British Journal of Guidance & Counselling

ISSN: 0306-9885 (Print) 1469-3534 (Online) Journal homepage: http://www.tandfonline.com/loi/cbjg20

Cultural brokers’ role in facilitating informal and

formal mental health supports for refugee youth
in school and community context: a Canadian case
study

Novjyot Brar-Josan & Sophie C. Yohani

To cite this article: Novjyot Brar-Josan & Sophie C. Yohani (2017): Cultural brokers’ role
in facilitating informal and formal mental health supports for refugee youth in school and
community context: a Canadian case study, British Journal of Guidance & Counselling, DOI:
10.1080/03069885.2017.1403010

To link to this article: https://doi.org/10.1080/03069885.2017.1403010

Published online: 15 Nov 2017.

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BRITISH JOURNAL OF GUIDANCE & COUNSELLING, 2017
https://doi.org/10.1080/03069885.2017.1403010

Cultural brokers’ role in facilitating informal and formal mental

health supports for refugee youth in school and community
context: a Canadian case study
Novjyot Brar-Josana and Sophie C. Yohanib
a
Centre for Cognitive Behavioral Therapy, Edmonton, AB, Canada; bDepartment of Educational Psychology,
University of Alberta, Edmonton, AB, Canada

ABSTRACT ARTICLE HISTORY

Refugee youth, who experience developmental, settlement and/or pre- Received 28 August 2016
migration related challenges, rarely utilise mental health services due Revised 30 October 2017
systemic and cultural barriers. Cultural brokering, the act of linking Accepted 3 November 2017
different cultural groups to enhance practice and communication, is one
KEYWORDS
approach to addressing barriers to mental health service provision Cultural brokering; refugee
experienced by refugees. Results from a qualitative case study in youth; cross-cultural issues;
Canada, identified informal and formal activities of four cultural brokers counselling; adaptation;
that facilitate the mental health and adaptation of refugee youth in settlement supports; school
schools: facilitating cultural integration and sense of belonging, bridging supports
to settlement services, supportive counselling, facilitating referrals to
mental health practitioners, educating about mental health, providing
contextual information and cultural interpretation. Results provide initial
insights into a holistic approach that could be used by mental health
service providers to enhance service provision and the wellbeing of
refugee youth in schools and community settings.

Introduction
Background information
At the end of 2016, 65.6 million individuals were forcibly displaced worldwide which represented an
increase of 300,000 people over the previous year (UNCHR, 2017). Half of the 22.5 million documen-
ted refugees were children below 18 years of age (UNHCR, 2017). In resettlement counties, refugee
youth represent a high risk group due to the elevated likelihood of exposure to trauma (Attanayake
et al., 2009; Tol, Song, & Jordans, 2013) yet they tend to underutilise mental health services (Colucci,
Szwarc, Minas, Paxton, & Guerra, 2012; Michelson & Sclare, 2009). According to the Refugee Health
Technical Assistance Center (2011) rates of Post Traumatic Stress Disorder (PTSD) in refugee youth
ranged between 50% to 90%, and depression ranged from 6% to 40%. These findings are consistent
with a systematic review of the literature (Colucci et al., 2012) which reported wide-ranging preva-
lence rates for PTSD, depression, and suicide among refugee youth. Explanations for underutilisation
of services include preoccupation with meeting basic needs, language barriers, limited knowledge of
services, parent-related barriers, system-related barriers, and cross-cultural differences (De Anstiss,
Ziaian, Procter, & Warland, 2009).
Recently, the role of cultural brokering has emerged in health and education as one approach to
addressing cultural barriers to service access and provision. A cultural broker is an individual who
takes on the role of bridging individuals or groups of differing cultures for the purpose of improving

