Does Integrated Care Affect Healthcare Utilization in Multi-problem Refugees?
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.
KeywordsRefugees Political trauma Integrated care Special populations Primary care
- 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.CrossRefGoogle 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
- 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.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.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.CrossRefGoogle 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