Afghan Adjustment Support Groups

Many of the Afghans displaced by the Taliban takeover of Kabul in 2021 found refuge in the United States through Operation Allies Welcome (OAW) and the ongoing Operation Enduring Welcome (OEW) Response. OAW was an interagency initiative that coordinated efforts across the federal government, military, state and local governments, NGOs, and private partners to manage the resettlement of nearly 90,000 Afghans. As Afghan newcomers began arriving in the US in 2021–amid the COVID-19 pandemic–resettlement agencies worked alongside federal offices, healthcare systems, public health departments, social service providers, and community-based organizations to provide much-needed assistance.

Resettled Afghans are acclimating to life in the United States, enriching their new communities, securing public benefits, and seeking opportunities for their families. At the same time, they are experiencing ongoing challenges related to the trauma of sudden displacement and navigating complex systems like healthcare and mental health services as English-language learners.

Mental Health Challenges Facing Afghan Newcomers

Many Afghan newcomers face numerous challenges that can impact mental health, such as trauma from past experiences, separation from family and social networks, concerns for loved ones still in Afghanistan, housing insecurity, and difficulties in meeting basic needs. They also grapple with uncertainties regarding their immigration status, employment and education challenges, language and cultural barriers, loss of social and economic status, and discrimination. These factors may contribute to mental health issues among Afghan newcomers. However, there are numerous barriers to accessing mental health services, including the limited availability of culturally and linguistically appropriate providers, stigma, limited exposure to compassionate and effective treatment in Afghanistan, transportation, and childcare.

Overview of the Afghan Adjustment Support Groups Initiative

The IRC offices in Sacramento and Oakland both implemented support groups to enhance well-being in new-arrival Afghan communities and to introduce Afghan newcomers to the concepts of mental well-being and mental health challenges, as well as strategies for coping with related issues. The support groups were developed by adapting an open-source Pathways to Wellness (PTW) curriculum.

The IRC in Sacramento focused its curriculum on Afghan adults while the IRC in Oakland focused on youth. Both teams used an iterative process that included having Afghan staff review and adjust the curriculum, and then making changes based on staff and participant feedback during the implementation phases.

The IRC Sacramento and Oakland adjustment support groups are designed to be led by culturally sensitive facilitators who share linguistic and cultural backgrounds with participants or trained community members who are compensated. The groups offer participants a safe space to share experiences, learn coping strategies, and build connections. The support groups are generally held one time per week for 8 weeks and sessions are delivered remotely via Zoom.

Key subjects covered in the curriculum include:

• Cultural Shock: Explores the common experiences of culture shock and normalizes participants’ experiences.
• Refugee Experiences: Allows participants to reflect on the challenges and opportunities of coming to a new country and normalize the ups and downs of adjustment.   
• Mental Health: Explores the various ways in which mental health is viewed and talked about in the U.S. and normalizes common reactions to trauma, stress, and adjustment.
• The Mind and Body Connection: Increases understanding of how the mind and body are connected, and participants learn relaxation and/or calming techniques.
• Goals and Dreams: Helps participants set goals for themselves and realistic time frames for achieving them. Participants also understand step-by-step what is needed to achieve goals. 
• Creating Wellness: Helps participants understand that resettlement can be hard and that they may have to work at maintaining physical and emotional wellness.

Program Participants

• IRC Oakland
  The IRC Oakland provides adjustment support sessions for Afghan adults and youth in the community. They chose to initiate a youth-focused program due to their area's large Afghan youth population, and the unique challenges Afghan youth face in adapting to a new school system and culture. The Oakland office tailors its program to Afghan youth, serving high-school-age participants between 14-19 years old who are still in school. Cohorts of 6-8 students are enrolled in an 8-week session to engage with the Afghan Adjustment Support curriculum delivered in Dari and Pashto.
• IRC Sacramento
  The IRC Sacramento tailors its program primarily to Afghan adults, with a focus on women while also welcoming men's participation. They form cohorts for 8-week sessions, typically consisting of 6-15 participants. Groups tend to have a female majority due to scheduling availability. Male participation is lower as many are working during session times.

