Review of child maltreatment in immigrant and refugee families.
LeBrun, Annie ; Hassan, Ghayda ; Boivin, Mylene 等
Child maltreatment is a worldwide public health concern that is
associated with numerous and severe, short- and long-term health and
developmental consequences for children. (1, 2) It is also accompanied
by important social and economic costs. (1) Child maltreatment consists
of neglect and/or physical, sexual and psychological abuse, including
exposure to intimate partner violence.
Over the past two decades, increased attention has been given to
culture and ethnicity in the field of child maltreatment. Studies and
reviews based on ethnic minority samples have certainly been crucial and
are highly informative for the promotion of more culturally sensitive
practices. However, generalizing their results may be not only
inappropriate but also inequitable for immigrant (first and second
generations) and refugee populations, as they do not take into account
the specific characteristics (e.g., migratory and settlement conditions)
and needs of these groups. (2, 3) Although Western countries, and
particularly the US and Canada, have a long history of migration and
cultural diversity, social and health institutions must increasingly
adapt to a shift in immigration patterns. (4) The greatest influx of
immigration to Canada is no longer from Europe but, rather, increasingly
from developing countries affected by war or severe political, social or
economic unrest. (4) These newly arrived families may share many
characteristics with longer settled members from their countries or
ethnic groups of origin. However, they also face specific and unique
challenges that need to be examined in relation to child maltreatment,
and to access and response to care. (3) A unique systematic evidence
review (2) on the prevalence, screening and treatment of child
maltreatment among recently settled immigrants and refugees published in
2011 by Hassan and colleagues, in collaboration with the Canadian
Collaboration for Immigrant and Refugee Health (CCIRH), recommended
"against routine screening because of poor performance of screening
instruments and the potential harms caused by the very high
false-positive rates" (p.2). The authors also recommended a home
visitation program for immigrant and refugee mothers living in high-risk
conditions during the first two years of their child's life. No
review has yet been conducted on the predictive risk or protective
factors for child maltreatment in immigrant and refugee populations.
The main objectives of this review are: 1) to review the state of
evidence on the prevalence, risk and protective factors for child
maltreatment among immigrant and refugee populations, and 2) to
integrate the evidence in an ecosystemic analytical framework that would
guide future research. To meet these objectives, this review is guided
by three key questions: 1) Are immigrant or refugee children at higher
risk of child maltreatment? 2) What are the specific risk and protective
factors for child maltreatment in immigrant and refugee populations from
an ecosystemic analytic framework? and
3) What are the future research recommendations?
METHODS
In order to answer each question, we followed 14 standardized steps
developed by the CCIRH5 and inspired by the Appraisal of Guidelines for
Research and Evaluation (AGREE) instrument, (6) both of which we used in
previously published systematic reviews. (1-3, 7-9) The AGREE is
recognized internationally for evidence-based guideline development. (5)
The steps we used are also in line with the checklist of the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses. (10)
We first identified the rationale for the review and the PICO
(Population, Intervention, Comparison, Outcome) (5) questions that guide
the review (see Key Questions 1 to 3 in the current article) in line
with the ecological conceptual framework. In the next steps (see Table
1), we designed the search strategy and criteria used to assess the
eligibility of existing reviews and papers, and identified data specific
to immigrant and refugee populations. The following definitions were
used to determine study eligibility based on sample immigration status:
1) an immigrant adult is a foreign-born adult who is settled in a host
country; 2) an immigrant child/adolescent is either a foreign-born child
who lives in the host country (first-generation immigrant) or a child
born in the host country to immigrant parents (second-generation
immigrant); 3) a refugee is a person (adult or child) who is foreign
born and lives in the host country under refugee claimant policy (we
included under the term "refugees" those who may be asylum
seekers or undocumented). Table 1 presents the results of the
bibliographic searches and inclusion criteria.
Several databases (PsycINFO, MEDLINE, ERIC, Social services
abstracts, Famili@) were consulted, from "the oldest date available
to July 2014". The search strategy was formulated on the basis of
the PsycINFO database and then adapted specifically for the structure of
each database with different combinations, using the following key words
(with relevant synonyms and truncations): "child maltreatment OR
child abuse OR child welfare OR child neglect OR emotional abuse OR
domestic violence OR physical abuse OR verbal abuse";
"prevention OR treatment OR intervention"; "immigrant OR
refugee OR racial and ethnic minority OR racial and ethnic groups";
"risk factors OR protective factors". The search was completed
by consulting websites as well as the reference lists of all relevant
articles for eligible studies that did not come up in the search
strategy. The key words "racial and ethnic minority, racial and
ethnic groups" and "prevention, treatment, intervention"
were included in the initial data search in order to ensure that the
literature search covered a large portion of the research on the topic,
but only data specific to immigrant and refugee populations were
selected from these papers.
The first selection was based on titles and abstracts and was
performed separately by two reviewers. A second selection process was
then performed, again separately, by both reviewers after they had read
the full texts. The disagreements around the inclusion and exclusion of
articles were discussed between the two reviewers and resolved by
consensus. Twenty-four articles met the eligibility criteria, 18 of
which focused on families who received child protection services (CPS);
the 6 others consisted of studies involving immigrant and refugee
families not benefiting from CPS. These six studies focused on
parents' perception of physical child abuse, stressors experienced
by families and self-reported current or past physically abusive child
discipline practices.
We used the AGREE instrument (6) in order to rate the quality of
evidence provided by the studies and to critically evaluate the rigour
of the methods (e.g., sample representativeness), implementation (e.g.,
method coherence), reliability of the outcome measures and results.
The eligible studies were then reviewed in order to integrate the
data and synthesize the evidence, as well as integrate the results into
the ecosystemic framework. The 24 studies (11-34) are presented in Table
2 (sample, outcomes measured, instruments and level of strength), along
with the score based on the AGREE rating. Given the significant
heterogeneity of studies in terms of sample, methods and outcome
measures, we decided to present the results by key question and based on
the ecosystemic model. The final steps of the review presented in the
discussion section consisted of identifying the main conclusions and the
main gaps in the existing literature, and formulating recommendations
for future research.
