{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:04:04Z","timestamp":1784099044189,"version":"3.55.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    There are over 120 million forcibly displaced people in the world, with numbers steadily increasing. The majority of refugees and asylum seekers are displaced in urban settings with fragmented access to health services, and those living in countries without refugee protections face particularly dire circumstances. High rates of trauma exposure and related mental disorders persist alongside structural barriers to care, underscoring an urgent public health equity challenge. This community case study describes the Cope program, a refugee community-led mental health and psychosocial support (MHPSS) initiative implemented by the Refugees and Asylum Seekers Information Center (RAIC) in Jakarta, Indonesia. Using an apprenticeship model, community members transition from program participants to trained, supervised facilitators across three phases (\n                    <jats:italic>n<\/jats:italic>\n                    = 30 at baseline,\n                    <jats:italic>n<\/jats:italic>\n                    = 16 at endline). Pre- post-assessments using validated measures found significant reductions in depressive symptoms (52%), anxiety symptoms (50%), and Post-traumatic Stress Disorder (PTSD) symptoms (46%) from baseline to endline, with large effect sizes. These findings demonstrate that community-led, culturally grounded MHPSS programming can produce meaningful mental health gains among protractedly displaced populations in non-signatory countries. Beyond individual-level outcomes, the Cope model illustrates how Refugee-Led Organizations (RLOs) can serve as sustainable pillars of inclusive health system delivery\u2014a critical consideration for governments, UNHCR, and global health actors working to advance universal health coverage for displaced populations.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2026.1850816","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:05:40Z","timestamp":1784095540000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From healing to leading: a case study of a community-led mental health program for forcibly displaced people"],"prefix":"10.3389","volume":"14","author":[{"given":"Flora","family":"Cohen","sequence":"first","affiliation":[{"name":"School of Social Work, University of Illinois Urbana-Champaign","place":["Champaign, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Yau","sequence":"additional","affiliation":[{"name":"Counseling Department, Asian Theological Seminary","place":["Manila, Philippines"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Refugees and Asylum Seekers Information Center (RAIC)","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Saxby","sequence":"additional","affiliation":[{"name":"Give Freedom International","place":["Newcastle, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mozhgan","family":"Moarefizadeh","sequence":"additional","affiliation":[{"name":"Refugees and Asylum Seekers Information Center (RAIC)","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4614-8238-3_8","article-title":"Arab American acculturation and ethnic identity across the lifespan: sociodemographic correlates and psychological outcomes","volume-title":"Biopsychosocial Perspectives on Arab Americans","author":"Amer","year":"2014"},{"key":"B2","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s13031-019-0233-x","article-title":"Ecologies of care: mental health and psychosocial support for war-affected youth in the U.S.","volume":"13","author":"Bennouna","year":"2019","journal-title":"Conflict Health."},{"key":"B3","first-page":"18","article-title":"Migration, cultural bereavement and cultural identity","volume":"4","author":"Bhugra","year":"2005","journal-title":"World Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1016\/S0140-6736(11)61094-5","article-title":"Mental health and psychosocial support in humanitarian settings: linking practice and research","volume":"378","author":"Tol","year":"2011","journal-title":"Lancet."},{"key":"B5","volume-title":"IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings","year":"2007"},{"key":"B6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1093\/rsq\/hdi0123","article-title":"IDP LIVELIHOODS; using microenterprise interventions to support the livelihoods of forcibly displaced people: the impact of a Microcredit Program in Idp Camps in Lira, Northern Uganda","volume":"25","author":"Jacobsen","year":"2006","journal-title":"Refugee Survey Quart."},{"key":"B7","unstructured":"UNHCR\n          Figures at a Glance\n          \n          2020"},{"key":"B8","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1037\/a0016675","article-title":"The impact of acculturation and religious identification on perceived discrimination for Arab\/Middle Eastern Americans","volume":"16","author":"Awad","year":"2010","journal-title":"Cult Divers Ethnic Min Psychol."},{"key":"B9","unstructured":"Baron\n              N\n            \n          \n          Urban Mental Health and Psychosocial Support in Egypt\n          \n          2021"},{"key":"B10","doi-asserted-by":"crossref","unstructured":"d'Orsi\n              C\n            \n          \n          Refugee Camps Versus Urban Refugees: What's Been Said \u2013 and Done\n          \n          2019","DOI":"10.64628\/AAJ.633pyhhm5"},{"key":"B11","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/WTF.0000000000000089","article-title":"Mental health and psychosocial support in humanitarian settings: reflections on a review of UNHCR's approach and activities","volume":"13","author":"Meyer","year":"2015","journal-title":"Intervention"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1001\/archpsyc.65.10.1205","article-title":"Estimating clinically relevant mental disorders in a rural and an urban setting in postconflict Timor Leste","volume":"65","author":"Silove","year":"2008","journal-title":"Arch Gen Psychiatry."