ABSTRACT UNACCOMPANIED REFUGEE MINORS AND THEIR STRATEGIES TO NAVIGATE A NEW WORLD: A GROUNDED THEORY By Justin Scott Lee A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2012 Chair: Pamela J. Kovacs, Ph.D. Associate Professor This study explored how unaccompanied refugee minors (URMs) define success. The population of URMs consists of individuals who, through forced migration from their country of origin, were resettled in the United States through the URM program. Little is known about the ways in which refugee adolescents view the resettlement process once they have left the URM program. Through a traditional grounded theory method, 15 interviews with former URMs were conducted with the aim of laying the groundwork for a theory that would explain how success is defined, the unique challenges URMs face, the mechanisms for overcoming challenges, and the role that culture plays in the resettlement process.

This thesis explores negotiations of belonging among unaccompanied young refugees in Sweden. The thesis further aims to shed light on methodological aspects of bringing out their voices. The analysis draws on postcolonial and poststructuralist approaches to belonging and relates belonging to the concepts of home, place, racialization and notions of “Swedishness”. The thesis analyses qualitative interviews with 17 young people, who arrived in Sweden as unaccompanied asylum-seeking minors and have been granted permanent residency. The interviews are complemented with walk-alongs and photography-based interviews. Paper 1 gives an overview and discussion of research on unaccompanied asylum-seeking minors. I argue that there is a lack of their voices in the research, and that their own agency and perspectives are not addressed due to a focus on vulnerability and emotional health (or lack thereof). Paper II, which is delimited to participants in a rural village, shows that they negotiate belonging and a sense of home related to places but that othering is constraining. In paper II and III I suggest that the participants’ belongings and position in Sweden can be understood as conditional due to othering and racialization. In paper III, I argue that expressing gratitude can be understood as a form of impression management and, thus be a strategy to negotiate their position in the interview setting as in the host country. I finally argue that in order to understand the participants’ negotiations of belonging attention has to be paid to their agency as well as the conditioning of belonging in discourses and in interactions on the local level.

In the last couple of years there has been an immense increase in the number of unaccompa­nied refuge minors seeking asylum in Sweden. These minors share one thing in common; they have all abandoned things they hold dear in pursuit of a better life. The majority of them are placed into residential care homes, accommodations where they are aided and cared for by personnel. Unfortunately, there is a lack of research regarding how these personnel experience their work. With help of the method grounded theory and interviews, I investigate their working situation and their role in these homes. All participants agree that their primary role and task are to establish a feeling of safety amongst the minors, however, organizational aspects can hinder this process. Organizational aspects are also key factors that have to be adequate in order for the personnel to increase their professional knowledge. By including the framework resilience therapy and comparing this to my result, I put my study in a bigger context, suggesting that if the minors are capable of feeling safe, they will also develop skills that increase their wellbeing throughout their lives.

Background: Unaccompanied refugee minors (URM) report increased levels of mental health problems, specifically symptoms of post-traumatic stress disorder (PTSD) are very common. They have often experienced multiple trauma events and additional stressors related to migration, acculturation and family separation. High-quality measurements of PTSD symptoms that are brief and easy to administer among URM are therefore needed. Aims: The aim of this study was to evaluate the psychometric properties of the Children’s Revised Impact of Events Scale (CRIES-8) when used in a population of URM. Method: Confirmatory factor analyses, internal consistency and test-retest agreement were analyzed using data from two previous studies; one Norwegian longitudinal study of URM mental health including 284 participants and 104 participants from a Swedish intervention study. Results: CRIES-8 in this population showed questionable levels of internal consistency and moderate test-retest agreement. The two-factor model of Intrusion and Avoidance was confirmed to have god model fit in this study, while the one-factor model of PTSD had poor model fit. Three items related to Avoidance (2,5 & 8) were found to have a large proportion of error in the one factor model. Conclusion: When CRIES-8 are used in studies of PTSD among URM the reliability and validity seems lower than previously found in other contexts. Especially the items related to avoidance seem potentially problematic in this context. It is recommended that researchers and clinicians are cautious when interpreting CRIES-8 scores when used with URM.

