Mental Health of Refugee
Children: A Guide for the
ESL Teacher
Dina Birman
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Mental Health of Refugee
Children: A Guide for the
ESL Teacher
Dina Birman
Copyright © 2002 by Spring Institute for Intercultural Learning
This publication has been produced pursuant to grant number 90 RB 0005 from the U. S. Office of
Refugee Resettlement(ORR). The views expressed are those of the Spring Institute and may not
reflect the view of ORR.
No portion of this publication may be reproduced or excerpted without the written consent of the
Spring Institute for Intercultural Learning.
Spring Institute for Intercultural Learning
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Denver, Colorado 80218
Phone: (303) 863-0188
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Email: elt@springinstitute.org
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Spring Institute for Intercultural Learning
E L T
Technical Assistance for
English Language Training Projects
2002-2003
Sponsored by the
Office of Refugee Resettlement
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Preface
 ESL teachers often are some of the first resources available to help refugees cope
with a new cultural environment. Their role as cultural informants is very important.
Although the identified role of the teacher is to teach English language skills, there is
potential for the classroom to be an environment where refugees can make significant
progress on the path toward adjustment to a new life in an unfamiliar culture.
In order to conceptualize the purpose of this booklet, which is designed for ESL
service providers and focuses on the topic of cultural adjustment and mental health
for youth, it also seems essential to point out what it is not:
• It is not meant to turn ESL providers into therapists or mental health
specialists.
• It does not provide a diagnostic tool or suggest that ESL providers are,
in general, qualified to make definitive judgments about students’ mental health
or need for therapy.
• It is not an ESL curriculum utilizing the topic of mental health.
• It does not imply that many or most refugees suffer from any symptoms
which require mental health intervention.
In providing this information we hope teachers can do a better job of meeting
needs and knowing how, when, and where to refer students to other parts of the
service provider network. There is now substantial research and experience on cultural
adjustment and mental health issues which refugees face; but not as much
attention has been focused on youth. We know that refugee youth come with not
only the residue of the refugee experience, but with the anxiety of becoming adults,
“fitting in” and “belonging” in a family and with a peer group.
We recommend that schools, agencies and other groups who want to fully utilize
the information here contact the English Language Training Technical Assistance
Project to schedule training to accompany the use of this resource.
2
3
Part I
INTRODUCTION AND
BACKGROUND
For many years the focus of the U.S. refugee resettlement program has been on
assisting adults and families transition into American life. “Refugees” refers to a legal
status granted to those migrants entering the U.S. for resettlement who are fleeing their
country of origin due to a well-founded fear of persecution (The Refugee Act of 1980).
Since its beginnings, the refugee program has resettled large numbers of Vietnamese,
Cuban, Soviet Jewish and Evangelical Christian, and Bosnian refugees. In recent years
increasing numbers of refugees from Africa, Central Asia, and the Middle East have
also been entering the country.
Voluntary Agencies and other state and local organizations provide re-settlement
services to refugees to help ease their transition. Initially refugees received cash assistance
for as long as 3 years. The program has gradually decreased the length of time refugees
can receive such support to the current time frame of 4-8 months, depending on the
program. As a consequence, the primary focus of the refugee resettlement programs has
been on helping refugee adults become employed as quickly as possible after resettlement
in order for the family to become economically self-sufficient. This includes assistance
with preparing for and finding employment and learning English in order to become
gainfully employed. Further, with recent changes in welfare reform, efforts have also
focused on citizenship training to enable refugees to become U.S. citizens as quickly as
they are eligible in order to maintain their eligibility for welfare, unemployment, and
social security supplemental income benefits, should they need them.
Because of these great pressures on refugee adults to secure employment, the
needs of refugee children have not been the focus of resettlement programs. Similarly,
within the refugee families, as adults focus on employment, learning English, and taking
care of the family’s basic needs, the lives of the children can go unattended. Refugee
adults often make the assumption that the children’s transition into life in the U.S. will
be easier because they will learn the language more quickly, and adapt more easily to
4
their surroundings. In some refugee communities adults refer to themselves as the
“sacrifice generation”, feeling that they’ve made a move to a country where they will
never feel at home for the sake of their children. However, the needs of these children
during the resettlement process itself often can go unaddressed because of the
assumption that their adjustment will be relatively automatic and uncomplicated.ESL
teachers can and do play an extremely important role in the lives of newly resettled
children. This manual will:
• Review developmental and mental health issues for children in general,
• Highlight two important factors in lives of refugee children that are
layered onto developmental and mental health issues: acculturation and trauma
• Explain treatment options, and
• Give specific suggestions on the role of ESL teacher.
5
II. CHILDREN
’S ADJUSTMENT
AND MENTAL HEALTH ISSUES
For refugee children resettlement involves managing several important tasks.
The main ones involve:
a) moving
b) adjusting to school
c) mental health issues in general.
Before reviewing special considerations for refugee children involved in coping
with these issues, it is useful to consider what we know about how children in general
cope with them. This can help identify aspects of a “normal” or usual process of
adjustment and adaptation that occurs as children develop. This is useful for two reasons.
First, it allows us to apply what is known about how children cope with these processes
to refugee children. Secondly, it helps us understand which issues and needs of refugee
children are similar to those of other children, and which are unique, requiring special
considerations and services.
A. STRESSFUL EVENTS FOR CHILDREN IN GENERAL
Moving
Moving is generally considered to be one of the most stressful life events,
ranked near the top on various “life events lists” that assign points to the level of
stress produced by these events. Moving is considered to be extremely stressful
because of the extent to which it disrupts one’s routines and demands readjustments
to many aspects of life. Further, life events such as moving are considered to be even
more stressful when they are unanticipated, and when the person experiencing them
has little control over when or whether this event occurs. For these reasons, moving
can be particularly stressful to children because they don’t make the decision to
move—for them the move is out of their control—and sometimes they are not told
about it until right before it occurs. While parents may hope that the move will be a
positive experience for their children, children may approach it with apprehension.
Moving involves the loss of the familiar environment, friends and neighbors, as well
6
as demands that the child cope with adjustment to the new environment.
There are many things that parents can do to help ease this transition for their
children. For example, they can help children anticipate the transition, perhaps even
take them to the new town, visit the school, share information about the new place in
order to prepare them for the move. After the move parents can help children recreate
aspects of their environment that they miss, such as bringing familiar items and
furnishings, and re-establishing family routines. Finally, many parents may encourage
their children to continue their relationships with friends and neighbors left behind
through phone calls, email or visits.
Because moving is stressful, it is not uncommon for children to be very distressed
about this process, but children may not express this through words or may not even
appear sad. However, changes in behavior may be signals that the child is very upset
and having difficulties adjusting. For example, some children may revert to bedwetting
even though they have mastered toilet training a long time ago, or may exhibit irritability,
aggressive behavior, or act unusually withdrawn. In general, mental health professionals
suggest that parents explore whether the child is indeed upset and help the child talk
about these feelings. It is also very important not to ignore the behaviors that are
inappropriate, and to help the child cope with new problems. Parents may need to
consult a professional about bedwetting, establish more explicit rules for behavior, or
encourage the child to reach out socially. Although the child is suffering, it is not
unkind to establish the same rules and structure that existed before the move. The
sooner routines are reestablished and the child’s and family’s functioning return to normal,
the easier it will be for the child to adapt.
School Transitions and Adjusting to School
For school-age children school is one of the most important settings in their
lives; it is their “work”, the place where they interact with peers and reach developmental
milestones. Transition to school is one of the most important changes in a
child’s life, a key developmental step toward independence. For many children,
particularly those who did not attend preschool, entering school represents their first
experience with adjusting to a peer group, the need to attend to teachers, and separation
from parents. U.S. parents frequently anticipate the challenges of this transition,
as evidenced by parents exhibiting as much anxiety as the children when they
drop them off at school.
Similarly, transition from one school environment to another has been noted to
be stressful for children. For example, research has shown that following transition to
7
high school children tend to have more disciplinary problems, lower grades, and are
more likely to engage in high risk behaviors. These changes are attributed to difficulties
in adjusting to new school norms and a reshuffling of the peer group. Upon moving
from middle school into the high school building, adolescents who had been the oldest
in their school building become the youngest. They experience new and unfamiliar
stressors and often need to renew patterns of friendships and relationships with peers.
Three important factors have been identified by researchers that help ease school
transitions for children: (1) having friends and peers from the old school accompany
them in their move; (2) having smaller classes; and (3) having significant relationships
with important adults, such as a special teacher, counselor, or someone else in the school
system to help with the transition.
Having old friends around provides a comfortable environment because the
child both knows these peers and is known to them. Smaller classes are positive for a
number of reasons, but in this case they allow for greater contact with other students
and the teacher, helping everyone to get to know one another sooner and establish
stronger relationships. The positive influence of an important adult (other than parents)
in a child’s life is attributed to the fact that the adult can provide guidance and support
to the child at a time when children may not be receptive to parental authority, and
peer relationships can be particularly complicated.
Mental Health Issues
All children may experience mental health issues. While it is probably
cumbersome and unnecessary for teachers to know the range of mental disorders in
children, teachers are often the first to observe symptoms of such disorders and problems.
Many times inappropriate behavior in the classroom may be merely a signal that the
child needs help in adjusting at school. However in some cases signs that the child’s
functioning at school is impaired may be symptoms of a mental disorder. In general
symptoms of mental disorders can be characterized as “internalizing” and “externalizing”
behaviors.
8
SYMPTOMS OF MENTAL DISORDERS
Types of Behaviors When extreme, behaviors may be
 symptoms of disorders such as:
“Externalizing” Behaviors:
❊ Fights ❊ Attention Deficit Disorder (ADD)
❊ Difficulty in sitting still ❊ Conduct disorders
❊ Difficulty in following
 rules/expectations
“Internalizing” Behaviors:
❊ Unusually withdrawn ❊ Depression
❊ Sad or display little energy ❊ Anxiety
In general externalizing behaviors are more likely to draw a teacher’s attention, and
create problems in the classroom.
