Report of the Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees
1988

Background - Executive Summary - Chapter 1 - Chapter 2-6 - Chapter 7-9 - Chapter 10-11 - Chapter 12 Conclusion & Appendices

While most clinicians probably would agree that it is important to understand a client's culture,

the challenge remains to translate this proposition into training programs for mental health

personnel. Appropriate training can help practitioners understand more specifically how culture

affects the definition and presentation of mental disorder, how it shapes the therapist-client

interaction, and how it helps determine response to treatment.

Several undergraduate, post-graduate, and in-service programs across Canada provide

cross-cultural training to students and practitioners in mental health fields. However, this training

does not assume a high priority. It is rarely mandatory or evaluated. Reports of apparently

successful training programs have not been widely circulated so that they can be copied in or

adapted to other settings.

To ensure that mental health care providers receive the training they need to work with a

multicultural clientele and to serve on advisory bodies, the federal and provincial governments

must provide incentives to educational institutions and professional associations to make

cross-cultural training a priority.

While many Canadian colleges and universities offer courses focussing on consciousness-raising

and cultural sensitization, there are no requirements that future service providers participate in

this curriculum. In addition, Canadian professional organizations and accreditation bodies have

assumed little initiative in designating cross-cultural training as a priority. The result is that

immigrants and refugees experience limited access to culturally sensitive service providers.

Initiatives in cross-cultural training search usually undertaken by interested individuals who may not

always have ongoing administrative support. The Department of Counselling Psychology at the

University of British Columbia and the Clarke Institute of Psychiatry in Toronto are two

examples of such programs in Canada. Submissions indicated the need for cross-cultural training

for specialists in a wide range of services: educators, family therapists, general practitioners,

nurses, psychiatrists, psychologists, public health personnel, and social workers.

Submissions to the Task Force suggested that course content must be designed to teach students

how sociocultural factors affect the occurrence, presentation and prognosis of illness as well as

how people go about seeking care. Specific topics should include:

C pre- and post-migration factors which increase risk;

C the impact of socio-political and cultural factors on diagnosis;

C how culture affects perceptions of the cause of illness;

C socio-cultural factors affecting the development, onset and cause of illness;

C the effects of culture on help-seeking patterns, treatment and response to care;

C service needs of "high-risk" groups such as torture victims, the elderly, children,

C adolescents, and women; and

C differentiating between immigrants and refugees and their respective problems and

needs.

Knowledge Of specific cultures may not necessarily be transferrable. Awareness of Japanese

culture may help a family practitioner in Vancouver, where a significant Japanese population

resides; but if the practitioner were to move to Montreal, familiarity with Portuguese or Algerian

culture would probably be more relevant. Programs for most professionals should include a

generic cultural sensitivity component complemented by more specific education about local

cultural groups.

As far as the Task Force was able to ascertain, none of the accreditation bodies that control

training requirements for professional groups such as family medicine, nursing, psychiatry,

psychology and social work requires training in cultural sensitivity. The Royal College of

Physicians and Surgeons of Canada requirements for specialization in psychiatry include

knowledge about "psychosocial reactions to disease." However, training guidelines do not

specify a compo- in cultural awareness. Similarly, the College of Family Physicians of Canada

does not list training in cultural sensitivity among its requirements.

The accreditation criteria for clinical psychology programs and internships of the Canadian

Psychological Association (1984) specify an ideal that, if acted upon conscientiously, would help

ensure effective psychological services for minority group clients. The criteria state: "respect for

cultural and individual differences search attitudes which should be reflected in all phases of a

programme's operation, including faculty recruitment and promotion, student recruitment and

evaluation, curriculum planning, and field training." The statement stops short, however, of

requiring mandatory cross-cultural training.

Professional accreditation bodies do permit individual initiatives in training programs across the

country. The resident training program at the Department of Psychiatry, McGill University,

devotes 10 hours of seminar time to culture-related topics such as culture and depression,

schizophrenia and culture, culture-bound syndromes, and cultural influences on substance abuse.

A comprehensive survey of the amount of cultural sensitivity education in Canadian psychiatry

training programs is not available. However, a 1977 survey conducted in the United States

inquiring about the teaching of cultural issues in psychiatric residency programs is instructive. Of

110 training programs which responded to the questionnaire (a 50 per cent response rate), 10 per

cent stated that they offered a special course on minority/transcultural issues and 35 per cent said

they included these issues in connection with other topics (Moffic et al., 1987). A 1984 study

suggested that, in the seven-year interval interest in cultural teaching in U.S. programs declined.

