Kudos to Irene Felsman, assistant professor, Ellen Andrews from Church World Service (CWS) and their entire team for the submission of their Duke Clinical Translational Science Institute (CTSI) - Community Engaged Research Initiative (CERI) Population Health Improvement Multi-PI application entitled: “Digital Storytelling as a Mental Health Intervention for Refugee Immigrants." This proposal requests funding for a one-year period with a start date of September 1, 2021.

There are over 26 million refugees in the world today (UNHCR); less than 1 percent of refugees are ever resettled permanently in a country of asylum. Those refugees who do have the opportunity for permanent resettlement are the most vulnerable and traumatized. There are an estimated 10,000 refugees currently resettled in the Triangle area (CWS, 2021). Many refugees suffer from a “Triple Trauma Paradigm”, which includes trauma in countries of origin, trauma in flight, and trauma in their resettlement country (Michultka, D., 2009). Exposure to intimate partner violence, sexual assault, social isolation, forced family separation, loss of social role, loss of family identity, community and culture, acculturation stress, and anti-immigrant attitudes are common experiences for refugees.

Individual mental health services for resettled refugees are not readily available and require costly, difficult-to-schedule medical interpretation services. In addition, typical Western modes of individual mental health interventions are often not well understood or accepted by refugee populations. Low-cost mental health interventions accessible to the entire refugee immigrant community are particularly important at this time juncture given the recent reduction of federal funds allocated to refugee resettlement, and the increase in refugees currently being resettled who are at high risk for compromised mental health due to traumatic conflict experiences. Research findings indicate that the digital storytelling process is a valuable research method.

CWS has employed several alternative interventions to address mental health needs of refugees, finding them an equitable and cost-effective way to reach more people in need. These include art therapy techniques, yoga and meditation classes, and role-play. Digital Storytelling (DST) is an arts based participatory process that is emerging as a mental health research, education and practice method in community level humanitarian settings. However, while digital storytelling has the potential to promote mutual understanding of and empathy towards lived experiences in mental health, there is very little research in this area to date (De Vecchi, N., Kenny, A., Dickson-Swift, V., & Kidd, S. 2016). The purpose of this project is to test the efficacy of using digital storytelling as an alternative intervention modality to western therapy for the reduction of distress and the promotion of mental health for resettled refugees. This study will contribute to improvements in health equity by addressing barriers to mental health care for immigrant refugees.

DUSON and CWS have worked within an equity framework to collaboratively design this study proposal and carefully thought through the conduct of the study to ensure equitable access to funds, data, and final products. The premise of this proposal is equity- to overcome barriers to mental health for the refugee immigrant population who have experienced high levels of disparities. In addition, CWS staff will benefit through gaining expertise in research methods useful in determining best practices for health interventions, continuing a strong academic partnership.

Specific Aims: 1) To pilot test digital storytelling as an innovative, cost effective psychosocial intervention for health promotion and prevention for resettled refugees. 2) To explore the use of recorded digital stories as a teaching tool for caseworkers, health professionals and students working with refugees. 3) To contribute to an archive of advocacy materials for the mental health needs of refugees.