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Refugee children's experiences are situated in specific places where they interact with significant people. They are not usually asked about their perspectives although they are social agents with distinctive perspectives and feelings about relationships and events. We investigated the perspectives of refugee children on their experiences of places and relations as they resettled in Australia after their families fled from violence in Syria and Iraq and transitioned through Middle Eastern countries. One hundred-and-nine children chose to work with a computer program in either English or Arabic. They sorted feelings associated with home, school, and where they lived before and rated being nurtured at home. Hierarchical cluster analysis revealed five subgroups of children with distinctive patterns in their sorting of eight feelings for three places. Three subgroups had patterns of positive feelings about home and school. Two smaller subgroups had mixed, ambivalent feelings about either school or home. One subgroup was strongly positive, and two others were negative about before settlement. Subgroups identified on their sortings of feelings differed in their experiences of being nurtured, with positive feelings of places related to higher ratings of being nurtured at home. The study points to the importance of children's perspectives and feelings in how they interpret experiences with people and places and argues against assuming that refugee children are homogeneous in their experiences or perspectives.

In this paper we analyze the contemporary ambivalence to child migration identified by Jacqueline Bhabha and propose a developmental relational approach that repositions child refugees as active participants and rights-bearers in society. Ambivalence involves tensions between protection of refugee children and protection of national borders, public services and entrenched images. Unresolved ambivalence supports failures to honor the rights of refugee children according to international law and the UN Convention on the Rights of the Child. There is failure to protect and include them in national public services and in international coordination of public health and wellbeing. We identify misrepresentations of childhood and refugeeness that lie behind ambivalence and the equitable organization and delivery of public services for health and wellbeing. With illustrative studies, we propose a developmental relational framework for understanding refugee children’s contributions in the sociocultural environment. Contrary to the image of passive victims, refugee children interact with other people and institutions in the co-construction of situated encounters. A developmental relational understanding of children’s ‘co-actions’ in the social environment provides a foundation for addressing misrepresentations of childhood and refugeeness that deny refugee children protection and inclusion as rights-bearers. We point to directions in research and practice to recognize their rights to thrive and contribute to society.

Understanding the perspectives of refugee children on their lives is important for acknowledging children’s rights, competence, and contributions to practice and policy. Children’s perspectives are the views they construct for framing events, relationships and images, and the meanings they convey in relational coactions with other people and institutions. We demonstrate the usefulness of digital technology in the form of computer-assisted interviews (CAIs) for enabling refugee children to express perspectives on their lives in resettlement. We describe how CAIs constructed by adopting a child’s perspective recognize the children’s agency and enable their expressions of their perspectives. We illustrate the facilities of CAIs with analyses of children’s ratings and open-ended typed comments about their worries and who helps them to feel better. Children’s views revealed the predominance of family members as sources of worry and help. We discuss the implications of using digital technology in research to provide children with ways of contributing to knowledge construction.

Background Climate change is anticipated to have profound effects on mental health, particularly among populations that are simultaneously ecologically and economically vulnerable to its impacts. Various pathways through which climate change can impact mental health have been theorised, but the impacts themselves remain understudied. Purpose In this article we applied psychological methods to examine if climate change is affecting individuals’ mental health in the Small Island Developing State of Tuvalu, a Pacific Island nation regarded as exceptionally vulnerable to climate change. We determined the presence of psychological distress and associated impairment attributed to two categories of climate change-related stressors in particular: 1) local environmental impacts caused or exacerbated by climate change, and 2) hearing about global climate change and contemplating its future implications. Methods The findings draw on data collected in a mixed-method study involving 100 Tuvaluan participants. Data were collected via face-to-face structured interviews that lasted 45 min on average and were subjected to descriptive, correlational, and between-group analyses. Results The findings revealed participants’ experiences of distress in relation to both types of stressor, and demonstrated that a high proportion of participants are experiencing psychological distress at levels that reportedly cause them impairment in one or more areas of daily life. Conclusions The findings lend weight to the claim that climate change represents a risk to mental health and obliges decision-makers to consider these risks when conceptualizing climate-related harms or tallying the costs of inaction.

