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Cited by 0Migration, Health and TraumaCultural Competency in Health CareSocial Work Education and Practice

The DOI matches its Crossref record; 26 of the 26 references it cites were found in a registry or an index; 18 of the 24 sources its claims cite were checked for support.

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

Open access
Van Bogaert, Charlotte Angela, Jame, Benji, Serneels, Geertrui Maria, Van Daele, Tom·2026·JMIR Formative Research
DOI 10.2196/86809PMC PMC13671483
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Abstract

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.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative development and usability study analyzed 905 help desk questions and interviewed 19 Belgian professionals to inform IMPACCT, a digital decision-support tool for culturally responsive reflection and case conceptualization with refugee children. Professionals found IMPACCT useful for structuring early reflection and next steps, but time demands, workflow fit, and limited perceived value among experienced users require further refinement.

Key findings

  • In 905 help desk questions, trauma symptoms were the most common clinical concern (282, 31.2%; half of cases where clinical concerns were mentioned), followed by anxiety/stress (130, 14.4%) and depressive symptoms (91, 10.1%); acculturation was the dominant culture-migration category (235, 26.0%); family problems (253, 28.0%) and school/work problems (160, 17.7%) were frequent; care pathway was coded in 548 (60.6%), referral in 304 (33.6%), next steps in 294 (32.5%), and professional needs in 852 (94.1%), mostly supervision/support (842, 93.0%).
  • Mapping help desk topics onto IMPACCT found the tool covered nearly all identified topics except radicalization; 11 topics were well represented, 4 partially represented, and 6 underrepresented.
  • In interviews (N=19), participants described the interface as clear and easy to navigate, valued embedded explanations, and reported that IMPACCT supported better-structured early reflection, lessened some decision-making burden, and enabled a more structurally informed understanding of culture in migration.
  • Reported barriers included time required and lack of workflow adaptation, with more experienced professionals reporting less perceived value; suggestions included shorter run-throughs, more concise advice, clearer referral guidance, more flexible response options, and use as a training/supervision aid or standard decision support in ambulatory and inpatient care.

Methods

  • Qualitative descriptive study in 3 phases: Phase 1 analyzed 905 anonymized Solentra help desk questions submitted May 2021–November 2023 using a predeveloped coding framework; interrater reliability was assessed on 70 questions (Fleiss κ: adverse experience κ=1.00; four categories 0.67<κ<0.78; culture and migration κ=0.57), after which remaining questions were single-coded.
  • Phase 2 mapped all help desk question categories onto the initial IMPACCT conceptualization, classifying topics as well represented, partially represented, or underrepresented.
  • Phase 3 recruited 19 professionals in Flanders, Belgium through convenience sampling between December 2024 and February 2025; participants used a web-based IMPACCT prototype with a recent case and then completed semistructured interviews analyzed using deductive qualitative content analysis across five predefined categories.

Limitations

  • The paper states that tool development relied on help desk questions that were not exclusively focused on children with a refugee background; interrater reliability varied and was lowest for culture and migration; remaining questions were single-coded after calibration, so frequencies are indicative patterns rather than precise prevalence estimates; refugees were not directly involved in tool development; and the first evaluation relied on self-reported professional feedback vulnerable to memory and social desirability bias.
  • The paper also notes that the expected 10–15 minute completion time was not evaluated, and reasons for nonparticipation after initial interest could not be determined; the study did not yet test efficacy or effectiveness.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/86809

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

18 of 24 cited sources checked · 2 supported · 2 flagged · accuracy not yet measured

  • Premisecitation

    Existing screening tools, such as the Screening Tool for Asylum-seeker and Refugee Mental Health (STAR-MH) or the Self-Report Questionnaire-5, are primarily designed as diagnostic instruments, not as digital decision support tools.

