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

Autores/as

  • 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
  • aaron.gallagher@ucsf.edu 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

Palabras clave:

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

Resumen

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.

Biografía del autor/a

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

aaron.gallagher@ucsf.edu, 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

Citas

Aguirre, N. G., Milewski, A. R., Shin, J., & Ottenheimer, D. (2020). Gender-based violence experienced by women seeking asylum in the United State: A lifetime of multiple traumas inflicted by multiple perpetrators. J Forensic Leg Med, 72. https://doi.org/10.1016/j.jflm.2020.101959

Almendral, A. (2021, Jan. 14). Meet some of the millions of women who migrated recently, risking everything. National Geographic Magazine. https://www.nationalgeographic.com/magazine/article/meet-some-of-the-millions-of-women-who-migrated-recently-risking-everything-feature

Asgary, R. G., Metalios, E. E., Smith, C. L., & Paccione, G. A. (2006). Evaluating asylum seekers/torture survivors in urban primary care: a collaborative approach at the Bronx Human Rights Clinic. Health Hum Rights, 9(2). https://doi.org/10.2307/4065406

Atkinson, H., Wyka, K., Hampton, K., Seno, C., Yim, E., Ottenheimer, D., & Arastu, N. (2021). Impact of forensic medical evaluations on immigration relief grant rates and correlates of positive outcomes in the United States. Journal of Forensic and Legal Medicine, 84. https://doi.org/10.1016/j.jflm.2021.102272

Baranowski, K. A., Wang, E., D'Andrea, M. R., & Singer, E. K. (2019). Experiences of gender-based violence in women asylum seekers from Honduras, El Salvador and Guatemala. Torture, 29(3), 46-58. https://doi.org/10.7146/torture.v29i3.111970

Blackmore, R., Boyle, J. A., Fazel, M., Ranasinha, S., Kylie, M. G., Fitzgerald, G., Misso, M., & Gibson-Helm, M. (2020). The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS Med, 17(9). https://doi.org/10.1371/journal.pmed.1003337

Budiman, A. (2020). Key findings about U.S. immigrants. https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/

Clément, R., Lebossé, D., Barrios, L., & Rodat, O. (2017). Asylum seekers alleging torture in their countries: Evaluation of a French center. J Forensic Leg Med, 46, 24-29. https://doi.org/10.1016/j.jflm.2016.12.011

Cuneo, C. N., Huselton, K. E., Praschan, N. C., Saadi, A., & Gartland M. G. (2021). What counts as 'safe?': Exposure to trauma and violence among asylum seekers from the Northern Triangle. Health Affairs 40(7), 1135-1144. https://doi.org/10.1377/hlthaff.2021.00082

De Schrijver, L., Beken T. V, Krahé B., & Keygnaert, I. (2018). Prevalence of sexual violence in migrants, applicants for international protection, and refugees in Europe: A critical interpretive synthesis of the evidence. Int J Environ Res Public Health, 15(9), 1979. https://doi.org/10.3390/ijerph15091979

Doherty, S. M., Craig, R., Gardani, M., & McMillan, T.M. (2016). Head injury in asylum seekers and refugees referred with psychological trauma. Glob Ment Health, 3. https://doi.org/10.1017/gmh.2016.23

Grace, B., Bais, R., & Roth, B. (2018). The violence of uncertainty — undermining immigrant and refugee health. N Engl J Med, 379, 904-905. https://doi.org/10.1056/NEJMp1807424

Gu, F., Chu, E., Milewski, A., Taleghani, S., Maju, M., Kuhn, R., Richards, A., & Emery, E. (2021). Challenges in founding and developing medical school student-run asylum clinics. J Immigr Minor Health, 23(1), 179-183. https://doi.org/10.1007/s10903-020-01106-2

Hameed, S., Sadiq, A., & Din, A. (2018). The increased vulnerability of refugee population to mental health disorders. Kans J Med, 11(1), 20-23. https://doi.org/10.17161/kjm.v11i1.8680

Heffron, L. C. (2019). “Salía de uno y me metí en otro”: Exploring the migration-violence nexus among Central American women. Violence Against Women, 25(6), 677-702. https://doi.org/10.1177/1077801218797473

Hilbe, J. B. (2011). Negative binomial regression. 2nd ed. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511973420

Hvidtfeldt, C., Petersen J. H., & Norredam M. (2020). Prolonged periods of waiting for an asylum decision and the risk of psychiatric diagnoses: a 22-year longitudinal cohort study from Denmark. International Journal of Epidemiology, 49(2), 400-409. https://doi.org/10.1093/ije/dyz091

Hyland, P., Shevlin, M., Fyvie, C., & Karatzias, T. (2018). Posttraumatic stress disorder and complex posttraumatic stress disorder in DSM-5 and ICD-11: Clinical and behavioral correlates. J Trauma Stress, 31(2), 174-180. https://doi.org/10.1002/jts.22272

