AIMS:Youth with an immigrant or refugee background face elevated mental health risks. Schools have been proposed as a suitable setting for mental health interventions for this group, but evidence on effects is limited, and even less is known on dosage impact. Using variations in intervention exposure due to COVID-19 school closures, this study examined the association between the number of modules of the Welcome to School intervention and mental health and resilience outcomes among young immigrant and refugee newcomers. METHODS:In 2019-2020, 11-22-year-old newcomer immigrants and refugees in Denmark, Belgium and Norway were cluster randomised by schools/classes into a control and intervention group. Mental health and resilience outcomes were measured at baseline and following the intervention using the strengths and difficulties questionnaire and the child and youth resilience measure. Due to COVID-19 school closures, the intervention group received different amounts of the 14-modules Welcome to School intervention. Using data from 147 participants, multiple linear regression analyses were performed. RESULTS:Adjusting for age, gender, resettlement country, and migration reasons, the analyses showed that the emotional symptoms score decreased by 0.19 (95% confidence interval 0.06; 0.32) per Welcome to School module received. No significant dose-response associations were found for resilience scores or the other studied mental health outcomes (i.e. total difficulties, conduct problems, hyperactivity, peer problems, and prosocial behaviour). CONCLUSIONS:The Welcome to School intervention appears to have the potential to reduce emotional difficulties among young newcomers in case of sufficient intervention dose. Further studies are needed to assess the effectiveness of the full intervention.

Education policies in different countries recognise the needs and abilities of newcomer students in different ways, with consequences for their social inclusion and academic progress at school. We highlight the importance of context to debates around the politics of recognition in newcomer education by drawing on qualitative research in Norwegian and English secondary schools. Taylor’s (1994) political theory of “recognition” provides the analytical lens through which we explore how teachers perceive newcomer students to be recognised (or not) in national education policies in each country. We underscore teachers’ agency in responding to these policies through their own politics of recognition at school.

Torture victims struggling with post-traumatic stress often experience elements in the dental treatment situation that may trigger trauma-related reactions. The aim of the study was to explore intervention strategies that will enable dental health workers to adapt dental treatment to the needs of torture survivors. Exploratory interviews were conducted with 10 torture-exposed resettled refugees with dental treatment experience in Norway. The data was analyzed using qualitative content analysis, which suggested that to minimize trauma-reactions, dental personnel should focus on creating a safe therapeutic space and strengthening the patient's sense of control. Four main categories of clinical advice were proposed: (i) Acquire knowledge about psychology, consequences of torture, cultural differences, trauma-informed care, and the patients' individual needs; (ii) Recognize the trigger-potential of busyness or delays; (iii) Avoid surprises, such as sudden moves or actions and explore triggers individually, but make sure not to evoke images of interrogation, and; (iv) Provide overview both with respect to visibility in the clinical room, and to predictability regarding the dental treatment. Although undergoing dental treatment may be challenging for torture-exposed individuals, it is possible to reduce the predicaments considerably by making feasible adaptions to the treatment and adopting a trauma-informed approach.

Based on focus group discussions with secondary school teachers in Denmark, Finland, and Sweden, we investigated teachers' views on home-school collaborations with migrant families in the context of student wellbeing. We asked 1) what roles and strategies constituted home-school collaborations in teachers' views, 2) what norms of belonging characterized teachers' perceptions on collaborations; and, 3) to what extent teachers' perceptions of home-school collaborations reflected equity. The findings revealed two major themes: seeing parents in paradoxical roles and attempting to collaborate in a context of constraints. These themes were often underpinned by teachers' perceived 'ideals' on the educational, cultural-linguistic, familial and psychosocial characteristics of a 'family' and a 'parent'. These assemblages seemed to set belonging for migrant families on condition of meeting teacher-perceived ideals, and pointed to the necessity to enable plural belonging to a collaborative school community that fosters wellbeing.

