MPH INTERNSHIP PLAN

MPH Internship Plan

Program Evaluation: CNNC Community Centers
Sana Ansari
The University of North Carolina at Greensboro

The Center for New North Carolinians

Site Preceptor: Dr. Holly Sienkiewicz, DrPh

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Part 1: Problem Statement

Description of Health Problem: Trauma and PTSD among refugees
The refugee experience is often characterized by trauma. The United Nations High
Commissioner for Refugees (UNHCR) estimates that more than 42 million persons have been
forcibly displaced either within their home countries or across national borders (Nickerson et al,
2011). By definition, refugees leave their home countries to escape war, genocide, persecution,
and imprisonment, and many are exposed to the murder of family and friends, rape, torture and
trauma, prior to their resettlement (Lamba & Krahn, 2003). Studies conducted within conflict
areas and post-resettlement countries illustrate that refugees across ethnicities and with diverse
backgrounds have higher rates of psychological disorders compared to non-refugee populations
(Nickerson et al., 2011).
Most of the research examining the mental health of refugees has focused on the
diagnosis of post-traumatic stress disorder (PTSD). PTSD can develop immediately or several
months after a traumatic incident and symptoms include flashbacks, avoidance of events or
objects that are reminders of the experience, depression, and hyper-arousal (The National
Institute of Mental Health, 2014). Refugees are 10 times more likely to have PTSD than the
general population in the countries in which they resettle (Fazel et al., 2005). Traumatic events
are disproportionately experienced by refugees before resettlement and serve as triggers for
PTSD.
Approximately half of the worlds refugees are children (UNHCR, 2002a), and children
are also victims of trauma due to war and civil upheavals. PTSD symptoms manifest differently
among refugee children. Young children (aged 0-6) are at increased risk for brain development
complications (National Child & Traumatic Stress Network, 2010). A study demonstrated that

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between 49%-69% of refugee children experienced anxiety disorders, while 40% experienced
PTSD (Fazel & Stein, 2002). Another study showed that children aged 0-6 exposed to trauma
were prone to displaying excessive anger, startling easily, fearing adults who remind them of the
traumatic event, showing excessive irritability and sadness, exhibiting attachment disorders and
act withdrawn (National Child & Traumatic Stress Network, 2010). Some children experience
avoidance and numbing symptoms in private and may not come to attention of teachers or social
service or health care providers (Kinzie et al., 2006). When these effects of trauma are not
apparent, children are unlikely to be referred to services.
Post-resettlement risk factors also contribute to psychological distress. Refugees
experience a loss of their homelands, family, friends, and material possessions and the challenges
of a new language and culture (Lustig et al., 2004). Additionally, social isolation, conflicts with
cultural expectations, and gender and role changes can add to the increased stress (Lamba &
Krahn, 2003). Hopes for a safer and prosperous life for adults and their children may temporarily
postpone grief (Lustig et al., 2004). However, once the initial resettlement period of 6-months
ends, the reality of life comes rushing back.
Refugees in the Piedmont Triad
The Piedmont Triad is home to a growing population of refugees from throughout the
world. The area has one of the largest concentrations of Hmong and Montagnard refugees, and
the last decade has seen an influx of arrivals from Burma, Iraq, Iran, and African countries
including the Democratic Republic of Congo, Eritrea, Somali, and Sudan (Sills, 2010).
Although there has been limited research on PTSD among refugees in NC, there is gap in
mental health services targeting refugee adults and children. Due to the growing size and
diversity of refugees, the need for culturally competent mental health services has also increased.

