May 8, 2017
Child Refugees and Trauma
Trauma is a complex word that can be given countless definitions. I define trauma as a stressful or disturbing event that happens to someone that causes the person to experience psychological changes and exhibits different behaviors such as withdrawal and anger. The American Psychological Association (APA) defines trauma as an “emotional response to a terrible event like an accident, rape, or natural disaster” (“Trauma”). Trauma is objective and subjective, allowing each person to respond and interpret it differently, including children, adolescents, and adults. When someone lives through a traumatic event, they can be left unable to endure and respond to the threat (Yoder, 15). Events such as violence, abuse, natural disasters, sudden loss of someone, illness, poverty, homelessness, and even being a refugee can cause trauma. Unfortunately, “violence often leads to trauma, and unhealed trauma, in turn, can lead to violence and further loss of security” (Yoder, 5). However, if trauma is treated, a person can find himself or herself on the path to transformation referred to as posttraumatic growth. This paper will focus on four parts, first, the foundational concerns of child refugees suffering from trauma. Followed by how humanitarian organizations can address trauma. Third, resources organizations can practice to provide child refugees the opportunity to heal from their trauma, and finally my personal response and engagement with this topic.
A refugee is someone who is living outside of his or her country of origin. They have usually been forced to leave their country to escape war or persecution steaming form different reasons. Refugees may leave due to a natural disaster leaving them unable or unwilling to return to their home. They experience a loss of control (Fancher). A child refugee can be with their family or unaccompanied and potentially become an orphan leading to risks related to displacement. According to UNHCR, “Every minute 24 people were displaced in 2015…children made up an astonishing 51 per cent of the world’s refugees in 2015…many were separated from their parents or travelling alone” (Edwards, 2016).
Children left unprotected can end up easy prey to forced labor, abuse, recruited to armed forces, or forced into sexual exploitation. They may face discrimination, loss of identity, and thus resulting in an inability to have access to education and even healthcare. Effects of trauma can be expressed differently depending on age and stages of development (“Refugee Services”). Some children experience the effect of trauma that leaves them battling daily just to try and function. Some effects may be crying, stomachaches, headaches, anxiety, depression; nightmares, hard time paying attention, withdrawal, and trouble sleeping (“Refugee Services”). Trauma left unhealed can perpetuate these effects and even lead to posttraumatic stress disorder (PTSD). If a child develops symptoms such as increased arousal, re-experiencing the event, numbing resulting from trauma lasting longer than a month, a doctor may diagnose PTSD (Yoder, 31).
Boris Drožđek, et al concluded that refugees who attended group treatment in a 1-year phase-based trauma-focused, multimodal, and multicomponent therapy day program approach appeared to have improved mental health both in the short and long term (385). Though this research focused on adult refugees, the authors noted that this conclusion is valuable since there are such limited studies of psychosocial treatment for PTSD. Similarly, there is not extensive research literature on the psychological or educational impact of trauma on children and young people who are refugees (qtd in Hart, 352). Robert Hart et al did address the fact that children and adults experience trauma differently. Adults may protect their children from different stressors, however children may develop trauma vicariously, leaving the parent’s intention to protect children possibly counter-productive (Hart, 355). Children that are unable to talk about what they are experiencing may struggle to understand. Changing schools and housing can lead to further complications where children may suffer from the inability to cope. Children may realize that there is no one similar to them and they may be exposed to bullying (Hart, 356). Child refugees may have had access to services and moving has the potential to disrupt that. Hart refers to using Urie Bronfenbrenner’s ecological approach and how it can be used to understand refugee children and trauma.
It is necessary to consider the child’s microsystem (school, home/family, support services, peer groups), mesosystem (interactions between, say, home and school), exosystem (government agencies and religious community) and macrosystem (the society’s ideology, laws and customs). Construe the experience and development of refugee children in terms of three phases of changing ecologies; pre-migration, trans-migration and post-migration. From this perspective the challenge for children who are refugees and their families is to manage these transitions and establish adaptive ecosystems. (qtd in Hart, 360)
Child refugees’ trauma experiences can be wide in scope and difficult to address, however interventions can happen at different levels of systems to allow the children a place to cope and heal. Schools can be encouraged to be a safe place for children, to tell their stories, mourn, and receive counseling.
Another concern is for refugee children who experienced traumas and become resettled in English speaking countries. They often have to learn a new language and adjust to a new culture causing them to be over diagnosed with learning disorders and given inappropriate educational placements. Schools, medical professionals, and refugee resettlement agencies have to look at the effects of these experiences on the cognitive functioning and performance of refugee children. These professionals should consider that PTSD, depression, and anxiety might indirectly affect cognitive achievement (Kaplan et al 85). Impact of trauma, family functioning, school experiences, health problems, and developmental history all need to be considered when developing interventions to help improve cognitive functioning of refugee children. If these considerations are taken seriously, children may be able to reach their full potential academically (Kaplan et al).
