The Empowerment Program: An Application of an Outreach Program for Refugee and Immigrant Women.

Refugee and immigrant women may face a variety of pre- and post-migration stressors that make them susceptible to mental health disorders and adjustment problems. Recommendations on how to effectively provide mental health services to this population, based on a mental health program developed to meet the specific needs of refugee and immigrant women in a Midwestern city, are provided. This specific program offers a holistic approach, including counseling, home visits, psycho-educational workshops, and support and advocacy from other refugee and immigrant women. A case study is included to illustrate how this program functions. ********** The purpose of this article is to provide recommendations regarding service delivery to refugees based on our work in the Empowerment Program, which was developed to meet the specific needs of refugee and immigrant women in the Kansas City metropolitan area. First, we highlight common challenges that refugee and immigrant women may face including pre-migration stressors, post-migration stressors, and barriers to mental health services. Next, we describe the main elements of the Empowerment Program and provide a case study to illustrate our approach in working with refugee women. Finally, we present lessons learned from our work with this population and recommendations for other mental health organizations. Common Challenges for Refugee and Immigrant Women A refugee is an individual who is "unable or unwilling to return to his or her country of nationality because of persecution or well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion" (Ridge, Hale, & Hoefer, 2004, p. 40). Although refugees and immigrants face similar challenges, their migration stories are different. Compared to refugees' forced migration, immigrants willingly leave their homeland for career and financial opportunities (Ager, 1999; Bemak & Chung, 2000). In this article, we focus mainly on the experiences of refugees although we draw from the common literature concerning adjustment for both groups. Both pre-and post migration stressors can affect refugees' mental health. Researchers have demonstrated that pre-migration experiences such as torture, forced labor, starvation, observed violence, and murder/loss of family members, and post migration stressors such as limited English-speaking skills, unemployment, and poverty, are associated with major depression and post-traumatic stress disorder (PTSD) (Marshall, Schell, Elliott, Berthold, & Chun, 2005). Specifically, Fazel, Wheeler, and Danesh (2005) found that refugees resettled in Western countries are 10 times more likely to have PTSD compared to age-matched general populations. Similar results were found by Porter and Haslam (2005), whose meta-analysis of 59 empirical studies revealed that refugees scored lower on indices of mental health than nonrefugees. Adjusting to a new culture can lead to changes in gender and family roles, and consequently, it can create stress and a sense of loss of control and power for refugees (Friedman, 1992; Ito, Chung, & Kagawa-Singer, 1997). For example, refugee children who often are more skilled in English may be asked to translate for their parents, causing shifts in family roles (Bemak & Chung, 2000). Several studies have also shown that younger refugees more readily acculturate to new environments as compared to older refugees (Chung, Bemak, & Wong, 2000; Marshall et al., 2005; Porter & Haslam, 2005). Another source of stress for refugee women is the necessity to work outside of the home for the first time to help support their families. This can be especially stressful when their husbands are unemployed or underemployed (Gong-Guy, Cravens, & Patterson, 1991). Friedman (1992) suggested that post-migration stressors together with pre-migration trauma may make refugee men resort to violence as a way of reestablishing power and control. …