Kuala Lumpur: Refugee Child Mental Health Clinic -- Emotion Regulation, Depression, and PTSD Screening Interview and Therapy -- Fulbright New Leaders Group Award makes it sustainable!

A HELP University clinical psychology graduate student using a semi-structured psychiatric interview with a Burmese refugee teen at Harvest Centre school, as part of the Child Refugee Mental Health Clinic and research study.

Another HELP graduate student interviewing another refugee teen. Click HERE for a quick video of this interviewer conducting asking the teen questions.

Another HELP University graduate student interviewing a Sri Lankan refugee teen student from Harvest Centre for the clinic and study.

June, 2011

There were a few parts to the Fulbright research I completed in partnership with UNHCR, HELP University students, and the refugee child NGO, Harvest Centre: (1) We evaluated the impact of a manualized intervention to train refugee teachers to better manage refugee students' attention, behavior, and emotions in the hidden Kuala Lumpur refugee schools; (2) I went to Thailand and Burma to research the impact of government policies denying these refugee kids education and more, especially the ethnic minority Burmese, on the refugee kids' mental health; (3) We started a Child Refugee Mental Health Clinic where HELP University clinical psychology graduate school students do emotion regulation, depression, and PTSD mental health screens then provide therapy, as needed. This mental health screening is also part of a research study to determine the mental health issues of refugee kids in Malaysia. 

A big concern was how to continue this mental health clinic after I left. I didn't want to be some sort of superman swooping into a developing country, do an intervention, then leave without the work continuing somehow. This Child Refugee Mental Health Clinic was able to be continued after I left because I competed against current and former Fulbright Scholars and got the Fulbright New Leaders Group Award which gave me enough money to continue the clinic and hire a local Malaysian Clinical Psychology professor and former director of the HELP clinical psychology program to supervise the clinic and the graduate students. I was thrilled to see the clinic continue this year! We will, however, need to get more funding by this summer to continue the clinic.

But, let's focus on the research and clinical work done in the Child Refugee Mental Health Clinic. This clinical research project was to screen the refugee students for mental health issues and get them therapeutic help. We used semi-structured psychiatric interviews to screen the teens for Depression and Post-Traumatic Stress Syndrome, both issues that teachers are typically unable to accurately report. This measure had previously been used in my NYU research study with low-income, minority teens.

Harvest Centre, HELP University, and NYU have preliminary results from this mental health screen research; we created a University-Community-based Partnership to conduct mental health screens, allow access to quality therapeutic services by using HELP University clinical psychology students, and to strengthen linkages in the Malaysian community. We have processed 41 of our ultimate goal of 50 to 75 teenage depression and post-traumatic stress syndrome (PTSD) semi-structured psychiatric interviews. Of our preliminary sample of 41 (Mean age = 15; 61% female), 80% were largely Burmese refugees and 20% were low-income, local minorities like Indian-Malaysian.

We found that 23% of the teens were diagnosed with depression during the past year. For comparison purposes, only 5 to 7% of the general U.S. teen population is diagnosed with depression. We compared the refugee teens’ depression with my U.S.-based, highly stressed, low-income minority urban sample of teens from my recently completed NYU study. The rate of 23% depression for refugee teens in Malaysia is comparable to a 29% depression rate among the sample of high-risk U.S. teens.

However, the rate of 17% PTSD for refugee teens here is much higher than the New York City minority sample where only 8% were diagnosed with PTSD. 

The U.S. model of “Wraparound” community services was applied here so that when the refugee teens were diagnosed via our interviews with a current case of depression or PTSD, they immediately saw a HELP University clinical psychology student for therapy; they were also linked to additional support services from the refugee school or given refugee relief provided by UNHCR. 

It is important to note that refugees cannot either receive or afford government-supported mental health services in Malaysia because they are refugees who are seen as illegal in Malaysia, since the government did not sign the 1951 UN Convention protecting refugees. Of the approximately 100 teens screened, over 40 students have received further assessment or therapy as a result of the initial mental health screen. The wraparound screening and therapy system has preliminary evidence for working in this community-based refugee school.

June 2011 Update: Fulbright New Leaders Group Award


It's very exciting that this refugee mental health interview, therapy, and teacher training work will be sustainable through the financial support of my receiving the Fulbright New Leaders Group Award. This award allows us to officially open the Refugee Child Mental Health Clinic and continue the mental health work we started. Wai Sheng Ng, above, will continue my clinical supervision work in the clinic. Amazingly, it is a karmic process having Dr. Ng take over -- Dr. Ng was a Fulbright Student to the US, years ago, to get her doctoral degree, and now she's implementing this Fulbright-funded project in Malaysia from 2011 to 2012! Dr. Ng was director of the HELP University clinical psychology graduate program, and she will continue supervising clinical psychology students from HELP in refugee assessment and therapy, and she will continue the refugee teacher training at Harvest Centre for the next year. It will also allow us to collect more mental health data on a larger set of refugee students, to inform future refugee mental health interventions. Our mental health intervention has now become grass-roots-based, with local supervision and support -- hopefully, this local approach will lead refugee mental health work to be more sustainable in Malaysia and lead to more mutual understanding over how to best help the most vulnerable in Southeast Asian society.