I have neither given nor received unauthorized assistance with this written work.

Transcription

1 Running head: ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 1 One Strategy to Empower Adolescent Refugees to Acculturate Successfully Through the Implementation of a Bicultural Intervention Elizabeth Leon University of North Carolina at Chapel Hill I have neither given nor received unauthorized assistance with this written work.

2 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 2 Introduction Forty-two million people have been displaced because of civil or political turmoil (Baird, Boyle, 2011). The United Nations has defined 10 million of those fleeing as refugees (Hadley, Zolhates, & Sellen, 2007). Half of all refugees are minors (Ellis, Lincoln, MacDonald, & Cabral, 2008). In the United States, 70,000 refugees are resettled every year and make up 10% of yearly immigrants (Hadley, et al., 2007; Singer & Wilson, 2006). 29,000 of those refugees are from Africa (Hadley, et al., 2007). Especially in smaller communities, refugees can make a big impact on the resident population (Singer & Wilson, 2006). The Center for New North Carolinians is an agency that has been responding to that impact by creating solutions and offering support to these newcomers for over a decade. Two of the largest groups that the Center for New North Carolinians serves are people from African and South East Asian countries. The war in Sierra Leone between the years increased the number of refugees to the United Sates, many of whom were settled in New York City. Liberians began to be resettled in the US in 2000, after a seven year civil war (Hadley & Patil, 2009). In 2006, it was reported that the political unrest in Africa has caused Somali, Sudanese, Liberian, and Ethiopian refugees to comprise most of refugees admissions (Singer & Wilson, 2006). Roughly 15,000 African refugees live in Guilford County (The Center for New North Carolinians and UNC Greensboro, n.d.). In 2000, South East Asian refugees numbered 1.6 million in North Carolina, a number that had grown from 750,000 in 1980 (Walcott, 2012). The largest groups among South East Asians are Hmong, Laotians, Vietnamese, and Cambodians (Walcott, 2012). Many Cambodians came as a result of the Pol Pot regime (Walcott, 2012). Hmong refugees are from tribes in Laos (Walcott, 2012). 300,000 arrived in the US by the year 2000 (Walcott, 2012). Still suffering the consequences of the Vietnam War, another South East Asian group to arrive almost exclusively in North Carolina is the Montagnards (Walcott, 2012). Montagnards are also tribal people from the mountains of Vietnam (Walcott, 2012). However, Vietnamese is not their first language but rather they have two distinct languages and five dialects (Walcott, 2012). This seemingly minor detail about language represents the bigger challenge of over generalization of people groups and the complexity of finding solutions for the refugee population in the United States. Culture, premigration factors, post-migration factors, and culture of the host country and development of the individual must be taken into account. Professionals should strive to base their practice on evidence but the challenge is combining evidence-based interventions and services in a way that is culturally appropriate. Additionally, applying evidence-based practice to adolescents at such a critical part of their development requires another facet of expertise. There is research that has begun to fill some of these gaps by trying to understand needs associated with acculturation and adolescents in order to help them manage the thin line between vulnerability and empowerment that [they] straddle (Akbari, et al., p65, 2010). Needs According to Barber s study in 1997, there are three experiences which contribute to healthy development of adolescents: connection, regulation, and psychological autonomy. Connection to stable relationships provides a sense of security (Barber, 1997). Regulation teaches adolescents how to self-regulate and decrease impulsive behavior (Barber, 1997). Autonomy helps them to develop their sense of identity and self-worth (Barber, 1997). Not only do refugee adolescents have the natural challenge in navigating this process; they also have to undergo the process of acculturation.

