge of community resources and their understanding of lived experience of forced migrants and their within the community. Furthermore, exploring intervention barriers and facilitators revealed merits aligned with program change theories and areas for adjustment, while cataloged guidelines addressed community needs, showcasing competence beyond standard checkboxes. Strategic dissemination guidance provided by the central office in a supportive and nonintrusive manner facilitated uptake in a participatory and context-specific manner. This study emphasizes the importance of leveraging community partnerships and local knowledge to result in sustained improvements in the mental health and well-being of refugees. [ABSTRACT FROM AUTHOR]

Urban refugees often face tremendous adversities during displacement that exacerbate mental health and psychosocial outcomes. Given the lack of research on how extended displacement affects mental health in urban refugee youth, this study examines the differential effects of country of birth on trauma exposure and psychosocial factors that influence mental health experiences among Somali refugee youth in urban Kenya (n = 303). Findings reveals that childhood trauma and impeded social functioning predicted mental health outcomes. Being born in Kenya was a significant predictor of poor mental health despite there being no significant difference in trauma exposures and psychosocial factors between Somali-born and Kenya-born youth. This difference can be attributed to prolonged displacement, disrupted development of cultural identity, and discrimination experienced in the host country. Given the widely devastating effects of childhood trauma and community violence, mental health interventions need to be two-prolonged: addressing and preventing intergenerational trauma sequelae through family-based interventions; and community-level programs and advocacy for safety and protection for the displaced. Our findings also emphasize that future interventions for urban refugee communities should be inclusive to all community members, considering shared vulnerability to community violence as well as intergenerational transmission of traumas through childhood adversities and lacking support. [ABSTRACT FROM AUTHOR]

Background: Refugee youth often face numerous adversities before and during forced migration. Although experiences vary across settings and subpopulations, common mental disorders are prevalent among refugee youth who are displaced in low- and middle-income countries. It is important to examine how risk factors are intricately linked and contribute to common mental health issues to inform clinical practice and social policy. Aims: This study aims to test the pathways from risk factors previously identified as determinants of Somali refugee youth mental health (i.e. trauma exposure, substance use, social functioning, aggression) to symptoms of PTSD, depression, anxiety, and somatic pains. Method: We collected survey data in 2013, using snowball sampling to recruit Somali refugee youth (15–35 years old) living in Eastleigh, Kenya. We ran three structural equation models to assess paths from trauma exposure to mental health symptoms, through psychosocial factors including substance use, aggression, and functional impairment. We first conducted this analysis with a mixed-gender sample (N = 305) and then assessed gender differences by running one model for male participants (n = 124) and another for female participants (n = 181). Results: In the mixed-gender sample, trauma exposure directly predicted substance use and both directly and indirectly predicted aggression, functional impairment, and mental health symptoms. Substance use directly predicted aggression and functional impairment, and substance use both directly and indirectly predicted mental health symptoms. The split-gender models revealed gender differences, with only functional impairment directly predicting mental health symptoms in the male sample and with many significant direct and indirect pathways in the female sample. Conclusions: This study shows the role of trauma exposure, substance use, aggression, and social functioning in determining mental health outcomes among refugee youth and how CMD symptoms are differently manifested across genders in this population. [ABSTRACT FROM AUTHOR]

Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth. [ABSTRACT FROM AUTHOR]

This paper introduces culturally responsive and trauma-informed mental health training modules to build and enhance competences and partnerships among mental health professionals and refugee community leaders, while facilitating intercultural, mutual learning between participants from various cultural and professional backgrounds. Focus group interviews and participant self-reflections with the training participants (N = 54) were analyzed using thematic analysis. Findings revealed an enhanced understanding of culturally unique as well as universal trauma responses and coping in the refugee community, which led to the building and strengthening of a sense of community and an expansion of social networks and support systems. This study highlights the effectiveness of interactive learning and knowledge transference among participants with various cultural and professional backgrounds, showing that face-to-face interactions and mutual learning reportedly facilitated building relationships and trust among participants and especially those between refugee/immigrant community leaders and service providers. [ABSTRACT FROM AUTHOR]

