Pathways to Wellness: Integrating Refugee Health and Well-Being
This entry has been selected as a finalist in the
Making More Health: Achieving Individual, Family and Community Well-Being competition.
Pathways to Wellness is a new approach to detecting depression, anxiety, and traumatic stress in refugees and connecting them to the care they need to heal. It also trains mental health providers how to effectively deliver services to refugee populations, and partners with refugee communities to better understand and address mental health issues.
About You
About You
First Name
Elizabeth
Last Name
Farmer
Facebook Profile
About Your Organization
Organization Name
Lutheran Community Services Northwest
Organization Website
Organization Phone
206-816-3253
Organization Address
4040 S 188th Street, Suite 200
Organization Country
United States, WA, King County
Country where this project is creating social impact
United States
Is your organization a
Non‐profit/NGO/citizen sector organization
How long has your organization been operating?
More than 5 years
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Innovation
Entry Form title
Pathways to Wellness: Integrating Refugee Health and Well-Being
What change do you want to bring to the world?
Pathways to Wellness is a new approach to detecting depression, anxiety, and traumatic stress in refugees and connecting them to the care they need to heal. It also trains mental health providers how to effectively deliver services to refugee populations, and partners with refugee communities to better understand and address mental health issues.
What are the primary activities of your project?
Refugees come from unimaginable situations—war, torture, being encamped for decades. King County, WA is one of the largest resettlement sites in the United States, with several thousand refugees arriving each year. Many of these newcomers experience significant and ongoing distress related to violence, trauma, and loss. Pathways to Wellness: Integrating Refugee Health and Well-Being offers an innovative model for finding refugees who are hurting the most and ensuring they get connected to the care they need to heal.
Pathways collaborated with refugee communities and a renowned psychiatrist to create a culturally competent, short assessment that detects symptoms of anxiety and depression in refugee populations from different countries. After a rigorous year-long evaluation, the assessment was empirically proven to be reliable and effective, with 35% - 40% of people showing significant distress. The tool is now fully integrated into the physical health screening that every new refugee arrival receives.
Every Iraqi, Bhutanese, Burmese and Karen refugee 14 years of age or older being resettled in King County is now screened for mental health issues, and if they have significant symptoms, connected to an agency for further support. To make sure that providers can effectively deliver services, Pathways provides training and consultation on culturally-responsive assessment, treatment planning, and therapy. The project also partners with refugee communities to design and deliver effective education on stress, resettlement, and mental health.
In 2011, the Pathways tool was cited as an emerging best practice by the Refugee Health Technical Assistance Center. Several refugee resettlement programs from Vancouver, BC, to Phoenix, AZ, and Philadelphia, PA have expressed interest in replicating the model. Our goal is to get Pathways tools into the hands of those serving refugees so that nationwide, more refugees can get the care they need to heal and begin again in their new home in the United States.
What is innovative about your initiative? How is it a new contribution to the field?
Pathways to Wellness is working on enhancing culturally-responsive health services to newly arrived refugees. All refugees are required to have a health screening when they enter the United States. Each state contracts with counties and other medical entities to conduct these screenings. Part of the mandate of the health screening is to assess mental health in some way. However, it has rarely been done because of a number of factors:
- Few evidenced-based tools that effectively capture mental health issues across cultures
- Lack of time from medical staff
- Lack of referral resources
The Pathways to Wellness’ Refugee Health Screening (RHS-1) takes less than 10-minutes to administer, which is critical to primary care staff who have limited time. It is also validated, meaning it has empirically been shown to effectively capture symptoms of depression and anxiety – the most common mental health problems among refugee populations. Because it was designed with refugees and translated through a vigorous community translation process, the RHS-1 is unique in its effectiveness across cultures.
What stage is your project in?
Operating for 1‐5 years
Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.
The United States settles close to 80,000 refugees annually. Refugees come from the direst of situations – war, violence, deprivation and persecution. Violence, fear, deprivation, and loss are catalysts for depression, anxiety and other mental health issues. Research supports the relationship between trauma and poor mental health, and numerous studies prove that refugees are acutely at risk when it comes to mental health issues. Refugees have been found to have ten times the rate of Post-Traumatic Stress Disorder [PTSD] as compared to the general population, and higher rates of mental disorders in general.
When refugees resettle to the U.S. they are given a short duration of assistance (90 days), and are expected to become self-sufficient quickly, with cash and medical assistance ending at eight months. Most refugees will live in poverty for many years after coming to the United States as they attempt to learn English, get employment, and make connections.
Share the story of the founder and what inspired the founder to start this project
Beth Farmer is a social worker with a long-history managing various non-profit projects. In 2006, Beth was employed in resettlement, placing newly arrived refugees into housing, jobs, English classes and more. She noticed a large number of refugees who had symptoms of traumatic stress and depression, but found it almost impossible to find mental health resources. Beth was also surprised that given refugees trauma history, mental health was not considered in any systematic way during resettlement.
Later that year Beth began working for Lutheran Community Services Northwest, and the agency agreed to explore the issue further. LCSNW has a long history of working with refugees as well as a community mental health program. A number of meetings were held with refugees, mutual assistance organizations, primary care doctors and more. A tentative project plan was created and Asian Counseling and Referral Services, Public Health Seattle & King County, and Dr. Michael Hollifield became partners in the project.
The Pathways to Wellness project was later funded in part by the Robert Wood Johnson Foundation and the Bill and Melinda Gates foundation. All tools created through the project will be free and open to the public. The goal is to have mental health be considered for every new arrival refugee, so that these new members to our neighborhoods and communities can get the help they need to heal.
