Review of refugee mental health interventions following resettlement : best practices and recommendations

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.

Negotiating family, navigating resettlement : family connectedness amongst resettled youth with refugee backgrounds living in Melbourne, Australia

Refugee adolescents resettling in a new country face many challenges, and being part of a supportive family is a critical factor in assisting them to achieve wellbeing and create positive futures. This longitudinal study documents experiences of family life in the resettlement context of 120 young people with refugee backgrounds living in Melbourne, Australia. Family instability was a core feature of the early settlement period. In this paper, we focus specifically on changing household composition, and levels of trust, attachment, discipline and conflict in family settings during young people’s first years of resettlement. Our results suggest that while families are central to the wellbeing of these young people, changing family dynamics can also pose a threat to wellbeing and successful settlement. We argue that youth focused settlement services must explicitly engage with family contexts in assisting refugee youth to achieve wellbeing and successfully resettle.

Review of refugee mental health interventions following resettlement : best practice and recommendations

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.

Migrants, refugees and mobility : how useful are information communication technologies in the first phase of resettlement?

The rate at which people move and resettle around the world is unprecedented. Mobility and resettlement is now greatly assisted by the use of inexpensive internet communication technologies (ICTs) for a wide variety of functions: to communicate locally and across territories, for localised information seeking, geo – locational mapping and for forging new social connections in host countries and cities. This article is based on a qualitative study of newly arrived migrants and mobile people from non English speaking backgrounds (NESB) to the city of Brisbane, Australia and investigates how the internet is used to assist the initial period of settling into the city. As increasing amounts of essential information is placed online, the study asks how people from NESB communities manage to negotiate the types of information they require during the early stages of resettlement, given varying levels of access to ICTs, digital and language literacy. The study finds that the internet is widely used for specific location information seeking (such as accommodation and job-seeking), but this is often supplemented with other non-mediated sources of information. The study identified implications for social policy in regard to the resourcing and access of information. While findings are specific to the study location, it is feasible that the patterns of internet use for resettlement have relevance in a broader context.

A five year longitudinal study of wellbeing in resettlement amongst humanitarian migrants from Burma

This thesis research was conducted to identify factors that impact the psychological well-being of refugees from Burma who have been resettled in Australia. Qualitative analysis of interviews conducted within the first year of resettlement, and again at four years and five years post-resettlement demonstrated that refugee well-being is influenced by the context of resettlement and the continuity of existing relationships. Results have implications for immigration policy and contribute to knowledge of understanding and assisting with the process of resettlement.

Sudanese perspectives on resettlement in Australia

Resettlement programmes for people from a refugee background must respond to a variety of concerns as people from diverse backgrounds and often long-standing periods of upheaval and hardship enter their new resettlement communities. Host countries approach the demands of resettlement through varying programmes and policies and those differences across countries can profoundly affect the newcomers’ experiences. The current study employs quantitative and qualitative methods to examine the individual and contextual factors that influence the resettlement experience for adults from Sudan being resettled in Queensland, Australia. Ninety Sudanese adults were recruited through snowball sampling techniques for the quantitative study, with 10 individuals purposefully selected to complete the semi-structured qualitative interview. In the quantitative sample, 25 to 30% of participants reported significant symptoms of psychological distress and frequent experiences of discrimination, and the majority of participants reported integration (identifying with both Australian and Sudanese cultures) as their method of acculturation. Participants reported feeling initially welcomed into Australia, with positive influences including bonding and bridging capital which helped them in their adaptation and negative influences including problems with the resettlement programmes and experiences of discrimination. The findings underscore the importance of socio-political context on refugee experiences of the resettlement process.

The persistence of predictors of wellbeing among refugee youth eight years after resettlement in Melbourne, Australia

This short report assesses the predictors of subjective health and happiness among a cohort of refugee youth over their first eight years in Australia. Five waves of data collection were conducted between 2004 (n=120) and 2012–13 (n=51) using mixed methods. Previous schooling,self-esteem, moving house in the previous year, a supportive social environment, stronger ethnic identity and perceived discrimination were significant predictors of wellbeing after adjusting for demographic and pre-migration factors. When compared with a previous analysis of this cohort over their first three years of settlement, experiences of social exclusion still have a significant impact on wellbeing eight years after arriving in Australia. This study contributes to mounting evidence in support of policies that discourage discrimination and promote social inclusion and cultural diversity and which underpin the wellbeing of resettled refugee youth.

Community-led resettlement: From a flood affected slum to a new society in Pune, India

This paper describes the resettlement process of a community devastated by annual floods, to newly constructed housing in Pune, India. The relocation from Kamgar Putala slum to a housing society at Hadapsar was organized by a community-led NGO partnership in 2004. The housing development was coordinated by the local NGO Shelter Associates with significant community participation. The housing has been revisited in 2010 to evaluate the sustainability of the resettlement project’s delivery model via stakeholder perception. The process of organizing for resettlement after natural disaster is described along with the implementation and evaluation of the new housing nearly six years after initial occupation. The strong partnership approach overcame a series of political and financial hurdles at various stages of the relocation project. The story of resettling Kamgar Putala is detailed alongside an outline of the current political climate for an alternative slum-upgrading policy in India and Pune. The advantages of an empowered community supported by an influential local NGO demonstrate a commendable team effort which has tackled the threat of floods. The paper highlights the merits of a community-led partnership approach to housing development for achieving sustainable urban development as well as the alleviation of poverty in a developing context.

