Providers' and Afghans' Views of Integrated Mental Health Screening during the Disaster Relief Phase of Resettlement: A Focused Ethnographic Evaluation

Background and Purpose: Between September 2021 and February 2022, 1260 Afghan evacuees were resettled in Minnesota following Operation Allies Welcome. The Refugee Health Program and university-based Global Health and Medical Reserve Corps teams established a collaborative emergency response to meet evacuees’ immediate health needs. Mental health screening was a particular concern due to the high rates of trauma exposure. Eighty-six percent of Afghans have experienced at least one traumatic event, and 47% report experiencing resultant psychological distress. Of 529 adults screened upon arrival, 23% were identified and referred to mental health support. Evaluation research to inform disaster response efforts is limited and rarely culturally informed. Case studies from refugee crises highlight the importance of inter-agency collaboration, interdisciplinary working groups, and less reliance on non-governmental response. We evaluated the effectiveness of Minnesota’s collaborative, integrated mental health screening response from the cultural perspectives of team leadership, medical and mental health providers, and Afghans.

Methods: We used a focused ethnographic approach to 40 semi-structured interviews with leadership team members (n=9), medical (n=12), mental health providers (n=8), and evacuees (n=11). Participants were recruited through an IRB-approved process. Evacuees received a $25 gift card. Evacuees were recruited following their screening and interviewed in late 2022. Medical, mental health, and leadership team members were recruited following the response and interviewed in 2024 and 2025. Questions explored positive and challenging experiences, the usefulness of early mental health screening, what administrative processes worked well, and what could be improved. Spradley’s Developmental Research Sequence informed data analysis. Interviews were transcribed and independently coded into domains, categories, and themes using Dedoose version 10.0.25. The research team (PI and research assistants) met weekly for iterative reflections and coding reconciliation. Trustworthiness was established through multiple coders, member checking, and reconciliation.

Results: Ethnographic analysis of medical provider interviews revealed the following domains of experience: challenges and benefits of the mental health screener, the importance of prior training and relationships, and positive experiences. Mental health providers emphasized the importance of early mental health screening, the value of interdisciplinary collaboration, assessment challenges related to timing and culture, and positive and stressful experiences. Afghan evacuees reported the benefits of early mental health screening and brief intervention, and challenges to and opportunities for personal agency and resilience in medical contexts. Leadership team members emphasized the importance of effective vertical and horizontal communication among the response teams, the challenges associated with competing stakeholder goals and perspectives, and the importance of evaluating responses to inform future efforts and gain perspective. Each group offered suggestions to improve future responses.

Conclusion and Implications: All participants viewed early mental health screening as important to Afghans' healthy adjustment. Effective interdisciplinary collaboration for mental health screening and referral linked evacuees to needed care, thus reducing emergency department visits. Prior training in mental health and ongoing communication are essential for improving providers’ implementation of screening. Findings suggest improvements to policy and practice related to the organization of complex integrated health and mental health responses to humanitarian crises.