This paper draws from the clinical perspectives of a multidisciplinary group of mental health providers serving refugees and asylum seekers during the COVID-19 pandemic within the largest safety-net hospital and Level 1 trauma center in New England, United States. Weaving our clinical observations with relevant pandemic-era policy and empirical trauma literature, we identify key contextual factors (legal, clinical, sociocultural, and environmental) and related inequities affecting refugees and asylum seekers. Guided by the American Psychological Association's Layered Ecological Model of the Multicultural Guidelines, Liberation Psychology, and Kleinman's Explanatory Model, we discuss the advantages and disadvantages of teletherapy with refugee populations, ethical considerations for teletherapy delivery and trauma treatment specifically, and adoption of telehealth as a long-term modality for refugee patients. We close this paper with specific recommendations for systems of care serving refugees and for teletherapy delivery at the practitioner, institution, and policy levels. Clinical Impact StatementThis paper highlights unique clinical practice issues for providing trauma-focused teletherapy to refugees and asylum seekers during and beyond the COVID-19 pandemic. The focus is on understanding refugee and asylum-seeking patients in context. We provide recommendations to clinicians and institutions for reducing barriers to accessing care for refugee patients and improving teletherapy practice.

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