Leaving no children or families outside: the challenges of immigration

Editorial: The Impact of Policy on Children's Mental Health: The Case of Immigration

Most of the policy debates in the United States center around ideological and political beliefs. This is particularly the case in regard to immigration, specifically undocumented immigration, where there is much polarization of viewpoints. The focus of this debate is largely on the direct or material impact of such policies on reducing or accommodating immigration. These policies largely erect or lower legal or socioeconomic barriers for immigrants and as a consequence hope to impact decisions to pursue entry into the United States. Though immigration is technically a federal responsibility, many states have weighed in with state-level policies on both sides of the debate. This is not unusual for many areas of national policy where there are regional differences, which can set up comparative studies of policy analysis and impact.

Navigating cultural transitions during resettlement: the case of unaccompanied refugee minors

Introduction

Refugees face the process of cross-cultural transitions upon arrival in their host country. This process is commonly referred to as acculturation and can be particularly challenging for asylum-seeking children and adolescent unaccompanied by a caregiver. To more effectively facilitate unaccompanied refugee minors (URMs) resettlement, this study sought to obtain an enhanced understanding of the acculturation processes of these youth'.

Methods

Thus, interviews with 48 URMs, all of whom arrived before the age of 16 years, were analyzed in two steps. First, how the youth described their host country's society and culture, followed by how they navigated within this societal and cultural landscape during resettlement.

Results

The youth described how they navigated the Norwegian cultural and societal landscape by gaining cultural competence, adapting and finding ways to contribute, which made it easier for the youth to gain access to the society, to succeed as well as enhance their sense of agency. However, the youths also reported having to navigate between the expectations of their original and host country cultures, struggling with finding a balance between the two cultures.

Discussion

The youth' acculturation processes seemed to be the result of both their own needs, wishes and behavior as well as specific features in their host country culture, which supports the notion that acculturation processes to some degree are context- and culture-dependent. Knowledge regarding the cultural and societal framework that these youth face and how they navigate within it during resettlement is critical for identifying possible cross-cultural challenges and promoting positive developmental tracks. To understand more about acculturation and integration processes, future research should include specific cultural and societal features as well as immigrants' own perspectives and experiences during resettlement.

[Migration loss and grief among immigrants with little education in Quebec]

Qualitative research conducted in Quebec aims to trace the psychosocial profile of immigrants in a vulnerable situation due to their migratory journey and to identify the challenges of the actors involved in their integration process. The participants in the research are enrolled in a francization program specific to Quebec for immigrants with low literacy skills (Foreign Investment Promotion and Protection Agreement). The results raise several issues related to the grief and loss experienced by the most fragile immigrants. Indeed, the challenges of post-migration life and integration into the host society are added to the many migratory losses and the suffering of ongoing grief.

Factors Related to Immigrant/Nonimmigrant Children's Experience of Being Bullied: An Analysis Using the Multiple Disadvantage Model

Applying the multiple disadvantage model, a study of children in the United States examined experiences of being bullied in terms of 5 factors: social disorganization, social structural factors, social relationships, mental health and access to care, and acculturation. The study was a secondary data analysis of 19,882 immigrant and non-immigrant children, using data from the 2018 National Survey of Children's Health. Logistic regression results show children's likelihood of being bullied to be associated positively with racial discrimination; child mental health problem (either attention deficit/hyperactivity disorder, depression, anxiety, behavioral/conduct problem, or Tourette Syndrome); family substance use; being female; being age 6-10; being age 11-13; and parent education level. Likelihood of being bullied was associated negatively with safe neighborhood; being Black; being Asian; family cohesiveness; neighbor support; parent mental health; being a first- or second-generation immigrant; and parent age. The results imply the usefulness of interventions promoting racial harmony and family support.