CONTACT Novjyot Brar-Josan jbrarccbt@gmail.com

© 2017 Informa UK Limited, trading as Taylor & Francis Group
2 N. BRAR-JOSAN and S. C. YOHANI

communication and reducing conflict (Jezewski & Sotnik, 2001). Paraprofessionals, settlement
workers, bilingual co-workers, diversity liaisons, and bi-cultural members within an ethnic commu-
nity group are all examples of cultural brokers who can assist mental health practitioners in service
provision (Birman, Weinstein, Chan, & Beehler, 2007; Owen & English, 2005). As a mental health
therapist and a second-generation immigrant in Canada, the first author (N.B.) often found
herself in numerous situations where she had to take on an informal cultural broker role. She
also observed the improvement in service delivery when a cultural broker was available. While par-
ticipating in cross-cultural counselling courses, a review of the cultural brokering literature identified
little information on the actual activities that brokers engaged in when assisting individuals with
mental health difficulties. At the same time, the second author (S.Y) was conducting a larger
study looking at the cultural brokers’ role in supporting the adaptation of refugee youth and
families. Results presented in this manuscript are part of that larger study, and provides an in-
depth description of the specific informal and formal mental health supports taken on by a
group of cultural brokers in a Canadian city.

Mental health interventions for refugee youth

Migration and resettlement in a new country represents a difficult transition for refugee youth due
both to their age and general pre- and post-settlement challenges. Youth, like adults, also face the
task of adapting to a host country with an unfamiliar culture. While physical safety is achieved,
youth, particularly unaccompanied minors with histories of loss and trauma, are vulnerable to experi-
encing ongoing trauma-related challenges such as survivor guilt and cultural bereavement (Kelly,
2007; Wilmsen, 2011).
In addition to settlement challenges, refugee youth are required to cope with normal develop-
mental challenges, such as identity development and negotiation of independence (Erikson, 1959).
Identity crises and acculturation stress may result as a function of refugee youth trying to negotiate
two opposing cultures. The stress associated with balancing both the old and new culture is referred
to as acculturative stress. Social challenges within school and community settings can further contrib-
ute to experiences of isolation and lack of belonging (Montero, Ibrahim, Loomis, & Newmaster, 2012),
family conflict (Koh, Liamputtong, & Walker, 2013), and discrimination (Khanlou, Koh, & Mill, 2008;
Stewart, 2012). Perceived discrimination in turn has an adverse effect on the adolescents’ sense of
self-worth (Derluyn & Broekaert, 2008) and is the strongest predictor of depressive symptoms (Ellis
et al., 2010; Ellis, MacDonald, Lincoln, & Cabral, 2008). Ultimately, refugee youth experience a
number of developmental, settlement and pre-migration related challenges that may warrant receiv-
ing mental health supports.
Although refugee youth are at risk of psychological distress, the literature suggests they underu-
tilise mental health services (Bean, Eurelings-Bontekoe, Mooijaart, & Spinhoven, 2006). Given the sys-
temic and cultural barriers in accessing mental health services, refugee youth are more likely to
access psychological supports through school-based mental health interventions. Collaboration
among teachers, refugee families, and mental health providers show promising results of children
benefiting from school-based interventions including reduction in symptoms, better understanding
of school environment, increased peer groups, and enhanced sense of self (Chiumento, Nelki, Dutton,
& Hughes, 2011; Fazel, 2015; Fazel, Doll, & Stein, 2009; Rousseau & Guzder, 2008). Furthermore, the
importance of including cultural competence in the development of school-based programmes
and interventions has shown to improve access to high-quality mental health care and increase
youth and family engagement (Fertman, Delgado, & Tarasevich, 2014). Currently, the literature on cul-
turally adapted interventions for underserved and under researched populations, including refugee
youth, is limited, and there is a need for research that explores which interventions work and how
they work from the perspective of ethnic minorities (Bernal & Saez-Santiago, 2006; Tyrer & Fazel,
2014). One approach to enhancing mental health service provision, that requires additional knowl-
edge, is the inclusion of cultural brokers when working with refugee youth. Given that cultural
 BRITISH JOURNAL OF GUIDANCE & COUNSELLING 3

brokering is not a designated profession but often a role played within the context of other duties
(e.g. translation, settlement), it is important to understand the ways in which cultural brokers facilitate
access to mental health care for refugee youth in order to transfer these recommendations to policies
and practice relating to this population.

