Child, Adolescent and Family Refugee Mental Health A

Global Perspective 1st Edition

Visit the link below to download the full version of this book:

https://medipdf.com/product/child-adolescent-and-family-refugee-mental-health-a-
global-perspective-1st-edition/

Click Download Now

Foreword

Meeting the mental health needs of child and adolescent refugees poses major prob-
lems for all communities. Most mental health workers are well trained in helping
individual families and children, but few are experienced in meeting the very com-
plex needs of refugees. For a start, the sheer numbers are currently overwhelming.
With many low- and middle-income countries having few qualified mental health
personnel, how can they be expected to meet the acute and chronic needs of forced
migrants? Faced with such challenges, people usually fall back on adapting and
applying their existing skills and knowledge which may not always be appropriate.
This welcome text in turn challenges many assumptions and points the way to
applying better understanding based on contemporary models of child and family
development.
Historically, it has to be conceded that many mental health workers responded to
the perceived needs of refugees focusing on mainly individual therapeutic interven-
tions. However, it soon became clear that these were insufficient in themselves and
may even have been harmful. Cultural differences in understanding of mental health
and widely differing contexts of family life rightly posed challenges. Focusing on
stress reactions was seen as ignoring strengths and resilience. Outsiders rushing in
to help without understanding the background of survivors and without knowing the
supports and barriers within communities were inevitably less effective than they
might have been.
This book provides helpful lessons from a wide range of academic and applied
perspectives. Considerations of culture and the need to see the child in the context
of family and community provide suggestions for improving the assessment of
needs. Good, sensitive interviewing techniques—both with parents and children—
form the basis of most assessments. Healthy skepticism is aired about question-
naires but screening remains a necessity. Similarly, while warning against an
exclusive individual therapeutic approach, the particular needs of children with
developmental disabilities, substance abuse, depression, grief and, yes, even PTSD
are discussed. Throughout there are clinical examples that bring the issues to life.
One overriding problem is the great lack of acceptable evidence for the
approaches recommended. At the wider community level, psychosocial interven-
tions that claim they are not “clinical” offer help at what seems to be an acceptable
level. But where is the evidence that safe child spaces or even psychological first aid
are really effective in helping refugee children adjust to their reactions to being

v
vi Foreword

uprooted? Difficult as it is, there is a moral as well as scientific imperative to evalu-

ate all efforts to help.
While the main approaches discussed rightly argue that children should be sup-
ported along with and within their families, a high percentage of child refugees
arrive at a hopefully safe and welcoming country but alone. The additional issues
that unaccompanied minors pose to authorities require even greater planning. This,
and evaluation, will feature in the next edition of this book, provided the mental
health community takes heed of the lessons given here.

London, United Kingdom William Yule

Contents

Part I Theoretical Approaches to Comprehensive Understanding

of Child, Adolescent, and Family Refugee Mental Health
1 Bridging the Humanitarian, Academic, and Clinical Fields
Toward the Mental Health of Child and Adolescent Refugees��������������   3
Peter Ventevogel and Suzan J. Song
2 Children and Adolescents in Conflict and Displacement ���������������������� 17
Cyril Bennouna, Lindsay Stark, and Michael G. Wessells
3 Unpacking Context and Culture in Mental Health Pathways
of Child and Adolescent Refugees������������������������������������������������������������ 37
Ria Reis, Mathilde R. Crone, and Lidewyde H. Berckmoes
4 Supporting Mental Health in Young Refugees: A Resilience
Perspective�������������������������������������������������������������������������������������������������� 53
Sophie Vindevogel and An Verelst

Part II Mental Health Assessment of Refugee Children

5 Principles of the Mental Health Assessment of Refugee
Children and Adolescents�������������������������������������������������������������������������� 69
Suzan J. Song and Peter Ventevogel
6 Conducting the Mental Health Assessment for Child
and Adolescent Refugees �������������������������������������������������������������������������� 81
Suzan J. Song and Julia Oakley
7 UNICEF Community-Based Mental Health and Psychosocial
Support (MHPSS) Operational Guidelines �������������������������������������������� 101
Leslie Snider and Zeinab Hijazi

