Caregiver Strain: Assessment of Stress and Needs for Caseworkers and Paraprofessionals Serving International Refugees

Saturday, 28 October 2017: 3:35 PM

Dawn Garrett-Wright, PhD
School of Nursing, Western Kentucky University, Bowling Green, KY, USA
Cheryl Wolf, PhD
Department of Counseling and Student Affairs, Western Kentucky University, Bowling Green, KY, USA
Saundra Starks, EdD
Department of Social Work, Western Kentucky University, Bowling Green, KY, USA


Increasing numbers of international refugees are being resettled in the United States. Caregivers (caseworkers and paraprofessionals) are responsible for assisting these refugees in obtaining services related to education, healthcare, employment, and housing. The purpose of this mixed-methods study was to ascertain concerns and training needs of these caregivers in a southeastern state.


The convenience sample consisted of 27 caregivers drawn from three agencies including the local housing authority, a refugee resettlement agency, and a local community services agency. Participants completed demographic forms and a researcher-developed questionnaire on work stressors, job satisfaction, and client community resources. Additionally, four focus groups using semi-structured questions helped collect information on caregiver stressors and the availability of needed resources and training for both the caregivers and refugees. Descriptive statistics were calculated and qualitative data was analyzed using thematic analysis. Two researchers coded the data independently and then collaboratively. A third researcher then used the codes developed to confirm the coding structure. Trustworthiness was enhanced by meeting with participants following coding to discuss and confirm findings. IRB approval was obtained before data collection began and participants signed consent forms prior to participation.


The sample was predominately female (n=24, 88.9%) and the average age of participants was 37.2 years (range 22-55 years). Ten of the 27 participants (37%) had personal experience as an immigrant or refugee and 85.2% (n=23) were current U.S. citizens; 4 participants were permanent residents. Although 37% of participants reported this was the most stressful job they ever held, 77.7% felt satisfied with their current job. Language barriers when assisting international refugee clients and lack of appropriate translation services were concerns for 66.6% of the participants. Analysis of qualitative data revealed several themes including: the most stressful parts of working with refugees (e.g, client dependency, deadlines, lack of resources/access, language barriers, and safety); the physical, mental, and emotional consequences of job stress; positive and negative strategies to cope with stress; and needed community resources and trainings to ensure quality services.

Discussion and Conclusions

The results of this study point to the difficulties experienced by those who assist refugees. The findings indicate that nurses and other health professionals can assist those who work with refugees by helping them manage the negative consequences of their personal stress through more positive coping strategies and assisting them with locating resources for themselves and their clients. It is important that nurses lead the way in helping caregivers find culturally sensitive healthcare for physical and psychological needs of their refugee clients and to work with other social service providers to ensure that basic needs related to housing, education and employment are met. Partnerships with social workers and counseling professionals can provide interdisciplinary approaches to manage the complex problems faced by refugees and the caregivers serving them.