3 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 3 Acculturation is the process of moving to, living in and adapting to a culture different from one s own culture of origin (Poppitt & Frey, 2007, p 160, 2007). Culture provides us a way to create meaning in our lives (Poppitt & Frey, 2007). People in different cultures acculturate differently because of different degrees of stress and risk factors and differing opinions about adopting values (Poppitt & Frey, 2007). Adaptation rate is influenced by a person s ability to engage in acculturation, status, desire to leave or remain in the host country, and personal strategies to adapt (Poppitt & Frey, 2007). There are four strategies for adaptation that have been identified: integration, assimilation, separation, and marginalization (Poppitt & Frey, 2007). Integration is identifying with both cultures (Poppitt & Frey, 2007). Assimilation is leaving behind the old culture (Poppitt & Frey, 2007). Separation is not accepting the host culture (Poppitt & Frey, 2007). Marginalization is not identifying with either culture (Poppitt & Frey, 2007). Family is the key to how well a refugee is able to acculturate and cope. A study examining the compound effect of trauma and extended separation looked at refugees migrating from two different geographical locations (South America and Africa) to the West, specifically, Canada (Rousseau, Mekki-Berrada, & Moreau, 2011). A major part of the refugee process is the separation that occurs in families (Rousseau, et al., 2011). Separation can bring feelings of worry about those left behind as well as guilt (Rouseau et al., 2011). Additional stress is caused because families are working individually rather than as a group on adaptation to the new culture which can increase feelings of isolation (Rousseau et al., 2011). The hypothesis put forth by the researchers was two-fold: refugees with traumatic experiences before migration are more negatively impacted by separation than those that did not experience trauma (Rousseau, et al., 2011). Secondly, it was proposed that culture affects the way families deal with separation (Rousseau, et al., 2011). Researchers found that separation was a huge stress on families and negatively impacted marriages (Rousseau, et al., 2011). Refugees who were separated from their family were not able to benefit from the comfort of relationships to relieve some of their distress (Rousseau, et al., 2011). Separation also influenced feelings of identity and it was found that being with family is critical to constructing cultural identity in a new place (Rousseau, et al., 2011). On the other hand, it was observed that trauma may positively impact families in strengthening them for adaptation in high stress circumstances (Rousseau, et al., 2011). The study by Berry, Phinney, Sam and Vedder (2006), looked at whether or not acculturation is experienced by adolescents the same as by adults. More specifically there were three aspects of acculturation studied: the experience of living between cultures, coping mechanisms, and the strategies adolescents use to engage both cultures (Berry, et al., 2006). Early studies assumed eventual absorption of adolescents into the host community (Berry, et al., 2006). However, Berry, Phinney, Sam and Vedder (2006) and Poppitt and Frey (2007), outline four strategies refugees and immigrants use to acculturate. They are: separation, national, integration, and inconsistent (Berry, et al., 2006). The sample population was 7,997 youth from 26 different countries, resettled in 13 countries (Berry, et al., 2006). Youth fell into one of the four categories. It was found that separation includes low assimilation and a high level of support for family values (Berry, et al., 2006). The national strategy refers to those youth with a high level of national identity, that is, identity with the host country, a high level of assimilation and a low ethnic identity (Berry, et al., 2006). Integration was characterized by high involvement with both cultures (Berry, et al., 2006). The inconsistent youth were those who had both a low ethnic identity and a low national identity (Berry, et al., 2006). Three additional findings were that

4 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 4 adaptation methods of youth were similar to adults; integration is a quicker way to adapt; and discrimination correlates with poor adaptation (Berry, et al., 2006). The strategies suggested by researchers to help adolescent refugees are nearly as varied as the needs. Authors of a study done with refugees in Toronto, Canada, describe another major part of the resettlement experience as the effect the conflicting values of the host country have on their psyche (Akbari, et al., 2010). On the one hand there is safety, security, freedom, legal rights, hope, empowerment and humanitarianism, while on the other hand there is loss, separation, tragedy, displacement and marginalization (Akbari, et al., 2010, p.73). Even in Canada, where refugee