Community-led resettlement: From a flood-affected slum to a new society in Pune, India

This paper describes the resettlement process of a community devastated by annual floods, to newly constructed housing in Pune, India. The relocation from Kamgar Putala slum to a housing society at Hadapsar was organized by a community-led NGO partnership in 2004. The housing development was coordinated by the local NGO Shelter Associates with significant community participation. The housing has been revisited in 2010 to evaluate the sustainability of the resettlement project's delivery model via stakeholder perception. The process of organizing for resettlement after natural disaster is described along with the implementation and evaluation of the new housing nearly six years after initial occupation. The strong partnership approach overcame a series of political and financial hurdles at various stages of the relocation project. The story of resettling Kamgar Putala is detailed alongside an outline of the current political climate for an alternative slum-upgrading policy in India and Pune. The advantages of an empowered community supported by an influential local NGO demonstrate a commendable team effort which has tackled the threat of floods. The paper highlights the merits of a community-led partnership approach to housing development for achieving sustainable urban development as well as the alleviation of poverty in a developing context. © 2011 Taylor & Francis.

No longer Sukumbasis: Challenges in grassroots-led squatter resettlement program in Kathmandu with special reference to Kirtipur Housing Project.

The paper is the outcome of a systematic effort to study and analyze the experiences of the Kirtipur Housing Project (KHP), the first ever grassroots-led squatter resettlement project in Kathmandu. It is widely hailed as a success story as it has been able to provide a legal, affordable and good quality housing solution to the Sukumbasis through grassroots mobilization. The paper analyses the dynamics of this mobilization and the roles of different actors to show how community empowerment, civil actions and local government interests have converged to create a constructive partnership in line with wider enabling principles. Apart from meeting the narrowly defined objective to rehouse 44 households, the project reflects capacity of the community, quite apart from lobbying and protest, in areas of project planning and management. While no grassroots mobilisation can be expected to replicate in a dynamic environment, the paper draws some policy insights that indicate the ability of the grassroots mobilization in Kathmandu to continue and grow. Conversely, the lessons learned from the project also point to limitations in terms lack of prerequisite critical mass or economic benefits to influence the government to prepare a policy framework under which it can foster in a more structured way.

The implications of being an international medical graduate (IMG) in Canadian society : a qualitative study of foreign-trained physicians' resettlement, sense of identity and health status

This qualitative research study used grounded theory methodology to explore the settlement experiences and changes in professional identity, self esteem and health status of foreign-trained physicians (FTPs) who resettled in Canada and were not able to practice their profession. Seventeen foreign-trained physicians completed a pre-survey and rated their health status, quality of life, self esteem and stress before and after coming to Canada. They also rated changes in their experiences of violence and trauma, inclusion and belonging, and racism and discrimination. Eight FTPs from the survey sample were interviewed in semi-structured qualitative interviews to explore their experiences with the loss of their professional medical identities and attempts to regain them during resettlement. This study found that without their medical license and identity, this group of FTPs could not fully restore their professional, social, and economic status and this affected their self esteem and health status. The core theme of the loss of professional identity and attempts to regain it while being underemployed were connected with the multifaceted challenges of resettlement which created experiences of lowered selfesteem, and increased stress, anxiety and depression. They identified the re-licensing process (cost, time, energy, few residency positions, and low success rate) as the major barrier to a full and successful settlement and re-establishment of their identities. Grounded research was used to develop General Resettlement Process Model and a Physician Re-licensing Model outlining the tasks and steps for the successfiil general resettlement of all newcomers to Canada with additional process steps to be accomplished by foreign-trained physicians. Maslow's Theory of Needs was expanded to include the re-establishment of professional identity for this group to re-establish levels of safety, security, belonging, self-esteem and self-actualization. Foreign-trained physicians had established prior professional medical identities, self-esteem, recognition, social status, purpose and meaning and bring needed human capital and skills to Canada. However, without identifying and addressing the barriers to their full inclusion in Canadian society, the health of this population may deteriorate and the health system of the host country may miss out on their needed contributions.

Le rapport Displaced Persons and Their Resettlement in the United States et le début des politiques d’accueil aux États-Unis

RÉSUMÉ : Avec le dénouement de la Deuxième Guerre mondiale, le problème des réfugiés en Europe devient un enjeu international. Plusieurs millions de personnes, que l’on nomme les Displaced Persons (DP), sont sans refuge et doivent recevoir une aide immédiate pour survivre. Même si la majorité de ces gens retourneront dans leurs pays d’origine, il reste encore des centaines de milliers de réfugiés en 1948. La seule solution concrète pour régler cette problématique est l’émigration des réfugiés dans des pays prêts à les accepter. Les Américains jouent un rôle crucial en acceptant 415 000 DP entre 1948 et 1952 grâce au Displaced Persons Act de 1948 et ses amendements en 1950 et 1951. Après d’âpres discussions entre les restrictionnistes et ceux qui défendent la libéralisation des lois d’immigration, naîtra le Displaced Persons Act (DP Act) signé avec beaucoup de réticence, le 25 juin 1948, par le président Harry S. Truman. Cette loi qui prévoit la venue de 202 000 DP en deux ans, contient des mesures jugées discriminatoires à l'endroit de certaines ethnies. Afin d'améliorer le DP Act, le Congrès effectue des recherches sur la situation des réfugiés toujours dans les camps en 1949 tout en étudiant l’impact de la venue des DP aux États-Unis entre 1948 et 1950. Cette étude est soumise sous forme de rapport, le Displaced Persons and Their Resettlement in the United States, le 20 janvier 1950. Ce mémoire propose une analyse minutieuse du rapport et de son contexte politique afin de démontrer le rôle important de cette étude dans le processus décisionnel du Congrès américain visant à accueillir un plus grand nombre de DP tout en posant les bases pour une politique d’accueil en matière de refugiés.