Abstract
Parents and children exposed to war and relocation have high rates of negative relational and mental health outcomes. The Karen are an ethnic minority from Burma (Myanmar) and Thailand, recently resettled in the United States. Karen refugee parents have been significantly strained by both war-related trauma and resettlement stress. We conducted three focus groups with Karen caregivers (N = 12, 5, and 12) to assess parenting practices in the Karen refugee community. Standardized mental health and parenting assessments completed by 11 Karen caregivers and 11 children were used to triangulate focus group data. Key themes identified related to mothers’ physical care for their children, parenting difficulties after relocation to the U.S., and practices of discipline, direction-giving, and encouragement. These findings have implications for culturally relevant clinical and research approaches to support Karen refugee parents and children.
Similar content being viewed by others
References
Anxiety and Depression Association of America. (2016). Facts and statistics. Retrieved December 16, 2016 from https://www.adaa.org/about-adaa/press-room/facts-statistics.
Bek-Pedersen, K., & Montgomery, E. (2008). Narratives of the past and present: Young refugees’ construction of a family identity in exile. Journal of Refugee Studies. https://doi.org/10.1093/jrs/fej003.
Brand, S. R., Engel, S. M., Canfield, R. L., & Yehuda, R. (2006). The effect of maternal PTSD following in utero trauma exposure on behavior and temperament in the 9-month-old infant. Annals of New York Academy of Science. https://doi.org/10.1196/annals.1364.041.
Brand, S. R., Schechter, J. C., Hammen, C. L., Brocque, R. L., & Brennan, P. A. (2011). Do adolescent offspring of women with PTSD experience higher levels of chronic and episodic stress? Journal of Traumatic Stress. https://doi.org/10.1002/jts.20652.
Bureau of Population, Refugees, and Migration. (2015). Proposed refugee admissions for fiscal year 2016. Retrieved December 1, 2016 from http://www.state.gov/j/prm/releases/docsforcongress/247770.htm.
Capaldi, D. M. (2014). Offspring of mothers who had antenatal depression and experienced maltreatment in childhood are more likely to experience child maltreatment themselves. Evidence Based Nursing. https://doi.org/10.1136/eb-2013-101378.
Catani, C., Jacob, N., Schauer, E., Kohila, M., & Neuner, F. (2008). Family violence, war, and natural disaster. A study of the effect of extreme stress on children’s mental health in Sri Lanka. BMC Psychiatry. https://doi.org/10.1186/1471-244X-8-33.
Coulter, S., & Mooney, S. (2018). Much more than PTSD: Mothers’ narratives of the impact of trauma on child survivors and their families. Contemporary Family Therapy. https://doi.org/10.1007/s10591-017-9408-z.
Dvorak, R. D., Sargent, E. M., Kilwein, T. M., Stevenson, B. L., Kuvaas, N. J., & Williams, T. J. (2014). Alcohol use and alcohol-related consequences: Associations with emotion regulation difficulties. The American Journal of Drug and Alcohol Abuse. https://doi.org/10.3109/00952990.2013.877920.
Executive Order No. 13769, 3 C. F. R. (2017).
Fazel, M., & Stein, A. (2003). Mental health of refugee children: Comparative study. BMJ. https://doi.org/10.1136/bmj.327.7407.134.
Finklestein, M. (2016). Risk and resilience factors in families undergoing terror along the life cycle. Contemporary Family Therapy,38, 129–139. https://doi.org/10.1007/s10591-015-9356-4.
Gewirtz, A., Forgatch, M., & Wieling, E. (2008). Parenting practices as potential mechanisms for children’s adjustment following mass trauma: Literature review and prevention research framework. Journal of Marital and Family Therapy. https://doi.org/10.1111/j.1752-0606.2008.0063.x.
Gonzalez, N., & Méndez-Pounds, J. (2018). The impact of acculturation and cultural values on Hispanic immigrants’ parenting. Contemporary Family Therapy,40, 56–67. https://doi.org/10.1007/s10591-017-9428-8.
Goodman, R., Meltzer, H., & Bailey, V. (1998). The strengths and difficulties questionnaire: A pilot study of the validity of the self-report version’. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s007870050057.
Harpaz-Rotem, I., Rosenheck, R. A., & Desai, R. (2009). Assessing the effects of maternal symptoms and homelessness on the mental health problems in their children. Child and Adolescent Mental Health. https://doi.org/10.1111/j.1475-3588.2008.00519.x.
