Findings from an Extended Case Management U.S. Refugee Resettlement Program

Group-Based Intervention Models in Treating Refugee Mental Health in High-Income Countries: A Systematic Review

Refugees within the post-migration context experience higher rates of mental health symptoms due to a variety of pre- and post-migration factors. However, there is a lack of research in understanding best practices in culturally grounded interventions aimed at improving well-being outcomes. Recent research shows group interventions are a potential pathway to mental health treatment for refugees. This systematic review aimed to (1) assess best practices among group-based interventions within the refugee context, (2) provide literature-informed guidance on best practices within group-based interventions for this population, and (3) examine the impact of group-based interventions on the mental health outcomes of adult refugees in the post-migration context in high-income countries. A systematic literature search was conducted using Academic Search Complete, Social Work Abstracts, and PsycINFO. A total of 2,243 studies were identified, with 19 meeting the inclusion criteria to be from a peer-reviewed journal article; be published from 2003 to 2023; be written in English; have a study population of refugees in the post-resettlement context in a high-income country; include a group-based intervention model; and be quantitative or mixed methods. Results demonstrated that group-based interventions improve mental health symptoms, including post-traumatic stress disorder, depression, and anxiety. Studies varied on their use of culturally grounded mechanisms in developing and implementing interventions. Future research is needed to understand the longitudinal impacts of group-based interventions on mental health and better support current practices to facilitate access to intervention implementation.

The relationship between employment and health for people from refugee and asylum-seeking backgrounds: A systematic review of quantitative studies

Background

For the general population, the positive effects of paid employment on health and wellbeing are well established. However, less is known for people from refugee and asylum-seeking backgrounds. This review aims to systematically summarise the quantitative literature on the relationship between employment and health and wellbeing for refugees and asylum seekers.

Method

A search strategy was conducted in online databases, including MEDLINE, PsychINFO, EMCARE, SCOPUS, CINHAL, ProQuest and Web of Science. Articles were screened against inclusion and exclusion criteria. Studies published in English between 2000 to October 2021 were included if they used quantitative methods to consider the relationship between employment and health for refugees and asylum seekers in resettlement countries. Study quality was assessed using The Joanna Briggs Institute's Critical Appraisal Tools. Findings were synthesised using a narrative approach.

Results

Seventy-two papers were identified. The majority of papers (N = 58, 81%) examined the association between employment and mental health outcomes. Overall, while there were inconsistencies in the findings, employment had a positive effect on mental health particularly in reducing levels of psychological distress and depression. Though more limited in number, the papers examining physical health suggest that people who are employed tend to have better physical health than unemployed persons. There was some evidence to support the bi-directional relationship between employment and health. Poor mental and physical health negatively impacted the odds of employment and occupational status of refugees.

Conclusion

Good quality employment is an essential component of refugee resettlement and this review found that in general employment is also beneficial for refugee health, particularly aspects of mental health. More research regarding the effects of employment on physical health is required. The effects of refugee-specific factors such as gender roles, torture, and trauma on the relationship between employment and health also require further investigation.

Financial Challenges and Capacity among African Refugees in the Southern USA: A Study of Socio-demographic Differences

Refugees’ successful integration into US society requires adaptation to economic, financial and social norms. Despite the importance of considering financial challenges (financial stress and financial anxiety) and financial capacity (financial literacy and financial self-efficacy) in reaching personal financial goals, literature examining the relationship between financial challenges and capacity—critical in refugee resettlement and integration—is sparse and fragmented. This study explored financial challenges and capacity amongst resettled African refugees (N = 130) in the southern USA using data from a larger community-based participatory research study that used a mixed-methods approach. We explored socio-demographic differences in financial stress, financial anxiety, financial literacy and financial self-efficacy across African refugee subpopulation groups. Our study highlights the importance of social work advocacy for data disaggregation, which helps establish the scope of the problem, unmask subpopulation differences and make vulnerable groups more visible to facilitate the development of tailored programmes and services to reach economic integration goals. We provide social work implications for data disaggregation in the current corona virus context, which will leave long-term financial scars on refugee subpopulations.

Safety Among Newly Resettled Refugees in the USA

Within a context of changing political and social perspectives toward refugee resettlement in the USA, this mixed methods study examines experiences of safety among recently resettled refugees. The study was conducted by resettlement agency personnel within two states, Utah and Arizona. We examine risk and protective factors associated with perceptions of safety among a sample of 243 participants, as well as experiences related to safety as described in focus groups with 50 participants. Of the environmental factors examined, attending events related to one’s culture, language, or religion and more frequent home visits were associated with higher levels of perceived safety, while experiencing discrimination was associated with lower levels of perceived safety. Some individual and social factors such as nation of origin were also associated with perceptions of safety. Focus groups identified key themes related to safety in the USA which included discrimination, concerns about family safety, and feeling safe in the USA. An increased emphasis on safety as a key resettlement outcome can strengthen resettlement policy and guide community responses.

Community Health and Wellness Fair: A strategy for Assessment of Social Determinants of Health, Inclusion and Engagement of Newcomers

Community health fair has been used informally as a way of offering health promotion, education, and screening services onsite to underserved and hard to reach populations such as the newcomers. To utilize an annual health fair for the assessment of the overall perception of health status of newcomers in relation to the determinants of health; and to evaluate its effectiveness as an intervention to engage attendees in their community. The 3rd Annual refugees and immigrant's health and wellness resources fair in Allegheny County. A cross sectional study was designed using questionnaires focused on the health and social determinants of health, with few open-ended questions related to engagement and networking. A total of 107 individuals participated in the study. The age ranged between 18-75 years, 46.9% males and 53% females. The largest representations from Bhutan, Arab Middle Eastern countries, and Ghana. Perception of health was examined in relation to other determinants such as language, regular checkups, employment, income, education, access to health, and psychosocial needs. Results revealed that health perception varied by ethnicity, was influenced by English proficiency, access to health, employment, and regular checkups, while education, and income did not show an impact. A qualitative analysis to the narrative responses revealed that the health fair was very effective in breaking the structural barriers with providers as well as for community engagement. The annual health fair was a successful strategy in the assessment of the health determinants and for community engagement of the newcomers.

Paper integration: The structural constraints and consequences of the US refugee resettlement program

The migration literature contends that, unlike other immigrants, refugees resettled in the US benefit from a federal program of integration. These claims do not consider the barriers that may complicate the implementation of resettlement policy. Based on 16 months of ethnographic fieldwork at a refugee resettlement agency in California, I argue that the organizational structure of the US Resettlement Program shapes how caseworkers provide resettlement services on a daily basis. The financial insecurity of Resettlement Agencies coupled with high stakes government oversight creates an organizational culture of vulnerability where caseworkers rely on discretion as they put resettlement policy into practice. Caseworkers develop coping mechanisms to get by as they simultaneously attend to the demands of their funders and their refugee clients. Given these structural constraints and limited resources, caseworkers instrumentalize paperwork as a discretionary tool. When files and documents are privileged over the quality and extent of resettlement services, caseworkers creatively utilize paperwork to separate policy from practice in order to protect themselves and appease their refugee clients. This policy of integration instead becomes a practice of paper integration, which problematizes prior theories and assumptions about US refugee resettlement. This practice of paper integration ultimately affects the services that arriving refugees receive and the degree to which they benefit from this ostensible program of integration.