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Access to health care for undocumented migrant children and pregnant women: the paradox between values and attitudes of health care professionals.

https://arctichealth.org/en/permalink/ahliterature126329
Source
Matern Child Health J. 2013 Feb;17(2):292-8
Publication Type
Article
Date
Feb-2013
Author
Mónica Ruiz-Casares
Cécile Rousseau
Audrey Laurin-Lamothe
Joanna Anneke Rummens
Phyllis Zelkowitz
François Crépeau
Nicolas Steinmetz
Author Affiliation
Department of Psychiatry, McGill University, Montreal, Canada. monica.ruizcasares@mcgill.ca
Source
Matern Child Health J. 2013 Feb;17(2):292-8
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Attitude of Health Personnel
Canada
Child
Female
Health Care Surveys
Health Policy
Health Services - utilization
Health Services Accessibility - statistics & numerical data
Healthcare Disparities
Human Rights
Humans
Middle Aged
Pregnancy
Pregnant Women
Questionnaires
Socioeconomic Factors
Transients and Migrants - statistics & numerical data
Young Adult
Abstract
Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n = 1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children's rights are needed to promote equitable practices and advocacy against regulations limiting services.
PubMed ID
22399247 View in PubMed
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Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts).

https://arctichealth.org/en/permalink/ahliterature296787
Source
Early Interv Psychiatry. 2018 Dec 16; :
Publication Type
Journal Article
Date
Dec-16-2018
Author
Ashok Malla
Srividya Iyer
Jai Shah
Ridha Joober
Patricia Boksa
Shalini Lal
Rebecca Fuhrer
Neil Andersson
Amal Abdel-Baki
Daphne Hutt-MacLeod
Ann Beaton
Paula Reaume-Zimmer
Jessica Chisholm-Nelson
Cécile Rousseau
Ranjith Chandrasena
Jimmy Bourque
Diane Aubin
Mary Anne Levasseur
Ina Winkelmann
Meghan Etter
Jill Kelland
Caroline Tait
Jill Torrie
Helen Vallianatos
Author Affiliation
Department of Psychiatry, McGill University, Montréal, Québec, Canada.
Source
Early Interv Psychiatry. 2018 Dec 16; :
Date
Dec-16-2018
Language
English
Publication Type
Journal Article
Abstract
Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes.
We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post-secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation.
Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study.
Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.
PubMed ID
30556335 View in PubMed
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Classroom drama therapy program for immigrant and refugee adolescents: a pilot study.

https://arctichealth.org/en/permalink/ahliterature160711
Source
Clin Child Psychol Psychiatry. 2007 Jul;12(3):451-65
Publication Type
Article
Date
Jul-2007
Author
Cécile Rousseau
Maryse Benoit
Marie-France Gauthier
Louise Lacroix
Néomée Alain
Musuk Viger Rojas
Alejandro Moran
Dominique Bourassa
Author Affiliation
McGill University, Canada. cecile.rousseau@muhc.mcgill.ca
Source
Clin Child Psychol Psychiatry. 2007 Jul;12(3):451-65
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Drama
Educational Status
Emigrants and Immigrants - psychology
Female
Humans
Male
Mental Disorders - prevention & control
Psychotherapy - methods
Quebec
Refugees - psychology
School Health Services
Self Concept
Social Adjustment
Abstract
This evaluative study assesses the effects of a school drama therapy program for immigrant and refugee adolescents designed to prevent emotional and behavioral problems and to enhance school performance. The 9-week program involved 136 newcomers, aged 12 to 18, attending integration classes in a multiethnic school. Pretest and posttest data were collected from the students and their teachers. The self-report and teacher's forms of the Strengths and Difficulties Questionnaire were used to assess emotional and behavioral symptoms. At the end of the program, although there were no reported improvement in self-esteem or emotional and behavioral symptoms, the adolescents in the experimental group reported lower mean levels of impairment by symptoms than those in the control group, when baseline data were controlled for. Their performance in mathematics also increased significantly compared to that of their control peers. The findings suggest that the workshops may have an impact on social adjustment of recently arrived immigrants and refugees. This drama therapy program appears to be a promising way of working preventively and in a nonstigmatizing manner with adolescents who have been exposed to diverse forms of adversity, among which are war and violence.
PubMed ID
17953131 View in PubMed
Less detail

