Supresión Grasa

Denmark

The Danish Red Cross has a Psychological Unit, centralized in Copenhagen, which serves the whole country. This Unit has a specialised Child Unit focusing on the needs of asylum seeking children. The psychologists travel to different asylum centres to undertake psychological screenings (interview with psychologist and psychiatrist). In August 2008, the Danish Red Cross and the Danish Immigration Service signed an agreement stating that all newly arrived asylum seeking children should get a psychological screening. The government is financing the screening. However, with rising numbers of asylum seekers it has been difficult to reach the goal of the 2008 contract. The contract in 2013 was changed to screening of 700 children, while the current (2014) contract requires the Red Cross to screen all

vulnerable children. To evaluate whether a child is vulnerable or not they use what they call The Child Ruler (børnelinealen) (interview with psychologist), which categorizes between 5

types of situations: 1) Ordinary children with ordinary problems, 2) Children with temporary risk of social problems (sensitive children), 3) Children with specific needs of chronic or long-term nature, 4) Children with significant need of special support and 5) Children with obvious risk of suffering serious harm. With regards to children in category 4) and 5) there is an obligation by Health and Social Services (Social- og sundhedsforvaltningen) to provide supportive measures. According to interviews, Social Service should already be involved with regards to asylum-seeking children belonging in category 5). The main focus of the Child Psychological Unit at the Danish Red Cross is on screening and supporting children in category 3) and 4). The Child Ruler is a tool which specifies concrete assessment criteria for each category regarding the child, parental skills/capacities and the child‘s broader network. The screening should normally take place within the first three months after arrival to Denmark. This, however, is not always the case (interview with psychologist and psychiatrist). The Psychological Unit used to employ the Strengths and Difficulties Questionnaire (SDQ) but abandoned this tool as it proved not well adapted to the target group. ―Many of those we screen have very little or no schooling, are not familiar with this kind of questions, nor to answer using a scale from 1 to 5‖ (interview with psychologist). Currently they use a semi- structured interview guide that has been developed by the Psychological Unit at the Red Cross. The screening of children in families is based on a conversation with the parents about the

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Normally, inhabitants in Luxembourg are members of the compulsory public health insurance which allows free access for basic healthcare. Those in work as well as employers contribute with 10% of their gross income. Asylum seekers and other who do not have immediate access to the labour market become members of what is called voluntary social insurance providing them free access to the national health system.

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family, the parents‘ well-being, and the children's well-being and development. Screening of UAM is done through a conversation with the young people themselves.

The purpose of the psychological screening is ―(…) to identify the asylum seeker children who have either developed or are at risk of developing psychological difficulties or who have other special needs upon arrival in Denmark‖ (Shapiro et al. 2010: 6). Results from psychological screening of children in 2009 shows that about 20 % have been in life- threatening situations, 38 % live in families where at least one parent has been subjected to torture, and 60 % live in families where at least one parent has been subjected to violence (ibid.). The results indicate that 32 % are at high risk of having psychological problems or mental illnesses. About 56 % are deemed to need ―(…) coordinated psychosocial attention‖ and are therefore assigned to multidisciplinary psychosocial teams (Ibid.: 6). Measures and interventions offered to children in need of special care are often family-focused support with a strong element of psycho-education.

Children who need to receive individual counselling and treatment must travel to Copenhagen to attend sessions with psychologists or psychiatrists at the Child Unit (interview with psychologist and psychiatrist). This seems inconvenient, probably creating an extra barrier for both children and their parents, who in many cases will have to accompany them to Copenhagen. The interviewed psychologist expresses that the travel distance may increase the likeliness of children and youths not showing up for their sessions, and holds the view that it is better if ―(…) we meet them where they are.‖ Nonetheless, due to Denmark‘s small size the centralized unit works relatively well. In addition, the social curator or social worker at the centre may organize different interventions/measures like drawing therapy, music therapy, bilingual social educator, and bilingual support person. Some children also participate in friRum groups and Joyful Play activities. About 40-50 out of the 800 residents that stayed at Avnstrup at the time of the fieldwork had some kind of special support (interview with social worker).

Except for friRum and Joyful Play, where Red Cross has competent facilitators among their own staff, they normally buy services from Solvita22, a consultancy agency with specialised competence on traumatized children, youths and adults. Solvita includes a variety of professional disciplines - psychologists, music therapists, acupuncturist, social educators and mentors – who work jointly to solve the psychosocial tasks. Their staff is multicultural and therefore also fluent in the mother tongue of children and adults at asylum centres. The social curator at Avnstrup notes that they have particularly good results with a family-focused

support which combines a bilingual social educator and a music therapist. ―The boy who was

suicidal, who refused to go to school and would never be away from his mother, he started school again after only two sessions with the social educator and the music therapist. He is not quite in place, but there is a great progress in a very short time. But it is still a long process that must be followed up to avoid relapse‖ (interview with social worker).

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Parents interviewed at Avnstrup also hold the view that music therapy combined with a social educator is a fruitful method. However, what they value the most is what is called a support

person. These approaches will be outlined in the section on good practices.

