School Counselling Service for Migrant Children
The issue of concern
Migration is a prevalent and rapidly increasing phenomenon worldwide. Although in some cases, people choose to relocate for economic reasons, family or education, in many other cases, individuals and families are forcibly displaced due to conflict, persecution or human rights violations (United Nations, n.d.). According to the United Nation’s most recent estimates, as of 2022, there are a record number of 103 million forcibly displaced people worldwide (United Nations High Commissioner for Refugees, 2022). Of these, 32.5 million of this number are refugees which means they have fled their country due to serious risks to human rights violations (Amnesty international, 2022). Refugees are legally recognised and have a right to international protection. Another estimated 4.9 million are asylum seekers, meaning they have fled their country to seek protection but are waiting to receive a decision on their asylum claim for refugee status (Amnesty international, 2022). Throughout this briefing, I will use the term migrant to encompass all those living outside of their birth country, though it will be mostly referring to forcibly displaced refugees and asylum seekers. The current situation is seen by many to be a ‘global refugee crisis’, and with over half of refugees under the age of 18, there are clear implications for the young people involved (Arakelyan & Ager 2021). Forced migration understandably takes a toll on both physical and mental health, as individuals and families are uprooted and often have prolonged unstable living situations or traumatic experiences. The subject of this briefing will focus on the mental health of this population and outline how school counselling services may best support them.
Considerations
This section will explore the various risk and protective factors facing young migrants using the biopsychosocial (BPS) framework. Formulated by George Engel in 1977, the BPS framework demonstrates how interactions between biological, psychological, and social factors determine the cause, manifestation, and outcome of wellness and disease (Engel, 1977). The migration process could be seen to progress through three stages, each with its own potential risks. These will be referred to as: before migration, during migration and after migration (Fig.1).
Fig 1: Risks during the migration process (Giacco et al., 2017)
Before Migration
Young people are likely to come across adversity at any stage of the migration journey but before migration, they may experience stressors that were factors in their decision to flee. Extreme poverty can limit access to food, shelter and other basic resources, affecting individuals at both a biological and a psychological level. War, persecution and violence is a factor in many refugees’ decisions to leave their home country. In such cases, studies have reported many atrocities occuring before migration including armed conflict, political persecution, homelessness, physical violence, sexual abuse, maltreatment, torture or loss of a family member (Arakelyan & Ager 2021). Repeated or extreme exposure to violence is associated with an increased risk for mental disorders including post-traumatic stress disorder (PTSD). Many studies have found increased prevalence of PTSD and psychotic illness comparative to non-migrant populations (Giacco et al., 2017)
During Migration
Once migration is underway, many migrants continue to be exposed to violence, hunger, homelessness, abuse, trafficking and forced labour (Arakelyan & Ager 2021). Oftentimes, the journey involves unsafe boat travel or enclosure in trucks (Giacco et al., 2017). These experiences are particularly prevalent for unaccompanied refugee children. In one study, all unaccompanied refugee minors reported experiencing physical abuse and more than half sexual abuse (Longobardi et al., 2017).
Mental Health Outcomes
Both before and during migration, risk and protective factors can affect the mental health outcomes of individuals and families. Individual factors may act as a moderator for the impact these adversities have, with developmental stage being a notable one. Erikson’s psychosocial theory can be useful when examining vulnerabilities for children at different stages of development. According to his theory, development interacts with biological cognitive and social domains. The theory defines ‘life stages’ which involve challenges for individuals to overcome at specific ages (Fig. 2) (Brennan, 2021).
Fig 2: Erikson’s Stages of Psychosocial Development (Cherry K, 2023)
Beginning with the first three of Erikson’s life stages (up to age 5), the early years are a time of rapid brain development and neuro-synaptic pruning (WHO, 2020). This makes infant brains particularly susceptible to environmental stimuli, both positive and negative for their development (Irwin, 2007; Minh at al., 2017). Through a process called biological embedding, social and environmental experiences in a child’s early years can have lifelong protective or detrimental effects on children’s learning, behaviour, health and wellbeing (Berens, Jenson & Nelson, 2017). As a result, adverse childhood experiences (ACEs) at this time are likely to have a greater impact, especially if they involve trauma: events which are seen as threatening to a child’s safety and well-being initiating intense and long lasting reactions (Murray, 2019).
Repeated, perhaps life-threatening experiences can undermine basic trust in others. Long term, this can impact on the development of close relationships: a strong protective factor against psychosocial problems (Arakelyan & Ager 2021). This links with Erikson’s first stage of psychosocial development as well as attachment theory. Both highlight the role of responsive and dependable caregivers in children’s psychosocial development. According to Erikson, failure at this stage gives individuals the sense that others are not dependable and trustworthy (Brennan, 2021).
