16 minute read
Forced Migration
Forced Migration
Supporting the mental health of migrants, refugees and immigrants
STORY BY TYNAN POWER
More than 40 million immigrants live in the United States—a population that increases by more than a million each year. Varied groups of naturalized citizens, permanent and temporary legal residents and more than 10 million undocumented people are served by social workers in roles as clinicians, case workers, school counselors, advocates, researchers and sometimes role models with their own immigration stories.
“When we think about immigration, because of how politicized and how criminalized it has been, we automatically think of people from Central America and Mexico. We think of people of color, brown people. We mostly don’t think about immigrants who are from Europe, English-speaking, or more resourced. I always say that if you walk here, it’s different than if you fly here,” said Silvia Sandoval, Ph.D. ’21, who was brought by their parents to the U.S. people from Guatemala when they were 12 years old. worldwide.
Differences among immigrants— and attitudes toward them—show up in the language used in popular discourse. While people once spoke idealistically (and problematically) of a “melting pot” of immigrants with a shared American identity, today the common use of legalistic terms like “resident,” "refugee", "asylee", "undocumented" and “unaccompanied minors” recognizes distinct experiences—and reveals a less romanticized view of immigration. Even the term “immigration” itself has been called into question for glossing over harsh realities.
“A lot of people who are centering social justice or social work values say ‘forced migration’ instead of ‘immigration,’” said Johanna Creswell Báez, Ph.D. ’16, an assistant professor at the University of Colorado. “In some cases, people have been forced out of their communities and families. They have walked for two to three months. They’ve most likely experienced multiple traumas. Often, they didn’t just make a choice and get on a plane.”
IN SOME CASES, PEOPLE HAVE BEEN FORCED OUT OF THEIR COMMUNITIES AND FAMILIES. THEY HAVE WALKED FOR TWO TO THREE MONTHS. THEY’VE MOST LIKELY EXPERIENCED MULTIPLE TRAUMAS. OFTEN, THEY DIDN’T JUST MAKE A CHOICE AND GET ON A PLANE.
-Johanna Creswell Baéz
DIFFICULT CHOICES BRING LOSS, HOPE AND MOTIVATION
Bao Chau Van, M.S.W. ’09, came to the U.S. as a child in the 1990s when her family fled Vietnam.
“It was a very diffcult decision for my family to leave Vietnam,” said Van. “Due to my father’s participation in the war—protecting and defending the Republic of South Vietnam’s democracy—he was captured and spent time in a ‘re-education’ camp after the fall of Saigon. After his release, my family fought stigma and discrimination under the new communist regime.”
Van’s family was among more than a million people who made the risky choice to leave Vietnam by boat between 1975 and 1995; only 800,000 survived the journey.
Van’s sister and brother left first. They were rescued at sea and taken to a refugee camp. Her brother was sponsored to immigrate to Australia, but her sister was sponsored by someone in the U.S.
“When you’re a refugee, you have to pick whichever country will take you—or go back, and that would mean death,” said Van. “So my brother went to Australia and my sister came here.”
The rest of Van’s family spent a year in a refugee camp in the Philippines, then followed her sister to Massachusetts. Decades later, this forced separation of their family remains a source of pain for Van.
“The adjustment and adaptation to living in a new country was not easy,” said Van. “I was faced with many obstacles such as racism, oppression and challenges with assimilation. For example, I was told by a professor that I will not be able to speak English, because I am not an American.”
“I was helped by many people such as my middle school science teacher who believed that I could create change, my English tutors who didn’t judge my grammar errors, and the church group that helped our family with food, clothes and groceries. The Vietnamese Buddhist youth group helped me by instilling hope and a sense of a community far away from my true home,” said Van. “That’s why I’m in the field I’m in, because I believe in that extra hand reaching out to be supportive and be welcoming and coaching you along. I want to give back to the community, to be available to those in need and support them.”
