Five years in the making, a landmark study by the Center for Victims of Torture was recently published in BMC Family Practice, titled “Intensive Psychotherapy and Case Management for Karen Refugees with Major Depression in Primary Care: A Pragmatic Randomized Control Trial.” Detailing the first known trial of its kind, the study demonstrates the importance of including intensive psychotherapy and case management in the primary care routines for refugees suffering from depression. From 2013-18, this study served as the beating heart of the holistic, cooperative endeavor bringing rehabilitative care to the Karen refugee community. The endeavor is known as the “Healing Hearts, Creating Hope” project.
“I work with my community. I’m from the community,” says Novia Josiah-Isaac, MSW, LGSW, a CVT case manager and the first licensed Karen social worker in Minnesota. “It was a matter of building trust at the beginning of this project because there were rumors in the community itself about how psychotherapy doesn’t work amongst the Karen people.”
Fleeing an armed conflict in Burma, Karen refugees exposed to war and torture found their way to St. Paul. They arrived shouldering high levels of depression, post-traumatic stress disorder (PTSD), anxiety, and chronic pain from surviving trauma. The health effects of these experiences were further complicated by long tenures in refugee camps on the Thai-Burma border where access to adequate food and medical care were next to impossible. The project studied how the inclusion of intensive psychotherapy and case management affected the recovery from major depression in a refugee population. And the results were resoundingly positive.
The trial occurred in partnership with two St. Paul primary care clinics M Health Fairview Clinic-Roselawn and M Health Fairview Clinic-Bethesda, clinics with reputations of providing phenomenal care for refugee populations. Participants receiving the psychotherapy and case management from CVT were compared to a control group who received care as usual, without CVT’s interventions.
“In the beginning, some of the participants were hesitant,” continues Novia. “They asked: ‘How will therapy and case management help me with my life?’ But they have become more open-minded about therapy and case management. After the study, it’s more acceptable now.”
Novia watched the participants transform, their symptoms of depression improved. She noted meaningful progress in their independence and interaction within social groups. “It is rewarding to see clients become a little more independent each week,” she remarks. With these improvements, their signs of major depression abated.
The results of the study attest as much. According to the study, participants who received additional psychotherapy and case management from CVT “demonstrated mental health symptom reduction, pain reduction, and improvements in social functioning.”
“I’m hoping that this study can help influence and elevate our work with policymakers,” says Alison Beckman, MSW, LICSW, senior clinician for CVT’s external relations, who served as the manager and clinical supervisor for the project. “This kind of care actually helps people, but you can’t do it in just a few weeks. It takes time and funding. We hope other torture rehabilitation programs and mental health providers who work with refugees can use this study to elevate the services they provide.” Alison credits the willingness and grace of the Karen participants for the successful completion of this study.
While the study is finished, the “Healing Hearts, Creating Hope” project continues to provide mental health services to Karen refugees. The control participants who did not receive the psychotherapy and case management during the trial received the services afterward. Novia reports the healing and hope that the results of the study confirmed endure in its participants and are found taking hold in the hearts of new CVT clients today.