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Description of the Non-Health Problem - Lack of data needed to know how to improve
community center programming to support refugee mental health
The non-health program faced by the community centers is a lack of data on how well the
programs are running. In order to address this non-health program, an evaluation must be
conducted. The CNNC community centers have offered programs for several years now;
however no comprehensive evaluation has ever been conducted to see how well the programs are
performing. The purposes of the evaluation are to understand how well the programs are
functioning in order to determine their impact, and to learn how to improve their program design
and implementation to better serve the target immigrant/refugee communities. The overall
mental health goal of the evaluation is to determine how the community centers serve as a safe
space for participants by promoting safety and support networks.
Overview of CNNCs Community Centers
The first community center opened at Glen Haven apartment complex in 2002 when
volunteers noticed an unmet need for after-school tutoring of refugee children. CNNC partnered
with Lutheran Family Services, a refugee resettlement agency that has now closed, to provide
tutoring services in a vacant apartment donated by the Glen Haven management. Staff expected
the program to draw around 20 children; instead, 68 children sought out tutoring services. The
program slowly expanded to include adult programming such as ESOL classes and special
presentations from local firefighters. As Greensboros immigrant and refugee populations grew,
the need for expanded services grew as well. In 2010, the CNNC opened its second community
center in the Oakwood Forest mobile home community. In the fall of 2012, the CNNC opened its
third center at the Ashton Woods apartment complex. The programs offer services to immigrants
and refugees from a wide variety of backgrounds.

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CNNCs Solution: To increase social capital and social support

Because the goal of refugee resettlement is economic self-sufficiency, resettlement staff
and service providers focus their attention on meeting language, healthcare, employment, and
educational needs, thereby neglecting refugees distinctive experiences, reasons for escape, and
personal goals and needs. While refugees gain access to financial capital, they have limited
access to social capital in the form of social support networks (Lamba & Krahn, 2003).
Successful transition and acculturation of refugees have been aided by psychosocial
approaches. The goal of the CNNCs community centers is to promote social capital among
refugees, immigrants, and other residents by providing adult and children programs. In several
studies (Kovacev & Shute, 2004; Stoll & Johnson, 2008), social support is considered a crucial
factor in the psychosocial adjustment of adolescent and adult refugees. Social support in the form
of healthy relationships and activities can help an individual master emotional distress (Warren,
Jackson and Sifers, 2009). These programs have the potential to contribute to long-term mental
health benefits by providing a safe and supportive network of people to learn and grow with.
Relevance of the Problem for the CNNC
The CNNC community centers serve refugees from a variety of backgrounds, including
Bhutan, Burma, Liberia, the Congo, Iraq, and Sudan. The CNNCs mission is to advance the
capacity of immigrants and refugees and build bridges between immigrant populations and
existing communities throughout the state by providing: community-based outreach and
advocacy, educational programming, research and evaluation, immigrant and refugee leadership
development, and educational opportunities for faculty and students. The centers advance the
capacity of refugees by providing them with educational and social opportunities to learn and

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grow together. Participating in the centers help refugees gain educational, language, and social
skills which will assist in their transition to life in America.
SWOT Analysis- CNNC
Strengths

CNNC has the expertise needed to conduct this evaluation. They have
knowledgeable and passionate researchers, academics, students, and
volunteers who are interested and engaged with immigrant/refugee issues.
The CNNC has the necessary funding and support from UNC-G and NC
A&T to conduct this evaluation.

Weaknesses To date, the CNNC has not completed a comprehensive evaluation of the
three community centers. CNNC interns are currently surveying
community center staff and participants in order to develop objectives on
which to base the evaluation. As with any new initiative, there is a level
of trial and error.
This weakness is minimized by the fact that Dr. Holly Sienkiewicz is
overseeing all evaluation work. Dr. Sienkiewicz has experience working
on several evaluation projects. She has been working as a researcher with
the Center for Social, Community and Health Research and Evaluation in
Greensboro for a couple of years. This experience gives her the expertise
needed to oversee the CNNC evaluation project.
Opportunities
The results of the evaluation will shed light on what CNNC can do to
improve their programming by creating new programs and/or improving
existing ones.
Opportunities exist for increased collaboration with service providers to
improve/expand these programs.
Given the changing demographics of these diverse neighborhoods, there
is a potential to attract new members.
Threats

Potential risk of a community center closure? - Avalon Trace was a former

site of a CNNC community center that recently closed. The other centers
at Ashton Woods, Glen Haven, and Oakwood may also be at risk for an
unexpected closure.
Risk of losing funding - Funding is always dependent upon precarious
situations. There is always a risk that the CNNC will lose funding to
support one if not more community centers.

