Systematic Review of Trauma-Informed Approaches and Trauma-Informed Care for Forced Migrant Families: Concepts and Contexts

Abstract

In the past decade, there has been a significant increase in the forced migrant and refugee population in Europe. As the journey to arrive at the country of destination is mostly irregular, research has shown that forced migrants survive a number of traumatic experiences trying to reach safety and ensure the well-being of themselves and their families. Since research shows that exposure to traumatic experiences refugee and migrant families endure on their journey is severe, a systematic literature review was conducted to understand the concept of trauma-informed approaches for migrant and refugee families. A total of seven research databases have been a part of this study, and the search resulted in 45 papers that were analyzed and their results presented. The following inclusion criteria were considered: (a) migrant/refugee families living with their children and (b) migrant/refugee families approaching care (health, social, educational, legal). Inclusion criteria refer to phenomenological studies, consider trauma/resilience of migrant/refugee families, include studies that are published in English language only; published literature only; 2013 onwards, and only full-text studies. The results of this analysis imply that papers are more focused on the experiences of trauma than on the approaches to treat it. However, this analysis did result in identifying approaches, interventions, and tools in working with trauma refugee and migrant families. Trauma-informed approaches for forced migrant families require a culturally adapted response provided across all sectors of family support to refugees and migrants.

Keywords

forced migrants migrant and refugee families trauma-informed approaches systematic literature review mental health

Modern migrations of people are highly dynamic. Motivations people have to move (internally or internationally) vary and can include economic, sociodemographic, ecological, cultural, political, and security reasons (Shymanska et al., 2017). Today, the migration of people is characterized by diversity: migrants¹ differ based on their reasons for moving, legal statuses, skills, demographic characteristics, circumstances, and prospects (World Bank, 2023). At the same time, countries are defined in the frame of three possibilities: countries of origin—countries of nationality or a former habitual residence of a person or a group of persons who have migrated abroad (IOM, 2019); destination countries—countries that are the destination for a person or a group of persons (IOM, 2019); and countries which are, at the same time, countries of origin and destination countries—those producing the migrants to economically more developed countries, while being the countries of destination for the migrants originating from less developed countries (Lima et al., 2016). There are also countries of transit defined as those through which migration flows move. More precisely, these are countries, different from the country of origin, which migrants pass through to enter the country of destination (European Migration Network, 2022).

The multitude of reasons driving people to relocate has shaped the development of policies and strategies aimed at aiding migrants. This diversity in motivations has been particularly influential in shaping responses to what are termed mixed migration movements (Sharpe, 2018). At the same time, the diversity of migrants has produced different definitions of migrants based on the reasons they are moving and the consequences the movement has on their immigration and/or citizenship status. The biggest difference is made between forced migrants—those whose movement involves force, compulsion, or coercion, although the drivers of migration can be diverse (IOM, 2019), and voluntary migrants—those who move motivated, not by persecution or possible serious harm or death, but by improving their living condition, marriage, or reuniting with family (World Bank, 2023). Forced migrants encompass refugees, asylum seekers, and other support seekers, whose fleeing the country involves some sort of coercion, including those fleeing extreme poverty and impossible living conditions that put in danger people’s survival in that country (European Migration Network, 2022). In this sense, a refugee is a person who was granted international protection in a country of asylum based on their proven fear of persecution, violence, armed conflict, or belonging to a certain social or political group (World Bank, 2023). An asylum seeker is a person who has submitted their request for asylum in a certain country but has not yet received the final decision. Since this paper aims to explore the concept of trauma-informed approaches (TIA) in migration, it will not tackle voluntary migration, as this type of migration rarely includes traumatic experiences in countries of origin or during the journey.

A significant body of research argues that forced migrant families are faced with numerous challenges ranging from the existential (UNHCR, 2022) to the emotional (Ataullahjan et al., 2020, Jovanovic & Besedic, 2020) and social (Bjekic et al., 2020; PIN, 2018; Zegarac et al., 2022). During their journey to their country of destination, forced migrant families receive scarce support from the local authorities of the countries that they travel through (Papadopoulos et al., 2022; Weine et al., 2021). The support that they do receive from authorities is mostly goods and shelter, while emotional support is provided mainly by the international and non-government sectors (PIN, 2018). Even then, because their migrations are forced and often irregular, many support seekers do not complete the processes involved with counseling and service provision (Zegarac et al., 2021).