Indicators of the well-being of refugee children are under explored, especially from children’s perspectives. We used a child-friendly computer-assisted interview (CAI) to investigate patterns in refugee children’s positive and negative indicators of well-being as they resettled in Australia. Thirty-seven children aged 7 to 13 years were clients of a specialized refugee trauma service. Analyzes revealed 3 cluster subgroups with distinctive patterns of indicators of high, moderate, low levels of well-being indicators. One subgroup with a high level of well-being differed from low and moderate level subgroups in consistently expressing indicators of faring well with little worrying, and the absence of intrusive worries. A subgroup with a low level of well-being expressed indicators of not faring well, worrying about family members, and having worries that intruded in daily functions. A subgroup with a moderate level of well-being differed from the low cluster in having less severe and less intrusive worries. Subgroups expressed common positive indicators of what they needed to help them feel better, their reliance on family members for help, and the forms of close interactions and talk they received as help from family members. Implications include the value of enabling refugee children to express their perspectives, and the importance of including these perspectives as a basis for tailoring intervention strategies for children and their families and for including children’s perspectives in policy and service decisions and strategies.

PurposeThe purpose of this paper is to examine barriers to accessing mental health services, from the perspective of young people of refugee background who have been service users, and to suggest strategies to improve access to mental health services.Design/methodology/approachA qualitative study was conducted with 16 young people (aged 18-25), who had been refugees and who had attended mental health professionals in Australia. Interview transcripts were analysed thematically to examine participants’ perspectives on what hinders initial access to mental health services.FindingsStigma about mental health problems was particularly prominent. Many believed a high level of disturbance was the threshold for entering services, and for some there was no knowledge of such services’ existence. Options for assistance other than mental health services were often preferred, according to young people’s explanatory models. Apprehension was expressed that sessions would be uncomfortable, distressing or ineffective. The desire to be self-reliant functioned as a further barrier. Finally, structural obstacles and social exclusion deterred some young refugees from accessing services.Practical implicationsImplications include the need for service providers to be equipped to provide culturally sensitive, responsive services that ideally offer both practical and psychological assistance. Potential referrers, including health professionals and community leaders, could facilitate increased access if trained to recognise and address barriers. Finally, findings indicate potential content for awareness-raising initiatives for young refugees about mental health problems and services.Originality/valueThis paper is original in its sample, method, topic and findings; being drawn from the first known qualitative research exploring views of young mental health service users who have been refugees about barriers to accessing mental health services.

There has been a growing recognition of the mental health needs of refugees in countries of settlement, as many are survivors of torture and other traumatic events experienced in countries of origin, during flight, and in places of temporary refuge. The challenges in providing access to services and quality mental health care arise not only from the fact that refugees generally come from cultures very different to the societies in which they settle and are not proficient in the languages of their new homes. Other significant barriers relate to the impact of the trauma and psychosocial stressors they experience despite finding apparent security. In response to the challenges, specialist agencies have developed ways of providing services that are trauma-informed, culture-informed, and holistic. This paper describes an Australian example of a mental health clinic as part of a community-based service for refugees who are survivors of torture and other traumatic events.

Each year, approximately 60,000 children of refugee background are resettled in Western countries. This paper reviews the effects of the refugee experience on cognitive functioning. The distinctive influences for these children include exposure to traumatic events and the need to acquire a new language, factors that need to be considered to avoid overdiagnosis of learning disorders and inappropriate educational placements. Prearrival trauma, psychological sequelae of traumatic events, developmental impact of trauma, and the quality of family functioning have been found to influence cognitive functioning, learning, and academic performance. In addition, the refugee child may be semiproficient in several languages, but proficient in none, whilst also trying to learn a new language. The influence that the child’s limited English proficiency, literacy, and school experience may have on academic and test performance is demonstrated by drawing on the research on refugees’ English language acquisition, as well as the more extensive literature on bilingual English language learners. Implications for interventions are drawn at the level of government policy, schools, and the individual. The paper concludes with the observation that there is a major need for longitudinal research on refugee children’s learning and academic performance and on interventions that will close the academic gap, thereby enabling refugee children to reach their educational potential.

Children have the right to express themselves and to be involved in the construction of knowledge. In this article, we argue for the right of refugee children to express their thoughts and feelings in research, and for the obligation of researchers to enable their self-expression. We propose respect as the driving force for enabling children's rights and entitlements. As respect is translated and instantiated in the specifics of research activities, it brings those rights into practice. We describe a set of computer-assisted interviews (CAIs) developed at the Victorian Foundation for the Survivors of Torture (VFST). We show how they meet the criteria of respect and enable refugee children's contributions to knowledge. CAIs allow children to express their thoughts and feelings about their own well-being through their accessibility, in how they present children with multiple ways to contribute to knowledge, and in the usefulness of the individualized profiles of responses they provide for holistic analyses. This research using CAIs is suitable for providing an evidence base for tailoring assessment and services for refugee children and has potential for use in rights-based practice.

