Outcomes of a Mental Health Screening Initiative for Newly Arriving Refugees in Minnesota

Purpose: Refugees arriving in the United States frequently have war-related mental health symptoms (Johnson and Thompson, 2008).  Very few culturally relevant and valid mental health screening tools for refugees exist that are easy to use at the public health level (Hollifield, 2002).  Most tools currently in use were developed in the United States and tested with English-speaking populations (Guillemin et al., 1993).  In addition to being culturally valid, tools must be simple to use and implement at a busy public health clinic.  This paper describes the methodological procedure for developing, implementing and validating a brief mental health screening tool for refugees from five ethnic groups (Somali, Oromo, Karen, Iraqi and Bhutanese) at public health clinics in Minnesota. It presents preliminary prevalence of torture, war trauma and mental health symptoms for refugees screened. 

Methods: The screening tool was developed through an intensive procedure starting with focus groups in each refugee community.  Data from the focus groups was used to develop an 21-item screening tool that was implemented at three public health clinics in the Minneapolis-St. Paul area.  The measures were developed in a step-by-step process that paid specific attention to cultural and linguistic concepts from the focus groups as well as ensuring the tool met standards for psychometric properties.  The measure underwent a rigorous forward and backward translation process and alternative words and phrases were captured.  To date, the tool has been administered to 150 refugees.  PASW 18 for Windows was used for the analysis of quantitative data.  Primary and secondary torture and war trauma experiences were qualitatively coded and categorized using the UN definition of torture and the HURIDOCS standard events tool for documenting human rights violations (2001). 

Results:. First, the process to develop a culturally appropriate and valid screener of relevant mental health-related items will be discussed, including initial psychometric results from approximately 200-250 screened refugees. Second, the paper will discuss cultural adaptations and mental health outcomes using this screener.  Preliminary qualitative data analysis reveal primary and secondary torture prevalence rates of 26% and 50% respectively.  War trauma experiences have been reported by over 80% of screened refugees.  The prevalence of overall mental health symptoms is consistent with previous research. 

Implications:  Findings indicate that mental health screening is possible and important even in the busy contexts of public health and primary care clinics.  Recommendations for screening of war trauma, torture, and mental health symptoms are reviewed. Recommendations for implementing culturally appropriate screening is discussed.   Processes for collaborating with the Minnesota State Department of Health for implementing mental health screening as part of the statewide public health screening of new arrivals is described