Social work education in the U.S. may emphasize cultural issues more than other disciplines, but

com- survey results search not available. The lack of training in cultural matters in psychology

appears to be quite similar to that of psychiatry. In the 1970's, conferences and guidelines

recommended an increase in this education in American psychology programs; however, a

survey in the 1980's found that well below half of the responding graduate programs offered

cultural psychology courses (Moffic et al., 1987).

Cultural training in Canada in psychiatry, psychology, and social work is probably not too

different from that in the United States, but surveys of training programs in Canada would now

seem to be warranted. Service delivery is very different from that of the U.S. The availability,

content and methodology of training search influenced by demographic distribution of immigrants and refugees; cultural background of the client groups most frequently encountered in practice; and government policy regarding the provision of services.

Submissions to the Task Force strongly reinforced the need for cross-cultural training of persons

already engaged in the delivery of social, health, educational and legal services. There is a need

to be aware of the similarities and differences. Policies, programs and resources search required to

improve staff competence in assessment, diagnosis, treatment and rehabilitation. Training

programs should also target the needs of " high-risk " groups such as torture victims, women,

adolescents, children and the elderly.

In Canada, mining in health and social service agencies, most of which occurs on an ad hoc

basis, is usually developed by agencies to meet their immediate- needs or at the initiative of agency staff with a special interest in the topic. Since most of these training activities search propelled by the press of cases seen at the agencies, they do not evolve into ongoing, requisite or long-term educational programs.

The large numbers of immigrants and refugees settling in urban areas force agencies to provide

their staff with training. In this situation, professionals and/or leaders from the immigrant and

refugee communities can assist with training. Social and health service agencies and other

general community organizations across Canada are employing an increasing number of persons

with minority-group backgrounds. These workers also require training in order to deal with

persons from cultures other than their own.

In smaller centres located far from resources, the lack of pressure often leads to a diminished

sense of priority for cross-cultural training. When immigrants and refugees with problems are

encountered, lack of training leads to helplessness and frustration on the part of immigrants and

staff As the Association for New Canadians in St. John's, Newfoundland stated, "The most

frustrating thing for those of us who search trying to help is a sense of powerlessness and a lack of knowledge about where to turn for help. "

Models of training exist which can be adapted to cross-cultural education of service providers in

less populated areas. For example, a multidisciplinary team which travels regularly to health

stations in the Arctic provides consultation, clinical supervision and in-service training to Inuit

health workers. The Itinerant Worker Model in Settlement Agencies, Alberta Mental Health

Services, assists many practitioners outside Edmonton. Technology such as interactive television, audio-visual aids and self-instruction packages can also be harnessed for these purposes.

A recent report entitled Access to Health and Social Services for Members of Diverse Cultural

and Racial Groups by the Social Planning Council, Metropolitan Toronto, states:

This aptly describes what appears to be happening throughout Canada. Lack of funding is often

cited as an obstacle to providing cross-cultural training for mental health practitioners and mental

health training for ethno-specific, front-line workers. Yet very few models have been tried that

provide much needed training for both groups.

Several submissions outlined how immigrant service agencies search involved in the cross-cultural training of staff in general community services, not only to increase their cultural awareness and sensitivity but also to raise their level of comfort and effectiveness with immigrants and refugees. Many of these immigrant service agencies conduct conferences and seminars, and consult with staff of general community services. Some also provide field placements for students. The efforts of the Hong Fook Mental Health Association present a model of how multicultural and ethno-specific agencies can and do provide training for general community service workers.

Although they have neither the mandate nor the educational or occupational backgrounds to

provide mental health services, minority group staff workers in multicultural and ethno-specific

agencies are often forced to deal with clients who have psychological problems. To make their

work more effective, these workers need to be exposed to basic mental health concepts, to

understand how to recognize problems early and to be equipped to make appropriate referrals.

The Reciprocal Training Program in Alberta has designed a program to address these needs. The

Clarke Institute of Psychiatry in Toronto also provides a training program for immigrant

settlement workers called "Understanding Psychosocial Problems and Psychiatric Disorders in

Immigrants and Refugees. " These seminars cover the symptoms, treatment, and management of

major psychiatric diagnoses such as schizophrenia, manic depressive psychosis, somatoform.

disorders, and anxiety disorders, plus discussion of cultural matters such as the impact of culture

on the pattern and management of psychiatric disorders.