Scholars draw increasing attention to the importance of belonging for young refugees’ and migrants’ well-being, indicating the need to develop an in-depth understanding of their experiences seeking to belong in resettlement. For refugee and migrant newcomers, schools might constitute particularly significant spaces in their negotiation of belonging, due to being a central developmental and acculturative context in resettlement, and a context where newcomers are situated within interpersonal and cultural positions of their families, home, and host society. Rooted in a conceptualization of belonging as a dynamic, plural, and relationally negotiated experience, this study explores how young newcomers’ negotiation of belonging takes shape within the school context and how their experiences seeking to belong relate to their well-being. To that, the study engages with the qualitative inquiry of 163 newcomers’ (age 11–24) experiences through focus groups conducted in Belgium, Denmark, Norway, and Sweden. Cross-national, joint thematic analysis resulted in two themes: 1. Ambivalences shaping belonging; and 2. Challenging barriers to belonging. Our findings suggest that, in school, newcomers meet opportunities and barriers in their negotiation of belonging that takes shape at the intersection of family, transnational, and host society relations. Schools furthermore seem central spaces for newcomers to exercise agency and creativity in their search for belonging in resettlement. Our findings spark thought on belonging as a reconstructive process in coping with migration and have implications for how schools can support belonging and well-being, through engaging with life stories of migration and the plurality of meanings encroaching upon newcomers’ school trajectories.

High levels of post-traumatic stress are well-documented among refugees. Yet, refugee youths display high heterogeneity in their type of trauma and symptom levels. Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among youths from Afghanistan (n=148), Syria (n=234), and Somalia (n=175) living in Europe. The model fit for the factor structures was tested as well as measurement invariance between the three groups. The robustness of results was evaluated by also testing measurement invariance between recently arrived and settled youths, and between different response labelling options. Reliability estimates were calculated as well as prevalence estimates. The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali youths and strong measurement invariance between Syrian and Somali youths. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian youths, whereas high among Somali youths. There were statistically significant differences in symptom prevalence: Afghan youths had high prevalence compared to Syrian and Somali youths, and unaccompanied refugee minors (URMs) compared to accompanied youths. This study mostly supported the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult as the risk for misclassification is high.

Teachers are pivotal in creating safe and efficacious learning environments for ethnic minority students. Research suggests that teachers’ multicultural attitudes, self-efficacy, and wellbeing at work may all play important roles in this endeavor. Using survey data on 433 teachers in Belgium, Denmark, Finland, Norway, Sweden, and the United Kingdom, the present study used structural equation models to analyze the paths between teachers’ multicultural attitudes and work-related wellbeing (work dedication and exhaustion), and whether self-efficacy mediates these paths. We further investigated how these associations differ between teachers of reception classes for migrant and refugee students versus teachers of multi-ethnic mainstream classes. The results show that positive multicultural attitudes were directly associated with high level of work dedication, but not with work exhaustion. Self-efficacy mediated the association between multicultural attitudes and work-related wellbeing, indicated by both higher work dedication and lower work exhaustion. Concerning the role of teacher’s class type, self-efficacy mediated the association between positive multicultural attitudes and work dedication for both types of teachers, whereas the mediation to low work exhaustion was only evident in mainstream class teachers. To conclude, teachers’ multicultural attitudes and work-related wellbeing are mediated by self-efficacy and this important link should be acknowledged when designing professional development programs in order to create supportive and competent learning environments for all students.