Outreach Strategies

Effective outreach is crucial in reaching and engaging Afghan newcomers in adjustment support groups. Both the IRC in Oakland and Sacramento employ multi-faceted approaches to promote the program and ensure wide awareness among the target population. Some of these strategies commonly used by both offices include internal referrals across IRC departments, promotion during initial resettlement programming intake visits and orientation sessions when newcomers first arrive in the U.S., and distribution of linguistically accessible program information at community events. 

The Oakland office also collaborated with local schools and school districts with large Afghan youth populations, presenting program information directly to students and teachers. They reviewed district data on newcomer enrollments to target their outreach efforts effectively. Meanwhile, the Sacramento office utilized existing WhatsApp groups in Dari and Pashto to disseminate program information and integrate program promotion into other IRC workshops and programs for Afghan newcomers.

Adaptations and Success Factors

• Adaptability of curriculum: Both offices adapted the PTW curriculum content to meet the specific needs of the targeted population:
  Oakland (Youth-focused):

  • Shifted focus from exploring past experiences to present-day challenges in the "PTW refugee experience" session. This section was modified to include adjusting to the new school system, understanding and identifying mental health needs, communicating mental health needs with family members, and seeking help when needed.
  • Emphasized culture shock in school settings.
  • Added a new section on healthy relationships with exercises on identifying healthy relationship scenarios.
  • Tailored scenarios and examples to be more relevant to Afghan youth experiences.

  Sacramento (Adult-focused):

  • Integrated familiar Afghan traditions into stress management techniques, such as “Teatime with Friends” to create connections and space for stress reduction.
  • Offered one-on-one sessions for clients with severe trauma carried out by IRC staff trained in providing psychosocial support. 
  • Adapted relaxation techniques to incorporate Afghan practices.
• Cultural and linguistic competence: Both offices ensured that facilitators shared cultural and linguistic backgrounds with participants, enhancing trust and communication. Sessions were conducted in languages spoken by participants (Dari and Pashto).
• Flexible online format: Both offices offered online sessions to overcome transportation barriers and geographical dispersion, making the program more accessible to participants.
• Safe and supportive environment: Creating a judgment-free space where participants could openly discuss their experiences and challenges was crucial for both offices. Both offices prioritized creating a safe environment by thoroughly explaining the program's purpose to participants. They focused on building trust from the beginning, with Sacramento staff who had lived experiences sharing their own experiences of adjusting to life in the U.S. to foster rapport and connection with clients. To assist participants and address different literacy levels, Sacramento office staff created some material, for example, a template for a vision board using digital tools like Canva to give to clients to use.
• Digital literacy support: The Sacramento office's provision of assistance with Zoom before the series began helped overcome technological barriers, a strategy that could be beneficial for both youth and adult participants.
• Informed consent and building trust with participants and parents: Offices built in additional time before programs started to build trust with participants, and in the case of Oakland, with participant’s parents. This included detailed explanations of the program, opportunities to ask questions, and a thorough review of the program goals and activities through a formal consent-to-participant process.
• Stakeholder capacity building: The Oakland office provided training to school district staff to enhance their understanding and ability to meet the needs of Afghan youth enrolled in schools.

Impact

The Afghan Adjustment Support Group program has yielded significant positive outcomes for Afghan participants in both IRC Oakland and Sacramento. 

• In Oakland, where the program focused on youth, 28 unique individuals participated in the adjustment support groups during fiscal year 2023 (October 2022-September 2023). Post-assessments revealed high satisfaction levels among participants, with all surveyed participants (n=6) reporting satisfaction with the services. 100% of participants indicated they were likely to apply the knowledge gained from the program.
  
  When surveyed participants were asked in the final week of programming what they noticed following a week of sessions and journaling, youth gave compelling feedback. One participant noted, “In the past couple of days … I had a contentment feeling because I wrote more about my feelings and it gave me strength in believing in myself and increased my confidence.”
   
• Sacramento, which primarily serves adult participants, reported that 81 adult participants attended adjustment support sessions from October 2022 to September 2023. These participants experienced improvements in key areas, including adjustment to life in the United States. Notably, participants' comfort in discussing mental health increased in a pre/post assessment demonstrating the program's effectiveness in addressing mental health concerns.