Publications

Les pratiques de recherche et d’intervention dans le champ des sciences sociales sont assujetties à des changements structuraux et sociohistoriques majeurs dans nos sociétés. Des développements théoriques et méthodologiques issus, entre autres, de la psychologie sociale, de la sociologie et de l’anthropologie ont défini une approche clinique du social. Les pratiques qui en découlent peuvent être associées à des formes de résistance, voire à des réponses aux orientations et aux institutions sociales dominantes. Ce qui caractérise cette nouvelle approche est le travail de proximité avec les personnes et les groupes, la réponse à leur demande sociale et l’implication des intervenants.

Le présent ouvrage, qui présente les contributions de nombreux collaborateurs du Québec et d’ailleurs, témoigne de la vivacité et de la nécessité de la clinique en sciences sociales. Sont ainsi explorés les fondements théoriques et méthodologiques de la posture clinique, les pratiques d’intervention sociales éclairées – en particulier par des contributions brésiliennes – et les pratiques innovantes d’une recherche clinique du travail et des organisations.

Does social media lead vulnerable individuals to resort to violence? Many
people believe it does. And they respond with online censorship, surveillance
and counter-speech. But what do we really know about the Internet as a
cause, and what do we know about the impact of these reactions?
All over the world, governments and Internet companies are making decisions on the basis of assumptions about the causes and remedies to violent attacks. The challenge is for analysis and responses to be firmly grounded. The need is for policy constructed on the basis of facts and evidence, and not founded on hunches or driven by panic and fearmongering.

It is in this context that UNESCO has commissioned the study titled Youth and Violent Extremism on Social Media. This work provides a global mapping of research (mainly during 2012-2016) into the assumed roles played by social media in violent radicalization processes, especially as they affect youth and women.

Les récits de dignité ont été recueillis auprès d’enfants immigrants de quartiers défavorisés de Montréal par Lilyane Rachédi, professeure à l’école de Travail social de l’UQAM et par le Centre de ressources de la Troisième avenue. Ils mettent de l’avant des expériences vécues par les jeunes à l’école et expriment leur opinion sur leurs droits et valeurs en matière d’éducation.

Cette thèse de doctorat propose de comprendre la spécificité rituelle des pratiques funéraires au début du XXIe siècle. Les analyses rituelles classiques (interactionnistes et structuro-fonctionnalistes) nous ont conduit à nous intéresser au processus rituel plutôt qu’au rituel lui-même et à cheminer par l’entremise d’une approche de l’action rituelle, plutôt que par celle des fonctions ou des symboles. Pour restreindre la part de réalité sociale étudiée, nous avons considéré que, parmi les différentes transformations funéraires, le phénomène de la crémation était une porte d’entrée pour comprendre cette spécificité. Cette thèse poursuit un double objectif : 1) Le premier objectif est descriptif. Dans la trajectoire du mourir, à partir d’une perspective relationnelle, nous avons exploré le processus funéraire, notamment celui ayant pour perspective la crémation comme mode de transformation du corps, en le décomposant comme une chaîne opératoire du mourir. Nos données sont recueillies par la méthode de la participation observante de pratiques au sein du milieu funéraire. L’exemplarité du phénomène crématiste, en tant que pratique réunissant les attributs de l’évolution récente funéraire à partir des années 1980, a dirigé notre sélection vers un échantillon diversifié dans deux contextes socioculturels (France et Québec) et deux agglomérations (Strasbourg et Montréal) où le taux de crémation est historiquement élevé. 2) Le second objectif consiste à comprendre la spécificité de la ritualisation funéraire à partir de ces données, en s’intéressant à l’action rituelle en train de se faire dans le processus funéraire, c’est-à-dire expliquer la mise en forme et en acte de relations sociales. Par-delà une lecture socioanthropologique de l’organisation des relations contextuelles de ritualisation, une lecture psychosociologique des actions rituelles complète l’interprétation. Notre compréhension de la spécificité du processus rituel funéraire fait apparaître la complexité relationnelle de cette pratique sociale : d’une part, en tant qu’actions interagies par et dans des relations interindividuelles, faisant appel à des ressources réflexives (habilitantes) et permettant la réduction de l’état de dissonance provoqué par la mort; d’autre part, en tant qu’actions enserrées par et dans les règles des systèmes sociaux. La mise à jour de la prépondérance de ces caractéristiques relationnelles dans la ritualisation funéraire actuelle a pour vocation de comprendre à la fois la diversification des pratiques funéraires et leur normalisation.

With unprecedented numbers of displaced persons worldwide, mental health clinicians in high-income countries will increasingly encounter refugee and asylum-seeking patients, many of whom have experienced significant adversity before and after their migration. This paper presents a summary of the recent evidence on the assessment and treatment of refugees across the lifespan to inform clinicians’ approaches to care of refugee patients in mental health care settings. Assessment and interventions for refugees are grounded in an ecosystemic approach which considers not only pre-migratory trauma, but social, familial, and cultural determinants of mental health in the host country. Evidence for psychotherapy and pharmacological treatments are reviewed, highlighting promising interventions while acknowledging that further research is needed. Ultimately, serving refugees necessitates a biopsychosocial approach that engages clinicians as medical experts, therapists, and advocates

Les taux élevés de suicide chez les jeunes Inuit sont souvent considérés comme symptomatiques des changements culturels survenus en quelques générations seulement. Aujourd’hui, les jeunes Inuit ont à transiger entre des cultures qui peuvent être vécues comme deux mondes opposés, avec des valeurs, des attentes et des contraintes parfois inconciliables. La littérature en santé mentale soulève le problème de l’accès aux soins, mais aussi le manque d’adéquation des services avec les besoins spécifiques des Inuit et de leur culture. Plusieurs auteurs suggèrent des modèles de guérison alternatifs prometteurs qui se distinguent des modèles conventionnels de soins « occidentaux ». On dit souvent « penser à l’extérieur de la boîte ». Mais qu’en est-il de penser autrement, « dans la boîte », en s’intéressant aux ressources déjà présentes ? Le Black Box, local d’Artcirq à Igloolik où s’entraînent des Inuit à l’art du cirque, nous amène à réfléchir sur l’intervention en santé mentale en contexte inuit. Cet article vise à élaborer une réflexion sur l’espace de « l’entre deux » où se trouvent les jeunes Inuit d’aujourd’hui, dans une culture en transformation. Cette situation pourrait nécessiter un ajustement créatif pour répondre à la fois aux contraintes d’une société contemporaine et à celles liées à un ancrage dans une identité inuit. Pour ce faire, nous explorerons le concept de la tradition ainsi que l’apport de l’art pour la négociation des identités culturelles à l’aide de l’exemple d’Artcirq. Le potentiel thérapeutique de cet espace artistique au niveau communautaire sera discuté à partir de nos observations d’un terrain ethnographique.

Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners with crucial background information to improve their capacity to work efficiently and with maximum benefit. In this paper, we draw on experience implementing desk review guidance from the World Health Organization (WHO) and UNHCR, the United Nations Refugee Agency (2012) in four diverse humanitarian crises (earthquakes in Haiti and Nepal; forced displacement among Syrians and Congolese). We discuss critical parameters for the design and implementation of desk reviews, and discuss current challenges and future directions to improve mental health care and psychosocial support in humanitarian emergencies.