Part III Mental Health Symptom Clusters in Refugee Children

and Adolescents
8 Grief and Loss in Displaced and Refugee Families�������������������������������� 123
Lynne Jones

vii
viii Contents

9 Intervening to Address the Impact of Stress and Trauma

on Refugee Children and Adolescents Resettled
in High-Income Countries������������������������������������������������������������������������ 151
Cécile Rousseau and Melanie M. Gagnon
10 Depression and Anxiety in Refugee Children������������������������������������������ 165
Peter Ventevogel and Joop T. V. M. de Jong
11 Substance Use Among Refugee and Conflict-Affected
Children and Adolescents�������������������������������������������������������������������������� 179
M. Claire Greene and Jeremy C. Kane
12 Children and Adolescents with Developmental Disabilities
in Humanitarian Settings�������������������������������������������������������������������������� 195
Vanessa Cavallera, Ramzi Nasir, and Kerim Munir
13 Severe Mental Disorders and Neuropsychiatric Conditions
in Refugee Children and Adolescents������������������������������������������������������ 213
Nancy H. Liu and Neerja Chowdhary

Part IV Transforming Theory into Intervention Programs

14 What My Grandmother Would Have Taught Me: Enhancing
Resilient Behavior in Unaccompanied Young Males
in Denmark – A Pilot Project�������������������������������������������������������������������� 231
Anne-Sophie Dybdal
15 A Family-Centered Approach to Working with Refugee
Children and Adolescents�������������������������������������������������������������������������� 243
Trudy Mooren, Julia Bala, and Yoke Rabaia
16 Engaging Refugee Families in a Family-­Strengthening
Intervention to Promote Child Mental Health and Family
Functioning������������������������������������������������������������������������������������������������ 257
Rochelle L. Frounfelker, Tej Mishra, Bhuwan Gautam,
Jenna M. Berent, Abdirahman Abdi, and Theresa S. Betancourt

Index�������������������������������������������������������������������������������������������������������������������� 271
Contributors

Abdirahman Abdi Shanbaro Community Association, Chelsea Collaborative,

Chelsea, MA, USA
Julia Bala, PhD ARQ National Psychotrauma Centre, Diemen, The Netherlands
Cyril Bennouna, MPH Political Science, Brown University, Providence, RI, USA
Lidewyde H. Berckmoes, PhD African Studies Centre, Leiden University, Leiden,
The Netherlands
Jenna M. Berent, MPH Research Program on Children and Adversity, Boston
College School of Social Work, Chestnut Hill, MA, USA
Theresa S. Betancourt, ScD, MA Research Program on Children and Adversity,
Boston College School of Social Work, Chestnut Hill, MA, USA
Vanessa Cavallera, MD, MPH Independent Consultant, Milan, Italy
Neerja Chowdhary, MD Department of Mental Health and Substance Abuse,
World Health Organization, Geneva, Switzerland
Matty R. Crone, PhD Department of Public Health & Primary Care, Leiden
University Medical Center (LUMC), Leiden, The Netherlands
Anne-Sophie Dybdal, MSc Save The Children Denmark, Frederiksberg, Denmark
Rochelle L. Frounfelker, ScD, MPH, MSSW Division of Social and Transcultural
Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada
Melanie M. Gagnon, PhD CIUSSS West-Central Montreal, Montreal, QC, Canada
Bhuwan Gautam, MPA Bhutanese Society of Western Massachusetts, Inc.,
Springfield, MA, USA
M. Claire Greene, PhD, MPH Department of Psychiatry, Columbia University/
New York State Psychiatric Institute, New York, NY, USA
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

