Asylum 2: Working with refugee children and families

There is much that psychologists from all disciplines can offer when working with refugee/asylum-seeking children and families (see Ehntholt & Yule, 2006; Papadopoulos, 2002; Price & Iszatt, 1996).

This article will take a practical look at how psychologists can apply their skills to meet the needs of young refugees within both school and community settings.

This type of work falls within the remit of current government initiatives and policy in both education and health to include socially disadvantaged community groups (Department for Education and Skills, 2004; Department of Health, 2003; Social Exclusion Unit, 2004).

More specifically, local authorities are now expected to provide psychological support for refugees within schools (Office for Standards in Education, 2003).

For the purposes of this article the term refugee will be used synonymously to include both asylum seeker (those applying for refugee status), those who have been granted humanitarian protection or discretionary leave to remain and those who have indefinite leave to remain (those with full refugee status).

School-based interventions

Often school is the first place where a refugee child can experience consistency and emotional containment. Therefore, psychologists from all disciplines can take advantage of liaising with school staff to share information, help with initial assessment and collaboratively plan a programme of intervention and support.

There is much good practice that schools are already engaged in that addresses the general needs of refugee pupils and has become part of everyday school curriculum and practice, with published guidance also available (DfES, 2003). This includes admission and induction procedures, effective communication with parents using interpreters and translated information, buddy systems, and the use of welcome and inclusion activities in the school curriculum which explore the nature of the refugee experience (Bolloten & Spafford, 2003; Lee, 2003).

Where these interventions are not in place, psychologists can offer support via consultation on their implementation. It is also good practice for psychologists to raise awareness of the emotional needs of refugees at a whole-school level via multidisciplinary liaison meetings and training.

Various issues, such as uncertainty regarding asylum status, threat of dispersal and deportation, poor housing and poverty, can have a stressful impact upon the emotional well-being of refugee children and families. Therefore, psychologists should bring these issues to the attention of school staff and assist them in thinking about the link between these problems and the child's psychological well-being.

Despite the difficulties and challenges they face, many refugee children are extremely resilient and do well in school (Rutter, 2003). However, there may be some children that teachers are particularly concerned about because they appear isolated or withdrawn or display behavioural problems that may be due to previous traumatic experiences and losses or present difficulties. These children could benefit from a variety of psychological interventions that specifically addresses their psychosocial and emotional needs (Fazel & Stein, 2002; O'Shea et al., 2000).

School teachers are sometimes concerned because refugee pupils want to talk about their traumatic wartime experiences but they feel unable to listen – either because there is not enough time available in their teaching schedules or because they are afraid that they will feel overwhelmed by what they hear.

But there are examples of good practice for others to follow. Teachers in several inner London schools requested the help of a psychologist in setting up groups for children who had been attending school for at least two years and spoke fluent English, but remained troubled by past war-related experiences.

One of us (KE) worked closely with Ethnic Minority Achievement (EMA) staff to identify children who might benefit from this type of group. Children were invited to an information session at the school if they were known to have experienced traumatic wartime events and appeared tired, sad or withdrawn or complained of sleep problems, nightmares, frequent thoughts about upsetting past experiences, poor concentration and high levels of anxiety (common PTSD symptoms).

During this session, the children were able to meet the psychologist who would be running the weekly group sessions, listen to the aims and purpose of the group and ask questions. The psychologist explained that the group was for children who had experienced frightening or sad war-related events. The main purpose of the group was to share ideas about ways of coping with intrusive upsetting memories, sleep problems and worries.

During the first two sessions, children talked, drew pictures and wrote about their past wartime experiences (see Drawing 1). Many children said that they enjoyed having a safe place to discuss these memories as they avoided talking to their family and friends about these things because they did not want to upset them.

The children were often amazed to discover that other children had similar past experiences that they continued to dream and think about. Group discussions enabled the children to realise that their reactions, including nightmares, flashbacks and anxiety, were normal and common responses to abnormal life events. In addition, children enjoyed sharing with one another helpful coping strategies, such as praying, listening to music or asking a family member to tell them a story before bedtime.

The children also enjoyed testing out the cognitive-behavioural techniques which the group leader shared, such as progressive muscle relaxation, visual imagery involving a 'Safe Place' (see Drawing 2), pleasurable activity scheduling and positive-coping self-statements.

In the final session, children also spent time discussing and drawing pictures about their hopes and ambitions for the future. Sessions were based on a manual (Smith et al., 2000) developed by the Children and War Foundation.

An evaluation of this intervention revealed that the children found the sessions helpful in decreasing war-related PTSD symptoms, such as recurrent thoughts and nightmares about past traumatic events (Ehntholt et al., 2005). Most importantly, the children clearly enjoyed attending the groups. They were rarely absent and brought along friends, who also wanted to join the group. Teachers reported improvements in the children's emotional well-being and behaviour after the group intervention.

Where school-based strategies have been tried but ongoing concerns about learning and emotional needs remain, psychosocial support groups can be effective. Such interventions are firmly rooted within multisystemic community psychology that aims to empower marginalised and vulnerable groups.