Background: Refugee and non-refugee migrant youths may carry a double burden of past adversities and post-migration stress while trying to continue schooling and adapt to their new social and cultural environment. Executive functioning skills are central to learning and navigating in the new context. Knowledge of how young migrants’ executive functioning is associated with stressful factors and positive or potentially protective factors, could contribute to understanding and possibly finding ways to support these young learners.Objective: To investigate how potentially stressful and positive factors are associated with executive function skills.Method: In a secondary, explorative analysis of questionnaire responses from 1312 migrant students in secondary schools in five European countries, the associations of planning- and initiative executive function skills (PIS-EF) with stressful factors (e.g. emotional and behavioural problems, daily stress, discrimination) and positive factors (e.g. resilience, school belonging, social support) were analysed by linear regression. Furthermore, differences between male/female and refugee/non-refugee migrants were examined.Results: Positive factors accounted for almost one-fifth of the variance in the students’ self-reported PIS-EF and stress factors only one-tenth. Resilience showed the strongest association with students’ PIS-EF, followed by Prosocial behaviour and School belonging. Hyperactivity, and symptoms of anxiety and depression were negatively associated with PIS-EF. Posttraumatic stress symptoms were minimally associated with the investigated aspects of executive functions. Adjusted for other variables, no variables showed significant differences in the association with EF between males and females, and refugee and non-refugee migrant students.Conclusions: Positive factors were more strongly associated with executive functioning than stressful factors and could represent pathways to strengthen executive functioning. To support migrant youths’ functioning, the school, healthcare, and social systems should take a resource-oriented perspective and lay the ground for migrant youth's feeling of belongingness and active use of their personal resources.

School-based psychosocial interventions are increasingly put forward as a way to support young refugees' and migrants' well-being and mental health in resettlement. However, the evidence on these interventions' effectiveness remains scarce and scholars denounce particular gaps in the evidence to date, pointing to a lack of large-scale, controlled studies and studies including social outcome measures. This cluster randomized study aims to strengthen the evidence base on school-based psychosocial interventions for refugee and migrant youth by assessing the effect of two interventions, Classroom Drama and Welcome to School, on youth's mental health, resilience, and social relations in Belgium, Denmark, Norway, and the United Kingdom. Multilevel analyses were conducted separately for the two interventions (Classroom Drama, n = 307, ages 11-19; Welcome to School, n = 251, ages 11-23), using separate no-treatment control groups. Our analyses indicated a significant main, positive effect of Classroom Drama on perceived family support, and an effect on perceived support from friends that was moderated by country: in the United Kingdom, the intervention group reported an increase in perceived friend support, whereas the control group reported a decrease. Furthermore, baseline resilience moderated the effect of the Classroom Drama intervention on behavioral difficulties and well-being. No effects of Welcome to School on any of the outcome variables were found. Overall, this study provides novel, nuanced evidence on school-based psychosocial interventions for refugee and migrant adolescents.

This article investigates school belonging among migrant students and how this changed during the Covid‐19 pandemic. Drawing on quantitative data gathered from 751 migrant students in secondary schools in six European countries (Belgium, Denmark, Finland, Norway, Sweden, and the UK), we examined the impact of Covid‐19 school closures, social support, and post‐traumatic stress symptoms on changes in school belonging. Linear regression showed a non‐significant decrease in school belonging, and none of the studied variables had a significant effect on this change in our whole sample. However, sensitivity analysis on a subsample from three countries (Denmark, Finland, and the UK) showed a small but significant negative effect of increasing post‐traumatic stress symptoms on school belonging during Covid‐19 school closures. Given that scholarship on school belonging during Covid‐19 is emergent, this study delineates some key areas for future research on the relationship between wellbeing, school belonging, and inclusion.

Abstract Background Limited research exists on pain and especially the co-occurrence of pain and mental ill health in general refugee populations. The present study aimed to approximate the prevalence of chronic pain (CP) among adult refugees from Syria resettled in Norway; investigate the association between CP and mental ill health; and explore how CP and mental ill health associate with both perceived general health and functional impairment. Gender as potential effect modifier in these associations was also examined. Methods Cross-sectional, postal survey questionnaire. Inclusion criteria: ≥ 18 years old; refugee from Syria; and arrived in Norway between 2015 and 2017. Study sample was randomly drawn from full population registries, and n = 902 participated (participation rate ≈10%). CP was measured with 10 items on pain lasting for ≥ 3 consecutive months last year. Symptoms of anxiety, depression and PTSD were measured with the HSCL and HTQ scales, respectively. Ordered and binomial logistic regressions were used in analyses. Gender was tested as effect modifier with Wald test for interaction. Results In the sample overall, the proportion of participants who reported severe CP was 43.1%. There was strong evidence that anxiety, depression and PTSD were associated with higher levels of CP. In fully adjusted regression models, including both CP and mental health variables, CP was strongly associated with poor perceived general health whereas mental health showed much weaker associations. The association between mental health (anxiety and PTSD) and functional impairment was highly gender specific, with strong associations in men but not in women. CP was strongly associated with functional impairment with no difference across gender. Conclusion The study shows a high burden of CP in a general population of adult refugees from Syria with likely substantial adverse consequences for daily functioning. The strong association between CP and mental ill health suggests personnel working with refugees’ health should be attuned to their co-occurrence as both problems may need to be addressed for either to be effectively mitigated. A clear mismatch exists between the burden on health caused by pain in general refugee populations and the amount of available evidence to guide mitigating strategies. Trial registration NCT03742128.

