Unaccompanied Minor Asylum Seekers Research Articles

Challenges for unaccompanied asylum-seeking minors in Swedish compulsory institutional care

This qualitative thematic study aimed to examine the placement of unaccompanied asylum-seeking minors in compulsory institutional care in Sweden, to expand knowledge regarding their care and treatment. The dataset comprised official documents and anonymized journal documents from personnel detailing the experiences of twenty-five unaccompanied asylum-seeking minors in compulsory institutional care organized by the Swedish National Board of Institutional Care in 2015. The study identified three main themes: traumatic life events and mental health, alignment between needs, goals, and treatment, and language difficulties. The findings revealed a high prevalence of severe traumatic experiences among the asylum-seeking minors, with half having endured significant psychological and physical trauma. Mental health issues were inconsistently addressed, and prior traumas were often overlooked in care planning. The majority exhibited various mental health problems, underscoring the need for tailored interventions. The study highlights challenges in aligning unaccompanied asylum-seeking minors' individual needs, treatment goals, and provided care. Language barriers emerged as a critical concern, impeding effective communication and treatment. Approximately 80% of the asylum-seeking minors experienced difficulties in understanding and expressing themselves in Swedish. The limited use of professional interpreters further exacerbated this issue. The study underscores the need for targeted interventions to better support unaccompanied asylum-seeking minors within compulsory institutional settings.

Mapping evidence-based interventions to the care of unaccompanied minor refugees using a group formulation approach.

How we adapt treatment algorithms to complex, clinically untested, difficult-to-engage patient groups without losing evidence base in everyday practice is a clinical challenge. Here we describe process and reasoning for fast, pragmatic, context-relevant and service-based adaptations of a group intervention for unaccompanied minor asylum seekers (UASC) arriving in Europe. We employed a distillation-matching model and deployment-focused process in a mixed-method, top-down (theory-driven) and bottom-up (participant-informed) approach. Prevalence of mental disorders amongst UASC is extremely high. They also represent a marginalised and hard-to-engage group with limited evidence for effective treatments. Content and process adaptations followed four steps: (1) descriptive local group characterisation and theoretical formulation of problems; (2) initial adaptation of evidenced treatment, based on problem-to-component grid; (3) iterative adaptation using triangulated feedback; and (4) small-scale pilot evaluation. Based on evidence and participant feedback, adaptations included minimising verbal demands, facilitating in-session inductive learning, fostering social connectedness via games, enhancing problem-solving skills, accounting for multi-traumatisation, uncertainty and deportation. Quantitative evaluation suggested improved feasibility, with increased attendance, low drop-out and symptom improvement on depression and trauma scores. By describing the principles under-pinning development of a group intervention for severely traumatised UASC, we contribute to the literature supporting dynamic adaptations of psychological interventions, without losing reference to evidence base. Complex and difficult-to-reach clinical groups are often those in most need of care, yet least researched and most affected by inequality of care. Pragmatic adaptations of proven programs are often necessary to increase feasibility.

Narrating Paradox Affects: Unaccompanied Minor Asylum-Seekers in Austria

Asylum-seeking unaccompanied children and youngsters are situated at the crossroads between exclusionary and repressive asylum policies, on the one hand, and relatively inclusive and caring child welfare policies, on the other. This is the ‘asylum-child welfare paradox’ (Dursun and Sauer 2021). In this article, we explore the role of affect, feelings, and emotions in how unaccompanied minors respond to and process but also co-construct and resist this structural paradox through their ‘affective narratives’ (Bargetz and Eggers 2022). Based on qualitative interviews conducted with (former) unaccompanied minors in Austria in 2015, we observe that minors mobilize a set of feelings of fear, disappointment, frustration, and uncertainty due to experiences of rejection or loss of control; but unaccompanied minors also express feelings of confidence, joy, hope, and solidarity vis-à-vis their new environment and their future. Furthermore, the highly affective issues of belonging and non-belonging to their host country, of proximity and distance to other human beings hold an important place in their narratives as well as the ordering of time. We conclude that, rather than merely reacting to paradoxes that structure their social positions, minors actively shape such paradoxes and render them tangible and workable by means of narrating contradictory feelings and emotions and by mobilizing affectivity.