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These threats play into the broader socio-ecological factors that may
impact the community centers ability to function. If the CNNC is in need
of funding, then they will need to devise strategies to address this
problem, such as reaching out to more community foundations, applying
for more grants, and/or fostering new collaborations with community
agencies.
Ethical Analysis
An ethical issue that may arise is evaluator bias. There are a couple of programs the
community centers currently do not offer which staff members believe will be beneficial to the
community. An example is developing a protocol for handling mental health and developing
informational tools to educate the community on mental health issues in a culturally competent
manner. This might lead to bias in the initial surveys and assessments that may reflect the high
need of such a program.
Other ethnical issues that may result are related to cross-cultural competency issues. The
evaluators will survey/interview participants through the assistance of trained interpreters.
Therefore, evaluators must ensure that the questions will not lead to response bias and are
worded in simple words. There are also elements of trust issues that may arisesome refugees
may fear giving an answer that may not be disliked by the evaluator. Evaluators need to put
participants at ease so that they answer the questions truthfully. One way they can do this is
changing the wording of negative questions to positive ones. For example, instead of asking:
What programs do you dislike? The evaluator should ask: What programs do you not attend,
or What programs are least helpful to you? Another way of putting participants at ease is by
making sure the evaluation setting is comfortable to the participantsasking these questions at
home rather than at the community centers may put participants at ease to respond truthfully and
may prevent bias from occurring.

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Part 2: Problem Analysis

Refugees suffer from PTSD and other mental health issues stemming from the trauma
they experienced in their homelands. Post-resettlement factors such as social exclusion, changing
familial roles, and difficulty adjusting to a new language and culture contribute and may even
exacerbate mental health issues. Given the complexities of each refugees personal experiences
and the many contributing factors associated with poor mental health outcomes, a conceptual
model will be useful in understanding how each of these factors correlate with one another. This
model is detailed below:
Figure 1: Conceptual Model: Causal Factors of PTSD

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Explanation of the Conceptual Model using the SEM:

Poor mental health outcomes among refugees are impacted by macro and micro level
factors as explained by the socio-ecological model (SEM). These include intrapersonal,
interpersonal, organizational, environmental, and societal factors (McLeroy et al., 1988).
Intrapersonal Factors
Intrapersonal factors impacting poor mental health include a perceived need for care,
perceived susceptibility to mental health issues, poor coping mechanisms, and lack of access to
mental health services. These factors are largely influenced by cultural values that assign stigma
to mental health issues, making it difficult for refugees to admit to having mental health issues
and seek out health services. Cultural explanations may also downplay the seriousness or the
existence of mental health issues, making it difficult to conceptualize a health condition that they
have never been familiar with.
Interpersonal factors
Interpersonal factors including relationships with family, friends, and members of the
same ethnic/religious groups. Research on East European immigrants found that relationships
with family are found to provide crucial social support and protect their psychological well-being
(Jasinskaja-Lahti & Liebkind, 2006). These relationships provide social support which can serve
as a type of social therapy for refugees with mental health concerns. Although research exists
suggesting the positive impact that formal and informal social ties have in the acculturation
process of immigrants, few researchers have documented a similar impact among refugees
(Lamba & Krahn 2003). Fewer studies discuss the specific functions of these valuable social ties.
Lamba & Krahn (2003) note that the construction and maintenance of an extensive social
capital base is essential for successful [refugee] resettlement.