Background Schools are natural environments in which to enhance young people’s social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to. Methods A three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ). Discussion The current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group. Trial registration ISRCTN ISRCTN64245549 . Retrospectively registered on 10 June 2020

Introduction: The flow of refugees towards Europe over the past decade has placed increased demands on the health care services. A significant proportion of refugees have been subjected to torture involving their mouth or teeth, still the importance of oral health challenges is often overlooked or underestimated in the rehabilitation of torture victims. In this qualitative study, we set out to explore the processes that complicate torture victims’ ability to engage in and tolerate dental procedures. Methods: Ten resettled refugees with experience of torture were recruited among patients affiliated with specialized clinics for oral health rehabilitation in Norway. Data were collected through semi-structured exploratory interviews, and analyzed using a qualitative content analysis approach. Results and discussion: We present an exploration of what we have called the social and material anatomy of the triggering event; the process through which trauma-related reactions are produced in torture victims in the course of undergoing dental treatment. All professionals who work with torture survivors should be aware that these individuals often suffer from oral health problems that may affect both their physical and their psychological quality of life. However, although dental treatment is essential, it may still represent a major challenge. Our data suggest, we propose, that dental treatment often involves an experience being suspended, albeit temporarily, in an objectified position, acted on by subjects capable of producing deeply undesirable mental, emotional or bodily states. Three main categories emerged as the most prominent factors with such an agentic capacity: 1) pain, 2) traumatic memories and 3) the dentist. Submitting to dental treatment hence requires the patient’s willingness to give in to the actions of these factors, and avoiding treatment may therefore, in this situation, represent a means of retaining control.

Background Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees’ social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers’ cultural competence and capacity for supporting refugee youths in schools. Methods This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered ( n = 350), (2) the wait-list control arm ( n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI). Discussion This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools. Trial registration ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.

While scholarly literature indicates that both refugee and non-refugee migrant young people display increased levels of psychosocial vulnerability, studies comparing the mental health of the two groups remain scarce. This study aims to further the existing evidence by examining refugee and non-refugee migrants’ mental health, in relation to their migration history and resettlement conditions. The mental health of 883 refugee and 483 non-refugee migrants (mean age 15.41, range 11-24, 45.9% girls, average length of stay in the host country 3.75 years) in five European countries was studied in their relation to family separation, daily material stress and perceived discrimination in resettlement. All participants reported high levels of post-traumatic stress symptoms. Family separation predicted post-trauma and internalizing behavioral difficulties only in refugees. Daily material stress related to lower levels of overall well-being in all participants, and higher levels of internalizing and externalizing behavioral difficulties in refugees. Perceived discrimination was associated with increased levels of mental health problems for refugees and non-refugee migrants. The relationship between perceived discrimination and post-traumatic stress symptoms in non-refugee migrants, together with the high levels of post-traumatic stress symptoms in this subsample, raises important questions on the nature of trauma exposure in non-refugee migrants, as well as the ways in which experiences of discrimination may interact with other traumatic stressors in predicting mental health.

