Risk factors

Refugee children have experienced an almost complete loss of control over their home environment through a social earthquake of catastrophic proportions. Refugee-specific risk factors, primarily related to violence, and traditional risk factors, such as poverty and lack of social support, can accumulate, resulting in an extremely toxic psychosocial environment for the child. These environments can be especially destructive for those children who have had difficult and compromising lives prior to the refugee experience. However, most refugee children have many potential strengths which can be fostered and developed by the mental health professional. These include the love and support of family members and peers, spirituality, altruistic activities, and self-esteem enhanced by their achievements in school, work, and traditional cultural events. Treatment and prevention must be culturally adapted to each refugee community. The psychiatrist's best course of action in working with refugee children is to speak directly to the child. No matter how old or young the child, the clinician needs to observe his or her behaviour, and to have the child report what he or she thinks or feels is important. The refugee child is the most important source of information about him- or herself. After speaking with the child, the clinician can involve parents, teachers, and others. Confidentiality cannot be overemphasized, since there may be abusive adults exploiting the refugee child.

Safety and the physical and emotional protection of the refugee child must be the clinician's top priority. Once the latter has been secured, the physician can begin to identify those additional risk factors in the child's immediate care-giving environment that need to be modified, as well as those resiliency factors in the child that can be stimulated and developed. Finally, the clinician must affirm the idealism and positive world view that has been damaged in almost all refugee children. It is important to focus on refugee children's sense of dignity and identity, and their cultural and spiritual beliefs, in order to help them shape a realistic and positive attitude towards their future.

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