Famille et parentalité

Globally, the COVID-19 pandemic is causing extensive morbidity and mortality and is fueling psychological distress across populations. Early evidence has shown an increase in anxiety, depression and sleep problems in the general population.1
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Although pandemics shatter the functioning of communities and families globally, there is a paucity of studies targeting the effects of pandemics on youth mental health.
As mental health professionals, our fields have become aware of how the COVID-19 outbreak represents an extraordinarily stressful experience for youths, including how necessary public health measures may also threaten personal and collective meaning-making, and disrupt family dynamics and youths’ usual social environment. Because of the COVID-19−related school closures and social distancing measures, millions of children have been confined at home. Although families, communities, and schools have attempted to adapt, at times successfully, many children and youth have been deprived of structured support, trapped in dysfunctional family settings, and are relying largely on peer relations through the unsupervised use of social media.3
In the absence of much needed evidence, clinical experience and available evidence on stress-related disorders in emergency settings is provisionally informing clinical practice and defining the role of child mental health services during a pandemic. Although it is impossible and premature to address all aspects of pediatric mental health during the COVID-19 pandemic, it is important to begin conceptualizing what this pandemic has meant for our practice and where and how we can promote pediatric mental health during a global emergency that is not currently remitting.

• COVID-19 lockdown left parents as the sole respondents for their children’s needs.
• We examine parents’ reports on the response their child received to their needs during the lockdown.
• Parents of older children reported less fulfillment of children’s needs.
• Societies must ensure pandemics do not create context for child neglect.

L’adolescence est une période critique du développement, au cours de laquelle un trouble psychiatrique sur cinq apparaît. L’anxiété, la dépression et le suicide sont les plus courants. Cependant, la plupart des enfants et des jeunes qui ont besoin de services de santé mentale au Canada n’y ont pas accès. Il existe peu d’informations sur les programmes d’éducation et de soutien destinés aux parents d’adolescents pour promouvoir la santé mentale de leurs enfants, en particulier parmi les populations ethnoculturelles. De plus, la qualité des études axées sur ces programmes est variable. Une analyse de l’environnement a été menée pour identifier les programmes communautaires à travers le Canada visant à aider les parents d’adolescents dans la promotion de la santé mentale, ainsi que les défis et les domaines à améliorer de ces interventions. Parallèlement, un examen de la littérature internationale et canadienne sur ce sujet a été effectué. Ce résumé de recherche présente les résultats et les recommandations des deux études.

En 2019, 30 615 demandes d’asile ont été traitées au Québec, ce qui représente presque la moitié des demandes au Canada. Les familles avec des enfants de 0 à 5 ans représentent un pourcentage important de cette population. Le Canada ainsi que le Québec ont l’obligation de protéger les demandeurs d’asile et d’assurer que les politiques publiques soient favorables à la santé, surtout chez les enfants. Toutefois, certaines politiques publiques actuelles excluent les demandeurs d’asile et affectent négativement les familles. Ce commentaire vise à sensibiliser l’ensemble des acteurs impliqués dans l’élaboration des politiques publiques, surtout les décideurs politiques, sur des enjeux concernant trois domaines de politiques publiques qui contribuent à l’isolement social, à l’appauvrissement et à un accès réduit aux services de soins pour les familles demandeuses d’asile avec de jeunes enfants. Ceux-ci incluent la non-éligibilité aux allocations familiales, l’accès difficile aux garderies à prix abordables et les difficultés à obtenir des services d’un médecin de famille. En conséquence, les parents et les enfants subissent des impacts sur leur santé et leur bien-être. Nous demandons à nos gouvernements d’assumer leurs responsabilités et d’éliminer ces inégalités, et d’assurer que la santé des demandeurs d’asile soit prise en compte dans toutes les politiques.

Background
Migrant families’ transnational ties (i.e., connections to their countries of origin) may contribute to their hardships and/or may be a source of resiliency. A care approach that addresses these transnational ties may foster a positive identity and give coherence to experiences. We conducted an integrative review to determine what is known about transnational ties and the care of migrant families during pregnancy, postpartum and early childhood.

Methods
We searched 15 databases to identify literature reporting on a health or social program, service, or care experience of migrant families during pregnancy up to age five in a Western country (i.e., Canada, US, Australia, New Zealand or a European country). Information regarding if and how the service/program/care considered transnational ties, and care-providers’ perceptions of transnational ties, was extracted, analyzed and synthesized according to transnational ‘ways of belonging’ and ‘ways of being’.

