Exploring Mental Health Status and Syndrome Patterns Among Young Refugee Children in Germany

Post-traumatic stress disorder in youth exposed to the Syrian conflict: A systematic review and meta-analysis of prevalence and determinants

A decade of ongoing armed conflict in Syria has damaged the physical and mental health of millions of adults and children. This study aimed to systematically review the prevalence of post-traumatic stress disorder among youth exposed to the Syrian conflict, and understand its individual and contextual determinants. The screening procedure resulted in 26 studies, with a total of 11,400 Syrian children and adolescents. The prevalence was 36% (95% CI (0.29-0.43), p < 0.001). Loss of family members or acquaintances, witnessing violence, and social withdrawal increased the risk of post-traumatic stress disorder, while social trust and social support were protective factors.

Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia's invasion of Ukraine in 2022

BACKGROUND

With Russia's invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription.

MAIN BODY

In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems.

CONCLUSION

As children's and adolescents' mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.

Refugee child health: a systematic review of health conditions in children aged 0-6 years living in high-income countries

This study describes the extent, quality and cultural appropriateness of current research on the health conditions of refugee children aged 0-6 years settled in high-income countries. A systematic review was conducted, including original articles published on the health conditions experienced by refugee children. A total of 71 papers were included. The studies varied considerably in their research design, population characteristics and health conditions. Studies included information on 37 different health conditions, with the majority non-communicable diseases, in particular growth, malnutrition and bone density. Although the studies identified a wide range of health issues, a coordinated effort to prioritise research on particular health topics was lacking, and health conditions studied do not align with the global burden of disease for this population. Additionally, despite being rated medium-high quality, most studies did not describe measures taken to ensure cultural competency and community involvement in their research. We suggest a coordinated research effort for this cohort, with greater emphasis on community engagement to improve the evidence-base of the health needs of refugee children after settlement.

Envisioning the future for families running away from war: Challenges and resources of Ukrainian parents in Italy

Since February 2022, 7.8 million people have left Ukraine. In total, 80% are women and children. The present quali-quantitative study is the first in Italy to (i) describe the adaptation challenges and the resources of refugee parents and, indirectly, of their children and (ii) investigate the impact of neuropsychopedagogical training on their wellbeing. The sample includes N = 15 Ukrainian parents (80% mothers, mean age = 34 years) who arrived in Italy in March and April 2022. The parents participated in neuropsychopedagogical training within the program Envisioning the Future (EF): the 10 Keys to Resilience. Before the training, participants completed an ad hoc checklist to detect adjustment difficulties. After the training, they responded to a three-item post-training questionnaire on the course and to a semi-structured interview deepening adaptation problems, personal resources, and the neuropsychopedagogical training effects. Participants report that since they departed from Ukraine, they have experienced sleep, mood, and concentration problems, and specific fears, which they also observed in their children. They report self-efficacy, self-esteem, social support, spirituality, and common humanity as their principal resources. As effects of the training, they report an increased sense of security, quality of sleep, and more frequent positive thoughts. The interviews also reveal a 3-fold positive effect of the training (e.g., behavioral, emotional-relational, and cognitive-narrative).

Study Protocol for the SC-SD4ASA Project: A Self-Care/Self-Development Guidebook for Asylum-Seeking Adolescents

From 2015 to 2016, about 1. 3 million refugees arrived in Europe. Half of them were children under the age of 18. The combination of (specially forced) migration and adolescence increase the risk of psychological problems among refugees including asylum-seeking children and adolescents. Therefore, along with the significant increase in the number of refugees, investigating effective ways to improve their health status has grown. The planned project aims to improve self-care and self-development among asylum-seeking adolescents aged 15–18. With the long-term goal of improving wellbeing and quality of life, this multi-method study aims to develop a self-care and self-development intervention guidebook for asylum-seeking adolescents. The SC-SD4ASA project will focus on three main work packages: 1. assessment of needs and knowledge concerning self-care and self-development; 2. development of a guidebook to promote self-care and self-development for asylum-seeking adolescents; and 3. assessment of the guidebook fidelity, reliability, and validity. For the first work package, an intra-triangulation approach including three qualitative methods [in-depth interviews, focus group discussions and photographic means (photovoice)] will be used. The collected data will be analyzed using cross-cultural and multilingual approach to thematic analysis, known as meta-theme analysis. The results of the first stage will be utilized for developing the guidebook in the second (main) work packages. The guidebook fidelity will be assessed based on the National Institutes of Health Behavior Change Consortium fidelity framework in the last workplan. Empowering asylum-seeking adolescents with self-care /self-development skills can help them to sustain their wellbeing and better manage the challenges in their new situation. When successfully implemented, a guidebook will be developed to support all individuals involved in planning, managing, and promoting health among asylum-seeking adolescents that can be used for future self-care/self-development programs in practice.