policy has taken a nondiscriminatory stance, refugees are still vulnerable due to such policies as the long application process, the lack of means to appeal if they are rejected status, lack of options present in resettlement, and repayment that is required for transportation expenses (Akbari, et al., 2010). Systemic barriers often times hinder refugee youth from achieving their goals even though they recognize the educational potential in their host country (Akbari, et al., 2010). Additionally, their family responsibilities are often weighty in light of the acquisition of the host language place. Because they can communicate easier than their parents, it places them in a position that is between vulnerability and empowerment (Akbari, et al., 2010). Akbari et al., suggest Proactive mentoring from teachers and guidance counselors is critical to enabling refugee students (Akbari, et al., 2010, p.75). Also suggested is the elimination of much of the financial burden in resettlement to allow money to be saved for education as well as the creation of targeted programs to help refugee youth access higher education (Akbari, et al., 2010). Baird and Boyle discuss another strategy to help refugees acculturate (Baird & Boyle, 2012). They state that researchers should engage in collaborative efforts between researchers and refugee communities to develop interventions that include socialization to the American way of life in their region and cultural values. It is important to note they find interventions to be more effective in a group setting as opposed to an individual setting. Interventions should also include consideration of religious practices. Acculturation needs are varied when dealing with adolescent newcomers. A third strategy is explored by Berry and Vedder. The adolescent s desire to integrate should be nurtured through cultural maintenance and inclusion in the larger community and policies affecting them should reflect these two priorities. Also crucial is the attention given to the role discrimination has on adolescents (Ellis, MacDonald, Lincoln, & Cabral, 2008). In response to what Poppitt and Frey (2007) found: unfulfilled expectations were found to fuel restlessness and violence among young Sudanese at school and at home, they suggested a few needs that afforded attention. Not only is greater language and cultural integration support needed but a better understanding of employment opportunities for youth and adults in order that they might have realistic expectations (Poppitt & Frey, 2007). Secondly, to help with acculturative stress, parents should understand more of the education process and culture (Poppitt & Frey). Third, there is a need for culturally specific counseling strategies (Poppit & Frey). Last, youth need additional coping mechanisms in dealing with their frustrations (Poppit & Frey). The following is a description of an intervention that would follow several of the suggestions laid out. Intervention In an effort to combine some of the recommendations on how to help refugee adolescents, one evidence based intervention has been chosen. Evidence Based Interventions

5 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 5 (EBI) are treatments that have been proven effective (to some degree) through outcome evaluations (University of Missouri, 2011). Because of increasing demand for EBI s as well as increasing cultural diversity in the US, there is a need for EBI to be culturally informed (Castro, Barrera, & Steiker, 2010). Due to rapid growth in diversification of the population, EBI s have not kept pace (Castro, et al., 2010). There are challenges to creating culturally appropriate EBI s (Castro, et al., 2010). Developing a cultural framework is also difficult because of the tendency to equate culture and ethnicity or ethnicity with nationality (Castro, et al., 2010). Furthermore, even within ethnic groups, there can be considerable cultural differences (Castro, et al., 2010). There is a need to recognize that culture is dynamic (Castro, et al., 2010). Nevertheless, it is necessary to develop EBI s because the degree of cultural competence will positively or negatively impact the effectiveness of the intervention (Castro, et al., 2010). The intervention chosen for the refugee youth population was developed in response to research around acculturation in Latino immigrant families. The researchers recognized that the stress was aggravated by discrimination and difficulty navigating language barriers. They also recognized that assimilation, defined as unidirectional adaptations made by minority individuals to conform to the dominant group was not a healthy strategy for Latino adolescents (Smokowski & Bacallao, 2011, p.150). It was found that assimilation resulted in increased aggressive behavior, parent-child conflict and substance abuse (Smokowski & Bacallao, 2011). Instead they highlight alternation theory and the practical outworking of alternation theory: biculturalism. Alternation theory posits that