An essential component for successful engagement in these group interventions was to set up pre-group individual interviews with all the participants to build rapport, share information and explain the aims of the group, and to then see if they wanted to participate. Such groups can be powerful in promoting the student's emotional development, problem-solving skills, learning and positive social interaction.

For example, in a multicultural London comprehensive school, a support group for Somali boys was set up following concerns that the youngsters were not only underachieving but were demonstrating a range of difficulties, such as poor adjustment to the school culture, communication difficulties, isolation, emotional difficulties and poor peer relationships (German, 2004b). The group was facilitated by an educational psychologist, a member of the school's EMA staff and an interpreter.

The boys chosen by the EMA staff had come from complex refugee backgrounds, and all except one had experienced exclusion from school. They were all separated from or had lost their fathers, as well as other family members. The main focus of the eight group sessions was to enable the boys to discuss and reflect on issues and difficulties that they themselves identified and wanted to discuss.

The group was encouraged to problem-solve by sharing their ideas and experiences to find helpful solutions. The issues brought by the boys included: frustration with lack of English-language skills; feelings of isolation; difficulties in making friendships; bullying and racism; peer pressure to engage in antisocial behaviour; fighting and cussing; cultural differences in expectations of school behaviour between Somalia and the UK.

Supervision with the group facilitators, interpreter and key EMA staff (led by another educational psychologist) created a space to reflect on what the pupils had brought to the session, group dynamics and any issues that the school needed to act upon. Qualitative evaluation of the project based on structured interviews with the Somali boys was very positive, revealing an ongoing need for such support in schools:

• 'The others were aware of the how to behave in a school setting. I was not aware before.'
• 'It was good to have a group for Somali boys because some don't know English or how the school or the system works. You could practise and learn how to make friends in school and in the class.'
• 'It was useful to hear how other Somali boys were coping.'

In addition, the EMA staff commented that they had gained a deeper understanding of the particular needs of Somali boys and they had noticed an improvement in the behaviour of these boys. One of the students at risk of permanent exclusion was successfully reintegrated into the school.

Community-based interventions

An exceptionally vulnerable group of young refugees are unaccompanied minors, children under the age of 18 who arrive in the UK without a parent or any adult carer. These young people receive little practical or emotional support and often face extremely stressful situations entirely on their own, particularly when they reach the age of 18 (Ayotte & Williamson, 2001; German, 2004a).

Psychosocial support groups can be a particularly powerful form of help as they provide social contact for these adolescents, who are usually extremely isolated and often struggling to build trusting relationships within a new and frequently intimidating environment.

Prior to implementing a psychosocial support group, it is essential to recognise that these young people will require a great deal of practical support outside of the group sessions.

It is strongly recommended that the group leaders are prepared to spend time outside of the group offering this practical support or ensuring that community workers are involved, who can devote a substantial amount of time to solving housing or legal problems, as well as helping the young people register with GPs or enrol in colleges and extracurricular activities.

Whilst this work is immensely rewarding, it can also be emotionally exhausting; therefore psychologists must ensure that they are receiving an adequate level of supervision and support themselves.

Other community-based interventions can focus on empowering parents. Current government initiatives such as Sure Start are aimed at addressing poverty and enabling socially disadvantaged families with young children to access early-years provisions.

However, for refugee parents knowledge of these services and access can be problematic for a variety of reasons, including language/cultural barriers, socio-economic factors or simply not living within the Sure Start catchment area.

Frequently non-statutory voluntary agencies and refugee community organisations (RCOs) have set up services that inform and enable refugee parents to access support. Often these organisations are staffed by workers who have come from refugee backgrounds themselves and therefore have good cultural and social understanding of the complexities facing refugee families.

It is important for psychologists to link up with these organisations in order to learn from, share skills and expertise, as well as to provide mutual support and understanding. Such cultural bridges can enable non-stigmatising access to statutory services and can do much to prevent social exclusion.

The establishment of refugee parent support groups is another good example of community psychology and empowerment practice. Such a group was set up by one of us (MG) for mothers from refugee backgrounds with young children under five, who were living in temporary accommodation and attending a playgroup run by a local voluntary community organisation.

Separate parent groups were organised according to the languages spoken. An interpreter was trained for each group prior to running the group sessions alongside the psychologist. A block of eight sessions were offered. Debriefing and planning time was built in after each session which included the interpreter. The aims of the parent support groups were:

• to give refugee parents an opportunity to share their experiences of raising children and living in the UK;
• to learn from one another and offer mutual support;
• to help refugee parents support their children's early learning and development;
• to gain knowledge and understanding of the English system and services available.

The parents were invited to contribute to the planning of the topic areas to be discussed. Each group was different but generally included the following areas.

The first few sessions dealt with aspects of child development, behavioural difficulties, play and learning in the home; dealing with children's sleeping and eating difficulties. As the parents became more at ease with one another the topics became more pertinent to themselves as parents from refugee backgrounds and incorporated: dealing with loss and bereavement, including cultural bereavement (Eisenbruch 1991); coping with the asylum-seeking process; maintaining confidence and self-esteem; supporting partners who suffer from mental health difficulties.