Methodology
This study utilised a single design case study to explore the work of educational cultural brokers
providing services to refugee youth in school settings. Case studies are best used to explore con-
temporary phenomenon in depth within real life contexts (Creswell, 2009; Yin, 2009) and when the
goal is to obtain a richly descriptive account of the phenomenon (Merriam, 2009). The case study
methodology is also useful when there is not much written about a complex social phenomena
(Yin, 2009), such as cultural brokering. According to Stake (1981), knowledge learned from case
studies is more concrete, contextual, and can be generalised to readers’ experiences. Further,
case study findings often strive to uncover descriptive information on multiple variables and inter-
actions that can lead to new insight (Merriam, 2009). This methodology was also appropriate given
our interest in cultural brokers who work with refugee youth as opposed to individuals who work
with other immigrant groups.

Participants
Using purposeful sampling, that relies on individuals’ expertise and competence with the purpose of
inquiry, 4 participants were recruited based on the following criteria: (a) their job role included edu-
cational cultural broker, (b) they worked directly with refugee youth, and (c) they had experience col-
laborating with a mental health practitioner in the context of providing services to refugee youth.
Educational cultural brokers were selected over settlement workers because the former provide ser-
vices that go beyond helping newcomers with their settlement issues. The following working defi-
nition of an educational cultural broker was used in the present study:
Community representatives who are present in the school system and provide a welcoming environment for
newcomer children and their families. By holding the middle ground, brokers assist schools and newcomer chil-
dren and families adapt to one another through: (a) Micro-level: Day-to-day bridging, support, settlement, and
educational activities that assist children’s adaptation through direct contact with families, school personnel,
and community, (b) Macro-level: Slow process of transforming system to be more open and flexible to cultural
diversity through activities that are not obvious but whose outcome is seen over time (e.g. cultural interpretation
and awareness raising; advocacy). (Yohani, 2013, pp. 8–9).

The educational cultural brokers in the present study were employed within an immigrant-serving
agency located in a large urban city in Western Canada. The agency partnered with schools that
had large numbers of immigrant and refugee children. All participants worked out of the agency’s
In-School Settlement Programme whose objective was to enhance the home and school environ-
ment for students and their families. As cultural brokers, the participants engaged in their own cul-
tural sensitivity and systems information (in this case educational system) training. Their activities
included facilitating school adaptation programmes (culture club, homework club), bridging
families and children to school and community services, cultural interpretation and awareness
raising, supportive counselling, mediation and conflict resolution, and advocacy (see Yohani,
2013). The In-School Settlement programme supported children between the ages 5and 18 years
old. The participants had worked with immigrant and refugee families anywhere from two to
sixteen years and their educational backgrounds included education, social work, sociology, and
counselling psychology. To ensure anonymity and confidentiality, they chose the following pseu-
donyms: Karim, Abdiyo, Lokuku, and Asiya. Their countries of origin included Somalia (2), Sudan,
and Afghanistan and together they served the following communities: Somali, Sudanese,
Afghan, Iranian, and Iraqi.
4 N. BRAR-JOSAN and S. C. YOHANI