Prevalence of abnormalities seen on orthopantomograms performed for forensic age estimation in unaccompanied minor asylum seekers.

Evaluate the prevalence of radiological anomalies on orthopantomograms (OPT) performed as part of forensic age estimation in unaccompanied minors. This is a retrospective study conducted on 208 OPT examinations requested by a magistrate. These OPTs were interpreted independently by two readers to establish the number of missing teeth (MT), presence of dental fillings (DF), and dental anomalies (DA). The presence of radiolucent (RL), radiopaque, and mixed lesions was also assessed. Most radiologic anomalies were RL, detected on 41% and 39% of the subjects evaluated for R1 and R2, respectively, with a mean of 1.3 ± 2.4 (1-16) and 1.1 ± 2 (1-13) RL lesions per subject. Among the RL identified, the majority were dental (70% for R1 and 65% for R2), all of which had a suspected infectious origin. Among readers, 43% and 41% of the subjects evaluated presented MT, 21% and 15% presented DF, and 22% and 20% presented DA for R1 and R2, respectively. The inter- and intra-observer reproducibility for OPT classification was considered excellent (Kappa = 0.84, 95% CI 0.78-0.90, and Kappa = 0, 95, 95% CI 0.86-0.99). There was a non-negligible prevalence of radiological anomalies in OPT studies performed for forensic age estimation. Most of these lesions were suspected to be infectious in origin, potentially requiring medical care. This constitutes an ethical dilemma inherent in the judicial expertise injunction requiring a limited specific response. This study highlights a non-negligible prevalence of supposedly infectious radiological abnormalities. The restricted possibility for the legal expert to declare these abnormalities raises ethical and medical questions. • Orthopantomograms can be performed as part of forensic age estimation. • Results indicate the majority of radiological anomalies detected on OPTs were of suspected infectious origin. • These findings give rise to ethical and medical questions about the way in which these forensic examinations are carried out.

Social work in shelters for unaccompanied asylum-seeking minors: challenging the traditional model of social work and the call for critical and political reflexivity

"Social work in shelters for unaccompanied asylum-seeking minors: challenging the traditional model of social work and the call for critical and political reflexivity" published on Nov 2022 by Policy Press.

Impact of a single information session with oral hygiene instructions on unaccompanied minor asylum seekers living in Switzerland.

Asylum-seeking adolescents who have passed the age of mandatory schooling may not have had the opportunity to receive oral hygiene instructions (OHI) similar to Swiss adolescents. Therefore, the aim of this study was to evaluate the impact of a single information session with OHI on both the knowledge about the consequences of lacking oral hygiene and the likelihood of implementing these instructions in unaccompanied adolescent asylum seekers living in Switzerland. Before and after a single information session with OHI, adolescent asylum seekers in two asylum centres (Menziken and Suhr, AG) were surveyed with written questionnaires. During the event, the consequences of lacking oral hygiene on oral health were explained and the Bass brushing technique was instructed and practised. The present analysis included 30 male asylum seekers aged 15-18. In total, 90% (n=27) cleaned their teeth daily and 70% (n=13) had received previous OHI at their school (19.1%) or a doctor's office (9.5%) in their country of origin or in Switzerland (19.1%), respectively. Following the event, 90% (n=27) stated they had learned something new and 93.3% (n=28) wanted to implement the instructions in their daily routine. While 63.3% (n=19) of the respondents knew the consequences of lacking oral hygiene on oral health before the event, this value increased to 96.7% (n=29) reaching statistical significance (p=0.0039). In conclusion, the results of the present study suggest that the implementation of a single information session with OHI in asylum centres may improve the level of knowledge in adolescent asylum seekers and their oral health.