Researchers in the field of Aboriginal health generally have a keen interest in ‘participating in change’ to address the ongoing injustices experienced by Aboriginal peoples. Perhaps the most promoted methods for this purpose are those described as Indigenous methods and action research. Criteria of authenticity are generally used to assess the quality of research. In this essay, we reflect on how certain basic principles of action research, more notably ontological authenticity and educative authenticity can penetrate the process of knowledge exchange, creating spaces of ontological contamination and transformation. We reflect on the context of sharing ‘difficult knowledge’, knowledge that is encountered and shared in a post-colonial context of unequal power dynamics. We describe a trilogy of methods used for such knowledge exchange activities with three distinct audiences, and distinct goals. A commonality amongst the three described methods is the ‘unfinished’ and unorganised nature of what is transmitted, requiring the receptor to actively participate in the differentiation and reorganisation of information in a way that makes sense to him/her.

Structural competency is an approach to clinical training and practice that aims to improve health care by directing attention to the social inequities that are among the root causes of health disparities.¹ Recognizing these forms of social adversity may allow clinicians to better understand patients’ predicaments. However, to move beyond mere recognition, psychiatrists must find ways to address social structural issues and work toward systemic change. Without specific actions, structural competency risks being an academic exercise. Advocacy is one crucial way to translate insights into the social determinants of health into structurally competent practice. In this Viewpoint, we argue that advocacy can be a key aspect of structural competency.

In 2012 the Canadian government made significant cuts to its historically strong federal refugee health coverage plan. While this policy had negligible effects on the level of coverage provided to asylum seekers in Quebec, there is evidence that this group nonetheless experienced reduced healthcare access during the period of polarized national debate that ensued. This study engaged the “candidacy” model of healthcare access to illuminate factors contributing to the observed gap between entitlement and access. Twenty-five semi-structured interviews were conducted with asylum seekers in Montreal to elicit narrative accounts of difficulties encountered in the pursuit of healthcare. Thematic content analysis in conjunction with a holistic examination of help-seeking trajectories revealed several important barriers to obtaining care, including widespread confusion and misinformation about refugee health coverage, cumbersome administrative procedures specific to asylum seekers, and long wait times. Feelings of marginalization and insecurity associated with precarious migratory status appeared to amplify the effects of these barriers to care such that even a minor access difficulty could have dramatic effects on future help-seeking and access outcomes. Demonstrating awareness of public discourses interrogating their deservingness of health coverage, participants often interpreted access difficulties as evidence of health professionals’ unwillingness to serve them. Such interpretations conspired with fears associated with the asylum claim process to suppress self-advocacy, further help-seeking, and at times even information-seeking. This finding is particularly significant in that it suggests a mechanism through which hostile public representations of forced migrants–increasingly prevalent in Western host countries–can themselves endanger the physical, psychological, and social health of highly disadvantaged populations, even in the presence of strong entitlement policies. We close with reflections on how theoretical models of healthcare access might be adjusted to better accommodate the unique experiences of precarious status migrants.

Asylum seeking children arriving in Canada regularly face incarceration in medium-security-style immigration detention centres. Research demonstrates the human cost of detaining migrant children and families and the psychiatric burden linked with such imprisonment. This study aims to understand the lived experiences of children aged 3–13 held in detention. Informed by a qualitative methodology of narrative inquiry, child participants created worldsin the sand and generated stories to express their subjective experience. Results suggest that children’s sandplay confirms the traumatic nature of immigration detention while also revealing children’s sometimes conflicting understanding of the meaning of detention and their own migration. The results are contextualized by a description of detention conditions and the psychiatric symptoms associated with immigration incarceration. The study highlights the need for more research examining the impact of immigration detention on children’s mental health, while also underlining how refugee children’s voices provide important direction for policy change.

Cet article documente les perspectives d’intervenants de la santé et des services sociaux desservant des communautés pluriethniques de Montréal au sujet de l’impact du débat public sur le projet de Charte des valeurs proposé par le gouvernement du Québec à l’automne 2013. Les résultats suggèrent que ce débat public a eu des répercussions sur les intervenants et sur le bien-être des communautés, surtout minoritaires, mais également de la majorité. Ces résultats soulignent également que des débats sociaux suscitant la division peuvent influencer le vivre-ensemble et le rapport à l’Autre dans les services de santé et de services sociaux.

La recherche qualitative auprès de populations vulnérables en institutions de soins soulève de nombreux enjeux éthiques. Cet article se veut un exercice réflexif sur la particularité et la complexité des enjeux soulevés par ce type de recherche.

Pour ce faire, nous revisiterons notre expérience récente d’une recherche en santé mentale jeunesse auprès de réfugiés. Partant de
considérations méso-éthiques pour en arriver à des considérations micro-éthiques, nous aborderons la question de l’éthique de la recherche avec les réfugiés, les complexités éthiques d’ordre procédural rencontrées dans le processus d’approbation institutionnelle du projet (enjeux de protection) ainsi que les enjeux éthiques fondamentaux qui ont été soulevés lors du recrutement des participants et de la cueillette des données par entretien (responsabilité et sollicitude). Notre expérience nous permet de conclure à la complémentarité des différents niveaux éthiques (procédural/pratique) en recherche qualitative et à la nécessité de la réflexivité du chercheur pour permettre le développement de pratiques éthiques, particulièrement dans des contextes de vulnérabilité.

Our goal was to examine maternal mental health and associated stresses in a sample of high-risk immigrant mothers, and its association with child insecure attachment in the years following childbirth. Mothers and their child (Mage = 37 months) were recruited through a Health and Social Service organization in the Parc-Extension neighborhood in Montreal, Quebec. Mothers completed the Hopkins Symptoms Checklist (HSCL-25), the Multidimensional Scale of Perceived Social Support (MPSS) and a sociodemographic questionnaire that included questions on premature delivery and birth weight. Attachment behaviors were coded out of a videotaped free play sequence using the Preschool and Early School-Age Attachment Rating Scales (PARS). Analysis revealed high levels of clinical anxiety and depression, low social support and low attachment security. Significant mean differences and associations were found between anxiety, depression, social support, preterm delivery and child attachment. These results underscore the importance of screening for anxiety and depression early in the postnatal years, in order to prevent associated consequences such as child insecure attachment. Results also highlight the importance of building positive social networks, especially with immigrant populations.

