JMIR Publications

ABSTRACT

Background:

At the end of 2023, over 117 million people were forcibly displaced worldwide, 40% of them children. These refugee children are at higher risk for PTSD, depression, and anxiety. Professionals who work with them frequently experience difficulties engaging with mental health problems and trauma-related behaviours in cultural contexts with which they might not be familiar. One approach to strengthen culturally competent and sensitive mental health care, is the Psychiatry Assisting the Culturally Diverse Community in Creating Healing Ties approach, which was created as a community-based intervention model to work with culturally diverse families. First-line professionals however often lack accessible and actionable support to apply such an approach in routine care.

Objective:

The aims of this study are therefore (1) to obtain insights on current needs and questions of professionals regarding their work with refugees (2) to present the conceptualization and a step-by-step walkthrough of IMPACCT, a first iteration of a digital decision-support tool, and (3) to gather feedback for further development and refinement for future use in practice.

Methods:

We conducted a qualitative descriptive study with two data sources: (1) analysis of 905 anonymized helpdesk questions submitted to Solentra (n=905) to map recurrent needs and (2) semi-structured interviews with 19 professionals after hands-on experience with a first iteration of the tool. Helpdesk question were coded using a predeveloped framework and interviews were analyzed thematically.

Results:

Based on the helpdesk questions, trauma-related concerns were the most common, followed by anxiety/stress and depressive symptoms. Acculturation was the most dominant culture-migration theme. Most contexts were family- and school-oriented. For most questions, the professionals were asking for supervision or concrete next-step guidance. The interviews (N = 19) found that the professionals thought that IMPACCT provided them with better structured and early reflection, lessened some of the decision-making burden, and enabled a more structurally-informed understanding of culture in the context of migration. Reported barriers included the time required and lack of adaptation in workflow, with more experienced professionals reporting less perceived value. Additionally, participants suggested using IMPACCT as training and/or supervision aid in first-line services and as standard decision support in ambulatory and inpatient care.

Conclusions:

The study offers first insights into the possible conceptualisation of a digital decision-support tool for first-line professionals to help them support children with a refugee background. Further technical optimization of the tool, also taking into account first user feedback is however necessary, before subsequently exploring its efficacy as well as effectiveness in strengthening first-line professionals’ competencies in working with the vulnerable population.