Cultural Competence of Professionals Working With Unaccompanied Minors: Addressing Empathy by a Shared Narrative.

BACKGROUND: The number of migrant youth traveling without parents continues to rise in Europe and North America. Some of t hem leave their home countries on their own and find themselves in a new country, separated from their family and cut off from their cultural roots. Besides those who leave to study, work, and pursue a better life, others are escaping war-torn countries. They need adequate social, educational, and therapeutic spaces, where they can feel entitled to speak. Social workers often ask about how they can understand these young people better so that they can provide them with better care (cope with their trauma and suspicion, deal with the cultural distance between the adolescents and their social workers, etc). AIM: At Cochin Hospital in Paris, we led a participative action-research program to transmit cultural competence to social workers who provide care for these youth. The aim was to develop an approach to help these young migrants to share their representations about themselves and to train these social workers to encourage this sharing in a culturally sensitive manner. METHODS: This study used a qualitative method that mixed narrative and transcultural approaches. Two researchers met each youth and social worker with an interpreter-cultural mediator three times (once a month) to assess changes in their relationships during the study. The youth were asked to bring three items of their choice, representing their past, present, and future. They could use their imagination and creativity. We also used the circle test described by Cottle for this purpose. We used a phenomenological approach to analyze the interviews. RESULTS AND DISCUSSION: This study included 29 young people from 13 different countries and 29 social workers. A transcultural approach appears to be a useful framework for reactivating their identity construction process. It promotes the emergence of cultural representations and takes their experiences before, during, and after migration into account. We assisted them in developing their ability to produce a thorough narrative of their bicultural adolescences and simultaneously helped their social workers to develop their cultural competence. CONCLUSION: Together, a transcultural approach and methods stimulating the production of narrative are relevant ways to help children to describe their representations of themselves, especially those who have learned to protect themselves by remaining silent. This protocol could be useful for both preventive action and therapy for psychotrauma.

The fate of Jews hospitalized in mental hospitals in France during World War II.

The fate of Jewish psychiatric patients in occupied Europe during World War II is inseparable from the fate of the disabled and mentally ill, as planned by the Nazi regime. But Jews found themselves at the confluence of eugenics, Christian anti-Judaism and Nazi racist and anti-Semitic madness. They faced the twin promise of death - both as Jews and as mentally ill. They did not escape from the euthanasia programme and, if by a miracle they survived, they disappeared into the extermination camps. The modalities of annihilation of Jewish psychiatric patients are inseparable from the forms of German occupation, which differed from country to country. In this research we focus initially on various countries in occupied Europe, and then on France.

[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.

Resilience in Haiti: is it culturally pathological?

Not for the first time in recent history, the people of Haiti have been obliged to fall back on their resilience strategies in the aftermath of Hurricane Matthew. Following the powerful earthquake that struck the country on 12 January 2010, the entire population had to find the resources to survive in the face of extensive material damage and loss of life: over 222 000 dead, more than 300 000 injured and between 4000 and 7000 amputees (UNDP, 2010).

[The drawing as a therapeutic mediation tool for gifted children]. / Le dessin comme médiation thérapeutique pour les enfants intellectuellement précoces.

Intellectual precocity arouses a number of preconceived ideas. While it labels the children concerned as gifted and destined to become exceptional adults, it confines and prescribes and does not guarantee academic success. Based on the hypothesis of the suffering of these children, mediation through drawing is a valuable therapeutic tool.

Religious Beliefs, PTSD, Depression and Resilience in Survivors of the 2010 Haiti Earthquake.