Johnson, H., Perez, C. A. & Mejia, M. C. (2021). Immigrants in California. Public Policy Institute of California. https://www.ppic.org/publication/immigrants-in-california/

Knipscheer, J. W., Sleijpen, M., Mooren, T., Ter Heide, F. J., & van der Aa, N. (2015). Trauma exposure and refugee status as predictors of mental health outcomes in treatment-seeking refugees. BJPsych Bull, 39(4), 178-182. https://doi.org/10.1192/pb.bp.114.047951

Leyva-Flores, R., Infante, C., Gutierrez, J. P., Quintino-Perez, F., Gómez-Saldivar, M., & Torres-Robles, C. (2019). Migrants in transit through Mexico to the US: Experiences with violence and related factors, 2009-2015. PLoS One, 14(8). https://doi.org/10.1371/journal.pone.0220775

Lustig, S. L., Kureshi, S., Delucchi, K. L., Iacopino, V., & Morse, S. C. (2008). Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health, 10(1), 7-15. https://doi.org/10.1007/s10903-007-9056-8

Maercker, A. (2021). Development of the new CPTSD diagnosis for ICD-11. Borderline Personal Disord Emot Dysregul, 8. https://doi.org/10.1186/s40479-021-00148-8

Member Centers of the National Consortium of Torture Treatment Programs. (2015). Descriptive, inferential, functional outcome data on 9,025 torture survivors over six years in the United States. Torture, 25(2). https://doi.org/10.7146/torture.v25i2.109673

Miller, M. S., D'Andrea, M. R., Wang, E., Singer, E. K., & Baranowski, K. A. (2021). Patterns and evidence of human rights violations among US asylum seekers. Int J Legal Med, 135, 693-699. https://doi.org/10.1007/s00414-020-02405-x

Nicholson, F., & Kumin, J. (2017). A guide to international refugee protection and building state asylum systems. 2017. https://www.unhcr.org/3d4aba564.pdf

Office of the United Nations High Commissioner for Human Rights. (2004). Istanbul Protocol manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment. https://www.ohchr.org/documents/publications/training8rev1en.pdf

Pfortmueller, C. A., Schwetlick, M., Mueller, T., Lehmann, B., & Exadaktylos, A. K. (2016). Adult asylum seekers from the Middle East including Syria in Central Europe: What are their health care problems? PLoS One, 11(2). https://doi.org/10.1371/journal.pone.0148196

Policy Link & Program for Environmental and Regional Equity. (2017). An equity profile of the nine-county San Francisco Bay Area region. https://www.policylink.org/sites/default/files/Final_9_County_BayAreaProfile_0.pdf

Portnoy P. S., Kuppa, J. O., Rocroi, I., Tatel, E., Diaz, A., Mehta, K. M., & Nelson, N. (2021). Patterns of torture among forcibly displaced Eritrean men in California: A cross-sectional study. Torture, 31(1), 53-63. https://doi.org/10.7146/torture.v31i1.121786

SAMHSA’s Trauma and Justice Strategic Initiative. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf

Sharp, M. B., Milewski, A. R., Lamneck, C., & McKenzie, K. (2019). Evaluating the impact of student-run asylum clinics in the US from 2016-2018. Health Hum Rights, 21(2), 309-323. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927377/

Song, S. J., Subica, A., Kaplan, C., Tol, W., & de Jong, J. (2018). Predicting the mental health and functioning of torture survivors. J Nerv Ment Dis, 206(1), 33-39. https://doi.org/10.1097/NMD.0000000000000678

Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA, 302(5), 537-549. https://doi.org/10.1001/jama.20091132

Transactional Record Access Clearinghouse (TRAC). (2021). Immigration Court Backlog Tool. https://trac.syr.edu/phptools/immigration/court_backlog/. Accessed 15 Nov. 2021.

United National High Commissioner on Refugees. (2021). Figures at a glance. https://www.unhcr.org/en-us/figures-at-a-glance.html.

van der Boor, C. F., Amos, R., Nevitt, S., Dowrick, C., & White R. G. (2020). Systematic review of factors associated with quality of life of asylum seekers and refugees in high-income countries. Confl Health, 14. https://doi.org/10.1186/s13031-020-00292-y

Descargas

Publicado

2022-09-14

Cómo citar

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

Número

Vol. 32 Núm. 3 (2022): Torture Journal: Journal on Rehabilitation of Torture Victims and Prevention of Torture

Sección

Research and Scientific articles

Licencia

Derechos de autor 2022 Torture Journal

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.

We accept that some authors (e.g. government employees in some countries) are unable to transfer copyright. The Creative Commons Licence  Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) covers both the Torture Journal and the IRCT web site. The publisher will not put any limitation on the personal freedom of the author to use material contained in the paper in other works which may be published, provided that acknowledgement is made to the original place of publication.