Data Collection
After review and approval from the authors’ university Research Ethics Board, participants were
recruited through the coordinator of the settlement programme at the identified agency. The four
participants were selected from a larger research project that examined the roles and activities of
educational cultural brokers in schools. Participants with experience working with youth who had
experienced mental health challenges were recruited for a more in-depth examination of some of
the specific work they engaged in. Upon giving consent to their coordinator to be contacted, each
participant was scheduled for a semi-structured interview which lasted approximately 60 min. Partici-
pants were asked to recount important experiences of supporting the mental health of refugee youth
in their role as a cultural broker. Sample probing questions consisted of: what did you do during the
incident, what did others involved in the incident do, how do cultural brokers and mental health pro-
fessionals collaborate, and what supportive activities do you engage in? All interviews were recorded,
transcribed with identifying information removed, and then analyzed by the authors of this study.
Follow-up interviews were conducted with 2 cultural brokers to clarify information that was obtained
from their original interview. In order to ensure accurate representation of emerging themes,
member checks were conducted with all participants to obtain their perspective on the preliminary
findings. Participants reported satisfaction with the preliminary themes. Document analysis of pro-
gramme manuals, brochures, and programme evaluations further supplemented the interview
data in order to enhance understanding of contextual information.

Data Analysis
Data analysis was guided by Braun and Clarke’s (2006) thematic analysis framework and included the
following steps: (a) memo writing, (b) coding for descriptive labels, (c) identification of themes, (d)
refining themes, (e) defining and naming of the themes, and (f) developing a written narrative. Meth-
odological rigour was attended to throughout this study including providing participants with pre-
liminary results to elicit their feedback, maintaining an audit trail and research journal, using
memos, data analysis by both authors, recording in-depth descriptions of results, discussion
between authors, and inclusion of detailed descriptions in the results to strengthen the themes.

Findings
Two themes emerged from the interviews that describe the ways in which educational cultural
brokers support the mental health of refugee youth: (1) informal supports to youth and families,
and (2) formal supports in collaboration with mental health practitioners (Figure 1).
These themes represent the specific roles that were identified as being supportive by cultural
brokers who directly work with refugee youth and families.

Informal Supports to Refugee Youth and Families

This theme refers to informal ways in which cultural brokers indirectly support the psychological well-
being of refugee youth. They consist of roles that take place outside of traditional counselling and
include activities that overlap with settlement and academic support:.

Facilitating cultural integration and sense of belonging

Participants identified cultural integration and sense of belonging as key for youth adaptation in the
Canadian context. Belonging in this context refers to the experience of developing an affiliation with
the various social groups that were deemed important by the refugee youth. This sub-theme refers to
activities that educational cultural brokers engage in to support youth in their development of a
coherent cultural identity and sense of belonging. The participants suggested that a weak sense
 BRITISH JOURNAL OF GUIDANCE & COUNSELLING 5

Figure 1. Themes and sub-themes generated from participant interviews … … … … .31.

of identity was linked to low self-esteem and isolation. For instance, Karim paraphrased what some of
the 18-year-olds have reported when struggling with ‘they don’t want me here in Canada, they think
I’m inferior, I’m not good enough, they don’t understand me, they hate me, I hate them, I will never
make it, there’s no future.’
In order to facilitate cultural integration and sense of belonging, the brokers facilitated after school
activities such as a culture clubs where they introduced youth to different aspects of the Canadian
culture. An objective of the club was to validate the importance of diversity and maintaining one’s
heritage culture. Abdiyo explained that the culture club was:
A space for them to feel that ‘yes, I am not alone.’ ‘All the students that are sitting in this class with me have the
same challenges.’ ‘Here is where I can express myself who I am whatever my faith, my culture, my background’ –
‘here is a place where I can be who I am!’

In order to increase sense of belonging and prevent isolation, cultural brokers actively encouraged
refugee youth to develop healthy interpersonal relationships and know their environment. One
approach was through providing out-of-school trips to places such as the public library. Lokuku
further explained the importance of social recreational opportunities away from daily stressors:
The way they interact and open up in a positive environment is different than meeting them in a setting where
there are challenges, such as the classroom environment. Our extended role has given us the opportunity to learn
more from them and about them. In this social recreational opportunity, the students are able to talk freely about
their experiences and life challenges.

In addition to field trips, club activities included guest speakers, cultural presentations, and group dis-
cussions. The group discussions specifically focused on cross-cultural conflicts, differences between
the two cultures, and retaining their heritage culture.

