Addressing Global Health Needs among Refugee Children and Families in Durham County (2017-2018)

Background

In September 2016, UNICEF released a report estimating that 50 million child refugees and migrants worldwide have been displaced from their countries of origin. The U.S. receives 70,000 refugees annually. From July 2015 to June 2016, Durham received roughly 14% of the 3,000 refugee families resettled to North Carolina.

Evidence suggests that refugee children face unique health challenges. There is a pressing need for the healthcare community to understand how best to deliver accessible physical, emotional and mental healthcare to these children in a culturally appropriate manner that also supports the parents’ wishes and values. As caregiver well-being has been shown to be a large predictor of child well-being, mothers of refugee children must be considered.

Project Description

This Bass Connections project serves as the pilot for an ambitious multidisciplinary effort to develop a culturally appropriate, robust healthcare model that can help reduce health disparities among some of Durham’s newest, most vulnerable community members. In 2017-2018, this project team will study three central questions:

  1. What are the most significant health needs of Durham’s refugee children, as perceived by their families and themselves, as well as by the medical community?
  2. What barriers to accessing care currently perpetuate these health disparities?
  3. How can these barriers be overcome?

The team will be engaged in these six activities:

  1. Conduct an appraisal of existing models of refugee healthcare elsewhere in the U.S., in order to learn from the particular strengths and weaknesses of concurrent efforts.
  2. Investigate current health systems available to refugee families in Durham, scouting the various pathways to care as well as common pitfalls.
  3. Create a research design for a comprehensive needs assessment of physical and mental health needs among refugee children and their caregivers in Durham.
  4. Collect quantitative and qualitative data for needs assessment.
  5. Design and plan a culturally appropriate intervention based on results from prior activities as well as reactions from a meeting with key stakeholders.
  6. Disseminate research deliverables to local refugee care providers and potential funders.

Ultimately, this pilot aims to lay the foundation for a model of healthcare delivery that will meet the multidimensional needs of refugee children the local community.

Team members will design a study that incorporates both quantitative and qualitative measures. This will involve collecting quantitative data from healthcare facilities where refugee children currently seek care, including emergency rooms, clinics and other community health centers. In order to obtain exploratory descriptions of perceived needs among refugee families, the team will gather qualitative data from refugee families who have lived in Durham for a minimum of one year and thus can speak to particular challenges in accessing care from personal experience. Students will work with faculty to conduct in-depth interviews and focus groups with both providers and refugees in the community.

Once the research has been completed, students will work on data analysis, produce a needs assessment and make policy intervention recommendations. This intervention will include a cost-effectiveness analysis as well as stakeholder analysis. Finally, the team will disseminate findings through presentations to Lincoln Community Health Center’s administrative leadership as well as its healthcare team that currently serves refugee populations and Carolina Outreach; video and/or posters to present at Duke’s undergraduate research conference and global health conference; a journal article aimed at North Carolina Medical Journal; and selection of a child refugee mental health screening tool.

Anticipated Outcomes

Report on the scope of current initiatives in refugee care; resource brochure (in multiple languages) for refugees; sampling frame, survey and focus group instruments, IRB proposal; qualitative data from three focus groups and 100 surveys; needs assessment and report on barriers to refugee care; intervention recommendation; video, conference posters, journal article, refugee mental health screening tool

Timing

Summer 2017 – Summer 2018

  • Summer 2017: PhD student and faculty leaders begin Activity 1: review refugee care practices in other cities and produce report on findings
  • Fall 2017: Finish Activity 1; Activity 2: identify available resources in Durham and produce brochure for distribution; Activity 3: design research methods for needs assessment (survey and focus group instruments)
  • Spring 2018: Activity 4: administer surveys and conduct focus groups; Activity 5: data analysis (produce needs assessment and report, develop intervention recommendation); Activity 6a: disseminate research (presentations to stakeholders, academic conferences)
  • Summer 2018: PhD student and faculty leaders conduct Activity 6b: disseminate research (journal article, mental health screening tool); grant applications for external funding

Reflections

How Children without Refuge Celebrate World Refugee Day (B. Emily Esmaili)

Saving Syrian Children (B. Emily Esmaili)

The Franklin Humanities Institute provides additional support for this project.

Faculty/Staff Team Members

Deborah Reisinger, Trinity - Romance Studies*
Nathan Thielman, School of Medicine - Infectious Diseases*
Kathryn Whetten, Sanford School of Public Policy*

Graduate Team Members

Kelly Hunter, Public Policy Studies-PHD
Rita Masese, Global Health - MS

Undergraduate Team Members

Esther Brown
Alexandra Chan, Public Policy Studies (AB)
Maram Elnagheeb, Program II (AB)
Pranav Ganapathy, Economics (AB), Global Health (AB2)
Tyler Lian, Mathematics (BS), Computer Science (BSE2)
Jake Wong, Chemistry (BS)
Ailing Zhou, Public Policy Studies (AB)

Community Team Members

Carolina Outreach
NC Refugee Health Program
Church World Service (CWS)
Lincoln Community Health Center
Center for Child & Family Health

* denotes team leader

Status

Active