Public schools have processes for addressing needs of children who may be
exhibiting behavioral problems or signs of a mental disorder. Traditionally, in such
cases a child is disciplined, and if the behavior continues the child may be referred to
the school’s mental health team, which decides whether an assessment is called for. As
a result of the assessment, the child may then be referred for individual, family, or group
therapy, and/or special education classrooms. In this way the focus of the intervention
is on how to help the individual child, and the approach is to pull the child out of the
classroom environment in order to give him the skills necessary to adjust to the classroom
and school setting. In this approach the assumption is that it is the child who lacks the
skills to handle the classroom, and not the classroom that needs to be changed in order
to accommodate the needs of the child.
Recently some psychologists have questioned the effectiveness of such a
traditional approach, particularly in schools and classrooms in urban, low income, and
ethnic minority settings where behavior problems (or externalizing behaviors) are so
rampant that teachers spend more time on discipline than teaching. The strategy of
referring each child for assessment and treatment seems hardly practical when this would
require referring most children in a classroom.
As an alternative, interventions are now being proposed (Atkins et al., 2001)
that attend to problem behaviors at different levels. Methods include not only finding
9
ways to help the children adjust to the classroom, but also techniques to create classroom
environments that can help all children function better. One example of this approach
is Positive Behavioral Interventions and Supports (PBIS) a program that puts into place
behavioral interventions at the school-wide and classroom level for all students, and
offers individualized interventions for students who need more intensive services. This
program is now being widely disseminated nation-wide with funding from the U.S.
Department of Education.
While the details of this program are beyond the scope of this paper (see
www.pbis.org for more information on PBIS), the positive and proactive philosophy of
the program is reflected in several ways. It attends to children at different levels of need,
from those who need a little extra structure and support to those who need intensive
special education service. This affords interventions ranging from school-wide
interventions that improve the social and learning environment for all students, classroom
interventions that clarify rules and create a positive environment for the class, and
individualized interventions that provide mental health, special education, academic
support, or other needed services to individuals for whom the class-wide and schoolwide
interventions are not enough. It uses behavioral intervention techniques that have
been shown to be effective in helping individual children with behavior problems, and
that can be applied at the school-wide and class-wide levels. At the same time, the
program creates a positive and supportive climate at the school and in the classrooms
for the benefit of all students and teachers.
Although PBIS is designed as an approach to address only externalizing
behaviors, psychologists working with PBIS teams (Atkins) are interested in expanding
its scope to include internalizing behaviors and disorders as well. Using the PBIS
philosophy, the idea would be to enhance school and classroom environments so that
they can not only reduce disruptive behaviors, but also encourage full participation and
engagement of all students. When some children do not improve as a result of the
preventive approach, individualized interventions can then be developed to address
their specific needs with participation of their families.
Because the PBIS approach encourages thinking across multiple levels of analysis
and intervention (child, family, classroom, school), it can be particularly useful in
developing ways to intervene with refugee students for reasons discussed in the next
section.
10
The next section will consider in more detail the special processes and issues
that refugee students confront, including acculturation and post-traumatic stress. It
continues with a discussion of school-based mental health services that can address
refugee concerns, and offers specific suggestions for ESL teachers.
B. STRESSFUL EVENTS FOR CHILDREN IN A REFUGEE
CONTEXT
The previous section described some general developmental and mental health issues
experienced by all children as they cope with stressful life events such as moving,
and school adjustment. Now we shift the focus to a refugee child going through the
transitions described above.
With respect to moving, similar issues to those experienced by non-refugee
children are likely to be salient, including feelings of loss and sadness, and difficulties
readjusting to a new environment. However, there are also additional issues brought
about by the extreme nature of the move from one culture to another, often in the
context of war and other political conflict, which are outlined below:
1. Refugee families often leave under extremely stressful circumstances,
making it impossible to anticipate problems and prepare the child for the
move. Thus moving for them is extremely stressful, and may be “traumatic.”
2. The circumstances of resettlement are also very stressful, as refugees
often resettle in low income communities, and experience a substantial drop
in their standard of living that they had prior to their move, or prior to the
war or other violence that forced them to move. They may live in unsafe
neighborhoods and run-down buildings, their apartments filled with donated
furniture, worn clothing and toys.
3. For refugee families it is much harder to comfort the child with familiar
objects and reassurances from loved ones left behind. Refugees generally do
not arrive in resettlement countries with their possessions, as they often had
to leave them behind, perhaps under traumatic circumstances. Refugees
have also often lost family members and neighbors, and don’t have the
11
opportunity to stay in touch with them across geographic and political
boundaries.
4. Parents have a hard time re-establishing a sense of “normalcy” and setting
up appropriate rules and expectations for their children following the move
because of how unfamiliar the new culture is. The norms and rules of
behavior on the playground, available activities that are safe for children,
and many other aspects of life are unfamiliar and confusing. Parents
themselves may be very anxious about the future making it difficult to
reassure the children that everything will be fine.
5. Parents have little time to devote to such tasks in resettlement as they
struggle to survive economically. If and when children then begin to show
signs of distress, they may be misunderstood or overlooked.
For these reasons, the losses suffered by refugee children as a result of moving
are more extreme. Eisenbruch ( 1992 ) has written about “cultural bereavement” as
part of the psychological experience of migration, suggesting that refugees are grieving
for their culture and country as they might for a lost loved one. In addition, because
the move can be so traumatic for parents, they may be particularly stressed, irritated,
and unsure of themselves. Moreover, though parents are physically present, the children
may be grieving for the way their parents used to be. In a poignant article about the
refugee adolescent experience, Miriam Yaglom ( 1991 ) wrote about the experience of
refugee children essentially “missing” their parents, seeing them become relatively
powerless, confused, stressed, and unavailable in resettlement, whereas they seemed allpowerful,
competent, and strong when the family was leaving their homeland.
Overwhelmed with the need to provide for the family, the parents may not even realize
the impact their own difficulties have on the children. To justify the hardships to
themselves, they may reinforce in their minds that the move is much easier for the
children, since it appears that children adapt to the culture faster. Because from the
outside it may appear that children are doing fine, many of the needs of these children
and families that were stimulated by the move may go unaddressed in the resettlement
process.
With respect to school transitions, for refugee children such transitions are
even more extreme because they are faced with the developmental task of moving up in
grade levels while at the same time coping with the cultural transition that makes it
extremely difficult to understand what is expected of them. Yet school is an extremely
important setting for refugee children, because it is at school that they encounter the
U.S. American culture, and are socialized into its norms.
12
Refugee families arrive in the U.S. with very different expectations of the structure
and role of school. For example, in many cultures the relationships between teachers
and students in the classroom are much more formal than in the U.S. school. Rules
that require students to stand up when speaking to the teacher, discourage class discussion,
and in general defer to the teacher as authority and expert are very common in other
countries. Some students have never experienced having a teacher ask them to express
their opinions (rather than report a fact or solution to a math problem) out loud or in
writing during class. Some students have never experienced small group discussions in
a classroom. Others come from cultures where boys and girls do not attend school
together, and may find it uncomfortable to participate in activities with students of the
opposite sex. Perhaps most importantly, U.S. schools differ from school in many
countries where refugees come from because they expect children to develop their analytic
skills and de-emphasize accumulation of factual knowledge. This can be extremely
confusing to a child who is trying hard to do well, yet cannot understand why the
teacher finds her or his work unsatisfactory. Regardless of the specific differences in
rules and expectations, the most important point is that most of the rules and norms in
U.S. schools and classrooms are implicit. In other words, schools don’t explain to
students how to sit at a desk, how to use a locker, what to do when the bell rings, how
to take a multiple-choice test, or how to ask a teacher a question. These are things that
U.S.-born children absorb from their past school experience, from talking with their
parents, from watching sitcoms on TV, and through other experiences of “enculturation”
or socialization into their own culture. For refugee children even the most simple and
basic of rules may need to be made explicit because of lack of experience with U.S. type
of schooling.
For example, with respect to discipline, there is frequently a perception on the
part of refugee children that U.S. schools are extremely permissive, with children not
paying attention in class, misbehaving in hallways, etc. Teachers may appear very nice
rather than stern, and as having less authority than teachers in other countries. Observing
this, some children may conclude that there are no rules in U.S. schools, and that
children have extreme freedoms in this country. They, too, may want to have this much
freedom in their behavior. However, in truth, while U.S. schools may be and appear to
be more permissive, they do have rules and norms, though some may be implicit. For
example, while in other countries schools may rely on close monitoring, strict
punishment, and discipline to manage student academic work and behavior; U.S. schools
expect children to take responsibility for their own work and behavior. Refugee parents
may assume that schools and teachers are closely monitoring their child’s behavior and
performance at school, and when they don’t see any negative notes from the child’s
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teacher, they may assume that the child is doing fine. These parents may then be
shocked when at the end of the semester the child’s grades are very poor. This “rule” or
“norm” of being responsible for one’s own work without constant monitoring is
particularly subtle, yet extremely important for children and parents to understand.
For all of these reasons it is very important for schools and teachers to be extremely
explicit about rules and provide refugee children with extensive orientation to classroom.
With respect to coping with these transitions, refugee children are unlikely to
have around them the support and company of peers who went through similar
experiences . This is made even more difficult because being “different” is not easy in
U.S. schools, especially for middle and high school age children. However, the ESL
and bilingual classrooms provide unique opportunities to be extremely helpful to these
children not only with English language skills, but also with the emotional aspects of
this transition. It is not uncommon for refugee children to say that ESL class is their
favorite during the school day. The presence of other children, either of the same
ethnic group, or even of other ethnic groups but engaged in the same acculturation and
adaptation process, can be very supportive for refugee children. Additionally, the smaller
size of many ESL or bilingual education classes can allow teachers to give individual
students more attention and to form a mentoring relationship with them.
The ESL teacher can then become an important adult in these children’s lives
and help guide them through this transition. Refugee children frequently express that
they feel they have a special relationship with their ESL teacher who understands some
of the ways in which they are different and appreciates many of the hardships they face.
This holds great promise for having ESL/bilingual education teachers meet some of the
needs of these children; however, this expectation can surely feel overwhelming for a
teacher, whose main job is to teach rather than provide counseling and mentoring.