Strategies for Humanitarian Organizations
Strategies that humanitarian organizations can utilize to help child refugees experiencing trauma and break the cycle include creating safety, acknowledgment, and reconnecting (Yoder, 79). Organizations can create a sense of safety. Yoder explains that if physical safety is not an option, people can create environments where refugees feel supported with reflective leaders, spiritual, and psychological grounding. This environment should create space for people to tell their story, mourn, name fears and strengths, and express feelings such as shame and honor (79). Allowing refugees to reconnect includes steps for them to possibly forgive, become open to the ideas of reconciliation, risk contact with others, and sense interconnectedness (Yoder, 80).
The National Child Traumatic Stress Network (NCTSN) provides the core stressor assessment as a tool that looks at four stressors of refugees: resettlement, trauma, acculturation, and isolation. The tool provides questions and an assessment of each category along with a list of prevention and intervention tasks (“Refugee Services”). This assessment could become a tool used by schools, organizations, and medical professionals to assess how to best walk alongside a child refugee that is dealing with any of the four stressors.
NCTSN notes that protective factors can increase a child’s resilience to trauma and reduce suicide by having strong cultural identity, religious beliefs, and peer relationships along with positive relationships with a caring adult. Children in school should feel connectedness, and have access to medical or mental health care. “In order to provide the best possible care, providers should make efforts to understand and respect refugee families’ culturally informed interpretations of behavior” (“Refugee Services”). Understanding cultural behavior is essential if outsiders are assisting refugees heal from trauma. They should be trained to acknowledge cultural differences especially for children who are unaccompanied. Children may have been taught to not talk about their feelings to adults.
Organizations can partner together to assist refugee children in their rehabilitation. If the humanitarian organization is Christian, they have the knowledge to holistically care for refugees by also focusing on spiritual needs. Humanitarian workers have the ability to teach children forgiveness and reconciliation as they heal from their pain and trauma. Phyllis Kilbourn has four criteria to forgiveness. First, name the wrong and acknowledge the pain. Second, refuse to seek a penalty from the wrongdoer. Third, begin to have some empathy for the humanity of the wrongdoer. Fourth, work to restore community relationships (276). Kilbourn also notes that teaching repentance and forgiveness, works to break the cycle of violence and hatred, inspire others, and allows people to have hope for the future (278). Through story telling, children can “release internal feelings and conflicts” (Kilbourn, 253). As organizations work, serve, learn, and pray together, children have the opportunity to forgive, become peacemakers, and move towards posttraumatic growth (PTG).
PTG is evaluated using five different areas to identify if people have a positive outlook within appreciation of life, relationships with others, new possibilities in life, personal strength, and spiritual change. This system was developed by psychologists Richard Tedeschi, PhD, and Lawrence Calhoun, PhD, in the mid-1990s. PTG allows people to make sense of the trauma, understand themselves, relate to others, and realize they can live a different future (Collier).
Resources for Support
There are many resources people, organizations, and medical professionals can utilize to allow children to process and heal from their trauma. The resources of art, play therapy, and theater are among resources that can be applied in any location and culture. Bethany Williams, who has a PhD in counseling and psychology and a master’s in clinical social work, has specialized in the rehabilitation of children who have experienced war. She also leads a nonprofit called Exile International. In her book, The Color of Grace, she states that it can be hard for children to talk about their feelings. It’s easier for them to draw how they feel. “If they can express their feelings through their drawings, it will help them” (73). She puts on a workshop that allows children to use art therapy to draw both the darkness and the light of their lives (103). She wants children to feel the pain but not live in it. She tells the children to dream and to know that there is life beyond the pain and suffering they experienced, which permits the children to transform their grief. She lets them know that God can use their pain for good. She has the children draw two pictures, one of a sad time in their past and one of a dream for their future. She then has them draw Jesus in the middle of each picture signifying that Jesus is with them no matter what. Children are able to share their stories if they would like. After, they enter into small groups to pray. She has all the children throw their sad time pictures into a pile saying they are not defined by their past. While holding their dream pictures, they take a stone that represents their burdens and lays it at a cross. This signifies they are no longer defined by their past. Jesus has made them new. Williams ends the session with song and dance.
Through Exile International, children of war are able to receive material, social, psychological, and spiritual needs. They receive ongoing counseling and art therapy to allow for posttraumatic growth, effective reconciliation within their communities, and develop peace- building skills.
