1. Acculturation and Adjustment of Refugees and Refugee Mental Health Services Dina Birman Associate Professor of Psychology University of Illinois at Chicago dbirman@uic.edu

3. Types of Immigrants Immigrants Refugees (Asylees) Undocumented

4. Waves of Immigration to U.S.: from Assimilation to Multiculturalism Early in U.S. history- “the English” 1840’s – 1860’s – N. Europeans Early 1900’s - S. and E. Europeans 1975 – present – Asians, Latin Americans, and Africans

5. History of immigration policies 1882 Chinese Exclusion Act 1924 Immigration and Nationalities Act 1948 Displaced Persons Act 1951 UN Convention for the Rights of Refugees 1967 UN Convention for the Rights of Refugees expanded 1965 Immigration and Naturalization Act 1980 Refugee Act 1990 Immigration Act

6. 1951 UN Convention Created UNHCR: UN High Commissioner of Refugees Defined Refugees: persons who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country

8. US Refugee Admissions Refugee Policy – Arm of US Foreign Policy Refugees flee from countries that are “enemies” of US Post WWII Fall of Saigon in 1975 – Vietnamese migration 1970’s – 90’s Jews and later Evangelical Christians from Soviet Union, Cubans mid-1990’s – Bosnians, others from former Yugoslavia 2000’s – Afghanistan, Iraq; Somalia, Burma; n “warehoused populations”

9. Bhutanese http://www.youtube.com/watch?v=k9 Mhb6DBo2c&feature=fvsr

10. Burma

14. Burundi and Somalia

19. Kakuma, Kenya

26. “Slavic” Community http://online.wsj.com/article/SB100 01424052748704739504576067550 205353230.htmlhttp://online.wsj.com/article/SB100 01424052748704739504576067550 205353230.html Soviet Jews

27. US Resettlement Program Orientation before arrival Met at airport Apartment $900 per person cash assistance Job placement services ESL for adults Registering for school Some offer afterschool, summer programs

28. REFUGEE RESOURCES: BRYCS: Bridging Refugee Youth and Children's Services http://www.brycs.org/ CAL: Center for Applied Linguistics http://www.cal.org/ Spring Institute for Intercultural Learning http://www.springinstitute.org/ ORR: Office for Refugee Resettlement: http://www.acf.hhs.gov/programs/orr/index.html

29. Stressors in Resettlement Migration Acculturation Trauma

30. What’s the best way to Acculturate?

31. Is there a best way to acculturate?

32. Acculturation

33. Assimilation Traditional Bicultural

34. Assimilation - Children with respect to Language Time in U.S. Acculturatio n

35. Language Acculturation: Russian and Vietnamese Adolescents

36. Language Acculturation: Russian and Vietnamese Parents

37. Cultural Maintenance Time in U.S. Acculturatio n

38. Acculturation Gap: Assimilation and Additive Time in U.S. Acculturatio n

39. Acculturation Gaps

40. Acculturation Gaps?

41. What are some implications of acculturation gaps?

42. Parents don’t know about their children’s lives outside the home Diminishes parents’ capacity to help their children Undermines their authority Children feel parents can’t understand or help them

43. Culture Broker Role Children helping parents with communication, phone calls, forms “Role reversal” or “parentification” between adults and children? Competence and maturity?

44. Native Language Support Difficult for children to learn literacy skills in a language they are not verbally fluent in Learning literacy in native language helps promote academic achievement in English Research also suggests that acculturation gaps in native language predict conflict

45. Ways to reduce acculturative stress Helping parents understand children’s experience Helping parents learn about the lives of their children (for e.g. at school) Helping children retain their native language Not asking children to serve as brokers in settings where not appropriate

46. Migration Stress: Moving Worse when unexpected or not by choice Loss of family and friends Loss of familiar possessions and surroundings Disruptions on family arrangements Changes in loved ones as a result of stress

47. Ways to help children cope with moving: a) re-establish routines b) anticipatory guidance c) support from peer group d) support from important adults

48. Traumatic Stress Symptoms of PTSD –Traumatic Event is re-experienced –Dissociation and numbing, avoidance of stimuli –Increased arousal, irritability, startle reflex, concentration

49. Treatment for PTSD –Cognitive-Behavioral Approaches TF-CBT (Trauma Focused Cognitive Behavior Therapy) http://tfcbt.musc.edu/http://tfcbt.musc.edu/ CBITS (Cognitive Behavioral Intervention for Trauma in Schools Support for Students Exposed to Trauma SPARCS (Structured Adolescents Exposed to Chronic Stress)

50. Treatment Components “PRACTICE” Parenting skills and Psychoeducation Relaxation skills Affective modulation skills Cognitive Processing Trauma narration In vivo desensitization Conjoint parent-child sessions Enhancing safety

51. The CBT Triangle : Feelings Thoughts Actions

52. Treatment Adaptations for Refugees Extensive outreach and engagement Provide services in the community Done with cultural sensitivity Groups for lower symptoms, individual for more symptomatic kids

53. School Transitions for Refugee Children

54. School Transitions for Immigrants and Refugees: Differences in –student – teacher relationships –roles of teachers and parent –School’s role in discipline –Expectations for discussion and analysis vs. rote learning –Peer norms

55. ESL Classroom as a Safe Place smaller classroom or small group work peers who are going through similar experiences, attentive adult

56. Understanding U.S. schools: Most of the rules and norms in U.S. schools and classrooms are implicit. Lack of strict rules and expectations for autonomy create the impression that there are no rules. For refugee children even the most simple and basic of rules may need to be made explicit

57. Children with no prior schooling: Somali Bantu, some girls from Afghanistan Need to learn about: - being in a school building - sitting at a desk - holding a pencil - reading or looking through books - playing with toys

58. Strategies for working with traumatized refugee children

59. What Can Schools Do for refugee children? Educate them about the culture, language, and academics Provide Structure Re-establish routines Provide access to caring adults Help integrate into peer group

60. Should teachers be expected to help children talk about their traumatic experiences? It is not the teachers’ job to help children tell their story of trauma. If and when it does come up, the most important part to remember is not that the story be told, but that the child experience trust and support while telling it or trying to tell it.

61. Should teachers discipline children who have been traumatized? Children who’ve never been in school need to learn about how to be in school When done in a caring way, setting limits and helping the child observe and monitor her own behavior is extremely helpful to the child, helps normalize the situation, and gives the child skills to cope with trauma as well as every day life.

62. How to structure classrooms for refugee children STRUCTURE and expectations, routines Structure in unstructured time Integrate content and English language learning Make content meaningful Warmth and Praise Personal relationships and opportunities to deepen relationships

63. Relationships Matter