TIAs have been developed across several sectors including health, mental health, social care, social protection, and others that work with vulnerable populations to answer their need to be supported and for their trauma to be recognized (Brooks et al., 2022; Meléndez Guevara et al., 2021; Thirkle et al., 2021; Van Es et al., 2021; Yohani et al., 2019). These approaches have become increasingly cited in policy and adopted in practice as a means for reducing the negative impact of trauma experiences and supporting mental and physical health outcomes (Dalgaard & Montgomery, 2015; Grant & Guerin, 2014; Papadopoulos et al., 2022).

The purpose of utilizing TIA is to enhance the accessibility and quality of services, aiming to create culturally sensitive and safe environments that foster trust among forced migrant families (Thirkle et al., 2021). These approaches equip practitioners with the necessary skills to engage in collaborative partnerships with forced migrant families, empowering them to actively participate in decisions concerning their health and overall well-being (Thirkle et al., 2021). The available data suggest that TIAs should be integrated into service provision both during the journey of forced migrant families and upon their settlement in the destination country (Das, 2019; Meléndez Guevara et al., 2021; Thirkle et al., 2021). It is evident that TIA serves as an overarching framework that encompasses trauma-informed care (TIC) and extends beyond healthcare settings to include all aspects of support provided to forced migrant families.

TIC complements the principles of TIAs by offering compassionate and strength-based interventions that take into account potential trauma triggers (Ranjbar et al., 2020; Slobodin & De Jong, 2015). These interventions recognize the profound implications of traumatic experiences and acknowledge the diverse life experiences, environments, and cultural backgrounds of individuals within various interactions (Ranjbar et al., 2020; Slobodin & De Jong, 2015). Importantly, TIC is a fundamental component of TIA, emphasizing the need for care providers to be sensitive to the unique needs and experiences of forced migrant families as they navigate the complexities of trauma and healing within different care settings.

This study aims to understand the concept of TIA and TIC for forced migrant families and make recommendations for approaches and interventions that support forced migrant families.

Method

This systematic review was conducted according to the Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines for conducting and reporting systematic reviews and meta-analyses (Moher et al., 2015).

Search and Inclusion Criteria

The inclusion criteria encompass (a) studies (qualitative, quantitative, and mixed methods), a literature review, and meta-analyses of TIA and TIC to forced migrant families who were living with their children and approaching care services (health, social, educational, and/or legal); (b) Only full-text studies that were published in the English language during the last 10 years (since 2013), which consider the trauma and resilience of forced migrant families were included. All searches included central terms: refugee or migration families, and TIA or TIC. Figure 2 summarizes the outcome of the search strategy. All studies that met the inclusion criteria were included in the review, as the nature of the review question made it difficult to predefine the appropriateness of different methodologies.

Studies that focused exclusively on child trauma and not the experience of children’s families were excluded. Commentaries, reviews, editorials, letters, comments, commentaries, “points of view,” unpublished papers, papers published before 2013, and studies where the full text was not available were also excluded. Articles published before 2013 were excluded as the motivation for this study was to analyze TIA and TIC approaches developed for forced migrant families in the last decade which is considered the decade of forced migration (UNHCR, 2023). A bias assessment was undertaken for each included study, which considered the extent to which the study had TIA or TIC as a primary focus.

Once all relevant papers (n = 36) were extracted, a search of reference lists provided nine additional papers. In total, 45 papers were extracted from 7 databases. Two researchers autonomously reviewed full-text papers, extracting categories. Subsequently, they collaboratively reached a consensus on how to present the identified topics. This research spanned from October 2021 to April 2022. The following electronic databases were searched (a) APA PsycInfo, (b) APA PsycArticles, (c) ProQuest humanities index, (d) ProQuest Social Science Premium Collection, (e) Web of Science, (f) Scopus, and (g) Applied Social Sciences Index & Abstracts.

To identify subject-related research terms, we performed a preliminary literature search and consulted TIA and TIC experts and associates from the University of Sheffield. Based on these findings, an iterative search was carried out on each electronic database by matching two sets of terms, including both truncated and thesaurus terms (Figure 1).

Figure 1.

Search strategy.

Results

Records were sorted by relevance and duplicates were removed. The relevance of each study was determined by screening the title and/or the abstract of the retrieved record. If the study was not in the relevant subject area, it was excluded based on its title. After this selection process, studies that met the eligibility criteria were evaluated in further detail. Studies that made references to TIA or used TIA for services or programs for forced migrant families were included in the review.

The database search provided a total of 68,060 records (Figure 2). After adjusting the search for keywords, date of publication, types of publications, and English language publications, 6,492 records remained. Out of these, 6,029 were discarded because after reviewing their titles and abstracts, it was concluded that they did not meet the inclusion criteria. Finally, 12 studies were excluded since full papers were not available.