BACKGROUND: This study examines relationships between religious beliefs regarding the origin of the 2010 earthquake in Haiti and posttraumatic symptomatology as well as depressive symptoms and resilience among its survivors. METHOD: We used convenient sampling to recruit participants (n=167). They completed six scales, which had been translated into Haitian Creole, including measures such as the Earthquake Experiences Exposure (EEE), the Peritraumatic Distress Inventory (PDI), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the PTSD Checklist (PTSD-CL), the Beck Depression Inventory (BDI) and the Connor-Davidson Resilience Scale (CD- RISC) RESULTS: Among our participants, 51% were male, (mean age=30.5, SD=11.03), 92% (n=155) were believers in some sort of supernatural force and 65% (n=108) endorsed the earthquake as a natural phenomenon. There was significant difference in average scores at peritraumatic distress, PTSD symptoms and Resilience measures between those perceiving a divine origin and/or a punishment through the event and those who did not. Peritraumatic responses were best predictors for PTSD (ß=.366, p<.001) and Depression symptoms (ß=.384, p<.001). Voodoo adherents appeared to be vulnerable to depression, but reported superior resilience factors.

Psychometric properties of the Haitian Creole version of the Resilience Scale with a sample of adult survivors of the 2010 earthquake.

BACKGROUND: Resilience is defined as the ability of people to cope with disasters and significant life adversities. The present paper aims to investigate the underlying structure of the Creole version of the Resilience Scale and its psychometric properties using a sample of adult survivors of the 2010 earthquake. METHODS: A parallel analysis was conducted to determine the number of factors to extract and confirmatory factor analysis was performed using a sample of 1355 adult survivors of the 2010 earthquake from people of specific places where earthquake occurred with an average age of 31.57 (SD=14.42). All participants completed the Creole version of Resilience Scale (RS), the Impact of Event Scale Revised (IES-R), the Beck Depression Inventory (BDI) and the Social Support Questionnaire (SQQ-6). To facilitate exploratory (EFA) and confirmatory factor analysis (CFA), the sample was divided into two subsamples (subsample 1 for EFA and subsample 2 for CFA). RESULTS: Parallel analysis and confirmatory factor analysis results showed a good-fit 3-factor structure. The Cronbach α coefficient was .79, .74 and .72 respectively for the factor 1, 2 and 3 and correlated to each other. Construct validity of the Resilience scale was provided by significant correlation with measures of depression and social support satisfaction, but no correlation was found with posttraumatic stress disorder measure, except for factor 2. CONCLUSIONS: The results reveal a different factorial structure including 25 items of the RS. However, the Haitian Creole version of RS is a valid and reliable measure for assessing resilience for adults in Haiti.

Prise en charge des dyades mère traumatisée-bébé: une contrainte à la pensée et à la pratique / Tratando mães traumatizadas e seus bebês: os desafios da teoria e a prática / Treating traumatized mothers and their children: the need for improvement / Tratando a madres traumatizadas y a sus bebés: los desafíos de la teoría a la práctica

Dans le champ de la protection de l’enfance, la prise en charge de certaines dyades mère-bébé met en difficultés les professionnels et on constate une mise en échec des suivis. L’objectif est de montrer qu’il faut penser un soin plus adapté pour ces dyades. Au travers de la présentation d’une situation clinique et de son suivi, les auteurs montrent l’impact des traumas vécus par une mère dans son pays d’origine sur le développement de son bébé né en France, et de quelles façons ces traumas contaminent également les professionnels prenant en charge la dyade. Les contre-transferts négatifs peuvent créer parfois des divergences de points de vue dans les prises en charge et mettre en échec le soin proposé aux dyades mère-bébé. Ces contre-transferts témoignent d’un “partage du traumatisme”. Ce suivi est mis en lien avec une recherche qui est menée actuellement sur les modalités de transmission du trauma mère-bébé. Cette recherche implique de nombreux chercheurs-cliniciens qui travaillent à l’analyse des interactions mère-bébé et de la dynamique triadique: mère-bébé-chercheur. L’analyse du contre-transfert du chercheur permettrait d’accéder au vécu du bébé. Le but de cette recherche est d’améliorer le soin, et d’aider au mieux les professionnels accompagnant les dyades mère-bébé.

