Missing Pieces: Learnings & Next Steps from Focus Groups with Cultural Navigators and Brokers for Newly Resettled Afghan Refugees

By KP Hartman, Lydia Mathis, & Dr. Tiamo Katsonga-Phiri

What struck us the most was the desire for connection with other navigators. This group of seven navigators had dedicated their Saturday morning to this focus group in the hopes that we’d be able to support their work with newly resettled Afghan refugees and understand the challenges they faced alongside their clients. They represented various organizations and seemed unaware of the others. As result, each navigator and their respective employers were trying to be everything to the individuals and families they served. They spoke frankly and openly about their struggles as navigators – some having been thrust into their roles as the only Afghan employees of their clinics, others were newly arrived and resettled and had chosen to take up the helm to support others as they arrived, and others were not Afghan themselves but found themselves in the messy and bureaucratic work of supporting Afghan refugees. In meeting each other, they came to realize that other people and organizations could fill some of those roles. Someone else could take up certain responsibilities so they didn’t have to be everything to each of their clients. The next piece to explore would be the how. 

Context 

By mid-2022, an estimated 2.8 million Afghans were displaced as refugees (UNHCR, 2022). As part of ongoing initiatives to support newly resettled Afghan refugees in the Denver-Metro area, our initial aim was to deliver mental health and psychosocial support to the community. However, initial literature review efforts and consultation with local experts suggested that the Afghan community had high levels of internal resourcing and was unlikely to trust providers who were not embedded within their communities. Initial outreach efforts reinforced these suggestions but ultimately our expert consultants led us to a network of cultural navigators to better understand the resettlement needs of the Afghan refugee community. 

Cultural navigators are critical agents in helping newly arrived families interact with systems of care such as medical, social services, and mental health care. They tend to possess unique insight into the lives of newly resettled individuals, including, but not limited to, the challenges they face navigating the legal and social processes of resettlement and navigating new education, employment, and medical systems. They also possess insight into the challenges that services providers such as doctors or legal advocates may experience in their efforts to provide services. Despite the necessity of this pivotal role, the literature remains sparse as it pertains to the kind of support navigators may need as they continue. Existing literature regarding burnout, compassion fatigue, and vicarious trauma in first responders (EMTs and Paramedics) and primary care professionals (doctors, nurses, etc.) and the impact that has on their physical and mental wellbeing. However, we have been unable to uncover any literature addressing the psychological impact cultural navigators experience despite often being immigrants or refugees themselves while acting as support roles in high-stress environments. As a result, psychosocial supports are rarely tailored for navigators specifically. Navigators act as cultural brokers and thus have a unique experience in their communities, which requires specific intervention around cultural identity formation, prevention of burnout, and general mental health support.  

Initial Learning 

During Spring of 2023, a group of graduate students from the Graduate School of Professional Psychology at the University of Denver hosted two focus groups with a total of eleven participants. Inclusion criteria was limited to being a cultural navigator for newly resettled Afghan refugees. Cultural navigation could be their full-time job within resettlement agencies and other organizations aiming to support refugees or part of their overall job description in other roles. For example, two participants were doctors and research associates who became cultural navigators as they were the only Afghan providers in their respective clinics. Participants did not have to be refugees or Afghan themselves to participate. 

The focus groups each took about 2 hours. The following third hour was spent providing psychoeducation on trauma and burnout, teaching basic emotional regulation and coping skills, and referring participants to further mental health resources as needed. While we are still in the process of analyzing the resulting data from our focus groups, the most significant theme discovered so far is the needs for navigator connection and social support.  

In both of our focus groups, navigators sought each other out for additional resources and began to draw connections between each other and how their work supported the efforts of others in the room. An initial conclusion from observing these interactions is that while many organizations providing navigation to newly resettled Afghan refugees exist, the organizations are not talking amongst each other. This may result in silos of care and each organization – and by default, each – attempting to be everything to each client and family. 

Navigators also spoke about experiences of symptoms that Western psychologists may refer to as vicarious trauma. Symptoms included a sense of hopelessness and helplessness, difficulty sleeping, changes in appetite, irritability and quickness to anger, and prolonged periods of sadness. In both of our focus groups, participants stated that these symptoms were maintained, at least in part, by their work as navigators. Out of 11 total participants, six of them were Afghan themselves and had immigrated to the United States. Of these, four of them disclosed having refugee status themselves. Many of these navigators may be doubly dealing with their own personal trauma around resettlement in addition to the vicarious trauma they experience through their employment regardless of their personal legal status. 

So, What? 

Based on the initial findings, we believe that establishing a psychosocial support system for navigators and developing a streamlined continuum of care and network of related providers will serve both the navigator community at large and their subsequent clientele. We intend to direct efforts into building up these (or other) potential solutions upon completion of the final data analysis.