This study addressed psychological needs, patterns of service utilization and provision of care in a specialist mental health service for young refugees and asylum seekers in London. Comparisons were made between two groups with different levels of postulated mental health need: unaccompanied minors (UAMs; n = 49) and children accompanied to the UK by one or more primary caregivers (n = 29). Significant differences were observed in referral pathways, with UAMs more likely to be referred by social services and less likely to be referred from medical agencies. UAMs also attended fewer sessions during treatment, and missed a greater proportion of scheduled appointments. Contrary to prediction, group comparisons revealed similar levels of post-migration stress and overall psychological morbidity. However, UAMs experienced significantly more traumatic events prior to resettlement, and were more likely to exhibit symptoms of post-traumatic stress disorder (PTSD) than their accompanied peers. Despite their elevated risk of PTSD, UAMs were less likely than accompanied children to have received trauma-focused interventions. UAMs were also significantly less likely to have been treated using cognitive therapy, anxiety management and parent/carer training, as well as receiving fewer types of practical assistance with basic social needs. The clinical and service implications of these findings are discussed.
Ajdukovic, M., & Ajdukovic, D. (1993). Psychological well being of refugee children. Child Abuse and Neglect, 17, 843-854.
2.
Appleyard, K., Egeland, B., van Dulmen, M.H., & Sroufe, L.A. (2005). When more is not better: The role of cumulative risk in child behavior outcomes. Journal of Child Psychology and Psychiatry, 46, 235-245.
3.
Audit Commission. (1999). Children in mind: Child and adolescent mental health services. London: Audit Commission for Local Authorities and the National Health Service in England and Wales.
4.
Ayotte, W., & Williamson, L. (2001). Separated children: An overview of the current situation. London: Save the Children.
5.
Bann, C., & Tennant, R. (2002). Highlight no. 190: Unaccompanied asylum-seeking children. London: National Children's Bureau.
6.
Bean,T., Derluyn, I., Eurelings-Bontekoe, E., Broekaert, E., & Spinhoven, P. (2007). Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. The Journal of Nervous and Mental Disease, 195, 288-297.
7.
Bean,T., Eurelings-Bontekoe, E., Mooijaart, A., & Spinhoven, P. (2006). Factors associated with mental health service need and utilisation among unaccompanied refugee adolescents. Administration and Policy in Mental Health and Mental Health Services Research , 33, 342-355.
8.
Birman, D., Ho, J., Pulley, E., Batia, K., Everson, M.L., Ellis, H., et al. (2005). Mental health interventions for refugee children in resettlement: White paper II. National Child Traumatic Stress Network. Los Angeles & Durham, NC: Refugee Trauma Task Force.
9.
Boothby, N. (1998). Unaccompanied children from a psychological perspective . In E. Ressler, N. Boothby, & D. Steinbock (Eds.), Unaccompanied Children (pp. 130-180). New York: Oxford University Press.
10.
Cohen, P., Cohen, J., Kasen, S., Velez, C.N., Hartmark, C., Johnson, et al. (1993). An epidemiological study of disorders in late childhood and adolescence: I. Age- and genderspecific prevalence. Journal of Child Psychology and Psychiatry, 34, 851-867.
11.
Davies, M., & Webb, E. (2000). Promoting the psychological well-being of refugee children. Clinical Child Psychology and Psychiatry, 5, 541-554.
12.
Department of Health. (2004). National service framework for children, young people and maternity Services: Standard 9. The mental health and psychological well-being of children and young people. London: Department of Health.
13.
Ehntholt, K.A., Smith, P.A., & Yule, W. (2005). School-based cognitive-behavioural therapy group intervention for refugee children who have experienced war-related trauma . Clinical Child Psychology and Psychiatry, 10, 235-250.
14.
Ehntholt, K.A., & Yule, W. (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma . Journal of Child Psychology and Psychiatry, 47, 1197-1210.
15.
Espino, C.M. (1991). Trauma and adaptation: The case of Central American children. In F.L. Ahearn & J.L. Athey (Eds.), Refugee children: Theory, research and services. The Johns Hopkins series in contemporary medicine and public health (pp. 106-124). Baltimore, MD: The Johns Hopkins University Press.
16.
Fazel, M., & Stein, A. (2002). The mental health of refugee children. Archives of Disease in Childhood, 87, 366-370.
17.
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. Lancet, 365, 1309-1314.
18.
