1. Denise C. Bates Ph.D., R.R.T., CHES, Assistant Professor, Programs in Public Health, University of Tennessee 1914 Andy Holt Avenue, 373 HPER Building, Knoxville, TN 37996-2710 dbates2@utk.edu Multiple levels of resources are emphasized: Personal : e.g., occupational and language skills; Material : e.g., employment and transportation; Social : e.g., emotional and tangible support; and Cultural : e.g., spirituality and collectivism. Focus on gaining an understanding of resource loss/gain related to pre- and post-migration contexts: o discrepancies between expected resources in the post-migration context and actual access. o discrepancies between refugee families with regard to resource access (e.g., some families have access to a sponsor; refugees of different cultural origins are perceived to receive preferential treatment from their resettlement agency). Collaboration between Cherokee Health Systems, Healing Transitions at the University of Tennessee, & other organizations/individuals facilitate refugees’ resilience and access to resources. The resettlement process for refugees is extremely challenging and complex (e.g., language barriers, adjusting to a new culture, securing resources, coping with trauma/loss). Access to culturally competent health services is crucial to maximize refugees’ functioning in their host society. Medical models that focus on deficiencies among refugees fail to address the complexities of adaptation to host societies, as well as resilience/resourcefulness. The Resource-Based Model of Migrant Adaptation addresses multiple levels of resources (personal, material, social, and cultural), constraints with regard to resources, pre- and post-migration phases, and encourages host societies to explore ways they can facilitate refugees’ resilience and access to resources. Cherokee Health Systems is a leader in integrated care, a holistic approach integrating mental health services into primary care. Committed to providing care to underserved populations, Cherokee Health Systems partners with Healing Transitions at the University of Tennessee to address medical and mental health needs of the Burundian community in Knoxville, TN. Healing Transitions is a multidisciplinary project that explores the short- and long-term transition needs of refugees living in Knoxville, TN. One of the outcomes of the Cherokee Health Systems - Healing Transitions collaboration is a support group for Burundian women. Influenced by the Resource-Based Model of Migrant Adaptation, some of the group’s goals have included: o developing a voice/vision related to life in the host society; o enhancing awareness of resources/resilience ; o maximizing self-efficacy ; o exploring common issues refugees face; o facilitating development of a bicultural identity ; o assessing pre-migration trauma and its possible impact on adaptation to the host society. The Burundian women’s support group has evolved into interventions with the larger Burundian refugee community, i.e., children, adolescents, and men. This presentation addresses conceptual frameworks underlying the development and implementation of interventions, examples of interventions to date, and future directions. A Resource-Based Approach to Integrative Mental Health Services with Burundian Refugees in East Tennessee Frances (Fran) L. Palin, Ph.D., Clinical Psychologist, Cherokee Health Systems 2018 Western Avenue, Knoxville TN, 37921 frances.palin@cherokeehealth.com Overview Conceptual Frameworks For Interventions Resource-Based Model of Migrant Adaptation Developing Culturally Competent Biopsychosocial Interventions Community-Based Participatory Research approach is used: o provides refugee community with a voice to inform resource providers what is desired/needed o fosters empowerment, resilience, and access to the most salient resources o guides readiness to explore sensitive topics (e.g., domestic violence). Interventions related to sensitive topics have a greater impact when the community voices the need for these topics to be addressed. A Family Stabilization Committee formed with individuals from the larger community (e.g., public health, mental health, law enforcement) to discuss the needs of the refugee community. Cultural brokers (bicultural individuals who are Burundian by origin) play a vital role in all contact with the refugee community. Cherokee Health Systems uses an integrated team approach for refugees’ care: o mental health providers, medical providers, and case managers consult about relevant clients o discuss ways to enhance refugees’ access to culturally competent care. Refugee community is not viewed as static entity - requires flexibility and ongoing sensitivity to evolving climate and community needs. Incorporate research indicating exposure to trauma can produce lasting alterations in endocrine, autonomic, and central nervous systems (e.g., PTSD impacts speed of language acquisition). Address associations between mental and physical health (e.g., somatic manifestation of depression). Demonstrate sensitivity to mental health stigma in refugee community. Emphasize trust between providers and refugee community. Refugees’ history of trauma : o symptoms labeled PTSD are considered normal reactions to trauma o trauma applies to individuals and communities o manifestation of psychological trauma must be understood within cultural contexts o trauma culminates in disempowerment and disconnection from others. A relational context is necessary for healing o establishing safety and restoring connections between trauma survivors and their community are essential to recovery o creating meaning from trauma is important in the healing process, and may include testimony (verbal and/or non-verbal formats). Providing refugee communities with educational material facilitates the development of a bicultural identity. Refugees choose how to integrate the information into their cultural identity (e.g., gender roles in U.S. when both parents are employed). Examples of Refugee Interventions Burundian women request a support group. Women bring up power dynamics in marriage (including domestic violence ). Women emphasize that Burundian men will not support the discussion of this topic in the support group. Adolescent and children’s groups are created and led simultaneous to the women’s group. The Burundian community develops their own non-profit organization, SODELA. Burundian men become more active in interfacing with providers. Healing Transitions/University of Tennessee provides health-education modules (e.g., nutrition) to the larger community (men and women). Burundian men request their own support group. Due to lack of an appropriate interpreter to date, this request is currently on hold. The Burundian community (men) request workshops on marital relationships in the U.S. due to conflict between spouses. A relationship workshop is conducted with Burundian men and women. Three couples (Caucasian – U.S.; African – originally from Africa, transitioned to living in the U.S.) share information about their relationships with an emphasis on power, communication, trust, and parenting. A Burundian woman raises the issue of domestic violence. Burundian men validate her concerns. Medical and mental health providers at Cherokee Health Systems conduct a focus group with Burundian men and women to explore how they view health, illness, and medical treatment. In response to the focus group, refugees request educational workshops (e.g., diabetes). A Burundian male raises mental health, e.g., depression; the impact of trauma in Africa (women being sexually assaulted; experiencing war) on their current functioning and the importance of addressing mental health. Refugees request educational mental health workshops. Several refugee families seek mental health treatment (individual /families) at Cherokee Health Systems. Examples of Future Interventions Continue to explore refugees’ physical and mental health through workshops, focus groups, and support groups. Continue adolescent and children’s groups. Start men’s support group.