ix
x Contributors

Zeinab Hijazi, MsC, PsyD Mental Health and Psychosocial Support Specialist,
Child Protection in Emergencies, Programme Division, New York, NY, USA
Lynne Jones, OBE, FRC Psych., PhD FXB Center for Health and Human Rights,
Harvard University, Cambridge, MA, USA
Joop T. V. M. de Jong, MD, PhD Cultural Psychiatry and Global Mental Health,
Amsterdam UMC, Amsterdam, The Netherlands
Boston University School of Medicine, Boston, MA, USA
Jeremy C. Kane, PhD, MPH Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
Department of Epidemiology, Columbia University, New York, NY, USA
Nancy H. Liu, PhD Department of Psychology, University of California, Berkeley,
Berkeley, CA, USA
Tej Mishra, MPH Research Program on Children and Adversity, Boston College
School of Social Work, Chestnut Hill, MA, USA
Trudy Mooren, PhD ARQ Centrum’45, Diemen, The Netherlands
Kerim Munir, MD, MPH, DSc Boston Children’s Hospital, Harvard Medical
School, Boston, MA, USA
Ramzi Nasir, MD, MPH Consultant in Developmental Behavioral Pediatrics,
London, UK
Julia Oakley, LCSW Northern Virginia Family Services, Program for Survivors
of Severe Torture and Trauma, Arlington, VA, USA
Yoke Rabaia, PhD Institute of Community and Public Health, Birzeit University,
Birzeit, Palestine
Ria Reis, PhD Department of Public Health & Primary Care, Leiden University
Medical Center (LUMC), Leiden, The Netherlands
Department of Anthropology, University of Amsterdam, Amsterdam, The
Netherlands
Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam,
The Netherlands
The Children’s Institute, School of Child and Adolescent Health, University of Cape
Town, Cape Town, South Africa
Cécile Rousseau, MD Division of Social and Cultural Psychiatry, McGill
University, Montreal, QC, Canada
Leslie Snider, MD, MPH The MHPSS Collaborative, Save the Children,
Copenhagen, Denmark
Contributors xi

Suzan J. Song, MD, MPH, PhD Department of Psychiatry, George Washington

University, Washington, DC, USA
Lindsay Stark, DrPH Brown School, Washington University in St. Louis, St.
Louis, MO, USA
Peter Ventevogel, MD, PhD Public Health Section (Division of Resilience and
Solutions), United Nations High Commissioner for Refugees, Geneva, Switzerland
An Verelst, PhD Department of Social Work and Social Pedalogy, Ghent
University, Gent, Belgium
Sophie Vindevogel, PhD Department of Social Educational Carework, University
of Applied Sciences and Arts Ghent, Gent, Belgium
Michael G. Wessells, PhD Program on Forced Migration and Health, Columbia
University, New York, NY, USA
About the Authors

Abdirahman Abdi is a Somali Bantu community leader and partner with the
“Refugee Behavioral Health Program” at the Research Program on Children and
Adversity at Boston College School of Social Work, Chestnut Hill,
Massachusetts, USA.

Julia Bala, PhD is a clinical psychologist, psychotherapist, and independent con-

sultant, a former staff member of ARQ Centrum45 in the Netherlands. Her main
fields of interest include the intergenerational consequences of trauma, preventive
multi-family interventions, and strengthening family resilience.

Cyril Bennouna, MPH is a Fellow at the Center for Human Rights and
Humanitarian Studies and a PhD student in comparative politics and international
relations at Brown University. His research focuses on the politics of forced migra-
tion and efforts to reduce violence against civilians during armed conflict.

Lidewyde H. Berckmoes, PhD is assistant professor at the African Studies Centre

at Leiden University in the Netherlands. Having a background in anthropology, her
research focus is on the long-term effects of conflict and violence on children and
youth in war-affected and refugee contexts. She has extensive research experience
in the Great Lakes region, particularly Burundi.

Jenna M. Berent, MPH is a program manager for the “Refugee Behavioral Health
Program” at the Research Program on Children and Adversity at Boston College
School of Social Work, Chestnut Hill, Massachusetts, USA.

Theresa S. Betancourt, ScD, MA is the inaugural Salem Professor in Global

Practice at the Boston College School of Social Work and Director of the Research
Program on Children and Adversity, Chestnut Hill, Massachusetts, USA.

