Leveraging Implementation Science and Design Methods to Sustain Community-Based Mental Health Services for Refugees

There has been an unprecedented increase in the number of refugees worldwide, with approximately 26
million men, women and children forcibly displaced from their homes at the end of 2019. More than half of the
world’s refugees live in dense urban areas or refugee camps in low- and middle-income countries. A smaller
percentage are permanently resettled in high-income countries. Across these contexts, refugees have elevated
rates of common mental disorders. War and forced migration also contribute to systematic disruptions in social
relationships including family separation, tension and conflict, and losses of social networks. There is an
emerging evidence base of models regarding refugees’ mental health and psychosocial needs, but major gaps
exist regarding how to adapt evidence-based interventions (EBIs) to refugee populations and sustain them in
community settings. To address these gaps, my career goal is to establish an independent research program
focused on the implementation of community-based mental health services for refugee communities across the
displacement continuum. In collaboration with community partners, I aim to examine methods for integrating
EBIs into non-traditional service settings to enable refugees’ access to prevention and care interventions that
promote positive mental health outcomes. A central concern my research seeks to address is how to best
mobilize social and family resources to enhance coping and wellbeing. These research priorities are shaped by
my more than fifteen years of clinical practice experience working with war-affected populations in the U.S and
globally, doctoral training at the University of Chicago and early research experiences. This K01 application is
structured to build upon my strengths and develop new knowledge and skills in key areas needed to achieve
my long-term goals. My training aims focus on 1) implementation science methods to adapt, scale up and
sustain EBIs in community settings; 2) the application of human-centered design to community-based refugee
mental health services; and 3) community-based trial design and analysis. With support from an accomplished
multidisciplinary team of mentors, I will apply these skills to a research project that focuses on implementing a
peer-led multiple family group (MFG) prevention intervention called CAFES in two community-based
organizations in Chicago to promote uptake and meet the multi-level needs of refugee families. Using a pilot
randomized type 1 hybrid implementation-effectiveness design, the research aims include: 1) Adapting the
multiple family CAFES model for Syrian refugee families and delivery by peer providers in community-based
organizations using the ADAPT-ITT framework and human-centered design methods; 2) Piloting the adapted
CAFES model to assess implementation science domains; and 3) Exploring changes in mental health
outcomes and family and community support and mechanisms of change. Drawing on the new knowledge and
skills and pilot study data obtained from this K01, I will prepare an R01 proposal to further test the model
implementation and effectiveness.

Grant Number: 5K01MH128524-04
NIH Institute/Center: NIH
Principal Investigator: Mary Bunn