Rowe et al, says that art therapy uses the creative process to encourage personal growth and alleviate symptoms of mental illness (26). The effects of trauma and the benefits of art therapy in young refugees could be better assessed by adding tools that avoid language barriers and focus on growth. Accurate evaluation could be accomplished by incorporating results of an art-based assessment tool, including a tool that measures posttraumatic growth and adding a qualitative interview that allows participants to express themselves in their own words (Rowe et al, 32).
A second set of resources is called grounding techniques. When a person is reliving the trauma they experienced, these techniques allow the person to stay in the present moment. Techniques include; action, objects, breathing, and statement. Action involves some type of action like dancing, drawing, or eye contact. Breathing is inhaling and exhaling slowing. As the person breaths in and out they can relax and say a prayer or a statement that is calming to them. Objects refer to something a person can hold, look at, listen to, that may be distinguished by smell, shape, and weight. Grounding statements are something that has meaning to the person that enables them to return to the present (Fancher).
Mindfulness is another resource. The U.S Department of Veterans Affairs states, “mindfulness is a way of thinking and focusing that can help you become more aware of your present experiences…mindfulness practices may be of benefit to trauma survivors.” Research findings show that mindfulness can help with problems and symptoms often experienced by survivors (“Mindfulness Practice”). One type of mindfulness practice is taking a raisin or similar object and focusing on every detail about it to achieve two things: “paying attention to and being aware of the present moment and accepting or being willing to experience your thoughts and feelings without judging them” (“Mindfulness Practice”).
A couple volunteered after they were asked to participate in a psychosocial support project called Refugee Trauma Initiative where they used mindfulness practices to help refugee families cope with the stress and trauma of fleeing their country and living in a camp on the northern border of Greece. Finding food, water, and other resources were a daily struggle. Children were often bored and violence was a common occurrence. The mindfulness activity started by handing the refugees a raisin and allowing them to focus on their present moment while listening to their breathing rather than focusing on the noise of the chaos around them. The participants stated how they felt peace and calmness. The volunteers noted how it restored dignity and allowed the adults to cry and process their pain, which is usually held back to protect their children (“Just Do It!”).
Other resources include family therapy, group therapy, eye-movement desensitization, and reprocessing (EMDR), and “play” therapy (Hart, 361). There is evidence that Cognitive Behavioral Therapy (CBT) can reduce post-traumatic problems in children and adults (Hart, 362). School-based interventions can be used effectively to address posttraumatic stress symptoms in children. One intervention is the Teaching Survival Techniques programme (sic) produced by the Children and War Foundation (qtd in Hart). It is designed for people who do not have significant experience of working within mental health, or working with children who have experienced trauma (Hart, 363). A manual now called Teaching Recovery Techniques was produced in ten different languages after years of direct experience of nine colleagues working with child survivors of war and disasters in diverse cultures. It teaches children “skills, which help them cope with difficulties and prepare for possible future difficulties. The techniques have been effective” (“Teaching Recovery”).
Child refugees are in need of long-term holistic approaches to help them overcome the effects of trauma. Children need economic, educational, and socio-cultural rebuilding (Fancher). Children should know they are loved and feel that they belong. They can have hope for their future as they process their pain and find purpose and acceptance. Children participating in repentance, forgiveness, and peace building have the ability to experience post traumatic growth and possess the willingness to live a life without violence and hate.
Personal Engagement & Response
I noticed the media’s rhetoric that Americans should fear refugees and make it harder for them to seek safety in America. Hearing about refugees in the media, I realized I had never met a refugee. How could I judge a group of people without even really knowing the whole story? I was given an ethnography assignment and encouraged to step outside of my comfort zone. I decided I would step into the world of Muslim refugees. I volunteered with a local nonprofit that provides English-speaking language (ESL) classes to refugees. As relationships formed, I met with three refugee families in Beaverton and was given the opportunity to hear their stories and ask questions. Many speculations I possessed were inaccurate. I learned that there was not only ISIS, but also Al-Qaeda and AL Mahdi militia that were not only targeting Christians, but Muslims as well. I discovered that Muslims that had been working with U.S based nonprofits or other American based organizations, even if they stood for peace, became targets of these groups. The families I listened too had lost family members that stood up for peace. My theory that Muslims may not be welcoming was totally incorrect. I had never encountered such hospitality and kindness. I was experiencing that we cannot allow the media to determine how we feel about people. We have to build relationships and understand people’s culture and stories. The stories that were shared with me were eye opening. I wondered how people could leave everything they knew behind. They wanted their families safe, they wanted peace, and they yearned to return home, however they were so thankful for America allowing them to seek safety, yet they wondered if they would be hated in their new homeland. Despite the challenges of moving to a different country, the three families I met were resilient and found hope in knowing that many in their local community cared about refugees and were committed to walking alongside them. During my time with Alaa Alabassi, a prior Muslim, he told me, “Only America and Jesus’ teachings make me feel like a human that I should live on this Earth. I love the people here especially the Christian community. They changed my life… Jesus is changing the black things to be white and hatred to love. I am so thankful for America.” His statement is such a wonderful reminder that as followers of Jesus, we have a special opportunity to build relationships and watch to see how God uses His bride to sow seeds and how He will change hearts.
