Scientific Publications

OBJECTIVE:

The overall aim of this article is to examine the self-defined role of romantic relationships, intimacy and sexuality in recovery from severe mental illness.

METHOD:

Semistructured interviews were conducted with 35 people with severe mental illness, accompanied by participant observation. Data were analyzed using thematic analysis.

RESULTS:

The vast majority of participants considered a supportive relationship that was emotionally or sexually intimate to be a key facilitator and indicator of recovery. However, only a small minority of participants were actually in such a relationship. Participants reported numerous barriers to forming and maintaining such relationships such as financial strain and enduring stigma against people with mental illness.

Addressing relational and intimate needs have not been a focus of traditional psychiatric services. As such, some form of “supported dating” within the field of psychosocial rehabilitation may be an essential development to foster an oft-overlooked but important aspect of recovery

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.

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.

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.

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.

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.

This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS (r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8–17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4–6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0–7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3–19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented.

Highlights

This article maps the global governance processes on migration and assesses whether the human rights of migrants are effectively included and mainstreamed therein. It is argued that the lack of a comprehensive framework for migration governance and the insufficient focus on the human rights dimension in migration management have led to serious human rights violations in the treatment of migrants and asylum seekers, and to a lack of oversight and accountability when these violations occur. The article commences with an examination of the legal and normative framework related to the three areas that have been the main objects of global migration governance: the refugee regime, international labour standards and transnational criminal law regarding human trafficking. It goes on to explore the complex institutional framework of global migration governance and how it has been mostly informal, ad hoc, non-binding and State-led. The article concludes with a discussion on the future perspectives for a human rights-centred approach in global migration governance. It is contended that there is a need to bring the migration dialogue inside the United Nations, as it already plays a key role in international cooperation, with human rights as one of its pillars.

Since 2011, the war in Syria has resulted in mass displacement of its population both inside and outside the country. 

Although neighbouring countries have hosted most of the refugees, since the summer of 2015 a surge of Syrian citizens have crossed through Turkey into Greece, with the ultimate aim of reaching western Europe. Thousands of Syrians are being subjected to harsh natural and manmade obstacles on their journey, while receiving poor medical care along the way

AIMS:

This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.

METHODS:

We conducted a systematic literature search designed to capture clinical, social science and general literature examining the mental health of the Syrian population. The main medical, psychological and social sciences databases (e.g. Medline, PubMed, PsycInfo) were searched (until July 2015) in Arabic, English and French language sources. This search was supplemented with web-based searches in Arabic, English and French media, and in assessment reports and evaluations, by nongovernmental organisations, intergovernmental organisations and agencies of the United Nations. This search strategy should not be taken as a comprehensive review of all issues related to MHPSS of Syrians as some unpublished reports and evaluations were not reviewed.

RESULTS:

Conflict affected Syrians may experience a wide range of mental health problems including (1) exacerbations of pre-existing mental disorders; (2) new problems caused by conflict related violence, displacement and multiple losses; as well as (3) issues related to adaptation to the post-emergency context, for example living conditions in the countries of refuge. Some populations are particularly vulnerable such as men and women survivors of sexual or gender based violence, children who have experienced violence and exploitation and Syrians who are lesbian, gay, bisexual, transgender or intersex. Several factors influence access to MHPSS services including language barriers, stigma associated with seeking mental health care and the power dynamics of the helping relationship. Trust and collaboration can be maximised by ensuring a culturally safe environment, respectful of diversity and based on mutual respect, in which the perspectives of clients and their families can be carefully explored.

CONCLUSIONS:

Sociocultural knowledge and cultural competency can improve the design and delivery of interventions to promote mental health and psychosocial wellbeing of Syrians affected by armed conflict and displacement, both within Syria and in countries hosting refugees from Syria.

The current study aims to identify what newly arrived migrant women do, in the early months post-birth, to respond to abuse associated with pregnancy. Textual data from 59 migrant women were analyzed thematically to identify common responses to abuses. The most common response was to physically leave their countries of origin and move to Canada, or to move out of the shared dwelling. Other responses included taking legal action, remaining silent, reporting the abuse, seeking counseling, isolating themselves, and supporting anger management for the abuser. These results enhance our understanding of the decisions, including inaction, made by migrant women.

