Understanding the “Complicated Landscape” of Care for Refugees with Disabilities: Systems and Structures of Service

Background and Purpose: Since 1980, the United States has resettled over 3.5 million refugees, and we estimate about one in five resettled refugees has a disability (Kaur et al., 2023). Despite the large number of refugees with disabilities, targeted services to meet their needs are seldom established, and refugee and disability service providers largely operate in isolation from one another. Even when both services work at their best, this siloed service provision creates additional challenges for refugees who need access to both resettlement and disability support. To effectively support refugees with disabilities, it is crucial to understand the unique needs and barriers facing refugee communities and two types of service providers working with refugees with disabilities.

Methods: Four focus groups (two for disability and two for resettlement service providers) and two individual interviews were conducted with 29 refugee and disability service providers, and three community meetings and two individual interviews were conducted with 26 individuals from four refugee communities. The three individual interviews were conducted separately due to logistical and practical needs. One resulted from a group scheduling issue, while two were scheduled to capture perspectives from unique positions - one as a provider of both services and the other as a community advocate and a parent of a child with a disability. In each refugee community meeting, interpreters were present to provide interpretation and two individual meetings with refugee community members were conducted in English. Recordings of each focus group, community meeting, and individual interview were transcribed verbatim and analyzed using Braun and Clarke’s (2006) six-phase thematic analysis.

Findings: Data analysis revealed three key findings: 1) service silos, 2) “layers of barriers”, and 3) experiences and expectations. Service providers and community members reportedseveral challenges impacting care, including resources, awareness, and system-level challenges that make access to services difficult. They also reported limited understanding of the systems and services available outside their own area of practice. Community members’ experiences with disability prior to the U.S. impact their beliefs and expectations for services.

Conclusions and Implications: The findings highlight the challenges refugees with disabilities face and point to the need for increased communication and collaboration between refugee and disability service organizations. Organizational partnerships, along with clear referral pathways, may help providers and community members alike in navigating the complex systems of disability care. Additionally, refugees’ previous experiences related to disability care and access influence access and expectations of services in their country of resettlement. An understanding of this may help providers reach and support communities. Findings suggest the need for cultural humility among providers to facilitate culturally responsive services. The use of cultural brokers may help providers understand how refugees with disabilities are impacted by systems of healthcare and refugee resettlement. The inclusion of cultural brokers in the service provision landscape may also increase community understandings of service and resource availability.