TST-R is designed to enhance refugee youth engagement in services by offering services along a continuum of care. The first and broadest level of care involves community outreach to engage families and develop trust between communities and providers before a specific mental health need is identified; mental health information is made available, and efforts are made to destigmatize seeking care. Concrete assistance with family needs may be provided at this stage as a means of preventing stress within families and building rapport between the program and the community. Partnerships with religious and community agencies are key at this level.
The second level of care focuses on decreasing acculturative stress and increasing social support, factors known to be associated with better mental health among refugee youth. This is accomplished through acculturation peer groups held in the school setting. Working in a group format further helps to build rapport with families by providing non-stigmatizing, supportive services for the youth in a highly valued setting (school). Coming to know children in a group setting also allows clinicians to more effectively identify those children in need of more intensive services.
The final level of care is full TST and focuses on those children who are demonstrating problems with emotion regulation and for whom the community-level and group-level care is not sufficient. TST services are provided for these youth in the school, with home-based care integrated for those in the Surviving and Stabilizing phases of treatment. Cultural provider (e.g. trained clinicians from a given community) and cultural broker (e.g. paraprofessionals partnering with clinicians who are not from the given community) models of care have both been used to help address cultural and linguistic barriers in the implementation of TST at this level of care.