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Question Persuade and Refer for Refugee Gatekeepers

In October, 2012, the Center for Disease Control and Prevention published a report on suicides among Bhutanese Refugees in the US. This investigation sought to determine whether refugees were disproportionately at risk for committing suicide. What they found was that suicide among refugees in resettlement was mixed. Some communities showed markedly higher rates compared to both host country rates and country of origin rates, and others where others showed no difference or even lower rates of suicide than for non refugees. It highlighted a number of factors, such as culture, the context of resettlement, and trauma history, that likely play a role in determining whether a particular group is at greater risk for suicide. Most importantly, this report started a nationwide conversation about suicide prevention efforts in refugee communities as well as spurred the development of resources designed to address this gap in awareness and training efforts.qpr

 In Virginia, the refugee suicide prevention strategy is another project under the larger Virginia Refugee Mental Health Initiative. This initiative includes plans to strengthen connections between behavioral health providers and resettlement communities as well as the identification and expansion of culturally and linguistically appropriate services prepared to work with these communities.

Although evidence on which suicide prevention programs are effective is limited, research shows that strategies aimed at providing specific education for groups defined as ‘gatekeepers’ has been indicated as one of the most promising suicide prevention strategies. After a review of available gatekeeper training, the QPR model was selected based on its potential for nationwide dissemination and adaptation. Bhutanese community members were integral in adapting the QPR model to be culturally appropriate for refugee communities and were recently certified as QPR trainers by the QPR Institute. The Refugee Health Technical Assistance Center developed this cultural adaptation and made it available to QPR trainers qualified to train refugee gatekeepers and community members.

In Virginia, gatekeeper training instructors have been certified by the Question Persuade Refer (QPR) Institute to deliver the Gatekeeper training to refugee stakeholders including resettlement case managers, ESL teachers, ethnic-community based organization members, and others who come into regular contact with refugee populations.


DBHDS offers QPR for Refugee Gatekeeper training in multiple languages across the state.  Trainers are certified as QPR Gatekeeper Facilitators and are available across the state.  

The QPR Refugee Gatekeeper training is offered in

  • Arabic
  • Amharic
  • Dari
  • Spanish
  • Tagalog

These classes are offered by request and when resources are available.  You can make a request for a training by emailing the OCLC


  • Taysir Al Janabi, Caseworker, Commonwealth Catholic Charities- Roanoke
  • Laxman Chamlagai, Medical Liaison, Church World Services - Richmond
  • Selamawit. Gonfa, Medical Liaison, Catholic Charities Diocese of Arlington - Fredericksburg
  • Rabab Hassan, Peer coach, Harrisonburg Public Schools, Harrisonburg
  • Ibrahim Maroof, MPH, Medical Liaison, Commonwealth Catholic Charities - Hampton Roads
  • Cecily Rodriguez, MPA, Director, Health Equity Advancement and Workforce Development, DBHDS, Richmond
  • Eva P. Stitt, PhD., Refugee Mental Health Analyst, DBHDS - Hampton Roads