An issue of access: delivering equitable health care for newly arrived refugee children in Australia

Exploring factors that influence vaccination uptake for children with refugee backgrounds: An interpretive description study of primary healthcare providers' perspectives

BACKGROUND

Children with refugee backgrounds are at high risk of acquiring vaccine preventable diseases (VPDs) due to a complex set of factors, one being under-immunisation. In Aotearoa New Zealand (NZ), reported age-appropriate vaccination rates are suboptimal among children with refugee backgrounds.

METHODS

A qualitative interpretive description study was undertaken to explore factors associated with access and uptake of immunisations and develop strategies to improve age-appropriate vaccinations among refugee children post-resettlement in NZ. Semi-structured interviews were conducted with healthcare providers (nurses and doctors) (N = 14) across seven resettlement locations in NZ. Collected data was transcribed verbatim and thematically analysed.

RESULTS

Five themes were derived from the data that demonstrate the interrelated factors that influence vaccination uptake across the refugee caregiver, health provider and system levels. Providers discussed how caregivers' competing resettlement priorities and challenges early in the resettlement phase influenced their knowledge and access of vaccines and health services in NZ. Providers' knowledge of refugee caregivers' concerns was seen as a driver for positive change in forming therapeutic relationships with, and delivering health services to, former refugees. They discussed system level factors that influence access to and provision of immunisation services, such as resourcing, resettlement policies, system inefficiencies and missed opportunities. Emphasis was placed on communication between patients and providers to facilitate positive immunisation experiences. Overwhelming, providers displayed high motivation to improve immunisation services. Strategies were suggested to overcome identified barriers and included the provision of culturally and linguistically appropriate resources, education campaigns, reducing access barriers (e.g., after-hours clinics), and improving system efficiencies.

CONCLUSIONS

These findings highlight root factors that impact immunisation uptake and experiences among children with refugee backgrounds. To reduce the burden of VPDs, broad system level changes are required to address the barriers to vaccine uptake faced by both families of refugee backgrounds and health providers.

Community paediatric clinics and their role in supporting developmental outcomes and services for children living in disadvantaged communities

Children living in disadvantaged communities have substantially increased risk for deleterious health and developmental outcomes. A considerable proportion of developmental delay is avoidable; however if children do not receive appropriate treatment within this critical period, damage can be irreparable. Community paediatric clinics provide medical and developmental assessment; deliver health promotion services, counselling, and advice to caregivers; and referral to services. The aim of this study was to systematically search, appraise, and synthesise the literature exploring the role of community paediatric clinics in supporting developmental outcomes and services for children living in disadvantaged communities. Electronic databases were searched using a carefully developed search strategy. Validated tools and appropriate guidelines assessed quality and confidence in evidence. Data analysis and mixed-methods synthesis was guided by the Segregated Framework for Mixed-Method Systematic Reviews. Eighteen studies were selected for inclusion. Areas of emphasis in the literature include the identification and monitoring of developmental delay; engagement of vulnerable families; relational working with children, families, and local services; referral to early intervention services; parental empowerment, practitioner capacity building; and tackling barriers to healthcare access. Through use of a child and family-centred model of care, community paediatric clinics can better meet the needs of vulnerable populations.

Infectious disease screening outcomes and reducing barriers to care for unaccompanied asylum-seeking children: a single-centre retrospective clinical analysis

OBJECTIVE

Evaluate the Unity Clinic's infectious disease screening programme for unaccompanied asylum-seeking children (UASC), calculate rates of infection and identify further health needs.

DESIGN

Retrospective audit of electronic patient data.

SETTING AND PATIENTS

UASC who attended the Unity Clinic between 1 November 2019 and 22 March 2022.

MAIN OUTCOME MEASURES

Baseline demographics, social, mental health and journey details, infection screening and investigation results.

RESULTS

155 UASC were reviewed: 89% (138 of 155) male, median age 17 years (IQR 16-17). Most frequent countries of origin were Sudan, Eritrea and Afghanistan. Median duration of travel to the UK (n=79) was 2 years (IQR 0.5-4); 35.6% (47 of 132) arrived by boat and 54.5% (72 of 132) by road. 44.8% (69 of 154) had one or more positive infection screening results: 22.7% (35 of 154) and 1.3% (2 of 154) positive for latent and active tuberculosis, respectively; 4.6% (7 of 152) chronic active hepatitis B and 17.1% (26 of 152) for past infection; 1.3% (2 of 154) for HIV; 13.0% (19 of 146) for Strongyloides. There were three cases of syphilis (n=152; 2.0%) and one chlamydia (n=148; 0.7%)-none of whom disclosed prior sexual activity during screening. 39.6% (61 of 154) and 27.9% (43/154) reported disturbances to mood or sleep, respectively. 55.2% (85 of 154) disclosed traumatic incidents during and/or prior to their journey, including physical and sexual assault.

CONCLUSIONS

The Unity Clinic provides a thorough infectious disease screening service for UASC following national guidance. Results highlight the need for universal, non-judgemental screening for sexually transmitted infections, as targeted screening would not identify positive cases. High rates of well-being issues and previous abuse emphasise the need for multidisciplinary, collaborative approaches to care.

Factors influencing refugees' willingness to accept COVID-19 vaccines in Greater Sydney: a qualitative study

OBJECTIVES

Achieving high vaccination coverage is a critical strategy to reducing the spread of COVID-19 infection. This study, undertaken before the Delta variant outbreak, aimed to understand potential drivers and barriers influencing COVID-19 vaccine uptake for refugees.

METHODS

Four focus group interviews were conducted with 37 refugees from four language groups (Arabic, Dari, Dinka and Karen). Data were analysed thematically.

RESULTS

Willingness to accept COVID-19 vaccines was associated with participants' perceptions of disease severity, and benefits such as increased immunity against COVID-19 disease and prevention of the spread of the disease. Cues for increasing individual willingness to get vaccinated included obtaining information from trusted sources and community engagement. By contrast, information gaps on vaccines compounded by misinformation on social media contributed to a reluctance to be vaccinated.

