Table 1
Overlap of child returnees with other types of childhood trauma and adversity.
| Refugee Children | War- Impacted Children | Child Criminal Gang Members | Child Victims of Maltreatment | Child Victims of Sex Trafficking | |
|---|---|---|---|---|---|
| Prior Childhood Adversity & Trauma | X | X | X | X | X |
| Family Violence | X | X | X | X | X |
| Community/Political Violence | X | X | X | X | |
| Combat Involvement | X | X | |||
| Victim of Indoctrination | X | X | X | ||
| Family Loss & Separation | X | X | X | X | X |
| Displacement & Adjustment Stressors | X | X | X |
Table 2
Rapid review results.
| Population | Studies | Outcomes (Goal) | Risk Factors | Protective Factors | Intervention Strategies |
|---|---|---|---|---|---|
| Refugee Children | Review (Fazel et al. 2011) | Decreased psychological disturbance and adverse mental health symptoms | Exposure to violence Poor parental health Discrimination | Family cohesion Parental health Social support Community acceptance School safety and belonging | Psychotherapy combined with structural interventions (housing and skills training) Equitable access. |
| Review (Ehntholt & Yule 2006) | Decreased adverse psychiatric symptoms | Traumatic events Post-migration stresses Poor parental health | Family cohesion and adaptability Social support Belief systems | Phased model approach – establish safety and trust, trauma therapy, then reintegration Cognitive behavior treatment (CBT) Narrative exposure therapy (NET) Testimony psychotherapy | |
| Review N. Korean Refugees (Lee et al. 2017) | Decreased adverse psychiatric symptoms Psychological adaptation | Strenuous immigration process Acculturative stress | Social support | — | |
| 7 Countries (Mohamed & Thomas 2017) | “Ability to bounce back from adversity and even thrive in the face of challenges” | Bullying and racism Poor connectedness to the community Language barriers | Social support and friendships Education Teacher support | Education and care plans for training NET Robust anti-bullying policies CBT Partnerships with parents Cultural acceptance and celebration programs | |
| Arab Refugees (Kira et al. 2013) | Good health outcomes in spite of adversity | Stigmatization Exposure to trauma Acculturation stressors | Intact family Religion and religious leaders Perception of self-control Forgiveness Perception of retributive justice | Family therapy CBT NET Psycho-educational group therapy Assertiveness training Trauma systems therapy Recreational activities Multisystemic therapy Structural ecosystems theory Rights-based care | |
| Canadian and Southeast Asian Refugees (Rousseau et al. 1998) | Increased prosocial behaviors Decrease in internalizing symptoms | Exposure to trauma Parental depression Family conflict Family separation Family trauma | Social support Network of peers Sponsorship | — | |
| Review (Eruyar et al. 2018) | Increase in resilient behavior and absence of psychopathy | Poor parental health Discrimination School Exclusion Criminality Absence of environmental safety | Parental support Family connectedness Social support | Parent-child therapy and family-based intervention CBT-focused teaching recovery techniques program Interpersonal group psychotherapy NET Creative therapy Eye movement desensitization and reprocessing therapy Multimodal interventions | |
| War-impacted Children | Afghanistan (Panter-Brick & Eggerman 2011) | Positive social adjustment and functional behavior in the midst of conflict | Domestic violence Community and political violence Family health Economic hardship Separation from close friend Social suffering Overcrowding | School attendance Family unity Strong family values Faith Social support networks Better living conditions | Child and family-focused mental health interventions |
| Palestine (Nguyen-Gillham et al. 2008) | Positive health outcomes in spite of dehumanizing conditions | Chronic exposure to violence Economic hardship Lack of environmental security/comfort Humiliation | Networks of social support (friends and family) School attendance Political activism/identity | Fostering new social networks | |
| Review (Karadzhov 2015) | Absence of psychopathy Increased prosocial behaviors | Economic hardship Stigmatization Domestic violence Motivation to seek revenge Acculturation Inequitable access to facilities | School attendance Community acceptance High SES Perceived spiritual support Social intelligence Empathy and hope Cultural affiliation Social Support Political Participation | Community resilience and rehabilitation Trauma counseling | |
| Review (Tol et al. 2013) | Good mental health and developmental outcomes | — | Optimism Mental flexibility and social intelligence Religiosity Parental monitoring and support Safe home environment School retention Peer social support Community Acceptance | Develop supportive socio-ecological context Don’t over idealize cultural resources | |
| Review (Jordans et al. 2009) | Reduction in symptoms | Family separation Community tension | Parental support and interaction Strong family roles Social support Recreational activities Secure school environment Community awareness Group cohesion | Creative-expressive, recreational, psycho-education activities Narrative exposure therapy Trauma group psychotherapy Dance and movement therapy CBT Group interpersonal therapy Parent-child interaction therapy Teacher and health worker sensitization | |
| Review (Williams 2007) | Adapt psychologically, emotionally, and physically well in spite of adversity | Exposure to trauma Family Loss Poor parental practices Poor family health Loss of places of education and social gathering Loss of routine | Intelligence and temperament Family relationships and support Social and institutional support | Culturally sensitive approach Psychological first aid Community mental health services Specialist psychiatric and psychotherapeutic services Engage in recreational activities | |