The mental health needs of children and adolescents living with HIV (ALHIV) in Namibia are poorly understood, despite the dramatic improvement in their survival. ALHIV in resource poor contexts face particular risk factors, such as poverty, orphanhood, and poor social support. This study examines the mental health of ALHIV in Namibia, and the factors that contribute to mental health problems. A case-control design assessed emotional and behavioural symptoms of distress, risk and protective factors among adolescents aged 12-18 years. Case participants were 99 HIV-positive adolescents. Case controls were 159 adolescents from the same community who were not known to be HIV seropositive at the time of the study. Control group participants were selected from schools using a stratified random sampling. A larger proportion of HIV-positive adolescents were orphaned (62.6% vs. 20.8%, p < .001); the groups showed no differences in poverty factors. HIV-positive adolescents scored lower than the control group on total perceived social support (p < .05) and caregiver support (p < .05), but no differences in perceived friend support and support from a self-selected person were present. HIV-positive adolescents reported significantly more total emotional and behavioural difficulties (p = .027) and conduct problems (p = .025), even after controlling for socio-demographic factors. However, after controlling for the effects of orphanhood, group differences in mental health outcomes were no longer significant. Furthermore, mediation analysis suggested that social support completely mediated the relationship between HIV status and mental health (standardised pathway coefficients = .05, p = .021). Policies and programmes that aim to strengthen social support and take orphanhood status into consideration may improve the mental health of adolescents living with HIV.

Abstract

Introduction. Despite greater father participation in child care/rearing nowadays and the challenge of involving fathers in nursing interventions, no instrument exists to measure professional attitudes toward father involvement in family interventions. Objectives. The aim of this study was to adapt an existing measure that assesses nurse attitudes regarding the importance of including families in nursing care into a measure that assesses professionals’ attitudes towards the importance of involving fathers in interventions with families. Method. The Professionals’ Attitudes towards Father Involvement (PAFI) scale was adapted from the Families’ Importance in Nursing Care – Nurse Attitudes (FINC-NA) scale. A total of 297 professionals in family care completed the 26 items of the PAFI. Results. Items analysis indicated three items had low variability and abnormal distribution. Principal component analysis was conducted with the 23 remaining items. Results revealed a solution with four factors reproducing the structure of the original scale: Father as conversational partner, Father as resource, Father as burden, and Father as own resource. Most items loaded on their original factor. The four subscales and the global scale showed good internal consistency. Discussion and conclusion. Even though further studies are needed, this adapted scale now enables researchers and practitioners to assess professionals’ attitudes towards the importance of involving fathers in interventions with families.

Résumé

Introduction. Les pères sont de plus en plus engagés auprès de leurs enfants. Plusieurs professionnels, dont les infirmières, peinent à s’adapter à cette nouvelle réalité. Aucune échelle n’existe pour mesurer l’attitude des professionnels par rapport à l’importance d’inclure les pères dans leurs interventions. Objectifs. Le but de cette étude est d’adapter une échelle qui mesure les attitudes des infirmières quant à l’importance d’inclure les familles dans leurs soins pour en faire un instrument permettant de mesurer les attitudes des professionnels envers l’importance d’inclure les pères dans leurs interventions auprès des familles. Méthodes. L’échelle Attitudes des professionnels envers l’inclusion des pères (APIP) a été adaptée à partir de l’échelle Importance des familles dans les soins infirmiers – Attitudes des infirmières. Au total, 297 professionnels ont répondu aux 26 items de l’échelle APIP. Résultats. L’analyse des items révèle que trois d’entre eux présentaient une faible variabilité et une distribution anormale. L’analyse à composantes principales a été effectuée avec les 23 items restants. Les résultats confirment quatre facteurs, reproduisant la structure de l’échelle originale : le père comme partenaire de conversation, le père comme ressource, le père comme fardeau et le père comme ayant ses propres ressources. Les quatre sous-échelles et l’échelle globale ont montré une bonne cohérence interne. Discussion et conclusion. Même si d’autres études sont nécessaires, cette échelle adaptée permet maintenant aux chercheurs et aux praticiens de mesurer les attitudes des professionnels quant à l’importance d’impliquer les pères dans leurs interventions auprès des familles.

This pilot study examined psychological, social and cultural risk factors for child insecure attachment in a sample of South Asian immigrant families experiencing high migration stress in Montreal, Canada. Thirty-three participants were recruited through a local Health and Social Service organization. Maternal anxiety and depression, social support, and national and religious sense of belonging were assessed. Child attachment behaviors were coded from a 15 min free play period. Results indicated that maternal depressive symptoms were related to lower child attachment security scores. Lower support from friends was related to greater child ambivalent attachment behaviors. A higher sense of belonging to the country of origin was related to greater child disorganized attachment behaviors. These findings suggest that migration stresses, which include maternal depression, lack of social support and the sense of belonging, are associated with child attachment, and these variables should be considered in the design of appropriate interventions.

Recent changes in U.S. immigration policies and enforcement have precipitated a 300% rise in arrests and planned deportations. Although some family members face deportation, other family members may have state-sanctioned status. Such mixed status puts hundreds of thousands of families at risk of forced separation and associated mental health problems. Building on cross-cultural work with refugee families and other groups and on work with families separated by parental incarceration, the authors provide recommendations to guide clinicians working with families who are separated or who fear separation. Mental health problems among separated families can in part be addressed through identifying the origins of distress, elucidating family structures and roles, strengthening communication practices, linking with legal and economic resources, and facilitating decision making through distress reduction.

Le contre-transfert culturel est un concept qui souligne la dimension socioculturelle, et donc collective, du contre-transfert. Dans ce texte, nous analysons, au moyen de cinq histoires cliniques présentées dans le cadre de séminaires de discussion de cas transculturels et interinstitutionnels menés à Montréal, Canada, les diverses formes que peut prendre le contre-transfert culturel pour des cliniciens en situation d’impasse thérapeutique face à la prise en charge de familles migrantes. Nous examinons ensuite le rôle éventuel de ces séminaires dans la transformation de ce contre-transfert et dans la formulation de pistes permettant de relancer ou de soutenir le processus thérapeutique. Les résultats indiquent que les séminaires transculturels et interinstitutionnels de discussion de cas facilitent un travail d’élaboration sur les représentations collectives des cliniciens et que ce travail groupal permet de contenir et parfois de dépasser certaines situations d’échec thérapeutique.

With the sharp increase of refugees’ arrival and resettlement in western communities, adequate mental health care forms a pivotal dimension in host societies’ responses to those individuals and communities seeking protection within their borders. Here, clinical literature shows a growing interest in the development of family therapy approaches with refugees, in which therapeutic practice engages with the pivotal role of refugee family dynamics in posttrauma reconstruction and adaptation in resettlement and aims at supporting posttrauma reconstruction through strengthening capacities to restore safety, meaning and connectedness within family relationships. In this article, we focus on the narrative restoration of meaning as central mode of posttrauma reparation and explore its specific dynamics and relational complexities in the context of therapeutic practice with refugee families. Hereto, we integrate theoretical and clinical scholarly work on trauma narration and its intersection with empirical findings on trauma communication in refugee families. Furthermore, we develop case reflections to illustrate different processes of engaging with trauma narration in refugee family therapy. This analysis develops an understanding of the multivoiced ways in which refugee families engage with traumatic suffering through different modes of expression that may entail both narration and silence and explores how family therapeutic practices can engage and mobilize voices of narration and silence as relational stories of restoration.

In this article, we question the unilateral discourse of benefit of participation in participatory refugee theatre in the context of a growing socio-political climate of polarisation and stigmatisation of refugees in European countries of resettlement. By integrating critical voices from the fields of applied theatre and refugee research, we analyse the micro and macro dramaturgy of a Berlin-based participatory refugee theatre project. Through this analysis, we explore how refugees’ participation entails opportunities for empowerment, agency and giving voice, but also risks disempowerment and silencing in the interconnected relations between the participant, theatre maker, audience and the broader socio-political context.