CONCLUSION

As this study was conducted before the Delta variant outbreak, participants' stance on COVID-19 vaccines may have changed. However, addressing vaccine literacy needs for this group remains an on-going priority. Health promotion initiatives must be tailored to the different socio-cultural contexts of each community.

IMPLICATIONS FOR PUBLIC HEALTH

Engagement with refugee populations is critical for optimising access and uptake of vaccines to protect health, prevent death and ensure that control of the pandemic is equitable. This may also provide valuable public health lessons for other marginalised populations.

Community-based interventions for improving mental health in refugee children and adolescents in high-income countries

BACKGROUND

An unprecedented number of people around the world are experiencing forced displacement due to natural or man-made events. More than 50% of refugees worldwide are children or adolescents. In addition to the challenges of settling in a new country, many have witnessed or experienced traumatic events. Therefore, refugee children and adolescents are at risk of developing mental health problems such as post-traumatic stress disorder, and require appropriate and effective support within communities.

OBJECTIVES

To assess the effectiveness and acceptability of community-based interventions (RCTs only) in comparison with controls (no treatment, waiting list, alternative treatment) for preventing and treating mental health problems (major depression, anxiety, post-traumatic stress disorder, psychological distress) and improving mental health in refugee children and adolescents in high-income countries.

SEARCH METHODS

Databases searches included the Cochrane Common Mental Disorders Controlled Trials Register (all available years), CENTRAL/CDSR (2021, Issue 2), Ovid MEDLINE, Embase, six other databases, and two trials registries to 21 February 2021. We checked reference lists of included study reports.  SELECTION CRITERIA: Studies of any design were eligible as long as they included child or adolescent refugees and evaluated a community-based mental health intervention in a high-income country. At a second stage, we selected randomised controlled trials.

DATA COLLECTION AND ANALYSIS

For randomised controlled trials, we extracted data relating to the study and participant characteristics, and outcome data relating to the results of the trial. For studies using other evaluation methods, we extracted data relating to the study and participant characteristics. W derived evidence on the efficacy and availability of interventions from the randomised controlled trials only. Data were synthesised narratively.

MAIN RESULTS

We screened 5005 records and sought full-text manuscripts of 62 relevant records. Three randomised controlled trials were included in this review. Key concerns in the risk of bias assessments included a lack of clarity about the randomisation process, potential for bias is outcome measurement, and risk of bias in the selection of results. Primary outcomes There was no evidence of an effect of community-based interventions when compared with a waiting list for symptoms of post-traumatic stress (mean difference (MD) -1.46, 95% confidence interval (CI) -6.78 to 3.86: 1 study; low-certainty evidence), symptoms of depression (MD 0.26, 95% CI -2.15 to 2.67: 1 study; low-certainty evidence), and psychological distress (MD -10.5, 95% CI -47.94 to 26.94; 1 study; very low-certainty evidence).  There were no data on adverse events. Secondary outcomes Three trials reported on short-term changes in child behaviour, using different measures, and found no evidence of an effect of the intervention versus a waiting list (low to very low certainty). None of the trials reported on quality of life or well-being, participation and functioning, or participant satisfaction.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the efficacy and acceptability of community-based mental health interventions for refugee children and adolescents.

Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges

Background

About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia.

Methods

We conducted a scoping review of the literature published from 1^st January 1970 to 30^th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model.

Results

A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations.

Conclusions

People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13256-z.

Response to language barriers with patients from refugee background in general practice in Australia: findings from the OPTIMISE study

Background

Language is a barrier to many patients from refugee backgrounds accessing and receiving quality primary health care. This paper examines the way general practices address these barriers and how this changed following a practice facilitation intervention.

Methods

The OPTIMISE study was a stepped wedge cluster randomised trial set within 31 general practices in three urban regions in Australia with high refugee settlement. It involved a practice facilitation intervention addressing interpreter engagement as one of four core intervention areas. This paper analysed quantitative and qualitative data from the practices and 55 general practitioners from these, collected at baseline and after 6 months during which only those assigned to the early group received the intervention.

Results

Many practices (71 %) had at least one GP who spoke a language spoken by recent humanitarian entrants. At baseline, 48 % of practices reported using the government funded Translating and Interpreting Service (TIS). The role of reception staff in assessing and recording the language and interpreter needs of patients was well defined. However, they lacked effective systems to share the information with clinicians. After the intervention, the number of practices using the TIS increased. However, family members and friends continued to be used to interpret with GPs reporting patients preferred this approach. The extra time required to arrange and use interpreting services remained a major barrier.

Conclusions

In this study a whole of practice facilitation intervention resulted in improvements in procedures for and engagement of interpreters. However, there were barriers such as the extra time required, and family members continued to be used. Based on these findings, further effort is needed to reduce the administrative burden and GP’s opportunity cost needed to engage interpreters, to provide training for all staff on when and how to work with interpreters and discuss and respond to patient concerns about interpreting services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06884-5.

Male unaccompanied refugee minors' perceptions of relationships and information about sexual health in Sweden - 'it feels like you've been in prison and then set free'

Unaccompanied refugee minors represent a potentially vulnerable group regarding sexual and reproductive health and rights, particularly due to the circumstances surrounding their migration. Research is scarce about the sexual and reproductive health and rights needs of unaccompanied minors, many of whom come from countries with limited access to information about sexual and reproductive health and rights. This study aimed to gain a deeper understanding of how unaccompanied minors in Sweden experience romantic and/or sexual relationships and their need for sexual and reproductive health and rights information. In-depth interviews were conducted with eight young men who had sought asylum in Sweden as unaccompanied minors. Qualitative content analysis identified three themes: "being confronted with a different type of 'sexual' society", "becoming ready for information about sexual and reproductive health and rights" and "moving forward as a person 'in the know'". These themes illustrate the process of relating to a society with different norms and beliefs about relationships and sexual and reproductive health and rights information than in the country of origin. The Young men's difficulties in taking the initiative when talking about sexual and reproductive health and rights in combination with their perceived strong self-efficacy in finding sexual and reproductive health and rights information is noteworthy and should be considered by health professionals aiming to reach this group. The findings highlight the importance of access to formal sexual and reproductive health and rights information for unaccompanied minors and young migrants with similar needs.

Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews

Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals' knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.

Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data

Background

Asylum seekers are a vulnerable group with special needs in health care due to their migration history and pre-, peri- and postmigratory social determinants of health. However, in Germany access to health care is restricted for asylum seekers by law and administrative regulations.

Methods

Using claims data generated in the billing process of health care services provided to asylum seekers, we explore their utilization of health care services in the outpatient sector. We describe the utilization of outpatient specialties, prevalences of diagnoses, prescribed drugs and other health care services, as well as total costs of health care provision.

Results

The estimated prevalence for visiting an ambulatory physician at least once per year was 67.5% [95%-Confidence-Interval (CI): 65.1–69.9%], with a notably higher prevalence for women than men. The diagnoses with the highest one-year prevalence were “Acute upper respiratory infections” (16.1% [14.5–18.0%]), “Abdominal and pelvic pain” (15.6% [13.9–17.4%]) and “Dorsalgia” (13.8% [12.2–15.5%]). A total of 21% of all prescriptions were for common pain killers. Women received more diagnoses across most diagnosis groups and prescribed drugs from all types than men. Less than half (45.3%) of all health care costs were generated in the outpatient sector.

Conclusion

The analysis of claims data held in a municipal social services office is a novel approach to gain better insight into asylum seekers’ utilization of health services on an individual level. Compared to regularly insured patients, four characteristics in health care utilization by asylum seekers were identified: low utilization of ambulatory physicians; a gender gap in almost all services, with higher utilization by women; frequent prescription of pain killers; and a low proportion of overall health care costs generated in the outpatient sector. Further research is needed to describe structural and individual factors producing these anomalies.

Potential Impact of COVID-19 on Recently Resettled Refugee Populations in the United States and Canada: Perspectives of Refugee Healthcare Providers

Recently resettled refugee populations may be at greater risk for exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a virus that causes coronavirus 2019 (COVID-19), and face unique challenges in following recommendations to protect their health. Several factors place resettled refugees at elevated risk for exposure to persons with COVID-19 or increased severity of COVID-19: being more likely to experience poverty and live in crowded housing, being employed in less protected, service-sector jobs, experiencing language and health care access barriers, and having higher rates of co-morbidities. In preparing for and managing COVID-19, resettled refugees encounter similar barriers to those of other racial or ethnic minority populations, which may then be exacerbated by unique barriers experienced from being a refugee. Key recommendations for resettlement and healthcare providers include analyzing sociodemographic data about refugee patients, documenting and resolving barriers faced by refugees, developing refugee-specific outreach plans, using culturally and linguistically appropriate resources, ensuring medical interpretation availability, and leveraging virtual platforms along with nontraditional community partners to disseminate COVID-19 messaging.

Parents' ability to access community health occupational therapy services in a disadvantaged area: A proof of concept study

INTRODUCTION

In New South Wales, children from disadvantaged backgrounds have poorer health outcomes and reduced access to health services than their more advantaged counterparts. This study aimed to identify barriers and enablers to accessing child and family occupational therapy services in a disadvantaged area.

METHODS

This was a mixed methods study that included: (a) a retrospective analysis of de-identified routinely collected Community Health service utilisation data from 2016 to 2017, and a (b) face to face interview guided survey with parents and carers.

RESULTS

The retrospective data analysis showed outreach at the targeted suburbs' Early Childhood Health Centres (ECHC) improved attendance for families living in these suburbs. Parents' responses indicated that they were able to access the Community Health Centre (CHC) and certain barriers to accessing the service remain, including difficulty in parking and not having a license or car to attend appointments. Low health literacy was also a barrier to accessing health appointments as parents were unaware of the range of services provided at CHC, did not know how to make appointments, or that these services did not generate out-of-pocket expenses to clients. Conversely, enablers that would make it easier for parents to attend appointments include the provision of home visits, after hours and weekend appointments, and outreach such as delivering services in community spaces such as the ECHCs, library, or mosque.

CONCLUSION

This research suggests that outreach occupational therapy services are valued by families in this disadvantaged area and contribute towards improving access to allied health services for disadvantaged families with young children. However, additional work is required to increase awareness among disadvantaged families on the role of allied health in improving child development outcomes and to reduce some of the transport and logistical issues that can reduce access to health care.

Renal Crisis in Children during Armed Conflict

Armed conflicts continue to occur in some regions of the globe, mostly in developing countries. These man-made disasters affect all segments of the population; however, some groups are more vulnerable and suffer more seriously from the unfavorable consequences of such conflicts. Among these, the pediatric population deserves special attention because they cannot protect themselves, and hence carry a higher threat of injuries and probability of death during conflicts. In addition, children who do survive the disaster are more prone to exploitation. Pediatric victims, including those who sustain acute kidney injury or those suffering from chronic kidney disease before armed conflicts, face higher risks of morbidity and mortality as a result of treatment problems, specifically limited dialysis options. Displaced children, forced to flee their homes as a result of armed conflicts, are also at risk for various health problems because they may not find ideal circumstances for disease treatment. Making preparations in anticipation of armed conflicts, such as disaster-relief scenarios and action plans, may be useful to decrease the death toll in these children, who are dependent on their caregivers for survival. Adopting principles of disaster nephrology may contribute to improved survival chances of pediatric kidney patients in chaotic circumstances.

Pregnancy outcomes in asylum seekers in the North of the Netherlands: a retrospective documentary analysis

BACKGROUND

With more than 20,000 asylum seekers arriving every year, healthcare for this population has become an important issue. Pregnant asylum seekers seem to be at risk of poor pregnancy outcomes. This study aimed to assess the difference in pregnancy outcomes between asylum seekers and the local Dutch population and to identify potential substandard factors of care.

