Running head: TSOKODAYI DISSERTATION Refugee Migration Stress and Family Functioning: A Phenomenological Study of Refugee Mothers from East and Central Africa Ruvimbo T. Tsokodayi, M.S., MFT Dissertation proposal
submitted to the faculty of Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of Doctorate
in
Philosophy in Human Development
Christine E. Kaestle (Chair) Isabel S. Bradburn Julie C. Dunsmore Erika L. Grafsky Cynthia L. Smith Spring 2019 Blacksburg, VA Keywords: refugee migration stress, family functioning, parental self-efficacy, interpretative phenomenological analysis ii Refugee Migration Stress and Family Functioning: A Phenomenological Study of Refugee Mothers from East and Central Africa Ruvimbo T. Tsokodayi ABSTRACT Refugee families who flee their homes as a result of conflict or persecution and face stressful migration experiences often struggle with trauma that may put them at increased risk for family discord and dysfunction. The
purpose of this
study
was to use an
interpretative phenomenological
approach to
explore the lived experiences of 8 refugee mothers resettled in the United States, in particular their experiences pre-, during, and post-migration, and to further examine the impact that these experiences had on their relationships to their children and families. The study also examined mothers’ experiences with different forms of support systems post-resettlement. Participants were recruited through a resettlement agency in Roanoke, Virginia. This study illuminated a number of key findings to further inform research, theory, and practice with this population. Refugee mothers reported stressful and traumatic experiences across their migration, describing harsh living conditions, prolonged stays in refugee camps, and loss of children and other family members as some of the most stressful experiences. Once resettled, mothers spoke of continued challenges, including language barriers and inconsistent or arbitrary support from formal social support services. Findings also suggest resiliency among this sample of refugee families, with mothers highlighting strong relationships with their children during and post-migration. The current study further informs the family stress literature and contributes a strength-based framework to understanding challenges faced by refugee families across the migration period. iii Refugee Migration Stress and Family Functioning: A Phenomenological Study of Refugee Mothers from East and Central Africa Ruvimbo T. Tsokodayi GENERAL AUDIENCE ABSTRACT Refugee families who flee their homes as a result of conflict or persecution and face stressful migration experiences often struggle with trauma that may put them at increased risk for family dysfunction.
The purpose of this study was to explore the lived experiences of 8
refugee mothers resettled in the United States, in particular their experiences pre-, during, and post-migration, and to further examine the impact that these experiences had on their relationships with their children and families. The study also examined mothers’ experiences with different forms of support after resettlement. Participants were recruited through a resettlement agency in Roanoke, Virginia. This study highlighted a number of key findings to further inform research, theory, and practice with this population. Refugee mothers reported stressful and traumatic experiences across their migration, describing harsh living conditions, prolonged stays in refugee camps, and loss of children and other family members as some of the most stressful experiences. Once resettled, mothers spoke of continued challenges, including language barriers and inconsistent support from social services. Findings also showed mothers’ resiliency, with mothers highlighting strong relationships with their children during and post-migration. The current study further informs the family stress literature and contributes a strength-based framework to understanding challenges faced by refugee families across the migration period.
iv Table of Contents LIST OF FIGURES...……..………………………………………..........vi LIST OF TABLES………………………………………………………vii LIST OF
APPENDICES
……………………………………………….viii CHAPTER
I.
INTRODUCTION…………………………………….....1
Overview
of Chapter……………………….................................................
1 Who are Refugees? ................…………..................................1 Statement of the Problem…………………………………………………..2 Refugee Trauma………………………………………………3 The Refugee Migration Experience…………………………..4 Refugee Migration Stress……………………………………..4 Study Purpose and Research Questions……………………………………6 CHAPTER II. THEORETICAL FRAMEWORKS……………………7 Overview of Chapter……………………………………………………….7 Family Stress Theory………………………………………........................7 Assumptions………………………………………………….7 Concepts……………………………………………………...9 Double ABC-X Theory……………………………………..10 Family Stress Theory for Economic Hardship…………….......................11 The Current Model…………………..……………………........................13 Research Questions.………….………………......................14 CHAPTER III. EMPIRICAL EVIDENCE..…………………..............16 Overview of Chapter…………………………………….…………..........16 Key Terms………………………………………………….17 Refugee Migration Stress and the Individual……….................................17 Pre-Migration Stress ………………………………………18 Migration Stress……………………………………………20 Post-Migration Stress………………………………………20 Overall Impact on the Individual…………………………..22 Refugee Migration Stress and the Parent-Child Relationship……………23 Parenting stress, trauma, and parenting practices………….24 Acculturation gaps and parental role disruption…………...25 Parental self-efficacy………………………………………27 Refugee Migration Stress and Family Functioning………………………28 Formal and Informal Social Support……………………….………….....29 CHAPTER IV. RESEARCH METHOD……………………………....33 Overview of Chapter…………………….………………………………..33 The Qualitative Paradigm………………………………….33 Phenomenology…………………………………………....35 Data Collection……………………………………...................................37 v Overview of Refugee Resettlement………………………..37 Participant Inclusion Criteria.……………………………...37 Sampling and recruitment of participants………………….38 Phase I………………………………………………...38 Phase II………………………………………………..39 Development of Interview Protocol………………………..40 Procedure…………………………………………………..43 Step 1: Verbal consent process……………….............44 Mandated reporting..........................................44 Step 2: Interview……………………………………...45 Step 3: Post-interview memoing……………………...46 Step 4: Data storage…………………………………...46 Data Analysis……...…………………………….......................................47 Interpretative Phenomenological Analysis………………...47 Bracketing.……………………………………………48 Transcription.…………………………………………49 Analysis………………………….................................50 Analysis software…………………………….50
Looking for themes in the first case.…............
50
Connecting themes…………………………...
52
Continuing
analyses with
the other cases……
53 Rigor……………………………………………………………………...53 Credibility……………………………………………….54 Transferability…………………………………………..55 Dependability………………………………...................55 Confirmability…………………………………………..56 Reflexivity Statement…………………………………………………….57 Conclusion…………………………………………………......................58 CHAPTER V: FINDINGS……………………………………………...59 Overview of Chapter……………………………………………………...59 Sample Description……………………………………………………….60 Becoming a refugee………………………………………………………62 Stress in the Family (Individual Domain)………………………………...85 Stress in the Family (Parent-Child Domain)……………………………..91 Stress in the Family (Family Functioning Domain)……………………...98 Formal and Informal Support………………………………………...…105 CHAPTER VI: DISCUSSION………………………………………...112 Overview of Chapter…………………………………………………….112 Summary of Findings……………………………………………………112 Research Question 1………………………………………….113 Research Question 2………………………………………….114 Research Question 3………………………………………….115 Discussion of Findings………………………………………………….116 vi Situating the Sample……………………………………….…116 Congolese and Burundian refugee resettlement………..116 Homogeneity of sample………………………………...116 Refugee Migration Stress and the Individual………………...119 Stress of camp life………………………………………119 Continued post-resettlement challenges………………..121 Loss of agency across the migration period…………….123 Refugee Migration Stress and the Family…………………….125 Parental self-efficacy…………………………………...125 Parental stress and trauma………………………………126 Family functioning……………………………………...128 Refugee Migration Stress and Formal/Informal Support.........132 Advancing the Family Stress Literature………………………………...133 Model for Refugee Family Stress and Coping………………..134 Limitations………………………………………………………………135 Future Directions………………………………………………………..137 Conclusion………………………………………………………………137 REFERENCES…………………………………………………………139 vii
List of Figures Figure
1.
Hill’s ABC-X Model
of Family Stress………………………………………………….9 Figure 2. Double ABC-X Model of Family Stress………………………………………………11 Figure 3. Family Stress Theory for Economic Hardship………………………………………...12 Figure 4. The Current Model: Model for Refugee Family Stress and Coping…………………..14 Figure 5. Visual Representation of Findings for Research Question 1…………………………125 Figure 6. Synthesized Model for Refugee Family Stress and Coping………………………….135 viii
List of Tables Table 1. Summary of
Interview Schedule
and
Interview Lengths
………..………………….…47 Table 2.
Participant Characteristics ………………………………………………………….…59
Table 3.
Findings for Research Question One……………………..……...…………………….84 Table 4. Mothers’ Responses to Scaling Questions and Representative Quotes……..…………86 Table 5. Findings for Research Question Two…………………………………………………104 Table 6. Findings For Research Question Three…………………..………..………………….111 ix
List of Appendices Appendix A:
English Flyer…………………………………………………………………….152
Appendix B:
Arabic Flyer……………………………………………………………………...153
Appendix C:
Verbal Consent and Interview Protocol………………………………………….154 Appendix D: Mental Health Resources………………………………………………………...158 Appendix E: IRB Approval Letter……………………………………………………………..159 CHAPTER 1: INTRODUCTION Overview of Chapter In this chapter, I introduce the magnitude of the refugee crisis and the problems it poses for families and those who work with families. Currently, the term refugee describes a person who is “forced to flee his or her country because of persecution, war, or violence” (UNHCR, 2019). Refugees differ from people who are immigrants or internally displaced persons in that they are forcibly displaced from their countries of origin to a different country (unlike internally displaced persons, who are forced to flee to another part of their country but remain in their country of origin, or immigrants, who choose to resettle in another country) (UNHCR, 2019). Refugees are also different from asylum seekers, who are people granted protected status directly by the country they enter (UNHCR, 2019). Who are refugees? In 1951, the Geneva Convention established the definition of refugees, which at the time was limited to people who were displaced prior to January 1, 1951 as a result of war in Europe (The
Convention Relating to the Status of Refugees, 1951).
In
1967,
the
Protocol Relating to the Status of Refugees
expanded
the
criteria
to
include any person displaced as a result of war, anywhere in the globe (The
Protocol Relating to the Status of Refugees, 1967).
The
United Nations High Commissioner for Refugees
(UNHCR) was established then as the sole body able to grant refugee status, and countries who ratified both the Convention (1951) and Protocol (1967) were tasked with working with the UNHCR to resettle refugees. According to the UNHCR, “states undertake to cooperate with UNHCR in the exercise of its functions, which are set out in its Statute of 1950 along with a range of other General Assembly resolutions, and, in particular, to facilitate this specific duty of supervising the application of these instruments. By its Statute, UNHCR is tasked with, among others, promoting international instruments for the protection of refugees, and supervising their application” (UNHCR, p. 4). Statement of the Problem
According to the United Nations High Commissioner for Refugees (UNHCR), there
are roughly
68.5 million people who
have had to
forcibly
flee their homes as a result of conflict or persecution since 1951, and just under a third of those (25.4 million) are refugees (UNHCR, 2018). In recent years, the refugee crisis has become increasingly urgent. The number of people now displaced from their homes is at a record high due to increased conflict in various parts of the world. Roughly 44,000 families flee their homes daily in search of safety, up from 34,000 in 2016, and globally the refugee population has increased by fifty percent in the last five years (UNHCR, 2018). With this increase in conflict globally, refugees are increasingly relying on resettlement in
countries such as the United States and
other developed
countries as
a way to flee persecution and conflict. However, there is starting to be a mixed picture surrounding refugee resettlement in the United States. Close to 70,000 refugees were admitted into the United States in 2013, and those figures were expected to grow to 110,000 by 2017, (the US Department of State resettled 84,995 refugees during the 2016 fiscal year). The number of refugees being resettled in the US has drastically declined since 2017, however, due to the current administration’s pursuit of refugee policy that caps the number of refugees at 30,000. The number of refugees admitted into the US was just 22,491 in 2018. Further, funding for resettlement is also at a record low. According to figures from the US Office of Refugee Resettlement, funding allocated for resettlement country-wide was $395 million in the 2018 fiscal year, down 11 percent ($445 million from the previous year). As the need to resettle families grows globally, family researchers and practitioners are tasked with understanding how families are affected by the refugee crisis; in particular how the migration and resettlement process affects individual and family functioning overall. Because of the unique experience of forced migration and resettlement on the part of refugee families, service providers and policy makers can provide better services to refugees if they understand what is unique about them. Refugee Trauma Challenges faced by refugee families are complex and multifold. Because the majority of refugees flee their homes as a result of conflict or persecution, both parents and children struggle with dealing with and processing trauma (DeHeane et al., 2013; Hinton et al., 2009; Gardiner & Walker, 2010). Traumatic experiences and exposures can range from witnessing a family member’s death to witnessing or experiencing rape, torture, illness, or loss of loved ones in flight or while in a refugee camp (Gardiner & Walker, 2010). Witnessing or experiencing such traumatic events can have a negative impact on the children’s emotional development (Gewirtz, Forgatch & Wieling, 2008). Refugee children are particularly at risk for problems related to emotional withdrawal or distance (DeHeane et al, 2013), anxiety and depression, low self- esteem, learning and behavioral problems, and psychosomatic symptoms (Gardiner & Walker, 2010). The effect of trauma on young refugee children can also lead to post-traumatic stress disorder, chronic stress, loneliness, and depression (Betancourt et al, 2015). Lincoln, Lazarevic, White, & Ellis (2016) suggest that a history of trauma prior to the resettlement process among refugee teens impacted their subsequent mental health after resettlement. Refugee parents too are not spared from negative consequences of trauma. Once resettled, refugee parents often report experiencing feelings of isolation, loneliness and stress (Stewart et al., 2015), and are also at
risk for developing depression
and
anxiety and post-traumatic stress disorder
(Mollica et al., 1992, Schweitzer, Brough, Vromans & Asic-Kobe, 2011). The Refugee Migration Experience It is critical to understand what challenges refugee families face before they arrive for resettlement. Kirmayer et al., (2011) argue that the migration process can be conceptualized in three phases: the pre-migration phase, the migration, and the post-migration phase. The pre- migration phase involves the various experiences that families undergo that eventually lead to the migration. These experiences often include war, persecution and torture in many cases (Gardiner & Walker, 2010, Kim, 2016). The actual migration phase includes the period that families are in transition, usually fleeing from their home country and ending up somewhere in a transition country and sometimes in a camp (while more recent UNHCR policy argues for the reduction in the use of camps as a form of permanent housing for refugees, the reality for many families is camps (UNHCR, 2017; Ramadan, 2013)). In addition to the trauma of the pre- migration and refugee migration experience, families face a variety of post-migration stressors in their new environment (Kirmayer, 2011; Li, Liddell, & Nickerson, 2016). The post-migration phase is characterized by final resettlement and adjustment to a new life, the excitement of which is often attenuated by the realities of the new environment and the struggle to find formal support in the context of limited resources (Li et al., 2016). Refugee Migration Stress Resettled refugee families whose migration experiences are characterized by negative or traumatic events are at increased risk for family discord and dysfunction (De Haene, Verschueren & Grietens, 2010). Subsequently, refugee families in the United States and around the world often have difficulty transitioning back to normal family life after the migration experience (Kim, 2016). Broadly, refugee migration stress refers to the negative outcomes that refugees experience as result of forced displacement (Hollifield et al., 2013; Hollifield et al., 2016). As mentioned before, these negative outcomes can range from mental health challenges, lack of food and water, serious bodily harm such as rape or torture, or harsh living conditions such as camps (Schweitzer et al., 2011). Kirmayer et al., (2011) hypothesize that the totality of the migration stress process (from pre-migration to post-migration) is characterized by three factors which lead to stress. The first is a loss or breakdown of social ties. For children, this stress can result from separation from immediate and extended family members, as well as from peers, and for adults it can result from a disconnect from social network and previous employment and status. The second is characterized by economic stress that inevitably accompanies the transition, which for parents and children can be exacerbated by the uncertainty of migration outcomes (Kirmayer et al., 2010). The third is the change from one cultural system to another. Both parents and children experience this in the form of acculturation stress as they struggle to adjust to life in a new culture (Koh et al., 2013; Berry, 1997). These pre- and post-migration experiences can have vastly different impacts on different families depending on a number of factors. Effects of traumatic exposure, and subsequent refugee migration stress, can range from person to person depending on variety of factors related to developmental age and developmental stage, type of trauma, presence of other co-occurring negative events, the mental and physical health of the children and parent, and country of origin (Gewirtz, Forgatch & Wieling, 2008). In order to understand the impact that the refugee experience has on refugee families, I propose a study to examine the concept of refugee migration stress and explore its impact on various domains of the family, including the individual and dyadic relationships, and the family as a whole. Study
Purpose and Research Questions The purpose of this study was to explore
links between refugee migration experiences and refugee migration stress, and how that stress relates to family outcomes at the individual level, the parent-child level, and the family as a whole. The following three research questions were addressed: 1. How do newly resettled refugee mothers experience the refugee migration process and how do they interpret their experiences? 2. What family outcomes are most salient to newly resettled refugee mothers as a result of the totality of their migration experience? 3. What social support systems (either formal or informal) do newly resettled refugee mothers cite as most important, most needed, or most helpful? How trauma and stress may relate to family function is explored in the following theory and empirical evidence chapters. Patterson (1988) suggests that families who experience conditions of adversity will experience challenges at two levels: individual and family. Boss (1988) writes that families in crisis can be characterized by “(a) inability of family members to perform usual roles and tasks, (b) inability to make decisions and solve problems, (c) inability to care for each other in the usual way, and (d) focus shifting from family to individual” (p. 50). It is with this in mind that I move on to address the theoretical frameworks that help us to understand how stress affects the family. CHAPTER II: THEORETICAL FRAMEWORKS Overview of Chapter Family Stress Theory (Hill, 1949, 1958; McCubbin, Cauble, & Patterson 1982) and
Family Stress
Theory
of Economic Hardship (Conger & Conger, 2002; Conger et al., 2002)
provide a framework to help understand how stressful, negative, or traumatic experiences may influence families and their development. Each of these frameworks offers a unique perspective about what aspects of family development or functioning are at play both during ‘normal’ times and during times of stress or strain. I present these theories as foundations of my research on refugees. Family Stress Theory Family stress theory was developed by Hill (1949) as a way to explain response processes that occur when families are confronted with stressful or negative events. Hill, in his work with families who had endured separation and reunion during World War II, noticed that several factors were related to the ability of families to recover from this upheaval (McCubbin et al., 1982). In developing his theory, Hill posited that families will continually seek to maintain equilibrium. I discuss these assumptions and their related concepts below. Assumptions Central to Hill’s theory was that families would undergo differing responses to stressful or negative events based on four main factors. These factors help in determining the degree to which a family may experience a negative outcome as the result of a stressor or negative, or the degree to which they may “bounce back” from a negative or stressful event. Hill conceptualized families as systems which operate in certain ways that always seek to maintain equilibrium. He posited that certain factors can affect how well a family is able to maintain this equilibrium, and these include previous experience with stressors, whether the stressor is originating from within the family or from without the family, the family’s own perception of stress, the severity
of the stressor, the
family’s
level of
adaptability to
stress,
and
the family’
s “externalization of blame for the stressful event” (Hill, 1949, p. 17, Hill; 1958).
A stressor event in a family social system influences the amount of crisis in the system.
Hill argues that negative or stressful events that occur within the family’s social system, but not within the family system itself, can lead to a crisis response on the part of the family. He also states that the more stressful the event, the more crisis is felt on the part of the family. For example, if there is an economic depression in a family’s town where many jobs are lost (a stressor event), a family may be negatively impacted by the resulting economic upheaval that besets the town. Similarly, if a war breaks out in a family’s home country, (a stressor event) a family may be negatively impacted as a result of having to flee or go without certain resources. The family’s level of vulnerability to stress
influences the amount of
the
crisis in the system.
Vulnerability
to
stress can also make a family unable to effectively adapt or reorganize (maintain equilibrium) as a result of stress. Vulnerability refers to the degree to a stressor can wreak havoc on a family’s ability to function or maintain equilibrium. Families who have had previous experience with the same or similar stressors or negative events can either learn to better adapt to the stressor or can become overwhelmed by the stressor. Families’ vulnerability is also affected by the amount of resources a family has available to them to withstand the stress, resources that can be in the form of emotional and material. The
definition a family makes of the severity of changes in the family social system influences the family’s vulnerability to stress.
Hill posited that how the family perceives their stress can have an impact on their subsequent response to the stress. Family perceptions are processes that involve how the family interprets their negative or stressful situations. Perceptions call into play the family’s way of conceptualizing their situation, and this perception can make some families more vulnerable to stress and can lead to a more severe crisis response.
The amount of change that occurs when a stressor event occurs in the family social system influences the amount of crisis that results from the event.
Hill suggested that families who experience a more severe stressful or negative events are more likely to experience a more severe crisis response as a result. The more families have to reorganize themselves, the more resources have to be called in and the more stress this puts on the family. Concepts Based on these assumptions, Hill came up with his ABC-X Model describing the pathways through which families experience and adapt to stress. Hill’s ABC-X Model is operationalized as follows: families undergo a stressful event (A), and this stressful event leads to a crisis response (X). The crisis response (X), however, is not always inevitable; that is, families can avoid a crisis response based on what family resources (B) are available to them, and how the family perceives the stress (C). Figure 1 below provides a visual representation of the ABC-X Model. Figure 1.
Hill’s ABC-X Model of Family Stress Family
Family Family C Family Stressors A Resources B Perceptions Crisis (X) (A) (B) (C) Hill thought that families with fewer resources (B) were more likely to
suffer more frequent
or severe
crises
(X),
longer periods of disorganization,
more difficult
recovery, and
were
less likely to return to their former functionality.
And while his conceptualization of family stress is widely considered to be the basis for the family stress literature, his model has been criticized as being too linear and deterministic and gave rise to various expansions and revisions over the years (Boss, 2002). Double ABC-X Theory McCubbin, Cauble, and Patterson (1982) expanded Hill’s original theory by incorporating a Double ABC-X Model (see Fig. 2). A key assumption missing from Hill’s conceptualization of family stress is that families who experience conditions of adversity will experience challenges at two levels: the individual level, and the family level (Patterson, 1988). The Double ABC-X incorporates (a), (b), (c), and (x) from the already existing ABC-X, and posits that families can experience adaptation (X) in response to a stressful event or pile-up of stressful events (A), by making use of adaptive resources (B) and by what meaning (C) they assign to whatever the stressful event is (see Figure 2). McCubbin et al., (1982) suggested that over time, a pile-up of stressful events (Aa) may lead to an adaption response (either good (bonadaptation) or bad (maladaptation)) based on the family’s ability to withstand an initial crisis response by making use of both new and existing resources, and coming up with new perceptions of their resources and the stress. The way in which families cope with or adapt to stress was a large focus of McCubbin et al., (1982)’s model, and is shown in figure 2 below. Figure 2. Double ABC-X Model of Family Stress Existing and Existing resources (b) new resources b (B) Bonadaptation Stressors (a) Crisis (X) Pile Up a (A) Coping Adaptation Perception of x (X) Perceptions x+aA+bB of (a) c (C) Maladapation Pre-crisis Crisis Time Post-Crisis Time Family Stress Theory for Economic Hardship Family stress theory has been extended further over the years to produce
the family stress
theory
of economic hardship (Conger & Conger, 2002).
In studying families affected by an economic downturn in rural Iowa in the 1980s, Conger and Conger (2002) suggested that the experience of economic hardship creates an environment of economic stress for parents. This economic stress in turn affects parents’ mental and emotional state, which can lead to conditions such as depression or anxiety. Conger and Conger (2002) further suggest that when parents’ emotional state is affected as a result of not being able to deal with this economic stress, their parenting and couple-relational abilities (i.e., high parent-parent relational conflict) are also affected, which in turn leads to externalizing behavioral problems for children of these parents. Key to Conger and Conger’s framework is that over time, child outcomes such as externalizing behaviors do not occur directly as a result of the experience of hardship or adversity; rather, economic stress and negative child outcomes are indirectly linked through parental emotional distress, which leads to harsh parenting and high couple conflict (see Figure 3). Essentially, Conger and Conger (2002) suggest it is parents’ inability to manage their own stress that can lead to negative outcomes for children. Figure 3, from Conger and Conger (2002)’s original publication, shows this theoretical framework. Figure. 3. Family Stress Model for Economic Hardship (Conger & Conger, 2002) The figure above is taken from Conger and Conger (2002) and summarizes theoretical considerations of the role of economic pressure on families. This longitudinal study of families in rural Iowa beginning in the 1980s explored the relationship between economic hardship and family outcomes (parent emotional distress, parenting style, degree of couple conlfict, and child externalizing behaviors). Overall, this section highlights that the experience of stress does not have to lead directly to crisis in families (Hill, 1949). Instead, there are many trajectories that are available to families in the event of traumatic or negative experiences, or in the case of refugees, a pile-up of stressors. The Current Model The current model explores the relationships between the experience of refugee migration stress and various family outcomes as informed by Family Stress Theory (Hill, 1949, 1958; McCubbin et al., 1982) and
Family Stress
Theory
of Economic Hardship (Conger & Conger, 2002; Conger et al., 2002).