Common mental health problems in immigrants and refugees: general approach in primary care.

https://arctichealth.org/en/permalink/ahliterature142408
Source
CMAJ. 2011 Sep 6;183(12):E959-67
Publication Type
Article
Date
Sep-6-2011
Author
Laurence J Kirmayer
Lavanya Narasiah
Marie Munoz
Meb Rashid
Andrew G Ryder
Jaswant Guzder
Ghayda Hassan
Cécile Rousseau
Kevin Pottie
Author Affiliation
Division of Social and Transcultural Psychiatry, McGill University, Montréal, Que. laurence.kirmayer@mcgill.ca
Source
CMAJ. 2011 Sep 6;183(12):E959-67
Date
Sep-6-2011
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cultural Characteristics
Emigrants and Immigrants
Health Status Indicators
Humans
Language
Mental Disorders - diagnosis - epidemiology - therapy
Prevalence
Primary Health Care
Refugees
Risk factors
Abstract
Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care.
We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health.
The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations.
Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.
Notes
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PubMed ID
20603342 View in PubMed
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A diversity of voices: the McGill 'Working with Culture' seminars.

https://arctichealth.org/en/permalink/ahliterature115037
Source
Cult Med Psychiatry. 2013 Jun;37(2):347-64
Publication Type
Article
Date
Jun-2013
Author
Jaswant Guzder
Cécile Rousseau
Author Affiliation
McGill University, Montreal, QC, Canada. jaswant.guzder@mcgill.ca
Source
Cult Med Psychiatry. 2013 Jun;37(2):347-64
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Canada
Cultural Competency - education
Curriculum
Group Processes
Humans
Mental health services
Narrative Therapy
Prejudice - psychology
Psychotherapy - education
Teaching - methods
Vulnerable Populations - psychology
Abstract
The Working with Culture seminar is offered as a course during the month long Annual McGill Summer Program for Social and Transcultural Psychiatry, attended by local and international participants each May since 1994. The article outlines some of the premises and pedagogical approaches of this clinically oriented biweekly seminar series with discussions and didactic teaching on cultural dimensions of mental health care. The course readings, seminar topics and invited speakers focus mainly on therapist client encounters constructed by the multiple voices with dimensions of psychiatric, social, historical, legal, ethical, political, systemic and intra-psychic domains. The dual leadership emphasizes the gaps and complementarity amongst voices, and it invites and supports a destabilizing decentering process and the creation of solidarities amongst participants. Applying a bio-psychosocial case study method, each 3-h seminar engages the participants in a critical dialogue on apprehending the enmeshment of social suffering with psychiatric disorders whilst examining the usefulness and the limits of cultural formulation models. The seminar working group and teaching approach acknowledges cultural hybridity as a dynamic process marked by continuous therapist attunement to uncertainty or 'not knowing' which implies a dethroning of an expert position.
Notes
Comment In: Cult Med Psychiatry. 2013 Jun;37(2):390-723564248
PubMed ID
23549711 View in PubMed
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Ethnic and religious discrimination: the multifaceted role of religiosity and collective self-esteem.

https://arctichealth.org/en/permalink/ahliterature108478
Source
Transcult Psychiatry. 2013 Aug;50(4):475-92
Publication Type
Article
Date
Aug-2013
Author
Ghayda Hassan
Cécile Rousseau
Nicolas Moreau
Author Affiliation
University of Quebec at Montreal.
Source
Transcult Psychiatry. 2013 Aug;50(4):475-92
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anxiety - epidemiology - etiology - psychology
Arabs - ethnology - psychology
Depression - epidemiology - etiology - psychology
Ethnic Groups - psychology
Female
Haiti - ethnology
Humans
Male
Middle Aged
Prejudice - psychology
Quebec - epidemiology
Questionnaires
Religion
Self Concept
Stress, Psychological - epidemiology - etiology - psychology
Young Adult
Abstract
This study analyses the roles of collective self-esteem and religiosity in the relationship between discrimination and psychological distress among a sample of 432 recent immigrants from Haiti and Arab countries living in Montreal, Quebec. Collective self-esteem (CSE), religiosity, discriminatory experiences, and psychological symptoms of depression and anxiety were assessed. Regression analyses revealed direct negative effects of discrimination, CSE, and religiosity on psychological distress for the entire sample. CSE, however, also appeared to moderate the effects of discrimination on psychological distress. Participants with higher CSE reported lower levels of anxiety and depression as a result of discrimination compared to those who expressed lower CSE levels. The results suggest that the relationship between CSE, discrimination, and psychological distress must be reexamined in light of recent sociopolitical changes and the upsurge in ethnic and religious tensions following the war on terror.
PubMed ID
23883587 View in PubMed
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Evaluation of a classroom program of creative expression workshops for refugee and immigrant children.

