Good afternoon, everyone. My name is Vishal Madan. I'm the Chief of Education and Deputy Medical Director at the American Psychiatric Association. I'm delighted to have with us Dr. Gigi Bastian, who will be talking about Between Two Worlds, Promoting Mental Health in Migrating Populations. Next slide, please. This slide looks at the funding and the disclaimer statement for our talk. Next slide, please. Today's webinar conversation has been designated for one AMA, PRA category, one credit for physicians. We are now a joint accredited organization as APA, and we look forward to continuing that. Next slide, please. Now, as you can see in the chat button, you can look at how to download the handouts. There's a PDF that will be made available. Next slide. And the captioning also for today's presentation is available. To enable the captions, what you got to do is click on Show Captions at the bottom of your screen, then click the arrow and select View Full Transcript to open the captions in a side window. Next slide, please. Of course, please feel free to submit your questions throughout the presentation and type them into the question area, which is also found in the lower portion of your control panel. We will have around 10 to 15 minutes at the end of the presentation for Q&A. Next slide. And without any further delay, I would like to introduce Dr. Gigi Bastian. She's a clinical psychologist and Haiti native. She's a licensed clinical psychologist and serves as the associate director for the Office of Global Health Equity at Morehouse School of Medicine. Dr. Bastian is also an assistant professor in MSM's Department of Psychiatry or Department of Community Health and Preventive Medicine with a secondary appointment in psychiatry and behavioral sciences. Dr. Bastian's research and clinical interests focus on the intersection of culture and mental health aimed at improving accessibility, acceptability, and efficacy of mental health services for the underserved populations. Next slide. And over to Dr. Bastian. Thank you so much, Dr. Madan, and grateful to the APA for the opportunity to be with you all this afternoon to share a bit about some of the work we have been undertaking here at the Morehouse School of Medicine to promote mental health and well-being among our immigrant and refugee populations. Next slide. So I'll share a bit about beyond sort of the bio that you heard a little bit about my path to this work to sort of highlight that for me, this is more than work that comes out of intellectual curiosity or something that I'm purely pursuing for scientific sort of gratification but an issue that is near and dear and has affected me personally and family and friends that I care about. The first picture there of little G, as some will call her, was taken just a bit before my family made their immigrant journey from Haiti to South Florida in the early 90s in the context of what was a difficult political time. And for us, the intention was that this would be a temporary separation from our homeland and that ultimately when things settled, we would return to Haiti. And then unfortunately, as many of us know, things have continued to be a difficult and political instability and insecurity unfortunately continue to be a challenge back home. So we haven't yet had the chance to return. So those experiences as a member of an immigrant family largely shaped my interest in mental health around the experiences of a range of migrating populations. But also another key kind of event in my own personal journey was the 2010 earthquake that some of you may recall, which is captured in that image at the bottom of the slide, that resulted in the death of over 300,000 people, 300,000 folks in Haiti, significant number of physical injury, devastating infrastructure damage, and not to even speak of the psychological and sort of mental health repercussions of that event. So that was also a huge event that led to an influx of some folks who were displaced by that disaster, some of whom landed here in Georgia where I'm based that we have been supporting in terms of reestablishing themselves after that event. And then the last picture is of a cousin of mine in Haiti who was challenged with some mental health issues that really brought to light to me the work that we needed to do to help increase mental health literacy, mental health awareness, even within my family when at the time I was in graduate school and she was experiencing the beginnings of some sort of psychotic episode and found the family really at a loss in Haiti in terms of where to turn for resources and for support. So these three events really brought home for me the importance of doing work that helps us to bridge the work that we're doing locally to a global audience. So we sort of refer to that as a global mental health equity mission or agenda. So these events have been seminal in shaping the direction of the work that I'll be talking to you about today. Next slide. And so what we're learning in approaching efforts to address mental health challenges affecting our immigrant and refugee populations here in the U.S. is that we have challenges that I sort of think about as a stone in our shoe, as a field in terms of mental health. And what I mean by that is that we, in many ways, have been sort of trekking along, attempting to really raise awareness around the importance and the visibility of mental health. Yet at the same time, we haven't quite kept pace in terms of adapting to develop tools that can make the approaches, the interventions, the solutions that we can bring to bear fit and appropriate for a variety of groups. Jeffrey Arnett, who's a celebrated sort of professional in our field, wrote a seminal paper in the 90s titled The Neglected 95%. And in it, he points to this reality that a significant chunk of the base of science and research that informed the development of many of the models and approaches that we lean on and many of us employ in our work of providing mental health supports are based on research that involve participants that look like roughly about 5% of the world's population, right? And so he raises the question of what about this other 95, right? What can we bring to bear that is reflective of their reality, reflective of their challenges, that can meet the needs that they are bringing to us in whatever