Felsman, J.K., Leong, F.T., Johnson, M.C., & Felsman, I.C. (1990). Estimates of psychological distress among Vietnamese refugees: Adolescents, unaccompanied minors and young adults. Social Science and Medicine, 31, 1251-1256.
19.
Free, E. (2003). Young refugees: Providing emotional support to young separated refugees in the UK. London: Save the Children.
20.
Garbarino, J., & Kostelny, K. (1996). The effects of political violence on Palestinian children's behavior problems: A risk accumulation model. Child Development, 67, 33-45.
21.
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1337-1345.
22.
Grey, N., & Young, K. (2008). Cognitive behaviour therapy with refugees and asylum seekers experiencing traumatic stress symptoms. Behavioural and Cognitive Psychotherapy, 36, 3-19.
23.
Hargreaves, S., Holmes, A., & Friedland, J. (2003). The United Kingdom's experience of providing health care for refugees: Time for international standards? Journal of Travel Medicine, 10, 72-74.
24.
Harrington, R.C., Kerfoot, M., & Verduyn, C. (1999). Developing needs-led child and adolescent mental health services: Issues and prospects. European Child and Adolescent Psychiatry, 8, 1-10.
25.
Hek, R. (2005). The experiences and needs of refugee and asylum seeking children in the UK: A literature review. Nottingham : Department for Education and Skills.
26.
Heptinstall, E., Sethna, V., & Taylor, E. (2004). PTSD and depression in refugee children: Association with premigration trauma and post-migration stress. European Child and Adolescent Psychiatry, 13, 373-380.
27.
Herman, J.I. (1997). Trauma and recovery. New York : Basic Books.
28.
Hodes, M. (1992). The clinical relevance of the social anthropology of childhood. Newsletter of the Association for Child Psychology and Psychiatry, 14, 257-261.
29.
Hodes, M. (2000). Psychologically distressed refugee children in the United Kingdom. Child Psychology and Psychiatry Review , 5, 57-68.
30.
Hodes, M. (2002a). Implications for psychiatric services of chronic civilian strife: Young refugees in the UK. Advances in Psychiatric Treatment, 8, 366-374.
31.
Hodes, M. (2002b). Three key issues for young refugees' mental health . Transcultural Psychiatry, 39, 196-213.
32.
Howard, M., & Hodes, M. (2000). Psychopathology, adversity and service utilization of young refugees. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 368-377.
33.
Jones, D.J., Forehand, R., Brody, G., & Armistead, L. (2002). Psychosocial adjustment of African-American children in single-mother families: A test of three risk models. Journal of Marriage and Family, 64, 105-115.
34.
Kazdin, A.E., Holland, L., Crowley, M., & Breton, S. (1997). Barriers to Treatment Participation Scale: Evaluation and validation in the context of child outpatient treatment. Journal of Child Psychology and Psychiatry and Allied Disciplines, 38, 1051-1062.
35.
Kinzie, J.D., Sack, W., Angell, R., & Clarke, G. (1989). A three-year follow-up of Cambodian young people traumatised as children. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 501-504.
36.
Kinzie, J.D., Sack, W.H., Angell, R.H., Manson, S., & Rath, B. (1986). The psychiatric effects of massive trauma on Cambodian childrenI. The children. Journal of the American Academy of Child Psychiatry, 25, 370-376.
37.
Leavey, G., Hollins, K., King, M., Barnes, J., Papadopoulos, C., & Grayson, K. (2004). Psychological disorder amongst refugee and migrant schoolchildren in London. Social Psychiatry and Psychiatric Epidemiology, 39, 191-195.
38.
National Collaborating Centre for Mental Health. (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. National clinical practice guideline number 26. London and Leicester: The Royal College of Psychiatrists and British Psychological Society.
39.
O'Shea, B., Hodes, M., Down, G., & Bramley, J. (2000). A school-based mental health service for refugee children. Clinical Child Psychology and Psychiatry, 5, 189-201.
40.
Papadopoulos, R.K. (2007). Refugees, trauma and adversity-activated development . European Journal of Psychotherapy and Counselling, 9, 301-312.
41.
Pettitt, B. (2004). HAZ Young Refugee Mental Health Project: External evaluation. Unpublished manuscript.
42.
Raval, H. (2005). Being heard and understood in the context of seeking asylum and refuge: Communicating with the help of bilingual co-workers. Clinical Child Psychology and Psychiatry, 10, 197-216.
43.