This can become even more overwhelming if teachers suspect that serious mental health
issues are involved.
With respect to mental health, it is sometimes easy to forget that refugee children
are just as likely to experience a range of mental disorders as non-refugee children, such
as Depression, Attention Deficit and Hyperactivity Disorder (ADHD), and many others.
The earlier discussion about mental health issues in childhood generally applies to refugee
students as well. All students, including refugee students, can benefit from school-wide
and class-wide interventions that set clear expectations for behavior and create a positive
atmosphere where appropriate behavior is encouraged and rewarded. In addition, it is
inevitable that there will be situations when assistance of mental health professionals is
required, and a referral to the school mental health team needs to be made in order to
14
determine if the child requires mental health treatment that the teacher cannot possibly
provide. However because many refugee children have suffered traumatic events, their
internalizing and externalizing behaviors at school may also be signs of Post Traumatic
Stress Disorder (PTSD). An added complication is that it is particularly difficult to
determine whether problem behaviors such as not following school rules are symptoms
of a disorder or signs of the child’s being unfamiliar with the school rules and culture.
Further, the child may be following particular school traditions that come from her or
his culture, but which may be perceived as insubordinate in the current school
environment. To the child, these behaviors make sense. For example, chewing gum,
engaging in fist fights, or speaking out of turn in class have all been perceived as problem
behaviors by teachers and interpreted as possible symptoms of mental disorder; but in
some instances these behaviors were the result of the child’s not knowing or fully
understanding school rules. The special considerations in addressing the mental health
needs of refugee children are discussed in more detail in the following section.
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III. REFUGEE CHILDREN
’S
MENTAL HEALTH: COPING
WITH ACCULTURATION AND
TRAUMA
Special considerations in adjustment and mental health of refugee issues stem
from two important issues that are highlighted below: (a) the need to adjust and adapt
while simultaneously going through a cultural transition, and for many, (b) the legacy
of trauma. The next section discusses aspects of the cultural transition and its implications
for the child’s adaptation and mental health. It also explains in more detail how children
cope with traumatic stress and how it is treated.
A. CULTURAL TRANSITION
Acculturation is a term used to describe the cultural transition, or cultural change
experienced by immigrants and refugees. In addition, three important implications of
acculturation are particularly relevant to understanding refugee children: the
acculturation gap, the role of “culture broker”, and the implications of acculturation for
school adaptation and school transitions.
Acculturation: to assimilate or not to assimilate, this is the question. Perhaps
the most important task faced by refugee children is acculturation, or the need to learn
the new culture in order to function within it successfully. Generally, we think of many
aspects of acculturation: learning about the new culture and how things work, learning
the language, and over time, perhaps even identifying with this culture and considering
oneself an “American”. It is clear to most scholars, teachers, parents, and students that
learning the English language, as well as the norms, customs, institutions, and traditions
of American culture, is very important, adaptive, and beneficial for children. However,
there is some disagreement about whether or not it is also important for these children
to abandon their old culture and stop using their native language, in other words
“assimilate” to the U.S. culture. Some of the information shared below comes from a
series of studies on adaptation of different immigrant and refugee groups including
16
Central American adolescents (Birman, 1998), former Soviet refugee children and parents
(c.f. Birman, 1994; Birman & Trickett, 2001;, Birman, Trickett, & Vinokurov, 2002),
and Vietnamese and Somali families (manuscripts in preparation).
With respect to language, traditionally it has been assumed that as children
learn the new culture they lose the old, as if the new knowledge somehow displaces that
which they knew before. Indeed, this may happen for many refugee children. In our
research with former Soviet refugees, for example, we found that children who were on
average 10 years old when they came to the U.S. learned English very quickly. In a
typical pattern, they also discontinued using Russian in approximately 4-5 years, after
they became more fluent and comfortable speaking English than Russian (Birman &
Trickett, 2001). For children who were younger when they arrived, this process occurred
even more quickly, with English becoming their better language in 2-3 years. In other
refugee and immigrant groups, however, particularly those living within ethnic enclaves,
the tendency may be to maintain their native language. However some researchers
have suggested that immigrant children who learn English and also retain their native
language actually do better in school in the long run than those who do not maintain it
(Crawford, 1992). For this reason maintaining fluency in their native language can be
very helpful for refugee children, as long as they are also learning English. Another
important aspect of acculturation is identity. Having a strong and positive sense of their
ethnic identity has been noted as being very important for refugee and immigrant
children’s adjustment. In psychological literature it is generally believed that a strong
ethnic identity is related to positive self-esteem (Phinney, 1990). As with language,
most scholars believe that there is nothing wrong with encouraging newcomer children
to identify with American culture and consider themselves “American” in principle, as
long as this does not preclude their continuing to identify themselves with their ethnic
culture at the same time. If a child feels that being part of both cultures and considering
oneself Vietnamese-American or Cuban-American is not possible, either choice can be
detrimental. Having an exclusively Cuban identity can prevent the child from integrating
into the American culture; yet having an exclusively American identity can be
accompanied by a feeling that being Cuban or Vietnamese is inferior, contributing to
low self-esteem and perhaps other psychological outcomes.
In our research with former Soviet refugees, we found that children who embraced
both cultures simultaneously were better adjusted psychologically. We found that
children across different communities of resettlement became more identified with
American culture over time. However, we also discovered that in one community this
process tended to be “additive”, so that over time the American identity was “added” to
17
their Russian identity. These children tended to become bicultural and consider
themselves both Russian and American. However, in a different community, in which
these children experienced discrimination, they felt that this was an “either-or” process,
and they had to choose between being “Russian” or “American”; it seemed impossible
for them to be both simultaneously (bicultural). For example, the children in this
community had to essentially choose whether to sit at the “Russian” or the “American”
tables in the lunchroom. Yet at other schools in a different community, no such
distinctions were evident, and tables were mostly multicultural. Thus, while it is clear
that becoming more identified with American culture can be very positive for children
who become bicultural, it is also evident that identifying with American culture can be
detrimental if children must do so at the expense of losing their ethnic identity. And in
some communities and schools, becoming bicultural may be difficult or nearly
impossible. For these reasons schools and communities that acknowledge and respect
cultural differences and encourage biculturalism can foster positive adjustment and
mental health.
Another reason that biculturalism may be advantageous for refugee children
involves the concept of “acculturation gap”. Because adults (and parents) acculturate at
a slower rate than their children, and because those who arrived in the U.S. as adults are
less likely to lose their language and culture, a “gap” develops between children and
parents over time. In our research (Birman & Trickett, 2001), parents did not lose their
fluency in Russian over time, and while they did learn English, their fluency level in
English was much less than that of their children. Parents also identified with American
culture less than their children did. As a result of the acculturation gap at home
children live according to the norms of their native culture and speak their native
language; whereas at school they have to switch cultures and be “American”.
Because parents are immersed predominantly in one culture and children in
another, refugee parents often know little of their children’s lives outside the home.
Adult refugees didn’t attend school in this country, and have a hard time imagining
what school is like. They may also not know what to expect of school, and assume that
the role of school in the U.S. is similar to what it was in their country. This can result
in many misunderstandings between the parents and child, and between the parents
and school.
In our research we’ve talked to many parents from a variety of refugee cultures
who have felt confused by academic standards and requirements in U.S. schools, by the
ways that discipline is handled, and by the extent to which U.S. schools in general
18
expect parents to be involved. Parents from several cultures (we’ve found this with
Somali, Vietnamese, and former Soviet refugees particularly) have complained that U.S.
schools are not strict enough, and they don’t understand why schools ask parents to
discipline the children for infractions committed at school. “Why doesn’t the school
punish them appropriately?” is a question we’ve heard often from parents in our research.
Parents have also been confused by curriculum in U.S. schools (“Why don’t they just
use a textbook?”), and don’t know how to assess the importance of achievement tests or
the significance of standardized tests. In general, the expectation in the U.S. that parents
function as advocates for their child’s schooling is quite incomprehensible to those who
come from foreign countries where education is much more standardized and schools
have more authority over the child.
The result is that refugee parents often can’t be helpful to their children with
respect to various aspects of school and school transitions. This can include homework
and preparation for tests, choice of classes or academic program in higher-grade levels,
or orientation to options for work, college, or further training after high school. Perhaps
most importantly, it is difficult for parents to buffer children from unnecessary stress
when parents themselves lack the knowledge of how various developmental milestones
and school transitions are handled in this culture.
Another consequence of the acculturation gap is that it not only diminishes the
capacity of parents to help their children, it also undermines their authority. In the
U.S. growing up often means adolescents’ continually testing parental limits, with parents
gradually giving children increasing independence. For parents in refugee families, this
transition toward greater independence can be extremely complicated. Without sufficient
knowledge or understanding of their children’s lives outside the home, parents may set
rules that are overly strict, too permissive, or both. For example, not knowing about
the danger of crime, gangs, and drugs in the inner city, parents may not supervise their
adolescent children enough with respect to what they do after school while parents are
at work. Children may grow adept at forging excuse notes for school, or concealing how
they are doing at school. At the same time, parents may be overly strict with the same
children in the evenings, requiring unusually early curfews, or even restricting contact
with peers of the opposite sex. As a result, refugee adolescents may be reaching
developmental milestones without sufficient supervision or guidance.
For adolescents, this experience can be extremely alienating, because in essence
it implies that there is no one who truly understands their experience. Their parents
19
don’t fully know or understand their circumstances outside the home; their American
peers can’t fully appreciate what it’s like for them at home; and school personnel may
try to be helpful without understanding that huge adjustments need to be made in their
usual practices in order to effectively communicate with refugee parents and children.
