Explaining psychosocial care among unaccompanied minor refugees: a realist review

Abstract

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.

Psychotherapeutic and Psychosocial Interventions with Unaccompanied Minors: A Scoping Review

“…Of course, research with female UAMs should be conducted as well, but given their small numbers, it might be better to test interventions through well-designed case series rather than recruiting just a few of them in controlled quantitative studies where the vast majority of participants are male. As Ulrich et al [ 32 ] have pointed out, psychosocial care is male-specific or gender non-sensitive, and thus, the special challenges and needs of female UAMs are not sufficiently addressed and confronted [ 120 ]. Gender-specific studies could solve this issue.…”

“…As Chase et al [ 113 ] point out, research is always influenced by our beliefs, assumptions and expectations. Thus, we actively participate in the construction of UAM’s definitions, characteristics, vulnerabilities, resiliences and needs through our discourses and methods [ 32 , 113 ]. Furthermore, we often do so by applying our western ways of understanding and treating mental distress to them, while power and status inequalities and differences between researchers and participants may affect the latter’s participation and the findings.…”

“…A recent realist review [ 32 ] on the psychosocial care of UAMs underlined minors’ intersections of transitions of adolescence and migration, their needs for culture- and gender-sensitive psychosocial care and the undersupply of such care. It also discussed how the contexts and outcomes of UAMs’ psychosocial care were mediated by pre-, peri- and post-migratory stressors as well as care structures that were, in turn, influenced by overarching discourses and concepts.…”

Applying and reporting relevance, richness and rigour in realist evidence appraisals: Advancing key concepts in realist reviews

“…Descriptions of how richness assessments were applied were often interwoven with relevance. Ulrich et al 25 describe how relevant papers were classified on 'the thick/ thin continuum, which refers to a paper's density of evidence regarding CMOs that are relevant to the study's scope' where 'thick' articles offered more detail on CMOs relevant to the review topic and 'thin' articles provided less. This ranking of relevance in terms of contribution to theory testing was a common operationalisation of richness assessments.…”

Implementing a package of essential non-communicable diseases interventions in low- and middle-income countries: a realist review protocol

“…Those that provide less evidence and deem less relevant will be classified as low richness. 57 We will assess relevance by scoring the articles in relation to the richness relative to the research questions as proposed by Waldron et al 58 To score highly, an article should provide sufficient details in relation to how PEN was expected to work; documenting the process and explaining contextual factors that influenced PEN implementation and/or outcomes. We will rate the richness as follows: 0=nothing of interest, not focused on design, implementation or use.…”