Refugee populations have risen in Eastern Iowa in recent years, but there are often gaps in access to resources as they transition to a new life in a new place with a different language and culture. University of Iowa College of Public Health professors William Story and Rima Afifi want to make mental well-being support more available to refugees who come here.
William Story, PhD, MPH, assistant professor of community and behavioral health, and Amy Weismann, JD, assistant director of the Center for Human Rights, are leading the University of Iowa’s efforts. Rima Afifi, PhD, MPH, professor of community and behavioral health and an expert on immigrant and refugee populations and community-based mental health interventions, is providing guidance on the project.
They are working in collaboration with the Iowa Bureau of Refugee Services to evaluate mental health needs for refugees, train health care providers on addressing mental health with refugees, and train refugees in problem management and stress.
“Refugees are often coming from difficult circumstances like post-conflict settings or refugee camps, so moving to a new society requires a lot of adjustment,” Story says. “We’re hoping this program will help them adjust to life in Iowa and build a set of skills and capacities to work through issues as they arise.”
The project is in its third and final stage, which involves providing training and supervision to community facilitators who then provide mental well-being support to refugees in their own communities, including Johnson County, Linn County, and Scott County.
The team hired community facilitators who are mostly from Eastern African countries, are well known in their community, and share the same language, culture, and often similar experiences to the refugees they are sharing the mental well-being intervention with.
Rania Awad is one of eight current community facilitators who are now providing mental well-being support to a group of refugees.
“Being from Sudan, I know there are many things my country went through — the civil war, revolution,” Awad says. “Going through this training made me think, ‘Wow, people can have trauma, psychological problems, and they can’t go through the health system easily.’ The training gives me the keys to know how to help these people.”
The research team selected an evidence-based intervention developed by the World Health Organization (WHO) called Problem Management Plus (PM+). PM+ is a low-intensity psychosocial intervention that aims to improve mental health, functioning, and well-being of adults impaired by distress in communities exposed to adversity, and it has often been used in humanitarian crises. The intervention consists of five individual sessions, of 90 minutes each.
This project is the first time PM+ has been piloted in the US. The sessions started in person and when COVID-19 hit, the research team transitioned to virtual platforms.
“It’s a basic program, not designed for people who have severe mental health needs like diagnosable depression or psychotic disorders, but for people who have some anxiety or stress in their lives,” Story says. “The idea, in the refugee context, is to help people who might be dealing with some past trauma, but also people who are dealing with problems of daily living while integrating into a brand new society and figuring out how to manage those.”
Refugees learn strategies to manage stress and relax the body, address how they are feeling and respond to problems that arise, find motivation for important activities, and strengthen social support.
One aspect that made the PM+ program ideal is that it can be delivered by a community facilitator who has a brief training of about 10 days and receives ongoing supervision as opposed to something a psychiatrist, psychologist, or social worker needs to deliver, according to psychiatrist and anthropologist Brandon Kohrt, MD, PhD, of George Washington University.
Kohrt visited the University of Iowa to advise and help train community facilitators in PM+. He also helped train health care professionals to address mental health with refugees.
“We train people around the world who might not have a mental health background at all in how to deliver PM+,” Kohrt says. “It seemed like that was a great fit for the refugee community in Iowa, so that people that are from the same culture, speak the same language, could be trained up and be able to deliver this support to their neighbors, their communities, and other people who are going through similar experiences”
Currently, the team is providing PM+ to a small number of refugees and is evaluating the intervention in order to determine if it is appropriate to scale up for refugees throughout Iowa. The pilot project can also indicate any adaptations that could be made to make the program more relevant and effective.
“We have had tremendous enthusiasm about this project, so I think that if we’re able to find the funding we won’t have a problem finding community facilitators and supervisors and others around Iowa who really see the need and want to implement this at a larger scale,” Story says.