No campo da proteção da infância, o atendimento de algumas díades mãe-bebê coloca em dificuldade os professionais de saúde, e podemos constatar o fracasso de parte desses acompanhamentos. O objetivo deste artigo é trazer contribuições para o atendimento mãe-bebê. A partir da apresentação de um caso clínico, os autores buscam evidenciar o impacto dos traumas vivenciados por mães em seu país de origem sobre o desenvolvimento do seu bebê nascido na França, país de acolhida. Mas, não apenas, pois diremos que o trauma contamina igualmente os professionais de saúde que atendem à díade mãe-bebê. A força dos laços contratransferenciais negativos podem levar a uma divergência de abordagem e contribuem para o fracasso dos atendimentos centrados na díade mãe-bebê. Esses efeitos de contratransferência dão testemunho de um “compartilhamento do trauma”. Esses atendimentos fazem parte de uma pesquisa sobre as modalidades de transmissão do trauma mãe-bebê. Nesta pesquisa, em que estão envolvidos inúmeros pesquisadores clínicos, buscamos pensar as interações mãe-bebê, a transmissão do trauma e a dinâmica mãe-bebê-pesquisador. A análise da contratransferência do pesquisador permite o acesso à instância do vivido do bebê. Nosso objetivo é de facilitar o atendimento clínico e de contribuir para a prática dos professionais que acompanham a díade mãe-bebê.

Regarding child welfare, health care professionals sometimes face difficulties when they take care of certain mother-child dyads, which may result in partial care failure. A clinical picture is used to illustrate the impacts of traumas experienced by mothers in their home countries on the development of their babies, who were born in France. However, those traumas also seem to contaminate health care professionals in charge of those dyads. The impact of negative counter transferential bonds may result in conflicts regarding approaches and result in mother-child dyad care failure. Those effects of counter-transference reveal a kind of “trauma sharing”. That type of care is part of a research that involves a large number of clinical researchers and analyzes the modes of transmission of traumas between mother and child. We focused on the mother-child interaction, trauma transmission, and the mother-baby-researcher relationship. Analyzing the researcher’s countertransference helps accessing the instance of the child’s experience. We aim to facilitate clinical care and to support professional care of those mother-child dyads.

En el campo de la protección de la infancia, la atención de ciertos dúos madre-bebé, pone en aprietos a los profesionales de la salud, y podemos constatar el fracaso en el seguimiento de parte de estos casos. El objetivo de este artículo es traer contribuciones en lo relacionado con la atención madre-bebé. Desde la presentación de una situación clínica y de su seguimiento, los autores muestran el impacto que tienen los traumas vividos por una madre en su país de origen en el desarrollo de su bebé nacido en Francia, país de acogida. Sin embargo, no solamente, una vez que diremos que estos traumas contaminan también a los profesionales de la salud que le hacen el seguimiento a estos casos. La fuerza de los lazos contratransferenciales negativos, puede inducir a una divergencia en el abordaje y contribuyen en el fracaso de la atención a los dúos madre-bebé. Estas contratransferencias dan testimonio de una “trauma compartido”. Estos seguimientos hacen parte de una investigación relacionada a la transmisión del trauma madre-bebé. Esta investigación implica a numerosos investigadores clínicos, que trabajan en el análisis de las interacciones madre-bebé y en la dinámica del trío: madre-bebé-investigador. El análisis de la contratransferencia del investigador permitiría acceder a lo vivido por el bebé. Nuestro objetivo es facilitar la atención clínica y contribuir a la práctica de los profesionales que acompañan a los dúos madre-bebé.

