Foreword: Banking on mobility over a generation
Créeau, F. (2016)
Global Migration Governance: Avoiding Commitments on Human Rights, Yet Tracing a Course for Cooperation
Crépeau, F.; Atak, I. (2016)
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.
Facilitating Mobility and Fostering Diversity: Getting EU Migration Governance to Respect the Human Rights of Migrants
Crépeau, F,; Purkey, AL. (2016, mai)
Migration towards Europe has surged over the past few years, overwhelming government authorities at the national and EU levels, and fuelling a xenophobic, nationalist, populist discourse linking migrants to security threats. Despite positive advances in the courts and worthy national initiatives (such as Italy’s Operation Mare Nostrum), the EU’s governance of migration and borders has had disastrous effects on the human rights of migrants. These effects stem from the criminalisation of migrants, which pushes them towards more precarious migration routes, the widespread use of administrative detention and the processing of asylum claims under the Dublin system, and now the EU–Turkey agreement. Yet, this paper finds that with the right political leadership, the EU could adopt different policies in order to develop and implement a human rights-based approach to migration that would seek to reconcile security concerns with the human rights of migrants. Such an approach would enable member states to fully reap the rewards of a stable, cohesive, long-term migration plan that facilitates and governs mobility rather than restricts it at immense cost to the EU, the member states and individual migrants.
Les rumeurs du blâme en temps d’épidémie
Atlani-Duault, L,; Mercier, A,; Rousseau, C,; Guyot, P,; Moatti, J.P. (2016)
Aujourd’hui comme hier, dans la vie publique comme dans la vie privée, le mensonge et son contraire, la vérité, occupent une place ambivalente.
En politique, le rêve d’une société transparente a abouti au cauchemar totalitaire. Le mensonge est à première vue incompatible avec l’idéal démocratique, qu’il pervertit. Pourtant, il semble devenu inhérent à l’activité politique, même s’il est rendu plus difficile qu’avant avec les technologies nouvelles de communication qui, elles-mêmes, favorisent le succès des théories du complot.
Le mensonge et le secret sont associés parfois à des valeurs supérieures : ne faut-il pas accepter l’existence de secrets d’État, ou de secrets de familles, pour rendre possible le vivre ensemble ? Mensonges et secrets permettent aussi de résister à un pouvoir ou une domination, ménagent l’espace privé, toujours menacé d’intrusion.
Cet ouvrage offre une réflexion sur les conditions qui permettraient de renforcer la démocratie, le vivre ensemble en réduisant la part du mensonge (et celle du secret) à ce qui serait un strict minimum. Mais lequel ?
L’anthropologie et la clinique : épistémologies et pratiques
Fortin, S.; Dorval, G. (2016)
Building Intercultural Competences in Monocultural Organisations : Issues and Perspectives in Planning Rehabilitation Services in Montréal
CÔTÉ D.; GRATTON D.; DUBÉ J.; GRAVEL S. (2016)
L’équité en santé mondiale : qu’en est-il de la fabrique, de la circulation et des conséquences des stéréotypes sur les populations ?
Cloos, P.; Belaid, L. (2016)
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.
Collaborative youth mental health service users, immigration, poverty, and family environment
Nadeau, L.; Lecompte, V.; Johnson-Lafleur, J.; Pontbriand, A.; Rousseau, C. (2016)
Background
This article examines the association between immigration, poverty and family environment, and the emotional and behavioral problems reported by youth and their family receiving mental health (MH) services within a collaborative care model in a multiethnic neighborhood.
Method
Participants in this study were 140 parent–child dyads that are part of an ongoing longitudinal project looking at the association between individual, familial, social and organizational factors, and outcomes of youth receiving MH services in local health and social service organizations in the Montreal area. Measures included in this study were collected at the initial phase of the longitudinal project (Time 0). Parents completed a sociodemographic questionnaire and the Family Environment Scale (FES), and both parents and children completed the Strength and Difficulties questionnaire (SDQ).
Results
Results suggest that the family environment, especially family conflicts, has a significant role in the MH problems of children seeking help in collaborative MH services. In this specific population, results also show a trend, but not a statistically significant association, between poverty or immigration and emotional and behavioral problems. They suggest as well that boys show more MH problems, although this could be a contamination effect (parents’ perspective).
Conclusions
The results support the importance of interventions that not only target the child symptomatology but also address family dynamics, especially conflicts. Collaborative care models may be particularly well suited to allow for a coherent consideration of family environmental factors in youth mental health and to support primary care settings in addressing these issues.
Predictors of Unplanned Cesareans among Low‐Risk Migrant Women from Low‐and Middle‐Income Countries Living in Montreal, Canada
Merry, L.; Semenic, S.; Gyorkos, TW.; Fraser, W.; Gagnon, AJ. (2016)
Background
Research has yielded little understanding of factors associated with high cesarean rates among migrant women (i.e., women born abroad). The objective of this study was to identify medical, migration, social, and health service predictors of unplanned cesareans among low‐risk migrant women from low‐ and middle‐income countries (LMICs).