THE ECOSYSTEMIC ANALYTICAL FRAMEWORK
The ecosystemic theoretical analytical framework guides the
presentation of results, their interpretation and recommendations. This
model is based on developments from Garbarino, (35) Belsky (36) and
Cicchetti (e.g., Cicchetti & Lynch), (37) who have applied
Bronfenbrenner's ecological model (38, 39) to child maltreatment.
Variables at different levels of analysis are addressed in a balance of
risk and protective factors in which, most importantly, their
interactions may increase the probability of maltreatment occurring in a
given immigrant family. The ecosystemic theoretical framework is applied
to child maltreatment in the particular context of immigration. The
following definitions for each system were used: 1) the ontosystem
refers to the ontogenetic developmental aspects of the child (36, 40)
that can be related to the pre-migratory history (e.g., exposure to
trauma, undernutrition) the child brings with him/her to the host
country; 2) the microsystem refers to the environment in direct contact
with the child, including parents' history/characteristics,
parent-child relationship and parenting, cultural, ethnic or religious
beliefs and practices of origin, daycare and school; 3) the mesosystem
includes the interactions between two microsystems, the child being in
direct contact with elements from the mesosystem; 4) the exosystem
includes variables of the workplace, neighbourhood and communities, such
as social isolation or support, unemployment or access to economic
resources; 5) the macrosystem is composed of the host society's
dominant cultural beliefs and practices, which may or may not contradict
those of the immigrant or refugee parent practices; and 6) the
chronosystem, which refers to the passage of time. Those systems are
concentric, included in one another and characterized by complex and
reciprocal relations at different levels. The meso, macro and chrono
systems were excluded in the results of this review because none of the
eligible studies included risk or protective factors from these systems.
SUMMARY OF FINDINGS
Key question 1: Are immigrant or refugee children at higher risk of
child maltreatment?
Official data on rates of child maltreatment in the US and Canada
do not incorporate information on immigration status and thus constitute
unreliable sources of information on child maltreatment prevalence in
immigrant and refugee populations. At present, the most reliable source
of evidence comes from non-official data extracted from studies
conducted with non-representative samples of immigrant or refugee
families involved with Child Protection Services (CPS).
Studies of Immigrant Families Involved With Child Protection
Services (CPS)
A total of 18 studies that focused on immigrant families involved
with CPS met the eligibility criteria. Six of the 18 studies reported
that children of immigrant families were disproportionately represented
within the CPS. Two studies conducted in the Netherlands found that
immigrant children were over-represented within CPS as compared with the
general population. (11, 20) On the other hand, three studies in the US,
using data from the National Survey of Child and Adolescent Well-being,
showed that immigrant children (all nationalities confounded (16) and
Hispanic immigrant children (17, 18)) were underrepresented in CPS as
compared with their size in the US population. (16-18) Within the large
Asian group, one study conducted in Los Angeles found that Vietnamese,
Cambodians, Laotians, Pacific Islanders and Samoan immigrant families
were over-represented in CPS while Filipinos, Hmong and Korean were
under-represented. (21)
Three California-based studies have looked into factors that may be
related to reports of immigrant children made to CPS for alleged
maltreatment. They showed that Hispanic children whose mother or both
parents (22) were born outside the US and/or received benefits from
Medi-Cal assistance (California's state health insurance program)
(30) were significantly less likely to be reported to CPS for alleged
maltreatment or to receive followup, as compared with Hispanic children
whose mother was born in the US. (22, 29, 30)
Of the 18 studies, 11 explored associations between country of
origin and type of maltreatment (see Table 3 for details of these
studies' results). The results generally show that children of
immigrant families are most frequently reported for physical abuse (11,
15, 18, 20, 21, 26, 31, 32) and to a lesser extent for physical neglect,
(11, 14) emotional/educational neglect (11, 20) and sexual abuse16, (17,
26) or to experience emotional abuse. (20, 26) The authors explain that
the higher rates of emotional abuse may be due to different parental
practices and expectations regarding child rearing (16, 32) or to the
occurrence of intimate partner violence as reported by studies involving
families of Mexican (26) and Korean origin. (15)
Studies of Immigrant Children Not Involved With CPS Studies
conducted with immigrant families not involved with CPS generally focus
on parent-to-child discipline practices, namely the use of physical
punishment. Lau et al. report lower rates of parent-to-child minor
aggression but higher rates of parent-to-child severe aggression among
foreign-born Asian mothers in comparison with US-born parents. (23) In a
study conducted in Washington State, 50% of Cambodian and 56% of
Vietnamese immigrant parents of the sample (57% in a study by Segal
(33)) reported having used corporal punishment with their children. (34)
In a fourth study, Altschul & Lee reported that foreign-born
Hispanic mothers used significantly less corporal aggression toward
their five-year-old children as compared with native-born mothers, after
maternal psychosocial risk factors, child behaviour and
socio-demographic factors had been controlled for. (12) A Texas-based
study reported that Korean immigrant mothers did not favour physical
abuse of children but were in favour of physical discipline. (27)
Finally, a study conducted in Norway revealed that children of immigrant
parents were at higher risk of witnessing domestic violence, which is
considered as maltreatment (psychological or emotional abuse) in some
CPS. (13)
Key question 2: What are the specific risk and protective factors
for child maltreatment in immigrant and refugee populations within an
ecosystemic framework?
Ontosystemic Risk Factors for Child Maltreatment Some studies
examined immigrant children's developmental or personality
characteristics in relation to maltreatment, but none found behavioural
problems or disabilities among the majority of maltreated children. (14,
15, 31, 32) There were no differences in maltreatment as a function of
child gender in three studies, (14, 31, 32) but three others reported
that being a boy constituted a risk factor (18, 27, 34) and another
three reported that more girls from immigrant families were involved
with CPS. (16, 21, 22) Two studies reported that children born outside
the US and involved with CPS were more likely to be older than those
born in the US and involved with CPS. (17, 26) In the Johnson-Motoyama
et al. study, maltreated children who had one foreign-born and one
US-born parent were significantly older than children whose parents were
both US-born. (22)
Microsystemic Risk Factors for Child Maltreatment Most studies have
documented the characteristics of immigrant parents involved in CPS.