},{"key":"B13","unstructured":"Global Trends\n          \n          2026"},{"key":"B14","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1093\/ijrl\/eeab043","article-title":"The 1951 refugee convention and non-signatory states: charting a research agenda","volume":"33","author":"Janmyr","year":"2021","journal-title":"Int J Refugee Law."},{"key":"B15","doi-asserted-by":"publisher","first-page":"E959","DOI":"10.1503\/cmaj.090292","article-title":"Common mental health problems in immigrants and refugees: general approach in primary care","volume":"183","author":"Kirmayer","year":"2011","journal-title":"Can Med Assoc J."},{"key":"B16","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511815355","volume-title":"Situated Learning: Legitimate Peripheral Participation","author":"Lave","year":"1991"},{"key":"B17","volume-title":"Integrated Model for Supervision for Mental Health and Psychosocial Support: Handbook","author":"McBride","year":"2023"},{"key":"B18","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/1752-4458-5-30","article-title":"Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers","volume":"5","author":"Murray","year":"2011","journal-title":"Int J Mental Health Syst."},{"key":"B19","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1037\/0003-066X.64.8.842","article-title":"Do no harm: Toward contextually appropriate psychosocial support in international emergencies","volume":"64","author":"Wessells","year":"2009","journal-title":"Am Psychol."},{"key":"B20","year":"2016","journal-title":"Ecuador Earthquake 16 April 2016: Desk Review of Existing Information with Relevance to Mental Health and Psychosocial Support (MHPSS)"},{"key":"B21","volume-title":"The Global Governed? Refugees as Providers of Protection and Assistance","author":"Betts","year":"2021"},{"key":"B22","doi-asserted-by":"crossref","DOI":"10.1017\/9781108848831","author":"Pincock","year":"2020","journal-title":"The Global Governed?: refugees as Providers of Protection and Assistance"},{"key":"B23","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1080\/00220388.2020.1802010","article-title":"The rhetoric and reality of localisation: refugee-led organisations in humanitarian governance","volume":"57","author":"Pincock","year":"2021","journal-title":"J Dev Stud."},{"key":"B24","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12960-021-00605-z","article-title":"Conceptual framework for task shifting and task sharing: an international Delphi study","volume":"19","author":"Orkin","year":"2021","journal-title":"Hum Resour Health"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2633489521998790","DOI":"10.1177\/2633489521998790","article-title":"Task-shifting for refugee mental health and psychosocial support: a scoping review of services in humanitarian settings through the lens of RE-AIM","volume":"2","author":"Cohen","year":"2021","journal-title":"Implement Res Pract"},{"key":"B26","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.socscimed.2013.08.004","article-title":"The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review","volume":"97","author":"Padmanathan","year":"2013","journal-title":"Soc Sci Med."},{"key":"B27","unstructured":"Indonesia: February 2023\n          \n          2023"},{"key":"B28","unstructured":"Llewellyn\n              A\n            \n          \n          Aljazeera\n          Desperate Afghan Refugee Sets Himself on Fire in Indonesia\n          \n          2021"},{"key":"B29","doi-asserted-by":"publisher","first-page":"102672","DOI":"10.1016\/j.janxdis.2023.102672","article-title":"Intolerance of uncertainty, posttraumatic stress, depression, and fears for the future among displaced refugees","volume":"94","author":"Nickerson","year":"2023","journal-title":"J Anxiety Disord."},{"key":"B30","unstructured":"In Indonesia, desperation grows for refugees trapped in limbo for years\n          \n          \n            \n              Timmerman\n              A\n            \n          \n          The New Humanitarian\n          \n          2021"},{"key":"B31","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.psychres.2016.03.014","article-title":"Investigation of abbreviated 4 and 8 item versions of the PTSD Checklist 5","volume":"239","author":"Price","year":"2016","journal-title":"Psychiatry Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1002\/da.22942","article-title":"Developing an optimal short-form of the PTSD Checklist for DSM-5 (PCL-5)","volume":"36","author":"Zuromski","year":"2019","journal-title":"Depress Anxiety."},{"key":"B33","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1186\/s12888-018-1839-z","article-title":"The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq","volume":"18","author":"Ibrahim","year":"2018","journal-title":"BMC Psychiatry."},{"key":"B34","unstructured":"Blackwell\n              TL\n            \n            \n              McDermott\n              AN\n            \n          \n          Test Review: Patient Health Questionnaire\n          \n          2014"},{"key":"B35","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"113236","DOI":"10.1016\/j.psychres.2020.113236","article-title":"Establishing reliability and validity for mental health screening instruments in resource-constrained settings: systematic review of the PHQ-9 and key recommendations","volume":"291","author":"Carroll","year":"2020","journal-title":"Psychiatry Res."},{"key":"B37","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/j.jad.2019.11.055","article-title":"Is depression comparable between asylum seekers and native Germans? An investigation of measurement invariance of the PHQ-9","volume":"262","author":"Grupp","year":"2020","journal-title":"J Affect Disord."