My resulting conceptual model aims to describe the processes involved in the development of refugee migration stress (RMS) as the result of refugee experiences, and the impact that RMS may have on individual emotional functioning, dyadic functioning between family members (parent-child), and overall family functioning. First, this model aims to describe a stressor (A) that refugee families undergo, as Hill (1949) describes. The stressors in the context of refugee families are the pre-migration and migration experiences, characterized largely by trauma (Gardiner & Walker, 2010), a disintegration of social relations, and economic hardships (Kirmayer et al., 2011). Post- migration experiences are also included in this. These stressors can lead to the development of refugee migration stress, a concept previously studied with refugee families (Li et al., 2016) and conceptualized by McCubbin et al., (1982) as a pile-up of stressors (Aa). This refugee migration stress (like economic stress in the Conger & Conger (2002) model) can lead to various outcomes within the family,
at the
individual
level, the
dyadic
level, and the
family
level. This
model also explores
the
role that external family resources (specifically informal and formal forms of social support) can play for newly resettled families. Hill (1949, 1958) and McCubbin et al., (1982) inform this part of the model. Family stress theorists describe risk and protective factors that can either exacerbate or attenuate the effects of the refugee migration stress on the family’s outcomes, and these risk and protective factors can be either internal or external. Hill (1949, 1958) and McCubbin et al., (1982) conceptualize the family’s resources (B and Bb respectively) as largely internal. Boss (2002), however, later suggested that resources can be external. Figure 4. Model for Refugee Family Stress and Coping Point of resettlement FAMILY OUTCOMES Individual Impact Refugee experiences Refugee Migration Stress Dyadic Impact Family Impact Resources – informal/formal support This proposed Model for Refugee Family Stress and Coping (see Figure 4) illustrates the specific mechanisms that may leave refugee families at increased risk for poor overall family functioning, and that may leave refugee parents with a decreased ability to parent effectively. The model also highlights the role that resources in the form of formal and informal support can have on families under stress. From this, I have formulated research questions that explore the role of refugee migration stress on family functioning and test the viability of this model. Research Questions To summarize, the following research questions were developed from the proposed Model for Refugee Family Stress and Coping: 1. How do newly resettled refugee mothers experience the refugee migration process and how do they interpret their experiences? 2. What family outcomes are most salient to newly resettled refugee mothers as a result of the totality of their migration experience? 3. What social support systems (either formal or informal) do newly resettled refugee mothers cite as most important, most needed, or most helpful? CHAPTER III: EMPIRICAL EVIDENCE Overview of Chapter As previously stated, refugee families
are at increased risk for
experiencing multiple stressors
as a result of the
forced migration process (Gardiner & Walker, 2010; Renner, Laireiter, & Maier, 2012; Kartal & Kiropoulos, 2016). At each stage of the migration, families encounter distinct and unique challenges, which add to the complexity of their experience (Kirmayer et al., 2011). How these experiences relate to the development of refugee migration stress, and in turn individual and overall family functioning, is a central focus of this study. The previous section employed theoretical reasoning to develop the Model for Refugee Family Stress and Coping, which offers a framework for understanding the individual and family processes that are affected by the stress of forced migration within the refugee community. But what does previous empirical research tell us about how these concepts (refugee migration stress, individual adaptation and coping, parenting, and family functioning) relate to each other? What literature can we draw from to further our understanding, and what gaps in the literature require further exploration? In this section, I use data-driven literature to support my theoretical work extending the Family Stress Theory for Economic Hardship Model (Conger & Conger, 2002) to refugee families, and expanding it to include an exploration of the impact that refugee migration stress has on family functioning. I also make a case for using qualitative methodology to fully explore this system and fill critical gaps in the literature. I present relevant empirical studies, both in the refugee community and not, as evidence to support the need for the current study. Key Terms
While the focus of this study
is on
the role of
refugee migration stress and its impact on individual and family functioning, I believe it is important to first present some key terms to better contextualize this section. Many of the empirical studies that I discuss and that relate to stress in the refugee community use trauma, depression, anxiety, and post-traumatic stress as markers of stress within the refugee community. Some of the earliest studies of stress and its impact on refugees were conducted by researchers focused on developing assessment measures of trauma within the community. For example, Mollica et al., (1992) developed the Harvard Trauma Questionnaire to assess refugees who had fled the Cambodian dictatorship in the late 1980s for PTSD. The Hopkins Symptom Checklist, also developed by Mollica and colleagues (1987) was developed for use with Cambodian, Laotian, and Vietnamese refugees who had similarly fled war for depression and anxiety. In developing these assessments, researchers sought to come up with a comprehensive set of stress-related symptoms that develop as the result of the experience of war-related trauma. The results of these studies show that refugees
are at risk for developing depression, anxiety, and post-traumatic stress
as a result of war-related trauma (Mollica et al., 1992; Mollica et al., 1996; Mollica et al., 1987). Many others that have subsequently employed these measures (Slobodin & de Jong, 2015; Knipscheer et al., 2015; Li, Liddell, & Anderson, 2016) found that indeed refugees are at higher risk for developing PTSD and related, comorbid disorders than those in the general population. Refugee Migration Stress and the Individual Stress and its impact on the individual has long been a topic of interest for researchers. Stress is defined as anything that exerts a negative toll on an individual and can impact the person in the physical, social, cognitive domains (Yakushko, 2010). Researchers who study its development within the refugee community posit that stress results from the cumulation of negative events or traumatic experiences, over a period of time of transition, also known as the migration period (Kirmayer et al., 2011; Li et al, 2016). This refugee migration stress can be characterized by three stages: pre-migration, migration, and post-migration periods; and each of these are associated with unique challenges that can lead to stress. Pre-Migration Stress Pre-migration stressors can contribute to the development of refugee migration stress, but exactly how? Pre-migration stressors are stressors associated with the individual’s life prior to fleeing their home country. In a
systematic review of literature on the effects of
stress
on
refugees, Kirmayer et al., (2011) found that some of the most commonly reported stressors that refugee adults faced prior to becoming refugees included persecution for political reasons, employment insecurity, and financial stress. In addition, the authors identified several factors that were associated with an increased risk in developing psychiatric mental health issues after resettlement (i.e. PTSD, anxiety, and depression). These factors were type and severity of trauma experiences, disruption in social ties and networks, economic and educational status, and political involvement. Pre-migration stress can also be compounded by any previous existing psychiatric issues (Mollica et al., 1992). Another study (Kartal & Kiropoulos, 2016) showed that pre-migratory trauma (when coupled with acculturative stress caused by post-migratory experiences) were a significant predictor of anxiety and PTSD among Bosnian refugees resettled in Australia. Existing studies that shed light on the impact of pre-migration stress on refugee adults do so by using largely quantitative measures. In one recent study of 420 newly resettled African refugees in Sweden, for example, Steel, Dunlavy, Harvey, and Thorell (2017) use the Harvard Trauma Questionnaire (Mollica et al., 1992)
Post-Migration Living Difficulties Scale, the Cultural Lifestyle Questionnaire; and the Hopkins
Symptom
Checklist
to assess pre-migration and post-migration trauma experiences and how they relate to current mental and emotional health within their sample. Steel and colleagues found that 89
percent of participants
had experienced
at least one traumatic
event
prior to
migrating from their home country, which resulted in greater level of post-migration PTSD and depression (by 47 percent and 20 percent respectively).
Knipscheer, Sleijpen, Mooren, ter Heide,
and
van der Aa (2015)
used the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist to assess trauma exposure and depressive symptoms respectively, and they found mean severity for trauma exposure and subsequent depression symptoms to be in the clinical range. The literature in this area (pre-migration period) is scant, due to the fact that a person becomes a refugee only once they leave their home country, so most studies focus on this part of the person’s experiences. Further, studies rarely clearly delineate the pre-migration and migration periods (for example, Knipscheer et al., 2015), which further complicates analyses of just what factors are contributing to a person’s current mental and emotional functioning. The current study explores these issues in greater depth through qualitative interview techniques that elicit thick descriptions of stressors and subsequent effects of those stressors from participants in their own words. Furthermore, I ask participants about their pre-migration experiences and migration experiences as two distinct periods, and I explore how they view their current mental and emotional functioning as impacted distinctly and jointly by these two periods. Migration Stress Migration stressors (i.e., stressors that are endemic to the migration or transition period) also contribute to a large degree to current (post-resettlement) refugee migration stress. In the same systematic review discussed above, Kirmayer et al., (2011) found that refugees largely struggle with the effects resulting from the disruption of family and social ties, exposure to harsh or uncertain living conditions, and the “uncertainty of the outcome of the migration” (p. E961). Of note, Kirmayer and colleagues found that refugees who had “severe exposure to violence” during the migration period were at higher risk for developing PTSD. Other studies that elucidate the link between migration stress and current functioning do so by linking the length of time in this transition. One study of Iraqi asylum seekers in the Netherlands showed that those Iraqi asylum seekers who spent more time waiting for decisions on their asylum application (up to 2 years) were more at risk for depression and anxiety than those who received decisions on their asylum applications within 6 months (Laban, Gernaat, Komproe, Schreuders, & De Jong, Joop, 2004). While this study looked at Iraqi asylum seekers, it supports the need for a study to explore the role that length of time in a camp or in transition between migration and resettlement has on the mental and emotional functioning of refugee parents. All of the above is compounded by the fact that refugees are significantly less likely to seek out help from healthcare providers than their non-refugee counterparts (Kirmayer et al., 2011). This finding demonstrates the need for more exploration into how exactly refugee parents cope, especially if they are not actively seeking out professional help for their ailments. Post-Migration Stress Refugee parents experience a host of challenges as a result of the migration and resettlement process. Several studies explore what unique challenges refugee parents encounter during the post-migration phase, which could have important effects on their children and family. The first is Stewart et al. (2015), who conducted a mixed methods study of 72 refugee parents from Sudan and Zimbabwe. The authors sought to explore what challenges refugee parents face individually, what challenges are linked specifically to parenthood, and what challenges relate to services and policy matters. Researchers used an 8-item open-ended qualitative interview schedule that they developed, in addition to the UCLA Loneliness Scale and
the Clinician-Administered Post Traumatic Stress Disorder Scale Life Events Checklist
(Blake et al., 1995). The Loneliness Scale contained 20 items which measure the individual’s level of satisfaction with social relationships and level of social isolation, while the PSTD scale
is a 17-item measure
which
assesses the
individual’s frequency
and severity of
exposure
to traumatic
life events. The qualitative interview focused on questions of adjustment to new life in Canada and asked participants to discuss how much support they felt they were receiving, what stresses and challenges they had encountered in the resettlement process, and what other difficulties they were coping with in the context of parenting. Results from Stewart et al. (2015) showed that with regard to challenges in the parenting context, participants cited
marital conflicts, gender role conflicts, insufficient time for family
due to long working hours, and cultural conflicts in parenting as the biggest challenges as a result of the migration and resettlement process. Female participants were significantly more likely to report loneliness and on average scored higher on the trauma scale than did males, highlighting the potential importance of gender in the migration experience and adjustment process. Morantz, Rousseau and Heymann (2011) conducted a qualitative study of 36 refugee children and 39 refugee adults recruited from a pediatric hospital in Montreal, Canada (children of parents in the study had to be between 7-18 years of age). Families were originally from Haiti, Colombia, India, Peru, and Algeria. Interview questions were open-ended and semi- structured and addressed four main themes. The first asked about experiences leaving home countries; the second asked about strategies employed and commitment to maintain transnational ties; the third focused on post-resettlement experiences, and the fourth focused on life satisfaction and adjustment in Canada. After a cross-sectional thematic analysis of all participants and a dyadic analysis of parent-child responses, Morantz et al., (2011) found that
older children
expressed
more difficulties with leaving their social networks
than did younger children, and that children overall experienced resettlement more positively than their parents. Much of this has to do with exposure to more diverse social network, which in turn seems to lead to more ease of acquisition of the new host country’s language. Children overall reported having more opportunities to meet friends who spoke another language other than their own, which greatly improved their mastery of the native French language spoken in their new city of Montreal. This study highlights the potential for qualitative inquiry to expand our understanding of adjustment processes in resettlement. Overall Impact on the Individual The existing literature discussed above demonstrates potential connections between specific pre-migration, migration, and post-migration stressors and the wellbeing and adjustment of refugees. This may help elucidate why many studies overwhelmingly find that refugees
are at risk for developing depression, anxiety, and post-traumatic stress
(Mollica et al., 1992; Slobodin & de Jong, 2015; Knipscheer et al., 2015). A family stress framework applied to the refugee community could be helpful in structuring further inquiry to shed light on how refugee individuals cope with the vast array of their experiences. First, the family stress model as applied to refugee families offers refugee parents an opportunity to describe, in their own words, the impact of their refugee experiences on their current functioning. Most of the studies above employ quantitative measures to assess outcomes of stress. However, how parents perceive the impact of their experiences may be just as critical as those measures. A family stress model as applied to refugee families also offers researchers a look into how some parents cope; what strategies they employ that can then be useful to translate to into further research in the area of coping and adaptation. Refugee Migration Stress and the Parent-Child Relationship It is well-accepted in the family stress literature that one domain in which stress can impact a family’s functioning is in the parent-child relational domain (Conger & Conger, 2002; Conger et al., 2002, Patterson, 1988; Boss, 1988). In this sub-section I do not limit my review to a specific pre-set list of parenting behaviors as outcomes; rather, I review studies that relate parental trauma to parenting behaviors and child outcomes in general, both in the refugee population and in other populations that have experienced trauma-related stress. I have chosen to do this largely because the current study is qualitative, giving parents enough room to express for themselves exactly what areas in their parent-child relationship have changed or been affected as a result of their experience. Therefore, I review studies that I believe are broad enough to explore a diverse selection of parenting behaviors that may be affected by the negative events or traumatic experiences. The goal of this study is to get a sense from parents about which aspects of the parent-child relationship are more affected than others. A large number of studies exist that are not specific to refugee parents but do explore how parental trauma relates to child outcomes under other circumstances and with various populations. This literature is included in this review because it can shed light on the role that parental experience of trauma plays on parenting abilities and subsequent child development (Sullivan
et al., 2011;
Ammerman
et al., 2013;
Sprang
et al., 2013;
Kelley
et al.,
2010). Overall, results from these studies show that parents who are under duress or distress can suffer a disruption in their parenting abilities, which in turn has negative effects for children and families. Parenting Stress, Trauma, and Parenting Practices Parenting stress is defined as any stress that arises from the parenting role (Deater- Decker, 2004). Ammerman et al., (2013) define parenting stress as “the gap between the demands of parenting and available personal resources and the negative mental appraisals that emerge in response to this discrepancy” (p. 234). In a study of 190 caregivers of children aged 3-12 years old in the rural Appalachian region of the US results showed that parents who experienced trauma reported
higher levels of parenting stress
were
more likely to
perceive their child
as
“difficult”, and were at increased risk for “overall dysfunctional parent-child relationships” (Sprang et al., 2013, p. 296). Sprang and colleagues’ finding highlights the dangers of the parenting stress phenomenon. Another study by Sullivan et al. (2011) showed that mothers with a history of childhood trauma had difficulty being sensitive toward their children (specifically, correctly interpreting their children’s needs). In an examination of maternal parenting stress, maternal access to social support, maternal depression and maternal childhood trauma among 208 new mothers, Ammerman et al., (2013) showed that mothers who experienced some form of childhood trauma experienced parenting stress at significantly higher rates when depression and lack of social support were present. A study done in the aftermath of Hurricane Katrina also found that across four time periods, parent trauma exposure (i.e., Hurricane Katrina) predicted parenting stress and other negative parenting practices, which subsequently correlated with higher levels of PTSD symptoms in children (Kelley et al., 2010). Ammerman et al. also found that mothers who have a history of trauma exposure find it difficult to correctly interpret their children’s emotional cues, which is an important precursor to sensitive and responsive parenting. Evidence indicates that responsive parenting could have substantial repercussions for children. Bell and Ainsworth (1972) conducted a study where they tested the effect of maternal responsiveness on infant crying in the first year of life. According to Ainsworth, maternal responsiveness inherently requires primary caregivers, in this case mothers, to be able to be in-tune with their infants and to be able to interpret both verbal and non-verbal cues (Bell & Ainsworth, 1972). Ainsworth also believed that mothers who display high levels of responsiveness will have more securely attached children. Results of that study showed that indeed high maternal responsiveness to infant cries led to a significant decrease in infant crying by the end of the first year. Results also showed that maternal responsiveness was also associated with the development of other forms of communication between mother and infant (i.e., non-crying modes of communication). These are important findings as they show that parental warmth/sensitivity is hugely dependent on parents being able to read and even anticipate the verbal and non-verbal cues of their children, something which may be greatly diminished when parents are dealing with trauma or PTSD (Ammerman et al., 2013; Sullivan et al., 2011). Therefore, it is critical to better understand refugee parents’ experiences because of the direct impact that parents’ traumatic or stressful events during the refugee migration process has on the subsequent development of children. Acculturation Gaps and Parental Role Disruption Another related challenge that refugee families face is having differing levels of acculturation between children and their parents (Koh et al, 2013), which can lead to parent-child conflict as a result of differing behavioral and cultural expectations. Research on migrant/immigrant culture shows that children
tend to
acculturate
to
a
new culture
faster and
more
easily
than their parents
(Garcia-Coll, 2004; Chuang & Gielen, 2009). Other studies that have explored the impact of parent-child acculturation gaps and acculturative stress for refugee children include Poppitt and Frey (2007), Hynie, Guruge, and Shakya (2012), and recently Lincoln et al. (2016). Poppitt and Frey’s qualitative study examined the impact of acculturation on 20 Sudanese adolescents aged between 13 and 18 years of age whose families had resettled in Brisbane, Australia. The authors tested their assumptions based on Berry’s (1997) acculturation framework, which states that “the adaptation outcome is affected by the particular acculturation used: integration (identifying with the host culture while continuing to identify with the culture of origin), assimilation (rejecting the culture of origin), separation (rejecting the host culture), and marginalization (no sense of belonging to either culture)” (p. 162). Results showed that teens reported that their greatest source of acculturative stress resulted from not being able to speak the host country’s language and feeling like they were between two cultures, and issues with parental control. As one teen explained to researchers: “It’s hard to learn English, talk properly and all that…when it comes to schooling and these things, it’s more difficult than I thought it would be” (p. 167). Hynie et al. (2012)’s study focused on 70 Afghan, Karen (Burmese), and Sudanese youth aged 16-24 years of age living in Toronto, Canada. With the use of semi-structured interviews, participants were asked about how role reversal (parentification) and acculturation gaps as a result of refugee migration and resettlement contributed to family conflict and stress. Results showed that parentification was a reality for many refugee youth; because refugee youth picked up the host country’s language faster and developed social relationships faster than did their parents, they found themselves becoming “resettlement champions” (p. 24) for their families by taking on tasks such as serving as interpreters for their parents or other older family members. While the focus of the current study is on refugee parents, these findings do have important implications for the parent-child relationship. As children have to take on more responsibility, this may upset the equilibrium of the family and cause strain in the parent-child relationship. Parental Self-Efficacy What is less clear is how refugee migration stress affects parents’ sense of self-efficacy in their parent-child relationship. Parental self-efficacy
refers to the degree to which a parent feels
themselves to be capable of effectively parenting their child (Coleman & Karraker, 1997; Jones & Prinz, 2005).
De Montigny, & Lacharité (2005)
describe
parental self-efficacy as
“beliefs or judgements a parent holds of their capabilities to organize and execute a set of tasks related to parenting a child”
(p.
390). This can entail being able to effectively deal with their child’s negative behaviors. Parental self-efficacy can be influenced by many factors. Coleman and Karraker (2005) suggest that parental self-efficacy is influenced by both parents’ experiences prior to having children and current factors. Some current factors include “child factors” (such as child’s age and temperament) “current ecological conditions” such as income, neighborhood quality, and social support, and “parental factors [such as] parental perceptions of stress and psychological health” (p. 75). Parental self-efficacy is related to parental competence, which refers to observable appraisals of successful parenting behaviors, such as warmth and sensitivity (Jones & Prinz, 2005). In a study of just over 1100 parents of children aged 0-4 years old, researchers sought to understand
the relationship between parental
fatigue,
parental self-efficacy,
and
parenting behaviors
(measured as
parental
warmth and hostility; Chau & Gallo, 2015). Results showed that parental self-efficacy
mediated the relationship between parental fatigue and parental warmth;
that is, parents who scored high for fatigue were found to still display warmth toward their children when they had high parental self-efficacy. Other studies show that parental self- efficacy can lead to a decrease in postpartum depression (Kohlhoff & Barnett, 2013; Leahy‐ Warren, McCarthy, Corcoran, 2012). While there were no studies within refugee communities that related to parental self- efficacy at the time of this literature search, I hypothesize that within the refugee community, parental self-efficacy may be reduced by the cumulation of pre-migration, migration, and post- migration stress. Further, there could be a parent-role disruption or a sense of reversal as children take on more responsibility in the post migration environment, which may have profound impacts on various areas of family functioning, such as problem solving, communication, and maintenance of the roles. Refugee Migration Stress and Family Functioning A large and critical part of the gap in the stress literature as it relates to refugees is how this stress manifests through family functioning. Family functioning is a pivotal factor in families maintaining equilibrium and homeostasis (Bowen, 1978; Epstein et al., 1983). Research indicates that families operate in six of the following relational dimensions:
roles, affective responsiveness,
communication,
affective involvement, behavior control,
and problem solving
(Epstein et al., 1983).
Explorations of family function dimensions can be clinically useful for identifying dysfunctional or problematic patterns (Epstein et al., 1983; Ridenour, Daley & Reich, 1999). Studies involving refugees show that resettled refugee families whose migration experience is characterized by negative or traumatic events are at increased risk for family discord and dysfunction (DeHaene et al., 2010). But how does this discord or dysfunction look? Bjorn et al., (2013) conducted a small qualitative case study of three refugee families from Bosnia-Herzegovina using transcripts from family therapy session to analyze how families struggled. Bjorn and colleagues found three main themes emerged:
everyday life at home, influence of war on everyday life, and the new life.
