Publications

For social workers striving for cultural competency and strength-based approaches with refugees resettled in the West, attention to the role of religion and faith as potential resources is particularly vital. With rising numbers of refugees fleeing from Islamic societies to Western host countries over the past two decades, social work research has articulated Islam as a source of strength and group solidarity, as well as the trigger for anti-Islam bias and discrimination. However, Muslims are not a monolithic group. This article reports on a qualitative study with fourteen Muslims seeking US asylum due to persecution based upon their gender role non-conforming behaviours.

Findings suggest that, for persons in this category, relationships to religion and faith may be complex, and potentially traumatic. Creating opportunities for gender role non-conforming refugees from Islamic societies to discuss religion and spirituality, with appropriate psychological support and without judgements from co-ethnic others or service providers, is an important clinical intervention for social workers to consider.

Malgré le nombre important d’immigrants de sexe masculin accueillis au Québec chaque année, il existe peu  d’études québécoises portant sur les enjeux rencontrés par les pères immigrants ou sur les services qui leur sont  offerts. Depuis dix ans, certains travaux ont tenté de combler cette lacune. Parmi eux, l’un porte sur un programme  de soutien aux pères immigrants offert par un organisme montréalais d’accueil et d’intégration des nouveaux  arrivants, un autre sur la relation père-enfant, la relation conjugale, l’identité paternelle et l’exercice de la  discipline, avec une attention particulière accordée à la période périnatale.

Cet article propose une synthèse de ces  travaux, inspirée par le modèle bioécologique du développement humain, avec comme objectif de faire ressortir  les convergences à propos des enjeux auxquels font face les pères immigrants dans leurs relations avec leur enfant,  leur conjointe et leur travail, puis de dégager quelques pistes pour l’amélioration des services offerts dans les  milieux institutionnels et communautaires.

The use of the category “race/ethnicity” intensified in the field of U.S. Public Health following the Clinton administration’s announcement of a budget increase for research focusing on ethnic and racial disparities in health. This article discusses the ways in which racialized difference is produced and represented as an object of knowledge and regulated by discursive practices in public health documents from U.S. federal government offices and a major public health journal published between 2001 and 2013. Races are approached, following Foucault’s proposition, as the product of racism, a technology of power of the modern State that consists of fragmenting humanity to permit colonizations. Thus, “race” has been established within the discourse to mark difference. Racism has developed concomitantly with the affirmation of power over life aimed at ruling out bodies and populations through public health practices, among others. The results suggest that the discourse on race varies throughout time. They indicate the relative permanence of a racialized regime of representation that consists of identifying, situating, and opposing subjects and groups based on standardized labels. This regime constitutes an ensemble of representational practices, which, together with disciplinary techniques and the use of culture as an idea, lead to the characterization and formation of racialized objects and stereotypes. These operations tend, together with medicalization and culturalization, to naturalize difference and constitute racial identities.

Résumé Cet article présente l’évaluation en méthode mixte d’une formation-accompagnement en santé mentale à l’école, proposée aux enseignants, aux équipes-écoles et à leurs partenaires des Centres de santé et des services sociaux (CSSS). Les résultats démontrent que la formation a augmenté le sentiment de compétence des participants quant à leurs interventions, leur confort par rapport aux décisions partagées avec leurs partenaires et leur motivation face aux collaborations interdisciplinaires. Ces résultats suggèrent que cette formation peut améliorer l’arrimage entre les milieux de l’éducation et de la santé face aux problèmes de santé mentale des jeunes à l’école.