[The Mental Health Problems of Unaccompanied and Accompanied Refugees in Childhood and Adolescence in Germany]

The Mental Health Problems of Unaccompanied and Accompanied Refugees in Childhood and Adolescence in Germany Abstract. Abstracts: Objective: This articles investigates the psychological distress and stressful life events in unaccompanied minor refugees (UMR) in adolescence and accompanied minor refugees (AMR) in childhood and adolescence living in Germany. Additionally, it analyzes the predictors of psychological distress in the adolescents. Method: We assessed 170 children and adolescents (adolescents: n = 56 UMR, n = 72 AMR; children: n = 42 AMR) using questionnaires on emotional and behavioral problems and stressful life events. In addition, we questioned the adolescents on PTSS (adolescents: self-report; children: caregiver report). Results: 45.8 % UMR (adolescents), 42.4 % AMR (adolescents), and 56.1 % AMR (children) showed emotional and behavioral problems. On average, we identified 7 stressful life events in UMR (adolescents) and 4 in AMR (adolescents, children). UMR (adolescents) reported more emotional problems, more PTSS, and more stressful life events than did AMR (adolescents). 43.8 % UMR (adolescents) and 27.9 % AMR (adolescents) reported PTSS. The number of stressful life events was found to be the most robust predictor for emotional and behavioral problems as well as PTSS in adolescents. Conclusions: The results indicate the need for psychological interventions of refugee minors in Germany.

Empowering refugee families in transit: the development of a culturally competent and compassionate training and support package

Background

Refugee parents who fled conflicts suffered violence and traumas and face huge challenges in supporting the health and welfare of their children while in transit.

Aims

To describe the development of a culturally competent and compassionate training and support package (TSP) for nurses, social and health care workers and volunteers, with a focus on parenting needs among unsettled refugees fleeing conflict.

Methods

The multi-method approach included: a scoping review covering parenting needs of refugees fleeing conflict zones; collection of stories from refugee parents, healthcare workers and volunteers via a mobile application; discussions between team members; a piloted and evaluated curriculum.

Results

High levels of family distress and deterioration of parental identity were identified. Informed by these results, the curriculum is articulated along 20 bite-sized learning units, covering four age stages of childhood as well as targeting adults’ well-being. Pilot training was evaluated positively, confirming feasibility and usefulness of the TSP.

Conclusions

Unsettled refugee parents fleeing conflicts face psycho-social and practical difficulties negatively affecting their parenting skills. The care workforce should be trained in order to provide culturally competent and compassionate support to help these families. Open access digital platforms are promising as autodidactic and self-help tools among hard-to-reach populations.

Association between psychosocial functioning, health status and healthcare access of asylum seekers and refugee children: a population-based cross-sectional study in a German federal state

BACKGROUND

The mental health condition and healthcare needs of asylum seeking and refugee (ASR) children may go unrecognized if barriers to healthcare access exist accompanied by exclusive focus on somatic illness. We analysed the relationship between psychosocial functioning, health status and healthcare access of ASR children.

METHODS

During 2018, 560 ASR adults in 58 collective accommodations in Germany's 3rd largest federal state were randomly sampled and assessed. The parent-reported Strengths and Difficulties Questionnaire (SDQ) was used to assess child psychosocial functioning. SDQ dimensions (Emotional, Conduct, Peer, Hyperactivity, Prosocial, Total) were compared by demographics (sex, age, region of origin, time since arrival, subjective social status), health status (long-lasting illness, physical limitation, pain) and healthcare access (utilization: paediatrician, specialist, dentist, psychologist, hospital/emergency department, prescribed medicines; and unmet needs: for paediatrician/specialist, reduced spending to cover healthcare cost). Age and sex-adjusted odds ratios (AOR, 95%CI-Confidence Intervals) for scoring in borderline/abnormal ranges in SDQ dimensions were estimated through logistic regression depending on children' health status and healthcare access.