The Kessler 10 (K10) and embedded Kessler 6 (K6) was developed to screen for non-specific psychological distress and serious mental illness in mental health surveys of English-speaking populations, but has been adopted in Western and non-Western countries as a screening and outcome measure in primary care and mental health settings. This review examines whether the original K6/K10's validity for culturally diverse populations was established, and whether the cultural equivalence, and sensitivity to change of translated or culturally adapted K6/K10s, has been demonstrated with culturally diverse client groups. Evidence for the original K6/K10's validity for culturally diverse populations is limited. Questions about the conceptual and linguistic equivalence of translated/adapted K6/K10s arise from reports of changes in item connotation and differential item functioning. Evidence for structural equivalence is inconsistent, as is support for criterion equivalence, with the majority of studies compromising on accuracy in case prediction. Research demonstrating sensitivity to change with culturally diverse groups is lacking. Inconsistent evidence for the K6/K10's cultural appropriateness in clinical settings, and a lack of clinical norms for either majority or culturally diverse groups, indicate the importance of further research into the psychological distress construct with culturally diverse clients, and the need for caution in interpreting K6/K10 scores.

While much literature documents the mental health needs of young people from refugee backgrounds, and the barriers they face in accessing mental health services, researchers have yet to document the perspectives of service users from this population about their contacts with clinicians and services. We therefore individually interviewed 16 young people (aged 18–25 years) who were refugees about their experiences of seeing mental health professionals. Participants were born in 9 different countries and had lived in Australia for an average of 5.2 years. They placed most emphasis on in-session factors, and particularly on interpersonal considerations. Among the main themes identified via thematic analysis were the practitioner's sensitivity to the young person's cultural background and to the stressors affecting him or her, including traumatic refugee experiences, and the therapeutic relationship—especially the qualities of trust, understanding, respect, and a caring connection. The participants had diverse reactions to treatment strategies. They emphasised the role of their preconceptions around mental health services, and called for systematic mental health awareness-raising for young people from refugee backgrounds. Implications for research, policy, and practice are discussed with a focus on findings that may guide efforts to improve service acceptability, accessibility, and effectiveness. In particular, there is a need for practitioners to attend to their clients' experiences of sessions, to adopt an attuned, contextualised, systemic approach, and especially to take a nuanced approach to cultural sensitivity.

This article reports analyses of the perspectives on their wellbeing expressed by four unaccompanied minor refugees resettling in Australia. We used a computer-assisted interview (CAI) to set up a research environment to facilitate young people's expressions and to treat them and their expressed perspectives with respect and integrity. Participants' data are represented in tables as full transcripts with CAI questions and tasks, and are analyzed using exegetical textual analysis. Analyses reveal similarities and differences in young people's themes and personalized concerns in relation to their life circumstances in resettlement. All four unaccompanied minors were worried about the families from whom they were isolated. Two young women who were humanitarian refugees were preoccupied with family separation and reunion, and also with their own inner states and behavior. Two young men who had been asylum seekers were focused on family and their own educational advancement. The value of the CAI approach is discussed in relation to criticisms of reductionism in quantitative and qualitative data; its ability to support young refugees to express their views with agency and confidence; and the representation of young people's expressed perspectives as a basis for understanding and for supportive programs.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs160268, Este artículo informa los análisis de las perspectivas sobre su bienestar expresadas por cuatro menores refugiados no acompañados reasentados en Australia. Se utilizó una entrevista asistida por computadora (EAC) para establecer un entorno de investigación que facilitara las expresiones de los jóvenes, y para tratarlos a ellos y a sus puntos de vista con respeto e integridad. Los datos de los participantes están representados en tablas así como las transcripciones completas con preguntas y tareas de las entrevistas asistida por computadora (EAC), y se analizan mediante análisis textual exegético. Los análisis revelan similitudes y diferencias en las temáticas de los jóvenes, y preocupaciones personalizadas en relación con sus circunstancias de vida en el reasentamiento. Los cuatro menores no acompañados estaban preocupados por las familias de las que fueron aislados. Dos mujeres jóvenes, refugiadas humanitarias, estaban preocupadas por la separación familiar y el reencuentro, y también por sus propios estados internos y comportamiento. Dos hombres jóvenes que habían sido solicitantes de asilo se enfocaron en la familia y en su propio avance educativo. El valor del enfoque de EAC se discute en relación a las críticas sobre su reduccionismo en datos cuantitativos y cualitativos; su capacidad para apoyar a jóvenes refugiados a expresar sus puntos de vista con agencia y confianza; y la representación de las perspectivas expresadas por los jóvenes como una base para el entendimiento y para programas de apoyo.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs160268, In diesem Beitrag beschäftigten wir uns mit dem Wohlbefinden von vier nichtbegleiteten minderjährigen Flüchtlingen nach ihrer Ankunft in Australien, deren Perspektiven mittels eines Computergestützten Interviews (CI) erhoben wurden. Die entlang von CI-Fragen und -Aufgaben erhobenen Daten wurden in Tabellen als Komplett-Transkripte präsentiert und einer Textanalyse unterzogen. Ähnlichkeiten und Unterschiede zwischen den individuell relevanten Themen und Sorgen, bezogen auf die Ansiedelung in der neuen Heimat, konnten so herausgearbeitet werden. Alle Jugendlichen beklagten die Trennung von ihren Herkunftsfamilien. Dies betraf vor allem zwei weibliche Flüchtlinge und deren intensive Auseinandersetzung mit Fragen des Getrenntseins und Wiederzusammenkommens mit ihren Familien und damit einhergehenden emotionalen und Verhaltensproblemen. Die beiden jungen Männer beschäftigte neben familiären Sorgen vor allem die Möglichkeit der eigenen Aus- und Weiterbildung.Die CI-Nutzung wird vor allem diskutiert vor dem Hintergrund einer von einigen Seiten befürchteten Reduktion qualitativer und quantitativer Daten. Zusätzlich skizzieren wir Möglichkeiten der Nutzung von CI, um das Erleben der Befragten angemessen abzubilden sowie die Nutzung der so erzielten Ergebnisse u.a. für Förderprogramme.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs160268