health setting we may be operating in? And so we continue to sort of sit with that challenge and that question as the U.S.'s population continues to diversify. It constantly begs this question of which voices, which perspectives are missing from our broader kind of mental health conversation. Next slide. So I think it's important to sort of level set and not assume that we mean the same things by these terms. So I wanted to say a bit about what I mean by some of these words. In the titling of this presentation, we refer to migrating populations, which is the all-encompassing term that encapsulates a number of subgroups of individuals who experience different versions of some of what you'll be hearing described throughout this presentation. And so that can include, like in that top picture, folks like our migrant farm workers who move around according to seasons and harvesting in pursuit of work in the U.S. I grew up in Florida, so that's a phenomenon that I was accustomed to. You know, peers in school who I wouldn't see for a number of months because their families had migrated north for work. We know also that this includes our migrating populations include people who are displaced due to certain events. So if we consider Katrina as an example and how folks from New Orleans were displaced to Houston, some settled here in the Atlanta area. With our immigrant populations, we often think of that as groups of folks who tend to have more of a bit of say and it's more of a voluntary sort of choice, though we could debate factors that may force folks hand over time. But largely, we tend to think of that most as folks who had some amount of time to kind of plan and prepare and come to a conscious decision about leaving home. Whereas with our refugee populations, their decision to leave home is often prompted by some sort of imminent fear of danger to themselves or to loved ones. And there's some degree of overlap around these terms, but they're slight nuances in terms of the kinds of challenges we see with these different groups. And with refugee populations, we have often cases where they've obtained pre-approval to join us here in the state. So the picture at the bottom of the folks standing outside of the airport in Afghanistan is such an example where the U.S. government has approved a certain number of folks on the basis of sort of recognizing the challenges and the issues of insecurity that were in play around the time that they came to us. Whereas with asylum seekers, that final group, we have folks who similarly are in fear of imminent threat of danger, but are seeking that approval at one of our borders or entry points in country. Next slide. So for some additional context, when we talk about who are the folks that we're talking about in terms of immigrant refugee populations in the U.S., we have, according to our last set of census data, documented that roughly 48% of our U.S. population is comprised of folks that we would describe as immigrant. What we also know, given some of the climate and environment around immigrants and migrant groups, is that there's a fear in terms of being counted and being in the number. So likely this is an underestimate of the number of folks that we're talking about. But to help you get a sense that this is, you know, a significant chunk of our society here in the U.S., and of those documented members of our society, we know, we estimate that about 19% are uninsured, and this is almost triple the rate for U.S.-born citizens. We also know that there tends to be a higher risk for a number of health challenges, and I'll share a little bit more about some nuance around this particular group with that. But that also includes mental illnesses, which disproportionately affect this group. Next slide. So important to consider as we think about folks who are, who have undergone a process, a migration kind of journey to come to us, is that we have identified in this field that there are exposures to trauma that are weaved kind of throughout that journey that can compound over time to have a really detrimental cumulative effect when we consider trauma, right? So there's the reality that often there are, at a minimum, distressing and up to severely traumatic experiences that folks have had back home in their native country that often instigate the decision to leave in the first place, right, that can include the type of living condition that folks are in, experiences of war, of distress, of violence, environmental issues and challenges, and this doesn't even speak to something that is gaining more of our attention in this field, which is the extent to which we consider a historical and collective trauma that can be passed down intergenerationally when it comes to trauma. And so we know that even before folks have taken on that journey, they're dealing with issues related to exposure to trauma that then continues as they move into journeying from their home country to the states of experiences that can often generate fear, witnessing difficult things. We had an opportunity to interview some families that found themselves at that U.S.-Texas border that you may have seen some news coverage of over the past couple of years from Haiti, and women describing to us having to escape situations in which assault, physical sexual assault was imminent, witnessing the death of folks who had been on the path with them, where they on foot were making their way through Brazil, Chile, and difficult kind of terrain to get to that U.S.