The reciprocal training arrangement is ideal from a financial perspective. Other alternatives

include lending training staff to different agencies and purchasing service agreements between

general community and immigrant service agencies.

Regardless of which model is used, the goals of training should include:

C sharing much-needed cross-cultural insights;

C sharing limited training resources;

C networking;

C utilizing the strengths in each other; and

C breaking down suspicion and lack of trust.

Whether training is geared to service providers from the majority culture or to minority group

workers, it is important to actively seek the involvement of immigrants and refugees. Their

knowledge and experience can enrich the content of any program. Several presentations to the

Task Force warned against the danger of stereotyping other cultures. Suggested ways to involve

immigrants in the planning, implementation and evaluation of training programs include:

consultation with a multicultural advisory committee; involving members of ethno-specific

communities as guest speakers or lecturers; having segments of the training take place in situ, as

Alberta's Reciprocal Training Program operates.

This approach:

C ensures that training is culturally sensitive and appropriate,

C utilizes the resources and talents of immigrants and refugees and invites them to

C participate in society;

C encourages the emergence of leaders in the immigrant community; and

C enhances the much-needed linking of the "two solitudes. "

"Culture brokers " are persons who can help bridge the gap between the culture of a client and

the culture of professional care-givers. Culture brokers can translate a bewildering world of

professional attitudes, strange jargon and endless referrals to clients. At the same time, they help

professionals understand how the culture of a client has helped shape his or her problems.

Culture brokers have evolved out of necessity in a variety of places. The Province of Manitoba

has initiated an innovative program to train culture brokers. Students selected from the largest

ethnic groups in the province have been enrolled in a program which will provide training in

health and social service delivery as well as cross-cultural sensitivity. This potentially important

program should be carefully monitored and its results made widely available.

Canada's multiculturalism policy has had limited effect on professional, educational and service

delivery institutions. Because there appears to be a lack of direction from ministries, professional

organizations and department heads, cultural training is often offered only as an elective or on an

ad hoc basis. It is not surprising, therefore, that with few exceptions, cultural education in

Canada is essentially "preaching to the converted. "

Funding is definitely lacking, as is an explicit mandate to procure funds for cross-cultural

education. Training in cultural sensitivity must become an on-going priority of educational

institutions, and of both general community and immigrant service agencies. Teaching materials,

other than printed information - for example, audio-visual materials - should be developed and

made available to groups across the country. A list of individuals who can make significant

contributions to the planning, implementation and evaluation of educational programs should be

compiled and made accessible to interested groups. An evaluation process must be built into any

program to measure effectiveness. A range of flexible programs to accommodate the educational

needs of various disciplines in different regions of the country must be developed.

To achieve these objectives at minimal cost, existing resources must be used in developing

training modules and in the delivery of cross-cultural training programs. The Task Force

recommends that Health and Welfare invite requests for proposals on the development of

cross-cultural training modules in education, family practice, nursing, psychiatry, psychology

and social work. The programs developed for each discipline should be made available by Health

and Welfare to each educational institution and professional association responsible for the

training of professionals in that discipline.

The delivery of cross-cultural training requires more than training materials and recognition of

their importance. The "political will" to implement them is needed. The Task Force recommends

that Health and Welfare, Secretary of State and their provincial counterparts encourage

institutions of higher learning to identify cross-cultural education as a priority, particularly for

students of education, medicine, nursing, psychiatry, psychology and social work.

The training modules developed for each discipline and disseminated to each training program

may also be adapted for in-service use by general community agencies. This type of education is

still more effective, however, when delivered by staff of immigrant service agencies.

Since immigrant service workers who will provide cross-cultural sensitivity require training

themselves, reciprocal inter-agency training agreements should be encouraged and expanded

wherever possible.

The Task Force recognizes, however, that there are many more general community services

agencies and staff than immigrant service agencies or staff. The demands on immigrant service

staff for cross cultural training in many cases already impinge on the time needed for direct

services to clients. The development of effective cross-cultural training modules should make

training more efficient, and help limit demands on immigrant service agencies to reciprocal,

mutually beneficial arrangements.