In this article we present a framework for the development of psychosocial indicators of wellbeing for refugee children and young people which can be used to assess outcomes of interventions in the settlement context. While some experiences of refugee children and young people overlap with the general population of children and young people, many of their experiences are distinctive because of their exposure to violence prior to arrival and a range of stressors upon resettlement. Drawing on research conducted into outcome indicators at the Victorian Foundation for Survivors of Torture, several indicator domains are presented that have sensitivity and specificity for resettled refugee children and young people. The domains presented are distinctive and multifaceted. They encompass the perspectives of young people, parents, and service providers. They incorporate individual and relational aspects, subjective emotional states and observable behaviours. They include signs and symptoms of disturbances to psychological wellbeing, family wellbeing, connections to social groups and community, and positive expressions of wellbeing. They have been developed with an ecological context in mind and thus take into account a range of key contextual mediating variables.

The aim of the present research was to examine the experience of extended periods of immigration detention from the perspective of previously detained asylum seekers and to identify the consequences of these experiences for life after release. The study sample comprised seventeen adult refugees (sixteen male and one female; average age 42 years), who had been held in immigration detention funded by the Australian government for on average three years and two months. They were interviewed on average three years and eight months following their release and had been granted permanent visa status or such status was imminent. The study employed a combination of qualitative and quantitative methods to explore detention and post-detention experiences, and mental health some years after release. The qualitative component consisted of semi-structured interviews exploring psychological well-being, daily life, significant events, relationships, and ways of coping throughout these periods. This was supplemented with standardised quantitative measures of current mental health and quality of life. All participants were struggling to rebuild their lives in the years following release from immigration detention, and for the majority the difficulties experienced were pervasive. Participants suffered an ongoing sense of insecurity and injustice, difficulties with relationships, profound changes to view of self and poor mental health. Depression and demoralisation, concentration and memory disturbances, and persistent anxiety were very commonly reported. Standardised measures found high rates of depression, anxiety, PTSD and low quality of life scores. The results strongly suggest that the psychological and interpersonal difficulties participants were suffering at the time of interview were the legacy of their adverse experiences while detained. The current study assists in identifying the characteristics of prolonged immigration detention producing long-term psychological harm.

All psychological assessments occur in a cultural context, whoever the participants. When the participant being assessed is someone of refugee background, several contextual domains, both current and historical, require close attention. Those domains are the effects of torture, violence and traumatic loss; pre-arrival hardships such as poor nutrition, inadequate shelter, lack of access to health services and disruptions to schooling; settlement stresses involving unfamiliarity with Australian systems and discrimination; and family functioning and fractures to family nurturance, maintained by ongoing separation from and dangers to significant others left behind. Given that the purpose of psychological assessment is to formulate appropriate interventions for promoting mental health, learning and wellbeing for individuals presenting with special needs, professional expertise demands a comprehensive analysis of the causes of identified problems.