During my time with one family, the mother talked about how her son had only known refugees camps and because of the country they fled too, he had little contact with other children. When he started school in Beaverton, it was hard for him to adjust, often bullied, and the school offered little support. She fought for her son and would not allow the school to label her son with a learning disability. She explained what he had been through. After her son started receiving counseling at school, he learned to behave in class and how to interact with his peers.
Although I am moving to Florida, I hope to be involved in the refugee community there. I am gaining a better understanding of trauma and what life as a refugee entails. Learning what is involved in addressing and healing from trauma allows me to humbly listen to others and accept that I will not have all the answers.
As I continue to partner with my friend, Lufafa, who resides in Uganda, I hope to be able to hear from him how trauma has affected the children he cares for. Since I am not familiar with all the children’s stories, I would love to buy art supplies during my trip this summer to visit Lufafa for the children to express themselves, explore feelings, and learn about how Jesus is with them no matter what. As Lufafa continues to holistically care for children and feels led to partake in community development, trauma healing may be an area we will consider to develop and reach out to partner with advocacy and support services. Reading The Color of Grace was such a beautiful story of how one person made a difference in the lives of child soldiers by using art, prayer, counseling, and dance to help them process their pain. I now understand the importance of trauma healing and have a holistic concept of how to provide caring support.
Collier, Lorna. “Growth After Trauma.” American Psychological Association. Nov. 2016, 47, No 10. http://www.apa.org/monitor/2016/11/growth-trauma.aspx. Accessed 26 March 2017.
Drožđek, Boris, et al. “Seven-Year Follow-Up Study Of Symptoms In Asylum Seekers And Refugees With PTSD Treated With Trauma-Focused Groups.” Journal Of Clinical Psychology 70.4 (2014): 376-387. Psychology and Behavioral Sciences Collection. Web. 3 Feb. 2017.
Edwards, Adrian. “Global Forced Displacement Hits Record High.” UNHCR. 20 June 2016. http://www.unhcr.org/afr/news/latest/2016/6/5763b65a4/global-forced-displacement-hits-record-high.html. Accessed 21 March 2017.
Fancher, Karen. “Trauma and Peace Building in the Humanitarian Context.” 18 Jan. 2017- 31 March 2017. Multnomah University, Portland, OR. Class Lectures.
Hart, Robert. “Child Refugees, Trauma And Education: Interactionist Considerations On Social And Emotional Needs And Development.” Educational Psychology In Practice 25.4 (2009): 351-368. Psychology and Behavioral Sciences Collection. Web. 3 Feb. 2017.
“Just Do It!” Refugee Trauma Initiative. http://www.refugeetrauma.org/new-page-1-1-1. Accessed 20 March 2017.
Kaplan, Ida, et al. “Cognitive Assessment Of Refugee Children: Effects Of Trauma And New Language Acquisition.” Transcultural Psychiatry 53.1 (2016): 81-109. Academic Search Premier. Web. 3 Feb. 2017.
Kilbourn, Phyllis. Healing the Children of War. MARC publications: CA, 1995. Print.
“Mindfulness Practice in the Treatment of Traumatic Stress.” U.S. Department of Veteran Affairs. http://www.ptsd.va.gov/public/treatment/therapy-med/mindful-ptsd.asp. Accessed 20 March 2017.
“Refugee Services Toolkit.” The National Center Traumatic Stress Network. learn.nctsn.org/mod/book/view.php?id=4518. Accessed 17 March 2017.
Rowe, Cassandra, et al. “Evaluating Art Therapy To Heal The Effects Of Trauma Among Refugee Youth.” Health Promotion Practice 18.1 (2017): 26-33. Academic Search Premier. Web. 3 Feb. 2017.
“Teaching Recovery Techniques.” Children and War Foundation. http://www.childrenandwar.org/resources/teaching-recovery-techniques-trt/. Accessed 19 March 2017.
“Trauma.” American Psychological Association. http://www.apa.org/topics/trauma/. Accessed 18 March 2017.
Williams, Bethany Haley. The Color of Grace. New York, NY: Howard Books, 2015. Print.
Yoder, Carolyn. The Little Book of Trauma Healing. Intercourse, PA: Good Books. 2005. Print.