Background
Poverty is known as an important determinant of health, but empirical data are still missing on the relationships between poverty, other adverse living conditions, and psychological distress, particularly in low-income countries.

This study aimed to assess mental health needs and psychological distress among the poorest in rural settings in Burkina Faso where food security and access to water, electricity, schooling, and healthcare are limited.

Methods
We randomly selected 2000 individuals previously identified as indigents by a community-targeting process. Interviewers visited participants (n = 1652) in their homes and completed a questionnaire on mental health variables that included presence and intensity of anxious, depressive, psychotic, and aggressive symptoms, as well as level of psychological distress. Descriptive statistics, Spearman correlations, and logistic regressions were performed.

Results
In all, 40.2% of the sample reported 10 or more anxious/depressive symptoms in the past 30 days, and 25.5% reported having experienced at least one psychotic symptom over their lifetime, 65.6% of whom had had those symptoms for many years. The number of anxious and depressive symptoms was significantly associated with the level of psychological distress (r = 0.423, p < .001). Predictors of distress level included: poor health condition (F(1) = 23.743, p <. 001), being a woman (F(1) = 43.926, p < .001), not having any income (F(1) = 16.185, p < .001), having begged for food in the past 30 days (F(1) = 12.387, p < .001), being illiterate, and being older (F(1) = 21.487, p < .001). Approximately one third of respondents reporting anxious/depressive or psychotic symptoms (28.2 and 30.0%, respectively) had not talked about their symptoms to anyone in their social network.

Conclusions
These results suggest alarmingly high levels of psychological distress and reported symptoms among the poorest in rural settings in Burkina Faso, which can be explained by their difficult living conditions. However, these results must be interpreted from a transcultural perspective to avoid decontextualized misinterpretations. Ethnographic works are needed to document the larger context within which these distress results can be analyzed.

The objective of this study was to explore housing insecurity among women newcomers to Montreal, Canada. Semi-structured interviews were conducted with 26 newcomer women who had experienced housing insecurity and five women’s shelter service providers. The primary cause of housing insecurity for newcomer women was inadequate income in the face of rapidly rising housing costs, coupled with unfamiliarity with the dominant culture and the local housing system. Specific events often served as tipping points for immigrant women—incidents that forced women into less secure housing. To avoid absolute homelessness, most women stayed with family, couch surfed, used women’s or educational residences, shared a room or an apartment, lived in hotels, single rented rooms, or transitional housing. These arrangements were often problematic, as crowded conditions, financial dependency, differing expectations and interpersonal conflicts made for stressful or exploitive relationships, which sometimes ended abruptly. Only two of the 26 women interviewed described their current living situation as stable. Based on the findings on the study, we recommend training for housing and immigration service providers, wrap-around services in terms of health, housing and immigration settlement programs that take into account a broad range of immigration statuses and transitional housing that caters to the specific needs of migrant women.

La santé mondiale est un vaste champ de savoirs et d’interventions dont l’intérêt porte sur des grands enjeux comme les inégalités sociales transnationales qui affectent toutes les populations dans le monde. La constitution d’un savoir issu de pratiques comparatives entre groupes sociodémographiques est un moyen d’informer l’intervention destinée à ce qui est communément qualifié de communautés. Selon une certaine littérature, les disparités raciales et ethniques sanitaires sont un problème de santé mondiale. Malgré la controverse qui entoure l’usage de la catégorie de race, à laquelle sont souvent associées voire préférées celles d’ethnicité ou encore de culture, certains auteurs jugent que leur mobilisation comme cadre d’analyse reste pertinente pour discuter et rendre compte des iniquités sociales dans le monde. En d’autres mots, ces catégories permettraient d’identifier des groupes et des individus désavantagés sur le plan médico-sanitaire.

