[Relevance of the transcultural approach to improve the care relationship in the perinatal period]. / Pertinence de l'approche transculturelle pour améliorer la relation de soins en période périnatale.

The international literature review highlights higher neonatal morbimortality in migrant patients and their babies. The explanatory hypotheses include late pregnancy follow-up with difficulty accessing care, language barriers, and different cultural representation in pregnancy support. On the one hand, we propose to explain the cultural factors that can impact the caring relationship during the perinatal period. On the other hand, we set out tools for anthropological and psychological understanding to enhance the sharing of cultural representations around pregnancy follow-up, the needs of a baby, and obstetrical or postnatal complications. The request for a specialised transcultural opinion needs to be more systematic; the transcultural posture is adaptable to each care professional. This requires the professional to address explicitly the impact of culture in care and consider their own cultural distance. Specialised advice is recommended in certain situations of cumulative vulnerability (complex trauma, perinatal depression with cultural coding of symptoms), blockage or refusal of care for cultural reasons and to avoid cultural misunderstandings. We detail two modalities: mediation and a discussion group around cultural issues set up in the maternity ward. The institutional work we propose within the multidisciplinary team in the maternity ward also allows the acquisition of transcultural competencies.

Assessment of transcultural psychotherapy to treat resistant major depressive disorder in children and adolescents from migrant families: Protocol for a randomized controlled trial using mixed method and Bayesian approaches.

OBJECTIVES: Cultural variations complicate psychiatric care, especially for migrant children. Transcultural psychotherapy (TCP) is an original psychotherapeutic technique developed to address complex situations of resistant mental disorders in the context of migration. This research will aim to assess the efficacy, the acceptability, and describe the therapeutic processes of TCP for the treatment of depression in first or second generation of migration children and adolescents. METHOD: Mixed method study using a multicenter, Bayesian randomized clinical trial with blinded evaluation of the primary outcome. Two parallel groups of 40 children or adolescents from 6 to 20 years old and their family will be included. In the experimental group, patients will attend six sessions of transcultural therapy in addition to usual care. RESULTS: The improved Clinical Global Impression scale scores at 6 months will be compared across groups. Qualitative analysis of families and therapists' interviews will allow to specify the therapeutic processes and acceptability of the therapy. CONCLUSION: The findings will encourage the development and routinization of TCP for second-line use and its adaption as a first-line technique in this population.

Qualitative assessment of transcultural psychotherapy by adolescents and their migrant families: Subjective experience and perceived effectiveness.

OBJECTIVE: Adolescent migrants present psychological disorders more frequently than the corresponding host population but their access to care and to follow-up are less effective. The French method of transcultural psychotherapy (TPT) was conceived to respond to these problems. Our objective is to assess how these adolescents and their families perceive the experience and effectiveness of TPT. METHOD: We conducted semistructured interviews with the families of adolescents seen for TPT. The data were analyzed by a qualitative thematic methodology. RESULTS: We spoke to 21 participants in 8 families. The families came to TPT with a sense that the teen's current treatment was at an impasse. During the follow-up, they noted that family communication and relationships had improved, as had their connection to their culture of origin. Besides commenting on what they perceived as limitations, families identified specific elements of TPT as therapeutic. CONCLUSION: The pronounced diversity of the group and the use of both multiperspective narration and an interpreter were specific elements driving the construction of a good therapeutic alliance, despite the initial barriers. Pursuit of the evaluation of TPT is essential to advance the psychiatric care of adolescent migrants.

[Unaccompanied Minors: Individual Trajectories Confronting Politics]. / Les mineurs non accompagnés : des destins individuels qui interrogent le politique.

