A3. Clinical Assessment and Screening – Oral Paper Session

Thursday, 30 March 2017
11am-12.30pm

A screening tool for identifying mental disorders in asylum-seekers & new refugees: the STAR-MH

Abstract
Despite the high prevalence of mental disorders in asylum-seekers and refugees (ASR), there is no extant sensitive and brief screening tool designed to be administered by non-health trained workers. We report the results of a pilot study for such a tool – the STAR-MH.

The STAR-MH was developed through an iterative piloting process. Adult ASR without a known current psychiatric diagnosis were recruited through two agencies which provide for the health and psychosocial needs of ASR in Melbourne, Australia. Participants were administered the 9-item STAR-MH by non-mental health workers and subsequently interviewed (MINI 6.0) to determine psychiatric morbidity. Data was analysed by Rasch, CART and ROC analyses. Sensitivity/ specificity analyses determined the most accurate cut-off score to detect PTSD &/or Major Depressive Disorder (MDD).

Findings are based on 192 ASR from 36 countries. The median age was 33 (IQR=28–43) and the majority was male (70%), had arrived by boat (54%), and required an English language interpreter (65%). Median screening time was 6 minutes (IQR=5–7) with a screen-to-interview time of 5.5 days (IQR 0.0–9.0). 32% met criteria for at least one clinical diagnosis – 30% for MDD, 20% for PTSD – despite only 27% of these individuals having received mental health treatment in Australia. A cut-off score of ≥ 2 produced 0.93 (SN) and 0.74 (SP) for PTSD &/or MDD with a ROC of 0.91 p<.0001.

The STAR-MH is a simple, efficient screening tool to facilitate mental health referrals for adult ASR at their agency of first presentation.

Authors
Debbie Hocking (Cabrini Institute)

Adversity and resilience amongst resettling Western Australian paediatric refugees

Abstract
Background: Refugee children are exposed to multiple negative experiences. Cumulative adverse childhood experiences have long-term consequences and may manifest within and influence health, educational and psychosocial domains. The Princess Margaret Hospital Refugee Health Service (RHS) undertakes multidisciplinary screening of refugee children 5 years), family separation/death, interrupted schooling, detention experience.

Results: Initial SDQ data were obtained from 204 patients (mean age 9.2 ± SD 4.4 years) with follow-up SDQs available in 143. One third (37.3%) had at least one psychological symptom identified based on initial screening proforma. Multiple R-ACE were disclosed with 126/201 (62.7%) experiencing ≥3. African ethnicity, age >10 years, separation anxiety on initial proforma, and nil formal parental education were associated with higher R-ACE. Initial SDQ results varied with age/ethnicity, however peer problem scores were consistently elevated. Total difficulty SDQ scores did not capture psychopathology at expected frequencies. Improvement in follow-up SDQ results were appreciated for children aged 4-10 years. Most patients (80.2%) disclosed improvement in health status following RHS involvement.

Conclusion: Refugee children have complex backgrounds with exposure to multiple traumatic events. Comprehensive standardised health and psychological screening is recommended to target intervention. Further validation of culturally age-appropriate mental health screening tools in this population is required.

Authors
Gemma Hanes (Princess Margaret Hospital for Children) Raewyn Mutch, Lydia Sung and Sarah Cherian
Refugee Health Service , Princess Margaret Hospital for Children

Development and Validation of a Computerised Self-Report Assessment Platform at STARTTS

Abstract
Background: Paper-based questionnaires present challenges when assessing clients from CALD communities with limited traditions of written language. When interpreters are used to read questionnaires aloud, this may reduce standardization, introducing uncertainty when comparing responses across time and between participants. Computerized administration of questionnaires allows items to be presented together with pre-recorded audio in the client’s preferred language, preserving standardized presentation to non-literate individuals. One such platform (“MultiCASI”) is being trialled at STARTTS, in collaboration with refugee trauma services internationally.
Aims: 1) To assess the validity and acceptability of a computerized self-report assessment platform compared to paper-based questionnaires, for refugees presenting for counselling. 2) To identify areas for improvement in future implementations of computerized self-report assessment platforms.
Methods: A pilot study compared clients’ acceptability of the questionnaire administration between two groups of 30 participants: one group completed computerized questionnaires, the other paper-based questionnaires. The current study is comparing the acceptability and validity of these two forms of administration in a larger sample who are using both methods of questionnaire completion.

Results: The pilot study showed no significant differences in acceptability of the mode of questionnaire administration between groups. We will present data from the larger study on the procedural validity of the computerized format.

Discussion: Computerized administration of questionnaires provides a promising alternative to translated questionnaires for refugee clients with limited literacy. We will discuss our experiences with introducing the computerized platform to counsellors and clients, and our progress with developing a new, specialized computer platform for refugee services (“CAMLAP”).

Authors
Jorge Aroche (STARTTS (NSW Service for the Treatment And Rehabilitation of Torture and Trauma Survivors)), Mariano Coello (STARTTS), Shakeh Momartin (STARTTS (NSW Service for the Treatment And Rehabilitation of Torture and Trauma Survivors)), Russell Downham (STARTTS (NSW Service for the Treatment And Rehabilitation of Torture and Trauma Survivors)), Amina Iqbal (STARTTS), Helen Bibby (STARTTS)

The Use of TOVA Test in the Clinical Practice with Refugee Children

Abstract
In this presentation we will explore the benefits of using the Test of Variable of Attention (T.O.V.A.) when assessing refugee children who are presenting with trauma related symptoms.
In our clinical practice we use TOVA with children from age 4 to 18 to assess for difficulties in attention, focus and impulse control and to design treatment protocols when using neurofeedback intervention. We also use TOVA to evaluate treatment outcomes when running groups or providing individual based interventions.

To illustrate the use of TOVA in our clinical practice, we will present several case vignettes where TOVA was used in the process of assessment, treatment and for the evaluation of treatment outcomes.

In addition, we will also discuss the results of our preliminary data analysis done on a sample of 120 children assessed with TOVA test as part of our routine clinical assessment. Preliminary data analysis indicated some marked differences in TOVA performance between children from different ethnic groups and with different clinical presentations. The clinical implications of this results will be discussed.In this presentation we will explore the benefits of using the Test of Variable of Attention (T.O.V.A.) when assessing refugee children who are presenting with trauma related symptoms.

In our clinical practice we use TOVA with children from age 4 to 18 to assess for difficulties in attention, focus and impulse control and to design treatment protocols when using neurofeedback intervention. We also use TOVA to evaluate treatment outcomes when running groups or providing individual based interventions.

To illustrate the use of TOVA in our clinical practice, we will present several case vignettes where TOVA was used in the process of assessment, treatment and for the evaluation of treatment outcomes.

In addition, we will also discuss the results of our preliminary data analysis done on a sample of 120 children assessed with TOVA test as part of our routine clinical assessment. Preliminary data analysis indicated some marked differences in TOVA performance between children from different ethnic groups and with different clinical presentations. The clinical implications of this results will be discussed.

Authors
Sejla Murdoch (STARTTS)