Brian Isakson

Healing After Torture The Role of Moving On

The experience and sociocultural context of torture and its treatment have received little attention in the biopsychosocial model of Western mental health for survivors of torture. The main focus has been on the reduction of symptoms of posttraumatic stress disorder and related conditions. Using grounded theory methodology, we investigated survivors’ perceptions of the nature and process of healing after torture. The participants included 11 adult refugee torture survivors (9 men and 2 women) from African and Asian countries. Their stories of healing centered on the role of “moving on” with their lives, which included aspects of cognitive reframing and empowerment. Reliance on belief and value systems, safety measures, and social support, despite continuing psychological and physical symptomatology, enabled the moving-on process. Implications for theory, research, and practice are discussed.

Reducing Mental Health Disparities Through Transformative Learning: A Social Change Model With Refugees and Students

Distribution of power and resources greatly impacts the mental health of individuals and communities. Thus, to reduce mental health disparities, it is imperative to address these social determinants of mental health through social change. Engaging in social change efforts requires people to critically engage with present conditions on personal, local, national, and global levels and to develop knowledge, capacity, and experience with envisioning and creating more equitable conditions. This critical engagement can be fostered through a process of transformative learning. In this article, we examine the Refugee Well-being Project (RWP), a program that aims to improve the mental health of refugees in the United States. From 2007 to 2009, participants in the RWP in New Mexico were refugees from the Great Lakes region of Africa. The RWP paired undergraduate students with refugees to engage in mutual learning and advocacy. Data from in-depth qualitative interviews with 72 refugees and 53 undergraduate students suggest that participation in the RWP constituted a transformative learning experience through which refugees and students came to new understandings of the relationship between social inequities and well-being. For many, this provided an impetus to work toward change at multiple levels.

Adapting and Implementing Evidence-Based Interventions for Trauma-Exposed Refugee Youth and Families

Refugee youth routinely encounter difficult challenges related to past trauma, loss, and resettlement stressors. The recent surge in refugees resettling in the United States has made it increasingly likely that mental health service providers will receive referrals to work with refugee youth. It is thus essential to prepare the national mental health workforce to provide the best care possible. Although the current evidence base regarding the use of empirically-supported treatments with refugee youth living in Western countries is insufficiently developed to provide authoritative standards for evidence-based practice (EBP), sufficient advances have nevertheless been made to offer evidence-informed suggestions and guidance to practitioners who work with this unique population. We thus focus on three primary considerations for adapting and implementing evidence-based interventions with refugee youth by drawing on the American Psychological Association’s (Am Psychol 61:271–285, 2006) framework for EBP, which integrates (1) the best research available, (2) client characteristics, culture, and preferences; and (3) clinical expertise. We use this framework as a lens to selectively review research pertaining to the refugee youth experience and identify sound therapeutic practices. We recommend key factors to consider when seeking to provide culturally sensitive, developmentally appropriate trauma interventions to this at-risk yet underserved population in real-world settings. We discuss the promise of modularized interventions that integrate both common elements of evidence-based trauma interventions and common therapeutic factors, while also underscoring the importance of addressing extra-therapeutic factors within the broader ecology that can powerfully influence the well-being and functioning of refugee youth and their families.

Reducing Health Disparities Experienced by Refugees Resettled in Urban Areas: A Community-Based Transdisciplinary Intervention Model

There is a growing recognition that social inequities in education, housing, employment, health care, safety, resources, money, and power contribute significantly to increasing health disparities globally, within countries, and even within specific urban environments. Thus, to promote health and well-being for all people, the World Health Organization recommends improving daily living conditions, measuring and understanding problems of health inequity, assessing the impact of action to address these problems, and ensuring equitable distribution of money, power, and resources (CSDH, 2008). Among the diverse populations that bear the burden of social inequities and health disparities are the increasing numbers of refugees and immigrants settling in urban areas.

