1 Session # D6b Planning to check out poster presentations in between sessions? See below for posters related to this session: 1.) Coping styles predict poor health related quality of life (HRQOL) in rural Appalachians (Friday Only) Authors: Shannon Beish, M.A., Penny Koontz, Psy.D., April Fugett, PhD, Marshall University, Emily Selby-Nelson, Psy.D., Cabin Creek Health System, Alyssa Frye, M.A., Marshall University Please insert the assigned session number (track letter, period number), i.e., A2a Please insert the TITLE of your presentation. List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation. You may acknowledge other authors who are not attending the Conference in subsequent slides. CFHA 18th Annual Conference October 13-15, 2016  Charlotte, NC U.S.A. Collaborative Family Healthcare Association 12th Annual Conference

2 An Integrated Care Delivery Model Targeting Newly Resettled Refugee FamiliesSession # D6b Eboni Winford, Ph.D., Licensed Psychologist and Behavioral Health Consultant Jean Cobb, Ph.D., Licensed Psychologist and Behavioral Health Consultant Michael Caudle, M.D., Director of Women’s Health Services Cherokee Health Systems Please insert the assigned session number (track letter, period number), i.e., A2a Please insert the TITLE of your presentation. List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation. You may acknowledge other authors who are not attending the Conference in subsequent slides. CFHA 18th Annual Conference October 13-15, 2016  Charlotte, NC U.S.A. Collaborative Family Healthcare Association 12th Annual Conference

3 Faculty Disclosure The presenters of this session have NOT had any relevant financial relationships during the past 12 months. You must include ONE of the statements above for this session. CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message. The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community. Collaborative Family Healthcare Association 12th Annual Conference

4 Learning Objectives At the conclusion of this session, the participant will be able to:Describe the core steps of the initial medical and behavioral health screening for newly resettled refugees List and describe three lessons learned while implementing this integrated care delivery model for newly resettled refugees List three advantages to newly resettled refugees’ access to the continuum of care offered in a fully integrated health care systems Include the behavioral learning objectives you identified for this session Collaborative Family Healthcare Association 12th Annual Conference

5 Bibliography / ReferencesBarnes, D. M. (2001). Mental health screening in a refugee population: A program report. Journal of Immigration Health, 3(3), Goldfield, A. e., Mollica, R. F., Pesavento, B. H., & Faraone, S. V. (1988). The physical and psychological sequelae of torture: Symptomatology and diagnosis. Journal of the American Medical Association, 260(4), Kaczorowski, J. A., Williams, A. S., Smith, T. F., Fallah, N., Mendez, J. L., & Nelson-Gray, R. (2011). Adapting clinical services to accommodate needs of refugee populations. Professional Psychology: Research and Practice, 42(5), Savin, D., Seymourn, D., Littleford, L., Bettridge, J., & Giese, A. (2005). Findings from mental health screening of newly arrived refugees in Colorado. Public Health Reports, 120(3), U.S. Census Bureau (2001). U.S. Department of Health and Human Services. (2015). Guidelines for mental health screening during the domestic medical examination for newly arrived refugees. Yakushko, O. (2010). Clinical work with limited English proficiency clients: A phenomenological exploration. Professional Psychology: Research and Practice, 41(5), Continuing education approval now requires that each presentation include five references within the last 5 years. Please list at least FIVE (5) references for this presentation that are no older than 5 years. Without these references, your session may NOT be approved for CE credit. Collaborative Family Healthcare Association 12th Annual Conference

6 Learning Assessment A learning assessment is required for CE credit.A question and answer period will be conducted at the end of this presentation. Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements. Collaborative Family Healthcare Association 12th Annual Conference

7 Together…Enhancing LifeOur Mission… To improve the quality of life for our patients through the integration of primary care, behavioral health and substance abuse treatment and prevention programs. Together…Enhancing Life

8 Broad overview of refugee resettlement process

9 Definition of Refugee Refugee/asylum seeker = a person who “…owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership in a particular group, or political opinion, is outside the country of his [or her] nationality, and is unable to or, owing to such fear, is unwilling to avail himself [or herself] of the protection of that country.” (UN Refugee Agency)

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11 Resettlement trends in TennesseeDuring 2015 fiscal year (October 1, 2015-August 31, 2016), Tennessee welcomed 1,591 new refugees Most (n = 368) were from Democratic Republic of Congo, followed by Iraq (n = 267) & Syria (n = 210) 114 were resettled in Chattanooga, TN (Burundi, Colombia, Cuba, Iraq, Kazakhstan, Russia, Somalia, Sudan, Ukraine, Moldova) 75 were resettled in Knoxville, TN Tennessee Office for Refugees, 2016

12 CHEROKEE HEALTH SYSTEMS – Medical Screenings at 2 of 4 TN RESETLLEMENT CITIESHAMBLEN GRAINGER CLAIBORNE HAMILTON MCMINN MONROE LOUDON BLOUNT SEVIER KNOX COCKE JEFFERSON UNION CAMPBELL ANDERSON Tennessee Kentucky North Carolina Virginia Georgia Smoky Mountain National Park Cumberland Gap National Park Describe the engagement plan for your award

13 Chs’ integrated care model for newly resettled refugee families

14 Overview of CHS’ integrated care model for newly resettled refugee familiesFamily arrives & resettlement agency arranges initial lab visit at CHS Family seen for initial lab visit (within 2 weeks of arrival) Family receives initial medical & behavioral health screening at concurrent visits. CHS PCP is assigned at this visit Family seen for BHC follow up at subsequent vaccinations (typically at 30 day intervals)* Family seen for regularly scheduled follow up appt. with PCP & BHC as clinically indicated

15 Medical Considerations Behavioral Health ConsiderationsKey things to assess Medical Considerations Behavioral Health Considerations Parasitic treatment Demographic info Immunization status Circumstances surrounding resettlement Comparing pre- & post-travel ROS Trauma history Basic physical examination Behavioral health history & symptoms including substance misuse Readiness to start school, begin work Psychoeducation

16 Case example 20 y/o woman from Burundi & lived in Tanzanian refugee camp Living with parents & learned she was pregnant during initial lab visit preceding medical screening visit Did not want to tell parents Arranged for patient to come into clinic for follow up labs (really an initial OB visit to confirm pregnancy) on same day that younger sibling saw pediatrician for WCC in the same building Patient then told family about pregnancy once confirmed

17 Benefits of integrated refugee screening and longitudinal careFosters a sense of home & builds trust Reduces barriers to access After being displaced, coming to one location to receive all aspects of care helps facilitate adjustment Early detection, prevention, & evidence-based interventions at point of care for the whole family Availability of interpretation without having to coordinate with outside, community partners Shared EHR enhances ability to deliver trauma-informed care

18 Lessons learned Need for systematic BH follow upInverted U-curve adjustment pattern Minimization of symptoms at initial exam Benefits of on-site interpretation vs. language line Diagnostic accuracy, cultural considerations Culturally sensitive service delivery is key Gender sensitivity Ask permission, particularly when asking to disrobe

19 LEARNING ASSESSMENT TRUE OR FALSERefugees can choose to be re-settled in the US and the process is usually completed in 3-6 months. One of the lesson’s learned by CHS providers is that psychological symptoms most likely present within the first days of a refugee’s arrival in the US.

20 Have additional questions? Email us at:

21 Session Evaluation Please complete and return the evaluation form before leaving this session. Thank you! This should be the last slide of your presentation Collaborative Family Healthcare Association 12th Annual Conference