Keeping Refugee Children and Teens Safe
We need genuine connections because "Fine" doesn't always mean "fine."
Posted August 2, 2017
“We want our clients to be okay,” affirmed Janelle Stanley, LMSW, a New York City school social worker. “And young people will say what they think we want to hear. So they may reassure us to make us feel better, when they really are in urgent need of help.” Stanley noted that refugee adolescents are especially attuned to what people in power want to hear from them. She suggested that we can find out what is really going on through:
- observing their behavior;
- having warm "real" relationships with them (while still observing professional boundaries);
- pushing a bit in our questions—not simply taking “fine” for an answer;
- fostering strong peer networks among young people; and
- promoting cooperation among various resources such as parents, school administrators and counselors, mental and physical health providers, and substance abuse programs.
Stanley and her colleague, Emma Larson (LMSW), described suicidal and homicidal ideation in immigrant and refugee teens in a talk at the Advanced Training Summit of the American Professional Society on the Abuse of Children (APSAC).
Suicidality in Refugee Children and Teens
Emerging literature shows that evaluating suicidality by assessing for a plan and future orientation, as most of us have been trained to do, does not give as clear a link to suicidal behavior as we once thought: passive ideation may be just as likely to be associated with suicide attempts as active ideation (Silverman & Berman, 2014). Additionally, young children have magical thinking and cannot calculate the risk of their actions. They may believe they can kill themselves by taking two vitamins or that they can jump out of a window and then pop up again like a cartoon character. Therefore, we cannot assess the seriousness of a child’s intent based on the severity of an attempt or gesture. It is unusual for children to state, “I want to die.” If they do, we should take them seriously. They may be parroting a suicidal adult in the home, or they may be expressing the depth of their despair and/or need to be protected from an abusive situation at home, school, or in the community.
Teens rarely express their suicidal feelings to adults but will sometimes share these feelings with peers. (This is one reason schools need to educate students about bystander responsibilities and provide clear channels for young people to report their concerns about their friends). Teens communicate their distress behaviorally, and concerned adults may note worrisome changes such as a sudden lack of hygiene, social withdrawal, newly aggressive behavior, giving away treasured items, and radical changes in appearance. While none of these symptoms alone is diagnostic of suicidality, they suggest reasons for us to begin investigating the sources of distress. Refugee children may be at special risk of suicidality caused by acculturative stress, their history of trauma both before and after immigration, and the many disruptions in their lives.
Homicidal Ideation/Aggressive Thoughts
Refugee children may sometimes feel angry and be tempted to act on these feelings, just like everyone else. Refugee children and teens sometimes encounter problems if they fail to differentiate between culturally accepted ways to express that anger, and ways that will get them in a heap of trouble. At the same APSAC conference, Hugo Kamya, Ph.D., described a refugee boy whose classmate sprayed him with a water pistol and then told him he stank and needed a shower. Humiliated and with a limited vocabulary in English, the refugee child responded with, “I will kill you.” Fortunately, the school called in Kamya, a psychologist experienced in working with refugees, who was able to determine that the young man had no intention of killing anyone—he just felt embarrassed and wanted to respond forcefully. Kamya was able to help the young man understand the implications of even a joking death threat in the current U.S. climate, and together they devised a list of possible responses to aggressive peers. In these circumstances, it is also crucially important to enlist the help of the student body in providing a welcome to immigrants and refugees, and stamping out xenophobia.
Similarly, Stanley and Larson described the importance of distinguishing between true homicidal or aggressive ideation, and the fantasies or feelings that many people experience in moments of great frustration or anxiety, which are not of clinical significance. What is the difference between hypothetically wanting to kill a person who deliberately banged into you in the school hallway and making a plan to do the same? Larson says that the less concerning aggressive fantasies are often characterized by being more improbable and unrestrained, like a daydream, and are not directed at guiding an action or solving a problem. Harmless fantasies are also NOT likely to be scary and disagreeable to the person experiencing them, while clinically significant homicidal ideation is often anxiety-provoking for the person experiencing the intrusive thoughts, particularly in the early stages of a psychotic episode.
Although immigrants are actually less aggressive and less likely to be involved in crime than their native-born peers (Rojas-Gaona, 2016), given the anti-immigrant climate in the U.S. today and the potentially severe consequences if a young person is mistakenly classified as dangerous, it is important for clinicians and school personnel to distinguish between harmless aggressive thoughts and feelings, which we all have, versus aggressive intent. We can seek information:
- Has the young person behaved aggressively in the past?
- Does the young person want options for resisting the aggressive impulses?
- Asking, simply, “Would you ever do that?”
Working across differences of race, culture, language, class, and age can complicate any assessment, putting into high relief the stark power differential between the refugee child and his or her family, on one hand, and the clinician or school professional on the other. As authorities in the lives of vulnerable children we have a grave responsibility to keep them safe: safe from dangers at home, on the streets, and in school; safe from their own suicidal and aggressive impulses; and safe from systems that might pathologize ordinary feelings of anger, needlessly sending a young person into a punishing criminal justice system. In the service of child safety, counselors must be diligent in assessing our own implicit bias and the biases embedded in our professional training, lest we harm vulnerable young clients, even with the best intentions.
Rojas-Gaona, Carlos E., et al. "The Significance of Race/Ethnicity in Adolescent Violence: A Decade of Review, 2005–2015." Journal of Criminal Justice, vol. 46, 01 Sept. 2016, pp. 137-147.
Silverman, M. M., & Berman, A. L. (2014). "Suicide Risk Assessment and Risk Formulation Part I: A Focus on Suicide Ideation in Assessing Suicide Risk." Suicide & Life-Threatening Behavior, vol. 44, no. 4, , pp. 420-431.
The Bridging Refugee Youth and Children's Services Clearinghouse is an excellent resource on helping refugee children.