maintaining moderate to high levels of the culture of origin provides the acculturating individual with the least psychosocial problems and the best adjustment (Smokowski & Bacallao, 2011, p.152). Biculturalism, therefore, is the ability to competently navigate within and between two different cultures (Smokowski & Bacallao, 2011, p.152). Smokowski and Bacallao made biculturalism the target of their intervention program, Entre Dos Mundos/Between Two Worlds, a multifamily group intervention for Latino families just beginning their journeys in the process of acculturation (Smokowski & Bacallao, 2011). Skills training programs that focused on building bicultural skills in particular have been done before with other groups such as the Native Americans, African Americans, and Asian Americans (Smokowski & Bacallao, 2011). A program designed for Native American youth used a model for social skills training in order to address tobacco, alcohol and substance use (Smokowski & Bacallao, 2011). The goal of the researchers was to encourage communication to increase assertiveness, help adolescents resist acculturation and teach participants discretionary skills to determine the appropriateness of behavior (Smokowski & Bacallao, 2011). In comparison to the control group, the participants scored higher in measures that looked at selfcontrol, assertiveness and responding to pressure to abuse substances (Smokowski & Bacallao, 2011). A couple of programs were developed for Puerto Rican youth (Smokowski & Bacallao, 2011). These programs used models as a way to teach ethnic values (Smokowski, & Bacallao, 2011). One model used folk tales for younger children while another used biographical Puerto Rican heroes for middle school and high school aged youth (Smokowski & Bacallao, 2011). Compared to control groups that either had a different intervention, art, for example, or had no intervention, participants reported less anxiety and aggression (Smokowski &Bacallao, 2011). There have been further variations of these models and each variation brings something to add to research in bicultural training (Smokowski & Bacallao, 2011). However, most of the previous studies have not produced results that can be applied to other populations due to the small sample sizes and lack of replication (Smokowski & Bacallao, 2011). In an effort to fill this

6 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 6 gap, Smokowski and Bacallao designed and implemented their own intervention program for Latino participants called Entre Dos Mundos or Between Two Worlds. An experimental research design with a randomized selection of participants was used (Smokowski & Bacallao, 2011). Participants were Latino and each child needed to be between the ages of twelve to eighteen. The participation of at least one parent was required. Groups were closed after recruitment was finalized. A major technique used throughout the program is the use of psychodrama (Smokowski & Bacallao, 2011). When the model was tested it was important to establish the effectiveness of psychodrama as opposed to the traditional support group method (Smokowski & Baccallao, 2011). The intervention is designed for eight sessions with a different theme for each session (Smokowski & Bacallao, 2011). The theme for each session is posed as a question and includes the subjects of anxieties, parent/child conflict, school, friends, and discrimination (Smokowski & Bacallao, 2011). Each session is three hours and begins with a shared meal (Smokowski & Bacallao, 2011). A pre-test was conducted before the start of the intervention (Smokowski & Bacallao, 2011). Transportation and childcare was provided for the entirety of the intervention (Smokowski & Bacallao, 2011). The last session includes a graduation ceremony to encourage a sense of pride (Smokowski & Bacallao, 2011). An initial post-test was conducted after eight weeks and a final post-test was administered 12 months after the first post-test (Smokowski & Bacallao, 2011). The researchers found that the rate of attendance affected the outcome (Smokowski & Bacallao, 2011). Additionally, the group that engaged in the psychodrama reported even lower levels of depression, conflict and other adolescent problems in the second post-test than were reported at the initial post-test (Smokowski & Bacallao, 2011). The use of psychodrama is based on 70 years of use as an intervention tool in groups and was found to be as more effective in long term results than other techniques in large groups (Smokowski & Bacallao, 2011). The process of becoming bicultural is a sign of personal, familial, and national resourcefulness that should be nurtured and celebrated (Bacallao, 2011, p. 164). This intervention looks like it could help meet some of the needs of refugee adolescents served by an agency in Greensboro, North Carolina: the Center for New North Carolinians. Organizational Case Study The website for the Center for New North Carolinians, provided for by the University of North Carolina at