Hormozi, T., Miller, M. M., & Banford, A. (2018). First-generation Iranian refugees’ acculturation in the United States: A focus on resilience. Contemporary Family Therapy. https://doi.org/10.1007/s10591-018-9459-9.
Internal Displacement Monitoring Centre. (2016). Myanmar. Retrieved November 20, 2016 from http://www.internal-displacement.org/database/country/?iso3=MMR.
Kelley, M. L., Self-Brown, S., Le, B., Bosson, J. V., Hernandez, B. C., & Gordon, A. T. (2010). Predicting posttraumatic stress symptoms in children following hurricane Katrina: A prospective analysis of the effect of parental distress and parenting practices. Journal of Traumatic Stress. https://doi.org/10.1002/jts.20573.
Kilic, C., Kilic, E. Z., & Aydin, I. O. (2011). Effect of relocation and parental psychopathology on earthquake survivor-children’s mental health. Journal of Nervous and Mental Disease. https://doi.org/10.1097/NMD.0b013e3182174ffa.
Kim, L., Knudson-Martin, C., & Tuttle, A. (2019). Transmission of intergenerational migration legacies in Korean American families: Parenting the third generation. Contemporary Family Therapy,41, 180–190.
Kovacs, M. (1992). Children’s depression inventory. North Tonawanda, NY: Multi-Health Systems Inc.
Kwak, K. (2003). Adolescents and their parents: A review of intergenerational family relations for immigrant and non-immigrant families. Human Development. https://doi.org/10.1159/000068581.
Lauterbach, D., Bak, C., Reiland, S., Mason, S., Lute, M. R., & Earls, L. (2007). Quality of parental relationships among persons with a lifetime history of posttraumatic stress disorder. Journal of Traumatic Stress. https://doi.org/10.1002/jts.20194.
Levi, M. (2014). Mothering in transition: The experiences of Sudanese refugee women raising teenagers in Australia. Transcultural Psychiatry,51, 479–498.
Lewig, K., Arney, F., & Salverson, M. (2010). Challenges to parenting in a new culture: Implications for child and family welfare. Evaluation Program Planning. https://doi.org/10.1016/j.evalprogplan.2009.05.002.
Lewis, F. J., Paik, S. E., & Tseng, C. F. (2017). Deconstructing the legal process for the immigration population in the United States: Ethical implication for mental health professionals. Contemporary Family Therapy,39, 141–149. https://doi.org/10.1007/s10591-017-9418-x.
Marchetti-Mercer, M. C. (2016). “If you uproot a tree you leave a big hole behind”: Systemic interconnectedness in emigration and family life. Contemporary Family Therapy,38, 339–352. https://doi.org/10.1007/s10591-016-9386-6.
Masten, A. S., & Narayan, A. J. (2012). Child development in the context of disaster, war, and terrorism: Pathways of risk and resilience. Annual Review of Psychology. https://doi.org/10.1146/annurev-psych-120710-100356.
McIlwaine, F., & O’Sullivan, K. (2015). ‘Riding the wave’: Working systemically with traumatised families. Australian and New Zealand Journal of Family Therapy. https://doi.org/10.1002/anzf.1114.
Morrow, S. L. (2005). Quality and trustworthiness in qualitative research in counseling psychology. Journal of Counseling Psychology. https://doi.org/10.1037/0022-0167.52.2.250.
Parker, G., Tupling, H., & Brown, L. B. (1979). A parental bonding instrument. British Journal of Medical Psychology. https://doi.org/10.1111/j.2044-8341.1979.tb02487.x.
Polusny, M. A., Kehle, S. M., Nelson, N. W., Erbes, C. R., Arbisi, P. A., & Thuras, P. (2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in National Guard soldiers deployed to Iraq. Archives of General Psychiatry. https://doi.org/10.1001/archgenpsychiatry.2010.172.
Powell, R. A., & Single, H. M. (1996). Focus groups. International Journal for Quality in Health Care. https://doi.org/10.1093/intqhc/8.5.499.
Robin, A. L., & Foster, S. L. (1989). Negotiating parent-adolescent conflict: A behavioral-family systems approach. New York: Guilford Press.
Schweitzer, R. D., Brough, M., Vromans, L., & Asic-Kobe, M. (2011). Mental health of newly arrived Burmese refugees in Australia: Contributions of pre-migration ad post-migration experience’. Australian and New Zealand Journal of Psychiatry. https://doi.org/10.3109/00048674.2010.543412.
Shannon, P. J., Vinson, G., Wieling, E., Cook, T., & Letts, J. (2015). Torture, war trauma, and mental health symptoms of Karen refugees. Journal of Loss and Trauma. https://doi.org/10.1080/15325024.2014.965971.