Methods
We used a case–control research design. The sampling frame included migrant women from LMICs living in Canada less than 8 years, who gave birth at one of three Montreal hospitals between March 2014 and January 2015. Data were collected from medical records and by interview‐administration of the Migrant‐Friendly Maternity Care Questionnaire. We performed multi‐variable logistic regression for low‐risk women (i.e., vertex, singleton, term pregnancies) who delivered vaginally (1,615 controls) and by unplanned cesarean indicated by failure to progress, fetal distress, or cephalopelvic disproportion (233 cases).
Results
Predictors of unplanned cesarean included being from sub‐Saharan Africa/Caribbean (OR 2.37 [95% CI 1.02–5.51]) and admission for delivery during early labor (OR 5.43 [95% CI 3.17–9.29]). Among women living in Canada less than 2 years predictors were having a humanitarian migration classification (OR 4.24 [95% CI 1.16–15.46]) and admission for delivery during early labor (OR 7.68 [95% CI 3.12–18.88]).
Conclusion
Migrant women from sub‐Saharan Africa/Caribbean and recently arrived migrant women with a humanitarian classification are at greater risk for unplanned cesareans compared with other low‐risk migrant women from LMICs after controlling for medical factors. Strategies to prevent cesareans should consider the circumstances of migrant women that may be contributing to the use of unplanned cesareans in this population.
Mental Health and Psychosocial Wellbeing of Syrians Affected by Armed Conflict
Hassan, G.; Ventevogel, P,; Jefee-Bahloul, H,; Barkil-Oteo, A.; Kirmayer, LJ. (2016)
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.
Accueillir les réfugiés: pratiques et politiques
L’arrivée des réfugiés syriens au Canada et au Québec a mis en évidence un enthousiasme certain au sein de la société hôte pour l’accueil des réfugiés et une multiplication d’initiatives citoyennes pour leur venir en aide. Mais alors qu’il y a eu une mobilisation sans précédent dans des communautés pour accueillir des réfugiés, nous devons […]
Des pictogrammes pour surmonter la barrière de la langue. Une étude de cas dans une ressource intermédiaire
Alvarez, J. (2016)
Lorsqu’on donne des soins et que la personne que l’on tente d’aider ne parle pas la même langue que nous, il est parfois difficile de comprendre l’autre et de se faire comprendre. Et si on pouvait utiliser des images pour s’aider? C’est le pari qu’a fait Juliana Alvarez, designer industrielle et cofondatrice d’IDE3S. Avec l’aide des professionnels de la santé et des services sociaux travaillant dans une ressource intermédiaire hébergeant des personnes âgées, elle a conçu une gamme d’outils visuels ayant pour but de faciliter la communication entre les intervenants et les personnes âgées allophones
Effects of Individual Immigrant Attitudes and Host Culture Attitudes on Doctor-Immigrant Patient Relationships and Communication in Canada
Whittal, A.; Rosenberg, E. (2015)
Introduction
In many countries doctors are seeing an increasing amount of immigrant patients. The communication and relationship between such groups often needs to be improved, with the crucial factor potentially being the basic attitudes (acculturation orientations) of the doctors and patients. This study therefore explores how acculturation orientations of Canadian doctors and immigrant patients impact the doctor-patient relationship.
Methods
N = 10 participants (five doctors, five patients) participated in acculturation orientation surveys, video recordings of a regular clinic visit, and semi structured interviews with each person. Acculturation orientations were calculated using the Euclidean distance method, video recordings were analyzed according to the Verona Coding System, and thematic analysis was used to analyze the interviews. Interviews were used to explain and interpret the behaviours observed in the video recordings.
Results
The combined acculturation orientations of each the doctor and immigrant patient played a role in the doctor-patient relationship, although different combinations than expected produced working relationships. Video recordings and interviews revealed that these particular immigrant patients were open to adapting to their new society, and that the doctors were generally accepting of the immigrants’ previous culture. This produced a common level of understanding from which the relationship could work effectively.
Conclusion
A good relationship and level of communication between doctors and immigrant patients may have its foundation in acculturation orientations, which may affect the quality of care, health behaviours and quality of life of the immigrant. The implications of these findings are more significant when considering effective interventions to improve the quality of doctor-patient relationships, which should have a solid foundational framework. Our research suggests that interventions based on understanding the influence of acculturation orientations could help create a basic level of understanding, and therefore improved interaction between doctors and immigrant patients.