Challenges and Innovations in a Community-Based Participatory Randomized Controlled Trial

Randomized controlled trials (RCTs) are a long-standing and important design for conducting rigorous tests of the effectiveness of health interventions. However, many questions have been raised about the external validity of RCTs, their utility in explicating mechanisms of intervention and participants’ intervention experiences, and their feasibility and acceptability. In the current mixed-methods study, academic and community partners developed and implemented an RCT to test the effectiveness of a collaboratively developed community-based advocacy, learning, and social support intervention. The goals of the intervention were to address social determinants of health and build trust and connections with other mental health services in order to reduce mental health disparities among Afghan, Great Lakes Region African, and Iraqi refugee adults and to engage and retain refugees in trauma-focused treatment, if needed. Two cohorts completed the intervention between 2013 and 2015. Ninety-three adult refugees were randomly assigned to intervention or control group and completed four research interviews (pre-, mid-, and postintervention, and follow-up). Several challenges to conducting a community-based RCT emerged, including issues related to interviewer intervention to assist participants in the control group, diffusion of intervention resources throughout the small refugee communities, and staff and community concerns about the RCT design and what evidence is meaningful to demonstrate intervention effectiveness. These findings highlight important epistemological, methodological, and ethical challenges that should be considered when conducting community-based RCTs and interpreting results from them. In addition, several innovations were developed to address these challenges, which may be useful for other community–academic partnerships engaged in RCTs.

“Seeing the Life”: Redefining Self-Worth and Family Roles Among Iraqi Refugee Families Resettled in the United States

Social and geographic displacement is a global phenomenon that precipitates novel stressors and disruptions that intersect with long-standing familial and social roles. Among the displaced are war-torn Iraqi refugee families, who must address these new obstacles in unconventional ways. This study explores how such disruptions have influenced associations between gender and apparent self-worth experienced by Iraqi refugee families upon relocation to the USA. Further, the psychosocial mechanisms requisite of any novel approach to a new social construct are explored and reveal that production in the family is at the core of instability and shifting power dynamics during resettlement, preventing family members from “seeing the life” in the USA that they had envisioned prior to immigration. Over 200 semi-structured qualitative interviews with Iraqi participants and mental health providers were conducted over the course of the study, which demonstrate a plasticity among social roles in the family and community that transcends the notion of a simple role reversal, and illustrate the complex positionalities that families under stress must approximate during such physical and social displacement.

Understanding Study Attrition in the Evaluation of Jail Diversion Programs for Persons With Serious Mental Illness or Co-Occurring Substance Use Disorders

Study attrition is a problem in all community-based intervention studies using longitudinal research designs, but is compounded with hard to reach populations. High attrition poses threats to internal and external validity and may result in an inadequate sample size. The purpose of our study was to determine the characteristics associated with attrition. The study employed data from a cross-site evaluation of jail diversion programs. A self-report interview was conducted at baseline for 1,289 individuals. A 33% and 52% attrition rate was observed at the 6-month and 12-month follow-up interviews, respectively. The characteristics associated with loss to follow-up were male gender, part-time or full-time employment, drug offenses, jail days, baseline interview location, community supervision, and community geography. Knowing which individuals are more likely to attrit allows evaluators to develop targeted sampling strategies and participant engagement strategies.

“My World Is Upside Down”: Transnational Iraqi Youth and Parent Perspectives on Resettlement in the United States

ABSTRACT The U.S. war with Iraq led to the displacement of millions of Iraqis, many of whom have resettled in the United States as refugees. We explore the challenges Iraqi families face after resettlement, with a particular focus on the agency of refugees and challenges/opportunities of familial social reproduction in a transnational context. We conducted 181 qualitative interviews with 38 Iraqis (11 youth, 27 adults) and 5 service providers. Our findings highlight the importance of exploring refugee agency and illuminate how the interplay between structure and agency in transnational contexts is a useful framework for understanding transformations around social roles.