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School-Based Mental Health Services for Immigrant and Refugee Children

53751c65a6By Ji Won Kim

When the mental health needs of young people go unaddressed, their performance in school can suffer. Immigrant and refugee children often have unique mental health needs as a result of hardships endured in their native countries, during their journey to the US, and as they and their families adjust to new circumstances, new roles, and a new culture. Addressing those needs is crucial to improving their academic performance and, as a consequence, their overall chances for success.

Working Harder, Falling Short

Not every child of immigrants gets pushed by a Tiger Mother like Amy Chua. But many immigrant parents do stress the importance of good grades in school; they see educational achievement as a path to a better life. Perhaps, then, it’s not surprising that children with immigrant parents study more than children of native-born Americans. According to data from the US Labor Department’s American Time Use Surveys from 2003 to 2010, children of immigrants study about three more hours per week than children with US-born parents.1

This does not mean, however, that children of immigrants do better in school. In fact, the high school dropout rate for foreign-born students is much higher than the national average. In 2010, foreign-born youth had a high school dropout rate of 18 percent; significantly higher than the dropout rate of 11 percent for US-born youth.2 So why do many immigrant youth study harder, but fall short? Part of the answer appears to involve mental health needs that are going unaddressed.

The failure to cash in on the hard work and academic potential of an ever-growing population of young immigrants has been on the national radar for some time. Immigrant advocates, who argue that immigration has spurred US economic growth and development, have been pushing for legislation that expands opportunities for immigrant youth. Unfortunately, insufficient attention and support have been given to the tailoring of social services to meet the needs of immigrant youth. There is a crucial shortage of mental health services that address those needs.3 And when those needs aren’t met, young immigrants have fewer resources to draw upon when they encounter challenges in the classroom.4

Immigrant Hardships And Their Impact

Many immigrant and refugee children have traumatic experiences before reaching this country. They may witness or fall victim to violence; their journeys to the US may be hazardous or unexpected.5 Some immigrant children have been separated from family members for extended periods,6 and refugee children are likely to have experienced severe distress; they may have witnessed, or been otherwise affected by, wartime atrocities.7 Moreover, because children tend to learn English faster than their immigrant parents, they are often compelled to assume roles, like translating and serving as intermediaries that are more appropriate for adults.8

Yet despite their higher exposure to mental health risks, immigrant children are less likely to receive mental health services. A study of suicidal adolescents found, for example, that Asian American youth were less than half as likely as their white counterparts to get counseling.9

When emotional and mental health needs go unaddressed, academic performance can suffer. Studies have shown that childhood mental health and behavioral problems negatively affect performance on standardized math and reading tests in elementary school, and increase the likelihood that a youth will drop out of high school and not go on to college.10 Leaving school or getting subpar grades can foreclose the prospect of a good job and the economic security that comes with it.11

Identifying And Removing Barriers To Services

Improving access to mental health services should therefore be given urgent priority. This means that the many barriers to such access must be identified and overcome. Poor immigrant and refugee youth face obstacles that other children from low-income families encounter, such as an inability to afford adequate care. Immigrant children can also face linguistic barriers, as well as obstacles rooted in negative cultural conceptions of mental health care; in a number of immigrant and refugee communities, seeking counseling is frowned upon or stigmatized.12

So what can be done? Engaging with immigrant youth and their families at school, rather than at home, can make a big difference. Because school-based interventions may carry less stigma than clinic-based services, parents of immigrant children may be more receptive to the former.13 In addition, school-based mental health providers can work with teachers, who see the child on a daily basis, to educate parents about the child’s mental health needs.14 Immigrant parents’ trust in school as an institution may also prompt them to enroll their child in school-based programs that enhance the youth’s educational and mental health development.15

A significant proportion of school-based solutions involve parental training. Family engagement in the school enhances students’ social skills, behavior, and adaptation to the classroom.16 School programs can also help parents grow as caregivers, adjust to new circumstances, and gain familiarity with the concept of mental health treatment. Higher levels of family engagement increase the chances that parents will recognize and seek support for the mental health needs of their children.17

