Psychometric properties of the Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia.

Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels.Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe.Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated.Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717-.856), whereas it was higher among Somali adolescents (.831-.887). The total score had medium-sized correlations with emotional problems (.303-.418) and low correlations with hyperactivity (.077-.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%).Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.

We investigated the psychometric properties of the 8-item Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia living in Europe.We found support for the CRIES-8 as a suitable assessment tool for Afghan, Syrian, and Somali adolescents.The reliability of the CRIES-8 was low among Afghan and Syrian adolescents, whereas among Somali adolescents, reliability was higher.

Silencing or silent transmission? An exploratory study on trauma communication in Kurdish refugee families.

Trauma communication in refugee families is increasingly recognized as an important relational dynamic influencing psychosocial well-being, yet studies exploring interactional dynamics and meaning making at play in intra-family trauma communication remain scarce. This article reports on a qualitative study with Kurdish refugee families including parents (N = 10) and children (N = 17) resettled in Belgium, aiming to explore practices on trauma communication within refugee family relationships. In a multiple-phased qualitative design, semi-structured family interviews and participant observation administered in the homes of the participant families are followed by parental interviews involving a tape-assisted recall procedure to investigate observed intergenerational trauma communication and parent-child interactions. Data analysis shows parents and children seldom explicitly talked about the families' lived experiences of trauma. This silence was especially related to parental wishes to avoid their children's future involvement in violence. However, findings also indicate how the intra-family transmission of memories of collective violence occurs in many subtle ways. Four modes of indirect trauma communication could be distinguished: (1) focusing on the repetition of violence in the present; (2) transmission of the collective trauma history; (3) family storytelling; and (4) interaction with meaningful objects of the past. These findings shed light onto the interwoven nature of personal-familial and collective trauma and loss and illuminate the meanings of silence and disclosure in the context of the Kurdish diaspora. In the final section, we discuss our findings and outline its clinical implications for family therapeutic practices in refugee trauma care.

"It will always be Temporary": A qualitative study of Syrian young adults expressing histories of collective violence and forced displacement in participatory theatre.

Given the increased prevalence of mental health problems in Syrian refugee communities, there have been efforts to develop adequate mental health care for their well-being. Herein, clinical literature is increasingly emphasizing the importance of locating refugees' healing at the nexus of personal and social realities, understanding the process of trauma narration within social restorative spaces of witnessing and communal support. Alongside this debate, there is growing interest in the relevance of participatory theatre for refugees. This innovative approach understands how voicing narratives of life histories within a broader social sphere may support personal and socio-political transformation. In this article, we aim to further the understanding of participatory theatre's relevance to these issues, focusing on the reparative dimensions of trauma narration. Based on a case study of a theatre project with Syrian young adults resettled in Belgium, we explore the different ways participants expressed experiences of collective violence and displacement in dialogue with each other, their diasporic and home communities, and their host society, and consider how these processes relate to their construction and meaning and coping with trauma. In a final section, we discuss the implications of our findings, raising questions about the value of participatory theatre as a reparative space and outlining suggestions to introduce and mobilize reparative modes of trauma narration in therapeutic practices in refugee trauma care.

The role of school-based creative expression interventions in the aftermath of migration: A qualitative exploration of parents' and teachers' perspectives.

This study explored supportive relational processes for immigrant children's well-being between peers, teachers, and parents in the development of school-based creative interventions in European multi-ethnic societies. Within the present study, we integrated the perspectives of teachers and parents to broaden the dominant focus on the assessment of individual symptomatology within the existing body of studies of school-based interventions studies. As a part of a larger multi-method study on the implementation of a creative expression program for immigrant children ages 8-12 years in three schools in Belgium, we conducted focus group discussions to learn parents' and teachers' perspectives on the role of school-based creative interventions in children's coping with histories of migration and life in exile. Parents and teachers identified the need for the intervention to foster emotional expression impacting children's self-esteem and social connectedness with peers and to foster emotional connections between parents, teachers, and children. Parents also stressed the importance of the intervention within society as a forum to engage with social conditions, promote cultural belonging, and social integration. Results identified the importance of school-based interventions in terms of individual benefits as well as connectedness and coherence in entire communities, thereby strengthening the development of transcultural research evidence for school-based interventions in multi-ethnic societies.

The effect of a school-based creative expression program on immigrant and refugee children's mental health and classroom social relationships: A cluster randomized trial in elementary school.