    “Existing screening tools, such as the Screening Tool for Asylum-seeker and Refugee Mental Health (STAR-MH) [25] or the Self-Report Questionnaire-5 [26], are primarily designed as diagnostic instruments, not as digital decision support tools.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [25] Hocking, Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH, BMC Psychiatry source

      The Discussion describes STAR-MH as a screening tool that alerts workers to refer people for mental health evaluation, not as a diagnostic instrument. The Methods > Instruments section explicitly identifies the M.I.N.I. as the diagnostic instrument used to validate STAR-MH. This citation identifies STAR-MH, not the separately cited Self-Report Questionnaire-5; the paper does not establish a digital-tool comparison. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [26] Bell, Development of a brief screening tool for women’s mental health assessment in refugee settings: a psychometric evaluation, Int J Nurs Stud source

      The Discussion (Clinical Implications) describes the SRQ-5 as an initial screening tool and recommends secondary evaluation for those who screen positive. The Limitations section says its performance was not compared with clinical diagnosis. The paper therefore contradicts the characterization of the SRQ-5 as primarily a diagnostic instrument; it does describe verbal or check-box use rather than digital decision support. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Professionals working with children with a refugee background frequently experience difficulties engaging with mental health problems and trauma-related behaviors in cultural contexts with which they might not be familiar.

    “Professionals who work with children with a refugee background (eg, teachers, youth care workers, and clinicians) frequently experience difficulties engaging with mental health problems and trauma-related behaviors in cultural contexts with which they might not be familiar [4].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] BeLue, Culturally responsive psychiatric services for refugee and immigrant adolescents: are child and adolescent psychiatrists prepared to serve refugee children? A focus on African refugee families, Health Equity source

      The Conclusion (page not provided) says practicing psychiatrists feel unprepared to provide culturally responsive care to African immigrant and refugee children and adolescents, and notes that providers and patients may hold different beliefs about mental illness. It does not establish that teachers or youth care workers frequently have these difficulties, or specifically describe difficulty engaging with trauma-related behaviors. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    Professionals frequently report feeling unprepared to deal with mental health issues in refugees and asylum seekers due to cultural and language barriers.

    “Studies suggest they frequently report feeling unprepared to deal with mental health issues in refugees and asylum seekers due to factors such as cultural and language barriers [5-7].”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [5] Silver, Cultural competency and mental health training for medical students:learning from refugees and asylum seekers, Health Educ J source
    • cites [6] Mirza, Language discordance in mental health services: an exploratory survey of mental health providers and interpreters, Societies source

      Section 3.5 reports limited prior training among surveyed providers, and the Discussion reports that 54% wanted additional training, including on sociocultural communication with patients with limited English proficiency. Section 1.2 also describes practitioners identifying language discordance as a barrier to mental healthcare. The paper does not establish that professionals frequently reported feeling unprepared specifically to address mental health issues in refugees and asylum seekers. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [7] Robertshaw, Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research, BMJ Open source

      In Results > The healthcare encounter (page unavailable), the review reports that professionals found psychological conditions challenging and felt they lacked the skills, knowledge and support to meet refugees’ complex psychological needs. The Discussion and Results > Thematic synthesis findings identify language and cultural barriers to care, but do not specifically say those barriers caused professionals to feel unprepared for mental-health issues. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    Digital mental health interventions for refugee populations are mostly patient-facing and focus on psychoeducation, self-management, symptom monitoring, and treatment delivery.

    “In recent years, this interest has also extended to refugee populations, with most interventions being patient-facing and focusing on psychoeducation, self-management, symptom monitoring, and treatment delivery [12,13].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [12] Liem, Digital health applications in mental health care for immigrants and refugees: a rapid review, Telemed J E Health source
    • cites [13] El-Haj-Mohamad, Smartphone-delivered mental health care interventions for refugees: a systematic review of the literature, Glob Ment Health (Camb) source

      The Results section (“Characteristics of included interventions”; page unavailable) describes smartphone-delivered interventions for refugees, including guided and unguided treatment, which supports the broad patient-facing and treatment-delivery characterization. It reports a symptom-severity self-test in only 1 of 12 interventions and does not establish that most focus on psychoeducation, self-management, symptom monitoring, and treatment delivery as a group. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    The application of digital decision-support approaches to support frontline professionals working with refugee children and families remains largely unexplored.

    “However, the application of such approaches to support frontline professionals working with refugee children and families remains largely unexplored [12,13].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [12] Liem, Digital health applications in mental health care for immigrants and refugees: a rapid review, Telemed J E Health source
    • cites [13] El-Haj-Mohamad, Smartphone-delivered mental health care interventions for refugees: a systematic review of the literature, Glob Ment Health (Camb) source

      The Discussion describes a sparse evidence base for smartphone-delivered mental health interventions for refugees, while the Impact statement says the review covers interventions for refugees, including adolescents and young people. Neither addresses whether digital decision-support approaches for frontline professionals working with refugee children and families have been explored (searched: decision support, frontline professionals, children, and families). (LLM, conf=0.77)

      Experimental — accuracy not yet measured
  • It may state two separate claims as one. 33
  • Probably not a substantial claim. 31
  • The quote only partly states this claim. 1

  • It may state two separate claims as one.

