History of the BRiTA project
The BRiTA project began in 2002 in response to a study ( “Coping in a New World”, 2001 ) that investigated the mental health needs of young people from culturally and linguistically diverse (CALD) populations. The initial phase of the project involved the development of a 10-session group-based program with content specifically designed to build resilience and mental health literacy in CALD young people through the use of culturally relevant learning activities. Evaluation methods were also developed, along with a training program for BRiTA group facilitators.
What is resilience and why is it important?
Resilience refers to a person's capacity to "bounce back" or adapt successfully after negative life experiences, lifespan transitions, or difficult circumstances. It develops throughout the lifespan in response to the balance between risk factors (such as traumatic life events) and protective factors (such as supportive relationships), and underpins mental wellbeing and quality of life.
Why develop a resilience program for CALD young people?
The breakdown of family ties and community cohesiveness, social isolation, loss of employment or "under-employment", high density living conditions, lack of access to culturally appropriate health services, language barriers, intra-generational conflicts, and breakdown of traditional cultural lifestyles and values are just some of the many risk factors faced by children, young people and adults arising from migration and acculturation. These risk factors have consistently been linked to early school dropout and poor achievement, as well as numerous mental health and social problems. However, no programs specifically designed to help young people from CALD backgrounds to develop skills for coping positively with these issues have been developed either nationally or overseas.
What makes the BRiTA Program unique?
Most programs designed to promote lifeskills in children and young people make the implicit assumption that resiliency protective traits are common across all cultural groups, and therefore interventions tend to be developed according to the "one-size-fits-all" model. The BRiTA Project is unique in that it is founded on an extensive review of the international research literature to identify those elements of resiliency that are culturally-determined, while the content has been carefully selected to ensure that cultural issues are woven into each module, both in terms of group activities (both content and processes) as well as topics to trigger group discussions and personal reflection activities.
The BRiTA Adolescent Program is a 10-module resiliency building program that utilizes creative and interactive activities, discussion questions and take home activities to facilitate the learning of key objectives. It includes a facilitators manual, participant's workbook, a training program for facilitators and evaluation materials. The BRiTA program is designed for use with small groups in school or community settings or in CALD or youth related agencies. It can be used with young people who were born overseas and migrated here either recently or sometime ago, newly arrived refugees, or those who are from 1st, 2nd, or 3rd generation migrant families (Brita Program Outline ).
The Aims of BRiTA
BRiTA uses a Train-the-Trainer model to train facilitators and co-facilitators in the running of the BRiTA program. The most recent training program for facilitators of the BRiTA Adolescents program was run in November of 2007.
The BRiTA program is evaluated using pre and post-questionnaires developed to measure change in the key learning areas. The questionnaires used include the General Health Questionnaire-12 and a questionnaire developed specifically for this program called the Multicultural Youth Resiliency Questionnaire. The GHQ-12 has been internationally validated in it's use with CALD youth. There are also weekly/sessional questionnaires for both the participants and the facilitators to measure responses to each session and a focus group to be held at the completion of the program.
Is the BRiTA Program effective?
The BRiTA-Adolescents program was piloted in Brisbane, Logan, the Gold Coast, Townsville and Canberra, with CALD young people including those with a recent refugee background. The pilot programs were evaluated using a self-report questionnaire measuring 7 resilience factors; 3 indicators of social connectedness; measures of depression, anxiety and stress; and acculturation stress. Overall, the results from the piloting of BRiTA have been positive. Quantitative results showed; a significant improvement in the variables: "goals & aspirations" and "help-seeking". The other 5 variables increased slightly. Community connectedness was noticeably weaker than family and school connectedness, which increased slightly. Acculturation stress was rated dramatically higher than general stress, depression and anxiety, and improved slightly but not significantly. Also noted was a strengthening of pro-social relationships with peers, improvements in young people helping others outside the home, believing they could make a difference and trying to work out problems by talking about them. These results clearly suggest that addressing specific issues related to acculturation is significantly more relevant than general stress management interventions, and culturally relevant resilience protective skills rather than universal life skills are clearly more effective for CALD young people.
