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Psychological evaluation of refugee children: contrasting results from play diagnosis and parental interviews
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
2011 (English)In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 16, no 4, 517-34 p.Article in journal (Refereed) Published
Abstract [en]

Many refugee families from Bosnia and Herzegovina arrived in Sweden during the Balkan conflict in the 1990s. We studied 14 of these families to compare psychological evaluation of the children using two different methods. We first carried out a semi-structured interview of a parent or parents in each family. The symptoms of each of the children, who ranged in age from 5 to 12 years, were evaluated based on these interview results. Then a second method, the Erica play-diagnosis method, was used to study the inner thoughts and feelings of the children. Results from the Erica play-diagnosis method were compared with results from Erica play- diagnosis from a normal group. According to results from the parental interviews all but one child in this study had a low level of psychological symptoms. In contrast, results from Erica play-diagnosis of these children showed that there were higher frequencies of not-normal play in these children compared with those in the normal group, which is an indication of deficiencies in the psychological well-being of these children. The results emphasise the importance of getting diagnostic information from the child in order to understand each child's psychological condition.

Place, publisher, year, edition, pages
Sage Publications, 2011. Vol. 16, no 4, 517-34 p.
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-81011DOI: 10.1177/1359104510384550PubMedID: 21565870OAI: oai:DiVA.org:liu-81011DiVA: diva2:549849
Available from: 2012-09-05 Created: 2012-09-05 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Refugee Children and Families: Psychological Health, Brief Family Intervention and Ethical Aspects
Open this publication in new window or tab >>Refugee Children and Families: Psychological Health, Brief Family Intervention and Ethical Aspects
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: There are more than 45 million refugees and displaced people in the world. Children constitute almost half of the refugee population. It is an enormous challenge and a complex situation for refugee children and families escaping from their home country, to a new system of society to which they have to adapt and where they have to recapture a sense of coherence. This thesis focuses on the psychological health of younger refugee children before and after an intervention with family therapy sessions. The experiences and perceptions of refugee families who fled to Sweden as a result of the war in Bosnia and Herzegovina from 1992 to 1995 and who have permanent residence permits were explored. The ethical aspects of treatment of traumatized refugee children and families were also analysed.

Aims: To investigate parent-child agreement on the psychological symptoms of the refugee children; to explore refugee children’s well-being before and after three sessions of family therapy; to explore, in more detail, the complexity of various family members’ experiences and perceptions of their life before the war, during the war and their escape, and in their new life in Sweden; and also to highlight ethical issues and conduct ethical analyses using basic ethical principles that take into account the varying perspectives of the actors involved with regard to the psychological treatment of refugee children and families.

Methods: Data was collected using parental interviews and psychological assessments of children aged five to twelve years. In the first study, 13 children were assessed using the Erica Method and compared with a Swedish reference group consisting of 80 children. In the second study, the Erica Method assessments from before and after an intervention with brief family therapy were compared for ten out of those 13 children, complemented by parental interviews. Family therapy sessions were videotaped, and in the third study, the verbatim transcripts of nine family therapy sessions were analysed using a qualitative method with directed content analysis. Finally, the basic ethical principles in two case studies of teenage refugee children concerning psychological treatment were analysed taking into account the varying perspectives of the actors involved in the treatment.

Results: Parents’ assessments of their children’s psychological health according to a symptom and behaviour interview did not correlate with the findings of the psychological assessments of children using the Erica Method. The majority of the parents were unaware of their children’s psychological problems, as identified in the psychological assessments. There was a higher rate of not-normal sandboxes (Erica Method) in this group of refugee children, compared to the Swedish reference group. A statistically significant number of cases had improved after a brief family therapy intervention when evaluated with Erica Method. Three main categories emerged from the analysis of the family therapy sessions: “Everyday life at home”, “Influence of war on everyday life”, and “The new life”. The three main categories were comprised of a total of ten subcategories: the family, work and school/preschool, the war, the escape, reflections, employment, health, relatives and friends, a  limited future, and transition to the new life. A structured ethical analysis concerning the principles of autonomy, beneficence, non-maleficence, and justice is feasible and valuable when dealing with refugee children and families in clinical practice as well as in research.

Conclusion: The findings from these studies show the importance of highlighting individual perspectives from the point of view of children, parents, and siblings in order to better understand the complexity of family systems. Family interventions could be beneficial for refugee children and families, even if the children do not present with overt psychological problems. Salutogenic perspectives facilitate the provision of support to refugee families. Such support helps refugee families to adapt to a new system of society and recapture a sense of coherence. In research as well as in treatment sessions, basic ethical principles, from the point of view of all actors involved, is recommended to be taken into consideration.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 100 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1373
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97333 (URN)978-91-7519-543-8 (ISBN)
Public defence
2013-10-04, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2013-09-12Bibliographically approved

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Jarkman-Björn, GunillaSydsjö, GunillaGustafsson, Per A

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Child and Adolescent PsychiatryFaculty of Health SciencesDepartment of Child and Adolescent Psychiatry in LinköpingDepartment of Clinical and Experimental MedicineObstetrics and gynecologyDepartment of Gynaecology and Obstetrics in Linköping
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