Another study
of
nuclear family units looking at the prevalence of anger and PTSD found that anger directed toward family members was common, with anger being mostly directed at children within the family (Hinton et al., 2009). Most studies done in this area focus on largely on dyadic relationships within the family as their sample (for example marital and parent-child). However, researchers in the field of family development have long advocated for a systemic approach to the conceptualization of problem family functioning (Minuchin & Fishman, 1981; Bowen, 1978). Parental perceptions of family functioning, as a result, become critically important to collect and analyze as it relates to how they view the health of their families and what specific family-level issues they grapple with. As it relates to outcomes of families under stress, Boss (1988) writes that families in crisis can be characterized by “the inability of family members to perform usual roles and tasks, the inability to make decisions and solve problems, the inability to care for each other in the usual way, and a focus shifting from family to individual” (p. 50). With this in mind, the current study aims to explore family functioning as it relates to the domains of family decision-making processes, problem-solving, and communication. Formal and Informal Social Support What role does social support play within the resettled refugee community, and during their migration? Is the social support during the migration period (in a camp for example) different from the support received after resettlement? How might these forms of support influence parenting and family function? Within the non-refugee literature, we can go as far back as Crockenberg (1981)’s landmark mother-infant attachment study to see just how critical strong social support can be for parents facing personal and social challenges. Crockenberg (1981) sought to, in part, explore whether availability of social support for mothers can lead to more responsive mothering, especially in the context of a stressful parenting environment. Her sample was 48 infant-mother dyads in two parent households (46 Caucasian, 2 Asian-American) who were assessed for the nature of their attachment relationship with their infant at 3 months and 12 months, and who were also assessed for their degree to which they felt social support made an impact in their wellbeing. A social support interview was conducted with mothers when their baby was 3 months old, with social support was measured as “an assessment of the affective and material assistance experienced by the mother in her mother role, relative to the stresses experienced by her” (p. 859). Crockenberg found that social support was the best predictor of the development of a secure
attachment. Low social support was associated with high resistance
and
avoidance, and
overall
with
an
anxious attachment
style between parents and their children. Social support has been explored in other contexts as well. Oravecz, Koblinsky, and Randolph (2008) conducted a study about how social support among a sample of African- American families that found that a greater level of informal social support provided to parents (in the form of help from family members, friends, and acquaintances) was a significant predictor of children’s positive social skills. Sprang et al. (2013) also found that parents who lacked social support were also at risk for parenting stress. The above studies highlight the idea that parenting is not a singular, isolated process that happens in a vacuum; the context is important too. The more supported parents feel by those in their community, the more competent they feel and the better outcomes for their children. While all of the above studies illustrate the critical role of positive social supports for parents facing challenges, these populations are vastly different than refugees, who encounter much more deleterious experiences. Moving from place to place and experiencing language barriers, coupled with trauma-laced migration experiences calls for researchers to explore the role that social support plays in refugee families. With this in mind, we can turn to look at social support within the refugee community. Social support can have an important role in alleviating some of the stresses that refugee parents and families face. Renner et al.’s study examined the role of
social support as a moderator
for
acculturative stress among
Chechen
and
Afghan refugees and
asylum seekers
in Austria. Participants were 63 refugees/asylum seekers who were administered the Harvard Trauma Questionnaire (HTQ) and sorted into an intervention group or control group. Those in the intervention group were set up with social support services in the form of a “sponsorship” by a family who volunteered to be responsible for helping the refugee adult acclimate to life in Austria for 6 months. Results of the study showed that those refugees who had a history of trauma and received the intervention (sponsorship) benefitted immensely from it; they experienced a decrease in depression and anxiety symptoms when compared to the control group. Further, women benefitted from it more than men, possibly due to men’s reluctance to seek out help and social support in general (Renner et al., 2012). Social support clearly plays an important role in successful parenting (Abidin, 1992). But its potential role in refugee families should be further explored. In particular, the roles of informal versus formal social supports are not well documented in the literature on refugee families, making it difficult to parse out the influence of social structures and systems that surround these families. The current study provides a detailed assessment of the contributions of a wide variety of types of social support, which could guide future intervention efforts. CHAPTER IV: RESEARCH METHOD Overview of Chapter In this section, I discuss the rationale for the methodology for the current study and outline the methods for data gathering and data analysis used to answer the three following research questions: 1. How do newly resettled refugee mothers experience the refugee migration process and how do they interpret their experiences? 2. What family outcomes are most salient to newly resettled refugee mothers as a result of the totality of their migration experience? 3. What social support systems (either formal or informal) do newly resettled refugee mothers cite as most important, most needed, or most helpful? To explore the links between refugee migration stress and these parenting and family functioning phenomena in-depth, I used a phenomenological study design (Spiegelberg, 1960; Cohen, 1987). By using qualitative approaches to data collection (semi-structured interview technique; Rubin & Rubin, 2012) and
data analysis (Interpretative Phenomenological Analysis (IPA); Smith
and
Osborn, 2008),
I shed light on critical and salient aspects of the parenting and family functioning experiences of refugees in Roanoke, Virginia, with the hope of helping family researchers and policy-makers develop a deeper understanding of some of the issues refugee parents face. The Qualitative Paradigm Qualitative research is a form of research that values in-depth inquiry of the human experience (Lincoln and Guba, 1985). Some key components of qualitative methods include a focus on emerging design, open-ended data collection, an emphasis on participant views and researcher bias, and an inductive data analysis process (Daly, 2007). At the core of the qualitative research paradigm is a process that seeks to understand and explain complex experiences not adequately explained by a quantitative design (Patton, 1990). The inductive nature of the qualitative paradigm lends itself well to the deeper and more nuanced exploration of people’s experiences (Lincoln, Lynham, & Guba, 2011). Open-ended data collection, for example, allows researchers to collect details about people’s lives in ways that quantitative researchers cannot, because when people tell their stories in their own words or in a way that makes sense for them, they are engaging in a process of meaning-making (LaRossa, 1995). It is this process of meaning-making (the process by which people make sense of or interpret their experiences) that adds an extra layer of richness not always seen in the quantitative paradigm (LaRossa, 1995; Daly, 2007). Among the refugee literature, some researchers have successfully used the qualitative paradigm and qualitative methods to conduct research to better understand refugee experiences. Björn, Gustafsson, Sydsjö, & Berterö, (2013), for example, used qualitative approaches to explore the “complexity” of family relationships among Serbian and Bosnian refugees in resettled in Sweden to “create useful guidelines for professionals in the health and social welfare sector” (p. 2). Hynie, Guruge, & Shakya (2012) used focus groups and interviews to explore the role of acculturation gaps between Afghan, Karen, and Burmese refugee parents and children resettled in Toronto, Canada in the development of family conflict and distress. In a study of Burmese resettled youth in Australia, Koh, Liamputtong, & Walker (2013) explored changes in parental expectations across pre-, during, and post-migration periods by using “semi-structured in-depth interview techniques” (p. 297). These examples illustrate both the advantages and the need for qualitative methods and paradigms in refugee research. Painting a detailed and nuanced picture of people’s lived experiences is what these examples have in common, and qualitative research serves to deepen our understanding of issues within the refugee community. Phenomenology Phenomenology is an approach to
research that aims to
explore
how people make
meaning
of their
lived experiences (Cohen, 1987). Smith (2004) writes that, “traditional phenomenology has focused on subjective, practical, and social conditions of experience” (p. 3) and how people interpret those experiences. The phenomenological paradigm also asserts that there are commonalities between the lived experiences of people (also called intersubjectivity), and that these commonalities in experience are the phenomena under study (Starks and Trinidad, 2007; Cohen, 1987). Historically, phenomenology is grounded in European philosophy of the 1800s and 1900s and came about in three phases during the 19th and 20th centuries (Spiegelberg, 1960). The first phase, also called the preparatory phase, was notable for “the idea of describing and clarifying before undertaking causal studies” (Cohen, 1987, p. 32). Phenomenologists during this period focused heavily on subjective reality on the part of the individual “value of inner perception” (p. 32) at a time where positivism was the dominant movement of the time and concerned with the objective study of the human condition (Cohen, 1987). The second phase, known as the German phase, incorporated a deeper scientific emphasis of the study of inter-subjectivity, which emphasized a common shared experience (Cohen, 1987). This phase was well-known because of its influence by German philosophers Martin Heidegger and Edmund Husserl. Husserl coined the term anschauung, which refers to the use of intuition in “looking at” something under study. This intuition, according to Cohen (1987) is logical insight based on careful consideration of representative examples” (p. 32). This anschauung serves as the basis for framing the role of the researcher in phenomenology, which I discuss later under the section on bracketing. Husserl also discussed the importance of Lebenswelt, or life- world, which refers to lived experiences. Husserl argued that phenomenological study is needed due to the nature of Lebenswelt; it is not readily accessible in the everyday experience of people, therefore, it should be uncovered through in-depth study (Cohen, 1987). The third phase of the European phenomenological movement, developed in France, was characterized by an existential approach also known as phenomenological existentialism, which argued people are themselves the authors and directors of their experience and that intentionality is at the core of consciousness or “being” (Cohen, 1987). One notable French philosopher during this stage argued that phenomenological approaches to examining people’ experiences were superior to positivist approaches because of the ability to gain “valuable insights” about the nature of people’s experiences (p. 34). As illustrated through its history, phenomenology lends itself well to the study of people’s experiences because of its focus on subjective experience of reality, and focus on the meaning that people assign to those experiences (Spiegelberg, 1960; Creswell, 1997; Groenewald, 2004). Therefore, I chose phenomenology as the overarching paradigm within which to explore refugee parents’ experiences with stress during their migration experiences. It is a paradigm that facilitates understanding the first-person voice in regards to individual trauma experiences; that attempts to understand the lived experience of change in one’s parent-child relationship or understanding of one’s self as a parent; and one that gives voice to parents’ experiences with change in the overall family relationship as a result of the migration. Data Collection In this section, I discuss the steps I took to collect data for this study, beginning with how I determined inclusion criteria and speaking at length about my two-phase recruitment effort and development of the interview protocol. The section ends with a step-by-step description of my data collection procedure. I also give a brief overview of refugee resettlement mechanisms and processes in the US. Overview of Refugee Resettlement In the United States, refugee resettlement is the legal and financial responsibility of the United States government. This legal basis for refugee resettlement came into law with the passing of the Refugee Act of 1980, which set up the Reception and Placement program under the State Department for initial resettlement of refugees, and
which created
the
Office of Refugee Resettlement
under
the Department of Health and Human Services
for long-term administration of resettlement activities (US Department of State, 2019). Once refugees have been granted refugee status by the UNHCR in a host country abroad, it is the responsibility of the US government to fund resettlement activities, and so in order to streamline services for refugees, the US government works together with non-governmental organizations and affiliated partners such as charity organizations to administer funds and resettle refugees. Participant Inclusion Criteria Eight refugee mothers were recruited for this study (six from Democratic Republic of Congo (Congolese) and two Burundian). The rationale for focusing this study on mothers was primarily to ensure that constructs being measured and (subsequent results) would be an accurate representation of lived experiences under the phenomenological paradigm, which calls for samples to be as homogenous as possible in order to match people’s experiences as closely as possible (Smith & Osborn, 2008). A second reason for a focus on mothers is that several of the constructs under scrutiny, (e.g. parent-child, family function, and relationships with formal and informal supports) are well documented in the non-refugee literature in the context of mother- child interactions (Ammerman et al., 2008, Ainsworth, 1972, Crockenberg, 1981). With this in mind, participants had to be refugee mothers resettled in Roanoke within the past five years who were parents of children aged between 5-17 years at the time of data collection, because I wanted mothers to be able to draw from recent experiences in light of resettlement. Further inclusion criteria included having at least one child that was with the refugee parent during their migration experience (i.e. from the time that they left their country of origin to the time they resettled permanently in the US) because the current study seeks to explore changes in the parent-child relationship over time. Refugee parents could be from any country represented in the refugee population in Roanoke and could be married or unmarried. Sampling and Recruitment of Participants I divided my sampling and recruitment efforts into two phases. Phase I involved the recruitment efforts I undertook alone prior to connecting with the interpreter who helped me recruit mothers. Phase II involved my recruitment efforts that I undertook with the help of the interpreter. Phase I. IRB approval was granted on January 24, 2018 (Appendix E). Participants were recruited through Commonwealth Catholic Charities (CCC), a government grant sponsored charity organization that resettles refugees in the Roanoke area. CCC is the only refugee resettlement agency in Roanoke and resettles all refugees in this area. Because this study involved newly arrived refugees, I needed to recruit translators (to translate the recruitment flyer into Arabic) and interpreters (to help me conduct interviews). I chose to have the flyer translated specifically into Arabic because at that time the majority of refugees resettled in Virginia came from Arabic-speaking countries (Virginia Department of Social Services, 2019). To start, I contracted the translation services at CCC to translate the flyer into Arabic. Then, I began recruiting participants by putting up flyers (English and Arabic; Appendix A and Appendix B respectively) in the CCC entryway and by asking CCC case workers to spread the word about the study to their respective families who met criteria. I had my telephone number and email address listed on the flyer. The flyer let potential participants know that they would be compensated with a $50 Walmart gift card for their participation in the study and that their interviews would be audio-recorded. The flyer also let participants know that they could expect confidentiality of their interview responses. To increase the chances of finding participants I also put up flyers at local Kroger and Food Lion stores in Roanoke, Va., Salem, Va., and Blacksburg, Va., in case there were refugee families who did not frequent the agency often. Phase II. As a result of my efforts of putting up flyers, I connected with a CCC interpreter who called me when he saw the flyer at a Starbucks in Salem. The interpreter, Venant, was a Burundian native who came to the US as a refugee in 2004 and subsequently became a naturalized US citizen. As a result of his background as a Burundian refugee and familiarity with Burundian and Congolese women around Roanoke and Salem (he spent time in Congo during his teen years), recruitment went much smoother than anticipated. He was able to spread the word to refugee mothers he knew within the community of refugees he was familiar with who were refugees from Congo and Burundi. He was also a married father with three children of his own, which helped when interviewing for the parent-child and family functioning because he could contextualize the questions. The resulting sample of mothers from East and Central Africa is in line with a qualitative phenomenological paradigm, which calls for samples to be as homogenous as possible in order to match people’s experiences as closely as possible (Smith & Osborn, 2008). It is also in line with a purposive sampling strategy (Patton, 1990). The goal of purposive sampling is to “select information-rich cases for in-depth study” but to do so in a way which you select for a specific characteristic among your sample or for a specific objective of your study (Patton, 1990, p. 169). Because I was largely interested in the role that trauma plays in the development of family stress and had background knowledge about experiences of African refugee mothers in camps from my time as a family mentor volunteer at CCC, I knew this sample was information rich and fit the specific objective of the study. So, while I did not set out to have a sample of just east and central African mothers, purposive sampling for this study fulfilled one of the key philosophical requirements of a phenomenological sample: homogeneity for the development of a coherent narrative of lived experiences of this particular group. Partly as a result of connecting with Venant, snowball sampling was very effective in this community. Snowball sampling refers to the process by which participants of a study spread the word about the study to friends and acquaintances, and subsequently recruit new participants (Patton, 1990). As I anticipated, refugee mothers who participated in my study told other refugee mothers about it, and those refugee mothers contacted the interpreter and expressed their interest in participating in the study. Word-of-mouth recruitment was in the end how I gained most of my participants. My first interview took place on February 19th, 2018, just under a month after I obtained IRB approval (the last interview took place March 22, 2018). Development of Interview Protocol In interviewing for a phenomenological study, according to Starks and Trinidad (2007), the participant “describes their experience [and the] interviewer probes for detail [and] clarity” (p. 1373). Thus, questions should be “directed to the participant’s experiences, feelings, beliefs and convictions about the theme in question” (Welman & Kruger, 1999, p. 196). In keeping with this frame, questions were designed to be open-ended and follow a semi-structured format. Semi-structured interviews are beneficial in that they allow the researcher to be flexible in directing the interview based on responses from participants (Rubin & Rubin, 2012). I also employed a technique called funneling, which is common among qualitative researchers who engage in interpretative phenomenological analysis (Smith & Osborn, 2008). Funneling involves asking participants a general question about their feelings on a topic, and then following up with specific questions that probe further (Smith & Osborn, 2008). Demographic questions. An oral demographic survey was administered to each participant
at the
beginning
of the interview
session.
Participants were asked
to answer
questions about their
age, marital status, number of children, country of origin, length of time in the US, and length of time in a camp. Questions about refugee experiences. The first question of the protocol involved having the participants give me some background on why and how they became a refugee, and what that experience was like for them and for their family. I asked them questions like “Can you tell me about your experience as a refugee?” or “What led you to flee your home country?” I was also interested in details about their living conditions such as what country they fled to, and particularly whether they were in a camp and if so, for how long. Questions about refugee migration stress. The next part of the interview focused on questions about stress related to the mothers’ refugee experiences. In this part of the interview, I wanted to get a sense of how refugee parents perceived that their refugee experiences have led to overall feelings of stress in their lives. To elicit this, I asked mothers to rank what experiences were the most stressful on a scale of 0-10 with 0 being the least stress and 10 being the most stress. I also asked mothers to tell me whether any stressful experiences have continued for them and their family in the US or whether there are new stresses that they or their family are facing now that they are living in Roanoke. Questions surrounding stress related to resettlement in Roanoke are key to parsing out whether the stress is related to the resettlement process or their broader experience, and those questions also give me the opportunity to explore what aspects of the refugee experience are more or less stressful than others. Questions about how refugee migration stress relates to individual, dyadic, and family outcomes. The next part of the protocol involved getting the participants to talk about how the stress they discussed above has affected them in the three domains introduced in Section II.A of this proposal (i.e. individually, dyadically, and family functioning). Specifically, I asked ask refugee mothers how they perceive that their refugee experiences have affected them individually in their ability to cope and adapt with current challenges. With regard to their parent-child relationship, I asked refugee mothers to talk about their relationship with their child/children. I was careful to begin this section with questions as open- ended as possible in order to elicit a discussion of mothers’ lived experiences. If mothers struggled to answer the questions, then I sensitized mothers to some concepts, like how they react when their child gets upset. I also asked mothers how self-efficacious they feel as parents since they became refugees and whether those feelings have changed since before they became refugees. To elicit this, I asked mothers to compare their parenting with that of other parents they know. Participants were prompted to talk about parenting practices that illustrate their sense of efficacy as parents, such as the degree to which they feel their child listens to them or follows their expectations. I ended this section by asking refugee parents to tell me about what they think of their overall relationship with their child or children (i.e. whether they believe it is a positive relationship). Lastly, in this part of the interview refugee parents were asked to describe their perception of family functioning as it relates to problem solving, communication, and how the family makes decisions together. Again, I first started by asking a general question about how they perceive their families have fared as a result of the stress they experienced across their migration, before I moved on to asking about specifics of their family function. Questions about
formal and informal social support systems. The
last part
of the
interview protocol involved asking mothers to describe their experiences with formal and informal social support systems since they have been permanently resettled in Roanoke. Specifically, I asked refugee parents to tell me what resources were available to them and to their family, who among their social circles have been helpful (e.g. family, friends, others), and whether there are specific services that have been more helpful than others. In each of the above parts of the interview, I asked participants to give examples to further illustrate their experiences, because these examples can paint a deeper and more nuanced picture of the experience of refugee parents in the individual, parent-child, and family domains. For a full description of the interview protocol, including script and questions, please see Appendix C. Procedure I conducted all interviews at the refugee mothers’ home. Again, Venant, the CCC interpreter, set up my first interview. He knew the mother from having interpreted for her through CCC and knew she fit the criteria for the study. For the second and subsequent interviews, mothers I had already interviewed had shared with their friends about their experience with me, and interested refugee mothers contacted Venant to set up a time. Venant would then contact me to check if that time worked. Before each, Venant and I would review the protocol to clarify any questions he had. Step 1: Verbal consent process. All interviews were conducted in the presence of the interpreter. Because low education and literacy is one of the potential barriers to conducting research with refugee families (Gabriel et al., 2017), consent for participation was obtained verbally at the beginning of each interview session (see Appendix C for full verbal consent script). I introduced myself to mothers and explained that I was a student at Virginia Tech conducting research on refugee mothers and their families. As I read from the verbal consent script, the interpreter interpreted what I said. I would pause at certain places and ask the mothers whether they understood and if I could continue. If they said yes, I continued. If they said no, I thanked them for their time and ended the interview. I also explained to mothers
that they
were
not
obligated
to answer questions they
did
not
want
to answer,
and once they began interview (the portion after the verbal consent was given) they would still receive their gift card even if they decided they wanted to stop. Mandated reporting. As part of the verbal consent process, I let mothers know my duty to report any instances of child abuse or neglect that they might tell me about during the course of the interview.
Section 63.2-100 of the Code of Virginia defines child
abuse and neglect
as
one or more of the following: ?
Causes or threatens to cause a nonaccidental physical or mental injury; ? Has a child present during the manufacture or attempted manufacture of a controlled substance or during the unlawful sale of such substance where such activity would constitute a felony violation; ? Neglects or refuses to provide adequate food, clothing, shelter, emotional nurturing, or health care; ? Abandons the child; ? Neglects or refuses to provide adequate supervision in relation to a child’s age and level of development; ? Knowingly leaves a child alone in the same dwelling with a person, not related by blood or marriage, who has been convicted of an offense against a minor for which registration is required as a violent sexual offender; or ? Commits or allows to be committed any illegal sexual act upon a child, including incest, rape, indecent exposure, prostitution, or allows a child to be used in any sexually explicit visual material.
I informed mothers verbally during the consent process in the “Risk and Benefits” section of the informed consent (see Part I of Appendix C) that statements related to abusing a child necessitates breaking confidentiality, and I am required by law to report the individual to relevant local authorities. I also advised them that they should consider the consequences should they decide to participate if there was a chance they might make such a revelation. According to the Virginia
Department of Social Services
website,
I
can
report
cases
of child abuse
and
neglect
via
the Child Abuse and Neglect Hotline at 1-800-
552-7096, seven days a week, 24 hours a day.
Step 2: Interview. Interviews lasted between 41 minutes and an hour and 23 minutes (average time in minutes: M=59.38; table 1 summarizes interview schedule and length of times of interviews). For the interview portion of the session (i.e. demographic survey and interview), I read all questions aloud to the participant while Venant interpreted what I said. In most cases, I read the questions in full while Venant listened and waited for me to finish before he repeated the question. He then listened to the responses of the mother and interpreted back to me what the mother said. Recalling or recounting negative experiences associated with being a refugee may leave participants feeling that they need to talk to a mental health professional. Therefore,
at the end of each
interview
I
gave mothers
a list of
mental health resources in the Roanoke area (Appendix D) that are accessible to them should they feel the need to seek those as a result of the interview. Step 3: Post-interview memoing. I did not take notes during the interview session, as I wanted to be able to devote my full attention to the participant and the stories they were telling me. As soon as the interview session concluded, however, I jotted down any thoughts or notes I wanted to remember and included those in a memo about each interview later the same day. Groenewald (2004) defines memos as “the researcher’s field notes recording what the researcher hears, sees, experiences and thinks in the course of collecting and reflecting on the process” (p. 48). Memoing is a common research practice among qualitative researchers that can serve as an additional source of data from which the researcher can draw inferences, hypotheses or conclusions about their study (Groenewald, 2004; Lincoln & Guba, 1985). Memoing helps to track the researcher’s thoughts about the data, track their own reactions to participants and their stories, and track how they are interpreting the data in real time (Lincoln & Guba, 1985). Again, I wrote memos after each interview and continued to do so during the analysis process as well. Step 4: Data storage. All interviews were recorded on my personal iPad, and then uploaded to my personal laptop immediately after the interview (if I had two interviews that day, I uploaded both when I arrived home). Both my iPad and my personal laptop are password protected, and only I have access to both devices. Audio files are kept in an encrypted folder on my personal laptop. Below is a table summarizing the dates and lengths of each interview. I identify the mothers by the order in which they were recruited and subsequently interviewed. Table 1 Summary of Interview Schedule and Interview Lengths Interview Date Interview Length (in minutes)* Mom 1 February 19, 2018 65 Mom 2 February 20, 2018 43 Mom 3 February 21, 2018 48 Mom 4 February 26, 2018 70 Mom 5 February 27, 2018 41 Mom 6 February 27, 2018 58 Mom 7 March 22, 2018 83 Mom 8 March 22, 2018 67 Note. *M=59.38 minutes Data Analysis In this section, I introduce my data analysis approach and detail the steps I took to reach subsequent findings. I also discuss bracketing and the researcher role and reflect on lengths I took to ensure that findings were free from researcher bias. I end the section by detailing the process through which I maintained rigor throughout the study. Interpretative Phenomenological Analysis Participant responses were analyzed using an interpretative phenomenological analysis approach (Smith & Obsorn, 2008; Smith et al., 2009; Smith, 2011). Interpretative phenomenological analysis (IPA) is an approach to data analysis that
explores how people make sense of their
lived experiences
and
is one
of
the notable analytical approaches used within the phenomenological framework (Smith & Osborn, 2008). At its core, IPA seeks to build a narrative of a given person’s or group of people’s experiences, and does so by gathering and synthesizing participants’ views, thoughts, and ideas on a given topic or subject (Smith & Osborn, 2008; Smith 2011). IPA also uses the interpretations of the researcher, based on participants’ words and views, to help build coherent narratives of people’s lived experiences (Smith & Osborn, 2008; Smith, 2011). According to Larkin and Thompson (2012), the outcome of an interpretative phenomenological analysis should be successful in illuminating two key elements: giving voice and making sense. Starks and Trinidad (2007) argue that the successful outcome of an interpretative phenomenological analysis is that it the illuminates the “essence” of people’s lived experiences. IPA employs a multistep and deliberate approach to reach this goal, which I discuss later in this section. Bracketing. The researcher’s role in a phenomenological framework is an important one. Early phenomenologists were concerned with suspending the concept of a common reality or objectivity as much as possible, so that the participant’s reality (or subjectivity) could be the focus of study (Spiegelberg, 1960). As Larkin and Thompson (2012) state, the outcome of an IPA study is to give voice to participants and help make sense of their experiences. Giving voice allows participants an opportunity to give an account of their lived experiences, while making sense involves an interpretative, iterative process on the part of an engaged researcher. In IPA, this interpretative and iterative process involves having the researcher check his or her biases and assumptions, which can be achieved through a process called bracketing (LeVasseur, 2003; Tufford & Newman, 2012). Bracketing is the process by which the researcher acknowledges and subsequently sets aside his or her “personal views and preconceptions” about the data in order to come to accurate and unbiased conclusions about the data (Groenewald, 2004, p. 50). Therefore, in an IPA, the researcher has the unique task of both engaging his or her biases and assumptions from the data and guarding those biases and assumptions from influencing the data. But how is this bracketing achieved? Bracketing is done in a number of ways, and it is important that researchers engage in bracketing during both the data collection and the data analysis processes (Chan, Chien, & Fung, 2013). Similar to reflexivity in general qualitative terms, Chan et al., (2013) suggest engaging in self-reflexive exercises, such as maintaining a researcher journal where the researcher notes his or her thoughts and feelings about any aspect of the topic under study. Reflexivity helps the researcher bracket his or her own personal thoughts and views by first helping to acknowledge their existence, and then set them aside so as to not get in the way. For example, I acknowledged that some of my experiences migrating to the US as an immigrant may be similar to those of my participants prior to an interview with a refugee mother, however I had to set those aside because I did not want to color what the participant said with reflections of my own experiences. Bracketing can also be done by listening to and/or reading transcripts repeatedly in order to familiarize oneself with the participant’s words (Chan et al., 2013). The more crystallized the participants’ words are, the less likely the researcher’s personal biases and preconceptions are to inaccurately influence the outcome of the data. Throughout this section, I make note of specific and general places where I engaged in bracketing. Transcription. After all interviews were completed, I began transcribing interviews. I transcribed all interviews myself. In IPA, interviews are transcribed in detail; “the level of transcription is generally at the semantic level: one needs to see all the words spoken including false starts; significant pauses, laughs and other features also worth recording” (Smith & Osborn, 2008, p. 65). In determining the significance of the what to transcribe and what not to transcribe, the researcher judges the degree of relevance of the material to the broader topic under study. So, if a mother in this study paused uncomfortably after being asked a question about their experiences in a refugee camp and how they believe those experiences impacted their family, the pause was noted on the transcript. (Note: I bracketed here by being the transcriber and therefore further familiarizing myself with the participant’s voice and words). Analysis. My approach to analysis, in line with the IPA approach, was to analyze transcripts with the goal of highlighting key themes expressed by participants about their lived experiences in the individual domain, parent-child domain, and the domain of the family overall. Smith and Osborn (2008) write that in an IPA analysis, what the researcher is trying to do is to delve into the participants’ accounts of their experience to give meaning to their accounts; “…meaning is central, and the aim is to try to understand the content and complexity of those meanings rather than measure their frequency” (p. 66). The researcher gives meaning by
engaging in an interpretative
process
with the
transcripts; it is
the researcher
who actively helps
to
bring about meaning to what the participants say. This is done through a multi-step process that involves
looking for themes in the first case, connecting themes,
and
continuing
analyses
with other cases.
Analysis software. I used a qualitative analysis software called MAXQDA to analyze the transcripts. MAXQDA allows the user to upload transcripts as word documents and manually analyze by highlighting and labelling text. The labeled text can then be organized into similar groupings under main headings. MAXQDA also allows the user to type and save memos into the document as comments, so that the researcher can keep track of their thoughts throughout the analysis process.
Looking for themes in the first case. The first
step in an IPA approach is to read and re- read through the first transcript, or case, to familiarize yourself with the participant’s account (Smith, Flowers, & Larkin, 2009). In my case, the goal of this exercise was to become comfortable with the transcript and the participant’s words. This process involved making annotations and notes on one margin about my interpretation of what the participant was saying, based on my own insights and insights drawn from theoretical and empirical literature (Smith, 2011). I did this part by hand. This was also an opportunity to make note of the participant’s use of language (i.e. a certain phrase repeated) and to start developing insights into what ideas or responses appear to be more salient than others. Again, the goal of this part
of the analysis is for the researcher to
familiarize herself
with the data
and begin
to
develop
insights
into it. After going through the transcript a few times (an opportunity for bracketing), I then read through the transcript with the goal of highlighting emergent themes (Smith & Osborn, 2008). Emergent themes are themes that appear salient and frequent and are noted on the opposite side of the margin. Specifically, I was looking to highlight emergent themes in participants’ responses that address questions asked in the protocol. These themes are emergent in nature because they are very preliminary and are not yet integrated or confirmed by a recheck of the transcript.