When practitioners search fluent in the language and culture of immigrant and ethno-cultural groups, patients tend to use services more readily, disclose information more fully, and follow through with treatment more faithfully than when an interpreter is required. However, minority group practitioners are in desperately short supply. Ironically, professionals trained in other countries who might serve ethnic clients search often barred from practice by licensing restrictions and by the admissions requirements of post-graduate institutions.

By liberalizing the evaluation of foreign-earned mental health credentials, and by actively

recruiting minority group applicants to enter mental health training programs, Canada could

capitalize on professional expertise already available. This would be a significant contribution to

the mental health care of migrants.

Virtually all the submissions to the Task Force expressed a need for more mental health

practitioners who speak the language and know the culture of immigrant clientele.

Practitioners feel more satisfied when they can communicate directly with clients and search more confident in their diagnoses when they search familiar with the cultural context of symptoms. In addition, minority group practitioners serve as role models for their immigrant patients; they provide effective outreach to immigrant communities, and they represent a valuable source of consultation and in service training for majority group colleagues.

As noted in Chapter Five, working through interpreters during counselling and therapy is a

second-best solution to the need for linguistically and culturally appropriate mental health care.

Several submissions described a "boomerang effect, " whereby minority group settlement

workers and general practitioners refer immigrants to psychiatrists and psychologists who do not

learn the culture, only to have them referred back again.

Figure 8.1 examines the proportions of professionals in health and allied fields from Europe,

North America, Asia and Latin America admitted to Canada relative to proportions of all

immigrants from the same areas. Europe accounted for about 28 per cent of all immigrants from 1978 to 1987, but almost 40 per cent of health, social science and education professionals. By contrast, newcomers from Asia made up 45 per cent of all immigrants, but only about 25 per cent of health professionals, 20 per cent of the social science professionals and 28 per cent of the

teachers. The over-representation of professional groups is even more marked in the case of

migrants from North America than from Europe.

We do not know how, where and whether these people practise their professions. Nevertheless,

from the data in Figure 8.1, one can reasonably infer that European immigrants and North

American-born persons with mental health needs have available to them more professionals from

their own ethnic backgrounds than non-European migrants. Even if all professionals admitted

were allowed to practise, Asian clientele would likely be under-served relative to European and

North American-born migrants. However, restrictive policies and licensing restrictions, which

make it particularly difficult for Asians and Latin Americans to practice their professions,

compound the problem.

At the federal level, Employment and Immigration Canada strives to select, for its Independent

Class of immigrants, persons whose training and experience can be used in the Canadian labour

market. "Employment-related factors account for about half of the total possible rating points

that can be awarded" under the present point system (Employment and Immigration Canada,

1986). Individuals with pre-arranged employment or with good prospects of self-employment

receive extra rating points.

Medical doctors search actively discouraged from applying to immigrate (Canada Employment and Immigration, March 27, 1987). The few physicians who immigrate in the Independent Class are selected abroad to fill specific, pre-arranged positions. Physicians may also enter Canada in the Convention Refugee and Family Classes, but they do so with the knowledge that they may never be able to practise their profession.

Other mental health practitioners such as psychologists, social workers and psychiatric nurses, do

not receive official "negative counselling" from Immigration. But they also do not immigrate in

large numbers. A recent agreement signed between the Canada Employment and Immigration

Commission (CEIC) and the Canadian Public Health Association (CPHA) may help remedy this

situation. CEIC and CPHA will work together to guarantee that members of at least visible

minority groups have "full representations at all levels in the public health field" (Canada

Employment and Immigration, February 24, 1987).

By controlling registration and licensing, professional regulatory bodies attempt to ensure that all

practitioners meet Canadian standards of proficiency. It is assumed that these standards search best met through Canadian education and Canadian training. Recognition of foreign degrees and

experience varies widely between professions and between provinces. On the whole, it is difficult to obtain.

Immigrants who must repeat or who wish to repeat their training prior to taking professional

qualifying examinations may be excluded from educational institutions by admissions criteria, including language requirements. Physicians face a further dilemma. Even if they meet admissions criteria, the number of intern and residency training positions available barely exceeds the number of Canadian medical school graduates, who are given first priority for training positions (Canada Employment and Immigration, March 27, 1987).

In addition to being extremely difficult and time-consuming, obtaining permission to practise as a mental health professional in Canada can be costly. Fees must be paid to have foreign

qualifications estimated for equivalency, to take oral and written examinations, and to become

registered or licensed. If re-training is necessary, immigrants or refugees must support

themselves and any dependants as well as Pay their tuition.