Qualitative feedback from participants has also shown that they enjoyed learning more about other people and other cultures, having an opportunity to talk about issues relevant to them and learning through interactive group activities. What they saw as their core learning also reflected the themes for each session, as did the goals that they committed to as a result of each session. These had a strong emphasis on taking more responsibility for their lives and actions, eg. "Make more effort to understand own feelings and those of others", "Go for help with problems", "Manage stress better".
Programs Delivered
2007 saw BRiTA- Adolescents being delivered to students at Milpera State High School (a secondary school providing English language, an intensive and settlement services to prepare newly arrived immigrant and refugee students for participation in secondary schools around the Brisbane area), and to a group of young Samoans.
BRiTA Primary-School (PS)
An 8-module primary-school version of BRiTA was developed, and evaluated within a Health Promoting Schools framework. The BRiTA PS version was piloted in 6 schools across Brisbane and was conducted in the classroom using a whole-class approach with students in years 5 & 6. The results of the piloting of the PS program are currently being written for publication. A link will be provided once the final draft is complete.
Publications, presentations and conferences
BRiTA has been published in the International Journal of Mental Health Promotion and presented at the 18th World Conference on Health Promotion & Health Education in Melbourne and the Multicultural Families Conference at University of Sunshine Coast.
In 2008, QTMHC will be establishing a team of expert trainers to further develop the training program and train BRiTA PS and Adolescent group facilitators across the state of Queensland. This is to ensure a sustainable model for implementation of the program in community and school settings. Adapting the BRiTA program for the families and the early years is currently being investigated.
Anyone interested in finding out more about BRiTA can contact:
Elvia Ramirez,
Mental Health Promotion, Prevention
& Early Intervention Coordinator
Elvia_Ramirez@health.qld.gov.au
Melissa Telford
BRiTA Project Coordinator
Melissa_Telford@health.qld.gov.au
Caroline Lenette
BRiTA Project Coordinator
Caroline_Lenette@health.qld.gov.au
The Multicultural Consumer and Community Participation in Mental Health Project was a partnership with the Multicultural Centre for Mental Health and Wellbeing Inc and the following nine CALD communities: Arabic-speaking, Bosnian, Farsi-speaking, Filipino, Samoan, Somali, Spanish-speaking, Sudanese and Vietnamese.
The project was implemented in three stages which involved:
Nowadays, it is clear that depression assumes an important role in the aetiology, course and outcomes associated with chronic conditions. Untreated depression adds to the burden of chronic disease since it adversely affects the course and complicates the treatment of chronic disease. If we consider the panorama of CALD communities, the reality is not promising. Depression, as are chronic diseases, is associated with social isolation, lower income, unemployment, and education and housing disadvantages, all of which are more common in CALD populations.
Despite the growing recognition of the importance of both chronic disease and depression to the health of individuals in disadvantaged communities, much needs to be done in order to tackle the burden these conditions represent to individuals and communities from a CALD background.
The evidence about self-management approaches in CALD communities is promising. Nevertheless, there is continued concern that programs may not address the need of more diverse cultural, social and economic settings, as well as their effectiveness in dealing with a condition such as depression. Hence we took into account local circumstances when developing the Transcultural Approach to Honouring the Mind and Body Program. This is an ongoing, never-ending process.
We have selected the Indian, Samoan, Arabic-speaking, Vietnamese and Sudanese communities to focus on in the initial phase of this program based on the best evidence available to us. We believe the model we have selected (Critical Care Model) is flexible enough to adapt when people from other communities are included at a later stage.
We have also consulted with the Logan-Beaudesert and North Lakes based chronic disease initiatives to look at ways of linking in with their well advanced projects and will keep looking at alternative ways to work in collaboration. We also consulted with general practitioners from a CALD background and general practitioners working with CALD populations.
It was also very important for us to hear what members of the selected communities had to say. We ran focus groups in order to learn about health related behaviours as well as learning the relevance of self-management concepts in these communities.
All of this consultation has assisted us in developing a plan containing three pillars:-
1. Depression and chronic disease self-management programs
2. Physical activity programs
3. Mental health promoters.
To use resources wisely, we are working closely with Ethnic Communities Council of Qld (ECCQ) who have also received funding to target chronic disease in CALD communities and are currently working on a joint plan.
For more information, please contact Andres Otero-Forero via email: andres_otero-forero@health.qld.gov.au.
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