title: Multi-tier mental health program for refugee youth.
abstract: OBJECTIVE
  We sought to establish that refugee youths who receive a multi-tiered approach to services, Project SHIFA, would show high levels of engagement in treatment appropriate to their level of mental health distress, improvements in mental health symptoms, and a decrease in resource hardships.
  
  
  METHODS
  Study participants were 30 Somali and Somali Bantu refugee youths in the English language learner classroom in a middle school in New England. Project SHIFA is a multi-tiered program including prevention and community resilience building for the community at large, school-based early intervention groups for at-risk students, and direct intervention using an established trauma model (trauma systems therapy) for those with significant psychological distress. Data were collected from students at time of enrollment, 6-month follow-up, and 12-month follow-up. Measures used were the War Trauma Screening Scale, Adolescent Post-War Adversities Scale-Somali version, UCLA PTSD Reaction Index for DSM-IV (Revision 1), and the Depression Self-Rating Scale.
  
  
  RESULTS
  Students across all tiers of the program demonstrated improvements in mental health and resources. Resource hardships were significantly associated with symptoms of posttraumatic stress disorder over time, and the stabilization of resource hardships coincided with significant improvements in symptoms of depression and posttraumatic stress disorder for the top tier of participants.
  
  
  CONCLUSIONS
  Project SHIFA is a promising model of treatment for young refugees.
authors.affiliation: Department of Psychiatry, Children's Hospital Boston, Boston, MA 02115, USA. heidi.ellis@childrens.harvard.edu
authors.forename: B Heidi
authors.initials: BH
authors.lastname: Ellis
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Miller
authors.forename: Saida
authors.initials: S
authors.lastname: Abdi
authors.forename: Colleen
authors.initials: C
authors.lastname: Barrett
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blood
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008605:Mental Health Services; D012036:Refugees / Q000523:psychology*; D012572:School Health Services; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D014857:Warfare