IMMIGRANT INTEGRATION LAB
 
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BOSTON COLLEGE SCHOOL OF SOCIAL WORK

Faculty Profile: Dr. Theresa Betancourt, ScD, MA

By: Annette Mooney

In a time and place when anti-immigrant rhetoric is incredibly pervasive, there are moments of hope and inspiration when we hear of refugee's resilience and trials in overcoming adversity. Although anti-immigrant rhetoric is prevalent in the most abstract parts of speech and activity in our society today, there are a number of concrete examples which demonstrate the resilience and hope in profound and visible ways. One concrete example uses applied research to demonstrate how the fostering of refugee children's wellbeing can be accomplished through community engagement, resource allocation, and developing key partnerships. Such a program can be found at the Boston College School of Social Work, directed by a new face on Boston College's campus who is aiding in efforts of the development of such applied research. Theresa Betancourt, ScD, MA, joins Boston College School of Social Work as the Salem Professor in Global Practice and Director of the  Research Program on Children and Adversity (RPCA). New to the school, though familiar in the field of global social work, Professor Betancourt sat down with members of our newsletter staff earlier this month to update us on her work and share her anticipations for the lab's future.
 
Dr. Betancourt came to Boston College School of Social Work from the Harvard T.H. Chan School of Public Health, where she also directed the Research Program on Children and Global Adversity and was affiliated faculty of the Harvard Center on the Developing Child. Her research history spreads across settings where children and families are low-resourced, often faced with humanitarian emergencies. Her current work is highlighted as Principal Investigator of a National Institute of Minority and Health Disparities (NIMHD) funded project in Sierra Leone, an intergenerational, longitudinal study of war. The research behind this project has already led to the development of mental health group interventions with war-affected youth for improving emotion regulation, daily functioning and school functioning. In the United States, she has led family strengthening intervention with refugee families, through a community-based participatory research partnership, funded by the NIMH, with Massachusetts Somali Bantu and Bhutanese refugee communities.
 
Betancourt's ongoing research interests focus on the developmental and psychosocial consequences of  concentrated adversity on children, youth, and families; resilience and protective factors found in child and adolescent  mental health and development; and applied cross-cultural mental health research of refugee families.  A full list of the RPCA lab's projects can be accessed  online .
 
Betancourt is excited about the social justice platform that comes with working at Boston College. As the nature of RPCA's research has focused on mental health with intervention development and evaluation, it is only fitting the program ties into the graduate program in social work, with its strong reputation for training in clinical practice, systems theory, and active policy reform. Betancourt's hope is for highly enriched work in the program's research, student engagement, and individual outcomes.
 
While it can appear as though the work of the RPCA team is centered in Boston, Betancourt asserts it is a bit of false dichotomy to separate the work, that it is in fact global, borderless, and full of cross-site learning. Yes, they have nodes at work in Sierra Leone and Rwanda, led by staff there, doing incredible work, but many of these lessons prevail in more local work as well. Practices abroad have frequently come back to influence protocols here in the United States, for example the NIMH project designing family-based preventive interventions with Somali Bantu and Bhutanese refugees in the Boston metropolitan area. "The work is about developing partnerships and maturing together," Betancourt says.


[The work is about  developing partnerships 
and maturing together.]
 

What did Betancourt set out to know at the start of her research? What was her driving force?
"We can study all sorts of things about risk and resilience from an observational perspective," she says, "but can we move the needle? Can we use what we learn to identify leverage points that interventions can target? And can those interventions have impact? We can hypothesize, but we don't know - until we do the research." That is precisely why Betancourt finds intervention research exhilarating, and why she is here recruiting others and sharing it with our BC community and abroad.  Their goal is to maintain a full perspective of the policy context, developing models that can be billable, sustainable, and most importantly safe. The team recognizes vulnerability in communities, and they are simultaneously trying to innovate. "It is okay to pursue that," Betancourt says, "if you pursue with a 'do not harm' lens, thinking first about issues of ethics and safety, monitoring that at all times."


[We can hypothesize,  but we don't know - 
until we do the research.]

 
How does policy work cross with this clinical research?
Looking to the U.S. project with refugees, the team acknowledged its desired focus on prevention services. Moreover, they were interested at how the services could be sustained and billable beyond a grant cycle. In the Affordable Care Act, prevention services are allowable as a billable service, largely through community health workers (CHW). At a state level, the team is also tracking. Massachusetts has generous policies around CHW involvement, offering credentialing standards and Federally Qualified Community Health Centers (FQCHC) with CHWs on staff. The team is asking how CHWs can take on providing prevention services and ensure these prevention services fall under CHWs credentialing standards. Long term, the hope is health centers and refugee resettlement services, local partners, will pick up this prevention work. A perfect example is the Maine Immigrant and Refugee Services in Lewiston, Maine. They have hired a social worker to their staff, who is thrilled about partnering alongside Betancourt, her team, and their model.
 
