11/08/2021
By Maureen Martin

The Zuckerberg College of Health Sciences, Solomont School of Nursing, invites you to attend a doctoral dissertation defense by Yifat Pe'er on "Closing the Service Gap: A Qualitative Case Study of the IBHC Model and the Iraqi Refugee Population."

Date: Monday, Nov. 22, 2021
Time: 11 a.m. to 1 p.m.
Location: This will be a virtual defense via Zoom. Those interested in attending should email Yifat_Peer@student.uml.edu and committee chair Ainat_Koren@uml.edu at least 24 hours prior to the defense to request access to the meeting.

Committee Chair: Ainat Koren, Ph.D., DNP, PMHNP, Ph.D. Director and Associate Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell

Committee Members:

  • Ramraj Gautam, Ph.D., Associate Teaching Professor, Solomont School of Nursing, University of Massachusetts, Lowell
  • Pamela DiNapoli, Ph.D., RN, Associate Professor, Graduate Program Coordinator, College of Health and Human Services – Nursing, University of New Hampshire

Abstract:

Background: Approximately one-third of the United States (US) population is affected by some form of mental illness, which is associated with poor health outcomes, fragmented care, and inadequate access to community care. This increases the burden on hospitals and the cost to society. The annual expenditure associated with mental illness is estimated at $213.3 billion in the US (CDC, 2018; Falconer et al., 2018; Lake & Turner, 2017; McCance-Katz, 2018; Patel & Chatterji, 2015). The refugee population in the US has especially high rates of mental illness, including major depression, elevated anxiety, and post-traumatic stress disorder (PTSD) (Ao et al., 2016; Bolton et al., 2013; Isok, 2016; Li et al., 2016; Mahmooth et al., 2018; Marshall et al., 2005; Thompson et al., 2018; Uribe Guajardo et al., 2018; Weiss et al., 2016).
Iraqi refugees, one of the largest refugee populations in the US, are confronted with challenges such as those related to language and illiteracy, navigating the health system, financial stress, social isolation, and fear of being re-victimized (Ao et al., 2016; Fix et al., 2017; Isok, 2016; Reavy et al., 2012; Uribe Guajardo et al., 2018; Weiss et al., 2016). Iraqi refugees who have resettled in the US have further reported perceptions about their mental health associated with hopelessness, high acculturative stress, social isolation, and fear of being persecuted by their own community (Rihab Mousa & Bipasha, 2014).

To improve the mental health of refugees, a high level of complex and culturally appropriate care that addresses structural and socio-cultural factors of post-resettlement is needed. The integrated behavioral health care (IBHC) model is a collaboration between mental health and providers to provide cost-effective patient-centered care that improves health outcomes and reduces preventable hospital utilizations among underserved populations (Drake et al., 2016; Grazier et al., 2016; Lake & Turner, 2017; Mauer, 2010; O’Loughlin et al., 2019; Pomerantz et al., 2014; Possis et al., 2016; Post et al., 2010; Thota et al., 2012). This service model is designed to reduce disparities, stigma, and cultural barriers associated with mental health services (Bridges et al., 2014; Bridges et al., 2015; O’Loughlin et al., 2019). As refugees have high rates of depression, anxiety, and PTSD, as well as additional challenges to overcome, it is important to study how use of the IBHC model improves mental health outcomes, which factors facilitate its implementation, and if and why Iraqi refugees require special adjustments.

Aim: The purpose of this study was to investigate the experience of providing and receiving integrated mental health care and what challenges and facilitating factors are associated with it, regarding Iraqi refugees in the US. The research focused on the perspective of the patients, clinicians, and administrators that are part of Metta Health Center, a department at Lowell Community Health Center that specializes in providing IBHC to refugees and torture survivors.

Method: The socio-ecological model is a multifaceted model that describes health behavior at the intrapersonal, interpersonal, community, organizational, and policy levels. This model guided the integrated review and the qualitative case study that explored the experience of 15 patients and 11 professional staff who are connected to the IBHC model at Metta Health Center. Individual interviews were conducted as part of the intrinsic qualitative case study methodology. Data were analyzed in NVivo version 12 for PC.

Findings: Eleven themes emerged from the thematic analysis and were based on the SEM levels: Intrapersonal - engagement with behavioral health related to losing home support, and gender-driven engagement; interpersonal - stigma and the need for discretion, trusting relationship with the care team, and the important role of the family; community - collaboration with community resources, and integrator from the community; organizational - holistic care in their native language, long-term behavioral health care, and engagement through groups; and policy - insufficient educational preparation.

Conclusion: Results from this study serve as an exemplary model sharing barriers and facilitators to implementing the IBHC serving a vulnerable population, in this case Iraqi refugees. The perspective of the patients and professional staff in this study at the intrapersonal, interpersonal, community SEM levels are vital for a successful implementation of the IBHC model. It is anticipated that findings will apply to marginalized populations in general, and will contribute to practice, policy, and research. Future research is suggested to further explore the implementation of IBHC model among other vulnerable populations. The exploration should include cultural adjustments, the effect of social groups, and the incorporating community resources as part of the integrated care team.