Abstrakt: Antalet ensamkommande barn som anländer till Sverige har ökat kraftigt de senaste åren. Detta gör att man vid mottagandet av dessa barn måste se till att deras behov efterlevs, även på lång sikt. Det ställs i synnerhet krav på de boenden där de flesta av barnen hamnar efter att de får permanent uppehållstillstånd. I denna studie efterfrågas hur personalen arbetar på dessa boenden, och vilka metoder som används. I studien har gruppintervjuer samt enkäter använts. Resultatet visar på att specifika metoder generellt anses som mycket användbara, men inte anses som något av det viktigaste i arbetet. Ospecifika metoder används betydligt mer, och bygger mycket på anpassning till olika situationer och klienter. Den viktigaste och mest användbara resursen i arbetet anses vara att ha en relation som bygger på förtroende och tillit, och att skapa trygghet. Synen på varför relationen är viktig är uppdelad, ofta mellan boendena, i praktiskt användbar och för den ensamkommande barnen emotionellt positiv. De som ser relationen som emotionellt positiv tenderar till att lägga större vikt vid relationsskapande. / The number of unaccompanied refugee minors arriving in Sweden has risen significantly in recent years. This calls for a reception in which their, (also long term) needs are covered. In particular, this accentuates the responsibility of the group-homes where most of these children and youth are placed after their asylum claims are accepted. In this study attention is focused on how the staff in these group-homes work, gaining information on current methods being used in the group homes, and exploring how effective and sufficient these methods are considered to be. The study involves a mixed-methods design, including both interviews and survey methods. The results show that specific group-home methods in general are perceived as very useful, but not the most important aspect in their work. Unspecific methods are used significantly more frequently, and are based in the ability to adapt to different situations and clients. The most important and useful resource in this work is considered to be having a relationship built on confidence and trust with the children, and to create a place of safety for the children. The perceptions of why the relationship is important are varied, often between the group-homes. Some emphasize practical areas, other emphasize emotional and developmental areas. Those who view the relationship as emotionally positive tend to further emphasize the importance of building relationships.

In recent years, Europe has witnessed a flow of refugees from war struck areas who seek asylum in various European countries, where Sweden is one of the recipient country. A large portion of these refugees comprise of unaccompanied refugee minors (URMs). Aim: The aim of the present study is to examine how unaccompanied refugee minors have the conditions in Malmo when it comes to individual health and lifestyle (tobacco, alcohol and drug use) and social environment (absence of family, living situation, school, social support and future prospects) as compared to the general population of the same age; and also, if these conditions could possibly put them at a risk to encounter or commit a crime. Method: The data is collected using quantitative survey questionnaires distributed to URMs (N=30). The data of the general population has been obtained through Region Skåne. Results: The findings indicate that in comparison to the general population, URMs report high level of ill-health, tobacco use, access to narcotics and low social support, which are termed as risk factors. The institute of school, however, is termed a protective factor for the URMs, where they score almost equivalent to the general population in terms of school satisfaction and better than them in terms of help and support from the teachers. The implication of the findings are discussed further in the paper.

Family reunification for unaccompanied refugee minors is one of the most debatable issues when it comes to deciding whether it should be viewed as a right or it can be justifiable for states to completely prevent it and rather provide it only as a privilege. The discussion in the legal sphere proved that the issue is still problematic in both international and European laws. In this thesis, I have analyzed this issue through assessing the three claims that were provided by the United Kingdom for its negative position on the case. Through the lens of the child’s best interests’ principle, the non-discrimination principle, and the global distributive justice theory, I argued for considering family reunification as a right rather than a privilege. Children should always be treated as children. It cannot be justifiable for states to completely prevent them from being reunited with their families for being refugees.

Individer som kommit till Sverige som ensamkommande barn möter olika svårigheter. I tidigare forskningsansatser har fokus lagts på ensamkommandes tidigare erfarenhet av våld och krig samt betydelsen av socialt stöd. Studiens syfte är att få ökad förståelse om stress och stresshantering bland ensamkommande samt ta reda på betydelsen av sociala relationer gällande stresshantering. Denna kvalitativa studie är byggd på tio semistrukturerade intervjuer med tio unga vuxna mäns subjektiva berättelser. De har sitt ursprung i Afghanistan och har kommit till Sverige som ensamkommande barn. Intervjumaterialet analyserades utifrån Bronfenbrenners utvecklingsteori och Lazarus stressteori med hjälp av tematisk analys. Resultatet visar att ensamkommande upplever stress på grund av a) krav från familjen, b) familjens situation i hemlandet, c) språklig interaktion med infödda svenskar, d) kunna hitta ett arbete och e) att inte känna igen den fysiska miljön. Gällande stresshantering visar resultatet att individens sociala nätverk, hjälp från de professionella kontakter och den egna personligheten var betydelsefull. Att kunna arbeta och utbilda sig var viktiga stresshanterings strategier för deltagarna. Vänner från hemlandet och interaktion på det egna modersmålet var källor till trygghet för deltagarna. / Individuals who have come to Sweden as unaccompanied refugee minors meet different difficulties. In previous research, the main focal points have been the unaccompanied minors' previous experiences of violence and war, and the importance of social support. The aims of this study were firstly to gain a greater understanding regarding stress and stress management among unaccompanied refugee minors, and secondly, to look at the importance of social relationships regarding stress management. This qualitative study is based upon ten semi-structured interviews. Ten young adults gave their subjective narrative. The interviewees had their roots in Afghanistan. They all came to Sweden as unaccompanied refugee minors. The interview was analyzed based on Bronfenbrenner´s Ecological systems theory and Lazarus stress theory, using thematic analysis. The results drawn were that unaccompanied refugee minors experience stress because of a) expressed and perceived demands from the family, b) for the family's situation in the home country, c) the oral interaction with ethnical Swedes, d) be able to find work, and e) not recognizing the physical environment. The result regarding stress management shows that social relations, help from professional contacts, and their own personality were of importance for the study participants. Furthermore, the results show that being able to work and to educate themselves were important stress management strategies. Friends from the homeland and the mother tongue were sources of comfort for the participants.