This study evaluated the effects of a school-based creative expression program on mental health and classroom social relationships in elementary school children with refugee and nonrefugee migration backgrounds. It was hypothesized that children receiving the intervention would report less externalizing and internalizing problem behaviors, less posttraumatic functioning, and more positive classroom social relationships at posttest than children receiving education as usual, particularly for refugee children. Classes in three multiethnic Belgian elementary schools were randomly assigned to a creative intervention (7 classes, 68 students) or control condition (6 classes, 52 students). All participants (8-12 years old) had a migration background. Almost half (47%) were refugees, 53% were first- to third-generation nonrefugee immigrants. Data collection included pre- and posttest assessment with children, parents, and teachers. Multilevel analysis was used to assess outcomes. Children in the intervention condition rated the classroom climate at posttest more positive than their control peers (d = .33). Children who received the intervention did not show less symptomatic functioning than children in the education-as-usual condition. However, post hoc analysis by baseline severity showed that students with high baseline levels of posttraumatic stress reported less trauma symptoms at posttest in the intervention group than in the control group (d = -.97). This effect was moderated by children's refugee background, indicating a differential effect in which refugee children show more reduction of trauma symptoms as compared to nonrefugee immigrant children. The intervention supported classroom climate and alleviated posttraumatic stress in children with increased posttraumatic symptomatology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mental health problems in refugee and immigrant primary school children in Flanders, Belgium.

BACKGROUND: European countries face the challenge of promoting refugee and immigrant children's well-being within their host communities, invoking the necessity of adequate mental health assessment. This study aims to contribute to document the psychosocial well-being of primary school refugee and non-refugee immigrant children in Flanders, Belgium. METHOD: A total of 120 children (8-12 years old) with migration backgrounds participated in the study. Through self-report, parent and teacher questionnaires we scrutinized externalizing and internalizing behavioral problems, post-traumatic stress problems, and classroom relationships. RESULTS: Thirty percent of the participants reported high levels of post-traumatic stress; around 25% reported a high or very high prevalence of internalizing and externalizing behavioral problems. Self-reported mental health problems are elevated in comparison to the general population. Refugee children did not report more difficulties than their immigrant peers. In the perception of parents and teachers, respectively 20% and 5% of children showed high or very high amounts of internalizing and externalizing behavioral difficulties. Almost 70% of the participants perceived the class climate as unsafe. CONCLUSIONS: Refugee and immigrant children are at risk for mental health difficulties, and experience classroom dynamics as markedly distressful. School-based intervention might be particularly suited to support these children's psychosocial well-being in resettlement.

Working With the Encounter: A Descriptive Account and Case Analysis of School-Based Collaborative Mental Health Care for Refugee Children in Leuven, Belgium.

Scholars increasingly point toward schools as meaningful contexts in which to provide psychosocial care for refugee children. Collaborative mental health care in school forms a particular practice of school-based mental health care provision. Developed in Canada and inspired by systemic intervention approaches, collaborative mental health care in schools involves the formation of an interdisciplinary care network, in which mental health care providers and school partners collaborate with each other and the refugee family in a joint assessment of child development and mental health, as well as joint intervention planning and provision. It aims to move away from an individual perspective on refugee children's development, toward an engagement with refugee families' perspectives on their migration histories, cultural background and social condition in shaping assessment and intervention, as such fostering refugee empowerment, equality, and participation in the host society. Relating to the first stage of van Yperen's four-stage model for establishing evidence-based youth care, this article aims to engage in an initial exploration of the effectiveness of a developing school-based collaborative mental health care practice in Leuven, Belgium. First, we propose a detailed description, co-developed through reflection on case documents, written process reflections, intervision, an initial identification of intervention themes, and articulating interconnections with scholarly literature on transcultural and systemic refugee trauma care. Second, we engage in an in-depth exploration of processes and working mechanisms, obtained through co-constructed clinical case analysis of case work collected through our practice in schools in Leuven, Belgium. Our descriptive analysis indicates the role of central processes that may operate as working mechanisms in school-based collaborative mental health care and points to how collaborative mental health care may mobilize the school and the family-school interaction as a vehicle of restoring safety and stability in the aftermath of cumulative traumatization. Our analysis furthermore forms an important starting point for reflections on future research opportunities, and central clinical dynamics touching upon power disparities and low-threshold access to mental health care for refugee families.

Psychologists' Perspectives on the Psychological Suffering of Refugee Patients in Brazil.

