Behavioral health and refugee youth in primary care: An ecological systems perspective of the complexities of care

Abstract

• Experiences of resettled refugee families within exo- and macro-system levels impact the overall health care experiences and needs of youth. Resilience of refugee youth and their families was a common theme among participants. • Participants reported care and assistance challenges in treating refugee youth and families in primary health care settings. More validated tools and resources would be helpful in supporting providers in managing these mesosystem level interactions. • Participants reported various levels of behavioral health needs and support within their respective refugee youth populations. Addressing physician burn-out and implicit bias was a mesosystem level influence that could support refugee youth behavioral health care in pediatric primary care settings. Upon U.S. resettlement, refugee youth may present various behavioral health needs in primary health care settings unique to their displacement and relocation experiences. Primary health care presents the opportunity to assess and treat behavioral health needs and is one of the most frequently attended medical settings. Primary health care providers are instrumental in identifying behavioral health needs and connecting youth with appropriate resources and referrals. A study, grounded in Urie Bronfenbrenner’s Ecological Systems Theory, was created to assess the behavioral health of refugee youth specifically through the perspectives of the primary health care providers who treat them. Clark Moustkas’ phenomenological approach was utilized for the qualitative analysis. After recruitment and voluntary consent, semi-structured interviews were conducted with 12 participants. Inclusion criteria required that the primary care provider had direct experience treating refugee youth. Data collection took approximately nine months and Colaizzi’s method of phenomenological analysis was utilized. From the data, 11 thematic clusters were uncovered under three overarching categories, experiences of resettled refugees, care & assistance for refugee families, behavioral health support. Implications included incorporating a strength-based, resilience focused approach in treatment, resources for screeners, assessment and diagnosis, and discussion of physician burn-out and implicit bias. Directions for future research include validation of assessment and diagnostic tools for this population as well as treatment options focused of displaced youth in primary health care settings.