While the authors did not investigate the relation between these
characteristics and the likelihood for maltreatment to occur, we believe
that they can be considered as potential risk factors. Some studies
report that immigrant parents involved with CPS are older than those
born in the US. (16, 17, 22, 26) Most parents reported experiencing
difficulties because they did not speak the local language. (25, 27, 32,
33) In terms of family structure, the majority of immigrant children
involved with CPS lived in two-parent households (mostly with both
biological parents), in which the parents were either married or living
with a common-law partner. (14-18, 22, 31, 32)
Only six studies investigated the link between these
characteristics and the likelihood of maltreatment occurring. These
studies showed that immigrant families share several risk factors in
common with non-immigrant families. High family stress is the most
frequently reported risk factor for child maltreatment among immigrant
and non-immigrant families alike. (16-18, 22) Other microsystemic risk
factors found among immigrant families involved with CPS included living
in a step-parenthood family (11) or a single-parent family; (11, 20)
living in a family with a low to very low educational level; (11, 20)
belonging to large families; (20, 26) and witnessing or having witnessed
domestic violence against the caregiver. (16, 22)
Most importantly, studies reported risk factors that are specific
to immigrant parents, and these seem to stem from the challenges of
resettlement in the host country. The severity of the abuse was
inversely related to the length of residence in the host country: more
years living in the US was associated with less severe physical abuse.
(21, 31, 32, 34) This was explained by the acculturative stress
hypothesis, which stipulates that immigrant families may be at higher
risk during the first years of settlement because they face increased
stress for acculturation and because they are less familiar with the
laws, norms and values of the host society. (31) Park found a
significant association between high family conflict due to
acculturative stress and higher risk of child physical abuse. (27)
Studies have also reported the use of excessive physical discipline
(18, 22) and having beliefs and practices that approve of excessive
physical discipline as additional risk factors. (14-16, 22, 27, 31, 32)
The parents' history of maltreatment as a child was positively
associated with an increased likelihood of physical punishment being
used with their own children. (34) However, 38% of mothers who did not
report a history of maltreatment as a child did use physical punishment
with their own children. (34)
With regard to refugee parents specifically, two studies reported
parents' experiences in the country of origin, namely trauma and
emotional difficulties, as potential risk factors for physical abuse
(20) and neglect. (21)
Exosystemic Risk Factors for Child Maltreatment
The parents' immigration status, namely refugee or
undocumented status, emerges as a consistent risk factor for child
maltreatment, (11, 19, 20) probably because of the resultant high levels
of stress and the fear of being separated from the children and family.
(16, 22) On the other hand, Dettlaff and colleagues highlight that
having an undocumented status can be a deterrent for parents and reduce
the risk of abuse, given the possible consequences, including
deportation and hence the separation of family members. (16, 17)
Nine studies report financial hardships faced by immigrant families
where child maltreatment has occurred. In three studies conducted by
Dettlaff and colleagues, more than 70% of parents had a yearly family
revenue lower than $20,000, which is similar to non-immigrant families
involved with CPS (60%). (16-18) Significantly more immigrant families
involved with CPS had no access to public assistance (63.9% vs 31.2%) or
no sources of income (30% of parents in Rhee et al. (31)). The
association between revenue and child maltreatment was statistically
significant in only one study. (17) In an Alaska-based study, receiving
public aid was significantly related to child maltreatment among
non-Alaskan natives. (28)
Financial hardships can be related to unemployment: (19, 25) three
other studies reported very high unemployment rates among immigrant
parents (reported percentage of unemployed parents varied from 48%, (31)
64% (14) and 91% for mothers and 86% for fathers (24)). Immigrant
families may also experience difficulties related to work conditions,
such as professional deskilling or poor work conditions. (25)
Finally, six studies reported that immigrant families involved with
CPS had low to no social support, (25, 31) but the link between social
isolation and increased risk of maltreatment was not significant.
(16-18, 22)
Protective Factors Specific to Immigrant or Refugee Families
Very few studies investigated protective factors for child
maltreatment among immigrant or refugee families. Two studies found that
having a foreign-born mother was related to a lower likelihood of child
maltreatment. (12, 30) Additional protective factors found to be
associated with lower risk of maltreatment were lower average alcohol
consumption among foreign-born mothers, (12, 24) higher level of
education (31) and living in a two parent household. (16, 22) The
mechanism by which this last factor may act is through lower levels of
stress and less financial hardships. (16, 22) Finally, living in a
neighbourhood with higher immigrant density and ethnic diversity was
found to be protective against child maltreatment, which may be due to
the development of social support networks. (17) This was protective for
Cambodians families but not for Vietnamese families in a study conducted
in Washington state. (34)
DISCUSSION
This paper reviewed and rated evidence on the prevalence and
risk/protective factors for child maltreatment in immigrant and refugee
families. There is low-quality evidence on the prevalence of child
maltreatment in immigrant and refugee families, and results are too
contradictory to be conclusive. There is thus currently no evidence that
immigrant and refugee children are at higher risk of maltreatment. They
do, however, seem to be over-represented for substantiated cases of
physical abuse within CPS. This may indeed be related to harsher
discipline practices among some immigrant or refugee families. However,
it can also be explained by numerous correlated factors, such as poverty
and related social risks, biases of professionals involved in
decision-making and the lack of cultural competence and appropriate
resources. (41)
This review shows the dearth of evidence on risk and protective
factors for child maltreatment among immigrant and refugee families. The
available evidence is mixed, and study designs vary considerably, which
precludes any possibility for a meta-analysis. The 24 studies are very
heterogeneous in terms of methods, objectives and outcomes measured.
Some are conducted with samples of families involved with CPS, whereas
others survey the general population. Sample sizes vary considerably,
and most studies are exploratory or descriptive. Data collection methods
include case file analyses, self-report questionnaires or qualitative
interviews with parents, children or social workers. Several studies
relied on instruments developed by the authors with little information
on the sources and validation of these instruments, which makes it
difficult to rate the reliability of the evidence.