METHODS

Using a retrospective study design we compared pregnancy outcomes of asylum-seeking and Dutch women who gave birth in a northern region of the Netherlands between January 2012 and December 2016. The following data were compared: perinatal mortality, maternal mortality, gestational age at delivery, preterm delivery, birth weight, small for gestational age children, APGAR score, intrauterine foetal death, mode of delivery and the need for pain medication. Cases of perinatal mortality in asylum seekers were reviewed for potential substandard factors.

RESULTS

A total of 344 Asylum-seeking women and 2323 Dutch women were included. Asylum seekers had a higher rate of perinatal mortality (3.2% vs. 0.6%, p = 0.000) including a higher rate of intrauterine foetal death (2.3% vs. 0.2%, p = 0.000), higher gestational age at birth (39 + 4 vs. 38 + 6 weeks, p = 0.000), labour was less often induced (36.9 vs. 43.8, p = 0.016), postnatal hospitalization was longer (2.24 vs. 1.72 days p = 0.006) and they received more opioid analgesics (27.3% vs. 22%, p = 0.029). Babies born from asylum-seeking women had lower birth weights (3265 vs. 3385 g, p = 0.000) and were more often small for gestational age (13.9% vs. 8.4%, p = 0.002). Multivariate analysis showed that the increased risk of perinatal mortality in asylum-seeking women was independent of parity, birth weight and gestational age at birth. Review of the perinatal mortality cases in asylum seekers revealed possible substandard factors, such as late initiation of antenatal care, missed appointments because of transportation problems, not recognising alarm symptoms, not knowing who to contact and transfer to other locations during pregnancy.

CONCLUSION

Pregnant asylum seekers have an increased risk of adverse pregnancy outcomes. More research is needed to identify which specific risk factors are involved in poor perinatal outcomes in asylum seekers and to identify strategies to improve perinatal care for this group of vulnerable women.

Dental services provided to Syrian refugee children in Jordan: A retrospective study

BACKGROUND

Little is known about oral health care in Syrian refugee children in host countries. We describe the pattern and nature of oral healthcare service provided to Syrian refugee children in Jordan METHOD: The clinical records of 3 to 7-year-old children who attended dental clinics at Zaatari refugee camp over a period of 8 months were retrieved and analyzed.

RESULTS

Records of 259 children were analyzed. The mean age of the study sample was 5.6 years, and all included children were born in Zaatari refugee camp. Most children (66%; n = 171) presented because of dental pain and/or dental infection. Dental extraction was the most common procedure (55%), followed by dental fillings (25%), pulpotomy (10.6%), and stainless steel crown (9.2%). Most patients (75.3%; n = 195) received only one dental procedure during their stay in the camp, and no significant correlation between age and number of dental procedures was found.

CONCLUSIONS

Oral health care is not a priority in this population, and the available capacity for dental services is insufficient. Dental health programs should be implemented to improve refugee dental care.

The oral health of refugees: Issues and challenges arising from a case series analysis

OBJECTIVES

Little is known of the oral health of refugees globally. The objective of this study was to characterize the oral health and care-seeking behaviours of refugees by investigating patterns of dental services provided to Syrian refugees in Jordan and their association with their oral health status.

METHODS

Clinical records from 444 patients who had received dental treatment over a 9-month period were retrieved and analysed. Collected data included gender, age and the type and number of treatment procedures provided for each patient.

RESULTS

Of the total sample (51.8% female; 48.2% male; aged 18-60 years), pain was the most common presenting complaint (73.0%), with poor aesthetics (17.1%) the second most common presenting complaint. About 63.3% of patients received only one procedure due to patients' lack of follow-up. Over half (54.5%) of dental treatments carried out were extractions, 74.1% of which were due to dental caries; 27.4% were fillings. Endodontic treatment was the least provided procedure (18.2%).

CONCLUSIONS

The oral health status of Syrian refugees is a major concern, given the often-deplorable living conditions in camps and limited, often inadequate access to oral healthcare services. This situation dramatically negatively affects a refugee's oral health. There is an urgent need to provide targeted dental services for this at-risk population. Additional research is warranted on refugees worldwide, and on the provision of appropriate interventions to enable optimal oral health for this population.

The Rohingya Little Local: exploring innovative models of refugee engagement in Sydney, Australia

The Rohingya community living in the City of Canterbury-Bankstown in Sydney have been identified as a priority population with complex health needs. As part of ongoing work, AU$10000 was provided to the community to address important, self-determined, health priorities through the Can Get Health in Canterbury program. Program staff worked with community members to support the planning and implementation of two community-led events: a soccer (football) tournament and a picnic day. This paper explores the potential for this funding model and the effect of the project on both the community and health services. Data were qualitatively analysed using a range of data sources within the project. These included, attendance sheets, meeting minutes, qualitative field notes, staff reflections and transcripts of focus group and individual discussions. This analysis identified that the project: (1) enabled community empowerment and collective control over funding decisions relating to their health; (2) supported social connection among the Australian Rohingya community; (3) built capacity in the community welfare organisation –Burmese Rohingya Community Australia; and (4) enabled reflective practice and learnings. This paper presents an innovative model for engaging with refugee communities. Although this project was a pilot in the Canterbury community, it provides knowledge and learnings on the engagement of refugee communities with the health system in Australia.

A house is not a home: Modeling the effects of social support and connection within resettled refugee populations

AIM

The U.S. resettlement program currently resettles refugees in communities of similar or the same ethnic background known as like-ethnic communities. This practice provides resettled refugees with a familiar community who may be able to provide support through the difficult resettlement process. However, by associating with a like-ethnic community, resettled refugees may limit interaction with the host community, which may have subsequent adverse effects on well-being.

METHODS

This study examined whether satisfaction with community support is moderated by a premigration factor (trauma history) or a postmigration factor (English fluency) in predicting depressive symptoms in a resettled refugee community (N = 179). Four moderation models were analyzed and compared.