Objectifs

Cahier REALISME n°11 : L’équité en santé mondiale : qu’en est-il de la fabrique, de la circulation et des conséquences des stéréotypes sur les populations ? vise à discuter la manière dont ces trois catégories sont instrumentalisées par les pratiques sanitaires qui constituent, ensemble, comme cela avait déjà été proposé dans un autre contexte, un système d’opposition et de différence. En d’autres mots, la construction de cette forme de savoir relève de pratiques dans le champ sanitaire qui en viennent à reproduire, renforcer et donner un nouveau sens à la différence dans l’opposition. C’est un ensemble d’opérations qui aboutissent éventuellement à la constitution de stéréotypes à connotation raciale, ethnique voire culturelle.

Méthodes

Nos propos s’appuient sur deux recherches ayant été menées aux États-Unis et au Burkina Faso. La première a procédé à une déconstruction du discours de la santé publique américaine et plus précisément des pratiques et des représentations à propos de la catégorie de race. Elle la situe dans son contexte historique et politique. La seconde a observé la circulation de stéréotypes à propos de certaines populations locales au sein des discours de professionnels de santé au Burkina Faso. Elle a aussi permis de discuter des conséquences potentielles de ces stéréotypes sur une politique sanitaire.

Résultats

Plus globalement, dans ce commentaire, nous discutons des conséquences potentielles des stéréotypes sur la santé des populations visées et sur leurs conduites. Enfin, nous cherchons à dégager des moyens de sortir d’un discours qui a tendance à naturaliser la différence et à donner beaucoup de place à la question de la diversité tout en omettant, dans une certaine mesure, la question du racisme et des inégalités sociales et économiques partout présentes.

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15–24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross‐sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long‐term impacts on Inuit youth, as well as exposure to culturally meaningful activities.

Background and Purpose

Migrant-sensitive care provision has been identified as a priority in the World Health Assembly Resolution, ‘Health of Migrants’. Little research has been done on the extent to which migrant-sensitive (‘friendly’) maternity care (MFMC) is currently being provided, factors that support or inhibit provision of such care, and whether specific components of MFMC may be more important than others. We sought to determine: (1) to what extent recommended components of MFMC are being provided to recently-arrived international migrant women giving birth in an urban Canadian city; and (2) what contextual factors support the implementation of MFMC.

Methodology

We conducted a mixed quantitative-qualitative study of 2400 women recently giving birth, speaking any language, in Canada <8 years, and from non-Western countries; and 63 health professionals. Medical records and unit documents were reviewed. The Migrant Friendly Maternity Care Questionnaire was administered and open-ended interviews were completed.

Results

Women from over 97 countries, speaking any of 79 languages reported on their perceptions of how the health system responded to their needs including communication facilitation, promotion of social support, education for healthy weight, treatment of pre-pregnancy/perinatal/maternal illnesses, early access to prenatal care, and responsiveness to preferences for care, among other indicators of MFMC. A range of professionals reported on challenges to care provision and how these were met.

Conclusions and Discussion

Empirical data on migrant-sensitive maternity care, contextual factors supportive of that care, and associated reproductive health outcomes offer baseline data for programming and to permit benchmarking nationally and internationally.

Key messages

• Empirical data on migrant-sensitive maternity care offer baseline data for health programming

• Migrant-friendly maternity care data allow for benchmarking for the future

From 2011 until 2012, members of the Canadian parliament debated three iterations of legislation relating to the detention of asylum seekers. The final bill, unlike its predecessors, exempted children under the age of 16 from mandatory year-long detention, opening the door to children’s prolonged separation from parents or invisible detention as guests alongside mandatorily detained parents. Using a critical discourse analysis approach, we examine parliamentary debates and seek to determine how speech acts within the Canadian parliament construct a (detained) migrant child. Our results suggest that parliamentarians invoke logics of human rights and humanitarianism and that a reconfiguration of these paradigms places the state rather than the refugee in need of protection, thus introducing a hierarchy of compassion. Within this discourse, children are rendered so vulnerable as to be voiceless, enforcing the corollary image of the threatening adult refugee, which ultimately allows detention of children to be framed as a protective measure. We hypothesize mechanisms that make such constructions possible and discuss the implications for advocacy efforts.

