Developing a new refugee assessment tool: The Screening of Refugees Self-Report (ScoReSR)

​1. Title: 

Developing a new refugee assessment tool: The Screening of Refugees Self-Report (ScoReSR) 

2. Project period: 

February 2016 – December 2020 

3. Investigator: 

Charlotte Sonne, MD, PhD, postdoc fellow 

4. Supervisors and collaborative partners 

The project supervisor and collaborators include Senior Consultant Jessica Carlsson, PhD and postdoc Erik Vindbjerg (Competence Centre for Transcultural Psychiatry at Mental Health Centre Ballerup), Professor Etzel Cardeña, University of Lund, Professor Derrick Silove, University of New South Wales, Australia and The New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS). 

5. Background 

Refugees and asylum seekers (referred to as refugees henceforth) are at significant risk of developing psychological complications as a result of exposure to high levels of cumulative trauma before and during migration as well as exile stressors during the process of cultural transition (1– 4). In order to target intervention towards the actual need of this population we need a concise measurement tool that takes into account not only the broad range of mental health symptoms reported by refugees but also matters of social functioning and general wellbeing which will inevitably influence the individual refugee’s ability take part in the surrounding society including his/her attachment to the labour market. As such a measurement tool does not presently exist, the aim of the current project is to design and validate a measurement tool based on previous research undertaken by the partner organisations and consultations with clients, counsellors and experts in the field. 

6. Aim/s 

The aim of the project is to provide a screening tool for mental health symptoms and psychosocial problems among trauma-affected refugees that can be used internationally. The objectives are: 1) To undertake a review of measurement tools currently used by partner organisations 2) To undertake focus groups in order to gain a more comprehensive understanding of the problems experienced by refugee communities who have recently arrived in Australia 3) To design a new measurement tool for refugees based on 1 and 2 4) To pilot-test and translate this new tool into the languages most often spoken by newly arrived refugees. 5) To make a final version of the measurement tool which can be used by refugee mental health service providers internationally 

7. Methods 

A self-rating screening tool of approximately 40-50 items covering the most common psychiatric symptoms as well as life quality and social functioning problems among traumaaffected refugees will be developed in cooperation between the Danish, Swedish and Australian research groups. The screening tool will be constructed on the basis of data collected in previous research projects in Denmark, Sweden and Australia as well as an ongoing project at CTP about cultural validity of rating scales. The tool will be electronic so users will be able to complete the ratings on computers, tablets or smart phones. The screening tool will be available in the participant’s own language and software that read the questions aloud is currently being tested in order not to exclude illiterate participants. The screening tool will be piloted among the target group of refugees in Australia and Denmark. 

7.1 Number of participants (N): 

300 for the pilot phase 

7.2 Population: 

Trauma-affected refugees 

7.3 Description of data and data collection 

Development and validation of the screening tool 

The study consists of four phases. Phase 1 is divided into two parts (1a and 1b) which will run parallel but independently of each other. Phase 1a: Review of current assessment tools, including analysis of existing clinical data and selection of most relevant items. 

Phase 1b: Collection of qualitative data from newly arrived refugees whose psychosocial problems and needs might be different to those of the ethnic and cultural subgroups for whom we have existing data. This involves two rounds of focus group with refugee clients from STARTTS. 

Phase 2: The information obtained from Phase 1a and 1b will form a joint basis for the draft of a new measurement tool. The process of item development will include consultations with counsellors and international experts in the field. We will translate and adapt the draft tool prior to piloting. 

Phases 3 and 4: Piloting and final adaptation of the tool. The measurement tool will be piloted with individual refugee clients at STARTTS and CTP and subject to psychometric analysis to examine its suitability as a screening assessment tool (Phase 3) and an outcome measure (Phase 4). When a final version is agreed on, the tool will be translated through standard translation and back-translation procedures with final corrections made through translational focus groups. 

Success criteria: A screening tool that is appropriate and acceptable for the target group. 

7.4 Application/acceptance from the Danish Data Protection Agency, the National Committee on Health Research Ethics: 

All relevant permissions will be obtained before the project commence. 

7.5 Analysis 

Analyses of quantitative data will include descriptive statistics (means and standard deviations), standard epidemiological analyses, psychometric tests including principal component analysis, confirmatory factor analyses (CFA), and Multigroup CFA will be applied to assess the psychometric properties and factorial structures of the core psychiatric constructs across culturally diverse groupings.

Analyses of qualitative data will be undertaken using NVivo. Deductive coding will be used to examine how well the participants' statements fit into the proposed structure for the psychosocial subscale, with additional themes identified where indicated. 

8. Expected results 

The project is expected to contribute with new important knowledge about the effect of early interventions on the mental health and wellbeing among refugees. In the long term the results can be used to prevent that individuals with refugee background develop chronic mental disorders and thus potentially cut down society’s expenses of treatment, flexible jobs and early retirement. 

9. Dissemination of results 

Two publications are planned based on the results from the project: 1) Design of a multi-module rating scale for trauma-affected refugees 2) Validation of the ScoRe-SR screening tool for trauma-affected refugees 

10. References 

1. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet [Internet]. Jan [cited 2013 Oct 31];365(9467):1309–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15823380 

2. Nickerson A, Liddell BJ, Asnaani A, Carlsson J, Fazel M, Knaevelsrud C, et al. Trauma and Mental Health in Forcibly Displaced Populations - An International Society for Traumatic Stress Studies Briefing Paper. 2017. 

3. Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z. Anxiety, depression and PTSD in asylum-seekers: assocations with pre-migration trauma and post-migration stressors. Br J Psychiatry [Internet]. 1997 Apr [cited 2015 Dec 10];170:351–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9246254 

4. Silove D, Steel Z, McGorry P, Miles V, Drobny J. The impact of torture on post-traumatic stress symptoms in war-affected Tamil refugees and immigrants. Compr Psychiatry [Internet]. [cited 2016 Jun 27];43(1):49–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11788919

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