Successful Programs

A number of promising initiatives have been launched. The Caring Across Communities (CAC) Initiative, created by the Robert Wood Johnson Foundation, has funded 15 projects across the US that foster innovative partnerships among schools, mental health service providers, and immigrant and refugee community organizations.18 According to an evaluation conducted in 2010, school-based mental health services programs operated through the CAC Initiative improved children’s affect and behavior, enhanced students’ access to mental health services, and empowered parents and children to advocate for themselves.19 As part of this initiative, the Asian American Recovery Services’ Tam An (Inner Peace) Project in San Jose, California, worked with families at a middle school to address cultural bias in the Vietnamese community against mental health programs and services.20

Ninety-six percent of the students at Norwood Street Elementary School in central Los Angeles are of Latin American descent; 79 percent of those are English Language Learners, or ELLs. In an effort to address the mental health needs of its uninsured immigrant students, the school developed the 3Rs (Relationships, Resiliency, and Recovery) Project, aimed at increasing “access to culturally competent, trauma-informed mental health services” for such students.21 The project instituted a team-based approach; a family advocate and a mental health counselor work alongside school staff and community partners to deliver a comprehensive set of services.22 Community partners include the Norwood Healthy Start and Parent Center; the Los Angeles Child Guidance Clinic, which focuses on mental health; and Casey Family Programs, which runs foster care prevention programs that serve immigrant students and their families at Norwood Street Elementary.23

Programs In Alameda County

Although Alameda County has not developed any projects through the CAC Initiative, it does fund five prevention and early intervention (PEI) programs through the Mental Health Services Act (MHSA).24 Because PEI funding is for services “designed to prevent the development or worsening of a mental illness” and is not limited to treatment services for severe mental illness,25 service providers are able to offer a greater array of preventive and therapeutic services. PEI programs provide a multitude of services ranging from one-on-one treatment to cultural wellness activities and community events. Community Health for Asian Americans (CHAA) and Asian Community Mental Health Services (ACMHS) serve students at Oakland International High School, where all of the students are immigrant and refugee youth.26

State law requires that public mental health services be delivered in a culturally competent manner.27 That can be a difficult requirement to meet. Alameda County Behavioral Health Services typically places only one provider in every school site. Thus that provider, regardless of his or her expertise, must serve any child referred to him or her.28

Conclusion

Immigrant and refugee children constitute the fastest-growing sector of the US student population.29 Supporting these youth with school-based programs and mental health services should be a top priority. Enhancing their chances in school will generate favorable long-term outcomes for US society as a whole.

In a recent focus group study, immigrants expressed a desire for programs that addressed cultural differences and for those that addressed issues specific to age groups.30

Ji Won Kim, a 2012 Summer Law Clerk at NCYL, is in her second year at the University of Michigan Law School. 

