Skip to main content

Advertisement

Log in

Does Integrated Care Affect Healthcare Utilization in Multi-problem Refugees?

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

A history of trauma is common in refugee populations and appropriate treatment is frequently avoided. Using a convenience sample of 64 patients in a Somali primary care clinic, a culture and trauma specific intervention was developed to address retention into appropriate treatment. One goal of the intervention was to improve the rate of engagement in psychotherapy after a mental health referral and to test the effect of psychotherapy on health care utilization using a staged primary care clinical tool. Forty-eight percent of patients given a mental health referral engaged in psychotherapy. Patients engaging in psychotherapy had higher baseline utilization and over 12 months trended towards less emergency room use and more primary care. Our findings suggest that the intervention improved referral and retention in mental health therapy for East African refugee women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jaranson JM, Butcher J, Halcon L, et al. Somali and Oromo refugees: correlates of torture and trauma history. AJPH. 2004;94:591–8.

    Article  Google Scholar 

  2. Adams KM, Gardiner LD, Assefi N. Healthcare challenges from the developing world: post-immigration refugee medicine. BMJ. 2004;328(7455):1548–52.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Kirmayer LJ. Confusion of the senses: implications of ethnocultural variations in somatoform and dissociative disorders for PTSD. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM, editors. Ethnocultural aspects of posttraumatic stress disorder: issues, research, and clinical applications. 3rd ed. Washington: American Psychological Association; 1996. p. 131–64.

    Chapter  Google Scholar 

  4. Eisenman DP, Keller AS, Kim G. Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed? West J Med. 2000;172(5):301–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Lecrubier Y. Posttraumatic stress disorder in primary care: a hidden diagnosis. J Clin Psychiatry. 2004;65(Suppl 1):49–54.

    PubMed  Google Scholar 

  6. Switzer GE, Dew MA, Thompson K, et al. Posttraumatic stress disorder and service utilization among urban mental health center clients. J Trauma Stress. 1999;12(1):25–39.

    Article  CAS  PubMed  Google Scholar 

  7. Saechao F, Shamrock S, Recharger D, et al. Stressors and barriers to using mental health services among diverse groups of first-generation immigrants to the United States. Community Ment Hlt J. 2012;48:98–106.

    Article  Google Scholar 

  8. Hollifield M, Warner T, et al. Measuring trauma and health status in refugees: a critical review. JAMA. 2002;288(5):611–21.

    Article  PubMed  Google Scholar 

  9. Moffic HS, Kinzie JD. The history and future of cross-cultural psychiatric services. Community Ment Hlt J. 1996;32(6):581–92.

    Article  CAS  Google Scholar 

  10. Shannon P, O’Dougherty M, Mehta E. Refugees’ perspectives on barriers to communication about trauma histories in primary care. Mental Health in Family Med. 2012;9:47–55.

    Google Scholar 

  11. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162(2):214–27.

    Article  PubMed  Google Scholar 

  12. Bisson JI. Pharmacological treatment to prevent and treat post-traumatic stress disorder. Torture. 2008;18:104–6.

    PubMed  Google Scholar 

  13. Silber MH. Chronic insomnia. NEJM. 2005;353(8):803–10.

    Article  CAS  PubMed  Google Scholar 

  14. Mollica R. Medical best practices for the treatment of torture survivors. Torture. 2011;21(1):8–17.

    PubMed  Google Scholar 

  15. Neuner F, Catani C, Ruf M, et al. Narrative exposure therapy for the treatment of traumatized children and adolescents: from neurocognitive theory to field intervention. Child Adolesc Psychiatr Clin N Am. 2008;17(3):641–64.

    Article  PubMed  Google Scholar 

  16. Bass J, Annan J, Murray SM, et al. Controlled trial of psychotherapy for Congolese survivors of sexual violence. N Engl J Med. 2013;368:2182–91.

    Article  CAS  PubMed  Google Scholar 

  17. Kayzen D, Lindgren K, Zangana GA, et al. Adaptation of cognitive processing therapy for treatment of torture victims: experience in Kurdistan, Iraq. Psychol Trauma Theory Res Pract Policy. 2013;5(2):184–92.

    Article  Google Scholar 

  18. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical co-morbidity. Arch Gen Psychiatry. 2005;62(8):903–10.

    Article  PubMed  Google Scholar 

  19. Holman EA, Silver RC, Waitzkin H. Traumatic life events in primary care patients: a study in an ethnically diverse sample. Arch Fam Med. 2000;9(9):802–10.

  20. Elkin I, Falconnier L, Smith Y, et al. Therapist responsiveness and patient engagement in therapy. Psychother Res. 2014;24(1):52–66.

    Article  PubMed  Google Scholar 

  21. Elkin I, Yamaguchi J, Arnkoff D, et al. Patient-treatment fit and early engagement in therapy. Psychother Res. 1999;9(4):437–51.

    Google Scholar 

  22. Surgeon general: mental health: culture, race and ethnicity (executive summary). 2001; Rockville, MD: US Department of Health and Human Services, Public Health Service.

  23. Manderscheid R, Kathol R. Fostering sustainable, integrated medical and behavioral health services in medical settings. Ann Intern Med. 2014;160:61–5.

    Article  PubMed  Google Scholar 

  24. Bartels SJ, Stephen J, Coakley EH, et al. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry. 2004;161:1445–62. doi:10.1176/appi.ajp.161.8.1455.

    Article  Google Scholar 

  25. Ayalon L, Arean PA, Linkins K, et al. Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly. Am J Geriatr Psychiatry. 2007;15(10):906–12. doi:10.1097/JGP.0b013e318135113e.

    Article  PubMed  Google Scholar 

  26. Szymanski B, et al. Integrated care: treatment initiation following positive depression screens. J Gen Intern Med. 2013;28(3):346–52.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Isakson B, Jurkovic G. Healing after torture: the role of moving on. Qual Health Res. 2013;23(6):749–61.

    Article  PubMed  Google Scholar 

  28. Neuner F, Schauer M, Klaschik C, et al. A Comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee resettlement. JCCP. 2004;72(4):579–87.

    Google Scholar 

  29. Otto MW, Hinton D, Korbly NB, et al. Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther. 2003;41(11):1271–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Authors received Grant support from Minneapolis Medical Research Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Deborah H. Boehm.

Additional information

Carol C. White—Retired from Center for Victims of Torture.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

White, C.C., Solid, C.A., Hodges, J.S. et al. Does Integrated Care Affect Healthcare Utilization in Multi-problem Refugees?. J Immigrant Minority Health 17, 1444–1450 (2015). https://doi.org/10.1007/s10903-014-0088-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-014-0088-6

Keywords

Navigation