Pathways to Wellness

4040 S. 188th St SeaTac, WA 98188 • 206-816-3252 • E-Mail


Pathways to Wellness

Creating Pathways for Refugee Survivors to Heal

Early intervention and evidenced-based screening to help refugees with significant depression, anxiety and traumatic stress get connected to the care they need to heal.

Pathways to Wellness is a partnership project between Lutheran Community Services NW, Asian Counseling and Referral Service, Public Health Seattle & King County, and Dr. Michael Hollifield of the Pacific Institute for Research and Evaluation.

Pathways is generously funded by The Robert Wood Johnson Foundation, The Bill and Melinda Gates Foundation, United Way of King County, The Medina Foundation, The Seattle Foundation, MJ Murdock Trust, and Boeing Employees Community Fund.

Click Here Watch Our Video

The Pathways Project

Pathways to Wellness is a new approach to detecting depression, anxiety, and traumatic stress in refugees and connecting them to the care they need to heal. It also trains mental health providers how to effectively deliver services to refugee populations, and partners with refugee communities to better understand and address mental health issues.

photoThe United States settles close to 80,000 refugees annually. Refugees come from the direst of situations – war, violence, deprivation and persecution. Violence, fear, deprivation, and loss are catalysts for depression, anxiety and other mental health issues. Research supports the relationship between trauma and poor mental health, and numerous studies prove that refugees are acutely at risk when it comes to mental health issues. Refugees have been found to have ten times the rate of Post-Traumatic Stress Disorder [PTSD] as compared to the general population, and higher rates of mental disorders in general.

Pathways collaborated with refugee communities and a renowned psychiatrist to create a culturally competent, short assessment that detects symptoms of anxiety and depression in refugee populations from different countries. After a rigorous year-long evaluation, the assessment was empirically proven to be reliable and effective, with 35% - 40% of people showing significant distress. The tool is now fully integrated into the physical health screening that every new refugee arrival receives.

Every Iraqi, Bhutanese, Burmese and Karen refugee 14 years of age or older being resettled in King County is now screened for mental health issues, and if they have significant symptoms, connected to an agency for further support. To make sure that providers can effectively deliver services, Pathways provides training and consultation on culturally-responsive assessment, treatment planning, and therapy. The project also partners with refugee communities to design and deliver effective education on stress, resettlement, and mental health.

In 2011, the Pathways tool was cited as an emerging best practice by the Refugee Health Technical Assistance Center. Several refugee resettlement programs from Vancouver, BC, to Phoenix, AZ, and Philadelphia, PA have expressed interest in replicating the model. Our goal is to get Pathways tools into the hands of those serving refugees so that nationwide, more refugees can get the care they need to heal and begin again in their new home in the United States.

Click Here to Find Out More About Our Validated Screener

Download the recent ORR webinar on Adjustment Support Groups (Adobe PDF)

View the recent ORR webinar on Adjustment Support Groups (Audio included)

Request a copy of the Pathways to Wellness Adjustment Support Group Curriculum (Word document)


Why is Pathways Important? Ask Pem.

photoPem came from a small country in Asia. As a young mother, Pem fled her village when civil war broke out and soldiers began burning and looting homes. She spent over a month walking with her infant daughter to safety. For the next 13 years, Pem languished in a refugee camp. Fortunately, she was one of the lucky few that received an opportunity to come to the United States.

When she arrived, Pem was given a required health screening that also looked for signs of depression and anxiety. Pem admitted to not being able to sleep at night and crying on an almost daily basis. Her body hurt, she said. “Too many thoughts.  So many thoughts, I can not think well.” Pem was immediately connected to support to help her with these symptoms, and is now thriving with a new job and new hope. Pem’s assessment took less than 10 minutes, but it is not happening for most refugees.

Pathways to Wellness is a new approach to finding depression, anxiety, and traumatic stress in refugees and connecting them to the care they need to heal. We provide training for mental health providers to effectively deliver services to refugee populations, and partner with refugee communities to better understand and address mental health issues. Pathways is working with other cities across the United States to duplicate its success.

No refugee should suffer any more than they already have. Click Here to get more information on how Pathways can benefit your community.


The Refugee Health Screener (RHS-15)

photoAll refugees are required to have a health screening when they enter the United States. Each state contracts with counties and other medical entities to conduct these screenings. Part of the mandate of the health screening is to assess mental health in some way. However, it has rarely been done because of a number of factors:

  • Few evidenced-based tools that effectively capture mental health issues across cultures
  • Lack of time from medical staff
  • Lack of referral resources

Pathways has validated a Refugee Health Screening tool in five langauges, and the tool is currently integrated into Public Health Seattle & King County. This means that now every Nepali, Karen, Burmese, Russian, and Iraqi refugee that arrives in King County is being screened for symptoms of depression and anxiety and referred to care when needed. Additional translations are forthcoming.

The Pathways to Wellness’ Refugee Health Screener (RHS-15) takes less than 10-minutes to administer, which is critical to primary care staff who have limited time. It is also validated, meaning it has empirically been shown to effectively capture symptoms of depression and anxiety – the most common mental health problems among refugee populations. Because it was designed with refugees and translated through a vigorous community translation process, the RHS-15 is unique in its effectiveness across cultures.

Click here to download the Refugee Health Screener ToolKIT (353 KB Adobe PDF)

Contact Us

Please contact us if you would like to implement the RHS-15 tool in your community, if you need technical assistance, training, or outreach materials.

SeaTac Office:

4040 S. 188th St.
SeaTac, WA 98188
Fax: 206-838-2680
Email: Beth Farmer