Refugees around the world are particularly vulnerable to various forms of trauma and toxic stress — from persecution in their home country, process of transport, to resettling to their host-country. The same is true for more than 75,000 Afghan refugees in the United States who have been displaced after the Taliban return to power in the midst of COVID-19 pandemic last year (Wang & Rodriguez-Delgado, 2022). Thus, considering the cumulative experiences of threat and stress of Afghan refugees, manifestations of ranging common mental disorders related to traumatic stress, loss, and grief are prevalent and are in urgent need for trauma-informed and culture-informed approach of care. The interventions will apply a multi-tier approach that reflects the multiple levels of influence that may impact the health behaviors of the Afghan refugees. At the same time, the interventions must be culture responsive care such as considering language access and elements of cultural beliefs to be effective.
Trauma-Informed Principles
As described in the Trauma-Informed Philanthropy, (SAMHSA, 2014) the program will uphold the principles of trustworthiness and transparency evident in the incorporation of four representatives from the community that will work alongside the program in order to ensure not only the authenticity of the needs and implementations of the interventions but also to be ensure the advocacy for the interests of the Afghan refugees at all times. The training will not be limited for trauma-informed and culturally-sensitivity for healthcare providers but the community representatives will also be empowered in ways that they will be trained to conduct mental health outreach and education. This way, not only trust and partnership are galvanized but it will maintain the authenticity of the representation as the community will have someone who comes from their community to engage with and learn from.
Overall, humility, patience, and transparency will be strive for in the entire duration of the program to fully integrate the principles of TIC of collaboration and trust (SAMHSA, 2014). The healthcare providers and other key players will not only aim to be culturally competent and sensitive but will be encouraged to practice cultural humility — which is the process that learning and navigating various cultures is a life-long process and will require introspection and reflection from their sides. This will demand understanding their position in the society whether by socioeconomic status and race and how these positions paint the way they are perceived. In this awareness, the program hopes to establish the principles of trauma-informed care so as to prevent possible re-traumatization, emotional distress, and stigmatization (SAMHSA, 2014).
Socio-Ecological Model (SEM)
Using the CDC’s Social-ecological Framework for Prevention, the program identified levels that are hoped to be influenced, which are individuals, community, and the organizational levels (CDC, 2019). Treatments and recommendations from the ACEs screenings will be specific for an individual. Further, the integration of the community through mental health education and outreach hopes to strengthen the community’s capacity and resiliency. The participation of women, religious leaders, and even community leaders in the process will build transparency and rapport for a stronger morale of the overall Afghan refugee community as inter-agencies and nonprofit organizations work simultaneously alongside them. Lastly, as the heart of the program is to train healthcare providers and educators that will eventually serve with the Afghan refugees for trauma-informed and culturally-sensitive care approaches, the program hopes to promote integrated care for effective health interventions and positive health outcomes in which targets the organizational level of the socioecological model (CDC, 2019).
Public Health Framework
The program will centralize the public health framework in order to create multi-level and multi-sectoral impacts which are addressed as secondary and tertiary prevention strategies in concert. As the program targets the Afghan refugees who have mental health issues and/or trauma-related behavioral and emotional problems, the efforts for screenings and mental health education enable for early detection to reduce the progression of the health issues (Philanthropy Network Greater Philadelphia, 2016). This will also help strengthen protective factors such as community resilience among the Afghan refugees. Further, the tertiary prevention strategies aim will address treatment aspects such as minimizing the impact of the health issues and further complications (Philanthropy Network Greater Philadelphia, 2016). The aim to proliferate and establish the importance of culturally-sensitive and trauma-informed care approaches for Afghan refugees population will also buffer to prevent retraumatization that may be experienced in the healthcare system (Philanthropy Network Greater Philadelphia, 2016). Further, the hopes of a multi-tier approach in partnerships and collaboration is also to provide the utmost cumulative care from basic needs of food and shelter to mental health services and support.
References:
Wang, F., Rodriguez-Delgado, C. (2022). Tens of thousands of Afghans have resettled across the US. Now, the challenge is making a home. PBS NewsHour. https://www.pbs.org/newshour/n...nge-is-making-a-home
SAMHSA. (2014). SAMHSA’s Concept of Trauma and Guidance for Trauma-Informed Approach. SAMHSA Trauma and Justice Initiative.
Centers for Disease Control and Prevention (2019). The Social-Ecological Model: A Framework for Prevention. Retrieved February 28, 2019, from https://www.cdc.gov/violencepr...ecologicalmodel.html
Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, and United Way of Greater Philadelphia and Southern New Jersey. (2016). Trauma Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed. Practice in the Delaware Valley.
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