À chaque année au Québec, un grand nombre de travailleurs reçoivent des indemnités après avoir subi une lésion professionnelle. Selon des estimations de la CSST, près de moitié des travailleurs touchés par une lésion professionnelle sur l’île de Montréal seraient issus de l’immigration. Bien que ces estimations ne tiennent pas compte du phénomène de la sous-déclaration qui touche particulièrement ce groupe, elles montrent une surreprésentation de ces travailleurs par rapport à son poids relatif dans la population montréalaise dans son ensemble. Ces travailleurs sont souvent concentrés dans des secteurs d’activité et dans des postes qui représentent de plus hauts risques en matière de santé-sécurité du travail (SST). Ils sont aussi sujets, dans le contexte de la restructuration actuelle de l’emploi, à de multiples formes de précarisation (voir Frozzini et Gratton, ce numéro). Ces travailleurs vivent plus souvent des contraintes liées au contexte de travail en plus des barrières linguistiques et culturelles qui peuvent rendre la relation thérapeutique plus difficile. À défaut d’un soutien organisationnel approprié ou adapté à la réalité des prises en charge dans les contextes de pluralité ethnoculturelle, nous découvrons que les intervenants accumulent sentiments d’échecs et d’incompétence, surcharge de travail et stress, ce qui met leur propre SST à risque. Cet article présente une réflexion sur les conditions d’inclusion dans le contexte de la réinsertion professionnelle en soutenant qu’il n’est pas possible de penser l’inclusion des personnes issues de l’immigration sans penser aussi aux conditions dont ont besoin
les intervenants, les ressources et les formes d’organisation nécessaires pour optimiser les prises en charge.

Au Québec et au Canada, les politiques d’immigration visent à attirer « les meilleurs et les plus brillants ». Les médecins font partie de cette élite transnationale et leur « fuite » soulève des enjeux éthiques dans les zones mal desservies. Or, un second enjeu éthique apparaît au pays hôte : leur reconnaissance professionnelle parcellaire. Elle soulève là encore de nombreux défis pour ces médecins, dont celui d’une identité professionnelle malmenée, qui reste pourtant peu documentée. Le caractère dynamique et relationnel de l’identité professionnelle est mis en relief, mais surtout, la puissance des conditions d’appartenance qui oblige à une flexibilité professionnelle et parfois au retrait de la profession ou du pays ; la notion de pouvoir et celle de reconnaissance sont au cœur de ces processus identitaires. Dans cet article les auteurs posent un regard critique sur les approches centrées sur l’individu qui ignorent les normes et les contraintes sociales.

L’embauche des travailleurs étrangers temporaires (TET) a des impacts sur  la cohabitation résidentielle et sur la cohabitation des métiers dans lescommunautés rurales. Cette étude repose sur le discours des chefsd’entreprises (n=17) et d’informateurs-clés (n=23) des secteurs agricole,horticole et de l’aménagement paysager au Québec. Ce type d’embauche aincité différents acteurs à reconsidérer leurs pratiques de gestion pour recréerun équilibre dans des petites communautés déstabilisées par l’apportdémographique saisonnier entraîné par l’arrivée des TET. De l’analyse dediscours a émergé un modèle de gestion de la diversité qui rend compte desdéfis de cohabitation pour les employeurs et les TET.

Background: Substance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada,issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2). Methods/Design: Phase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence.
Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health.Discussion: Findings from this research program will contribute to the understanding of factors associated with implementation of frontline sevices for substance dependence and help to inform future policy and organizational support for the implementation of evidence-based practices.

An analysis of worker participation was carried out as part of a larger study on strategies for managing occupational safety and health in small businesses that hire immigrant workers. This analysis was based on the triangulation of three data sources: interviews with those who answered the questions on behalf of the small business owners or managers (n = 28); occupational health professionals who gave advice to the same small businesses (n = 26); and questionnaires completed by the immigrant workers (self-administered, n = 181). The results converged in that immigrant workers, compared to workers of Canadian origin, received less initial training when hired and were less able to identify risks. Immigrant workers informed their employer less often when they were injured and participated less in investigations following an accident. Many did not have protective equipment and, where the employer did provide it, they were less inclined to wear it. Generally, insufficient effort was made by small businesses to protect or inform immigrant workers of their rights and obligations, or to integrate them into the workplace. The study shows that it would be useful if company directors provided support to manage the occupational safety and health of immigrant workers and compliance with regulations, as well as endeavouring to understand the issues underlying equal labour and management representation in occupational safety and health.