Enhancing Social Support for Migrant Families: A Case Study of Community Services in a Shanghai Urban Village and Implications for Intervention
Wen, Y.; Hanley, J. (2015)
Recent years have witnessed the growing emphasis of the Chinese central government to develop community services as a method of building communities and strengthening social solidarity. With the increased involvement of multi‐generation households in China’s internal rural‐to‐urban migration, however, little is known about what community services are available for migrant families. Nor do we know much about how such services can enhance social support for migrants, which is crucial for their psychological well‐being in managing the ongoing challenges that arise from migration and further integration into cities. This article presents a case study conducted in Shanghai where social services are emerging in a few urban villages. We begin with a brief background on China’s rural‐to‐urban migration and the emergence of urban villages, followed by a discussion of community services and social support for Chinese migrant families. We then document existing services in an urban village to explore how they can influence migrant families’ social support. Drawing on the perspective of service providers, we highlight the effects social work interventions can have on improving social support for migrant families. Finally, we propose an intervention framework based on multi‐dimensions of social support, emphasizing an integration of formal and informal social support through community services for migrant populations.
Les travailleurs étrangers temporaires au Québec: le paradis, un peu plus loin
Villanueva, F.; Crespo-Villareal, D.; Bernstein, S.; Hanley, J.; Gravel, S.; Ostiguy, E. (2015)
Multilayered Ethics in Research Involving Unaccompanied Refugee Minors
Vervliet, M.; Rousseau, C.; Broekaert, E.; Derluyn, I. (2015)
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
Travailleurs immigrants et SST au Québec – État des connaissances statistiques et recension des sources de données
Prudhomme, P. ; Busque, M-A,; Duguay, P.; Côté, D. (2015)
Depuis plusieurs années la population immigrante est en forte croissance au Québec. L’augmentation de ce segment de la population modifie les caractéristiques de la main-d’œuvre, ce qui peut avoir des répercussions sur la santé et la sécurité du travail (SST). Dans ce contexte de diversité de la main-d’œuvre québécoise, il devient nécessaire de connaître les caractéristiques du travail des immigrants pouvant influencer les risques pour la SST. La présente étude vise à dresser un portrait de la main-d’œuvre immigrante en s’appuyant sur des études dont les analyses reposent sur des données statistiques et à répertorier les enquêtes populationnelles pouvant contribuer à documenter les caractéristiques du travail des immigrants et les risques pour leur santé et leur sécurité. Une meilleure connaissance de la littérature et du potentiel qu’offrent les bases de données issues d’enquêtes populationnelles contribuera à orienter l’exploitation des données statistiques pour le Québec afin d’alimenter les recherches et d’identifier les lacunes informationnelles en matière de SST concernant cette population de travailleurs.
Les résultats de la revue de la littérature ont été divisés en cinq grandes thématiques : le contexte et les caractéristiques de la population immigrante; les immigrants sur le marché du travail; les conditions de travail et d’emploi des immigrants; la santé et la sécurité du travail des immigrants; les résidents temporaires.
L’analyse du contexte de l’immigration et des caractéristiques sociodémographiques de cette population a permis de relever plusieurs différences avec les natifs du Canada. Ils forment, entre autres, une population plus jeune, présentent un rapport de masculinité plus élevé dans le cas des immigrants économiques, comptent une proportion de diplômés universitaires supérieure et affichent un état de santé général plus favorable à leur arrivée.
En ce qui concerne la situation des immigrants sur le marché du travail, les études constatent qu’ils ont une plus grande difficulté d’intégration sur le marché du travail que la population née au Canada. En plus de méconnaître le marché du travail canadien, leur expérience de travail, leurs titres de compétence ou leurs diplômes sont rarement reconnus. À ces facteurs pouvant expliquer les difficultés qu’éprouvent les immigrants, s’ajoutent aussi les barrières linguistiques et culturelles.
L’analyse des conditions de travail et d’emploi des immigrants a permis de relever que, pour certaines variables (formation, cumul d’emplois, taille d’entreprise, etc.), il existe peu ou pas de différences entre les immigrants et les personnes nées au Canada. Toutefois, les résultats peuvent fluctuer selon les variables considérées (durée de résidence, profession, secteur d’activité, etc.), la méthodologie choisie et la source de données utilisée.
Bien que les immigrants soient nombreux sur le marché du travail, peu d’études quantitatives se sont intéressées aux risques spécifiques auxquels ils doivent faire face. Ceci s’explique, entre autres, par le fait que les enquêtes nationales incluent rarement de l’information sur les lésions professionnelles et les conditions de travail et, lorsque c’est le cas, la taille de l’échantillon limite les analyses. La recherche bibliographique a tout de même permis de recenser quelques études sur le sujet. L’une d’elles (Smith et Mustard, 2010) montre que les immigrants sont davantage exposés aux risques pour la SST comparativement aux canadiens de naissance.
Par ailleurs, même en tenant compte dans les analyses du secteur d’activité économique, les relations se confirment.