Tremendous traumas relating to refugee situations have substantially hindered the mental and behavioral health of refugee youth. Prolonged and cumulative adversities during forced migration have led refugee populations to be exposed to a high risk of substance misuse as part of a coping mechanism. This study aims to explore the role played by substances within the lives of Somali refugee youth who are displaced in low-resource, urban settings. We conducted in-depth individual interviews with twenty Somali refugee youth who are involved in gang activities in urban Kenya. Using a thematic analysis, this study revealed how substances have been used to cope with the negative impacts of trauma and how substances operate as a strategic tool for survival within the lives of displaced Somali refugees. This study discussed the implications for breaking the cycle of substance use. [ABSTRACT FROM AUTHOR]

Background: Comorbid common mental disorders (CMDs) are pervasive in refugee populations. However, limited research has explored psychosocial factors for mental disorder comorbidity in Somali refugee samples. Aims: This study aims to explore potential risk and protective factors for comorbid depression-anxiety and comorbid depression-PTSD by examining associations between trauma exposure, psychosocial factors, and mental health symptoms among a sample of Somali refugees displaced in urban Kenya. Methods: We used snowball sampling to recruit Somali youth aged 15 to 35years(N = 250, n = 143 female, n = 88 male, n = 19 unknown gender). We measured 16 common types of trauma exposure and three psychosocial factors (endorsing violence, willingness to share problems, and symptom awareness) and used the HSCL-25 and PCL-C to capture individual and comorbid CMD symptoms, using guided cutoff points and/or algorithms. We then ran a series of logistic regression analyses to examine relationships between trauma exposure, psychosocial factors, and individual and comorbid CMD symptoms. Results: Findings showed that increased trauma exposure predicted symptoms of individual and comorbid CMDs. Increased symptom awareness and endorsement of violence predicted comorbid depression-PTSD and comorbid anxiety-depression symptoms, respectively. Willingness to share problems buffered depressive symptoms but did not predict comorbidity. Conclusions: These findings revealed the high CMD comorbidity prevalence with differential effects of trauma and psychosocial factors on individual or comorbid mental disorders. This study suggests a need for transdiagnostic approaches that cut across Western diagnostic boundaries and consider culturally responsive and relevant items for mental health measures. [ABSTRACT FROM AUTHOR]

The coronavirus (COVID-19) pandemic has significant impacts on refugee populations and created social, economic as well as public health crises that led to multipronged challenges and barriers to resettlement services and community support. This study aims to explore the impacts of the pandemic on refugee service provision from the standpoint of refugee-serving professionals, refugee community leaders, and volunteers. Using rapid evaluation and appraisal methods, we conducted individual and focus group interviews with 42 key stakeholders in refugee services, followed by a brief online survey with 69 service providers. A thematic analysis revealed how preexisting are conflated with emergent barriers during the pandemic and how such cumulative adversities experienced by the refugee community have widened the gaps in social services and healthcare as well as social support within the refugee community. This study proposes several implications for future research and policy in social work with refugee populations during the post-COVID time. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore exposure to trauma as well as demographic and psychosocial factors as predictors of mental health symptoms among Somali refugees in Kenya. Participants were recruited via snowball sampling to complete a survey and included 86 Somali refugee youth, aged 15 to 34 years, who were living in Eastleigh. We measured trauma using a total traumas experienced variable as well as four trauma types categories (pre-migration/migration trauma, post-migration trauma, family trauma, and individual trauma). We measured anxiety and depression symptoms using the Hopkins Symptom Checklist-25 (HSCL-25) and PTSD using the PTSD Check List – Civilian Version (PCL-C). We ran descriptive statistics followed by multiple linear regression models with trauma exposure, education, gender, and willingness to share problems as predictors of mental health symptoms. Out of 12 possible traumatic events, most participants (83.7%) reported experiencing at least one trauma, and participants reported experiencing an average of 3.76 total traumas. The regression models predicted between 11.5% and 35.5% of the variance of the mental health symptoms. Willingness to share problems was a significant predictor of decreased mental health symptoms in most models. These findings highlight the role of trauma exposure and psychosocial factors in predicting Somali refugee mental health and indicate that implementing programs to encourage problem sharing may help address Somali refugee mental health needs. Further research is needed to explore the differential impact of trauma exposure and various psychosocial factors on Somali refugee mental health. [ABSTRACT FROM AUTHOR]