    Premisecitation

    Children with a refugee background are at elevated risk of posttraumatic stress, depression, anxiety, and difficulties with school functioning, particularly in the absence of coordinated, culturally responsive support.

    “Children with a refugee background have, therefore, unsurprisingly been found to be at an elevated risk of posttraumatic stress, depression, anxiety, and difficulties with school functioning, particularly in the absence of coordinated, culturally responsive support [3].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [3] Müller, Mental health and associated stress factors in accompanied and unaccompanied refugee minors resettled in Germany: a cross-sectional study, Child Adolesc Psychiatry Ment Health source

      The Background reports elevated psychological distress among asylum-seeking minors and identifies posttraumatic stress symptoms, depression, and anxiety as major problems. The Conclusions recommend better access to mental-health support, but the paper does not establish elevated risk of difficulties with school functioning or show that the stated risks are particularly high without coordinated, culturally responsive support. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. It may state two separate claims as one.

    Premisecitation

    Digital decision-support systems in broader mental health settings may help structure clinical reasoning, reduce uncertainty, and support more consistent decision-making.

    “Such systems may help structure clinical reasoning, reduce uncertainty, and support more consistent decision-making [14,15].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [14] Bertl, A systematic literature review of AI-based digital decision support systems for post-traumatic stress disorder, Front Psychiatry source

      The Introduction (page unavailable) describes DDSSs as organizing and analyzing information and helping evaluate assumptions, which supports the idea that they may structure clinical reasoning. The review focuses on PTSD, however, and our copy does not establish that these systems reduce uncertainty or make decisions more consistent across broader mental health settings. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [15] van Kasteren, Automated decision support for community mental health services using national electronic health records: qualitative implementation case study, JMIR Hum Factors source

      The Methods (Actionable Intime Insights Application) describe guideline-based alerts and a patient-history timeline, while the Results (Reflexive Monitoring: Reviewing) say clinicians saw the timeline as useful for care planning and that it was adopted to inform clinical-review decisions. This supports the possibility of better-informed, more structured decisions in community mental health care, but the paper does not establish reduced uncertainty or more consistent decision-making. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Premisecitation

    Migration often involves bereavement and broader forms of loss, including family separation, loss of status, language, and routines.

    “migration often involves bereavement and broader forms of loss, including family separation, loss of status, language, and routines [20]”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [20] Renner, Migratory grief: a systematic review, Front Psychiatry source

  • Probably not a substantial claim.

    Premisecitation

    Cultural responsiveness is widely recognized as a condition for equitable mental health care.

    “even though it is widely recognized as a condition for equitable mental health care [22]”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [22] Place, Perceived barriers to care for migrant children and young people with mental health problems and/or neurodevelopmental differences in high-income countries: a meta-ethnography, BMJ Open source

      In “Implications for practice and future research,” the paper says improving cultural responsiveness will be critical to building trust and ensuring engagement with mental health services in migrant communities. That supports its importance for access to care, but the paper does not establish the broader claim that it is widely recognized as a condition for equitable mental health care generally. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Premisecitation

    Attention to resilience and protective factors is important for gaining a comprehensive understanding and for facilitating the processing of trauma and loss.

    “Such attention to resilience and protective factors is important for gaining a comprehensive understanding and for facilitating the processing of trauma and loss [23,24].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [23] Dangmann, Mental health in refugee children, Curr Opin Psychol source

      The ‘Ecological models of risk and resilience’ section supports considering resilience factors for a broader understanding of refugee children’s mental health and says those factors can support recovery after traumatic events. The copy does not specifically link resilience or protective factors to processing loss, so that part of the claim is not established. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [24] Abate, Resilience after adversity: an umbrella review of adversity protective factors and resilience-promoting interventions, Front Psychiatry source

      The Introduction and Discussion > Implications for research (page unavailable) say that studying protective factors is important for understanding resilience after adversity. The Discussion also links resilience and protective factors to coping with stressful experiences. Our copy does not address processing loss or establish that attention to these factors facilitates the processing of trauma and loss. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Findingown data

    Although acculturation issues were identified regularly, professionals generally described them as issues related to integration, rarely framing it within an acculturation process or linking this process with symptoms of stress, anxiety, or depression.

