Question and Answer

The Immigrant and Refugee Mental Health Project facilitates a virtual Community of Practice (CoP) comprised of health, settlement and social services providers across Canada who support the mental health of immigrants and refugees. The CoP online discussion board allows providers to pose questions to the Project’s panel of subject matter experts (SMEs). We will be bringing you some of the questions posed by providers and answers provided by the SMEs.

Question 

The children we see coming out of refugee situations often display symptoms of developmental delays. Sometimes when we gently suggest referrals to health screening services, the parent will become very defensive about their child, maybe out of shame/cultural norms surrounding disabilities. What is the most appropriate way of coming alongside the parent? If the children can get the supports they need prior to kindergarten, it would be very beneficial for their ongoing education and integration?

Response

Dr. Debra Stein, staff psychiatrist (children and adolescents), SickKids Centre for Community Mental Health, writes:

Thank you for this very important question regarding supporting families when there is a suspected developmental challenge in a child.

The writer very astutely wonders about the impact of shame and cultural norms surrounding disabilities, and certainly this can be explored with the parents with some simple questions. For example, if the parents have brought specific developmental concerns to the clinician, the clinician can ask how these concerns would be explained and named in their home country, how they would be viewed, and how they would be managed. This can lead to a useful discussion which allows for some exploration of parental shame and even fear for what a possible developmental disability could mean for the child and the family.

There is also, in my experience, a mistrust of sharing mental health information with broader health institutions and schools, as parents can also be concerned that once referred for a service, the child will become labeled as somehow deficient or mentally ill, and that this could impact their trajectory in the new country. It is important to have a conversation with families about confidentiality, and Canada's laws around the privacy of health information.

If the clinician, after seeing a child, is concerned about developmental challenges that have not been flagged by the parents, the clinician can reduce defensiveness considerably by first sharing their observation of the child's strengths and capacities, as well as the parents' skills at promoting their child's healthy development and wellbeing. The clinician should then convey a desire to partner with them in the good work they are already doing with their children.

Finally, it can sometimes be useful to take a direct approach, as in, "I see some hesitancy here as I discuss referring X to service Y. Do you have specific concerns about this referral?" That way we are not making assumptions that the hesitancy is due to shame or distrust. Often parents surprise us with their answers, and from there we are able to really get to core concerns, and move forward together.