The Need for Parental Support for Migrant Parents in Transition Into Sweden: A Perspective

Migration is a stressful experience and research shows that newly arrived migrants in Sweden suffer from different challenges and struggle to relate to parenting in a new culture that is different from their own. The Swedish Child Health Services (CHS) focuses on promoting health among children, as well as supporting parents in parenting. Although this is a goal, migrant parents participate at lower rates in parental support groups. This paper aims to discuss how the Swedish CHS can support these families and address the need for improvement in the parental support offered to migrant parents during transition into their host country. In addition, this paper also aims to review and discuss the advantages of using a community-based participatory research approach together with the Swedish CHS to identify and apply culturally appropriate support programs to increase health literacy among migrant parents. The Swedish government decided to place greater emphasis and resources on supporting parents and promoting equal health among families in Sweden, with special emphasis on migrants and other vulnerable groups. This report from the Swedish government indicates the importance of creating knowledge about new ways, methods, and actions that may be needed to increase this support. One suggestion of this paper is to provide culturally appropriate healthcare work using a community-based participatory research approach, where migrant parents themselves are actively involved in the development of support programs. This approach will not only provide migrant families knowledge and support, it will also build on their needs and the challenges they can share, and receive support to overcome.

Demographic Correlates of Movement Behaviors in Infants: A Longitudinal Study

BACKGROUND

Demographic correlates of movement behaviors in infants are unclear. This study examined the longitudinal associations between demographic correlates and movement behaviors in infants.

METHODS

Participants were 411 parents of infants from the Early Movers project in Edmonton, Canada. Movement behaviors, infant and parental age, and nonparental care time were assessed using a parental questionnaire at 2, 4, and 6 months of age. Other infant and parental demographic variables were assessed at 2 months of age. Linear and generalized linear mixed models were conducted.

RESULTS

Infant age was associated with all movement behaviors except for restrained time. White infants and those with older parents had less tummy time but increased odds of having reading time. Infants of the most educated parents also had lower tummy time. Higher parental education and more siblings were associated with no screen time and longer infant sleep time. Infants with immigrant parent(s) were less likely to have reading time. No associations were found for infant sex, time spent in nonparental care, and parental marital status.

CONCLUSION

Since no single demographic group demonstrated healthy patterns for all movement behaviors, promotion of a healthy balance of movement behaviors may be needed universally for all infants.

A Community-Based Organization Model to Promote Latinx Immigrant Mental Health Through Advocacy Skills and Universal Parenting Supports

The unique mental health context of children in Latinx immigrant families calls for innovative community-based intervention strategies. We use an ecological public health approach to highlight the importance of community-based organization (CBO) settings, the critical role of community-based paraprofessionals (i.e., non-clinicians, near-peers) and capacity-building, and the expansion of mental health promotion strategies to include realistic, day-to-day supports for Latinx immigrant parents and families. This realigns mental health with the goals and mission of trusted spaces, like CBOs, that can offer more equitable and non-stigmatized access for Latinx immigrant families. We draw upon two strength-based and empowerment-focused interventions that utilize community-based workforces to promote positive parenting skills (Partners Achieving Student Success-PASS; Mehta et al., 2019) and self-advocacy skills (Community Advocacy Project-CAP; Sullivan & Bybee, 1999) to provide the conceptual framework for Family Mental Health Advocacy (FMHA). FMHA aligns mental health promotion with the advocacy mission of CBOs, engages CBO staff with feasible mental health "messages," and empowers immigrant parents as critical change agents in the lives of their children. We acknowledge the challenges associated with implementing mental health promotion strategies and providing workforce support, as well as the importance of local and national policy influences.

The Association Between Self-perceived Health and Sleep-Quality and Anxiety Among Newly Arrived Refugees in Sweden: A Quantitative Study

Previous research findings suggest that insomnia could be related to decreased health status and that it could also be affected by traumatic life experiences, such as war. Good health is important for newly arrived refugees for an effective integration process. The aim of the present study is, therefore, to investigate the association between self-perceived health and sleep quality among newly arrived refugees in Sweden. The results are based on 681 migrants who participated in a survey between 2015 and 2016. There was a significant odds ratio (OR) after adjustment for confounders for newly arrived refugees that were experiencing bad self-perceived health to also experience bad sleep: OR 8.07 (4.34-15.00). Furthermore, the OR remained significant but lower after adjustments for confounders for newly arrived refugees that had bad self-perceived health to be suffering from anxiety during sleep, with OR 3.83 (2.11-6.94).