    “Although issues around acculturation were identified regularly in the help desk questions, professionals generally described them as issues related to integration, rarely framing it within an acculturation process or linking this process with symptoms of stress, anxiety, or depression.”
    • Also stated in: § Principal Findings · plain
      “Although acculturation-related questions were present, they were often framed as individual difficulties with integration rather than as potentially stressful psychological and relational processes shaped by broader social conditions [21].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [21] Choy, Systematic review: acculturation strategies and their impact on the mental health of migrant populations, Public Health Pract (Oxf) source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Premisecitation

    While valuable for detecting disorders such as depression or posttraumatic stress disorder, existing screening tools do not have an educational function, are not interactive, and do not support professionals in broader case conceptualization.

    “While valuable for detecting disorders such as depression or posttraumatic stress disorder, these tools do not have an educational function, are not interactive, and do not support professionals in broader case conceptualization.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [25] Hocking, Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH, BMC Psychiatry source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [26] Bell, Development of a brief screening tool for women’s mental health assessment in refugee settings: a psychometric evaluation, Int J Nurs Stud source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingown data

    Priorities for further improvement focused primarily on shorter run-throughs, more concise advice at the end, and more concrete referral guidance.

    “Priorities for further improvement focused primarily on shorter run-throughs, more concise advice at the end, and more concrete referral guidance”
    • Also stated in: § Principal Findings · plain
      “Participants also highlighted the need for shorter versions, concise summaries of advice, and clearer referral options.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    Participants suggested more flexible response options.

    “Participants also suggested more flexible response options”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Findingown data

    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.

    “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.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    To a lesser extent, there were questions around grief and cultural interpretation.

    “To a lesser extent, there were also questions around grief and cultural interpretation.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Most help desk queries sought a referral; a comparable share asked for actionable next-step guidance.

    “Most queries sought a referral; a comparable share asked for actionable next-step guidance.”
    • Also stated in: § Results · plain
      “professionals were primarily asking for supervision or concrete next-step guidance.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    The tool facilitated early reflection and clarified thresholds for action/referral; participants described it as a useful filter when they were unsure.

    “The tool facilitated early reflection and clarified thresholds for action/referral; participants described it as a useful filter when they were unsure”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Family- and school-related questions were present with moderate frequency, but professionals did not routinely refer to parental distress or trauma as possible drivers of child difficulties.

    “In addition, family- and school-related questions were present with moderate frequency, but professionals did not routinely refer to parental distress or trauma as possible drivers of child difficulties.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Of the remaining topics, 11 were classified as well represented, 4 as partially represented, and 6 as underrepresented.

    “Of the remaining topics, 11 were classified as well represented, 4 as partially represented, and 6 as underrepresented.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    Several participants mentioned greater potential for professionals with less experience.

    “At the same time, several participants mentioned greater potential for professionals with less experience”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Trauma- and adversity-related concerns were prominent, followed by indicators of anxiety or depression and issues associated with acculturation.

    “Trauma- and adversity-related concerns were prominent, followed by indicators of anxiety or depression and issues associated with acculturation.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Participants consistently described the interface as clear and easy to navigate, with embedded concept explanations being particularly valued.

    “Participants consistently described the interface as clear and easy to navigate, with embedded concept explanations being particularly valued”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    A minority of highly experienced professionals reported limited incremental value, while other professionals reported added value.

    “A minority reported limited incremental value in highly experienced settings.”
    • Also stated in: § Phase 3: Semistructured Interviews · plain
      “However, other professionals did report added value”
    • Also stated in: § Principal Findings · plain
      “While highly experienced professionals reported gaining fewer new insights, others described the tool as a helpful guide in complex cases and a valuable learning resource.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Reported barriers to IMPACCT included the time required and a lack of adaptation in workflow.

    “Reported barriers included the time required and a lack of adaptation in workflow, with more experienced professionals reporting less perceived value.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Participants highlighted value in prompted reflection on one's own reference frame and in reframing behavior within the migration context.