As the Affordable Care Act appears to be persisting, efforts down this path are viable and continuing. Things may need to shift, and the RPCA team will monitor changes.
 
What has most surprised Betancourt?
We have been witness to policy change. When the proposals were being written, the context was different. Early on, staff would report observed bullying and racism. Recently, the findings have been stunning. "To do this project in the middle of the current political context has been interesting; it feels all the more important, to cite evidence of another narrative."
 

[Refugee communities 
have proven  contrary
  t o the dominant narrative, 
that they are indeed assets 
to their communities.]

 
Horizon for expanding
Within the next two years, Betancourt feels her team may have ample data to share and advocate for carrying over these prevention services under private insurances.
 
How to engage?
Visit the team's  interactive website for project updates, publications, annual meeting details, interest groups, and opportunities for student engagement on research teams.
 
Welcome, Professor Betancourt and RPCA team! It is both an honor and pleasure to have you at Boston College.
 

 


Qualitative data informs assessment and intervention



References:




Agency AGENCY FOCUS
 
Research Program on Children and Adversity, Boston College School of Social Work

By: Jessica Slicer

Aimed to provide students and their families with better mental health outcomes, the Research Program on Children and Adversity (RPCA) is currently developing a pilot Refugee Project in  Boston and Springfield. Housed in Boston College's School of Social Work, the RPCA works to  understand the trajectories of risk and resilience in children who face adversity. Using a  combination of quantitative and qualitative research methods, the program looks at  mechanisms that influence child development and mental health. Using evidence-based  interventions, the RPCA team supports positive life outcomes.
 
Specifically, the Refugee Project focuses its work on refugee families in the Greater Boston  area, Springfield, MA and Lewiston, ME. Somali Bantu and Lhotshampa Bhutanese refugees  who have resettled in the United States can opt in to participate in the Project. Both of these  populations are ethnic minorities in their native countries. The Project team engages with  community members, stakeholders, and local nonprofits to successfully implement the  intervention. Their approach, the Family Strengthening Intervention (FSI), was originally  developed by Dr. William Beardslee for use with children who have parents suffering from  depression. It was adapted to use in Rwanda and then again for the Refugee Project.  Under the FSI, trained community health workers (CHWs) from the community that they serve,  use a ten module approach to help the families build strengths, resilience, and overcome  barriers to successful outcomes. The CHWs will meet with children and their parents both in  individual and group sessions. As a result of the information learned from these modules, they  will create a family narrative, discussing their history and identifying mechanisms to help them  succeed. The families also learn about educational structures and institutions in the United  States to help them better understand and navigate U.S. services and overcome resettlement  and acculturation stressors. The meetings are once per week for two hours and run the course  of ten weeks.
 
Refugee families from these populations must deal with acculturating into a new society and  frequently with limited economic resources. Using the community-based participatory approach, these families can learn to leverage support from within their communities to gain important skills and become better linked to critical resources. When young people work with the CHWs, they can help to identify unique stressors they experience in their everyday lives and together come up with strategies to face them. The Refugee Project hopes its work will help achieve better mental health outcomes among diverse groups of refugee children and adolescents and ultimately strengthen the family unit.




Current CURRENT RESEARCH 

Bentancourt, T.S., Frounfelker, R., Mishra, T., Hussein, A., & Falzarano, R. (2015).
American Journal of Public Health, 105(3), pp.S475-S482
Refugee youth have a much higher risk of experiencing psychological distress and mental health disorders than their non-refugee U.S. peers. Much of this elevated risk is due to "multiple acute and chronic stressors" that youth face throughout their refugee experience. To explore the mental health needs and community strengths of Somali Bantu and Bhutanese refugee youth in Massachusetts, this study utilized a community-based participatory research approach - a method that ensures the communities being studied are meaningfully involved at all research stages. Results indicated that both Somali Bantu and Bhutanese refugee youth experience symptoms of conduct problems, anxiety, and depression. Participants in both groups emphasized that financial problems and language difficulties - both inter-generationally and with outside institutions - were major concerns for youth and their families. However, both groups indicated that their communities, family and friends, and refugee service organizations were sources of support. Moreover, 25% of the Somali Bantu participants identified teachers and school personnel as important resources. In addition to providing a comprehensive understanding of the mental health needs of refugee youth, this study also illustrates how service providers working with refugees are well-positioned to act to protect youth from negative outcomes.


