School of Social Work, University of Minnesota, St. Paul, MN, USA.
Research Department, Center for Victims of Torture, Minneapolis, MN, USA.
Ethn Health. 2021 Jul;26(5):737-755. doi: 10.1080/13557858.2018.1547369. Epub 2018 Nov 19.
Refugee populations arriving to the United States report high rates of exposure to trauma and associated psychiatric distress that may necessitate referrals to mental health services. Although refugee arrivals receive a voluntary health screening, mental health screening is not routine. Public health providers report that one barrier to mental health screening concerns uncertainty about how to connect refugee patients to mental health services. This article reports essential components of successful and unsuccessful care coordination related to mental health referrals of refugees. A community based participatory research study explored the characteristics of successful and unsuccessful mental health referrals of refugee patients through an online survey of refugee providers. Ten coders sorted provider stories of mental health referrals into critical incidents that were analyzed using principle components analysis (PCA). Care coordination emerged as an important characteristic of referral success. This category of care coordination was analyzed further into components of successful and unsuccessful care coordination using a higher order PCA. A similar process was followed examining providers' perceptions of why care coordination was successful or unsuccessful. Components describing successful care coordination include ongoing communication between providers, scheduling initial appointments directly, access to emergency mental health services, and case management provided by health plan staff. Components related to unsuccessful care coordination describe the failure to communicate about care or establish appointments in a timely manner and the failure to resolve access barriers. Trust in relationships among providers and between refugee patients and providers was an important reason why care coordination was successful. Ongoing communication between providers is essential to successful mental health referrals of patients with refugee backgrounds. Multidisciplinary systems of care may benefit from education about the importance of building relationships among providers and the essential components of successful care coordination.
抵达美国的难民群体报告称，他们接触创伤和相关精神困扰的比率很高，这可能需要转介到精神卫生服务机构。尽管难民抵达时会接受自愿健康检查，但精神健康检查并非常规检查。公共卫生服务提供者报告说，精神健康检查面临的一个障碍是不确定如何将难民患者转介到精神卫生服务机构。本文报告了与难民精神健康转介相关的成功和不成功的护理协调的基本组成部分。一项基于社区的参与性研究通过对难民服务提供者的在线调查，探讨了成功和不成功的难民患者精神健康转介的特征。十名编码员将提供者的精神健康转介故事分类为关键事件，并使用主成分分析（PCA）进行分析。护理协调被认为是转介成功的一个重要特征。使用高阶 PCA 进一步分析了该类别护理协调的成功和不成功组成部分。采用类似的过程来检验提供者对护理协调成功或失败的看法。描述成功护理协调的组成部分包括提供者之间的持续沟通、直接安排初始预约、获得紧急精神卫生服务以及由健康计划工作人员提供的病例管理。描述不成功护理协调的组成部分包括未能就护理进行沟通或未能及时安排预约，以及未能解决获得服务的障碍。提供者之间以及难民患者与提供者之间的信任关系是护理协调成功的一个重要原因。提供者之间的持续沟通对于成功转介有难民背景的患者的精神健康至关重要。多学科的护理系统可能受益于关于建立提供者之间关系以及成功护理协调的基本组成部分的重要性的教育。