RESULTS

We analysed parents' answers pertaining to 90 children aged 1-17 years old, 57% of which were girls and 58% with (Eastern or Western) Asian nationality. Scoring in the borderline/abnormal range of the SDQ Total Difficulties score was associated with feeling bodily pain (compared to no pain, AOR, 95%CI = 3.14, 1.21-8.10) and with an unmet need for a specialist during the previous year (4.57, 1.09-19.16). Borderline/abnormal SDQ Emotional scores were positively associated with a long-lasting illness (5.25, 1.57-17.55), physical limitation (4.28, 1.49-12.27) and bodily pain (3.00, 1.10-8.22), and negatively associated with visiting a paediatrician (0.23, 0.07-0.78), specialist (0.16, 0.04-0.69), and the emergency department (0.27, 0.08-0.96).

CONCLUSION

Poor psychosocial functioning among ASR children is associated with somatic problems, unmet medical needs, and lower healthcare utilisation. Somatic clinical encounters with ASR should include children' mental health symptomatology assessment, especially in those with worst physical health conditions.

Refugee Mental Health, Global Health Policy, and the Syrian Crisis

The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced and 26.4 million registered refugees. The ongoing conflict in Syria is a major contributor. After a decade of violence and destabilization, over 13.4 million Syrians have been displaced, including 6.7 million internally displaced persons and 6.7 million refugees registered in other countries. Beyond the immediate political and economic challenges, an essential component of any response to this humanitarian crisis must be health-related, including policies and interventions specific to mental health. This policy and practice review addresses refugee mental health in the context of the Syrian crisis, providing an update and overview of the current situation while exploring new initiatives in mental health research and global health policy that can help strengthen and expand services. Relevant global health policy frameworks are first briefly introduced, followed by a short summary of recent research on refugee mental health. We then provide an update on the current status of research, service provision, and health policy in the leading destinations for Syrians who have been forcibly displaced. This starts within Syria and then turns to Turkey, Lebanon, Jordan, and Germany. Finally, several general recommendations are discussed, including the pressing need for more data at each phase of migration, the expansion of integrated mental health services, and the explicit inclusion and prioritization of refugee mental health in national and global health policy.

An overview of the mental and physical health status and post-migration psychosocial stressors of refugee toddlers and preschoolers

PURPOSE

Although thousands of refugee children are being born in resettlement areas, few studies have described the mental and physical status in early childhood. We aimed to study the mental, physical status, and post-migration psychosocial stressors of refugee toddlers and preschoolers.

DESIGN AND METHODS

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood was used to assess psychiatric disorders, parent-child relational context, physical health conditions, psychosocial and environmental stressors, and developmental competencies of children who were evaluated at the clinic site. This study was a retrospective examination of these health records. Seventy participants were divided into two groups: children born during resettlement in Turkey and children born in Syria. The Syria group consisted of 33 participants aged 66.73 ± 13.05 months. The Turkey group consisted of 37 participants aged 38.78 ± 16.82 months.

FINDINGS

In both groups, children suffered from a wide range of mental and physical disorders and a variety of psychosocial stressors. Monthly income and resettlement time in the Turkey group were more statistically significant (χ²  = 10.611, p = 0.014; χ²  = 5.976, p = 0.050). Also in the Turkey group, parents and siblings had significantly more mental health problems (χ²  = 4.39, p = 0.04; χ²  = 5.38, p = 0.02).

PRACTICE IMPLICATIONS

Child and adolescent mental health workers need to be aware of the specific needs of this particular age group of refugees. Social, economic, and policy efforts are needed to improve the living conditions of refugee children.