    “Participants highlighted value in prompted reflection on one’s own reference frame and in reframing behavior within the migration context.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The most common professional need request was for supervision, referring to case guidance to improve decision-making, quality, and worker well-being across cross-cultural situations.

    “professionals were primarily asking for supervision or concrete next-step guidance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    PACCT was created as a community-based intervention model to work with culturally diverse families.

    “As a first step in response to the need for culturally competent and sensitive mental health care, the Psychiatry Assisting the Culturally Diverse Community in Creating Healing Ties approach (PACCT) was created as a community-based intervention model to work with culturally diverse families [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Annual report 2023. Solentra; 2024. URL: https://solentra.be/app/uploads/2024/06/Annual-report-2023_EN.pdf [Accessed 22-09-2026]

  • It may state two separate claims as one.

    Interpretationown data

    Although participants generally found the tool easy to operate, its length could limit its use in time-pressured settings.

    “Although participants generally found the tool easy to operate, its length could limit its use in time-pressured settings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Interpretationreasoning

    IMPACCT was not designed to simply reproduce the concerns most frequently raised in the help desk questions but to translate ecological and culturally responsive formulation into a practical, guided workflow.

    “IMPACCT was therefore not designed to simply reproduce the concerns most frequently raised in the help desk questions but to translate ecological and culturally responsive formulation into a practical, guided workflow.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Although the broader PACCT framework offered a counterweight, the possibility of remaining blind spots cannot be ruled out.

    “Although the broader PACCT framework offered a counterweight, the possibility of remaining blind spots cannot be ruled out.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Interpretationreasoning

    Grief-related processes may have been less visible in the help desk questions because professionals used trauma as a broad umbrella term or because the help desk format encouraged them to foreground the most urgent difficulties to obtain advice.

    “Rather, grief-related processes may have been less visible in the help desk questions because professionals used trauma as a broad umbrella term or because the help desk format encouraged them to foreground the most urgent difficulties to obtain advice.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationown data

    The tool's perceived value lay not only in providing information but also in encouraging professionals to reconsider assumptions that may shape their interpretation of a case.

    “These responses suggest that the tool’s perceived value lay not only in providing information but also in encouraging professionals to reconsider assumptions that may shape their interpretation of a case.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Interpretationreasoning

    This supports the need for a tool that prompts professionals to consider not only adversity and symptoms, but also acculturation, cultural meaning-making, family and school context, resilience, and protective factors.

    “This supports the need for a tool that prompts professionals to consider not only adversity and symptoms, but also acculturation, cultural meaning-making, family and school context, resilience, and protective factors.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductnone given

    A further limitation is that refugees were not directly involved in the development of the tool, meaning that their perspectives were included only indirectly.

    “A further limitation is that refugees were not directly involved in the development of the tool, meaning that their perspectives were included only indirectly.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductreasoning

    The first evaluation of IMPACCT relied on self-reported feedback from professionals and is therefore vulnerable to memory and social desirability bias.

    “Finally, the first evaluation of IMPACCT relied on self-reported feedback from professionals and is therefore vulnerable to memory and social desirability bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductown data

    Because culture and migration showed lower agreement than the other categories, findings for this category were interpreted cautiously.

    “Because culture and migration showed lower agreement than the other categories, findings for this category were interpreted cautiously.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Help desk questions were analyzed according to a fixed coding structure developed by an author with extensive professional experience in refugee mental health, drawing on prior work and domain expertise.

    “Help desk questions were analyzed according to a fixed coding structure, developed by an author with extensive professional experience in refugee mental health (BJ), drawing on prior work and domain expertise.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.

    Interpretationown data

    The findings underline that such digital decision support must remain both clinically useful and practically feasible.

    “At the same time, the findings underline that such digital decision support must remain both clinically useful and practically feasible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Interpretationreasoning

    IMPACCT operationalizes this perspective in a practical and accessible format by combining decision support with educational and reflective elements.

    “IMPACCT operationalizes this perspective in a practical and accessible format by combining decision support with educational and reflective elements.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationown data

    The tool could support both individual decision-making and collaborative case discussions.

    “These responses suggest that the tool could support both individual decision-making and collaborative case discussions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductcitation

    The study used the SRQR reporting guideline to guide reporting.

