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Refugee Children and Families: Psychological Health, Brief Family Intervention and Ethical Aspects
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
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: urn:nbn:se:liu:diva-97333ISBN: 978-91-7519-543-8 (print)OAI: oai:DiVA.org:liu-97333DiVA: diva2:646924
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
List of papers
1. Psychological evaluation of refugee children: contrasting results from play diagnosis and parental interviews
Open this publication in new window or tab >>Psychological evaluation of refugee children: contrasting results from play diagnosis and parental interviews
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
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-81011 (URN)10.1177/1359104510384550 (DOI)21565870 (PubMedID)
Available from: 2012-09-05 Created: 2012-09-05 Last updated: 2017-12-07Bibliographically approved
2. Brief Family Therapy for Refugee Children
Open this publication in new window or tab >>Brief Family Therapy for Refugee Children
2013 (English)In: The Family Journal, ISSN 1066-4807, E-ISSN 1552-3950, Vol. 21, no 3, 272-278 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to compare refugee children’s psychological well-being before and after brief family therapy. Families from Bosnia-Herzegovina with one child aged 5–12 years received three family therapy sessions. Psychological assessments using the Erica play-diagnostic method and parental interviews were made before and after the intervention. The main finding was that more children built normal sandboxes (showing no pathological findings)after the intervention than before, indicating that the rather short intervention had a positive effect on the children’s psychological well-being. To conclude, it might be valuable to offer refugee families a few family therapy sessions even if the children do not have psychiatric symptoms with the aim of helping them adapt to a new system of society.

Place, publisher, year, edition, pages
Sage Publications, 2013
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-97332 (URN)10.1177/1066480713476830 (DOI)2-s2.0-84878060705 (Scopus ID)
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2017-12-06Bibliographically approved
3. Family therapy sessions with regugee families: a qualitative study
Open this publication in new window or tab >>Family therapy sessions with regugee families: a qualitative study
2013 (English)In: Conflict and Health, ISSN 1752-1505, E-ISSN 1752-1505, Vol. 7, 7Article in journal (Refereed) Published
Abstract [en]

Background

Due to the armed conflicts in the Balkans in the 1990s many families escaped to other countries. The main goal of this study was to explore in more detail the complexity of various family members’ experiences and perceptions from their life before the war, during the war and the escape, and during their new life in Sweden. There is insufficient knowledge of refugee families’ perceptions, experiences and needs, and especially of the complexity of family perspectives and family systems. This study focused on three families from Bosnia and Herzegovina who came to Sweden and were granted permanent residence permits. The families had at least one child between 5 and 12 years old.

Method

Family therapy sessions were videotaped and verbatim transcriptions were made. Nine family therapy sessions were analysed using a qualitative method with directed content analysis.

Results

Three main categories and ten subcategories were found - 1. Everyday life at home, with two subcategories: The family, Work and School/preschool; 2. The influence of war on everyday life, with three subcategories: The war, The escape, Reflections; 3. The new life, with five subcategories: Employment, Health, Relatives and friends, Limited future, Transition to the new life.

Conclusions

Health care and social welfare professionals need to find out what kind of lives refugee families have lived before coming to a new country, in order to determine individual needs of support. In this study the families had lived ordinary lives in their country of origin, and after experiencing a war situation they escaped to a new country and started a new life. They had thoughts of a limited future but also hopes of getting jobs and taking care of themselves and their families. When analysing each person’s point of view one must seek an all-embracing picture of a family and its complexity to tie together the family narrative. To offer refugee families meetings with family-oriented professionals to provide the opportunity to create a family narrative is recommended for the health and social welfare sector. Using this knowledge by emphasizing the salutogenic perspectives facilitates support to refugee families and individuals. This kind of support can help refugee families to adapt to a new system of society and recapture a sense of coherence, including all three components that lead to coherence: comprehensibility, manageability and meaningfulness. More studies are needed to further investigate the thoughts, experiences and needs of various refugee families and how refugee receiving societies can give the most effective support.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keyword
Migration, Refugee children, Family therapy, Qualitative method
National Category
Other Health Sciences
Identifiers
urn:nbn:se:liu:diva-90882 (URN)10.1186/1752-1505-7-7 (DOI)23537380 (PubMedID)
Available from: 2013-04-08 Created: 2013-04-08 Last updated: 2017-12-06Bibliographically approved
4. Ethical aspects when treating traumatized refugee children and their families
Open this publication in new window or tab >>Ethical aspects when treating traumatized refugee children and their families
2004 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 58, no 3, 193-198 p.Article in journal (Refereed) Published
Abstract [en]

Basic ethical principles are worth analysing step by step when dealing with refugee children and their families. Three issues where potential ethical conflicts might arise for healthcare professionals in treating refugees with different cultural background are pointed out-traumatic life events, hierarchy and repatriation. An ethical analysis of the decision to admit a traumatized teenage refugee to a psychiatric ward is discussed with respect for the ethical principles autonomy, non-maleficence, beneficence and justice. There are both gains and losses, which are valued differently depending on the actors involved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22021 (URN)10.1080/08039480410006223 (DOI)1049 (Local ID)1049 (Archive number)1049 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
5. Ethics and interpreting in psychotherapy with refugee children and families
Open this publication in new window or tab >>Ethics and interpreting in psychotherapy with refugee children and families
2005 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 6, 516-521 p.Article in journal (Refereed) Published
Abstract [en]

Basic ethical principles like autonomy, non-maleficence, beneficence and justice should be taken into consideration step by step when treating refugee children and their families. These principles may be considered from the point of view of each of the actors involved - patient, therapist and interpreter. This paper is focused on the role of the interpreter and on different aspects to be considered by the therapist when working with interpreters in psychotherapeutic treatment of refugee children and families. Elements of case histories are used to illustrate situations faced in working with an interpreter. An ethical analysis of a case where a teenage refugee received therapeutic treatment using an interpreter is made. © 2005 Taylor & Francis.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-31038 (URN)10.1080/08039480500360740 (DOI)16746 (Local ID)16746 (Archive number)16746 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13

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