A Digital Tool for Culturally Responsive Reflection and Case Conceptualization in First-Line Services to Support Children With a Refugee Background: Development and Usability Study.

BACKGROUND: In 2023, over 117 million people were forcibly displaced worldwide, 40% of them children. Refugee children are at higher risk for posttraumatic stress disorder, depression, and anxiety, while professionals may struggle to address mental health and trauma-related concerns across unfamiliar cultural contexts. The Psychiatry Assisting the Culturally Diverse Community in Creating Healing Ties (PACCT) approach supports culturally responsive care for culturally diverse families, but first-line professionals often lack practical support to apply such an approach in routine care.

OBJECTIVE: The study aimed to (1) identify professionals' support to inform the development of Implementing PACCT through a Culturally Contextualized Tool (IMPACCT), a digital decision-support tool; (2) map these needs onto the initial IMPACCT conceptualization; and (3) gather initial feedback from professionals to guide further refinement.

METHODS: We conducted a qualitative descriptive study in 3 phases. First, we analyzed 905 anonymized help desk questions submitted between May 2021 and November 2023 to Solentra, a Belgian center of expertise providing transcultural mental health support and consultation for refugees and other vulnerable migrant populations. Questions were coded using a predeveloped framework to identify recurrent professional needs. Second, we mapped all help desk question categories onto the different components of the first conceptualization of IMPACCT to ensure that its content reflected users' questions and expectations. Third, 19 professionals working with refugee and migrant populations in Belgium were recruited through an open call between December 2024 and February 2025 using convenience sampling. After hands-on experience with a first iteration of IMPACCT, they provided feedback during semistructured interviews. These interviews were subsequently analyzed using deductive qualitative content analysis.

RESULTS: In the help desk questions, trauma-related concerns were the most common, followed by anxiety/stress and depressive symptoms. Acculturation was the most dominant culture-migration category. Most contexts were family- and school-oriented, and professionals were primarily asking for supervision or concrete next-step guidance. The interviews (N=19) found that the professionals thought that IMPACCT provided them with better-structured and early reflection, lessened some of the decision-making burden, and enabled a more structurally informed understanding of culture in the context of migration. Reported barriers included the time required and a lack of adaptation in workflow, with more experienced professionals reporting less perceived value. Additionally, participants suggested using IMPACCT as a training and/or supervision aid in first-line services and as standard decision support in ambulatory and inpatient care.

CONCLUSIONS: The study offers first insights into the possible conceptualization of a digital decision-support tool for first-line professionals to help them support children with a refugee background. Further technical optimization of the tool, also taking into account first-user feedback, is, however, necessary before subsequently exploring its efficacy as well as effectiveness in strengthening first-line professionals' competencies in working with the vulnerable population.