Family-Based Mental Health Promotion for Somali Bantu and Bhutanese Refugees: Feasibility and Acceptability Trial

Abstract

Purpose: There are disparities in mental health of refugee youth compared with the general U.S.

Population: We conducted a pilot feasibility and acceptability trial of the home-visiting Family Strengthening Intervention for refugees (FSI-R) using a community-based participatory research approach. The FSI-R aims to promote youth mental health and family relationships. We hypothesized that FSI-R families would have better psychosocial outcomes and family functioning postintervention compared with care-as-usual (CAU) families. We hypothesized that FSI-R would be feasible to implement and accepted by communities.

Methods: A total of 40 Somali Bantu (n = 103 children, 58.40% female; n = 43 caregivers, 79.00% female) and 40 Bhutanese (n = 49 children, 55.30% female; n = 62 caregivers, 54.00% female) families were randomized to receive FSI-R or CAU. Refugee research assistants conducted psychosocial assessments pre- and post-intervention, and home visitors delivered the preventive intervention. Multilevel modeling assessed the effects of FSI-R. Feasibility was measured from retention, and acceptability was measured from satisfaction surveys.

Results: The retention rate of 82.50% indicates high feasibility, and high reports of satisfaction (81.50%) indicate community acceptance. Across communities, FSI-R children reported reduced traumatic stress reactions, and caregivers reported fewer child depression symptoms compared with CAU families (β = -.42; p = .03; β = -.34; p = .001). Bhutanese FSI-R children reported reduced family arguing (β = -1.32; p = .04) and showed fewer depression symptoms and conduct problems by parent report (β = -9.20; p = .04; β = -.92; p = .01) compared with CAU. There were no significant differences by group on other measures.

Conclusions: A family-based home-visiting preventive intervention can be feasible and acceptable and has promise for promoting mental health and family functioning among refugees.

Keywords: Family functioning; Intervention; Prevention; Refugees; Youth mental health.

Figure 1.. FSI-R Intervention Modules

Figure 2.. CONSORT Flow Diagram

^a When children and caregivers moved away, the study team attempted to locate them for post-assessment ^b Primary analyses included all randomized families with data for at least one time point, using 20 multiply imputed data sets to account for missingness. ^c Two Bhutanese families (n= 5, 2 children, 3 caregivers) were excluded from analysis due absence of both baseline and follow up assessments. Baseline data were lost due to a technology malfunction. Post-test data were not collected because the family moved or declined to participate in the post-assessment.