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Trauma and Foreign-Born Children
Working with vulnerable children who have experienced the trials, traumas and triumphs of migration calls for special attention by all the helping professions.
While Syria has universal public education, nearly half of Syrian children did not attend school last year. This is common for children fleeing failing states, civil war, regions dominated by gangs and cartels or whose family's flight to safety has disrupted the most basic patterns of life.
Two studies bring focus to work with children in migration: The Educational and Mental Health Needs of Syrian Refugee Children by Sirin and Rogers-Sirin (2015) and Promoting Resilience of Immigrant Children in the Classroom by Morland, Birman, Dunn, Adkins, and Gardner (2013). Syrian children are documented to have high levels of trauma, 79% having experienced a death in the family, 60% seen physical harm from an attack, 30% having suffered from being kicked, shot at or in other ways physically hurt.  Half of these children display Post Traumatic Stress Disorder (PTSD) symptoms.  BCSSW adjunct faculty member Saida Abdi, part of the SHIFA program for Somali students in the US, found a history averaging 7 traumatic events/per child in their pre-settlement history. Regardless of whether these students remain in Turkey, move to Germany or the US, the receiving society is embodied in the classroom teacher and school social service staff who are challenged to successfully educate and integrate the child.
Sirin and Rogers-Sirin (2015) state plainly "If the widespread mental health needs of the vulnerable refugee program are left unaddressed, their successful development into adulthood will be impaired, as the grim prospect of a lost generation looms ever closer." It is incumbent on educators to recognize and respond to signs of trauma while helping newcomers learn the host country language, increase self-sufficiency skills, embrace new homes and opportunities, and provide links to needed resources. 
Morland et al. (2013) points to the acculturative stress elements of facing a new life including the gaps in education, the differences in cultural traditions and expectations, and the harsh reality of discrimination. Again recognizing the probability of PTSD, Morland et al. (2013) calls for culturally competent staffing and mental health service integration. Educators need to take a strength-based approach, affirming the resilience demonstrated in the student's life experience, recognizing family ties and positive behavioral differences from the native born. Affirming culture and first language skills can be seen as protective factors and utilized while addressing the myriad of other issues that might be present in the classroom.
The patterns of effective schools are described as valuing safety and offering predictability, fostering an inclusive community and having mentoring programs. Mentoring programs have special significance for the group of children who have been denied a primary requisite - an attachment  to a person who will provide security, predictability and faith in them. Without this kind of connection, they will be more prone to health problems, poor educational achievement, relationship difficulties and mental health problems. A positive relationship with a caring adult can repair earlier damage and help bring about positive life outcomes. There is promise in engaging families, supporting bi-culturalism, and having a welcoming climate or institutional culture. The elements are known, but with competing priorities in schools, the locus of responsibility is often unclear and the need often recognized only in hindsight.
This month 10,000 Syrians will join the 3 million refugees already settled in the US. Evidence points to their success. Previous war victims have found safe harbor in the US but they, like the teens cast into early emancipation who came alone across the southern border fleeing violence, will thrive where there is preparation, expectation, articulated services and appropriate assessments of need.

Westy Egmont, Director
BCSSW, Immigrant Integration Lab

Morland, L., Birman, D., Dunn, B. L., Adkins, M. A., & Gardner, L. (2013). Immigrant students. In E. Rossen & R. Hull (Eds.), Supporting and educating traumatized students: A guide for school-based professionals (pp. 51-72). New York, NY: Oxford University Press.

Sirin, S. R., & Rogers-Sirin, L. (2015). The educational and mental health needs of Syrian refugee children. Washington, DC: Migration Policy Institute.