Borderland and Borderline: Understanding and Treating Adolescent Migrants in Crisis

Background::

Much of the literature on adolescent refugees has focused on their experiences of trauma, and trauma-focused psychotherapy has been emphasized. In addition to having experienced trauma, adolescents with refugee or migration backgrounds are confronted with distinct challenges in the process of identity formation. These problems result from the normal processes of identity formation and restructuring during adolescence (the socalled second individuation phase) complicated by their transition from their culture of origin to the new culture. This process has been called a third individuation phase. These teenagers live on the border between two worlds and are called borderland adolescents.

Method::

This paper describes the developmental processes of young migrants, using case examples to illustrate how the migrant experience affects development, particularly identity development.

Discussion::

Splitting, which is part of normal adolescent development, also occurs during the process of adaptation to a new culture. Although the process of splitting can support the integration into the new culture, it can also lead to dangerous polarization with borderline features. It is important to take this into account in psychotherapeutic work with borderland adolescents.

Newly arrived refugee parents in Sweden and their experience of the resettlement process: A qualitative study

Aims: The Swedish public support system for the integration and establishment of newly arrived refugees includes an individualized introduction plan, containing language, civic and health information classes. As the plan requires active involvement, the simultaneous establishment of childcare and school start for children risks creating additional challenges and frustrations. The aim of the study was to explore the experience of adjustment among newly arrived refugee parents in the resettlement process, so as to understand how this risk may be mitigated. Methods: This paper presents findings from a qualitative study conducted with 24 Syrian refugee parents participating in the resettlement process and having received asylum status. Results: Parents experienced stress due to long waiting times for residence permits and the struggle to find stable housing. The parents established themselves by enrolling in language studies and looking for employment. They also faced challenges adjusting socially since they were mainly meeting people from their own country and, therefore, felt excluded from the Swedish society. Conclusions: The parents describe the experiences of having escaped from a war-torn country and arrived in new surroundings as mainly challenging for their current situation. Feelings of uncertainty arise as families struggle with daily life while waiting for residence permits, finding stable housing, learning a language and adjusting to new social circumstances. Having this in mind, we conclude that this group of refugees is exposed to health risks in the near future and, as such, is in need of additional support.

Filhos das fronteiras: revisão de literatura sobre imigração involuntária, infância e saúde mental

Na atualidade há um expressivo contingente de refugiados que deixam suas casas devido a conflitos –guerras, perseguições e violações dos direitos humanos– em busca de novas oportunidades. O Brasil tem se tornado um dos destinos destas pessoas, inclusive recebendo crianças refugiadas. Este estudo objetiva revisar a literatura científica disponível em bases de dados eletrônicas nos últimos treze anos a respeito dos impactos psicológicos da imigração involuntária em crianças. A pesquisa foi realizada em cinco bases de dados (BVS-PSI, Periódicos Capes, Francis, Redalyc e PsycARTICLES), a partir da interseção dos descritores “immigration”, “children” e “mental health”. Selecionou-se 48 artigos para análise, sendo constatada a ausência de publicações nacionais. Os conteúdos abordados nos trabalhos foram agrupados constituindo três categorias, a saber: 1) desafios enfrentados pelas crianças ao chegar ao país de acolhimento, 2) impactos psicológicos do processo migratório forçado na infância e 3) propostas de intervenção na saúde mental dos pequenos refugiados. A partir das informações obtidas, enfatiza-se a elaboração de políticas públicas no contexto brasileiro, sobretudo direcionadas a Atenção Básica com vistas a considerar as singularidades da criança refugiada no seu acolhimento.

Diverse Experience of Immigrant Children: How Do Separation and Reunification Shape Their Development?

Although many immigrant children to the United States arrive with their parents, a notable proportion are first separated and later reunited with their parents. How do the experiences of separation and reunification shape the well-being of immigrant children? Data were from a national survey of legal adult immigrants and their families, the New Immigrant Survey from 2003 to 2004 (for academic achievement, age 6-12, N = 876; for psychosocial well-being, age 6-17, N = 1,084). Results indicated that immigrant children who were once separated from their parents exhibited poorer literacy and higher risk of emotional and behavioral problems than those who migrated with parents. A protracted period of separation and previous undocumented status of parents amplified the disadvantages experienced by these children.