Further, not only do refugee children often need more supervision and guidance
than their parents can provide them, but they may also find themselves serving the role
of “Culture Broker” for their family. Because refugee children are generally better able
to communicate in English than parents, they may be the most fluent in the family, and
even younger children may be assigned the role of translating and helping parents
communicate with others (including school personnel). It is not uncommon in refugee
families to find that children make phone calls to schedule doctors’ appointments, handle
conversations with the public aid office, or fill out various forms and applications for
employment, aid, housing, etc. While many children are delighted to be able to be
helpful to their families, this role may place an undue burden on them. This is particularly
true when it may not be appropriate for children to be in this role. For example,
translating during a medical exam for one’s parent or grandparent may be inappropriate,
embarrassing, and result in the child’s knowing far more than parents may want the
child to know about their own health, etc. In the spring, it is not uncommon to find
that many refugee adolescents help their parents fill out tax forms, which results in the
children’s knowing exactly how much their parents earn – a position that U.S. born
children are rarely in. Moreover, in many families adolescents must work to help support
the family. Though many U.S. born youth work, they can generally keep their earnings
for spending money rather than contribute to the family income. In all these ways,
children act more like “adults” in their families, and the adults more like “children”, a
role reversal that can have negative consequences.
A final comment about acculturation: because many children pick up
the English language relatively quickly, begin to adopt clothing styles and haircuts
fashionable among U.S. youth, and in other ways seem “American”, it is often assumed
that they have become completely “American” and do not have any further acculturation
or orientation needs. However, refugee children may require continued orientation
and guidance to aspects of U.S. culture many years after resettlement. For example, a
child entering high school may find its structure, academic requirements, and other
nuances extremely confusing, not having grown up in this country, and not having
parents who have themselves gone through high school experience in the U.S.
Adolescents may be confused by career and higher educational options, and their parents
may not be able to help them. They may not know the norms about what to do at
20
graduation, how to act at a school event, or what the “rules” of dating are. For these
reasons many of these youth need adult support and orientation long after they’ve
mastered English. Teachers can serve a critically important role in this regard.
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Acculturation: Concepts, Examples and Implications
Definition Examples Implications
Acculturation
Cultural change Learning English, wearing Acculturation takes a
 same styles of clothing and long time, and even
 haircuts as U. S. children, when children learn
 being friends with U. S.- English very quickly
 born children, listening to and appear “American”,
 same music and eating they may continue
 same foods as Americans, to need orientation to
 and considering oneself the culture and what is
 “American”. expected of them in
 school many years
 after resettlement.
Acculturation Gap
The difference that Refugee parents don’t know The relationship
develops over time between about their children’s lives between refugee parents
and children and parents outside the home because and children may
as the result of the rate and their acculturation process become increasingly
degree of cultural change is slower. This diminishes strained after resettle-
– children adapt to the the capacity of parents to ment. Programs that
U.S. culture much faster help their children. try to help refugee
than parents Refugee children feel that children adapt to the
 their parents don’t under- U.S. culture
 stand them and can’t help must involve their
 them. parents to support
 their relationship
 with their children.
 Family problems may
 emerge several years
 after resettlement,
 as the acculturation
 gap widens with time.
Culture Broker
The role refugee children Making phone calls to Role reversal between
take on in translating and schedule doctors’ adults and children can
helping parents appointments, going with lead to children not
communicate with others parents to a medical exam, respecting their parents’
 handling conversation with authority, and thus not
 the public aid office, or receiving the guidance
 filling out various forms and supervision they
 and applications. need.
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B. TRAUMATIC EXPERIENCES
Another factor that makes understanding adjustment and mental health issues
of refugee children more complex involves the fact that many have suffered trauma.
The diagnosis of PTSD, or PostTraumatic Stress Disorder, is made when a constellation
of symptoms is present in those who have experienced a horrifying or frightening event.
It is difficult to specify what exactly is traumatic, because something that is extremely
upsetting and distressing for one person may not be for another. Nonetheless, the
assumption is that experiencing or witnessing physical or emotional violence with the
potential of serious injury or death is traumatic. A car accident, death of a loved one,
surviving an earthquake, being lost in the woods for extended periods of time, torture
or concentration camp experiences, and living through war or bombing can all be
extremely traumatic events. In general, it is assumed that traumas that result from
natural occurrences (such as earthquakes) are somewhat less devastating than those that
result from accidents; with acts willfully committed by other people, such as torture or
murder, being the most traumatic because they can undermine one’s ability to trust or
feel close to others.
However, it is also possible that less violent events may also feel traumatic to the
child, and result in PTSD. For example, the migration itself may be “traumatic”,
particularly when the child has lost the safety, familiarity, and connections to an entire
world that used to surround him or her. The stress and response to loss experienced by
parents can add to these feelings. As a result, the child can demonstrate many of the
symptoms in the table below without an apparent event (other than the migration) that
is generally thought of as “trauma”.
23
Symptoms of Post Traumatic Stress Disorder:
Types of Symptoms Example Special considerations
 for children
The traumatic event Distressing and intrusive Symptoms may be:
 is persistently re- memories and thoughts, repetitive play in
 experienced dreams, feeling that the which themes or
traumatic event is happening aspects of the
again, intense distress and trauma are expressed
even physical reactions when without recognizable
there is a reminder of the content or traumaevent
specific reenactment
.
 Persistent Efforts to avoid thoughts, It may be difficult to
 avoidance of stimuli feelings or conversations observe some of these
 associated with the about the trauma; symptoms in young
 trauma and Efforts to avoid activities, children because it is
 numbing of general places,or people associated not clear if they are
 responsiveness (not with the trauma; avoiding or truly
 present before the Inability to recall an impor- forgetting the event.
 trauma) tant aspect of the trauma;
Markedly diminished interest
or participation in significant
activities. Feeling of detachment
or estrangement from
others, Restricted range of
affect (e.g. unable to have
loving feelings), Sense of a
foreshortened future
 Persistent Difficulty falling or staying May be expressed as
 symptoms of asleep, Irritability or problems with school
 increased arousal outbursts of anger, Difficulty work, classroom
 behavior concentrating, and difficulties
 (not present before Hypervigilance, paying attention
 the trauma) Exaggerated startle response in class.
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In response to such intense feelings, children may cope by trying to avoid thinking
about what happened and to distance her/himself from what is currently happening.
As a result, they experience “numbing” of feelings and “avoidance of stimuli associated
with trauma” (see description of symptoms of PTSD). These symptoms are referred to
as “dissociation”. Dissociation allows children to block out that which is too painful
to think about or to remember. At the same time, the child copes not only by blocking
out the memory itself, but also by trying to block the painful feelings associated with
the memory. As a result, the child may try to suppress all feelings, including feelings of
joy as well as feelings of fear, in an effort to stop the pain of the memories. Some
children may use dissociation to cope with the stresses of migration and resettlement.
Children sometimes report not being able to remember what happened when they first
came to the U.S., which implies that they probably worked hard to numb the feelings
they were experiencing at that time. Some refugee children talk about their initial
experiences of speaking in a new language and being in a completely different culture
and environment as an almost “out of body” experience—as somehow not real, as if
they were not really there, or watching themselves in a movie.
It is important to remember that dissociation is a very adaptive coping mechanism
in many situations, especially when the trauma has been recent. Numbing ones feelings
may be a way to get through the day without getting so upset that one can’t handle daily
tasks. However, over time, because efforts to forget and to repress feelings require so
much energy (though the child may not even realize she or he is doing this), it may
become necessary that the child cope with the trauma in a different way. Ways of
coping that seemed to have worked before begin to interfere with the child’s ability to
pay attention and function well at school, have good relationships with peers, or get
along with family members. This is the point where treatment may be recommended.
Most people have heard that the process of treating PTSD may involve having
the person retell the traumatic event. In fact, most mental health providers believe that
this can be helpful for children; but it is also important to remember that the re-telling
of the memory itself is not what’s helpful. Rather, it is the retelling of the memory in
the context of a trusting relationship with another person who will not judge, but who
will be supportive, that is helpful.
To put it another way, this type of treatment can be described as “desensitization”.
Desensitization is a behavioral technique used by psychologists when they are treating
phobias, such as fear of flying, fear of snakes, or fear of elevators. Imagine someone
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who is afraid of flying coming to treatment. The recommended treatment involves
many different steps in order to help the client get as close as possible to the situation
that causes the greatest fear (e.g. flying on an airplane). These steps may include talking
about airplanes, closing one’s eyes and imagining being on an airplane, boarding a
airplane but not flying, and finally getting on a plane and flying. Throughout this
process the therapist helps the client get closer and closer to that which is most feared.
First the therapist helps the client to imagine coping with this situation, and then the
therapist provides support when the client is in the situation itself (on the plane).
Gradually, the therapist helps the client relax when thinking about being in an airplane,
then while actually on a plane, so that the client learns to associate flying with relaxation
rather than panic. Just being exposed to the situation that is feared without this gradual
process and ongoing support and reinforcement would not work. Placing this person
into an airplane too quickly would simply terrorize him or her, and perhaps cause an
even greater fear. It is the gradual, supportive process that facilitates the transition from
panic to calm.
Treatment for PTSD involves a similar process, and with children Cognitive
Behavioral Therapy has been shown to be effective. In this case the feared situation is
the memory of what happened and the feelings (fear, helplessness, guilt) associated with
it. The task of the therapist is to help the child gradually approach thinking and talking
about this situation in the context of a supportive relationship, including family when
possible. With younger children techniques such as drawing can be used to help the
child express thought and feelings. The “telling” of the story may take a very long time,
as the child shares some parts but not others. The story is gradually reconstructed, and
as it is, the child describes the events and feelings associated with the trauma. Through
this gradual process, the task, as it is in treating a phobia, is to help the child first
strategize about how she or he would cope with the feared situation (in this case,
remembering what happened and the attendant feelings of intense pain and fear). While
it is not possible to eliminate the memory itself, treatment can help diminish the intensity
of feelings associated with it, over time.
There are several implications of this that may be helpful to teachers. First, it is
important that teachers don’t assume that it is their job to help children tell their story
of trauma. Rather, the teacher can become aware that there may be a traumatic story
that the child has to tell. If and when it does come up, the most important part to
remember is not that the story be told, but that the child experience trust and support while
telling it or trying to tell it.
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Second, symptoms of PTSD may be evident through observing the behavior
of the child, as the child may “internalize” (seem tearful, sad, exceedingly shy), or
“externalize” the symptoms (by getting into fights or displaying temper tantrums).