The current lack of a conceptual model is a considerable barrier to
an efficient integration of research findings for immigrant and refugee
families. It remains unclear whether the reported differences in rates
and risk of maltreatment are due to migratory factors (e.g., recent
settlement, economic challenges, refugee status), social factors (e.g.,
state-specific laws or practices that may influence reporting and
retention of cases), cultural factors (e.g., values and norms about
child discipline) or to a dynamic interaction between the three. We
attempt to illustrate this dynamic interaction within a conceptual
ecosystemic framework. Figure 1 shows our predictive model, which
incorporates evidence summarized in this review on child maltreatment in
immigrant and refugee families. The model provided highlights the
potential impact that various factors have on child maltreatment among
immigrant and refugee families. While certain variables are specific to
immigrant and refugee families, such as immigration status,
pre-migration trauma and family disruptions due to acculturative stress,
other risks factors are not unique to these populations. This highlights
the importance of undertaking complete and comprehensive assessments in
order to grasp the specific experiences, difficulties and needs of each
family.
[FIGURE 1 OMITTED]
Immigration status
The immigration status seems to be the strongest risk factor for
child maltreatment among immigrant and refugee families. (19, 20)
Refugee children and families, refugee claimants, asylum seekers,
undocumented immigrants and unaccompanied minors may constitute a
high-risk group, as they live with ongoing fear of discovery or
deportation (42) but also because status may co-vary with other risk
factors, such as higher likelihood of having survived trauma, higher
risk of poverty, social isolation, forced unemployment, lack of
information about host country laws, poor access to interpretation
services, poor access to health and social services, lack of
opportunities to develop trust relationships in a relatively safe
environment, (42) as well as poor mental health consequences. (43)
Several studies and reports confirm that asylum and refugee status
strongly determine income, employment opportunities and access to
support services. (44) In immigrant and refugee families, financial
hardship and social isolation are often the most important challenges
during the first years of settlement. To support the family, mothers may
have to enter the workforce, in low-wage jobs, increasing the pressure
of multiple responsibilities for them and requiring the fathers to
accept additional responsibilities for child care and housework, which
they may be less familiar with. (45) This may increase family stress,
particularly when parents have to struggle with unemployment or
employment that does not correspond to their educational levels or
diplomas. Studies conducted among ethnic minority families indicate that
employment of wives and unemployment of husbands is significantly
associated with an increase in family conflict and intimate partner
violence. (46)
The impact of uncertain immigration status and/or financial
hardship and social isolation on the mental health of parents tends to
be compounded with settlement stressors and discrimination. These
factors may all contribute to the emergence of abusive parental
behaviours by increasing the level of family and parental stress. (21,
23, 47) Recently settled immigrant or refugee parents may lack the
resources to help their children negotiate safely through educational
systems, street crime, racism and intolerance. (33, 48) Okamura et al.
argue that the anger and powerlessness caused by these experiences can
be expressed within the family in the form of harsher or more violent
disciplinary practices with children. (49) This is often done with the
aim of protecting children from the perceived dangers of the host
society. Perceived dangers may include, but are not limited to,
discrimination, structural violence, and the influence of gangs and drug
use. (33, 50)
Stress and trauma
The challenges that accompany migration and resettlement, including
acculturation and adaptation, create their share of specific
family-level vulnerability factors. (17) Fear of the unknown, stress,
loss of previously established support systems, (25, 51) social
isolation, (21, 25) decrease in socio-economic status (52) and
uncertainty about the future are often experienced by immigrant families
and may put high pressure on the parents. Recently settled immigrants
and refugees experience substantially more stressful life events and
trauma than native families and longer settled immigrant families. (20,
48) This may explain why high family stress has been found to be a
prevalent risk factor among immigrant families. (17)
The risk of child maltreatment among refugees may also be related
to parental re-traumatization during the migration journey and during
resettlement in the host country. (20, 53) Research suggests that peri-
and post-migratory experiences can have a greater impact on immigrant
well-being than pre-migratory stressors. (54) These re-traumatizing
stressors include the prolonged status claim procedures, the uncertainty
about the refugee status, (55) inconvenient housing, discrimination and
unemployment during the waiting time for status-related court decisions.
(56)
Acculturation-related family disruptions
Immigrant and refugee families experience major disruptions in
family life during their first months or years of settlement. Such
disruptions may create pressures that destabilize established nuclear
and extended family relationships and hierarchies. This can influence
long-established gender and parent-child roles. (33) Children learn the
host country language and acculturate at a faster speed than their
parents. For this reason, they are often given the role of interpreting
for family members and negotiating with social structures, thus
undermining the natural family hierarchy and roles of parents. (57) This
new role not only threatens the parents' position as the
"knowledgeable elder" (33) but also creates situations in
which children are made aware of information and issues that, because of
their sensitive nature, are meant to remain within the realm of the
adults. Furthermore, the acculturation gap between children and their
parents may lead to parents losing control over their children, which
may put some parents at increased risk of using more rigid discipline
strategies. (17)
CONCLUSION
Key question 3: What are the future research recommendations?
We recommend that future research incorporate elements from our
proposed model, examine the model's applicability, improve it, as
well as provide a basis for risk assessment and intervention planning.
One way to improve the model is by incorporating variables from the
exosystem and macrosystem levels, which were excluded in the reviewed
studies. For instance, several factors that put immigrant and refugee
families at higher risk of child maltreatment are located in the larger
legislative, social and economic dynamics of phenomena such as
globalization and migration. (17) Public policies and laws can limit
parents' access to economic and social benefits. (25) Public
policies directly affect immigrant families' abilities to function.
(16, 17) Many Western societies, such as Canada and the US, have
developed policies that resulted in reduced funding of medical, social
and community services available to vulnerable immigrant families. (17)
We found no studies that assessed the impact of such factors on risk of
maltreatment among immigrant or refugee families, although some authors
make assumptions about the impact of the parents' living conditions
(difficulties in finding a job and other factors listed above) on the
risk of child maltreatment.
