Developing preventive mental health interventions for refugee families in resettlement

In refugee resettlement, positive psychosocial outcomes for youth and adults depend to a great extent on their families. Yet refugee families find few empirically based services geared toward them. Preventive mental health interventions that aim to stop, lessen, or delay possible negative individual mental health and behavioral sequelae through improving family and community protective resources in resettled refugee families are needed. This paper describes 8 characteristics that preventive mental health interventions should address to meet the needs of refugee families, including: Feasibility, Acceptability, Culturally Tailored, Multilevel, Time Focused, Prosaicness, Effectiveness, and Adaptability. To address these 8 characteristics in the complex environment of refugee resettlement requires modifying the process of developmental research through incorporating innovative mental health services research strategies, including: resilience framework, community collaboration, mixed methods with focused ethnography, and the comprehensive dynamic trial. A preventive intervention development cycle for refugee families is proposed based on a program of research on refugees and migrants using these services research strategies. Furthering preventive mental health for refugee families also requires new policy directives, multisystemic partnerships, and research training.     

Diamonds in the Rough: Bridging Gaps in Supports for At-Risk Immigrant and Refugee Youth

Immigrant youth come to Canada with enormous potential to make a significant, positive contribution to the future of their adopted country. In many cases, this potential is realised; in others, it is not. The ease with which immigrant youth and their families integrate into Canadian society has a strong impact on their futures; those who become marginalised during this process risk becoming alienated or involved with the criminal justice system. Interviews were conducted with 12 stakeholders (including representatives from social service agencies, community groups and the criminal justice and forensic mental health systems) who frequently come into contact with immigrant and refugee youth involved in criminal and/or gang activity. Based on the family, individual, peer, school and community risk and protective factors reported to have an influence on immigrant and refugee youth, recommendations are made for bridging gaps in programming and policy initiatives to support at-risk youth.     

Establishing Therapeutic Dialogue with Refugee Families

The article describes an investigation into dialogues between native Swedish psychotherapists and refugee families. Dialogue is needed to establish the therapeutic alliance, which is ultimately important for healing, whether of individual sickness or family crisis. However the development of dialogue is hindered by cross-cultural and language barriers. We concentrate on one aspect of research originally presented in a Doctoral Thesis by the first author, asking how culture and power differences, together with their resettlement in a strange country, affected meetings with refugee families, and how these problems were overcome; language and the presence of an interpreter are not discussed. A multi-perspective methodology was used in the original research, combining text analysis, review of video-recordings by the participating therapists, and interviews with the families. All these forms of investigation are drawn on here, but particularly text analysis. Significant hindrances to dialogue turn out to be differences in cultural values between refugee and therapist, their different power positions, and the refugee’s weariness and distrust of meetings. Strategies to minimise power differences are an essential aspect of the Finnish open dialogue approach, which turns out to be particularly relevant to such refugee meetings.     

Therapy with Refugee Families: What Is a “Good” Conversation?

This article addresses the question of what is a “good” conversation by analyzing “poor” conversations. During a project on family therapy with refugee families, we often experienced what we labeled as “poor” conversations. We present examples of a variety of such conversations, which we then analyze with reference to therapeutic maps and central concerns of the therapists. We describe four patterns of therapist/client relationships that emerged from this analysis. The main focus of our discussion is to clarify when “poor” conversations may be an important part of the therapeutic process, and when and how they should be avoided. We believe that the issues we raise are central to therapeutic work in general and not just to therapy with refugee families.     

