Research & Action Report Fall/Winter 2009
by Michelle Porche, Ed.D.

Michelle Porche, Ed.D., a senior research scientist at Wellesley Centers for Women (WCW), studies academic achievement in literacy and science among young children and adolescents. She is especially interested in the influence of gender and socioemotional factors on the academic achievement of children from low-income families. More recently she has expanded her work to study the impact of trauma on learning and achievement. In addition to work at WCW, Porche spent ten years as a researcher on the longitudinal Home-School Study of Language and Literacy Development at the Harvard University Graduate School of Education, where she received her doctorate. She is co-author of Is Literacy Enough? Pathways to Academic Achievement for Adolescents , which describes findings from the Home-School Study. In 2002 she was a corecipient of the International Reading Association’s Albert J. Harris Award for contributions in literacy research.

Lisa Fortuna, M.D., M.P.H., a board certified child and adolescent psychiatrist, is an assistant professor of psychiatry and the Director of Child and Adolescent Multicultural Health Research at the University of Massachusetts Medical School. Her research interests include Latino mental health services, immigrant mental health, post-traumatic stress disorder, and substance abuse. As the recipient of a five-year Career Development Award from the National Institute of Drug Abuse, Fortuna has been working with Stanley Rosenberg, director of the Trauma Interventions Research Center at the Dartmouth University Medical School, on post-traumatic stress disorder in adolescents and children.

What was the impetus for your work with young African refugees, and how was the needs assessment funded?
Porche: This work is one of several collaborative projects Lisa and I have done investigating the consequences of trauma on mental health , as well as on school and achievement outcomes.
Fortuna: This project grew out of my work on post-traumatic stress disorder (PTSD) in adolescents and children with Stan Rosenberg, who’s been doing a lot of training on trauma-informed, evidence-based therapies for kids in New Hampshire. Endowment for Health, a foundation which helps fund some of his work, felt they could do more to reach youth in the refugee community, who clearly have a high trauma exposure. So Stan and I and the Endowment for Health program officers brought in Michelle, and we put our heads together to think about how to disseminate evidence-based treatments for kids in the refugee community.
Porche: The original small grant came from the National Child Traumatic Stress Network, through Stan. We also had money from the Endowment for Health. But the funding was very limited and we could not have done the project without matching funds from Wellesley Centers for Women (WCW) to support my work.

Who are these young Africans, and what kinds of trauma are they fleeing from?
Porche: They come from many countries that have experienced political violence — especially Somalia, but also Sudan, Sierra Leone, Liberia, Burundi, Congo. But they seldom come directly from their home country.
Fortuna: They move first to refugee camps in different parts of Africa, where they may spend up to ten years. And some kids were born in the camps.
Porche: But some of the older adolescents had witnessed direct political violence — their fathers being killed, horrible atrocities...
Fortuna: And many of the parents had experienced atrocities. We didn’t ask about specific trauma, but some parents volunteered information about violence in their countries of origin, including rape and sexual assault against women. It’s part of the political violence.

How did they end up in New Hampshire?
Porche: Everyone wants to know—why African refugees in New Hampshire, which seems to be such a rural place? Placement is facilitated by the Lutheran Social Services, which partners with the U.S. Department of State to resettle refugees all over the country. New Hampshire has about 5,000 African refugees.
Fortuna: The refugees have no control over where they land; once placed, they receive time-limited self-sufficiency services from the State’s Office of Refugee Resettlement. Later on, when they’re really settled, some refugees may move to another state to be with other family members, or where the refugee community may be more vibrant.
Porche: For example, Minnesota is a big state for a lot of refugees, especially Somalis. By the way, the U.S. takes in fewer refugees than most countries.

This project required much collaboration by stakeholders. How did that come about, and how did you collect data?
Porche: The Endowment for Health was key to the success of the needs assessment. Their program officers helped us make contact with appropriate providers and agencies as well as the African Coalition, a group of leaders of grassroots African refugee organizations. The program officers invited about 60 of these stakeholders to an introductory meeting — African leaders, the Resettlement Office, school people, therapists from mental health clinics, primary care providers. We presented our design for the needs assessment and let people know that we wanted to come talk with them.
The African refugee leaders were eager to collaborate with us and helped recruit the families and young adults we wanted to talk to. They also served as translators. Some of the kids spoke to us in English, but all the parents spoke in their native languages and the African leaders translated.
Fortuna: We held individual interviews with many of those people, and then dialogues in groups with all levels of stakeholders to look at data from the interviews—to identify problems and areas where something might be done better.