To be able to apply the proposed model, researchers must assess
parents' immigration status and birth place, (22) and include
information about pre-migration conditions, the immigration
journey's history and the challenges of settlement in a new
country, as well as assess possible re-traumatization. (20) Length of
stay in the host country should not be used as a proxy for
acculturation. In addition, studies on risk factors would benefit from
controlling for the possible impact of co-variables with immigration or
refugee conditions, such as deskilling, low socio-economic status and
social isolation. Our model also incorporates "cultural"
variables. This is particularly relevant in immigrant and refugee
families because they may be less acculturated than longer settled
ethnic minority groups. Including cultural variables also allows us to
examine how heritage cultural practices and modes of coping may
constitute significant protective factors and sources of empowerment, or
conversely may put children at further risk of abuse.
Child maltreatment is a result of a dynamic interaction between
risk and protective factors. Studies have generally examined risk
factors with little attention to protective factors and the interaction
between the two. Dettlaff and colleagues remind us that the strengths
and protective factors of immigrant families are too often overlooked,
which may bias study results. (16-18) Immigrant families strive for a
better life and better conditions for their children. The motivation and
hope they carry can constitute sources of resilience for the
difficulties they may face during the migration and acculturation
processes. (16-18, 22, 25) Researchers may want to combine quantitative
data collection with qualitative methods that give voice to the usually
unheard populations, as well as provide better information on the
complexity of the power relationships between immigrant families and the
diverse institutions involved in child maltreatment interventions.
Finally, the ecosystemic model can be used to guide the adaptation
of intervention programs to the specific needs and characteristics of
vulnerable immigrant and refugee populations at risk of child
maltreatment. We had initially included in our review search terms on
intervention programs, with only two resulting studies. More evaluative
studies are needed on the efficiency of intervention programs for
immigrant and refugee families at risk or where child maltreatment has
occurred.
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Annie LeBrun, BSc, [1] Ghayda Hassan, PhD, [1] Mylene Boivin, PhD,1
Sarah-Louise Fraser, PhD, [2] Sarah Dufour, PhD, [2] Chantal Lavergne,
PhD3
Author Affiliations
[1.] Department of Psychology, University of Quebec at Montreal,
Montreal (Quebec)
[2.] Department of Psychoeducation, University of Montreal,
Montreal (Quebec)
[3.] Centre de recherche Jeunes en difficulte du Centre integre
universitaire de sante et de services sociaux du
Centre-Sud-de-l'Ile-de-Montreal, Montreal (Quebec)
Correspondence: Annie LeBrun, Department of Psychology, University
of Quebec at Montreal, C.P. 8888 succursale Centre-ville, Montreal, QC
H3C 3P8, E-mail: lebrun. annie.2@courrier.uqam.ca
Acknowledgements: This work was supported by funding from the Fonds
de recherche du Quebec--Societe et Culture (FRQSC), CSSS de la Montagne
- Migration et ethnicite dans les interventions en sante et en services
sociaux (METISS), Groupe de recherche et d'action sur la
victimisation des enfants (GRAVE) and Centre jeunesse de
Montreal-Institut universitaire (CJM-IU). The authors also thank
Marie-Eve Clement and Jacques Moreau for their review and comments on
this paper.
Conflict of Interest: None to declare.
Table 1. Five-step process for articles search and selection
Number of
studies from
Search search strategy
Literature search steps strategy results
Identification 1) Developing * Key words # of total
the (with relevant records
bibliographic synonyms and found: 624
search truncations)
protocols
* Search
databases:
PsyclNFO,
MEDLINE, ERIC,
Famili@, Social
services
abstracts
* Search
completion:
websites,
reference lists
of all relevant
articles.
Screening 2) Searching Eligibility # of eligible
and identifying criteria: records: 495
studies that
meet * Qualitative
eligibility or quantitative
criteria based methodologies;
on the search
protocols * Full-length
articles
published in a
peer-reviewed
journal;
* Written in
English or
French;
* Describe,
assess or
review the
prevalence,
risk and
protection
factors;
* Immigrant or
refugee
populations.
Rating 3) Selection of The first # of eligible
eligibility relevant selection was records: 495
studies by two based on titles
reviewers and abstracts
and was
performed
separately by
two reviewers.
A second # of reviewed
selection records: 49
process was
then performed
after the full
texts had been
read, again
separately by
both reviewers.
The
disagreements
around the
inclusion and
exclusion of
articles were
discussed
between the two
reviewers and
resolved by
consensus.
Included 4) Organizing # of included
studies the data studies: 24
5) Summarizing,
synthesizing
and reporting
the results
Table 2. Summary table of studies of risk and protective factors
for child maltreatment among immigrant and refugee families
Authors Sample
Alink, Data from the second
Euser, van Netherlands Prevalence
Ijzendoorn, &
Bakermans- Study of Maltreatment of
Kranenburg, Youth, 2010:
2013 (11)
--1l27 professionals
--12,127 families; cases
substantiated in 2010 by Dutch
CPS
--1759 high school students
(Dutch: 88%; Moroccan: 4%;
Turkish: 3%; Surinamese: 1%;
Antillean: 1%; Other
ethnicity: 3%)
Altschul & Lee, Participants from the Fragile
2011 (12) Families and Child Wellbeing
Study (FFCWS): 328 foreign-
born and 517 US-born Hispanic
mothers
B0 Vatnar & 157 interviews ran with
Bj0rkly, 2010 intimate partner violence
(13) (IPV) help-seeking women
recruited from family
counselling, police and
shelters in Norway
Chang, Rhee & 243 Cambodian refugees' case
Megan Berthold, files of child maltreatment
2008 (14) treated by the Los Angeles
County Department of Children
and Family Services (LAC-
DCFS)
Chang, Rhee & 170 active immigrant Koreans
