Article scientifique

Objectives :Violence committed by extremists has serious violent and non-violent public health consequences. Researchers have hypothesized an association between experiencing discrimination and support for radicalization. This study examines the relationship between perceived discrimination and support for violent extremism among youth and young adults in Belgium.

Methods:  A total of 2037 young adults between the ages of 16 and 30 participated in the study. We used multivariate linear regression to determine the association between sociodemographic characteristics, experiences of perceived discrimination, and scores on the Radical Intention Scale (RIS).

Results:  Sex, religion, generation status, and language were associated with experiencing discrimination. Sex and language were associated with scores on the RIS. Discrimination based on language and political views was independently associated with scores on the RIS. Discrimination experienced during interactions with the police/justice system was also associated with RIS scores.

Conclusions : Public health primary prevention programs and policies that target the relationship between discrimination and sympathy for violent radicalization need to be situated on micro- to macro-levels. Of primary importance is the development of partnerships between stakeholders in public health, legal, political, and educational sectors to develop strategies to diminish discrimination and promote positive civic engagement among youth.

Precarious status migrants are a group of persons who are vulnerable, heterogeneous, and often suspicious of research teams. They are underrepresented in population-based research projects, and strategies to recruit them are described exclusively in terms of a single cultural group. We analyzed the recruitment strategies implemented during a research project aimed at understanding precarious status migrants’ health status and healthcare access in Montreal, Canada. The research sample consisted of 854 persons recruited from a variety of ethnocultural communities between June 2016 and September 2017. This article analyzes the strategies implemented by the research team to respond to the challenges of that recruitment, and assess the effectiveness of those strategies. Based on the results, we share the lessons learned with a view to increasing precarious status migrants’ representation in research.

A mixed sequential design was used to combine qualitative data gathered from members of the research team at a reflexive workshop (n = 16) and in individual interviews (n = 15) with qualitative and quantitative data collected using the conceptual mapping method (n = 10).

The research team encountered challenges in implementing the strategies, related to the identification of the target population, the establishment of community partnerships, and suspicion on the part of the individuals approached. The combination of a venue-based sampling method, a communications strategy, and the snowball sampling method was key to the recruitment. Linking people with resources that could help them was useful in obtaining their effective and non-instrumental participation in the study. Creating a diverse and multicultural team helped build trust with participants. However, the strategy of matching the ethnocultural identity of the interviewer with that of the respondent was not systematically effective.

The interviewers’ experience and their understanding of the issue are important factors to take into consideration in future research. More over, the development of a community resource guide tailored to the needs of participants should be major components of any research project targeting migrants. Finally, strategies should be implemented as the result of a continuous reflexive process among all members of the research team.

OBJECTIVE:

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

METHOD:

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

RESULTS:

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

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

Purpose

This paper presents an analysis of how health intersects with the experience of housing insecurity and homelessness, specifically for migrant women. The authors argue that it is important to understand the specificities of the interplay of these different factors to continue the advancement of our understanding and practice as advocates for health and housing security.

Design/methodology/approach

An exploratory, qualitative, methodological approach was adopted, using a broad definition of housing insecurity: from absolute homelessness (e.g. residing rough) to invisible homelessness (e.g. couch surfing) to those at risk of homelessness. In total, 26 newcomer (foreign-born women who came to live in Canada during the previous ten years, regardless of their immigration status) women were recruited in Montreal, Canada. Participants were recruited directly through advertisements in public places and in collaboration with community organizations (women’s centers, homeless shelters, crisis centers, domestic violence shelters, immigrant settlement agencies and ethnic associations) and they self-identified as having experienced housing insecurity. Efforts were made to include a diversity of immigrant statuses as well as diversity in ethnicity, race, country of origin, family composition, sexual orientation, age and range of physical and mental ability. Women were engaged in semi-structured, open-ended interviews lasting approximately 1 h. Interviews were conducted in English or French in a location and time of participants’ choosing.

Findings

The findings are presented around three themes: how health problems instigate and maintain migrant women’s housing insecurity and homelessness; ways in which women’s immigration trajectories and legal status may influence their health experiences; and particular coping strategies that migrant women employ in efforts to maintain or manage their health. The authors conclude with implications of these findings for both policy and practice in relation to migrant women who experience or are at risk of housing insecurity and homelessness.

Intersections of women experiencing migration and housing insecurity in Canadian contexts have rarely been examined. This paper addresses a gap in the literature in terms of topic and context, but also in terms of sharing the voices of migrant women with direct experience with housing insecurity.