Ellis, B.H., Miller, A.B., Abdi, S., Barrett, C., Blood, E.A., & Betancourt, T.S. (2013).
Journal of Consulting and Clinical Psychology, 8(1), pp. 129-140
The research literature indicates that a lack of resources has a significant impact on the overall psychosocial well-being of refugee youth, perhaps playing an even larger role in predicting psychological distress than the experience of trauma itself. Taking into account environmental factors, including resource hardships and acculturative stresses, is crucial for any intervention promoting the mental well-being of refugee youth. The authors of this study report preliminary findings from an intervention implemented with Somali refugee middle school students in New England. The intervention followed a multi-tier service model to maximize participation of the Somali refugee community through building trust and engagement with providers before offering more intensive mental health services. The intervention targeted "community resilience building" in the general Somali community as well as "youth resilience building" through weekly group sessions offered in the middle school, as well as increasing levels of intensive, individualized counseling through the Trauma Systems Therapy model for youth identified as needing an advanced level of care. Preliminary results supported this multi-tiered model's effectiveness with engaging and retaining Somali refugee youth in treatment, as well as reducing symptoms of depression and PTSD and resource hardships.




Pieloch, K. A., McCullough, M.B., & Marks, A. K. (2016).
Canadian Psychology/Psychologie Canadienne, 57(4), pp. 330-339
Many refugee children and youth have undoubtedly endured trauma at some point in their lives, and may continue to face numerous stressors in the resettlement country. Service providers and those working with refugee youth, in any capacity, should be aware of these stressors, as well as the multiple levels of factors that promote recovery and resilience for these individuals. This review of the research literature illustrates the wide variety of individual-level sources of resiliency for refugee youth, ranging from having their basic needs for food and shelter met to building trusting relationships with interpreters. "Maintaining a positive outlook", hopefulness, and future aspirations also helped promote resiliency among youth. Family-level protective factors included family support, cohesion, and adaptive communication patterns, while school-level factors included feeling safe at school and value for education. Community-level factors included having space to play, joining social activities or clubs, and community networks that promoted engagement and a sense of belonging. Finally, "maintaining a connection with home culture and religion" as well as "pride and loyalty" to their home culture were society-level factors that had a positive impact on refugee youth's resilience.











Crea, T. M., Lopez, A., Taylor, T., Underwood, D. (2017).
Children and Youth Services Review, 73, pp. 93-99
Beginning in 2011, there was an increase of unaccompanied children from the Central American Northern Triangle (El Salvador, Guatemala, and Honduras,) entering the U.S. While many children were placed with adult sponsors, about 5%-35% remain in long term foster care (LTFC) waiting for deportation hearings. Research has shown that instability in the foster system such as moving frequently has led to poor outcomes. Unaccompanied children experience possible trauma during pre-migration, during migration, and post-migration as a result of forced displacement due to violence in their home countries, including abuse, exploitation, and rape. This study examined data from unaccompanied children served by the Lutheran Immigration and Refugee Service (LIRS) from 2012 to 2015. Findings show that girls were more likely to change placements, and those who experienced violence in their countries of origin were twice as likely to move. It is imperative that social services agencies are cognizant of the multi-layered experiences of unaccompanied children and strive for culturally competent and trauma-informed care when working with unaccompanied children in LTFC. 

Sharma, M., Fine, S. L., Brennan, R.T., & Betancourt, T. S. (2017).
Development and psychopathology, 29(1), pp. 11-23
An 11-year civil war in Sierra Leone affected the lives of over 48,000 young children who were coerced into participating with war-related activities. Many witnessed and were involved in traumatic experiences such as rape, and murder causing long-term effects of depression, anxiety, and post-traumatic stress disorder. Moreover, re-integration into mainstream society proved challenging with high unemployment rates, stigmatization, and lack of familial, peer, and community support. Five hundred twenty-nine war-affected youth were recruited for this study and longitudinal data was collected in three time periods: Time 1 (T1) in 2002, Time 2 (T2) in 2004, and Time 3 (T3) in 2008. Results indicate that children who killed or injured someone had higher externalizing, internalizing, and posttraumatic stress symptoms at T3 as well as those whose parent(s) died during the war. Participants who reported high T3 adaptive/prosocial behaviors were more likely to engage in approach coping strategies and lower externalizing and internalizing behaviors at T3. Avoidance coping may be a mechanism in reducing depressive and anxiety symptoms while approach coping may have an effect in long-term adaptive/prosocial behaviors. Researchers and practitioners should advocate in helping Sierra Leone create a mental health infrastructure that is severely lacking. 