Attachment security is widely recognised to support healthy developmental trajectories in individuals (Allen et al., 2007). A number of studies have highlighted the protection that warm, responsive and stable parent-child relationships have towards mental health outcomes in refugee children, linking it to post-traumatic growth and mitigating the impact of atrocities on children (Arakelyan & Ager 2021). However, research suggests that attachment relationships can become severely compromised in migrating families. Caregivers are less likely to be attuned and emotionally available when exposed to stressors such as war, violence and displacement (Arakelyan & Ager 2021). Furthermore, literature has consistently shown that parents with unresolved trauma and losses are more likely to have children with disorganised attachment (Arakelyan & Ager 2021). Ainsworth expanded on Bowlby’s initial attachment theory to define three different insecure attachment styles (Fig.3) Disorganised attachment in particular has had strong associations with an elevated risk for later psychopathology (Arakelyan & Ager 2021).
Fig.3: Attachment Styles (Poppmeier, 2022)
Unaccompanied asylum seeking children are seen to be at particular risk of psychopathology as they have faced trauma, loss and separation from attachment figures. Consequently, establishing close and trusting relationships is likely to be a challenge and greater care may be needed in treatment and recovery to account for this (Jakobsen et al., 2014).
It should be noted that attachment research has disproportionately studied WEIRD (white, educated, industrialised, rich and democratic) populations which may limit its cross-cultural application. Many migrant populations are from rural communities which may base their sense of security on the availability and reliability of a caregiving environment rather than in individual attachment relationships (Keller, 2014). Relationships with caregivers may therefore look different to those we expect from a Western standpoint. Awareness of differences such as these are an important part of cross-cultural competence. There are well documented disparities in the health treatment of minority ethnic groups (Sue et al., 2009) so cultural competence via collaboration with, and sometimes deference to, ethnic minority communities and experts should become part of common practice (Sue et al., 2009)
After migration
We have seen the impact that significant relationships have on migrating children but in this section, we will take a look at some of the wider systems that can also have a profound impact on their lives. Brofenbrenner’s ecological systems theory demonstrates the complex and interrelated spheres of influence impacting on development (Fig.4). Through this model, we can see that a child is affected by multiple levels of the surrounding environment, from immediate settings of the family in the microsystem to broader context of culture and customs of the residing country in the macrosystem (Brofenbrenner, 2009).
Fig. 4: Bronfenbrenner Ecological Systems model (Edwards, 2012)
Arakelyan and Ager (2021) note that the ecological systems model’s focus on examining multiple levels of context and change over time can be especially useful in understanding the factors and processes shaping the mental health of refugee children. They created an adapted model (Fig.5) to demonstrate the risk factors associated with refugee children within each sphere of influence.
Fig.5: Risk factors for refugee children (Arakelyan & Ager, 2021)
As previously discussed, adversities both before and during migration leave individuals more vulnerable to mental disorders, particularly PTSD. However, new research is beginning to uncover the importance of the post-migration context in determining mental health. It is believed that post-migration factors may in fact moderate the ability of migrants to recover from pre-migration trauma (Hynie, 2018) and although there is a higher prevalence of PTSD in the first years after resettlement, rates of anxiety and depression are higher in longer-term resettled refugees. Evidence suggests that poor social integration and difficulties in accessing care contribute to higher rates of mental disorders in the long-term (Giacco et al., 2017). The wider spheres of community factors and institutions and policy factors seen in Fig. 5 may have an important part to play in this.
Community factors appear to be particularly influential on adjustment and mental health for migrants, especially the extent to which they feel welcomed (Hynie, 2018). Experiences of discrimination and exclusion have been found to be associated with high levels of stress, anxiety and depression (Hynie, 2018). To this extent, a Canadian study found that the rate of internalising disorders in refugee youth were no longer significant once their greater experiences of post-migration trauma and discrimination were taken into account (Hynie, 2018).
Globally, attitudes towards migrants are mixed but prejudice continues to be a prevalent, and in some cases, increasing problem. According to polls in 2017, Europeans hold the most negative attitudes towards migrants with more people anti-migration rather than pro-migration (Dempster & Hargrave, 2017). Within the UK, many believe that immigration threatens British values, culture and living standards, public services and security through rising extremism and criminality (Holloway et al., 2019). We can gain some understanding of the reasoning behind these prevailing attitudes if we look at them through the lens of social identity theory.
