Resilience resilience across and within cultures Describe the - - PDF document

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Elizabeth Dawson-Hahn, MD, MPH University of Washington Seattle Children’s Research Institute Harborview Medical Center October 1, 2018

Promoting Resilience in Migrant Children with the Support of their Families and Communities

“Many children may have experienced a disruption in what we call the “scaffolding of childhood”— the basic experiences we expect to be in place for children to develop and thrive, such as access to schools, health care, adequate food and water, safe neighborhoods, and intact families”

• Refugee Technical Assistance Center

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• Review the personal and environmental factors that promote

resilience across and within cultures

• Describe the features of successful school integration programs

and the role of health care provider in promoting educational success

• Outline the community resources that are needed to support

children and their families through the resettlement process

Objectives

Resilience

“Resilience…the capacity of a dynamic system to withstand or recover from significant challenges that threaten its stability, viability, or development.”

• Masten & Narayan, 2012

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“Resilience is the process of harnessing biological, psychosocial, structural, and cultural resources to sustain wellbeing.”

• Panter-Brick and Leckman, 2013

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Child Child

Lancet, 2016

Child

Institutional Environment Family Community

Child

Institutional Environment Family Community

Child

Institutional Environment Family Community

Child

Institutional Environment Family Community

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Child

Institutional Environment Family Community

Child

Institutional Environment Family Community

Resilience is ordinary magic.

• Masten, 2009

School and Health

“Every child in every classroom bring a history to the classroom.”

• Dryden-Peterson, 2015

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Refugee Children Education Access

50% 22% 1% 0% 10% 20% 30% 40% 50% 60% Primary School Secondary School University

UNHCR, September 2016

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Protracted Conflict – No Access

3.20 1.75 2.20 2.20 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 Iraq Syria Yemen South Sudan

ICRC, 2018

Million Children

“I was always worried and thought about the future of my children because they were not going to school when the other children of their ages were going to school. This was my biggest challenge since I could not afford it. Even they asked several times mother when are we going to school? And this was heartbreaking and [my] biggest problem when I lived in Kenya. ”

• Mother, Somali Refugee, Study Participant, 2018

School Integration

• Access to school
• Celebration of language
• Extra support vs. Tracking & Grade

repetition

• Engaging parents
• High quality early education

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Role of Health Care Provider?

• Migration History
• Developmental and Behavioral

Screening

• Mental Health Screening
• Care Coordination

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Migration History

• Location of birth
• Preferred Language
• Country of birth
• Path of Migration
• Family members traveling
• Health care access
• School attendance

Migration History

• Location of birth
• Preferred Language
• Country of birth
• Path of Migration
• Family members traveling
• Health care access
• School attendance

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EVERY Child *Children up to 72 months

Who

Developmental and Behavioral Screening

Build rapport first.

When

EVERY Child *Children up to 72 months

Who

Developmental and Behavioral Screening

Build rapport first.

When

Developmental Screening tools Language Cultural tailoring

How

EVERY Child *Children up to 72 months

Who

Developmental and Behavioral Screening

Build rapport first.

When

Developmental Screening tools Language Cultural tailoring

How

Clinic In-patient setting Early childhood programming Public Health outreach

Where

EVERY Child *Children up to 72 months

Who

Developmental and Behavioral Screening

Build rapport first.

When

Identifying Tools Strengths and Difficulties Questionnaire

How

Clinic School Early childhood programming Public Health outreach

Where

EVERY Child Young children (Parents)

Who

Mental Health Screening

Care Coordination

• Identifying educational rights

and expectations

• Partnering at school
• School nurse
• Therapists
• Teachers
• School Lunch
• Advocacy

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Community Resources

Social Determinants of Health

Child

Institutional Environment Family Community

New Arrivals Working Group

• Coordinated by Washington State

Department of Health

• Multi-disciplinary bi-monthly

meetings

• Community developments and

needs

• Partner in projects

Refugees Northwest WA Department of Health Harborview Medical Center WA Office of Refugee and Immigrant Assistance Office of Refugee Resetttlement Refugee Health Promotion Project

Somali Health Board

• Ethnic Community Based

Organization

• Somali Health Professionals
• Aim to decrease health disparities by

partnering with health systems to influence policies and services

• 2018 Community Resilience Award

Recipients

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Family Based Approaches

• Wellbeing of children contingent on

wellbeing of the parents

• Ensuring parental access to mental

health services

• Access to group support and classes
• First Foods

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• Somali Health Board
• Refugees Northwest
• Mother Africa
• International Rescue

Committee

• World Relief
• Jewish Family Service

Community Partners

• Seattle-King County Public

Health

• WA Department of Health
• Centers for Disease Control

and Prevention

• International Organization for

Migration

Public Health Partners

• Harborview Medical Center
• University of Washington
• Seattle Children’s Research

Institute

Academic Partners Patients and Families

With Gratitude

References

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• 1. Masten AS, Narayan AJ. Child development in the context of disaster, war,

and terrorism: pathways of risk and resilience. Annu Rev Psychol. 2012;63:227- 257.

• 2. Dryden-Peterson S. The Educational Experiences of Children in a Country of

First Asylum. Migration Policy Institute;2015.

• 3. McNeely CA, Morland L. The Health of the Newest Americans: How US

Public Health Systems Can Support Syrian Refugees. Am J Public Health. 2016;106(1):13-15.

• 4. Panter-Brick C, Leckman JF. Editorial Commentary: Resilience in child

development--interconnected pathways to wellbeing. J Child Psychol

• Psychiatry. 2013;54(4):333-336.
• 5. Britto PR, Lye SJ, Proulx K, et al. Nurturing care: promoting early childhood
• development. Lancet. 2017;389(10064):91-102.
• 6. International Federation for the Red Cross and Red Crescent Societies. IFRC

Position Paper, Protection and Assistance for Children on the Move. Geneva, 2017.

• 7. UNHCR. Missing Out: Refugee Education in Crisis. September 2016.
• 8. OECD. Helping Immigrant Children to Succeed at School and Beyond. 2015.
• 9. The Integration Outcomes of US Refugees: Successes and Challenges. Capps

R, Newland K, et al. Migration Policy Institute: Washington, DC.

• 10. Masten A. Ordinary Magic: Lessons from Research on Resilience in Human
• Develoment. Canadian Education Association, 2009.
• 11. Refugee Health Technical Assistance Center. Youth and Mental Health.

RHTAC, 2011.

• 12. Washington Chapter of the American Academy of Pediatrics. WA Immigrant

Health Toolkit. 2018. http://wcaap.org/wp-content/uploads/2018/09/WCAAP- Immigrant-Health-Toolkit-2.pdf

• 13. NEJM Catalyst. Social Determinants of Health. New England Journal of

Medicine, December 2017. https://catalyst.nejm.org/social-determinants-of- health/ Children’s Art #peacerun Colosseo September 2018