Leveraging Implementation Science and Design Methods to Sustain Community-Based Mental Health Services for Refugees

There has been an unprecedented increase in the number of refugees worldwide, with approximately 26 million men, women and children forcibly displaced from their homes at the end of 2019. More than half of the world’s refugees live in dense urban areas or refugee camps in low- and middle-income countries. A smaller percentage are permanently resettled in high-income countries. Across these contexts, refugees have elevated rates of common mental disorders. War and forced migration also contribute to systematic disruptions in social relationships including family separation, tension and conflict, and losses of social networks. There is an emerging evidence base of models regarding refugees’ mental health and psychosocial needs, but major gaps exist regarding how to adapt evidence-based interventions (EBIs) to refugee populations and sustain them in community settings. To address these gaps, my career goal is to establish an independent research program focused on the implementation of community-based mental health services for refugee communities across the displacement continuum. In collaboration with community partners, I aim to examine methods for integrating EBIs into non-traditional service settings to enable refugees’ access to prevention and care interventions that promote positive mental health outcomes. A central concern my research seeks to address is how to best mobilize social and family resources to enhance coping and wellbeing. These research priorities are shaped by my more than fifteen years of clinical practice experience working with war-affected populations in the U.S and globally, doctoral training at the University of Chicago and early research experiences. This K01 application is structured to build upon my strengths and develop new knowledge and skills in key areas needed to achieve my long-term goals. My training aims focus on 1) implementation science methods to adapt, scale up and sustain EBIs in community settings; 2) the application of human-centered design to community-based refugee mental health services; and 3) community-based trial design and analysis. With support from an accomplished multidisciplinary team of mentors, I will apply these skills to a research project that focuses on implementing a peer-led multiple family group (MFG) prevention intervention called CAFES in two community-based organizations in Chicago to promote uptake and meet the multi-level needs of refugee families. Using a pilot randomized type 1 hybrid implementation-effectiveness design, the research aims include: 1) Adapting the multiple family CAFES model for Syrian refugee families and delivery by peer providers in community-based organizations using the ADAPT-ITT framework and human-centered design methods; 2) Piloting the adapted CAFES model to assess implementation science domains; and 3) Exploring changes in mental health outcomes and family and community support and mechanisms of change. Drawing on the new knowledge and skills and pilot study data obtained from this K01, I will prepare an R01 proposal to further test the model implementation and effectiveness.