Vanessa Cavallera, MD, MPH is child neurologist and psychiatrist with a

Master’s Degree in Public Health. She has been working for the World Health
Organization and other UN agencies and NGOs focusing on early childhood devel-
opment and child and adolescent mental health in developing and humanitarian
contexts.

xiii
xiv About the Authors

Neerja Chowdhary, MD Technical Officer in the Department of Mental Health

and Substance Use, World Health Organization, Geneva.
A psychiatrist by training, she works as part of WHO’s brain health team, sup-
porting implementation of the global action plan on the public health response to
dementia 2017–2025. Her other areas of work include provision of technical assis-
tance for WHO’s mental health Gap Action Programme (mhGAP) including devel-
opment of training and guidance documents and providing technical support to
country implementation. She is one of the co-authors of the WHO guidelines for the
management of physical health conditions in people with severe mental disorders.

Mathilde R. Crone, PhD is a health scientist and has extensive research experi-
ence in the field of public health, in particular child health. She has particular exper-
tise in exploring the determinants of (un)healthy behavior and chronic physical and
mental health conditions of children/adults, evaluation studies of (preventive) care
programs, and implementation studies. https://www.researchgate.net/profile/
Matty_Crone/publications

Anne-Sophie Dybdal, MSc is a Licensed Clinical Child Psychologist from

University of Copenhagen. She has 28 years of experience working with children
and families with a focus on child development, resilience and well-being. Anne-
Sophie Dybdal has worked in the humanitarian sector since 2000 and from 2006 as
senior child protection and MHPSS advisor for Save The Children Denmark. For
the last 5 years she has been involved in implementation of the Save The Children
Youth Resilience Programme, currently running in 10 countries globally, including
in refugee camps and extremely vulnerable communities.

Rochelle L. Frounfelker, ScD, MPH, MSSW is a social epidemiologist and post-

doctoral fellow in the Division of Social and Transcultural Psychiatry, Department
of Psychiatry, McGill University, Montreal, Canada.

Melanie M. Gagnon, PhD is a clinical psychologist. She is also responsible for

coordinating the Center of Expertise for the Wellbeing and Physical Health of
Refugees and Asylum Seekers at the Centre-Ouest-de-l’Île-de-Montréal
CIUSSS. She is involved in the field of research and is a researcher-practitioner at
the Sherpa Research Center, University Institute for Ethnocultural Communities.

Bhuwan Gautam, MPA is a Bhutanese community leader and co-investigator in the

“Refugee Behavioral Health Program” at the Research Program on Children and
Adversity at Boston College School of Social Work, Chestnut Hill, Massachusetts, USA.

M. Claire Greene, PhD, MPH is a psychiatric epidemiologist in the Department

of Psychiatry at Columbia University. Her research focuses on the implementation
and evaluation of interventions to address alcohol and other drug use, mental health,
and psychosocial problems in humanitarian settings.
About the Authors xv

Zeinab Hijazi, MsC, PsyD is a Global Mental Health and Psychosocial Support
Specialist, UNICEF, New York Headquarters.
Zeinab has 14 years of experience supporting MHPSS programs globally, and
was in an advisory role with International Medical Corps providing guidance and
oversight in the development, monitoring, evaluation, and running of culturally
appropriate MHPSS activities in Lebanon, Jordan, Syria, Turkey, Palestine, Iraq,
Tunisia, Libya, and Yemen.
At present, Zeinab is the MHPSS specialist and technical lead at UNICEF, and
provides program guidance and technical support to enhance UNICEF’s approach
to the provision of mental health and psychosocial support for children and families
in humanitarian settings. This includes supporting UNICEF country teams in
designing and implementing locally relevant, comprehensive, and sustainable
MHPSS strategies that (1) promote safe, nurturing environments for the recovery,
psychosocial well-being, and protection of children; and (2) engage children, care-
givers and families, community systems, and service providers at all levels of the
social-ecological framework.

