Taking a history with newcomer children and adolescents

Cultural and language barriers are a major cause of disparities in health care access and health outcomes for immigrant and refugee children and adolescents. To practice culturally effective health care and promote health equity, health care providers need to be aware of their own cultural backgrounds and biases, and sensitive to differences between their own backgrounds and their patients’ backgrounds. For newcomer children, adolescents and families, health care providers need to understand immigration history, possible immigration trauma, identity development, acculturation, family conflicts, sociocultural dimensions of health beliefs, experiences with bias or racism, and adolescent risk behaviours and protective factors. All of these issues are influenced by culture, and can profoundly affect health status as well as health care-seeking behaviours and relationships with health care providers.

What follows are sample questions that can be gathered in the health and psychosocial history of newcomer children and adolescents. These sample questions are not meant to be exhaustive, nor are they meant to be used as a ‘checklist’ to be asked in a certain order, similar to a structured interview. Rather, these questions illustrate approaches that providers can use to begin exploring issues that significantly affect the health of newcomer children and adolescents (1–6). These questions can be asked of the child and/or parent as appropriate. The issues can be explored directly with the older child or adolescent in a developmentally appropriate manner, including as part of the confidential adolescent psychosocial interview.

Cultural competence and culturally effective health care is an important investment in promoting health equity and health, reducing disparities for newcomer children and youth. Please visit the Canadian Paediatric Society’s Caring for Kids New to Canada website (www.kidsnewtocanada.ca) for more information and resources on serving this population.

Assess immigration history and possible immigration stress or trauma

• What is your country of origin? What ethnic group(s) do you identify with?

• Why and when did you come to Canada? How did you arrive in this country? What were some of the challenges and difficulties? What or who helped you and your family adjust and cope?

Assess identity development, acculturation, potential acculturation gaps and conflicts within families

• Is there anything causing you stress or difficulty? Do you have a support system? Have you made contact with local cultural associations?

• Do you feel more comfortable being with people of your family’s background or mainstream Canadian society, or both or neither?

• What language(s) do you speak? What language is usually spoken at home? What language do you prefer speaking? Do you ever interpret for your parents?

• Are you in school yet? How do you like it? How many days do you miss? Have you made friends? Who is your best friend? Where do you play with your friends?

• What are your hopes for the future?

Explore sociocultural dimensions of health and health beliefs

This will help with developing a treatment plan.

• What do you think has caused this problem? What do you call it? How do you understand it?

• How does it affect your life?

• Have you had this problem before? How was it treated before? What do you believe will cure it?

• Are there any healing practices or medicines that are traditional for your family that you think may help? Is there anything that may help you to feel better that doctors may not know about?

• Who helps you to handle health issues?

• What do you fear most about this problem? Are you afraid of being excluded from your own community because of this problem? (eg, tuberculosis or a congenital abnormality)

• Is there anything else you want to tell me about this situation, or your family or culture that will help me provide you with better care?

Ask about bias, racism or discrimination

Ask about these experiences as part of the social history, validate them, and provide appropriate counselling or referrals to mental health and community agencies.

• Some other children (young people) with the same background have told me about being teased, bullied or harassed just because of their background or the way they look. Has that ever happened to you?

Routinely perform a confidential, developmentally appropriate adolescent psychosocial assessment on all newcomer youth

Screen all adolescents equally for risky behaviours such as sexual activity or substance use. Never assume that adolescents from a particular cultural group are more or less likely to adopt a behaviour than someone from another group.