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The Center for Refugee and Disaster Relief


Research Projects

Child-Focused Research

Ethiopia (IRC) - The International Rescue Committee (IRC) has received an award from the Gates Foundation to provide mental health services to Somali children living in refugee camps in Ethiopia. AMHR is assisting by providing technical assistance in program design, implementation, monitoring, and evaluation. Qualitative study results suggested that priority mental health problems include trauma, anxiety, depression and some externalizing problems. As part of the program, IRC and AMHR are also developing and testing assessment instruments to monitor change in outcomes. Components-Based Intervention (CBI) an intervention developed by Drs. Murray and Dorsey will be provided by local counselors who will be trained by AMHR faculty and consultants. The major outcomes address the priority mental health problems and functioning among children aged 6 -18years. (Ongoing)

Funding Source – IRC via a grant from the Gates Foundation.

Thai-Burma border  Ethiopia (IRC) - The International Rescue Committee (IRC) has received an award from the Gates Foundation to provide mental health services to Karenni children living in a refugee camp. As with the Ethiopia project, AMHR is assisting by providing technical assistance in program design, implementation, monitoring, and evaluation. Qualitative study results suggested that priority mental health problems include internalizing and externalizing issues, as well as some trauma. IRC conducted a reliability study of mental health instruments. Components-Based Intervention (CBI) an intervention developed by Drs. Murray and Dorsey will be provided by local counselors who were trained by AMHR faculty and consultants. The study aims focus on demonstrating the feasibility and acceptability of CBI in this population. (Ongoing)

Funding Source – IRC via a grant from the Gates Foundation.

Zambia  – AMHR has been working in and around Lusaka, Zambia since 2004.

  • CDC: In February of 2005 AMHR conducted a qualitative study looking at the problems of HIV infected mothers and their children in Lusaka, Zambia. This study revealed that child sexual abuse is a major problem among this HIV-affected population, along with a number of other traumatic experiences such as domestic violence, physical abuse and traumatic grief.  (Completed)
  • NIMH, K23: AMHR then developed a collaboration with the University Teaching Hospital (UTH) and the University of Zambia (UNZA) to further examine the psychosocial issues of child sexual abuse and how to treat them. Four mental health assessment measures were chosen, adapted, tested and validated in a UTH One-Stop Centre for sexually abused children.  Simultaneously, the qualitative data was used to guide us in the selection of an appropriate intervention, Trauma-Focused Cognitive Behavior Therapy (TF-CBT), to treat the symptoms. Training was completed for 16 Zambians on Trauma-Focused Cognitive Behavioral Therapy (TF-CBT;, during which the local counselors helped adapt the treatment.  A feasibility study was conducted examining the acceptability of a Western model for client and counselors, the ability of lay counselors to implement TF-CBT with adherence, and a pre/post measure of mental health outcomes. We are conducting an additional reliability and validity test on additional measures for children and caregivers. (Ongoing)
  • USAID: In February of 2009, AMHR collaborated with Catholic Relief Services (CRS) in Zambia to use the validated assessment tools and examine the feasibility of integrating TF-CBT into existing HIV service infrastructures to serve orphans and vulnerable children (OVC). Over 45 home-based caregiver volunteers were trained in and implemented the assessment tools. A new cohort of 18 Zambian counselors were trained in TF-CBT and supervised through training cases. Results showed significant improvement in symptoms in a pre/post evaluation. (Completed)
  • USAID DCOF: As a continuation from our previous work, AMHR has joined with SHARPZ, a local NGO in Lusaka, to conduct a randomized controlled trial of TF-CBT with OVC. Local assessors have been trained on the validated mental health assessment tools, and local counselors trained on TF-CBT.  Pilot cases are now starting. (Ongoing)
  • NICHD RO1:  AMHR received a grant to run a randomized controlled trial to examine the effectiveness of TF-CBT and Psychosocial counseling on reducing HIV risk behavior among OVC. A wide range of other outcomes are going evaluation such as mental health and functioning. Instruments are currently being created on a computerized system. (Ongoing)Funding source: USAID, CDC, and NIH

