Assessing trauma in refugees using ITEM and ITI: clinician's reported challenges and ethical-professional considerations.

Introduction

This study investigates clinical reported challenges and ethical-professional considerations related to the use of the International Trauma Interview (ITI) and International Trauma Exposure Measure (ITEM) with trauma-affected refugees in Denmark. These instruments were implemented in 2023 across several Danish refugee rehabilitation clinics to screen for trauma and assess ICD-11 PTSD and Complex PTSD diagnoses.

Methods

Data collection included individual and focus group interviews with 12 clinical psychologists administering ITEM and ITI across three refugee treatment clinics. Interviews were analyzed and coded to identify key issues experienced by clinicians regarding their use of ITEM and ITI with refugee patients.

Results

All clinicians reported challenges using ITEM and/or ITI, with the majority expressing ethical-professional considerations. Main themes included: When and how to administer the measures, to whom, and the perceived appropriateness of the content for refugees. Simultaneously, all clinicians found the measures clinically useful to some extent.

Conclusions

Clinicians' ethical and professional considerations on the use of ITI and ITEM with refugees indicated multiple ways to improve the measures' clinical utility and reduce patient distress. Key recommendations included introducing more flexible timing of assessments, implementing training on integrating and communicating assessment findings to patients and revising the language to be clearer and more culturally sensitive. Further regular supervision and dedicated spaces for discussing challenges may be needed to support the use of the measures in a refugee setting.