https://arctichealth.org/en/permalink/ahliterature176414
Source
J Child Psychol Psychiatry. 2005 Feb;46(2):180-5
Publication Type
Article
Date
Feb-2005
Author
Cécile Rousseau
Aline Drapeau
Louise Lacroix
Déogratias Bagilishya
Nicole Heusch
Author Affiliation
Department of Psychiatry, Montreal Children's Hospital, Quebec, Canada. Cecile.rousseau@muhc.mcgill.ca
Source
J Child Psychol Psychiatry. 2005 Feb;46(2):180-5
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Art Therapy
Child
Child Behavior Disorders - prevention & control
Emigration and Immigration
Female
Humans
Male
Mental Disorders - prevention & control
Quebec
Refugees - psychology
Regression Analysis
Self Concept
Abstract
This evaluative study assessed the effect of a creative expression program designed to prevent emotional and behavioral problems and to enhance self-esteem in immigrant and refugee children attending multiethnic schools.
The 12-week program involved 138 children, aged 7 to 13, registered in both integration classes designed for immigrant children and regular classes at two elementary schools. Pretest and posttest data were collected from the children themselves and from their teacher. Teachers used Achenbach's Teacher's Report Form to assess the emotional and behavioral symptoms of their pupils whereas children self-reported their symptoms with the Dominic, a computerized questionnaire. Self-esteem was measured with the Piers-Harris Self-Concept Scale administered by interviewers to the children.
At the end of the program, the children in the experimental groups reported lower mean levels of internalizing and externalizing symptoms and higher mean levels of feelings of popularity and satisfaction than the children in the control groups, when controlling for baseline data. In integration classes, the effect on self-esteem was especially notable in boys. The intervention's effect on internalizing and externalizing symptoms was not modified by gender, age or fluency in the mainstream language.
The study provides some evidence that creative workshops in the classroom can have a beneficial effect on the self-esteem and symptomatology of immigrant and refugee children from various cultures and backgrounds. These quantitative results support previous qualitative analysis showing that the workshops participate in the reconstruction of a meaningful personal world while simultaneously strengthening the link of the child to the group. They also transform the teachers' perceptions of newcomers by placing an emphasis on their strength and their resilience, while not negating their vulnerabilities.
PubMed ID
15679526 View in PubMed
Less detail

Evidence-based clinical guidelines for immigrants and refugees.

https://arctichealth.org/en/permalink/ahliterature143020
Source
CMAJ. 2011 Sep 6;183(12):E824-925
Publication Type
Article
Date
Sep-6-2011
Author
Kevin Pottie
Christina Greenaway
John Feightner
Vivian Welch
Helena Swinkels
Meb Rashid
Lavanya Narasiah
Laurence J Kirmayer
Erin Ueffing
Noni E MacDonald
Ghayda Hassan
Mary McNally
Kamran Khan
Ralf Buhrmann
Sheila Dunn
Arunmozhi Dominic
Anne E McCarthy
Anita J Gagnon
Cécile Rousseau
Peter Tugwell
Author Affiliation
kpottie@uottawa.ca
Source
CMAJ. 2011 Sep 6;183(12):E824-925
Date
Sep-6-2011
Language
English
Publication Type
Article
Keywords
Canada
Cultural Characteristics
Emigrants and Immigrants
Evidence-Based Medicine
Female
Health services needs and demand
Health Status Disparities
Humans
Male
Mass Screening - standards
Practice Guidelines as Topic
Refugees
Risk factors
Notes
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Comment In: CMAJ. 2011 Sep 6;183(12):E926-720530162
PubMed ID
20530168 View in PubMed
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Evidence-based medicine: opportunities and challenges in a diverse society.