When children externalize symptoms of PTSD, service providers may feel reluctant
to discipline the child or to insist that the child follow rules of behavior in school and
other settings, fearing that this will further traumatize the child. However, when
done in a caring way, setting limits and helping the child observe and monitor her
own behavior is extremely helpful to the child, helps normalize the situation, and
gives the child skills to cope with trauma as well as every day life.
C. SECONDARY TRAUMATIZATION
Secondary traumatization is the term used to refer to the stress of workers
providing services to those who have suffered trauma. Doctors, nurses, psychologists,
rescue workers, and teachers are some of those who may learn about horrific experiences
because they listen to stories, and witness the wounds of trauma survivors. While
secondary traumatization is not nearly as severe as actually living through the trauma,
it is important that workers attend to their feelings to avoid burnout and maintain
enthusiasm and optimism in their work. Mental health professionals frequently use
supervision with more experienced professionals or time with colleagues to “process”
such experiences. Rescue workers have “debriefings” to do the same. Teachers,
however, rarely have mechanisms for creating a “safe space” and setting aside the time
to discuss, share, and reflect on what they are feeling and thinking as a result of
working with children who have lived through extreme trauma and are now going
through difficulties in their adjustment process. It is important for teachers to find
ways to create such opportunities, whether it’s getting together informally as a group
on a regular basis with other teachers to discuss such experiences, or seeking out
another colleague one-on-one to share thoughts and feelings. Learning a few relaxation
techniques and finding other ways to cope with stress can also help. What is important
is to remember to attend to one’s own feelings and to take care of oneself while taking
care of others.
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IV. THE ROLE OF THE ESL
TEACHER
ESL teachers frequently find themselves in uncomfortable situations in a
classroom, knowing that some of the children may have experienced horrific traumatic
events, but not knowing how to deal with them. All of the following situations are
instances that have happened in ESL classrooms:
❋ A boy came to class with a headset and a CD player, and during class
would always wear the headset and listen to music. When the teacher
asked him to remove the headset and attend to class, he became very upset.
The teacher stopped approaching him in class after that, assuming that he
needed to go through a process of adjustment before she could ask him to
engage in the classroom again.
❋ Several teenagers who had been in violent situations before coming to
U.S. were very prone to escalating any disagreement into a fight. The level
of rage expressed during these occasions was frightening. Some of the
other students engaged in the fighting, and some were frightened by it.
❋ On one occasion a student brought very graphic pictures of war,
violence, and murder to class. He proceeded to pass these pictures around,
and watch the other students’ and teacher’s reaction. The other students
became very upset, and the teacher did not know how to deal with this
situation, because this was the first time this boy opened up in any way,
and she was afraid of hurting his feelings by asking him to stop.
❋ During a class discussion, a student brought up having witnessed his
uncle being murdered in front of him, and proceeded to describe the graphic
details of what he saw.
In all of these cases, the teacher either knew or suspected that these children
had been exposed to trauma. Teachers in such situations are frequently at a loss about
how to respond to these children. They are afraid to cause harm by saying or doing
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something that exacerbates the child’s distress; at the same time they are afraid to do
nothing because it is possible that the event represents a “cry for help”. Teachers may be
reluctant to approach the parents because they fear that the parents may severely punish
the child if the school contacts them. However, it is important for ESL teachers to have
some guidelines to follow in these situations, not only to help the child who is displaying
such behaviors, but also to help the other children cope with it. Classmates are also
likely to feel uncomfortable and not know what to do during such outbursts.
First, ESL teachers cannot be expected to be mental health service providers,
nor should they expect this of themselves. It is important to identify mental health
resources and seek help when needed. It may be helpful to keep in mind that mental
health professionals can recommend or provide treatment, and can also give suggestions
to the teacher about techniques to use in the classroom. However, while ESL teachers
can’t treat severe mental disorders, they can play a very special role in the lives of refugee
children, and improve their adjustment and mental health. The classroom can be a
setting for teaching newcomer children not only English language skills, but also what
is expected of them in U.S. classrooms and school buildings, and what the rules and
norms for behavior are. Teachers can implement class-wide behavioral interventions to
clarify rules, and this can be used as a technique to identify children who need additional
help outside the classroom. Children whose behavior does not improve sufficiently to
function appropriately in the classroom after such interventions may be candidates for
additional help.
A. ESL CLASSROOM AS A SAFE SPACE
The ESL or Bilingual Education classroom can be a very special place in a
refugee child’s life, whether she or he attends it for only a few periods or for the entire
day. As mentioned earlier, refugee children frequently comment that ESL is their favorite
class, that the ESL teacher is the one teacher they feel most connected to in the school,
and that most of their friends are other ESL students. This occurs for several reasons.
First, the ESL classroom is a place where there are other children who are experiencing
similar cultural transitions. Refugee children feel less embarrassed here when they speak
English and are less likely to be made fun of for their “strange” accent, dress, behavior,
or contents of their lunchbox. Second, the ESL classrooms are frequently smaller. If
classes themselves are not smaller, activities are often conducted in small groups to
accommodate the variety of ability levels among children in the process of learning
English. This helps create a more relaxed atmosphere, and small group work further
helps children get to know one another. Finally, because of the nature of the work, ESL
29
teachers are perhaps the only adults in the school building (and perhaps the only Englishspeaking
adults in each child’s life) that take an interest in each child’s background,
communicate that they value their culture, and express empathy for their circumstances.
These three factors— the smaller classroom or small group work, peers who are going through
similar experiences, and an attentive adult— have all been found to be extremely helpful
for children in general during school transitions. In the experience of refugee children,
the ESL teacher is most likely to meet these needs.
There are several implications of this. On one hand, ESL class is indeed where
many children unwind from the stresses of the mainstream school. Here, they are able
to express themselves and be understood by the teacher and other students who may be
patient enough to listen, and not feel alone in their new environment. This is what is
meant by a “safe space”. On the other hand, children are also more likely to “act out” in
this safe space, because their guard is down, and because they may feel that in this
setting their distress will be noticed. If a child is a survivor of trauma and is trying to
repress a recurring memory, it is more likely to come up when she is relaxed, and it is
more likely to happen in ESL class than elsewhere. For this reason ESL teachers can be
faced with difficult psychological issues that come up in the course of daily classroom
activities.
However, safe doesn’t mean unstructured, or without limits or expectations. In
fact, an overly liberal and unstructured classroom atmosphere may be very frightening
to children who have experienced trauma and dislocation. An environment with regular
routines, clear rules and expectations may be more comforting to children who have
lived through traumatic events beyond their control. It may be helpful to think about
any outbursts of emotion or inappropriate behavior in an ESL classroom as “teachable
moments”, or opportunities to provide support and orientation to students in need.
B. WHAT CAN ESL TEACHERS DO TO HELP REFUGEE
CHILDREN WITH THEIR MENTAL HEALTH ISSUES?
Setting Expectations for behavior. One of the most helpful things any teacher,
and an ESL teacher in particular, can do in a classroom is to begin by orienting children
to what is expected of them. Explaining the rules to children orally and posting rules
around the classroom can be helpful by allowing limited English speakers to hear them
as well as see them in writing. Posters and posted slogans that clarify classroom rules
will serve as ongoing reminders. Younger children often enjoy pretending to show
appropriate and inappropriate classroom behavior. The teacher can ask them to show
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how to behave inappropriately by jumping up and down in class, and then practice
appropriate behavior by sitting quietly for a minute, getting up from the desk slowly, or
lining up for lunch. A reward system can be put into place to help reinforce appropriate
behavior and help establish the rules and routines. When integrated into classroom
practices, setting expectations doesn’t need to take away from class time, but can greatly
enhance the classroom environment. Further, English language activities can be built
around understanding classroom rules early in the year.
Expectations can also be set about to how to handle traumatic content if and
when it comes up in the classroom. In some ways this is easier to do after the first time
someone brings it up. This can be a “teachable moment” to explain to students how
important it is to listen and be respectful at such times. The teacher may model this
behavior by expressing support to the child. Perhaps some “rules”, guidelines or norms,
or even classroom traditions can be developed for times when a student shares something
important. One technique is to ask each child, going around the room, to say something
kind to the person who has revealed something painful. It may be important to explain
that there are also places and times that students can approach the teacher in private. A
suggestion can be that some things are best shared in private with the teacher. Perhaps
class time can be structured to ensure such opportunities, e.g. when students are working
on their own or in groups, so that you can be available for brief, one-on-one conversations
for students who prefer to seek you out.
While it can be helpful for children to tell their stories, it is not useful to probe
about traumatic events. At the same time, children do like to be asked about themselves,
about their culture, and about where they came from. It is important not to fall into
the other extreme and never ask a child anything about his or her background and past.
Find a way to let children know that you’re interested in the cultures and countries they
have come from, and invite them to share what they would like you and their classmates
to know.
Problems with Punishment. While structure can be extremely helpful, strictness
is not. To the extent possible, the teacher can be more successful at behavior management
by rewarding appropriate behavior, doing so consistently, and giving reminders about
the rules. It is also important, to the extent possible, to avoid using punishment for
inappropriate behavior for several reasons. While punishment can be very effective at
stopping a behavior, there are other consequences associated with it. First, the person
administering the punishment can become extremely “aversive” to the child. If the
31
child is humiliated as a result of punishment, he or she may try to retaliate in some
other way. Second, punishment stops the undesirable behavior only in the presence
of the person who is doing the punishing. When the teacher steps out of the room—
when there is a substitute, or in the halls or cafeteria— the behavior will continue, and
the child will not have learned how to act appropriately at school. Third, when it is
absolutely unavoidable to use punishment, it is important to combine it with rewards
when the child acts appropriately. If rewards for desirable behavior are not used together
with punishment, the teacher can enter the “slippery slope” of punishment, where in
order to maintain its effectiveness the intensity of punishment will need to be
continuously increased. The escalation in punishment is bound to reach a point where
it’s impossible to think of a punishment that’s powerful enough to stop the undesirable
behavior.