What did you find are some of the key resettlement challenges for these young people?
Porche: Let’s make that “young people and families.” The original grant mechanisms were to find out more about the risk for youth. But as soon as we got into it, we knew it had to be a family-systems piece.
Fortuna: That made sense. I’m a child psychiatrist, so I always think there’s a family-systems element to the work we do. But even the refugee leaders said, “This is really about families.” Here are parents and older adolescents experiencing physical violence that causes them to leave their country of origin, then everyone trying to manage in the camps, then coming here with continued issues of displacement and family members’ being no longer together — that’s a very powerful loss for everyone.
Porche: Some mothers have come without their children. It’s especially hard for them to feel settled here, to have a sense of the future.
Of course, for everyone there are huge hurdles at startup. Everything’s new. They don’t know how to turn on a light, how to use the stove—and everyone they see is white. Worse, parents struggle for jobs to provide for the family’s needs. And each family must pay the government back for travel expenses to the U.S., so they start out in debt.
Fortuna: School soon becomes a major area of stress. The refugee camps may not have had schools, or if there were schools, the parents may have been fearful about sending kids there. So a lot of kids come over with no literacy skills. There are some who can’t read or write in their native languages, or at a minimum have no sense of structured school.
Porche: But they learn English quickly and become pretty proficient in about a year.
That’s a good thing for the children, but it’s a double edged sword, because the kids end up serving as interpreters and mediators for the parents. That’s not good for the parent-child relationships, because the children then have knowledge and some power that really should be the parents’. So as children do better in school and learn English it can create problems in other areas of their lives.
Fortuna: Here are moms, whose husbands may have been killed, challenged by a big shift in their parenting role while dealing with adjustment to the United States—then finding their children empowered in some ways, while they feel disempowered. That can be very stressful and demoralizing.
Porche: Meanwhile, a key struggle for the children is that in the U.S. they’re placed in classrooms by age, so a 15-year old who’s had no formal education is put into high school with peers who’ve had ten years of formal schooling. (In African education systems, if someone needed to start at a second-grade level, that’s where they’d start in a mixed-age classroom.) They do get help, and they get English as a Second or Other Language (ESOL), but even though they make a lot of progress quickly it’s very hard for them to catch up. And if they don’t have a way to do well academically, they’re going to figure out other ways to feel good about themselves—acting tough, getting into fights, all sorts of things.
There are identity issues, too. For example, there are different African groups or tribes that don’t get along because of historical conflicts. That creates tension when children have to share the same school.
Fortuna: And the kids of color fight each other a lot. A couple of African girls said, “We really fight with the Latino kids.”
Porche: That may be about the scarce resources of new groups coming in and the tensions of being different in the schools.
Fortuna: And about “who will be who” in this new dynamic.

Say more about the stresses for parents.
Porche: Discipline issues cause a lot of stress. Many refugees are used to using corporal punishment, which we generally don’t allow in the U.S. Kids are told, “Your parents can’t hit you any more,” so they say to their parents, “You can’t touch me. If you do, I’ll call 911.” That creates incredible tension. Parents feel disempowered.
Fortuna: And other people are controlling the situation. The police come, the parents can’t speak English, and it’s the child who’s telling the police what’s happened. It’s a really scary situation for parents.
Porche: It’s a matter of language barriers as well as cultural misunderstandings.
And there are difficulties about school. Parents arrive with great respect for education. They’ve survived every horrible trauma so that their children can thrive here and get a good education. In their home countries, teachers were the experts;
parents didn’t get involved in formal schooling the way parents do here. So teachers here may feel, “Those parents don’t care; they don’t come to school or help with homework.” While the parents are thinking, “But you’re the teacher. I take care of the children, I raise them, I make sure they’re respectful. I don’t sit and do homework with them—that’s the teacher’s job.”
Employment is another challenge. Jobs are very difficult to come by. This isn’t a great time to be here, in the middle of a horrible recession.
Fortuna: There are gender issues, too. Some of the women can find work like childcare and house cleaning, but jobs for men are harder to find right now.
Porche: It’s especially hard for men who had jobs with particular skills and status and now can’t get equivalent work. Men do get limited assistance with job training and placement and an opportunity to take ESOL classes, but a lot of them feel those classes don’t help much. And finding transportation is often very difficult.
Also, large families have been coming in, and the housing stock often isn’t well suited for large families.
And now the families face racism—they’re a visible minority. They haven’t experienced that before.
Fortuna: That’s what triggers PTSD. They already have a history of trauma because of who and where they were — but not because they were black. Then they come to this country and their skin color is another marker that makes them vulnerable to discrimination or attack.
Porche: But the biggest sense of loss is the parents’ realization that they’ve escaped from torture, rape, and danger, struggling to get to this country for their children — who are, as they say, “their wealth, their treasure” — and then, in the midst of all their acculturative distress, they feel they’re losing their children to this culture that allows crime and the misbehavior of young people. That is very painful.
Fortuna: We also often heard the parents wish that their children would keep their religion and cultural values. That’s a way of saying, “Then they’d still be part of us.”