Results
Over 34,000 records were screened; 69 articles were included. Care, programs and services examined included prenatal interventions (a mhealth app, courses, videos, and specialized antenatal care), doula support, maternity care, support groups, primary healthcare and psycho-social early intervention and early childhood programs. The results show that transnational ties in terms of ‘ways of belonging’ (cultural, religious and linguistic identity) are acknowledged and addressed in care, although important gaps remain. Regarding ‘ways of being’, including emotional, social, and economic ties with children and other family members, receipt of advice and support from family, and use of health services abroad, there is very little evidence that these are acknowledged and addressed by care-providers. Perceptions of ‘ways of belonging’ appear to be mixed, with some care-providers being open to and willing to adapt care to accommodate religious, cultural and linguistic differences, while others are not. How care-providers perceive the social, emotional and economic ties and/or the use of services back home, remains relatively unknown.

Conclusion
Significant knowledge gaps remain regarding care-providers’ perceptions of transnational ‘ways of being’ and whether and how they take them into account, which may affect their relationships with migrant families and/or the effectiveness of their interventions. Continued efforts are needed to ensure care is culturally safe for migrants.

The field of refugee family research and intervention forms a growing field of scientific study, focussing on the refugee family as the central niche of coping with, and giving meaning to, trauma, cultural uprooting, and exile. This important new book develops an understanding of the role of refugee family relationships in post-trauma healing and provides an in-depth analysis of central clinical-therapeutic themes in refugee family psychosocial interventions. Expert contributions from across transcultural psychiatry, psychology, psychotherapy and social work have provided chapters on post-trauma reconstruction in refugee family relationships, trauma care for refugee families, and intersectorial psychosocial interventions with refugee families. This exploration of refugee family systems in both research and clinical practice aims to promote a systemic perspective in health and social services working with families in refugee mental health care.

L’étude Réactions a pour but de comprendre de façon longitudinale l’expérience des enfants et adolescents d’âge scolaire de la pandémie de la COVID19 ainsi que ses effets sur eux-mêmes et leurs parents. Plus précisément, il s’agit de :1) Dresser un portrait des connaissances et de la compréhension des jeunes de  la pandémie de la COVID19; 2)Explorer les représentations des jeunes des conséquences positives et négatives des mesures de prévention et de protection imposées en réponse à la COVID19; 3) Identifier les facteurs qui contribuent et nuisent au bien-être des enfants, des adolescents et de leur parent en contexte de confinement et de déconfinement; 4) Décrire l’évolution du bien-être, du fonctionnement parental, du fonctionnement familial et du soutien social des familles du Québec au cours de la crise de la COVID19; 5) Générer des connaissances pouvant être mobilisées par les décideurs afin d’être mieux préparés pour soutenir les familles lors de prochaines situations de crise.

While there is increasing attention to the perspectives of people caught up in human trafficking – attention that has helped illuminate the cloudy nature of consent and agency in situations of human trafficking – the perspectives of children are relatively absent from the debate. Western notions of childhood downplay children’s agency and decision-making. In this chapter, the results of a study that explored the perspectives of over 50 West African children “rescued” by Nigeria’s NAPTIP, a governmental agency mandated to fight human trafficking and protect its victims, are shared. One theme that emerged strongly from the children’s narratives was the centrality of their quest for education, training, and other life opportunities as a factor that led them into situations of human trafficking, a situation likely to exist in other contexts as well. The children’s desire for education was often part of what led them away from home, kept them in their situations of trafficking, and made many of them unwilling to return home after being “rescued” by NAPTIP. These findings suggest a critical need to provide for children’s educational needs if we hope to combat child trafficking, as well as the need to provide meaningful alternatives to children we purport to “rescue.”

Il s’agit du résumé d’une étude mixte réalisée avec 43 enfants immigrés et réfugiés récemment installés au Québec dans le but de comprendre : 1) Comment les enfants s’adaptent à leur immigration : 2) Comment les enfants perçoivent leur immigration et quels en sont principaux enjeux selon leur point de vue.

Following the 6th Conference of the International Society for Child Indicators  Montreal, 2017), this Special Issue was compiled to advance an interdisciplinary understanding of the complexity of conceptualizations, determinants, consequences, and measurement of child neglect around the world and to highlight the need for reforms in child protection systems. The most common type of child maltreatment with long term damaging consequences for children, families, and societies child neglect continues to receive limited scientific and public attention, particularly in resource low settings and in the field of child indicators. Lack of clarity in definition and measures, weak multi-sectoral coordination, and unclear accountability lines, are among the factors that contribute to the insufficient attention to neglect in research and action. Adopting an eco-systemic perspective of child neglect allows us to incorporate the perspectives of families and to question the role and responsibility of the State and the broader conditions within which parents operate. Sound statistical and qualitative indicators of child wellbeing in cases of neglect are urgently needed across geographic areas and over time. Combining child-centredness and attention to socio-economic, cultural, and political context issues will be important in advancing the field.

