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Refugee Trauma & Resilience | Overview

Since 2003, our team has partnered with refugee and immigrant communities and agencies to develop evidence-based programs and resources to support the healthy adjustment of refugee and immigrant youth and families in the United States. Through innovative research and program evaluation, resource development, intervention development, advisory boards, and training and consultation, we support providers and service systems in delivering exceptional, effective care to refugee and immigrant youth and their families.

We are a site in the National Child Traumatic Stress Network and funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), under the U.S. Department of Health and Human Services.

Intervention development

Trauma Systems Therapy for Refugees (TST-R)

Our flagship intervention model, Trauma Systems Therapy for Refugees (TST-R), embeds mental health services for refugee and immigrant youth where they seek services, such as community, school, and integrated pediatric health settings. TST-R is an adaptation of Trauma Systems Therapy (TST) for refugee and immigrant children/adolescents and their families that takes into account the migration experience in addition to cultural, social, and logistical barriers (e.g., stigma, language, distrust) to engaging in mental health services.

TST-R was specifically designed to increase engagement in mental health services and to promote culturally responsive, linguistically appropriate care by pairing clinicians with cultural brokers. Cultural brokers are members of the refugee and immigrant community who speak the language and are from the same cultural background programs are hoping to serve. Our TST-R consultants provide training and consultation to organizations on our multi-tiered model.

Trauma Systems Therapy-Refugees (TST-R) Advisory Boards

Implementation Science and Practice Advisory Board (ISPAB)

In an effort to continue the effective and sustainable expansion of TST-R, in 2022 our program launched the TST-R Implementation Science and Practice Advisory Board (ISPAB). The goal of the ISPAB is to elevate and integrate the voice(s) of Trauma Systems Therapy-Refugees (TST-R) providers and program leaders into the continued development, adaptation, dissemination, and implementation of TST-R. We hold three national video conference meetings a year where we discuss and explore implementation and adaptation factors within the delivery and sustainability of TST-R. Drs. Jeff Winer and Luna Mulder direct the ISPAB, and we work in partnership with the TST-R NCAB.

National Community Advisory Board (NCAB)

The overall goal of the NCAB is to empower cultural brokers, experts, and leaders to play an active role in the TCRC’s implementation science and practice advisory board (ISPAB). The NCAB focuses on building connections, sharing experiences, and uplifting your unique perspectives as cultural brokers and leaders in TST-R programs across the country. We have 16 NCAB members representing six states. The NCAB is co-led by Ms. Naima Agalab of the Refugee and Immigrant Assistance Center, and Drs. Alisa Miller and Luna Mulder of the TCRC.

Training & Consultation

TST-R model consultants provide ongoing training and consultation to prevention and intervention programs across the country and around the world. This work is centered on the empirically supported behavioral health intervention and organizational model of Trauma Systems Therapy for Refugees (TST-R). 

TCRC team members may be able to offer individualized trainings, presentations, or workshops for members of your organization with the goal of sharing best practices and increasing your capacity to best support refugee and immigrant youth and families. We have a long history of training school systems, colleges and universities, mental health agencies, hospitals, resettlement agencies, government agencies, and non-profit organizations. See our free webinar series.

If you are interested in a specialized training, please fill out our training request form.

Research, program evaluation, and related initiatives

We conduct etiological research related to refugee and immigrant mental health, program evaluation of our Trauma Systems Therapy for Refugees (TST-R) model, and support-related initiatives. 

Somali Youth Longitudinal Study (SYLS)

Between May 2013 and February 2019, researchers at the TCRC engaged in a collaborative partnership to conduct the Somali Youth Longitudinal Study (SYLS). SYLS collected quantitative and qualitative data on Somali-American youth in the United States and Canada at four time points between 2013 and 2019. The study was designed to address concerns in the Somali community over youth violence. It broadened its focus to adopt a life-course perspective to examine Somali immigrant experiences with discrimination and marginalization associated with religion, race, ethnicity, and immigration status, and their relationship to health outcomes. 

Trauma Systems Therapy for Refugees (TST-R) Program Evaluation

Trauma Systems Therapy for Refugees (TST-R) is an adaptation of Trauma Systems Therapy (TST) for refugee and immigrant children/adolescents and their families. TST is a comprehensive model for treating traumatic stress in children and families (Saxe, Ellis, & Kaplow, 2006; Saxe, Ellis & Brown, 2016) and is identified by the National Child Traumatic Stress Network (NCTSN) as an empirically supported treatment and promising practice.