With all of this pain and stress, do any refugees wish they hadn’t come?
Porche: Everyone we talked to said, “We’re really grateful to be here.” The challenges are difficult and cause a lot of worry. But as one mother said, “In this country, when my children go to school, I know that they’re going to get there safely and they’re going to come home.”

What was the follow-up to your needs assessment?
Porche: This past May we held a two-day learning collaborative conference for the people we’d invited to the first kick-off meeting and others we’d since learned should be involved. We brought in research teams, from Boston, Vermont, and Minnesota, with expertise in treatment and support for resettled African refugees. The research teams included researchers, clinicians, and front-line African outreach persons. We had great attendance from stakeholders from various parts of New Hampshire.
Fortuna: The research teams presented best practices, their experience of what has been successful in working with African refugees in their communities—such as models for parenting that help with disruptive behavior and communication in a family under stress.
Porche: Afterward we held a debriefing with the African leaders, who said that the parenting piece was their priority. We hope to support the development of an adaptation of what we learned that will also incorporate traditional African parenting values. One of the primary outcomes is an initiative led by Geraldine Kirega of the Women for Women Coalition, a grassroots organization in New Hampshire, which will be a program that integrates support for mothers with afterschool tutoring for their adolescent children. I will collaborate with the Women for Women Coalition to evaluate a pilot of the program to be conducted with women from different African ethnicities, but who all speak Swahili. Besides supporting parenting in general, the goal will be to help mothers make connections with school personnel that will support their children’s academic achievement. Because that’s really the parents’ goal: They want their children to do well.
Fortuna: Another result of the meeting is that Stan and I want to collaborate with the mental health clinics that actually have African clinicians to develop an evidence-based intervention for the kids around behavioral and emotional needs. The African clinicians can speak the language, so they can involve the parents and may know some culturally useful adaptations of the intervention.
Porche: We also hope to work with the African leaders and communities in developing other kinds of interventions. It’s important that these be truly collaborative, that the African leaders lead the way in the services provided.
Fortuna: Another thing that came out of the learning collaborative conference was the idea of building a New England network of researchers, African leaders, and providers sharing lessons learned—and maybe a web-based interactive learning network. I do some telemedicine already, and I’m interested in how technology can be a bridge for communication and information sharing.
Porche: The value of that two-day meeting will continue for a long time to come. We presented some of this work at the American Psychological Association annual convention in August, and one of the next big steps is for us to write up our results so we can publish them.
Fortuna: That’s an important piece that we don’t have money for.

Say a bit more about funding. In these economically difficult times, how do you find funding for what seems like a very specialized area of need?
Porche: I think there’s plenty of interest in immigrant and refugee communities as a growing population. What we’re learning seems specialized, but it has broader implications. We’re working on collaborative grants for those projects with the leaders and their communities. The Endowment for Health is interested in being one of several funding sources for the program to integrate parent support and afterschool tutoring for children, and the African Coalition leaders are looking for other grants.
Fortuna: Meanwhile, I’m putting in grant proposals with Stan for work with those leaders and African clinicians, probably focusing on mood and disruptive behaviors. The National Child Traumatic Stress Network and other agencies have a lot of interest in this area. And we’re putting out some other proposals in New Hampshire. There’s still evidence-based knowledge that’s needed.
Porche: It’s also true that all of us, including the African leaders, do a lot of work that’s not funded. It’s a matter of get-a-little-money-and-push-it-as-far-as-you-can—and a lot isn’t covered. It’s really a commitment and a labor of love.
Fortuna: It plays to our passion and why we do research—to make an impact for communities that are vulnerable, that need to have something work better.