Integrating Refugee Youth Mental Health Screenings into the Domestic Refugee Medical Examination

Refugees are people displaced from their native countries and unable to return due to a fear of persecution. Refugees often experience cumulative stressors during the preflight, flight, and resettlement periods. Refugees of all ages have considerable risks for the development of mental distress. A high proportion of refugee youth experience mental health disorders, particularly posttraumatic stress disorder and depression. The tool currently used in Utah to screen for mental health concerns during the domestic refugee medical examination (DRME) is validated for refugees age 14 and older. The Utah Refugee Mental Health Subcommittee has recognized the need to identify a tool to screen for mental health concerns in refugees under the age of 14. The purpose of this project was to determine the practicality and provider acceptability of a tool to screen for mental health concerns in refugee patients under the age of 14. Four primary objectives were designed to meet this purpose: 1) identify a tool, 2) assist two clinics to implement a pilot test of the identified tool, 3) evaluate the use and outcomes of the tool; and 4) disseminate the findings. The Strengths and Difficulties Questionnaire (SDQ) was chosen as an appropriate tool. Meetings with the key stakeholders at the pilot clinics were held to identify concerns and assist in the development of a suitable clinic process flow. Five providers involved in the pilot were surveyed using a new questionnaire designed to identify barriers and supports for the project. Education was delivered to providers based on information from the stakeholder meetings and the identified barriers and supports. A six-week pilot test of the SDQ was conducted tool use and mental health referrals were monitored. Out of the 41 children who presented for a DRME during the pilot period, nine children were screened using the SDQ. Of the nine children screened, two had positive SDQ scores and were offered referrals for mental health services (compared to 0 referrals during the same range of dates in 2014). At pilot conclusion, the involved providers were surveyed using a newly developed questionnaire designed to measure provider satisfaction with the SDQ and clinic process flow as well as perceived parent reception. Providers were neutral about continued tool use and identified the SDQ questions and increased ability to identify children who would benefit from mental health services as positive features of the SDQ. Concerns with the tool included length, time required for completion, cumbersome scoring, and interpretation difficulties. Results from the pilot were shared with members of the State Refugee Health Advisory Committee, Refugee Mental Health Subcommittee, and the pilot clinics who have determined they will extend the pilot. The University of Utah and Utah Department of Health Institutional Review Boards approved this project. A standard procedure to screen refugee youth under the age of 14 for mental health concerns did not exist in Utah prior to this project. This project served as an initial pilot test to determine the practicality and provider acceptability of the SDQ to screen for mental health concerns in refugee youth under the age of 14 in Utah. Ultimately, this project will contribute to improved health and wellness of refugee youth under the age of 14 due to early identification of mental health concerns and timely referral to appropriate services.