In this paper, which is empirically grounded in ethnographic research conducted among persons living in Norway without legal permission, we explore the temporal dimensions of irregular migration. In the first half, we consider the time aspects of migration control. In particular, we examine the politicization of time within the host of b/ordering policies, practices, and processes through which migrant irregularity is produced and governed in the Norwegian welfare state. We then move into a discussion of migrant irregularity as it is subjectively experienced, in which we solicit time as fundamental unit of analysis with the potential to render phenomenologically intelligible irregularity as it is lived and negotiated. In doing so, we draw upon two classical Greek concepts of time, chronos and kairos, and we consider the conditions of limitation and possibility for reckoning as meaningful experiences of and in time. This entails an exploration of the ways in which the research participants had emplotted their experiences within narratives that they, in retrospect, recalled having crafted at various points in their lives, and of the existential dilemmas that they confronted when these narratives could no longer be sustained. Ultimately, these endeavors produce an analysis of both these meaning-making strategies and what might be understood as the unique temporalities of irregular migration, as it is produced and governed, lived and embodied, and potentially also renegotiated and transformed.

Unmarried, young women constitute a significant proportion of women who undergo unsafe abortion in Ethiopia. Based on material from an ethnographic study, the experiences of young, unmarried women who had been admitted to the hospital in the aftermath of an unsafe, clandestine abortion are explored in this article. The routes the young women followed in their search of abortion services and the concerns and realities they had to negotiate and navigate are at the fore. Despite their awareness of the dangers involved in clandestine and illegal abortion, the young women felt they had no choice but to use medically unsafe abortion services. Two reasons for this are highlighted: such services were affordable and, significantly, they were considered socially safe in that the abortion remained unknown to others and the stigma of abortion and its consequences could hence be avoided. In situations in which choices had to be made, social safety trumped medical safety. This indicates a need for abortion services that address both the medical and social safety concerns of young women in need of such services.

The recognition of the role of discourse in the production of self-understandings and subjectivity has undergone considerable theoretical development over the past decades. Yet, attention to possible ramifications for the status of conversation-based research has been limited and parochial. This article examines the research interview, as a methodological technique and as a social and cultural event, in relation to representations of drug use, agency and responsibility, arguing that research conversations about drugs cannot be understood in separation from the cultural repertoire of speaking positions evoked by the particular topic of inquiry. In the context of drug research, such positions are embedded in circulating narratives of drug use and drug users, as well as in generalized images of responsibility, self-sufficiency, and the personal management of information and risk. Drawing on material from an ethnographic study of recreational substance use among young adults in Norway, it is suggested that such conversations are unique occasions for the deployment of and reflection on subject positions, giving rise to functions of the research interview beyond the generation of sociological data. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs140323

In Ethiopia, as in many other countries, moral discourses about female sexuality in general, and pre- and extramarital sexual experience in particular, create an environment that discourages women from engaging in open dialogue about their sexuality and their past or future sexual experience. In the study of induced abortion among unmarried women in Addis Ababa on which this paper rests, women describe a situation in which they are both surrounded by silence about sexual issues and forced to remain silent themselves. This paper investigates the nature of, and conditions for, this silence and the ways in which it is socially brought about and negotiated. In particular, it explores the ways through which young, unmarried women who have undergone abortion seek to reconcile seemingly contradictory, condemning discourses about premarital sex and more general codes addressing social, as well as moral, propriety and integrity. The discussion highlights that, while issues of sexuality are silenced, neither the silence nor the silencing power of dominant, gendered moral discourses is absolute. Moreover, silence may also be jointly produced and negotiated in social discourse fraught with moral objectives and ends.

In contemporary Ethiopia, abortion decision-making is a challenging process involving moral and/or religious dilemmas, as well as considerations of health and safety. Amidst widespread condemnation of female premarital sex and clear moral sanction against induced abortion, young Ethiopian women are nevertheless sexually active and induced abortions are still sought and performed, with the potential for grave physical harm and social stigmatization. This paper examines young unmarried Ethiopian women's narratives of abortion decision-making. In particular, it identifies and explores the operations of a particular discursive shape from within in such narratives, here described as The tale of the hearts. Analysing The tale of the hearts as a decision-making resource, it is argued, allows us to explore the particular, local, historical and cultural character of Ethiopian women's abortion decision-making dilemmas and the culturally available resources contributing to their resolution.