Lynne Jones, OBE, FRC Psych., PhD is a child psychiatrist, relief worker, and
writer. She has spent much of the last 25 years establishing and running mental
health programs in areas of conflict or natural disaster including the Balkans, East
and West Africa, South East Asia, the Middle East, Haiti, and Central America.
Most recently she has worked in the migrant crisis in Europe and Central America.
She is a course director for the annual course on Mental Health in Complex
Emergencies, run by the Institute of International Humanitarian Affairs at Fordham
University, in collaboration with UNHCR. Her most recent book is Outside the
Asylum: A Memoir of War, Disaster and Humanitarian Psychiatry (Orion 2017).
Jones has an MA in human sciences from the University of Oxford. She qualified in
medicine before specializing in psychiatry and has a PhD in social psychology and
political science. In 2001, she was made an Officer of the British Empire for her
work in child psychiatry in conflict-affected areas of Central Europe. She regularly
consults for UNICEF and WHO. She is an honorary consultant at the Maudsley
Hospital, London, and with Cornwall Partnership NHS Foundation Trust. She is a
visiting scientist at the François-Xavier Bagnoud Centre for Health and Human
Rights, Harvard University.

Joop T. V. M. de Jong, MD, PhD is Emeritus Professor of Cultural Psychiatry and

Global Mental Health at UMC Amsterdam, Adjunct Professor of Psychiatry at
Boston University School of Medicine, and Emeritus Visiting Professor of
Psychology at Rhodes University, South Africa. He founded the Transcultural
Psychosocial Organization (TPO), a relief organization in mental health and psy-
chosocial care of (post)conflict and post-disaster populations in over 20 countries in
Africa, Asia, and Europe. He worked part time as a psychotherapist and psychiatrist
with immigrants and refugees in the Netherlands. His research interests focus on
cultural psychiatry, public and global mental health, epidemiology, psychotrauma-
tology, and medical anthropology.
xvi About the Authors

Jeremy C. Kane, PhD, MPH is a psychiatric epidemiologist whose research is

focused on measuring patterns of alcohol use, substance use, and related mental
health problems among populations affected by HIV and violence in low- and
middle-­income countries and adapting, testing, and implementing evidence-based
interventions for these problems.

Nancy H. Liu, PhD Assistant Clinical Professor, Department of Psychology,

University of California, Berkeley.
Nancy is a clinical psychologist. Her expertise is in the clinical training and
implementation of evidence-based psychological interventions for trauma, depres-
sion, and severe mental disorders. She teaches coursework in global mental health
and clinical diagnosis, assessment, and interventions. She was a former Consultant
with the WHO focusing on guidelines for reducing excess mortality in individuals
with severe mental disorders.

Tej Mishra, MPH is an epidemiologist and researcher with the “Refugee

Behavioral Health Program” at the Research Program on Children and Adversity at
Boston College School of Social Work, Chestnut Hill, Massachusetts, USA.

Trudy Mooren, PhD is a clinical psychologist and senior researcher at ARQ

Centrum’45 and Endowed Professor ‘Family Functioning after Psychotrauma’ at
the Department of Clinical Psychology, Faculty of Social Sciences, Utrecht
University. She studies the consequences of psychotrauma and forced migration for
family functioning and is interested in assessment and interventions to support fam-
ily resilience.

Kerim Munir, MD, MPH, DSc is Director of Psychiatry, University Center in

Developmental Disabilities, Division of Developmental Medicine, Boston
Children’s Hospital, and Holmes Society Fellow in Global Health and Associate
Professor of Psychiatry and Pediatrics, Harvard Medical School, Boston, USA.

Ramzi Nasir, MD, MPH is a Consultant Paediatrician in Developmental-Behavioral

Paediatrics at the Royal Free London NHS Foundation Trust and the Portland
Hospital, London, UK. He is involved in a variety of initiatives to promote the well-
being of children with developmental disabilities in the humanitarian context.