Prise en charge des dyades mère traumatisée-bébé: une contrainte à la pensée et à la pratique / Tratando mães traumatizadas e seus bebês: os desafios da teoria e a prática / Treating traumatized mothers and their children: the need for improvement / Tratando a madres traumatizadas y a sus bebés: los desafíos de la teoría a la práctica

Dans le champ de la protection de l’enfance, la prise en charge de certaines dyades mère-bébé met en difficultés les professionnels et on constate une mise en échec des suivis. L’objectif est de montrer qu’il faut penser un soin plus adapté pour ces dyades. Au travers de la présentation d’une situation clinique et de son suivi, les auteurs montrent l’impact des traumas vécus par une mère dans son pays d’origine sur le développement de son bébé né en France, et de quelles façons ces traumas contaminent également les professionnels prenant en charge la dyade. Les contre-transferts négatifs peuvent créer parfois des divergences de points de vue dans les prises en charge et mettre en échec le soin proposé aux dyades mère-bébé. Ces contre-transferts témoignent d’un “partage du traumatisme”...(AU)

No campo da proteção da infância, o atendimento de algumas díades mãe-bebê coloca em dificuldade os professionais de saúde, e podemos constatar o fracasso de parte desses acompanhamentos. O objetivo deste artigo é trazer contribuições para o atendimento mãe-bebê. A partir da apresentação de um caso clínico, os autores buscam evidenciar o impacto dos traumas vivenciados por mães em seu país de origem sobre o desenvolvimento do seu bebê nascido na França, país de acolhida. Mas, não apenas, pois diremos que o trauma contamina igualmente os professionais de saúde que atendem à díade mãe-bebê. A força dos laços contratransferenciais negativos podem levar a uma divergência de abordagem e contribuem para o fracasso dos atendimentos centrados na díade mãe-bebê. Esses efeitos de contratransferência dão testemunho de um “compartilhamento do trauma”. Esses atendimentos fazem parte de uma pesquisa sobre as modalidades de transmissão do trauma mãe-bebê. Nesta pesquisa, em que estão envolvidos inúmeros pesquisadores clínicos, buscamos pensar as interações mãe-bebê, a transmissão do trauma e a dinâmica mãe-bebê-pesquisador. A análise da contratransferência do pesquisador permite o acesso à instância do vivido do bebê. Nosso objetivo é de facilitar o atendimento clínico e de contribuir para a prática dos professionais que acompanham a díade mãe-bebê.(AU)

Regarding child welfare, health care professionals sometimes face difficulties when they take care of certain mother-child dyads, which may result in partial care failure. A clinical picture is used to illustrate the impacts of traumas experienced by mothers in their home countries on the development of their babies, who were born in France. However, those traumas also seem to contaminate health care professionals in charge of those dyads. The impact of negative counter transferential bonds may result in conflicts regarding approaches and result in mother-child dyad care failure. Those effects of counter-transference reveal a kind of “trauma sharing”. That type of care is part of a research that involves a large number of clinical researchers and analyzes the modes of transmission of traumas between mother and child. We focused on the mother-child interaction, trauma transmission, and the mother-baby-researcher relationship. Analyzing the researcher’s countertransference helps accessing the instance of the child’s experience. We aim to facilitate clinical care and to support professional care of those mother-child dyads.(AU)

En el campo de la protección de la infancia, la atención de ciertos dúos madre-bebé, pone en aprietos a los profesionales de la salud, y podemos constatar el fracaso en el seguimiento de parte de estos casos. El objetivo de este artículo es traer contribuciones en lo relacionado con la atención madre-bebé. Desde la presentación de una situación clínica y de su seguimiento, los autores muestran el impacto que tienen los traumas vividos por una madre en su país de origen en el desarrollo de su bebé nacido en Francia, país de acogida. Sin embargo, no solamente, una vez que diremos que estos traumas contaminan también a los profesionales de la salud que le hacen el seguimiento a estos casos. La fuerza de los lazos contratransferenciales negativos, puede inducir a una divergencia en el abordaje y contribuyen en el fracaso de la atención a los dúos madre-bebé. Estas contratransferencias dan testimonio de una “trauma compartido”. Estos seguimientos hacen parte de una investigación relacionada a la transmisión del trauma madre-bebé. Esta investigación implica a numerosos investigadores clínicos, que trabajan en el análisis de las interacciones madre-bebé y en la dinámica del trío: madre-bebé-investigador. El análisis de la contratransferencia del investigador permitiría acceder a lo vivido por el bebé. Nuestro objetivo es facilitar la atención clínica y contribuir a la práctica de los profesionales que acompañan a los dúos madre-bebé.(AU)

Screening for psychological difficulties in young children in crisis: complementary cross-cultural validation.