Greensboro (UNCG) provides a short history of the agency: in response to an influx in refugees in the eighties and a boom in the Hispanic/Latino population in the nineties, faculty and staff from the UNCG, in addition to community members, founded the Task Force on Outreach to New North Carolinians. They unified around a passion to see education and essential services like health care and job training more accessible to the newest residents of North Carolina. The Center for New North Carolinians (CNNC) was founded in April of 2001 by the Board of Governors of the University of North Carolina to provide research, training, and evaluation for the state of North Carolina in addressing immigrant issues; collaboration with government and social organizations to enhance responsiveness to immigrant needs; and community support to provide training and workshops (The Center for New North Carolinians, n.d.). CNNC s director, Dr. Raleigh Bailey, is a Senior Research Scientist with UNCG s Department of Social Work as well as founder of the AmeriCorps ACCESS Program (Accessing Cross-Cultural Education Services Systems) which now operates under CNNC. The major programs of CNNC are as follows: the AmeriCorps ACCESS Project, the Interpreter ACCESS Project, the Immigrant Health ACCESS Project and the Community Centers Program. The AmeriCorps ACCESS Project, a domestic Peace Corps, is a federal

7 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 7 initiative to provide culturally competent services to refugees and immigrants in North Carolina. AmeriCorps Members serve one to two years and every year, roughly 60 members are trained to provide cross cultural human services. The Interpreter ACCESS Project provides interpreter training and supplies the health system in Guilford County with additional interpreting support. The Immigrant Health ACCESS Project recognizes language and cultural barriers as the principal healthcare problems for growing number of new immigrants in the Greater Guilford area. By providing culturally and linguistically appropriate services IHAP responds to the critical need to deal with disease-specific treatment and establish prevention programs to low-income immigrant and resident minority populations (The Center for New North Carolinians, n.d.). The Community Centers Program grew out of one AmeriCorps member s vision for the children of these newcomers. One day, she watched a group of children kick around a soccer ball after school and realized what they needed was an after school tutoring program. She took it upon herself to inquire about getting space with the management of the apartment complex and in the end they donated one apartment to use for programs for the community. A few years later there are not one but three Community Centers in strategic locations in Greensboro, characterized by their high concentrations of immigrants and refugees. All of the services are open to the community but specifically tailored to the needs of immigrants and refugees. Services for adults include employment readiness training, English for Speakers of Other Languages, and a handicrafts group for women. The youth program includes after school tutoring, summer school and field trip opportunities (The Center for New North Carolinians, n.d.). The youth program at the Community Centers is thriving and full of the energy of young refugees and immigrants soaking up as much of the world around them as they can. Meanwhile volunteers, mostly students from surrounding colleges and universities, eagerly bond with these kids and often give them so much more than homework help. However, there is a bleak side to growing up a refugee or the child of a refugee. Providers and parents alike are seeing the effects that acculturation stress is having on their children. Too many youths are getting involved with gangs that make their presence felt even in middle schools in Greensboro. Just this past summer, an 18 year old male shot at and fatally wounded an 18 year old refugee male. According to Dr. Busch of the Center for New North Carolinians in Greensboro, the shooting was gang related (personal communication, July 5, 2012). Another African refugee girl around the age of fifteen is pregnant and yet another teenage girl has become mixed up in a trafficking ring of some kind. These events are not isolated and the need for culturally competent solutions is pressing. The innovative climate of the youth program and the need make the Community Centers Program at the Center for New North Carolinians a prime candidate to implement the bicultural intervention program, Entre Dos Mundos/Between Two Worlds. It is noted that Entre Dos Mundos (EDM) is an intervention designed specifically for the Latino population. However, this bicultural intervention was designed from theory and frameworks that have been tested with other populations. For this reason, adaption of Entre Dos Mundos to fit either a broader refugee population or other populations that share a language (French, Vietnamese, etc.) is suggested. There are at least four stages in the development of a culturally adapted Evidenced Based Intervention: information collection, initial adaptation, pilot testing, and refinement (Castro, et al., 2010). For example, Cognitive Behavioral Treatment (CBT) is widely used to treat depression through behavior modifications, teaching social skills, and cognitive restructuring (Castro, et al., 2010). To adapt this model for a certain ethnic culture one would want to involve that ethnicity in development, explore cultural values, religion and

