Progress Toward the Evaluation of the Mental Health Service Delivery System for Newly Arriving Refugees

Purpose: The lack of mental health resources has been identified as a reason for not screening the mental health of newly arriving refugees. The objective of this project is to evaluate the effectiveness of the current mental health service delivery system for newly arriving refugees from the perspective of public health screening clinics, insurance-based health network providers and  newly arriving refugees (including cultural leaders and new arrivals).  In a previous study to establish the need for mental health screening conducted in 2009 by the PI, 22 agencies surveyed indicated that they do make mental health referrals but they believe that they are only sometimes successful.  Most agencies do not have the resources to follow up on whether or not mental health referrals are successful. 

Methods:  This is a participatory research design that engages stakeholders in the development of an interview protocol to assess the effectiveness of the mental health delivery system processes from screening through referral processes to successful enegagement with mental health providers (Fonesca-Becker & Boone, 2008; Creswell, 2007; Patton, 1997).  We invited public health screening clinic staff, health network administrators and key providers with expertise in the treatment of trauma, and refugee cultural leaders from each of the five ethnic groups to a meeting to discuss the development of an interview protocol.  Questions were  developed in a participatory way to include the perspectives of all community stakeholders.  Confidential interviews were piloted, revised in collaboration with stakeholders. Interviews  were conducted with key public health screening clinics, a sample of trauma trained providers from each insurance network, and cultural leaders and recent arrivals from each of the five refugee groups. Qualitative data was inductively coded and categorized into domains, categories and subcategories across the questions using several coders (Creswell, 2007) .  Summaries of categories and findings were prepared for member checking with each of the groups interviewed.  Scaled items were scored and means summarized.   A subset of the key stakeholders is meeting on a quarterly basis to review the progress of the evaluation process.  

 Results:  Processes of collaboration toward the evaluation of the mental health service delivery system for newly arriving refugees will be discussed.  The stakes and stakeholders in this process will be identified and processes for overcoming conflict will be discussed.  Preliminary outcomes of interviews will be shared as well as lessons learned.  Common barriers to care will be discussed including the lack of interpreters in mental health clinics, cultural differences in understanding mental health, lack of reliable transportation, and difficulty navigating complex systems of care. Implications of findings for screening and recommendations for changes in the referral and service delivery will be discussed. 

 Implications:   As the state begins to incorporate mental health screening into the public health screening protocol for newly arriving refugees, it is essential to assess the mental health referral processes and availability of culturally appropriate mental health services for refugees.  The strength of participatory processes for conducting evaluations will be discussed.  Recommendations for further training or system change improvements will be discussed.