Family Strengthening Intervention for Refugees

Project Summary

The Family Strengthening Intervention for Refugees (FSI-R) was developed and tested culturally and linguistically tailored in partnership with immigrant and refugee communities. Based off of previous research in Rwanda on the FSI for HIV affected populations, the FSI-R was developed using a community-based participatory research (CBPR) approach, initially co-created with Somali Bantu and Lhotshampa Bhutanese refugee communities in Chelsea and Springfield, MA, and in Lewiston, ME, with funding from the National Institute on Minority Health and Health Disparities (NIMHD) (R24MD008057-03S1). Following a first planning grant from NIMH using community-based participatory research (CBPR) approaches to co-develop and pilot the intervention, we conducted a Hybrid Type II effectiveness trial of the standard FSI-R from 2019-2022 with a second grant from the NIMHD (R01MD010613-06). The FSI-R has a whole-family prevention intervention approach and is supported by multiple organizations including the U.S. Committee for Refugees and Immigrants. The FSI-R has been adapted for Afghan, Somali Bantu, and Lhotshampa Bhutanese refugee communities in the United States.  The FSI-R is designed to be delivered by non-specialists who are from the community they are serving in a home-visiting 10-12 module approach. In addition, our research has developed a digital application  intended to help increase fidelity to the evidence-based intervention by providing an easy-to-use format that is more user-friendly than a paper manual. The digital tool has been co-developed and co-created by refugee populations, UI/UX researchers, and computer science students. The FSI-R is currently being administered for Afghan populations in the United States. We have conducted a pilot study of our Afghan FSI-R in Maine and we are now working with partners in Michigan to further the impact of the FSI-R for vulnerable Afghan families across the state.

The RPCA works with national and global partners to license our interventions with rigor to ensure the adaptability of our research in multiple contexts.

Background and Aims

Newly arriving refugee families have experienced trauma from forcible displacement, family loss, and violence compounded by additional acculturative and post-resettlement stressors in the United States (U.S). Many intervention models focusing on refugee trauma and mental health emphasize deficit-based approaches that can foment stigma and are initiated after symptoms become severe. In contrast, preventive interventions can reduce disparities by targeting family functioning (e.g., family conflict, communication, positive parenting, school-systems navigation) to reduce stressors known to increase risks for poor child mental health, strengthen protective factors, and reduce or eliminate undesirable outcomes in resettlement. ​​The Family Strengthening Intervention for Refugees (FSI-R) is an evidence-based, preventive, whole-family intervention to promote child mental health and family functioning among resettled families. Our team has been at the forefront of developing and implementing innovative culturally and linguistically tailored evidence-based interventions in partnership with immigrant and refugee communities for more than a decade. Prevention science informs and supports our approach, focusing on family dynamics and functioning (e.g., family conflict communication, positive parenting, school and social services-system navigation) to reduce stressors that increase the risk of poor child mental health and prevent negative outcomes. The FSI-R was modeled after the Family-Based Preventive Intervention, an effective program designed to prevent depression in children of depressed caregivers by promoting positive and healthy parenting practices. It was one of the first family-based preventive programs adopting an ecological approach to chronic family stress; it demonstrated sustained effectiveness, particularly in low-resource and culturally diverse settings. Partnering with the Office of Global Michigan to support the sustainability of the FSI-R program to Afghan evacuees in the U.S., the RPCA and the state of Michigan will be establishing a train-the-trainer program model with the goal of training more agencies to implement the FSI-R. 

Aims: 

• Establish a train-the-trainer model, which will be delivered to current Michigan FSI-R interventionists.
• Set up Afghan community advisory boards throughout the state of Michigan.
• Train more agencies to implement the FSI-R.
• Provide technical assistance to existing and new interventionists/agencies.
• Monitoring and evaluating the FSI-R program.
  

Key Findings of Projects to Date

• Findings from previously published FSI-R research with Somali Bantu and Bhutanese populations demonstrate 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 care as usual (CAU) families.
• Bhutanese FSI-R children reported reduced family arguing  and showed fewer depression symptoms and conduct problems by parent report compared with CAU.
• The FSI-R has promise for promoting family functioning and mental health in refugee children and families.

Findings of Afghan FSI-R are under peer review.

Aims: 

• Establish a train-the-trainer model, which will be delivered to current Michigan FSI-R interventionists.
• Set up Afghan community advisory boards throughout the state of Michigan.
• Train more agencies to implement the FSI-R.
• Provide technical assistance to existing and new interventionists/agencies.
• Monitoring and evaluating the FSI-R program.