Refugee Council. (2005). Tell it like it is: The truth about asylum. Retrieved April 17, 2006, from http://www.refugeecouncil.org.uk/downloads/news/Election_guide_online_pdf_05.pdf .
44.
Refugee Health Team LSL. (2004). Briefing number 6, December 2004: Statistical information on refugee populations with focus on distribution of asylum seekers in Lambeth, Southwark and Lewisham by country of origin and language. London: Lambeth PCT.
45.
Rumbaud, R.G. (1991). The agony of exile: A study of the migration and adaptation of Indochinese refugee adults and children. In F. L. Ahearn, & J.L. Athey (Eds.), Refugee children: Theory, research and services. The Johns Hopkins series in contemporary medicine and public health (pp. 53-91). Baltimore, MD: The Johns Hopkins University Press.
46.
Rutter, M. (1999). Resilience concepts and findings: Implications for family therapy. Journal of Family Therapy, 21, 119-144.
47.
Sack, W.H., Angell, R.H., Kinzie, J.D., & Rath, B. (1986). The psychiatric effects of massive trauma on Cambodian children: II. The family, the home and the school. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 377-383.
48.
Sack, W.H., Clarke, G.N., & Seeley, J. (1996). Multiple forms of stress in Cambodian adolescent refugees. Child Development, 67, 107-116.
49.
Sack, W.H., Him, C., & Dickason, D. (1999). Twelve-year follow-up study of Khmer youths who suffered massive war trauma as children. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1173-1179.
50.
Sack, W.H., McSharry, S., Clarke, G.N., Kinney, R., Seeley, J., & Lewinsohn, P. (1994). The Khmer Adolescent Project: I. Epidemiologic findings in two generations of Cambodian refugees. Journal of Nervous and Mental Disease, 182, 387-395.
51.
Sameroff, A.J. (2000). Dialectical processes in developmental psychopathology . In A. Sameroff, M. Lewis, & S. Miller (Eds.), Handbook of developmental psychopathology (2nd ed., pp. 23-40). New York: Kluwer Academic.
52.
Savin, D., Sack, W.H., Clarke, G.N., Meas, N., & Richart, I. (1996). The Khmer adolescent project: III. A study of trauma from Thailand's Site II refugee camp. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 384-391.
53.
Servan-Schreiber, D., Le Lin, B., & Birmaher, B. (1998). Prevalence of posttraumatic stress disorder and major depressive disorder in Tibetan refugee children. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 874-879.
54.
Sinnerbrink, I., Silove, D., Field, A., Steel, Z., & Manicavasagar, V. (1997). Compounding of premigration trauma and postmigration stress in asylum seekers. The Journal of Psychology, 131, 463-470.
55.
Smith, P., Perrin, S., Yule, W., Hacam, B., & Stuvland, R. (2002). War exposure among children from Bosnia-Hercegovina: Psychological adjustment in a community sample. Journal of Traumatic Stress, 15, 147-156.
56.
Sourander, A. (1998). Behaviour problems and traumatic events of unaccompanied refugee minors. Child Abuse and Neglect, 22, 719-727.
57.
South London and Maudsley NHS Foundation Trust. ( 2006). Key performance indicator report: Quarter 4, April 2005-March 2006. London: SLaM NHS Foundation Trust.
58.
Street, C., Stapelkamp, C., Taylor, E., Malek, M., & Kurtz, Z. (2005). Minority voices: Research into the access and acceptability of services for the mental health of young people from black and minority ethnic groups. London: Young Minds.
59.
Summerfield, D. (2001). The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. BMJ, 322, 95-98.
60.
Tousignant, M., Habimana, E., Biron, C., Malo, C., Sidoli-LeBlanc, E., & Bendris, N. (1999). The Quebec adolescent refugee project: psychopathology and family variables in a sample from 35 nations. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1426-1432.
61.
Unhcr. (1951). Convention relating to the status of refugees. Geneva: United Nations High Commission on Refugees.
62.
Unhcr. (2001). Protection and assistance to unaccompanied and separated refugee children: Report of the Secretary-General. Geneva: United Nations High Commission on Refugees.
63.
Unhcr. (2004). Trends in unaccompanied and separated children seeking asylum in industrialised countries (2001-2003) . Geneva: United Nations High Commission on Refugees.
64.
Weine, S.M., Becker, D.F., McGlashan, T.H., & Laub, D. (1995). Psychiatric consequences of `ethnic cleansing': Clinical assessments and trauma testimonies of newly resettled Bosnian refugees . American Journal of Psychiatry, 152, 536-542.