-Mexico border, experiences of harassment and exploitation. We hear from a lot of these folks experiences of their money being taken by folks who promise to be able to help them in some way, and those promises are not always kept. And so these things continue to bear a toll psychologically, right? And then what I think is perhaps one of the more distressing phases of this journey for members of the immigrant refugee community is what they encounter upon settling, because for all that they've endured in the pre-migration phase and throughout the path to get here, folks often have some sort of expectation or sense that it may be rough getting there, but there's often this idealized notion of what the U.S. is, if you think about the issues about streets paved in gold and what they've seen in movies and etc. about the states, and so when folks settle and are now dealing with the challenges around finding your way in a completely foreign land, that the challenges there can be particularly distressing, right? So when folks who are fully functioning adults now are limited by language and are having to rely on the children in the family who perhaps are picking up English quicker to be the spokespeople for the family, to be the ones translating medical bills and communications and explaining to the parents what's going on, and children having to take on these sort of adult roles as a part of the process, these things have consequences in terms of mental health. Loss of identity and status, right? So sometimes folks have been accustomed to operating at a certain level in their society. I think even in my own personal journey of my father who was an attorney who had practiced law for many years in Haiti, and when we initially settled in the states, that sort of education and his credentials were not recognized and didn't translate here, and so he literally had to start off working in an agricultural set in the fields to initially meet the financial needs of the family. So what comes along with that, those shifts and sort of social status and what that can mean, the economic hardships that folks are enduring, housing challenges which we hear a whole lot about here in Georgia in our context, so the overall sort of weight of these unmet expectations and that uncomfortable gap between the America they'd envisioned and idealized and the reality that they meet can really take a toll, and when you consider all of these things compounding over time, the cumulative impact can be significant. Next slide. So the other piece that's interesting in a phenomenon that has been documented in the immigrant refugee health space is this idea of a health paradox, right? And so this is the reality that often when folks are coming to us initially from the states, they present with health profiles that actually have them faring better than their U.S.-born counterparts in terms of some of the chronic illnesses that are particularly problematic for us here in the states in terms of diabetes, hypertension. We see lower numbers of this, or this has been the pattern that's been documented, but we know that over time those differences between those groups and U.S.-born folks kind of dwindle, and they start to look, their health profiles start to look more like folks in the states as they kind of take on some of the dietary habits and are less active and et cetera. So there's growing interest in trying to better understand and investigate what those health protective factors and resiliencies are for members of our immigrant refugee populations initially and how those can be maintained and bolstered so there's not that loss of the health advantage over time, but also an increasing understanding of some nuance in this story, right, that perhaps this is not something that applies across the board, this health advantage, that if we take a closer look at this paradox that we might see some trends across subgroups that tell a different story. Next slide. And one of the ways we've been thinking about that is in terms of different demographic variables that can affect and influence the health status of folks when they come to us, right, so there's this increasing recognition and acknowledgement that migrating populations are not a monolith, right, folks come to us from a variety of countries with different infrastructure in terms of health and primary health and certainly mental health resources and workforce. To what extent do we see gaps in terms of language and cultural congruency from the host culture to here in the states. Race is something that factors into the experience that folks are having that has repercussions for their health and certainly mental health functioning. Our policies, right, the political climate is also something we are paying increasing, paying attention to increasingly in the field, as well as other features of the host environment that include, you know, what was the built environment that folks had access to back home as compared to here in the U.S. Can they access fresh healthy foods? Are they able to find safe spaces to move around and to get the exercise that they need? And how does that play into the broader picture of health and mental health functioning? So all of that is reinforcing this need to really take a closer look at this phenomenon of the immigrant health paradox to better understand what that looks like across various subgroups. Next slide. So zeroing in on, you know, as I just laid out, the populations we're referencing here are not a monolith. So my work, not surprisingly, sort of focuses on immigrants and refugee populations of Haitian descent. And this does represent one of the fastest growing migrant groups in the U.S. And certainly we're seeing that here in the state of Georgia, where Haitians, the population here ranks fifth in terms of the size of the Haitian migrant and refugee community. We do recognize that this is a largely understudied group in terms of the mental health challenges and resiliencies that they bring to us here in the states. But what few studies have looked at this group have documented significant and concerning challenges in terms of mental health, with trauma being a particularly prominent area that folks have examined. And at the same time, we know that there are a number of barriers to mental health care, notably among those an insufficient access to culturally and linguistically appropriate services. Next slide. And so a number of other barriers that have come out of some of our initial examinations of the experiences of Haitian immigrant and refugee communities here in Georgia are worth keeping in mind here for this conversation. One, this issue of mental health literacy and awareness, right? I referenced it in talking about my cousin, this member of my own family, where it really brought to light for me how much work we need to do there in terms of educating folks about what depression is, what anxiety is, what is the appropriate course of action. If we see this, the pattern of behavior among family members, et cetera, we have seen this as well in the work that we're doing here in Georgia, where often there is more of a spiritual or religiously based paradigm or framework for