After graduating from Smith SSW, Van started New Path Counseling in East Longmeadow, Massachusetts, with another Vietnamese immigrant, Phuong Do, M.S.W. ’03, who shared a desire to serve Vietnamese immigrants. Today, their practice has 16 diverse clinicians and serves a range of clients.
“Since the pandemic, there has been an increase in people of color seeking services,” said Van. “They report feeling comfortable with having a BIPOC clinician whom they can relate to and who can understand their background, culture, and the family dynamics and generational challenges in a person of color family.”
FACING THE DAUNTING CHALLENGES OF TRANSGENDER IMMIGRANTS
Sandoval, a senior mental health provider in the TransLife Program of the Black Health Portfolio at the San Francisco AIDS Foundation, has been working with immigrants for over 20 years.
“I work with people who are trans, gender expansive, nonbinary and gender fluid —people who are marginalized within a marginalized community,” said Sandoval.
Many of Sandoval’s clients are or have been sex workers, who face additional dangers —and bias—on the streets, in encounters with law enforcement and even in medical settings.
It’s especially challenging for Sandoval when trans-identified immigrant clients die on the streets.
“It’s a loss, and it’s really hard that they pass away under those circumstances, but it’s also really hard to find loved ones or family members—not only here but also back in their country of origin,” said Sandoval. “It makes me really angry because they had a really hard time living and that immigrant experience is still catching up with them, even after they pass.”
Sandoval sees the strength of their clients in their determination to survive and to immigrate in the hope of finding greater safety.
“I feel honored and privileged when somebody says to me, ‘thank you’,” said Sandoval. “Social work is hard, but it is also very rewarding.”
This motivates them as a clinician—and as an instructor who wants social workers to have the tools—and resources—to work with immigrant populations.
“To do better, we need a lot more funding to create better access to services. That includes better pay for social workers,” said Sandoval, noting that clinicians often can’t afford to live in cities with high immigrant populations. “We need better education of families and healthcare providers, funding for campaigns to decriminalize sex work and create safer streets for all and protect people—especially TGNB people who are members of BIPOC communities— from discriminatory arrests based on how they are dressed and the profession they practice.”
Sandoval would also like to see more research that focuses on immigrant populations.
“Scholarship is so important, but it’s also very difficult to recruit populations that we want to study and serve,” said Sandoval. “There’s a lot of fear and, in the past, research has caused a lot of harm to marginalized populations.”
THE ADJUSTMENT AND ADAPTATION TO LIVING IN A NEW COUNTRY WAS NOT EASY. I WAS FACED WITH MANY OBSTACLES SUCH AS RACISM, OPPRESSION AND CHALLENGES WITH ASSIMILATION. FOR EXAMPLE, I WAS TOLD BY A PROFESSOR THAT I WILL NOT BE ABLE TO SPEAK ENGLISH, BECAUSE I AM NOT AN AMERICAN.
-Bao Chau Van
HELPING AFRICAN REFUGEES ADJUST
Jean Paul Gatete, M.S.W. ’21, was inspired to become a clinician through his work with the refugee resettlement and integration program at Jewish Family Service of Western Massachusetts. His own experience gives him insight and compassion for his clients. Gatete was born in Burundi, where his family had resided as refugees since his grandparents fed Rwanda due to the 1959 revolution. He returned to Rwanda after the 1994 Tutsi genocide, before immigrating to the United States in 2017.
“I don’t have the severe background of trauma some have experienced, but I had some challenges, as well, when I was growing up,” said Gatete. “So I understand what they’re going through.”
The reality of American racism can be one unexpected challenge for African refugees.
“When they come to the U.S., they have hopes that this is a safe place in the world,” said Gatete. “When they get here, they experience racism and they feel disappointed…They feel like they’re not safe where they came from, and then they come here and they don’t feel safe. Families I work with have disclosed to me that they feel there’s misinformation about racism [in the U.S.], but the truth is, it’s there and it’s diferent from other parts of the world. Like in South Africa, it was really obvious, there were places that were just for white people. But in the U.S., people don’t really openly do those kinds of things. It’s just internal.”