Weaver, 2006 reported for maltreatment and
(15) case files treated by the
Asian Pacific Unit (APU) of
the LAC-DCFS
Dettlaff & Data from the National Survey
Earner, 2012 of Child and Adolescent
(16) Well-Being (NSCAW):
--3717 children (ages birth to
14) living with a biological
parent: 3366 US-born parent,
Dettlaff, Data from the National Survey
Earner & of Child and Adolescent
Philipps, 2009 Well-Being (1999-2000)
(17)
--636 Hispanic/Latino children
(ages birth to 14) living with
a biological parent: 406
US-born parent, 230 immigrant
parent
Dettlaff & Data from the National Survey
Johnson, 2011 of Child and Adolescent
(18) Well-Being (1999-2001):
--947 Hispanic/Latino children
(ages birth to 14): 891
US-born children and 56
immigrant children)
Euser, Alink, Data from the second
Pannebakker, Netherlands Prevalence Study
Vogels, of Maltreatment of Youth
Bakermans- (NPM-2010):
Kranenburg, &
Van Ijzendoorn, --1127 professionals
2013 (19)
--22,661 substantiated cases
in 2010 by Dutch Child
Protective Services
--1920 high school students
(Dutch: 87%; Moroccan: 4%;
Turkish: 3%; Surinamese: 1%;
Antillean: 1%; Other
ethnicity: 3%)
Euser, van Data from the NPM-2005
Ijzendoorn,
Prinzie, and --1121 professionals
Bakermans-
Kranenburg, --795 children: 546 native
2011 (20) Dutch, 163 from traditional
immigrant families, 113 from
non- traditional immigrant
families
--Sample of the general
population: 3089 families
(91.6% Native Dutch, 4.6%
traditional immigrant and 3.8%
non-traditional immigrant)
Ima & Hohm, 158 Asian or Pacific Islander
1991 (21) cases of child maltreatment
treated by the Union of Pan
Asian Communities (UPAC) in
San Diego, California
Johnson- Data from the second National
Motoyama, Survey of Child and Adolescent
Dettlaff, & Well-Being (2008-2009)
Finno, 2012
(22) --713 Hispanic children from
US-born parents (470), mixed
nativity (90), immigrant
parents (153)
Lau, Takeuchi & 1293 interviews ran with Asian
Alegria, 2006 American parents for the
(23) National Latino and Asian
American Study survey
Lindell & 113 children reported to
Svedin, 2004 police and CPS for physical
(24) abuse in Sweden (3 groups: all
children, children of
immigrant parents and children
who had been injured from the
abuse)
Maiter, Stalker 20 South-Asian immigrant
& Alaggia, 2009 parents involved with CPS and
(25) living in Canada
Osterling & 2152 child welfare data (CWS/
Han, 2011 (26) CMS) merged with eligibility
data (CaIWIN)
Park, 2001 (27) 144 Korean immigrant mothers
Parrish, Young, All Alaska PRAMS respondents
Perham-Hester & for birth years 1997-1999
Gessner, 2011 (29,432: 3441 with CPS records
(28) through 1997-2004 and 25,991
without)
Putnam- Same as Putnam-Horstein &
Horstein, Needell, 2011
Needell, King &
Johnson-
Motoyama, 2013
(29)
Putnam-Horstein Entire cohort of children born
& Needell, 2011 in California in 2002 (531,035
(30) children) and CPS records for
those children referred for
maltreatment before the age of
5 years old
Rhee, Chang, 124 Vietnamese refugees' case
Berthold & Mar, files treated by the APU of
2012 (31) the LAC-DCFS
Rhee, Chang, 221 active Chinese case files
Weaver & Wong, treated by the APU of the LAC-
2008 (32) DCFS
Segal, 2000 --28 Vietnamese refugee
(33) parents who had 8--to
18-year-old children living at
home
--28 of those children (1
child by interviewed parent)
Tajima and --Data from the 2002
Harachi, 2010 interviews in the Cross-
(34) Cultural Families project in
Washington State
--Vietnamese and Cambodian
first-generation immigrant
parents
Authors Outcomes measured
Alink, --Professionals: immigrant
Euser, van status, family composition
Ijzendoorn, & (number of children, single
Bakermans- parenthood, stepfamilies),
Kranenburg, educational level (parents'
2013 (11) highest education)
--CPS cases: type of
maltreatment, ethnicity,
number of children, single
parenthood, stepfamilies
--Students' self-report: type
of maltreatment, socio-
demographic characteristics of
themselves and their family
Altschul & Lee, --Maternal use of physical
2011 (12) aggression
--Indicators of acculturation:
nativity, years of residency
in the US, religious
attendance, endorsement of
traditional gender norms
--Maternal Psychosocial Risk
Factors: parenting stress,
major depression, heavy
alcohol use, intimate partner
aggression or violence, child
behaviour factors, socio-
economic and demographic
controls (household income,
education level, relationship
status, mother's age at time
of child's birth, child's
gender)
B0 Vatnar & --IPV categories, severity,
Bj0rkly, 2010 frequency, duration,
(13) regularity, and predictability
--Guilt and shame
--Partner's ethnicity
--Children's exposure
Chang, Rhee & --Victims' characteristics
Megan Berthold, (gender, age, living
2008 (14) arrangement, language
preference, behaviour
problems, disabilities)
--Type of abuse, severity and
chronicity
--Perpetrators'
characteristics (age, gender,
marital status, relationship
with the victim, education,
length of residence, mental
illness, substance abuse)
--Referral source, emergency
response status, disposition
of the case, placement
decision
Chang, Rhee & --Same as Chang et al., 2008
Weaver, 2006 in addition to circumstance of
(15) abuse (domestic violence,
divorce, excessive discipline)
Dettlaff & --Primary caregiver nativity
Earner, 2012
(16) --Child and caregiver
socio-demographic
characteristics
--Family and household
characteristics: household
yearly income, family
composition, caregiver
instability, language use
within the home.
--Alleged and substantiated
maltreatment
--Parent and family risk
factors: alcohol abuse, drug
abuse, mental or emotional
problems, physical,
intellectual or cognitive
impairments, poor parenting
skills, domestic violence,
excessive discipline,
caregiver history of
maltreatment, arrests, low
social support, high family
stress, difficulty meeting
basic needs
Dettlaff, Same as above (Dettlaff &
Earner & Earner, 2012) in addition to:
Philipps, 2009
(17) --Neighbourhood and community
environment characteristics:
assaults, delinquent or drug
gangs, drug use or dealing,
unsupervised children, safety
of neighbourhood, involvement
of parents, neighbourhood as a
good place to live.