OBJECTIVES: Study results on child maltreatment based on general population samples cannot be extrapolated with confidence to vulnerable immigrant or
refugee families because of the specific characteristics and needs of these families. The aims of this paper are 1) to conduct an evidence review of the
prevalence, risk factors and protective factors for child maltreatment in immigrant and refugee populations, and 2) to integrate the evidence in an analytical
ecosystemic framework that would guide future research.
METHODS: We used a 14-step process based on guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Canadian
Collaboration for Immigrant and Refugee Health. We searched major databases from “the oldest date available to July 2014”. The eligibility criteria for paper
selection included qualitative or quantitative methodologies; papers written in English or French; papers that describe, assess or review prevalence, risk and
protection factors for child maltreatment; and a studied population of immigrants or refugees.
SYNTHESIS: Twenty-four articles met the criteria for eligibility. The results do not provide evidence that immigrant or refugee children are at higher risk of
child maltreatment. However, recently settled immigrants and refugees experience specific risk factors related to their immigration status and to the
challenges of settlement in a new country, which may result in high risk of maltreatment.
CONCLUSION: Future research must incorporate more immigrant and refugee samples as well as examine, within an ecosystemic framework, the interaction
between migratory and cultural factors with regard to the prevalence, consequences and treatment of child maltreatment for the targeted groups.

International adoption is a relatively recent phenomenon and research in this field is emerging, particularly on issues of ethnic identity development and its implications for psychological adjustment and well-being. This article presents a critical review of the literature on ethnic identity in transracial adoptees as it relates to discrimination and psychological well-being. The review results show no clear evidence on the relation between a strong ethnic identity of origin, racial socialization efforts by parents and psychological adjustment in transracial adoptees. Studies investigating the effects of discrimination are too scarce to be conclusive. Results are discussed in light of future research and clinical recommendations

À l’adolescence, les enfants adoptés à l’international sont confrontés à un double défi identitaire : celui de l’adoption et celui de la négociation du statut minoritaire. S’ajoute à cette tâche complexe la possibilité que certains d’entre eux soient victimes de discrimination. Le but de la présente étude est de documenter les processus en jeu dans la négociation identitaire des adolescents adoptés à l’international en portant une attention particulière aux enjeux culturels et de discrimination. Des entrevues semi-structurées ont été menées auprès de 13 participants âgés entre 12 et 17 ans et adoptés de pays d’Asie. Une analyse par théorisation ancrée révèle l’existence d’une variation dans les stratégies identitaires bien que la majorité privilégie l’assimilation. Les expériences de discrimination poussent certains à surinvestir leur culture d’accueil au détriment de leurs origines ou, à l’inverse, rend impossible leur intégration. Les implications cliniques sont discutées en lien avec les bénéfices possibles de la socialisation culturelle.

The issue of irregular migration is experiencing heightened attention in political, social and legal arenas. While deterrence and crime-control discourse and practices dominate current approaches to irregular migration, this article seeks to focus on the problematic neglect of the treatment of irregular migrants in destination countries, in relation to their ability to access fundamental rights and basic public services. This article will put forth an argument for the establishment of firewalls – a separation between immigration enforcement activities and public service provision. This article will canvass existing trends and practices that have both contributed to the erosion of firewall protections, and have built and maintained meaningful firewalls between immigration and public service provision.

Children and parents seeking asylum are regularly detained in Canada, however little is known about the experiences of detained families. International literature suggests that the detention of children is associated with significant morbidity. Our study aims to understand the experiences of detained children and families who have sought asylum in Canada by using a qualitative methodology that includes semistructured interviews and ethnographic participant observation. Detention appears to be a frightening experience of deprivation that leaves children feeling criminalized and helpless. Family separation further shatters children’s sense of well-being. Children’s emotional and behavioral responses to separation and to detention suggest that the experience is acutely stressful and, in some cases, traumatic–even when detention is brief. Distress and impairment may persist months after release. Given the burden of psychological suffering and the harmful consequences of separating families, children should not be detained for immigration reasons and parents should not be detained without children.