Crossing International Borders in Search of a Better Life: Examining the Psychological Impact of the Immigration Experience

The focus of this paper is to discuss the cycle of migration and its psychological impact on the lives of immigrants. An overview of current migration trends, a discussion on the cycle of immigration (Casas, 2014), and its psychological consequences are presented. A qualitative phenomenological approach was utilized to analyze the stories of four immigrants, which resulted in a thematic analysis that discusses the cycle of immigration and its impact. The paper concludes with a discussion of implications, limitations, and future research.

Integration of Unaccompanied Migrant Youth in the United States: A Call for Research

Between October 2013 and July 2016, over 156,000 children traveling without their guardians were apprehended at the US-Mexico border and transferred to the care of the Office of Refugee Resettlement (ORR). During that same period, ORR placed over 123,000 unaccompanied migrant youth-predominantly from Central America-with a parent or other adult sponsor residing in the US. Following placement, local communities are tasked with integrating migrant youth, many of whom experience pre- and in-transit migration traumas, family separation, limited/interrupted schooling, and unauthorised legal status, placing them at heightened risk for psychological distress, academic disengagement, maltreatment, and human trafficking. Nonetheless, fewer than 10% of young people receive formal post-release services. This paper addresses the paucity of research on the experiences of the 90% of children and youth without access to post-release services. To bridge this gap, this article: (a) describes the post-release experiences of unaccompanied youth, focusing on legal, family, health, and educational contexts; (b) identifies methodological and ethical challenges and solutions in conducting research with this population of young people and their families; and (c) proposes research to identify structural challenges to the provision of services and to inform best practices in support of unaccompanied youth.

Charting Directions for Research on Immigrant Children Affected by Undocumented Status

Three groups of children from Mexico and Central America are vulnerable to effects of US immigration policies: 1) foreign-born children who entered the US with undocumented immigrant parents; 2) unaccompanied children who entered the US alone; and 3) U.S.-born citizen children of undocumented immigrant parents. Despite the recent demographic growth of these youth, scholarship on their strengths and challenges is under-theorized and isolated within specific disciplines. Hence, service providers, researchers, and policymakers have insufficient research to inform their efforts to support the children's wellbeing. A group of scholars and service-providers with expertise in immigrant children convened to establish consensus areas and identify gaps in knowledge of undocumented, unaccompanied, and citizen children of undocumented immigrant parents. The primary goal was to establish a research agenda that increases interdisciplinary collaborations, informs clinical practice, and influences policies. This report summarizes key issues and recommendations that emerged from the meeting.

Suicidality among immigrants: Application of the interpersonal-psychological theory

Immigrants constitute a significant percentage of the total population living in the United States; however, there is a paucity of research unique to suicidality among immigrants. The present article examines the applicability of the three variables of the interpersonal-psychological theory of suicidal behavior-acquired capability for suicide, sense of thwarted belongingness, and perceived burdensomeness-to conceptualize, assess, and treat suicidality among immigrants. Risk and protective factors and mechanisms are discussed in the context of 2 case studies and immigrant paradox. Clinical implications include assessment and treatment of immigrant-specific experiences. Obstacles to treatment and future research directions are presented.

Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap

Dissemination and implementation science (DI) has evolved as a major research model for children's mental health in response to a long-standing call to integrate science and practice and bridge the elusive research to practice gap. However, to address the complex and urgent needs of the most vulnerable children and families, future directions for DI require a new alignment of ecological theory and public health to provide effective, sustainable, and accessible mental health services. We present core principles of ecological theory to emphasize how contextual factors impact behavior and allow for the reciprocal impact individuals have on the settings they occupy, and an alignment of these principles with a public health model to ensure that services span the prevention to intervention continuum. We provide exemplars from our ongoing work in urban schools and a new direction for research to address the mental health needs of immigrant Latino families. Through these examples we illustrate how DI can expand its reach by embedding within natural settings to build on local capacity and indigenous resources, incorporating the local knowledge necessary to more substantively address long-standing mental health disparities. This paradigm shift for DI, away from an overemphasis on promoting program adoption, calls for fitting interventions within settings that matter most to children's healthy development and for utilizing and strengthening available community resources. In this way, we can meet the challenge of addressing our nation's mental health burden by supporting the needs and values of families and communities within their own unique social ecologies.