https://arctichealth.org/en/permalink/ahliterature130862
Source
Can J Psychiatry. 2011 Sep;56(9):514-22
Publication Type
Article
Date
Sep-2011
Author
Rob Whitley
Cecile Rousseau
Elizabeth Carpenter-Song
Laurence J Kirmayer
Author Affiliation
Douglas Mental Health University Institute, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada. robert.whitley@mcgill.ca
Source
Can J Psychiatry. 2011 Sep;56(9):514-22
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Canada
Cultural Diversity
Delivery of Health Care - ethnology - standards
Evidence-Based Medicine - methods - standards - trends
Guidelines as Topic - standards
Humans
Mental Health Services - standards
Review Literature as Topic
United States
Abstract
In this article we explore the discourse and practice of evidence-based medicine (EBM) in the context of social and cultural diversity. The article consists of 2 parts. First, we begin by defining EBM, describing its historical development and current ascendance in medical practice. We then note its importance in contemporary psychiatry, comparing dynamics between the United States and Canada. Secondly, we offer a constructive critique of the application of EBM and evidence-based practices in the context of ethnocultural diversity, as one consistent reflection on the EBM literature is that it is does not adequately address issues of diversity. In doing so, we use the situation here in Canada as an extended case study, though our observations will likely be applicable in other diverse nations, such as the United States, the United Kingdom, and Australia. We critically examine the following 6 issues related to the practice of EBM in a diverse society: generalizability and transferability of evidence-based interventions; diversifying standards of evidence in EBM; strategies to address diversity in EBM research; cultural adaptations of evidence-based interventions; integrating idiographic knowledge; and, training and health service delivery. Concurrent with our critique, we offer research and practice suggestions that may address outstanding challenges vis-à-vis the practice of EBM in a diverse society. These include a need for more effectiveness research, more openness to diverse sources of knowledge, better integration of idiographic and nomothetic knowledge, and a critical approach to extrapolation and transfer of knowledge.
Notes
Comment In: Can J Psychiatry. 2011 Sep;56(9):511-321959025
PubMed ID
21959026 View in PubMed
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Health care access for refugees and immigrants with precarious status: public health and human right challenges.

https://arctichealth.org/en/permalink/ahliterature155345
Source
Can J Public Health. 2008 Jul-Aug;99(4):290-2
Publication Type
Article
Author
Cécile Rousseau
Sonia ter Kuile
Marie Munoz
Lucie Nadeau
Marie-Jo Ouimet
Laurence Kirmayer
François Crépeau
Author Affiliation
Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC. cecile.rousseau@muhc.mcgill.ca
Source
Can J Public Health. 2008 Jul-Aug;99(4):290-2
Language
English
Publication Type
Article
Keywords
Delivery of Health Care - organization & administration
Emigrants and Immigrants - statistics & numerical data
Ethics, Medical
Health Services Accessibility - ethics - legislation & jurisprudence
Human Rights - legislation & jurisprudence
Humans
Public Health - legislation & jurisprudence
Quebec
Refugees - statistics & numerical data
Abstract
Migration flux is being transformed by globalization, and the number of people with either undocumented or with a precarious status is growing in Canada. There are no epidemiological data on the health and social consequences of this situation, but clinicians working in primary care with migrants and refugees are increasingly worried about the associated morbidity. This commentary summarizes findings from a pilot study with health professionals in the Montreal area and suggests that the uninsured population predicament is a national problem. Although ethical and legal issues associated with data collection by clinicians, institutions and governments need to be examined, estimating the public health consequences and long-term cost associated with problems in access to health care due to migratory status should be a priority. Current regulations and administrative policies appear to be at odds with the principles of equal rights set out by the Canadian Charter of Rights and Freedoms and the UN Convention on the Rights of the Child. Beyond the commitment of individual clinicians, Canadian medical associations should take an advocacy role and scrutinize the ethical and medical implications of the present system.
PubMed ID
18767273 View in PubMed
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