Forced migration and extended time spent migrating may lead to prolonged marginalization and increased risk of HIV. We conducted a population-based cohort study to examine whether secondary migration status, where secondary migrants resided in a transition country prior to arrival in Ontario, Canada and primary migrants arrived directly from their country of birth, modified the relationship between refugee status and HIV. Unadjusted and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated using log-binomial regression. In sensitivity analysis, refugees with secondary migration were matched to the other three groups on country of birth, age and year of arrival (+/− 5 years) and analyzed using conditional logistic regression. Unmatched and matched models were adjusted for age and education. HIV prevalence among secondary and primary refugees and non-refugees was 1.47% (24/1629), 0.82% (112/13,640), 0.06% (7/11,571) and 0.04% (49/114,935), respectively. Secondary migration was a significant effect modifier (p-value = .02). Refugees with secondary migration were 68% more likely to have HIV than refugees with primary migration (PR = 1.68, 95% CI 1.06, 2.68; APR = 1.68, 95% 1.04, 2.71) with a stronger effect in the matched model. There was no difference among non-refugee immigrants. Secondary migration may amplify HIV risk among refugee but not non-refugee immigrant mothers.

L’école occupe une place centrale dans le développement du bienêtre psychologique des enfants traumatisés et endeuillés. Une recherche-action nous a permis d’évaluer positivement les retombées de la mise en place de groupes de parole dans les classes accueillant des élèves réfugiés.

International migration to North America continues to rise, and with it the meeting of different cultural norms surrounding child caregiving and supervision. Previous research shows that high rates of reporting of supervisory neglect involving migrant families may partly result from these different norms and challenges particular to the migrant context. In this study, five focus groups were conducted with migrant caregivers (n = 19) and children aged 12–17 years (n = 25) to explore their experiences surrounding caregiving changes in migration as well as factors that help and hinder child supervision in migrant communities in Montreal, Canada. Results following thematic analysis indicate that family roles change in migration, but that caregivers and children perceive these changes differently. Families perceive and experience discrimination and judgment of their parenting practices from community members and fear that those will be labelled neglectful. Change in families’ social support, especially at the neighbourhood level, has an important influence on caregiving practices. Results also show that parents’ preparation of children to provide care for siblings and others is often not recognised as a strength by service providers in direct contact with families. Directions for future research and implications for practice are discussed.

Background: Considering the growing number of asylum-seeking children worldwide, research
on interventions which may buffer the effects of early resettlement conditions on asylum-seeking
children’s adjustment is warranted. In Canada, creative expressive workshops for asylum-seeking
children and adolescents were implemented as a Psychological First Aid (PFA) intervention in
temporary shelters. The present exploratory study aims to describe the implementation of
these workshops to assess whether the intervention met core elements of PFA and explore its
potential in supporting the diverse needs of asylum-seeking youth in temporary shelters, adopting
a process-evaluation research approach.
Method: The intervention was evaluated via a qualitative thematic analysis of extensive field and
supervision notes and focus groups with facilitators.
Results: Preliminary results suggest that the intervention contributed to fostering emotional safety
and a sense of normalcy in children and supported the creation of connections among both children
and parents. Children’s expression of past and present experiences during the workshops was seen
as a way to promote self-efficacy in children and was reported as a potential way to provide some
comfort and hope in a time of high instability. However, the high needs of children and the lack of
resources in the temporary shelters represented significant challenges and barriers.
Conclusions: PFA using creative expression may be a promising youth mental health prevention
intervention in temporary shelters

• Opening up dialogue with children and youth can add to research and support participation.
• Young people’s advisory groups contribute a valuable ethical dimension to research practice.
• Institutional ethics requirements can create challenges for ethical practice with children and youth.
• Young people and adults may have differing expectations of the role and process of advisory groups.
• Virtual communications can facilitate dialogue, but have limitations in the Global South.

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

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

Pendant la transition à la parentalité, les pères sont confrontés à deux principaux défis, soit le développement de leur identité paternelle et de leur engagement paternel. Pour les pères immigrants, des défis particuliers s’ajoutent en termes de construction de leur identité paternelle, que l’on connaît encore peu.

Objectif. Cette comparaison des résultats de deux études qualitatives a pour objectif de décrire l’engagement paternel et le processus de construction de l’identité paternelle de pères originaires du Maghreb. Méthodologie. Les données ont été recueillies lors d’entretiens semi-dirigés auprès de six pères maghrébins de première génération immigrés au Québec et six pères maghrébins de deuxième génération résidant en Belgique.

Résultats. Les pères des deux groupes s’impliquent auprès de leur enfant et partagent des facteurs facilitants ou faisant obstacle à la construction de leur identité paternelle. Des recommandations pour la pratique clinique, pour la formation et pour la recherche sont formulées.