Personal Contact with Refugees is Key to Welcoming Them: An Analysis of Politicians' and Citizens' Attitudes Towards Refugee Integration

Politicians are influential both in directing policies about refugees and in framing public discourse about them. However, unlike other host country residents, politicians' attitudes towards refugees and integration are remarkably understudied. We therefore examine similarities and differences between politicians' attitudes towards refugee integration and those held by citizens. Based on the stereotype content model, we expect that political ideology informs stereotypes about refugees, which subsequently shape attitudes towards refugee integration. Based on the Contact Hypothesis, we further argue that personal contact with refugees reduces negative stereotypes about them—in particular for those endorsing a right-wing ideology. We draw on data collected via two surveys with 905 politicians and 8013 citizens in the Netherlands to show that (1) unlike those with a left-wing orientation, residents (i.e., both politicians and citizens) with a right-wing orientation hold more negative stereotypes about refugees, which in turn relate to more negative attitudes towards refugee integration; (2) personal contact with refugees is associated with less negative stereotypes among residents; and (3) politicians, compared to citizens, report less negative stereotypes and more positive attitudes towards refugee integration. The practical implication of fostering residents' contact with refugees as well as the implications for future research are discussed.     

A Review of the Use of Trauma Systems Therapy to Treat Refugee Children,Adolescents, and Families

ABSTRACT

Children and adolescents within refugee families face adverse childhood experiences emanating from multiple sources. These traumatic events can begin with persecution within their country of origin, during the migration process, and within their re-settled countries. More specifically, these children and their families are more prone to the four core stressors being: traumatic, acculturative, isolative and resettlement stress. Trauma Systems Therapy for Refugees (TST-R) is a promising treatment model to address child and adolescent mental health disparities revolving around direct and vicarious trauma. In TST-R, the treatment team systematically targets the needs of the child, while collaborating with cultural brokers from the refugee community, their school, and family unit. Researchers have used TST-R as an intervention for reducing trauma symptoms in Somali, Somali-Bantu, and Bhutanese children, adolescents, and their families. We review the strengths and limitations of this model. Further research is needed to determine its applicability to other communities within the United States and abroad.     

Family consequences of refugee trauma

OBJECTIVE: To construct a model on the consequences of political violence for refugee families based upon a qualitative investigation. METHODS: This study used a grounded-theory approach to analyze qualitative evidence from the CAFES multi-family support and education groups with Bosnian refugee families in Chicago. Textual coding and analysis was conducted using ATLAS/ti for Windows. RESULTS: A grounded-theory model of Family Consequences of Refugee Trauma (FAMCORT) was constructed that describes Displaced Families of War across four realms of family life: (1) changes in family roles and obligations, (2) changes in family memories and communications, (3) changes in family relationships with other family members; and (4) changes in family connections with the ethnic community and nation state. In each realm, the model also specifies family strategies, called Families Rebuilding Lives, for managing those consequences. CONCLUSIONS: Political violence leads to changes in multiple dimensions of family life and also to strategies for managing those changes. Qualitative family research is useful in better understanding refugee families and in helping them through family-oriented mental health services.     

L’enfant réfugié en consultation : quelques considérations cliniques sur l’évaluation interculturelle

This article provides some cues to develop intercultural competency in clinical practice with migrant children and their families. Specific difficulties of refugee children in terms of psychopathology, school achievement and acculturation process are pointed out. A clinical vignette concerning a psychological assessment of an 11-year-old girl is presented to illustrate critical points. Some strategies to improve clinician's ability to provide services to people from diverse cultural backgrounds are discussed.     

“Seeing the Life”: Redefining Self-Worth and Family Roles Among Iraqi Refugee Families Resettled in the United States

Social and geographic displacement is a global phenomenon that precipitates novel stressors and disruptions that intersect with long-standing familial and social roles. Among the displaced are war-torn Iraqi refugee families, who must address these new obstacles in unconventional ways. This study explores how such disruptions have influenced associations between gender and apparent self-worth experienced by Iraqi refugee families upon relocation to the USA. Further, the psychosocial mechanisms requisite of any novel approach to a new social construct are explored and reveal that production in the family is at the core of instability and shifting power dynamics during resettlement, preventing family members from “seeing the life” in the USA that they had envisioned prior to immigration. Over 200 semi-structured qualitative interviews with Iraqi participants and mental health providers were conducted over the course of the study, which demonstrate a plasticity among social roles in the family and community that transcends the notion of a simple role reversal, and illustrate the complex positionalities that families under stress must approximate during such physical and social displacement.     