RESULTS

The model in which English fluency moderated the relationship between satisfaction with community support and depressive symptoms had the best overall model fit. In addition, trauma history was found to also be a meaningful but secondary moderator within this relationship. English fluency and trauma history within this study did not significantly interact.

CONCLUSION

These results highlight the importance of early English language lessons and community support during resettlement. Further, they emphasize the need to integrate refugees with individuals from similar backgrounds, as well as with host communities throughout resettlement.

How can healthcare professionals address poor health service utilisation among refugees after resettlement in Australia? A narrative systematic review of recent evidence

This systematic narrative review of qualitative studies examined health service barriers and facilitators in Australia for refugees after resettlement. Twelve qualitative studies published between 2006 and 2017 involving more than 500 participants were included in the review. Approximately half of all participants were healthcare professionals. A meta-synthesis approach was used to compare and combine findings from across studies. Few facilitators were identified. Barriers to accessing health services were commonly attributed to refugees, but several barriers were associated with healthcare professionals and health services. Barriers attributed to healthcare professionals included gaps in knowledge and skills; poor cultural competency; poor communication skills; and time constraints. Understanding such barriers is the first step in developing strategies to overcome them. The skills and knowledge of healthcare professionals are important to facilitating access to healthcare among this vulnerable population.

The oral health status of Syrian refugee children in Jordan: An exploratory study

OBJECTIVES

To examine the oral health status and dental treatment needs of children Syrian refugees in Jordan.

METHODS

A convenience sample of Syrian refugee children who aged between 6 and 12 years at al-Zaatari camp was used for the purpose of this study. Examination was performed according to the method proposed by WHO. DMFT and gingival indices were examined and reported by a trained dentist.

RESULTS

A total of 125 children were examined. The mean DMFT score was 3.64 ± 9.83, and the mean dmft score was 2.98 ± 4.7. More than half of children (50.4%) were found to have high caries risk according to CAMBRA scale. Most of the DMFT score was contributed by decayed and missing teeth. Nearly, half of children (44.8%) showed fluorosis and almost all children had chronic gingivitis. More than half of the participants (55.2%) reported that they needed dental treatment during their stay at the camp, but only half (52%) received treatment mainly tooth extraction and prescription of medication. Only 6.4% of children received conservative dental treatment.

CONCLUSION

Syrian refugee children in Jordan were found to have high levels of unmet dental needs. Accessibility of dental services was found to be a primary barrier to care.

Reducing infectious disease inequities among migrants

BACKGROUND

migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies.

METHODS

This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care.

RESULTS

For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials.

CONCLUSIONS

Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.

The Effects of Armed Conflict on Children

More than 1 in 10 children worldwide are affected by armed conflict. The effects are both direct and indirect and are associated with immediate and long-term harm. The direct effects of conflict include death, physical and psychological trauma, and displacement. Indirect effects are related to a large number of factors, including inadequate and unsafe living conditions, environmental hazards, caregiver mental health, separation from family, displacement-related health risks, and the destruction of health, public health, education, and economic infrastructure. Children and health workers are targeted by combatants during attacks, and children are recruited or forced to take part in combat in a variety of ways. Armed conflict is both a toxic stress and a significant social determinant of child health. In this Technical Report, we review the available knowledge on the effects of armed conflict on children and support the recommendations in the accompanying Policy Statement on children and armed conflict.

Sexual and reproductive healthcare for women asylum seekers in Switzerland: a multi-method evaluation

BACKGROUND

Forced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers' health. Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study's objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.

METHODS

The study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.

RESULTS

The accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.

CONCLUSIONS

The standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.

Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists

Purpose

Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin.

Methods

Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board.

Results

Four overarching themes regarding health care for refugee patients were identified: 1) difficulty balancing the dynamic of autonomy versus support for refugees; 2) educational needs of refugee families outpacing available resources; 3) challenges for refugees developing trust; and 4) diversity of cultures, education levels, and experiences among refugee families. Language barriers in accessing health care services and insufficient time to meet educational needs of refugees were major challenges outside of the clinic visit setting. Poor health literacy and difficulties communicating health needs and building trust within the interactive triad of refugee, physician, and interpreter impacted clinic visits.

Conclusions

Refugee patients and other participants in refugee care work to navigate a complicated path to equitable health care for a vulnerable population. Continued pursuit of strategies that increase time allocation, education, and support for all parties are needed as we seek to improve health outcomes for newly arrived refugee families.

Challenges in immunisation service delivery for refugees in Australia: A health system perspective

BACKGROUND

Refugees are at risk of being under-immunised in their countries of origin, in transit and post-resettlement in Australia. Whilst studies have focused on identifying barriers to accessibility of health services among refugees, few focus on providers' perspectives on immunisation service delivery to this group. Health service providers are well placed to provide insights into the pragmatic challenges associated with refugee health service delivery, which can be useful in identifying strategies aimed at improving immunisation coverage among this group.

METHODS

A qualitative study involving 30 semi-structured interviews was undertaken with key stakeholders in immunisation service delivery across all States and Territories in Australia between December 2014 and December 2015. Thematic analysis was undertaken.

RESULTS

Variability in accessing program funding and vaccines, lack of a national policy for catch-up vaccination, unclear roles and responsibilities for catch-up, a lack of a central immunisation register and insufficient training among general practitioners were seen as the main challenges impacting on immunisation service delivery for refugees.

CONCLUSIONS

This study provides insight into the challenges that impact on effective immunisation service delivery for refugees. Deliberate strategies such as national funding for relevant vaccines, improved data collection nationally and increased guidance for general practitioners on catch-up immunisation for refugees would help to ensure equitable access across all age groups.

