Building Client-Centered and Trauma-Informed Mental Health Services for Refugees: Perspectives of Healthcare Providers

Background and Purpose: Given the importance of achieving health equity in preventive services, one population, among many other disadvantaged groups, whose preventive mental health care has not been fully provided or been mostly ignored is the newly arrived refugees and refugees in general. Lack of mental health service delivery for refugees during the first months of resettlement can adversely impact different aspects of their lives in a new country. Untreated and unacknowledged conditions, such as loss of loved one or homeland and war-related violence, can prevent refugees from attaining an adequate standard of living. This study is informed by the patient-centered care (PCC) and trauma-informed care (TIC) frameworks, which aim to provide a physically and emotionally safe environment and clear communication in service delivery among refugees and health care providers. PCC’s domains include the patient’s perspective, the psychosocial context, shared understanding, and sharing power and responsibility (Epstein et al., 2005). The application of PCC in healthcare settings is often associated with providers’ confidence and beliefs in their capabilities (Zachariae et al., 2015). Openness to experience in diverse cultural settings is also related to a provider’s capability to function effectively, which is defined as cultural intelligence (CQ) (Ang et al., 2006). This study aims to identify the ways that help build client-centered and trauma-informed mental health services for refugees and strengthen the capacity of providers to function effectively with refugee clients.

Methods: This is an explanatory sequential mixed methods study. The sample consists of healthcare providers and staff from the health clinics and agencies who have worked or are currently working with the refugee and asylee population in Central Florida. The Self-Efficacy in Patient Centeredness Questionnaire and the CQ Scale were administered to 20 participants. Based on the findings from the QUAN data, an interview protocol was developed to conduct a focus group with providers.

Results: The results indicate that there is a positive relationship between providers’ self-efficacy and CQ. Particularly, providers who have higher level of knowledge about the culture of the client feel more confident about their helping process and effectively deal with communicative challenges in healthcare settings. There was no association between the number of years working with refugees and self-efficacy nor CQ. Gaps in refugee mental health services were explored in detail through a focus group. It was suggested that trainings for providers on trauma-informed and culturally responsive practices can meaningfully facilitate the communication between the provider and the refugee client and increase providers’ confidence in their knowledge and skills.

Discussion and Implications: Findings suggest that TIC principles (safety, trustworthiness and transparency, collaboration and peer support, empowerment, choice, and intersectionality of identity characteristics) and culturally responsive services can guide health care providers to avoid miscommunication and practices that are likely to retraumatize refugees. Open and compassionate trauma-informed and patient-centered communication can foster a shared understanding and sense of safety between refugees and providers. The implementation of a partnership model between local clinics and community services can ensure the provision of essential services to improve refugees’ overall wellbeing.