[Evaluation of the Use of Interpreters in Medical and Psychosocial Health Care of Refugees in a Reception and Registration Centre of the German Federal State of Baden-Wuerttemberg]. / Evaluation des Einsatzes von DolmetscherInnen in der medizinischen und psychosozialen Versorgung Geflüchteter in einer Erstaufnahmeeinrichtung des Landes Baden-Württemberg.

OBJECTIVE: In the medical and psychosocial health care of refugees the use of interpreters is of fundamental importance. The involvement of interpreters changes the dyadic practitioner-patient system to a triad requiring different behavior guidelines. The aim of the present study was to evaluate the involvement of interpreters in the medical and psychosocial outpatient clinic in a registration centre for refugees in the state of Baden-Württemberg. METHOD: For a general overview of the use of interpreters in different types of consultation hours and a comparison of the local practice with guidelines from the literature, a systematic survey was conducted in N=75 treatment cases with N=19 practitioners, N=27 interpreters and N=75 patients using an observation sheet. Among the factors studied were sitting positions in the triad, the manner of translation by interpreters, eye contact and orientation of speech of practitioners and patients towards each other during the phases of linguistic production, the interaction with family members and the occurrence of briefings or meetings after the consultation. RESULTS: Results show that the observed interpreters were almost exclusively non-professionals without qualification for this profession. Interpreters translated according to the so-called black box model or predominantly self-initiated as co-therapists and usually did not act as references of cultural aspects. Furthermore it could be observed that practitioners oriented the communication - eye contact and direct speech - primarily towards interpreters, not to patients. In addition, there was no briefing between the therapist and the interpreter or meeting after the consultation in any of the consultation hours surveyed. CONCLUSION: The practice of involving interpreters differs from guidelines of research literature. The present study uncovers these discrepancies and thus has implications for the work of practitioners and interpreters in refugee care.

Prevalence of and Risk Factors for Secondary Traumatization in Interpreters for Refugees: A Cross-Sectional Study.

BACKGROUND: A substantial proportion of refugees, fleeing persecution, torture, and war, are estimated to suffer from psychological traumatization. After being sheltered in reception centers, the refugees come in close contact with different occupational groups, e.g., physicians, social workers, and interpreters. Previous studies ascertained that such interpreters themselves often suffer from primary psychological traumatization. Moreover, through translating refugees' potentially traumatic depictions, the interpreters are in danger of developing a so-called secondary traumatization. OBJECTIVE: The present study aimed (1) to analyze the prevalence rates of primary traumatization in interpreters, (2) to assess the prevalence of secondary traumatization, depression, anxiety, and stress symptoms, (3) to examine the association between secondary traumatization symptoms and resilience factors in terms of sense of coherence, social support, and attachment style, and (4) to test whether these resilience factors mediate the relationship between primary and secondary traumatization. METHODS: Participating interpreters (n = 64) were assessed for past exposure to potentially traumatic events as well as symptoms of posttraumatic stress disorder (PTSD), secondary traumatization, depressive symptoms, anxiety, and subjective stress levels. Furthermore, we conducted psychometric surveys to measure interpreters' sense of coherence, degree of social support, and attachment style as potential predictors. RESULTS: (1) 9% of the interpreters fulfilled all criteria for PTSD and a further 33% had subclinical PTSD; (2) a secondary traumatization was present in 21% of the examined interpreters - of these, 6% showed very high total scores indicating a severe secondary traumatization; furthermore, we found higher scores for depression, anxiety, and stress as compared to representative population samples, especially for females; (3) a present sense of coherence, an existing social support network, and a secure or preoccupied attachment style correlated significantly with low scores for secondary traumatization; and (4) a significant correlation emerged between primary and secondary traumatization (r = 0.595, p < 0.001); a mediation analysis revealed that this effect is partially mediated by secure attachment. CONCLUSION: A substantial proportion of interpreters working with refugees suffer from primary as well as secondary traumatization. However, high scores for sense of coherence and social support, male gender, and especially a secure attachment style were identified as resilience factors for secondary traumatization. The results may have implications for the selection, training, and supervision of interpreters.

A Walk-In Clinic for Newly Arrived Mentally Burdened Refugees: The Patient Perspective.

Providing refugees with psychosocial support is particularly important considering the high level of mental health problems prevalent in this population. A psychosocial walk-in clinic operating within a state reception and registration center in Germany has been supporting mentally burdened refugees since 2016. This study focused on patients' perspectives on their mental health burden, the psychosocial walk-in clinic, and future help seeking. We conducted interviews with n = 22 refugees attending the walk-in clinic from March to May 2019. Qualitative analysis focused on the following four topics: (1) mental burden from the patients' perspective, (2) access to the psychosocial walk-in clinic, (3) perception of counseling sessions, and (4) perception of follow-up treatment. The results show that the majority of interviewees were burdened by psychological and somatic complaints, mostly attributed to past experiences and post-migratory stress. Therapeutic counseling and psychiatric medication were found to be particularly helpful. Most of the participants felt motivated to seek further psychosocial support. Key barriers to seeking psychosocial help included shame, fear of stigma, and lack of information. Overall, the psychosocial walk-in clinic is a highly valued support service for newly arrived refugees with mental health issues.