Screening and Primary Care Access for Newly Arrived Paediatric Refugees in Regional Australia: A 5 year Cross-sectional Analysis (2007-12)

This study aimed to determine the prevalence of health conditions in newly arrived refugee children and access to timely heath screening. Methods: Cross-sectional data from screening of refugee children in regional Australia (2007-12) were analysed for health conditions and timeliness of primary care access. The health of 376 newly arrived refugee children (0-15 years) was assessed. Refugee children came from African (45%), Southeast Asian (29%) and Eastern Mediterranean (10%) regions. Access to primary care screening was present in 367 children (97% of arrivals). Completion of all recommended screening tests was 72%. Of 188 children with arrival and screening dates recorded, 88% were screened within 1 month and 96% within 6 months of arrival. Timely access of remaining children could not be assessed. Conclusion: Primary care was highly accessible to almost all newly arrived refugee children. Health screening was timely in those children with complete medical records.

Explaining culturally and linguistically diverse (CALD) parents' access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the 'Watch Me Grow' study

Background

Regular health visits for parents with young children provide an opportunity for developmental surveillance and anticipatory guidance regarding common childhood problems and help to achieve optimal developmental progress prior to school entry. However, there are few published reports from Australian culturally and linguistically diverse (CALD) communities exploring parents’ experiences for accessing child health surveillance programs. This paper aims to describe and explain parental experiences for accessing developmental surveillance and anticipatory guidance for children.

Methods

Qualitative data was obtained from 6 focus groups (33 parents) and seven in-depth interviews of CALD parents recruited from an area of relative disadvantage in Sydney. Thematic analysis of data was conducted using an ecological framework.

Results

An overarching theme of “awareness-beliefs-choices” was found to explain parents’ experiences of accessing primary health care services for children. “Awareness” situated within the meso-and macro-systems explained parents knowledge of where and what primary health services were available to access for their children. Opportunities for families to obtain this information existed at the time of birth in Australian hospitals, but for newly arrived immigrants with young children, community linkages with family and friends, and general practitioner (GPs) were most important. “Beliefs” situated within the microsystems included parents’ understanding of their children’s development, in particular what they considered to be “normal” or “abnormal”. Parental “choices”, situated within meso-systems and chronosystems, related to their choices of service providers, which were based on the proximity, continuity, purpose of visit, language spoken by the provider and past experience of a service.

Conclusions

CALD parents have diverse experiences with primary health care providers which are influenced by their awareness of available services in the context of their duration of stay in Australia. The role of the general practitioner, with language concordance, suggests the importance of diversity within the primary care health workforce in this region. There is a need for ongoing cultural competence training of health professionals and provisions need to be made to support frequent use of interpreters at general practices in Australia.

[The health of children and adolescents from families with insecure residence status compared to children with permanent residence permits: analysis of KiGGS data 2003-2006]

BACKGROUND

The health of children and adolescents from families with insecure residence status could be poorer compared to other children with permanent residence permits in Germany due to exposure before and during flight. Their insecure residence status and their comparably low social status in the destination country may contribute towards access barriers to health care. However, selection effects might also lead to better health compared to other children in the destination country. This study compares the health status of children and adolescents with insecure residence status to that of other children with and without migration background in Germany.

METHODS

We use data from the Health Interview and Examination Survey for Children and Adolescents (KiGGS). In multivariable logistic regression models we analyze the associations between children's residence status and their subjective and mental health, as well as their utilization of emergency services and vaccination status while adjusting for the children's social status and migration background.

RESULTS AND CONCLUSION

Among 17,245 children, 197 (1.1 %) had an insecure residence status. Adjusting only for age and sex, an insecure residence status is associated with poorer subjective health (OR=3.12 (2.07-4.94)), mental problems (OR=1.83 (1.16-2.87)), an incomplete vaccination status (OR=2.0 (1.33-3.0)) and the use of emergency health services (OR=2.28 (1.2-4.36)). After adjusting also for social and migration status, only the association with the use of emergency care remains significant (OR=2.53 (1.18-5.43)). This association possibly indicates barriers to the use of regular primary care services, which requires further research.

Medical and social issues of child refugees in Europe

In mid-2015, there were an estimated 20.2 million refugees in the world; over half of them are children. Globally, this is the highest number of refugees moving across borders in 20 years. The rights of refugee children to access healthcare and be free from arbitrary detention are enshrined in law. Unaccompanied asylum-seeking children have a statutory medical assessment, but refugee children arriving with their families do not. Paediatricians assessing both unaccompanied and accompanied refugee children must be alert to the possibilities of nutritional deficiencies, infectious diseases, dental caries and mental health disorders and be aware of the national and international health guidance available for support.

Methods for a longitudinal cohort of refugee children in a regional community in Australia

PURPOSE

Few studies explore the long-term health and well-being of refugee children. A longitudinal cohort of refugee children was created to determine health and well-being outcomes over time. This article describes the methodology used to conduct this study, including sample characteristics and effectiveness of recruitment and retention strategies.

PARTICIPANTS

Newly arrived refugee children settling in a regional part of Australia aged 6 months to 15 years were recruited between 2009 and 2013 and 85% were followed for an average of 31 months.

METHOD AND DESIGN

General practitioners conducted health and pathology examinations shortly after arrival. Additional follow-up assessments were conducted by the research team at an average of 13 months after arrival for the first (year 2) and 31 months for the second (year 3) assessment. Children under 5 years had developmental and children aged 4-17 years had social-emotional screening. Families were assessed for risk and protective factors using a structured interview and the Social Readjustment Ratings Scale. Parent experience of the research was explored.

FINDINGS TO DATE

Eligibility criteria were met by 158 of 228 (69%) newly arrived children, 61 of whom (39%) were enrolled. Retention was 100% (n=61) at year 2 and 85% at year 3. The study sample was younger than and had an over-representation of African refugees as compared to the eligible population. Parents reported that the research was respectful.

FUTURE PLANS

This study demonstrates that a longitudinal cohort study in refugee children is feasible and acceptable, and retention rates can be high. The establishment of this cohort provides the opportunity to analyse valuable data about the early settlement experience, risk and protective factors and long-term health and well-being outcomes in refugee children. These are necessary to identify refugee children in need of additional support and to guide future service delivery.