8 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 8 spirituality, rate of acculturation, and the level of racism and discrimination that group faces (Castro, et al., 2010). The first step to take towards implementation of this intervention would be to identify experts on biculturalism and create a relationship with them around this issue in Greensboro. Ideally, the acquaintance with the creators of EDM would be nurtured and interest would be generated for them to continue their research by using the Community Centers youth program. This relationship is necessary in strategizing about how to adapt their model to another population while keeping the fidelity of the intervention. In the adaptation design, decisions would need to be made about whether to pursue a broad refugee population or a language specific population. There are pros and cons to both approaches. Students in Guilford County schools represent 120 first languages (Guilford County Schools, 2009). While it is agreed that interventions are the most effective when done in the participant s first language, to reach a larger number of individuals it may be more attractive to practice in English and target participants whose English language skills are at a certain level (Castro, et al., 2010). However, this may not be a feasible approach and would run a number of risks. Another approach would be to target specific language groups. For example, a large number of African refugees speak French. A number of refugees from Asian countries are proficient in Vietnamese. Although the nationalities they represent are diverse, there may be enough common ground in ethnicity, language, and refugee experience to form a cohesive group. The second step for implementation would be to begin culturally adapting an evidence based intervention by performing a data collection. Program personnel would need to identify major challenges and themes in the broader population s experience as well as in their experience as immigrants and refugees. This will help to inform designers how to adapt the themes in the intervention model to their new population. Once the necessary changes have been made to the intervention, a piloting could begin. This process would need at least three years from beginning to completion. Roughly four months would be used initially to adapt the intervention. Then a series of four eight week sessions could be done with time in between for evaluation and documentation over two years. The third year would allow for final post-tests one year afterwards and a formal report to be written and submitted for peer review. In order to facilitate this intervention implementation, funding would be required for a researcher s salary and a bi-lingual or multi-lingual therapist s salary. Both the researcher and the therapist would work in tandem to collect data and facilitate the group sessions as part of the intervention. In addition, a consultant fee would be necessary for program planning, data analysis and evaluation. Ideally, the consultant would be one of the creators of EDM. The intervention would require space but this is already provided through the use of the community centers. Several tangible outcomes would be measured. Levels of aggression, depression and parent-child conflict would be decreased among the targeted refugee/immigrant population. There would be an increased level of coping through biculturalism. Gang involvement would decrease as well as other risky behaviors. Not the least important, the work done with adolescents and their parents through the use of this intervention would contribute critical information about refugees and immigrants in North Carolina. In summary, an intervention to address the struggles that adolescent refugees are facing in Greensboro is sorely needed. Researchers have suggested mentoring, policy changes, integration, goal setting, education, and developing coping mechanisms for the youth. Combining several of these strategies, the bicultural intervention Entre Dos Mundos is a means to help youth decrease aggression, depression as well as reduce parent-child conflict. This will,

9 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 9 in turn, strengthen the natural support system of the family and increase adolescents ability to be bicultural. The end goal is a group of adolescent refugees that are able to acculturate successfully and be leaders in their community.