Recent changes in U.S. immigration policies and enforcement have precipitated a 300% rise in arrests and planned deportations. Although some family members face deportation, other family members may have state-sanctioned status. Such mixed status puts hundreds of thousands of families at risk of forced separation and associated mental health problems. Building on cross-cultural work with refugee families and other groups and on work with families separated by parental incarceration, the authors provide recommendations to guide clinicians working with families who are separated or who fear separation. Mental health problems among separated families can in part be addressed through identifying the origins of distress, elucidating family structures and roles, strengthening communication practices, linking with legal and economic resources, and facilitating decision making through distress reduction.

Ce merveilleux conte, paru aux éditions Remue Ménage¹, est un ouvrage tout en finesse à travers lequel l’auteur a le courage d’aborder une des tâches les plus délicates qu’un parent ait à faire : parler à son enfant de la violence du monde. Mais puisqu’il le faut, pour le protéger, l’auteur nous fait don de ce conte et nous accompagne avec une délicatesse et une profondeur, qui témoignent d’une réflexion mûrie et d’un grand amour des enfants. Comment  aborder ce sujet sensible avec les petits sans les angoisser, ni les brimer dans leurs élans, dans leurs pulsions de vie ? Sans induire de progression traumatique, comme un fruit devenu mûr trop vite pour avoir été confronté au réel (Ferenczi, 1933) ? Pour ce faire, l’auteur use brillamment de métaphores que le lecteur de tout âge comprendra à l’aulne de son développement. Et c’est là le génie de sa méthode.

Cette puissance d’évocation est décuplée par les créations picturales qui accompagnent le texte. Il s’agit des illustrations d’Albin Christen. La première page, noire, remémore à l’enfant son milieu originel : le ventre de sa mère, lieu des premiers échanges sensoriels, d’où il recevra un premier bain de parole. Puis il y a ces forces invisibles qui jalonnent le parcours de l’enfant et qui sont illustrées de façon magistrale : des tenailles légèrement anthropomorphisées en bras, pour symboliser l’oppression ; les barrières de métal qui représentent les obstacles ; les rouages complexes qui métaphorisent l’appareillage intriqué et pervers qu’est la violence systémique.

Les services en santé mentale jeunesse comprennent des interventions multimodales interdisciplinaires complexes et leur évaluation tire profit des méthodes mixtes, particulièrement auprès de populations caractérisées par leur diversité culturelle.

Ce chapitre présente les résultats d’une étude pilote visant à développer une méthode d’évaluation des soins en collaboration en santé mentale jeunesse à Montréal. La méthode combinait la réalisation d’entrevues semi-dirigées auprès de cinq triades jeune-parent-intervenant et de questionnaires mesurant la satisfaction envers les services et l’amélioration du portrait clinique.

Nous aborderons principalement les forces et les limites de la méthode mixte employée. Les points de convergence et de divergence des données quantitatives et qualitatives sont présentés et l’accent est mis sur l’importance de l’intégration des résultats.

Les résultats mixtes ont permis d’améliorer la rigueur scientifique de la recherche en complétant et en contextualisant les résultats des composantes qualitative et quantitative de l’étude, et en permettant une meilleure adéquation culturelle de la méthode utilisée.

Sur le plan éthique, nous considérons que l’approche qualitative a amélioré la prise en considération de la voix des participants, une question particulièrement importante pour des recherches sur des enjeux de santé pouvant faire l’objet de stigmatisation et menées auprès de populations culturellement minoritaires, marginalisées ou peu représentées dans la littérature scientifique. Les contributions de l’étude pilote au développement d’un devis de recherche mixte longitudinal sont également présentées.

Despite the importance of adequate supervision to child wellbeing, the academic conversation around this topic is scattered across disciplines and for this reason is difficult to follow. Researchers and decision-makers would benefit from a preliminary overview of conceptualizations, cultural variations, and facilitators and barriers to providing supervision to children in low- and middle-income countries (LMICs). A scoping review was conducted. Two searches of the literature were run within Embase, Medline, PsycInfo, Social SciencesFull Text, ERIC, SocIndex with Full Text, and Academic Search Complete. Additional papers were identified through a call to experts. Out of 2049 publications initially identified, 44 studies met our inclusion criteria, thus reflecting the scarcity of scientific evidence in LMICs. Child supervision was addressed in the literature in terms of links to psychological, health, social and academic outcomes, suggesting a multidisciplinary interest in the topic. However, a vague conceptualization of child supervision emerged across studies. Of importance, cultural and socio-economic influences interacted to shape caregivers’ vision of the family, the child, and the decision-making process regarding supervision practices. Barriers and/or facilitators to adequate child supervision were addressed only in 18 studies. There was substantial variation in how cultural influences on child supervision were taken into account across studies. Our review aims to inform and guide future research and action on child supervision practices in LMICs and calls for a more coherent and comprehensive body of literature on this matter. Programming and policy efforts should take socio-economic and cultural influences into account, as well as be tailored according to the specificities of each child, caregiver(s), and setting.

Beginning in 2015, Canada undertook an exceptional undertaking of sponsoring of more than40,000 Syrian refugees to resettle in Canada. As the excitement of their initial arrivals dissipates,it is important to consider their longer-term settlement and integration in their new communities.This article offers a portrait and analysis of how Syrian refugees sponsored to Montreal are able tocreate social networks and access social support in order to build social capital for employmentand housing purposes. Part of a larger, three-province, 4-year longitudinal study, here we report onthe first wave of survey data collected from 626 Privately-Sponsored Refugees living in Quebec.We report on their family support and friendships, as well as the ways that these social connectionshelped them in terms of employment and housing. Differences in terms of age, gender and time inCanada are analyzed. We find strong evidence of bonding social capital among recently resettledSyrians in Montreal, and growing bridging capital.

We examine patient–provider interactions for Indigenous childbirth evacuees. Our analysis draws on in-depth interviews with 25 Inuit and First Nations women with medically high-risk pregnancies who were transferred or medevacked from northern Quebec to receive maternity care at a tertiary hospital in a southern city in the province. We supplemented the patient data with interviews from eight health care providers. Three themes related to patient–provider interactions are discussed: evacuation-related stress, hospital bureaucracy, and stereotypes. Findings show that the quality of the patient–provider interaction is contingent on individual health care providers’ ability to connect with Indigenous patients and overcome cultural and institutional barriers to communication and trust-building. The findings point to the need for further training of medical professionals in the delivery of culturally safe care and addressing bureaucratic constraints in the health care system to improve patient–provider communication and overall relationship quality.

Objectives Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes.

Design This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data.

Setting and participants Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014.

Primary outcomes Numerous adverse maternal and perinatal health outcomes.

Results Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers.