Refugee child oral health

The number of people forced to flee their homes and move around the world is increasing rapidly. Such refugee populations are not only more likely to have poor physical, mental and social health outcomes but also to experience difficulties accessing health services in their new country. In particular, children from refugee backgrounds are at increased risk of poor oral health which in time is associated with poor adult oral health and impacts on child health (e.g. growth and development) and well-being. To date, there is little evidence about the nature and extent of their oral health problems nor interventions to improve their oral health status. This article summarises the evidence surrounding the oral health status of children from refugee backgrounds. In addition, a systematic review of the international literature over the past 10 years is presented which identifies interventions to improve the oral health of these vulnerable paediatric populations. Based on this evidence, potential strategies available to dental service providers to optimise provision of responsive dental care are discussed.

Closing the gap in maternal and child health: a qualitative study examining health needs of migrant mothers in Dandenong, Victoria, Australia

We conducted a qualitative study that explored the views and perceptions of migrant women in, Dandenong, Victoria, Australia about sociocultural barriers and health needs during pregnancy and in the postnatal period. The study was informed by the Social Identity Theory and the Acculturation Theory. It involved five focus group discussions with 35 migrant mothers from Afghanistan, Africa, China, Palestine, Lebanon, Syria, Iran and Jordan. Five themes emerged from the analysis: (1) the need for family support and complex social environments; (2) dealing with two cultural identities; (3) the health of mother and offspring; (4) access to the health system; and (5) life-skills for better health. Pregnancy and motherhood are challenges that are made more difficult by migration. The findings point towards the need for policies and interventions: (1) to reduce the negative impact of social isolation and lack of support during pregnancy and postnatally; (2) to support greater fathers' involvement in childcare; and (3) to reconcile different practices and expectations between traditional cultures and Australian norms. They also suggest a need to test culturally competent interventions that address health and lifestyle needs in migrant women and education programs for mothers that effectively address their concerns about maternal and child health.

Access to medicines by child refugees in the East Midlands region of England: a cross-sectional study

OBJECTIVES

To explore access to primary healthcare and drug therapy by refugee children in the East Midlands region of England.

DESIGN

Interviews with refugees with children and a control group of British parents with children.

SETTING

East Midlands region of England.

PARTICIPANTS

50 refugees with children and a control group of 50 parents with children.

MAIN OUTCOME MEASURES

Number of medicines used by children in the last month and the past 6 months. Health of parents and children. Registration with a general practitioner (GP).

RESULTS

All families in both groups were registered with a GP. There was no difference in the number of children in the two groups experiencing illnesses .In the last month, 30 refugee children received 60 medicines and 31 control children 63 medicines. In the past 6 months, 48 refugee children received 108 medicines and 43 control children 96 medicines. There was no difference between the two groups of children in relation to the likelihood of receiving any medicines in either the last month (P=0.839) or the past 6 months (p=0.81). Children in the refugee group were more likely to receive prescribed medicines for the last month (p=0.008) and the past 6 months (p<0.001). They were also less likely to receive over the counter (OTC) medicines in the past 6 months (p=0.009).

CONCLUSIONS

The refugee children in this study in the East Midlands had access to primary healthcare, medicines and a family doctor. They were more likely to receive prescribed medicines and less likely to receive OTC medicines, especially paracetamol.

Educational, developmental and psychological outcomes of resettled refugee children in Western Australia: a review of School of Special Educational Needs: Medical and Mental Health input

AIM

There are limited data regarding the educational backgrounds and associated psychological and developmental outcomes of refugee children resettling in Western Australia (WA). The WA paediatric Refugee Health Service (RHS) revised its first consult questionnaire (August 2011) to increase educational and psychosocial documentation, concurrent with engagement of a School of Special Educational Needs: Medical and Mental Health (SSEN: MMH) liaison teacher. This study aims to utilise these data to increase understanding of this cohort's educational, developmental and psychological needs and to describe SSEN: MMH's role within the RHS.

METHODS

Retrospective audit and analyses were performed on all initial standardised questionnaires for school-aged refugee children (4-18 years) and SSEN: MMH referrals between August 2011 and December 2012.

RESULTS

Demographic data from 332 refugees are described (mean age 9.58 ± standard deviation 3.43 years). Detailed educational information was available for 205 children. Prior education was limited (median 2 years), 64.9% experienced likely schooling interruption and 55.8% received education in their primary language. Language development concerns were significantly associated with previous education in a second language (odds ratio (OR) 4.55, P < 0.05). Other severe developmental and schooling issues were uncommon at presentation, with few correlations to prior education. In contrast, several migration factors, including family separation and mandatory detention, were significantly associated with psychological comorbidities such as post-traumatic stress disorder (OR 5.60, P < 0.001 and OR 14.57, P < 0.001, respectively). SSEN: MMH reviewed 59 complex cases. Referral was significantly associated with multiple educational, developmental and psychological concerns.

CONCLUSIONS

Refugee children have varied migration, trauma and educational backgrounds, impacting on health and psychological outcomes. In-depth multidisciplinary history including prior education and psychosocial issues is recommended. Partnering with education services appears to play an effective, multifaceted role in aiding resettlement; however, longitudinal studies are required.

Immigrants and the utilization of hospital emergency departments

BACKGROUND

Immigrants with language barriers are at high risk of having poor access to health care services. However, several studies have indicated that immigrants tend to use emergency departments (EDs) as their primary source of care at the expense of primary care. This may place an additional burden on already overcrowded EDs and lead to a low level of patient satisfaction with ED care. The study was to review if immigrants utilize ED care differently from host populations and to assess immigrants' satisfaction with ED care.

DATA SOURCES

Studies about immigrants' utilization of EDs in Australia and worldwide were reviewed.

RESULTS

There are conflicting results in the literature about the pattern of ED care use among immigrants. Some studies have shown higher utilization by immigrants compared to host populations and others have shown lower utilization. Overall, immigrants use ED care heavily, make inappropriate visits to EDs, have a longer length of stay in EDs, and are less satisfied with ED care as compared to host populations.

