Community Sponsorship and Accessing Health and Mental Health Services for Newly Arrived Refugees in the United States

Background and Purpose: The Biden administration has initiated a federal program to increase refugee resettlement through community and private sponsorship. The use of volunteers to support the integration and wellbeing of refugees has potential, but it can flounder due to their insufficient experience with health and social service systems. While community sponsorship is considered the most important innovation in resettlement in more than four decades, scant research exists about the strengths and limitations of the approach, particularly in the U.S. context where health systems are strained and often difficult to navigate.

This presentation examines data from a larger qualitative study on the strengths and limitations of community sponsorship of refugees in the United States. The presentation focuses on analysis of data from interviews related to securing access to quality health and mental health care and sustaining support for newcomer families, who often have complex health challenges and longstanding chronic health and mental health concerns.

Methods: We conducted 57 in-depth, semi-structured qualitative interviews between 2017 and 2023 with community sponsor volunteers and service providers serving newcomer refugees. Participants were adults in Connecticut, Illinois, Kentucky, Massachusetts, Michigan, Minnesota, New York, Utah, and Virginia. Based on those who disclosed their identities, the sample of volunteers were predominantly White, female, and middle-aged or retired and service providers were predominantly young and middle-aged White, female professionals. Participants were recruited using key informants, direct outreach, and snowball sampling. Interviews were conducted by phone, in-person, and via videoconference. Interviews elicited participants’ motivations for working with newcomer refugees, perspectives on community sponsorship, key challenges they faced, and their perceptions of refugees’ experiences in accessing health and mental services. All interviews were recorded and transcribed, coded thematically, and guided by principles of modified grounded theory.

Results: Many of the refugees had serious health and/or mental health concerns such as posttraumatic stress disorder, depression, chronic pain, headaches, physical injuries, diabetes, epilepsy, heart conditions, or gynecological issues. Overarching concerns included: obtaining required initial health assessment and navigating the U.S. healthcare system; lack of access to health insurance and care, particularly with chronic health issues; language barriers preventing access to quality care; capacity of health providers serving the numbers of refugees requesting care; and the need for trauma-informed and cultural humility training for health providers.

Conclusions and Implications: This research addresses a call by the U.S. State Department and Office of Refugee Resettlement to strengthen and reimagine refugee resettlement. Community sponsor volunteers are increasingly playing a critical role in resettling refugees across the country, often navigating for the first time complex health systems. Social work researchers are well positioned to work with resettlement agencies and community sponsorship groups to understand this new approach to resettlement and to disseminate findings among these groups to strengthen their capacity. Findings from this study illustrate the necessity of health policy change at the state and national levels, including access to care, insurance, streamlined navigation processes, and language supports, to address the vulnerabilities of newcomer refugees and enhance their opportunities to flourish in the United States.