The groups proved to be very successful and highlighted a need for this type of work within the community, as demonstrated by the following quote from one of the mothers:

'For me this group was great. It helped me think about a lot of things and it was good support to hear how the other mothers were doing. Sometimes I don't have time to think about what we can do in the home to help our children because we have so many problems. There should definitely be more of this type of parent groups for asylum seekers. It helps us feel strong to help our children.'

An important role to play

We hope we have demonstrated that all psychologists (whether educational, clinical or counselling) can play an important part in supporting refugee children and families as long as we are prepared to work collaboratively with other key organisations.

We have a wide range of generic skills that when applied within school and community settings, have the potential to provide accessible, non-stigmatising, culturally appropriate psychological support to large numbers of refugees.

We should not forget that what all of these approaches tap into are the refugee's strengths and resilience, while at the same time paying due regard to the impact of the sociopolitical context. In essence, we are nurturing hope for positive changes in their lives. As one unaccompanied youngster wrote, 'Hope is the refugee's bread.'

• Dr Mala German is an educational psychologist at Enfield CAMHS & EPS Refugee Team, Enfield. E-mail: [email protected].
• Dr Kimberly Ehntholt is a clinical psychologist at the Lambeth Young Refugee Mental Health Service, South London & Maudsley NHS Trust. E-mail: [email protected].

Discuss and debate

• Are there disadvantages to offering support within school and community rather than clinical settings?
• Is it preferable to use group or individual interventions with refugee children?
• Can psychologists truly carry out interventions with refugee children and families without addressing their social, legal and practical needs?
• Should the BPS take a stand against the detention of asylum-seeking children on the grounds that it is detrimental to their mental health?

Have your say on these or other issues this article raises; email 'Letters' to [email protected].

Weblinks

• Children and War Foundation
• UNICEF
• Save the Children
• No Place for a Child

References

• Ayotte, W. & Williamson, L. (2001). Separated children in the UK: An Overview of the current situation. London: Save the Children UK.
• Bolloten, B. & Spafford, T. (2003). Managing mid-phase pupil admissions: A resource guidance folder for schools. Newham: Education Action Zone.
• Department for Education and Skills (2003). Aiming high: Guidance on supporting the education of asylum-seeking and refugee children. A guide to good practice. Nottingham: DfES Publications.
• Department for Education and Skills (2004). Children Bill. London: The Stationery Office.
• Department of Health (2003). Guidance on the education of children being Looked after by local authorities. Circular LAC. London: The Stationery Office.
• Ehntholt, K.A., Smith, P.A. & Yule, W. (2005). School-based cognitive-behavioural therapy group intervention for refugee children who have experienced war-related trauma. Clinical Child Psychology and Psychiatry, 10(2), 235–250.
• Ehntholt, K.A. & Yule, W. (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma. Journal of Child Psychiatry and Psychology, 47(12), 1197–1210.
• Eisenbruch, M. (1991). From post-traumatic stress disorder to cultural bereavement: Diagnosis of Southeast Asian refugees. Social Science and Medicine, 33, 673–680.
• Fazel, M. & Stein, A. (2002). The mental health of refugee children. Archives of Disease in Childhood, 87(5), 366–370.
•  German, M. (2004a). Enabling reconnection: Educational psychologists supporting unaccompanied, separated, asylum-seeker/refugee children. Educational and Child Psychology, 21(3), 6–29.
• German, M. (2004b). Working with Somali boys in a secondary school: An educating experience. In P. Travers & G. Klein (Eds.) Equal measures: Ethnic minority and bilingual pupils in secondary schools (pp.65–77). Stoke-on-Trent: Trentham Books.
• Lee, F. (2003). The Refugee Project: Learning about refugees with refugees. Nottingham: Aegis Institute.
• Office for Standards in Education (2003). The education of asylum-seeker pupils. London: HMSO.
• O'Shea, B., Hodes, M., Down, G. & Bramley, J. (2000). A school-based mental health service for refugee children. Clinical Child Psychology and Psychiatry, 5, 189–201.
• Papadopoulos, R.K. (Ed.) (2002). Therapeutic care for refugees: No place like home. London: Karnac.
• Price, R. & Iszatt, J. (1996). Meeting the needs of refugee children, their families and schools. In A. Sigston, P. Curran, A. Labram & S. Wolfendale (Eds.) Psychology in practice with young people, families and schools (pp.55–70). London: David Fulton.
• Rutter, J. (2003). Supporting refugee children in 21st century Britain. A compendium of essential information. Stoke-on-Trent: Trentham Books.
• Smith, P., Dyregrov, A., Yule, W. et al. (2000). Children and war: Teaching recovery techniques. Bergen, Norway: Foundation for Children and War.
• Social Exclusion Unit (2004). Tackling social exclusion: Taking stock and looking to the future. London: Social Exclusion Unit, Office of the Deputy Prime Minister.