Objectives The article presents the clinical description and discussion of a 17 years old Moroccan unaccompanied minor who migrated on his own to France. This case illustrates the complexity of the foreign unaccompanied minors' trajectories and the challenges of the clinical and institutional accompaniment provided in France. In the lights of the results of our clinical work and research, we suggest transcultural tools and perspectives that facilitate the construction of a narrative and that reinforce trust with the professionals-care givers working along with this population. Creativity is needed in the care of foreign isolated young people, in the absence of the family. Past traumatic experiences in these youths' lives hinder the process of building trust in the host country's educational accompaniment. Method In the framework of our action research, we describe the transcultural therapy setting created by our team to address the unaccompanied minors' psychological distress. Aiming to encourage the emergence of a life narrative that had been obstructed and ruptured by traumatic experiences, we resort to various tools facilitating the storytelling (objects, circle test, mediators interpreters, transcultural interpretations). Results The discussion follows three stances: the anthropological perspective focusing on the specific situation of the harraga-young people wandering both on the psychic and physical levels-, the political perspective, and the trauma clinic perspective. The enhancement and deepening of the cross-cultural skills of social workers strengthen their resources and provide them with better tools to accompany these young people. Additionally, results highlight the impact of the political discourse and strategies in the social workers' self-perception and the strains it creates in their daily work. Conclusion The transcultural approach addressed to unaccompanied minors relaunches the identity construction process in adolescence, impeded by their traumatic journey in migration. This implies restoring coherence in the life path of young people despite the rupture caused by the migration, often reactivated by new separations during the repetitive changes of foster homes. The unaccompanied minors have the possibility, through this clinical setting to depict an accurate representation of themselves, to develop narratives that can outgrow the preconceptions associated with their status, opening a brighter way for their individual destinies.

Transcultural mediation programme in a paediatric hospital in France: qualitative and quantitative study of participants' experience and impact on hospital costs.

OBJECTIVE: In France, immigrants with chronic diseases encounter numerous difficulties in gaining access to care and then in its initiation and organisation, difficulties only partly explained by socioeconomic factors. A transcultural mediation consultation programme has been set up in Necker Hospital in Paris to help families and professionals deal with these situations. The objective of this study was to assess the economic impact and the experience of this consultation. DESIGN: Qualitative and quantitative descriptive study. SETTING: This study of inpatients treated at Necker Hospital included those whose families participated in transcultural mediation in 2014 through 2016. PARTICIPANTS: The first portion of the study applied quantitative methods and compared hospital costs before and after the mediation from the patients' records and accounting data for 15 cases. The qualitative portion analysed 15 semistructured interviews of physicians and families after the mediation, and a focus group of three psychologists. RESULTS: The results show a systematic reduction in costs after mediation, associated with fewer emergency hospitalisations and the shift of care toward less specialised facilities, calmer relationships between families and professionals, improved mutual understanding and increased confidence by the professionals in the families' ability to manage the treatment. CONCLUSION: Transcultural mediation can benefit both patients and the healthcare system and may be useful for other hospitals that care for socially and culturally diverse patients.

Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study.

BACKGROUND: Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted. METHODS: One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out. DISCUSSION: We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03350594 . Registered on 22 November 2017. IDRCB number 2016-A00818-43.

[Different perspectives of educational systems with a cross-cultural assessment]. / Regards croisés entre systèmes éducatifs lors d'une expertise transculturelle.

In the framework of cross-cultural assessments, the nursing team is instructed by the family court judge to provide a clinical assessment taking into account the cultural dimension of the young person concerned. The aim is also to define appropriate psychoeducational support for certain migrant families, notably those describing a brutal confrontation between the educational worlds of here and elsewhere. The situation of a Togolese family, whose adolescent daughter is taken into care due to a practice judged to be abuse in France, is analysed in order to provide some keys to understanding and to discuss the anthropological aspects relevant to the educational and psychological care.

Maternal perception of emotional difficulties of preschool children in rural Niger.

Mental health care for infants and young children is often greatly limited in low-resource settings. The purpose of this study was to describe maternal perception of emotional difficulties of preschool children in a rural area of Niger (Maradi). In this context, both mental health awareness and services were scarce. This research was part of a larger cross-cultural validation study of a screening tool for psychological difficulties in children aged 3 to 6 years old. Data collection included group discussion and individual interviews. A total of 10 group interviews and 83 individual interviews were conducted. The results highlight mothers' perceptions concerning their children's psychological difficulties. Sleep difficulties were considered significant by the mothers and were used often as an entry point for further discussion of concerns. Peer and sibling relationships, separation anxiety, and reactions to difficult events were also described. Identification of mothers' perceptions of children's main difficulties through a mixed-method approach shows promise as a way to inform interventions to provide culturally appropriate care for children in need.

[Breaking the silence in Colombia to resist violence 2/2]. / Briser le silence en Colombie pour résister a la violence 2/2.

The war in Columbia is the source of permanent and widespread violence, of which the civilian population is the main victim. Medical-psychological teams from Médecins Sans Frontières France worked in Tolima, a region particularly affected by the conflict, between 2001 and 2008, and were able to study the complexity of the forms of violence and their consequences. While the consequences for individuals, analysed in part one, are devastating, the impact of the conflict on society and families provides a better understanding of this society and its generalised violence.