},{"key":"B38","doi-asserted-by":"publisher","first-page":"781095","DOI":"10.3389\/fpsyt.2022.781095","article-title":"Psychometrics of the Patient Health Questionnaire (PHQ-9) in Uganda: a systematic review","volume":"13","author":"Kaggwa","year":"2022","journal-title":"Front Psychiatry"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1007\/s10461-017-1843-1","article-title":"Reliability, validity, and factor structure of the hopkins symptom checklist-25: population-based study of persons living with HIV in rural Uganda","volume":"22","author":"Ashaba","year":"2018","journal-title":"AIDS Behav."},{"key":"B40","first-page":"51","article-title":"Validation of the multiple language versions of the Hopkins Symptom Checklist-37 for refugee adolescents","volume":"42","author":"Bean","year":"2007","journal-title":"Adolescence"},{"key":"B41","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/ajpy.12221","article-title":"Factor structure and psychometric properties of the Hopkins Symptom Checklist: an investigation with culturally and linguistically diverse youth in Australia","volume":"71","author":"Khawaja","year":"2019","journal-title":"Aust J Psychol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1207\/s15327752jpa5201_2","article-title":"The Multidimensional Scale of Perceived Social Support","volume":"52","author":"Zimet","year":"1988","journal-title":"J Pers Assess."},{"key":"B43","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1080\/07399330903052145","article-title":"Adaptation and psychometric evaluation of the multidimensional scale of perceived social support for arab immigrant women","volume":"31","author":"Aroian","year":"2010","journal-title":"Health Care Women Int."},{"key":"B44","doi-asserted-by":"publisher","first-page":"805","DOI":"10.3390\/ijerph21060805","article-title":"A scoping review of instruments used in measuring social support among refugees in resettlement","volume":"21","author":"Boateng","year":"2024","journal-title":"Int J Environ Res Public Health."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7275\/e4r6-dj05","article-title":"Using the student's t-test with extremely small sample sizes","volume":"18","author":"de Winter","year":"2013","journal-title":"Pract Assess Res Eval."},{"key":"B46","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1093\/heapro\/dat049","article-title":"Community-based participatory research in complex settings: clean mind-dirty hands","volume":"29","author":"Makhoul","year":"2013","journal-title":"Health Promot Int."},{"key":"B47","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.rhm.2016.05.003","article-title":"Sexual and gender-based violence against refugee women: a hidden aspect of the refugee \u201ccrisis","volume":"24","author":"Freedman","year":"2016"},{"key":"B48","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s10560-008-0129-x","article-title":"Creating an ecology of hope: arts-based interventions with refugee children","volume":"25","author":"Yohani","year":"2008","journal-title":"Child Adolesc Soc Work J."},{"key":"B49","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1080\/09581596.2012.761675","article-title":"Governing through community allegiance: a qualitative examination of peer research in community-based participatory research","volume":"23","author":"Guta","year":"2013","journal-title":"Crit Public Health."},{"key":"B50","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1146\/annurev.publhealth.29.091307.083824","article-title":"The value and challenges of participatory research: strengthing its practice","volume":"29","author":"Cargo","year":"2008","journal-title":"Annu Rev Public Health."},{"key":"B51","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1093\/heapol\/czr001","article-title":"Developing a logic model for youth mental health: participatory research with a refugee community in Beirut","volume":"26","author":"Afifi","year":"2011","journal-title":"Health Policy Plan."},{"key":"B52","volume-title":"Review of Existing Practices to Ensure Participation of Disaster-Affected Communities in Humanitarian Aid Operations","author":"Barry","year":"2012"},{"key":"B53","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1353\/cpr.2007.0006","article-title":"Ethical issues in community-based participatory research: balancing rigorous research with community participation in community intervention studies","volume":"1","author":"Buchanan","year":"2007","journal-title":"Progress Community Health Partnersh."},{"key":"B54","volume-title":"Global Study in Consultation and Participation of Disaster-affected Populations (Country Monograph: The Case Study of Sri Lanka AL006)","year":"2003"},{"key":"B55","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s13033-023-00579-6","article-title":"Indonesia free from pasung: a policy analysis","volume":"17","author":"Hidayat","year":"2023","journal-title":"Int J Ment Health Syst"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e646","DOI":"10.1016\/S2214-109X(20)30106-6","article-title":"Self-help or silenced voices? An ethnographically informed warning","volume":"8","author":"Torre","year":"2020","journal-title":"Lancet Glob Health."},{"key":"B57","doi-asserted-by":"publisher","first-page":"e018331","DOI":"10.1136\/bmjgh-2024-018331","article-title":"The localisation of humanitarian response to conflict and displacement: a scoping review from a health systems perspective","volume":"10","author":"McGrath","year":"2025","journal-title":"BMJ Glob Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1850816\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:05:44Z","timestamp":1784095544000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1850816\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":57,"alternative-id":["10.3389\/fpubh.2026.1850816"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1850816","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"article-number":"1850816"}}