Addressing the Mental Health
Needs of Immigrant and
Refugee Youth and their
Families
Olga Acosta Price, Ph.D.
Mark Sander, Psy.D.
Caring Across
Communities
Addressing Mental Health
Needs of Diverse Children and
Youth
Demographics
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In 2000, 31.1 million individuals in the US were
foreign-born (an increase of 57% since 1990)
According to the 2000 Census, 1 of every 5
children in the US is a child of immigrants
In the past 30 years, over 2 million refugees have
resettled in the US, with a significant number
being under 18 years old
19% of children 5-17 speak a foreign language
at home and 5% of all children have difficulty
speaking English
Challenges Faced
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Poverty rates are much higher for children in immigrant
and refugee families than children in native-born
families
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Parents are more likely to perform low-wage work with no
benefits (lack of health insurance) or limited benefits
Pre-migration, migration, and post-migration exposure
to traumatic events creates vulnerabilities
People with limited English proficiency (LEP) are less
likely to seek care and receive needed services (even
when economic factors and ethnicity are accounted for)
Utilizing a School Base
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Important resources at hand
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ESL, student support services, special education,
offices of multicultural services
Familiarity with translation and interpretation
Understand the value of community
partnerships
Often less stigmatizing to receive services as
part of support offered in school
Cultural Competence
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How do we know that our constructs around
mental health mean the same thing to our
clients?
Do processes for obtaining informed consent
need to be modified?
Are our evidence-based practices really
appropriate for the families and children from
other countries of origin?
What adaptations are necessary to make sure our
treatment programs are effective?
Robert Wood Johnson Foundation
Caring Across Communities National
Program
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Commitment to vulnerable populations and ending
disparities in health care & outcomes
Expectations concerning CAC National Program
 Developing models for assuring language access for
children & their parents
 Developing models for building cultural competence
 Adapting evidence-based prevention and treatment
interventions to effectively meet the needs of
immigrant and refugee families and their children
Over 355 applications were received
Program Summary & Key Elements
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15 grantees identified and awarded up to $100,000 a
year for three years (starting March 2007)
Serving an immigrant or refugee-dense community
Building on the combined strengths of a community
partnership
Utilizing a school base
Understanding the target community & its most
pressing mental health issues
Reducing barriers to care created by language and
cultural difference
Program Monitoring and Evaluation
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Program monitoring
 Quarterly narrative
 data reports
 ‘success stories’
Evaluation
 Utilization
 Satisfaction
 Outcomes
Lessons learned- redefining best practices
School Mental Health:
Building Cultural
Connections and Competence
Minneapolis Public Schools, Hennepin
County, and Community Mental Health
Agencies
Program Overview
The Minneapolis Expanded School Mental Health
(ESMH) Program provides a broad continuum of
Mental Health services through public/private
partnerships that are:
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Universally accessible
Culturally competent
Effective
Sustainable
Compliant with data privacy requirements
Program Overview
The Caring Across Communities Initiative allows us to
enhance our Expanded School Mental Health Program
by:
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Improving language access
Enhancing service by training and adapting interventions
Providing culturally specific support services
Disseminating lessons learned to school staff, local providers
and organizational leaders and policy makers
Program Overview
The Continuum includes:
On site services for prevention, early intervention, screening,
diagnostic evaluation and treatment (including individual, family
and group)
 Teacher consultation
 Capacity Building – School staff training
As needed:
 Access to Targeted Mental Health Case Management
 Day Treatment
 Residential Treatment
 Crisis Assessment and Intervention
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Program Overview
The ESMH Program is built on a partnership
between:
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Community Mental Health Providers
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Hennepin County
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Minneapolis Public Schools
Program Overview:
Minneapolis Context
Minneapolis is a culturally diverse city,
The school district has:
76% Students of Color
 26% ELL
 Large African immigrant population
 Largest Somali and Oromo communities in the
nation
 Growing Spanish speaking population
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Program Overview:
Need for Cultural Connections and
Competence
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Significant change in demographic of Minneapolis
Public Schools in past 15 years
Large unmet need for mental health services for
children and families, especially low income and
immigrant and refugee students and families
Delivering usual care and/or evidence based
interventions might not work for immigrant and
refugee students and families
Project Plan:
Overarching Goals
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Goal 1: Improve access to mental health services
for all students and families
Goal 2: Expand cultural competence of mental
health clinicians and school staff
Goal 3: Build family and community
connections and interventions
Goal 4: Capture lessons learned and disseminate
knowledge and best practice
Improving access: 1st Year Progress
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Bilingual providers on-site and/or culturally
