Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Philadelphia Refugee Mental Health Consortium (PRMHC)

Name of Innovative Program: 
Provision of Psychosocial Services to a Refugee Population
Sponsoring Organization
Philadelphia Refugee Mental Health Consortium (PRMHC)
Name of Innovative Program Lead: 
David A. Goodwin PhD, Melissa Fogg MSW
E-mail Address of Innovative Program Lead: 
goodwind@einstein.edu
Project Description: 
 Based on current understandings of psychosocial  risk factors, refugees represent a population vulnerable to developing mental health concerns.  Refugees are often  plagued by diffuse fears, profound losses, deep rage and shame and a pervasive sense of distrust and existential alienation: exposed to unfamiliar cultural symbols and institutions, they lack meaningful validation for their experience of forced migration.  Furthermore, cultural, linguistic and logistical barriers often prevent access to mental health services resulting in  long-term psychosocial consequences including poverty, disability, domestic violence, incarceration and family dysfunction. Federal policy is based on an unrealistic expectation of self sufficiency with cessation of supportive benefits after eight months.  Resettlement agencies lack the necessary resources to adequately address the psychosocial challenges of refugee families. For this reason the Philadelphia Refugee Mental Health Collaborative Project (PRMHC www.culturalcommunities.org)  was established as an innovative  multi-agency collaborative venture to address the complex needs of this population with an emphasis on culturally informed community based treatment approaches as well as individual models, ranging from art based group projects to individual therapy and medication management.  Further funding is sought to help refugee families mitigate against potentially catastrophic psychosocial stressors and to support psychosocial programming.  
Creativity and Innovation: 
This project represents an innovative and creative approach to tackling the reality that the complex psychosocial needs of refugees and asylees are presently inadequately addressed and that it requires a comprehensive network of health-related providers, community agencies and resettlement agencies to provide coordinated interventions to redress this glaring need.    These collaborations are offering national leadership through the development of a comprehensive yet flexible network of providers offering an array of services all aimed at enhancing the biopsychosocial functioning of this population.  The collaborative is committed to following the recommendations outlined by The Psychosocial Working Group http://www.forcedmigration.org/psychosocial/papers/Conceptual%20Framework.pdf  by providing both community-based psychosocial interventions and access to culturally informed trauma-based individual treatment.  For example, the collaborative partnered with the Mural Arts Program to convert an empty storefront into a community-arts center, allowing  refugee communities to become engaged in healing programming through cultural art forms, including dancing, weaving, storytelling, cooking,  and art therapy.    
Leadership: 
The Collaborative has strived to offer a conceptually informed approach to the provision of psychosocial services and in so doing has provided national leadership in the construction and implementation of a comprehensive network that is able to offer a unique breadth of interventions.   Community based interventions have included art therapy based projects for refugee children through BuildaBridge, a photovoice project that was displayed at a local urban museum  ( http://www.phillymagicgardens.org/news/exhibitions) entitled Envisioning Home  and many others. http://www.culturalcommunities.org  .   By participating in creative healing programs, participants build the foundation of a new life while celebrating their cultural identity.  Individual approaches have included the provision of psychotherapy and medication management to refugee populations at Belmont Behavioral Health.  Additionally there are ongoing training initiatives aimed at case aides from local refugee communities, graduate clinical psychology students and psychiatry residents.
Sustainability: 
The collaborative has received positive attention from the Department of Behavioral Health and established journalists including Maiken Scott at WHYY.   The work of the collaborative will continue to draw more sponsors and providers and Philadelphia has been an established resettlement area for decades.  The members of the Collaborative are clearly committed to the delivery of services to this marginalized population and have established a durable broad network of providers over the past decade.  The project continues to build on strong relationships via  monthly meetings held with resettlement agencies, hospitals, schools, businesses, social service providers, and artists who are embedded in immigrant communities. Philadelphia is pioneering an effective and sustainable approach to the delivery of mental health services to the refugee population. Changes in health care access will also hopefully contribute to further sustainability of service delivery to this population.
Replicability: 
Replicability, in other urban centers, is certainly feasible though would require formation of a comprehensive network of committed service providers.   Seattle, WA has also been able to implement an effective system of service delivery with the assistance of funding agencies.  Information has certainly been shared between their Pathways to Wellness program (http://www.lcsnw.org/pathways )and the Philadelphia Refugee Mental Health Collaborative particularly around the implementation of the RH15, a mental health screening tool deployed in primary care offices.  The work of the Collaborative has been presented at a number of national and state forums and key members are open to consulting to other initiatives.The project’s innovative use of community based “hope restoration” projects as a means to positive mental health outcomes is also generally applicable to disenfranchised populations.  All providers are committed to treatment models that recognize contextual/psychosocial components of psychological dysfunction. 
Results/Outcomes: 
Initial mental health data is collected via administration of the RH-15,  a standardized mental health screening tool developed for refugee populations. All collaborative projects initiatives are evaluated with quantitative and qualitative data such that findings can be appropriately disseminated in local and national forums.   Three papers were recently presented at the North American Refugee Health Conference in Toronto: The first presentation: “Forming Interdisciplinary Cross-Institutional Community-Based Refugee Health Programming” covered the PRMHC’s structure, model and best practices. The second, “Community Based Approaches to Refugee Health: The Philadelphia Refugee Mental Health Photovoice Project” reviewed findings from the photovoice project, a photographic representation of the resettlement experience. Finally, “An Assessment of Refugee Health Provider Perceptions of Refugee Mental Health in Philadelphia” looked at outcomes from a comprehensive survey of social service and health providers in 2011 which formed the basis of a needs assessment. 
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