Vietnam ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2015, signalling a commitment to the basic human rights of citizens with disabilities. Previous research has shown people with disabilities in Vietnam to be marginalised in society, often with limited educational or work opportunity, and with limited financial means. Using in-depth semi-structured interviews conducted in Vietnam and a thematic analysis approach to data interpretation, this article examines the current status of people with disabilities in Vietnam in relation to the core elements of the CRPD, from the perspectives of people with disabilities, their families, and professionals who support them. Findings suggest that, while Vietnamese society has made strides supporting people with disabilities, work remains to be done for the country to comply with the CRPD's core principles. Suggestions for future action are offered, including ways to support human rights of people with disabilities within cultural contexts. [ABSTRACT FROM AUTHOR]

Despite the rapidly growing need to understand and address the unique needs of refugee elders in resettlement, few studies have focused on how continued losses of culture affects coping and distress among refugee families with elderly parents. This qualitative study explores Hindu Bhutanese elders' cultural losses and coping and their bereavement of cultural resources and life transition. Thematic analysis revealed three major thematic domains of cultural losses: cultural collision, cultural trauma and bereavement, and continued distress and loss spiral. This study emphasizes efforts to address cultural losses and trauma to bridge intergenerational gaps and to invigorate family and social support. [ABSTRACT FROM AUTHOR]

Refugee mental health needs are heightened during resettlement but are often neglected due to challenges in service provision, including lack of opportunities for building capacity and partnership among providers. We developed and implemented culturally-responsive refugee mental health training, called Cross-Cultural Trauma-Informed Care (CC-TIC) training. We evaluated CC-TIC, using a free listing and semi-structured retrospective pre- and post-training evaluation with five localities in two states in the U.S. The results showed significant improvement in providers' knowledge of trauma impacts, cultural expressions of trauma/stress-related symptoms, and culturally-responsive trauma-informed care. Trauma-informed care specific to refugee resettlement was regarded as the most helpful topic and community partnership building as the most requested area for future training. This study emphasizes that culturally-responsive trauma-informed approaches can help bridge gaps between mental health care and resettlement services and promote exchanges of knowledge and expertise to build collaborative care and community partnership. [ABSTRACT FROM AUTHOR]

Female genital mutilation or circumcision (FGM/C) is a perilous social and cultural practice that affects the physical, mental, and psychological health of affected women. It is widespread around the world, affecting 200 million women and girls. This study aimed to explore the relation of FGM/C to mental and physical conditions in Somali refugees displaced in a low-resource setting, applying the concept of poly-victimization to reveal multifaceted trauma sequelae. Data for this cross-sectional study with 143 female Somali youth living in Eastleigh, Kenya were collected between April and May in 2013. FGM/C was strongly associated with negative physical and mental health outcomes, including post-traumatic stress disorder and depressive, anxiety, and somatic symptoms. Logistic regression analysis revealed that separation from a parent and poly-victimization experiences were significantly associated with FGM/C experience. The results also showed that FGM/C and other traumas did not occur singly but were indicative of cumulative adversities, especially for women who were socially vulnerable and marginalized. The results of this study highlight the practice of FGM/C in the context of other adverse living conditions of refugees and the importance of attending to other co-occurring risk factors that prevail with FGM/C practice in the ecological system of refugee forced migration. [ABSTRACT FROM AUTHOR]