Les croisements entre trauma et violence sont souvent pensés sous l’angle de la violence subie, le premier s’inscrivant dans le sillage de la seconde. Les effets de la violence se traduisent alors en symptômes, mais aussi en agir, dans des cycles de répétition traumatique où la personne traumatisée peut se remettre dans des situations de risque. Qu’ils empruntent le vocabulaire de la psychanalyse ou celui d’approches biomédicales, de nombreux écrits en psychologie mettent ainsi de l’avant le caractère déstructurant de la violence traumatique.

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.

Objectif
Évaluer les stratégies d’interventions dans la lutte contre le choléra à Uvira dans la perspective de les
renforcer
Matériel et méthodes.
L’étude a été évaluative recourant à des entrevues avec des acteurs impliqués dans la lutte contre le choléra et à la revue documentaire. Elle concerne la période de 2013 à 2016. Les données quantitatives relatives aux nombres de nouveaux cas et des décès ont été analysées à l’aide d’Excel. L’analyse des données qualitatives a été faite par thème en fonction des questions de recherche et au regard de la stratégie nationale de lutte contre le choléra en RDC.

Résultats
La corrélation entre les stratégies de lutte contre le choléra mises en place par les acteurs et les stratégies nationales de lutte contre le choléra reste relativement très faible dans la zone de santé. Des inadéquations entre ces deux groupes de stratégies sont ainsi relevées au cours de l’étude. Les effets positifs des différentes interventions mises en œuvre se traduisent par la diminution du nombre des nouveaux cas de choléra de 28% entre 2014 (1839 cas) et 2015 (1316 cas) et une certaine stagnation depuis 2016 autour de 1392 cas par an. L’efficacité des interventions est perçue efficace par seulement par 25% des membres de la  communauté contre 62% des agents des organisations; les effets des interventions sont estimés durables par 38% des membres de la communauté contre 68 % des agents des organisations et 34% des membres de la communauté (68% des agents des organisations) pensent que la participation communautaire est sollicitée lors des interventions de lutte contre le choléra. Par contre, la grande majorité des membres de la communauté (87%) et des agents des organisations (99%) jugent pertinentes les interventions de lutte contre le choléra au cours de l’étude. La faible implication de la communauté dans les actions de lutte contre le choléra et le caractère urgentiste des interventions sont fortement fustigés.

Conclusion
L’élimination du choléra en tant que problème de santé publique fait face à plusieurs défis dont le plus important semble être l’accès durable à plus de ressources par tous les acteurs, principalement l’État. L’implication plus visible des autorités politico-administratives est souhaitée.

Climate change is one of today’s major challenges, among the causes of population movements and international migration. Climate migrants impact health systems and how they respond and adapt to their needs and patterns. But to date, the resilience of health systems in the context of climate change has been little explored.

The purpose of this article is to show the importance of studying, from an interdisciplinary perspective, the relationships between climate change, migration, and the resilience of health systems.
Resilience is an old concept, notably in the field of psychology, and is increasingly applied to the study of health systems. Yet, no research has analysed the resilience of health systems in the context of climate change.

While universal health coverage is a major international goal, little research has to date focused on the existing links between climate, migration, health systems and resilience.

We propose an interdisciplinary approach relying on the concept of health system resilience to study adaptive and transformative strategies to articulate climate change, migration and health systems

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.

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

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

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.

Abstract

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

Résumé

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Depuis 2015, le Canada est engagé dans un processus exceptionnel de parrainage de plus de40,000 réfugiés syriens réinstallés au Canada. Alors que l’enthousiasme initial suscité par leurarrivée se dissipe, il est important d’examiner leur installation et leur intégration à long terme ausein de leurs nouvelles communautés. Cet article offre un portrait et une analyse de la manièredont les réfugiés syriens établis à Montréal réussissent à créer des réseaux sociaux et à accéder àl’appui social afin de pouvoir développer du capital social pour les fins de l’emploi et du logement.Faisant partie d’un projet longitudinal de 4 ans dans 3 provinces, ici nous partageons une partiedes résultats de la première vague de données provenant de 626 réfugiés parrainés par la collec-tivité et vivant au Québec. Nous décrivons leur réseau de soutien familial et social et comment cesconnections sociales les ont aidé à accéder à l’emploi et au logement. Les différences en termesd’âge, de genre et de résidences au Canada sont analysés. Nous observons une forte présence ducapital social de liaison (bonding) parmi les réfugiés syriens installés dans la région de Montréal,et l’émergence du capital social de transition (bridging).

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

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

Abstract Background

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

Methods

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

Results

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

Conclusion

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

Aim

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

Method

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

Results

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

Conclusions

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

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.

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

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.

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

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

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

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

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

Conclusion

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

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.