Uganda (RO1) - in October 2011, JHU in collaboration with colleagues at Michigan State University and Global Health Uganda received funding to implement a randomized controlled trial of a caregiver intervention to improve neurodevelopmental and psychological outcomes among young (ages 2-5) HIV-affected children and to improve maternal mental health and functioning.  The intervention, Mediational intervention for sensitizing caregivers (MISC) is a structured training program to enable caregivers to improve their children’s cognitive and social development during everyday casual interactions in the home.  Samples will include HIV-infected and HIV-uninfected, but affected, children. (Ongoing)

Funding source: NICHD, NIH

Funding source: USAID, CRS

Cambodia – Working with World Vision and their partners, AMHR completed a qualitative needs assessment in 2007 to examine the mental health needs of formally-trafficked and/or exploited girls who had been rescued and are currently living in transition shelters in and around Phnom Penh.  Using the result of this study, AMHR adapted standard measures of trauma, depression and anxiety symptoms along with measures of shame and hope to develop the Child Exploitation Psychosocial Assessment Tool (CEPAT).  Simultaneous to the development of this instrument, the qualitative data was used to guide us in the selection and adaptation of an appropriate intervention, Trauma-Focused Cognitive Behavior Therapy (TF-CBT), to treat the symptoms.  AMHR trained local staff at two shelters, and provided weekly supervision via skype during a feasibility study. Results showed feasibility and acceptability among counselors, as well as significant decreases in symptomatology from pre-to-post treatment. (Completed)

Funding source: World Vision

Global - Providing expertise in design, implementation, monitoring and evaluation (DIM&E) of mental health interventions for multiple World Vision country programs assisting children in crisis. This includes qualitative assessments, training workshops, and instrument development and validation. Many of the World Vision programs are for street children or children affected by war or conflict, whose experiences predispose them to mental health problems. (Completed)

Funding source: World Vision

Jordan – Together with the International Medical Corps (IMC), AMHR conducted a qualitative needs assessment to identify the needs of adolescent Iraqi refugees and their families.  This data was used to develop psychosocial well-being assessment tools geared towards the adolescents and their parents and to inform the development of a family-based social interaction/community-building activity among Iraqi refugee families currently living in and around Amman.  As part of this collaboration, AMHR completed an impact assessment, with control families, to understand the impact of the intervention activities on family and social cohesion and general psychosocial well-being. (Completed)

Funding source: International Medical Corps and US State Department (PRM)

Georgia - Working with Save the Children-Georgia and the USAID mission, AMHR completed a qualitative study in July of 2005 during which AMHR examined the causes of children going to the street. An additional qualitative study looking at the problems of children on the street and those that are institutionalized was conducted in May/June of 2006. The data from these 2 studies was used to adapt the Child Behavior Check List (an existing measure of child mental health and behavior) for use among this population. This instrument underwent reliability and validity testing among the same population (street children and those in institutions) in 2007.  The CBCL is currently being used by NGOs working in Georgia to assess need and impact of their programming among similar populations. (Completed)

Funding Source: USAID - Displaced Children and Orphans Fund (DCOF)

Northern Uganda - In 2005 AMHR in collaboration with World Vision Uganda and War Child Holland conducted a three-armed randomized controlled trial assessing the impact of two mental health interventions on depression, anxiety, and behavioral issues among local adolescents affected by war. The results of this trial were published in JAMA (see Publications) and have since informed programming by both our collaborating partners. (Completed)

Funding source: World Vision USA and War Child Holland.

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Adult-Focused Research

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Thailand-Burma Border – In collaboration with local partners (including Burma Border Projects, Mae Tao Clinic, Assistance Association for Political Prisoners, and Social Action for Women) in Mae Sot, Thailand, AMHR is working to assess effectiveness of a psychotherapeutic intervention – namely, Components-Based Intervention (CBI) – in reducing the severity of mental health symptoms experienced by torture and violence survivors displaced from Burma into Thailand.  Local counselors were trained in CBI along with 3 local supervisors, and are being supervised via skype by US trainers following the Apprenticeship model. The project also incorporates a “nested” qualitative study to explore issues of motivation and job retention among community mental health workers. (Ongoing)

Funding source: USAID - Victims of Torture Program (USAID-VOT)

Republic of Georgia  – Together with the Institute for Policy Studies in Tbilisi and other local partners in Georgia, AMHR conducted a one-year study (2010-11) of physical and mental health status of displaced older adults, including IDPs and Chechen refugees.  The study adopted a mixed-methods approach, incorporating both qualitative and quantitative methods in a sequential manner to gather contextual data on the IDP and refugee populations, develop and validate survey instruments, and implement a 900-household survey among displaced older adults, with a focus on comparing longer-term (“protracted”) displaced populations with those more recently displaced.  Preliminary results were presented in a technical report to the donor (Bureau of Population, Refugees and Migration) and several manuscripts are in development for publication in peer-reviewed journals.  Funding is also being sought to carry out a pilot intervention to train Georgian older adults to work as mentors and tutors of school-age children. (Completed)

Funding source: US State Department, Bureau of Population, Refugees and Migration (BPRM).