What are the most appropriate methodological approaches for researching the psychosocial determinants of health and wellbeing among young people from refugee backgrounds over the resettlement period? What kinds of research models can involve young people in meaningful reflections on their lives and futures while simultaneously yielding valid data to inform services and policy? This paper reports on the methods developed for a longitudinal study of health and wellbeing among young people from refugee backgrounds in Melbourne, Australia. The study involves 100 newly-arrived young people 12 to 18 years of age, and employs a combination of qualitative and quantitative methods implemented as a series of activities carried out by participants in personalized settlement journals. This paper highlights the need to think outside the box of traditional qualitative and/or quantitative approaches for social research into refugee youth health and illustrates how integrated approaches can produce information that is meaningful to policy makers, service providers and to the young people themselves.

Objectives: This qualitative study assessed how clinicians prepared and used interpreters during psychotherapeutic sessions and investigated the strategies they used to manage the dynamics of this process. Methods: Ten therapists were interviewed at the Victorian Foundation for the Survivors of Torture (VFST). A semi-structured interview format was used. Thematic analysis was conducted on transcripts of recorded interviews to identify key themes. Results: Factors affecting the provision of psychotherapy with interpreters agreed with general guidelines for working with interpreters but there were exceptions. The possible roles of the interpreter as a cultural consultant, community advocate and co-therapist were explored. Specific troubleshooting strategies were identified for improving empathy, redefining roles, and adjusting interactions with interpreters. Conclusions: Working with interpreters in psychotherapy is a complex process. These findings may benefit clinicians providing psychotherapy to patients using interpreters.

Recognition of the communal nature of the culture and traditions of many refugees who have resettled in Australia in recent years, particularly those from African countries, has urged a stronger consideration of community-based approaches to their recovery and resettlement. In 2004, a framework of recovery, developed to enhance the mental health and well-being of refugees during resettlement in Australia, was applied to a community capacity-building programme among South Sudanese refugees living in an outer western suburb of Melbourne. This paper explores the integration of recovery goals into the structures and processes initiated throughout the programme. It assesses the contribution of this model to strengthening the community's ability to adjust to resettlement and enable greater control in determining their lives in Australia.

The Kessler 10 (K10) and embedded Kessler 6 (K6) was developed to screen for non‐specific psychological distress and serious mental illness in mental health surveys of English‐speaking populations, but has been adopted in Western and non‐Western countries as a screening and outcome measure in primary care and mental health settings. This review examines whether the original K6/K10's validity for culturally diverse populations was established, and whether the cultural equivalence, and sensitivity to change of translated or culturally adapted K6/K10s, has been demonstrated with culturally diverse client groups. Evidence for the original K6/K10's validity for culturally diverse populations is limited. Questions about the conceptual and linguistic equivalence of translated/adapted K6/K10s arise from reports of changes in item connotation and differential item functioning. Evidence for structural equivalence is inconsistent, as is support for criterion equivalence, with the majority of studies compromising on accuracy in case prediction. Research demonstrating sensitivity to change with culturally diverse groups is lacking. Inconsistent evidence for the K6/K10's cultural appropriateness in clinical settings, and a lack of clinical norms for either majority or culturally diverse groups, indicate the importance of further research into the psychological distress construct with culturally diverse clients, and the need for caution in interpreting K6/K10 scores. Copyright © 2014 John Wiley & Sons, Ltd.

The Royal Park Multidiagnostic Instrument for Psychosis is a validity-oriented assessment procedure developed for the acute psychotic episode using serial interviews and multiple information sources. This article describes the development and structure of the RPMIP and reports the findings of an interrater reliability study (n = 50). In addition, results are presented from a study that examined aspects of the procedural validity of the instrument when contrasted with consensus diagnoses made by a team of clinicians applying operational criteria in a less formal way to a common sample of patients (n = 87). Finally, the role of assessment procedures of this type in research into psychiatric disorders is briefly discussed.

A systematic treatment approach for obsessional thoughts is proposed. It is based upon an analysis of the chain of convert events and incorporates the distinction between the obsessional idea or fear and the cognitive rituals which follow. Systematic Disruption of covert rituals and Cognitive Restructuring of obsessional ideas are included within the treatment programme. The application of this approach is demonstrated with three cases treated for severe obsessional thoughts and followed up after 2 years.