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Establishing a support network with members of the same ethnicity is common among
refugees. However, the availability and establishment of ethnic support networks may be very
limited, depending on where a refugee is resettled (Jasinskaja-Lahti & Liebkind, 2006).
Greensboro is lucky to be a home to diverse refugee ethnicities and communities, however, not
all cities share in this characteristic.
Organizational Factors
Organizations that work with refugees post-resettlement also impact mental health. These
organizations include religious institutions, refugee resettlement agencies, and ESL agencies.
Interactions through these institutions promote interpersonal interactions which may lead to
positive interpersonal relationships and a larger support network. Adults and children will be
influenced by employment and school. Both can be sources of great stress--adults feel pressure
to maintain their employment in order to financially provide for their families, and children may
feel pressure from their families to succeed academically. PTSD symptoms can harm
work/school performance which can lead to various adverse consequences, such as loss of
employment and academic discipline.
Environmental Factors
Environmental level factors include community level factors that influence mental health
outcomes. Refugees live in poor housing neighborhoods and frequently experience roaches and
insects. Refugees often do not know how to properly clean and maintain their homes.
Sometimes, refugees bring in furniture that they find near dumpsters without knowing that they
are bringing in bed bugs as well. They may leave food uncovered or let trash accumulate before
taking it out, leading to more insects. Having poor housing quality impacts ones health and well-

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being. Refugees may also lack transportation to mental health services because they either do not
live on the bus line or are unable to walk long distances.
The socio-economic status of refugees and the presence of cultural and language barriers
also impact PTSD treatment (Palic and Elklit, 2011). Refugees are enrolled in Medicaid for their
initial eight months, and it can be challenging for them to find a mental health provider who
accepts Medicaid. Additionally, many mental clinics do not offer interpretation, so if a refugee
seeks out mental health services, he/she would need to bring their own interpreter. Often, the
only available interpreter is a friend or a family member, and refugees are less likely to disclose
their mental health issues in front of these people for fear of stigma.
Societal factors
Societal factors include national and international policies that impact refugee
resettlement. These policies influence which countries and cities specific refugee ethnicities will
be resettled and how much funding is allocated to refugee services. National and international
health policy also impact mental health. Pre-resettlement factors such as access to mental health
services can help address some mental health concerns of refugees suffering from trauma or
PTSD. National factors such as access to Medicaid and culturally competent mental health
services can influence the progression of the illness.
CNNCs Solution
The CNNC seeks to address the lack of psychosocial support among refugees through an
organizational setting. The CNNC created community centers at three apartment complexes in
which a majority of refugees, immigrants, and others from lower socioeconomic status reside.
These centers operate out of vacant apartments at these complexes. The centers offer adult,
adolescent, and children programs such as ESL assistance, health referrals, sports activities, and

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tutoring sessions. On an organizational level, the community centers hope to address inter and
intra personal level factors that may contribute to mental health issues. Dr. Holly Sienkiewicz,
Director of Research at the CNNC, views the centers as a safe space for refugees of all
backgrounds to grow, learn, and interact with others.
Figure 2 below displays the types of psychosocial support that CNNC provides in order
to address PTSD.
Figure 2: Planning Model: PTSD addressed through CNNC

Connecting the Health and Non-Health Problems

Refugees suffer from PTSD and other mental health concerns. The community centers
attempt to address these concerns by promoting psychosocial support to the refugees and
immigrants they serve. As previously mentioned, several studies indicate that promoting social
interaction among vulnerable populations can lead to positive mental health benefits (decreased

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depression, sense of loneliness, etc.) (Jasinskaja-Lahti & Liebkind, 2006). These interactions can
lead to stronger relationships which can help expand a refugees social circle. Having weekly or
more social interactions can be something a refugee could look forward to during their busy and
hectic weeks, which gives them something to look forward to when they are feeling sad and
unproductive. It can serve as motivation for refugees to become more productive.
There are several non-health problems that the community centers face, but the focus of
this internship will be on one of them--the lack of data on how well the community centers are
addressing mental health issues. The CNNC does not have any quantitative or qualitative data to
measure how well they are meeting their program goals and objectives, which include addressing
mental health issues by promoting social support. This internship will seek to address the lack of
data problem by conducting a comprehensive evaluation of the community centers. This
evaluation will measure how successful the community centers are in decreasing mental health
issues through social interventions.
Previous Research on Addressing PTSD
Addressing PTSD in Refugees
Several studies discuss various treatment strategies and interventions for refugees with
PTSD. All the studies included in this review are focused on individual and group therapy
approaches. Kinzie (2001b) discuss a combination of medication and supportive psychotherapy,
with additional strategies aimed at reducing isolation. Kinzie (2001b) notes that this approach
was successful in reducing symptoms of PTSD in refugees. He also mentions that refugees have
diverse methods of confronting their trauma experiences. Some refugees share their stories to
attain a sense of relief, while others prefer to accept and avoid these experiences all together.