Refugees often experience high levels of trauma and overall stress that contribute to disproportionate risk for mental health problems. Despite a 136% increase in the number of Somali refugees over the past quarter century, culturally appropriate mental health screening and assessment instruments for use with this population remain limited. This study applies multidimensional item response theory to compare structural models and validity of the Posttraumatic Stress Disorder (PTSD) Checklist–Civilian Version. Data are from a purposive sample of 250 Somali youth living in Nairobi's Eastleigh Estate in Kenya. Using ConQuest software, we used a multidimensional extension of the Rasch model to test 7 competing models of PTSD in this sample. The four-factor emotional numbing model of PTSD provided the best fit for the data; there was no differential item functioning by sex or birth country. We found support for convergent validity, and canonical correlations generally supported theoretically expected relationships between PTSD Checklist–Civilian Version subscales and mental health and trauma-related measures. Identification of numbing, as a dimension distinct from effortful avoidance, permits a more refined determination of PTSD in this population. This finding can guide the development and implementation of targeted interventions. We also discuss the implications for advancing sound measurement of PTSD among Somali refugee youth. [ABSTRACT FROM AUTHOR]

Objectives: Previous research that revealed a high prevalence of low health literacy among immigrants and refugees tended to over emphasise functional health literacy as a risk factor for low health status and poor disease management. Despite a significant knowledge gap, little has been investigated regarding critical health literacy (CHL) in refugee populations whose culture deeply interweaves individual and contextual capacity to promote health. Design: This study adopted a qualitative approach to explore CHL that is built through community health workshops (CHWs) with Afghan and Congolese refugee communities in US resettlement. Setting: As part of a community-based participatory research project, the study was conducted with Afghan and Congolese refugees resettled in the USA. Method: A series of open-ended questions for focus group interviews were embedded in each workshop session explore health literacy skills and capacity over time. This study adopted a hybrid thematic design whereby the conceptual framework of CHL was applied to emergent themes from the data. Results: Thematic analysis revealed four major CHL thematic domains, as experienced and demonstrated by Afghan and Congolese refugee participants: (1) critical appraisal, (2) self-efficacy and confidence, (3) empowerment, and (4) collective problem solving. Conclusion: Study findings underline the importance of health education validating existing cultural knowledge and practices in a group setting so as to facilitate the building and enhancement of social support systems and community action for health promotion. [ABSTRACT FROM AUTHOR]

The current study developed and implemented a trauma-informed psychoeducation (TIPE) intervention that is culturally relevant to urban Somali refugees in Nairobi, Kenya. A total of 141 Somali refugee youth completed 12 sessions of peer-led TIPE intervention. A series of pre- and post-tests revealed that TIPE made positive impacts on PTSD symptoms and psychosocial factors, with a differential effect observed according to baseline PTSD symptom report. Participants with high baseline PTSD scores (i.e. above clinical threshold) reported a significant decrease in PTSD symptoms and increase in perceived social support. In the meantime, those with no to mild baseline PTSD symptoms showed an increase in self-awareness of trauma responses and thus PTSD symptom report within the range of normalcy. This research supports the effect of a culturally relevant psychoeducation intervention in addressing the high mental health and psychosocial needs of the marginalized urban Somali refugee community in low resource settings. [ABSTRACT FROM AUTHOR]

Abstract: Refugee communities face numerous health and mental health concerns both during and after resettlement. Health issues, already deteriorated by chronic poverty, malnutrition and poor living conditions, are exacerbated by acculturative challenges, such as cultural and language barriers, stigma, and lack of resources and information. Since such needs in refugee communities affect both individual and collective capacity, it is important to consider policy environment and socioecological contexts for cultural adjustment and community resources for navigating systems, rather than individual health behaviours and communication skills only. To expand our understanding of health promotion capacity and resources, a broad and context‐dependent concept will be necessary. Adopting a concept of health capital, this study aims to explore the impact of community‐based health workshops, while expanding and redefining the framework in the context of health promotion efforts for the refugee community in resettlement. As part of community‐based participatory research, this qualitative study conducted seven focus group discussions (FGDs) with 22 Bhutanese refugees in 2014. Using a hybrid thematic analysis, themes emerged from the FGD data were organised and categorised into health capitals in ecological systems. The participants reported enhanced confidence and capacity for health promotion at individual, family and community levels. Given the interdependent coping and lifestyles of refugee communities, impacts on the participants’ interactions and relations with family and community were significant, which emphasises the importance of assessment of interventions beyond an individualistic approach. The findings of this study underscore the vital role of varied forms of health capital in promoting health in the refugee community and connecting members to needed health resources and information. Health capital is an old and yet still new concept with a great potential to broaden our understanding of health resources by elaborating the impacts and interactions in individuals, family and community for health promotion. [ABSTRACT FROM AUTHOR]