Educational Cultural Brokers and the School Adaptation of Refugee Children and Families: Challenges and Opportunities

Canadian schools are utilizing services previously provided by settlement and community-based agencies to ensure the successful school adaptation of refugee children and families. This study examined the role of educational cultural brokers during the adaptation. Research queries addressed include strategies that cultural brokers use to facilitate the adaptation of refugee children in school settings, and opportunities and barriers to cultural brokering that exist in educational settings. A qualitative case study of eight educational cultural brokers was employed, using focus groups, critical incidents, document review, and semistructured interviews. Results suggest brokers engage in micro- and macrolevel activities through six brokering roles, with each role encompassing challenges and opportunities at the school, agency, and community level. This paper discusses aspects of these roles that have relevance for practice and policy for both cultural brokers and other providers of school-based services to refugee families.     

Counseling Vietnamese

The continuing influx of Vietnamese refugees means that increasing numbers of counselors unfamiliar with Vietnamese culture will be called on to build helping relationships with refugee children and their families. This article provides specific information to help the counselor establish rapport, avoid misunderstandings in explicit and implicit communication, minimize transference dangers, and deal with Vietnamese attitudes toward sex roles and the individual/family relationship. It also discusses relevant socioeconomic and ethnic differences among the Vietnamese themselves, as well as some war-related mental health problems. Practical matters, such as the proper use of Vietnamese names, are explained.     

Healing rituals with families in exile *

This paper describes work with families who have been subjected to torture and atrocity and forced into political exile. Exile is described as a state of limbo which may be resolved by involving families in rituals which reconnect them to communal life. Therapeutic dilemmas when working with families affected by torture and atrocity are discussed. The culture of refugee families is a resource which can be used to enable them to integrate experiences of atrocity and adapt to life in exile. Therapeutic strategies are discussed through case histories.     

Working with refugee families in Greece: systemic considerations

When refugee families leave their country of origin, they may also leave behind their culture and support systems but not their abilities to overcome the emerging adversities. This article addresses issues concerning the process of refugee families' ‘acculturation’ and adaptation to their new setting in Greek society. It attempts to develop culture‐sensitive approaches to family therapy based on narrative perspectives and inspired by Pike's ‘‐emic and ‐etic’ distinction. It discusses the innovative methods developed by the therapeutic team of the Greek Council for Refugees which included the use of ‘cultural therapeutic mediators’ and others in an endeavour to access the overlapping systems of refugee families in more effective ways.     

Pathways to Housing: The Experiences of Sponsored Refugees and Refugee Claimants in Accessing Permanent Housing in Toronto

In contrast to many new immigrants, refugees normally have limited financial resources upon arrival in a new country. Consequently, most refugees need some form of assistance in accessing good-quality, safe and affordable housing. This paper evaluates the assumption that refugee claimants in Toronto experience a much more difficult pathway to housing than sponsored refugees. The housing trajectories of a sample of refugees are examined using semi-structured interviews. The results confirm that this sample of refugee claimants experienced a more difficult pathway to housing, at least in the initial stages of settlement. Over time, claimants improved their housing position and narrowed the gap with sponsored refugees.     

The Afghan Refugee Client

With the advent of political turmoil in Afghanistan, increasing numbers of Afghan refugee families have been coming to the United States. Both the children and the adults perceive school as the primary resource for their successful transition into U.S. society. The school counselor is in a position to guide Afghan clients by providing them with necessary educational and career information. The historical isolation of Afghanistan and its remote location geographically make this rich and ancient culture unknown to many Americans. This culture has certain significant and unique characteristics that affect the way in which Afghans may adjust. The author describes aspects of the Afghan culture most relevant to counseling the Afghan refugee family or individual.     