La revue de la littérature portait également sur les immigrants temporaires. Bien que cette population soit difficile à estimer, les études indiquent une augmentation des effectifs depuis 2008. Parmi les études sélectionnées, aucune ne présentait de statistiques sur les immigrants temporaires et la SST. Toutefois, l’étude de Preibisch et Hennebry (2001) souligne que l’augmentation du nombre de travailleurs étrangers temporaires, en particulier ceux qui occupent des emplois peu spécialisés, pose certains défis au regard de la santé et la sécurité du travail.
L’inventaire des sources de données statistiques issues d’enquêtes populationnelles a permis d’évaluer leur potentiel d’analyse pour la population immigrante et les risques pour la SST. Au total, 12 bases de données ont été analysées au moyen de deux outils, soit la grille « travailleur, emploi et atteintes à la santé » et des fiches descriptives. Dans l’ensemble, les variables qui permettent de caractériser le travailleur sont très présentes dans les enquêtes. Par contre, si les variables liées à l’organisation du travail y figurent, elles portent davantage sur le temps de travail que sur les aspects psychosociaux. L’absence de données probantes sur la formation qu’ils reçoivent ou sur l’information en matière de prévention qu’on leur communique en milieu de travail constitue une limite de ces enquêtes. De plus, on constate d’importantes lacunes informationnelles pour les variables liées aux situations de travail. La littérature et les bases de données permettent de documenter les atteintes à la santé et leurs conséquences, mais la thématique plus pointue des atteintes liées au travail est souvent négligée.
Il ressort de la revue de littérature qu’il existe peu d’études statistiques qui ont exploité des données sur la santé et la sécurité des travailleurs immigrants. Par ailleurs, certaines variables clés comme la durée de résidence, la profession ou le secteur d’activité économique peuvent s’avérer utiles pour l’identification des groupes vulnérables. D’autre part, l’inventaire des sources de données statistiques montre clairement qu’aucune d’entre elles ne permet de brosser un portait complet des travailleurs immigrants et de la SST au Québec. Tenant compte des limites des bases de données, l’inventaire a fait ressortir la pertinence de certaines sources qui pourraient permettre de connaître ou de suivre la situation des immigrants sur le marché du travail, en lien avec certains aspects de la SST, ou de comparer celle-ci avec celle des natifs du Canada. Ainsi, le recours à plusieurs sources de données ou encore aux méthodes mixtes (qualitatives, quantitatives) pourrait servir à répondre à certaines questions de recherche sur cette thématique. Certaines recommandations sont d’ailleurs adressées aux organismes responsables de la collecte des données puisqu’ils déterminent le type et la disponibilité des informations concernant les immigrants et la SST.
A Model for Translating Ethnography and Theory into Culturally Constructed Clinical Practices
Nastasi, B.; Kaul, S, JJ. ;Schensul, SL. ; Mekki-Berrada, A.; Pelto, PJ.; Maitra, S.; Verma, R.; Saggurti, N. (2015)
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.
Towards a relational ethics: Rethinking ethics, agency and dependency in research with children and youth
Meloni, F.; Vanthuyne, K.; Rousseau, C. (2015)
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.
Changement climatique et droits de l’homme des migrants
Mayer, B.; Crépeau, F. (2015)
Évaluation du plan stratégique en matière de profilage racial et social
Rights, compassion and invisible children: A critical discourse analysis of the parliamentary debates on the mandatory detention of migrant children in Canada
Kronick, R.; Rousseau, C. (2015)
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.
Barriers to Accessing Health Care for Refugees, Government Policy and the Health Care Communities
Gruner, D.; Cleveland, J.; Demirdarche, L.; Pottie, K. (2015)
Migrant Friendly Maternity Care in a Western Urban Centre
Gagnon, A.; Pelaez, S.; Merry, L.; Amiri, A.; Hendricks, K. (2015)
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
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Empirical data on migrant-sensitive maternity care offer baseline data for health programming
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Migrant-friendly maternity care data allow for benchmarking for the future
UN Report : Recruitment practices and the human rights of migrants
Le défi des politiques migratoires: Entre compétitivité, sécurité, diversité et droits de l’homme
Crépeau, F. (2015)
Discrimination et double appartenance culturelle: la négociation identitaire des adolescents adoptés à l’international
Boivin, M.; Hassan, G.Ghayda Hassan (2015)
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.
