Experiences of Somali and Oromo Youth in the Child Protection System

Background: Little is known about the experiences or proportion of refugees involved with child protective services (CPS) in the United States, because they are not an identifiable group in CPS data systems. This study utilized an innovative data matching project to identify refugees in CPS data systems and explored the experiences of Somali and Oromo youth in Minnesota\u27s child protection system. Methods: A sample of 629 Somali and 62 Oromo youth who were involved with CPS between 2000 and 2013 were identified by linking datasets from the Minnesota Departments of Education and Human Services. Descriptive statistics, chi-square analysis, and t-tests were used to explore the proportion and characteristics of children involved with CPS, placement experiences, and child protection professionals\u27 documentation of families\u27 strengths and needs. Results: Somali and Oromo youth were involved with CPS at low rates (3.7%). Residential treatment facilities were the most common out-of-home (OHP) placement settings for Somali youth (41%), and almost a third of placements for Oromo youth were in a correctional facility (31.6%). Strengths identified for both groups included low alcohol and other drug use and few health issues. Needs included social support, mental health/coping support, and parenting skills. Conclusions: OHP settings for Somali and Oromo youth were highly restrictive. More research is needed to determine what is driving the high utilization of restrictive placements for Somali and Oromo youth, how accurately the Structured Decision Making tool assesses strengths and needs for families with refugee backgrounds, and how CPS professionals\u27 assessments of strengths and needs compare to the refugee families\u27 perceptions of their own strengths and needs

Health of War-Affected Karen Adults 5 Years Post-Resettlement

Background: An estimated 140 000 refugees from Burma have resettled to the USA since 2009, comprising 21% of total resettlement in the USA over the last decade. Our objective was to describe patterns of longitudinal health outcomes in a cohort of Karen refugees resettled in the USA for 5 years, and to translate these findings to a primary healthcare context. Methods: The study was a retrospective cohort study focused on the analysis of the first 5 years of electronic health records of a sample of 143 Karen refugees who were initially resettled between May 2011 and May 2013. Results: Through descriptive, inferential and survival statistics, we described patterns of retention in primary care, biometric trends, condition prevalence and survival probabilities. Highest prevalence health conditions documented at any point in the 5-year period included diagnoses or symptoms associated with pain (52%); gastrointestinal disturbance (41%); metabolic disorder (41%); infectious process (34%); mental health condition (31%) and central nervous system disorder (24%). Conclusions: This study is the first retrospective longitudinal analysis of patterns of health in Karen refugees originating from Burma and resettled to the USA. Findings identified in the 5-year, the post-resettlement period provided important clinical insights into the health trajectories of war-affected populations. Burden of illness was high although results did not demonstrate the extent of trauma-associated physical health conditions reported in the literature. Indicators such as significant increases in body mass index (BMI), the overall prevalence of dyslipidaemia and others suggested that the cohort may be exhibiting an early trajectory towards the development of these conditions. Authors summarize potential protective factors experienced by the cohort that promoted aspects of health frequently challenged in forced migration

“Basically, Everything Needs to be Adapted”: Provider Perceptions of Challenges and Recommendations for Effective Health Care with Karen People

Karen people from Burma are a new population in resettlement countries. While research increasingly documents their health needs, few studies describe how health-care providers adapt their practices to serve this group. The purpose of this study was to explore the experiences of providers who work with Karen patients/clients in health settings, documenting the challenges they face, how they adapt their practice and recommendations

Defining Effective Care Coordination for Mental Health Referrals of Refugee Populations in the United States

Objectives: 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. Design: 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. Results: 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. Conclusion: 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

Associations Between Gender, Torture, and Health: A 5-Year Retrospective Cohort Analysis

Our purpose was to identify longitudinal associations between torture exposure, physical and mental health outcomes, and gender in a cohort of 143 war-affected Karen adults five years post resettlement. Results showed that participants who self-reported primary torture experiences had higher rates of certain mental and physical health diagnoses. We observed gender differences in health over time in the cohort. Findings have implications for how primary care and public health providers implement war trauma screening tools and timelines, targeted healthcare services, and community resources to promote health and prevent disease in populations that have trauma from torture or war