Julia Oakley, LCSW is a mental health therapist and coordinator of the Program
for Survivors of Torture and Severe Trauma at Northern Virginia Family Service's
Multicultural Center in Falls Church, Virginia, USA. As part of a multilingual team
offering mental health and immigration legal services, she works predominantly
with asylum seekers, asylees, and refugees who are survivors of trauma. She earned
a Master of Science in Social Work and a Master of International Affairs from
Columbia University.

Yoke Rabaia, PhD conducts research related to mental and psychosocial health at
the Community and Public Health Institute at Birzeit University, Palestine.
About the Authors xvii

Ria Reis, PhD is a cultural anthropologist, specialized in religious and medical

anthropology. Her research focus is on young people’s health perceptions and strat-
egies, the intergenerational transmission of vulnerabilities in contexts of inequality,
and children’s cultural idioms of distress. She is an expert in, and passionate about,
the articulation of anthropological research within multidisciplinary (mental) health
research and interventions.

Cécile Rousseau, MD is professor of the Division of Social and Cultural Psychiatry

at McGill University. She has worked extensively with immigrant and refugee com-
munities, developing specific school-based interventions and leading policy-­
oriented research. Presently her research focuses on intervention and prevention
programs to address violent radicalization.

Leslie Snider, MD, MPH is a psychiatrist with over 20 years’ experience in men-
tal health and psychosocial support programs and research in diverse global set-
tings. She serves as Director of the Global MHPSS Collaborative for Children and
Families in Adversity, hosted by Save the Children Denmark. She began as a public
mental health clinician while directing International Mental Health Studies for 10
years at Tulane Public Health School. Internationally, she collaborates with various
UN agencies, governments, and NGOs in developing programs and quality care
standards for children and families affected by disasters, conflict, HIV/AIDS, pov-
erty and exploitation, and served as technical advisor to the US government,
UNICEF, and others. She has over 40 publications, developed several widely used
international resources for MHPSS in emergencies, and authored a children’s book
for children and caregivers affected by the Ebola crisis.

Suzan J. Song, MD, MPH, PhD is a double-board certified child/adolescent and

adult psychiatrist and humanitarian mental health and psychosocial (MHPSS) con-
sultant. Currently, she is Director of the Division of Child/Adolescent & Family
Psychiatry and Associate Professor at George Washington University, spokesperson
on Refugee Mental Health for the American Psychiatric Association, and subject
matter expert to the US Department of Health and Human Services on refugee men-
tal health and to the US State Department's Office to Monitor and Combat Trafficking
in Persons. She has provided multiple testimonies to Congress on the mental health
of unaccompanied minors and child trafficking. Her work as a humanitarian MHPSS
consultant with UNHCR, UNICEF, the International Medical Corps, and the
International Rescue Committee is informed by her clinical care of forcibly dis-
placed children, adults, and families (survivors of torture, refugees, asylum seekers,
unaccompanied minors, survivors of trafficking, and returned hostages) for over 10
years as medical director of two community clinics and in her current clinic. Dr.
Song completed training from the University of Chicago, Harvard, Stanford, and the
University of Amsterdam. Her two decades of global mental work span Sierra
Leone, Liberia, Ethiopia, KwaZulu/Natal, Haiti, Burundi, Syria/Jordan, the
D.R. Congo, and the USA as technical adviser to multiple refugee and survivor of
torture programs.
xviii About the Authors

Lindsay Stark, DrPH is an Associate Professor at Washington University in St.

Louis’ Brown School and an internationally recognized expert on the protection and
well-being of women and children in situations of extreme adversity. Dr. Stark’s
particular area of expertise is measuring sensitive social phenomenon and evaluat-
ing related interventions that seek to reduce violence, abuse, and exploitation of
women and children.

