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Background A range of services within Australia and internationally have been developed that are focused on the engagement of individuals who are of refugee background to work as a liaison between their communities and mental health services. The Community Liaison Worker (CLW) role at the Victorian Foundation for Survivors of Torture (VFST) was developed in 2008 in order to engage in such capacity-building initiatives. Aims To review and document the establishment, evolution and current status of the VFST CLW role, and examine the perspectives of CLWs on their role in trauma-informed community capacity-building. Methods The study comprised of two stages: a historical case study of the development of the CLW role, and a qualitative research study based on interviews with CLWs in order to identify key themes regarding various aspects of their role and understand the facilitators and barriers to their work of trauma-informed capacity-building with their respective communities. Results The CLW role has evolved from the provision of direct services through joint work with Counsellor Advocates at VFST to a broader role that is focused on building the capacity of community members. Thematic analysis of interviews with the seven current CLWs identified the complexity of their dual role as members of their community and employees of VFST, their role in addressing short-term goals to meet community needs, and the long-term objective of empowering their community to become integrated and self-sufficient. Conclusions CLWs at VFST demonstrate important work of liaison workers in facilitating trauma-informed capacity-building initiatives that are of benefit to members of their communities and also to service providers.

IntroductionPregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework.Methods and analysisThe evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation.Ethics and disseminationEthics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.

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

In diesem Beitrag beschäftigten wir uns mit dem Wohlbefinden von vier nichtbegleiteten minderjährigen Flüchtlingen nach ihrer Ankunft in Australien, deren Perspektiven mittels eines Computergestützten Interviews (CI) erhoben wurden. Die entlang von CI-Fragen und -Aufgaben erhobenen Daten wurden in Tabellen als Komplett-Transkripte präsentiert und einer Textanalyse unterzogen. Ähnlichkeiten und Unterschiede zwischen den individuell relevanten Themen und Sorgen, bezogen auf die Ansiedelung in der neuen Heimat, konnten so herausgearbeitet werden. Alle Jugendlichen beklagten die Trennung von ihren Herkunftsfamilien. Dies betraf vor allem zwei weibliche Flüchtlinge und deren intensive Auseinandersetzung mit Fragen des Getrenntseins und Wiederzusammenkommens mit ihren Familien und damit einhergehenden emotionalen und Verhaltensproblemen. Die beiden jungen Männer beschäftigte neben familiären Sorgen vor allem die Möglichkeit der eigenen Aus- und Weiterbildung.Die CI-Nutzung wird vor allem diskutiert vor dem Hintergrund einer von einigen Seiten befürchteten Reduktion qualitativer und quantitativer Daten. Zusätzlich skizzieren wir Möglichkeiten der Nutzung von CI, um das Erleben der Befragten angemessen abzubilden sowie die Nutzung der so erzielten Ergebnisse u.a. für Förderprogramme.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs160268

This study describes the extent, quality and cultural appropriateness of current research on the health conditions of refugee children aged 0–6 years settled in high-income countries. A systematic review was conducted, including original articles published on the health conditions experienced by refugee children. A total of 71 papers were included. The studies varied considerably in their research design, population characteristics and health conditions. Studies included information on 37 different health conditions, with the majority non-communicable diseases, in particular growth, malnutrition and bone density. Although the studies identified a wide range of health issues, a coordinated effort to prioritise research on particular health topics was lacking, and health conditions studied do not align with the global burden of disease for this population. Additionally, despite being rated medium–high quality, most studies did not describe measures taken to ensure cultural competency and community involvement in their research. We suggest a coordinated research effort for this cohort, with greater emphasis on community engagement to improve the evidence-base of the health needs of refugee children after settlement.

In this paper, we examine relational interactions between refugee children and social institutions, building the case for the recognition of the co-occurrence and intertwining of vulnerability and agency in children’s experiences in diverse refugee situations. This developmental relational approach offers refinement of a general relational worldview by specifying how vulnerable and agentic experiences are co-constructed by children and adult individuals and institutions. We analyze the conceptual roots of vulnerable and agentic experiences, and use the concept of co-construction to specify the processes and outcomes of interactive relational experiences. Evidence from example studies of the intertwining of vulnerability and agency in specific refugee situations demonstrates how refugee children contribute to power-oriented experiences. Due recognition of the relational co-construction of intertwining vulnerable and agentic experiences provides a basis for refining generalized relational observations, and a fine-grained basis for developing policies and procedures to dispel ambivalence to refugee children and to change inequitable policies and practices.

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

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

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

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