Prevalence of depressive symptoms and symptoms of post-traumatic stress disorder among newly arrived refugees and asylum seekers in Germany: systematic review and meta-analysis

BACKGROUND

In total numbers, Germany has faced the largest number of refugees and asylum seekers (RAS) in Europe in the past decade. Although a considerable proportion have experienced traumatic and stressful life events, there is no systematic review to date examining the prevalence of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms in RAS in Germany.

AIMS

To calculate the prevalence of depressive symptoms and PTSD symptoms in the general population of RAS living in Germany after the year 2000 and explore the impact of study- and participant-related characteristics on prevalence estimates.

METHOD

We systematically searched PubMed, CINAHL, PsycINFO, PSYNDEX, Academic Search Complete, Science Direct and Web of Science from January 2000 to May 2020 to identify articles reporting prevalence of depressive symptoms and PTSD in RAS in Germany (PROSPERO registration number: CRD42020182796).

RESULTS

In total, 31 different surveys met inclusion criteria with 20 surveys reporting prevalence estimates of depressive symptoms and 25 surveys symptoms of PTSD. Based on screening tools, the pooled prevalence estimate of PTSD symptoms was 29.9% (95% CI 20.8-38.7%) and of depressive symptoms 39.8% (95% CI 29.8-50.1%). Heterogeneity was large within and between subgroups. In multivariate meta-regressions on depressive symptoms, heterogeneity was largely explained by survey period, length of field period and study quality.

CONCLUSIONS

Prevalence rates of depressive symptoms and PTSD symptoms in RAS are notably large. They exceed the prevalence in the general German population. As a result of high heterogeneity, however, pooled prevalence rates should be interpreted with caution.

[Digital interventions for refugees. Challenges, opportunities, and perspectives of agency]

DEFINITION OF THE PROBLEM

Refugees show a high prevalence of mental health burden. Catering to the need for mental health services is made difficult by access barriers. These barriers consist of structural factors as well as culturally different attitudes towards mental health, mental illness, and therapeutic interventions. One option to overcome these access barriers and to provide mental healthcare services in an appropriate manner is seen in digital interventions. In the form of interactive websites or smartphone apps, these interventions have proven to be effective in mental healthcare. There are also promising examples of successful use of these technologies with refugees. However, the ethical aspects of digital interventions for refugees have scarcely been studied yet.

ARGUMENTS

Aim of this paper is to tackle this research desiderate. The instrument of the ethical analysis to be conducted is the concept of agency. According to the concept of agency, persons have to be seen as actors capable of acting based on their own resources and competencies. Agency is the guiding principle here for analyzing the opportunities and risks of digital interventions for refugees. In addition, I will attempt to point out prospects for an agency-based application of digital interventions.

CONCLUSION

The ethical analysis could be used as the blueprint for developing therapeutic concepts that contribute to the improvement of mental healthcare services for refugees from an ethical perspective.

Mental Health Needs of Refugee Children in Specialized Early Education and Care Programs in Germany

Refugee children are at risk to develop mental health problems, which have rarely been investigated in educational contexts. We conducted three studies in childcare programs for refugees in Germany. Children's behavior was assessed by educators on site (n = 84) and online (n = 50) using a two-stage-cluster sampling and on site (n = 107) using complete samples. In Study 1 and 2, children showed elevated attention problems ranging from medium to large effect sizes, r = 0.2 and r = 0.5, respectively, and aggressive behavior problems ranging from small to large effect sizes, r = 0.1 and r = 0.5, respectively, when compared to norm data. In Study 3, children showed elevated peer-problems, r = 0.5. Future research needs to investigate whether these problems are a consequence of adapting to a novel context or a precursor of a psychopathology caused by risk factors in the context of forced displacement.

Migrant adolescents' behavioral problems compared to host adolescents and adolescents in their region of origin: a longitudinal study

BACKGROUND

Since the 1990s, families from the ecologically hostile mountainous southern areas of Ningxia Province, China, have been migrating to the northern areas of the province. This study compared the prevalence of behavioral problems among migrant adolescents to those among host adolescents (adolescents from the northern areas) and adolescents in the region of origin (adolescents from the southern areas), to determine whether ecological migration is related to adolescent behavioral problems, and possible changes in such problems over time.