Background: There is a gap in understanding of refugee mental health risks unique to urban areas of low-income countries. Material: A qualitative rapid appraisal using focus group interviews with community stakeholders explored main stressors pervasive by Somali refugees in Nairobi, Kenya. Discussion: This study identified the intersection of war trauma and daily stressors that affect both functional and structural challenges and risk of mental health issues among Somali urban refugees. Conclusion: Findings underscore the importance of understanding mental health in the broader context of community adversities, suggesting development of contextually informed interventions responsive to complex needs of urban refugees. [ABSTRACT FROM AUTHOR]

Westernized approaches to mental health care often place limited emphasis on refugees’ own experiences and cultural explanations of symptoms and distress. In order to effectively assess community mental health needs and develop interventions grounded in local needs, mental health programs need to be informed by an understanding of cultural features of mental health, including cultural idioms of distress (CIDs). The current study aims to explore CIDs among Somali refugees displaced in Kenya to understand mental health needs in cultural context and serve the community in a culturally responsive and sensitive manner. This research was conducted as a two-phase qualitative study. First, key informant interviews with Somali mental health stakeholders generated a list of 7 common Somali CIDs: buufis, buqsanaan, welwel, murug, qaracan, jinn, and waali. Typologies of each CID were further explored through four focus group interviews with Somali community members. The findings from a template analysis revealed Somali lay beliefs on how trauma and daily stressors are experienced and discussed in the form of CIDs and how each term is utilized and understood in attributing symptoms to associated causes. This study highlights the need to incorporate colloquial terms in mental health assessment and to adopt a culturally relevant framework to encourage wider utilization of services and religious/spiritual support systems. [ABSTRACT FROM AUTHOR]

Somali children and youth in displacement are exposed to prolonged trauma and chronic violence. In spite of a striking link among trauma, gang activities, victimization, and perpetration of violence, however, few studies have been conducted with Somali refugee youth in low-resource urban settings. This qualitative study demonstrates how prolonged trauma shapes ecological conditions of refugee life that induce vulnerable youth to forge support systems through gang membership and violence. The accession of the challenges, from loss of family, to discrimination and police brutality, and to chronic impoverishment, forces the high-risk refugee youth to replicate the various forms of violence to which they have been exposed to survive. Undergoing such chronic and cumulated trauma, these youth continue to normalize and become further desensitized to violence. The systems perspective of this study expands understanding of the intersection of trauma and gang membership and implies the need for an expanded approach to trauma and understanding of the complexities of gang involvement, beyond posttraumatic stress disorder treatment and clinical intervention. [ABSTRACT FROM PUBLISHER]

Despite the high health and mental health care needs, resettled refugees often face cultural and linguistic challenges that hinder the access to appropriate and timely interventions and services. Additionally, such concepts as preventive health or mental health treatment are foreign to this population, which creates additional burdens to the refugee community that already have difficulty navigating a complex health care system in the U.S. To address multiple and complex gaps in health and mental health support for the refugee community, requested is an innovative approach that can convey culturally responsive and effective interventions for health promotion, such as peer-based health education. Few studies have been conducted on the effectiveness of peer-led community health interventions with refugee populations in the U.S. resettlement context. However, peer-led interventions have been shown to be effective when working with cultural minorities and interventions in an international context. Adopting a social capital framework, the current study conducted qualitative evaluation on the impact of a pilot peer-led community health workshop (CHW) in the Bhutanese refugee community. A hybrid thematic analysis of focus group discussion data revealed the improvement in health promotion outcomes and health practice, as well as perceived emotional health. The results also showed that the peer-led CHW provided a platform of community building and participation, while increasing a sense of community, sense of belonging and unity. The findings posit that a peer-led intervention model provides culturally responsive and effective tools for building social capital and promoting community health in the refugee community. [ABSTRACT FROM AUTHOR]