Active Listening and offering support. When structure and routines are paired
with a supportive atmosphere, the classroom environment can be most conducive to
feeling comfortable and learning. A key tool that counselors often employ with clients
is active listening. Active listening involves periodically restating to the speaker what
the listener has heard. For example, after listening to a story, the listener may say
something such as “Let me see if I understand..” or “You mean that .”, and repeat what
has been said. This restatement helps the speaker feel listened to and understood, and
allows both parties to clarify any misunderstandings. Further, restating can be used as
an excellent English language teaching tool in the ESL classroom. Children can practice
“active listening” with each other and with the teacher.
It is important that active listening, particularly at emotionally laden moments,
not be done mechanically, but in a way that the child hears concern in the listener’s
response. By taking the time to try to understand, the listener is essentially “sharing the
burden” of the problem by actively engaging with the speaker rather than finding a
solution. As mentioned earlier, children may be afraid of their memories because they
think that if they remember, they will feel such unbearable pain that they will not be
able to stand it. When a child sees that an adult can hear the story, be saddened by it,
but not fall apart, it can be very reassuring, and can help the child feel as if she or she
can do the same. Feeling understood is particularly important for refugees, (who so
often feel that they cannot express themselves), and offers the child tremendous support.
Active listening is one tool to provide such support.
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Providing orientation to aspects of the U.S. culture and lives of U.S. students.
ESL teachers are not just teaching language, but also the culture of the U.S. to the
newly arrived children. Culture has been defined in many ways, but perhaps the best
definition is that it is those values, norms, beliefs, behaviors, and customs in our lives
that seem so obvious to us, that we do not even realize they are there until we are
confronted with a different culture. Culture to us is as water is to fish, or the air around
us—we hardly ever think of it. Why do we light candles on a birthday cake? Why is it
that in this country grown children living with their parents are seen as having failed;
whereas in other countries leaving one’s parents in adulthood would be described as the
parents’ failure to raise the child properly? These are difficult if not impossible questions
to answer, and acculturation, or learning the culture, occurs in many subtle ways. For
these reasons structuring activities, setting expectations, and using a variety of verbal
and non-verbal techniques to teach about U.S. cultural situations can make absorbing
this culture easier for the refugee students.
In addition to the classroom, children and teens find themselves in many
situations that are difficult for them to understand. The importance of team sports in
this culture, dating customs and the ways boys and girls relate to each other more
generally, appropriate playground behavior, what to bring to a birthday party, and
many other aspects of every day life may be very difficult for these children to learn
about or adapt to. Activities that involve reading about various social situations, and
then engaging in discussions about how one might resolve this situation can be a useful
tool not only to teach culture but also as an English language exercise. For example, a
number of curricula to teach “social problem-solving” to children have been developed
(c.f. Elias & Tobias, 1996). In such a curriculum the teacher can use a series of scripted
sessions in which children are asked to examine uncomfortable or difficult social situations
through watching videotapes, discussions, and role plays, and are taught specific skills
and strategies to come up with ways to handle them. These curricula can easily be
adapted to help refugee children learn about social situations in the lives of U.S. children.
Peer Mentoring and peer mediation are approaches that have frequently been
used in schools. Peer mentoring involves pairing a child who needs some guidance with
a more experienced peer, or a slightly older child. Peer mediation refers to a program
that trains selected students at the school how to step in when conflict between students
occurs and de-escalate the confrontation. Extensive research on such programs has
shown that peer mentoring and mediation can be helpful to children who are mentored,
but are extremely helpful in furthering the social and emotional development of the
mentor. In other words, the opportunity of being in a leadership role, being taught
33
specific skills, being looked up to, and being helpful to another student has been shown
to be a very positive experience for students. The implication of this is that mentoring
programs can be helpful, but also that it is important to find ways to put newly resettled
refugee students in the position of mentor, because it can be extremely helpful to their
adaptation. For example, asking a refugee child to teach someone else, perhaps a U.S.-
born classmate, about her or his culture, may create a mentoring relationship that goes
both ways. Each child learns about the culture of the other. Classes that study Africa
and/or African-American history can benefit a great deal from having an African refugee
student give a talk or bring in pictures. The ESL classroom can support refugee children
in these roles by being a place where the child can develop such a presentation and
practice it. Asking refugees who have been in the U.S. for a year or more to “mentor”
new arrivals may be another approach. Because refugees are so often in the position of
understanding less than those around them and needing help with even the most basic
things, it is extremely valuable for them to be in the position of having something to
offer to others.
C. BEHAVIOR MANAGEMENT TOOLS
Some of the approaches described above, such as setting expectations and
rewarding behavior, are based on principles of behavior management. Some basic
principles and tools of behavior management are offered below. This is not to suggest
that a teacher should implement a comprehensive behavior management program.
Rather, the intent is to offer some tools and concepts that may be useful in creating a
supportive and structured environment.
“Behavior Management 101”
The first principle of Behavior Management is that all behavior is learned.
This includes children behaving both “appropriately” at school or doing things such
as fighting and “tuning out”. A child may be behaving inappropriately for two
reasons: either she or he has not learned the correct or appropriate behavior for a
given situation, or she or he has learned incorrect or inappropriate behaviors. It is
possible that children engage in a behaviors simply because they don’t know what else
to do, or because this behavior has worked for them in other settings. For example,
small children who throw tantrums at school might be doing this because it has
worked for them at home. They will keep trying this with you until you show them
that it won’t work with you by teaching the child the new rules.
34
 With refugee children in particular, most have not yet had an opportunity to
learn how to act in class and at school in the U.S., nor what is expected of them. If a
child is speaking in class out of turn, we must assume either that she has learned to do
this by being reinforced for it in the class, or that she has not learned that it is inappropriate
to speak out of turn in class. In addition, refugee children have learned patterns of
behavior in very different school environments in their own country. Further, children
who have lived through trauma may have learned to protect themselves in some ways
that may be inappropriate in their new setting – the U.S. school. For all of these
reasons, teaching and learning behaviors can be extremely helpful when working with
refugee children.
The second principle of behavior management is that behavior is learned because
it is reinforced, or that a desired consequence follows this behavior. In order to teach
behavior, the teacher must do two things: explain what is expected of children in the
classroom, and reward (reinforce) desired behaviors. Children will engage in behaviors
either because by doing so they get rewards (positive reinforcement), or because they
can get out of doing something they don’t want to do (negative reinforcement). For
example, a child may be speaking out of turn in class to get attention, or to get out of
engaging in a classroom activity which is difficult for her or him by being sent to the
principal’s office for misbehaving.
“Reinforcers” or rewards. Many different things can serve as a reward for
children of different ages. Treats or stickers are most commonly offered to smaller
children. Token economies, i.e. allowing a child to accumulate a certain number of
“points” to earn a reward, can also be used. Another technique is to reward the entire
class for appropriate behavior. For example, if a teacher wants to make sure that children
complete their homework, a point can be given to the class for each homework assignment
turned in. After a set number of points has been earned, a group reward can be
administered, such as a class party, watching a movie in class, or going to recess early.
In choosing a reward, it is important to start with something relatively small and
manageable, but significant enough to motivate students. This way, as requirements
for children’s behavior become greater, the reinforcer can be increased, as needed.
Some rewards can be “natural reinforcers”, that involve allowing children to do
activities that they find intrinsically enjoyable. For example, running around or jumping
up and down can be fun for small children, and a teacher may allow them 3 minutes of
running around in return for paying attention for 15 minutes in class. Being able to sit
35
and read a book may be something an adolescent particularly enjoys, so this can be used
as a reward for turning in a homework assignment early.
Cueing is a tool teachers can use to teach behaviors. Cueing refers to consistently
giving students a “sign” of some kind before starting a particular activity, so that they
can prepare to transition to this activity. For example, a teacher may raise her hand or
turn off the lights before she begins her lesson. When done consistently, it signals to
students that a particular behavior (e.g. being quiet) is expected of them. For children
who are distracted, have trouble paying attention, or who don’t understand verbal
instructions, cueing, when done consistently, may be particularly helpful. Cueing can
become a welcome routine, and a non-verbal way to help students understand what is
expected from them, since they can watch what other students do when the cue is
given.
Modeling refers to teaching a behavior by having a child watch someone else be
rewarded for this behavior. For example, praising another student who demonstrates
appropriate behavior makes it likely that other children will learn this behavior. Modeling
also works because it illustrates to children what is expected of them, and can be
particularly useful when the children’s English language skills are poor.
The same rewards don’t work for everyone.
Why is it that one child learns appropriate behavior right away; whereas another
seems to never sit still in class or keep his or her voice down? One possible reason is that
the reward chosen is reinforcing for the first student, but not for the second. For
example, having a note sent home to tell parents how well the child did in school today
may be very positive for the first child, who feels proud and enjoys his parents sharing
in his or her accomplishments. But for another child, sending a note home may involve
having to translate it to parents who may assume that if the school is trying to contact
them, the child must be in trouble. Or, parents simply ignore the note, and bringing it
home makes the child sad because parents don’t acknowledge it. In order to teach
behavior to this second child, it is important to find a reward that will be reinforcing
and that he or she will enjoy and want to receive.
Teachers frequently confront situations in classrooms in which it seems that
several children are always doing something disruptive to “get attention”. The teacher
is then caught in a bind, because if she makes a comment about the behavior, sends the
child out of the room, or does anything else to try to make it stop, this very act may be
36
gratifying the child’s need for attention. Teachers then may try to ignore this disruptive
behavior in an effort to withhold attention, but the child may escalate the disruptive
behavior in an attempt to try even harder to garner attention. Even without this
escalation, it is hard to ignore someone who is disrupting the class. What should the
teacher do?
One solution is to find a way to reward appropriate behavior and gradually
discontinue rewarding inappropriate behavior. First, the teacher can determine what
the child is “getting” through this behavior - is it positive reinforcement (such as
attention), or negative reinforcement (such as getting out of doing something he or she
doesn’t like to do). If the behavior is being reinforced because other students pay attention
to this child, the teacher could begin finding a way to reinforce other students for not
paying attention to the disruptive behavior when it occurs. Next, the strategy is to
identify times when the disruptive child displays appropriate behavior and reward this
with attention. Perhaps most importantly, after analyzing what the child is trying to
obtain through this behavior, it is most helpful to find another way to give it to him or her.