Conclusions Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further

The research subject of social identity among Western Muslims raises concern, as it is questionable if one can dissociate its political implications from academic analysis. This article uses the concept of social representations as a viable alternative in providing a more nuanced depiction of Western Muslim identity dynamics. We first illustrate the need to go beyond the identity construct in social psychology, as it may potentially reproduce the moral panic surrounding Muslims in public consciousness. We then propose an alternative conceptualisation Western Muslim identity – using social representations – which emphasizes the importance of common-sensical knowledge structures. We discuss the necessity of understanding Western Muslim group dynamics without politically reifying the implicit incongruity of national/religious affiliations via the construct of ‘identity’.

This article describes how autism spectrum disorder is experienced in the context of immigrant families and how the meaning of this condition, proposed by professionals in the host country, is negotiated between families and healthcare providers. The study sample consists of 44 parents of different nationalities and their 35 children with autism spectrum disorder (ASD) living in a socioeconomically deprived neighborhood of Montreal, Canada. Individual parent interviews were audiotaped and transcribed for subsequent analysis. Results suggest that – although they may sometimes be a source of anxiety – the uncertainties regarding the etiology of ASD, as well as the gap between the explanatory models (EMs) proposed by host country professionals and the impressions of parents, seem to increase the capacity of families to resist the imposition of what they perceive as external categories. Parents perceived the day-to-day difficulties associated with their child’s condition as a form of social exclusion that compromised their child’s future and independence. These day-to-day difficulties were also described as directly affecting the parents’ social life, constituting an important emotional and physical burden. When talking about their children, parents described the painfulness of their experiences, but also discussed how their autistic child had transformed and shaped their lives. Overall, these results show how the disease is “enacted” in the day-to-day life of parents; and suggest that such an embodied understanding of ASD may sometimes represent a form of re-appropriation of power by families faced with adversity.

Aim

Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes.

Method

We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post‐secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation.

Results

Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study.

Conclusions

Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.

Abstract Background

The objective of this article is to present an overview of the burden, spectrum of diseases, and risk factors for mental illness among subgroups of migrants, namely immigrants, refugees, and individuals with precarious legal status. This expert review summarizes some of the implications for primary care services in migrant receiving countries in the global North.

Methods

A broad literature review was conducted on the epidemiology of mental health disorder in migrants and refugee and on the available evidence on mental health services for this population focusing on key issues for primary care practitioners in high income countries.

Results

Although most migrants are resilient, migration is associated with an overrepresentation of mental disorder in specific subpopulations. There is general consensus that stress related disorders are more prevalent among refugee populations of all ages compared to the general population. Relative to refugees, migrants with precarious legal status may be at even higher risk for depression and anxiety disorders. Persistence and severity of psychiatric disorders among migrant populations can be attributed to a combination of factors, including severity of trauma exposures during the migration process. Exposure to stressors after resettlement, such as poverty and limited social support, also impact mental illness. Services for migrants are affected by restricted accessibility, and should address cultural and linguistic barriers and issues in the larger social environment that impact psychosocial functioning.

Conclusion

There is substantial burden of mental illness among some migrant populations. Primary care providers seeking to assist individuals need to be cognizant of language barriers and challenges of working with interpreters as well as sensitive to cultural and social contexts within the diagnosis and service delivery process. In addition, best practices in screening migrants and providing intervention services for mental disorders need to be sensitive to where individuals and families are in the resettlement trajectory.

In a time of mass displacement, countries across the globe are seeking to protect borders through coercive methods of deterrence such as immigration detention. In Canada, migrants—including children—may be detained in penal facilities having neither been charged nor convicted of crimes. In this paper we examine how we dealt with the series of ethical dilemmas that emerged while doing research in immigration detention centres in Canada. Using a critical ethnographic approach, we examine the process of our research in the field, seeking to understand what our emotional responses and those of the staff could tell us about detention itself, but also about what is at stake when researchers are faced with the suffering of participants in these spaces of confinement. The findings suggest that field work in immigration detention centres is an emotionally demanding process and that there were several pivotal moments in which our sense of moral and clinical obligations toward distressed detainees, especially children, were in conflict with our role as researchers. We also grapple with how the disciplinary gaze of the detention centre affects researchers entering the space. Given these tensions, we argue, spaces of critical reflection that can consider and contain the strongly evoked emotions are crucial, both for researchers, and perhaps more challengingly, for detention centre employees and gatekeepers as well.

Cet article présente l’analyse des résultats d’une étude commandée par le ministère de l’Immigration, de la Diversité et de l’Inclusion, portant sur les besoins et les enjeux entourant les demandes de terrains confessionnels pour les personnes de confession ou de culture musulmane au Québec. Il ne présente pas d’hypothèse scientifique en soi. Il propose d’abord de considérer les lieux de sépulture comme marqueurs de temporalité et d’intégration. Ensuite, les résultats démontrent un processus de négociation de la norme religieuse de la part des musulmans, entre autres, pour soutenir le deuil. Enfin, l’étude insiste sur l’urgence de considérer très sérieusement le sentiment d’islamophobie vécu et de traiter de l’enjeu des lieux de sépulture dans une optique de citoyenneté active et d’égalité.

La plupart des travaux de recherche sur les migrants queer et trans ciblent leurs expériences postmigratoires. Cet article fait en revanche suite à une étude doctorale qui comprend des entretiens avec les participants et une analyse de textes au contenu politique ou médiatique pour rendre les dimensions historiques, géopolitiques, sociales et économiques qui façonnent dans le monde non seulement la violence homophobe et transphobe, mais aussi les migrations de personnes queers et trans des pays du Sud vers le Canada. Ces réalités sont analysées sous le prisme de la colonialité et à l’échelle de l’empire, afin d’historiciser la manière dont les vies des migrants queer et trans sont façonnées par des histoires oubliées de violence coloniale. Cette étude laisse penser que l’hypervisibilité du traitement « généreux » du Canada vis-à-vis des réfugiés queer et trans occulte la manière dont le régime frontalier empêche les personnes provenant des pays du Sud d’entrer dans ce pays.

Background: The literature on trans youth has been dominated by etiological studies interested in trans experience as a medical phenomenon. An emerging body of literature has begun to document that trans youth are a diverse, vulnerable, yet resilient population, and to investigate the role of various sites of support such as the family, peer groups, institutions, and community spaces in contributing to or impeding trans youth’s well-being.

Method: This article presents the results of Stage One of interviews (n = 24) conducted for a Community-Based Participatory Action Research (CBPAR) qualitative research project based in Quebec. It studies the factors that enhance trans youth’s well-being as well as the factors of oppression that negatively affect it. This paper offers a brief overview of the anti-oppressive methodology used for this project, emphasizing how CBPAR was combined with Grounded Theory (GT) methods to encourage the direct involvement of communities and the translation of knowledge into action.

Results: We present preliminary categories emerging through the ongoing axial coding process. These categories address trans youth’s experiences in and perceptions of various “sites”: 1) healthcare services both for gender-related and general care, 2) other institutional spaces, 3) the family and other social circles, and 4) community spaces.

Conclusion: While much of this study’s results support existing evidence on trans youth’s experiences, they also provide a more nuanced portrayal of the complex ways in which recognition, as well as non-, mis-, or mal-recognition, influence trans youth’s well-being at different sites. We also argue that recognition itself must be considered through the lens of intersectionality.