According to social identity theory, a substantial part of our sense of self derives from the groups we are a member of. Such groups can be wide ranging from national, religious or even interest based but social identity involves internalising these groups as part of the self (Turner 1982). The theory can explain how humans form categorizations of different groups which can create ‘in-group’ and ‘out-group’ prototypes. A desire to view one’s own group positively can lead to more favourable treatment towards those within the ‘in-group’ than the ‘out-group’ (Reynolds et al., 2016; Hogg & Williams, 2000). Such cognitive biases can lead to prejudice: the holding of negative attitudes toward others based exclusively on their membership of a given group (Reynolds et al., 2016) and discrimination: actions towards an ‘outside’ group which impacts on them negatively (Reynolds et al., 2016).
For migrant youth to feel integrated into their new society, a process of both enculturation and acculturation needs to take place. Enculturation involves perceiving value and belonging in one’s heritage, minority culture. It is usually mediated through interaction with others from that culture (Milstein & Luci, 2004). Acculturation, in contrast, refers to the process of acquiring the values and behaviours of the new culture (Milstein & Luci, 2004). Children who are able to integrate these two processes are widely reported to have better mental health outcomes. Conversely, adopting an acculturation style based on separation or marginalisation contributes to persistent challenges and poor mental health (Arakelyan & Ager 2021).
Referring back to Erikson’s theory of psychosocial development, we have already seen the way that the early life stages can be impacted prior to and during migration. It is now worth looking at some of the later stages of development and how they may act as a mediator, post-migration. The life stage of industry vs inferiority occurs between the ages of 5 – 12 and has a profound impact on children’s feelings of competence (Brennan, 2021). School-age migrant children may have missed time in school both prior to and during migration which has the potential to create feelings of inferiority. Additionally, beginning school within a new culture may introduce conflicting cultural messages that are challenging to navigate. Teachers and parents may have different values on issues such as discipline, gender roles, work habits and occupational choices: all of which can be exacerbated by cross-cultural misunderstanding and miscommunication (Milstein, G & Luci, L, 2004).
The life stage of identity vs role confusion occurs between 12 – 19 years of age. This may play a particularly important role for migrant children who may feel balanced between two cultures and therefore find forming an identity particularly challenging. Erikson thought that a key aspect of identity formation is the degree to which an adolescent’s own cultural identity is validated by others in the community (Rothe et al., 2011). If adolescents experience problems in choosing and committing to a sociocultural identity, an identity crisis can occur, increasing the risk for distress and behavioral problems (Oppedal & Toppelberg 2016).
Recommendations
In light of the issues discussed thus far, I will now propose a recommended action plan for a school counselling service to mitigate risk exposure and support existing protective factors for their migrant student population (Table 1). The aim of the intervention is to promote integration of migrant students and prevent feelings of isolation and the accompanying risks to mental health.
| Sphere | Intervention | Intended Outcome | |
| A | Wider school | Whole school awareness through anti-discrimination drive:Inclusive curriculumInclusive anti-bullying policyAwareness raised through media intervention | Reducing prejudice and discrimination |
| B | Significant relationships | Intergroup connection | Assisting acculturation and integration |
| C | Individual support(on a needs basis) | Individual counselling or referral to outside services | Supporting specific difficulties stemming from pre-flight trauma. |
Historically, interventions have focused on treating pre-migration trauma. However, as has been noted, many studies have highlighted the lasting effects that post-migration stressors have on mental health outcomes. The focus on pre-migration trauma may even have the counter effect of exacerbating existing integration challenges: by defining migrants’ experiences in terms of trauma, stigma may be increased and perceived competence reduced (Hynie, 2018). To address post-migration stressors, interventions which address the broader conditions of migrants’ lives should be sought. The Inter-Agency Standing Committee (IASC) suggests psychosocial support for refugees should be offered in the following ways: 1) addressing the basic needs of resettling families; 2) offering parental support; 3) creating a supportive environment for children and; 4) addressing the need for professional psychosocial interventions (IASC, 2018, as cited in Murray, 2019). The proposed intervention addresses recommendations 2, 3 and 4.