understanding mental health challenges. And so not surprisingly, folks will often seek out, their initial attempts to seek out help will be through their churches, through faith-based organizations. And when we're able to successfully persuade and convince folks to seek out more traditional mental health supports, they often are disappointed. They report to us and we conducted surveys where folks reported to us being dissatisfied with what they experienced due to the lack of supports that really made sense or fit for them in terms of their cultural and linguistic realities. And recognizing that we are insufficiently staffed up to meet the needs of this population and not only in terms of the issue of ethnic match, of finding mental health providers who are from the Haitian community, but even in terms of folks who have an understanding of the cultural reality for this group, we recognize that this is a challenge and this is a space where we can do some additional work in terms of educating folks about the particular challenges for this group. And so what this has reinforced for us is that while we as public health, mental health professionals may have important tools to bring to bear and the right message, we are not always the right messengers, right? And so how do we empower folks within the community who are respected leaders, who already have the trust and credibility within the communities to be those right messengers? And I'll talk a bit more about how exactly we're tackling that work through the Morehouse School of Medicine's efforts. And then recognizing that the issues for these groups are complex enough that no single entity, agency, institution is equipped to take on that work alone, right? And so having broad coalitions of partners and leveraging community assets best positions us to begin to meet the needs of these communities. Next slide. So that brings us into looking at the efforts that I have been leading at the Morehouse School of Medicine over the past few years to begin to address some of the needs we're identifying for our local Haitian immigrant and refugee community. Next slide. So what we have been aiming to do over the past couple of years is to create a network of stakeholders and community partners who could help us to get a better understanding from the perspective of members of this community of what the core, what the key priorities are in terms of mental health. What are those challenges that they may be thinking about from a more religious or spiritual lens that perhaps we might be positioned to support or to help with from the mental health space. And then working collaboratively with our communities, right? Involving them substantively in the efforts to bring solutions and to bring interventions that will improve health and mental health outcomes and ultimately reduce disparities for this group and that we hope would eventually generalize out and potentially serve other migrant and refugee populations. Next slide. This has been from its inception, a very collaborative effort in academic and community partnership that has brought together a number of our departments, institutes, and centers here at the Morehouse School of Medicine, including our community health and preventive medicine department, our department of psychiatry, as well as our office of global health equity, and including some others, but these have been some of the primary units shaping this initiative. And importantly, we've had some key community partners around the table, including the Atlanta Haitian Catholic Chaplaincy, the United Front for the Haitian Diaspora, which is an advocacy group here that also does a lot of work around health promotion within the Atlanta area. Rebatis Sante Matal is an NGO that's based in Miami in that their name is Haitian Creole for Rebuilding Mental Health. So they, since 2010, in the wake of that earthquake in Haiti, started their initiatives to promote mental health literacy and overall mental health promotion in Haiti and throughout the Haitian diaspora. And finally, the International Women of Hope have been an important partner for us. They are an Atlanta-based NGO. Next slide. So this work has been an iterative process and an evolution that started for us in 2018, and it began with what I think is the best place to begin this kind of work is with us in the position of listeners and learners. So we convened a number of listening sessions initially with key community partners and stakeholders, and then eventually those formalized into focus groups. And we've since administered more comprehensive surveys to gather some additional information about what this community sees as mental health challenges, mental health priorities, what they see as the assets, the resiliencies, and the strengths, importantly, right? So capturing both sides of that coin. What do they see as the challenges, but what can they bring to bear in terms of assets and strengths to tackle those issues? So we sat down with elders in this community, folks 65 and up. We held focus groups with the younger members of the community, 18 to 25, focus groups with the men, with the women, with faith leaders, with health workers from this community. And all that we gathered there was eventually analyzed to help shape the direction that we would move and to help us to kind of prioritize challenges. Trauma emerged as a prominent issue. The surveys were conducted from 2018 through mid-2019, which was almost 10 years out from the 2010 earthquake, yet folks still spoke to ongoing sort of indirect impacts of folks here in Georgia from supporting their families since. And so we came away with the decision as a team to begin with a trauma-focused kind of intervention. In the process of preparing for that, we connected with some colleagues out of the University of South Carolina who wisely suggested, and they had developed a comprehensive readiness assessment framework that they used to better understand where an organization is in terms of their capacity and their willingness and ability to successfully implement any sort of new innovation or program. And so using their framework, we decided to take this intermediary step of a readiness assessment where we looked at three local churches in the Atlanta area to better understand their readiness to receive whatever intervention we were going to