Bridging to settlement services

This sub-theme refers to the ways brokers assist and connect newly arrived refugee families with
settlement challenges. Settlement related challenges that refugee youth and their families experi-
ence primarily consisted of accessing resources (Kuittinen et al., 2014). Financial barriers restricted
housing options to government subsidised housing in neighbourhoods where refugee youth were
more likely to be exposed to drugs, alcohol, and violence. These neighbourhoods also placed the
youth at a greater risk of joining a gang or engaging in criminal activity. In order to alleviate these
challenges, the brokers would first inform youth and families about the services offered through
the agency (e.g. assistance with housing and employment) then they would provide information
on broad community services.
6 N. BRAR-JOSAN and S. C. YOHANI

The brokers also facilitated specific activities that would aid refugee youth in finding employment
and registering for post-secondary education. For example, Asiya explained that the months of
October and November were dedicated to career development in preparation for upcoming tran-
sitions to post-secondary training and/or employment. The following provides a description of
some of the club activities that are directly in support of careers as described by Asiya:
We are going to have a job fair on November 18. Currently, we have five employers confirmed to come to the
school and conduct interviews. Prior to the job fair we will have a resume workshop at the computer lab
where we fix their resumes.

Providing supportive counselling

This refers to activities that were associated with providing guidance, information, encouragement,
and emotional support to refugee youth. One major area in which cultural brokers provided
support was personal development. According to Abdiyo:
You become the auntie or the teacher because they lost that extended support. They don’t have auntie, uncle or
somebody to go to. Their parents and teachers are also busy. These students need an adult who will sit with them
and understand them without judging.

All of the participants spoke about youth approaching them with stories that included trauma histories.
The brokers listened to the stories and acknowledged the reality of the war experiences. In some cases,
they would validate the experiences by sharing their own history before providing youth with
examples on how they could walk out of their past. In general, the brokers assisted refugee students
in building healthy and confident perceptions, by placing an emphasis on their strengths.
Extending support to the family was perceived by brokers as important in helping youth. In par-
ticular, they indicated that when parents felt supported it indirectly benefited the youth. Karim
shared the following conversation he had with a single mother who was struggling with depression:
There was a point I invited her to see one of our psychologist. She told me that she had seen so many people
[including] children services, social workers, and a psychologist. She said ‘well what has all that done? Nothing’s
changed. My son is still worse.’ I told her that I didn’t have the answers but I knew of a particular psychologist that
worked with other moms. I explained that it’s not going to fix her son but at least she will receive support. This
particular mother was open to seeing the psychologist. In a sense I feel that my role is to give them the oppor-
tunity to receive some care at a deeper level.

The primary type of support to the parents was providing information on the various types of resources
and supports and mediating conflicts between parent and youth. Conflicts often centred around accul-
turation differences, and in some families, it was observed that older youth would blame the parent for
the various losses experienced during the pre-migration stage. It was observed that these intergenera-
tional conflicts would sometimes escalate to the point where some youth would run away from home.
The mediation role consisted of doing home visits and facilitating communication between parent and
child. Their primary task was to help each party understand the perspective of the other. Lokuku
described the following scenario of a parent–child conflict involving domestic violence:
… she had this thought ‘mom was not always good with dad. Dad would beat her [mother] up but dad was not
killing her.’ For her it was okay, so this daughter decided to run away from home because she didn’t agree with
mom. She lived with some girls and things weren’t working okay. She went back home but still things not going
well between her and her mom. We tried to help because she was really torturing the mom about the whole situ-
ation. We tried to talk to her. She has really resisted but now she’s beginning to change. She’s beginning to com-
municate with her mom. She’s beginning to put it behind.

