Poster #97 - Where Access Breaks: Refugee Women, Providers, and Mental Health Care Mismatch

• In Event: Saturday Poster Luncheon

Abstract

Introduction/Background:
African refugee women and adolescent girls in the United States are facing a growing but underserved mental health crisis, shaped by an accumulation of various trauma exposure across pre-migration, migration, and post-resettlement contexts. Research shows that refugee youth experience significantly higher levels and types of trauma exposure than immigrant and U.S.-born peers (Betancourt et al., 2017). During the resettlement process, women and girls, who comprise roughly half of the global displaced population (UNHCR), are disproportionately exposed to gender-based violence (GBV), unsafe migration conditions, and ongoing discrimination after arrival (Miller et al.,2019).  

Prolonged trauma has well-documented intergenerational health effects, including increased risk of chronic illness and severe mental health conditions among both first-and second-generation refugee populations (Ekeberg et al., 2020). Despite this evidence, behavioral health systems remain inadequately equipped to respond, often constrained by cultural and linguistic mismatches, limited provider training in trauma-informed care (TIC), and fragmented service coordination. As a result, many refugee women and youth remain disconnected from care, highlighting a critical gap between existing policy frameworks and the lived realities of those they are intended to serve. 

Purpose/Research Question:
This study asks: Where do African refugee women and adolescent girls and the professionals serving them agree and disagree about barriers to mental health care, and what do these mismatches reveal about opportunities for policy and service improvement?
By comparing lived experiences with provider perspectives, the study examines how access breaks down across the continuum of care.  

Methods:
The study uses qualitative data collected through semi-structured interviews and focus groups (listening sessions). Participants include approximately 10 –16 African refugee women, 6–10 adolescent girls (ages 13–19), and 8–10 professionals, including clinicians, school counselors, case managers, and refugee service providers.

Participants are recruited from Midwestern U.S. cities with established refugee populations, including Des Moines, Omaha, and Minneapolis–St. Paul.

Data collection also includes a participatory care journey mapping activity to identify breakdown points in seeking, accessing, and sustaining care.

Early Findings:                  
Data are analyzed using thematic analysis with inductive coding. Findings are organized into a comparison matrix identifying areas of alignment and mismatch between refugee participants and providers across stages of care access. Preliminary findings suggest that while both groups recognize structural barriers such as language access and provider shortages, they diverge significantly in their understanding of trust, cultural responsiveness, and what constitutes “accessible” care (Gorman, 2012; Lee et al, 2024).

Conclusion/Implications:
These findings have direct implications for public policy and program design. By identifying where policy assumptions diverge from lived experience, the study highlights opportunities to improve trauma-informed care implementation, strengthen school-based referral pathways, and redesign service coordination. To conclude, this research advances more equitable, gender-responsive behavioral health systems by centering refugee women and girls as key informants in policy development.

Author

• Stella Okech, Southern Methodist University
  Presenting Author