Culturally Effective Practice With Refugees in Community Health Centers: An Exploratory Study


  • Nicole Dubus San Jose State Univesity
  • Ashley Davis Wheelock College



Refugee, community health center, cultural competence


The global refugee crisis requires providers of health and behavioral health services to develop culturally-effective practices that can meet the needs of the ever-changing demographics of those being resettled. Community health centers in the United States are often asked to provide services during the first year of resettlement for refugees. Social workers are among those professionals who provide the behavioral health services in the community health centers. To better understand the challenges for these providers, this qualitative study examines the experiences of 15 providers of refugee behavioral health services at community health centers in the northeast of the United States. The participants were interviewed, and those transcribed interviews were analyzed for themes. Findings revealed three main themes: client engagement as crucial; collaboration with interpreters; and cultural competence is an imperative but ill-defined. Important implications focus on the need for cultural competence and the challenge to obtain this competence given the resources and demands in community health centers.

Author Biography

Nicole Dubus, San Jose State Univesity

Nicole Dubus, PhD is an Assistant Professor in Social Work at San Jose State University, San Jose CA


Adams, K. M., Gardiner, L. D., & Assefi, N. (2004). Healthcare challenges from the developing

world: Post-immigration refugee medicine. British Medical Journal, 328(7455), 1548.

Al-Husban, M., & Adams, C. (2016). Sustainable refugee migration: a rethink towards a positive

capability approach. Sustainability, 8(5), 451.

Al-Makhamreh, S., Spaneas, S., & Neocleous, G. (2012). The need for political competence

social work practice: Lessons learned from a collaborative project on Iraqi refugees—The case of Jordan. British Journal of Social Work, 42(6), 1074-1092.

Al-Obaidi, A., West, B., Fox, A., & Savin, D. (2015). Incorporating preliminary mental health

assessment in the initial healthcare for refugees in New Jersey. Community Mental

Health Journal, 51(5), 567-574.

Ay, M., Arcos González, P., & Castro Delgado, R. (2016). The perceived barriers of access to

health care among a group of non-camp Syrian refugees in Jordan. International Journal of Health Services, 46(3), 566-589.

Barghadouch, A., Kristiansen, M., Jervelund, S. S., Hjern, A., Montgomery, E., & Norredam, M.

(2016). Refugee children have fewer contacts to psychiatric healthcare services: An analysis of a subset of refugee children compared to Danish-born peers. Social Psychiatry and Psychiatric Epidemiology, 51(8), 1125-1136.

Bozorgmehr, K., Szecsenyi, J., Stock, C., & Razum, O. (2016). Europe’s response to the refugee

crisis: Why relocation quotas will fail to achieve “fairness” from a health perspective.

The European Journal of Public Health, 26(1), 5-6.

Bryant, A., & Charmaz, K. (Eds.). (2007). The Sage handbook of grounded theory. Thousand

Oaks, CA: Sage.

Bustamante, L. H. U., Leclerc, E., Mari, J. D. J., & Brietzke, E. (2016). It is time to prepare

mental health services to attend to migrants and refugees. Revista Brasileira de Psiquiatria, 38(3), 263-264.

Campbell, J. R. (2014). Climate-change migration in the Pacific. The Contemporary Pacific,

(1), 1-28.

DeCola, A. (2011). Making language access to health care meaningful: The need for a federal

health care interpreters' statute. JL & Health, 24, 151.

Denzin, N. K., & Lincoln, Y. S. (Eds.). (2011). The Sage handbook of qualitative research.

Thousand Oaks, CA: Sage.

Ellis, B. H., Murray, K., & Barrett, C. (2014). Understanding the mental health of refugees:

trauma, stress, and the cultural context. In The Massachusetts General Hospital textbook on diversity and cultural sensitivity in mental health (pp. 165-187). New York: Springer.

Esses, V. M., Hamilton, L. K., & Gaucher, D. (2017). The global refugee crisis: Empirical

evidence and policy implications for improving public attitudes and facilitating refugee resettlement. Social Issues and Policy Review, 11(1), 78-123.

Fike, D. C., & Androff, D. K. (2016). “The pain of exile”: What social workers need to know

about Burmese refugees. Social Work, 61(2), 127-135.