If the child is trying to get attention, the teacher might think of a way to structure
classroom activities to give this child attention at times that are more convenient and
less disruptive. The teacher might give the child some one-on-one time on a regular
basis, give the child a special role that allows him or her to be the center of attention in
class, ask the child to speak in front of the class, or otherwise satisfy the child’s need to
be noticed while teaching him or her to do it in an appropriate way. If the child is
trying to get sent to the office to get out of participating in a math exercise because it’s
too hard, the teacher may offer some tutoring. If the child is trying to get sent to the
office to get out of recess because interacting with other children is too stressful, the
teacher may find a way to help this child interact in positive way with other children
during class, or to find other resources within the school to address the problem on the
playground. What is important is to discourage inappropriate behavior while trying to
attend to the need that the child is expressing.
Successive approximation is another useful tool in behavior management. It
involves taking very small steps to reach a bigger milestone. When the desired behavior
is very different from what the child is able to do, the strategy is to start small, and
progressively increase expectations and rewards. For example, a child who does not stay
in his chair during class can be rewarded for sitting in it for 5 consecutive minutes.
Gradually the expectation can increase to 7 minutes, and so on. If reinforcement does
not help this child sit in the chair for 5 minutes, perhaps the expectation is too great,
and it makes more sense to start with 3 minutes. Of course, in these situations, if the
37
behavior of the child is extremely disruptive or suggests great distress, the help of a
mental health professional may be required.
In sum, behavior management tools can be extremely useful in most
classrooms, but can be particularly helpful to ESL teachers with refugee students.
Behavior management tools described above can help in explaining expectations,
structuring classroom activities, and providing feedback to refugee children about
their behavior in the classroom. Mental health professionals can assist teachers in
finding techniques to use in the classroom to meet the needs of particular students.
Summary
ESL teachers can greatly improve the mental health and psychological adjustment
of refugee children. Refugee children may be just as likely to misbehave or not apply
themselves at school fully in the same ways and for the same reasons as children in
general. However, in addition, refugee children may lack understanding and knowledge
of the culture of schools and classrooms in the U.S. For these reasons ESL teachers can
be extremely helpful to refugee children by orienting them to the culture and setting
clear and consistent rules for behavior and expectations for performance. ESL teachers
can use a number of tools to set and explain expectations, create structure and routines
in the classroom, and reward desirable behavior. Various techniques, such as tools of
behavior management, can be used not only to create a more predictable and
understandable classroom environment, but also reinforce English language skills. When
inappropriate behavior does occur, an ESL teacher can use these tools to clarify rules
and re-evaluate they ways in which behavior in the classroom is rewarded. In addition,
the teacher can use this as an opportunity to find a way to address this child’s needs
whether they are expressed in words or behavior.
Whether or not refugee children have experienced extreme trauma, all are going
through a difficult and stressful psychological adjustment. ESL teachers can ease this
process by finding ways to provide support to these students. Support can be provided
through a variety of tools, such as allowing for students to receive individualized attention
from the teacher and structuring classroom activities that encourage students to interact
with one another. Active listening is a tool that teachers can use and can teach to
students, in order to improve communication and mutual understanding, a tool that
can also be used for English language learning. Such support can be particularly
important for students who suffer from PTSD. In general, the ideal combination of a
classroom climate for refugee children is clear expectations and structure coupled with
emotional support.
38
Finally, ESL teachers cannot be expected to treat mental disorders in children
and need to turn to mental health professionals when needed. Mental health professionals
not only can help provide referrals or treatment for children, but also can suggest strategies
that can be incorporated into classroom routines for the entire group, or to meet specific
needs of a particular child.
39
References
Adkins, M, Birman, D, Sample, B. (1999), Cultural Adjustment, Mental
Health, and ESL: The Refugee Experience, the Role of the Teacher, and ESL
Activities. ELT Technical Assistance Project
Atkins, M. S., McKay, M. M., Arvanitis, P., London, L., Madison, S.,
Costigan, C., Haney, P., Zevenbergen, A., Hess, L., Bennet, D., & Webster, D
(1998). An ecological model for school-based mental health services for urban lowincome
aggressive children. Journal of Behavioral Health Services & Research. Vol
25(1) Feb 1998, 64-75. Association of Behavioral Healthcare Management, US
Birman, D., & Trickett, E. J. (2001). The process of acculturation in first
generation Immigrants: A study of Soviet Jewish Refugee Adolescents and Parents.
Journal of Cross-Cultural Psychology, 32(4), 456-477.
Crawford, J. (1992). Hold Your Tongue: Bilingualism and the Politics of
English-Only. Addison-Wesley Publishing Company: Reading, MA.
Eisenbruch, M. (1992). Toward a culturally sensitive DSM: Cultural
bereavement in Cambodian refugees and the traditional healer as taxonomist. Journal
of Nervous & Mental Disease. Vol 180(1) Jan 1992, 8-10. Lippincott Williams &
Wilkins, US, http://www.lww.com
Elias, M., & Tobias, S. (1996). Social Problem Solving: Interventions in the
Schools. Guilford Publications
Phinney, J. S. (1990). Ethnic identity in adolescents and adults: Review of
research. Psychological Bulletin, 108(3), 499-514.
Yaglom, M. (1991). The impact of loss and mourning on Soviet immigrant
teenagers and their families: Some implications for clinical practice. In: Goldberg, B.,
Birman, D., Bornemann, T., Carp, J., Cravens, R.B., Goldberg, B., Handelman, P.,
Schulhoff, J., Shubert, P. (Eds.), A National Conference on Soviet Refugee Health and
Mental Health: Twenty Years of Soviet Resettlement, the State of the Art in Practice and
Cultural Issues in Health and Mental Health Services. Conference Proceedings, Jewish
Federation of Metropolitan Chicago, Chicago, Il.
Additional Resource
Refugee Children Traumatized by War and Violence: The Challange Offered to the
Service Delivery System, Prepared by Marva P. Benjamin and Patti C. Morgan, April,
1989, CSAT Technical Assistance Center, Georgetown University, Child Development
Center
40
REFUGEE MENTAL HEALTH PROGRAM
The Refugee Mental Health Program (RMHP) originated in the Alcohol, Drug
Abuse, and Mental Health Administration (ADAMHA,) in 1980, in response to the
arrival of nearly 125,000 Cubans on the South Florida shores. The basic mission of
the RMHP was to provide mental health assessment, treatment, and consultation to
Cuban and Haitian migrants,and their providers. In 1992, in conjunction with the
reorganization of ADAMHA, the activities of the RMHP were transferred to the
Center for Mental Health Services (CMHS), Substance Abuse and Mental Health
Services Administration (SAMHSA). In 1995, the original Cuban/Haitian
activities of the RMHP were transferred to the Department of Justice. Concurrently,
the consultative activities of the RMHP were retained in CMHS, SAMHSA.
Since 1995, the RMHP, through an intra-agency agreement (IAG) with ORR,
provides refugee mental health consultation and technical assistance (TA) to any
public or private federal, state, local or agencies. Priority is given to ORR-funded
programs. There is no cost for RMHP TA Services. Specific RMHP activities
include: on-site and distance consultation community assessments, program
development and dissemination of technical assistance documents development and
provision of workshops and training programs for resettlement staff and mental
health personnel. Special missions have included: planning for Operation Provide
Refuge in 1999, and serving on the ORR Director’s staff overseeing all mental health
planning and services for Kosovar Albanians processed at Fort Dix, N.J. Later,
RMHP staff participated in a Presidential Delegation to Kosovo. The delegation
completed a comprehensive psycho-social needs assessment of returning refugees.
John J. Tuskan, Jr.
Captain , United States Public Health Service
Captain John Tuskan, R.N., M.S.N., is a Commissioned Officer in the US Public
Health Service . He is currently assigned to the Center for Mental Health Services
(CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA),
Department of Health and Human Services (DHHS). In this assignment, CAPT
Tuskan provides mental health technical assistance and consultation to the Federal
Office of Refugee Resettlement and the U.S. refugee resettlement network, and
concurrently serves as CMHS’s Faith-Based and Community Initiatives Coordinator,
and International Initiatives Officer. He is also the Acting Chief of the Special
Programs Development Branch in CMHS, the Acting Emergency Coordinator for
SAMHSA., and an Instructor in Psychiatry at the Uniformed Services University of
the Health Sciences, Medical School, Bethesda, MD. His professional experience has
included clinical assignments with the US Army, clinical research assignments with
the National Institutes of Health (NIH), and mental health consultant assignments
with the US Immigration and Naturalization Service (INS) and the US Marshals
Service (USMS). Captain Tuskan has completed humanitarian field assignments in
response to domestic disasters, mass immigration exercises, and refugee emergencies
41
response to domestic disasters, mass immigration exercises, and refugee emergencies
in the Middle East and Eastern Europe. Captain Tuskan is a graduate of the
Pennsylvania State University and Yale University.
Telephone: 301-443-1761
Fax: 301-443-7912
E-mail: jtuskan@samhsa.gov
Angela González Willis, Ph.D.
CDR, USPHS
Angela González Willis, Ph.D. is a Commissioned Officer in the U.S. Public Health
Service. She is currently assigned as a Senior Public Health Advisor in the Refugee
Mental Health Program, Center for Mental Health Services (CMHS), Substance
Abuse and Mental Health Services Administration (SAMHSA), Department of
Health and Human Services (DHHS). In this capacity, Dr. González Willis provides
mental health technical assistance and consultation to the Federal Office of Refugee
Resettlement and the U.S. refugee resettlement network. She concurrently serves as
CMHS’s Cultural Competency Coordinator and is involved in disaster response and
recovery efforts.
Dr. González Willis earned an M.S. and Ph.D. in psychology from Northwestern
University.