BACKGROUND: Detection of children's psychological difficulties in crises and low resource settings is challenged by the lack of a validated, rapid and simple tool. We present the results of two confirmatory validations of the Psychological Screening for Young Children aged 3 to 6 years (PSYCa 3-6) scale. METHODS: We performed cross-cultural validations, assessing the performance of the scale in different contexts. These were conducted in Mathare, Nairobi, Kenya and Buenaventura, Colombia between December 2009 and February 2012. External validity was assessed comparing the PSYCa 3-6 against a clinical interview and the Clinical Global Impression Severity scale (CGI). RESULTS: A total of 160 mothers or caregivers of children 3 to 6 years old in Mathare and 148 in Buenaventura were included in the study. Both demonstrated good concurrent validity (Buenaventura ρ=0.49, p<0.0001; Mathare ρ=0.41, p<0.0001). Inter-rater reliability was found to be acceptable in Buenaventura (intraclass correlation [ICC]=0.69 [0.4-0.84]) and high in Mathare (0.87 [0.75-0.94]). CONCLUSIONS: As shown by its validation in diverse contexts, use in other populations may help improve the delivery of mental health care to children in crises and low-resource settings. Additional research on the design and delivery of intervention models for crises remains essential.

Prevalence of post-traumatic stress disorder and depression in two groups of children one year after the January 2010 earthquake in Haiti.

BACKGROUND: More than 500 studies were conducted in Haiti following the January 12 of 2010 earthquake, yet few of them assessed mental health of the population. To our knowledge, none targeted the effectiveness of various methods used to treat survivors, whether adults or children METHOD: Our study aimed to assess one year after the disaster, the effect of a specific psycho-social support offered to relocated children in Port-au-Prince compared with a control group. RESULTS: The two groups were homogeneous in the intensity of the peritraumatic distress they experienced. We were unable to show a significant difference between both in the average scores for PTSD, nor for depression, nor in three out of the four sub-scales of the Child Behavior Check-List. In case children, 68% and 40.9%, respectively, and 50% and 20.5% of the control group, reported severe levels of the symptoms of PTSD and depression. These surprising results can be explained by the absence of equivalence in the two groups from a socio-demographic point of view and because subjects were not randomly selected in the recruitment process. CONCLUSION: This study has not made it possible to indicate the effectiveness of a specific psycho-social support offered to children in the aftermath of the disaster. On the other hand, the sample illustrates the high prevalence (more than 50% for PTSD) of severe post-traumatic stress in this group of school-age children, one year after the earthquake. These results indicate that serious attention should be paid to the mental health aspects in reconstruction program for the country.

Jewish children hidden in france (1940-1944): what outcomes for feelings of shame?

This article explores how shame affects individuals over time, from childhood to late adulthood. A series of semi-structured interviews was conducted with 35 aging hidden Jewish children (21 women, 14 men; mean age of 74.9 years, range: 65-82 years), living in France 65 years after the Holocaust. For most of them, shame repeatedly acts as an "alarm signal." For many, the transformation has been possible: creation, recognition by the social group. We also discuss the fact that shame can lead to psychic exhaustion as well as handing down to the next generation. This outcome can prove fatal.

A rapid screening tool for psychological distress in children 3-6years old: results of a validation study.