“I try to help my clients to process that,” said Gatete. “We just have to make sure they understand what’s going on, and make sure they can navigate the system and face those challenges.”
Gatete works as part of an in-home therapy team working with youth between the ages of fve and 21.
“I feel really grateful to work with the entire family,” says Gatete. “If you’re working with a family, the mom might say they need help with something job-related, or maybe medical appointments…[or] I may be working with a child who is having adjustment challenges, like behavior challenges at school, but the in-home therapy program makes it more about the family.”
HELPING FAMILIES SEPARATED AT THE BORDER
Cheryl Aguilar, D23, is a clinician, co-author of a guide to support immigrants afected by DACA, and the founding director of Hope Center for Wellness in Washington, D.C.
Recently, Aguilar has provided mental health services to families who were separated at the border under the “zero tolerance policy.”
“Parents were detained upon entering and the kids were sent to shelters,” said Aguilar. “Parents didn’t know when they were going to reunite with the kids, and kids didn’t have any information…which creates a lot of uncertainty and fear on top of the pre-existing trauma families may have from having fed dire conditions. It’s a terrifying experience to come into the country and to literally be ripped apart.
The children are at a very vulnerable developmental stage, and they don’t have the support of the person who’s supposed to protect them—they’re calling out for those loved ones who are supposed to keep them safe and protect them. The narrative that is created in their minds is ‘you’re not there, you weren’t there for me.’ There’s a rupture in the emotional attachment, the emotional connection between the parents and the children. Once these families are ready to reunify, there’s a distance that has been created. Kids are not able to connect in the same way they did with their parents, parents are not able to connect with their kids.”
“Parents report trauma responses manifesting. Parents may report, ‘my kids are no longer listening to me, they are defant.’ Those are symptoms of responses to the trauma that they have experienced,” said Aguilar. “One of the important things to do is to provide healing space for them individually, for them to be able to process that traumatic experience they had, and eventually to bring them together. That’s the group work or family work to bring them together and allow them to reconnect through therapeutic processing and trauma and attachment-informed interventions.”
“One of the approaches that I have utilized is a strength-based approach,” said Aguilar. “I think the journey, that decision to take your family or yourself somewhere else and start all over again, to me, indicates a lot of strength. Seeing people healing, achieving their goals, whether therapeutic goals or goals in life, makes this work worth it.”
CENTERING SOCIAL JUSTICE PRINCIPLES WITH QTPOC IMMIGRANTS
As someone who immigrated from Bangladesh as an infant after being adopted by a family member in the U.S., Jordan Alam, M.S.W. ’20, doesn’t remember the process but is deeply aware of how immigration is intertwined with the history—and ongoing impacts—of colonialism. Today, Alam brings that awareness to work in a group practice that centers QTPOC clients and social justice principles.
“I believe that many of these clients come to me due to my identities,” said Alam, who identifes as a queer, non-binary person of color and “1.5 generation” immigrant. “My clients talk about the disillusionment they felt when arriving in the U.S. and being stripped of community, while also having to battle a system that is designed to keep people out and extract their labor.”
Some people Alam sees are undocumented or have undocumented family members, but others are on work or student visas. Alam has found that even these more resourced immigrants can face daunting challenges.
“I’ve worked with multiple Ph.D. students whose immigration status hinges on continuing to work for a toxic advisor, which strips them of their ability to self-advocate,” said Alam. “They can be paid less and asked to do work that others would not do, because of the looming threat of their status. Many of those folks don’t seek out mental health resources because they may not know they’re available, or they don’t have the funds if it’s not free/low cost, or they are worried about how seeking services will afect their immigration status.”
Witnessing clients unable to access resources is frustrating, but being part of the solution makes it worthwhile.
