Home > Public Resources > Trauma Blog > 2016 - February > Trauma and Diversity: Addressing Trauma and Attachment in Latino Immigrant Youth and Their Families Trauma and Diversity: Addressing Trauma and Attachment in Latino Immigrant Youth and Their Families Ryan Matlow, PhD, and Marisol Romero, PsyD February 2, 2016 Though not a new concern, awareness and attention to the challenges faced by children and families immigrating to the United States from Latin America have surged in recent years. Clinicians and service providers throughout the country are confronted by the unique needs of families immigrating from Mexico, Central America, and South America as these families face the challenges of transitioning to life in the U.S. and establishing their homes here. Latino families who immigrate to the U.S. experience stress related to acculturation, discrimination, employment, legal status and potential deportation, language acquisition, and separation from family and community of origin (and this list is by no means exhaustive). Further complicating the transition, Latino immigrant families are at heightened risk for exposure to violence and trauma (Jaycox et al., 2002; Gudiño et al., 2011). This risk for trauma exposure runs across the spectrum of the immigration experience: families often chose to immigrate because they are fleeing violence, poverty, and trauma in their home country; they are at risk for trauma exposure during the course of travel and migration (especially for those individuals and families who are undocumented); and the neighborhoods in which they settle are often marked by disproportionate rates of poverty, violence, and scarcity of resources and security (Jaycox et al., 2002). The unique circumstances and challenges of Latino immigrant families, along with the heightened risk for particular forms of trauma exposure, engenders a need for clinician and service provider sensitivity to the cultural and historical factors affecting this population. In particular, interventions and services being delivered to Latino immigrants may need to be modified and adapted according to the needs and circumstances of these individuals and families in order to effectively address and mitigate the stressors affecting their well-being. In addition to the heightened risk for trauma exposure, Latino families immigrating to the U.S. often face the unique challenge of prolonged family separation during the course of immigration. Often due to economic and legal factors, many families immigrate to the United States in a step-wise fashion. Studies assessing rates of family separation due to immigration in Latino immigrant youth report estimates ranging from approximately 50-90 percent (Gudiño et al., 2011; Suarez-Orozco et al., 2002). One common immigration pattern is for a parent to come to the U.S. first to establish a home and an economic foundation while leaving children in the care of family members in the home country until arrangements can be made for the children to reunify with their parent. Alternatively, in situations where other family or community members are already established in the U.S., a child may immigrate first, staying with extended family until their primary parent or caregiver can make the attempt for immigration. Unfortunately, it is not uncommon for unanticipated barriers to arise during this transition process, prolonging the separation between parent and child. Separation periods can range from one or two months to over a decade. Therefore, separation can potentially span the majority of an individual’s childhood. Due to the chronic and traumatic stressors and the relationship disruptions occurring during periods of separation, the process of family reunification is often more difficult than anticipated, with unique challenges often resulting from the mismatch between the idealized and yearned-for reunification experience and the unexpected reality of the difficult transition and lingering emotions associated with the experience of separation. Consequently, the experience of immigration-related family separation is linked with elevations in depression, PTSD, and externalizing problems in children (Suarez Orozco et al., 2002). These symptoms can lead to heightened family stress and conflict that is compounded with the standard stress of the immigration experience as well as with the psychological distress that results from traumas experienced before, during, or after the journey to the U.S. It is with these challenges and this presentation that families often arrive at the doorsteps of clinicians and service providers. As psychologists providing mental health services in pediatric primary care and child mental health outpatient clinics in a public sector hospital serving a largely Latino immigrant community, we were confronted by the unique needs and challenges of this group. We recognized the need to develop a tailored intervention approach and sought a modality to address the clinically significant psychological distress in Latino immigrant families that were likely related to immigration stress, trauma exposure, and disrupted attachment relationships. Using Blaustein and Kinniburgh’s Attachment, Self-Regulation, and Competency training model (ARC; 2010) as a foundation, we developed a multi-family group therapy intervention specifically tailored to the needs and concerns of Latino immigrant families. ARC training provides a flexible therapy model that addresses the “three core domains of intervention for children and adolescents who have experienced trauma and their caregiving systems: attachment, self-regulation, and competency” (Blaustein & Kinniburgh, p. 35). ARC’s emphasis on attachment and caregiver-child relationships is particularly relevant for families experiencing distress related to separation. Our group intervention was provided to caregiver-child dyads and families who had experienced (previous or ongoing) family separation due to immigration and whose members had some history of trauma exposure. Group goals centered on building skills for regulating stress reactions; strengthening caregiver-child relationships; and processing distress related to immigration, family separation, and trauma exposure. We chose a group approach in an effort to restore the sense of community and group support that is often lost when families leave their home communities, and in consideration of the collectivistic nature of Latino cultures and the increased comfort and empowerment that often comes from sharing with others that have had similar experiences. That said, the exercises, modifications, and interventions used in our groups can be readily applied and utilized in individual, dyadic, and family therapy modalities. We provided multi-family groups in Spanish that consisted of approximately 4-7 dyads or families, lasting for 10-12 sessions (typically 1-1.5 hours each). We strategically structured each session according to session content and goals; session activities sometimes separated child and caregivers into different groups and other times activities were completed by families together. In many ways, our group intervention taught the core components of the ARC intervention (see Blaustein & Kinniburgh, 2010) from an immigration stress framework. For example, conversation, education, and practice of ARC attachment components were framed around the disruption of secure relationships and attunement, family routines and traditions, and caregiver affect management that often accompanies immigration and separation experiences. In addition, the essential development and practice of self-regulation skills (including affect identification, culturally-appropriate expression, and modulation) were focused on affect and emotions that are common for children who have immigrated to the U.S. and have experienced separation from caregivers. In order to develop group rapport and to begin to process immigration-related stress, early sessions focused on discussion and community-building around the immigration experience: group members had the opportunity to share about themselves, where they came from, their cultural identity, what they missed about their home country, their accomplishments, and their difficulties and challenges. This focus often led to lively conversations about food, local traditions and holidays, and common experiences, despite the fact that families came from diverse communities and countries. Drawing from ARC’s focus on attunement, we placed special emphasis on perspective-taking and communication skill practice. These practices were designed to address the challenges in identifying, understanding, and responding to children’s emotional experiences that are common for families that have experienced trauma and separation. We drew from Latino pop culture (e.g., telenovelas and music) to engage group members in practicing understanding both sides of a caregiver-child conflict. We taught and practiced reflective listening communication techniques. These exercises laid the foundation for processing and sharing each individual’s experience and perspective of their family’s process of immigration and separation. Though the format varied depending on group dynamics, families were engaged in processing and integrating their immigration separation experiences (as well as additional and ongoing traumatic experiences) through narrative development and structured communication practice. For families entering our clinics, a primary challenge we frequently observed was in an individual’s ability to address and empathize with their family members’ experiences, as the separation often resulted in a relationship rupture and exacerbated intrafamilial cultural differences. Therefore, the perspective-taking and communication skills practice was the crux of the intervention that allowed families to process and support one another in their distress related to immigration separation. This work connects to a processing of the traumas that were experienced before, during, or after immigration to the U.S. While the group had an explicit primary focus on relationship ruptures due to immigration separation, the core components of trauma intervention were addressed, and family traumatic experiences naturally emerged and were processed during the course of the groups. Therefore, in many cases, the intervention model was able to dually address separation issues and exposure to additional traumas. We saw many families make great strides in this area that corresponded with reductions in psychological distress, in family conflict, and improvements in empathic perspective-taking and communication. Finally, our groups ended with a celebration and a focus on the future. In this domain, we worked to highlight family resilience and to bolster the qualities that helped them endure a daunting immigration process. In an effort to help families set goals and to build optimism, we elicited conversation around individual and family hopes for the future (including discussions about hopes for their life in the U.S. and hopes for how they will stay connected to their countries and communities of origin). Following the group focus on attunement and relationship development, we engaged families in the practice and communication of gratitude for their accomplishments, for their individual and family-wide strengths and resilience, and for the ways in which family members have supported them in their journey. While our modified group intervention clearly does not address all needs of Latino immigrant families, we observed how this intervention can help to set distressed families on a path towards healing and recovery, particularly when they are in the midst of reunification and the crisis of transition. Healing and recovery from immigration-related separation as well as additional trauma were promoted through the core intervention components that included psychoeducation to normalize distress in relationships, skill-building to increase the capacity to manage distress, communication and processing of responses to the family experience. Considering the collectivistic nature of Latino cultures, the emphasis on strengthening and rebuilding of family connection and attunement was especially crucial for supporting recovery. Given the unique impact of immigration separation on relationships, skill-development, and communication, tailored interventions such as the current group therapy model are warranted. As expected, we experienced challenges along the way in this effort. Our challenges included inconsistent attendance for some families (given their limited financial, transportation, and caregiving resources), reactions to the sensitive content (some individual and follow-up sessions were needed), and the difficulty of addressing the diversity of separation experiences in a group format. Nonetheless, the successes were substantial and we continue to develop the intervention model and the format and context in which it is delivered. For example, current efforts are underway to provide education and training on this intervention model in local schools such that school-based mental health staff can implement similar interventions to make these services more accessible to Latino immigrant students and families. As the pattern of immigration to the U.S. from Latin America continues, it will be important for trauma-informed clinicians and service providers to strive to develop and disseminate treatment interventions that meet the unique challenges faced by immigrant families. About the Authors Ryan Matlow, PhD, is a licensed clinical psychologist on faculty in the Department of Psychiatry and Behavioral Sciences at Stanford University. He is an associate director of Stanford’s Early Life Stress and Pediatric Anxiety Program. His clinical and research efforts focus on understanding and addressing the impact of stress, adversity, and trauma in children and families with an emphasis on engaging historically underserved communities. Marisol Romero, PsyD, is a licensed clinical psychologist in the Department of Psychiatry at the University of California, San Francisco (UCSF). She specializes in Pediatric Consultation at San Francisco General Hospital (SFGH) and in eating disorders at the UCSF Eating Disorders program. She was born in Mexico to a family of immigrant farm workers and, as an immigrant herself, she has focused her clinical work in addressing concerns of health disparity among underserved and vulnerable populations. References Blaustein, M.E., &Kinniburgh, K.M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. Guilford Publications, New York, NY. Gudiño, O.G., Nadeem, E., Kataoka, S.H., & Lau, A.S. (2011). Relative impact of violence exposure and immigrant stressors on Latino youth psychopathology.Journal of Community Psychology, 39(3), 316-335. Jaycox, L.H., Stein, B.D., Kataoka, S.H., Wong, M., Fink, A., & Escudero, P. Zaragoza, C. (2002). Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. Journal of the American Academy of Child & Adolescent Psychiatry, 41(9), 1104-1110. Suárez-Orozco, C., Todorova, I.L.G., & Louie, J. (2002). Making up for lost time: The experience of separation and reunification among immigrant families. Family Process, 41(4), 625-643.