It is important to note, as Smith
and Osborn
(2008)
state,
that
just because a theme appears frequently does not mean it is more important or significant than a theme that appears once or twice. The same goes for themes which may appear frequently across various participants’ transcripts (as opposed to just in on or two transcripts). For example, a refugee family who stayed in a certain camp may have a migration experience characterized by traumatic events in a camp, and this theme may come up repeatedly in a sample overrepresented by refugee parents from that camp. If, however, there are a few participants from other camps whose transcripts are void of negative experiences in a camp but instead speak of positive ones, then those themes emerging from those transcripts should also be noted and given equal attention, especially if they offer an explanation of how stress processes differ among families in differing contexts and environments. After reviewing the transcript for emerging themes, I transferred the themes to MAXQDA, my computer coding software. I essentially repeated what I did by hand but on the computer: I read through the transcript and highlighted the text that corresponded to the theme I generated, and then typed in the theme associated with that text. Connecting themes. After compiling a list of emergent themes in chronological order (MAXQDA did this for me), the next task in an IPA according to Smith et al., (2009) is to attempt to connect the themes logically and theoretically as they relate to the overall story being told about the participant’s experience. Connecting themes involves first “clustering” similar or related themes. This is done by grouping them into clusters that make sense for the researcher while also corroborating what the participant says. This process is iterative as the researcher needs to constantly
check back to the transcript
in order
to make sure
that
the
new grouping of themes is consistent with the participant’s words and has a logical basis in answering the overall research questions (this is also a good technique to help with bracketing). Still working with the first case, I did this in MAXQDA by moving the themes around in the code list. I would essentially drag the themes up and down the list on the left-hand side of my screen until I came up with a narrative that that told this mother’s story from the time she arrived at the refugee camp until the time she arrived to the United States. This process may also give rise to “superordinate themes”, which are consolidated themes that organize the clusters of the emergent themes (Smith & Osborn, 2008, p. 74). Superordinate themes may, for example, consolidate two emergent themes relating to loneliness in a refugee camp and loneliness post-resettlement into one overarching “loneliness” themes. It is important to note that all of the analyses until this point (i.e.
looking for themes in the first case
and
connecting themes)
are done with the single first case. In the current study, I used the first mother’s transcript to create emergent themes and superordinate themes. Continuing
analysis with the other cases.
Next, using
the
list generated
from the first transcript
to connect themes, I analyzed the remaining transcripts with the goal of connecting existing themes to the new transcript, while also incorporating new emergent themes as they came up, and creating new superordinate themes if the need arose. Smith et al., (2009) suggest that once analysis of all cases is complete, a final list of superordinate themes should be generated with accompanying representative quotes from participants for each of the emergent themes. Rigor In qualitative research, rigor refers to the degree to which a study’s methods adhere to the philosophical underpinnings of the study’s stated methodology (Guba, 1981). Rigor
is a broad term that encompasses a
number
of
concepts
and
procedures that researchers must ensure in order to achieve a level of trustworthiness about their research (Guba, 1981). The more researchers can demonstrate a close fidelity to the “philosophical perspectives” of their chosen paradigm, the more rigorous the findings are said to be (Guba, 1981; Meyrick, 2006; Krefting, 1991). It is important that researchers maintain rigor in all steps of the research study, including in their methods, sampling, data collection, and results (Meyrick, 2006). Rigor largely contributes to the idea of trustworthiness. In qualitative research, trustworthiness refers to the process by which the researcher ensures that their results are robust and believable (Lincoln and Guba, 1985; Patton, 1990). Some strategies for achieving trustworthiness include searching for negative cases (Patton, 1990), triangulation, peer debriefing (Guba, 1981; Carter et al., 2014), and member-checking (Sandelowski, 1993). Within the qualitative paradigm, researchers are concerned with four key measures of trustworthiness under which the above strategies fall. These measures are
credibility, transferability, dependability, and confirmability (Guba, 1981; Lincoln & Guba, 1985).
Credibility
In
qualitative research, credibility
refers to the degree to which results of
a
study
are valid or true; that is, whether the results are truly representative of what the participants said (Guba, 1981). Credibility tries to get at what would be the equivalent of internal validity in quantitative research (Guba & Lincoln, 1989). Strategies suggested by Lincoln and Guba (1985) for ensuring credibility in a qualitative study include prolonged engagement with, and persistent observation of the study population, triangulation, member-checking, negative case analysis, and peer debriefing. For this study, I primarily used peer de-briefing as my strategy to improve credibility. Peer de-briefing is the process by which a person who is familiar with the data provides a sort of “checks and balances”, by holding the researcher accountable for the research process, throughout the research process (Guba, 1981). A peer de-briefer, according to Creswell and Miller (2000) “plays devil’s advocate, challenges the researchers’ assumptions, pushes the researchers to the next step methodologically, and asks hard questions about methods and interpretations” (p. 129). For this study, my committee chair, Dr. Christine Kaestle, served as my peer de-briefer. Although we are not “peers” in the conventional sense, she is familiar with my sample as a result of working closely with me in developing this study. I also have a prolonged engagement with this particular study, having been a volunteer family mentor during the summer and fall of 2016. I believe both of these contributed to the rigor of this study. Transferability In qualitative research, transferability refers to the wider applicability of the results of a study. Qualitative researchers view transferability as a way to show that their findings are generalizable (or transferable) to populations outside of their study population (Guba, 1981; Lincoln & Guba, 1985). Transferability is achieved by engaging in theoretical and/or purposive sampling and by using “thick description”. Thick descriptions are defined as in-depth accounts of the sample under investigation. Thick descriptions give rise to more detail about the sample that can then be used to make more accurate comparisons between the study sample and the broader population (Guba, 1981). By engaging in purposive sampling, I ensured that the study is truly representative of the phenomenon under study (refugee stress in families), which allows for in-depth detail about the similarities among and characteristics of the sample. Using semi- structured interviews with probes to elicit rich first-person accounts also helped in achieving a thick description of the participants; I could move where the participant wanted me to but also come back to concepts that others had brought up or that were highlighted in previous literature. Dependability In qualitative research, dependability
refers to the degree to which the
findings
of
a
study can be
replicated reliably (Guba 1981; Lincoln & Guba, 1985). According to Guba (1981), dependability can be maintained both during and after the research process. During the process (i.e. data collection and analysis), the researcher can choose to maintain an audit trail. An audit trail documents the researcher’s steps throughout all stages of the study, from when and how participants were contacted, to how long it took to complete each interview and transcribe each recording, and any other steps the researcher took. An audit trail essentially makes it easier for any other person to redo the study. After the research process is over, Guba (1981) also suggests engaging in external auditing (i.e. having a person not involved with or knowledgeable about the data review it) in order to maintain dependability. There are many benefits and drawbacks to engaging an external auditor. One obvious benefit is the opportunity for feedback, which improves the research process at any stage (Lincoln & Guba, 1985). An external auditor has the ability to make suggestions or inquiries about things that a person too closely involved with the data may be blind to. A drawback of engaging an external auditor is that it may bring more confusion to the process due to the auditor’s lack of familiarity with the data. I used an audit trail to increase dependability. I did not use a formal external auditor for this study. However, to the extent that an external audit involves someone uninvolved with the data collection and analysis processes but who examines the processes involved in the study and judging whether findings are supported by the data, my dissertation committee members function in a similar manner. Confirmability Confirmability
refers to the degree to which results of
a
study can be
said
to
be free from researcher bias or interpretation (Guba, 1981; Lincoln & Guba, 2011). Confirmability requires that neutrality exists on the part of the researcher when engaging with both participants and the data. Lincoln and Guba (1985) suggest several ways in which researchers can achieve confirmability. They suggest researchers takes steps such as keeping an audit trail, engage in reflexivity and triangulation, and conduct a confirmability audit. For this study, my memos also served as part of my audit trail. The purpose of maintaining an audit trail is to document the interview and analysis process so that those who are not involved in or familiar with these processes can confirm what the researcher did (Guba, 1981). Reflexivity Statement While I focused largely on bracketing as part of the phenomenological approach, I use this section to present some reflective thoughts of my own related my identity and social location as an immigrant researcher of African origin studying African refugee mothers and their families. Throughout the research process, I was very intentional in wanting mothers to feel a sense of familiarity with me. I did this because I wanted mothers to feel as comfortable as possible sharing their difficult stories with me. I was very deliberate when introducing myself to mothers to let them know that I was as a researcher of African descent and from Zimbabwe. Again, I felt this made mothers more comfortable sharing their experiences with me. In one of the interviews, for example, I recognized a word in Swahili (“kumi”) as the number ten when a mother responded to a question, because the word for ten in my own native language of Shona is “gumi”. We chuckled about this before continuing with the interview. In several other interviews, mothers thanked me for coming into their home to talk to them about their experiences, which one mother explaining that she Another way I believe mothers were able to be more comfortable was I through my previous work with the agency. I volunteered as a family mentor for Commonwealth Catholic Charities (CCC) for four months in the summer and fall of 2016. While there, I assisted caseworkers with tasks such as driving families back and forth from appointments and doctor visits and going to the grocery store for them as well. While none of the families whom I had assisted in 2016 ended up being in the current study and it never came up with mothers that I had been a family mentor, I feel my own comfortability with that population was evident to mothers and in turn made them more comfortable. A challenge I faced researching this population of refugee mothers was related to the use of an interpreter. All interviews had to be conducted in the presence of an interpreter because of mothers limited knowledge of the English language and my own lack of knowledge of their native tongues. The use of an interpreter presents particular challenges in the research process and Gartley and Due (2017) state that an interpreter is an active part of the research process, not an “invisible being”. During interviews, I noticed the interpreter allowing mothers to speak at length and then telling me what the mothers had said. Part of the challenge of this was that it created a tension between trying to highlight mothers’ use of language in their expression (IPA suggests engaging in linguistic commenting in the analysis to pick out how mothers are using language to express themselves; Smith et al., 2009) and allowing the interpreter to do his work (i.e., interpret mothers experiences). Further, the interpreter, while experienced and familiar with this particular group of moms, had never been a part of a research project. I felt at various points that I was missing out on the linguistic nuances that mothers may have been putting across to the interpreter. Still, I appreciated the interpreter’s abilities and we sat together before and after each interview to discuss mothers’ responses and I used those moments to remind him to give me as much of what the mothers were saying as possible. Conclusion Interpretative phenomenological analysis is an approach to data analysis that helps researchers to understand people’s lived experiences in an in-depth, dynamic way (Smith & Osborn, 2008). It gets to the heart of what the participants believe is important and salient about their respective experiences. By using a phenomenological paradigm coupled with an IPA approach, I hoped to fill important theoretical and empirical gaps in the refugee literature. CHAPTER V: FINDINGS Overview of Chapter This chapter aims to capture the essence of “Lebenswelt” or the lived experiences of 8 refugee mothers resettled in Roanoke, Virginia. It is a synthesis of stories of their lived experiences, with findings addressing three research questions: 1. How do newly resettled refugee families experience the refugee migration process and how do they interpret their experiences? 2. What family outcomes are most salient to newly resettled refugees as a result of the totality of their migration experience? 3. What social support systems (either formal or informal) do newly resettled refugees cite as most important, most needed, or most helpful? Thus, I present my findings in 3 sections, with each section addressing a corresponding research question. The first section, Becoming a Refugee, addresses the most salient experiences for refugee mothers as they moved from being refugees to resettling in the United States. The second section, Stress in the Family, addresses mothers’ perceptions of their own stress, mothers’ relationship with their children and their family functioning relationship as a whole. The third section, Formal and Informal Support, addresses mothers’ perspectives about their experiences with various support systems since resettling. The goal is to provide a holistic picture of refugee mothers’ lived experiences and give them an opportunity to tell about their experiences with refugee migration stress. I precede these sections with a description of my sample. Sample Description Eight mothers were recruited for this study. Mothers ages ranged from 19-55 (M=33.1), and they were from Congo (n=6) and Burundi (n=2). Mothers arrived in the US between 2014 and 2016 (n=1 arrived in 2014, n=3 arrived in 2015, n=4 arrived in 2016). Mothers ranged from having one child to having 11 children, with the mean number of children being 5 and the median being 4. Six mothers were married, one single, and one was partnered but her partner was still in a refugee camp awaiting resettlement. All mothers spent time in refugee camps in Tanzania, Uganda, or Mozambique. The average length of stay in camps for mothers in this study was 18.75 years (range 4-23 years). For a full description of mothers’ demographics, see table 2 below. Table 2 Participant Characteristics Participant Age Country of Citizenship Married Number Camp Location Y/N of children Years stayed in Camp Year arrived in US Mom 1** 19 DR Congo N 2 Tanzania 19 2016 Mom 2 25 DR Congo Y 4 Tanzania 23 2016 Mom 3 34 DR Congo N 1 Uganda 4 2014 Mom 4 55 Burundi Y 7* Kanembwa, Nduta, 22 2015 Mtabila, Tanzania Mom 5** 22 Burundi Y 2 Kanembwa, Nduta, 22 2015 Mtabila, Tanzania Mom 6 40 DR Congo Y 11 Lugufu, Tanzania, 20 2015 Maratane, Mozambique Mom 7 41 DR Congo Y 6* Nyarugusu, Tanzania 20 2016 Lugufu, Tanzania Mom 8 29 DR Congo Y 5 Nyarugusu, Tanzania 19 2016 Note. *Lost one child in refugee camp **Born in a refugee camp Below I give a brief narrative of each mothers’ background. All interviews took place in February and March of 2018. Mom 1 (M1)
is a
19
-year-old
Congolese
mother of
2 children,
a
3-
year-old
boy and
a
girl who is 9 months. She moved to the US in September 2016 with her 2 children, her mother (who later died), father, older brother, older sister, and younger sister. Her 3-year-old son was born in a camp. Mom 2 (M2) is Mom 1’s older sister. She is 25 and married with 4 children ages 7, 5, 3,
1. The 7 and 5-year old
are boys, and
the
3 and 1
year old
are girls. The 7, 5 and 3-year-olds were born in a camp in Tanzania. Again, her mother died soon after they arrived in the US. Mom 3 (M3) is 34 years old, single, and has a four-year-old daughter. Her daughter was born in a camp in Uganda and was a year old when she came to the US. Her country of citizenship is DR Congo and she lived in a camp for the shortest period of all the participants in this study: 4 years. Mom 4 (M4) is a 54-year-old married mother of 7 (she lost an 8th son to cholera when she first moved to the camp) aged 30 (twin boys), 27 (girl), 25 (boy), 22 (girl), 20 (girl), and a 16-year-old girl. Mom 4 arrived in her first refugee camp in Tanzania in 1993 and came to the US in September 2015. Mom 5 (M5) is the 22-year-old daughter of Mom 4 and she also arrived in the US in 2015 at the same time as her mother. She is the mother of two children, a boy who is 4 and girl aged 1. She is married and lives with her spouse. Mom 6 (M6) is Congolese, married, and a mother of 11 children. She has sons who are aged 22, 20, 15, 13, 11 6, and 4. Her daughters are 17, 9, 2, and 7 months. She miscarried a pregnancy during her migration from Congo to a refugee camp in Tanzania. Mom 7 (M7) is also Congolese and she has 6 children, a 22
-year-old son, a 19-year-old daughter, a 16-year-old
girl,
a
9
-year-old
girl, and
a
five
-year-old
girl. She lost one son who was 9 years old at the time in the camp to sickle cell anemia. Mom 8 (M8) is also Congolese and has 5 children: three girls who are 11, 9 and 6, and 2 boys who are 3 and 10 months old. From this, it is clear that mothers had a diverse composition of family structures. Becoming a Refugee Below, I present the superordinate themes that emerged from analysis of mothers’ migration experiences and highlight the most salient experiences for these 8 refugee mothers. Four superordinate themes helped me to answer my first research question: How do newly resettled refugee mothers experience the refugee migration process and how do they interpret their experiences? Superordinate Theme 1: War is the Reason for Becoming a Refugee Each interview began with me asking the participant how they came to be a refugee. Each of the mothers, regardless of whether they had been born in the refugee camp or not, told me that war was the reason for becoming a refugee. Some had very specific stories of their migration, while others (who had been born in the camp or were very young when they fled their home country), said they had been told by parents or caregivers that war had led them to become refugees. Ethnic conflict. All the stories recounted instances of political instability and ethnic discord as a primary catalyst for having to flee. Mom 4 refers to an ethnic war breaking out in her country; what I later knew to be the Burundi Civil War that occurred 1993-2005: “So, the reason why we became the refugee was the problem in my country, the political problem. And especially happened when they killed the president Ndadaye, that’s when the war came in my country.” -M4 Mom 3 also went into specifics about what led her to flee: “What caused me to leave my country was insecurity. It also was the war, and the criminal issues… So, it was like the tribal issues. There were two tribes, one was Babuyu, the other one was Bembe. So, they were not getting along. So, there was kind of those insecurity.” -M3 Mom 7 also spoke in detail about the impact that political and ethnic instability had on her life: “It was the ethnic war but associated with politics. Because the president Mobutu used some people from Rwanda to come to fight....ah, no, no. The Kabila, the other president who wanted to come, wanted to come with the other people from Rwanda who were like Banyamulenge. So, they originated from Rwanda, and that was war between those people who have the government. It was in Fizi zone.” -M7 Moms 1 and 2, who are sisters and were both children when they first came to the camp, said their parents told them they fled Congo because of war. Migration stories and the trauma that came along with them were seemingly passed on to children who were born in the camp or who were too young to remember on their own. Mom 5, whose mother, Mom 4, was also in the study, was born in a camp: “Uhhh, what they [her parents] told me was that there was war for...ethnic war. Because of the tribes. But for them, the reason why they have to flee or to run, it was because someone was targeting them to kill them.” -M5 Superordinate Theme 2: War is Not Good Deadly threats and loss of loved ones. In many cases, their departures from their homelands of Congo and Burundi were sudden and involved some kind of extreme violence or disruption of personal safety, and separation from family members and loved ones. Mothers spoke of threats to their lives and witnessing family members being killed in the process of fleeing or as a catalyst for having to flee. Mom 5, for example, told me that she left her country “because of the war…when the war broke out, everyone had to run”. Mom 7 talked about the immediate deadly threat she and her grandmother were under just before they fled their home in the South of Congo in a small town of Kivu: “What happened was...it was war. I was with my grandma at home. And my mom and my older brother were in the farm, farming. And my father was a boat driver, you know, boat. Taking people from Congo to Tanzania. And what happened, someone came running to tell my grandma that...they slaughtered my father. Someone came to tell grandma that they throat my father and they killed him, because they accuse him that he's taking the enemies, the Banyamulenge, from one side to another side. So that's what happened. And then we ran away from there. I was 9 years old.” -M7 Mom 6 highlighted the devastation of losing her unborn child while fleeing from Congo to a camp in Tanzania. When I asked her how many children she had, she told me she had had 12 pregnancies but suffered a miscarriage due to the stress of the journey. Dangerous migration. Many times, the journey to refugee camps was marked with harsh conditions, which made an already hard life even more “hard”: “I went through a hard life. Because during that period I ran away by myself and my husband ran away by himself and I had all the children by myself. We slept outside in the bush and we couldn’t found anything to eat. And during that period was a time when the cowboys, they burn the bushes, so we couldn’t found where to sleep because all the grass was burned and was like hard. We couldn’t put anything to lie down on it to make it soft.” -M4 Mom 6 also highlighted the dangerous paths she was forced to take with her children after I asked her to give me more detail about how they got to a different camp in another country: So, when we went to Mozambique we took a train, and we went through Morogoro, which is one of the Tanzanian provinces. And from Morogoro we took a bus to Songea, and then when we left Songea, we went to the villages. I don’t know the names…And we arrived to the border of Tanzania and Mozambique, which was called Ruvuma…And there was a river separating Tanzania and Mozambique which is called Ruvuma river…And then we used canoes, because the river was large and deep, so we used canoes from one side to the other side. So, after we arrived in the Mozambique border, on the side of Mozambique, they helped us. There was a car which took us for free to the camp. The devastation of war robbed many of the mothers of their basic human dignity, such as attending a funeral for a relative. Mom 8 spoke movingly about the impact that war has had on her life: “I know the war is not good, and when any country have war, it's not a good thing. If it was not war, my dad or my mom could be dead, but I would know where they died. I could go to their body. I could go to their funeral. But since it was war, I didn’t have a chance to see them, or even say goodbye to my father. And me hearing what happened to my dad without no sickness, no nothing, just being alive and then they grab him and they kill him, hurts me so much.” -M8 For all mothers, leaving their respective homelands was a difficult choice that did not come lightly. They risked their lives and the lives of their children and families in order to find safety, which makes the next part of their journeys even more unfortunate in that their trauma was only just beginning. Where they thought they could go for safety, shelter, food, and protection would become another hell to face. Superordinate Theme 3: Camp Life is Not a Good Life In each interview, I asked mothers to tell me about their experiences living in camps. Camp life was largely difficult and harsh for many of the mothers and their families. Families struggled with a lack of food, water, and sufficient shelter, abuse from authorities and fear of persecution for being a refugee, general insecurity and lack of freedom or restrictions to personal freedom. Mothers also talked about the lack jobs, money, and opportunity as a stressful part of camp life, and a lack of good education for themselves and children. Lack of food/clean water. All 8 mothers spoke of their shock and dismay at the food situation in the camps. The food was either scarce or insufficient, and when it was available it was not edible or was unfamiliar. Mom 4 stated that “we didn’t have food for the first time” when they arrived at the refugee camp. According to Mom 1: “Sometimes the food was short, and they would tell us this month you will not have any food because we don’t have enough food to give you guys, so... and that caused people to be hungry all the time. So, it was so stressful.” -M1 Mom 2 also spoke of the difficulty of having to ration food provided to them: “In general, life there was very hard; it was super difficult. Because they would give the food, like the corn flower, which you could eat for only 2 weeks, but they tell you to eat for one month. So, it was super hard.” -M2 Mom 8 also spoke of the problem of not having enough food: “So, the life in the camp was so hard, so hard, so hard. I was too little, when I grew up to figure out what's going on, I found it was almost impossible because the food they was giving us was not enough. They gave us small amount of food to eat for the while month which could take couple weeks, one week or two weeks.” -M8 Many of the mothers spoke about being given beans in particular that were expired and inedible and ultimately made them and their families sick. The beans would have to be boiled for hours and even then, would not become soft enough to be consumed: “And, the food when they started giving us beans, the beans was not...was expired beans. Beans which you cook for maybe the whole day and would never get soft. And they also gave us like maize, those like corn grains. And they didn’t have the machine to use to make it into flour.” -M4 Still, mothers said they had no choice but to eat the beans because the alternative would be starvation. For some, this led to getting sick from diarrhea and other health problems: “…when we went to the camp, we found the food was hard. First of all, they gave us beans, which was pretty much expired. You could cook the beans about 6-10 hours and the beans would not be soft, will stay dry and hard. And even it was impossible to find those firewood. And other food they gave us was new food for us. We didn’t know what is this. And people have some other kind of diarrhea and sickness.” -M7 She continued: “Yea, life was difficult. It was super difficult, because the food was hard for us. It was new food, and many people died because of the food. We lived because God helped us, to protect us. Otherwise, many people died because of the food. So, we were in a hardship of life.” -M7 Mom 7 was not the only mother to speak about deaths in the camp due to malnutrition and lack of clean water: “And the other thing was that even when we arrived in Tanzania, life was super hard. We couldn’t find where to sleep. We couldn’t have what to eat. And the hygiene was almost impossible. We get sick of cholera and other nasty diseases. And that’s when we lost one of our children because of cholera.” -M4 Because food was so scarce and many times inedible, many refugees were forced to risk their personal safety and leave the camp to look for food or other goods to exchange for food. As Mom 7 put it, “…because life was super hard, we tried to sell stuff to make a little bit of business so we can change the food from what they gave us to another things.” Mom 3 spoke about this as well: “In the camp we were living having some help. So, we were getting help from the UN, and that was for the food. And that was not enough. So, in order to survive, we had to do another extra work for other people, so they can give us a little bit.” -M3 Death of loved ones due to harsh conditions. Harsh conditions and the lack of adequate healthcare in refugee camps led to two mothers losing their children as a result. As previously stated, Mom 4 lost one of her children to cholera. Mom 7 lost her 9-year-old son who was diagnosed with sickle cell anemia as an infant. Abuse from authorities and fear of persecution for being a refugee. When recounting their experiences in the camps, several of the mothers spoke of abuse or mistreatment they experienced from authorities who were mostly police meant to protect them, and citizens of the countries in which they lived, or host countries. Many of the examples they gave were of police or citizens of host countries victimizing them for being refugees. This led to a sense of insecurity or mistrust of the authorities in many cases where they were already experiencing hardships and wanted to provide for their families: “So, the problem, even if we get those food, we couldn’t have like, charcoal or woods to use for fire. And, when we go out of the camp a little but nearby in the forest, we were punished. Some were punished, some were kidnapped. Some would take the tools we have. Those...they were police people from that country. Even when you plant like corn or any garden, sometimes they came and destroyed it. The police were not helpful.” -M2 The experience of police victimization was reflected by Mom 4 as well. She spoke of the police victimization as compounding an already difficult and stressful situation: “And during the refugee camp life, yes, it was stressful because when you go even to go cultivate or to work for citizens to get something to eat, the police arrest you and say why did you went out? And then they confiscate everything you have. And you didn’t steal, you worked with your hands, so you can survive. So, it was stressful, yes, it was very stressful.” -M4 Police also perpetrated violence against refugees according to several of the mothers. Mom 4 spoke about seeing police beating and terrorizing refugees indiscriminately: “So, and then life was harder to harder because the food was not the real food, what we had to eat was not enough and it wasn’t good food we had to eat. So that area, some other people they started stealing stuff. They were like criminal things. And then they brought police, and that was harder for our lives because the police was generalizing everyone. If something happened or if me I meet you, would will be beaten, because they know that she’s from the camp… So, we tried to go outside the refugee camp to see if we can cultivate for the season, and they gave us like some food or money. If the police catch you they will take everything and also beat you so bad. So, it was terrifying.” -M4 Mom 4 spoke at length about the injustice she witnessed from the authorities in Tanzania, where her refugee camp was located: “The most stressful...it was the injustice in Tanzania. When you...when someone, a criminal committed a crime, they punish him and everyone in the area would be punished. If you meet with police, you didn’t do anything, you don’t know even what’s going on, they will spank you or punish you or, you know, do anything. They treat you like you’re a criminal, even if you don’t know anything that happened. And also, they terrify us or even our children, telling them that the we are following their parents doing crime instead to go back to their countries to continue their education. So, they are here to steal the things for citizen here in Tanzania.” -M4 Police would also mask themselves as rebels or bandits or jambazi, as she described them, in order to steal from or perpetrate violence against refugees: “…the rebels were all kinds of people. Even the police, they go camouflage, change their uniform, and they come at night when they know you have money. They come with a gun and they can kill you or force you to give whatever you have so they can kill you.” -M5 Refugees also faced abuse and violence from citizens of the countries in which they resided, who it appears would target them for being refugees: “So, the life was super hard, super hard. Sometimes when you fortify whatever effort you can to go to buy food from outside citizens, most of the time we were going to