Telephone: 301-443-2507
Fax: 301-443-7912
E-mail: agonzal2@samhsa.gov
42
Toture Treatment Programs
ACCESS Psychosocial Rehabilitation Center
Contact: Mahamed Farrag
5490 Maple
Dearborn, MI 48126
Phone: (313) 624-2243
Fax: (313) 624-9418
E-mail: mfarrag@accesscommunity.org
Web Page: www.accesscommunity.org
Advocates For Survivors Of Trauma And Torture
Contact: Karen Hanscom
431 E. Belvedere
Baltimore, MD 21212
Phone: (410) 464-9006
Fax: (410) 464-9010
E-mail: klh@igc.org
Web Page: www.ASTT.org
Amigos De Los Sobrevivientes
Contact: German Nieto-Maquehue
2244 Jefferson St
Eugene, OR 97405
Phone: (541) 484-2450
Fax: (541) 485-7293
E-mail: amigos@efn.org
Bellevue/NYU Program For Survivors Of Torture
Contact: Allen Keller
NYU School of Medicine
c/o Division of Primary Care Internal Medicine
NYU School of Medicine
550 1st Avenue
New York, NY 10016
Phone: (212) 263-8269
Fax: (212) 263-8234
E-mail: ask45@aol.com
Web Page: www.survivorsoftorture.org
43
Boston Center for Refugee Health and Human Rights
Contact: Lin Piwowarczyk
1 Boston Medical Center Place
Boston, MA 02118-2393 Phone: (617) 414-5082 Fax: (617) 414-1464
E-mail: piwo@bu.edu Web Page: www.glphr.org/bcrhhr.htm
Center For Survivors Of Torture
Contact: Manuel Balbona
5200 Bryan Street
Dallas, TX 75372-0663 Phone: (972) 317-2883 Fax: (972) 317-4433
E-mail: manuel@cstdallas.org
Center For Survivors of Torture and War Trauma
Contact: Jean Abbott
1077 S. Newsstead St. Louis, MO 63110 Phone: (314) 371-6500 Fax: (314) 371-6510
E-mail: jeanabbott4400@aol.com
Center For Survivors of Torture (AACI)
Contact: Jerry Gray
2400 Moorpark Ave. San Jose, CA 95128 Phone: (408) 975-2750 x 250 Fax: (408) 975-2745
E-mail: Gerald.Gray@aaci.org
Center For Victims of Torture
Contact: Douglas Johnson
717 East River Road Minneapolis, MN 55455 Phone: (612) 626-1400 Fax: (616) 626-2465
E-mail: Douglas_Alan_Johnson@compuserve.com Web Page: www.cvt.org
44
Center for the Prevention and Resolution of Violence
Contact: Amy Shubitz, MA
317 W. 23rd St.
Tucson, AZ 85713
Phone: (520) 628-7525
Fax: (520) 295-0116
E-mail: ashubitz@aol.com
Center for the Rehabilitation of Torture Victims
Contact: Randall Krakauer, MD
Contact: Eugene Packard, Director of Mental Health Services
Phone: (201) 794-6360
4247 Route 90 North, Bldg. 1
Freehold, NJ 07728
Phone: (908) 780-7650
Fax: (908) 780-8817
Cross Cultural Counseling Center
International Institute of New Jersey
Contact: Sara Kahn
880 Bergen Avenue
Jersey City, NJ 07306
Phone: (201) 653-3888
Fax: (201) 963-0252
E-mail: skahn@iinj.org
Doctors of the World
Contact: Maki Katoh
375 West Broadway, 4th Floor
New York, NY 10012
Phone: (212) 226-9890 x230
Fax: (212) 226-7026
E-mail: katohm@dowuse.org
Web Page: www.doctorsoftheworld.org
Florida Center for Survivors of Torture
Contact: Faina Sakovich
407 S. Arcturus
Clearwater, FL 33765
Phone: (727) 298-2749 x 22 or x 12
Fax: (727) 298-3499
E-mail: refugeeh@yahoo.com
Web Page: www.gcifs.org
45
Institute for the Study of Psychosocial Trauma
Contact: Carlos Gonsalves
380 Edlee Avenue
Palo Alto, CA 94306
Phone: (650) 424-1314
Fax: (650) 424-0304
E-mail: cigons@mac.com
International Survivors Center c/o
International Institute of Boston
Westy Egmont
One Milk Street
Boston, MA 02109
Phone: (617) 695-9990
Fax: (617) 695-9191
E-mail: wegmont@iboston.org
Web Page: www.iboston.org
Khmer Health Advocates
Contact: Mary Scully
29 Shadow Lane
W. Hartford, CT 06110
Phone: (860) 561-3345
Fax: (860) 561-3538
E-mail: mfs47@aol.com
Web Page: http://www.hartnet.org/khmer/
www.Cambodianhealth.org as of Dec. 2002
Marjorie Kovler Center For The Treatment Of Survivors Of Torture
 Contact: Mary Fabri
1331 W. Albion
Chicago, IL 60626
Phone: TBA
Fax: TBA
E-mail: mfabri@hotmail.com
Program for Survivors of Torture and Severe Trauma (PSTT) at CHMS
Contact: Judy Okawa
701 W. Broad Street, Suite 305
Falls Church, VA 22046
Phone: (703) 533-3302 x 143
Fax: (703) 237-2083
E-mail: okawaj@aol.com
46
Program for Torture Victims
Contact: Michael Nutkiewicz
3655 S. Grand Ave., #290
Los Angeles, CA 90007
Phone: (213) 747-4944
Fax: (213) 747-4662
E-mail: nutkiewicz@ptvla.org
Web Page: www.ptvia.org
Rocky Mountain Survivor Center
Contact: Paul Stein
1547 Gaylord Street, #100
Denver, CO 80206
Phone: (303) 321-3221
Fax: (303) 321-3314
E-mail: rmsc@earthlink.net
Web Page: http://www.home.earthlink.net/~rmsc
Safe Horizon/Solace
Contact: Ernest Duff, Senior Director
74-09 37th Avenue, Room 412
Jackson Heights, NY 11372
Phone: (718) 899-1233, Ext. 101
Fax: (718) 457-6071
Pager: 917-894-7815
E-mail: Eduff@safehorizon.org
Survivors International of Northern California
Contact: Margaret Kokha
447 Sutter Street, #811
San Francisco, CA 94108
Phone: (415) 765-6999
Fax: (415) 765-6995
E-mail: survivorsi@sbcglobal.net
Web Page: www.survivorsintl.org
47
Su
rvivors Of Torture, International
Contact: Kathi Anderson P.O. Box 151240 San Diego, CA 92175-1240 Phone: (619) 582-9018 Fax: (619) 582-7103
E-mail: surv.tort.intl@juno.com
48
The CMHS National Mental Health Services Knowledge Exchange Network (KEN) provides
information about mental health via toll-free telephone services, an electronic
bulletin board, and publications.
 Write:
P.O. Box 42490
Washington, DC 20015
 Call:
1-800-789-CMHS (2647)
Monday to Friday,
8:30 A.M. to 5:00 P.M., EST
Electronic Bulletin Board System (BBS): 1-800-790-CMHS (2647)
Telecommunications Device for the Deaf (TDD): 301-443-9006
Fax: (301) 984-8796
Email: ken@mentalhealth.org
Center for Mental Health Services: http://www.mentalhealth.org/
Phone: (310) 235-2633
Fax: (310) 235-2612
E-mail: kling@mednet.ucla.edu
Website: www.nctsnet.org
National Alliances for the Mentally Ill: 1-800-950-6264
National Center for Child Traumatic Stress
Mailing Address:
905 W. Main Street, Suite 23-E
Durham, NC 27701
Phone: (919) 687-4686 x 302
Fax: (919) 687-4737
E-mail: jholland@psych.mc.duke.edu
National Depressive and Manic Depression Association: 1-800-826-3632
National Mental Health Association: 1-800-433-NMHA (6642)
National Institute of Mental Health http://www.nimh.nih.gov/
National Council for Community Behavioral Health Care
Charles G. Ray
President and CEO
12300 Turnbrook Parkway, Suite 320
Rockville, Maryland 20852
Phone: (301) 984-6200
Fax: (301) 881-7159
E-mail: www.nccbh.org
49
About the author:
Dina Birman is a psychologist with expertise on acculturation, adaptation, and
mental health of refugees and immigrants. Dr. Birman received her Ph.D. in
Clinical/Community Psychology from the University of Maryland (1991), having
completed a clinical internship at Harvard Medical School. From 1991-1997 she
worked in the Refugee Mental Health Program in the Public Health Service, where
she provided consultation and technical assistance on mental health issues to the
Office for Refugee Resettlement (DHHS), and to the state and local programs that
they fund. Since 1998 Dr. Birman has been conducting research on acculturation,
adaptation, and mental health of adolescent, adult, and elderly refugees from the
former Soviet Union, Somalia, and Vietnam. She has been a research fellow at
Georgetown University (1998-2000), and most recently at the University of Illinois
at Chicago (2000-2003), where she will be joining the Psychology faculty in 2003.
Much of the research on refugees has been conducted in Maryland with funding
from the office of the State Refugee Coordinator – the Maryland Office for New
Americans. Since moving to Chicago in 2000, she has been working with Chicago
Public Schools and refugee resettlement organizations. She has given a series of
teacher workshops on mental health in the classroom for the Newcomer Center
Network, and has conducted evaluations of refugee mental health, educational, and
social service programs including the Illinois K-12 program funded through the
ORR Impact Grant. She also provides consultation to schools and agencies that
serve refugees, and is currently developing a model of school-based mental health
interventions for refugee students.
Acknowledgments
The ELT / TA Project would like to acknowledge all the people who have made
contributions to this booklet by typing, editing, proof reading, and providing encouragement
in so many different ways at needed moments. Special thanks to the ELT
partners (Burna Dunn, Myrna Ann Adkins, Barbara Sample, Allene G. Grognet, Miriam
Burt, Autumn Keltner, Inaam Mansoor, Diane Pecoraro, Margaret B. Silver, Brigitte
Marshall), Spring Institute staff Pam Herrlein and Yohannes Mengistu, ORR Staff,
Marta Brenden, and Angela Gonzales-Willis with RMHP the Refugee Mental Health
Technical Assistance provider.
 davido.extraxim@gmail.com