Asylum seeker trauma in a student-run clinic: reducing barriers to forensic medical evaluations

Abstract

Introduction: The number of forcibly displaced immigrants entering the United States continues to rapidly increase. Movement from Latin America across the southern border of the United States was the third-largest migration worldwide in 2017; the U.S. now serves as home to one-fifth of the world’s migrants (Budiman, 2020; Leyva-Flores et al., 2019). Reporting on the first two years of clients receiving forensic medical evaluations (FMEs) conducted by clinicians trained at University of California, San Francisco (UCSF), this descriptive study demonstrates the multiple layers and types of trauma in asylum seekers presenting to a student-run asylum clinic (SRAC) at an academic medical center.
 
 Methods: A retrospective review of the first 102 asylum seekers presenting to a university-affiliated SRAC for forensic medical and psychological evaluations is summarized. Demographics, immigration history, medical and mental health histories, descriptions of extensive trauma and referral patterns are reported. Multivariate statistics were employed to investigate the relationship between past trauma and current mental health status.
 
 Results: Clients reported extensive trauma histories, with an average of 4.4 different types of ill-treatment per person, including physical, psychological, and sexual violence. The current mental health burden was extensive with 86.9 percent of clients reporting symptoms of PTSD and/or depression. Clients were evaluated within a clinic structure that intentionally aligns with SAMHSA’s implementation domains of trauma-informed care using a continuous improvement model to reduce barriers to FMEs and promote longitudinal follow-up and referral access.
 
 Discussion: This study demonstrates the profound trauma exposure reported by asylum seekers, as well as the adaptation of a SRAC to better respond to complex trauma through intentional structural and leadership decisions. The HRC experience provides a blueprint for other asylum clinics to implement systematic trauma-centered services.

Implementing a Trauma-Informed Approach at a Student-Run Clinic for Individuals Seeking Asylum

“…This retelling can reactivate trauma symptoms for clients. 3 Furthermore, clinicians and students who hear about and document traumatic events during FMEs may experience secondary trauma. 4 Low clinician and student retention is a significant challenge for SRACs; trauma exposure is one likely reason for this.…”

“…Between April 2019 and April 2022, our SRAC provided 3 to 10 pro bono FMEs per month, as well as community referrals for individuals seeking asylum, clinician and medical student training on FMEs and TIC, and research on FMEs. 3 SAMHSA offers guidance to organizations for implementing a trauma-informed approach in 10 implementation domains (see below) that reflect change management concepts that are aligned with the 6 key principles of TIC (see above). 7 Because these implementation domains provide a highly practicable framework, we applied them to the development of the SRAC’s operations and training programs as detailed in the following subsections.…”