Provider contact with families of adults with severe mental illness: taking a closer look

This exploratory study examined the frequency and nature of providers' contact with families of persons with severe mental illness. Fifty-nine providers in six community mental health programs completed a self-administered survey. A subsample of 8 providers also completed two in-depth interviews. Although most providers had some family contact, the contact was restricted to a small percent of their caseloads. The nature of contact that providers have with families is generally limited by their professional role. Best practice guidelines for the treatment of mental illness and agency administrators responsible for instituting these guidelines will need to clarify the types of providers who are expected to implement various aspects of family involvement.     

Engaging refugee families in therapy: exploring the benefits of including referring professionals in first family interviews

The possible benefits of including referring professionals in the first family interviews are being explored as a way to engage refugee families in therapy. Families in exile confront a number of problems related both to premigration traumatic exposures and to present adaptation processes. Refugee clients and the referring professionals in the larger system frequently see the problems and their solutions quite differently. This situation may often result in unclear working alliances in a context of therapy. We will describe first family interviews in which referring professionals are interviewed about their reasons for referrals, and where the families are invited to discuss these considerations. The conversations permit families, referrers, and therapists to reflect upon differences in positions and perspectives. Their experiences suggest that agreements or contracts based on these joint interviews are less ambiguous and more clearly formulated than contracts based on interviews with families alone. Finally, these experiences are discussed as a potentially valuable approach in a cross-cultural context.     

When I Became a Refugee,This Became My Refuge: A Proposal for Implementing a Two-Generation Intervention Using Yoga and Narrative to Promote Mental Health in Syrian Refugee Caregivers and School Readiness in Their Preschool Children

ABSTRACT

This article represents our attempt to establish a blueprint for a comprehensive refugee intervention program to be disseminated across the globe. Specifically, we describe a proposal to conduct a two-generation intervention program that addresses the socioemotional needs of both Syrian caregivers and their preschool children who have fled the atrocities of their home country and have settled in Turkey. The goal is to improve the school readiness skills of preschool children ravaged by war, dislocation, and poverty. First, we describe a caregiver intervention, which consists of trauma-sensitive yoga; second, we describe a child intervention, which consists of a storytelling and story-acting activity. Finally, we discuss how to assess the effectiveness of this two-generation intervention program. Our hope is that this novel intervention program will be implemented in other regions experiencing an influx of refugee families who need immediate psychological services.     

The role of shared social identity in mutual support among refugees of conflict: An ethnographic study of Syrian refugees in Jordan

In the midst of an unprecedented refugee crisis and the shortfall of aid organization resources, a shift toward utilizing the capacity for collective resilience in refugee communities could be helpful. This paper explores experiences of psychosocial social support among a community of Syrian urban refugees in Jordan, especially the kind of support that helps them deal with secondary stressors. We were specifically interested in the role of shared social identity as a basis of support and the sources of such shared identity. We conducted an 8‐month ethnography that included observations and semistructured interviews with 13 refugees. We found many examples of support among refugees, on both personal and collective levels. Some of this support was based on sharing the identity of “refugee” that stemmed from a sense of common fate. This is similar to the process identified in the literature on disasters. Psychological membership in the refugee group is stigmatic, but it can also lead to positive outcomes in line with the social cure perspective. However, we also found examples of support that were value‐based or based on pre‐existing interpersonal networks. Implications of the findings for models of group processes in stressful situations and the practical question of refugee support are discussed.     

The Costs of Secondary Migration: Perspectives from Local Voluntary Agencies in the USA

In recent years, as the need for global refugee assistance has increased, so have fears and concerns of the costs of refugee resettlement in Western nations. Now, seemingly more than ever, international security and regional development depend largely on the composition and distribution of the world population. In many Western nations, dispersal policies are specifically designed to manage the distribution of recently arrived refugees. Secondary migration presents a challenge to the goals of dispersal policies and raises questions regarding regional development, population pressures, job security, welfare dependency, and the future of global refugee assistance. We survey administrators and caseworkers in a series of qualitative interviews about their experiences with secondary migration. We conclude that the US refugee resettlement system is ill-equipped in handling the complications of secondary migration. These results lead us to reimagine a better strategy for achieving the goals of refugee resettlement.