bring cassava over there, to see if we can change for the food, they would confiscate our money, and they would not give us anything. And sometimes they would rape people. They are Tanzanians. Tanzanian citizens.” -M8 Insecurity. As a result of all the above experiences, participants described a general sense of insecurity they felt being refugees and living in camps. The violence visited upon them by police and citizens in the countries in which they lived led them to live in fear for their lives. Mom 5 spoke about waking up to finding dead bodies outside of living areas and knowing they had been beaten and killed overnight, and the stress of that being high because “no matter what you do, no matter what you have, you know that you have to be scared because maybe tonight they can come to kill you. Anytime they can come to kill you.” Women in particular were targeted and victimized, according to Mom 5: “The problem was insecurity. For example, if you go out of the camp, they could, uh, beat you. They could kill you. They could do all kind of...especially like us, the girls. When you go like, get in the woods, they can catch you there, they can do anything they want. And you couldn’t have a right to defend or even where to go to show your case.” -M5 Mom 8 who was in a camp in Tanzania, also had a similar account regarding threats to women and girls in particular: “Life in the camp is not good for everyone. Because most of the people, even if they go to find firewood, most of the female they will be kidnapped or raped. So, it’s hard.” -M8 Lack of freedom/restrictions. Several of the mothers highlighted that much of their refugee camp life was characterized by restrictions and lack of freedom of movement. As Mom 1 put it, “we were not allowed to go out of the camp; we were supposed to stay in the camp all the time.” Mom 2 explained that “they told us that a refugee is not allowed to leave where they put her or him. So, you should stay in the camp, no going out of the camp”. Much of this, according to the mothers, was because refugees were seen as taking away resources from the citizens of the countries in which the camps were located. This was reinforced by mothers’ descriptions of being persecuted by both authorities and citizens. Mom 6 described the real impact being restricted had on her and her family, and was a huge factor in their decision to try to find a new camp: “Even in Tanzania, life was very hard. Even if my husband was working, he was a nurse, but we were like in prison. There was no freedom to do anything. And even the money he got was like, nothing. We were like in a prison. Not any help at all, pretty much. And we decided to say, OK, maybe we need to go to see somewhere else. So that's when we decided to leave Tanzania to go to Mozambique…Because if I want to go somewhere, I couldn’t go. Even if...there were so many refugee camps around us, and if one of your relatives could be in different camps. And when you heard someone is sick or she is sick, you couldn’t go to visit her or to see what’s going on because you are not allowed. If they catch you, you will be beaten. Even get destroyed or damaged or even killed. So, it was bad.” -M6 Overall, the restrictions on the movement of refugees meant that it was difficult to find and maintain jobs and there was a general lack of opportunity as reported by many of the moms. Mom 2 for example, talked about the stressful life that came from her parents not having jobs or access or employment: “There was a stressful life, because we couldn’t be...my parents were not allowed to go out of camp to find some job, and there was no job in the camp.” Longing to return home. These experiences were undeniably difficult and stressful and led many mothers to wish they could return home. As mothers told stories of their experiences making their way to refugee camps, some also told of their attempted journeys back when they found camp life too difficult to bear. Mom 6 recounted her story of arriving in a refugee camp in Tanzania and the circumstances that led her to consider returning to Congo: “Yes, Uh, living in the refugee camp, the life is stressful. And, when we heard some good news that the country is becoming more peaceful, we hoped that we would go back home and then find our regular jobs. So, that's the reason why we left the camp…When we went to Congo again, we found that the life was the worst there, and we had to flee again.” -M6 Mom 6 went into detail about risks they took to get back to Congo, only to find that the situation there was just too dire to stay: When we arrived in Tanzania, we were with the big family as I explained before. So, in 1997, because of hardship, or hard life in Tanzania, some people they decide to go back to Congo. The reason why is because there was no food, there was no medication, and people were dying every single day. More than even how it was in Congo. Some people they decided to go back. And some of our family members decided to go back. After two years, in 1999, the situation was super bad in Congo, so they came back again, and then we lived there until 2001. And in 2001, we found there is no development, no children's education. We were like in a prison. Not any help at all, pretty much. And we decided to say, OK, maybe we need to go to see somewhere else. So that's when we decided to leave Tanzania to go to Mozambique.” -M6 Mom 7 also recounted her decision-making process as it related to taking a chance to go back: “Because of that, people were feeling like we need to...we are forced to go back to our country and feel like maybe we will have peace or maybe we will live better life, the normal life we had before the war. But when we went back to Congo, the war came back and was so bad. And we saw that it’s better to survive than to die. So, we decided to go back...to go to the camp.” -M7 Superordinate Theme 4: The Stress Continues The next part of this chapter explores the most salient experiences for refugee mothers during the post-migration period. Mothers spoke about many of the stresses and challenges that continued now that they had resettled in the United States. An overarching theme across many of the mothers’ responses was that they felt that challenges did not end just because they were in the US. Challenges may have been somewhat different from the experiences in the camp, but life was still a struggle. Themes that emerged from this part of analysis were lack of support from social services, language barriers, too many bills and not enough money, and family separation as a result of resettlement. Mothers also spoke about the impact that negative statements by the president of the United States regarding refugee policy had in compounding their stress, and also about their nostalgia for home. As Mom 1 put it, “…some people will say here is beautiful or a nice place, but it depends on people. To me I think it’s the same and I am not lucky, you know. It is more stressful here to me…” Lack of support from formal social support services. One of the most talked about challenges mothers faced was the feeling of lack of support by formal social support services (in this section and subsequent sections, I refer to agencies such as CCC (Commonwealth Catholic Charities) and other government-sponsored social support services as formal social support services). Some mothers felt support from these formal avenues was arbitrarily given, sporadic, and inconsistent; not really based on need but on factors they could not really isolate. One mother, Mom 7, gave this example: “And the other thing we noticed was the benefit from social services. We didn’t get the food stamp like other people. They gave us food stamps for only 3 months, and after three months they stopped. And when we tried to re-apply, they gave us for a couple months and they stopped up to now. And we didn’t know why other people they kept getting the food stamp. Even the same, as well as TANF [Temporary Assistance for Needy Families], they stopped all the benefit they were giving us. So, we thought maybe it’s because we live in Virginia, maybe somewhere else could be better. Maybe, somewhere, other states, they treat people good and give everything, the benefits. We don’t know.” -M7 Mom 7 also spoke about another example of how she felt formal social support services were not helpful in the case of her daughter’s schooling situation: “Here, also we have problem and also stress continued. For example, when we came here, my daughter was 18, and they didn't allow her to go to school, because they said she is 18. And we expected since she’s 18, she's gonna get the money, the government money which everyone was getting every month. And they didn’t give to her, and we didn’t know why. And other kids were getting the same money. And she spent one year home. At least me, I was going to school, to CCC [Commonwealth Catholic Charities], taking some classes. But her, she was like ignored. She spent one year home here, alone.” -M7 Mothers also spoke of their frustration with how quickly benefits could be terminated without them knowing or realizing: “And the people from social services, they said while I’m working they’re gonna help with childcare. And now they are charging me, they said “you gotta pay half and we pay another half”. And that half I have to pay is the maximum money I get paid in my check. So pretty much there’s nothing that is there to keep with me. So that’s the biggest challenge for me.” -M1 Mom 4 gave the example of how she felt formal social support services were not supportive enough: “And the other problem we faced is, sometimes, two times, the case worker or the person who was in charge for the health from CCC took me to hospital at Lewis Gale and she dropped me there, and I didn’t know what bus I need to take or how I can come back home. I was struggling the whole day. And the other day she did the same thing, she left me outside and I stayed there for the whole day in that freezing cold. So, I can’t say they helped us. Even in the food we found here, the chicken, the first time we came, it was not sufficient compared to what other people received.” -M4 She also spoke about the stress of almost being evicted due to a lack of support from social services which left her husband wishing the police could take him back to his home country: “When we came here, they put us in a house, and we heard other refugees like us their rent was paid for 3 months. For us, was only two months. And then one day we came, after two months, the case worker from CCC came to say: “You need to pay rent, otherwise tomorrow at 10 o’clock they’re gonna take you out from this house.” And we said where? We don’t have a job, we don’t have any money. Where are we gonna found money? And then my husband was saying: “I gotta call the police to see if they can take me back to my country because this is horrible.” -M4 Mom 1 also shared her experience with poor communication about benefits: “I don’t think there is any other help maybe we can get. Because we got the response from social services that we can’t give you the help you need because we have to get the death certificate for your mom. So, when we received the death certificate we took it to social security and the social security said we are gonna wait for a while to study the case. And the response from social security was your mom when she arrived here she didn’t work enough to get benefits. And from there the case was closed.” -M1 Language barriers. Many of the mothers spoke about language barriers being a major challenge of resettled life. In their day-to-day activities and interactions, they struggled to communicate. Language barriers were not just an inconvenience of not being able to understand a conversation; the inability to express oneself in the English language led to major problems in the lives of the mothers and their families: “The problem we face here...it was with agencies...was because of language barriers. The first time we came here was hardship because we couldn’t communicate. We knew, like people at CCC, they are supposed to help us with some things. Like the person who was in charge for the medical issues like taking refugees to the hospital, because of language barriers, we tried to communicate to tell her what we feel and we saw like she was not available all the time we wanted. And also, like our case worker, when we heard what other refugees were getting every month, we didn’t get that money. And since we didn’t have the way to communicate or to express ourselves, our feeling or what we think is right for us, we couldn’t communicate to tell them. And that’s the things we faced the first time we came here. And that’s what I said in the beginning, that the language barrier was the problem for us here.” -M4 Language barriers also caused mothers to miss out on job opportunities that could further help them take care of their families, like in Mom 7’s case, whose husband’s inability to speak English made it that he could not work as a nurse like he used to in the camp. As she put it: “…you know, here is hard. Language is a barrier of everything. People they told him if you go to school here and you could maybe go to work at hospital. But the English is a problem. So, we are all together at laundry.” Still, some mothers were able to be positive about their life in America. Mom 4, who highlighted the example of how she felt social services were not helpful and how language barriers contributed to a lower quality of life still said that life here is manageable: “Because there even when you sleep, sometimes you couldn’t sleep, and sometimes you couldn’t sleep in our tent knowing that if something happen, they will come to wake us up and start beating us. So, but here, I sleep well knowing that there’s nothing that’s coming or something’s gonna happen, as long as I didn’t do anything wrong.” -M4 Mom 3 said even in the face of these challenges: “Here in US, there is problems, there is even problems more than in Africa. But we are happy because we get a little bit… As I told you, there is language, there is lack of job, and there is transportation problem. All those they are quite contributing to my stress.” - M3 Too many bills, not enough money. Another challenge mothers faced after resettling was the lack of money or sufficient income to pay for them and their families’ needs in their new life. Many times, in the camp, food was rationed out and housing, however insufficient it was, was provided by the UNHCR. Now that they had transitioned to life in America, the responsibilities of working and supporting their families were at times challenging for the mothers. Many times, young adult children in the family had to work and contribute to the household bills. Mom 7 put it this way as she spoke of her experiences: “You know, in the camp, I was more occupied making revenue, making income. I could make some beignets and sell them, and make revenue and be...my mind would feel fresh, because I could make something on the table. Or making cakes. Or making even these (pointing to doilies) and sell them. But here, you can’t do even those. Even when I’m trying to make these, people they don’t look like they are interested. You know, it's not like in Africa. So, it's a little bit hard, because when you are trying to make income, the bills they are stressful, and you don’t have money to pay the bills. It's hard.” -M7 She continued: “But we try all of us to push to go to work. So, I work, he works (pointing to young adult son in the room). But, the money issue is big because the money we get is not enough.” Several of the mothers spoke about the challenges they face as a result of having to work and be separated from their children. Mom 3, for example, explained the impact that this important change in family life had on her and her daughter’s relationship: “…when I was in Africa, we were together all the time, playing together, doing...spending time together. And now, sometimes when I was working, my daughter goes to daycare and I go to work, so when I came here at the end of the day, tired, I couldn’t have time to play with her, so that was like a separation.” -M3 She continued about how the differences between life in the US and life living as a refugee in a camp impacted her daughter: “I can say, maybe if I was working my daughter could go to daycare and have friends and play with them. But, now she’s not going to daycare because I’m home, so she doesn’t have that. And I think maybe that can be stressful too for me.” Family separation as a result of resettlement. While many of the mothers could pinpoint examples of how life had improved for them since resettling in the US, a harsh reality for them was that many were separated from family members as a result of being resettled. All but one of the mothers (Mom 3 who lost her parents and brother in Congo before she fled) had children and other extended family members left behind in camps, which caused a considerable amount of stress for them. Mom 4 spoke of the stress of missing two of her adult children who are left behind in the camp in Tanzania. Mom 8 whose mother and brother are still in a refugee camp in Malawi according to her, spoke of the stress that not having them around has led to. The father of Mom 1’s two children is back in the camp as well. Negative statements about refugee policy by the US president. At the time that these interviews took place, Donald Trump had recently been elected president and began to pursue a policy that
temporarily banned refugees from entering the United States.
His
executive order
13769 signed on January 2017 implemented a ban on Muslim refugees from 7 countries from entering the United States for 90 days, and then also banned refugees from all countries from entering the US for 120 days (Whitehouse.gov, 2019). The policy was so hastily put together that those refugees who were on their way by plane at the time the order was signed had to be turned back to where they flew from. Initially I asked mothers if they had heard of the ban and in particular if they were familiar with Donald Trump’s views on refugee migration into the United States, which they all had. I then proceeded to ask them if they had any thoughts about this and all responded that it was stressful to varying degrees. Mothers were affected and felt much anxiety about the president’s views. This was apparent because all of 8 knew about the statements and subsequent executive order when I mentioned them, and all spoke of their worry about loved ones back home. Mom 1, for example, spoke of the sadness she felt because she had hoped the father of her children could join the family in the US. The stress came from worrying about loved ones and in general other refugees who were left behind and seemingly would not have their suffering relieved. This loss of hope was something Mom 6 and Mom 8 captured in their responses: “Yea, in short, I can say that is not a good idea. And it is not good for anyone. For example, I lived in different camps and I found many refugees they have no hope. And some they have been refugees over 20 years. They don’t have any hope. Their hope was to go somewhere because their countries were still in war, and there is not any peace coming. There is not. And when they decided to say no more refugees, or taking the decision to cut off the refugees, it's not helpful.” -M6 Mom 8 responded: “Me, I was not happy to hear those words, or to hear any plans of stopping refugees to come to America. Because to be a refugee, you miss peace. You need somewhere you can be and be peaceful. So, when I heard that maybe they stop all refugees, not only from Tanzania, but all refugees, that’s bad. It didn’t make me to feel good.” -M8 Mom 1 spoke about the very real impact that the president’s statements about refugees could have on her and her family: “Um, about that, really it’s scary. And it’s no hope; it’s not good news. Because, you know, like, for example, in my case, the father of my 2 kids is in the camp. And I was hoping that he can come.” -M1 Mom 2 commented: “We regret so badly because our friends who remains there [in the camps], they are suffering. So, it’s something stressful.” Mom 4 said, “Yes, it’s sad, it’s very, very sad. To hear those words from the president it’s sad news.” Many of the mothers were not only worried about the impact that this policy could have on friends and relatives; they understood that the impact was not just on those they cared about but on the refugee population as a whole. So, if he [Donald Trump] close the case and no more refugees come here, the hope will end. And also there are so many other refugees who have hope to get life in somewhere else than where they are, and it’s very stressful. It’s not good news.” -M1 Nostalgia for home. All mothers who had memories of life before becoming refugees talked about the happy, peaceful, joyful lives they had prior to becoming refugees. One mother, Mom 4, spoke of what specifically made life in in her home country of Burundi happy and peaceful. “So, before the war where we lived, we were in peace. Happy life. Because even if you didn’t have a job, you had a farm, you got to cultivate, and you get what you wanted and it was a happy life. We never heard about any criminal things or thieves where we live…in the area we lived. So, it was a joyful life.” -M4 Another mother, Mom 6, also gave a detailed description of what life was like before fleeing to a refugee camp with her husband and children. “In the Congo, we lived not in town, but we lived in the village. My job was being at home, and also farming. And my husband was a nurse at a small clinic. But we were able to feed ourselves, get whatever we want…we were not people who have a lot of things, but we were happy. We were enjoying what we have. And we felt happy because we were home. We could do anything we want to do or do whatever and go wherever we wanted to go. But in the camp, it was totally different.” -M6 For most mothers who had memories of life before becoming a refugee, this period of their lives was marked seemingly by a euphoric or dreamed up ideal of life; the nostalgia was evident in their reminiscence of their stories: “So, uh, before we leave our country, we didn’t have any stress. We were farmers, but we were living happy and living a good life.” -M4 Mom 6 recounted: “I can say, before the war in Congo, there was no stress. Because, we didn’t have a lot of things, but we were not worried. Nothing to really care about. We were happy, we had everything we need as we need it.” -M6 Those who were old enough to recall life prior to becoming refugees seemed to have a preserved image in their heads that they held on to of a life that was perfect or near-perfect, something which stood out as potentially unrealistic but perhaps psychologically necessary for their survival. These memories certainly provided a home base, a point of reference or contrast for the stress experienced later in life. Mom 7 captured just why: “Congo is home. I was living a happy life. I didn’t worry about paying bills, paying house, anything. And I was having food which I want to eat and enjoy it. So, Congo is home, zero stress.” -M7 Summary of “Becoming a Refugee” themes related to research question 1. Overall, mothers experienced profound stressors during their migration. Table 3 below summarizes the four superordinate themes and related sub-themes that address research question one (how do newly resettled refugee mothers experience the refugee migration process and how do they interpret their experiences?). Table 3 Findings for Research Question One: Superordinate Themes and Corresponding Sub-Themes Mapped onto the Refugee Migration Pathway Becoming a Refugee Pre-migration Migration Post-Migration Theme 1: War is the Reason for Becoming a Refugee ? Ethnic conflict Theme 2: War is Not Good ? Dangerous migration ? Deadly threats and loss of loved ones Theme 3: Camp Life is Not a Good Life ? ? ? ? ? Lack of food/shelter/water Abuse from authorities and persecution for being a refugee Lack of freedom/restrictions Insecurity Longing for home Theme 4: The Stress Continues ? ? ? ? ? ? Lack of support from social services Language barriers Too many bills, not enough money Family separation as a result of Negative statements about refugee policy from the president Nostalgia for home Stress in the Family (Individual Domain) Over the next three sections, I address research question two (what family outcomes are most salient to newly resettled refugees as a result of the totality of their migration experience?) by exploring themes related to how stress might affect the family across three domains: the individual mother domain, the mother-child relationship dyadic domain, and the family functioning as a whole domain. To understand how migration stress has affected the family, it is critical first to understand how mothers have coped with that stress as individuals. Therefore, in this section, I present two superordinate themes that emerged from analysis of mothers’ responses about how the stress they experienced has affected them. The two superordinate themes emerged surrounding mothers attempts to manage camps stress and to manage post-resettlement stress. Superordinate Theme 5: Managing Camp Stress In light of all of the experiences mothers detailed in the previous section, Becoming a Refugee, how are mothers affected by those experiences and how do they interpret their experiences? To elicit this, I asked mothers to rank what experiences were the most stressful on a scale of 0-10 with 0 being the least stress and 10 being the most stress. I asked specifically about their level of stress during migration (in refugee camps) and post-migration (post- resettlement). Then I asked mothers to tell me why they ranked each the way they did. All mothers but one ranked their time in the refugee camp as the most stressful. Table 4 summarizes mothers’ responses to scaling question and includes representative quotes. Table 4 Mothers’ Numerical Responses to Scaling Questions and Accompanying Rationale Quotes Refugee camp Post-resettlement Accompanying rationale
Mom 1 Mom 2 Mom 3 Mom 4 Mom 5 Mom 6
10 10 10 3 6 8 10 0 10 0 10 0 “Yes, the stress is stays there. And even here, life is so stressful, because even here it’s hard to find food, it’s hard to find anything, and we are so like miserable really, even here. So, it’s the same way like I saw it in the camp.” No representative text “Here it could be 8, but when we talk about in Africa it was like 6 because there is no problem of transportation, there is no problem of language, what you worried about was only to get what you need life food. And small things.” “So, here I can’t say I have stress, because the only stress maybe I have or the difficulties I found, is because I don’t communicate with people, I don’t speak the language. Otherwise I don’t feel stress.” “So today, here, I can say I don’t have any stress because I don’t have anyone to run away from or to be scared that they’re gonna grab me or kill me. And whatever I have I can eat it peacefully. And do whatever I want to do peacefully. So, I can say, I don’t have any stress.” “So, in general, I can say we live in peace, it’s a happy life because I am here with my children and my husband, and we have what we need. So, my husband works, and my first-born son works. So, we are OK, we are fine.” Refugee camp Post-resettlement Accompanying rationale Mom 7 Mom 8 10 4 10 5 “…the life in the camp was super hard, really hard. You can't compare from there to here, because even if here when you go to shopping you gotta spend more than 100 dollars, and there you spend maybe 10 dollars, one tenth. But, here you can get that money better, faster than there. So, they think, maybe it can be 4 when compared to the camp life.” -M7 “What I can say here, it's because here, I didn’t go to school, but I am hoping I will find a job to do. And also, we get kind of benefits, like food stamps. My family has enough food to eat. And the other reason, my kids, they go to school. So that's the whole difference.” Mom 5, who earlier spoke about her experiences of waking up to see dead bodies in their living spaces, spoke about how those experiences affected her: “Yes, the stress and trauma, for me, it was something very severe, and it still been here because sometime when I go to bed I dream the same thing. And I feel like someone is running towards me to grab me. And also, sometimes I dream that I have been attacked and the person I’m with is killed. So yes, its stressful, even now.” -M5 Mothers spoke about the most stressful experiences they experienced in the camp, highlighting that losing family members was the most difficult: “The most stressful of all kind of things I went through...the most stressful was the situation of my son. Because he started getting sick when he was 7 months old. That was 2006. And he came to die in 2015. And, even if I was active, trying to learn, it was the way I could release myself out of the stress. Because the other kids...other families who has that situation, were sent somewhere to get better treatment, but we never got the chance. And that was so stressful to me.” -M7 Mom 8 said: “The most painful thing in my life was losing both my parents. Um, you know, everyone needs to see their parents around. So, most of the time, I was not told what happened to them, because of my age. They didn’t want me to cry, over-cry. But when I grew up and knew the truth, it was painful more than anything else.” -M8 Prayer and faith in God. How did mothers manage this stress during their time in the camp? Many mothers spoke about relying on their faith in God and prayer to reduce their stress: “So, the most important thing was prayer. Pray to God so he can help you to protect you for the next night or the next day.” -M5 Mom 6 said: I am a Christian. I prayed to God to help me. So, that helps me to reduce the stress.” -M6 Mom 4 also talked about the importance of prayer and “being a person who worships God and also pray.” -M4 Supportive female groups. Mothers also spoke of their experiences with supportive female groups and the importance of having those in their lives: “The other thing, in the camps, we had groups. The groups for female groups. And I was one of the leaders in the group, and we wanted to get some seminars and also help other females. And that really helped me...to reduce…my stress.” -M4 Mom 7 also referenced the role that having supportive groups had on her overall wellbeing in the face of hardships in the camps: “I continued to do my small business for fish, and making bread, and also agriculture. And in there, we made a group of women. And we made a sort of a cooperative or an association, which among them I was the president of the group.” -M7 Working to keep occupied. While mothers did not have jobs in the traditional sense of employment, mothers talked about the role that working had in keeping their minds occupied and away from the stress they felt from camp life: “So, what helped me, it was working. Because I had a garden. I had a farm for tomatoes, and also, I was praying to God. So being a farmer, working in the garden, taking care of it, it gives me hope to produce income, and also it keeps me busy.” -M6 Superordinate Theme 6: Managing Post-Resettlement Stress Again, to elicit an initial response about the perceptions of their stress I asked mothers to rank their
level of stress
post-resettlement
on a scale of 0-
10
with 0 being
the least
stress and 10 being
