San Diego County is home to many refugees. According to the California Department of Social Services, between the year of 1975 to 2017, 86,598 refugees came to San Diego County. The rate of arrival has increased in recent years. In 2017, 1532 individuals arrived.
A recent systematic review from a national cohort which included 779 refugee children found that psychiatric illness disproportionately impacts this group. In particular, and not surprisingly, rates of PTSD, depression, and anxiety were higher than expected. Prevalence of PTSD was 22.71%, depression 13.81%, and anxiety disorders 15.77%.
These elevated prevalence rates highlight the importance of multimodal intervention strategies for this vulnerable population to include screening for both general behavioral health problems and for overt psychiatric disorders in pediatric settings when refugee families come for care.
As with many at-risk populations, mental health service programs for refugee youth and families often encounter challenges in engaging the population. Amidst the multitude of challenges faced by these families include: adjustment to a new culture, language barriers, economic challenges, and cultural barriers to family engagement. Coupled with the perceived stigma and demands of pursuing treatment for mental health problems timely intervention for these problems are often put on the back burner by refugee families. In the face of these multiple issues, even sensitive healthcare providers may not adequately prioritize attention for timely and needed behavioral interventions for the youth and for their parents, many of whom have face similar emotional challenges.
Integrating behavioral health care within a nexus of community-based and family-focused services and supports in coordination with other care management activities for basic needs is generally seen as a best practice for refugee families (McNeeley et al, 2019). Actualizing this ideal remains a challenge in most communities.
Efforts to screen patients and raise awareness about the prevalence of psychiatric illness within primary care settings will increase our community’s opportunities to support refugee families. We know that building a trusting relationship with our patients, increasing access to basic needs and targeting resiliency factors makes a difference. Engagement of pediatric providers in screening, care coordination, treatment and appropriate referral activities can provide an important impetus and an access point to care when behavioral health intervention is indicated.
In San Diego, the following agencies provide services to the refugee communities:
San Diego County Health & Human Services Agency Office of Refugee Coordination: https://www.sandiegocounty.gov/content/sdc/hhsa/programs/sd/community_action_partnership/OfficeofRefugeeCoord.html
International Rescue Committee: https://www.rescue.org/united-states/san-diego-ca
Jewish Family Services: https://jfssd.org/our-services/refugees-immigration/refugee/
San Ysidro Health Center (Chaldean/Iraqi): http://www.syhc.org/cmss-social-services/
Catholic Charities: https://www.ccdsd.org/refugee-services
Border Angels: https://www.borderangels.org/about-us/
SD County Behavioral Health Services: https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/bhs/TRL/TRL%20Section%203/BHS-CYF%20Outpatient%20Clinics%204-4-19.pdf
Blackmore R, Gray KM, Boyle JA, Fazel M, Ranasinha S, Fitzgerald G, Misso M, Gibson-Helm M (2019). Systematic Review and Meta-Analysis: The Prevalence of Mental Illness in Child and Adolescent Refugees and Asylum Seekers. J Am Acad Child Adolesc Psychiatry. 2019 Nov 25. pii: S0890-8567(19)32175-6. doi: 10.1016/j.jaac.2019.11.011.
California Department of Social Services (2017) Refugee Programs Bureau FFY 2017 Refugee Population Data Snapshot By County. https://www.cdss.ca.gov/Portals/9/Refugee/Arrivals/2017_Comprehensive_Chart.pdf?ver=2017-12-27-111308-203
McNeeley, C., Sprecher K., Bates-Fredl, D., Price, O., Allen, C., (2019). Identifying Essential Components of School-Linked Mental Health Services for Refugee and Immigrant Children : A Comparative Case Study. Journal of School Health 2019 1–12. https://doi.org/10.1111/josh.12845