METHODS

We used the Children and Adolescents Ecological Migration Survey on Mental Health, administered to 4805 students aged 12-16 years and their parents between 2012 and 2014 (W1), of whom 1753 students and their parents completed the follow-up between 2014 and 2017 (W2). Parents answered questions related to adolescent behavioral problems, main source of family income, parents' desire to reverse migrate, improved standard of living, and parents' educational attainment, while children completed the Eysenck Personality Questionnaire and a classroom environment questionnaire.

RESULTS

The prevalence of behavioral problems among the migrant adolescents (28.04%) was significantly higher than among host adolescents (21.59%) or adolescents in the region of origin (24.37%; p < 0.001) at W1. After adjusting for gender and age, parents' work outside the home was the main source of family income (OR = 1.42, 95% CI = 1.13-1.78), and adolescents' learning burden (OR = 1.04, 95% CI = 1.01-1.06) in school negatively influenced behavioral problems. Strong student-teacher relationships (OR = 0.97,95% CI = 0.94-0.99) and parents who had no intention to move back to the original residence (OR = 0.70, 95% CI = 0.52-0.94) exerted a protective effect at W1; at W2, a protective effect was associated with improved living conditions (OR = 0.39-0.55, 95% CI = 0.25-0.84). The extent of behavioral problems among migrant adolescents significantly decreased after two years.

CONCLUSION

Ecological migration will increase children's behavioral problems in the early stage, with various factors influencing the extent of these problems.

Refugee mother-child dyads' hair cortisol, post-traumatic stress, and affectionate parenting

Refugees are a special population who experience adversity before, during and after forced displacement. Hence, many of them show post-traumatic stress symptoms (PTSS). PTSS can be transmitted from the mother to the child and are associated with alterations in cortisol responses. Positive parenting practices, such as maternal affection, counteracts psychopathology in early childhood. The aim of this explorative study was to investigate how children's cortisol is associated with mothers' cortisol after forced displacement, and whether or not an association depends on maternal affection. A total of 42 Arabic-speaking mother-child dyads, who came to Germany as refugees from Syria or Iraq within the past four years, participated in the present cross-sectional study. All children were below the age of 5 years. We assessed children's and mothers' hair cortisol concentration (HCC) and PTSS. Additionally, we observed and objectively rated maternal affection during mother-child interactions. The association between mothers' and children's HCC, as well as their associations with maternal affection, depended on the difference between children's and mothers' HCC. Furthermore, this HCC difference significantly predicted children's PTSS. Hence, in order to understand the mechanisms underlying children's PTSS, it is essential to consider maternal variables and differential effects within samples. We discussed possible explanations for those findings.

Management of mental health conditions in refugee youth: An overview for the psychiatric-mental health nurse practitioner

TOPIC

In 2017, there were a total of 70 million forcibly displaced individuals or refugees, worldwide. Unfortunately, over 50% of refugees are under the age of 18 years. Refugee youth are at-risk for a variety of mental health conditions.

PURPOSE

The purpose of this report is to provide psychiatric-mental health nurse practitioners (PMHNPs) with an understanding of unique cultural implications in refugee youth, risk factors towards the development of psychiatric illness, and means to identify those at-risk for sequelae or those meeting diagnostic criteria. Also presented are foundational treatment and management implications to ensure the provision of culturally sensitive and efficacious care to this unique population.

SOURCES USED

Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications pertaining to mental health issues in refugee youth spanning from 2013 to present. Reference lists of identified articles were also searched.

CONCLUSIONS

A variety of risk and protective factors are discussed, spanning from premigration, during flight, and postsettling periods. PMHNPs must be proficient in screening and diagnosis of mental health conditions in refugee youth and implementation of pharmacological and psychotherapeutic interventions. PMHNPs must also be well versed in community-based resources that can be utilized to promote optimal outcomes.

