CMAS: The Resilience Guide: Program Strategies for Responding to Trauma in Refugee Children

Photo Credit: Unsplash User Donnie Rosie

The authors of the Resilience Guide start with acknowledgement that “many of the things already part of early childhood programs – like providing safe, predictable routines; helping children manage feelings and behaviours; and providing creative, sensory and physical activities – not only support healthy child development, but also strengthen the capacity for resilience and recovery in young children who have experienced trauma.”

A 2017 Save the Children report, Invisible Wounds, states, “Two-thirds of Syrian refugee children have lost a loved one, had their house bombed or shelled, or suffered war-related injuries.”  The author of the Resilience Guide, Heather Savazzi, says, “Trauma can impact a child’s attachment and ability to bond with family, their alertness and attentiveness, their ability to play and control their behaviour, and their overall development.  Temporary challenges or regression due to trauma can also sometimes lead to children being misdiagnosed with special needs.”

The guide has been developed to support understanding of:

• The impact of the refugee experience at different ages
• The developmental effects of trauma and resettlement
• Key strategies to strengthen families’ capacity for resilience and support their settlement

The guide, produced by CMAS: Supporting Child Care in the Settlement Community and available in English and French, also provides practical tip sheets designed to easily print out and share within teams.

In her preface to the guide, Susan Hoo, CMAS Manager, acknowledges the work being done by community programs across Canada to support refugee families.  “What program staff have told us, above all else, is that families who have faced forced migration are resilient.  And studies show that supportive relationships are the most important factor in helping to foster resilience in children who have been exposed to trauma.  Your support, care and compassion are what make the greatest difference for the children in your program…. By combining the care and compassion you show on a daily basis with the information and strategies you’ll learn in this guide, you’ll be well on your way to making a lasting difference.  Working together, one child at a time, one day at a time, and one supportive act at a time, we can help refugee families to heal from trauma and to regain the sense of security many of them have lost.  And, in doing so, help families to step forward with confidence into their new lives in Canada.”

Heather Savazzi notes, “When we look at the research on trauma and resilience, it’s clear that early childhood educators and early years programs are uniquely positioned to help refugee families with young children as they cope with the effects of trauma… Refugees are survivors.  Yet even when parents do the best they can with the skills and resources they have, their ability to connect with, respond to, and care for their own children can be compromised by their own trauma, suffering and struggles – and the extreme nature of their child’s experiences can affect development and create unique settlement needs and challenges.  Your role as an educator and caregiver is incredibly important and can have a tremendous positive and long-term impact on the well-being of refugee children and families.”

The guide starts by looking at the refugee experience and how that experience impacts young children and their families, including: what is trauma; risk factors; and protective factors.  This section includes an imaginative experience, asking the reader, for just a moment, to imagine the situation in which the refugee family finds itself.  You must flee your home and everything familiar. The journey may be long and dangerous. You arrive in a country of asylum, but the hardship is far from over. The wait is long and hard. Finally, you arrive in Canada – but the uncertainty continues.

The guide discusses the developmental effects of trauma and resettlement.  “What we sometimes think of as misbehaviour in our programs is actually stress behaviour.  In these moments, it’s not that the child won’t behave, it’s that they can’t.”  The author points out that trauma can affect all areas of development:

• Physical:  frequent illness and weak immune system; difficulties with sleeping and/or eating’ toileting; headaches; seizures; fainting; regulation of arousal levels; blood pressure and heart rate
• Emotional:  fear and nervousness; unpredictable emotions
• Cognitive:  developmental delay or regressions; speech problems
• Behavioural:  crying; increased aggressive behaviour; bedwetting; hyperactivity
• Social:  withdrawal; difficulty trusting others; insecure attachment; disinterest in others

A detailed section looks at how trauma is experienced differently depending on the child’s age.