“Despite the pains of the system and its deep mental health impact, there is something really rewarding about helping people return to ritual and build community in their newfound home,” said Alam.
USING EVERY TOOL IN THE TOOLBOX
Under the auspices of Clinical Scholars, a national Robert Wood Johnson Foundation leadership program for healthcare providers advancing health equity, Johanna Creswell Báez, Ph.D. ’16, worked with an interdisciplinary team to make innovative contributions in working with unaccompanied immigrant minors (UM) in Houston. To improve access to resources, they created a website, Bridge UM: Bridging Borders in Houston (bbhouston.org) which provides an easy to navigate directory of services ranging from medical and mental health providers to food assistance and education services. The website also supports the CAM (Central American Migrants) Working Group, which connects providers, organizations and community members who are working on behalf of the area’s UMs. Other resources on the site include a toolkit for providers called Caring for Former Unaccompanied Immigrant Minors: A Culturally Relevant and Trauma Responsive Toolkit for Providers, co-developed by Báez, and a compelling 12-minute documentary called “Escúchame: Voices of Unaccompanied Immigrant Children.”
“These youth are so amazing. I feel honored to know them,” said Báez. “The clinical model, toolkit and the documentary all used their words and their ideas. We aren’t the experts in this; they are. As a qualitative and mixed methods researcher, it just comes naturally to center their voices and have them drive these programs.”
“This work is so exhausting and it’s really a 20-year project,” said Báez. “Working with immigration is really, really difficult and trying to get any kind of change at the policy level is a long game. So we definitely had to form a team. It’s also interdisciplinary. There are doctors that I’m collaborating with and we’re talking with lawyers. You need to have a team.”
Next, Báez is hoping to develop a protected app for UMs.
“Many of these youth at their initial interviews talked about losing contact with each other,” said Báez. “They may start in Houston, but they go all over the country, so we envisioned an app for them to connect that would also provide some case management services.”
I THINK THE JOURNEY, THAT DECISION TO TAKE YOUR FAMILY OR YOURSELF SOMEWHERE ELSE AND START ALL OVER AGAIN, TO ME, INDICATES A LOT OF STRENGTH. SEEING PEOPLE HEALING, ACHIEVING THEIR GOALS, WHETHER THERAPEUTIC GOALS OR GOALS IN LIFE, MAKES THIS WORK WORTH IT.
-Cheryl Aguilar
TAKING THE FIRST STEPS
For social workers approaching work with immigrants for the first time, the overwhelming advice from experienced practitioners is to learn about the different immigrant groups and recognize their unique clinical needs.
“Through local immigration organizations, we can better understand the needs in that location,” said Aguilar, who is also a Robert Wood Johnson scholar. “The needs in the DC Metro area may be different from those near the [Mexican] border.”
Bringing humility and transparency to the work is crucial, as well.
“Ask questions,” said Van. “Sometimes I don’t know much about a certain cultural background, but I’m willing to listen and hear and understand. It helps to say that: ‘I want to listen and hear you.’”
Social workers need to remember that immigration is almost always preceded, accompanied and followed by trauma.
“I encourage folks to view immigration through the lens of trauma and grief,” said Alam. “Often we view immigration as a positive change in peoples’ lives without acknowledging the factors that push people to leave their home countries and pull them to places where they often encounter layers of oppression created by the long shadow of colonialism. Even if one believes deeply that their survival and wellbeing are improved by leaving their home country—especially for queer communities and cis women feeing violence—there still exists that heartbreak which needs to be integrated into the conversation.”
Many who work with immigrants say the experience requires that they become advocates.
“We’ve got to be strong clinicians and we’ve also got to be strong in our macro practice,” said Báez. “Social workers need to learn about policy and advocacy, and what we can do for groups who’ve been systematically marginalized.”
“We’re not just clinical social workers. We hear stories of human suffering,” said Aguilar. “Because we’re witnesses to human suffering, we have a responsibility to mobilize whichever way we know how to create change. ◆