Depuis quelque temps, on observe une prise de conscience publique concernant les enjeux que vivent les personnes trans migrantes et les jeunes trans, surtout au Québec. Néanmoins, il existe très peu de littérature sur le vécu des jeunes trans migrants et racisés.

Notre article vise à pallier cette lacune apparente dans les recherches francophones sur les personnes trans migrantes, en particulier chez les jeunes, en présentant les résultats préliminaires d’un projet de recherche-action participative communautaire visant à mieux comprendre les expériences des jeunes trans âgés de 15 à 25 ans vivant au Québec.

Le présent article discute des facteurs d’oppression ainsi que de certains privilèges, de même que de l’influence qu’ils ont sur l’expérience des jeunes trans migrants et racisés lorsqu’ils naviguent les normes de genre préétablies. L’article traite des manières dont des facteurs tels que l’identité de genre, la citoyenneté, la race et l’âge s’entrecroisent et interagissent, et ultimement influencent les transitions médicales, sociales et légales de ces jeunes. De plus, nous discutons des axes de différenciation sociale, ainsi que la manière dont ils façonnent les difficultés qui marquent le parcours de ces jeunes et qui empêchent parfois l’affirmation de leurs multiples identités. Nous reconnaissons également la force et la résilience chez les jeunes trans migrants et racisés ainsi que la manière dont ces jeunes réagissent aux oppressions multiples.

La force de cet ouvrage réside dans le souci de traiter des enjeux propres à la diversité ethnoculturelle en conjuguant les points de vue de plusieurs acteurs des milieux scolaire et périscolaire – élèves, étudiants, parents, enseignants, gestionnaires et interve­nants communautaires. Il brosse un portrait nuancé de la situation actuelle et ses auteures, spécialistes des questions de diversité, d’équité et d’inclusion, présentent des analyses documentées et solides sur les conditions mises en place pour favoriser l’épa­nouissement des élèves issus de l’immigration, dans la perspective fondamentale du vivre-ensemble. L’ouvrage met en lumière des aspects importants de ces enjeux : le vécu migratoire des jeunes, leur construction identitaire ; les relations entre les élèves, les enseignants, les parents et les inter­venants communautaires, ainsi que les perceptions de chaque groupe d’acteurs ; les approches pour promouvoir la réussite scolaire et consolider le sentiment d’appartenance. Il présente des pistes d’action pour améliorer ou transformer les pratiques, inspirer les politiques et contribuer à la formation de ceux et celles qui travaillent dans les écoles et auprès des familles.

Morocco has become a permanent transit country for tens of thousands of sub-Saharan migrants heading to Europe. Many of these migrants are women who have a precarious legal status and can no longer reach Europe, whose borders have been considerably securitized since September 11, 2001. They also have no wish to risk their lives again returning south across the Sahara Desert. This paper discusses the results of an exploratory research project conducted in Morocco on the relationships between the sub-Saharan migrant women’s traumatic experiences, social invisibility, and emotional distress in the context of a massive securitization of Euro-Mediterranean borders.

Stemming from a study with families of migrant & non-migrant backgrounds in Montréal on children’s stomach pains, this paper questions how ways of dealing with medical uncertainty has bearing on pathways to care. These pathways are enacted within and beyond the family space as well as in medical settings. While acknowledging that group practices call for nuance, non-migrant children lead a greater quest for legitimacy of their pain while most migrant families place stomach aches in the range of normality.

The hospital is a place of encounter between health care providers, patients and family members, the healthy and the suffering, migrants and non-migrants, as well as social and cultural minorities, and majorities of various backgrounds. It is also a space where multiple conceptions of care, life, quality of life, and death are enacted, sometimes inhibiting mutual understanding between caregivers and the cared for, a scenario that in turn may provoke conflict. Through the lens of conflict, we explore in this article the theme of Otherness within the clinic, basing analysis on an ethnographic study conducted in recent years in three cosmopolitan Canadian cities. Daily practices and—on a larger scale—the social space of the clinic become material here for reflecting on recognition (and non-recognition) of the Other as actors in the clinical encounter. The examination of structural and situational conditions that contribute to the emergence of conflict offers an understanding of the diversity of values that pervade the clinic. By way of conclusion, we argue that recognition of diversity, at least on the part of practitioners, is a key condition for the emergence of a pluralist normativity in the social space of the clinic.

Ce manuscrit propose une première description d’un travail clinique spécialisé au regard de la radicalisation menant à la violence au Canada. Une équipe clinique multidisciplinaire rattachée à un programme de santé mentale et de soins de première ligne à Montréal offre depuis juillet 2016 un service de consultation spécialisée pour soutenir des partenaires sur l’ensemble du territoire du Québec. Cet article décrit l’approche de l’équipe, l’organisation de l’offre de service et documente à travers des vignettes cliniques les principales catégories de problèmes sociaux et cliniques pour lesquels l’équipe fut sollicitée durant sa première année de fonctionnement. Nos observations préliminaires confirment la pertinence d’une évaluation pluridisciplinaire fondée sur une approche systémique du phénomène de la radicalisation violente, pour appréhender les différents facteurs sociaux, familiaux et individuels qui influencent les manifestations de ce phénomène, et déterminer la nature des interventions psychosociales et/ou psychiatriques pertinentes. La présentation des cas cliniques propose aux intervenants sociaux, communautaires et en santé mentale des pistes d’intervention et une compréhension du phénomène de radicalisation violente tel qu’il se présente dans les réseaux de la santé, de la protection de la jeunesse et de l’éducation au Québec.

This Working Paper examines the concept of the vulnerability of migrants which has become a key term in the UN’s negotiations for a Global Compact on Safe, Orderly and Regular Migration. The authors argue that the concept must be interpreted inclusively and related to the human rights obligations of states through the UN conventions. All too often migrants are vulnerable because of state action. States must ensure that they deliver on their human rights obligations in ways which reduce the vulnerability of migrants.

À partir du cadre théorique de la niche d’activité professionnelle et d’études effectuées au Québec, un portrait des pratiques et représentations du travail avec interprètes dans les soins est dressé. Ce portrait est d’abord fait pour les contextes non sensibles aux dimensions linguistiques et culturelles des soins. Il est ensuite dépeint plus en détail avec deux études menées en contextes sensibles. Cette comparaison permet de mettre en évidence les niveaux de contexte qu’il est nécessaire de prendre en compte pour l’intégration des interprètes dans les équipes de soins et pour établir une collaboration interprète-praticien de qualité : politique, institutionnelle (qui inclut les dimensions structurelle et collaborative), de formation et déontologique. Pour chacun d’eux, les conditions idéales pour établir une collaboration interprète-praticien-usager constructive sont décrites.

Résumé:

Pour combler ses besoins de main-d’œuvre peu qualifiée dans les secteurs saisonniers, le Canada embauche des travailleurs étrangers temporaires (TÉT). Dans le cadre d’une étude sur les enjeux de gestion de l’embauche des TÉT, des employeurs et des informateurs-clés ont été interrogés sur les motivations des entreprises à recourir aux TÉT. La principale motivation, contrairement à celle à laquelle on s’attendrait, n’est pas l’économie de coût. L’intérêt d’embaucher des TÉT repose sur des considérations de coûts-utilités, comme celle de bénéficier d’une main-d’œuvre disponible, efficace, loyale, et présente toute la saison, une souplesse permettant aux employeurs de réduire les risques et les incertitudes de production. Les employeurs accordent ainsi leurs préférences aux TÉT plutôt qu’aux travailleurs locaux. Les TÉT répondraient à toutes leurs attentes en matière de souplesse en ce qui a trait au nombre, aux horaires, à la rémunération et aux compétences.