Farbotko, C., Stratford, E., & Lazrus, H. (2016). Climate migrants and new identities? The

geopolitics of embracing or rejecting mobility. Social & Cultural Geography, 17(4), 533-552.

Fondacaro, K. M., & Harder, V. S. (2014). Connecting cultures: A training model promoting

evidence-based psychological services for refugees. Training and Education in Professional Psychology, 8(4), 320.

George, M. (2012). Migration traumatic experiences and refugee distress: Implications for social

work practice. Clinical Social Work Journal, 40(4), 429-437.

Gitterman, A., & Germain, C. B. (1976). Social work practice: A life model. Social Service

Review, 50(4), 601-610.

Griswold, K., Zayas, L. E., Kernan, J. B., & Wagner, C. M. (2007). Cultural awareness through

medical student and refugee patient encounters. Journal of Immigrant and Minority Health, 9(1), 55-60.

Hansen, L., & Huston, P. (2016). Health considerations in the Syrian refugee resettlement

process in Canada. Canada Communicable Disease Report, 42(S2), S3.

Hsieh, E., & Kramer, E. M. (2012). Medical interpreters as tools: Dangers and challenges in the

utilitarian approach to interpreters’ roles and functions. Patient education and counseling, 89(1), 158-162.

Kale, E., & Syed, H. R. (2010). Language barriers and the use of interpreters in the public health

Services: A questionnaire-based survey. Patient Education and Counseling, 81(2), 187-191.

Krogstad, J. & Radford, J. (2017, January 30). Key facts about refugees to the U.S. Retrieved


McNeely, C. A., & Morland, L. (2016). The health of the newest Americans: How U.S. public

health systems can support Syrian refugees. American Journal of Public Health, 106(1), 13-15.

Morris, M. D., Popper, S. T., Rodwell, T. C., Brodine, S. K., & Brouwer, K. C. (2009).

Healthcare barriers of refugees post-resettlement. Journal of Community Health, 34(6),

Moulton, D. (2016). Refugee health clinics grapple with demand. Canadian Medical Association

Journal,188(11), E240.

NASW (2015) Standards and indicators for cultural competence in social work practice.

Alexandria, VA: National Association of Social Workers.

National Center for Cultural Competence. (n.d.). Definitions of cultural competence. Retrieved


Njeru, J. W., DeJesus, R. S., Sauver, J. S., Rutten, L. J., Jacobson, D. J., Wilson, P., & Wieland,

M. L. (2016). Utilization of a mental health collaborative care model among patients who require interpreter services. International Journal of Mental Health Systems, 10(1), 15.

Park, Y. (2008). Making refugees: A historical discourse analysis of the construction of the

“refugee” in U.S. social work, 1900–1957. British Journal of Social Work, 38(4), 771-787.

Pumariega, A. J., Rothe, E., & Pumariega, J. B. (2005). Mental health of immigrants and

refugees. Community Mental Health Journal, 41(5), 581-597.

Saechao, F., Sharrock, S., Reicherter, D., Livingston, J. D., Aylward, A., Whisnant, J., ... &

Kohli, S. (2012). Stressors and barriers to using mental health services among diverse groups of first-generation immigrants to the United States. Community Mental Health Journal, 48(1), 98-106.

Shaw, S. A. (2014). Bridge builders: A qualitative study exploring the experiences of former

refugees working as caseworkers in the United States. Journal of Social Service Research, 40(3), 284-296.

Sossou, M. A., Craig, C. D., Ogren, H., & Schnak, M. (2008). A qualitative study of resilience

factors of Bosnian refugee women resettled in the southern United States. Journal of Ethnic & Cultural Diversity in Social Work, 17(4), 365-385.

United Nations High Commissioner for Refugees (2017). Figures at a glance. Retrieved from

Weaver, H. N. (2005). Reexamining what we think we know: A lesson learned from Tamil

refugees. Affilia, 20(2), 238-245.

Weine, S. M., Kuc, G., Dzudza, E., Razzano, L., & Pavkovic, I. (2001). PTSD among Bosnian

refugees: A survey of providers' knowledge, attitudes and service patterns. Community Mental Health Journal, 37(3), 261-271.

Weiss, B. S., & Parish, B. (1989). Culturally appropriate crisis counseling: Adapting an

American method for use with Indochinese refugees. Social Work, 34(3), 252-254.