the most stress. Mothers responses ranged from 0-10. Now that they were living in the US, they still had stresses and talked about how they managed those. Mothers said they continued to pray and have a strong faith in God, sought counseling, and tried to distract themselves and try not to think about the past. Continued prayer and strong faith. Overall, mothers’ faith was a common theme that continued to be an important stress reducer across their migration from refugee camps to Roanoke. Several mothers again spoke of the importance of praying and keeping a strong faith in helping them to manage their stress now that they have relocated: “Yes, uh, here also I continue to pray and I continue to go to church. And also, here, I don’t really worry anything. I don’t worry about anyone who is going to come and break the house and start harassing me. So here, I am not worried.” -M4 Mom 8 said: “The thing I do is I pray to God, because I know this happened for a purpose. And I pray to God, and I take the bible and I pray and that helps me to reduce the stress.” -M8 She gave an example of how reading the Bible can give her relief in specific moments: “You see that I have the bible there (points to it). So, sometimes when I go to pick up my kids, I see them and they see me, and I remember I missed these moments. So, it's more stressful. So, I take the bible and read and I pray to God.” -M8 Seeking counseling. One mother spoke about seeking professional help to help reduce her stress and related symptoms: “So, some time ago, I had like a counselor or a doctor, I can’t say. And most of the time I was going there once a week. I was going there, and we spent time together; we talked. And then that helped me to reduce; not eliminate the stress, but reduce the stress.” -M3 That was not the only way she managed her stress, however. She, like other moms below, talked about ways in which she distracts herself: “Yea, before, I don’t have internet now, but when I had internet, I would go to watch movies on my YouTube channel, and I would feel more OK. Now since I don’t have it, I use my phone and watch movies and videos.” -M3 Trying to be distracted and not thinking about the past. Reading the Bible can also be a positive distraction for Mom 2: “I try to be distracted, and sometimes I take a book to read...I like to read...the Bible.” - M2 Mom 2 also spoke of how she tries to forget about the past in an effort to manage her stress: “Most of the times, if I remember what happens, it’s stressful. But when I don’t remember thinking about that, I’m fine.” -M2 Mom 1 spoke about how being distracted helps: “When I am stressed, most of the time I just stand up and then try to find something to do. When I try to do anything, it helps me to reduce my thinking and I reduce my stress.” M1 Stress in the Family (Parent-Child Domain) In this section, I present three superordinate themes that emerged from analysis of mothers’ relationships with their children in light of the various experiences they had from becoming refugees to living in refugee camps. As with the previous section, these findings correspond with research question two (what family outcomes are most salient to newly resettled refugees as a result of the totality of their migration experience?) However, in this section I focus specifically on the parent-child relationship domain. Superordinate themes that emerged from analysis include: I have a good relationship with my children, stress has not affected my relationship with my children, and mothers give an assessment of their own parenting where they talk about comparisons between themselves and other parents and talk about ways in which their parenting protects their children from the impact of their own stress. Superordinate Theme 7: I Have a Good Relationship with My Children In the second part of the interview, I asked mothers to tell me about their relationship with their children. This was a purposefully broad question because I wanted to see what relational aspects mothers would orient me to rather than the other way around. Still, I had prepared follow-up questions on specific domains of functioning based on previous literature related to the effects of stress on parenting: how they handled their children’s emotions and how they handle their children’s negative behaviors. Most mothers reported that they had a good relationship with their children and offered various examples as indicators of why they had a good relationship with their children, the most salient of which I highlight below. My children respect me. Mothers emphasized respect as a way to tell that they still had a good relationship with their children. Specifically, they emphasized that they could tell that they had a good relationship with their children because their children respected them. Respect could be demonstrated in many ways, as one mother put it: “I know that I have a good relationship with my children because if you don’t have a good relationship with your children your children don’t respect you. And when you tell them to do this they will not obey. So that shows me that I have a good relationship with them because when I told them, they respect.” -M2 Mom 8 gave an example relating to her relationship with her 11-year-old daughter, who is her eldest child: “Yes, I know because my children have a good communication with me and they respect me. When I tell them to do this, they obey, they follow. And even when I teach them something, they appreciate to learn that, and to follow. For example, I have a daughter who is 11 years. When I told her to wash her dish, she knows she can go and help me and wash the dishes.” -M8 Another mother, Mom 7, said she knew she had a good relationship with her children because “…they respect me, and they follow my rules, and they follow my directions.” Mom 4 said she knew she had a good relationship with her children because no matter what happened in life, her children still respected her. Mom 3, whose 4-year-old daughter lives here with her in the US, told me “Me and my daughter we have a good relationship. For example, if she goes outside she will come to report to me everything and tell me what happened. And that’s very unique.” My children are happy. Another way mothers could tell they had a good relationship with their children was if their children were “happy”. Mom 5 put it this way: “So, the reason I say yes, that overall my relationship with my children is good, is because most of the time they are happy. So, when I see children are not happy with their parents, that means the relationship is not good. But mine they are happy. So, that gives me the confirmation that we have a good relationship.” -M5 Mom 2 also spoke about her children’s happiness as an important part of indicating a good relationship: “Because all of them, my children, they are happy. And when they want to ask me something and when I have it, I give it to them. So, my kids, they are very happy.” -M2 My children communicate with me. A few of the mothers responded that they felt they
had a
good
relationship with their children
because
their children
communicate with them
and
listen to their advice. Mom 4 gave an example of this: “In general, I can say all my children do communicate very well, we have a good relationship. Even though I had one child, she used to be kind of....not, you know....having another bad influence, but when we sit together and advised her, she abandoned, and now the relationship is perfect.” -M4 Mom 6, for example, said: “I have a good relationship with my children…if something happened, we sit together as a family and solve the problem together.” While mothers were readily able to provide examples of emotional aspects of their relationships with their children, one mother’s response about the way she could tell her son was happy was tellingly related aspects of his physical development: “So, he is happy here more than in the camp. So, the reason why, I can say, it’s because in the camp, he was not developing. He couldn’t walk, he could even talk. And we don’t know if it was because of malnutrition or anything. But, when we came here, after a few months he started walking, he started talking and they didn’t give him any medication.” - M5 Superordinate Theme 8: Stress Has Not Affected My Relationship with My Children Mothers were asked whether they felt some of the stress they spoke of has impacted the relationship with their children. Mothers generally felt that their stress did not impact their relationships with their children. In fact, most mothers were emphatic in saying that they could not let their stress interfere with their ability to be present and there for their children. Mothers were clear that even though they currently experience stress as a result of their experiences, they could not abandon being good parents to their children as a result. As Mom 1 put it, “Even if I am stressed, I don’t have any idea to think like I have to ignore my kids.” Mom 2 said, “Even when I was in hardships of life, I couldn’t think to let my kids going alone.” Mothers told me that they were careful to ensure that the stresses they felt were not passed on to their children: “…actually, I’m adding more stress to them because they can’t help me. I’m the one who’s supposed to help them.” Mom 8 expanded on what drives resolve her to make sure the relationship with her children remains unaffected by the consequences of war and the stress of her experiences: “I can say, I didn’t have my parents with me when I was growing up, because the parents are there to help, to watch. And I didn’t have them to be there. But, in my side, when I see my children, all of them, I encourage them, I advise them. So, instead to destroy me, it causes me to build the relationship with my children.” -M8 Nothing changed. To get a sense for the stability of their relationships with their children over time, mothers were asked if they could compare their relationships with their children across their migration experiences. Mothers overall stated that their relationships with their children had stayed the same: “Nothing really changed about my children…the relationship with them didn’t change because [she] had a good relationship with them, no matter all those kinds of life they had.” -M4 Moms 5 said “it never changed, it was the same from when we came from Africa to here.” Mom 7 agreed: “the relationship never changed, and the relationship has been solid from there to here.” And Mom 8 concurred: “It’s the same.” A couple of mothers, while saying that their relationships with their children were the same or had not changed, acknowledged that some aspects of the relationships had changed due to circumstances not within their control: “So, it hasn’t changed too much, but I can say it changed. And, I don’t know to be honest, what I can answer that really…like for example, when I was in Africa, we were together all the time, playing together, doing...spending time together. And now, sometimes when I was working, my daughter goes to daycare and I go to work, so when I came here at the end of the day, tired, I couldn’t have time to play with her, so that was like a separation.” -M3 Superordinate Theme 9: Mothers’ Assessment of Their Own Parenting To help answer the part of research question 2 about how mothers felt their relationships with their children were impacted by the stress of their experiences, I asked mothers to assess their own parenting style by telling how they felt their compared to other parents they knew. This question was seemingly awkward and funny for mothers to answer as evidenced by their smiles, giggles, or even laughs when answering the question. “I think all of us we take care of our children very good”, Mom 1 responded with a laugh. “Everyone has his or her style to raise their children”, Mom 2 said while smiling. Everyone has his or her own style. Mothers however, were able to assess their parenting based on how they saw other people’s children behaving and responding to their parents. One mother, for example, explained that how she saw other children behaving confirmed that she was a good parent: “And compared to other neighbors' children...some other children they were like in another step of life, like disrespect their parents, and also growing up to be prostitute, and abandon their parents, go to another town where they can ignore the parents. But me and my children we were all united, still together no matter what.” -M4 Another mother explained it this way: “To compare with other parents, I think I’m in the middle. I’m not the best, and I’m not the worst, I’m in the middle of them. So, the reason why I say that is because I think other people can judge me and say, "This what you did is not what you should do", so they can judge me. And if I put myself the best, then I am wrong. So that’s why I said I’m in the middle.” -M5 Generally, mothers felt that everyone parents in his or her own way, and most strive to do the best they can. Mom 8 summed it up this way: “You know, you can’t say I’m better than anyone else. But what I do, I have to help my children. I have to make sure my children get the encouragement they need, they get the counsel they need. So, I think I am doing the best I can do, which I see is beneficial for my children.” -M8 I put my kids first. Putting their children’s needs first and responding appropriately to their children’s needs was a large part of how mothers ensured that the stress of their refugee experiences did not impact their children’s development negatively. This theme emerged when mothers were asked to give examples of how they could tell they were not letting the stress of their experiences interfere with their parenting: “Most of the time when the kids are crying so much, I have to be calm and to help them because if I get mad then I’m not going to help them…I put my kids first.” -M1 Another mother, who has a 3-year-old daughter, talked about ways in which she responds to her child’s needs: “Like for example, you see she wanted to go outside. And when I saw that, I have to go to follow her and to let her play outside. And I got her the board here for when she wants to write things down. Or sometimes I let her use my phone to watch some small things.” - M3 One mother talked about ways in which she calms her child down when he is crying or upset: “For example, if he cries without any reason or any kind of misbehaving, I try to calm him down, and if the cry is too big, I have to give him what I know he likes so it helps him to calm down.” -M5 Mothers seemed to have a sense of duty that they are responsible for their children being happy, and this showed through their responses. Their roles as mothers were important and meaningful to them. Stress in the Family (Family Functioning Domain) In this section, I present three superordinate themes that emerged from analysis of mothers’ accounts of their family relationships. As with the parent-child questions, I left mothers the ability to answer open-endedly about how their families as a whole were affected by the experiences of being refugees, however I sensitized mothers to certain concepts that I knew based on the stress literature: problem-solving, communication, and family support. I noticed that some mothers struggled to answer these questions about communicating about feelings in particular. Mom 5’s response, for example, highlights the difficulty of discussing a topic like this: “I don’t know if it's African style, because all my life I’ve never seen him coming to ask me if I’m not feeling good. I’ve never seen him coming to ask me: “What’s going on? Why do you look sad?’” -M5 Again, the interview was semi-structured in order to allow mothers the freedom to be able to focus their initial responses on topics most relevant to them, and to give me flexibility to give prompts where mothers were struggling to answer. Superordinate Theme 10: Communicating as a family Themes emerged around communication about feelings, problem-solving, and supporting each other. Reaching out to each other, sitting together to solve problems, asking each other what’s going on, and material support from family were some of the major themes that emerged. We reach out to each other. When it came to communicating about feelings, most mothers talked about that it was important to ask what is going on with each other and to reach out to each other in times of trouble. “Yes, we do reach each other when someone is happy. Or when someone doesn’t talk. So, we can ask what’s going on? Why don’t you talk today? Something like that…it’s normal when you see your family member is so sad, he doesn’t want to talk, yes, you reach out and you say why today you are so quiet? Why today you are so sad? And then when you see someone who’s very, very excited or happy. You ask today its looks like something is going on why are you so happy what’s going on.” -M1 Mom 2 also spoke of how her family communicates about feelings: “If someone is sad, yes, we approach each other. Even the children, we ask, why today you are mad, you are upset? And even the children can tell us that ok, you know, one of my schoolmates cussed me or did this to me. So, we reach each other to tell them what’s going on or to find out what’s going on.” -M2 We ask what’s going on. Mom 6 also gave her take on how the family navigates being there for each other: “If we see that someone is not happy, is sad, we have to reach out and ask what’s going on? Why? And then, if we find what's going on we try to solve the problem.” -M6 One mother, Mom 7, spoke of ways in which communication can lead to a reduction in conflict, as long as family members are willing to “forgive”. “If someone comes from work, or somewhere…school, comes sad or happy, we reach out to ask what’s going on today? And if we found there is something between us, we have to reconciliate to one another, or forgive one another.” -M7 Superordinate Theme 11: Problem-solving as a family We sit together. Mothers were also prompted to talk about ways in which they solve problems as a family. A common theme was that they would “sit together” and resolve conflicts as a family: “When we have a problem, or some questions and we don’t have an answer, we have to sit all of us together and find a solution together.” -M1 Mom 2 responded: “We can...we sit together and analyze the problem and see what we can do about them.” - M2 Mom 7 said the same: “If something happens, we sit together as a family and we talk about it”, and gave a specific example of a time when the family benefitted from this sitting together approach: “So, when we have a problem as a family, we sit together, and we think together as a family to see what we can do to solve the problem. For example, my daughter who didn't find education here, we decided to send her to Greensboro, North Carolina, and there, there was potential to go to school, and she’s at school now.” -M7 Mothers were also free to talk about their relationships with their spouses during the discussion about family, and the strategies they used between themselves and their spouse were similar to how they dealt with problems as a family: “Most of the time, like me and my husband, if we have like something we don’t agree, or something like if maybe he’s upset or I’m upset, we sit together and talk about what happened, what’s going on, what’s the reason. Because it could be anything, all of us we are not perfect. So, we reach out to each other to find out what’s going.” -M8 We ask for each other for forgiveness. Mom 6 also described how problems in her family can easily be resolved by asking each other for forgiveness if they have been in the wrong: “If, for example, there was an argument with one another or between one another, we ask questions. We tell them to go to forgive and ask forgiveness from one another, and that's how we solve the situation.” -M6 Seeking advice from family members. Mom 5 highlighted the benefit that having family members close by has had on her relationship with her husband in terms of seeking advice and support: “When there is a problem between me and him, we approach our parents to see if they can help us, so the life can continue...For example, I was separated with him and now I have gone back to live with him…We sat together with the parents, and the parents they helped us to advise us to show us many points and not to be uh, hating each other or see in different ways. So that’s why we are living together now.” -M5 Mom 4 explained that she sometimes turned to her adult daughters for advice on how to solve problems and explained that “if your child advises you, and if you are really wise, you should see that she doesn’t say it for nothing. She is helping you, so you respect that.” She gave an example of how she implements this in her life: “So, um, we do really have good relationship and communicate, you know. Me and my husband, because of, you know, people who grown up in certain area in Burundi, we sometimes get conflict. Sometimes it can happen that we don’t get along. And when we try to argue, one of my daughters who is at school will call us and most of the time she said “Can you stop that? You are old enough not to do this”. And then she starts laughing and then we start laughing too. And then after time, she shows us what she records (video) and she says: ‘Do you see what you were doing?’” -M4 She continued: “Yes, even those other daughters who are married somewhere...so, when they know something I did, they counsel me, they advise me and say: "Mom what you did last time, it’s not good, it’s not appropriate, you should not be doing it." And they advise me, and I respect them.” -M4 Superordinate Theme 12: Material Support from Family Support is not just emotional; it can be material. Another concept I sensitized mothers to is the concept of family support; specifically, how much support they felt was present among family members. Mothers reiterated that their families were generally supportive and that members of the family received support from each other when needed. Interestingly, examples of support came in material ways, such as helping babysit or being able to borrow money from each other, as Moms 1 and 5 explained: “Yes, we do really help each other. Because if we were not helping each other I would not be here with my kids. Because the one who pays for this house where we live, it’s my brother, And the one who helps him a little bit is my father. And then the one who buys the food we eat here is my brother. So really, we help each other.” -M1 Mom 5 said she experienced support from her husband: “So, helping or supporting each other, we do in everything. For example, I work nights, and he works daytime. So, when I go to work at night, he takes care of the kids. And now he’s a work, I stay home taking care of the kids.” -M5 Cannot lose the peace of the family. In all, this section illustrates mothers’ awareness of their stress but deliberate intention to protect their children and work collaboratively as a family to solve problems. This highlights two key things: mothers’ optimism about the relationships with their children and mothers’ concern for their children’s wellbeing in the face of refugee migration stress. Mom 8 captures the sentiments of this section: “When I remember what happened and stress comes, I understand but it has a limit. It doesn’t affect me in a way that we can lose the peace of the family. It's something past. It happened in the past and it has already passed, and I can’t bring it back.” -M8 Summary of “Stress in the Family” themes related to research question 2. Overall, mothers handled stress over several domains to protect their families. Table 5 below summarizes the four superordinate themes five through twelve and their related sub-themes that address research question two (what family outcomes are most salient to newly resettled refugees as a result of the totality of their migration experience?). These themes of stress management and family outcomes fell into the domains of the individual mothers, the parent-child relationships, and general family functioning. Table 5 Findings for Research Question Two: Superordinate Themes and Corresponding Sub-Themes Mapped onto the Individual, Parent- Child, and Family Functioning Domains. Stress in the Family Individual Domain Dyadic (Parent-Child) Domain Family Functioning Domain Theme 5: Managing Camp Stress ? Prayer and a strong faith ? Supportive female groups ? Working to stay occupied Theme 6: Managing Post- Resettlement Stress ? Continued prayer and strong faith ? Seeking counseling ? Trying to be distracted and not thinking about the past Theme 7: I Have a Good Relationship with My Children ? My children respect me ? My children are happy ? My children communicate with me Theme 8: Stress Has Not Affected My Relationship with My Children ? Nothing changed Theme 9: Mothers’ Assessment of Their Own Parenting ? Everyone has his or her own style ? I put my kids first Theme 10: Communicating as a Family ? We reach out to each other ? We ask what’s going on Theme 11: Problem-solving as a Family ? We sit together ? We ask for forgiveness ? Seeking advice from family members (can be one’s own adult children) Theme 12: Material Support from Family ? Support is not just emotional; it can be material ? Cannot lose the peace of the family Formal and Informal Support In this section, I present three superordinate themes that emerged from analysis of mothers’ perceptions of formal and informal forms of support. These responses correspond to research question three. Mothers were asked about their experiences with different forms of support post-resettlement, both formal and informal, and whether they thought one form was more helpful or valuable than another. Again, I refer to agencies such as CCC (Commonwealth Catholic Charities) and other government-sponsored social support services as formal social support services). Superordinate themes that emerged from analysis of mothers’ responses focused on help from the government, help from the African community, and cannot compare. Because in a previous section I highlighted mothers’ negative experiences with formal social support services (see mothers’ discussion of lack of support from social services under Superordinate Theme 4: The Stress Continues), in this section I only highlight mothers’ responses that do not fall in that category. The African community refers to other refugees who live in Roanoke and who had been in the US prior to the arrival of the refugee mothers. Superordinate Theme 13: Formal Support Help from the government. Support that came from the government ranged from things like helping mothers pay rent and pay for school supplies for their children and providing benefits such as food stamps and childcare. This support was instrumental for mothers and their families and included a resettlement stipend of $925 provided by the Department of Social Services. One mother who did respond that the government was more helpful was Mom 6, whose experience living in refugee camps in Tanzania and Mozambique helped to inform this view: “I can say the government is more helpful, because, for example, government has more power compared to a person. And for example, I have a big family, and up to now I have been here over 2 years, and I'm still getting food stamps. They just closed TANF [Temporary Assistance for Needy Families] because I'm not going to school. But I am still getting some other benefits from the government. Our friends, they help what they can, but they have limits. But the government has more power. For example, my brother who is in Tanzania, who is suffering, I don’t have the power to help him, because I have limits. So, the government has no limits, so the government, I can say is more helpful because they have no limits.” -M6 One mother highlighted the ways in which the government assistance was different from the assistance they received in camps in Africa and prior to becoming refugees: First, I can say, here the government helps a lot, because all the children they go to school for free. For example, in Mozambique, our children were going to school for free, but that was elementary school. But in high school, we had to pay, and children are supposed to stay at school, you have to pay their food, where they live, everything. So, it was expensive. I couldn’t manage to do it.” -M6 The government was also seen as a source of help in legal matters as well. One mother recounted to me a story that highlighted just how instrumental social services has been for her and her family, after the death of her mother and losing her son one afternoon while her mother was in the hospital: “I can’t say that they didn’t help us, because my son was lost a couple days. And then the social services helped us to get him back. So, it was under a big process and they helped us a big so I can’t say they didn’t help us, they do help us. Because we had a situation when my mom was very sick in hospital. And my dad was there in “Memorial” [Roanoke Memorial Hospital] and he called me, he said your mom’s situation is very, very bad. And I had two kids here. I couldn’t go immediately, but I waited until my young sister came from school. And when she came I told her, I said, I’ve got to go see my mom because they said the situation is super hard. And I couldn’t, I was not allowed to take a child over there with me. So, I told my sister to watch the children. And when I left, my young sister came here and fell asleep and the child somehow, we don’t know who opened the door, the child went. And then when I was at hospital, the guy who took me there, he said “we need to go home, we need to go home”. She continued: And I said why you are rushing me to go home? Because they had called him to say we are missing your son. So, but…he didn’t want to tell me why we had to go home. I said, why do we have to? He said, “we just saw your mom; we have already seen her, so we need to go back home”. So, I came back without knowing what happened. And when I came, here my young sister told me “I can’t see your son; I don’t know where he is”. I thought she was joking and I said why are you doing something like that when you know we are going through this situation with my mom? And I tried to look everywhere around the house and I couldn’t find him. And then I realized that it’s not a joke, that it’s serious. They, somehow, they found the child on the intersection there and they called 911 and the police took this child. They took him to the social service; it was long process of custody. And the child was in foster care for I think maybe 3 months. So, it was a big thing.” -M1 Superordinate Theme 14: Informal Support Help from the African community. Mothers also spoke about their experiences with the African community, and ways in which they have been helpful during their resettlement. As I highlight below, help from the African community came in the form of things such as driving newly resettled families around to bring them to appointments and grocery stores, offering support like translating, and offering prayers. Continuing her story about losing her son, Mom 1 explained the role that the African community played: “Yes, the people who are like the African community, they really helped also. Because for the death, they helped. Some they contributed. Also, losing a child, some they helped, they gave us ideas on what we can do, what we should do. And also they helped with the prayer. So, we get some kind of help.” -M1 Mom 2 spoke about her experience with the African community: “So, you know, when you come from overseas, most of the time you don’t speak English, so those in the community from the same countries, they are the ones who help us to show us where is the market, where you can go for this and so on. So, they are the ones who help us the most.” -M2 Mom 4 also felt that the African community was the most helpful of the two forms of support and explained to me why: “So, yea, we really feel supported with them. Because, um, they are the first who helped us, to take us to market, to groceries. And they are the same people who helped us to find jobs. So, I can’t say enough for them…we can say 100 percent the community helps us more than agencies. Especially like the community, African community we found here they helped us. Because they gave us almost everything we wanted.” -M4 Mom 5 also said she felt that the African community they found here were the most helpful because they came to aid of refugees more immediately and in cases where their help was more consequential: “The people who support us are the refugees who have been here for many years. I can’t say like the case worker at CCC helped us anything. No. They didn’t help us…pretty much everything we had to figure out by ourselves. Most things we can say, people...other refugees or other people from other countries, they are who helps us more, because food or things we need to use in the kitchen, they didn’t give us anything. And sometimes we could...we didn’t have any food, so other people they just brought us something to eat.” -M5 Superordinate Theme 15: Cannot compare formal and informal support Several mothers answered that they could not say one was better than the other because their roles in their lives are very different. “Both they support us. You are gonna forgive me about this, because both they help. Friends or community can’t help more than the agencies or organizations. But, I can’t say which one”, Mom 7 explained. Mothers went into more detail about ways in which the agencies and African community supports them, illustrating why they really cannot be compared: “So, I can’t really compare 100 percent to say which one is better. Because agencies they do their work and community they do their work. For example, if I needed to go somewhere, I can’t take my child to CCC (Commonwealth Catholic Charities) to say, “OK I’m going to find a job I’m for looking this, help me to hold the baby”. But I can go to my neighbor or my people who speak the same language and I know, today, so and so didn’t go to work, and I go to beg them to say, “can you hold, or babysit my child today and then I go to work?” So, everyone is doing his job.” -M3 Another mother said this: “So, for example, I can say the agencies they help me to give me like, beds, like seats, sofas, or anything in the house. And also give me food stamps for temporary, for short time, and also give me cash money a little bit. That's what I said they helped. And also, I can say also some friends, or the people in the community, helps to bring a little bit of what they can. And also, they have to take us to go to shopping, go to church, or other different areas. So that's what I can say. Both they help.” -M7 Another mother said this: “We are thankful for both of them. Because, for example, the agencies helps us to found us food stamps, other things we need for social security, for the babies. So, we thank them for that. And also, the community, they help us with taking us where we need to go, and some other small things. So, we thank them.” -M8 Mothers were able to highlight the benefits of both forms of support simultaneously: “Yes, like for example the agencies, they give us what we need, they give us food stamps, Medicaid, and other things we need. And, also the community here, we have good relationship; we visit each other, and we have good collaboration.” -M2 Mothers were clearly able to see how social services and the support from the African community helped: “…people from CCC they were there to help us in many things we wanted, especially when my mom died. And then, everyone tried to reach out to help because we didn’t have any money to go buy…to pay the funeral, to pay the expenses. So, they helped us. And then, about the social services, they help us a little bit for the food in the short term, but now I can’t say they keep helping us, because other refugees who came together with us, but we don’t get those benefits like food stamps.” -M1 As they highlighted above, several mothers were reluctant to say which form of support was better or more supportive or valuable. Instead, mothers were clear about what the role of each form of support was in their lives and were grateful for both. Summary of “Formal and Informal Support” themes related to research question 3. Table 6 below summarizes the three unique superordinate themes (13 through 15) and related sub-themes that address research question three (What social support systems, either formal or informal, do newly resettled refugees cite as most important, most needed, or most helpful?). The table also notes sub-themes from other sections that are also relevant to this research question. Table 6 Findings for Research Question Three: Superordinate Themes and Corresponding Sub-Themes. Formal and Informal Support Theme 13: Mothers’ Experiences with Formal Support ? ? Help from the government and social services For contrast see also Superordinate Theme 4 (The Stress Continues) sub-theme on lack of support from social services Theme 14: Mothers’ Experiences with Informal Support ? Help from the African community Theme 15: Cannot Compare Formal and Informal Support ? Each has its own role CHAPTER VI: DISCUSSION Overview of Chapter In this chapter, I summarize and discuss findings of this study. First, I summarize findings of each of the three research questions: 1. How do newly resettled refugee families experience the refugee migration process and how do they interpret their experiences? 2. What family outcomes are most salient to newly resettled refugees as a result of the totality of their migration experience? 3. What social support systems (either formal or informal) do newly resettled refugees cite as most important, most needed, or most helpful? Second, I situate the sample by first giving
a brief overview of
Congolese
and
Burundian refugee resettlement
in the United States
and offer further context about the sample. Then, I discuss findings of this study in the context of current theoretical and empirical understanding of this topic and population under study. I conclude the chapter by addressing limitations and possible future directions of this work.