Dettlaff & Same as Dettlaff & Earner,
Johnson, 2011 2012
(18)
Euser, Alink, --Risk factors in professional
Pannebakker, study: highest education of
Vogels, parents, parental
Bakermans- unemployment, single
Kranenburg, & parenthood, large family size,
Van Ijzendoorn, stepfamilies, child's age and
2013 (19) gender
--CPS cases: same risk
factors, except educational
background and parental
unemployment
--Students self-report:
socio-economic status,
student's education, single
parenthood, family size,
immigrant status, student's
age and gender
Euser, van --Immigrant status, child
Ijzendoorn, maltreatment risk, type of
Prinzie, and maltreatment, education level,
Bakermans- family composition (single
Kranenburg, parenthood and family size)
2011 (20)
Ima & Hohm, --Victims' characteristics
1991 (21) (gender, age, ethnicity), type
of maltreatment, perpetrator
characteristics (not
specified)
Johnson- --Same as Dettlaff & Earner,
Motoyama, 2012 in addition to
Dettlaff, &
Finno, 2012 --Case characteristics,
(22) caseworkers assessments, and
caseworker characteristics
Lau, Takeuchi & --Socio-demographic and socio-
Alegria, 2006 economic indicators
(23)
--Ethnicity and nativity
--Contextual stress
Lindell & --Age
Svedin, 2004
(24) --Gender
--Ethnicity
--Injury
--All CPS interventions and
contacts occurring prior to
and at the time of the abuse
incident
--Risk factors: age, gender,
ethnic background, parental
substance abuse, parental
mental illness, prior reports,
prior social interventions and
injury from the abuse
Maiter, Stalker --Stressors in immigrant
& Alaggia, 2009 parents' life. 15 themes in
(25) interview concerning migration
experience, acculturative
stress, family life and CPS
involvement
Osterling & --Demographic characteristics
Han, 2011 (26)
--Immigrant characteristics
(citizenship of parent and
child)
--Case characteristics (type
of maltreatment, type and
number of placements, previous
referrals, length of time in
CPS)
--Reunification outcomes
Park, 2001 (27) --Attitudes toward child
physical abuse, conflict
tactics, beliefs, and
perceptions
--Ecological variables at
micro, meso, exo and macro
levels
Parrish, Young, --24 factors: 6 from birth
Perham-Hester & records, 16 from PRAMS, 2 from
Gessner, 2011 both (demographics, maternal
(28) physical/sexual abuse,
financial concerns, substance
abuse, pregnancy intention,
factors related to bonding or
family cohesiveness)
Putnam- --Child's race and ethnicity,
Horstein, referral for maltreatment,
Needell, King & substantiated maltreatment,
Johnson- out-of-home foster care
Motoyama, 2013 placement
(29)
--Only for Latino children:
maternal nativity status
(US-born or foreign-born)
--Covariates: gender, birth
weight, prenatal care, birth
abnormality, maternal age and
education, paternity, birth
order, health insurance
Putnam-Horstein --Child's gender; birth
& Needell, 2011 weight; prenatal care; birth
(30) abnormality; maternal birth
place; maternal race/
ethnicity, age and education;
abortion history; paternity;
number of children born; birth
payment method
Rhee, Chang, --Same as Chang, Rhee & Megan
Berthold & Mar, Berthold, 2008
2012 (31)
Rhee, Chang, --Victim's characteristics:
Weaver & Wong, gender, age, language
2008 (32) preference, behavioural
problems
--Perpetrator characteristics:
age, gender, marital status,
relationship to the victim,
language preference,
education, occupation, length
of residence in the US, living
arrangement
--Family characteristics:
special circumstances under
which the abuse occurred,
presence of family problems
--Referral source, emergency
response status, disposition
of the case, placement
decisions
Segal, 2000 --Demographic variables (age,
(33) marital status, education
level, health, occupation,
family income, number of
children, length of residency
in the US, occupation in
Vietnam)
--Interview with parents:
subjects related to
resettlement, acculturation,
support systems, child rearing
in the US, services
utilization
--Interview with children:
subjects related to school,
leisure- time activities,
friendship with American
children, relationship with
siblings, perceptions of
discipline used by their
parents
Tajima and --Demographic variables
Harachi, 2010
(34) --Parenting beliefs
--Physical discipline
practices
--Breaking the
intergenerational cycle of
physical discipline
--Acculturation
--Personal support
--Neighborhood support
--Depression
--Child behaviour problems
--Household structure
--Education
Level of
Authors Instruments strength *
Alink, --Professionals: standardized 4
Euser, van registration form
Ijzendoorn, &
Bakermans- --Descriptive analyses of CPS
Kranenburg, cases
2013 (11)
--Students' self-report:
questionnaire based on the
Dating Violence Questionnaire
and Parent-Child Conflict
Tactics Scales
Altschul & Lee, --Parent-Child Conflict 3
2011 (12) Tactics Scale
--Parenting Stress Index Short
Form
--DSM-III-R
--Measure from the National
Institute on Alcohol Abuse and
Alcoholism (2005)
--Scale developed by authors
including items from Lloyd
(1996) and the Spouse
Observation Checklist and the
Conflict Tactics Scale
--Child Behavior Checklist
1%-5 years.
