Refugee Perspectives on Social Work Interventions during the First Five Years after Resettlement in the United States

Background and Purpose: Refugees face a number of intertwined psychosocial factors and traumatic experiences that put them at increased risk for developing mental illness during resettlement. Though an urgent need for mental health services persists, few studies have assessed refugees’ perspectives on which mental health interventions are effective for them. Using a critical feminist methodology, this exploratory qualitative study asked the following question: What are the specific factors related to social work practice and intervention that improve refugee mental health and well-being?

Methods: We recruited a convenience sample of 152 refugees with 16 different countries of origin through a refugee mental health non-profit. Participants had been in the United States between 0 and 4.6 years (mean= 0.58 years). Participants spoke 33 different languages, with the two most common being Swahili (n=40) and Arabic (n=37). Eighty six participants (n=86) received mental health treatment through the non-profit. The average Refugee Health Screener (RHS-15) score at the time of data collection was 21 (a score of 12 or greater indicates emotional distress).

In-depth interviews were conducted using a semi-structured guide developed by the non-profit. The interview assessed perceptions of mental health treatment and which services would be helpful in improving mental health. The interviews were conducted in the participants’ homes, and English interpretation was utilized when necessary. The qualitative data were analyzed in Atlas.ti 8 using a Grounded Theory approach. Line by line coding was used to develop a code book. The codebook was reviewed by a qualitative expert and refined after theoretical saturation occurred. Inductive analysis was used to identify emerging themes. Triangulation was established through qualitative work groups and theory. Multiple coders analyzed the data, and discrepancies were resolved through mutual consensus. Negative case analysis was conducted. Final themes were agreed upon by the research team consisting of experts in mental health and trauma, refugee service providers, and graduate student researchers.

Results: Refugees described a number of factors related to social work practice that improved mental health. These factors included the receipt of dual mental health treatment and case management, group therapy, and the utilization of the RHS-15 as a trauma assessment and therapeutic tool. The importance of social connectedness to other refugees, providers, and community members as a product of treatment was commonly mentioned as improving mental health. Many refugees expressed that social connectedness normalized traumatic experiences and facilitated cultural adjustment. Termination of services and mismanaged expectations of service scope were sources of stress for refugees.

Conclusions and Implications: This study highlights multiple implications for future social work practice with refugees: programs should serve as a one-stop-shop for mental health and case management services, facilitate social connectedness, and clearly communicate service scope. These findings contribute to a deeper understanding of how to adapt social work interventions to better address the intertwined psychosocial factors impacting refugee mental health. Given the high prevalence of mental health symptoms among refugees and their impact on self-sufficiency and well-being, the findings of this study demonstrate the need for innovative programs that support refugee mental health.