The Karen Chemical Dependency Collaboration: Lessons Learned in Using a Collaborative Framework to Promote Refugee Integration


  • Jennifer McCleary University of Minnesota Duluth Department of Social Work
  • Tonya Horn University of Minnesota Twin Cities School of Social Work; HealthEast Roselawn Clinic
  • Paw Wah Toe HealthEast Roselawn Clinic
  • Ehtaw Dwee Karen Chemical Dependency Collaboration
  • Shana Sniffen HealthEast Roselawn Clinic



Refugee resettlement, substance abuse, refugee integration, cultural adaptation


While refugee integration is defined as a bidirectional process of mutual learning and adaptation, in practice, the U.S. resettlement program continues to emphasize refugees’ acculturation processes and places little emphasis on cultural or logistical adaptation of existing services. When adaptation does happen, it is often structured around dominant notions of health and well-being. There is a need to explore bidirectional integration processes and existing systems adaptations to accommodate people with refugee backgrounds at the institutional level. This article details a framework to build a sustainable collaboration between a refugee community and existing health and social service systems to reduce harmful alcohol use. The conceptual framework emphasizes three components: 1) adaptation of refugees’ indigenous expertise, networks, systems, and resources; 2) adaptation of existing systems to serve new groups in culturally relevant and effective ways; and 3) the participatory processes through which refugees and existing systems collaborate to achieve mutual goals. This paper describes the application of this framework and concludes with a discussion of lessons to support replication of the framework in other settings. Lessons learned include: equalizing power, paying attention to relationships and roles, engaging in deep cultural adaption of interventions, and building individual and organizational capacity to support partners.


Ager, A., & Strang, A. (2008). Understanding integration: A conceptual framework. Journal of refugee studies, 21(2), 166-191.

Bakker, L., Cheung, S. Y., & Phillimore, J. (2016). The Asylum‐Integration Paradox: Comparing Asylum Support Systems and Refugee Integration in The Netherlands and the UK. International Migration, 54(4), 118-132.

Ball, C. L. (2008). Enhancing Community Capacity to Engage and Involve Immigrant and Refugee Families: A Model for Inclusive Collaboration. Families First Edmonton.

Barrera Jr, M., Castro, F. G., Strycker, L. A., & Toobert, D. J. (2013). Cultural adaptations of behavioral health interventions: A progress report. Journal of Consulting and Clinical Psychology, 81(2), 196.

Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40(4), 361.

Bryson, J. M., Crosby, B. C., & Stone, M. M. (2006). The design and implementation of Cross‐Sector collaborations: Propositions from the literature. Public administration review, 66(s1), 44-55.

Castro, F. G., & Yasui, M. (2017). Advances in EBI Development for Diverse Populations: Towards a Science of Intervention Adaptation. Prevention Science, 1-7.

Darrow, J. H. (2015). Getting Refugees to Work: A Street-level Perspective of Refugee Resettlement Policy. Refugee Survey Quarterly, 34(2), 78-106.

Epstein, J., Santo, R. M., & Guillemin, F. (2015). A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. Journal of clinical epidemiology, 68(4), 435-441.

Ezard, N. (2012). Substance use among populations displaced by conflict: a literature review. Disasters, 36(3), 533-557.

Ezard, N., Oppenheimer, E., Burton, A., Schilperoord, M., Macdonald, D., Adelekan, M., ... & van Ommeren, M. (2011). Six rapid assessments of alcohol and other substance use in populations displaced by conflict. Conflict and health, 5(1), 1.

Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365(9467), 1309-1314.

Healey, P., Stager, M. L., Woodmass, K., Dettlaff, A. J., Vergara, A., Janke, R., & Wells, S. J. (2017). Cultural adaptations to augment health and mental health services: a systematic review. BMC Health Services Research, 17, 1–26.

Kirkwood, S., McKinlay, A., & McVittie, C. (2014). ‘Some People It's Very Difficult to Trust’: Attributions of Agency and Accountability in Practitioners' Talk About Integration. Journal of Community & Applied Social Psychology, 24(5), 376-389.

Lee, S., Choi, S., Proulx, L., & Cornwell, J. (2015). Community integration of Burmese refugees in the United States. Asian American Journal of Psychology, 6(4), 333.

Miremadi, S., Ganesan, S., & McKenna, M. (2011). Pilot study of the prevalence of alcohol, substance use and mental disorders in a cohort of Iraqi, Afghani, and Iranian refugees in Vancouver. Asia‐Pacific Psychiatry, 3(3), 137-144.

Morris, M. D., Popper, S. T., Rodwell, T. C., Brodine, S. K., & Brouwer, K. C. (2009). Healthcare barriers of refugees post-resettlement. Journal of community health, 34(6), 529.

Murray, K. E., Davidson, G. R., & Schweitzer, R. D. (2010). Review of refugee mental health interventions following resettlement: best practices and recommendations. American Journal of Orthopsychiatry, 80(4), 576-585.

Newland, K., Tanaka, H., & Barker, L. (2007). Bridging divides: The role of ethnic community-based organizations in refugee integration. Washington, DC: Migration Policy Institute.

Posselt, M., Galletly, C., de Crespigny, C., & Procter, N. (2014). Mental health and drug and alcohol comorbidity in young people of refugee background: a review of the literature. Mental Health and Substance Use, 7(1), 19-30.

Semere, W., Yun, K., Ahalt, C., Williams, B., & Wang, E. A. (2016). Challenges in identifying refugees in national health data sets. American journal of public health, 106(7), 1231-1232.

South, A. (2012). The politics of protection in Burma: beyond the humanitarian mainstream. Critical Asian Studies, 44(2), 175-204.

Strang, A., & Ager, A. (2010). Refugee integration: Emerging trends and remaining agendas. Journal of Refugee Studies, 23(4), 589-607.

Thai Burma Border Consortium. (2016). Six Month Programme Report. Bangkok, Thailand. Author. Retrieved from:

U.S. Department of State. (2016). Refugee Admissions. Retrieved from:

Wallerstein, N., & Duran, B. (2008). The theoretical, historical, and practice roots of CBPR. Community-based participatory research for health: From process to outcomes, 2, 25-46.