Worldwide there are 79.5 million displaced people, many of which face war, violence, tragic flights and struggles in host countries. Research shows augmented prevalence rates of mental disorders among refugees internationally, but little is known about refugee mental health in Latin American countries. Furthermore, only a few studies have taken into consideration the knowledge of clinical psychologists who treat refugee patients. The present study examines the experiences of 32 psychologists in Brazil regarding their refugee patients' psychological suffering and mental disorders. Semi-structured interviews were conducted in various locations in Brazil and analysed following a consensual qualitative research approach. Four clusters of refugee patients' suffering were synthesised: post-migration stressors, traumatic experiences, flight as life rupture, and the current situation in the country of origin. The most frequently described conditions in patients were anxiety and depression. However, the results also show that the use of manuals for the classification of mental disorders is contested among psychologists in Brazil. Most psychologists stressed patients' socio-political suffering and saw patients' symptoms as normal reactions to their experiences. There is a need to acknowledge the socio-political suffering of refugees in Brazil and foster their mental health by tackling current post-migration stressors such as discrimination.

A contextualized perspective on research participation in collaborative refugee research: A multi-site exploration of relational dynamics in collaborative research.

OBJECTIVE: An increasing body of literature emphasizes the role of refugees' social context, with social conditions both at home and in the host society having an impact on the possibility of power redistribution and the mobilization of agency in collaborative research practices. Our aim is to develop a contextualized understanding of research participation for refugees in collaborative research in order to further enhance insights on the potential strengths and pitfalls of collaborative refugee research. METHOD: We closely study the various relational contexts that shape refugees' research participation and that may have an influence on power dynamics in collaborative research. In the present study, we explore participants' adaptation of research participation by means of an interpretive cross-case analysis of three psychosocial intervention studies sharing a collaborative approach with refugee participants, refugee families, refugee communities, and professional partners at different stages in the research process. RESULTS: We identify the developed collaborative strategies in our three case studies and provide an outline of the ways refugees mobilize research participation through these identified collaborative strategies, from within the relational contexts of the family, community, and institutional actors. CONCLUSIONS: This analysis shows how research participation operates as a relational forum in which refugees continuously navigate and negotiate within and between multiple relational contexts. We argue that performing research participation, as a way of relating to a relational context, is both an interactive and a dynamic process. For research practice, our analysis addresses the importance of an in-depth understanding of participants' relational contexts to foster both a reflective research practice and trustful research relationships between researchers and participants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"I Look at You and See You Looking at Me": Role Boundaries in a Dynamic Research Relationship in Qualitative Health Research With Refugees.

In institutional ethical and deontological guidelines, there is a prevailing, static understanding of the research partnership, with a clear boundary between researcher and participant. In this article, we argue that such a static understanding may run the risk of impeding the development of an enhanced contextual and dynamic intersubjective understanding of the research partnership and its impact on the growing importance of role boundaries in qualitative research. Drawing from a refugee health study on trauma and forced migration, we explore the different ways in which participants and the researcher engaged with the researcher's multiple positions and role boundaries. In doing so, we aim to contribute to a reflective research practice by providing tools to recognize signs of potential harm and offer potential vehicles of reconstruction and agency within the intersubjective space of a dynamic research relationship, within a continuous, shared renegotiation process of role boundaries.

Health-related quality of life in patients with cleft palate: Reproducibility, responsiveness and construct validity of the Dutch version of the VELO questionnaire.

OBJECTIVES: Recently, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire, which evaluates the impact of speech and swallowing difficulties on health-related quality of life (HRQoL) in patients with VPI (Skirko et al., 2012), was translated to Dutch (Bruneel et al., 2017). The purpose of this study was to evaluate the reproducibility, responsiveness and construct validity of this Dutch version of the questionnaire. METHODS: To evaluate the reproducibility, 50 parents and 14 children with cleft palate re-completed the questionnaire after two weeks. Thirty-five parents and 8 children with cleft palate completed the VELO questionnaire after one year for the evaluation of the responsiveness. The correlation between age and the VELO questionnaire (construct validity), and the internal consistency (Cronbach's α) were re-determined based on the responses of 73 parents and 24 children. RESULTS: Based on descriptive statistics, results of the Wilcoxon signed rank-test, and the absolute (SEM) and relative (ICC) consistency, the questionnaire showed good reproducibility. VELO scores did not significantly differ after one year, neither when performing separate analyses for the intervention (speech therapy) and the non-intervention group. Correlations indicated higher HRQoL, as perceived by the parents, with increasing age. The reverse was the case for the youth report. Cronbach's α showed excellent internal consistency for both reports. CONCLUSIONS: The VELO questionnaire showed good reproducibility and internal consistency. Moreover, results reconfirmed the age effect on VELO scores. To understand the implications of the results regarding the questionnaire's responsiveness, future research should focus on the identification of factors influencing the patient's evolution in HRQoL.