Éthique clinique et interculturalité
Fortin, S. (2015)
C’est à cause de leur culture que certains patients ne suivent pas leur traitement
Fortin, S. (2015)
Les enjeux de la santé-sécurité du travail et les conditions de l’inclusion
CÔTÉ, D.; GRATTON, D.; GRAVEL, S.; DUBÉ, J. (2015)
À chaque année au Québec, un grand nombre de travailleurs reçoivent des indemnités après avoir subi une lésion professionnelle. Selon des estimations de la CSST, près de moitié des travailleurs touchés par une lésion professionnelle sur l’île de Montréal seraient issus de l’immigration. Bien que ces estimations ne tiennent pas compte du phénomène de la sous-déclaration qui touche particulièrement ce groupe, elles montrent une surreprésentation de ces travailleurs par rapport à son poids relatif dans la population montréalaise dans son ensemble. Ces travailleurs sont souvent concentrés dans des secteurs d’activité et dans des postes qui représentent de plus hauts risques en matière de santé-sécurité du travail (SST). Ils sont aussi sujets, dans le contexte de la restructuration actuelle de l’emploi, à de multiples formes de précarisation (voir Frozzini et Gratton, ce numéro). Ces travailleurs vivent plus souvent des contraintes liées au contexte de travail en plus des barrières linguistiques et culturelles qui peuvent rendre la relation thérapeutique plus difficile. À défaut d’un soutien organisationnel approprié ou adapté à la réalité des prises en charge dans les contextes de pluralité ethnoculturelle, nous découvrons que les intervenants accumulent sentiments d’échecs et d’incompétence, surcharge de travail et stress, ce qui met leur propre SST à risque. Cet article présente une réflexion sur les conditions d’inclusion dans le contexte de la réinsertion professionnelle en soutenant qu’il n’est pas possible de penser l’inclusion des personnes issues de l’immigration sans penser aussi aux conditions dont ont besoin
les intervenants, les ressources et les formes d’organisation nécessaires pour optimiser les prises en charge.
La santé mentale à l’école:«Apprivoiser la complexité!» Évaluation d’une formation-accompagnement
Papazian-Zohrabian, G.; Rousseau, C.; Roy, D.; Arauz, MJ.; Laurin-Lamothe, A. (2015)
Résumé Cet article présente l’évaluation en méthode mixte d’une formation-accompagnement en santé mentale à l’école, proposée aux enseignants, aux équipes-écoles et à leurs partenaires des Centres de santé et des services sociaux (CSSS). Les résultats démontrent que la formation a augmenté le sentiment de compétence des participants quant à leurs interventions, leur confort par rapport aux décisions partagées avec leurs partenaires et leur motivation face aux collaborations interdisciplinaires. Ces résultats suggèrent que cette formation peut améliorer l’arrimage entre les milieux de l’éducation et de la santé face aux problèmes de santé mentale des jeunes à l’école.
Experiences of Faith for Gender Role Non-Conforming Muslims in Resettlement: Preliminary Considerations for Social Work Practitioners
S. Kahn (2015)
For social workers striving for cultural competency and strength-based approaches with refugees resettled in the West, attention to the role of religion and faith as potential resources is particularly vital. With rising numbers of refugees fleeing from Islamic societies to Western host countries over the past two decades, social work research has articulated Islam as a source of strength and group solidarity, as well as the trigger for anti-Islam bias and discrimination. However, Muslims are not a monolithic group. This article reports on a qualitative study with fourteen Muslims seeking US asylum due to persecution based upon their gender role non-conforming behaviours.
Findings suggest that, for persons in this category, relationships to religion and faith may be complex, and potentially traumatic. Creating opportunities for gender role non-conforming refugees from Islamic societies to discuss religion and spirituality, with appropriate psychological support and without judgements from co-ethnic others or service providers, is an important clinical intervention for social workers to consider.
Vivre avec de multiples barrières. Le cas des personnes LGBTQ racisées
El-Hage, Habib; Ou Jin Lee, Ed (2015)
Comment ça se passe quand on est lesbienne, gai, bisexuel, transsexuel, queer (LGBTQ), mais aussi immigrant, réfugié, demandeur d’asile? Quelles sont les conséquences de cette double appartenance sur le parcours migratoire? Sur l’affirmation identitaire? Les services offerts à cette population prennent-ils en compte leur réalité?
Cette publication présente les résultats d’une recherche réalisée par Habib El-Hage, sociologue, et Edward Ou Jin Lee, candidat au doctorat en travail social, à l’Université McGill. Des personnes LGBTQ issues de l’immigration ont été rencontrées, ainsi que des intervenants sociaux et des gestionnaires d’organismes qui offrent des services à cette population.
Consultation publique de la Commission des relations avec le citoyen
2015. Présentation de Catherine Gail Montgomery à la consultation publique de la Commission des relations avec le citoyen, au sujet du document «Vers une nouvelle politique québécoise en matière d’immigration, de diversité et d’inclusion» Consulter >>
Consultation publique de la Commission des relations avec le citoyen
2015. Présentation de Cécile Rousseau, Spyridoula Xenocostas et de Ghayda Hassan à la consultation publique de la Commission des relations avec le citoyen, au sujet du document «Vers une nouvelle politique québécoise en matière d’immigration, de diversité et d’inclusion». Consulter >>
Intervenir face à la traite humaine: La concertation des services aux victimes au Canada
Encouraging understanding or increasing prejudices: A cross-sectional survey of institutional influence on health personnel attitudes about refugee claimants’ access to health care
Rousseau, C.; Oulhote, Y.; Ruiz-Casares, M.; Cleveland, J.; Greenaway, C. (2014)
Background
This paper investigates the personal, professional and institutional predictors of health institution personnel’s attitudes regarding access to healthcare for refugee claimants in Canada.
