Service Providers' Perspectives of the System of Care for Refugee Youth in Tennessee

Background and Purpose: Many child and adolescent refugees present high levels of mental health needs due to exposure to extreme trauma and acculturation stress. Efforts from service providers to respond to refugee youth mental health needs and to foster positive development encounter numerous logistical and cultural barriers and complexities.  Gaining a more in-depth understanding of these barriers is essential to service provision and establishing a future research agenda to strengthen refugee youth mental health and development. Also critically important is developing a comprehensive lens of the scope of existing services and capacity for intervention at a broader systemic level. Toward these objectives we employed cross-sectional design and qualitative methodology to gain providers’ perspectives of refugee youth service barriers and needs.

Methods: Individual interviews were conducted with service providers (N = 14) who work in public schools, resettlement programs, behavioral health, and advocacy settings serving refugee youth and families in Tennessee. Participants were recruited through purposive and snowball sampling. Interviews were conducted until data saturation was achieved. Qualitative data were collected through audio-recorded, online semi-structured interviews addressing questions about the strengths of the population, effective service strategies, service gaps, assessment tools used, and knowledge and resources needed to strengthen services. Interviews were transcribed verbatim and data were analyzed through inductive thematic and grounded theory strategies in NVivo 12. Analysis proceeded applying constant comparative analysis. Transcriptions were independently coded by the two principal investigators and code lists were incrementally merged until arriving at a cohesive codebook. Codes were grouped into categories and sorted until researcher consensus was reached and distinct themes and their dimensions were determined. Validity of the findings was confirmed through a presentation and discussion of the findings with a group of service providers.

Results:  Five resulting themes convey participant perspectives of refugee youth and their families' strengths and challenges: Trauma exposure, Acculturation Stress, Impact on Family, Resilience, and Behavioral health problems. Service delivery challenges were found to occur in four themes: System barriers, Language barrier, Cultural competence challenges, and Service gaps. Assessment complexities and Measurement used are themes that emerged regarding instrumentation in practice. Two final themes that emerged represent participants' ideas about optimal services: Best practices and Services needed.

Conclusions and Implications: The shifting global, international, and local sociopolitical context creates a setting for service delivery that imposes a need to be reactive. The service network in the state has responded through collaboration and shared information, but a higher level of agility and continuity of care is needed. Strengthening the quality of linguistic interpretation services is a major priority given its central role in all service delivery. Assessment complexities tend to outweigh benefits. Training people from cultural groups to become clinicians and case managers may be optimal. Cultural competence training is needed across all systems with a primary focus on integration into society. Family involvement, community-level approaches, and afterschool programming are central practice recommendations. The primary research implication is the need for the perspectives of refugee youth and parents about what would help promote their integration and well-being.