A – The Wider School
To begin with, the intervention focuses on creating a supportive environment by addressing issues such as prejudice and discrimination on a whole school level. In their paper, Promoting fair and just school environments, Killen and Rutland state that in order to create nondiscriminatory school environments, strategies must be carried out at multiple levels (2022). These may include creating inclusive policies, promoting opportunities for intergroup contact and implementing evidence-based education programs (Killen & Rutland, 2022). Research examining prejudice against other minority groups such as LBGTQ has made similar recommendations. A Canadian study found that evidence-based anti-bullying policies and LGB inclusive curriculum materials improved both student mental health and academic achievement, while fostering a better school climate and reducing bullying (Burk et al., 2018). It is worth noting that such policies must be fully implemented and enforced by the whole school community in order to maintain effectiveness. The curriculum materials used with this intervention consisted of teen oriented and engaging short films based on key concepts related to diversity, issues of discrimination and ways to be inclusive. This was based on Intergroup Contact Theory, stipulating that structured exposure to people from stigmatised or marginalised groups can reduce negative stereotypes and prejudice (Burk et al., 2018). There is a strong possibility that such an intervention would have similar effects on other stigmatised groups such as refugees.
B – Significant Relationships
Research suggests that resilience strategies found to be helpful with child refugees include acting autonomously, engagement at school, support from peers and parents, and actively participating in the new community (Murray, 2019). Therefore, the next part of the intervention focuses on building resilience through supportive relationships. As previously discussed, warm, responsive parenting leads to greater resilience and mental health outcomes in all children but can be particularly beneficial in the turbulent lives of migrant children. As a result, family centred interventions which promote parental coping and positive parenting strategies could be of great value (Arakelyan & Ager 2021). This could take the form of parenting workshops in school which has the added bonus of connecting families. If newly arrived refugee families can be introduced to those who have already settled into the community, this is another way of creating support networks (Murray, 2019). Outreach for such services would need to be considered with translation provided where possible. Contact with parents may also support integrated acculturation. Clashes between the values of parents and teachers can hinder children’s development and schooling. By inviting dialogue between families and schools, valuable insight may be gained into the developmental priorities of teachers and parents, hopefully lessening any potential conflict (Milstein & Luci 2004).
As well as supportive family relationships, good relationships with teachers, and native students may facilitate migrant students’ access to and understanding of the new society and aid the acculturation process (Vedder & Motti-Stefanidi 2016). Positive interactions with classmates and teachers are seen to help migrants learn to reestablish reliable bonds with their new community and can support language proficiency. A sense of belonging to the community is a protective factor that not only helps with adaptation but also reduces the stress and anxiety associated with resettlement (Murray, 2019).
Opportunities for positive intergroup and intercultural contact help to reduce prejudice and discrimination according to the previously mentioned contact hypothesis (Vedder & Motti-Stefanidi 2016). Grapin et al. (2019) conducted a large meta-analysis which explored school-based interventions aimed at reducing prejudice. They found that optimal conditions for group contact include (a) common goals, (b) equal status, (c) intergroup cooperation (i.e., the absence of competition), and (d) authority sanction (i.e., support from societal customs and/or authorities). Some notable successes included the strategy of a “jigsaw classroom” where students were required to work collaboratively to solve a problem after being given pieces of a lesson. Outcomes of this strategy included interpersonal attraction, perspective-taking, social support, and constructive management of conflict (Grapin et al., 2019). For such practices to be implemented school wide, they should be part of the school’s teaching policy and all staff made aware of its value. The school counselling service should be able to offer guidance and modelling of any suggested strategies to further support their implementation.
C – Individual Support
In addition to creation of a supportive environment and relationships to aid resilience and recovery, some individuals may need individual therapy to address more severe trauma (Murray, 2019). Research suggests that migrant populations under-access mental health services despite having a greater need (Sue et al., 2009). This can be due to factors such as language barriers, a lack of trust in public organisations or cultural stigma surrounding mental health (Giacco et al., 2017). The school counselling service could therefore act as a bridge between families and mental health support services. Access through schools may feel more accessible to families as they are likely to be seen as a safe location, more culturally acceptable and less stigmatising (Murray, 2019). Successful interventions in refugee populations include Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT, and Narrative Exposure Therapy but research suggests they should be delivered by trained professionals (Murray, 2019).
Conclusion
In conclusion, it can be seen that the challenges involved with migration are multifaceted and as a result require a multifaceted approach in order to achieve the best outcomes. There are many risk factors at all stages of migration but the adversities that occur post-migration appear to have some of the longest lasting impacts and may therefore be most valuable to address with school-based interventions. Migrant youth are a vulnerable population and are likely to have faced a number of adverse experiences, some at extreme levels. However, a supportive community seems to be one of the best ways to build resilience and can support recovery even when more focused, individual therapy is required. The community systems required will need the collaboration of many individuals for them to work at their best, but where this is the case, the environment created is likely to be one in which migrant children can thrive.
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