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

By Jacqueline Brady, PhD, RN

Recent data estimate that nearly 88 million immigrants and their U.S.-born children account for approximately 27% of the total U.S. population. Identifying the key factors that impact the health and wellbeing of newly arrived children is a complex challenge, even for the most seasoned school professional.

Although school professionals spend considerable time attending to mental health issues (e.g., anxiety, depression, and post-traumatic stress disorder), they receive little training to detect and coordinate care for general mental and behavioral health issues, let alone issues specific to youth and families who have been forcibly displaced to immigration. Furthermore, school professionals consistently report challenges to providing culturally-responsive care such as barriers to accessing healthcare, interpreters/translators, and legal services. School professionals providing direct service need actionable, evidence-based frameworks to guide them to tangible resources; and strategies to help support their practice.

The Four Core Stressors Framework proposes that four stressors commonly impact newly arrived immigrant youth post-migration: trauma, acculturative stress, resettlement stress, and social isolation. The Four Core Stressors Framework is the theoretical foundation of the Refugee and Immigrant Core Stressors “Toolkit,” a web-based interactive screening tool for assessing the strengths and needs of newly arrived children and families. The Toolkit helps providers understand the unique experiences of newly arrived youth and identifies best practices in trauma-informed care for promoting academic, physical, social, and emotional well-being. Note that while the Toolkit’s four assessment domains address needs and risks, they also focus on the resources and strengths of newly arrived children, their families, and their communities by drawing on assets such as a strong drive to achieve in school, learn a new language, and family cohesion. A strengths-based approach is integral to service planning and advocacy.

School professionals are often the first practitioners to interface with newly arrived youth. School-based services are readily accessible to most families, offering a hub for assessment, brief intervention, and referral to community-based services. Our paper (1) introduces the Four Core Stressors Framework as a guide for school professionals who work with newly arrived children; and (2) describes the application of the Toolkit by school-based professionals. To our knowledge, our paper is the first to describe the use of the Toolkit for direct care within in a school-based nursing setting.

To illustrate the use of the Toolkit we use a composite case of “Jasiel,” a newly arrived youth to Florida from Honduras. Jasiel’s story is told by Roseline, the elementary school nurse at his school. Roseline uses the Toolkit’s four core assessment domains (resettlement, acculturative stress, isolation, and trauma) to assess Jasiel’s needs and strengths in an effort to promote his adjustment to his new school and community. Based on Roseline’s observations, clinical impressions, and suggested factors for consideration, she rates Jasiel’s level of risk ((1) low [green], (2) moderate [yellow], or (3) high [red]) across the four core stressors. Risk ratings populate suggested trauma informed interventions across Jasiel’s level of risk. Interventions focus on strategies for mobilizing resources and partnering with an interdisciplinary team to support families’ multifaceted needs. After submitting an individual Toolkit assessment, Roseline downloads a helpful “summary and feedback” PDF with risk ratings and intervention recommendations for each core stressor. Roseline uses this summary as a guide for developing a Student Success Plan for Jasiel. Roseline also incorporates the Toolkit into her ongoing assessment of Jasiel’s needs at regular intervals throughout the school year.

Figure 1: Four Core Stressors Framework
Source: Boston Children’s Hospital Trauma and Community Resilience Center [BCH TCRC]. (2021). Trauma and Community Resilience Center: Resources for providers & communities. Retrieved from https://redcap.tch.harvard.edu/redcap_edc/surveys/?s=RCDFFHWK4P7THRL4

The Refugee and Immigrant Core Stressors Toolkit builds a holistic view, maintaining a whole child perspective by articulating struggles and strengths to foster healthy development. Upstream approaches, such as applying the Four Core Stressors Framework, can enhance school professional’s applied knowledge and build a culture of health in communities where students live, learn, work and play.

Implications for school health policy: My colleagues and I recommend incorporating the Toolkit, or components of its framework, as part of a screening and referral process to improve the emotional and physical well-being of newly arrived children. To do this effectively would require coordinated and sustained interdisciplinary teamwork between school systems and community providers. Future studies are needed to refine how use of the Four Core Stressors Framework, or the RICST in particular, within school systems enhance key outcomes including school attendance, engagement with behavioral health services, and sense of belongingness.

Knowledge gained in these areas will continue to inform advocacy and will help to ensure that services for newly arrived children are maximally effective, culturally-responsive, and sustainable.

Article Details
Refugee and Immigrant Core Stressors Toolkit to Care for Newly Arrived Children in a School Nursing Setting
Jacqueline A. Brady, Ph.D., MEd, RN, NCSN, Christina S. Lee, Ph.D., Emma Cardeli, Ph.D., Jeffrey Winer, Ph.D., and Pamela J. Burke, Ph.D., RN, FNP, PPCNP-BC, FSAHM, FAAN
First published online October 11, 2021
DOI: 10.1177/10598405211045688
The Journal of School Nursing

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