BACKGROUND: The mental health needs of young children in humanitarian contexts often remain unaddressed. The lack of a validated, rapid and simple tool for screening combined with few mental health professionals able to accurately diagnose and provide appropriate care mean that young children remain without care. Here, we present the results of the principle cross-cultural validation of the "Psychological Screening for Young Children aged 3 to 6" (PSYCAa3-6). The PSYCa 3-6 is a simple scale for children 3 to 6 years old administered by non-specialists, to screen young children in crises and thereby refer them to care if needed. METHODS: This study was conducted in Maradi, Niger. The scale was translated into Hausa, using corroboration of independent translations. A cross-cultural validation was implemented using quantitative and qualitative methods. A random sample of 580 mothers or caregivers of children 3 to 6 years old were included. The tool was psychometrically examined and diagnostic properties were assessed comparing the PSYCa 3-6 against a clinical interview as the gold standard. RESULTS: The PSYCa 3-6 Hausa version demonstrated good concurrent validity, as scores correlated with the gold standard and the Clinical Global Impression Severity Scale (CGI-S) [rho = 0.41, p-value = 0.00]. A reduction procedure was used to reduce the scale from 40 to 22 items. The test-retest reliability of the PSYCa 3-6 was found to be high (ICC 0.81, CI95% [0.68; 0.89]). In our sample, although not the purpose of this study, approximately 54 of 580 children required subsequent follow-up with a psychologist. CONCLUSIONS: To our knowledge, this is the first validation of a screening scale for children 3 to 6 years old with a cross-cultural validation component, for use in humanitarian contexts. The Hausa version of the PSYCa 3-6 is a reliable and a valuable screening tool for psychological distress. Further studies to replicate our findings and additional validations of the PSYCa 3-6 in other populations may help improve the delivery of mental health care to children.

Trauma-related psychological disorders among Palestinian children and adults in Gaza and West Bank, 2005-2008.

BACKGROUND: Trauma from war and violence has led to psychological disorders in individuals living in the Gaza strip and West Bank. Few reports are available on the psychiatric disorders seen in children and adolescents or the treatment of affected populations. This study was conducted in order to describe the occurrence and treatment of psychiatric disorders in the Palestinian populations of the Gaza strip and Nablus district in the West Bank. METHODS: From 2005 to 2008, 1369 patients aged more than 1 year were identified through a local mental health and counseling health network. All were clinically assessed using a semi-structured interview based on the DSM-IV-TR criteria. RESULTS: Among 1254 patients, 23.2% reported post-traumatic stress disorder [PTSD], 17.3% anxiety disorder (other than PTSD or acute stress disorder), and 15.3% depression. PTSD was more frequently identified in children < or = 15 years old, while depression was the main symptom observed in adults. Among children < or = 15 years old, factors significantly associated with PTSD included being witness to murder or physical abuse, receiving threats, and property destruction or loss (p < 0.03). Psychological care, primarily in the form of individual, short-term psychotherapy, was provided to 65.1% of patients, with about 30.6% required psychotropic medication. Duration of therapy sessions was higher for children < or = 15 years old compared with adults (p = 0.05). Following psychotherapy, 79.0% had improved symptoms, and this improvement was significantly higher in children < or = 15 years old (82.8%) compared with adults (75.3%; p = 0.001). CONCLUSION: These observations suggest that short-term psychotherapy could be an effective treatment for specific psychiatric disorders occurring in vulnerable populations, including children, living in violent conflict zones, such as in Gaza strip and the West Bank.

The elder's child of Mare Island, New Caledonia.

On Maré Island in New Caledonia ;the elder's child' is an etiologic category with its own specific features. This article describes the work of a clinical psychologist with the family of a polyhandicapped child described as 'the elder's child.' Psychological and ethnographic perspectives provide complementary approaches to investigating cultural meanings, social organization and cosmogony, which all influence clinical interaction with the family and provides tools for developing a therapeutic alliance.