| Actionable Steps |
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1)
Utilize Trauma-Informed Care Practices with immigrant youth and families
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2)
Consider potential sources of trauma for immigrant and refugee youth
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Bullying or victimization at school
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Physical or sexual abuse
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Dangerous conditions during migration
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Family conflict or intrafamilial violence
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Unsafe neighborhoods or gun violence (in country of origin and after relocation)
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Racism and microaggressions (both in country of origin and after relocation)
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Anxiety about possible parental deportation or safety of family members in the country of origin
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Family separation, either planned separation or as a result of immigration policy or detention
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3)
Screen for and address health literacy
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4)
Provide culturally and linguistically appropriate care
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| Plan |
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Daniela and Antonia read the “All are welcome here” sign in the clinic and appreciate staff and physicians utilizing translation services since Spanish is their preferred language. Trauma-informed care interviewing reveals that Daniela is good at drawing and sketching. After asking permission to discuss her journey to the United States, Daniela shares that she was seldom allowed outside for fear of gang violence. She also shares that she is bullied by girls at her new school because her English is limited, and she frequently asks people to repeat things. She fears that her mother could be deported at any moment. She also worries about her mother's health since everyone in her family is uninsured except for her two younger siblings who were born in the U.S. Lastly, Daniela is concerned about her weight and thinks if she eats less (by skipping breakfast and drinking caffeine) it will help her lose weight. She acknowledges that she feels tired and irritable by mid-morning.
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After a brief discussion about the body's need for fuel, Daniela agrees to eat a piece of fruit with yogurt or milk from the school's breakfast at least 3 times per week. She also shares that she plans to sign up the intramural soccer team at school.
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| Follow-up |
Daniela returns to clinic 8 weeks later with evidence of weight stabilization and linear growth (BMI 37.5). She's eating breakfast at 4 times per week and has noticed that she has more energy. After a few weeks in intramural soccer, she had to quit because the family couldn't afford childcare for the younger siblings and cousins. However, now that they're living in a safer neighborhood, Daniela takes them to the park to play games (i.e. soccer, kickball, etc.) at least 3 times per week and once on the weekend. If it rains, they have a dance party at home. |
