Asylum seeker trauma in a student-run clinic: reducing barriers to forensic medical evaluations

Authors

  • Aaron Gallagher UCSF
  • Gabriela Steiner Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA
  • Martha Michel Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA
  • Cesar Nava Gonzales Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA
  • Sabrina Mendez-Contreras Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA
  • Alice Lu Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA
  • Marcos Armendariz Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA
  • Triveni DeFries Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
  • Suzanne Barakat Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA, USA
  • Coleen Kivlahan Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA, USA

DOI:

https://doi.org/10.7146/torture.v32i3.130227

Keywords:

Asylum seekers, Forensic medical evaluations, Health and human rights, Student-run asylum clinics, Complex trauma

Abstract

Introduction: The number of forcibly displaced immigrants entering the United States continues to rapidly increase. Movement from Latin America across the southern border of the United States was the third-largest migration worldwide in 2017; the U.S. now serves as home to one-fifth of the world’s migrants (Budiman, 2020; Leyva-Flores et al., 2019). Reporting on the first two years of clients receiving forensic medical evaluations (FMEs) conducted by clinicians trained at University of California, San Francisco (UCSF), this descriptive study demonstrates the multiple layers and types of trauma in asylum seekers presenting to a student-run asylum clinic (SRAC) at an academic medical center.

 

Methods: A retrospective review of the first 102 asylum seekers presenting to a university-affiliated SRAC for forensic medical and psychological evaluations is summarized. Demographics, immigration history, medical and mental health histories, descriptions of extensive trauma and referral patterns are reported. Multivariate statistics were employed to investigate the relationship between past trauma and current mental health status.

 

Results: Clients reported extensive trauma histories, with an average of 4.4 different types of ill-treatment per person, including physical, psychological, and sexual violence. The current mental health burden was extensive with 86.9 percent of clients reporting symptoms of PTSD and/or depression. Clients were evaluated within a clinic structure that intentionally aligns with SAMHSA’s implementation domains of trauma-informed care using a continuous improvement model to reduce barriers to FMEs and promote longitudinal follow-up and referral access.

 

Discussion: This study demonstrates the profound trauma exposure reported by asylum seekers, as well as the adaptation of a SRAC to better respond to complex trauma through intentional structural and leadership decisions. The HRC experience provides a blueprint for other asylum clinics to implement systematic trauma-centered services.

Author Biographies

Gabriela Steiner, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Martha Michel, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

Cesar Nava Gonzales, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Sabrina Mendez-Contreras, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Alice Lu, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Marcos Armendariz, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

School of Medicine, University of California, San Francisco, San Francisco, CA, USA

Triveni DeFries, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA

Suzanne Barakat, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA, USA

Coleen Kivlahan, Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA, USA

Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA

Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA, USA

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Published

2022-09-14

How to Cite

Gallagher, A., Steiner, G., Michel, M., Gonzales, C. N., Mendez-Contreras, S., Lu, A., Armendariz, M., DeFries, T., Barakat, S., & Kivlahan, C. (2022). Asylum seeker trauma in a student-run clinic: reducing barriers to forensic medical evaluations. Torture Journal, 32(3), 49–64. https://doi.org/10.7146/torture.v32i3.130227

Issue

Vol. 32 No. 3 (2022): Torture Journal: Journal on Rehabilitation of Torture Victims and Prevention of Torture

Section

Research and Scientific articles

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