Abstract:

To satisfy its need for seasonal low-skilled labourers, Canada is hiring temporary foreign workers (TFWs). As part of a study on the management issues related to the hiring of TFWs, employers and informants from related NGOs and governmental agencies were interviewed about their motivations to use TFWs. The primary motivation, unlike that which would be expected, is not cost savings. The interest in hiring TFWs would appear to be based on cost-utility considerations, including the benefit of an available, efficient, loyal workforce during the whole season and the flexibility for employers to reduce risk and uncertainties related to the availability of labour. Employers thus give preference to TFWs rather than local workers, because they meet the entirety of their expectations of workforce flexibility, be it numerically or in relation to scheduling, remuneration or skills.

Les exemples liés à l’utilisation de l’art comme moyen d’expression et de transformation foisonnent chez les autochtones. Toutefois, nous en connaissons peu sur ce qui se produit en termes de transformations via l’art et la créativité du point de vue de l’expérience des jeunes eux-mêmes. Cette étude, s’insérant dans un devis ethnographique, porte un regard phénoménologique sur un collectif de cirque (Artcirq) dans une communauté inuit et vise à mieux comprendre le vécu des jeunes qui y participent. Nos données de recherche incluent à la fois des entrevues avec les jeunes inuit impliqués dans Artcirq, des notes et observations de terrain et des entretiens complémentaires avec divers acteurs de la communauté. Nos analyses nous amènent à décrire trois dimensions centrales à l’expérience des jeunes, relativement à Artcirq comme espace : 1) où reconnaître et développer ses forces ; 2) où se lier et appartenir et 3) où vivre sa culture inuit et la transmettre. Les implications potentiellement thérapeutiques de tels espaces communautaires au service du mieux-être des jeunes inuit sont évoquées en discussion.

Cet article rapporte les constats d’une revue de la littérature et d’une consultation d’experts sur la santé de travailleurs cumulant des précarités : ceux embauchés par des agences de location de main-d’œuvre, les petites entreprises non syndiquées et les étrangers temporaires. On constate que : a) il est difficile de dresser un portrait de l’état de santé de ces travailleurs ; b) faute de pouvoir les distinguer au sein des entreprises, ils ne bénéficient d’aucune attention particulière ; c) ils sont souvent embauchés dans des secteurs non prioritaires, où la surveillance n’est pas assidue ; d) ils sont en marge des pratiques de SST parce qu’ils sont de passage dans les entreprises. Ces faits contribuent à les mettre à l’écart, alors qu’il serait possible d’adapter les pratiques préventives aux travailleurs cumulant des précarités en recadrant les obligations scientifiques, administratives, légales et morales de justice sociale des instances de santé et de sécurité au travail (SST).

Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners with crucial background information to improve their capacity to work efficiently and with maximum benefit. In this paper, we draw on experience implementing desk review guidance from the World Health Organization (WHO) and UNHCR, the United Nations Refugee Agency (2012) in four diverse humanitarian crises (earthquakes in Haiti and Nepal; forced displacement among Syrians and Congolese). We discuss critical parameters for the design and implementation of desk reviews, and discuss current challenges and future directions to improve mental health care and psychosocial support in humanitarian emergencies.

Concerns have arisen in recent decades about the impact of climate change on human mobility. Many people affected by climate change are forced or otherwise decide to migrate within or across international borders. Despite its clear importance, many questions remain open regarding the nature of the climate-migration nexus and its implications for laws and institutions. In the face of such uncertainty, this Research Handbook offers a comprehensive picture of laws and institutions relevant to climate migration and the multiple, often contradictory perspectives on the topic.

Carefully edited chapters by leading scholars in the field provide a cross section of the various debates on what laws do, can do and should do in relation to the impacts of climate change on migration. A first part analyses the relations between climate change and migration. A second part explores how existing laws and institutions address the climate-migration nexus. In the final part, the chapters discuss possible ways forward.

This timely Research Handbook provides much-needed insight into this complex issue for graduate and post-graduate students in climate change or migration law. It will also appeal to students and scholars in political science, international relations, environmental studies and migration studies, as well as policymakers and advocates

Cet article présente quelques réflexions critiques issues de la démarche inductive de deux projets de recherche impliquant des enfants. Ces projets portent sur les services publics en santé mentale jeunesse (SMJ), l’un avec des familles réfugiées et l’autre avec une population générale, tous deux intégrant le jeu et le dessin aux entretiens avec les enfants. Après avoir posé les bases critiques et inductives de la recherche « avec » les enfants, nous présentons quelques éléments de notre approche méthodologique. Cette dernière se situe entre les méthodes projectives de la clinique et les méthodes créatives de la recherche, en proposant un usage narratif, expressif et exploratoire de la projection. La démarche inductive de recherche est présentée à travers l’expérience de l’élaboration méthodologique et de la cueillette de données auprès des enfants. Six exemples sont tirés des projets pour illustrer nos questionnements autour de la directivité des entretiens et de leur exigence pour les enfants, de même que des interrogations autour du degré projectif impliqué, qui change le potentiel interprétatif en le rendant plus complexe, mais aussi plus riche. Nous concluons en proposant une conception créative de la projection en recherche comme un espace de jeu participatif. Cet espace de jeu est également envisagé comme contribuant à l’éthique de la recherche. Finalement, nous proposons, pour des recherches ultérieures, de faire participer les enfants à l’élaboration des méthodologies. Nous terminons en soulignant la pertinence d’une démarche inductive pour développer une réflexion critique en recherche.

This study of social representations about interpreted medical consultations examines the discourse of French language focus groups (FGs), conducted in Quebec, with 22 third year medical students (4 FGs), 29 family medicine residents (4 FGs) and 47 experienced family physicians (5 FGs). The audio-recorded FGs were transcribed. Each discussed two video vignettes of interpreted consultations. Statistical textual analysis showed that the students’ discourse patterns differed by FG. Residents prioritized access to the patient’s culture via the interpreter, though recognizing the need to respect the patient-physician relationship. Senior physicians organized their discourse differently for each vignette, associating it with a ‘standard’ response: for them, the two main issues were the quest for information, which we relate to the medical socialization process; and the interpreter’s stances, in terms of how s/he is perceived by physicians and the role(s) s/he is seen to play in the consultation. Physicians tend to represent the interpreter as a controllable ‘object’, not a full-fledged healthcare professional.

People who leave their country of origin, or the country of habitual residence, to establish themselves permanently in another country are usually referred to as migrants. Over half of all births in Montreal, Canada are to migrant women. To understand healthcare professionals’ attitudes towards migrants that could influence their delivery of care, our objective was to explore their perspectives of challenges newly-arrived migrant women from non-Western countries face when needing maternity care.