Consequences of 9/11 and the war on terror on children's and young adult's mental health: a systematic review of the past 10 years

This mixed method systematic review appraises the individual, familial and systemic effect of 9/11 and the war on terror for majority and minority children and youth in North America. The results highlight the broad social consequences of the socio-political transformations associated with the terror context, which cannot be understood only through a trauma focus analysis. The social stereotypes transformed youth experiences of belonging and exclusion. The difference between the consequences for majority and minority youth suggests the need for a broader appraisal of this societal context to support the development of prevention and intervention intersectorial programs.

Depressive symptoms in low-income, urban adolescents: cognitive and contextual factors

This study examined the relationships among cognitive variables, family immigration history, negative life events, and depressive symptoms in a sample of 306 low-income, urban fifth- and sixth-grade children. Explanatory style and negative automatic thoughts were the cognitive variables examined. There were three key findings. First, children who were immigrants reported significantly more depressive symptoms, more negative life events, and more negative automatic thoughts than children who were not immigrants. Second, both explanatory style and negative automatic thoughts were significantly associated with depressive symptoms above and beyond the effects of child immigration history and negative life events. Finally, negative automatic thoughts mediated the relationship between child immigration history and depressive symptoms. We discuss the clinical and research implications of these findings.

Depression in a Latino man in New York

This case illustrates some of the issues that may affect a Latino patient's presentation. Although the patient's constellation of symptoms are classically representative of major depression, the patient also raises themes regarding the process of immigration, subsequent challenges in acculturation and identification with the host culture versus the culture of origin, and culture-specific notions about causes of symptoms. In addition to some of the special features of stigma in Latino cultures, the prominence of physical concerns in the presentation and the use of traditional healers contribute to the complexity of selecting appropriate interventions for this young man.

Practice parameter for cultural competence in child and adolescent psychiatric practice

The United States faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural. In consequence, cultural and racial factors relating to mental illness and emotional disturbances deserve closer attention and consideration. This Practice Parameter outlines clinical applications of the principle of cultural competence that will enable child and adolescent mental health clinicians to better serve diverse children, adolescents, and their families.

Community-based applied research with Latino immigrant families: informing practice and research according to ethical and social justice principles

This manuscript describes the implementation of two community-based programs of research with Latino immigrant populations exposed to intense contextual challenges. We provide background on our program of research and specific implementation of an evidence-based parenting intervention. We also describe how our research efforts were seriously affected by immigration-related events such as the ICE raids in Utah and a history of discrimination and exclusion affecting Latino immigrants in Michigan. These external political and social challenges have affected the very core principles of our efforts to implement community-based approaches. The current manuscript describes key lessons that we have learned in this process. Finally, reflections for research, practice, and social policy are included.

Culturally informed child psychiatric practice

Child and adolescent psychiatrists are already serving an increasing population of culturally and ethnically diverse patients and families in their practices and in different agency settings. This article discusses adaptations to practice that enable child and adolescent psychiatrists to address the diverse clinical and cultural needs of this emerging population. Special attention is given to work in psychotherapy and in agency settings where diverse children and youth are found in large numbers.

Culture and development in children and youth

Although culture has long been recognized as having a significant impact on human development and its variations, many child and adolescent psychiatrists and mental health clinicians assume a universal nonvariance to normal development, with the risk of identifying variations as pathologic. This article reviews the conceptual basis for the role of culture in human development, particularly psychosocial and cognitive development, presents evidence and support from field observations of children in diverse cultures, and discusses the emerging evidence from the field of cultural neuroscience. Implications for these different perspectives on future research, childhood education, and even intercultural relations are presented.