Impact of a single information session with oral hygiene instructions on unaccompanied minor asylum seekers living in Switzerland

Asylum-seeking adolescents who have passed the age of mandatory schooling may not have had the opportunity to receive oral hygiene instructions (OHI) similar to Swiss adolescents. Therefore, the aim of this study was to evaluate the impact of a single information session with OHI on both the knowledge about the consequences of lacking oral hygiene and the likelihood of implementing these instructions in unaccompanied adolescent asylum seekers living in Switzerland. Before and after a single information session with OHI, adolescent asylum seekers in two asylum centres (Menziken and Suhr, AG) were surveyed with written questionnaires. During the event, the consequences of lacking oral hygiene on oral health were explained and the Bass brushing technique was instructed and practised.
 The present analysis included 30 male asylum seekers aged 15-18. In total, 90% (n=27) cleaned their teeth daily and 70% (n=13) had received previous OHI at their school (19.1%) or a doctor's office (9.5%) in their country of origin or in Switzerland (19.1%), respectively. Following the event, 90% (n=27) stated they had learned something new and 93.3% (n=28) wanted to implement the instructions in their daily routine. While 63.3% (n=19) of the respondents knew the consequences of lacking oral hygiene on oral health before the event, this value increased to 96.7% (n=29) reaching statistical significance (p=0.0039).
 In conclusion, the results of the present study suggest that the implementation of a single information session with OHI in asylum centres may improve the level of knowledge in adolescent asylum seekers and their oral health.
 Accepted for publication: April 14, 2022
 Published online: April 14, 2022

Health status and healthcare services utilisation among unaccompanied asylum-seeking minors settled in Switzerland: a protocol for a retrospective cohort study from a hospital-based youth outpatient clinic.

IntroductionUnaccompanied asylum-seeking minors (UASMs) represent a population group with complex healthcare needs. Initial and ongoing healthcare is challenging for host countries but considered essential. This publication describes the protocol concerning a large cohort of UASMs settled in Switzerland in 2015–2016. Our aim is to assess their health status and examine their trajectories of healthcare services utilisation during the 3-year period after their initial health control.Methods and analysisWe will retrospectively analyse data of all newly arrived UASMs aged 12–18 years who benefited from a first health assessment at the Youth Clinic of Geneva University Hospitals between 1 January 2015 and 31 December 2016. Source of data will be electronic medical records. Main outcomes include the determination of their health status (acute and chronic conditions) and the utilisation of different care sectors (ambulatory primary care and subspecialty clinics, emergency room and inpatient wards). A secondary outcome will be the identification of patients at risk for high use of services as well as those with limited access to care. We will extract the following data: demographic characteristics (age, gender and country of origin), social determinants (place of residence, the presence of family in Geneva, school performance and asylum status), clinical information (reason for attending service, anthropometric measurements and medical diagnosis at discharge) and laboratory parameters (complete blood count, ferritin level, 25-hydroxyvitamin D level, hepatitis B antigen and antibodies, tetanus antibodies, QuantiFERON and stool and serology tests for intestinal parasites). We will collect data from first health assessment and during a follow-up period of 3 years for each patient.Ethics and disseminationIn accordance with the Swiss clinical research law, this protocol has been approved by the local ethics committee (project ID: 2021–01260). Our findings will provide important information for the development of quality healthcare services focusing to UASMs. We intend to disseminate our results through publication in peer-reviewed journals.

Attachment insecurity in unaccompanied refugees: a longitudinal study

PurposeThis study aims to focus on the avoidance and anxiety attachment patterns among unaccompanied refugee minors (URMs) after resettlement in Norway. The authors explored the extent of stability and change in these attachment patterns and the role of demographic and interpersonal predictors of change in levels of attachment insecurity.Design/methodology/approachThree waves of data were analyzed with latent growth curve modeling. The sample consisted of 918 refugees who had arrived in Norway as unaccompanied minor asylum seekers and were granted residence. Of the initial sample, 82% were male and the mean age was 18.6 years (SD = 2.61).FindingsResults revealed substantial stability in attachment patterns: anxiety patterns did not change over time, while avoidance patterns increased, but only marginally.Research limitations/implicationsA large sample of URMs revealed rather stabile attachment patterns over time, underlining the need for social support that fosters their adjustment processes best. More research is needed to clarify the mechanism underlying the stability and change in attachment patterns and to understand better how these young people can be supported emotionally during their resettlement process in the absence of parental care.Social implicationsHost societies could perhaps invest more in promoting successful and sustainable adult relationships for unaccompanied refugees approaching the age of 18 years. This may help them to cope better with acculturation stressors and negative past experiences and may thereby improve their future mental health and social relationships.Originality/valueTargeting competencies to develop and maintain close relationships may be particularly important for URM’s, because this may alleviate risks for mental health related to past and current stressors as well as loneliness. To the best of the authors’ knowledge, the present study is the first to investigate stability and change in attachment insecurity among unaccompanied refugees.