Sweden

Psychological screening of asylum-seeking children is not part of the health services offered in Sweden. However, part of the conversation during the general health examination should be about the child's psychosocial situation or traumatic experiences and how these may affect how he or she feels today (Socialstyrelsen 2013a: 94). According to the Refugee Health Centre in Malmö the children often reveal psychosomatic problems such as concentration difficulties, sleep problems, headaches, tension, poor appetite, dizziness and sadness (Socialstyrelsen 2013b: 21). If an asylum-seeking child in Sweden is in need of psychological or psychiatric interventions the entity in charge is the Child and Adolescent Psychiatry (Barn och ungdomspsykiatrin - BUP). When a child is referred to BUP, BUP is obliged to carry out an assessment of the child within 3 months and according to the result of the assessment it will be determined whether or not to initiate immediate measures or interventions. According to an interview, BUP assessment is often done within a month after the child is referred. It should, however, be noted that a recent report by Stretmo and Melander (2013) reveals that some BUP receptions do not accept new registrations of young people who have turned 16 and some do not accept children who are in the asylum process. This means that asylum- seeking children in need of psychological or psychiatric treatment are not necessarily provided the same care in every municipality in Sweden.

Another interviewee, a nurse within the primary health services (Vårdcentral), notes that BUP only treats ―severely ill children‖. Depending on the needs of the child she may encourage him or her to rather contact the Youth Reception (Ungdomsmottagningen) or the School

Health Services (Elevhälsan). Staff at the Youth Receptions includes a midwife, social

worker/curator and most often also a medical doctor. Some Youth Receptions also have a psychologist, a nurse and a psychotherapist. The School Health Services are present at all schools from grade one to the end of upper-secondary/high school (gymnasiet). Here the children get help and support from a school nurse, a school doctor, a school curator, a school psychologist, and a special educator (spesialpedagog). When the situation is more critical the nurse responsible for the health examination will send a referral of concern to the Social Service. Upon an assessment of the child‘s situation and well-being, the Social Service may decide to initiate measures aimed at the individual child or in-home measures aimed at the family. One measure may, for instance, be sessions with a child psychologist (interview with social worker).As long as the child is in the asylum-seeking phase the Migration Board is financially responsible for these measures/interventions.

BUP Farsta, which participated in this study, has a specialised unit for asylum psychiatry which is particularly responsible for therapy and treatment of asylum-seeking children. Similarly in Malmö we find the specialist team for war and torture injured (Team for krigs- och tortyrskadade -TKT). Their competence, both with regards to treatment of traumatized children as well as the consultative role they have to the general BUP system, is well spoken of by interviewees at BUP. However, most municipalities do not have specialised units/teams

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with staff being particularly competent on treating asylum seeking children and children victims of war. Variations in how psychological/psychiatric health care is organized create a situation where some asylum-seeking children may get specialised help while others do not.

At the time of the fieldwork all, except one, of the UAM at Erikslust were seeing a psychologist. The staff is of the opinion that this is an important intervention, and that the youths also express the usefulness of having a psychologist to talk to. But not everyone agrees: ―When I talk with a psychologist about my painful memories it only makes me think about how everything was. It is better to let me be, to let me forget it‖ (interview with UAM).Whether we see an intervention as helpful or not depends on many things, but among them are both personality and culture. Hjern & Jeppsson refer to studies with divergent effects of talking and working through war experiences, and conclude that ―(…) the effect of a working through program in one context cannot automatically be translated to a different population with a different cultural discourse for dealing with painful memories‖ (2005: 120).

Luxembourg

In Luxembourg asylum seekers, especially victims of trauma, are granted psychological care and follow-up care if needed (Règlement grand-ducal du 8 juin 2012, Art. 1.8). This means that they can benefit from the service offered within the national health system. In Luxembourg there is no specific institution or centre to support war-affected or unaccompanied minors; psychological guidance or any treatment in the field of mental health is made by psychologists or psychiatrists (child and youth specialists) working in either private practice, public health system or in other organizations/associations within the domain of mental health, such as mental health centres (these centres are run by non-profit organizations and receive public funding). Within the department of Migrants and Refugees of the Red Cross, there is no specialised staff to work with traumatized children; however, children in need of transcultural psychological care, psychosocial support as well as pedopsychiatric care may benefit from the project Eng Bréck no baussen, of course with the permission and involvement of the parent of the child. The program is indeed created primarily for the care of adults, but unaccompanied minors or children are surely not excluded. In general, the Red Cross (Migrants and Refugees department) works closely together with internal and external partners, such as the Hospital Centre (Centre hospitalier), the Pediatric Hospital (Hôpital pédiatrique), the psychiatric service for children and adolescents (Service pédopsychatrie) to ensure expert care for this very specific population and their very specific needs (E-mail correspondence with Red Cross staff).

As no identification procedures exist, there are no statistics or even estimations on the number of war-affected children currently living in reception centres in Luxembourg. There are some families from currently war-affected countries like Syria, so with them it is highly probable that children have witnessed violent situations. As already mentioned, employees of Caritas and OLAI stated that they were not able to help with this research project, due to a lack of experience with war-affected children. The professionals and experts of the Red Cross and ORK related in the interviews that they would rather use a broad definition of the term ‘war- affected‘. To their assessment, not only children who have directly participated in or witnessed acts of war are affected by this, but also children whose families have been

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traumatized during a war maybe 15 years ago, such as in Kosovo, still show symptoms of psychological distress. Due to the transgenerational transmission of traumatization, they also might be defined as war-affected.