Does Integrated Care Affect Healthcare Utilization in Multi-problem Refugees?

Carol C. White, Craig A. Solid, James S. Hodges, Deborah H. Boehm. Journal of Immigrant and Minority Health, August 2014.

A history of trauma is common in refugee populations and appropriate treatment is frequently avoided. Using a convenience sample of 64 patients in a Somali primary care clinic, a culture and trauma specific intervention was developed to address retention into appropriate treatment. One goal of the intervention was to improve the rate of engagement in psychotherapy after a mental health referral and to test the effect of psychotherapy on health care utilization using a staged primary care clinical tool. Forty-eight percent of patients given a mental health referral engaged in psychotherapy. Patients engaging in psychotherapy had higher baseline utilization and over 12 months trended towards less emergency room use and more primary care. Our findings suggest that the intervention improved referral and retention in mental health therapy for East African refugee women.

This primary care intervention study may be useful in promoting assessment and trauma-informed treatment in mainstream settings of refugees with likely trauma experiences. The intervention model was  developed by adult nurse practitioner Deborah Boehm for her work with East African women. It details a four visit staged protocol for addressing common groups of symptoms presented by a new refugee patient. The results of the study demonstrate the efficacy of integrated care in fostering patient willingness to engage in psychotherapy after an initial referral. Table 2 is very useful for training in the staged approach for primary care providers.  

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