Faculty Bibliography

OBJECTIVE: Youth in war-affected regions are at risk for poor psychological, social, and educational outcomes. Effective interventions are needed to improve mental health, social behavior, and school functioning. This randomized controlled trial tested the effectiveness of a 10-session cognitive-behavioral therapy (CBT)-based group mental health intervention for multisymptomatic war-affected youth (aged 15-24 years) in Sierra Leone. METHOD: War-affected youth identified by elevated distress and impairment via community screening were randomized (stratified by sex and age) to the Youth Readiness Intervention (YRI) (n = 222) or to a control condition (n = 214). After treatment, youth were again randomized and offered an education subsidy immediately (n = 220) or waitlisted (n = 216). Emotion regulation, psychological distress, prosocial attitudes/behaviors, social support, functional impairment, and posttraumatic stress disorder (PTSD) symptoms were assessed at pre- and postintervention and at 6-month follow-up. For youth in school, enrollment, attendance, and classroom performance were assessed after 8 months. Linear mixed-effects regressions evaluated outcomes. RESULTS: The YRI showed significant postintervention effects on emotion regulation, prosocial attitudes/behaviors, social support, and reduced functional impairment, and significant follow-up effects on school enrollment, school attendance, and classroom behavior. In contrast, education subsidy was associated with better attendance but had no effect on mental health or functioning, school retention, or classroom behavior. Interactions between education subsidy and YRI were not significant. CONCLUSION: YRI produced acute improvements in mental health and functioning as well as longer-term effects on school engagement and behavior, suggesting potential to prepare war-affected youth for educational and other opportunities. Clinical trial registration information-Trial of the Youth Readiness Intervention (YRI); http://clinicaltrials.gov; NCT01684488.

Conflict throughout Africa has created havoc for many. This overwhelming chaos has led to the disintegration of social order and generated widespread gender-based violence. As a result, African women have become casualties, experienced brutal acts of sexual violence, and been forced into exile. Drawing on the tribulations of displaced African female survivors of conflict-related sexual violence, this article discusses these women's experiences and highlights the barriers and struggles encountered while seeking refuge. The article concludes by exploring the challenges of providing culturally informed, strength-focused mental health services to these women as they rebuild their lives in a new sociocultural context.

Because of ongoing political and social instability throughout the continent, many Africans have become forced migrants. Unlike immigrants who choose to migrate, forced migrants flee their countries in search of safety and often endure multiple traumatic events during their migration. They are often unprepared for new risks in their adopted country. There is a high incidence of newly-diagnosed HIV cases among West African immigrants in the New York City metropolitan area, but little research to date to understand why this might occur. In order to gain insight, the current pilot study explored HIV knowledge, risk and protective behaviors among 52 West African-born forced migrants in New York City. HIV risk behavior came primarily from unprotected heterosexual activities. While most participants were very knowledgeable about HIV transmission and risk factors, almost half reported that they had not used condoms during sexual activities in the past 6 months. Women were more knowledgeable about HIV transmission, yet reported significantly more STDs than men. Many participants did not know about HIV/AIDS treatments and could not identify HIV/AIDS services and resources within their immigrant communities. Factors influencing HIV risk and protective behaviors among this population are identified and discussed. Suggestions for future research and strategies to reduce risky behaviors while enhancing protective ones among forced West African migrants are highlighted.

Although many African women immigrate to the United States from countries with high prevalence rates for female genital cutting (FGC), there has been limited research exploring the incidence and impact of FGC among this growing immigrant population. This pilot study sought to examine the experiences of FGC among West African immigrant women in the US. Of the 23 participants, 7 reported a history of FGC, with Muslim participants reporting significantly higher rates of FGC than Christians (Fisher's Exact = .045). Most of the women who had experienced FGC were from Sierra Leone (Fisher's Exact = .027). Limitations of the study are discussed along with suggestions for future research aimed at understanding the impact of FGC, reducing the prevalence and demand for FGC among African immigrant women and improving the health and quality of life of women who have undergone the procedure.

Although the number of African immigrants arriving to the United States has increased significantly, there has been little investigation regarding their experiences of intimate partner violence or coping strategies. This study used focus groups and individual interviews to explore intimate partner violence among 32 heterosexual West African immigrants. Results suggest that although cultural expectations influence their coping strategies, West African-born men and women face different realities, with women reporting multiple instances of abuse and a sense of frustration with the existing options for assistance. Although participants discussed multilevel support structures within the immediate West African community to address intimate partner violence, all of these options maintained a gender hierarchy, leaving women dissatisfied. Challenges and barriers to partner violence resolution and coping strategies are identified. Results are examined in terms of their implications for addressing the needs of this underserved population. Implications for future research and services are discussed and highlighted.

The current study employs a grounded theory approach to examine West African immigrants' resolution of parent-child conflict and intimate partner conflict. Data from 59 participants present an interactive social ecological framework, where a lack of resolution at one level results in attempts to resolve problems at higher levels. Four levels are identified within West African immigrants' problem solving ecology, each with specific actors in positions of authority: individual/dyadic (parents and spouses), extended family (which includes distant relatives and relatives living in home countries), community leadership (non-family elders and religious leaders), and state authorities. From participants' descriptions of family challenges emerged a picture of a social ecology in flux, with traditional, socially conservative modes of resolving family conflict transposed across migration into the more liberal and state-oriented familial context of the United States. This transposition results in a loss spiral for the traditional social ecology, differentially affecting individual actors within families. Implications for helping professionals working with new immigrant communities include identifying variability in openness to adapting structures that are not working well (e.g., patriarchal protection of abusive husbands) and supporting structures known to be associated with well being (e.g., collective monitoring of youth).

The literature on older adults and sexuality suggests that culturally sensitive counseling may give older adults an opportunity to express sexual concerns and promote healthier attitudes toward sexuality. Guidelines for counseling older adults who self-identify with ethnic minority groups or as gay, lesbian, or bisexual are given, with recommendations for training, practice, and research.

The number of refugees and asylum seekers admitted to the United States has grown, with significant numbers arriving from sub-Saharan Africa. Given this reality, it is important that mental health professionals are equipped to provide culturally relevant services. This article describes the development and implementation of a group treatment model for African male forced migrants in a large urban hospital. Therapeutic techniques that draw on African cultural traditions in order to rebuild lives, reduce symptoms, recreate familial and community connections, and support adjustment are discussed. Suggestions for future treatment and research to address African refugee mental health needs are highlighted.

The number of forced migrants arriving in the United States continues to increase. To provide effective therapeutic services and interventions for them, it is important for clinicians to understand the unique role that mental health professionals can play in improving the mental health of this diverse population. This article draws attention to the mental health needs of forced migrants and highlights considerations, such as medical, social, legal, cultural, and linguistic factors, that providing services to this population may entail. It also suggests ways in which counselors can actively, competently, and ethically address the social justice issues that impact forced migrants.