Formal supports in collaboration with mental health practitioners

This theme refers to the formal supports that brokers provide in collaboration with mental health
practitioners. Despite the increased vulnerability to psychological distress, it was often the case
 BRITISH JOURNAL OF GUIDANCE & COUNSELLING 7

that the effects of trauma in youth were either misdiagnosed or untreated in schools. However, when
refugee youth would share their pre-migration experiences with the cultural brokers, it allowed the
brokers to identify the link between pre-migration experiences and current school problems. In turn,
brokers were able to help youth access appropriate supports.
This section reviews the four sub-themes that identify the ways in which brokers facilitated
refugee youth’s access to formal psychological support.

Facilitating referrals
As shown in Figure 2, the process used by cultural brokers to bridge refugee youth to mental health
services generally consists of four steps: (1) identifying mental health issues, (2) consultation with
youth and family, (3) determining which professional to refer to, and (4) introducing youth to the
professional.
The first step consisted of identifying mental health issues. Each of the brokers had their own means
of identifying at-risk youth. The brokers often used their knowledge of pre-migration experiences to
determine if somatic symptoms such as fainting and chronic headaches were linked to a medical or
psychological condition. In addition to recommending families access medical supports, Karim
shared the following example of broaching the subject of seeking help from a psychologist when
a somatic concern had become normalised in a family:
I felt a particular girl needed psychological support and I mentioned it to her and she said ‘oh, I’m okay’, but I knew
she was getting a lot of migraines and headaches. I then said ‘well it’s not normal to have headaches and you
know all those migraines’ and she said ‘oh it isn’t?’ Her mother was present at the time and she said ‘if she
wants to see the psychologist that’s okay.’ I think that’s when it clicked for her that it was not normal to have
these symptoms, but before that she just said ‘well, that’s just how it is.’

Once a psychological issue was identified, the next step was for the broker to consult with the
youth and their family about seeking help. If the youth was willing to move forward, the third
step in the process was to determine which mental health practitioner the broker would refer to.
Several considerations are made during this step, including a match between the mental
health practitioner’s expertise and the needs of the youth, cultural and linguistic backgrounds,
gender of the client and mental health practitioner, and the mental health practitioner’s
availability.
The final step in the process was to introduce the refugee youth to the mental health practitioner.
Often, this meeting was scheduled in a familiar and safe setting, such as the school. The broker’s pres-
ence during the initial meeting was deemed important because it increased the youth’s sense of

Figure 2. Educational cultural brokers’ four step referral process … … … … … … … … .32.

8 N. BRAR-JOSAN and S. C. YOHANI

safety and comfort. It was observed by several participants that the families were at ease and more
receptive when a broker was present during the initial meeting.

Educating
The brokers recognised that refugee families often have limited knowledge about available mental
health services. When refugees first immigrate to Canada, meeting basic needs is a priority and there-
fore immediate and formalised information pertaining to mental health services is often not retained.
On the other hand, when the psychological needs become too great, families do not have knowledge
of types of services, where to seek information, and how to navigage healthcare systems. In some
cultures the concept of mental health practitioners does not exist, therefore a barrier to accessing
support is not knowing what a mental health practitioner does. On a similar note, the brokers
explained that in some cultures there is a negative connotation associated with seeking psychologi-
cal support. For instance, brokers noted that psychological distress in some cultures is associated with
being crazy, lunatic, evil and, in some cases, a consequence of the ‘sins of the parents.’ According to
Lokuku, this type of cultural response to mental health would cause an individual to dwell in isolation
rather than seek help. In other cultures, the concept of discussing ones problems with a stranger is
considered unnatural and is disencouraged.
In order to bridge the gap, the brokers helped refugee youth and their parents learn about the
benefits of seeking mental health services. They would explain the process in a manner that the
family could understand and relate to. For example, they might link the process to talking to an
Imam or Elder. According to the brokers, refugee youth and families were more receptive to counsel-
ling once they understood the process. It should be noted that the relationship to the broker
appeared to be a critical component to this receptivity.

