Identifying Depression in Adult Refugees With the Refugee Health Screener-15: A Quality Improvement Project

Background: There are over 68.5 million people forcibly displaced worldwide due to persecution, violence, or conflict. Of this population, 25.4 million are refugees. Prevalence of depression and other mental health concerns is found to be around 30% in this population and yet current mental health screening guidelines for refugees lack cultural sensitivity and directness. Local Problem: In Utah alone, there are over 60,000 refugees. This population is constantly growing and mental health continues to be a concern. This project aimed to support the identification of depression in adult refugees living in the Salt Lake City region by introducing a clinical pathway for depression screening that included the use of the Refugee Health Screener-15 (RHS-15). Methods: The quality improvement project population included family practice providers (n=8) at University of Utah Health's Redwood Health Center. A survey was conducted to assess providers' baseline knowledge and use of the Refugee Health Screener-15 (RHS-15) tool, and then education and training were offered using the RHS-15 to screen for depression among refugee patients. Electronic health record (EHR) informatics specialists implemented and tracked RHS-15 use throughout an 8-week period. After this implementation period, a post-survey was sent to the participants to assess usability, feasibility, and satisfaction with the RHS-15 clinical pathway. Analysis was completed on the data collected from the EHR and the pre- post-survey results. Results: Post-intervention showed the RHS-15 was utilized 42 times during the 8-week period compared to no utilization in the year prior. Statistically significant increase in knowledge of where to find the RHS- 15 in the EHR was demonstrated, p=.02. The median score of providers who felt the RHS-15 increased their ability to recognized mental health concerns for refugee adults was 4 on a 5-point Likert scale. Median score of providers who felt that more refugees were connected to mental health services due to the RHS-15 was four. Conclusions: Post-intervention, the RHS-15 was used more frequently, and providers stated that it should become part of their practice habits. According to providers, the RHS-15 helped increase their ability to recognize mental health concerns among refugee populations and connect more individuals to mental health services. Replication of this quality improvement project is needed to determine if long-term usage of the RHS-15 increases provider diagnosis of depression in refugee populations. To make this project more sustainable, it is recommended that the RHS-15 be added to the clinic visit note template for all refugees' annual visits.