Adversity and resilience amongst resettling Western Australian paediatric refugees

Hanes, Gemma; Sung, Lydia; Mutch, Raewyn; Cherian, Sarah

doi:10.1111/jpc.13559

Cited by 28 publications

(43 citation statements)

References 32 publications

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“…The focus was more a rapid assessment of the problem magnitude in the target population than the individual diagnosis, similar to a study from Sweden, where the usefulness of a self-reporting questionnaire was analysed [ 40 ]. A study from Western Australia recommended the development of longitudinal studies to learn about the connection between previous suffering and the mental health outcome of refugee children [ 41 ]. It has to be kept in mind that the contact time between the physician and the examined URM was very low, and options for follow-up were practically non-existent, also due to a rapid allocation of refugees to different parts of Germany.…”

Section: Discussionmentioning

confidence: 99%

Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany

Kloning

Nowotny²,

Alberer³

et al. 2018

BMC Public Health

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BackgroundThis study aimed to investigate the morbidity profile and the sociodemographic characteristics of unaccompanied refugee minors (URM) arriving in the region of Bavaria, Germany, between October 2014 and February 2016.MethodsThe retrospective cross sectional study included 154 unaccompanied refugee minors between 10 and 18 years of age. The data was derived from medical data records of their routine first medical examination in two paediatric practices and one collective housing for refugees in the region of Bavaria, Germany.ResultsOnly 12.3% of all participants had no clinical finding at arrival. Main health findings were skin diseases (31.8%) and mental disorders (25%). In this cohort the hepatitis A immunity was 92.8%, but only 34.5% showed a constellation of immunity against hepatitis B. Suspect cases for tuberculosis were found in 5.8% of the URM. There were no HIV positive individuals in the cohort. Notably, 2 females were found to have undergone genital mutilations.ConclusionsThe majority of arriving URM appear to have immediate health care needs, whereas the pathologies involved are mostly common entities that are generally known to the primary health care system in Germany. Outbreaks due to hepatitis A virus are unlikely since herd immunity can be assumed, while this population would benefit from hepatitis B vaccination due to low immunity and high risk of infection in crowded housing conditions. One key finding is the absence of common algorithms and guidelines in health care provision to URM.

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Section: Discussionmentioning

confidence: 99%

Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany

Kloning

Nowotny²,

Alberer³

et al. 2018

BMC Public Health

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show abstract

“…Referrals for humanitarian entrants and ASs come from medical practitioners, the Humanitarian Entrant Health Service, school or community nurses/psychologists, case workers or via IHMS. Standardised RHS assessment proformas are completed for all new patients using professional interpreters . As previously described, RHS assessments are based on clinical experience, local research and audit and evidence‐based national refugee health screening guidelines .…”

Section: Methodsmentioning

confidence: 99%

Paediatric asylum seekers in Western Australia: Identification of adversity and complex needs through comprehensive refugee health assessment

Hanes

Chee

Mutch

et al. 2019

J Paediatrics Child Health

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Aim: Asylum seekers (ASs) report high rates of trauma and difficulty accessing health and educational services. This study aims to ascertain the needs of paediatric ASs managed by the tertiary Western Australian paediatric Refugee Health Service (RHS), including demographic features, the range of health and psychosocial issues and ongoing management challenges. Methods: An audit of multidisciplinary RHS assessments, health records and hospital admissions for new AS patients (<16 years) between July 2012 and June 2016 was undertaken. Results: Records for 110 ASs were reviewed (mean age 6 years, standard deviation 4.72 years). Multiple issues (medical, psychological, developmental, educational) were identified after the first tertiary assessment (median 4, interquartile range (IQR) 3-6) compared to referral sources (median 1, IQR 0-2, P < 0.001). The median number of issues per child at audit completion was 6 (IQR 4-7, P < 0.001). Multiple refugee adverse childhood experiences were identified, with all experiencing >3 (median 4, IQR 4-5). Most had detention experience (107/110, 97.2%), family separation (91/108, 84%) and interrupted education (41/46, 89.2%). The median duration of detention was 7 months (IQR 3-12.5 months) at time of initial review across multiple sites (median 2, IQR 1-3 locations). High rates of hospital interaction were evident, with 45.4% requiring hospital admission and 36% presenting to the emergency department. The median number of outpatient appointments attended per child was 5 (IQR 2-8). Parental and child mental health concerns were identified in 53.6 and 46.3%, respectively. Conclusions: Paediatric ASs have complex trauma backgrounds with exposure to multiple adverse events within disrupted family units. The majority of Western Australian ASs assessed demonstrated negative health or education sequelae compounded by detention not previously identified prior to comprehensive paediatric review. Our data support the urgent removal of ASs from held detention. Ongoing holistic assessment and management engaging multidisciplinary trauma-informed paediatric refugee services to optimise health and well-being is recommended.

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“…Hanes et al . used a refugee‐specific tool R‐ACE in their Western Australian paediatric refugee clinic that captured wider refugee ACEs and found that 63% of their clinic population had >3 risks . The modified version of the ACE checklist (Fig.…”

Section: Discussionmentioning

confidence: 99%

The adverse childhood experiences checklist: Can it serve as a clinical and quality indicator?

Wickramasinghe

Raman

Garg

et al. 2019

J Paediatrics Child Health

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Aim There is strong evidence that adverse childhood experiences (ACE) are associated with poor short‐, medium‐ and long‐term health outcomes. In South Western Sydney, we trialled a modified ACE checklist in community paediatric clinics. Our aim was to design the best version of the ACE checklist for routine clinical use to serve as both a clinical and quality indicator. Methods We trialled two versions of the modified ACE checklist based on a pre‐existing tool in child development (CD) and vulnerable child (VC) clinics over a 6‐month period in 2012 (V1) and 7‐month period in 2017 (V2). We analysed clinical and demographic data and correlated with ACE scores. We asked clinicians about the use of the ACE checklist and modified the checklist based on clinicians' recommendations. Results In phase 1, V1 was trialled in CD clinics only; 77 children were assessed, of whom 38 children (49%) had ACE score of ≥1, and 8 (10%) had a score of ≥4. In phase 2, of 279 children assessed, 178 (64%) had ACE ≥1, and 78 (28%) had ACE ≥4. In both phases, clinicians found the checklist simple to use and helpful in identifying especially vulnerable children. Conclusions The ACE checklist helps clinicians and managers identify the burden of exposure to trauma, violence and abuse of children attending paediatric clinics, both to facilitate intervention and aid service development. This version of the ACE checklist has the potential to be used across a variety of populations and settings as a clinical and quality indicator.

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Adversity and resilience amongst resettling Western Australian paediatric refugees

Cited by 28 publications

References 32 publications

Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany

Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany

Paediatric asylum seekers in Western Australia: Identification of adversity and complex needs through comprehensive refugee health assessment

The adverse childhood experiences checklist: Can it serve as a clinical and quality indicator?

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