CONCLUSIONS

Immigrants might use ED care differently from host populations due to language and cultural barriers. There is sparse Australian literature regarding immigrants' access to health care including ED care. To ensure equity, further research is needed to inform policy when planning health care provision to immigrants.

Providing health information for culturally and linguistically diverse women: priorities and preferences of new migrants and refugees

ISSUES ADDRESSED

Preferences for topics and means of access to health information among newly arrived, culturally and linguistically diverse women in Perth, Western Australia, were explored.

METHODS

A mixed-methods approach was adopted. Qualitative material obtained from focus groups and interviews with 22 service providers and 26 migrant women was used to develop a questionnaire, which was then administered to 268 newly arrived migrant and refugee women from 50 countries. Participants' information and support priorities were ascertained from a ranking exercise conducted in a non-threatening context. Responses of migrant and refugee women were compared quantitatively.

RESULTS

Women's top priorities for information and support included employment advice, as well as information regarding mental health issues, women's health, exercise and nutrition, family violence and alcohol and other drug issues. Their preferred methods for receiving information were interactive talks or presentations, with written material support. Audiovisual and Web-based material were also considered useful. There were differences between refugee women's and other migrants' preferences for means of receiving information and topics of most concern.

DISCUSSION

The use of a non-threatening ranking process encouraged women to prioritise sensitive topics, such as family violence, and revealed a need for such topics to be incorporated within general health information presentations. Internet-based technologies are becoming increasingly important methods for disseminating information to migrant women. SO WHAT? Differences between migrant and refugee women's priority health issues and their preferred methods for receiving information highlight the desirability of tailoring information to particular groups. Although advice on employment pathways and mental health concerns were top priorities, the study revealed a need for more discussion on other sensitive topics, such as family violence and alcohol-related issues, and that ideally these should be incorporated into general information sessions to destigmatise attendance The increasing relevance of computer technology and social media for information dissemination was also of note.

Caring for refugees in general practice: perspectives from the coalface

This qualitative research project explored the experiences of primary health care providers working with newly arrived refugees in Brisbane. Data from 36 participants (20 general practitioners, five practice nurses and 11 administrative staff) involved in five focus groups and four semi-structured interviews were analysed. The results indicated that despite difficulties, providers are committed and enthusiastic about working with refugees. The flexibility of the general practice setting enables innovative approaches. The establishment of a specialised refugee health service in Brisbane has improved providers’ capacity to deliver refugee health care. However, most practices continue to feel isolated as they search for solutions, and the need for greater supports and a more coordinated approach to care were emphasised. The themes of communication, knowledge and practice and health care systems encapsulated the factors that influence health care providers’ ability to care for refugees and provide a framework for improving available supports. Australian primary health care is currently undergoing great change, which provides an opportunity to make significant gains in the provision of care for refugees and other minority groups within our community. As health care reforms are implemented it is essential that they are responsive to the expressed needs of health care providers working in these areas.

Building knowledge about health services utilization by refugees

The objective of this study was to compare the utilization of outpatient physician, emergency department and hospital services between refugees and the general population in Calgary, Alberta. Data was collected on 2,280 refugees from a refugee clinic in Calgary and matched with 9,120 non-refugees. Both groups were linked to Alberta Health and Wellness administrative data to assess health services utilization over 2 years. After adjusting for age, sex and medical conditions, refugees utilized general practitioners, emergency departments and hospitals more than non-refugees. A similar proportion in the two groups had seen a general practitioner within 1 week prior to their emergency department visit; however, refugees were more likely to have been triaged for urgent conditions and female refugees seen for pregnancy-related conditions than non-refugees. Refugees were more likely to have had infectious and parasitic diseases. Refugees utilized health services more than non-refugees with no evidence of underutilization.

Depressive symptomatology and service utilisation among refugee children and adolescents living in South Australia

BACKGROUND

  Young refugees resettled in Western countries are at increased risk of mental health problems. However, most research has centred on post traumatic stress disorder (PTSD), with depression, other mental health disorders, and problems receiving comparatively less attention.

METHOD

  Depressive symptomatology was assessed using the Children's Depression Inventory (CDI) in a multiethnic community sample of 348 refugee children (n = 180) and adolescents (n = 168) aged 7-17 years living in South Australia.

RESULTS

  According to parent reports, 7.1% of children and adolescents had depressive symptomatology for which services were available and yet only 21.5% of these accessed services.

CONCLUSIONS

  Young refugees need improved access to culturally appropriate mental health care.

Unmet developmental, behavioral, and psychosocial needs in children attending pediatric outpatient clinics

OBJECTIVE

In this study of children attending general pediatric hospital outpatient clinics, we aimed to examine the proportion of (1) children with developmental and behavioral concerns; (2) parents with mental health problems; and (3) families with less than adequate psychosocial resources. We were also interested in the extent to which pediatricians discussed these problems with parents.

METHODS

This was a cross-sectional study of families with children aged 4 to 8 years attending pediatric outpatient clinics at the Royal Children's Hospital, Melbourne. The Strengths and Difficulties Questionnaire, Parents' Evaluation of Developmental Status, Kessler-6 Scale for Psychological Distress, and Family Resource Scale were administered postvisit to assess development and behavior, parental mental health, and psychosocial resources. Parents were asked whether these issues were discussed during the consultation.

RESULTS

A total of 162 families participated. Behavioral concerns were identified in 26% of children and concerns about language and motor development in 24% and 11%, respectively. Only 39% of consultations included discussion about development and 46% about behavior. Almost two-thirds (64%) of families reported less than adequate psychosocial resources, yet fewer than 10% of consultations included discussion of this, and only 7% addressed parental mental health. Parental perception of reasons why concerns were not discussed included "not relevant" (47%) and "the doctor did not bring it up" (21%). Only 2% of parents "didn't want to discuss the concern."

CONCLUSIONS

A high proportion of children and families attending pediatric outpatients have unidentified concerns in development and/or behavior, and parents have mental health or psychosocial issues; these concerns are often not discussed, and thus opportunities for timely intervention are missed.