Summary of Findings The purpose of this study was to
use an interpretative phenomenological approach to explore the lived experiences of refugee mothers resettled in the United States, in particular their experiences pre-, during, and post-migration, and to further examine the impact that these experiences had on mothers’ children and families. The study also sought to examine mothers’ relationships with different forms of support systems post-resettlement, in particular formal social support services and the wider African refugee community. This study illuminated a number of key findings that addressed three research questions and provides insights that will further inform research and practice with this population. Research Question 1: How do Newly Resettled Refugee Mothers Experience the Refugee Migration Process and How do They Interpret their Experiences? War driven by ethnic tensions had a devastating impact on mothers’ lives and was the primary catalyst for having to flee their homelands. Mothers reported harsh and traumatic experiences both on their way to find refuge (when some lost loved ones) and in refugee camps once they arrived. Mothers described profound distress about conditions and events that occurred in the refugee camps, which included experiencing lack of adequate food, water and shelter, losing children as a result of harsh conditions in the camp, experiencing abuse from authorities and persecution for being a refugee, and a general sense of insecurity. Once resettled, mothers continued to face challenges in the United States. Chief among these were a sense of not enough support from formal social support services. While this government-sponsored assistance was critical to mothers’ resettlement, it was also unpredictable and poorly explained, adding to a general sense of insecurity and stress. Language barriers, lack of financial resources and job opportunities, separation from family members as a result of resettlement, and stress that comes from the uncertainty about refugee policy moving forward also contributed to mothers’ stress. Mothers also talked about a nostalgia for home (Congo and Burundi) that appeared to contribute to their stress. Mothers reflected on their happy and peaceful lives prior to fleeing their home countries, where they talked about the freedom to live in peace and support themselves even if they if they did not have much. Research Question 2: What Family Outcomes are Most Salient to Newly Resettled Refugees as a Result of the Totality of Their Migration Experience? Mothers reported that many of these experiences led to individual stress in their lives. Mothers reported that their time during the refugee camps was by the most stressful (on a scale of 0-10 with 0 being no stress and 10 being the most stress, they described their stress level as a 10). Lasting stress and sadness came from mothers’ experiences with the death of children and family members during migration. While in the camps, they managed this stress through prayer and strong faith, supportive female groups, and working to take their minds of the stress. They continued to manage stress once resettled by a strong faith and reading the Bible, seeking counseling when needed, trying to distract themselves by engaging in various activities during their day, and making an effort to not think about the past. Each mother individually worked hard to shelter their children from her stress, prioritizing parenting over her own distress. Indeed, mothers generally were adamant that while they experienced stress as a result of the experiences during migration, they could not allow their stress impact their roles and responsibilities as parents. Mothers were able to tell that they were indeed good parents because their children respected them, listened to them, communicated with them, and were happy. They could also tell that they had a good relationship with their children because they put their kids first and could see themselves doing better than other parents in many ways, although some said they could not compare parenting styles because all parents are trying to do the right thing as it relates to their children. Overall, mothers’ relationships with their children appeared resilient due to the mothers’ deliberate efforts to protect and connect with their children. In addition to deliberately investing personal resources in their parenting, mothers also engaged family resources when challenges arose. Mothers reported that they sat together to resolve family problems, reached out to each other to figure out why family members were sad or unhappy, emphasized forgiveness as a way to resolve conflict, and supported each other in more ways than just emotional. Financial and material support was critical for the families to function; family members supported each other through things like adult children working to contribute money to the household and helping look after young children while mothers were working. Thus, encouraging family connections and collaborations contributed greatly to family resilience for resettled mothers. Overall, mothers were primarily focused on being good parents and keeping their families together during their migration, and outcomes included efforts to protect relationships with children and maintaining family problem-solving practices. Research Question 3: What Social Support Systems (Either Formal or Informal) Do Newly Resettled Refugees Cite as Most Important, Most Needed, or Most Helpful? Overall, several mothers reported that they could not compare formal and informal forms of social support, acknowledging that each played its role in mothers’ lives and was valuable in its own way. Refugee mothers spoke of the importance of the informal social support they received from the African community, while also acknowledging the invaluable support that came from formal support social services in the form of government-run programs such as Temporary Assistance for Needy Families (TANF), and government-sponsored resettlement agencies such as Commonwealth Catholic Charities (CCC). Mothers reported that the refugee African community provided things like help with translating into English, driving families around to appointments and getting groceries, and offering prayers and comfort during times of need. Help from the government was in the form of help with legal matters such as a custody case for one mother, providing food stamps and money for resettlement expenses, helping families find places to live and schooling for their children, and offering assistance with everyday life challenges such as getting to and from doctors’ appointments and childcare. Interestingly, no mothers spoke about support from the non-African community. Social support could have come from neighbors, employers or other sources of support in their system (one mother talked about receiving help from her local church), but mothers were primarily assisted by others in their community of refugees. Discussion of Findings Situating the Sample Congolese and Burundian refugee resettlement. The sample of this study was largely represented by mothers from Democratic Republic of Congo, and two mothers from Burundi rounded out the sample. Congolese refugees were by far the largest group of refugees resettled in the United States in the fiscal year 2018, after the January 2017 Executive Order led to a reduction in refugee influx from Syria and Afghanistan. Close to eight thousand Congolese refugees were accepted into the US during this period. In Virginia since 2013, 1003 Congolese refugees have been resettled, and 71 from Burundi. Since 2013, a total of 1004 refugees have been resettled in the city of Roanoke, with the majority coming from Afghanistan (n = 163), Bhutan (n = 110), and Democratic Republic of Congo (n = 107). Homogeneity of sample. The sample ended up being ethnically homogenous (mothers from East Africa) which helped to bolster the interpretative phenomenological analysis (IPA) approach (Smith & Osborn, 2008). As Smith and Osborn (2008) write, phenomenological researchers in particular: “…usually try to find a fairly homogeneous sample. The basic logic is that if one is interviewing, for example, six participants, it is not very helpful to think in terms of random or representative sampling. IPA therefore goes in the opposite direction and, through purposive sampling, finds a more closely defined group for whom the research question will be significant” (Smith & Osborn, 2008, p. 56). Using this sampling approach, I was able to delve more deeply into how mothers from this particular area of the world experience the refugee phenomenon. There are several reasons why the homogeneity of this sample was beneficial. First, the current sample helps to further our understanding of what refugee migration looks like for refugees in Africa. The experiences of Congolese refugees in Uganda, for example, is very different from the experiences of Congolese refugees in Tanzania. Uganda hosts refugees in “settlement areas” where they are free to move around and find employment. Tanzania, on the other hand, restricts refugees’ ability to move around freely outside of camps and work (Kreibaum, 2016). Mom 6, who spent time in refugee camps in both Tanzania and Mozambique, spoke at length about these differences in the way camps are run and told me her experiences in Tanzania were far more stressful than those in Mozambique (even though life in Mozambique was still challenging). This difference in the way camps are run has the potential to have critical implications for family life, as parents can have access to employment and children to schools, which can reduce the amount of stress a family has to manage (Kreibam, 2016; Thompson, 2018). Refugees can also benefit from having opportunities to interact with locals of their camp host country and further integrate into that society, which can decrease isolation for families (Kreibaum, 2016). Another reason it was helpful for the sample to be homogenous and include mostly Congolese mothers is that the war in Congo is ongoing. In an updated report provided by the UNHCR in August 2018, a total of 811,299 refugees have fled to camps along east and central Africa, with 133,719 fleeing just in the period of January 1st – August 31st (UNHCR Regional Update, 2018). Uganda by far hosts the most Congolese refugees (316,968); Tanzania is second with 84,088 refugees, and Rwanda is third with 81,740. Further, money already pledged by governments around the world is not being made available to the UNHCR for aiding Congolese refugees who are in need; just a quarter of the 201 million pledged for Congolese refugee resettlement since the crisis began has reached the UNHCR (UNHCR, 2019). Many of the mothers in this study spent time in refugee camps in Tanzania, where refugee policy has been increasingly under scrutiny as the government aims to reform. In August 2018, The Tanzanian government announced they would close “large businesses such as bars, chemists, video halls and mobile money stores” in order to clamp down on “Tanzanian businessmen profiting from refugee operations” outside the legal tax system and thereby taking advantage of refugees (UNHCR Regional Update, 2018, p. 8) This move however led to refugees fearing more insecurity because they rely on interactions with these Tanzanian businesses for their day-to-day survival. Abuse from authorities and citizens of host countries is also a documented challenge for refugee families. Kreibaum (2016) found that citizens of host countries fear that refugees are taking away resources from them, a sentiment that leads to refugees being shunned and persecuted. I end this section by highlighting the conclusions of the 2018 Regional Report by the UNHCR, which reiterated the challenges and need for action regarding the world community: “Government policies continue to limit refugee opportunities for livelihoods and self- reliance. Refugees at Nyarugusu refugee camp are almost completely dependent on humanitarian assistance and therefore at heightened protection risks, including SGBV, exploitation and abuse. Despite the challenges and the extremely reduced protection environment, UNHCR continues to focus its advocacy and resource mobilization efforts on increasing integration activities of stability and resilience, and mitigating as much as possible negative coping mechanisms that result from the precarious socio-economic environment, food insecurity and limited access to basic social services and infrastructure.” (UNHCR Regional Report, 2018, p. 9) Refugee Migration Stress and the Individual In this sub-section, I discuss findings of this study in the context of previous empirical and theoretical literature related to refugee migration stress and the individual. Specifically, I discuss the stress of camp life and post resettlement challenges and their effect on the agency of the individual mothers in this study. Stress of camp life. Previous and current literature has and continues to provide backing for the serious outcomes that refugee individuals face as a result of their traumatic experiences (Mollica et al., 1992; Gardiner & Walker, 2010; Renner, Laireiter, & Maier, 2012; Kartal & Kiropoulos, 2016). Refugees
are at risk for depression, anxiety, post-traumatic stress disorder
and other mental and emotional challenges which can affect they day-to-day life (Slobodin & de Jong, 2015; Knipscheer et al., 2015). In a recent study, researchers found that PTSD associated with refugee migration stress can lead to impairments in even cognitive functioning as well, specifically problems with working memory and executive functioning (Ainamani et al., 2017). While this current study did not ask mothers to identify specific mental health challenges, one mother spoke about experiencing night terrors as a result of the violence she witnessed while living in the camp. In two of the interviews, I had to stop the interview to allow the mother to recollect herself after breaking down during telling her story. I asked one mother how often this happens, and she told me that she cries every time she thinks of her brother, who was killed in Congo before she fled. She told me she now manages her emotions by seeing a doctor, who the interpreter later told me was a therapist. The most stressful experiences for refugee mothers in this study were by far their time in camps. Camps are usually located in forested, outlying areas away from large cities and access to basic city life (Kreibaum, 2016). Many times, refugees lack access to basic commodities such as food and water (according to the UNHCR, the
average water supply in
one
camp
in Uganda is
14.8
liters
per
day
person, which is
far
below the
required per person per day amount of 20 liters). All mothers in this study were clear about the devastation that a lack of food had on their survival and the survival of their families and others during their time in the camp. For further clarity, mothers were asked to rank their stress levels at each of their migration periods, (pre-, during, and post-) between 0 and 10 (0 being the lowest amount of stress and 10 being the highest amount of stress). All but one of the 8 mothers responded that during their time in camps, their stress level was 10. This finding highlights the need for governments, policymakers and UNHCR administrators to further examine the way in which they administer camps and also the length of time that families spend in the camps. Another finding relates to the length of time mothers and their families spent in camps awaiting resettlement. The average length of time in camps for mothers in this study was 18.75 years, which is far too long for any person or family to have to wait for a new life. Many had children and expanded their families there. Settling in refugee camps seemed at first to be a saving grace for the participants because they were fleeing war and deadly violence in their home countries, but the reality of camp life was disturbing and traumatic. Some participants and their families stayed in one camp for the entire time prior to resettling in the US. Others jumped from camp to camp, sometimes in a different country. While no literature currently exists examining the impact of length of stay for Congolese families, other research found families whose migration experiences are characterized by long waits for resettlement (up to 2 years) are at higher risk for negative mental health outcomes (Laban et al., 2004). This study therefore begins to shed light on the impact that long stays in refugee camps can have on the overall wellbeing of refugees, and future studies need to make this a priority. Continued post-resettlement challenges. From the time refugees are forced to flee their homelands to the time they finally resettle in a final host country, they endure a collection of traumas and hardships. Unfortunately, those hardships do not end; mothers in this study highlighted that their struggles continued due to various challenges that have been supported by previous literature. The state of Virginia resettled 1749 refugees from 30 countries in 2018, a decrease from 4257 in 2017 and 3425 in 2016. Mothers’ anxieties about the refugee program continuing were therefore valid and continue to be so. To compound this, the current administration further began separating children and parents who arrived at the border to seek asylum and has indicated it will pursue a policy to reject asylum seekers. The outcome is more uncertainty for refugees, in particular those who seek to come to the United States because they believe it to be a place where their families would be safe and “respected”. One mother expressed her hopes for this country when describing the harsh treatment she endured with her family: “So, the thing there, in the Tanzania, they didn’t care about the family. When they punish, they didn’t know the consequences, they just punish, and many people were disabled because of punishment. And also, they didn’t care about the family, they can separate you, take one of your family, and you never see him or her again. But here, when someone made a mistake, or make a crime…commit a crime, he will be judged by himself because of the crime he did. And also, here they respect life, they respect family, so they can’t separate the family from one another. So, here is better than in there.” -M4 Mothers in the current study grappled with sobering economic challenges. When refugees arrive in the United States, each member of the family is entitled to 925 dollars as part of a resettlement and placement (R&P) fund provided be law by the US federal government. So, for example, if a family of 7 (two parents and five children) arrives in the US, they are given 6,475 dollars to spend on resettlement expenses which include rent, food, clothing, and utilities. This sum might seem like a lot of money, but families often have little leeway for spending, especially if they have yet to find employment. In a recent study of mental health outcomes for 193 Somali and Bhutanese refugees in the Greater Boston and Springfield areas of Massachusetts, researchers found that within the Somali community “financial problems” was listed as the most frequently cited problem that community members experienced. Participants described not having enough money to pay for rent, food, clothing and other bills as their greatest stressor (Betancourt et al., 2015). Helping families to adjust to new life can be a critical element to successful resettlement, and to that end, the government encourages refugees to begin looking for work as soon as they arrive in the US for more successful outcomes. Mothers in the current study, however, cited language barriers as one of the most salient challenges they experienced post-resettlement. Proficiency in the host country’s language is vital for positive resettlement outcomes (Garcia- Coll, 2004). It can help with many other aspects of the resettlement process, such as finding employment and furthering one’s education (Bjorn
et al., 2013;
Koh
et al, 2013).
According to Betancourt
et al. (2015),
“language barriers” was listed as the most frequently cited problem by 83 percent of Bhutanese refugees. This included difficulty for parents and children when communicating with teachers or other outsiders, and parents having difficulty helping their children complete homework. In the United States, adult refugees are required to attend English classes as soon as possible after their arrival. Adult classes at CCC, for example, occur every weekday morning from 9-12, and classes are provided and paid for by the resettlement agency. Loss of agency across the migration period. Another important aspect of consideration this study highlighted in the mothers’ individual experiences is the devastating loss of a sense of agency mothers encountered as they moved through their migration experiences. One mother in particular captured the essence of this feeling when she juxtaposed life back home where she could work and take care of her family to life in the camp where she for the first time did not have food and had to accept rationed food. The UNHCR states that refugee in Tanzania in particular are almost totally dependent on humanitarian assistance from the host country (UNHCR, 2018). Agency refers to the “subjective awareness of initiating, executing, and controlling one’s own volitional actions in the world” (Jeannerod, 2003, p. 5). Gallagher (2008) defines a sense of agency as “the sense that I am the one who is causing of generating an action” (p. 15). Agency allows a person to take control over their own life and behavior and allows for a person to make decisions independently of another person (Gallagher, 2008), and studies previously done on this with other populations show that “the effects of protracted displacement that might have silenced their agency” (Abkhezr, McMahon, Glasheen, & Campbell, 2018, p. 18). Mothers in this study whether they recognized it or not lacked agency in their lives because they were so dependent on others. While in camps, mothers could not earn a living to be able to take care of their children, could not leave the camps to find employment, could not decide what food to eat, and could not choose an education for their children. Post-resettlement, they could not get to doctors’ appointments without the help of case workers or volunteers, could not communicate with non-family members without the help of translators, and could not get housing without the assistance of the government. The impact of this lack of agency was most evident in mothers’ reminiscence of their past lives in Congo and Burundi prior to becoming refugees. Perhaps it was the juxtaposition between the harshness of the conditions in the camps, but all but one participant spoke glowingly about their life in Congo and Burundi before having to flee. In Congo or Burundi, they could be self-sufficient and feel competent about their ability to look after themselves. This idea was reinforced when asked to rank the stress they felt prior to becoming refugees; mothers reported having no stress prior to becoming refugees; their stress level was 0 on a scale of 0-10 (10 being the most stress). Being able to look after their themselves and their families, find food they wanted to eat and be free to farm and live in peace reinforced the agency they had lost many years ago. It is therefore critical to delve deeper into the role that agency plays, and to further study the relationship between agency and length of stay in camps. I conclude this sub-section by offering a visual representation (Figure 5) of how findings of this study’s first research question support current literature describing stressors for refugee families as extending across pre-, during, and post-migration periods. Figure 5. Visual Representation of Findings for Research Question 1 Refugee Migration Stress and the Family In this sub-section, I discuss findings of this study in the context of previous empirical and theoretical literature related to refugee migration stress and parent-child and family functioning. Specifically, I discuss results in the context of parental self-efficacy and parental stress and trauma, and then I discuss results in the context of current family stress literature. Throughout, I offer possible explanations for findings in the context of attachment theory and cross-cultural development theory and research and social desirability. Parental self-efficacy. One area of particular interest in this study was parental self- efficacy. As previously stated, parental self-efficacy
refers to the degree to which a parent feels
themselves to be capable of effectively parenting their child, or the “beliefs or judgements a parent holds of their capabilities to organize and execute a set of tasks related to parenting a child” (De Montigny, & Lacharité 2005, p. 390; Coleman & Karraker, 1997; Jones & Prinz, 2005). Findings in this study suggested that mothers had relatively high-parental self-efficacy; their responses to questions about their relationships with their children and their assessments of their own parenting showed they could pinpoint what exact behaviors they did and their children did to highlight a good relationship. Self-efficacy was evident in how mothers spoke of how they blocked out the stress they felt because, according to one mother: “parents are supposed to help their children, not the other way around”. Examples of how their children respected them, were happy, and listened to them showed a degree of self-efficacy. These results are in line with similar findings in a previous study that found that parental self-efficacy can
mediate the relationship between parental fatigue and parental warmth;
that is parents who scored high for fatigue were found to still display warmth toward their children when they had high parental self-efficacy (Chau & Gallo, 2015). While I hypothesized that refugee mothers would report difficulties in their parenting due to previous trauma and current stress, refugee mothers in the current study showed a high degree of parental self-efficacy which is a promising finding for families. Practitioners can use these findings to inform further strength-based interventions with refugees. Parental stress and trauma. Another area of focus in this study relates to the role of parental stress and trauma in parenting and subsequently children’s development. While no child outcomes were collected from mother’s children in this study, mothers’ responses that they could not allow stress to interfere with their roles as parents and their children’s wellbeing was not expected and highlight the need for further exploration. Mothers reported putting their children first and experiencing no change in the relationship they had with their children prior to resettling and gave specific examples of ways they could tell their relationship with their children was strong. As previously highlighted, Ammerman et al., (2013) suggested that parental trauma can lead to a reduction in parental sensitivity and responsiveness and being able to read and even anticipate the verbal and non-verbal cues of their children, (Ammerman et al., 2013; Sullivan et al., 2011). In light of this inconsistent finding, it begs the question of why mothers in this study reported not to experience the expected negative outcomes seen in previous literature. Upon further examination, a possible explanation can be isolated from exploration of attachment theory and related concepts (Bowlby, 1969; Ainsworth, 1979). Bowlby (1969) came up with the concept of the attachment behavioral system, and he describes the attachment behavioral system as a series of behaviors that a child engages in order to promote proximity between the child and its primary caregiver. He proposed that human infants use these proximity-seeking behaviors to enhance their chances of physical survival and that proximity to a caregiver means they will have their physical and emotional needs met (Bowlby, 1969; 1973; 1980). Ainsworth (1979) sought to explain the nature of attachment between mothers and infants by coming up with three styles of attachment, and she also believed that attachment behaviors are closely related to exploration in children. She, like Bowlby, believed that children used the
caregiver as a secure base from which to explore
their environment (Ainsworth, 1978; Bowlby 1988). Another important assumption evident in her writings is that attachment is largely determined by the primary caregiver’s ability to be sensitive and responsive to a child’s physical and emotional needs (Ainsworth, 1979). From their own accounts, while mothers spoke of enduring traumatic experiences across their migration journeys, mothers were at no point in their migration ever separated from their children. Mothers were with their children and available to them even during the most difficult and traumatic times in their lives. Could this physical proximity and availability of mothers to their children (even more pronounced because they were in camps with limited freedom of movement) have played a role in mothers feeling their relationships with their children were positive and intact? As Mom 4 explained: “…me and my children we were all united, still together no matter what”. From this, I hypothesize that that closeness may have acted as a buffer or protective factor
for the impact of
trauma
on the
parent
-child
relationship.
