★ General questions
Q: What is the difference between the STAR-MH and the eSTAR-MH?
A: The STAR-MH is the screening tool which was first developed as a pen-and-paper form. The eSTAR-MH is the web-based electronic platform that enables the STAR-MH to be completed online with a client and worker together. The electronic version has oral translations of several languages for clients who are not literate in their primary language.
Q: Is the STAR-MH and eSTAR-MH free to use?
A: Yes, these tools are freely available for use by registered individuals who work with asylum seekers and new refugees. You will have to register and be granted approval prior to accessing the STAR-MH and eSTAR-MH for use with clients.
Q: Can I use the tool straight away?
A: Once you have registered to use the tool, you will receive an introductory email enabling you to log in for access to the tool.
Q: Is this screening tool suitable for other migrants?
A: The STAR-MH was developed and tested in a large population of asylum seekers and new refugees. We cannot ensure its validity for other populations, including other migrants.
Q: Can I use the eSTAR-MH on all devices and in all browsers?
A: The eSTAR-MH can be used on all devices and most browsers (it is not supported by Internet Explorer).
Q: I am having technical difficulties, what should I do?
A: If you encounter a technical problem in using the eSTAR-MH or accessing any of the resources on the site, you can email us via our contact page and by selecting ‘Technical issue’ in the subject menu.
★ Clinical use of the tool
Q: Who can use the STAR-MH?
A: Registered workers ("users") at agencies who work with refugees and asylum seekers ("clients").
Q: Can clients screen themselves using the tool?
A: No, the STAR-MH is designed for a worker (the user) to administer the tool, or be with the client while they complete the tool online.
Q: Do I need to be trained to use the STAR-MH?
A: The STAR-MH was designed to not require training. However, it is important that users are aware of (1) risk management procedures of their agencies, and (2) appropriate referral pathways in their region in order to refer the client to an agency which will accept their referral for assessment and be able to offer treatment or onward referral to appropriate treatment if required.
Q: Does the STAR-MH screen for all mental disorders?
A: The STAR-MH screens only for PTSD and major depressive disorder. However in developing the tool, we found that PTSD and/or major depressive disorder co-existed with any other mental disorder 99% of the time. Nevertheless, the STAR-MH does not specifically identify other mental or substance use disorders and if suspected these will need separate assessment.
Q: Will the STAR-MH definitely detect whether the client has a mental disorder?
A: No. The STAR-MH was designed to be highly sensitive, that is trying to identify as many positive cases as possible. It has a sensitivity of 93%, meaning that it will miss ~7 in 100 people who truly do have PTSD or major depressive disorder. It is less specific (75%), meaning that 1 in 4 people it screens as positive may not have PTSD/depression (but do have some symptoms and may still need support, e.g. psychosocial interventions). If you suspect your client may have a mental disorder but screens negative, it is essential you refer them for further assessment.
Q: Will this tool give the client a diagnosis?
A: No. The STAR-MH is a screening tool. This means it screens for likelihood of the client having post-traumatic stress disorder (PTSD), major depressive disorder, or both. If the client is 'screened in', they will need a psychiatric assessment by a physician, psychiatrist, psychologist or other mental health clinician.
Q: Where do I refer the client if they screen positive?
A: The client can be referred to the usual agencies or organisations in your region which offer primary care, mental health or torture and trauma services. The ‘letter to primary physician’ page on the downloadable PDF can be edited to include a relevant service if the client is referred to a primary care physician (for assessment) who may need guidance regarding onward referral for treatment. This may particularly be the case for asylum seekers, who may not have medical insurance or universal health care.
Q: Can I use the STAR-MH to screen for possible mental disorders in children?
A: The STAR-MH has been developed and validated for adults aged 18 years and over. The research team are currently developing a similar tool for people below 18 years.
★ Administering the tool
Q: Does the client have to complete the screening process online?
A: No. Once registered, you will have the option to download a PDF version in several languages which you can complete manually with the client.
Q: Do I have to ask questions in the same order as the tool has them?
A: Yes. Some users may initially feel uncomfortable with Q2, but our extensive research during piloting and field testing with many agencies has demonstrated that this question is not traumatic or stressful to clients.
Q: Does the client have to be alone when I administer the tool?
A: Yes, for the most valid result. Administering the tool with others present (e.g. family members) is not recommended and the validity of the screening outcome cannot be guaranteed if the client is not screened on their own, without the potential influence of others in the room.
Q: What happens if the client becomes distressed answering the questions?
A: This is rare but may happen. In this event, your agency's usual risk management process should be followed, as would be the case if a client spontaneously disclosed thoughts of self-harm or suicidality. If the client response to Q2 is yes, a follow-up question should be asked regarding recency. If the client is currently suicidal or having thoughts of self-harm, they should be seen by a primary care physician or mental health clinician immediately, or have arrangements made to be transferred safely to hospital or a crisis mental health service.
Q: In which languages is the STAR-MH available?
A: The client questions are currently available in the following languages:
User languages include English and Italian.
Q: Can I use it with an interpreter?
A: Yes, an interpreter can be used if needed. Our pilot research found that administration of the STAR-MH by a user takes approximately 6 minutes, with or without an interpreter.
Q: What if the client is not literate in their own language?
A: All client languages in written format are also available in oral format, as indicated by a clickable icon where applicable.
Q: Can the tool be re-administered?
A: Yes. There is no harm in re-administering the STAR-MH although doing so in less than 4 weeks is unlikely to give a different result unless the client has had a significant recent stressor in their life.
★ Data storage/use
Q: What happens to the information that my agency and clients send to the researchers?
A: Only de-identified client information will be collected by the researchers such as age, country of origin, language, and results of the screening tool itself. This is to track the usage and uptake of the tool in particular languages and countries. No agency, user or client data will be kept in the portal, and the data used to populate the STAR-MH is deleted from the server after a maximum of 24 hours.
Q: Will the data or completed PDFs be available to access later?
A: No. No data will be retained and is erased: after 60 minutes; if the language selection is changed or you log out before generating and saving the completed PDF to your device.