This thesis looks at how involved implementers of the Teaching Recovery Techniques-project in Uppsala, Sweden have experienced the project. Teaching Recovery Techniques is originally a group-based intervention created for use in disaster areas. This intervention has the aim to give self-help to unaccompanied refugee minors with post-traumatic stress symptoms in Uppsala and two neighbouring municipalities, by using non-psychiatric personnel to teach stress-mitigation. This is a pilot project as Teaching Recovery techniques have never been used in this type of setting before. To investigate the opinions of the involved personnel, qualitative interviews with roughly half of the group leader have been made. These have been analysed using manifest content analysis.     The thesis found that while many are happy with the project, it has required unexpectedly high workload as well as suffered from unclear responsibility delegations and lacking communication, primarily in the start of the project. However, due to strong motivation from involved implementers and adaptability from employers, these issues have been overcome to a great degree. Lesson for further TrT-projects targeting unaccompanied minors should put extra effort in planning and defining the roles of involved actors as well as include arenas for horizontal communication between group leaders. / Denna uppsats undersöker hur personal involverad i Teaching Recovery Techniques-projektet i Uppsala, Sverige har upplevt att arbete inom projektet.  Teaching Recovery Techniques är ursprungligen en grupp-baserad intervention ämnad att användas i katastrofzoner.  Syftet med Teaching Recovery Techniques är att ge hjälp till själv-hjälp till ensamkommande flyktingbarn med posttraumatisk stress symptom i Uppsala kommun samt två grannkommuner. Projektets mål är att använda icke-psykiatrisk personal för att lära ut stresshantering. Detta är ett pilotprojekt då metoden inte använts i denna kontext tidigare. För att undersöka personalens åsikter så har kvalitativa intervjuer utförts med hälften av gruppledarna. Dessa har sedan analyserats utifrån manifest innehållsanalys.      Denna uppsats visar att även om många är nöjda med projektet, så har det krävts mycket mer arbetstid än väntat samt att det har varit oklar ansvarsfördelning och kommunikation, framförallt i början av projektet.  Dock har stark motivation från personal och hög flexibilitet från arbetsgivare, motverkat dessa problem i de flesta fall. Lärdomar till framtida likande projekt för ensamkommande flyktingbarn är att ha ett ökat fokus på planeringsstadiet, samt att definiera roller och ansvar bättre från start. Det rekommenderas även att skapa forum för horisontell kommunikation mellan gruppledare.

Ensamkommande är en utsatt grupp där posttraumatiskt stressyndrom (PTSD) är vanligt förekommande. Den hälso- och sjukvård som ges är bristfällig och evidensbaserade interventioner för målgruppen på första linjen saknas. Studiens syfte var att belysa hur ensamkommande flyktingbarn i åldern 13-18 år, som screenat positivt för PTSD, upplever sitt deltagande i Teaching recovery techniques (TrT) grupperna. Material har inhämtats genom kvalitativa intervjuer, från sju grupper, totalt 22 ungdomar cirka tre månader efter avslutad intervention. Resultatet visar hur känslor, tankar och reaktioner normaliserades i gruppen. Den sociala gemenskapen och stödet från jämnåriga har framstått som en viktig komponent i ungdomarnas livssituation. Deltagarna har återfått kontrollen för att kunna strukturera upp sina känslor och reaktioner. Slutligen kände deltagarna att de med hjälp av de tekniker och verktyg som de lärt sig kunde klara av aktuella utmaningar och framtida kriser. Behovet av en traumafokuserad intervention som denna verkar finnas hos målgruppen. / Unaccompanied refugee minors (URM) is an exposed group in which post-traumatic stress disorder (PTSD) is common. The care provided is inadequate and there are few evidence-based interventions on the target group of URMs. The aim of this study was to examine URMs, aged 13-18, who screened positive for PTSD and their experiences of the Teaching Recovery Techniques-program. Qualitative interviews were conducted with 22 youth from seven groups, three months after the completion of the intervention’s final session. The results show that participants felt that sharing their stories helped them normalize their experiences. Feelings of fellowship and support have seemed as an important component of the youth's life. The program helped them feel more in control of their own body and reactions. Finally, the participants felt that, with the help of the techniques and tools they learned, they could cope with current challenges and future crises. Trauma-focused interventions like this appears be needed in this target group.