And
while parent
-child
attachment was not a concept explicitly under study in this study, further exploration of the role of parent-child attachment and the degree to which refugee mothers can still effectively serve as a secure base for their children in harsh and traumatic circumstances is needed. Family functioning. This study was theoretically informed by Family Stress Theory as put forward by Hill (1949) and McCubbin et al. (1983) and Family Stress Theory for Economic Hardship (Conger and Conger, 2002). Aside from telling the stories of refugee mothers and highlighting their lived experiences, another goal of
this study
was
to explore the
anatomy
of
family stress
in the
context
of refugees and
gain more perspective about how families under this particular kind of stress function, with the goal of informing future practice and interventions with refugee families. A number of findings illuminated key points of discussion that may help to increase our understanding of the totality of the experience of refugee families. First, mothers’ responses to questions related to family functioning suggest the need for a resiliency lens (focus on protective factors) when looking at refugee families, not just a problem-focused (risk factors) lens (Patterson, 1998). As stated in the previous literature review chapter, a large and critical gap in the literature relates to the mechanisms of how refugee families actually function under stress. Mothers in the current study spoke about sitting together to solve problems and reaching out to each other to isolate what might be going on with another family member. But what is it about this “sitting together” that brings about solutions to problems that the family could not otherwise resolve had they not engaged in this behavior? A possible explanation maybe due to the living conditions in the camp. When mothers talked about sitting together with their family to solve problems, and even being advised by their adult children, it may reflect a strategy born out of the living conditions in the camp. As previously mentioned in the case of parent-child attachment, families were perpetually together with their children living in small, close-knit conditions where they had no choice but to sit together to come up with solutions. Mothers could easily be forced to turn to family for counsel as they may be the only available source of counsel. Living conditions in camps, and in particular in Nyarugusu camp where many of the mothers in this study spent time, are notoriously bad (Thompson, 2018). So, was sitting together to resolve problems something that developed as a result of living for prolonged periods in the refugee camp? And considering the length of time mothers spent in camps, could this resilient way of solving problems have been all families knew across their developmental life? This is a strong possibility that can and should be further explored and previous literature suggests the following: “It is the lifestyles and environmental demands on people which leads them to develop in such a way as is optimal in those conditions. When those conditions change, as seen in…international migration, new lifestyles come into being which bring up new environmental demands requiring new adaptations” (Kagitcibasi, 2011, p. 296). The above leads to other discussions pertinent to the findings of this study that relate to two of Hill’s assumptions in the original family stress theory. Hill suggested that the
definition a family makes of the severity of changes in the family social system influences the family’s vulnerability to stress and
that
the amount of change that occurs when a stressor event occurs in the family social system influences the amount of crisis that results from the event
(Hill, 1949). Family perceptions are processes that involve how the family interprets their negative or stressful situations, and Hill posited that how the family perceives their stress can have an impact on their subsequent response to the stress. Further, perception can make some families more vulnerable to stress and can lead to a more severe crisis response (McCubbin et al., 1982). Mothers in this study were optimistic overall about how they saw their families solving problems together, and it may be that time in the camp with nowhere to go and relying only on each other for so long added a sense of stability to their family lives. Another possible explanation for why mothers perceived their families to be overcoming challenges well is that mothers were aware of and determined that the trauma and resulting stress they experienced could not influence or impede their duty as parents to take good care of their children: putting them first was their priority. While mothers and their families’ experiences were indeed traumatic and stressful, mothers spoke about ways in which they coped with this: Prayer and strong faith. Again, these findings highlight the need for a strength-based framework to further explore refugee mothers’ perceptions as protective factors for stress, and to isolate the degree to which having a strong religious faith is contributing to mothers’ optimism. After reviewing findings of this study, one must consider the possible role that social desirability may have had on mothers’ responses. Social desirability refers to the lengths to which a participant will go to give answers to questions that they believe the researcher wants to hear (Nederhof, 1985). Social desirability can lead participants to over-report good behaviors or under-report bad behaviors when self-reporting on their behaviors in the context of a study, with early work on its impact on social science research suggesting it can affect reliability and validity in a study (Crowne & Marlow, 1960; Marlow & Crowne, 1961). In the context of the current study, the question of social desirability leading to mothers’ overall positive assessments of their relationships with their children and families is important to consider. While I reassured mothers of confidentiality and that I would not share their responses with caseworkers at CCC, I did inform them in the risks and benefits section of the verbal informed consent that I would break confidentiality and report cases of suspected child neglect and abuse to Department of Social Services (DSS). Mothers, however, appeared to answer candidly about their experiences with CCC even in the presence of a CCC caseworker who was the interpreter (see mothers’ responses under Superordinate Theme 4: The Stress Continues about their negative experiences with CCC). It is therefore worthwhile to view mothers’ responses to questions about relationships with their children and families as genuine and truly reflective of how they felt. Another possible explanation for overall positive findings relates to mothers’ cultural context in how they define relationships. The primary sensitizing theory that helped to develop the framework for this study is
the Family Stress
Theory
of Economic Hardship (Conger
and
Conger, 2002)
that was developed with Western, rural Caucasian families in Iowa, but for further examination with this current population under study, we can look to cross-cultural perspectives as a guide for interpretation. Cross-cultural theorists (Kagitcibasi, 2011; Kagitcibasi, 2005; Kagitcibasi & Poortinga, 2000) explain that cultures can be collectivist or individualistic in nature, meaning that there is a focus on relational interactions and maintaining group identity and togetherness (collectivism) or a focus on autonomy, independence, and development of self (individualism). While perspectives continue to shift on how these concepts can be related or coexistent in a single culture, collectivist perspectives (togetherness and a focus on maintaining good relationships with their children) appeared to be highlighted in the current study through refugee mothers’ responses about their relationships with their children and families. Therefore, this collectivist orientation toward togetherness and relationality, or mothers’ ability to adapt to their environments as a result of stress, may be protective factors for refugee mothers and families merits further exploration. One last consideration with respect to the overall positive findings in the parent-child and family function domains is that this sample of mothers self-selected to be interviewed for the current study through snowball sampling. Mothers heard about the study and contacted me through the interpreter to be interviewed, so it is therefore plausible that mothers may have had largely resilient perspectives regarding their family life and wanted to share these perspectives with the researcher. Refugee Migration Stress and Formal and Informal Support Family resources (Hill, 1949; McCubbin et al., 1982) were also a critical element in this study, specifically the degree to which outside support acted as resources for the families. One of the most illuminating findings that emerged from analyses of mothers’ responses to questions about the degree to which they felt formal and informal social support services were helpful was their response that they cannot compare or say which of the forms of support was most helpful, because they each function in their own way. This finding highlighted two key elements that are supported by the literature. First, mothers’ responses highlighted what appeared to be a coping mechanism: their ability to successfully wrestle with the both/and. Systems theorists suggests that both/and thinking is helpful because it brings about attitudes that allow multiple perspectives to be considered, a tolerance for ambiguity, and more complex thinking (Stanton & Welsh, 2012). While it appeared that mothers contradicted themselves in answering those questions, it was their ability to be able to see multiple perspectives on an issue. Mothers showed they were capable of recognizing and examining systems at various levels (Bronfenbrenner, 1977; 1979), a skill researchers posit “facilitates the understanding of complex issues and problems” (Stanton & Welsh, 2012, p. 19). And while mothers did not use this term, they lived and made decisions under an accepted perpetual ambiguity: “tolerance for ambiguity implies that one is able to deal with uncertainty and/or multideterminacy” (Beitel, Ferrer, & Cecero, 2004, p. 569). Finally, mothers’ ability to handle complexity is evident here as well. Living in complexity, according to researchers, involves being able to accept the messiness or disequilibrium during time of decreased homeostasis: The
edge of chaos . . . is where the components of a system never quite lock into place, and yet never quite dissolve into turbulence . . . the edge of chaos is where life has enough stability to sustain itself and enough creativity to deserve the name of life.”
(Waldrop, 1992, p. 12). Advancing the Family Stress Literature Overall, findings in this study begin to help family practitioners and researchers to gain a better understanding of the mechanisms through which families, and in particular refugee families, find themselves operating under stressful conditions. The parent-child findings in this study are particularly promising and offer support for conclusions in Conger and Conger’s (2002) Family Stress Model for Economic Hardship. Mothers in this study were not fated to be bad mothers just because they were under stress, nor did they perceive their children being at any more risk for bad outcomes because of the experiences they had as refugees, which supports Conger and Conger’s (2002) finding that child outcomes do not occur solely as a result of the experience of hardship or adversity, but the negative child outcomes occur as a result of parents’ inability to manage their own stress leading to harsh parenting. The findings in the family function domain also help to further understanding of refugee families’ experiences and how they function pre-, during, and post-migration. Family stress theorists suggest that “the range and depth of the family's repertoire of coping and problem-solving strategies when employed to manage a crisis situation are related to the level of family adaptation” (McCubbin, 1993, p. 55), which highlights the highly developed repertoire of refugee mothers in this study. Mothers ability to adapt to stressful situations and manage stress experiences for themselves and their families in a resilient way is promising. Model for Refugee Family Stress and Coping A secondary goal of this study was to help inform practitioners about mechanisms through which refugee families function in the context of refugee migration stress by developing a Model for Refugee Family Stress and Coping. While the sample was not large enough to achieve saturation and generate concrete findings for a model, we can begin to see the model taking shape to explain the how refugee migration can affect refugee families in Figure 6. Refugee experiences or stressors (a or A), can lead to crises or maladaptation (x or X) in the individual, dyadic, or family domains, unless buffered by mothers’ perceptions of refugee migration stress and the role it should have on their children and families (c or C), and supported by family resources (b or B)
in the form of
formal
and
informal
social support. In the
case
of
the current study, mothers may have experienced a bonadaptation outcome rather than a maladaptation. McCubbin et al., (1982) suggested that over time, a pile-up of a (A) may lead to an adaption response (either good (bonadaptation) or bad (maladaptation)) based on the family’s ability to withstand an initial crisis response by making use of both new and existing resources, and coming up with new perceptions of their resources and the stress. Refugee mothers in this study showed a strong tendency to do this, so this model (Figure 6) is a very early start in a positive direction. Figure 6. Synthesized Refugee Model for Stress and Coping. Point of resettlement FAMILY OUTCOMES c (C) Individual Impact x (X) Refugee experiences Refugee Migration Stress Dyadic Impact x (X) a (A) Family b (B) Impact x (X) Resources – informal/formal support Limitations There are a number of limitations to consider as in the context of this study. First, a number of barriers exist to engaging refugees in research, such as language barriers, lack of cultural understanding, low education and literacy, and lack of trust of outsiders (Gabriel, Kaczorowski, & Berry, 2017). Two of the most notable and relevant to address for this study is the issue of language barriers and low education and literacy, making written surveys impractical. Further, because refugees have difficulty trusting people with whom they are not familiar or whom they view as outsiders (Betancourt et al., 2015), it was difficult to recruit a large number of mothers. These challenges were partially solved by hiring an interpreter who was already familiar with the mothers. It was the interpreter who introduced me to mothers and scheduled interviews on my behalf. The use of an interpreter came with challenges on its own, though. While this interpreter received training through CCC on delivering services to refugee mothers, he was not trained in conducting interviews for research purposes. Use of an interpreter also inevitably can lead to misinterpretations when asking or answering questions, and context and meaning of language can be lost. Further, an IPA approach analyses for the use of language (Smith and Osborn, 2008), which I was not able to do because I did not speak mothers’ native tongue and could not make judgments about how they used language in understanding and answering questions. Still, I am grateful for his invaluable work in helping me recruit and interpret for mothers in this study. Another limitation in this study was the lack of triangulation in the
data. Triangulation
involves
the use of multiple sources of data
to gather information about the same topic (Guba, 1981; Carter et al., 2014) and for this study only mothers were interviewed. Findings such as those related to parental behaviors and self-efficacy for example, may have been bolstered by also interviewing children or spouses to corroborate mothers’ responses. Another limitation of this study was that mothers were not asked to clearly delineate a specific child when responding to questions about parent-child relationships. This had the effect of compounding the responses in the parent-child and family sections. However, the more open-ended questions were helpful in this early stage of research to allow the mothers to orient the direction of this rich data towards what was most salient to them. Lastly, as previously discussed, findings of the parent-child and family outcomes do not fit with theory and literature reviewed (Hill, 1949; Boss, 2002; DeHeane, 2010). The McMaster Model for Family Functioning, for example, highlights that families will experience disruptions in all or some of the six domains
of family functioning (i.e., problem solving,
roles,
communication, behavior control, affective involvement, affective responsiveness;
Epstein et al., 1983). I state here again that social desirability bias may have played a role in influencing this work, however mothers’ stories and lived experiences were the focus for this particular study and future work will take into account strategies to reduce social desirability bias. Future Directions There are several future directions to consider in the context of this research. The first, is to expand recruitment of mothers to include a larger sample and offer the possibility of a grounded theory approach (Creswell, 1999). A grounded theory approach would be better equipped to inform and further develop the aforementioned Model for Refugee Family Stress and Coping because it could continue to explore concepts in the model until saturation is reached. Another future direction would be to add interviews with children and spouses for detail and to increase triangulation. Adding interviews with children and spouses would also begin to address social desirability bias by offering added sources of data. Quantitative measures of stress and parenting with a larger sampler would allow comparisons and statistical modeling of pathways hypothesized in the model, furthering development of the Model for Refugee Family Stress and Coping. Conclusion The
purpose of this
study
was to use an
interpretative phenomenological
approach to
explore the lived experiences of refugee mothers resettled in the United States, in particular their experiences pre-, during, and post-migration, and to further examine the impact that these experiences had on mothers’ children and families. The study also sought to examine mothers’ relationships with different forms of support systems post-resettlement, in particular formal social support services and the wider African refugee community. Findings of this study contributed to the already existing literature on outcomes for refugees who are resettled, and further provided first-hand accounts of what experiences were most salient to mothers. Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 pl Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study ease contact Ruvi Tsokodayi at 914-843-3331 or ruvitso1@vt.edu If this research study interests you and you would like to participate, be used as part of a dissertation and may be published. Participation is voluntary and confidential, and results will Walmart gift card for your participation. Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 interview will be audio recorded, and you will be given a $50 experiences with a Virginia Tech doctoral student. The
will be asked to participate in a
2-hour
interview about your
If so, please consider taking part in a research study. You born prior to your resettlement in Virginia? ? Do you have children aged 5-17 years who were Roanoke within the last 5 years? ? Are you a refugee mother recently resettled in TSOKODAYI DISSERTATION Appendix A: English Flyer Refugee Mothers Research Study 139 Ruvi Tsokodayi (914)-843-3331 Refugee Mothers Research Study Ruvi Tsokodayi (914)-843-3331 Appendix B: Arabic Flyer ھل أنت أم لاجئة وقد تم توطینھا مؤخرا في رونوك خلال السنوات الخمس الماضیة؟ ھل لدیك أطفال بعمر 5 - 17 سنة ولدوا قبل إعادة التوطی في ولایة فرجینیا؟ إذا كان الأمر ينطبق عليكِ يرجى النظر في المشاركة في دراسة بحثية مع جامعة ڤرجينيا .للتكنولوجيا وكل ما هو مطلوب من حضتكِ المشاركة في مقابلة لمدة ساعتی عن خبىاتك مع طالب دكتوراه من جامعة ڤرجينيا .للتكنولوجيا وسوف يتم تسجيل هذه المقابله كمقطع صوتي وسوف تحصلی على هديه وهي بطاقة بقيمة 50 دولار من وول مارت تقديراً لمشاركتك يف .هذا البحث مشاركتك في هذا البحث اختياريه وسوف تبق سرية، وسيتم استخدام النتائج لهذه المشاركه كجزء من البحث العلمي ومن الممكن أن يتم نشرها إذا كانت هذه الدراسة البحثية تهمك وكنت ترغبی في المشاركة، الرجاء التواصل مع روفي تسوكوديا على هذا الرقم: ٩١٤٨٤٣٣٣١ أو من خلال هذا الايميل ruvitso1@vt.edu دراسة علمية الأمهات اللاجئات دراسة علمية الأمهات اللاجئات دراسة علمية الأمهات اللاجئات )روڤي تسوكوديا( )روڤي تسوكوديا( )روڤي تسوكوديا( ٩١٤٨٤٣٣٣٣١ ٩١٤٨٤٣٣٣٣١ ٩١٤٨٤٣٣٣٣١ Appendix C: Verbal Consent and Interview Protocol Part I: Verbal Informed Consent Script “Thank you for agreeing to sit down and speak with me about your experiences. I
very much
appreciate
your time and look forward to hearing
about your experiences. This interview will last about two hours. First, I will share some information with you about my research study and what you can expect. After I tell you about my study, I will then ask you if you agree to participate, and if you tell me “yes” then we can go ahead and begin the interview. Is that OK?” [If “yes”, proceed to next paragraph. If “no”, thank them for their time and end session]. “So first, I am going to just explain to you a little bit about the study.
I am a PhD student at Virginia Tech.
My
research
study is called “Refugee Mothers Research Study” and I am interested in learning more about refugee families and their experiences before they came to the US, and also about their experiences after they came to the US. I am interested in interviewing about 10 mothers like you, who are refugees who came here no more than 5 years ago, and who have children aged 5-17. I am very interested in your thoughts and your opinions about your experiences. Therefore, there are really no “right” or “wrong” answers. Everything you say
is important to me. I want to hear about
your experiences from your opinion and how those experiences have affected you and your family or children. Is that OK?” [If “yes”, proceed to next paragraph. If “no”, thank them for their time and end session]. Great. So, in the first part of the interview, I will ask you some questions about yourself, such your name, how old you are, how long you’ve lived in the US and other things. That should take no more than a few minutes. And then the rest of the time, we will talk about your experiences. This interview will be recorded; I need to record it so I can transcribe what you say and use it for my research. I will delete this recording after I have transcribed it. [If “yes”, proceed to next paragraph. If “no”, thank them for their time and end session]. Next, I am required to let you know about some risks and benefits to you for participating in this research. Some benefits might be that you will help people in this country understand the experiences of refugees so that when other refugees come to this country, we know more and can have better services. You might also feel better about just getting some things off your chest that you maybe haven’t talked about or thought about in a long time. Sometimes just talking about what you’ve experienced is helpful. Sometimes however, talking about some of your experiences might leave you feeling upset. In that case, at the end of this meeting I will leave you with a list of places that you can call if you feel like you are upset and want to talk more with someone. Is that OK? [If “yes”, proceed to next paragraph. If “no”, thank them for their time and end session]. Good. I should just tell you that if you do decide to seek counseling services from that list of places, I will not be able to help you pay for these services; you will have to pay for them on your own. But, I have researched all the places on the list and many of them are free of charge, or they will work with you based on your income. You will be paid $50 dollars for this interview; it will be in the form of a $50 Walmart gift card, and you can use the gift card any way you like. You will get it at the end, unless you decide to end the interview early or before it’s finished.
If you decide to end the interview early,
I
will
give you
the gift card
at that point anyway. Do you have any questions so far? [If “yes”, answer any questions. If “no”, proceed to next paragraph]. Lastly, I should tell you that anything you tell me is confidential. That means that I will not share anything you tell me today with anyone else. I will not share your name or any details about you with anyone, and when I write about my research, I will not use your name at all. And if you tell me anything bad about CCC, I will not tell anyone at CCC and neither will the interpreter. The only thing I may have to report is if you tell me about any abuse related to children. The University may also have to review my research to make sure I am following all the rules of my study. I will give you the phone number the end of the interview. I also want to tell you that you are not required to answer any questions that make you feel uncomfortable, or share anything that you do not wish to share. Also, you can choose to answer some questions, but skip other questions that you do not want to answer; it’s completely up to you. If you find that during the interview you do not want to continue for any reason, you are free to stop and leave. There will be no consequences and you will get the $50 Walmart gift card. Also, if you contact me after today and tell me you no longer want your responses to be included in my research study, I will remove your responses from the study and you will not have to return the gift card. If there is anything you don’t understand or if you want me to repeat myself, just let me or the interpreter know. Ok, so do you give your permission to go ahead with the interview? [If participant gives verbal consent, i.e., says “yes” then proceed with the interview. If participant declines consent, thank them for their time and end session]. “OK, let’s begin.” Part II: Interview Protocol Demographics Name: ______________________________________________ Age: _____________ Study ID number: _______________________________________________________________ 1. Do you currently have refugee status? _____Yes ____No 2. When did you come to the United States? ______________________________________ 3. What is your country of citizenship? __________________________________________ 4. Are you married? ____Yes _____No 5. How many children do you have? ____________________________________________ 6. What are the ages of your children? __________________________________________ 7. Did you live in a refugee camp during part of your migration period? ____Yes ____No 8. If so, how long? __________________________________________________________ Questions about Refugee Experiences. “For the first part of the interview, I will ask you to give me some background on how you became a refugee, and what that experience was like for you. 1. So, tell me about your experience as a refugee? You can tell me about things like: a. What led you to leave your home country? What country did you flee to? b. What are some of the things you and your family experienced during this time (i.e., leaving your home country and finding a new place?) c. How long were you in that transition country before you came to US? Where did you live in that place? Did you live in a camp? If so, how long? d. Tell me about your experiences there and what life was like for you and your family in that place?” Questions about Refugee Migration Stress (based on RHS-15, Hollifield et al., 2013; Kirmayer et al., 2011). The next few questions focus on whether you feel the experiences you just described have led to any stress in your life. 2. What experiences were the most stressful for you and your family? a. How can you tell you are stressed? 3. What stressful experiences have continued for your family in US? a. From a scale of 0
-10, with 0 being no stress, and 10 being the
most
stress,
can
you rate your level of stress
before you became
a
refugee? b. From a scale of 0
-10, with 0 being no stress, and 10 being the
most
stress,
can
you rate your level of stress
now? i. How is it different? Questions about the Impact of Refugee Migration Stress. “The next part of the interview asks about how this stress that you’ve just described (that is, the stress of being a refugee) has affected you in three main areas of your life: individually, in your relationship with your child or children, and in your family as a whole.” 4. So first, for yourself, how do you manage your stress? a. What kinds of things do you do to make yourself feel better? b. How is that different from what you did in your home country? 5. Now, for the next part of the interview I would like you to think about your relationship with your child or children (based on Robinson et al., 1995; Gerard, 1994): a. Tell me about your relationship with your child or children. a. What do you do, or how do you respond, when your child is upset? b. Compared to other parents you know; how do you feel about your own parenting? b. How has your relationship with your child or children changed since you became a refugee? Can you give me an example? i. Do you feel like you have a good relationship with your child or children? How do you know? 6.
Now I would like to ask you some questions about your
family, and how your family interacts together (McCubbin et al., 1982; Patterson, 1988, Epstein et al., 1983). a. In your family, how do you make decisions? i. Tell me about a time when you found it easy to make a decision as a family. ii. Tell me about a time when you found it difficult to make a decision as a family. b. In your family, how do you communicate about feelings (either happy or sad, fears)? c. Tell me about how you solve problems as a family. i. Can you give me an example of a time you’ve solved a problem as a family? 1. For example, I am sure you experienced many problems when you were moving from place to place before you came to America. Maybe you can tell me about some problems you experienced during that time, and how you solved those problems as a family. ii. How has the way you solve problems changed? d. How do members of the family support each other? i. Give me some examples? Questions about Formal and Informal Social Support Systems (based on
Conger & Conger, 2002; Conger et al, 2002;
Patterson, 2002).
The
last part
of the
interview focuses on questions about how you feel supported in your new environment. 7. How do you feel supported in your new community, since you have resettled? a. What things/supports have you used? b. Are there specific services that have been more helpful than others? 8. How does the current political climate influence you or your family? “This brings us to the end of the interview. Now I will share with you this list of places [hand them the list and stapled business card with my name and info and VT IRB’s contact info] you can call or visit if you feel you need to talk more about some of the experiences we discussed that may have been upsetting to you. Also, here is a card with my name, and the name of a person at the University. This person is in charge of making sure that I am doing the right things in my study and you can contact this person
if you have questions
or concerns
about the study.
Do
you have any questions?
[If “yes”, answer any questions. If “no”, proceed to next paragraph]. Thank you again for your time.” Appendix D: Mental Health Resources
Local Crisis Numbers Blue Ridge Behavioral Healthcare 24 Hour Crisis Services (540) 981-9351
Calls taken 24 hours a day, 7 days a week.
Carilion CONNECT (540) 981-8181 or (800) 284-8898 This
is a confidential, 24-hour emergency evaluation and referral service provided by Carilion Clinic to members of
the local Roanoke
community. CONNECT is staffed by psychiatric nurses and clinical social workers trained to help people access psychiatric and behavioral medicine support.
Lewis Gale RESPOND (800) 541-9992 This
is a free, 24-hour crisis line for assistance, assessment and referral
that
lets you talk with a trained mental health professional any time of the day or night.
TAP Domestic Violence Hotline (540) 283-4813 [daytime]; (540) 580-0775 [after hours, weekends, holidays]
Calls taken
24
hours a day, 7 days a week.
SARA Roanoke 24 Hour Sexual
Assault
Hotline (540) 981-9352
All services are free, confidential, and voluntary. If you or someone you know has been sexually assaulted, call this number. SARA provides many services to survivors of sexual violence and members of their support system. Whether it happened recently or a long time ago, SARA can help. Outpatient Therapy Services
Mental Health America of Roanoke Valley
via the
Mental Health Care Collaborative
10 Church Ave SE #300, Roanoke, VA 24011 Tel: 540-344-0931 Eligible clients can be seen for free. Eligibility criteria:
be at least 18 years of age and no longer enrolled in high school; be a resident of Botetourt County, Craig County, Roanoke City or County, or Salem; have limited financial resources (income at 200% of the poverty level or lower, no health insurance coverage, or inadequate coverage for mental health care); be ineligible for mental health services through other systems of care available in the community; and be able to benefit from psychiatric care and medication management, counseling, or a combination of the two.
Regular
office hours are 9:00 am-4:
30
pm, Monday through
Thursday, and 9:00 am-1:00 pm on Friday.
Blue Ridge Behavioral Healthcare The Burrell Center 611 McDowell Avenue Roanoke, VA 24016
Tel:
540-
343-3007 Insurance is accepted, walk-ins are accepted, if no insurance the cost is $140 for initial assessment which is not due upfront; clients can make a payment plan which is affordable for them based on income. Adults and children
may access screening for services without an appointment by
going
to the Burrell Center between
8:30
AM and
3:00
PM
Monday through Friday. Appendix E:
IRB Approval Letter Office of Research Compliance Institutional Review Board North End Center, Suite 4120, Virginia Tech 300 Turner Street NW Blacksburg, Virginia 24061 540/231-4606 Fax 540/231- 0959 email irb@vt.edu website http://www.irb. vt.edu MEMORANDUM DATE:
January 24, 2018
TO:
Christine Kaestle, Ruvimbo Tapiwa Tsokodayi
FROM: Virginia Tech Institutional Review Board (FWA00000572, expires January 29, 2021) PROTOCOL TITLE:
Refugee Migration Stress and Family Functioning: Extending Family Stress Theory IRB NUMBER: 17-1074 Effective January 24, 2018, the Virginia Tech Institution Review Board (IRB)
approved the New Application request for the above-mentioned research protocol. This approval provides permission to begin the human subject activities outlined in the IRB-approved protocol and supporting documents. Plans to deviate from the approved protocol and/or supporting documents must be submitted to the IRB as an amendment request and approved by the IRB prior to the implementation of any changes, regardless of how minor, except where necessary to eliminate apparent immediate hazards to the subjects. Report within 5 business days to the IRB any injuries or other unanticipated or adverse events involving risks or harms to human research subjects or others. All investigators (listed above) are required to comply with the researcher requirements outlined at: http://www.irb.vt.edu/pages/responsibilities.htm (Please review responsibilities before the commencement of your research.) PROTOCOL INFORMATION: Approved As:
Protocol Approval Date:
Protocol
Expiration
Date:
Expedited, under 45 CFR 46.110 category(ies) 6,7
January 24, 2018 January 23, 2019
Continuing Review Due Date*: January
9, 2019
*Date a Continuing Review application is due to the IRB office if human subject activities covered under this protocol, including data analysis, are to continue beyond the Protocol Expiration Date. FEDERALLY FUNDED RESEARCH REQUIREMENTS: Per federal regulations, 45 CFR 46.103(f), the IRB is required to compare all federally funded grant proposals/work statements to the IRB protocol(s) which cover the human research activities included in the proposal / work statement before funds are released. Note that this requirement does not apply to Exempt and Interim IRB protocols, or grants for which VT is not the primary awardee. The table on the following page indicates whether grant proposals are related to this IRB protocol, and which of the listed proposals, if any, have been compared to this IRB protocol, if required. IRB Number
17-1074
page 2 of 2 Virginia Tech Institutional Review Board Date* OSP Number Sponsor Grant Comparison Conducted? * Date this proposal number was compared, assessed as not requiring comparison, or comparison information was revised. If this IRB protocol is to cover any other grant proposals, please contact the IRB office (irbadmin@vt. edu) immediately.
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