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.

Related Courses

CLAC (Culture and Languages Across the Curriculum) in Swahili, Arabic and French

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

Student Opportunities

The team will be comprised of five undergraduates and three graduate students (one medical student, one master’s student and one PhD student). Students will play an integral role in every project activity, and will learn about the research process from study design to data collection and analysis to presenting findings and program evaluation. The team will meet biweekly during the academic year; student attendance is mandatory. Students will facilitate many of these meetings to ensure collaborative learning.

Students will engage with local stakeholders, collaborate on field projects, learn formative survey development skills, build qualitative and quantitative analytical skills and engage in data interpretation of sociocultural and economic determinants of health. They will also develop intercultural communicative competencies.

A graduate student project manager will be in charge of the budget and other duties, such as maintaining project documentation, coordinating meetings and project work and coordinating among the faculty and community partners. Graduate students will gain leadership experience by guiding the teams of undergraduates, helping with their training in research and overseeing their fieldwork.

During Summer 2017, the PhD student will work with the faculty on setting up the project so that the team is ready to begin once the rest of the students arrive in Fall 2017. Academic year responsibilities include coordinating with students at all levels to ensure tasks are completed on time; mentoring students on survey design, implementation, writing and presenting research; and writing/submitting the IRB proposal. During Summer 2018, the PhD student will focus on finalizing any remaining tasks from the pilot project and writing grant proposals for future funding.

Priority will be given to applicants who speak a relevant language (French, Arabic, Karen, Swahili, Dari) or have taken CLAC courses (or other courses that emphasize intercultural competencies); are experienced in research methods; have completed global health courses such as research methods in global health, global health ethics or refugee studies; and/or demonstrate intercultural competencies (have experience studying abroad or working with minority communities locally). Students from psychology, medicine, anthropology, nursing, policy, global health, business, linguistics, sociology and bioethics are especially encouraged to apply.

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

Crediting

Independent study credit available for fall and spring semesters; summer funding

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

Emily Esmaili, Graduate School - MA in Bioethics and Science Policy

Community Team Members

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

* denotes team leader

Status

Active, New