collaboratively develop with them. And we've now, over the past two years, been engaged in implementation of our first intervention with these communities, while in parallel sort of conducting evaluation. Next slide. So this is a snapshot of some of the members of our team, that the team has evolved as well over time. And I wanted to share this because it reflects something that I think is an important feature of the way that we approach this work, which is that a significant number of the folks you see here are our community partners, folks from the Atlanta Catholic chaplaincy, folks from the United Front organization I mentioned. A number of the faces you see there, especially towards the bottom, are our students, public health students from the Morehouse School of Medicine, as well as over at Emory. There at the top in blue is my partner in good trouble, Dr. Joanne McGriff, who's at the Emory University, who's been an important partner in carrying out this work as well. Next slide. And that, the fact that you see those community research team members is an important reflection of our intentional effort to build research literacy and capacity within these communities, right? So we wanted to lead this community with the tools to be able to continue to leverage research as a potential tool for solutions for what they're describing to us, right? And so we took, we brought on formally community research assistants as a part of our team. They underwent similar ethics, research ethics, and IRB type training. Our IRB at Morehouse School of Medicine has a community facing version of that training that they carried out and they, you know, received certificates for having completed that. So that, you know, an effort to sort of overcome some of the inherent power imbalances in community academic partnerships to give them a window and a look behind the curtain. What is it that we're doing? Why are we approaching things in the way that we're doing it? And where do you fit into this process as well? So they were integrally involved in that, in those initial phases of understanding how and why we're going about data collection in the way that we are, what our plan is for managing that data, and involved in our ongoing analyses as well. Next slide. So here's a look at one of the first kind of interventions that have come out of this work. So for a number of years, Morehouse has been a leader in training community health workers for over 20 years. That work has led to community health workers, over 400 of them, that are positioned in various settings across the states helping to address, excuse me, health disparities for underserved populations. In 2016, we decided to focus that work on high school students as a particular subgroup. So that began with a pilot of training 13 high school students here in the metro Atlanta area that has since expanded to a program that has garnered national and now international sort of attention, has been featured in articles as a first of its kind program to train high school community health workers. So what we've been doing over the past couple of years through some NIH funding is conducting a cultural adaptation of that program for young adults between 18 to 24 from the Haitian American community. And we've been implementing that work both here in Georgia, as well as in Florida with our community partners there to, again, overcome this challenge of workforce, of not having enough specially trained folks to address, you know, what we're seeing across the country in terms of mental health, but certainly for our immigrant and refugee communities. And so how do we draw from the existing strength in the way of human resources in these communities to empower them to lead, bring in forth solutions to the mental health challenges that they're seeing in their schools, in their neighborhoods, and so on. And so this is what we've been working on over the past couple of years. Next slide. So what's the sort of makeup of this program? The initial phase is heavily didactic. And because we started this work in 2020 during COVID, it was largely kind of online based modules for the students. However, our partners on both the Georgia and Florida front helped us to also supplement that with some in-person activities and engagement field training experiences for our students. You see depicted there, one of the things the students are most excited about is getting some swag and a bag full of different materials, including tablets that they use to track and collect health data from their families, from their schoolmates, from their community. We trained them on how to take blood pressure and enter that data to help us get a community level, neighborhood level snapshot of the health status. They ultimately receive a certificate for completing the program and are incentivized as well with a stipend. And so we are now, we've completed an initial cohort that helped us to kind of refine and tweak our module and our curriculum. And we're now nearing the end of our second cohort. Next slide. Some additional information about the curriculum, as I mentioned, it's online based. We use a Canvas platform, which some of you may be familiar with, and try our best to make it as engaging and interesting as we can, including videos and different media for our students. The modules are made up of topics that align with the five core competency areas for training across the country for community health workers, such that our learners are able to come out of this program. And if they choose to take on a position as a community health worker, they've got everything they need to be able to transition into that work. Next slide. So additionally, we've been working on an effort to infuse trauma-informed education in how we are training our students across programs at Morehouse School of Medicine. And so Morehouse began as a standalone medical school where we're mainly training MDs. We've since expanded to a variety of programs, include public health, physician's assistance programs, and a range of master's and PhD programs, but all aimed at the same issue of advancing health equity for communities whose medical needs are often unmet. And so this next set of slides will address what we've been doing on that front. Next slide. What we've done is we had an existing course called Bridges to Health Equity