Optimising refugee children's health/wellbeing in preparation for primary and secondary school: a qualitative inquiry

Jess R Baker; Shanti Raman; Jane Kohlhoff; Ajesh George; Catherine Kaplun; Ann Dadich; Catherine T Best; Amit Arora; Karen Zwi; Virginia Schmied; Valsamma Eapen

doi:10.1186/s12889-019-7183-5

Optimising refugee children's health/wellbeing in preparation for primary and secondary school: a qualitative inquiry

BMC Public Health. 2019 Jun 27;19(1):812. doi: 10.1186/s12889-019-7183-5.

Authors

Jess R Baker¹, Shanti Raman², Jane Kohlhoff^{3

4}, Ajesh George^{5

6

7

8}, Catherine Kaplun^{9

10}, Ann Dadich¹¹, Catherine T Best¹², Amit Arora^{13

14

15

16}, Karen Zwi¹⁷, Virginia Schmied⁹, Valsamma Eapen^{18

19}

Affiliations

¹ the University of New South Wales, Liverpool Hospital Mental Health Centre Level 1, Liverpool, NSW, 2170, Australia. Jessica.baker@unsw.edu.au.
² South Western Sydney Local Health District, Health Services Building Level 3, Cnr Campbell & Goulburn St, Liverpool, NSW, 2170, Australia.
³ School of Psychiatry, University of New South Wales, Hospital Rd, Randwick, NSW, 2031, Australia.
⁴ Karitane, 138-150 The Horsley Dr, Carramar, NSW, 2163, Australia.
⁵ Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
⁶ South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
⁷ University of Sydney, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
⁸ Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
⁹ Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
¹⁰ Ingham Institute for Applied Medical Research, Locked Bag 1797, Penrith, NSW, 2751, Australia.
¹¹ School of Business, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia.
¹² Western Sydney University, The MARCS Institute, Locked Bag 1797, Penrith, NSW, 2751, Australia.
¹³ School of Science and Health, Penrith, NSW, 2751, Australia.
¹⁴ Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.
¹⁵ Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
¹⁶ Oral Health Service, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia.
¹⁷ Sydney Children's Hospital, Corner Avoca and Barker Street, Randwick, NSW, 2031, Australia.
¹⁸ Academic Unit of Child Psychiatry South West Sydney (AUCS), University of New South Wales & Ingham Institute, Elizabeth Street, Liverpool, Sydney, 2170, Australia.
¹⁹ Liverpool Hospital, Elizabeth Street, Liverpool, Sydney, 2170, Australia.

Abstract

Background: Children from refugee backgrounds are less likely to access appropriate health and social care than non-refugee children. Our aim was to identify refugee children's health/wellbeing strengths and needs, and the barriers and enablers to accessing services while preparing for primary and secondary school, in a low socio-economic multicultural community in Australia.

Method: Ten focus groups were facilitated with Arabic-speaking refugee parents of children aged 2-5 years (n = 11) or in first year secondary school (n = 22); refugee adolescents starting high school (n = 16); and key service providers to refugee families (n = 27). Vignettes about a healthy child and a child with difficulties guided the discussions. Data was thematically analysed and feedback sought from the community via the World Café method.

Results: Personal resilience and strong family systems were identified as strengths. Mental health was identified as a complex primary need; and whilst refugees were aware of available services, there were issues in knowing how to access them. Opportunities for play/socialisation were recognised as unmet adolescent needs. Adults spoke of a need to support integration of "old" and "new" cultural values. Parents identified community as facilitating health knowledge transfer for new arrivals; whilst stakeholders saw this as a barrier when systems change. Most parents had not heard of early childhood services, and reported difficulty accessing child healthcare. Preschooler parents identified the family "GP" as the main source of health support; whilst parents of adolescents valued their child's school. Health communication in written (not spoken) English was a significant roadblock. Differences in refugee family and service provider perceptions were also evident.

Conclusions: Refugee families face challenges to accessing services, but also have strengths that enable them to optimise their children's wellbeing. Culturally-tailored models of care embedded within GP services and school systems may assist improved healthcare for refugee families.

Keywords: Adolescent; Health service; Preschool; Qualitative; Refugee.

MeSH terms

Adolescent
Adult
Australia
Child
Child Health*
Child Welfare*
Child, Preschool
Cultural Diversity
Female
Focus Groups
Health Services Accessibility*
Humans
Male
Mental Health
Needs Assessment*
Parents / psychology
Poverty
Qualitative Research
Refugees* / psychology
Refugees* / statistics & numerical data
Schools

Grants and funding

RG172372/South West Sydney Small Research Grant