10 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 10 References Akbari, A., Alley, S., Guruge, S., Htoo, S., Hynie, M., Khogali, A. Aspirations for higher education among newcomer refugee youth in Toronto: expectations, challenges, and strategies. Refuge, 2010, 27(2), Baird, M.B., Boyle, J.S. Well-Being in Dinka refugee women of Southern Sudan. Journal of Transcultural Nursing, 2012, 23(1), doi: / Barber, B.K. Introduction: Adolescent socialization in context-the role of connection, regulation, and autonomy in the family. Journal of Adolescent Research, 1997, 12(5), Berry, J., Phinney, J., Sam, D., Vedder, P. Immigrant youth: acculturation, identity, and adaptation. Applied Psychology: An International Review. 2006, 55(3), Castro, F.G., Barrera, M. Jr., Steiker, L.K.H., Issues and challenges in the design of culturally adapted evidenced-based interventions. Annual Review of Clinical Psychology, 2010, 6, doi: /annurev-clinpsy Center for New North Carolinians and UNC Greensboro. (n.d.) Recent North Carolina. Retrieved from Ellis, H., MacDonald, H., Lincoln, A., Cabral, H.J. Mental health of Somali adolescent refugees: The role of trauma, stress, and perceived discrimination. Journal of Consulting and Clinical Psychology, 2008, 76(2), Guilford County Schools. (2009). Welcome Students. Retrieved from Hadley, C., Patil, C. Perceived discrimination among three groups of refugees resettled in the USA: Associations with language, time in the USA, and continent of origin. J Immigration Minority Health. 2009, 11(6), doi: /s x Hadley, C., Zodhiates, A., Sellen, D.W. Acculturation, economics and food insecurity among refugees resettled in the USA: a case study of West African refugees. Public Health Nutrition, 2007, 10(4), doi: Poppitt, G., Frey, R. Sudanese adolescent refugees: acculturation and acculturative stress. Australian Journal of Guidance & Counseling, 2007, 17(2), Rousseau, C., Mekki-Berrada, A., Moreau, S. Trauma and extended separation from family among Latin American and African refugees in Montreal. Psychiatry: Interpersonal and Biological Processes, 2001, 64(1), doi: /psyc Singer, A., Wilson, J.H. From there to here : refugee resettlement in metropolitan America. Living Cities Census Series. Retrieved from / _singe Smokowski, P.R., Bacallao, M. (2011). Becoming bicultural. New York, New York: New York University Press. University of Missouri. (2011). Evidenced based intervention network. Missouri: School of Psychology. Retrieved from University of North Carolina at Greensboro, North Carolina. (n.d.). The Center for New North Carolinians. Retrieved from

11 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 11 Annotated Bibliography Davies, A.Z. (2008). Characteristics of adolescent Sierra Leoneon refugees in public schools in New York City. Education and Society. 23, doi: / The author tells about how the civil war in Sierra Leone which ended in 2002, after over 10 years of brutal fighting, began the influx of African refugees in the United States and specifically, New York City. Up until recently, immigrants in the public school system had been treated as a single group and therefore policies and practices were not culturally informed or useful in helping a large variety of immigrants adapt. At the same time, schools are seen as a major player in the process of integration and adaption making knowledge of different immigrant circumstances crucial. Davies used the case study technique in this body of research performed through interviews with five Sierra Leonean students in high school at the New Century High School in New York along with their teachers. New Century High School is a school for new immigrants. Through interviews with the students, Davies learned that all of them had witnessed the violent death of a relative. They experienced loss and depression as a result. Nevertheless, they all articulated high goals and expectations for the future. From the teachers perspective, despite the adultification of these teenagers and the difficulty they had, especially in the beginning, managing their anger, these students were highly dedicated and motivated. According to the students, the school had a great impact on their adaption. Particularly, the nurturing environment, the value placed on good grades, and the advisory group available for the kids were instrumental in their success. The teachers attributed the success of integration to a number of things including the atmosphere of trust, tolerance, and respect, the small size of the school and therefore classes (the school consisted of 150 students), and the freedom to use a variety of teaching methods, peer mentoring and counseling. The research done with these Sierra Leoneans implies some specific recommendations for school based interventions for immigrant children. Dedicated teachers are a requirement as well as material that is both content and language arts, staff that is understanding, a limited number of students, curriculum that is relevant to the different cultural backgrounds represented, a healthy environment opportunities for leadership development, counseling, and