Post-Traumatic Stress Disorder in Unaccompanied Refugee and Asylum-Seeking Minors: A Scoping Review

Post-Traumatic Stress Disorder in Unaccompanied Refugee and Asylum-Seeking Minors: A Scoping Review

Unaccompanied minors’ experiences of narrative exposure therapy

AbstractDespite the understanding that unaccompanied minors’ (UAM) experience high rates of post-traumatic stress, the provision of evidence-based trauma-focused therapies is low for this population. Narrative exposure therapy (NET) is an effective short-term intervention for treating post-traumatic stress disorder (PTSD) after multiple traumatic experiences, such as those experienced by UAM. Within the existing literature, there is a lack of research investigating unaccompanied minors’ experiences of NET or any trauma-focused therapy. Participants were four UAM experiencing PTSD who formed part of a pilot delivery of NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted and transcripts were analysed using interpretative phenomenological analysis (IPA). This project identified five themes that encapsulated unaccompanied minors’ experiences of receiving NET, including the process of preparing for this therapy, what it was like to receive it, and the differences they identified at the end of treatment. The significance of this taking place within a safe therapeutic relationship was explored within the context of the attachment losses experienced by UAM, and the impact this has on emotion regulation was considered. The potential of a reduction in PTSD symptoms facilitating a positive spiral in adolescence was reflected on within this paper.Key learning aims(1)To understand the experience of unaccompanied asylum-seeking minors (UAM) receiving narrative exposure therapy (NET) for post-traumatic stress disorder.(2)To understand the key concerns and motivators for UAM when considering engaging in NET.(3)To understand how these experiences relate to theoretical frameworks and the existing literature relating to emotional difficulties in adolescence.

Responding to misrecognition – A study with unaccompanied asylum-seeking minors

Theories of recognition have received increasing attention in studies of children, young people and social care. However, the concept of misrecognition, as the opposite of recognition, is less featured. This article studies the experiences of misrecognition using evidence from the lived experience of underaged unaccompanied asylum-seeking boys in Finland. Drawing from conceptualizations of (mis)recognition and qualitative data created with 18 unaccompanied asylum-seeking boys living in residential care, we firstly look at how the boys articulate their experience of being seen as ‘refugees’. Secondly, we study how they respond to the refugee label. The findings show that the refugee stigma is mainly experienced as misrecognition, which influences the ways the young asylum-seekers strive to construct agentic identities. Four ways of responding to this misrecognition are identified: adopting a diminished identity (resigning), standing up against misrecognition (resisting), acting to prove the prejudice they encounter wrong (conforming), and claiming ordinariness (performing). We argue that the misrecognition experiences of unaccompanied asylum seeking minors offer a valuable lens for deepening our understanding of young people’s responses to adverse conditions. Their varying responses to misrecognition provide important insights into how social work and the care system can be more attentive to the experiences of marginalized children and young people.

Are the Problems and Motives Clear Enough? A Study on the Placement of Unaccompanied Asylum-Seeking Minors at Compulsory Care Institutions in Sweden

Abstract The Swedish National Board of Institutional Care (SNBIC) is an independent governmental agency that provides compulsory care for minors with psychosocial problems, criminal behavior, and substance abuse. During recent years, a noticeable number of the youth placed at compulsory care institutions have been asylum-seeking minors who have arrived in Sweden without parents or guardians. This steady increase in placements has raised questions and concerns among the involved actors regarding the motives and needs underlying these placements. This qualitative study investigates the main motives that lead unaccompanied asylum-seeking minors to be placed at SNBIC residential homes and the problems that are to be solved during their placement, according to social workers and SNBIC staff. The study is based on 28 in-depth interviews with social workers and SNBIC staff. Findings indicate clear disagreement between social workers and SNBIC staff with regard to the motives for placing unaccompanied minors at SNBIC homes. Although the social workers and SNBIC staff explain that most of the unaccompanied youth placed at SNBIC homes have some form of criminal behavior or substance abuse, SNBIC staff believe, in some cases, the problem is not sufficiently serious to warrant compulsory care. As these disagreements and misunderstandings between the actors have an impact on their collaboration and, consequently, the situation of the unaccompanied minors, all attempts to reach a consensus on the leading causes for placement and the problems that need to be solved with SNBIC placement would increase security for both the young people and the relevant staff.