Kurdistan, Northern Iraq – Together with Heartland Alliance, AMHR is working to improve the community-level mental health services for survivors of torture in Kurdistan.  Having completed initial needs assessment and instrument development and validation studies, AMHR are currently implementing a multi-armed randomized controlled trial of different psychological treatments for the depression, anxiety and trauma symptoms of torture survivors.  Kurdish Community Mental Health Workers (CMHWs) have been trained on one of three treatment options and are currently recruiting and treating survivors in three regions of Kurdistan:  Dohuk in the north, Erbil in the center and Sulaimaniya in the South.  Data from this study will allow us to understand the feasibility and effectiveness of the different intervention strategies for survivors of torture in this region. (Ongoing)

Funding source: USAID - Victims of Torture Program (USAID-VOT)

Eastern Democratic Republic of Congo - In 2006 AMHR began a collaboration with the International Rescue Committee (IRC) to assess the needs and improve services for survivors of Gender-Based Violence (GBV).  In the early part of this collaboration, AMHR assisted IRC with the development of a mental health monitoring and assessment tool for IRC’s ongoing clinic-based services. In June 2009 AMHR analyzed all data collected to date, with results suggesting rates of mental distress and dysfunction among those entering the program were high, and that participation was associated with substantial improvement in both parameters. Based on this initial evidence IRC and AMHR developed plans for two randomized controlled trials with GBV survivors in the same area. The first intervention is a group psychotherapy, Cognitive Processing Therapy (VSLA), provided by local psychosocial counselors and supervised by IRC psychosocial staff.  The second intervention is a group social-economic program, Village Savings and Loans Associations (VSLA), led by IRC. Both programs are being evaluated for their impacts on mental health, functioning, and economic development. (Ongoing)

Funding source: USAID - Victims of Torture Program (USAID-VOT); World Bank

Brazil – As part of a larger initiative on maternal HIV issues, AMHR with faculty from the University of Caxias do Sul, completed a series of qualitative studies with pregnant women and new mothers (HIV-infected and uninfected) in the Southern region of Brazil to investigate the experiences and risk factors associated with mental health problems in the perinatal period (prenatal and postpartum) related to HIV. (Completed)

Funding source: NIH – Fogarty Center

Indonesia - Working with the International Catholic Migration Commission (ICMC) in July 2006, AMHR conducted a qualitative study of psychosocial problems facing survivors of intentional violence in Jakarta. This information is being used to inform the development of program indicators for an ongoing counseling program. A similar qualitative study has been conducted in Aceh among non-Tsunami affected populations, and the data are currently being analyzed. This information will inform the development of a program monitoring and evaluation system.  (Completed)

Funding source: USAID – VOT

Haiti - A qualitative assessment of the problems affecting local people resulting from exposure to torture and organized violence. The project was based in Cap Haitien (northern Haiti) in February, 2006. A final report has been completed and can be accessed through the USAID Development Experience Clearinghouse. Download also available from the AMHR Group Publications page. (Completed)

Funding source: USAID – VOT

Mexico - In March 2006 AMHR conducted a qualitative study of the mental health problems facing violence affected populations in Tamaulipas, Mexico. The study was done in collaboration with a local human rights organization, to identify the mental health needs of affected individuals and inform the selection of promising mental health intervention models. (Completed)

Funding source: USAID – VOT

Democratic Republic of Congo - In February 2005, AMHR conducted an investigation of depression-like illness among post-partum women in Kinshasa, DRC. Using qualitative research methods, AMHR identified a depression-like syndrome among new mothers in the capital of the Democratic Republic of Congo. Using the information from the qualitative study, AMHR adapted and validated a quantitative instrument to be used to measure depression among this population. (Completed)

Funding source: NIH, Fogarty International Center

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