Research on the psychosocial care (PSC) of unaccompanied minor refugees (UMRs) has mainly taken a socioepidemiological approach and has focused on the perspectives of experts in the field. In contrast, the knowledge concerning the differing context factors and the underlying mechanisms of current PSC which could inform policy recommendations is scant. The study aims at unravelling the contexts, mechanisms and outcomes of PSC for UMRs. For a realist review (RR), scientific evidence and gray literature were synthesised consistent with the RAMESES publication standards for realist synthesis. Based on an iterative keyword search in electronic databases (e.g., PubMed) and screening, 34 works from 2005 to 2019 were included in a realist synthesis. Theory-informed context–mechanism–outcome configurations (CMOs) were extracted, to explain underlying processes and mechanisms. Characterised by their interrelatedness, the dominant CMOs included the UMRs’ intersections of transitions (e.g., adolescence and migration), their needs for culture-, and gender-sensitive PSC, and the undersupply of PSC. These contexts and outcomes are mediated by pre-, peri- and post-migratory stressors as well as care structures and are moreover influenced by overarching discourses and concepts. They comprise adverse and beneficial mechanisms in the PSC of UMRs. The existing literature grasps the PSC of UMRs by different disciplines and approaches but does not offer a comprehensive overview on micro–macro intersections and included discourses. The inclusion of lay perspectives and an intersectional approach could inform health service research. The reflection of UMR-related categorical constructs of resilience and vulnerability, discourses of othering, as well as restrictive health policies may guide policy recommendations.
IntroductionSeveral studies have identified that unaccompanied minor refugees (UMRs) are allegedly ‘vulnerable’ and belong to a high-risk group in terms of psychological distress and post-traumatic stress disorder due to their preflight, periflight and postflight experiences. Psychosocial care (PSC) is of high importance for UMRs, but little is known about barriers to access and utilisation of PSC across place and gender. The aims of this gender-sensitive qualitative study will be to build on the existing body of literature and to provide qualitative evidence on the contexts and mechanisms of PSC for male and female UMRs in Germany by comparing two German regions.Methods and analysisFollowing the study preparing realist review, a qualitative study will be undertaken in Berlin and Central German cities. Approximately 24 experts from the field of PSC and 12 lay UMRs will participate in face-to-face, semistructured interviews. Data will be transcribed and analysed based on the grounded theory research paradigm.Ethics and disseminationOnly participants who have been informed in both German and their native tongue and who have signed a declaration of consent will be included in the study. The study will comply rigorously with German data protection standards. Approval from the Ethical Review Committee at Martin Luther University Halle-Wittenberg, Germany has been obtained and granted. The results of the study will be presented at several conferences and will be published in high-quality, peer-reviewed international journals. The results will display a differentiated picture of the PSC of UMRs in Germany. Such knowledge is a precondition for a ‘science of change’ that translates explanations into practical recommendations on how to improve healthcare policies.Trial registration numberDRKS00018080.
Introduction Existing research on psychosocial care of unaccompanied minor refugees (UMRs) mainly focusses on socio-epidemiological accounts and qualitative evidence from the perspective of experts in the field of psychosocial care. In contrast, knowledge concerning differing context factors as well as underlying mechanisms of current healthcare barriers, which could inform policy recommendations, are rather scant. Methods To synthesize scientific evidence and gray literature dealing with the field of psychosocial healthcare of UMRs, a realist review (RR) was conducted following six methodological steps of RAMESES publication standards for realist synthesis. Based on a iterative search of keywords “UMR”, “UMF”, “UMA” and “mental health care” in electronic databases PubMed, GBV and Web of Science we gained access to 974 texts from 2005 to 2019. Screend studies and reports were systematically reviewed according rigor and relevance, which included n = 53 documents for realist synthesis with theory-informed context-mechanism-outcome configurations (CMOs). Results UMRs have a high prevalence risk for posttraumatic stress disorders and they face manifold institutional, cultural, ethical, juridical, and language-based barriers of care. A dominant and multiple CMO highlight residence status (C1), which limits access of UMRs to healthcare (M1) and produces psychosocially related mental health outcomes (O1). Residence status (C1) may also trigger mechanisms of structural or at least perceived discrimination (M2), which mediates undersupply of UMRs (O2). Conclusions The inclusion of lay perspectives and an intersectional approach could inform health services research and practitioners. The reflection of UMR’s social positions between categorical constructs of resilience and vulnerability, discriminatory discourses of othering, and restrictive health policies may guide policy recommendations to potentially reduce persistent disadvantages. Key messages The inclusion of lay perspectives and an intersectional approach could inform UMR related health services research and practitioners. The reflection of UMR’s social positions (between categories, discourses, and health policies) may guide policy recommendations to potentially reduce persistent disadvantages.
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