The Child Witness to Violence Project (CWVP) at Boston Medical Center is a counseling, advocacy, and outreach program that specifically seeks to address the mental health needs of children who have experienced domestic or community violence or other traumatic events. CWVP is staffed by social workers, psychologists, early-childhood specialists, a pediatrician, and an attorney and it is run under the auspices of the Department of Developmental and Behavioral Pediatrics at Boston Medical Center.
Immigration can be a traumatic experience for many children. It is possible that children are fleeing violence in their home country and have already experienced trauma by the time they arrive in the United States. Hardships faced during the process of migration can be traumatic, as recent accounts of migrants from Syria and Central America have shown. The CWVP attempts to heal trauma by removing some of the barriers faced by immigrant children seeking treatment for mental and emotional trauma. CWVP employs clinicians of multiple languages and cultures, so that children can be treated in their native language by someone who understands their culture. CWVP's services are free of charge for those who qualify, meaning that clients do not need health insurance to receive these services. This is an advantage for many who may be undocumented or in the process of gaining documentation and are not eligible for subsidized health care or have anxiety about using public benefits. By adapting services with the needs of immigrants in mind, the CWVP provides opportunities for immigrant children to process past traumas in order to successfully integrate into their new home.


Dalgaard, N. T., Todd, B. K., Daniel, S. I. F., & Montgomery, E. (2016)
Attachment & Human Development, 18(1), pp. 69-89
Research has begun to question the mechanisms for which trauma is transmitted inter-generationally. This study looks at the transmission of trauma in 30 Middle Eastern refugee families currently living in Denmark. The families who participated in the study had children ages 4-9 who were not directly traumatized themselves, however one or both of the parents in the families were showing symptoms of PTSD after experiencing war in their countries of origin. After examining the potential risk and protective factors, specifically looking at intra-family communication style, children's psychological adjustment, and attachment style, results show that parental trauma has a negative psychological impact on children, specifically affecting a child's attachment representations. As traumatic experiences may negatively influence an adult's internal representations of attachment, causing feelings of powerlessness and helplessness, it may be that, as parents, they have difficulty seeing themselves as a source of protection for their child. Subsequently, the child has difficulty forming secure attachments as well. That being said, parental symptom level, communication style, and attachment style may also have mediating effects in the transmission of trauma with therapeutic support around modulated disclosure, suggesting that family interventions may be much more effective than individual therapy when working with traumatized refugee parents.
Dalgaard, N. T. & Montgomery, E. (2015)
Transcultural Psychiatry, 52(5), pp. 579-593
Refugee parents who have experienced trauma must decide how, when, and if to disclose their traumatic experiences to their children. Research has begun to study the effects of different degrees of parental disclosure of traumatic memory on the psychological well-being of children in refugee families. Results show that the timing of the disclosure, and how the material is disclosed, might matter more than the disclosure itself. Additionally, whether or not the child has experienced trauma him or herself also determines the best course of action for disclosing parental trauma, as well as the age of the child when the disclosure takes place. It may be that modulated disclosure, or a manner of disclosure that is sensitive to timing and approach, is the best course of action, as it takes into consideration the child's cognitive and emotional needs. Furthermore, the process of disclosing trauma is culturally embedded and this must also be considered when working with refugee families who have experienced trauma. As such, there may very well be different culturally shaped variations in modulated disclosure of trauma that can be facilitated in family therapy. 
The cycle of violence: Associations between exposure to violence, trauma-related symptoms and aggression-findings from Congolese refugees in Uganda
Hecker, T., Fetz, S., Ainamani, H., & Elbert, T. (2015)
Journal of Traumatic Stress, 28(5), pp. 448-455
According to the United Nations High Commissioner for Refugees, there has been an increase in worldwide refugees. For those facing violence and forced migration, there can be many significant consequences. The cycle of violence suggests that war-related trauma in post-war communities is linked to aggression and increased community and family violence. This study explored connections between exposure to violence, trauma-related symptoms, and aggression. Hecker et al. conducted semi-structured interviews of 290 Congolese refugees in Uganda. Two types of aggression were examined - reactive aggression and appetitive aggression. Reactive aggression is an aggressive reaction to a perceived threat, and appetitive aggression is an intrinsically motivated form of aggression. The study found that war-related trauma exposure is positively correlated with exposure to family and community violence. Additionally, Hecker et al. found that reactive aggression is positively correlated to PTSD symptoms while appetitive aggression is negatively associated with PTSD. These results are consistent with past research.                    
Isakson, B. L., Legerski, J. P., & Christopher M. Layne, C. M. (2015)
Journal of Contemporary Psychotherapy, 45, pp. 245-253
With the increase of refugees resettling in the United States, mental health providers will likely see an increase in clients who are refugee youth. Many refugee children and adolescents need support related to past trauma, loss, and resettlement stressors. However, mental health service providers working with this population often encounter a broad range of challenges when seeking to incorporate evidence-based practice (EBP) into their work. There has been insufficient research regarding the use of empirically supported treatments with refugee youth living in Western countries. Isakson et al. make recommendations about sound therapeutic practices using the research that is currently available. The researchers selected studies based on the American Psychological Association's framework for EBP, which integrates (1) the best research available; (2) client characteristics, culture, and preferences; and (3) clinical expertise.

