Recently-Arrived Afghan Refugee Parents' Perspectives About Parenting, Education and Pediatric Medical and Mental Health Care Services

Perceptions and Experiences of Refugee Families in the Pediatric Emergency Department: A Qualitative Interview Study

OBJECTIVES

Refugees face significant barriers that make acculturation and utilization of the US health care system challenging. Prior literature regarding health care access for the refugee population has focused on adult refugee patients. However, children and adolescents account for approximately 40% of refugees arriving in the United States annually. The objective of this study is to explore the perceptions and experiences of refugee families in the pediatric emergency department when accessing emergent care for their children.

METHODS

We performed a qualitative study of pediatric refugee families presenting for emergency care through semistructured interviews of refugee families within the pediatric emergency department and focus group sessions with community stakeholders in Atlanta, Georgia over a 3-month period. Interviews were conducted until thematic saturation was reached. All interviews were transcribed and reviewed using an iterative and inductive approach to discover emerging themes.

RESULTS

A total of 1000 families were screened, and 40 (4.0%) were eligible refugee families. Of these families, 20 (50%) completed interviews, 10 (25%) declined participation, and 10 (25%) agreed to participate but had scheduling conflicts. Four major themes emerged from the thematic analysis: (1) impact of social support on navigating the US healthcare system, (2) exacerbation of pre-existing family stressors, (3) language and communication, and (4) respect during the health care encounter.

CONCLUSIONS

This study identified important areas of concern to families of pediatric refugees when accessing emergent care. These areas should be further explored as potential areas to optimize equitable emergency department care for pediatric refugee patients.

Psychological Impact of COVID-19 on Children and Adolescents: A Narrative Review of Mental Health Challenges, Interventions, and Long-Term Trajectories

The COVID-19 pandemic has significantly impacted the mental health and well-being of children and adolescents globally. This comprehensive narrative review synthesizes current research on the pandemic's psychological effects on young people, examining emotional distress, behavioral changes, sleep disturbances, educational disruptions, and the exacerbation of pre-existing mental health conditions. A systematic literature search was conducted using PubMed, MEDLINE, PsycINFO, CINAHL, and Web of Science, covering articles published from January 2020 to December 2024. Studies focusing on children and adolescents (aged 0-18 years) that examined mental health outcomes related to the COVID-19 pandemic were included. Data extraction was performed using a standardized form, and a narrative synthesis approach was employed to analyze and integrate the findings. Key findings reveal a substantial increase in anxiety, depression, and post-traumatic stress disorder among children and adolescents during the pandemic. School closures, social isolation, and disrupted routines have contributed to these mental health challenges. Sleep patterns have been notably affected, with delayed bedtimes, increased sleep disturbances, and a higher prevalence of insomnia and nightmares. The pandemic has widened educational disparities, particularly affecting children from disadvantaged backgrounds. Individuals with pre-existing mental health conditions have experienced exacerbated symptoms and faced challenges in accessing care. Various interventions, including cognitive behavioral therapy, social-emotional learning programs, and digital mental health support, have shown promise in mitigating the pandemic's psychological impact on young people. Children were more affected, as they faced a global crisis for the first time with limited coping skills. Disruptions in routine, social isolation, and family stressors heightened anxiety, depression, and behavioral issues, making them more affected. This review emphasizes the need for continued research, targeted interventions, and policy development to address the long-term mental health consequences of the COVID-19 pandemic on children and adolescents.

Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions

BACKGROUND

Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations.

AIMS

We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions.

METHOD

In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support.

RESULTS

Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body-mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture.

CONCLUSIONS

We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.

Considerations in designing trauma-focused interventions for displaced Afghan women

In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.

Challenges in the Medical and Psychosocial Care of the Paediatric Refugee-A Systematic Review

BACKGROUND

After the invasion of Ukraine, neighbouring countries were forced to find systemic solutions to provide medical care to those fleeing the war, including children, as soon as possible. In order to do this, it is necessary to know the communication problems with refugee minors and find proposals for their solutions.

METHODS

A systematic review of the literature from 2016 to 2022 was conducted according to PRISMA criteria.

RESULTS

Linguistic diversity and lack of professional readiness of teachers are the main constraints hindering the assistance of refugee children in schools. Problems during hospitalization include lack of continuity of medical care and lack of retained medical records. Solutions include the use of the 3C model (Communication, Continuity of care, Confidence) and the concept of a group psychological support program.

CONCLUSIONS

In order to provide effective assistance to refugee minors, it is necessary to create a multidisciplinary system of care. It is hoped that the lessons learned from previous experiences will provide a resource to help refugee host countries prepare for a situation in which they are forced to provide emergency assistance to children fleeing war.

Pilot Wellness Program With Adapted Social-Emotional Learning and COVID-19 Curriculum for Refugee Youth

Refugee children are less likely than their non-refugee peers to receive timely diagnoses and treatment for mental and/or behavioral health problems, despite facing multiple risk factors including potential exposure to trauma during premigration, migration, and postmigration experiences. Social-Emotional Learning offers preventive mental health education for children through well-established, evidenced-based curricula. Although there are clear benefits of Social-Emotional Learning curricula, which can help children achieve long-term success emotionally and academically, Social-Emotional Learning curricula are not easily accessible for refugee children, often because of language and socioeconomic barriers. In this pilot study, we evaluated the feasibility and acceptability of an adapted Social-Emotional Learning program that included culturally specific, multilingual, trauma-informed wellness, and physical education during the COVID-19 pandemic: EMPOWER (Emotions Program Outside the Clinic With Wellness Education for Refugees). We used the Intervention Mapping framework which guided the (1) planning, (2) program development, and (3) mixed-method evaluation of the feasibility and acceptability of the EMPOWER pilot. We found that this adaptation was well-received by Afghan refugee families and that COVID-19 safety measures were well-understood after participation. Challenges emerged around videoconferencing connectivity and around finding a common language for discussing emotions. Future iterations of the program and evaluations will require continued partnerships with community members and organizations. As we continue and expand EMPOWER, we aim to evaluate short-term improvement in Social-Emotional Learning competence as well as long-term mental and behavioral health outcomes for children and their families.