Methods
In Montreal, the staff of five hospitals and two primary care centres (n = 1772) completed an online questionnaire documenting demographics, occupation, exposure to refugee claimant patients, and attitudes regarding healthcare access for refugee claimants. We used structural equations modeling to investigate the associations between professional and institutional factors with latent functions of positive and negative attitudes toward refugee’s access to healthcare.
Results
Younger participants, social workers, participants from primary care centres, and from 1st migrant generation had the lowest scores of negative attitudes. Respondents who experienced contact with refugees had lower scores of negative attitudes (B = -14% standard deviation [SD]; 95% CI: -24, -4%). However, direct contact with refugees increased scores of negative attitudes in the institution with the most negative attitudes by 36% SD (95% CI: 1, 71%).
Interpretation
Findings suggest that institutions influence individuals’ attitudes about refugee claimants’ access to health care and that, in an institutional context of negative attitudes, contact with refugees may further confirm negative perceptions about this vulnerable group.
Implementation Science
Gil. K et al. (2014)
Background: Substance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada,issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2). Methods/Design: Phase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence.
Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health.Discussion: Findings from this research program will contribute to the understanding of factors associated with implementation of frontline sevices for substance dependence and help to inform future policy and organizational support for the implementation of evidence-based practices.
Les coûts liés à l’embauche des travailleurs étrangers temporaires dans les secteurs saisonniers au Québec: regard sur le point de vue des employeurs
Gravel, S., Bernstein, S., Hanley, J., Villanueva, F. & Crespo-Villareal, D. (2014)
L’embauche des travailleurs étrangers temporaires (TET) a des impacts sur la cohabitation résidentielle et sur la cohabitation des métiers dans lescommunautés rurales. Cette étude repose sur le discours des chefsd’entreprises (n=17) et d’informateurs-clés (n=23) des secteurs agricole,horticole et de l’aménagement paysager au Québec. Ce type d’embauche aincité différents acteurs à reconsidérer leurs pratiques de gestion pour recréerun équilibre dans des petites communautés déstabilisées par l’apportdémographique saisonnier entraîné par l’arrivée des TET. De l’analyse dediscours a émergé un modèle de gestion de la diversité qui rend compte desdéfis de cohabitation pour les employeurs et les TET.
Cultural competence and Canada’s security: Can being culturally competent assist police and security officers in ensuring Canada’s security?
Myrna Lashley; Ghayda Hassan; Sadeq Rahimi; Sara Thompson; Michael Chartrand; Serge Touzin; Raissa Graumans; Atif Akhtarh (2014)
Health Workers’ Perceptions of Access to Care for Children and Pregnant Women With Precarious Immigration Status: Health as a Right or a Privilege?
Vanthuyne, K.; Meloni, F.; Ruiz-Casares, M.; Rousseau, C.; Ricard-Guay, A. (2013)
The Canadian government’s recent cuts to healthcare coverage for refugee claimants has rekindled the debate in Canada about what medical services should be provided to individuals with precarious immigration status, and who should pay for these services. This article further explores this debate, focussing on the perceptions of healthcare workers in Montreal, a large multiethnic Canadian city. In April–June 2010, an online survey was conducted to assess how clinicians, administrators, and support staff in Montreal contend with the ethical and professional dilemmas raised by the issue of access to healthcare services for pregnant women and children who are partially or completely uninsured. Drawing on qualitative analysis of answers (n = 237) to three open-ended survey questions, we identify the discursive frameworks that our respondents mobilized when arguing for, or against, universal access to healthcare for uninsured patients. In doing so, we highlight how their positions relate to their self-evaluations of Canada’s socioeconomic situation, as well as their ideological representations of, and sense of social connection to, precarious status immigrants. Interestingly, while abstract values lead some healthcare workers to perceive uninsured immigrants as “deserving” of universal access to healthcare, negative perceptions of these migrants, coupled with pragmatic considerations, pushed most workers to view the uninsured as “underserving” of free care. For a majority of our respondents, the right to healthcare of precarious status immigrants has become a “privilege”, that as taxpayers, they are increasingly less willing to contribute to. We conclude by arguing for a reconsideration of access to healthcare as a right, and offer recommendations to move in this direction.