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Schreiber (1995) discusses the story of an Ethiopian woman whose baby had been killed.
After she was diagnosed with PTSD, she began psychotherapy during which she was asked to
talk about her memories of her childs death. Schreiber (1995) notes how anthropological
consultation enabled the therapist to identify specific cultural traditions carried out after having
contact with a dead corpse. The patient experienced decreased PTSD symptoms, including a
reduction in anxiety, a decrease of flashbacks, and an improvement in psychosocial behavior.
This study highlighted the importance of incorporating refugees unique traditions and rituals
into therapy.
Nicholl & Thompson (2004) reviewed ten studies of PTSD psychotherapy among
refugees and found that most of these studies included a psychosocial component to the
intervention, and often taking a more holistic approach encompassing elements of the social,
medical and psychological. The authors note that taking such an approach is crucial in working
with refugees given the pressures that refugees face during acculturation and in navigating the
healthcare systems. Mental health service providers therefore must the social conditions and
political elements governing refugee resettlement into account.
Palic and Elklit (2011) conducted a systematic review of twenty-five treatment studies of
refugees with PTSD. The authors highlighted the need for well established referral and
treatment procedures for refugees because when refugees finally reach mental health centers for
treatment, they had been suffering from PTSD and other mental health problems for years. The
authors recommend long-term treatment outcome studies that measure the changes in PTSD
status among refugees, since the majority of treatment studies have a short-term duration.

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The literature for PTSD treatment among refugees is limited, when an even smaller body
of literature containing research on psychosocial treatment. The following section contains
literature on psychosocial rehabilitation for non-refugees.
General Psychosocial Rehabilitation Techniques among Non-Refugees
The clubhouse model is a theoretical framework used by nonprofits targeting adults with
severe mental illness, including paranoid schizophrenia, bipolar disorder, and major depression.
This model is considered a psychosocial rehabilitation program that is based on the idea that
adults with mental illness do not have to be institutionalized but can live and function
independently and successfully in the community (International Standards for Clubhouse
Programs, 2012). Sanctuary House in Greensboro follows the clubhouse model. They offer a
physical space where members come together and perform daily tasks in the areas of
administration, catering, maintenance and employment. These tasks are designed to improve the
mental and overall health and well-being of individuals within the program (Sanctuary House,
2014a). A research study evaluating Sanctuary Houses implementation of the clubhouse model
found that rates of hospitalization of members decreased, while employment increased (Floyd &
Lorenzo-Schibley, 2010). This correlation suggests that recreational therapeutic services like
clubhouse programs can lead to positive well-being and better management of mental health.
Impact/Outcome Objectives
The purpose of this internship is to demonstrate how well the centers are meeting their
intended goals and objectives, which includes identifying how well these centers are providing
social support to refugee adults, adolescents, and children. This will be accomplished by
evaluating how well the centers are operating, meeting their objectives in promoting education,
health, language, etc., and meeting the needs and expectations of participants. The evaluation

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will also measure psychosocial factors, such as if the centers are facilitating the increase of social
capital by allowing adults or their children to make new friends, help with employment
opportunities, or help refugees feel happy.

Outcome Objectives (short-term, immediate outcomes):

1.
2.

Develop and conduct an objectives based evaluation plan

Assess the community center programs and determine how well these programs are meeting the

3.

goals and objectives of staff and participants.

Determine what skills or knowledge that community center members (adults, adolescents, and

4.
5.

children) acquired through participation

Determine the successes/weaknesses of the community center programs
Determine the impact that community center involvement has on social networks
Impact Objectives (long-term):

1.
2.
3.