Migrant mental health professionals who manage to become certified usually find themselves

competing with Canadian-born applicants for suitable positions. In the past, official hiring

policies have not given preference to individuals who might best serve under-served ethnic

minorities. There are, however, signs of change. In some major urban centres, a limited number

of specialized positions have been created for, and filled by, ethnic minority persons. Even for

routine positions, the Vancouver Health Department advises that "ability to speak a second

language and knowledge of different cultures" are assets. The City of Toronto has adopted an

Equal Opportunity policy which, along with equal access for citizens, aims to ensure that

"employment practices and policies are equal for all employees and applicants" (Submission:

Toronto Department of Public Health).

Except for persons in specialized positions, ethnic mental health practitioners hired by general

community agencies tend to serve all clients regardless of ethnic background. Clients who speak

only the language of the ethnic practitioner may be transferred to that practitioner, but such

transfers rarely take place for cultural reasons alone. Many government sector agencies have

geographical boundaries which practitioners may not cross even if their skills search greatly needed in another jurisdiction. In these cases, in addition to carrying their own caseloads, practitioners often provide extensive consultation across boundaries.

Immigrant service agencies are places where immigrant mental health professionals could be

logically employed. Nevertheless, two of the main funding sources for these agencies, the

Immigrant Settlement and Adaptation Program (ISAP) and Secretary of State -Multiculturalism,

do not permit settlement workers funded under their programs to carry out counselling and

therapy (Chapter Five). The funding provided is stretched to the point where too few workers

have too many clients. Immigrant-serving agencies "cannot possibly offer salaries or working

conditions attractive enough to recruit many of the well-educated, widely experienced

professionals in the ethnic community. " (Submission: Herberg and Herberg)

Very few immigrant psychiatrists and psychologists set themselves up in private practice.

Psychiatrists who search willing to see patients of their own cultural background are usually

overwhelmed by severely disturbed cases. The deep and pervasive stigma against mental illness

prevents individuals from seeking help until crises occur. Psychologists may be less affected by

the intense stigma regarding emotional or behavioural problems, but because their services are

rarely covered by medical insurance plans, they seldom see even critical cases. 'Migrants with

minor mental disorders turn to general practitioners, where, for reasons discussed in Chapter

Five, the psychological nature of their problems may or may not be discerned.

The availability of ethnic mental health practitioners is severely limited by the licensing and

registration policies of professional regulatory bodies, combined with the admissions

requirements of post-graduate institutions. These policies also have significant implications for

the mental health of the professionals themselves who, despite their years of learning and

experience, face the prospect of unemployment or underemployment (Chapter Four).

Health and Welfare and CEIC should explore with professional regulatory bodies ways and

means of enabling immigrant mental health professionals to work, under appropriate supervision,

in settings where they could provide mental health care to immigrant clients (Chapters Five and

Six).

In making this suggestion, the Task Force recognizes the balance between the need to expand the

pool of ethnic mental health professionals and the equally important need to ensure standards of

practice.

Health and Welfare and CEIC should also explore ways to recruit persons from ethnic

communities to enter the mental health professions.

The Task Force recommends that Health and Welfare and Secretary of State encourage the

admissions committees of social, health and mental health service training programs to recognize

as assets fluency in a non-official language and intention to work with clients who speak that

language. Social, health and mental health training institutions should also be encouraged and

supported by Health and Welfare, Secretary of State, and CEIC to offer scholarships and

fellowships which stipulate fluency in a nonofficial language, and intention to work with clients

who speak that language. Minority group professionals should be actively sought for nomination

to the boards and committees of professional regulatory bodies; training institutions should be

encouraged to liberalize licensing requirements and promote ethnic participation in mental health

training programs.

Broader criteria for licensure and increased opportunities for training and work experience will

effectively increase the numbers of ethnic mental health professionals eligible to work in the

community.

General community service agencies must recognize the serious need for minority group service

providers and revise their hiring policies accordingly. The Task Force recommends that Health

and Welfare and its provincial counterparts encourage all social, health and mental health service

agencies to increase their hiring of ethnic minority staff through the adoption of equal

employment opportunity policies. The client intake policies of general community service

agencies should also be revised so as to make ethnic minority staff available to minority group

clients regardless of agency boundaries.