Shannon, P., Wieling, E., Im, H., Becher, E., & Simmelink, J. (2014). Beyond stigma: Barriers to discussing mental health in refugee populations. Journal of Loss and Trauma. https://doi.org/10.1080/15325024.2014.934629.
Son, S. E., & Kirchner, J. T. (2000). Depression in children. American Family Physician, 62, 2297–2308. Retrieved November 20, 2016 from http://www.aafp.org/afp/2000/1115/p2297.html.
Sriskandarajah, V., Neuner, F., & Catani, C. (2015). Parental care protects traumatized Sri Lankan children from internalizing behavior problems. BMC Psychiatry. https://doi.org/10.1186/s12888-015-0583-x.
Steinberg, A. M., Brymer, M. J., Kim, S., Ghosh, C., Ostrowski, S. A., Gulley, K., et al. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Part I. Journal of Traumatic Stress,26, 1–9.
Stover, C. S., McMahon, T. J., & Easton, C. (2010). The impact of fatherhood on treatment response for men with co-occurring alcohol dependence and intimate partner violence. American Journal of Drug and Alcohol Abuse. https://doi.org/10.3109/00952990.2010.535585.
Straus, M. A., Hamby, S. L., Buncy-McCoy, S., & Sugarman, D. B. (1996). The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of’ Family Issues. https://doi.org/10.1177/019251396017003001.
Tingvold, L., Hauff, E., Allen, J., & Middelthon, A. (2012). Seeking balance between the past and the present: Vietnamese refugee parenting practices and adolescent well-being. International Journal of Intercultural Relationships. https://doi.org/10.1016/j.ijintrel.2012.03.004.
U.S. Department of State. (2016). Proposed refugee admissions for fiscal year 2017. Retrieved December 20, 2016 from https://www.state.gov/j/prm/releases/docsforcongress/261956.htm.
van Ee, E., Kleber, R. J., & Jongmans, M. J. (2016). Relational patterns between caregivers with PTSD and their nonexposed children. Trauma, Violence, & Abuse,. https://doi.org/10.1002/imhj.
Vervliet, M., De Mol, J., Broekaert, E., & Derluyn, I. (2013). That I live, that’s because of her: Intersectionality as framework for unaccompanied refugee mothers. British Journal of Social Work. https://doi.org/10.1093/bjsw/bct060.
Walter, J., & Bala, J. (2004). Where meanings, sorrow, and hope have a resident permit: Treatment of families and children. In J. P. Wilson & B. Drozdek (Eds.), Broken spirits: The treatment of traumatized asylum seekers, refugees, war and torture victims (pp. 487–519). New York, NY: Brunner-Routledge.
Wickrama, K. A. S., & Kaspar, V. (2007). Family context of mental health risk in tsunami-exposed adolescents: Findings from a pilot study in Sri Lanka. Social Science Medicine. https://doi.org/10.1016/j.socscimed.2006.09.031.
Wieling, E., & Erolin, K. S. (2009, April). The cultural and contextual adaptation of parenting and trauma interventions to a child maltreatment population in Mexico. Paper symposium presenter. Society for Research in Child Development Biennial Meeting, Denver, CO.
Wolmer, L., Laor, N., Gershon, A., Mayes, L. C., & Cohen, D. J. (2000). The mother-child dyad facing trauma: A developmental outlook. Journal of Nervous and Mental Disease,188, 409–415.
Ying, Y., & Han, M. (2007). The longitudinal effect of intergenerational gap in acculturation on conflict and mental health in Southeast Asian American adolescents. American Journal of Orthopsychiatry. https://doi.org/10.1037/0002-9432.77.1.61.
Yumbul, C., Wieling, E., & Celik, H. (2018). Mother-child relationships following disaster: The experiences of Turkish mothers living in a container city after the 2011 earthquake. Contemporary Family Therapy. https://doi.org/10.1007/s10591-017-9445-7.
Acknowledgements
We acknowledge and thank Marion Forgatch and the team at Implementation Sciences International, Inc. for their ongoing support and mentorship related to GenerationPMTO dissemination and implementation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors of this manuscript confirm that there are no conflicts of interest with the current manuscript.
Ethical Approval
The study included human subjects, and study protocols were approved by the Institutional Review Board at the authors’ academic institution.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ballard, J., Wieling, E. & Dwanyen, L. Parenting Practices in the Karen Refugee Community. Contemp Fam Ther 42, 95–107 (2020). https://doi.org/10.1007/s10591-019-09509-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10591-019-09509-6