The refugee experience for 0-5 year olds is a complex interaction of loss, direct traumatic events, poor access to nutrition and health services, disruptions through displacement and re-settlement, maternal perinatal stress and parents’ post-traumatic symptoms. All these factors will affect attachment, and the child’s development, as confirmed by clinical assessment data collected at the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS). The biopsychosocial and systemic STARTTerS Early Childhood Programme is a trauma informed response to these complexities, but many refugee families and communities are reluctant to engage with early childhood or trauma recovery services.
To explore these utilisation issues, and support the rights of very young refugee children to receive rehabilitation services, an ongoing Community Based Participatory Research (CBPR) mixed method research study was implemented. The CBPR model has been used widely to explore service utilisation issues and collaborative service design and delivery, in mental health services with cross-cultural populations, but not with very young refugee children.
To date, this study has involved the Karen, Mandaean, Assyrian and Chaldaean communities. It explores the communities’ perceptions and interpretations of signs and symptoms related to early childhood trauma, community goals and help seeking preferences, and potential collaboration.
Focus groups and interviews were used with adults who were in a position to observe very young children in the target communities. Data collection tools included surveys, discussions, visual prompts, and a pictorial Likert scale, measuring incidence and importance of 35 child-related test items, and 4 parent-related items. The parent items related to factors which may impact on their ability to engage with their children.
Ethics approval was obtained from the relevant local Health NSW Ethics Committee. The possible risk of participants’ traumatic memories being triggered was mitigated through inclusion of relaxation and grounding techniques, and counselling if needed.
The data, from 87 participants, indicated a high incidence of possible trauma signs and symptoms in the 0-5 year olds, across 9 areas of health and development, and of issues impacting on the parents’ engagement with their young children. Perceived importance of specific test items varied across different refugee communities. The communities’ identified goals focused largely on community survival, in addition to long term wellbeing of the children.
Several other emergent themes shed light on service utilisation barriers, and possible strategies to increase trust and engagement. This led to development of community engagement strategies, collaborative planning and service delivery, and referral of some children to STARTTS for individualised trauma recovery interventions.
Further research is needed to extend the project to other refugee communities, and to increase the input from men. Research could also explore causes of such symptoms as sensory processing difficulties, and to explore the most effective therapeutic interventions.
Funding & No Conflicts Declaration
The research is funded through ongoing operational Mental Health grants, and there is no conflict of interest.