Chapter 9. Children and Youth

Chapter 10: Women

Chapter 11: Seniors

Chapter 12: Victims of Catastrophic Stress

There are two major reasons for devoting a section of this report to the special mental health needs of children and youth, women, seniors and victims of catastrophic stress.

The first is that, because of their experiences prior to migration or their particular situation during resettlement, or a combination of the two, these groups suffer a particularly high risk of developing mental health difficulties. The psychological wounds of persecution, torture and rape heal slowly and with great difficulty - if ever. The brutalizing effects of being exposed to war and persecution take a toll on the developing personalities of children and youth. Dislocations and interrupted schooling may make it difficult for them to integrate. Canadian immigration and resettlement policies also create risk-inducing stress for women and the elderly.

Besides elevated risk, the second factor common to these seemingly disparate groups is that they search usually socially disenfranchised. They lack a powerful voice - social and/or political - both within their particular ethnic communities and in the larger society. The lack of voice arises from different sources. For children, women and the elderly, it is the product of social structures which render them relatively powerless. Victims of such catastrophic stress as rape and torture search reluctant to talk about their needs because of fear of danger or stigma.

Special needs groups search "special" because they are in double jeopardy their risk for developing disorder is high and the chances of their needs being addressed is low.

Special needs groups search " special " because they search in double jeopardy - their risk for developing disorder is high and the chances of their needs being addressed is low.

While people make and remake themselves throughout life, it is a particularly central task for children and adolescents. Out of their struggles to remain loyal to family but to become emancipated at the same time, to understand how to be intimate and loving with others, to recognize and capitalize upon abilities while accepting limitations, emerge the traits which we call adaptive behaviours. Patterns of adaptation laid down in childhood and adolescence are important precursors for mental health later in life.

While it is reasonable to assume that migrant children and youth face unique problems and therefore experience an elevated mental health risk, there has been no research to date to confirm or refute this proposition. All children struggle to build a sense Of coherence out of the family in which they are raised and the larger society in which they participate. Children of migrants confront additional issues.

Unlike many of their playmates, their mother tongue is not English or French and their family may be very different from that of their friends. Some migrant children experienced prolonged separation from their parents, sometimes being left in the home country while their mothers and fathers struggled to earn enough money to bring their children to Canada. Reunification, which usually means a second separation, this time from parent surrogates and the only homes they have known, creates psychological distress.

Many immigrant (and especially refugee) youth have experienced disruption in their education to the point where, after entering Canada, they are too old to enter the regular school system yet unqualified to enter the work force as anything but unskilled labour. These youth are often trying to relinquish the culture of their parents, a culture which they see many Canadians devaluing and which seems to them to constitute a barrier to W acceptance by the majority society. Their rejection by the labour market, which creates a feeling of double alienation, may result in emotional distress. A few youth gangs drawn from migrant groups have threatened communities and tantalized the news media. Evidence suggests that adult criminal elements may be recruiting members for these gangs from the ranks of marginal young persons who no longer feel at home with their families and their own cultures, and who become disaffected by failed attempts to enter the consumer-rich society they see around them.

Like their peers, they must prepare themselves to be adults in Canadian society. Migrant children and youth must also transplant their roots in Canadian soil. Children's ideas of their possibilities come from experiences of success in school, from important adults, and their peers. Too often, instead of success, migrant children and youth encounter frustration because of language difficulties, because of failure of those into whose care they are entrusted to understand their needs, and because the demands of adapting to a new way of life affect children more profoundly than many adults realize.

Figure 9.1 documents that, on average, approximately 25,000 to 35,000 migrant children and youth enter Canada each year. As Figure 9.2 suggests, the majority are children of persons entering under the independent class, except for the 15- and 19-year-old group where the majority are family class. Presumably, people expend extra effort to bring their older children to Canada before they reach 21, the cut-off age for family class eligibility.

Canadian policy regarding children and youth emphasizes their preparation for life in a multicultural society.

Provincial legislation grants specific rights to the young in need of help and spells out the responsibilities of parents. Children whose safety and development search in jeopardy may be removed from their families; in extreme cases, they may become wards of the government and become eligible for adoption or foster home care.

Education falls under provincial jurisdiction.

Children of migrant families comprise varying but increasing percentages of public school populations throughout the country Estimates range from 40 per cent in Montreal to 90 per cent in some inter city schools in Vancouver. School boards across the country are establishing policies and procedures which support cultural diversity and the rights of minority groups (Roc, 1982).