Consultation to Remote and Indigenous Communities
Cotton, M-E.; Nadeau, L.; Kirmayer, L. (2013)
Most models of mental health services have been developed in urban centres, with large populations and many specialized resources. Rural and remote communities pose challenges to these models for reasons of geography, social structure and culture. In Canada and other countries, rural and remote communities include a high proportion of Indigenous peoples, with important cultural differences from the urban population. In this chapter, we discuss the role of cultural consultation in providing mental health services for remote and rural communities, with an emphasis on the mental health of Indigenous peoples in Canada. The authors have worked as psychiatric consultants to First Nations and Inuit communities in Northern Quebec and draw from this experience and the work of the CCS to outline key issues for cultural consultation in this setting. The major social determinants of health and contextual factors that are distinctive for remote communities and Indigenous populations are reviewed. Models of service discussed include: onsite delivery of mental health services through collaborative care models; itinerant consultants; telepsychiatry; and satellite services. Mental health services for Indigenous communities need to be provided in culturally appropriate ways, both through supporting the use of traditional healing approaches and ensuring that mainstream mental health services are culturally safe and competent.
Addressing Cultural Diversity Through Collaborative Care
Nadeau, L.; Rousseau, C.; Measham, T. (2013)
This chapter describes principles of collaborative care in mental health and how this model, based on strong partnership between primary care and mental health professionals, can be adapted to provide culturally sensitive services. The patient-centred model of collaborative care aims at decreasing barriers to accessing mental health care, which are particularly tangible for ethnocultural minorities and marginalized groups. It recognizes the major role played by primary care professionals in delivering mental health services and the benefit of comprehensive networks of professionals and community partners. The chapter discusses necessary conditions for implementing such initiatives, describes the benefits of multidisciplinarity, which goes beyond a medically centred model, and addresses issues of power. It then considers the adaptation of collaborative care to address the cultural specificities of communities. It reviews the recommendations of the Canadian Collaborative Mental Health Initiative (CCMHI) Toolkit for Ethnoculturally Diverse Populations and of the Canadian Collaboration for Immigrant and Refugee Health (CCIRH), and then focuses on two key areas identified by these recommendations: partnership with communities and awareness of historical and cultural specificities. The chapter then describes a youth mental health care project in a multiethnic neighbourhood to illustrate how collaborative care can be adapted to local constraints, while fostering attention to cultural diversity in mental health. Finally, the chapter addresses training methods appropriate to support collaborative care and proposes a continuing education program based on the synergy of seminars, supervisions, and didactic teaching.
Gender, Power and Ethnicity in Cultural Consultation
Guzder, J.; Santhanam-Martin, R.; Rousseau, C. (2013)
Issues of gender, ethnicity, power and position not only influence the identity and social suffering of the patient, but shape the clinical encounter influencing therapeutic alliance, transference, countertransference and the process of assessment and treatment. This chapter uses case material from the work of South Asian cultural consultants to illustrate how the identity of the consultant influences clinical encounters with patients from the Indian subcontinent, with particular attention to gender and power issues. The cultural or racial similarities or differences in the identity of consultant and patient, or referring clinicians, raise complex issues encompassing institutional, familial, and individual dynamics. These issues may have positive effects on the clinical alliance, or create excessive ambivalence and negative responses that undermine therapeutic work. Mirroring of gender and power attributes can position the therapist as someone who shares vulnerabilities and strengths with minority patients. This can cause impediments to clinical work, with resistance, scotomas or excessive identifications. The intrapsychic, intra-familial and socio-political implications are explored using a case examples as well as reference to current literature on gender, migration and identity. As the cultural consultation strives to promote cultural safety as the primary basis of engagement, therapist and patient identity issues must be acknowledged and conflicting agendas of gender, power, ethnicity, as well as cultural dissonance and prejudice must be negotiated by consultants and clinical teams.
Development and Evaluation of the Cultural Consultation Service
Kirmayer, L.; Groleau, D.; Rousseau, C. (2013)
In this chapter, we describe the development, implementation and evaluation of the cultural consultation service (CCS). We begin with some background on the development of intercultural services in Montreal. The next section describes the rationale for the CCS approach and the steps involved in setting up the service. The third section provides an overview of the cases seen by the service in the first decade of its operation, including sources and reasons for referral, as well as socio-demographic and clinical characteristics. This provides a sense of the portfolio of cases from which vignettes are drawn throughout this book to illustrate key issues in cultural consultation. The remaining sections summarize findings from qualitative process and outcome evaluations of the service. The analysis of cases seen in the CCS and transcultural clinics indicates that access to mental health care varies widely by linguistic and cultural background. In a significant number of cases, language barriers and the cultural complexity of the cases had prevented adequate assessment in conventional mental health care settings. The CCS was able to provide clinical reassessment and redirection of treatment in a substantial proportion of cases and these interventions have been well received by referring clinicians. Although cultural consultations require substantial resources, in terms of specific expertise in cultural psychiatry as well as interpreters and culture brokers, the result of this intensive process is often a change in diagnosis and treatment plan with significant immediate and long-term consequences for patients’ functioning, use of services, as well as clinician satisfaction.
