Culturally Effective Practice With Refugees in Community Health Centers: An Exploratory Study

Abstract

The global refugee crisis requires providers of health and behavioral health services to develop culturally-effective practices that can meet the needs of the ever-changing demographics of those being resettled. Community health centers in the United States are often asked to provide services during the first year of resettlement for refugees. Social workers are among those professionals who provide the behavioral health services in the community health centers. To better understand the challenges for these providers, this qualitative study examines the experiences of 15 providers of refugee behavioral health services at community health centers in the northeast of the United States. The participants were interviewed, and those transcribed interviews were analyzed for themes. Findings revealed three main themes: client engagement as crucial; collaboration with interpreters; and cultural competence is an imperative but ill-defined. Important implications focus on the need for cultural competence and the challenge to obtain this competence given the resources and demands in community health centers.

Cultural Competence in Refugee Service Settings: A Scoping Review

“… 4 Several studies highlighted challenges of learning about clients' cultures and backgrounds, including time pressures and highly diverse client caseloads, with some providers developing strategies to obtain targeted knowledge relevant to the services they delivered. 4 , 20 , 30 , 36 , 39 , 41 Other studies highlighted the complexity and diversity of refugee communities and the importance of testing and contextualizing understandings of cultural knowledge. 2 , 22 , 34 …”

“…[21][22][23]31,33,38,43,44 Flexibility in organizational policies and procedures, lower caseloads, and sufficient staffing can also enable providers to support refugee clients' needs in a more culturally sensitive way. 22,41,42 Cultural competence training was widely recognized as a method of promoting cultural competence among refugee service providers. 21,22,29,31,31,33,39,45 Several cultural competence training programs for medical students, medical residents, social workers, and nursing students working with refugees were described in the literature.…”

“…Partnerships between service organizations and refugee communities can facilitate cultural competence and provide mutual benefits to providers and refugee clients. 20,21,31,33,35,41,43,44 Ethnic communities may have the advantage of offering more culturally appropriate support to refugees, but lack knowledge of signs and symptoms of trauma; more formal systems may have greater access to information about mental health, while struggling to offer support that is culturally congruent or appropriate. 35(p30) Kaczorowski et al 20 reported that strong partnerships between mental health clinics, schools, and refugee-serving agencies improved the cultural competence of mental health services for refugees, increased trust in and engagement with clinical services, and reduced barriers to treatment.…”

“…Professional interpreter services were the most frequently cited examples of this. [20][21][22]31,33,[38][39][40][41][42]46 There was a consensus that professional interpreter services were preferable to relying on family members, friends, or other staff members, due to issues of privacy, quality, and ethics. However, several barriers to using professional interpreters were identified, including cost and time constraints and limited availability of interpreters, particularly for rare languages.…”

“…However, several barriers to using professional interpreters were identified, including cost and time constraints and limited availability of interpreters, particularly for rare languages. 29,39,41 Several providers, including medical students, doctors, and social workers, highlighted the critical role of interpreters as cultural guides who improved the quality of interactions with refugee clients through triangulated discussion and constructive feedback. 20,40,46 Some studies recommended the provision of linguistically and culturally appropriate verbal, written, and visual material across the service continuum, including during scheduling, reception, appointments, referrals, and follow-up; providers believed that this improved engagement with and retention in services.…”