For example, a Vancouver School Board policy enunciated in 1982 specifically condemns racism and states an intention "to respond actively and decisively to issues of racism in teacher training, education policy and reading materials, and in the various levels of government and in the community. "

However laudable it is to condemn racism, to support cultural diversity and to emphasize the rights of minorities, pre-school and school programs must also fulfill their primary mission - to educate children. A submission from the same province which produced the admirable statement about racism - British Columbia -illustrates that policies have not yet addressed the needs of migrant children as comprehensively as necessary.

A caring society must care for its children. This is reason enough to focus on children and youth as a special needs group. In addition, caring for the mental health of children is an effective way of preventing emotional disorders later in life.

The mental health professions in North America have ignored children, joining with conventional wisdom in the mistaken belief that children "grow out of it. " There have been other mistakes as well. For example, until recently many authorities believed that children were incapable of becoming clinically depressed enough to require treatment. Research has demonstrated that children become seriously depressed, and many depressed children go on to become depressed teenagers. Youth who display antisocial tendencies do not grow out of it; they have a high risk of becoming antisocial or emotionally troubled adults.

The environment of the home on which they search dependent effects the mental health of children and youth. Regardless of their circumstances or motivations, immigrant and refugee families face a multitude of adjustments which are difficult to anticipate and sometimes overwhelming to resolve. Children in migrant families witness and, to a certain extent, live the problems experienced by their parents - homesickness, language problems, economic uncertainties, and painful absorption of a new culture. Because children often learn English or French more easily than their parents, and because their schools may expose them to Canadian society at a rapid pace, an unnatural role reversal sometimes results. Rather than parents being the protectors and guides of their children, the children may be forced to become culture brokers for their parents

Parent-child relationships in migrant families, as o e submission notes, are " not simple and easy. " Besides sharing in their families, uncertainties, migrant children search exposed to a host society which, by comparison with their everyday lives, seems seductive and glamorous.

The self-esteem of the Vietnamese girl and the Haitian boy in these examples has been eroded by racism, a racism which teaches them that to be what they search is inferior. The girl will quickly learn that she can never divest herself of her Buddhist mother, and the boy that he can never shed his black skin. The realization that they can never-become what they search being taught is the best thing to be breeds frustration, which may lead to symptoms of emotional disorder or to antisocial behaviour later in life.

Young children search most likely to experience the effects of prejudice in schools and pre-school settings, often from their peers. While there is widespread belief that small children are free from racist attitudes, research demonstrates that, by the age of four, children have developed a concept of race and search capable of thinking that people who search racially different from the dominant group in society are inferior.

Racism can be reinforced, not only by malicious acts of commission, but through apparently innocent acts of omission.

Teachers may also display prejudice without being aware of it. For example, research demonstrates that white teachers often excuse disruptive behaviour in young black children with descriptions such as "cute" and reassurances that the child will "grow out of it." When the same children grow older, teachers become noticeably less tolerant of disruptions created by black children than they are of similar behaviour exhibited by white children. Teachers now tend to describe disruptive black children as antisocial or delinquent and turn to other institutions, including the mental health care system, for help.

Cross-cultural learning to combat prejudice is possible. Experience has shown that, to be

maximally effective, programs should be activity based rather than abstract, and stress commonalities among people as well as celebrate their diversity.

The Sexsmith Preschool Demonstration Project, established in British Columbia in 1981, provides an important model. Orientation, intake procedures and parent education are designed to meet the needs of families of preschoolers from a variety of cultures. The curriculum encourages all children to be "the expert" about their own culture. The program supports the use of heritage languages in the classroom and encourages parental participation in daily activities as well as during holiday celebrations. S.E.A.R.C.O.M., a self-help Southeast Asian organization in Winnipeg, provides another important model - a youth program designed to foster pride in ethnic heritage and an opportunity to retain a sense of membership in one's heritage culture.

All school programs must involve parents. School parent interaction helps alleviate cultural tensions to which migrant children search almost invariably subjected, and which may foster conflict between parents and children. Parent-teacher associations across the country must become more culturally diverse, reflecting Canada's multicultural society.