that brings together learners from our various programs, including our MD programs, our PA students are in that class. We also have some of our public health students in there and thought we would leverage that sort of multidisciplinary space to create and pilot a module that deals with Haitian migrant and refugee health. Next slide. So with this module, we really wanted to begin to socialize our students to thinking about trauma, what it means, what its implications are in terms of physical health, as well as mental health, and what that looks like in particular for migrant refugee populations of Haitian descent. Next slide. So we guided them through understanding what are the particular social and political determinants of health that are prominent for this group. We helped them to think about researching and gathering information. How do we leverage qualitative and quantitative methods to better understand the challenges? And finally, how to engage and work collaboratively with community to develop deliverables and products, whether that's infographics that they developed or educational sessions that they were able to go on to do with community that came out of discussions they were having with our community partners about what they saw as needs. And what they also learned through this is not only can we not assume there's a monolith sort of across different ethnic groups and from folks coming to us from different countries, but even within folks coming to us from this country of Haiti, we have these different cohorts that look different and bring a sort of a different flavor of mental health challenges and strengths and assets that we can leverage. So for example, over the more recent years that we've had folks who have come through in what has become an increasingly alarming situation in Haiti right now with kidnappings and folks who really were living in areas of the country where they are literally living on edge, like in a perpetual state of hypervigilance, they're seeing particularly difficult iterations of traumatic issues that we had to think creatively about as a team. And so we're excited about what they're kind of learning about that in terms of just how many factors we need to keep in mind to get the clearest picture of what our patient population may need. Next slide. And so this gives a quick glimpse of the three-module curriculum that we developed. So part of it is sort of this broader education around immigrant refugee populations in the U.S. and understanding the particular history with folks from Haiti. What are some of the historical and collective traumas that are in play even before the migration sort of journey? Socializing them to trauma-informed care. What are the principles and tenets of that framework? How could that inform your work as a public health professional, as a doctor? What does that initial encounter perhaps need to look like with someone from this group? What are some things you may want to look for? And then ultimately helping them both initially from a didactic sense of knowing how to engage community partners effectively, but then having that applied experience of assigning them to work with these community organizations and having to work with them collaboratively to develop these products of infographics or holding health talks and sessions with the community through which they continue to learn more about how best to support and promote mental health needs within these settings. Next slide. This gives a little bit more on kind of the makeup of the course experience. We employ and use videos. There are a number of reflection questions that guide our students through thinking about our concepts more deeply. We brought on a number of experts from the community to talk with them and folks who also did videos for us that includes lawyers and folks in the legal space that could speak to them about TPS, temporary protected status, and the challenges that folks are dealing with around immigration and those stressors and how they might consider that and what the implications might be for care. We had one of our priests come talk to them about what he's seeing in his setting. And so those were all critical parts of the learning experience for our learners. Next slide. And so our work in this space continues and we're learning some important lessons along the way, including the fact that a collaborative and community-engaged process is really critical for even beginning to understand and certainly to move towards addressing the unique challenges facing these kinds of populations. So we've had it powerfully reinforced that our usual ways of operating and the ways that we can sometimes in ivory towers and in academic institutions can't work with this community, right? It requires building these broad coalitions of diverse partners who have the credibility and the respect and trust of these communities, yet also recognizing that these partnerships, academic and community partnerships, are dynamic and they come with their challenges and they require ongoing coming back to the table to see where we are, what we're seeing as the priorities, what our community partners are asking of us and how to meet them halfway and continuing to sort of refine and tweak our approach accordingly. Culturally and contextually tailored methods are absolutely critical, yet we're learning those things take time, right? So the curriculum for our high school students, we initially envisioned it would take us a few months to go through that culture adaptation and then be ready to begin our pilot. It took us quite a bit longer, but in the end, we were really proud of the product and have gathered some great feedback from our young folks around what they appreciated about it, but also where they see opportunities for us to continue to make that as appropriate a product as we can for Haitian American young folks. So continuing to keep that in mind and the reality also that as much as we enjoy and are fed and fueled by working with our young folks in this younger population, they keep us on our toes and they will let us know when things are coming across sort of dry and challenge us to keep things creative and to be nimble throughout our process of implementing this work. And also learning quite a bit about the policy space and how to leverage policy interventions to