Providing contextual information

This refers to the broker’s role in obtaining pertinent background information relating to clients and
transferring that information to the mental health practitioners. Brokers in the present study provided
information in two different areas: (1) The type of pre-migration experiences the youth and their
family endured such as exposure to trauma and loss, and (2) Post-migration and settlement chal-
lenges. The broker’s informal role of bridging refugee families to settlement services placed them
in a unique position that allowed them to understand the types of challenges experienced by the
families and the types of support that were available to them.

Cultural interpretation
Cultural interpretation refers to the brokers’ role in facilitating cultural understanding to help
mental health practitioners overcome cross-cultural differences that account for some of the bar-
riers in providing services to refugee and immigrant populations. The brokers observed that in
general psychological services were representative of Western cultures and values. Several modi-
fications to administrative practices emerged out of the interviews. For example, Karim observed
that in some cases newcomer women would have an aversion to using the phone to contact
their counsellors. He shared this information with one of the mental health practitioners
working for the same agency and they were able to develop a strategy to communicate with
these women without losing contact. This minor, yet tremendously impactful feedback, high-
lights how brokers’ cultural interpretation can efficiently and positively influence service
provision.
Cultural interpretation also assisted practitioners in modifying specific interventions utilised in
therapy including what would or would not work for a certain culture group. For example, Abdiyo
explained that emotion-focused approaches to therapy can be challenging for Somali clients
because the Somali language has a smaller vocabulary for emotions.
 BRITISH JOURNAL OF GUIDANCE & COUNSELLING 9

Discussion
Informal mental health supports
Cultural brokers provided supportive counselling to refugee youth by assisting them with making posi-
tive choices that would shift their experiences from feeling helpless to hopeful. According to Wallace,
Ye, and Chhuon (2012) the sub dimensions of youth belonging in the context of a school environment
are: generalised connection to teachers, connection to a specific teacher, identification and participat-
ing in official school-sanctioned activities, and perception of fitting in with peers. Furthermore, they
defined connection as ‘gaining authentic personal knowledge of students’ (pp. 128) and demonstrat-
ing a commitment to their academic success. The present study extends these findings by demonstrat-
ing sense of belonging can be further enhanced through the development of a connection to a
bicultural role model. The cultural brokers in the present study formed a connection by means of pro-
viding supportive counselling through guidance, encouragement, and emotional support.
While providing informal counselling support can be a useful preventative measure for youth, at
times this can be extremely demanding on cultural brokers who themselves are from similar refugee
backgrounds. The challenges associated with the role of brokering have been addressed in a separate
paper that was part of this project (see Yohani, 2013) and includes the need for brokers to have
ongoing mental health education and supports for personal self-care.

Formal supports in collaboration with mental health practitioners

Literature on the utilisation of mental health services indicates that minorities in general will turn to
community supports such as respected community members, family members, schools, churches,
and folk healers (Ellis et al., 2010). This research extends the literature by highlighting the role that
a community agent can play in facilitating referrals and increase access to mental health services.
The cultural brokers in the present study were well-known to the school board and were often
called upon in situations where refugee students displayed behavioural problems or absenteeism.
Having cultural and contextual information about the refugee families’ experiences, cultural
brokers were able to help school personnel understand behaviours and facilitate access to appropri-
ate supports. Since the brokers were also active members of their ethnic communities, families and
other members would also approach them with their concerns. Therefore, our findings highlight the
usefulness of this role in bridging schools, families and communities as well as facilitation of access to
mental health services. While existing research has speculated on the brokers’ role in the referral
process (Magoon, 2005), the present study identifies a general framework of the actual referral
process. For additional information on the opportunities and challenges involved in the collaboration
between mental health practitioners and cultural brokers see Brar-Josan and Yohani (2014).
Educating refugee youth and families about mental health was a significant formal support that
emerged in this study. Literature on the help seeking behaviours of refugees indicates that the
concept of mental health varies across cultures and this becomes a barrier to accessing mainstream
services (Bowles, 2006; Kuittinen et al., 2014). Consistent with the literature, participants revealed that
some of the families that they work with associate psychological distress with supernatural forces
(Fung & Wong, 2007) or in its more severe forms with perceptions of being ‘crazy’ and therefore
choose not to seek mental health services (De Anstiss & Ziaian, 2010). In order to encourage youth
and their families to make use of mental health services, the brokers educated them on the symp-
toms of trauma and how they can influence psychological adjustment. The brokers also discussed
the purpose of the services, how the process works (i.e. the client’s role, the clinician’s role), the cre-
dentials of the practitioner, what the interventions entailed, the expected outcomes, and the confi-
dential nature of the client-clinician relationship.
Providing cultural interpretation was another important formal support that was identified by the
participants. The overall importance of considering cultural and social factors when working with
10 N. BRAR-JOSAN and S. C. YOHANI