| Sierra Leone (Betancourt 2010) | Increases in prosocial behaviors | War trauma Stigmatization Daily hardship | Community acceptance Social support School attendance | Community sensitization and acceptance campaigns | |
| Colombia (Cortes & Buchanan 2007) | Exhibition of mild or no trauma related symptoms | — | Autonomy Self-confidence Interpersonal awareness Empathy Sense of hope Spirituality Morality | — | |
| Child Criminal Gang Members | Ottawa (Hastings et al. 2011) | Successful disengagement from gang and prosocial behavior | Fear of retaliation Low neighborhood or school attachment Family disorganization Social disorganization Commitment to delinquent peers Fear of retaliation Lack of education or employment Stigmatization | Access to education Healthy family relationships Safe Environment | Training and employment programs Combination of prevention, intervention, and suppression Peer mentoring |
| U.K. (Harris et al. 2011) | Desistance from gang activities | Attachment to gang Localization Stigmatization | Maturation Family Access to employment Social relationships | Resettlement Psychosocial treatment | |
| Arizona (Pyrooz & Decker 2011) | Desistance from gang activities | Embeddedness | Family responsibilities Job responsibilities Resettlement Maturation | Community and CJ supported desistance | |
| Review (Carson & Vecchio 2015) | Desistance from gang activities | Marital discord Police harassment Fear of rival gangs Unemployment | Maturation Disillusionment Official sanctions Police contact Spirituality and religiosity Encouragement from teachers, parents or adults Meaningful employment Romantic relationships Family responsibilities Resettlement | — | |
| Review (O’Brien et al. 2013) | Desistance from youth gang activities | — | Increased parental monitoring Social skills Commitment to school Attachment to mentors Family cohesiveness Maturation Traumatic Events | Phoenix gang intervention program CBT Motivational interviewing | |
| Glasgow, Scotland (Gormally 2014) | Desistance from criminal youth activities | Investment in the gang | De-identification Maturation Employment Religion | — | |
| Child Victims of Maltreatment | Review (Afifi & MacMillan 2011) | Absence of psychopathy, social functioning, positive self-esteem | Parental rejection Self-blame | Less unilateral parent decision making Stable family Normal adolescent relationships Good adult friendships Greater commitment to school Family cohesion Intelligence Life satisfaction Self-efficacy Optimism | Trauma informed clinical care |
| Review (Marriott et al. 2014) | Few long-term negative outcomes | Early abuse | Stable family environment Positive parenting practices Strong friendships Adulthood relationship Positive school experiences Religious participation | Focus on inner resources (internal resilience from strong family, friends, adult network) Health promotion initiatives and social programs | |
| United States (Folger & Wright 2013) | Reduction in symptoms of depression, anxiety and hostility | Dating abuse Cumulative maltreatment | Perceived support from family and friends Support from a partner | — | |
| Review (Domhardt et al. 2015) | Normal functioning and positive adaptation | — | Externalizing blame Education and school engagement Emotional intelligence Emotional attachment to family member Religiosity Leisure activities High SES Stable family Positive parenting Community social support School safety | Trauma focused cognitive behavior therapy Educational engagement Facilitate interpersonal trust Enhance social support provided by family members | |
| United States (Greenfield & Marks 2010) | Long-term resilience and positive health outcomes | Parental violence Psychological violence | Sense of community | — | |
| Women Survivors (Hyman & Williams 2001) | Absence of psychological difficulties | Personal substance abuse Parental substance abuse Criminal activity Re-victimization | Self-esteem Intimate relationships Community participation Adherence to community standards Stable family Family Support Social Support Education | — | |
| Child Victims of Sex Trafficking | Review (Muraya & Fry 2015) | Restoration of the physical and mental health of victims | Drug use Social detachment Social isolation Connections to traffickers Discrimination (in terms of receiving services) | Safe environment Education Social support Employment (job training) Adequate housing | Trauma informed services STOP-IT Chicago program rights -based care Individual counseling Group sessions Creative therapies Psychiatric care Trauma-focused CBT Appropriate medical care Holistic aftercare services |
| Dissertation (Evans 2019) | Recovery from trauma and improved health outcomes | Shame Dissociation Poverty Absence of social support network Stigmatization Drug use Forced involvement in CJ process Attachment to traffickers Unhealthy family relationships | Community support Adequate housing Strong family relationship Spirituality Structure and safety Personal growth Financial stability Education | Culturally appropriate services Language services Mental health care Housing Job training Trauma-focused CBT Public awareness campaign Legislation | |
| Review (Abu-Ali & Al-Bahar 2011) | Successful reintegration Absence of trauma-related symptoms | Early separation from caregivers Attachment to trafficker Marginalization Family punishment | Strong identity Cultural identity | Integrated psychotherapy and social justice model |
Figure 1
The rehabilitation and reintegration intervention framework (RRIF).
Figure 2
Risk and protective factors for the rehabilitation and reintegration of child returnees.
Figure 3
Policy goals for the rehabilitation and reintegration of child returnees.
Figure 4
The levers of community resilience for the rehabilitation and reintegration of child returnees.