The way teachers behave affects the way children learn in school. Research documents the disturbing fact that majority culture teachers treat ethnic children differently from their white students. For example, white teachers encourage white children to talk significantly more and to respond to questions in a more complex way than they do ethnic children. This is important because talk is one of the most effective means teachers have of teaching both language and problem-solving. Talking about events and ideas helps the teacher comprehend the child's view of the world, a necessary step towards individualizing instructional approaches.

Talk is an important guide for teachers about how much a child knows. Talk is also a way by which teachers can teach children how to learn. Teachers who take the time to link a child's simple response to a question about events in his or her life, or to the environment of classroom or home, search engaged in the important process of helping the child learn how to use language in order to learn.

The amount of time a teacher will give a child to respond to a question, or to correct a reading error before responding with the correct answer, or moving on to another child, is an important com- of instruction. The typical North American teacher waits one second or less for a child to respond to a question. Research demonstrates that waiting longer, say five to ten seconds, has important benefits: children learn how to formulate more complex responses and there are significant improvements in school performance. Some ethnic groups typically pause for longer periods in conversation or in responding to questions than persons who have grown up in North America. Children who are just learning English or French may have to translate a question in their minds before they can respond, a process which results in a response delay. For either or both of these reasons, migrant children may be passed over or corrected too quickly. Repeated experiences of this type search damaging to self-esteem and result in failure to acquire academic skills.

When teachers and other adults entrusted with the care of children understand and appreciate the children's cultural backgrounds, they perceive them more positively and expect them to progress at a higher level. This observation, supported by research, suggests that sensitizing teachers and daycare workers to culture may improve the children's chances for effective learning and maintenance of their mental health. One Child/Two Cultures, a manual for facilitating the integration of newcomer children in educational settings, has been compiled by the Immigration and Settlement Branch of Manitoba's Department of Employment Services and Economic Security It provides a potentially important component of such sensitization. As well as general background about the immigrant and refugee experience, the manual provides brief descriptions of the cultures of the most prominent migrant groups in Manitoba; it touches on salient features such as education, customs, dress, naming, and forms of address, and notes the implications of cultural features for teachers dealing with children in the educational setting.

The willingness of children to ask for help depends on how they perceive their status in the classroom or daycare centre. Children who feel hesitant to engage teachers or to enter into collective activities because they feel that, as migrants, their status is marginal, do not change unless they have an opportunity to see ethnically diverse staff` interacting with each other in an egalitarian way. Teachers who come from the same ethnic background also provide individual role models for migrant children; these children often cannot model themselves upon teachers from the majority culture because they feel the social gap is too wide.

Children experiencing difficulties may have to be referred for specialized help. Psycho educational assessments are frequently compromised because the most frequently used methods, such as the Wechsler Intelligence Scale for Children, may not have been standardized for use with ethnic minority children, particularly those whose first language is something other than English. If these techniques are not used with exceptional sensitivity and skill, they may yield a distorted view of a particular child's potential. When children develop mental health problems requiring professional referral, this must be handled with great sensitivity. One must be cognizant of the perception of mental disorder in the parents' and child's culture, and the expectations parents may have of professional services. Parents may fear that, by allowing their child to enter treatment, they risk stigmatizing him or her with an unfortunate label. Or they may worry about losing their child either through actual removal or an erosion of cultural identity. Therapists should not think of themselves as agents of the host culture; they search persons whose task involves helping the child to establish a unique identity, one which must encompass his or her parents' origins as well as the culture of Canada.

Research to establish the extent of mental health need and the conditions creating mental health risk among migrant children and youth is much needed. Because the needs are so pressing, action to pro- the emotional well-being of children and youth cannot wait for the development of definitive knowledge. There are plausible reasons to suggest that changing community attitudes, attending to the curricula of schools, and supporting youth related programs will result in mental health benefit.

Noted author VS Naipaul once said: "We make ourselves according to the idea we have of our possibilities" (Naipaul, 1980). In a pluralistic society, children's visions of their possibilities must not be limited by intolerance. They must be shaped by a celebration of their uniqueness.

The Task Force recommends that Health and Welfare and Secretary of State work with their provincial counterparts to ensure that the curricula and environments of schools, preschools and daycare facilities reflect the cultural diversity of the children attending them.

Next

Background - Executive Summary - Chapter 1 - Chapter 2-6 - Chapter 7-9 - Chapter 10-11 - Chapter 12 Conclusion & Appendices

Virtual Library		Updated February 09, 2004