Forgotten citizens: Deportation, children and the making of American exiles and orphans
By Zayas, L.
Oxford University Press (2015)
"The United States Constitution insures that all persons born in the US are citizens with equal protection under the law. But in today's America, the US-born children of undocumented immigrants--over four million of them--do not enjoy fully the benefits of citizenship or of feeling that they belong. Children in mixed-status families are forgotten in the loud and discordant immigration debate. They live under the constant threat that their parents will suddenly be deported. Their parents face impossible decisions: make their children exiles or make them orphans. In Forgotten citizens, Luis Zayas holds a mirror to a nation in crisis, providing invaluable perspectives for anyone brave enough to look. Zayas draws on his extensive work as a mental health clinician and researcher to present the most complete picture yet of how immigration policy subverts children's rights, harms their mental health, and leaves lasting psychological trauma. We meet Virginia, a kindergartener so terrified of revealing her family's status that she took her father's warning don't say anything so literally she hadn't spoken in school in over a year. We hear from Brandon, exiled with his family to Mexico, who worries that his father will die in the desert trying to immigrate again." - Publisher's Website
The handbook of resilience in children of war
By Fernando, C. & Ferrari, M.
Springer (2013)
"The handbook of resilience in children of war explores critical phenomena at the theoretical, research, and treatment levels, beginning with the psychosocial effects of exposure to war. Narratives of young people's lives in war zones as diverse as Afghanistan, Sri Lanka, Columbia, and Sudan reveal the complexities of their experiences and the meanings they attach to them, providing valuable keys to their rehabilitation. Other chapters identify strengths and limitations of current interventions, and of constructs of resilience as applied to youth affected by war. Throughout this cutting-edge volume, the emphasis is on improving the field through more relevant research and accurate, evidence-based interventions, in such areas as: an ecological resilience approach to promoting mental health in children of war, child soldiers and the myth of the ticking time bomb, the Child Friendly Spaces postwar intervention program, the role of education for war-zone immigrant and refugee students, and political violence, identity, and adjustment in children." - Publisher's Website

The distance between us
By Grande, R.
Atria Books (2012)
"In this poignant memoir about her childhood in Mexico, Reyna Grande skillfully depicts another side of the immigrant experience - the hardships and heartbreaks of the children who are left behind...Grande sheds light on the often overlooked consequence of immigration - the disintegration of a family." - Sonia Nazario, Pulitzer Prize winner, and author of Enrique's Journey

The new kids: Big dreams and brave journeys at a high school for immigrant teens
By Hauser, B.
Simon and Schuster (2011)
"An inspiring work of narrative journalism, The new kids chronicles a year in the lives of teenage newcomers who are at once ordinary and extraordinary in their paths to the American Dream. Hauser's unforgettable portraits include Jessica, kicked out of her father's home just days after arriving from China; Ngawang, who spent twenty-four hours folded up in a suitcase to escape Tibet; Mohamed, a diamond miner's son from Sierra Leone whose past is shrouded in mystery; and Chit Su, a Burmese refugee who is the only person to speak her language in the entire school. The students deal with enormous obstacles: traumas and wars in their native countries that haunt them, and pressures from their cultures to marry or to drop out and go to work. They aren't just jostling for their places in the high school pecking order-they are carving out new lives for themselves in America." - Publisher's Website
Follow Professor Egmont on Twitter @wegmont
EDITORS: E. Camacho, W. Egmont, K. Kalliontzi, J. Margolis, K. Medeiros, J. Ozieblowski, C. Palleschi, J. Verkamp,  & Q. Zhang-Wu