Special Aspects in Pediatric Surgical Inpatient Care of Refugee Children: A Comparative Cohort Study

Background: Recently, the number of refugees in Germany has skyrocketed, leading to a marked increase in refugee children admitted to hospitals. This study describes the special characteristics encountered in pediatric surgical inpatient refugees compared to locally residing patients. Methods: Hospital records of minor refugees admitted to our department from 2005 up to and including 2015 were retrospectively reviewed. Demographic data, diagnoses, comorbidities, body mass indexes, hemoglobin values, and lengths of stay were extracted and statistically compared to local patients. Results: A total of 63 refugee children were analyzed and compared to 24,983 locally residing children. There was no difference in median body mass index (16.2 vs. 16.3, respectively, p = 0.26). However, refugee children had significantly lower hemoglobin values (11.95 vs. 12.79 g/dL, p < 0.0001) and were more likely to be colonized with methicillin-resistant Staphylococcus. aureus (8% vs. 0.04%, p < 0.01). Refugees were much more likely to present with burn injuries (16% versus 3% of admissions, p < 0.001), esophageal foreign bodies (4% vs. 0.5%, p < 0.001), as well as trauma, except for closed head injury. Conclusion: The cohort of refugee children in this study was found to be at a particular risk for suffering from burn injuries, trauma, foreign body aspirations, and anemia. Appropriate preventive measures and screening programs should be implemented accordingly.

Treating children and adolescents with multiple traumas: a randomized clinical trial of narrative exposure therapy

Background and Objective: Millions of children and adolescents worldwide suffer from post-traumatic stress disorder (PTSD) and other problems due to prolonged exposure to traumatizing events. Forms of cognitive-behavioural therapy are the most commonly used treatment for PTSD, but evidence from sophisticated studies in clinical settings among children is limited. Method: This multicentre, parallel, non-blinded, pragmatic randomized controlled trial assessed the effectiveness of narrative exposure therapy (NET) in traumatized children and adolescents. Fifty 9-17-year-old participants, who had experienced prolonged traumatic conditions in the form of refugeedom or family violence and suffered from PTSD symptoms, were randomized into NET (n = 29) and treatment as usual (TAU; n = 21) active control groups. The objective was to determine whether NET can be feasibly implemented within the existing healthcare system of a high-income country and whether it would reduce mental health problems, especially PTSD, and increase resilience, in children and adolescents with multiple traumas more effectively than TAU. We hypothesized that NET would be more effective than TAU in reducing symptoms and increasing resilience. Results: Analysis of variance revealed that PTSD and psychological distress, but not depression symptoms, decreased regardless of treatment group. Resilience increased in both groups. Within-group analyses showed that the decrease in PTSD symptoms was significant in the NET group only. The effect sizes were large in NET but small in TAU. Concerning PTSD symptom cut-off scores, the reduction in the share of participants with clinical-level PTSD was significant in the NET group only. Intention-to-treat analyses using linear mixed models confirmed these results. Conclusions: Despite its shortcomings, this study gives preliminary support for the safety, effectiveness, and usefulness of NET among multiply traumatized children and adolescents in clinical settings. Close attention must be paid to the implementation of the new intervention as an everyday tool in healthcare.

Challenges and Solutions Perceived by Educators in an Early Childcare Program for Refugee Children

Immigration to Germany peaked in 2016. More than 105,000 refugees below the age of 7 years arrived within 12 months. Since then, Germany and other host nations have been in need of strategies to cover the emerging demand for childcare services. The German federal state North-Rhine Westphalia has funded a specialized early childhood education and care (ECEC) program for recently arrived refugees. The present study investigated challenges and possible solutions in this specialized ECEC. In a pilot study, inductive content analysis of n₁ = 28 semi-structured interviews with early childhood educators revealed 19 distinct challenges and four generic categories for solutions (provide clear and predictable structures, involve and support parents, ensure adequate structural features of the childcare group, convey trust and feelings of competence). For the main study, identified challenges were transcribed into items for a closed-format questionnaire, which was distributed to a second sample of educators (n₂ = 96). Challenges perceived as most difficult concerned language barriers and communication with parents. An exploratory factor analysis of the challenges questionnaire yielded four underlying domains (interpersonal stress, feasibility and attendance, cultural and communication barriers, structural features of a childcare group). Our study provides a first basis to adapt childcare settings for refugees, and to guide staff training for this special group. We discuss evidence in regard to understanding how ECEC programs can successfully promote refugee children’s psychosocial adaptation and educational outcomes.