Social Impact
This Entry is about (Issues)
Please describe how your project has been successful and how that success is measured
Pathways has validated a Refugee Health Screening tool, and the tool is currently integrated into Public Health Seattle & King County. This means that now every Nepali, Karen, Burmese and Iraqi refugee that arrives in King County is being screened for symptoms of depression and anxiety and referred to care when needed. Additional translations are forthcoming.
Of those that have been screened, approximately 35% have screened positive for significant symptoms. Over 70% of those referred to care have entered and stayed in services.
The project is a collaborative attempt to create cross-cultural, evidenced-based tools that can be used in any primary care setting. The Pathways project partners are excited about the opportunity to create lasting change in how refugee mental health services are delivered in the United States.
How many people have been impacted by your project?
101-1,000
How many people could be impacted by your project in the next three years?
More than 10,000
Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact
Replication in two new sites and national webinars to inform people about the project and train the on the tools.
Task 1
Market the Pathways tool packets to sites that have refugee health screening programs.
Task 2
Arrange for a training webinar.
Task 3
Create agreements with two provider sites to implement the project.
Identify your 12-month impact milestone
Have 5 sites in the U.S. screen refugees for mental health issues and to have the Centers for Disease Control add mental health screening into its' refugee health care screening guidelines.
Task 1
Discuss project and tools with the Office of Refugee Resettlement's state health directors.
Task 2
Leverage current relationships at the Centers for Disease Control and at ORR to revisit the guidelines for refugee health screening.
Task 3
Continue to provide training webinars through the Refugee Health Technical Assistance project.
How will your project evolve over the next three years?
The project will move to expansion of languages and to provide ongoing technical assistance to replication sites.
Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?
The Pathways project is time limited and so we have thought very strategically about how to achieve replicability and sustainability. Current barriers are state and local budget cuts that tax already overworked providers in refugee health screening programs. The tool was designed to overcome this barrier by being short and simple to use. Currently it takes ten minutes or less and can be self-administered. Screening will be embedded into the existing refugee health screening structures in each locale. Because refugees have medical coupons, they will be able to access community mental health agencies. Training materials and screening tools will be free and open to the public use and embedded into existing technical assistance platforms, including www.EthnoMed.org. Distribution will occur through both these technical assistance platforms and through avenues within the Office of Refugee Resettlement.
Tell us about your partnerships
Pathways has partnered with numerous refugee communities, as well as with Asian Counseling and Referral Services, Public Health Seattle & King County, and Dr. Michael Hollifield. The entire project has been collaborative across systems, from those who use the services to state and national agencies responsible for resettlement and health care. This integrated approach has led to the success and embrace of this project on all levels.
Current annual budget of project, in US dollars
$100,000‐250,000
Explain your selections
Pathways has been supported by the Robert Wood Johnson Foundation, the Bill and Melinda Gates Foundation, United Way King County, the Medina Foundation, and the Seattle Foundation. Pay points within current state contracts have also allowed sites to be reimbursed for mental health screening.
How do you plan to strengthen your project in the next three years?
We have agreements with all sites that implement the project to share data. that way the tools can constantly be evaluated and changed as needed. In addition, the tools will continue to be translated through rigorous back and forth community participatory translation process into new languages. Lastly, we hope to expand our reach to traditional primary care offices and offer this tool as a solid mental health screening for cross-cultural populations.
Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.
PRIMARY
Limited access to preventative tools or resources
SECONDARY
Limited human capital (trained physicians, nurses, etc.)
TERTIARY
Restrictive cultural norms
Please describe how your innovation specifically tackles the barriers listed above.
The screening tool is evidenced-based and has been proven to work well cross-culturally. It is short and easy to use, and a training curriculum has been designed. Because the project has collaborated extensively with refugee communities, the language used in the tools and subsequent referral are non-stigmatizing and educate refugees on what mental health means in the U.S. versus their country.
How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.
PRIMARY
Grown geographic reach: Within host country
SECONDARY
Influenced other organizations and institutions through the spread of best practices
TERTIARY
Enhanced existing impact through addition of complementary services
Please describe which of your growth activities are current or planned for the immediate future.
The goal of Pathways is to enhance culturally-relevant mental health screening for all new refugee arrivals. Pathways believes that we can support other locales in implementing the project's tools so that they can begin to get refugees suffering from mental health symptoms the care they need. By having evidenced-based, easy to use tools, we also hope to influence the inclusion of mental health into standard primary care services. The project would like to complement its existing products by providing ongoing capacity building around best practices in cross-cultural mental health delivery.
Do you collaborate with any of the following: (Check all that apply)
NGOs/Nonprofits.
If yes, how have these collaborations helped your innovation to succeed?
Collaboration has been key. While the output of the project is a refugee health screening and supportive curriculums, it was critical to understand systems and service delivery. To do that, the project has had to look at how health screening is funded, the process of the screening, where refugees could get referred, and how refugee communities might view a mental health referral. All systems had to be engaged for this project to be a successfully designed.
| Attachment | Size |
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| pathways_to_wellness.jpg | 1.08 MB |
 | 26 weeks agoElizabeth Farmer said: Jessi, Thank you for your question. When refugees arrive in the USA they receive Medicaid for 8 months. The vast majority of States ... about this Competition Entry. - read more > |
| 26 weeks agoJessi Wolz said: Congratulations on being selected a Finalist in the Making More Health competition! This is a novel idea in dealing with the unique ... about this Competition Entry. - read more > |
| 28 weeks agoPathways to Wellness: Integrating Refugee Health and Well-Being has been chosen as a finalist in Making More Health: Achieving Individual, Family and Community Well-Being. |
| 36 weeks agoElizabeth Farmer updated this Competition Entry. |
| 37 weeks agoElizabeth Farmer updated this Competition Entry. |
| 37 weeks agoElizabeth Farmer updated this Competition Entry. |
| 37 weeks agoElizabeth Farmer submitted this idea. |