Forty-four refugee health coordinators responded to a subset of questions from a 28-item, national survey exploring the mental health training of refugee health coordinators and the feasibility of refugee mental health screening. Most participants reported that it would be possible to administer a brief mental health screen; however, only half had received any mental health training. A minority of participants identified symptoms of posttraumatic stress disorder or major depression as their top concerns related to refugee mental health. The majority requested training on the mental health needs of arriving refugees. Training participation was associated with screening and positive referral outcomes. [ABSTRACT FROM PUBLISHER]

This study explores the reactions of social work students in a course on trauma treatment and how those reactions changed over time. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicate that students experienced a range of responses to traumatic material, including both positive and negative emotional, cognitive, behavioral, physical, and relational reactions. Student survivors of trauma reported reactions related to their own trauma. Although student reactions became less acute over time during the course, recommendations for the pedagogy of trauma are offered, including curriculum related to the management of vicarious and secondary trauma reactions as well as the development of evidence-based practices for self-care. [ABSTRACT FROM AUTHOR]

This article describes the development of self-care practices of social work students who were part of a larger study of students’ experiences in a graduate course on the treatment of trauma. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicated that students benefited from being introduced to evidence-based practices for mediating the stress of trauma education, including journaling and mindfulness-based stress reduction. Although students reported struggling with developing effective self-care practices, they demonstrated an ability to integrate self-care into their professional practice behaviors. The authors review recommendations for research and pedagogy of self-care practices in courses on trauma treatment. [ABSTRACT FROM AUTHOR]

One of the critical issues in addressing financial abuse in Korea is the absence of an appropriate definition voiced by the elderly. This study is designed to explore how Korean elders define financial abuse in given social and cultural contexts. Face-to-face, in-depth interviews were conducted with 124 elders, aged 60 to 79, residing in Korea. The results of qualitative data analysis using grounded theory revealed that a vast majorty of Korean elderly respondents defined financial abuse as lack of provision of financial support to elder parents, and a small portion of respondents defined it as financial exploitation by adult children. The definition of financial abuse reflects cultural beliefs based on filial piety about financial expectations within the parent–child relationship. Education on financial abuse for both elders and their adult children and establishment of income support programs are urgently needed efforts to increase the financial well-being of elderly Koreans. [ABSTRACT FROM AUTHOR]

A total of 44 state refugee health coordinators returned a survey assessing mental health screening practices and barriers to screening. Results show that less than half the states ask refugees about a history of war trauma or torture. Of the 25 states that provide mental health screening, 17 (70.8%) utilize informal conversation rather than standardized measures. Screening practices are highly associated with the number of refugees and community discretionary grants and with the presence of a Services for Survivors of Torture Program. Refugee health coordinators identified the need for short, culturally appropriate mental health screening tools to identify refugees who need assessment and treatment services. [ABSTRACT FROM AUTHOR]

Trauma-informed care (TIC) approaches have gained popularity in various contexts of human services over the past decades. However, relatively little has been explored about how it is applicable and built into services for refugee populations in resettlement programs. This study explores the current status of the application of TIC in refugee-serving agencies and identifies perceived and experienced challenges and opportunities for culturally responsive TIC in the United States. As designed as part of the evaluation of state-wide refugee health promotion programs, this study conducted individual interviews with 78 refugee service providers from five resettlement sites. Despite the burgeoning interest and attempt to embrace TIC, our findings show that there is clear inconsistency and inexperience in TIC adaptation in resettlement programs. This study highlights that TIC that is culturally responsive and relevant to refugee trauma and acculturation experiences is a vital way to address the chasms between refugee-specific programs and mainstream services including mental health care systems. This study also discusses community resources and opportunities to bridge the deep divide and substantial gaps between mental health services and refugee resettlement services and to address comprehensive needs around mental health and wellness in the refugee community. [ABSTRACT FROM AUTHOR]