help support our folks even at the level of organizational policy. And so helping our churches to think about how they do their work in ways that can support our folks and helping our health centers even inside the Morehouse School of Medicine to look at our documentation and how that can be changed in a way that allows us to better meet the needs of this population and to have a trauma-informed kind of lens informing that work. Are we doing an adequate job of asking and exploring about experiences of trauma, for example, is that reflected in our intake paperwork, has been one of the ways we've been thinking about this. And so this work continues. Next slide. And it's work that is definitely a collaborative and team-based work that sits on the work of a true village. Our community partners being key in that. We continue to work with them to find supports to extend this work. They've been very much engaged by the work that we're doing and where there wasn't full recognition of the need for some interventions and efforts around mental health. Our church partners have been adequately enlightened that these are challenges that their membership is seeing. And so they're fully engaged now and working with us to collaboratively apply for grants to be able to extend the work that we've started. Thus far, we leveraged some institutional funding to get started and subsequently were able to get an NIMHD grant to support the work that we're doing with the high school community health worker. We're looking at some foundation kind of work and leveraging some supports even through our religious organizations to be able to continue what we've started in this vein. I want to acknowledge my mentors and collaborators who've been instrumental in the implementation of this work, as well as our innovation learning lab, which is the group that brought about the curriculum for the high school community health worker program. The module that we have developed for trauma-informed education was done collaboratively with Drs. Rubina Josiah-Willick and Desiree Rivers. And we have an amazing group of graduate assistants, mostly public health MPH students from Morehouse School of Medicine, as well as over at Emory who have been a real asset in moving this work forward. So I want to acknowledge all of those folks. Next slide. And a few of our references. And I think that leaves us, I have a final slide, leaves us some time for questions. Thank you so much. Thank you so much, Dr. Bastian. What an amazing and informative talk. Truly, very, truly delighted to be here joining you. I would appreciate the audience if you can type up the questions in the Q&A section. In the meantime, I do have a comment and a few questions as we wait for the audience, Dr. Bastian. So your discussion of the triple trauma paradigm reminded me of a presentation many years ago where a speaker had asked some migrants from a natural disaster area about what's the one thing they needed to support their mental health. And the answer was rice. So it was a very different perspective and very critical, I think, to keep in mind as clinicians when we work with folks coming from disaster zones and other areas, thinking through a broader, more advocacy and not putting the clinician lens right away, thinking more humanitarian. So just that comment. And then a couple of questions I thought, while we discuss the mental health challenges related to migrants and the challenges related to access, could you share some thoughts or maybe a story or two about resilience and action that you may have seen over time? That'll be really appreciated. Yeah, that's a really great question and something that we continuously work to try to intentionally balance because the needs are significant and the barriers are real. So it's very easy to get hyper-focused on the challenging things that call for our attention. But one of the things I've really appreciated about our partnership with our faith-based communities is the window that it gives us into this other side of functioning and living for our communities. Because oftentimes there is this narrative of sort of loss. I spoke to the loss of identity and loss of all sorts of norms and things that they're grieving back home. Yet in that space, I think what we've seen, and we and I especially push our students to literally go sit in on a service, like get a flavor for this community and how they move. And so seeing perhaps some of the folks that they have seen through our interviews or who've even been to our clinics up leading the choir or thriving in this sort of area. And you'd see sort of a different version of them where they're able to tap into capacity for leadership and a version of themselves that they don't quite see in any other space in this new context. But they're able to find it and sort of leverage it in this space, which they speak to us at length in terms of just how much faith fuels them and brings into them. But to see them then channel that into being able to serve and to do in that space, I think for us has been one of the things that really stands out as despite all these challenges where we're trying to get with social work to figure out housing, to figure out how to address economic sort of challenges, yet they're able to show up in this space and connect with others in this way and to serve in the church in this other way, which gives us a window into another side of them that can easily be forgotten. Absolutely. And I think in the same context, you also talked about, you know, while working with children and youth, you need a little bit more creativity in your approach, right? And can you think of a specific clinical tip or two that you may have for the audience? You know, one thing that I always remember is how important it is to normalize, you know, the environment around you when talking about kids. So, you know, going to school, making sure, you know, the process is working as it was as much as you can attempt. But any other clinical tips you can think of? Yeah, I mean, I think that cultivating and building up that capacity to move out of the usual script, right, of being willing to sort of move outside of our typical ways of doing things. We have a child and adolescent program at Morehouse, a fellowship, and some of our residents have completed a global mental health webinar seminar with