The Place of Culture in Mental Health Services
Kirmayer, L.; Guzder, J.; Rousseau, C. (2013)
Cultural diversity presents an important challenge for health care services in every society around the world. In this introductory chapter, we consider the changing meanings of culture and the ways in which different societies have responded to cultural diversity in mental health services. We show how these approaches reflect local patterns of migration and demography, ideologies of citizenship and theories of the place of culture in mental health. We outline the rationale and key principles of the cultural consultation approach: focusing on social and cultural contexts in assessment; recognizing the ubiquity of culture in the experience of patients and clinicians; understanding culture not simply as mental representations but as embodied and enacted; using systemic, interactional and self-reflexive views; emphasizing problems of power, position and communication; approaching culture and community as resources for healing, adaptation and recovery; and working within health care systems to foster change. We illustrate what culture adds to clinical care including diagnostic assessment and treatment through the contextual framing of psychiatric disorders. Social and cultural processes shape the mechanisms of disease, the symptoms of distress, and subsequent ways of coping or help-seeking. Systems of healing reflect cultural models of body, self and person that are grounded in distinctive ontologies or notions of what constitutes the individual and the world. Finally, we consider the importance of understanding culture and context for clinical empathy.
Cultural consultation. Encountering the Other in Mental Health Care
Kirmayer, L.; Guzder, J.; Rousseau, C. (2013)
Cultural diversity is a global challenge for mental health services. The changing demography of communities requires rethinking approaches to cultural competence for health professionals and institutions. Cultural consultation is a way to improve the quality of mental health care by providing a nuanced understanding of the predicaments that prompt diverse clients to seek help, and the social contexts of their mental health problems, to guide clinical assessment and intervention.
Cultural Consultation explores the practice of cultural consultation as a strategy to improve the quality of mental health care for diverse populations. The contributors, who have worked together at an innovative clinical service, frame best practices in psychiatry clinical psychology, and social work in relation to empathy, human rights, and culturally responsive and ethically sound care. A detailed model of the process of cultural consultation, from initial intake, through assessment, to recommendations and referrals, provides guidelines for clinical practice. Expert contributors examine specialized settings (medical, psychiatric emergency, inpatient, social/legal services), populations (remote, indigenous, child and youth), and contextual issues in the care of people with a wide range of mental health problems. Numerous case examples, charts, and tools add depth for readers interested in developing similar services or enhancing existing practice. Among the key areas covered:
- Working with interpreters and culture brokers.
- Family systems in cultural consultation.
- Gender, power, and ethnicity in cultural consultation.
- Consultation and mediation with racialized and marginalized communities.
- Cultural consultation with refugees.
Collaborative care and primary care consultation.
A unique guide to challenges and opportunities in contemporary practice, Cultural Consultation will be immediately useful for health care professionals, clinical psychologists, and cultural consultants and provide a versatile knowledge source for years to come.
Language barriers in mental health care: A survey of primary care practitioners
Brisset, C.; Leanza, Y.; Rosenberg, E.; Vissandjée, B.; Kirmayer, L.; J Muckle, G.; Xenocostas, S.; Laforce, H. (2013)
Many migrants do not speak the official language of their host country. This linguistic gap has been found to be an important contributor to disparities in access to services and health outcomes. This study examined primary care mental health practitioners’ experiences with linguistic diversity. 113 practitioners in Montreal completed a self-report survey assessing their experiences working with allophones. About 40 % of practitioners frequently encountered difficulties working in mental health with allophone clients. Few resources were available, and calling on an interpreter was the most common practice. Interpreters were expected to play many roles, which went beyond basic language translation. There is a clear need for training of practitioners on how to work with different types of interpreters. Training should highlight the benefits and limitations of the different roles that interpreters can play in health care delivery and the differences in communication dynamics with each role.
Occupational Health and Safety in Small Businesses in Urban Areas: the Non-participation of Immigrant Workers
Gravel, S.; Rhéaume, J.; Legendre, G. (2013)
An analysis of worker participation was carried out as part of a larger study on strategies for managing occupational safety and health in small businesses that hire immigrant workers. This analysis was based on the triangulation of three data sources: interviews with those who answered the questions on behalf of the small business owners or managers (n = 28); occupational health professionals who gave advice to the same small businesses (n = 26); and questionnaires completed by the immigrant workers (self-administered, n = 181). The results converged in that immigrant workers, compared to workers of Canadian origin, received less initial training when hired and were less able to identify risks. Immigrant workers informed their employer less often when they were injured and participated less in investigations following an accident. Many did not have protective equipment and, where the employer did provide it, they were less inclined to wear it. Generally, insufficient effort was made by small businesses to protect or inform immigrant workers of their rights and obligations, or to integrate them into the workplace. The study shows that it would be useful if company directors provided support to manage the occupational safety and health of immigrant workers and compliance with regulations, as well as endeavouring to understand the issues underlying equal labour and management representation in occupational safety and health.