Poster Presentations (Group I)

This presentation discusses results of an innovative project to create mental health referral options for refugees within a primary care setting. This project aimed to identify the best ways to access and deliver psycho-education to the community of war trauma and torture survivors in the Brooklyn Park and Brooklyn Center (BP/BC) areas of the Minneapolis-St. Paul metropolitan region. The project focused its efforts on a large non-profit integrated care delivery system in Brooklyn Center lacking onsite mental health services.  Minnesota is one of the largest U.S. resettlement areas for refugees from Southeast Asia and Africa. In 2000, there were over 200,000 foreign-born residents in the Twin Cities. Estimates are that 12-15,000 Liberians live in BP/BC, constituting more than 15% of the population of those cities.

We initially conducted a needs assessment with clinic providers. They identified three barriers to working with immigrant and refugee populations: ongoing physical complaints with unclear etiology; lack of referral options related to likely mental health issues; and non-compliance with appointments, medications and treatment referrals. Our main needs assessment focused on the patients from this clinic with the purpose of identifying challenges faced by survivors in communicating health concerns relating to war trauma in the course of primary care visits. In 2006-07, we conducted 50 brief face-to-face interviews in the waiting area of the clinic with consenting adult participants from war-torn countries. Most participants (70% [n=37]) were Liberian and 60% were women.

The key lesson this research offered about mainstream health was the importance for healthcare providers to initiate communication with refugees about the impacts of war on their health. Results to the interviews showed: 69% participants reported they had never brought up the ways they had been affected by political conflict and violence in their home countries with a doctor; 65% of participants reported that no doctor had ever asked them about the political conflict in their country and ways they had been affected by it.  From refugee perspectives, the two main barriers to communication reported were: participants did not consider the impact of war to be a relevant or health related topic for clinic visits; participants were not asked about the topic and felt it was inappropriate for them to initiate the discussion. However, 76% of participants said they would like to talk to their doctors about war trauma in order to improve their health; and 80% of participants expressed interest in learning more about the impact of stress and trauma on their health.

The presentation closes with a discussion of recommendations for creating mental health referral options: first, ways primary care providers can initiate discussion with patients presenting with psychosomatic complaints as a result of exposure to war trauma; and second, a referral system for psycho-educational services.