Toby Measham

Addressing trauma in collaborative mental health care for refugee children

Primary care institutions, including clinics, schools and community organizations, because of their closeness to the family living environment, are often in a privileged position to detect problems in traumatized refugee children and to provide help. In a collaborative care model, the child psychiatrist consultant can assist the primary care consultee and family in holding the trauma narrative and organizing a safe network around the child and family. The consultant can support the establishment of a therapeutic alliance, provide a cultural understanding of presenting problems and negotiate with the consultee and the family a treatment plan. In many settings, trauma focused psychotherapy may not be widely available, but committed community workers and primary care professionals may provide excellent psychosocial support and a forum for empathic listening that may provide relief to the family and the child.

Lithium and clozapine-induced neutropenia/agranulocytosis

Lithium administration was used in a patient with a clozapine-induced neutropenia and in another with complete agranulocytosis to assess whether lithium could stimulate neutrophil production. In both cases, following lithium administration, the neutrophil count was increased to the normal range within 6 days. In the patient who had presented a neutropenia, clozapine treatment was then reinstated in the presence of lithium and continued without the neutrophil count dropping into the yellow-alert range thereafter.

Refugee children: mental health and effective interventions

The mental health consequences of war and other forms of organized violence for children represent a serious global public health issue. Much of the research on the mental health of war-affected civilians has focused on refugees who have sought asylum in high-income countries and face the dual stress of a traumatic past and resettlement. This review will focus on the mental health of refugee children who have fled war as well as interventions to both prevent and treat adverse mental health outcomes. While war can have devastating mental health consequences, children raised in the midst of armed conflict also display resilience. Effective interventions for refugee children will be discussed both in terms of prevention and treatment of psychopathology, with a focus on recent developments in the field.

Creative Expression Workshops for Immigrant and Refugee Children.

Journal of the American Academy of Child & Adolescent Psychiatry - Vol. 43 - N° 2 - p. 235-238

The acute management of aggressive behaviour in hospitalized children and adolescents

OBJECTIVE To examine how health care professionals attempt to manage acutely aggressive behaviours exhibited by children and adolescents in various hospital settings. METHOD A review of the literature examining management techniques on child psychiatric and pediatric wards is presented. Techniques reviewed include pharmacotherapy, psychotherapy, seclusion, restraint and the use of pro re nata (prn) medications. RESULTS Effects of various management techniques are presented, where available. CONCLUSION There is little evidence for the effectiveness of most presently used acute management techniques in containing aggressive child behaviours over the long term. Suggestions for improved evaluation of management techniques are made.Objective To examine how health care professionals attempt to manage acutely aggressive behaviours exhibited by children and adolescents in various hospital settings. Method A review of the literature examining management techniques on child psychiatric and pediatric wards is presented. Techniques reviewed include pharmacotherapy, psychotherapy, seclusion, restraint and the use of pro re nata (prn) medications. Results Effects of various management techniques are presented, where available. Conclusion There is little evidence for the effectiveness of most presently used acute management techniques in containing aggressive child behaviours over the long term. Suggestions for improved evaluation of management techniques are made.

Family Disclosure of War Trauma to Children

Objective: This article presents results from an exploratory study looking at the relationship between family disclosure of war trauma to children and their children’s play. Creative play was hypothesized to be an indicator of children’s well-being. Method: A comparison was made between a community and clinical sample of children whose families had experienced war. Twenty-one children from West and Central Africa and Algeria were administered a directed sand tray and story-telling play interview. Parents were interviewed about their children’s functioning, development, migration, war history and experience of family separation. A comparison of the children’s play and the family’s approach to the discussion of traumatic events was performed to explore the way in which disclosure was related to the children’s play. Results: The timing and manner in which trauma was disclosed to children appeared to be associated with the children’s ability to play creatively. Creative play appeared linked to a family feeling of safety to discuss their experiences and to a family’s manner of transmitting information so that children could process it. Conclusion: It is hypothesized that the timing and manner in which disclosure occurs may be more important than the disclosure or nondisclosure of war trauma in and of itself. This may have clinical implications for the treatment of children and families from multicultural contexts who have experienced war trauma.

Prevalence and correlates of conduct disorder and problem behavior in Caribbean and Filipino immigrant adolescents

This study investigates the prevalence and subtypes of conduct disorder (CD) and behavioral problems among youth in two communities characterized by prolonged parent–child separation upon immigration. CD and problem behaviors were assessed in 252 Caribbean–Canadian and Filipino–Canadian adolescents (12–19-year-old) using the DISC-C, the YSR and the CBCL cross-informant construct. Adolescents reported less problem behaviors than their host country peers, despite immigrant background or parent–child separation. The high adolescent-onset CD rate supports the hypothesis that psychosocial stressors play a role in the emergence of the disorder. Specifically, high levels of perceived racism and low collective self-esteem predicted problem behaviors in these youngsters.

Refugee Children and Their Families: Supporting Psychological Well-Being and Positive Adaptation Following Migration

The support of refugee children and their families is a worldwide concern. This article will highlight models of mental health care for refugee children and their families, focusing on collaborative care with primary care providers. Case vignettes are provided to illustrate how collaborative care can support refugee children׳s psychological well-being and positive adaptation following migration.

The work of culture in the treatment of psychosis in migrant adolescents

Psychotic illness in an adolescent is a catastrophic event for families, particularly migrant families, who tend to use mental health services less than mainstream families. This article presents a clinical approach that takes into account the work of culture in the construction of meaning and the development of coping strategies for migrant families faced with the onset of psychosis in an adolescent. This approach transforms the therapeutic space into a transitional one that allows the interplay of many different interpretations and strategies to deal with the crisis. Recognizing the potential value of non-western systems of knowledge, offering help as the family grieves the loss of its expectations for their child, mobilizing support systems, and strengthening the therapeutic alliance are the key elements in this process.

Addressing Cultural Diversity Through Collaborative Care

This chapter describes principles of collaborative care in mental health and how this model, based on strong partnership between primary care and mental health professionals, can be adapted to provide culturally sensitive services. The patient-centred model of collaborative care aims at decreasing barriers to accessing mental health care, which are particularly tangible for ethnocultural minorities and marginalized groups. It recognizes the major role played by primary care professionals in delivering mental health services and the benefit of comprehensive networks of professionals and community partners. The chapter discusses necessary conditions for implementing such initiatives, describes the benefits of multidisciplinarity, which goes beyond a medically centred model, and addresses issues of power. It then considers the adaptation of collaborative care to address the cultural specificities of communities. It reviews the recommendations of the Canadian Collaborative Mental Health Initiative (CCMHI) Toolkit for Ethnoculturally Diverse Populations and of the Canadian Collaboration for Immigrant and Refugee Health (CCIRH), and then focuses on two key areas identified by these recommendations: partnership with communities and awareness of historical and cultural specificities. The chapter then describes a youth mental health care project in a multiethnic neighbourhood to illustrate how collaborative care can be adapted to local constraints, while fostering attention to cultural diversity in mental health. Finally, the chapter addresses training methods appropriate to support collaborative care and proposes a continuing education program based on the synergy of seminars, supervisions, and didactic teaching.