Implementing a Trauma-Informed Approach at a Student-Run Clinic for Individuals Seeking Asylum

Katrin Jaradeh; Francesco Sergi; Coleen Kivlahan; Cesar Nava Gonzales; Mar Cury; Triveni DeFries

doi:10.1097/ACM.0000000000005064

Implementing a Trauma-Informed Approach at a Student-Run Clinic for Individuals Seeking Asylum

Acad Med. 2023 Mar 1;98(3):332-336. doi: 10.1097/ACM.0000000000005064. Epub 2023 Feb 17.

Authors

Katrin Jaradeh¹, Francesco Sergi², Coleen Kivlahan³, Cesar Nava Gonzales⁴, Mar Cury⁵, Triveni DeFries⁶

Affiliations

¹ K. Jaradeh is a medical student, School of Medicine, University of California, San Francisco, San Francisco, California.
² F. Sergi is a medical student, School of Medicine, University of California, San Francisco, San Francisco, California.
³ C. Kivlahan is professor, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California.
⁴ C. Nava Gonzales is a medical student, School of Medicine, University of California, San Francisco, San Francisco, California.
⁵ M. Cury is lead client liaison, UCSF Health and Human Rights Initiative, San Francisco, California.
⁶ T. DeFries is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0002-3050-4811 .

PMID: 36538690
DOI: 10.1097/ACM.0000000000005064

Abstract

Problem: Health care professionals complete forensic medical evaluations (FMEs) to corroborate evidence of persecution among individuals seeking asylum. Many FMEs are conducted at student-run clinics for individuals seeking asylum (or student-run asylum clinics; SRACs). Trauma-informed care (TIC) recognizes that trauma is pervasive and seeks to mitigate reexposure to trauma in health care interactions. Given that FMEs involve recalling trauma, TIC is an ideal model for supporting the individuals involved in an FME.

Approach: The authors operationalized TIC principles in an SRAC model (the Human Rights Cooperative) at the University of California, San Francisco. Between April 2019 and April 2022, the SRAC provided 3 to 10 pro bono FMEs per month, as well as community referrals for individuals seeking asylum, clinician and medical student training on FMEs and TIC, and research on FMEs. This report describes the SRAC operations, organized by the 10 implementation domains of the Substance Abuse and Mental Health Services Administration guidance to organizations for implementing a trauma-informed approach.

Outcomes: Between April 2019 and April 2022, the SRAC completed 160 FMEs. Sixty-nine clinicians performed FMEs, and 119 first-year medical students participated in the accompanying elective. Qualitative survey responses by clinicians, lawyers, students, and clients (individuals seeking asylum) highlighted the trauma-informed principles of safety; trustworthiness and transparency; empowerment, voice, and choice; peer support; collaboration and mutuality; and cultural, historical, and gender issues. All students who acted as leaders sustained their engagement with the SRAC over time.

Next steps: Future research should use validated tools to assess secondary trauma and resilience within SRACs. The SRAC concept, which engages medical students and experienced clinicians in learning skills that can be used in the pursuit of health justice and equity, should be expanded and supported in U.S. medical schools across the country, which is facing unprecedented levels of migration.

MeSH terms

Forensic Medicine
Health Personnel
Human Rights
Humans
Refugees*
Students, Medical*