    “The SRQR (Standards for Reporting Qualitative Research) reporting guideline [16] was used to guide the reporting (Checklist 1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] O’Brien, Standards for reporting qualitative research: a synthesis of recommendations, Acad Med source

  • It may state two separate claims as one.

    Interpretationown data

    The perceived value of the tool may depend on users' existing expertise, with less experienced professionals benefiting primarily from its educational and reflective structure and more experienced users requiring more efficient pathways and case-specific decision support.

    “This suggests that the perceived value of the tool may depend on users’ existing expertise and on what they expect the tool to provide.”
    • Also stated in: § Phase 3: Semistructured Interviews · hedged
      “Less experienced professionals may benefit primarily from its educational and reflective structure, whereas more experienced users may require more efficient pathways and more case-specific decision support.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    The prominence of trauma- and adversity-related concerns is consistent with the elevated exposure of refugee children and families to potentially traumatic experiences before, during, and after migration.

    “The prominence of trauma- and adversity-related concerns is consistent with the elevated exposure of refugee children and families to potentially traumatic experiences before, during, and after migration.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Refugee children and families have elevated exposure to potentially traumatic experiences before, during, and after migration.

  • Probably not a substantial claim.

    Study design and conductown data

    All help desk question categories were mapped onto the different components of IMPACCT to ensure that its content reflected users' questions and expectations.

    “All help desk question categories were subsequently mapped onto the different components of the IMPACCT to ensure that its content reflected users’ questions and expectations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    The reliability assessment was used as a calibration procedure to identify categories requiring further clarification, rather than as a formal stopping rule.

    “The reliability assessment was used as a calibration procedure to identify categories requiring further clarification, rather than as a formal stopping rule.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductreasoning

    Interrater reliability for the help desk coding varied across categories and was lowest for culture and migration.

    “In addition, interrater reliability for the help desk coding varied across categories and was lowest for culture and migration.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    All interviewees provided written informed consent before participating.

    “All interviewees provided written informed consent before participating.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    The coding framework for interviews was developed by the research team beforehand and consisted of 5 predefined categories, allowing for subcodes to emerge inductively within each.

    “The coding framework was developed by the research team beforehand and consisted of 5 predefined categories, allowing for subcodes to emerge inductively within each.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    The study was approved by the Ethical Committee of the Department of Applied Psychology at Thomas More University of Applied Sciences (ECTP2425_07).

    “The study was approved by the Ethical Committee of the Department of Applied Psychology at Thomas More University of Applied Sciences (ECTP2425_07).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Interpretationreasoning

    IMPACCT represents an initial attempt to translate this broader ecological and culturally responsive perspective into a practical digital decision-support tool.

    “IMPACCT represents an initial attempt to translate this broader ecological and culturally responsive perspective into a practical digital decision-support tool.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Interview data were pseudonymized during transcription and analysis, stored securely, and accessible only to the research team.

    “Interview data were pseudonymized during transcription and analysis. Data were stored securely and were accessible only to the research team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductreasoning

    As the remaining help desk questions were single-coded after calibration, frequencies should be interpreted as indicative patterns rather than precise prevalence estimates, particularly for categories with lower agreement.

    “As the remaining help desk questions were single-coded after calibration, frequencies should be interpreted as indicative patterns rather than precise prevalence estimates, particularly for categories with lower agreement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    Interrater reliability was assessed by three raters independently coding 70 help desk questions and calculating Fleiss κ for each overarching category.

    “To assess interrater reliability, three raters (CVB, BJ, and TVD) independently coded 70 help desk questions. This consisted of an initial calibration set of 50 questions and an additional set of 20 questions following discussion of discrepancies and clarification of coding definitions. Fleiss κ was calculated for each overarching category.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Study design and conductnone given

    The final sample size of 19 was considered sufficient for a pragmatic first-user evaluation aimed at collecting feedback across a range of professional practice settings.

    “The final sample size was considered sufficient for a pragmatic first-user evaluation aimed at collecting feedback across a range of professional practice settings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.

    Interpretationreasoning

    This study suggests that professionals working with children and young people with a refugee background need support not only in recognizing trauma- and adversity-related concerns but also in formulating these concerns within broader contexts of grief, acculturation, cultural meaning-making, family and school systems, resilience, and care pathways.