Improve or create new programs based on evaluation feedback

Create a systematic way of addressing mental health concerns among members
Measure the mental health improvements of refugees

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Part 3: Internship Activities Plan & Methods

The main focus of this internship will be evaluation of the CNNCs three community
centers. A preliminary survey of staff, current participants, past participants, and members of the
target community who are not participants is currently underway. Based on the Tylerian approach
(Fitzpatrick et al., 2011, p. 154), the survey results will be used to create broad goals from which
objectives will be defined in behavioral and measurable terms. Afterwards, evaluation data will
be collected and compared with the stated objectives. This evaluation will measure all objectives
of the community centers. In additional to mental health, these objectives include: academic
performance, ESL, employment, case management, physical health, and cultural brokering.
Figure 3 below shows a detailed description of the resources needed, intended activities,
and short-term and long-term outcomes of the evaluation:

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Figure 3: Program Logic Model

Inputs
Evaluation materials
CNNC community
center staff, interns,
and volunteers
Interpreters
Transportation
Immigrants/refugee
residents from the 3
community center
neighborhoods
(Ashton Woods,
Oakwood Forest, Glen
Haven)
Past participants (who
moved away)
Childcare

Activities
Determine
evaluation type
(most likely
objectives based)
Design
evaluation plan
Design surveys,
pre/posttests, and
interview
questions
Collect
qualitative
evaluation data
Code qualitative
data and analyze
Develop
Evaluation
Report

Outputs
Data Analysis

Short term Outcomes

Disseminate evaluation findings

Evaluation Plan

Develop suggestions for program

improvements based on
results/recommendations

50 surveys and
pre/posttests
collected
(projected)
20 interviews
completed
(projected)
Evaluation
Reportcontaining results
and
recommendations

Expand participation in tutoring

program
Improve academic performance
Expand participation in
ESL/employment program

Long-term Outcomes
Create a model for improving
psychosocial support of refugees
Improve refugees social
networks/social capital
Improve refugee access to mental
health care services that
complement psychosocial
rehabilitation

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Methods
Participant Recruitment
Participants will be recruited through convenience sampling, and the target population is
past, current, potential, and non-potential participants who live near the community center or
who use transportation to attend the community center programs.
Participants must realize that their participation is voluntary, and that the results will in
no way harm their participation in the community centers. One way to gain entry into various
refugee communities is to find ways to build trust with the target communities. Luckily, the
evaluators are internal to the CNNC, and CNNC staff members are personally connected with the
majority of participants and neighborhood residents.
Data Collection
Qualitative data for the evaluation will be collected through surveys, interviews, and
pre/posttests. The objectives will be broken down into measurable questions.
Example: Measuring decreased mental health concerns among refugees:
Increasing the social well-being of refugees can lead to decreased mental health concerns.
Therefore, Decreased mental health concerns will be measured by comparing how the social
interactions of refugees have changed since attending the community centers. These questions
will be derived from several social support questionnaires (Fetzer Institute, n.d.). The types of
questions that will be asked are:
How has the center helped you at home, work, etc.? How has the center helped your children?
Do you feel safe with your neighbors and at the center?
Do you spend time with your neighbors outside of the center? Are they from the same
background as you?

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Who would you call in case of an emergency? For example, if you didnt have a car and you
received a call from your childs school that he was sick and needed to be picked up, who would
you ask for a ride?
If a family problem arose, is there someone outside of your family that you could turn to for
help?
How do you feel when you are at the center? (do you feel happy/depressed/stressed)
Initially, pre/posttests will be distributed to participants and non-participants living in the
community center neighborhoods. A pre-test will be distributed among newly arrived refugees,
and post-tests will be distributed among established refugees. There is however, one threat to
internal validity that will occur--there is an assumption that natural maturation among the
participants will occur. The longer a refugee lives in their neighborhoods, the more likely that
their social circles will naturally increase. This increase in social support may not be attributed to
the community center. Therefore, pre/posttests will also be distributed among newer and older
participants.
After conducting pre/posttests, participants will be surveyed to measure the objectives.
This survey will include a checklist of activities the participant would like to see at the center.
Afterwards, interviews will be conducted with key participants to gather in-depth perspectives on
the community centers.
Data Analysis and Reporting
Data will be analyzed using content analysis. Per the permission of participants,
interviews will be audio recorded and transcribed. The surveys and interviews will be coded,
inputted into SPSS, and analyzed for similar and dissimilar patterns and themes.
Recommendations for improvement as well as identified strengths will be grouped categorically
and developed into a final report complete with findings and recommendations. This report will

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be delivered to the CNNC, and the findings will be presented to the public through presentations
and a published white paper.