While anthropologists have reflected on ethics and power since the late 1960s, the specific dilemmas that arise in research conducted with children and youth have scarcely been addressed. Nevertheless, critical anthropology’s reflections on power relations and reflexivity can valuably contribute to the interdisciplinary debate in the field of childhood studies, by complexifying categories of voice, dependency and agency, which are often taken for granted in the ethical conversation. Drawing on ethnographic fieldwork with undocumented youth in Montreal, this article argues for the importance of a critical understanding of childhood within a wider context of interdependence, and consequently, for a redefinition of ethics as a reflexive and relational space of intersubjectivity.

This article describes the development of a dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and public health, and mixed-method ethnographic research with practitioners, patients, and community members, contributed to the articulation of the NIM for HIV/STI risk reduction and prevention among married men living in low-income communities. The NIM involves a process of negotiation of patient narratives regarding their sexual health problems and related risk factors to facilitate risk reduction. The goal of the NIM is to facilitate cognitive-behavioral change through a three-stage process of co-construction (eliciting patient narrative), deconstruction (articulating discrepancies between current and desired narrative), and reconstruction (proposing alternative narratives that facilitate risk reduction). The NIM process extends the traditional clinical approach through the integration of biological, psychological, interpersonal, and cultural factors as depicted in the patient narrative. Our work demonstrates the use of a recursive integration of research and practice to address limitations of current evidence-based intervention approaches that fail to address the diversity of cultural constructions across populations and contexts.

Methods:

This two-year longitudinal prospective cohort study recruited patients with first-episode psychosis who were entering early intervention services in Montreal, Canada (N=223). Data on sociodemographic characteristics, symptoms, and social functioning were collected annually.

Results:

At two years, immigrants had more than three times the odds of attrition than nonimmigrants after the analysis controlled for potential confounding factors (first-generation immigrants: odds ratio [OR]=3.11, 95% confidence interval [CI]=1.01–9.57, p=.049); second-generation immigrants: OR=3.65, CI=1.07–12.50, p=.039). Medication adherence was similar among those who remained in the programs.

Conclusions:

During the two years after entering a program for first-episode psychosis, immigrants were more likely than nonimmigrants to disengage from treatment. Further research is warranted to understand this phenomenon and to improve the ability of services to engage immigrants with first-episode psychosis.

Research articles about unaccompanied refugee minors (UM) have rarely addressed ethical issues. This is remarkable, given UM’s specific, marginalized and vulnerable position within society, and the growing interest and developments in research ethics in refugee research. This article poses the question whether studies involving UM raise specific ethical issues compared to research on other refugee groups. We formulate personal reflections on ethical issues in a particular research project—a longitudinal study of UM in Belgium—and connect them to the existing body of literature on research ethics in qualitative and refugee research. We conclude that research ethics in studies with UM need to be multilayered because of researchers’ obligation to take ethical responsibility at both the micro and socio-political levels

China’s internal rural‐to‐urban migration has impacted the country in economic, social, and cultural terms. Despite the increasing number of families involved in migration, little is known about how migrant families as a unit adapt to new environments from rural to urban settings. Policy making needs to be informed to address migrant families’ needs. This article investigates how Chinese families experience transitions resulting from migration, exploring their use of formal and informal support to achieve adaptation and the process of making evolving choices for their children. We begin with a brief introduction to the literature on family resilience and its relation to Chinese migrant families. Then we provided an analysis of Chinese social policies most central to the experiences of rural‐to‐urban migrant families. After a brief description of methodology, we present our findings starting with a migrant family story to provide an anchor for the following discussion on how current policies can impede or facilitate migrant families’ resilience. Our conclusion is that lack of social support leaves migrant Chinese families vulnerable when coping with enormous social, cultural, and economic transformations. Family constitutes the basis of Chinese society; therefore, a policy framework on social support is important to support these families and foster family resilience.

Introduction