Betancourt, T. S., Newnham, E. A., Birman, D., Lee, R., Ellis, B. H., & Layne, C. M. (2017).
Journal of Traumatic Stress, 30(3), pp. 209-218
Although the experiences of immigrant children differ from refugee youth, both groups experience stressors associated with acculturation, resettlement, and potential abuse or community violence. Mental health care is underutilized among refugee youth given that most services do not take into account distinct traumatic experiences and histories resulting from war-related violence. To better understand and improve the mental health needs of trauma-exposed children, this study seeks to analyze the differences in the mental health profiles and service utilization between refugee children, immigrant children, and U.S. born children. Data was obtained from the Core Data Set (CDS) using a subsample of 339 children: refugee youth (n=60), immigrant youth (n=143), and U.S. born youth (n=140). Refugee children reported higher ratings of traumatic grief, dissociation, and somatization compared to U.S. born youth. Refugee youth were receiving services related to war/political related violence, traumatic loss, bereavement, cultural adjustment, sexual assault/rape, and forced displacement, but were not receiving services related to interpersonal or community violence, illness/medical problems, or serious injury/accident outcomes. Service providers need to implement comprehensive clinical assessments with refugee children, creating a multi-layered approach that involves the family, and assessing and addressing potential barriers for refugee children in accessing services.




ReviewsREVIEWS
 
Exploring the Psychological Benefits of Hardship: A Critical Reassessment of Posttraumatic  Growth  
By Jayawickreme, E.,  Blackie, L E.R.
Springer Briefs in Psychology (2016)
In five interdisciplinary and progressive sections, this book covers the topic of adversity as a precursor to the endurance of positive outcomes throughout the lifespan. With exploration and development of this topic through a critical lens, the authors provide a correction to prior theoretical limitations of current research, and argue the reconceptualization of posttraumatic growth as the potential for positive change in personality and psychological development. In posing a necessity for a 'reset' in research, this book provides a window into the context of posttraumatic growth in long term and short term situations of refugees in Sri Lanka, and survivors of the Rwandan genocide. In conclusion, the authors deliver a constructive set of recommendations for researchers and scholars alike, in hopes of improving both the quality and quantity of research in this field.

The Social Ecology of Resilience: A Handbook of Theory and Practice
By Ungar, W.
Springer (2012)
A comprehensive handbook which provides a broad look at how factors of culture and context might affect positive outcomes towards sources of adversity. Including perspectives from renowned scholars demonstrating both Western and non-Western approaches, the handbook offers a take on adversity which demonstrates the dominant view of being an innate individual characteristic might not always be the most accurate. On the contrary, the author offers the concept that resilience might rather, be the product of family and community processes, facilitated through the group level rather than the individual level. Additionally, because resilience is related to social risk factors, and multiple external sources of adversity, the author stresses the importance of including an ecological interpretation of the construction of resilience which takes into account the social and environmental contexts in which individuals reside.

_______________________________________________________________________________________________________

RESOURCES
  
The National Child Traumatic Stress Network 
This web page contains resources in regards to what needs to be considered to teach traumatized refugee children in the classroom. 

Bridging Refugee Youth & Children Services (2017)
 
Bridging Refugee Youth & Children Services (2017)
BRYCS also has a regularly updated toolkit for school educators to better their teaching with refugee children. 

Refugee Health Technical Assistance Center (2011)
well-known webinar which systematically addresses the problem of suicide amongst refugee populations and contributing factors. 

Project SHIFA (Supporting the Health of Immigrant Families and Adolescents (2010)
This video talks about Project SHIFA (Supporting the Health of Immigrant Families and Adolescents), a program that aims to provide culturally competent school social work services for Somali refugee children and families in Boston. 

Boston Children's Hospital: Refugee Trauma and Resilience Center
The SHIFA program is partnered with Boston Children's Hospital Refugee Trauma and Resilience Center, which utilizes Trauma Systems Therapy adapted for refugees (TST-R), and is dedicated to promoting understanding and research surrounding refugee youth and trauma.

University of Vermont Medical Center (2015)
Cathy Kelley, LICSW and Andrea Green, MD talk about their experiences working with refugee families.  

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EDITORS: F. Crutchfield-Stoker (Managing Editor), W. Egmont, A. Spratley, D. Lee, A. Mooney, J. Slicer, Y. Shi, & D. Maglalang