Empowerment

The objective of this research project was to improve integrated, person-centred integrated primary care for minors with a refugee background in the Netherlands who suffer from mental distress.  The approach consisted of early recognition, adequate referral and resilience-enhancing support, through building trustful relationships between general practitioner (GP) and patients who have a refugee experience.

Research questions

1. What do (minor) refugees need in their GP’s / mental health nurse’s support in mental health problems?
2. What do GP’s and mental health nurses need in training and education to adequately recognise, communicate and support mental health issues in (minor) refugees?
3. What does a guideline based on these insights for a culture-sensitive, person-centred, resilience-enhancing approach to GP’s / mental health nurses look like, the training required for this and an integrated approach in collaboration with other relevant local organisations?
4. What are the conditions of applying this person-centred integral approach?
5. What does this approach provide for refugees, GP’s/mental health nurses and other stakeholders?

Design

• The research took place in four municipalities, two larger ones (Nijmegen and Eindhoven) and two smaller ones (Cuijk and Oss);
• Four general practitioners in four participating municipalities opened their patient records twice for quantitative investigation, for a pre- and post-test;
• Four general practices received a training in the person-centred, integrated patient approach by the Empowerment team, working together with a doctor with a refugee background.
• Participating general practitioners were to invite about 15 patients each with a refugee background for a (renewed) introductory meeting;
• Semi-structured interviews conducted with refugees in the role of parents and patients, young adults who arrived in the Netherlands as a child and young adults who arrived in the Netherlands as an unaccompanied minor;
• Semi-structured interviews conducted with general practitioners and mental health nurses in four participating practices;
• Semi structured interviews conducted with other mental health, social and educational professionals working to improve the well-being of refugees, as well as experiential experts;
• Close collaboration with professionals and partners from the field through training and project group meetings using Participatory Learning and Action;
• Close collaboration with professionals and partners from the field through sounding board meetings using Participatory Learning and Action.

Intervention & collaboration partners

After the first analyses of minor refugee patients records, the participating general practitioners received a training which prepared them for the intervention: they invited some fifteen refugees from their practice for an extensive mutual acquaintance. In this, the background of the refugees was extensively discussed, both in terms of their health history, their expectations with regard to health care, as well as their family and social environment – both in the Netherlands and in their home country. In addition, the patients received an explanation (once again) about how the practice works, including the role of the assistant in the triage, and the function of the mental health practice nurse.

Besides the intervention within general practices, in all four participating municipalities we created project-groups with experiential experts and various social and health professionals who have experience with increasing refugees’ and their children’s’ mental well-being. We aimed at involving someone with a refugee background as well, and succeeded in two of four groups. The participating GP was also part of this group.

The project-group gathered several times over the course of the project, exchanging experiences and ideas, thus becoming part of a strong(er) local network, having short lines of communication.

Sister Project – Shabab Akwa

The Shabab Akwa project, a project financed by Hestia, was closely related to the Empowerment project. It focused on empowering refugee parents in supporting their children with stress-related problems and was carried out in the same period as the Empowerment project.