Consideraciones generales

As this report has shown, a child‘s well-being (as well as his or her resilience and coping strategies) is affected by past and current experiences and the social support available in the social ecologies of family and community (e.g., Kostelny 2006; Wessells 1998; see also

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Ingvarsdotter 2012). In contexts of war and conflict ―(…) systems that are normally sources of support and protection, such as the family, [may] become sources of risk and developmental damage‖ (Boothby et al. 2006: 5). This is particularly the case if parents are traumatized. How war-affected children cope is therefore also dependent on parents‘ exposure and coping with war traumas (Montgomery & Linnet 2012; Godani et al. 2008). Normally a child would turn to his or her parents for comfort and support, but when the parents are traumatized they are often pre-occupied with their own problems and less sensitive and able to meet the needs of the child.

In other words, they may be emotionally and functionally unavailable to their child which has a clear negative impact on the child‘s psychosocial well-being. Research from Sweden shows that 87 % of children with traumatized parents show disorganised attachment - ―(…) caught between a desire for nearness and a fear of approaching the parent‖ (Daud 2008: 8). Recent research also stresses the risk that parents may ‗transmit‘ their unprocessed traumas to their children (Daud 2008; van Ee 2013; Brendler-Lindqvist 2014). In addition, the risk of family violence is likely to increase in families where one or both parents are traumatized or suffering from other forms of psychological problems (interview with Montgomery). This close link between the psychosocial well-being of the child and the parents‘ mental health demands family-focused interventions which, if needed, include psychological support for the child‘s caregivers. Basically, we cannot ensure the realization of the child‘s right to rehabilitation without extending the right to treatment and support to their parents. As argued by Ascher and Hjern, re-creating the asylum-seeking child‘s feeling of hope and security is central and can partly be done through re-creating hope and security of the parents (Ascher & Hjern 2014: 115).

A family-focused approach to war-affected asylum-seeking children, focuses, as we have seen in the good practice of the Danish Red Cross, both on the individual child‘s well-being and on strengthening parents and building parental skills. It is of great importance to enable parents to feel more confident in their parenting role, in relation to children that are traumatized by armed conflict but also in relation to parenting in a new cultural setting. The family-focused psychosocial support should, in addition to attending to the individual child‘s and parent‘s psychological needs, also attend to the collective needs of the family, such as reducing daily stress in the family and address urgent practical problems. Many asylum-seeking parents as well as children and youth are unfamiliar with and sceptical to western approaches to psychological problems (they may not even call them such). To start immediately with treatment may therefore be impossible. As maintained by Ehntholt & Yule (2006), the phase of model to intervention of war-affected refugee children is normally a phase of establishing trust and safety. Practical issues and daily stressors in the life of a ‗traumatized family‘ must be attended to and through these interactions trust may be built. Again we would like to stress the importance of the support person measure in Denmark (see more above). Similarly to the implementation in the Danish Red Cross, it is psychosocial problems identified in the child that should lead to the provision of a support person, but the support offered by this person must also address challenges and needs in the family as a whole, not least challenges linked to parenting.

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A comprehensive family-focused approach requires, most likely, an interdisciplinary approach where several welfare services and professionals collaborate. The recently established Transcultural centre in Stavanger seems to be a good example of such an approach, as is the Danish Red Cross‘ collaboration with the interdisciplinary staff at Solvita. Parents who suffer from traumatization and other mental health problems must be ensured the necessary psychological and psychiatric help. Improved mental health of parents will evidently make them better able to support and care for their own children.

Recommendation 20: Ensure a family-focused approach to psychosocial support (for

instance the adult support person measure, see Recommendation 12) helping parents to cope with their own problems, support parents on how to minimize that their own mental stress and traumas affect their children, and help them understand how to handle the war-trauma reactions of their children. Competent professionals, preferably bi-lingual, should be used in this kind of interventions. Asylum centres must have a budget that allows hiring external professional consultants to implement this support.

Recommendation 21: Offer appropriate psychological and psychiatric treatment to asylum-

seeking adults. If necessary, adults with children should be prioritized. The right to psychiatric treatment must be extended to adults who have had their asylum application rejected. Adult psychiatric health services (regional) must be strengthened to be able to provide the necessary, rapid and appropriate psychological and psychiatric treatment to asylum-seeking adults affected by war. A close collaboration with other health services, particularly BUP, is crucial to succeed in improving the health situation in asylum-seeking families.