diverse clients has long been noted in the mental health literature (Aldarondo, 2007; Bowles, 2006).
According to Kirmayer, Groleau, Guzder, Blake, and Jarvis (2003), consultation with cultural brokers
and interpreters can lead to positive outcomes such as adequate diagnosis and treatment of refugees
and immigrants, and clinician satisfaction. In the present study, cultural interpretation was also associ-
ated with improved communication and case conceptualisation. The broker’s role was often summar-
ised as identifying the cultural barrier, explaining the cultural difference to the practitioner, and then
providing recommendations. In general, our findings suggest cultural interpretation can be associ-
ated with improved service delivery. These findings are consistent with Bowles (2006) community
model where bicultural counsellors took on a number of roles including cultural advisor, interpreter,
community worker, and advocate.

Limitations & future research

This study involved the unique experiences of a group of educational cultural brokers working for an
immigrant-serving agency. In order to further develop a cultural brokering framework, researchers
should explore the brokers’ role in supporting refugee youth across multiple cases. For example, it
would be valuable to study the brokers’ role within health settings, child services, and criminal
system. Other case studies with larger sample sizes are also needed to add to the brokering frame-
work. The current study identified both informal and formal supports that were provided by the
brokers. It is important to note that the findings were based on the perception of cultural brokers.
It is recommended that future studies continue to explore the complexities of the cultural broker
role by converging these findings with the perspectives of those utilising the services, such as the
school administrators and refugee students. For example, it would be worthwhile to compare the
youths’ perception of supports with the current findings, including how they view cultural brokering
as enhancing sense of belonging and social integration.

Conclusions
This exploratory study sought to provide information on the cultural brokers’ role in supporting the
psychological well-being of refugee youth. Findings indicate that culture brokers support refugee
youth by: facilitating cultural integration and sense of belonging, bridging youth and families to
settlement services, providing supportive counselling, facilitating referrals to mental health prac-
titioners, educating refugee clients about mental health, providing contextual information to
mental health practitioners, and providing cultural interpretation. The results of this study provided
initial insights into a holistic approach that could be used to enhance the mental health of refugee
youth. With this case study, the first steps to understanding the interaction among mental health
practitioners, cultural brokers, and refugee clients have been taken. Future research can examine
how these roles translate to different settings.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This research was supported by the University of Alberta’s Supports for the Advancement of Scholarship (SAS) grant.

Notes on contributors
Novjyot Brar-Josan is a registered psychologist at the Centre for Cognitive Behavioral Therapy. Her main research inter-
ests are multicultural counselling, refugee mental health, sense of belonging among refugee young adults. Her clinical
interests include the assessment and treatment of anxiety and mood disorders.
 BRITISH JOURNAL OF GUIDANCE & COUNSELLING 11

Sophie Yohani is an associate professor of counselling psychology at the University of Alberta. Her interests are in multi-
cultural counselling and refugee mental health, particularly pre-migration trauma, adaptation, and programme/practice
implications in community and educational settings.

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