Collaborative Processes and Outcomes of Integrated Health and Mental Health Screening during the Disaster Relief Phase of Afghan Resettlement in Minnesota Following Operation Allies Welcome

Background: Between October 2021 and February 2022, 1260 Afghan evacuees were resettled to Minnesota through a rapid, disaster relief phase of Operation Allies Welcome (OAW). Eighty-six percent of Afghans have experienced at least one traumatic event and 47% report experiencing psychological distress (Masfety et al., 2021). In response to this emergency evacuation, the Minnesota Refugee Health Program (RHP) mobilized an interdisciplinary team of providers to complete an initial Arrival Health and Safety Check (AHSC) which included an integrated mental health screening to identify Afghans in need of assessment and support. The screener is an abbreviated version of the WE-Check, which was developed by the RHP for arriving refugees. Although the Centers for Disease Control and Prevention recommends routine mental health screening during all initial domestic refugee health exams, many state programs continue to report challenges in integrating mental health screening into these health appointments. This study explored novel collaborative processes and outcomes of integrated mental health screening during the rapid resettlement of Afghans.

Methods: The RHP led an interdisciplinary collaboration with the UMN Global Medicine and Pediatrics Program, Mobile Health Initiative, and Medical Reserve Corps, to develop and implement an evidence-based and trauma-informed clinical protocol. We conducted a retrospective chart review study of provider records from the AHSC and follow-up appointments which were stored in a HIPPA-compliant REDCap database maintained by the Minnesota Department of Health. Quantitative items (frequencies of items endorsed, follow-up appointments, and referrals) were analyzed using descriptive statistics. Qualitative data extracted from provider notes and thematically coded included common psychological symptoms, contextual stressors, serious disorders, brief interventions, gender- and age-specific themes, and instances of physician discretion.

Results: Health intakes were conducted daily. 1206 (98%) of Afghans completed the AHSC within 2 days of arrival. Most (56%) were referred to at least one healthcare specialty including women’s clinic (51%), OBGYN (29%), Dental (25%), mental health (24%), primary care (21%), and vision (10%). 171 (33%) of Afghan adults endorsed at least one mental health screener question, 125 (73%) received a follow-up assessment, 53 received brief interventions, and 54 (43%) were subsequently referred for ongoing services. The most frequent psychological symptoms include worry/anxiety or thinking too much (93), sadness/depression (76), nightmares or flashbacks (16), and anger/irritability (14). Physical symptoms included sleep problems, headache, and pain. Contextual stressors include worries about family, housing, pregnancy, and trauma experiences. Younger women, especially those with children, experienced more difficulties, and younger people had more familiarity with mental health. We report thematic summaries of common and serious problems such as torture and psychiatric illness, characteristics of brief interventions, and instances of physician discretion. Adaptations to the process include a women’s clinic and weekly support groups.

Conclusions and Implications: Integrated mental health screening and care during the disaster relief phase of resettlement provided crucial, early interventions and access to mental health care for Afghan trauma survivors. As state public health departments increasingly seek to collaborate with universities to address resource constraints following disasters, this interagency and interdisciplinary collaboration provides a model for effective and efficient care.