B0 Vatnar & --Structured Sociodemographic 3
Bj0rkly, 2010 Questionnaire
(13)
--Semi structured IPV
Questionnaire developed by
authors including items from
the Conflict Tactics Scales
--Immigration profile (from
Statistics Norway's survey
Level of Living, 1995)
Chang, Rhee & --Data extraction form 3
Megan Berthold, developed by the authors
2008 (14)
Chang, Rhee & --Data extraction form 3
Weaver, 2006 developed by the authors
(15)
Dettlaff & --NSCAW interviews 3
Earner, 2012
(16)
Dettlaff, --NSCAW interviews 3
Earner &
Philipps, 2009
(17)
Dettlaff & --NSCAW first-hand reports 3
Johnson, 2011 from children, caregivers and
(18) CPS caseworkers
--Interviews with primary
caregivers
Euser, Alink, --Professionals and CPS 4
Pannebakker, agencies: standardized
Vogels, registration form based on the
Bakermans- one from NIS studies and
Kranenburg, & NPM-2005
Van Ijzendoorn,
2013 (19) --Self-report: questionnaire
with selected questions from
the Dating Violence
Questionnaire and the
Parent-Child Conflict Tactics
Scales
Euser, van --Standardized registration 3
Ijzendoorn, form developed by the authors
Prinzie, and
Bakermans-
Kranenburg,
2011 (20)
Ima & Hohm, --Interviews with 1
1991 (21) case workers
--Case files analysis
--Field observations
Johnson- --Limited Maltreatment 3
Motoyama, Classification System (Barnett
Dettlaff, & et al., 1993) to assess type
Finno, 2012 of maltreatment
(22)
Lau, Takeuchi & --Interviews: socio- 3
Alegria, 2006 demographic variables,
(23) perceived social standing
(Adler et al., 2000); language
acculturation and ethnic
identity (Cultural Identity
Scales for Latino Adolescents,
Felix-Ortiz et al., 1994);
family cultural conflict
(Family Cultural Stress
subscale of the Hispanic
Stress Inventory, Cervantes et
al., 1991); family closeness
(Olson et al., 1983);
perceived discrimination
(Detroit Area Study, Williams
et al., 1997); parent-to-
child aggression (National
Comorbidity Survey adaptation
of the Parent-Child CTS,
Straus et al., 1998); social
desirability (Marlow-Crowne
Social Desirability Scale,
Strahan & Gerbasi, 1972)
Lindell & --Case files from CPS 3
Svedin, 2004
(24)
--Case files from CPS 3
Maiter, Stalker --Qualitative Interview guide 3
& Alaggia, 2009 developed by the authors
(25)
Osterling & --Administrative and Child 3
Han, 2011 (26) welfare Database
--Data collection sheet
developed by authors
Park, 2001 (27) --Translated questionnaire 3
developed by author with
background questions, measures
of acculturation conflicts,
and of mothers' attitudes
toward child physical abuse
Parrish, Young, --Data collection sheet 4
Perham-Hester & developed by the authors
Gessner, 2011
(28)
Putnam- --Same as Putnam-Horstein & 4
Horstein, Needell, 2011
Needell, King &
Johnson-
Motoyama, 2013
(29)
Putnam-Horstein --Data collection sheet 4
& Needell, 2011 developed by the authors
(30)
Rhee, Chang, --Data collection sheet 3
Berthold & Mar, developed by authors
2012 (31)
Rhee, Chang, --Data collection sheet 3
Weaver & Wong, developed by authors
2008 (32)
Segal, 2000 --Demographic questionnaire 3
(33)
--Semi-structured interview
with parents
--Semi-structured interview
with children
--Child Abuse Potential
Inventory
--Conflict Tactics Scale
--Basic English Skills Test
(BEST)
Tajima and --Interviews with items from 3
Harachi, 2010 Child Development Survey of
(34) the Panel Study on Income
Dynamics (Hofferth et al.,
1998)
--Selected items from the
Conflict Tactics Scale
--Selected items from the 1985
National Family Violence
Survey
--Suinn-Lew Asian
Self-Identity Acculturation
Scale and a continuous
acculturation scale developed
by authors
--Five items from the Social
Support Behaviors Scale
--Items created for the CCF
study
--15 items from the Hopkins
Symptom checklist
--Scale developed by authors
from scales measuring child
behaviour problems
* 4 = No important limitations; 3 = Limitations in terms of
sample representativeness; 2 = Limitations in terms of
sample representativeness OR coherence of research design
and objectives; 1 = Major limitations leading to
inconclusive results.
Table 3. Type of maltreatment by family's ethnic
origin and/or immigration status
Authors Type of maltreatment in CPS files
Alink et al., --Traditional immigrant families *: over-
2013 (11) represented for physical and emotional/
educational neglect
--Non-traditional immigrant families
([dagger]): over-represented for physical
abuse
Chang et al., --Cambodian children were more likely to be
2008 (14) reported for neglect (41.2%) and less for
sexual abuse (4.9%) than other Asian Pacific
children.
Chang et al., --Korean children were more likely to be
2006 (15) reported for physical abuse (49.4%) and less
likely to be reported for neglect (20.6%) or
sexual abuse (1.8%) than other groups living
in the same region.
Dettlaff & Earner, --Sexual abuse (20.7%) was significantly more
2012 (16) reported (but not substantiated) for children
of immigrant parents.
--Emotional abuse (reported: 19.7% and
substantiated: 25.1%) was significantly more
reported and substantiated for children of
immigrant parents.
Dettlaff & Johnson, --Physical abuse (75.7%) was significantly
2011 (18) more substantiated for children of Latino
immigrant parents.
Dettlaff et al., --Sexual abuse (reported: 22.1% and
2009 (17) substantiated: 23.7%) was significantly more
reported and substantiated for children of
Latino immigrant parents.
Euser et al., --Traditional immigrant families *:
2011 (20) over/represented for physical abuse and
emotional/educational neglect.
--Non-traditional immigrant families1:
over-represented for physical and emotional
abuse.
Ima & Hohm, --Asians and Pacific Islanders were more
1991 (21) likely to be reported for physical abuse
(53%) and less likely to be reported for
neglect (36.1%), sexual (4.9%) or emotional
abuse (6%) as compared with the U.S
population.
Osterling & Han, --Children whose mothers were born in Mexico
2011 (26) had significantly more substantiated cases of
physical abuse (18.1%), sexual abuse (9.7%)
and emotional abuse (8.1%) but significantly
fewer cases of severe neglect (13.3%) than
non-immigrant children.
Rhee et al., --Vietnamese children were more likely to be
2012 (31) reported for physical abuse (51.6%) and less
so for incapacity or absence of caregiver
(3.3%).
Rhee et al., --Chinese children were more likely to be
2008 (32) reported for physical abuse (35.3%) and less
likely to be reported for neglect (22.3%) or
sexual abuse (4.9%) as compared with other
groups living in the same region.
* From countries with a long history of migration in the
Netherlands: Turkish, Moroccan, Surinamese and Antillean.
([dagger]) From other countries and often refugees: African
(except Morocco), Eastern European, Central Asian, South and
Central American.