Peter Ventevogel, MD, PhD is a psychiatrist and a medical anthropologist. Since

2013, he has worked with UNHCR, the refugee agency of the United Nations, as
their Senior Mental Health Officer based in Geneva. In this role he is responsible for
providing guidance and technical support to the country operations of UNHCR
worldwide. From 2008 to 2013 he was editor-in-chief of Intervention, Journal for
Mental Health and Psychosocial Support in Conflict Affected Areas. He worked
with the NGO HealthNet TPO in mental health projects in Afghanistan (2002–2005)
and Burundi (2005–2008) and as their Technical Advisor Mental Health in the head
office in Amsterdam (2008–2011). In 2011 and 2012 he also worked as psychiatrist
with Arq Foundation, the national trauma expert center in the Netherlands. Peter
regularly did consultancies for the World Health Organization and the UNHCR in
Egypt, Jordan, Libya, Pakistan, Sudan, and Syria. He is involved in several aca-
demic short courses such the annual course Mental Health in Complex Emergencies
(Fordham University, New York) and the Summer Institute Global Mental Health
(Teachers College, Columbia University).

An Verelst, PhD is a clinical psychologist with a doctoral degree in Educational

Sciences. Currently, An is project coordinator for Ghent University on a Horizon
2020 project called RefgueesWellSchool that evaluates the impact of six psychoso-
cial interventions for young refugees and migrants in schools. Previously, she man-
aged a psychosocial support center for children and communities affected by war in
Eastern Congo where she also carried out her doctoral research on the psychosocial
consequences of sexual violence during and after the armed conflict.

Sophie Vindevogel, PhD in educational sciences, has been working with popula-
tions affected by war and political violence for over ten years. Her research is situ-
ated at the intersection of strength-oriented, community-based, and transcultural
approaches. It addresses stressors and resources in the context of stressful events
and focuses primarily on how children, adolescents, families, and communities deal
individually and collectively with various forms of adversity and what contributes
to resilience and quality of life.

Michael Wessells, PhD is Professor at Columbia University in the Program on

Forced Migration and Health. A long time psychosocial and child protection practi-
tioner and researcher on the holistic impacts of war and political violence on chil-
dren, he currently leads inter-agency, multi-country research on community-led
child protection.
 Part I
Theoretical Approaches to Comprehensive
Understanding of Child, Adolescent, and
Family Refugee Mental Health
Bridging the Humanitarian, Academic,
and Clinical Fields Toward the Mental 1
Health of Child and Adolescent Refugees

Peter Ventevogel and Suzan J. Song

 onceptual Debates in the Field of Child Refugee

C
Mental Health

Many early publications on the effects of collective violence focused on posttrau-

matic stress disorder (PTSD), a diagnostic category that was only in 1980 enshrined
in the third edition of the Diagnostic and Statistical Manual (DSM-III), the formal
psychiatric classification system (DSM-III). While the concept was not completely
new [26], the adoption by the DSM prompted major research efforts around
PTSD. Increasingly, symptoms of PTSD were identified among children [90]
including among resettled refugee children [3, 5, 36, 86]. However, from the begin-
ning, there was a vocal group of critics who questioned the applicability of the
concept among refugees. They argued that framing phenomena like recurrent mem-
ories, high vigilance, and loss of hope in refugees as symptoms of PTSD requiring
medical treatment were an imposition of Western diagnostic categories. Doing so
would ignore the social context that produces “symptoms” and as such only makes
things worse by “pathologizing” reactions that could be better perceived as socially
and culturally patterned adaptive reactions to adversity and loss [10, 21, 61].
Overall, the debate among mental health professionals around the presence of
PTSD among refugees seems to have withered down over time, at least among men-
tal health professionals working with refugees in high-income countries. In recent
major publications around mental health of refugees and disaster-affected popula-
tions, the PSTD concept is not contested or seen as controversial anymore [28, 46,
82, 92].

P. Ventevogel
Public Health Section (Division of Resilience and Solutions), United Nations High
Commissioner for Refugees, Geneva, Switzerland
S. J. Song (*)
Department of Psychiatry, George Washington University, Washington, DC, USA
e-mail: [email protected]

© Springer Nature Switzerland AG 2020 3

S. J. Song, P. Ventevogel (eds.), Child, Adolescent and Family Refugee Mental
Health, https://doi.org/10.1007/978-3-030-45278-0_1