me. And through that, some of them have had an opportunity to engage our Haitian community in some health and mental health sessions that we've had. And so I recall a couple of years back, we had a soccer game out in front of the church as a part of that. And so one of our residents came back to share with me what had come out of discussions that he'd had with one of those little boys after the soccer game and about just kind of what it's been like for him with school, with being teased at school because of his accent and how he's trying to go about dealing with that. And we were reflecting on the fact that had we brought him into our clinic, I don't know how long it would have taken you to like hear that from him as compared to you were able to spend this afternoon doing kid things with him and establishing that rapport and in a different way. And so that I think unlike anything else I could have said to them, drove home the point of being willing to sort of set down our usual modes of how we operate and what a psychologist or psychiatrist's work looks like. And that's so critical in working with these communities to be nimble enough to meet them kind of where they are and be out in the community, first of all, and be willing to move in some ways that we might not typically think of as mental health kind of work. Yeah, I think that's very well stated. So thank you for that. You also mentioned how important it is to have multi-stakeholder partnerships, right? So now in political climates like we live in, can you highlight a practical way or two that you were able to utilize such partnerships in sort of contrasting political climates and how you were able to put things together for your program? That's an interesting question. Because on the one hand, the folks that we brought around the table all work directly with Haitian communities. And so it's easy to get sort of buy-in and consensus about doing things that they see as advancing the community. But I will say initially with this mental health kind of focus intervention and trying to engage some of our faith partners, we had a different reception across different religious organizations, right? And so learning the importance of kind of messaging and framing and how to sort of gain enough sort of consensus or shared understanding to be able to move with initiatives that have to do with mental health is something we had to negotiate as a team, right? And so we had perhaps with Father Carl, who's one of our real champions in the community, someone who as a part of his training as a priest had gone through psychology, he had sort of an understanding of this work in a way that didn't require us to do as much persuasion and case-making for it. Whereas with some of our faith partners, the need to sort of clearly communicate this is not something that's in competition with what we're doing faith-wise, that we see the two is coexisting, that we see this as supportive and supplementive to the work that you're doing required us to be a bit more intentional. And so I'm not sure if this exactly gets at what you were talking about, what we did have to think about sort of messaging and consensus establishing with those groups in a way that we didn't initially expect to. Yeah, no, I think that's great. I don't see any questions in the chat, so I'll be asking one last question from you on more of a personal note for yourself. How important is self-care for a clinician while working with immigrants from a traumatized background? It is enormous. It is incredibly important to the point. So one of my favorite courses that I get to teach at Morehouse School of Medicine is a community health course that's required for our first year medical students, right? So from the first week at Morehouse, we have a mountain community and we assign them to different community sites where they literally spend at least three hours a week working with communities. And so one of our partners is the Center for Victims of Torture in Clarkston, Georgia, which is referred to as the most diverse square mile in America. We have folks who resettle in that community from literally all over the place. And so what we've learned to do is to now have a built-in session about self-care from the providers at that center who share with the students because it's such a compelling community. The needs are so glaring in terms of the challenges. It's easy as folks in the helping profession to just get in that pattern of pouring, pouring, pouring. And so our students get to hear firsthand, not from Dr. Bastion, but from various members of that team about self-care and about their experiences with burnout and how they go about taking a pause and mandating that folks take a month off, members of the team, and how they go about doing that. And so I think that's been huge for our MDs to hear that and have that as an intentional block of their course during the first year of medical school that this is important as well. And certainly they have that reinforced as residents when we do talks around burnout prevention and self-care with them. But I love that they, in that first year, are hearing that message, not only from us, but from our community partners about to the extent that these are populations that are under-resourced and you're having to work harder and put on different hats of addressing social determinants, that's the extent to which you need to work even harder at shoring yourself up to be able to show up to that work. So it's been great to collude with our partners to help drive home that message to our learners. Absolutely. Thank you so much. A couple of next last slides, if you can move on to the next one. And a quick reminder about our next MSM webinar, which is going to be on Tuesday, August 29th from noon to 1 p.m. Eastern time and is titled Black Perinatal Mental Health, Current Evidence, Gaps, and the Road to Equity. The speaker will be Dr. Crystal Clark. We hope you can join us for the webinar. I truly appreciate your time and your expertise, Dr. Bastian, and thank you all for joining us today. Take care.

Dr. Gigi Bastian

clinical psychologist

Morehouse School of Medicine

mental health challenges

Haitian immigrant

refugee populations

unique experiences

trauma

culturally appropriate mental health services

linguistically appropriate mental health services