    “This study suggests that professionals working with children and young people with a refugee background need support not only in recognizing trauma- and adversity-related concerns but also in formulating these concerns within broader contexts of grief, acculturation, cultural meaning-making, family and school systems, resilience, and care pathways.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductown data

    Across the 70 items independently coded by all 3 raters, there was almost perfect agreement for adverse experience (κ=1.00), substantial agreement for 4 categories (0.67<κ<0.78), and moderate agreement for culture and migration (κ=0.57).

    “Across the 70 items independently coded by all 3 raters, there was almost perfect agreement for adverse experience (κ=1.00), substantial agreement for 4 categories (0.67<κ<0.78), and moderate agreement for culture and migration (κ=0.57).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Interpretationreasoning

    More broadly, this study highlights the potential of digital decision support to help professionals make more contextualized and better-informed decisions in refugee mental health care.

    “More broadly, this study highlights the potential of digital decision support to help professionals make more contextualized and better-informed decisions in refugee mental health care.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationown data

    The overwhelming demand for supervision indicates a clear need of professionals for support in decision-making, alongside opportunities for building knowledge and confidence in working with children with a refugee background.

    “Finally, the overwhelming demand for supervision can be seen as a clear need of professionals for support in decision-making, alongside opportunities for building knowledge and confidence in working with children with a refugee background.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationown data

    Its potential value lies not in replacing professional judgment but in helping professionals structure reflection, recognize less foregrounded dimensions of a case, and clarify possible next steps.

    “Its potential value lies not in replacing professional judgment but in helping professionals structure reflection, recognize less foregrounded dimensions of a case, and clarify possible next steps.”
    Quote in the paperSubstantial claim
55 of 55

  • The paper relies on this without support.

    A gap remains between the promise of PACCT and its implementation because it often relies on in-person guidance from specialized teams, limiting its uptake in broader primary and secondary care contexts.

    “However, despite some potential clinical success when using the PACCT methodology, a gap remains between the promise of PACCT and its implementation, as it often relies on in-person guidance from specialized teams, which limits its uptake in broader primary and secondary care contexts.”

  • The paper relies on this without support.

    There is limited evidence regarding how digital decision-support tools can help professionals interpret mental health concerns and determine culturally and trauma-sensitive responses in this population.

    “Consequently, there is limited evidence regarding how digital decision-support tools can help professionals interpret mental health concerns and determine culturally and trauma-sensitive responses in this population.”

  • The paper relies on this without support.

    Help desk questions submitted to Solentra are representative of the support needs of professionals working with refugees in first-line services.

    “Help desk questions were submitted to Solentra through an online form by professionals seeking advice on clients with a refugee background whom they were currently supporting or treating.”

  • The paper relies on this without support.

    Refugee children and families have elevated exposure to potentially traumatic experiences before, during, and after migration.

    “consistent with the elevated exposure of refugee children and families to potentially traumatic experiences before, during, and after migration”

  • The paper relies on this without support.

    Help desk questions were by nature problem-oriented and focused on obtaining advice.

    “which were by nature problem-oriented and focused on obtaining advice”
5 of 5

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Understanding the impact of trauma. In: Trauma-Informed Care in Behavioral Health Services. Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services; 2014:61-88. URL: https://www.ncbi.nlm.nih.gov/books/NBK207191 [Accessed 22-09-2026]

Cited by

Still being checked.

Related

Metadata

Authors
Van Bogaert, C. A., Jame, B., Serneels, G. M., & Van Daele, T.
Affiliations
Universitair Ziekenhuis Brussel (BE)
ORCID
Venue
JMIR Formative Research
Publisher
JMIR Publications Inc.
Published
2026-10-15
Volume
10
Pages
e86809-e86809
ISSN
2561-326X (ISSN-L)
DOI
10.2196/86809
PMC
PMC13671483
OpenAlex
W7212044961
Cited by
0
References
19
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Formative Research (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
  • Social Sciences › Public Administration › Social Work Education and Practice
Keywords
culturally responsive practice, reflective practice, case formulation, refugee children, usability, child mental health services, cultural competence
MeSH terms
Cognitive Reflection, Child, Female, Humans, Male, Refugees, Qualitative Research, Culturally Competent Care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-11-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

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Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

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