Layered journeys: Experiences of fragmented journeys among young Afghans in Greece and Norway

AbstractThis article focuses on the fragmented journeys towards and within Europe among a group of young people originating from a country marked by war and conflict. It explores how the journey towards Europe may be part of a complex migration history that leads to layered journeys. I use the term ‘layered journeys’ to refer to multidimensional and multi-experiential journeys in which past, present and future experiences of mobility are intertwined. They may include multiple stages and various statuses. The article is based on ethnographic fieldwork, creative methods and life-history interviews. It focuses on a case study of a group of young Afghan males who arrived in Greece and Norway between 2008 and 2015, looking at their journeys in the context of mobility, undocumentedness and return. Young Afghans have represented the largest group of unaccompanied minor asylum seekers arriving in Europe between 2008 and 2018. While the last decade saw a considerable increase in the number of young Afghans arriving in Europe, migration itself is not a new phenomenon in the Afghan context. Afghanistan has a long history of migratory movements as part of livelihood and survival strategies, of which the past four decades of war and conflict in Afghanistan and its resulting millions of refugees are part.

What are the experiences of education for unaccompanied asylum-seeking minors in the UK?

The number of refugees worldwide has increased in recent years, and with this, there has been an increase in the numbers of unaccompanied asylum-seeking minors (UASMs) in the UK. Refugees have been found to experience notable difficulties upon resettlement, and there is evidence to suggest that education can provide a supportive role for young refugees. Although there has been research that has found that UASMs value education, there has been less research that has directly looked at the experiences of education for UASMs. In the present study, six UASMs were interviewed and interpretative phenomenological analysis (IPA) was used as a methodology to analyse the data. Five themes were identified: education facilitating socializing; education and English proficiency leading to a better life in the UK; the impact of transitions; the impact of external stressors; and a desire for additional resources to learn at one's own pace. Participants within the present research expressed a strong desire for additional resources that would allow them to learn at their own pace. They also emphasized how transitions between different settings and external stressors had an impact on their experiences of education. The links between coping strategies and the participant's asylum status are also discussed with reference to relevant research in the field.

“More Alike Than Unalike?” A Personal Reflection on Working to Support the Mental Health and Wellbeing of Unaccompanied Refugee Minors in Greece

In late 2018, motivated (and intrigued) by the scale of one of the largest and long-standing humanitarian crises in history, we embarked on two separate but related journeys to the island of Lesvos to work with unaccompanied refugee and asylum-seeking minors and to link in with NGOs working in the region. Peering through the prism of the current pandemic, the aim of this paper is to reflect on this life changing experience to share the on-the-ground reality and the true stories of war, violence and displacement as narrated by the children/young people with whom we worked and whom we met. In particular, we suggest that the integration of culturally appropriate and creative mental health and psychosocial support interventions in schools/educational settings might provide one way of supporting these children, as suggested by several authors in the international literature, but also in the context of a number of key learning based on our own experiences.

Futures literacy theatre lab with unaccompanied asylum-seeking minors

This article discusses a Practice as Research project, the design and implementation of a Futures Literacy Lab in which tools derived from the arsenal of the Theatre of the Oppressed were applied. The lab involved asylum-seeking unaccompanied minors, and took place in the island of Lesvos, Greece in July, 2019. Applied theatre practices often deal with communities and individuals in a transformational manner, which is, by definition, future-oriented. In this respect, the work undertaken served as a first case study for potential interdisciplinary collaboration between Performance Studies and Futures studies. This exercise is not without its ethical implications, though. This paper will discuss some of the challenges, pitfalls and successes of this process.

