Global Health Initiatives, Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, 20007, USA.
Physicians for Human Rights, New York, NY, USA.
BMC Health Serv Res. 2021 May 26;21(1):508. doi: 10.1186/s12913-021-06539-5.
Asylum evaluations are highly specialized medico-legal encounters to collect physical or mental health evidence for use in immigration proceedings. Although the field of asylum medicine is growing, access to these evaluations is still inadequate, particularly for those in United States immigration detention or other forms of custody, such as under the U.S. Migrant Protection Protocols or "Remain in Mexico" policy. Given advances in telehealth in recent years and growing evidence of similar outcomes with in-person management, it seems prudent to examine whether remote modalities may also be effective for conducting mental health asylum evaluations in hard-to-reach populations.
We analyzed the responses of 12 U.S. clinicians who conducted 25 cross-border remote mental health evaluations with clients in Mexico prior to the COVID-19 pandemic, and completed a post-evaluation survey regarding their impressions and experiences of the remote encounter. Data were coded through a process of thematic analysis.
The average evaluation time was 2.3 h, slightly shorter than might be expected from an in-person encounter. Five themes emerged from the coding process: rapport building, achieving overall goal, comparison of in-person vs. remote, technical issues, and coordination. Clinicians encountered a number of challenges including technical difficulties and a decreased ability to establish rapport. Nearly uniformly, however, clinicians noted that despite difficulties, they were able achieve the goals of the evaluation, including rapport building and diagnosis.
Remote evaluations appear to achieve their intended goal and may be useful in expanding legal options for hard-to-reach asylum seekers.
庇护评估是高度专业化的医学法律程序，旨在收集身体或精神健康证据，用于移民程序。尽管庇护医学领域正在发展，但获得这些评估的机会仍然不足，尤其是对于那些处于美国移民拘留或其他形式拘留中的人，例如根据美国移民保护协议或“留在墨西哥”政策。鉴于近年来远程医疗的发展以及类似的面对面管理效果的证据不断增加，似乎有必要研究远程模式是否也可以有效地为难以接触到的人群进行心理健康庇护评估。
我们分析了 12 名美国临床医生的反应，他们在 COVID-19 大流行之前在墨西哥与客户进行了 25 次跨境远程心理健康评估，并完成了一项关于他们对远程接触的印象和经验的评估后调查。数据通过主题分析过程进行编码。
平均评估时间为 2.3 小时，略短于面对面接触的预期时间。编码过程中出现了五个主题：建立融洽关系、实现总体目标、比较面对面与远程、技术问题和协调。临床医生遇到了一些挑战，包括技术困难和建立融洽关系的能力下降。然而，几乎所有的临床医生都指出，尽管存在困难，但他们能够实现评估的目标，包括建立融洽关系和诊断。
远程评估似乎达到了预期的目标，并且可能有助于扩大难以接触到的庇护寻求者的法律选择。
