Examining Health Care Access for Refugee Children and Families in the North Carolina Triangle Area

Abstract

R efugees in the United States face multiple unique challenges related to acculturation, meeting basic needs, and accessing vital services such as health care [1]. Structural and contextual factors, such as "othering" and discrimination, are potential pathways through which acculturation can erode the health of refugees and their descendants [2]. Although experiences of trauma, displacement, and disruptions in health care are not unique to refugees, the experience of real or threatened danger is a defining characteristic of this population, and traumatic experiences may directly contribute to suboptimal acculturation, health care access, and health outcomes [3].Difficulties in health care access upon arrival in the United States include barriers to navigating complex medical and insurance systems, overcoming language and cultural barriers, institutional mistrust, and the residual impacts of trauma and challenging experiences prior to and during migration [1,4]. These challenges exacerbate health inequities and place families and individuals with refugee status at undue risk for numerous health issues.The barriers to health care faced by newly arrived refugees may be particularly challenging for children, who may fail to receive preventive care, lack proper nutrition, and experience developmental delays, all of which may be due to the often chaotic resettlement process and delayed access to care upon arrival in the United States [5]. Mental health issues are especially prevalent among refugee children, who are exposed to trauma before, during, and after the resettlement process [6,7].The North Carolina Triangle area (comprised of Durham, Chapel Hill, Raleigh, and their surrounding areas) has long been an important center for refugee resettlement in the state and in the southern United States. In recent years, refugees settling in North Carolina have come from diverse locations including Afghanistan, Central African Republic,

Clinician and academic perspectives on expressive arts therapy for refugee children and families: a qualitative study

“…Participants also described immense value in case management services provided by refugee resettlement agencies that integrate all aspects of the child’s care (Vostanis, 2016). Our study is supported by past research that emphasizes the importance of co-locating multiple services in community settings to improve access to care (Hunter et al , 2020). Refugee resettlement agencies currently support temporary case management services for refugees intended to coordinate various aspects of care.…”

“…There were also challenges related to language barriers, social isolation and chronic stress associated with socioeconomic instability and poverty (Kaur et al, 2021;Ziersch and Due, 2018). A prior study in North Carolina described refugee children as specifically vulnerable to the challenges of acculturation, communication and past trauma (Hunter et al, 2020).…”

“…Our study is supported by past research that emphasizes the importance of co-locating multiple services in community settings to improve access to care (Hunter et al, 2020). Refugee resettlement agencies currently support temporary case management services for refugees intended to coordinate various aspects of care.…”

“…There were also challenges related to language barriers, social isolation and chronic stress associated with socioeconomic instability and poverty (Kaur et al , 2021; Ziersch and Due, 2018). A prior study in North Carolina described refugee children as specifically vulnerable to the challenges of acculturation, communication and past trauma (Hunter et al , 2020). Our research identifies that arts-based therapies informed by principles of trauma-informed care are promising approaches for removing cultural barriers to mental health treatment for refugees.…”

Recognizing and Breaking the Cycle of Trauma and Violence Among Resettled Refugees

“…In the U.S., many refugee groups continue to face barriers due to racial and ethnic discrimination, restrictive immigration policies, limited English proficiency, limited social support, and economic insecurity, leaving many with limited options for employment, education, affordable housing, health care insurance, and other opportunities [ 9 , 47 – 50 ]. Accessing health care services can be particularly challenging due to barriers in transportation, translation, and cost, exacerbating the existing effects of trauma on increased risk of PTSD and increased risk of chronic diseases such as diabetes and hypertension [ 49 , 51 ]. Finding employment opportunities can also be especially challenging due to the physical and mental impairments caused by past experiences of trauma and violence [ 48 ].…”