Trauma-focused evidence-based interventions (EBIs) can support healing for children and families who have experienced forced displacement. Most EBIs, however, weren’t designed with newcomer communities in mind. Adapting an EBI to the community you serve helps you reach target outcomes, build trust, and extend care to people that services often miss.
Whether you’re a practitioner, a resettlement agency, a community-based organization, or an intervention developer, if you support children and families affected by forced displacement, you’ve likely already adapted a program to fit your clients’ needs. The Center for Adjustment, Resilience and Recovery’s (CARRE) new “Toolkit for Adapting Evidence-Based Interventions for Children and Families Impacted by Crisis and Conflict” gives that work a clear structure, specifically for EBI adaptation. In this blog post, we will discuss why adaptation matters and how you can use the CARRE toolkit to adapt EBIs to best suit your clients.
Why Adaptation Matters
Evidence-based interventions (EBIs) are treatment approaches tested through rigorous research that are shown to reduce mental health symptoms and improve well-being. Many trauma-focused EBIs, however, require adaptation to best serve communities who have experienced forced displacement.
People who have survived crisis, conflict, and forced displacement face elevated rates of depression, anxiety, and post-traumatic stress. These mental health concerns are often compounded by ongoing stressors such as family separation, insecure legal status, and the daily work of rebuilding a life in an unfamiliar place. How communities describe stress and distress, and what counts as healing or recovery, can look very different across cultures.
Adapting an EBI to the population you are working with helps you:
- Reach target outcomes. When an intervention is grounded in a community’s cultural values and beliefs, it becomes more effective as clients understand and connect with the content, making them more likely to enroll in services, stay engaged, and complete care.
- Build and sustain trust. Framing care in recognizable cultural terms and centering community voices signals respect and builds trust.
- Balance scale with community relevance. A well-adapted intervention can serve multiple communities while still responding to each community’s distinct needs.
- Create something that can be built on. A documented adaptation can be replicated and further refined for internal use or for trained staff within other organizations working with similar communities.
What You Can Find in the Toolkit
This toolkit offers providers specific adaptation guidance and insights drawn from three adapted pilot interventions, including:
- How to identify and assess appropriate interventions for specific communities
- Where to start, including how you identify and engage key stakeholders for suggestions around accurate and appropriate framing throughout the process
- Factoring various adaptation components to guide a suggested timeline so you can prepare for an often time intensive adaptation process
- How you set up and document ongoing adaptation using the Cultural Treatment Adaptation Framework (CTAF) and Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) through the combined CTAF/FRAME Excel Tracking Spreadsheet
- How you recognize core and peripheral treatment components
- What to avoid in the adaptation process
- Key considerations for success
Example: What Does Community Framing Actually Look Like?
In the pilot of the adapted intervention Attachment Vitamins with the University of California San Francisco (UCSF), we used the Tool to Measure Parenting Self-Efficacy (TOPSE) to measure parent and caregiver confidence in parenting approaches. The table below shows a snapshot of the community participatory translation review process, conducted with a focus group of four Dari speakers.
Idioms and concepts do not always translate across cultures. Input from the focus group, the intervention developers, and the TOPSE developers made the Dari translation more accurate while keeping the meaning of each item intact. These modifications make it possible to continue using a validated tool without compromising its accuracy.
| Language | Dari | Iteration 1 | |||
|---|---|---|---|---|---|
| Area/Item | Details | Semantic Terms [Dari] | Rationale/Notes | Suggested Change in English | |
| C_Understand | Instructions | The following section is about empathy and understanding. | یکدلی – همدلی | “Empathy” term needed to be described | Providing more context on how one may show empathy (having a description here would be helpful). There were various cultural perceptions of “empathy” within the Dari speaking Afghan review group. |
| 5 | I am able to put myself in my child’s shoes (Put myself in my child’s place) | من می توانم خودم را بجای طفل قرار دهم | Idiomatic phrase, do not translate literally | Put myself in my child’s place. |
Did you know? You can reach out to the CARRE team with tailored training and technical assistance requests related to crisis and conflict trauma. This includes developing educational products to support awareness raising and provider and client skill-building, consultations related to programmatic and delivery needs, guidance on selecting standardized instruments, facilitating connections across networks, and much more! You can submit a TA request here!
Conclusion
Practitioners and community-based organizations can use CARRE’s toolkit to begin a structured adaptation process, or to reflect and build on practices already in place. Braiding together the expertise of intervention specialists with the knowledge of impacted communities allows interventions to stay accessible and relevant, while being shaped by community framing. This strengthens the impact of interventions, extends care to hard to reach communities, and provides spaces where communities feel seen, understood, and respected. There is always time to ask: how can adaptation play a more prominent role and how can this help deliver more effective services today?
Learn More
- CARRE provides a resource library covering a variety of topics to support families and children coping with traumatic stress related to forced migration. You can access additional resources and information specific to piloting adapted mental health intervention, such as this backgrounder for culturally adapting evidence-based interventions and an overview of the pilot findings from the intervention PC-CARE.
- The National Child Traumatic Stress Network (NCTSN) offers a wide range of resources to support mental health practitioners on how to best work with immigrant and forcibly displaced populations, including this video on how to adapt parenting interventions to be culturally responsive.
- Measures that are Appropriate for Refugee Children and Families is an NCTSN resource that highlights standardized instruments suitable for children and families who have experienced forced displacement.
The IRC received competitive funding through the U.S. Department of Health and Human Services, Administration for Children and Families, Grant #90RB0053. The project is 100% financed by federal funds. The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services, Administration for Children and Families.
