Resilience resilience across and within cultures Describe the - PDF document

10/12/2018 “Many children may have Promoting Resilience in Migrant experienced a disruption in what we Children with the Support of their call the “scaffolding of childhood”— the basic experiences we expect to Families and Communities be in place for children to develop and thrive, such as access to schools, health care, adequate food and water, safe neighborhoods, and intact families” Elizabeth Dawson-Hahn, MD, MPH University of Washington Seattle Children’s Research Institute -Refugee Technical Assistance Center Harborview Medical Center iStock Getty Images: FatCamera October 1, 2018 Objectives • Review the personal and environmental factors that promote Resilience resilience across and within cultures • Describe the features of successful school integration programs and the role of health care provider in promoting educational success • Outline the community resources that are needed to support children and their families through the resettlement process “Resilience…the capacity of a “Resilience is the process of dynamic system to withstand or harnessing biological, recover from significant psychosocial, structural, and challenges that threaten its cultural resources to sustain stability, viability, or wellbeing.” development.” -Panter-Brick and Leckman, 2013 -Masten & Narayan, 2012 iStock Getty Images: VSanandhakrishna iStock Getty Images: FG Trade 1

10/12/2018 Child Child Lancet, 2016 Institutional Institutional Family Community Family Community Environment Environment Child Child Institutional Institutional Family Community Family Community Environment Environment Child Child 2

10/12/2018 Institutional Institutional Family Community Family Community Environment Environment Child Child Resilience is ordinary magic . School and Health -Masten, 2009 Refugee Children Education Access University 1% “Every child in every classroom bring a history to the classroom.” Secondary School 22% -Dryden-Peterson, 2015 Primary School 50% 0% 10% 20% 30% 40% 50% 60% iStock Getty Images: FatCamera UNHCR, September 2016 3

10/12/2018 Protracted Conflict – No Access “I was always worried and thought about the future of my children because they were not going to school when the other children of their South Sudan 2.20 ages were going to school. This was my biggest challenge since I could not afford it. Even they Yemen 2.20 asked several times mother when are we going to Syria 1.75 school? And this was heartbreaking and [my] biggest problem when I lived in Kenya. ” Iraq 3.20 - Mother, Somali Refugee, Study Participant, 2018 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 Million Children ICRC, 2018 School Integration Role of Health Care Provider? • Access to school • Migration History • Celebration of language • Developmental and Behavioral Screening • Extra support vs. Tracking & Grade repetition • Mental Health Screening • Engaging parents • Care Coordination iStock Getty Images: Joel Carillet • High quality early education iStock Getty Images: FatCamera Migration History Migration History • Location of birth • Location of birth • Preferred Language • Preferred Language • Country of birth • Country of birth • Path of Migration • Path of Migration • Family members traveling • Family members traveling • Health care access • Health care access • School attendance • School attendance 4

10/12/2018 Developmental and Behavioral Screening Developmental and Behavioral Screening Who Who When EVERY Child EVERY Child Build rapport first. *Children up to 72 *Children up to 72 months months Developmental and Behavioral Screening Developmental and Behavioral Screening Who When How Who When How Where EVERY Child Build rapport first. Developmental EVERY Child Build rapport first. Developmental Clinic Screening tools Screening tools *Children up to 72 *Children up to 72 In-patient setting months Language months Language Early childhood Cultural tailoring Cultural tailoring programming Public Health outreach Mental Health Screening Care Coordination • Identifying educational rights and expectations Who When How Where • Partnering at school • School nurse EVERY Child Build rapport first. Identifying Tools Clinic • Therapists Young children Strengths and School • Teachers (Parents) Difficulties Questionnaire Early childhood • School Lunch programming • Advocacy iStock Getty Images: Wavebreakmedia Public Health outreach 5

10/12/2018 Social Determinants of Health Community Resources New Arrivals Working Group • Coordinated by Washington State Department of Health Institutional • Multi-disciplinary bi-monthly Family Community Environment meetings Child • Community developments and needs • Partner in projects Somali Health Board Refugees Northwest WA Department of Health • Ethnic Community Based Organization Refugee Health • Somali Health Professionals Promotion Project • Aim to decrease health disparities by partnering with health systems to WA Office of Refugee and influence policies and services Immigrant Assistance Harborview Medical Center Office of Refugee • 2018 Community Resilience Award Resetttlement Recipients 6

10/12/2018 Family Based Approaches With Gratitude • Wellbeing of children contingent on wellbeing of the parents • Ensuring parental access to mental Patients and Families Community Partners Public Health Partners Academic Partners health services • Somali Health Board • Seattle-King County Public • Harborview Medical Center • Access to group support and classes Health • Refugees Northwest • University of Washington • WA Department of Health • Mother Africa • Seattle Children’s Research • First Foods • Centers for Disease Control Institute • International Rescue Committee and Prevention • International Organization for • World Relief Migration • Jewish Family Service iStock Getty Images: kate_sept2004 References 1. Masten AS, Narayan AJ. Child development in the context of disaster, war, and terrorism: pathways of risk and resilience. Annu Rev Psychol. 2012;63:227- 257. 2. Dryden-Peterson S. The Educational Experiences of Children in a Country of First Asylum. Migration Policy Institute;2015. 3. McNeely CA, Morland L. The Health of the Newest Americans: How US Public Health Systems Can Support Syrian Refugees. Am J Public Health. 2016;106(1):13-15. 4. Panter-Brick C, Leckman JF. Editorial Commentary: Resilience in child development--interconnected pathways to wellbeing. J Child Psychol Psychiatry. 2013;54(4):333-336. 5. Britto PR, Lye SJ, Proulx K, et al. Nurturing care: promoting early childhood development. Lancet. 2017;389(10064):91-102. 6. International Federation for the Red Cross and Red Crescent Societies. IFRC Position Paper, Protection and Assistance for Children on the Move. Geneva, 2017. 7. UNHCR. Missing Out: Refugee Education in Crisis. September 2016. 8. OECD. Helping Immigrant Children to Succeed at School and Beyond. 2015. 9. The Integration Outcomes of US Refugees: Successes and Challenges. Capps R, Newland K, et al. Migration Policy Institute: Washington, DC. 10. Masten A. Ordinary Magic: Lessons from Research on Resilience in Human Develoment. Canadian Education Association, 2009. 11. Refugee Health Technical Assistance Center. Youth and Mental Health. RHTAC, 2011. 12. Washington Chapter of the American Academy of Pediatrics. WA Immigrant Health Toolkit. 2018. http://wcaap.org/wp-content/uploads/2018/09/WCAAP- Immigrant-Health-Toolkit-2.pdf iStock Getty Images: Nabojsa Markovic 13. NEJM Catalyst. Social Determinants of Health. New England Journal of Medicine, December 2017. https://catalyst.nejm.org/social-determinants-of- health/ Children’s Art #peacerun Colosseo September 2018 7