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Improving Well-Being for Refugees in Primary Care: A Toolkit for Providers

Original Publication Date: February 22, 2019
Last Updated: April 12, 2023
Estimated Read Time: 3 minutes

CVT’s NEW Toolkit for Providers Working with Refugees

Meet Paw, a refugee from Burma seeking medical care in the U.S. for her headaches, nightmares and physical pain. She’s unfamiliar with the U.S. primary care system and she doesn’t speak English. Waiting alone at her first doctor appointment, Paw wonders, “How will the doctor understand me? What if I don’t like my interpreter? Will I ever be healthy again?”

Paw’s questions don’t end there. They’re only a few of several listed in CVT’s new manual, “Improving Well Being for Refugees in Primary Care: A Toolkit for Providers.”  Paw is a fictional character whose real-life experiences mirror those of clients in CVT’s Healing Hearts program.  Since 2013, Healing Hearts has used a holistic, team-based approach to bring specialized care to Karen clients, an ethnic minority from the eastern region of Burma, in a primary care setting. The program began as a research study between CVT and two St. Paul, Minn., clinics serving Karen refugees, HealthEast Roselawn, and the University of Minnesota Physicians Bethesda Clinic. It was a successful partnership. Not only did the study increase participants’ awareness and access to mental health services, it increased their opportunities to have complex health conditions treated.

While Healing Hearts better equips participants to find beneficial care, with the release of this new manual, the program now gives providers the necessary tools to improve treatment plans for patients who have lived through traumatic experiences. “It is difficult to fully attend to refugee patients with complex, interrelated needs in fast-paced primary care systems,” said Kathleen O’ Donnell-Burrows, MSW, MPP, LICSW, CVT’s mental health partnerships project manager and one of the toolkit’s three editors. “So we wanted to demonstrate the impact of language used by clinicians with concrete examples from our experience in the clinic setting.”

For instance, asking a patient, “How are you feeling today?” might not seem out of the ordinary for a provider. The toolkit, however, explains not just why, but how asking questions in a more culturally-appropriate way can yield richer information to ultimately address a patient’s health issues. “With Paw, we’ve tried to highlight the ways in which communication doesn’t go as well as it could have with her hypothetical care provider, or where things are missed because of cross-cultural dynamics,” explains Ally Beckman, MSW, LICSW, toolkit editor and CVT’s senior clinician for external relations. At the end of the chapter, the authors revisit the scenario and provide a resolution, demonstrating what Paw’s provider has learned and how he or she has adapted his or her behavior to better communicate and facilitate care.

Because Healing Hearts provides integrated care for clients, the scenarios don’t focus exclusively on Paw and her doctor, but also on interactions between Paw and her psychotherapist, and Paw and her social worker. “An underlying component of the manual is that care needs to be collaborative,” Kathleen said. “And that we’re not just providing recommendations to a single clinician.”

Although Paw’s scenarios provide a deeper, richer narrative for the toolkit, each chapter contains a bulleted summary of recommendations at the end, so clinicians on the go can quickly refer to it for practical advice. Some example sections feature patients from other refugee groups. Input from doctors at HealthEast Roselawn and Bethesda Clinic, as well as colorful visuals designed by Amanda Scheid, CVT graphic designer, who credits the textiles created and often worn by Karen refugees for influencing the toolkit’s look and feel, enhance the user experience.

The editors are hopeful about the toolkit’s impact. “I’d love to see it in the hands of every primary care clinic across the U.S. that sees refugee patients,” said Ally. Her colleagues and co-editors, Kathleen and former CVT clinician Jeff Walter, PhD, LP, MA, are just as enthusiastic about the scope it might have. They want refugees they’ll never see or know about to receive improved care because this toolkit exists.  “I hope that the public, whether they’re refugees themselves or healthcare providers, will engage with this manual and the ideas we reviewed within to work toward improving access and quality of care for refugees,” said Dr. Walter. “Opening up wider discussions about mental health so that care can be more widely offered would also be a great outcome.”

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