Prenatal/Infant/Toddler:

• Children born during war or migration may have long-lasting changes in physical, developmental, psychological and cognitive processes.
• Studies show that infants sense and respond to their parents’ stress.
• Trauma often weakens the family’s awareness and responsiveness to their young children.  When young children’s needs go unmet or are only met intermittently, they don’t understand that the parent does not intend to make them suffer.  The child only knows that they are suffering and that the parent is not relieving their distress.
• Those working with refugee infants and toddlers in programs might notice them to:
  • Have lower birth weight
  • Be more difficult to soothe or calm when upset
  • Be more prone to illness, digestive and upper-respiratory difficulties
  • Have difficulty developing trusting relationships and forming secure attachments
  • Have difficulty sleeping
  • Be sensitive to touch or easily startled and frightened by loud noises and unfamiliar sensory experiences
  • Be unresponsive, lack interest, curiosity and focus; and/or
  • Have delayed developmental milestones

Preschool-age Children (2-4 years):

The guide notes, “Preschoolers are learning to control their behaviour and emotions.  During forced migration, emotional control may be expected at a very early age.  Many children have had to suppress emotions and control their anger and feelings of distress.  Emotional expression may have been discouraged and cries rejected, putting the child at risk for attachment difficulties, isolation and feelings of disconnection.”

If a preschool-age child has experienced trauma during this time in their development, the guide points out that program workers may notice:

• Regressions and/or changes in eating habits, toileting, sleeping patterns, behaviour, and /or development
• A focus on ensuring basic needs are met rather than engaging in play, socializing and learning
• Strong emotional responses and behaviours
• Changes in arousal levels (too much energy/not enough energy/rapid swings between the two)
• Difficulty trusting others and seeking and accepting comfort and assistance
• Re-enactment of traumatic experiences, violent and war-related play, repetitive play and/or hoarding toys
• Bodily expressions of distress (vomiting, wetting themselves, headaches and stomach aches)
• Difficulties with sleep/nightmares
• Differences in comfort-seeking behaviour (too cling/failing to seek comfort and substituting behaviours such as rocking, moaning, chewing, sucking, rapidly falling asleep)
• Sensory processing and integration problems (hypersensitive and aware, covering ears in noisy environments, banging into walls/people, seeming overwhelmed or shutting down)
• Difficulty in engaging in play or demonstrating lack of interest in their peers (how to enter into play, take turns, share space and toys, tidying up and routines are often new to them)
• Speech difficulties (e.g. language switching, language suppression, selectively mute)

The guide also provides a symptom checklist for school-aged children, and then goes on to look at impacts of the refugee experience on the family as a whole, noting:

• Trauma can strengthen or weaken family bonds
• Roles may need to be re-defined
• Survival fatigue can cause parents to be stressed and unresponsive
• Each family member reacts differently to grief and trauma
• It takes time to heal and reconnect

Looking at Key Strategies, the guide points out, “Resilience is not a personality trait that some people are born with (and others are lacking).  Everyone has the capacity for resilience.”  The author also notes, however, “Resilience is not constant or permanent.  Even if a child or parent had the capacity to respond with resilience during their journey to Canada, it doesn’t mean they will always be able to respond well to adversity.  This also means that even children who have a difficult start may build resilience with the support of consistent, caring adults.” 

Heather Savazzi talks about the value programs can provide by offering a welcoming and predictable environment, a safe space where families can start to feel comfortable.  “When a child or parent who has experienced trauma first comes to your program, they might feel on constant alert for danger and be quick to react to threats.  Children may be too anxious or frightened to engage in play.  Or, especially if it’s the child’s first time in a group care setting, they could be overwhelmed by the new environment and all its sights, smells, sounds, people, toys, activities, expectations, limits and rules.”

The guide provides the following practical suggestions to help integrate refugee families into programming.

When working to create an environment that feels safe:

• Minimize clutter and create a welcoming entry where families can observe the program and join in at their own pace.
• Be sure to greet the family with a smile. A warm, personal greeting can help families to feel welcomed and valued, and can generally set them at ease.
• Welcome both the parent and the child, if the child is not stressed by your attention.
• Learn and use the parent’s and child’s names (including the correct pronunciation).