En juin 2005 la Coalition « Solidarités sans frontières » a organisé la « Marche sur Ottawa – Personne n’est illégal ». Cette marche de plus de 200 kilomètres a duré huit jours et elle visait à rendre visible la situation et la lutte de toutes les personnes migrantes et sans statut au Canada. Une centaine de personnes y ont participé, dont bon nombre de réfugiés et de « sans papiers ». Ces personnes quotidiennement touchées par les injustices et l’exclusion liées à leur situation ont, pour ainsi dire, « pris la route » parce qu’elles refusaient de demeurer invisibles, parce qu’elles voulaient que soient entendues leurs revendications.

Many migrants do not speak the official language of their host country. This linguistic gap has been found to be an important contributor to disparities in access to services and health outcomes. This study examined primary care mental health practitioners’ experiences with linguistic diversity. 113 practitioners in Montreal completed a self-report survey assessing their experiences working with allophones. About 40 % of practitioners frequently encountered difficulties working in mental health with allophone clients. Few resources were available, and calling on an interpreter was the most common practice. Interpreters were expected to play many roles, which went beyond basic language translation. There is a clear need for training of practitioners on how to work with different types of interpreters. Training should highlight the benefits and limitations of the different roles that interpreters can play in health care delivery and the differences in communication dynamics with each role.

Services that are designed by, and for, the host society majority group may be inadequate or inappropriate for ethnic minority or immigrant families. These issues are relevant to cultural consultants who are asked to provide advice to a variety of social service and institutional settings, including youth protection as well as legal and family services. Those who work within these agencies must be assisted to understand the difficulties encountered by migrant families during the process of resettlement, including separation and reunification, cultural variations in discipline and physical punishment, and the important roles of identity and intergenerational conflicts as well as distinguishing between situations of dysnormativity and dysfunctionality. Given that intimate partner violence is one of the challenges that institutional agencies face when assisting families, it is imperative that staff members be provided with the training necessary to adequately assist families confronted by these difficulties. The enormous power vested in these institutions and their representatives must also be considered when creating training strategies to assist workers. Finally, special attention must also be given to the challenges of migration and resettlement which can result in the destabilization of families, interrupt the transmission of traditional values from parents to children, diminish parental authority, and lead to the break-down of family structures which could result in the inappropriate removal of children from the parental home. Case vignettes and examples training programmes are used to demonstrate how cultural consultants can assist in the development of culturally safe spaces for families interacting with societal institutions.

Cultural diversity is a global challenge for mental health services. The changing demography of communities requires rethinking approaches to cultural competence for health professionals and institutions. Cultural consultation is a way to improve the quality of mental health care by providing a nuanced understanding of the predicaments that prompt diverse clients to seek help, and the social contexts of their mental health problems, to guide clinical assessment and intervention.

Cultural Consultation explores the practice of cultural consultation as a strategy to improve the quality of mental health care for diverse populations. The contributors, who have worked together at an innovative clinical service, frame best practices in psychiatry clinical psychology, and social work in relation to empathy, human rights, and culturally responsive and ethically sound care. A detailed model of the process of cultural consultation, from initial intake, through assessment, to recommendations and referrals, provides guidelines for clinical practice. Expert contributors examine specialized settings (medical, psychiatric emergency, inpatient, social/legal services), populations (remote, indigenous, child and youth), and contextual issues in the care of people with a wide range of mental health problems. Numerous case examples, charts, and tools add depth for readers interested in developing similar services or enhancing existing practice. Among the key areas covered: 

• Working with interpreters and culture brokers.
• Family systems in cultural consultation.
• Gender, power, and ethnicity in cultural consultation.
• Consultation and mediation with racialized and marginalized communities.

Collaborative care and primary care consultation.

• Cultural consultation with refugees.

A unique guide to challenges and opportunities in contemporary practice, Cultural Consultation will be immediately useful for health care professionals, clinical psychologists, and cultural consultants and provide a versatile knowledge source for years to come.