Health promotion for unaccompanied minor asylum seekers – a qualitative evaluation

Abstract Background We evaluated a health promotion program (HPP) for unaccompanied minor asylum seekers (UMA) in the canton of Vaud, Switzerland. UMA are particularly vulnerable to a range of health issues, due to their age and migration experiences. Effective health promotion programs are key to empower them to overcome these challenges and to improve their health. Methods We adopted a qualitative design with ethnographic and participatory elements to identify strengths, opportunities for improvement and appropriateness as perceived by UMA, educators and nurses responsible for UMA health care and the HPP. Data collection included observation of HPP courses, focus group discussions with UMA and interviews with educators. Analysis was based on a grounded theory in ethnography approach. Results Finding include three main themes: 1) UMA’s perceived low power and control, due to predominant rules and regulations and uncertainty about the future; 2) A need for health promotion in this population, due to UMA’s risk behaviours and the educators’ perceived discomfort with health-related issues and health promotion; 3) Practical feedback regarding topics, teaching methods and HPP organisation. Main recommendations include using effective adolescent health education methods to improve the appropriateness to age and context, enhancing participation of educators in health promotion and improving practical aspects of the HPP. Conclusions We evaluated and documented health promotion practice in the hard to reach population of UMA. Feasible changes in teaching methods and multidisciplinary collaboration may improve the HPP. However, UMA’s social environment needs to be taken into consideration to provide effective health promotion programs. Key messages Unaccompanied minor asylum seeker and educators perceive the health promotion program as useful and important. To address the health promotion needs of UMA, any program must be adaptive to the contextual complexity of UMA lives.

Clinical profile and care pathways among unaccompanied minor asylum seekers in Vaud, Switzerland.

The objectives of this study were to describe the overall clinical profile (somatic and psychological health) and the care pathways of unaccompanied minor asylum seekers (UMAS) who arrived in the Swiss canton of Vaud in 2015. This was a retrospective study based on information extracted from the medical files of 109 patients over 1 year of follow-up. All the reasons for consultation and referrals as well as the diagnoses made were noted and coded using ICD-10. The healthcare providers for all diagnoses and referrals were also noted. Our sample was predominantly male (87.2%) and hailed primarily from Eritrea (39.4%) and Afghanistan (32.1%). Gatekeeping nurses at a specialized migrant care facility (MCF) referred 67.7% of the UMAS to other providers for further medical care, including 45.4% to the Interdisciplinary Division for Adolescent Health (DISA). However, 46.8% of the 109 UMAS also sought care at other structures without any referral by MCF or DISA as intended. Of the patients 39.4% were found to have at least one mental health problem, mainly functional disorders (21.1%), symptoms and episodes of depression (17.4%), symptoms of post-traumatic stress disorder (PTSD) (13.8%) and sleeping disorders (12.8%). The most common diagnoses of infectious diseases included community-acquired respiratory infections (43.1%), scabies (20.2%) and cases of skin abscesses and furuncles (13.8%). In fewer instances, cases of active tuberculosis (3.7%), chronic hepatitis B (2.8%), intestinal parasites (1.8%) and gastritis caused by Helicobacter pylori (1.8%) were also diagnosed. A significant proportion of UMAS presented traumatological (30.3%) and ophthalmological (25.7%) problems. Among the female UMAS (12.8% of the sample), evidence of genital mutilation (21.4%), pregnancy (21.4%) and abortion (14.3%) was common. An integrated approach involving efficient coordination between different providers is necessary in order to respond adequately to the major healthcare needs of UMAS. Special attention should be paid to mental health.

Implementing Narrative Exposure Therapy for unaccompanied asylum-seeking minors with post-traumatic stress disorder: A pilot feasibility report.

There are high rates of post-traumatic stress disorder (PTSD) in unaccompanied asylum-seeking minors (UAM) and there is a requirement for feasible, acceptable and evidence-based treatments. Narrative Exposure Therapy (NET) is a short-term treatment for PTSD following multiple traumatic events. This article aims to examine the applicability of NET for UAM in routine clinical practice and to provide preliminary feasibility, acceptability and effectiveness data. The participants were four UAM receiving NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted to understand the acceptability of this approach and standardised measures of PTSD were used to provide preliminary data regarding the effectiveness of NET for these clients. The clients attended NET consistently with few missed appointments. At post-treatment, two clients' symptom scores were below the clinical cut-off for PTSD and all three clients who completed NET met reliable improvement criteria. The clients reported improvements in functional outcomes and mentioned that they would encourage other young people with similar difficulties to engage in NET. This study was limited by the small sample size and naturalistic time limitations in clinicians' contracts. This article highlights that it is possible to implement NET within routine clinical practice and observed improvements in PTSD symptoms and functional outcomes for UAM.