When working to achieve a predictable routine:

• Ensure a very gradual separation between the child and parent. A separation plan needs to be developed together with parents. For more information on how to ease the transition, the guide recommends another CMAS publication, A Parent’s Guide to Gradual Separations (available in 20 languages)
• Use visual cues before and during transitions (i.e., visual schedule, photos, gestures).

When working to provide consistent caregivers:

• Assign one staff member to take the lead with each family. This fosters stability, relationship building and trust for the parents and children.
• Introduce the family to the caregiver who will help their child settle. Show the family the room, where their clothes are stored and the indoor and outdoor play spaces. Introduce them to the other families, helping them to make social connections.
• Welcome each family personally each day, and give them your full attention. Asking how they slept or how they are feeling helps the parent realize that you want to know them better. Daily, friendly chats of 1–2 minutes are more effective than less frequent, longer conversations.

When working to provide clear expectations, boundaries and consequences:

• Guide the child through the daily routine, introduce them to activities and expectations, support their interactions with the other children, consistently re-direct behaviour that is harmful, respond calmly to emotional upset, and generally help the child to understand realistic boundaries and consequences.

Things to avoid:

• Having too many staff members help settle the child.
• Too many toys, transitions and/or long wait times.
• Overwhelming the family with a lot of information.
• Making judgements. Check your biases.
• Using children as translators for the parents.
• Responding emotionally to behaviour that challenges you. If you can’t respond in a calm, unemotional way, step away if possible.
• Using different words to describe the same thing (e.g., toilet, bathroom or washroom). Pick one word and use it consistently.
• Playing music all day long. Play only soothing music for a limited amount of time (10–15 minutes) each day. Too much background noise increases stress levels, which can make children irritable. It also makes it hard for them to hear and understand things being said to them when they are learning the new language.
• Trauma reminders/triggers. Think about your program and whether there might be any triggers that you need to plan ahead for. This might include toys with loud, sharp bursts of noise; lights that flicker; loud commanding voices or school bells and fire drills. Consider how you might be able to avoid the trigger or to support the child and family when the trigger happens.

The guide also offers suggestions for how to communicate more effectively with parents:

• Give them your full attention. Stand face-to-face so they can see any gestures or facial expressions.
• Echo back what you think they’ve told you (e.g., “You aren’t coming tomorrow, right?”)
• Match your communication style to theirs to increase their comfort level. Consider how physically close or distant you are, the volume of your voice, and the length of pauses between when they speak and you speak.
• Speak more slowly. Longer pauses allow parents more time to process your words and meaning.
• Discuss only one idea at a time. “How many hours did Zarlashte sleep?” while pointing at your watch vs. “When did she wake up and when did she go to sleep?” or “Zarlashte needs to get at least eight hours sleep in order to do well at school.”)
• Simplify your speech (e.g., “Can you come here tomorrow?” vs. “It is important to come to the program regularly.”)
• Be careful to avoid information overload. Tell parents only what they need to know. Remember that any major changes are often best achieved through baby steps!
• Understand that sometimes families who have been traumatized have unusual reactions (e.g., an embarrassed parent may laugh when their child is crying about separation).
• Encourage the use of the home language. Families wanting their child to succeed may have stopped using their home language at home. This often leaves the child feeling even more disconnected from their family. With less communication or strained communication, tension and misunderstandings can easily build.

These are only a small sampling of the useful information and explanations provided in the guide.  Additionally, the guide provides several tip sheets, including:

• Tips for Building Relationships with Refugee Children in Your Program
• Tips for Helping Refugee Children Understand and Manage Big Feelings and Challenging Behaviours
• Tips for Providing Opportunities for Mastery and Success for Young Refugee Children

The CMAS website:  www.cmascanada.ca is updated weekly with industry news and resources, ‘experts corner’ articles, videos and a variety of newcomer-focused child care resources that can be downloaded free of charge.  Their resources for supporting newcomer families include, All About Care for Newcomer Children (2017), A Parent’s Guide to Gradual Separation (2017), and a series of multilingual newcomer-focused brochures about topics related to child safety, New in Canada Parenting Support Series – Brochures.  These and other resources for supporting refugee children are included in the Resources section of the guide.