The Refugee and Immigrant Core Stressors Toolkit (RICST): Understanding the Multifaceted Needs of Refugee and Immigrant Youth and Families Through a Four Core Stressors Framework

Abstract

Research indicates that refugee and immigrant youth commonly face four core stressors during resettlement in a new country and culture: trauma, acculturative stress, resettlement stress, and isolation. This Four Core Stressors framework can be used to educate providers about these populations' unique needs and support assessment of relevant socioecological factors influencing health. To facilitate education, training, and dissemination of this framework and complement existing provider resources, we developed the Refugee & Immigrant Core Stressors Toolkit (RICST), a free, web-based toolkit that provides an overview of the Four Core Stressors framework, assessment questions across the four domains, scaffolding to identify needs and points of triage, and recommended interventions. Public hosting of the RICST via REDCap began in March 2018. In addition to the toolkit, users are prompted to provide location of service delivery, intended purpose of use, and interface feedback. Between March 2018 and October 2020, the RICST was used over 2300 times across 6 continents. Most providers used the toolkit to learn more about the needs of refugee and immigrant youth in general, and several noted that it is a valuable educational tool for staff unfamiliar with these populations. Open-ended qualitative feedback indicated high usability. Amidst historically high levels of forced displacement, tools to support provider effectiveness in working with these populations are increasingly needed. The RICST shows promise as an educational, assessment, and treatment-planning tool for providers working with refugee and immigrant families globally. Future directions include location-specific resource mapping and culture-specific intervention strategies.

Refugee and Immigrant Core Stressors Toolkit to Care for Newly Arrived Children in a School Nursing Setting

“…Although there is a wealth of general information online about immigrant and refugee children (e.g., Bridging Refugee Youth and Children's Services, Switchboard, JM REY'S IACAPAP), the majority of web-based tools (e.g., FindHello, Settle In, AsylumDK, RefAid, Step by Step, Refugee Buddy) focus on adult immigrants and refugees and tend not to provide suggestions for service providers (Davis et al, 2021). Boston Children's Hospital Trauma and Community Resilience Center recognizes the important role school nurses, many of whom interface daily with immigrants and refugees and therefore have been committed to development and dissemination of youth-specific and interactive tools to assist in the direct care for this unique population (Davis et al, 2021).…”

“…The RICST is a web-based tool that offers a framework for conceptualizing risk and resilience factors in resettlement and their impact on client health and well-being. It considers the resources and strengths of newly arrived children, their families, and their communities to be integral to service planning and advocacy (Davis et al, 2021;. Based on observations, clinical impressions, and suggested factors for consideration, the school nurse rates levels of risk across four core stressors: (1) low green, (2) moderate yellow, or (3) high red.…”

“…Financial stressors include poverty, food insecurity, inadequate or unstable housing, and parents with difficulties finding employment (Alegria et al, 2010;BCH TCRC, 2021;Tienda & Haskins, 2011). Logistical stressors involve obtaining legal status, finding affordable or efficient modes of transportation, and accessing available community resources (Davis et al, 2021;Tienda & Haskins, 2011). Unaccompanied and undocumented children face added resettlement stressors because they are not integrated into governmental and social service infrastructures that may require special assessment, especially if held in detention centers during their migration and resettlement journey (Ataiants et al, 2018;UNHCR, 2011).…”

“…Most school nurses are familiar with Bronfenbrenner's ecological systems theory for understanding children's development at the individual/family, community and societal level (Bronfenbrenner, 1979;Neal & Neal, 2013). Similarly, grounded in ecological systems theory, the Four Core Stressors Framework (Figure 1) proposes that four stressors impact newly arrived children post-migration to the United States: trauma, acculturative stress, resettlement stress, and social isolation (Boston Children;Hospital Trauma & Community Resilience Center BCH TCRC, 2021;Davis et al, 2021;.…”

“…The development of the RICST was originally supported by the National Child Traumatic Stress Network and was informed by a community based research process that included a comprehensive literature review of common stressors experienced by immigrant and refugee youth and families as well as feedback from providers, stakeholders, and community members (Abdi, 2018;Betancourt et al, 2017;Cardeli et al, 2020;Davis et al, 2021;Ellis et al, 2011;Ellis et al, 2012;Kaplin et al, 2019;Saxe et al, 2016). The RICST helps providers understand the unique experiences of newly arrived children and prompts best practices for resources and interventions to promote academic, physical, social and emotional well-being (BCH TCRC, 2021; Davis et al, 2021).…”