A new pilot program at the Lilla G. Frederick Pilot School on Columbia Road is offering culturally-sensitive, full-time mental health care to Somali children, many of them refugees.
"People here are alone and stressed, plus they've been through war," said, Saida Abdi, the project's manager at the Frederick, herself a Somali refugee who came over more than two decades ago. "If you had a breakdown in Africa, there was a space in the community where you would be taken care of, and explanations of being possessed could even give some a higher status. But here, going to a hospital for that, it's not part of our culture."
The program provides community outreach, teacher trainings to help BPS teachers to better understand where their Somali students are coming from, home-based care, and direct services based on a model called Trauma Systems Therapy. TST is a community-based model that helps children learn to deal with emotional and behavioral responses to stressors in their environment that trigger memories or feelings from traumatic times, and seeks to remove the barriers to treatment.
Dr. Heidi Ellis at Children's Hospital, one of many organizations collaborating on the project, said that TST has a lot of applicability to refugees, and the program is continually adapting to become more consistent with Muslim values, and tries to connect with community and religious leaders.
Local data from a study by Ellis showed that nearly all Somali youth had trauma histories from growing up in wars and refugee camps, roughly two-thirds had symptoms of Posttraumatic Stress Disorder, yet most never received help because of the strong stigma of mental illness in Somali culture, and a lack of culturally appropriate care: when Ellis searched for a Somali social worker in the state of Massachusetts at the time, she came up with none.
"There is so much need, and especially for supporting children in immigrant communities, for Somalis and all refugee kids," said Abdi. "When you arrive and try to integrate, it's a very challenging process, so having someone to support you through it is absolutely necessary."
A $100,000-a-year grant over three years from the Robert Wood Johnson Foundation has made this and a number of related services aimed at the Somali community possible. Besides Robert Wood Johnson and Children's, the partnership includes the Somali Development Center, the Refugee and Immigrant Assistance Center, Boston Public Schools, Home for Little Wanderers, Alliance for Inclusion and Prevention, and Boston University School of Social Work, which is donating two full scholarships to Somali social workers, including Abdi.
The hub of the effort is at the Frederick, which alone has more than 30 Somali students and reaches out to Somali students in other Boston Public Schools.
Soon after the program started, it reached its clinical capacity, and an expansion of the project is currently being evaluated. Over the three years, the program is expected to reach 738 individuals.
"We as a field didn't know how to help these kids," said Ellis. "In their culture, religion was a path to healing, and schools were helpful, valuable and trusted. What was missing was school-based mental health services."
Abdi meets with the middle school students during the school day at a time carved out for recreation. Sometimes they sing, draw, dance, and hold discussions, the conversation weaving in and out of perfect Somali and near-perfect English. The children relate to Abdi because she is Somali, but she also teaches them about their new country and the life skills they need to adjust to it. She is there for parents and family members of students, and for those who have suffered trauma in wars back home, she is a lifeline to help.
"We're supporting a group of people who need support, and we're doing it in such a powerful way by developing our own staff with members who can have a total understanding of the culture," said Frederick principal Deb Socia. "That's very, very powerful.
One of the most important things the program provides might be a well-written letter, said Ellis, as in the case of a young Somali girl whose family was living in substandard housing. Rats ran through the house at night, which was a traumatic reminder of life in refugee camps. In such cases, the program will actively advocate for better housing, so the child will not be exposed to these stressors. In the case of the young girl, Ellis' advocacy brought about improved management, which took care of the rat infestation.
The biggest barrier remains the cultural divides of coming to a brand new country. Abdi said that whole concepts were very new to the community, like defining mental illness and having a treatment for it.
"In Africa, in small communities, we share the burden of life. I never felt homeless because I knew there was always extended family support," said Abdi. "Now we come from war, we've lost our families, we've lost our homes, we've lost our way of life, we have to change, and that makes you depressed; but how you seek help and how you make sense of it is more difficult. One of the saddest parts about it is that the stigma prevents people from getting help.
The program has touched a nerve in the community, made up mostly of refugees who fled Somalia at the outbreak of civil war in 1991. Jo Hunter Adams, Program Manager at the Refugee and Immigrant Assistance Center in Boston estimated a population of 3,000 to 5,000 Somalis living in the greater Boston area, while estimates by the Somali Development Center in Boston, according to an article in the Boston Globe, has put the number closer to between 8,000 and 10,000.