informed interpretation
Translating core documents (i.e., HIPAA, ROI,
informed consent)
Translation of program brochures and agency
inserts
Cross-training with OMS, family liaison, and
clinicians
Expanding cultural competency: 1st Year
Progress
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Developed training plan for clinicians and
administrators
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Cross training with OMS and family liaison
Identification and Assessment of Trauma in Children
On-line TF-CBT offered through NCTSN
RWJF Web-based training
Discussions in Administrators’ and Clinicians’ meeting
regarding current cultural issues
Initiated Community Advisory Group
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September 25: 1st Meeting; November 8th next meeting
Building family and community: 1st
Year Progress
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Approximately 25% of clinicians’ contact are
with the family
Clinicians can deliver services in home
Work with Community Advisory Group to
develop additional outreach and engagement
strategies
Capturing lessons learned and
disseminating: 1st Year Progress
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Disseminate internally within partner agencies
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Disseminate externally to the local community
of mental health providers
Challenges
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Developing language access and cultural congruence of
concept of mental health/wellness
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Limited number of bi-cultural mental health professional, especially
from African cultures
Potential concerns using interpreters
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Confidentiality
Accurate interpretation of the questions and answers
Possible “intervention” by interpreter
Significantly different ideas of how one heals and the etiology of the
issue or concern
Little research on what works for different cultures
Opportunities
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Work with the African and Latino communities to develop better
engagement and intervention strategies
Work with the African spiritual community (Imams) to develop
better understanding of each other and do some cross-education
Develop and sustain strong partnership to develop a system of
mental health care for immigrant and refugee students and their
families
Learn what works with these students and families and
disseminate the knowledge locally, regionally and nationally
Partners:
District and School Staff
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District wide coordination and alignment
Principals and student support staff
Teachers
Partners:
Community Partners
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Community mental health staff
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The Mental Health Collective
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Provide mental health services at Andersen Open, Andersen
Elementary, and Sullivan schools
La Familia Guidance Center
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Provide mental health services at Jefferson School
Non-RWJF funded SMHP sites
 Washburn Guidance Center
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Provide mental health services at Tuttle and Longfellow Schools
NorthPoint Mental Health Center
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Provide mental health services at Lucy Laney School
Partners:
Community Partners
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Culturally specific agencies
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African Aid
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Hennepin County Office of Multicultural Services
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Have strong relationships in cultural communities served
Mental health outreach and education to African Immigrants
Have established trusting relationships with cultural communities
served
Provide linguistically and culturally appropriate support
assistance
Family Resource Centers: Parent Liaison
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Have strong relationships with parents
Understand the needs of immigrant and refugee families
Provide support services in schools
Partners:
Hennepin County Children’s Mental Health
Area
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Aligned county services and contracts to better
integrate services in schools and increase access
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Case Management
Day treatment
Residential Services
Contracts with community providers for students’
uninsured with serious emotional disturbance
Promoting cultural competence providers and
systems
Partners:
Consulting Partners
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Abigail Gewirtz, Ph.D., L.P., University of
Minnesota
Will assist in assessment and adaptation of child
trauma protocols for immigrant and refugee
communities
 Director, Minnesota Child Response Center
 Has a long history of partnering with MPS and
Hennepin County Children’ Mental Health
 Served as a consultant for program evaluation design
for MPS ESMH program
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Partners:
State Partners
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MN Department of Health
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MN Department of Human Services
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Ann O’Fallon, State Refugee Health Coordinator
Dr. Glenace Edwall, Director, Children’s Mental
Health
MN Department of Education
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Cindy Shevlin-Woodcock, School-based Mental
Health Specialist
Contact Information
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Olga Acosta Price, Ph.D.
Co-Director, Center for Health and Health Care in Schools
School of Public Health and Health Services, GWU
 Email: [email protected]
 Phone: 202-466-3396
 http://www.healthinschools.org
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Mark Sander, PsyD, LP
Minneapolis Public Schools/Hennepin County
 Project Director, RWJF Initiative
 Coordinator, Expanded School Mental Health Program
 Email: [email protected]
 Phone: 612-668-5489
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