Method

In this qualitative multiple case study, we conducted face-to-face interviews with 63 health care professionals from four teaching hospitals in Montreal, known for providing maternity care to a high volume of migrant women. Interviews were transcribed and thematically analysed.

Results

Physicians, nurses, social workers, and therapists participated; 90% were female; and 17% were themselves migrants from non-Western countries. According to participants, newly-arrived migrant women face challenges at two levels: (a) direct care (e.g., understanding Canadian health care professionals’ expectations, communicating effectively with health care professionals), and (b) organizational (e.g., access to appropriate health care). Challenges women face are strongly influenced by the migrant woman’s background as well as social position (e.g., general education, health literacy, socio-cultural integration) and by how health care professionals balance women’s needs with perceived requirement to adhere to standard procedures and regulations.

Conclusions

Health care professionals across institutions agreed that maternity care-related challenges faced by newly-arrived migrant women often are complex in that they are simultaneously driven by conflicting values: those based on migrant women’s sociocultural backgrounds versus those related to the implementation of Canadian guidelines for maternity care in which consideration of migrant women’s particular needs are not priority.

For women living with HIV infection in India, stigma is a pervasive reality and the greatest barrier to accessing treatment, quality of life and survival. Defining stigma according to Goffman as a socially conceived abnormality, this paper then draws on Engel’s biopsychosocial model for chronic disease to show the pervasive nature of stigma as a continuum affecting all dimensions of life for married, monogamous Indian women with positive HIV sero-status.
Two distinct perspectives were identified in the literature: 1) Public: social and relational stigma, or 2) Private: internalised psychological stigma. Only four of the twenty published works reviewed noted interrelationships between these public and private spheres. Only one of those employed an ethnographic
methodology to understand stigma from the perspective of the women themselves.
While concepts associated with stigma among women living with HIV are diversely employed in research, by considering them as a whole through an intersectional biopsychosocial lens, this paper attempts to provide a basis for implementing integrated and tailored responses. Once the manifestations and interconnected causes of particular groups of HIV-positive women’s marginalisation are identified from their perspective, corresponding HIV-care programs and research activities can be designed. Such programs can be tailored with dual objectives: 1) to respond in a coordinated manner to the particular women’s own identified and prioritised daily needs across biomedical treatment and social and psychological support, and 2) to work to promote change in social constructions of stigma that form barriers to care.

In June 2012, the government of Canada severely restricted the scope of the Interim Federal Health Program that had hitherto provided coverage for the health care needs of refugee claimants. The Quebec government decided to supplement coverage via the provincial health program. Despite this, we hypothesized that refugee claimant children in Montreal would continue to experience significant difficulties in accessing basic health care.

(1) Report the narrative experiences of refugee claimant families who were denied health care services in Montreal following June 2012, (2) describe the predominant barriers to accessing health care services and understanding their impact using thematic analysis and (3) derive concrete recommendations for child health care providers to improve access to care for refugee claimant children.

Eleven parents recruited from two sites in Montreal participated in semi-structured interviews designed to elicit a narrative account of their experiences seeking health care. Interviews were recorded, transcribed, coded using NVivo software and subjected to thematic analysis.

Thematic analysis of the data revealed five themes concerning barriers to health care access: lack of continuous health coverage, health care administrators/providers’ lack of understanding of Interim Federal Health Program coverage, refusal of services or fees charged, refugee claimants’ lack of understanding about health care rights and services and language barriers, and four themes concerning the impact of denial of care episodes: potential for adverse health outcomes, psychological distress, financial burden and social stigma.

Conclusion

We propose eight action points for advocacy by Canadian paediatricians to improve access to health care for refugee claimant children in their communities and institutions.

L’article a pour objectif d’examiner l’impact du contexte national sur la mixité conjugale et plus spécifiquement sur les processus de transmission identitaire à travers une comparaison du contexte marocain et du contexte québécois. Il s’appuie sur des travaux ethnographiques qui se sont intéressés aux projets identitaires parentaux d’individus engagés dans des expériences de mixité conjugale. Une telle comparaison entre deux contextes très différents (le Québec étant une société laïque et d’immigration et le Maroc un pays musulman et d’émigration) fait ressortir les différences et les similitudes dans les processus de transmission identitaires des couples mixtes. L’effet du contexte ne concerne pas tant les projets identitaires en tant que tels que leur déploiement. Dans les deux pays, les familles mixtes vivent leur projet familial en non-conformité avec le modèle social majoritaire.

BACKGROUND:

Global trends in migration accompanied with recent changes to the immigrant selection process may have influenced the demographic and human capital characteristics of internationally educated nurses (IENs) in Canada and in turn the assistance required to facilitate their workforce integration. This study aimed to describe the demographic and human capital profile of IENs in Canada, to explore recent changes to the profile, and to identify predictors of IENs’ workforce integration.

METHODS:

A cross-sectional, descriptive, correlational survey design was used. Eligible IENs were immigrants, registered and employed as regulated nurses in Canada. Data were collected in 2014 via online and paper questionnaires. Descriptive statistics were used to examine the data by year of immigration. Logistic regression modeling was employed to identify predictors of IENs’ workforce integration measured as passing the licensure exam to acquire professional recertification and securing employment.

RESULTS:

The sample consisted of 2280 IENs, representative of all Canadian provincial jurisdictions. Since changes to the immigrant selection process in 2002, the IEN population in Canada has become more racially diverse with greater numbers emigrating from developing countries. Recent arrivals (after 2002) had high levels of human capital (knowledge, professional experience, language proficiency). Some, but not all, benefited from the formal and informal assistance available to facilitate their workforce integration. Professional experience and help studying significantly predicted if IENs passed the licensure exam on their first attempt. Bridging program participation and assistance from social networks in Canada were significant predictors if IENs had difficulty securing employment.

CONCLUSIONS:

Nurses will continue to migrate from a wide variety of countries throughout the world that have dissimilar nursing education and health systems. Thus, IENs are not a homogenous group, and a “one size fits all” model may not be effective for facilitating their professional recertification and employment in the destination country. Canada, as well as other countries, could consider using a case management approach to develop and tailor education and forms of assistance to meet the individual needs of IENs. Using technology to reach IENs who have not yet immigrated or have settled outside of urban centers are other potential strategies that may facilitate their timely entrance into the destination countries’ nursing workforce.

Researchers are beginning to document the experiences of lesbian, gay, bisexual and transgender (LGBT) forced migrants in settlement. However, studies exploring the perceptions of service providers working with this vulnerable population are limited. These may shed light on the challenges of meeting the needs of LGBT forced migrants, especially mental health issues and problems.

This qualitative study elicited the views of 22 Canadian service providers, including advocates, lawyers and mental health practitioners, who serve LGBT forced migrants. Grounded theory analysis revealed the following four themes: facilitating safety, buffering rejection; tracking avoidance patterns; interpreting mental health; and negotiating identity paradigms.

Participants’ accounts suggest that LGBT forced migrants may be best served by providers who understand the exigencies of establishing trust and safety for their clients; recognise their clients’ nuanced social support needs; facilitate the refugee claims process; grasp the complexity of their clients’ mental health challenges; and interrogate their own cultural biases regarding sexual orientations and gender identities.