We continue to build the evidence base for TST-R. To date, empirical evidence from TST-R interventions with different refugee and immigrant populations indicate the efficacy of the addition of Tiers 1 and 2 (Cardeli et al, under review; Cardeli et al., 2020). Evaluations of TST-R also demonstrate high rates of treatment engagement and retention, and improvements in both PTSD and depression symptoms among Somali refugee youth (Ellis et al., 2010; Ellis, Miller, Baldwin, & Abdi, 2011). Findings to date also support the important role for the stabilization of social environmental stressors (resource hardships) in the reduction of mental health symptoms over time. Program evaluation data also supports the inclusion of cultural brokers into outpatient treatment teams as a strategy for providing linguistically appropriate, culturally responsive mental health services to multi-ethnic, refugee populations (Cardeli et al, under review; Cardeli et al., 2020).

Related initiatives

Refugee and Immigrant Core Stressors Toolkit (RICST)

The Refugee & Immigrant Core Stressors Toolkit (RICST) is a free, web-based toolkit that provides an overview of the Four Core Stressors framework (see Davis, Winer, Gillespie, & Mulder, 2021). These are common stressors experienced by refugee/immigrant youth and include resettlement stress, acculturative stress, isolation, and trauma. Preliminary research indicates that the RICST shows promise as an educational, assessment, and treatment-planning tool for providers working with refugee and immigrant families globally.

School-based Assessment Measure

We are currently developing a school-based assessment measure using the Four Core Stressors Framework. The measure is designed to assess youth resettlement experience to inform schoolwide prevention efforts as well as individual supports. The school-based measure has been piloted in eight languages with youth in grades 9 through 12 at a high school for newly arrived immigrant and refugee youth, Boston International Newcomers Academy (BINcA).

TST-R Tier 2 Adaptation for Students with Limited or Interrupted Formal Education (SLIFE)

In partnership with educators from a local high school serving newly arrived immigrant and refugee youth, the Boston International Newcomers Academy (BINcA), we are in the process of adapting the TST-R Tier 2 Group Curriculum for Students with Limited or Interrupted Formal Education (SLIFE). The goal of the adapted curriculum is to be culturally, linguistically, and developmentally affirming so that it can be implemented in classrooms serving SLIFE students by educators and support staff.

SOLA School of Leadership Afghanistan

The School of Leadership Afghanistan (SOLA) is the first and only Afghan-led boarding school dedicated to the education of Afghan girls. Now located in Kigali, SOLA is steadfast in its mission to provide a rigorous education in an environment where Afghan girls can grow to become compassionate, curious, confident women. The TCRC is proud to be working with SOLA to complete a comprehensive needs assessment and provide training and consultation to support SOLA in continuing their mission.

To learn more about SOLA, visit https://www.sola-afghanistan.org.

Cultural Brokers Learning in Partnership

Cultural Brokers Learning in Partnership is a group founded and facilitated by Osob Issa, and it is national innovative community of practice collaborative call to support cultural brokers implementing the TST-R model, and any other sites that we are contracted by that may find it beneficial. The group meets once a month for 90 minutes, and its main goals are to promote the members’ professional development, increase clarity in cross cultural communication, and advocate for policy that might be impacting the lives of the members, refugee children, and their families.

Current grant funding

Trauma and Community Resilience Center (TCRC) Refugee and Immigrant Core

The Refugee and Immigrant Core is a Category II site of the National Child Traumatic Stress Network and is funded by the Substance Abuse and Mental Health Services Administration. The purpose of the Category II is to raise the standard of care for refugee and immigrant children and their families, and to support the continued adaptation and wide-spread dissemination of Trauma Systems Therapy for Refugees, an effective evidence-based treatment. This includes training, consultation, and intervention and resource development. The Category II does NOT provide direct services to youth and families.

Project EPIC-Enhancing Pediatric Integrating Care

Project EPIC-Enhancing Pediatric Integrating Care implements Trauma Systems Therapy for Refugees (TST-R) to primary care patients at Boston Children’s Hospital. Project EPIC is a Category III site of the National Child Traumatic Stress Network and is funded by the Substance Abuse and Mental Health Services Administration. The Category III site provides direct services to youth who received their primary care at Boston Children’s Hospital’s Martha Eliot Health Center (MEHC) and at the main campus (Children Hospital Primary Care Clinic, or CHPCC).

Please click here to learn about Project EPIC.

Project SHIFA’s Marigold Families

Through the generous support of the Marigold Charitable Trust Foundation (Marigold’s), we have implemented Project SHIFA’s Marigold Families for more than 15 years to achieve Marigold’s mission to make a positive difference in the lives of young children (0-8) impacted by trauma and abuse. Project SHIFA’s Marigold Families is a trauma-informed, culturally responsive early prevention and intervention program for young refugee children (0 to 8 years) and their families in the greater Boston area. The TCRC partners with the Refugee and Immigrant Assistance Center (RIAC) to deliver Project SHIFA’s Marigold Families. We are committed to the healthy adjustment and successful futures of young refugee children and their families through prevention of further trauma exposure and a focus on culture, strength, and healing through child and parent groups, intervention, and provider consultation.