TIC for Immigrants and Refugees

Immigrants and refugees are a significant and growing part of the Canadian population. Both the American Academy of Pediatrics and the Budapest Declaration on the Rights, Health, and Well-Being of Children and Youth on the Move have identified Trauma Informed Care as a best practice in the care of immigrant and refugee youth.[1] Indeed, Trauma informed care is crucial when working alongside newcomer individuals, families, and communities.

Services providers and service systems must acknowledge that pervasive traumatic events have shaped the lives of newcomers pre-migration, during the process of migration, and post-migration.  Because refugees are fleeing extremely traumatic conditions, almost all of them have experienced losses and may have suffered multiple traumatic experiences. While some of the following examples are specific to refugee populations, immigrants may also share some similar experiences in their home countries.

Possible Trauma Experienced by Immigrants and Refugees

Pre-migration losses may include:

  • Family loss (violence, death, or poverty)
  • Community loss (violence, witnessing violence, losing trust in authority figures, imprisonment, rape, torture)
  • Neighborhood (loss of home, loss of country, war and conflict)
  • Culture (identity and beliefs targeted)

Migration losses may include:

  • Separation from Family, home, community and country of origin
  • Vulnerability during travel, including ongoing conflict and violence
  • Fear of the unknown, the new country, and what new losses await

Post-migration losses may include:

  • Individual and Family (changing roles, language barriers, employment, housing, financial stressors, lack of recognition of previous expertise/education)
  • Community (acculturation stressors, trying to understand dominant cultural norms, isolation and loss of supports)
  • Neighborhood (resettlement stressors, parent/child stressors as parents are disempowered).
  • Culture (racism and xenophobia)
  • Ongoing threat of deportation

Culture, Trauma, and PTSD

Culture effects symptom expression, help-seeking behaviour, healing mechanisms, meaning ascribed to trauma, type of trauma experienced. This includes cultural trauma, cultural bereavement, and intergenerational trauma.[1] While moving to a new and potentially safer country can help to ensure stability, ongoing traumatic events can continue to disrupt the wellbeing of Immigrants and Refugees, their families, and communities. 

I came to Canada to find peace. I’ve climbed the ladder of peace and I thought that would be all. I ran from flames, but now I’m faced with hidden flames. Integration is like that.

Somali Refugee (Klinic Toolkit)

Ways that service providers can address barriers:

  • Learning about Culturally Competent Care, Cultural Safety, and Trauma Informed Care
  • Acknowledging the mistrust of authority, power, and systems including government
  • Community engagement and building trusting relationships over time
  • Engage with cultural experts who have both the linguistic and cultural knowledge to improve services. 
  • Imbedding services within already existing services can help to reduce stigma and increase accessibility (examples include schools, workplaces, community health settings)

One Model of Care was developed by the Refugee Trauma and Resilience Centre entitled Trauma Systems Therapy (TST-R).[2] They lay out a Four-tier approach as well as outline the important role that cultural brokers play:

  • Tier One – Community Outreach (Important to outreach and form partnerships within communities to build trust and understanding of what services can provide and to also learn about that community)
  • Tier Two – Skills based groups (For example, within a school setting for all refugee youth to teach self-regulation and provide support around acculturation. This also allows for the possibility for more intensive services for individuals.)
  • Tier Three – Regulation focussed (Seek to provide individual and address stressors  and  triggers of social environment)
  • Tier Four – Safety focussed (Seeks to provide safe environment).
  • Integration of cultural brokering on all four levels of intervention.

Cultural brokering – Individuals who provide intimate community level knowledge and experience with an understanding of services and institutions in order to facilitate access for cultural minority communities and provide care. This enhances care because they are a part of the communities and are immigrants or refugees themselves. Mental health is such an intimate process and people have to trust workers with things they may have never trusted anyone with. A Cultural Broker can frame Mental Health care and needs an illness in a way that is acceptable. For example, a Cultural Broker may not say “mental health” they might say “support for success” “wellness” or “extra help to enhance education”. A Cultural Broker knows how to engage and they are able to provide services from the language of origin.

For further reading

Immigrant and Refugee Toolkits and Presentations:

Trauma and Distress of Immigrant and Refugee Families: The Journey of Strengths, Resilience and Healing

Refugee and Immigrant Core Stressors Toolkit

Resources Specific to Immigrant or Refugee Populations

Creating Accessible, Culturally Relevant, Domestic Violence­- and Trauma­-Informed Agencies

Trainings on Cultural Safety

Sexuality and Cultural Diversity: Humility and Safety in Cross-Cultural Work

[1] Miller, K. K., Brown, C. R., Shramko, M., & Svetaz, M. V. (2019). Applying Trauma-Informed Practices to the Care of Refugee and Immigrant Youth: 10 Clinical Pearls. Children (Basel, Switzerland)6(8), 94.

[2] NCTSN Webinar: Understanding Refugee Experiences and Improving Services

[3] Boston Children’s Hospital: Refugee Trauma and Resilience Center | Programs & Research