Mental health outcomes in refugee youth are diverse, ranging from prolonged difficulties to resiliency. Refugee communities rarely access services, even for those youth who are in need. Barriers include (a) distrust of authority and/or systems, (b) stigma of mental health services, (c) linguistic and cultural barriers, and (d) primacy and prioritization of resettlement stressors. Mental health promotion among refugee youth requires an integrated response to these barriers. This article includes a description of how the previously mentioned barriers may prevent refugee youth from receiving mental health services; approaches to addressing them; and a detailed description of Supporting the Health of Immigrant Families and Adolescents (Project SHIFA), a program developed in collaboration with the Somali community in Boston,Massachusetts.

Effective HIV prevention interventions with HIV-positive persons are paramount to stemming the rate of new infections. This paper describes an HIV-clinic-based demonstration project aimed at decreasing patient HIV-transmission risk behaviors and sexually transmitted infections. Systematic, computer-assisted assessment of patient risk aided primary care providers in delivering prevention messages. Patients at greater risk were referred to an HIV Prevention Specialist for behavioral counseling. Patients completed a computerized behavioral staging assessment to self-identify risk behaviors and readiness to change behaviors and counseling messages were individually tailored based on computer assessment. Challenges to project implementation: primary care provider buy-in, patient privacy concerns during risk assessment, and low participation in behavioral counseling. Forty-six percent of persons completing a risk assessment (2,124) were at risk for HIV transmission. Of 121 patients who scheduled counseling appointments, 42% completed at least one session. Despite challenges, successful implementation of a clinic-based prevention intervention is feasible, particularly with attention to patient and provider concerns.

Special populations have unique issues that need to be considered in the development and delivery of prevention and early intervention models. For these individuals, social context or stressors and support within their social environments may be particularly critical to consider in the wake of a traumatic exposure. In this chapter, we will discuss some of the environmental factors that are important to consider when planning and implementing prevention and early intervention programs for special populations and explore these factors in the case of refugee children.