  1. Catherine Rampell, “Children of Immigrants Study More,” New York Times, July 12, 2012, economix.blogs.nytimes.com/2012/07/12/children-of-immigrants-study-more/.
  2. High School Dropout Rates, Indicators on Children and Youth (Child Trends Data Bank, Washington, DC), April 2012, at 4.
  3. “Children of Immigrants and Refugees: What the Research Tells Us,” Fact Sheet (The Center for Health and Health Care in Schools, School of Public Health and Health Services, The George Washington University, Washington, DC), April 2011, at 2.
  4. Eileen Gale Kugler, “Partnering with Parents and Families to Support Immigrant and Refugee Children at School,” Issue Brief #2 (The Center for Health and Health Care in Schools, School of Public Health and Health Services, The George Washington University, Washington, DC), June 2009, at 2.
  5. Id.
  6. The Center for Health and Health Care in Schools, supra note 5, at 2 (citing Harvard Immigration Project, “85 percent of immigrant children separated from families during migration. More depression is seen among those who experience separation” [Abstract], Graduate School of Education, Harvard University, June 29, 2001).
  7. Id. (citing US DHHS, US Public Health Service, US Surgeon General, “Mental Health: Culture, Race and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General,” March 15, 2001).
  8. Supra Note 6.
  9. Id. (citing Krista M. Perreria and India J. Ornelas, “The Physical and Psychological Well-Being of Immigrant Children,” The Future of Children (Princeton University and The Brookings Institution), 2011.
  10. Krista M. Perreria and India J. Ornelas, “The Physical and Psychological Well-Being of Immigrant Children,” The Future of Children (Princeton University and The Brookings Institution), 2011, at 196 (citing James M. Fletcher, “Adolescent Depression: Diagnosis, Treatment, and Educational Attainment,” Health Economics 17, no. 11 (2008)).
  11. Id. at 197 (citing Alberto C. Palloni et al., “Early Childhood Health, Reproduction of Economic Inequalities and the Persistence of Health and Mortality Differentials,” Social Science and Medicine 68, no. 9 (2009)).
  12. Bridging Refugee Youth & Children’s Services, Spotlight for September 2005, www.brycs.org/documents/upload/brycs_spotsept2005.pdf.
  13. Supra note 5 at 4 (citing SA Kataoka, BD Stein, LH Jaycox et al., “A School-Based Mental Health Program for Traumatized Latino Immigrant Children,” 42 J Am Acad Child Adolesc Psychiatry 3, 311-18 (2003)).
  14. Supra note 6 at 6.
  15. Id. at 10.
  16. Id. at 4 (quoting AT Henderson and KL Mapp, A New Wave of Evidence: The Impact of School, Family and Community Connections on Student Achievement. Austin, TX: Southwest Educational Development Laboratory, 2002).
  17. Id. at 13.
  18. Id. at 4.
  19. Clea McNeely, Katharine Sprecher, and Denise Bates, “Comparative Case Study of Caring Across Communities: Identifying Essential Components of Comprehensive School-Linked Mental Health Services for Refugee and Immigrant Children” (Center for the Study of Youth and Political Violence and Department of Public Health, University of Tennessee, Knoxville, TN), May 24, 2010, at 5.
  20. “Tam An Inner (Inner Peace) Project, San Jose, California,” The Center for Health and Health Care in Schools, www.healthinschools.org/Immigrant-and-Refugee-Children/Caring-Across-Communities/Asian-American-Recovery-Services.aspx (accessed August 6, 2012).
  21. Supra note 21 at 8.
  22. Id.
  23. “The 3 R’s Project: Building Relationships, Resiliency, and Recovery in Children: Los Angeles, California,” The Center for Health and Health Care in Schools, www.healthinschools.org/Immigrant-and-Refugee-Children/Caring-Across-Communities/Los-Angeles-Child-Guidance-Center.aspx (accessed July 25, 2012).
  24.  E-mail from Sean Kirkpatrick, Associate Director, Community Health for Asian Americans, to Ji Won Kim (July 15, 2012) (on file with author).
  25.  California Department of Alcohol and Drug Programs Co-Occurring Disorders Unit, Planning Guide for Prevention and Early Intervention (PEI) under the Mental Health Services Act (MHSA), June 20, 2008, www.adp.ca.gov/COD/pdf/PEI_Guide.pdf (accessed on August 6, 2012).
  26. Supra note 26.
  27. Cal. Welf. & Inst. Code § 5600.2.
  28. Supra note 26.
  29. Carola Suarez-Orozco et al., The Significance of Relationships: Academic Engagement and Achievement Among Newcomer Immigrant Youth (citing NS Landale and RS Oropesa, “Immigrant Children and the Children of Immigrants: Inter and Intra-Ethnic Group Differences in the United States,” Population Research Group Research Paper No. 95-2, Michigan State University, East Lansing, MI, 1995).
  30. Pacific Clinics on behalf of Asian Pacific Islander Strategic Planning Workgroup (API-SPW), California Reducing Disparities Project: Asian Pacific Islanders Population Report Draft for Public View, March 2012 at xii, crdp.pacificclinics.org/files/resource/2012/04/Draft%20-%20API%20Report.pdf (accessed on August 6, 2012).
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