a community that cares. Additionally, parent support and engagement with what is going on at school is important. Weine, S.M. (2011). Developing preventative mental health interventions for refugee families in resettlement. Family Process, 50(3), Weine s focus was on preventative measures for mental health issues in the refugee population. According to his design, there are five steps to creating in effective intervention program. First is the collaboration of community researchers. Second is pooling expertise and research of conceptual frameworks in order to create an intervention design. Thirdly, the collaboration needs to choose a specific location and population and adapt the intervention design accordingly. Fourth is the implementation with a small sample size. Fifth follows another implementation to supplement the findings of the first implementation. Weine lists many obstacles to evidence based research regarding mental health and refugees. These include less and less funds allotted by the government for refugee families which by default means less services are available to them. Programming is mostly youth based and, although the parents appreciate the rest from the

12 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 12 children, many problems stem from improper or ineffective child discipline and domestic violence. There is a lack of trained volunteers and a lack of collaboration of agencies that are increasingly in competition for funds. Lastly, there is little emphasis on the family and community and more emphasis on the individual which can further isolate the individual especially in these populations that are natively community centered. Akamatsu, T.C., Cole, E.(2000).Meeting the psycoeducational needs of deaf immigrant and refugee children.canadian Journal of School Psychology. 15(2), This article studies the acculturation stress of refugee children who are deaf in Canada. A child without disabilities who is coming from a dangerous context has past trauma to recover from as well as the rigors of learning a new language, adapting to a new culture and establishing a stable identity. Refugee children who are deaf have these things to grapple with in addition to the challenges of not being able to hear the new language and perhaps never having had the opportunity to go to school because of cultural norms regarding individuals with disabilities. These cultural norms could include shame because of their disability and especially their lack of ability to hear seen as a lack of intelligence. Those that work with refugee children should be aware of the additional challenges those with disabilities face. Morris, M.D., Popper, S.T., Rodwell, T.C., Brodine, S.K., & Brouwer, K.C. (2009). Healthcare barriers of refugees post-resettlement. J Community Health, Although refugees are offered medical care upon arrival in the United States, after eight months, cash assistance is terminated and little is known about how refugees access healthcare in the years that follow. This article is about a study that focused on refugees in San Diego. It was qualitative by way of 40 interviews that collected viewpoint on accessing healthcare. The findings were that refugees had high expectations of healthcare but the reality that they experienced in the US was inadequate care. Again, language and miscommunication was were the largest barriers to accessing care. It was found that stress also greatly impacts the health of refugees. Renzaho, A.M.N., Vignjevic, S.The impact of a parenting intervention in Australia among migrants and refugees from Liberia, Sierra Leone, Congo, and Burundi: results from the African Migrant Parenting Program. Journal of Family Studies, 2011, 17(1), A study done in Australia recognized the supportive role families play as their children go through the process of acculturation. Renzaho and Vignjevic (2011) proposed that parenting challenges are one of the main sources of stress because of the change of values and perspectives between generations. Pre-migration, group identity and authoritarian and corporal discipline is the norm in African culture. Older children are expected to watch the younger children. Extended family is involved in child rearing and conflicts. Group harmony and loyalty are the most important as well as respect of elders. Migrations to places that have a higher level of income tend to be problematic because the new culture frowns upon many of these values. Selfidentity now is valued over the group. Children are drawn to independence and family breakdown and distance are likely to occur. In light of this, an evaluation of a parenting intervention called the African Migrant Parenting Program was conducted. There were a couple of findings. Firstly, due to the intervention, parents had more realistic expectations for their

13 ADOLESCENT REFUGEES AND BICULTURAL INTERVENTION Leon 13 children; there was increased empathy and less of an inclination for corporal punishment. However, parents did not change their perspectives about group identity and continued to discourage the independence of their children.