Figure 4: Gantt Chart (Project Timeline)

Internship Activities
Conducting initial assessments of
community center staff and participants
Developing indicators/objectives based on
assessments
Developing an evaluation plan based on
objectives
Collecting evaluation data
Analyzing evaluation data
Create evaluation report
Disseminate evaluation findings

Nov-Dec
2014
X

Jan.
2015

Feb.
2015

Mar.
2015

Apr.
2015

X
X
X
X
X
X

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References:
Fazel, et al. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western
countries: A systematic review. Lancet. 365, 13091314.
Fazel, M. & Stein, A. (2002). Community Child Health, Public Health and Epidemiology: the
Mental Health of Refugee Children. Archives of Disease in Childhood 87, 366-370.
Fetzer Institute. (n.d.). Self Report Measures for Love and Compassion Research: Social
Support. Retrieved from
http://fetzer.org/sites/default/files/images/stories/pdf/selfmeasures/Self_Measures_for_Lo
ve_and_Compassion_Research_SOCIAL_SUPPORT.pdf.
Fitzpatrick et al. (2011). Program Evaluation: Alternative Approaches and Practical Guidelines.
Upper Saddle River: Pearson Education Inc.
Floyd, M., & Lorenzo-Schibley, J. (2010). Academia and mental health practice evaluation
partnerships: Focus on the clubhouse model. Social Work In Mental Health, 8(2), 134139.
International Standards for Clubhouse Programs. (2012). Clubhouse International. Retrieved
from http://www.iccd.org/quality.html
Jasinskaja-Lahti, I., & Liebkind, K. (2006). Perceived Discrimination, Social Support Networks,
and Psychological Well-being Among Three Immigrant Groups. Journal of CrossCultural Psychology, 37, 3, 293-311.
Kinzie, et al. (2006). Traumatized refugee children: the case for individualized diagnosis and
treatment. The Journal of Nervous and Mental Disease, 194, 7, 534-7.
Kinzie, J. (2001b). Cross Cultural Treatment of PTSD. In J. P.Wilson, M. J. Friedman, & J. D.
Lindy, (Eds.), Treating psychological trauma and PTSD. New York: The Guilford Press.
Kovacev, L., & Shute, R. (2004). Acculturation and social support in relation to psychosocial
adjustment of adolescent refugees resettled in Australia. International Journal of
Behavioral Development, 28, 259-267.
Lamba, N. & Krahn, H. (2003). Social capital and refugee resettlement: The social networks of
refugees in Canada. Journal of International Migration and Integration, 4(3), 335-360.
Lustig et al. (2004). Review of Child and Adolescent Refugee Mental Health. Journal of the
American Academy of Child & Adolescent Psychiatry, 43,1, 24-36.

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McLeroy, et al. (1988). An ecological perspective on health promotion programs. Health

Education Quarterly, 15, 4, 351-77.
Nicholl, C., & Thompson, A. (2004). The psychological treatment of Post Traumatic Stress
Disorder (PTSD) in adult refugees: A review of the current state of psychological
therapies. Journal of Mental Health, 13, 4, 351-362.

Nickerson, et al. (2011). A critical review of psychological treatments of posttraumatic stress

disorder in refugees. Clinical Psychology Review, 31, 3, 399-417.
Palic, S., & Elklit, A. (2011). Psychosocial treatment of posttraumatic stress disorder in adult
refugees: a systematic review of prospective treatment outcome studies and a critique.
Journal of Affective Disorders, 131, 1-3.
Sanctuary House. (2014a) About Sanctuary House. Retrieved from
http://www.sanctuaryhousegso.com/aboutus.cfm.
Schreiber, S. (1995). Migration, traumatic bereavement and transcultural aspects of
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