There is a gap in research regarding transnational family support (emotional, practical, spiritual, informational and financial) as a resource for migrant families with children. From the perspective of migrant families and their family back home, the objectives of this study are to (1) identify the types and ways that transnational family support is provided to migrant families in Canada; (2) assess for patterns in the data that may suggest variations in the nature of this support (eg, by migration status, time in Canada, children’s ages, family circumstances) and over time and (3) explore the impact (positive and negative) in receiving and providing transnational support, respectively.

Methods and analysis:
A focused ethnography is planned. We will recruit 25–35 migrant families with children with different migration histories (eg, economic or forced migration from a mix of countries) and family circumstances (eg, single parenthood, families living with extended family, families with children in the home country) living in Montreal, Canada. Families will be recruited through community organisations. Data will be gathered via semistructured interviews. To capture the
perspective of those providing support, family members in the home country for each migrant family will also be recruited and interviewed through communication technology (eg, WhatsApp). Data collection will also involve observation of ‘transnational interactions’ between family members in Montreal and those back home. Data will be
thematically analysed and results reported in a narrative form with an in-depth description of each theme.

Ethics and dissemination :
Ethical approval was obtained from the sciences and health research ethics committee at the University of Montreal. Study results will be shared through traditional forums (publication, conference presentations) and via other knowledge dissemination/ exchange activities (eg, ‘lunch and learn conferences’ and seminars) through the research team’s research centres and networks to reach front-line care-pro.

La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families.

Introduction Every year, up to 1 billion children are victims of violence worldwide. Most child abuse takes place in the context of punishment. The Families First Programme, an adaptation of the Positive Discipline in Everyday Parenting Programme to the West Java context, is a parenting support programme anchored on children’s rights that gives parents guidance on child development, parenting and positive discipline practices. This trial will evaluate the effectiveness of the Families First Programme compared with a waitlist control group.

Methods and analysis This is a pragmatic, parallel-group, stratified, cluster-randomised controlled trial. Twenty rural and urban villages in the Cianjur District, Indonesia, involving 720 caregivers of children up to 7 years of age, will be randomised. Villages will receive either a parenting programme consisting of 10 group sessions and four home visits over 3 months and standard community health and social services or just the latter. After completion of the trial period, the programme will be offered to those in the delayed group. Outcome data will be collected before randomisation (baseline), immediately postintervention (3 months postrandomisation) and 6 months later (9 months postrandomisation). The primary outcome will be frequency of physical and emotional punishment as measured by a weighted sum from three self-report items. Primary outcome analysis will use Poisson regression with generalised estimating equations and assess the interaction between intervention and time over baseline and 3 and 9 months postrandomisation assessments. Concurrent process evaluation will be conducted to assess programme satisfaction and facilitators and barriers to the implementation of the programme generalisable to other settings.

Ethics and dissemination Ethics approval was obtained from McGill University and Universitas Katolik Indonesia Atma Jaya. Results will be published in peer-reviewed journals and presented at scientific conferences and events for decision-makers, including in the participating communities.

Synthèse du symposium du 28 novembre 2018.

Introduction : La « démence » est généralement vue comme un syndrome caractérisé par le déclin d’une ou de plusieurs capacités cognitives, comme la perte de mémoire. Toutefois, perte de mémoire ne signifie pas pour autant démence. La plus fréquente des démences est la maladie d’Alzheimer dont la fréquence augmente avec le grand âge. En anthropologie de la santé, les maladies et leur expression représentent des construits socio-culturels qui ne sont pas reconnus et interprétés de la même façon par tout le monde. Par ailleurs, le contexte migratoire est source de difficultés dans le domaine de la démence. Cet article vise à discuter les liens entre vieillesse, démence et recherche d’aide dans ce contexte.
Méthode : Nous nous appuyons sur une étude qualitative exploratoire. Dix entrevues semi-structurées ont été réalisées avec des femmes et des hommes nés en Haïti et qui ont ensuite immigré au Québec. Ces entrevues nous ont permis de discuter du statut des aînés, du sens donné à la perte de mémoire et de la recherche d’aide.
Résultats : Les entrevues révèlent une pluralité des représentations à propos des pertes de mémoire et de la maladie d’Alzheimer. Elles mettent en lumière une diversité de croyances, d’attitudes et de valeurs traduisant une variabilité culturelle et sociale au sein d’une même communauté. La prise en compte du contexte permet de comprendre tantôt la transformation, tantôt la continuité des représentations et des conduites vis-à-vis des pertes de mémoire.
Conclusion : La démence ne semble pas être un phénomène qui est abordé facilement au sein de la communauté haïtienne du Québec. Au final, cette étude révèle un manque d’information à ce propos.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

Highlights