Figure 2.

Preferred reporting items for systematic review and meta-analysis flow diagram of the systematic literature search.

Following examination of the full-text versions of the remaining 451 studies, a further 415 studies were excluded as they did not meet the inclusion criteria described above. To ensure data integrity, quality, and reliability, two different strategies were implemented to reduce the bias of both authors of this paper and identify bias in the selected papers. First, a table was created where the aims, main findings, methods and strengths, and limitations of each of the papers are presented. This table is attached as the Annex A of this paper and this table aims to provide additional assurance and an opportunity to check the contents of each of the analyzed papers to make sure the analysis is reliable.

Data Analysis

To identify topics, Table 1 was created to systematize results and identify themes. The following variables were extracted during the analysis of the selected studies: author(s) and date of publication, title, country, type of study, data analyses, sample size, and focus on TIA and/or TIC. The table in Supplemental Appendix A summarizes the aims, main findings, strengths, weaknesses, and methods of all identified studies.

Table 1.

Table of Systematized Results and Identified Themes.

Autor(s)/Year	Country/	Type of the Study			Sample Size			Data Analysis Method			Trauma-Informed Care Topics
Autor(s)/Year	Region	Qual Study	Quant Study	Lit. Revie w	Small Samp le	N/A	Big Study	Thema tic Analys is	N/A	Descriptive/Statistical	Tool s	Mod els	Perspect ives	Approach es	Theories
Brooks et al. (2022)	AU			+		+				+				+
Leung (2019)	UK		+	+		+				+		+	+
Van Es et al. (2021)	Netherlands	+	+		+			+		+	+
Thirkle et al. (2021)	UK			+		+				+		+		+
Das (2018)	USA			+		+			+		+
Meléndez Guevara et al. (2021)	USA	+			+			+					+	+
Ellis et al. (2013)	USA		+		+					+	+		+	+	+
Huntley et al. (2021)	UK	+			+			+		+		+	+
Rousseau et al. (2014)	Canada, AU	+			+			+			+		+
Im et al. (2021)	USA	+				+			+		+	+		+
NeMoyer et al. (2019)	USA			+		+				+	+		+
Genç (2022)	Turkey			+		+				+				+
Fragkiadaki et al. (2020)	Greece	+	+		+			+		+	+
Franco (2022)	USA	+				+			+		+		+
Im and Swan (2021)	USA	+	+		+			+		+	+			+
Luzzatto et al. (2022)	Tanzania	+				+			+		+			+
Barajas-Gonzalez et al. (2021)	USA			+		+				+		+
Alaoui and Scrubby (2019)	USA			+		+			+				+		+
Im and Swan (2022)	Kenya		+		+					+			+	+
Al-Hamad et al. (2022)	Canada	+			+			+				+	+
Slobodin and de Jong (2015)	Netherlands			+		+			+			+	+	+
Uy and Okubo (2018)	Cambodia	+				+				+	+		+	+
Davis et al. (2021)	USA			+		+			+		+	+
Opaas et al. (2020)	Norway	+			+			+		+			+
Riber (2017)	Denmark	+			+			+		+			+	+
Im and Swan (2022)	USA	+			+			+			+		+	+
Beaini and Shepherd (2022)	AU			+		+			+				+	+
Timshel et al. (2017)	Denmark			+		+				+			+	+
Grant and Guerin (2014)	AU			+		+				+		+		+	+
Dalgaard and Montgom ery (2015)	Denmark			+		+			+			+	+	+
Papadopoulos et al. (2022)	Greece, Italy, and Germany	+			+			+		+	+		+	+
Lamb (2020)	AU	+			+			+					+	+
Groeninck et al. (2020)	Belgium	+			+				+				+	+	+
El-Khani et al. (2020)	Serbia	+			+			+		+	+			+
Sangalang and Vang (2017)	USA			+		+			+				+	+
Critelli (2014)	USA			+	+					+		+	+
Yohani et al. (2019)	Canada	+			+			+				+	+
Weine et al. (2021)	Turkey	+			+			+					+	+
Van Ee (2018)	Netherlands	+	+		+			+		+	+	+	+
Dalgaard et al. (2016)	Denmark	+	+		+			+		+			+	+
El-Khani et al. (2020)	Israel		+		+					+	+			+
Lambert et al. (2014)	USA	+				+		+				+	+
Ranjbar et al. (2020)	USA		+		+			+						+
Lee and Choil (2022)	USA		+			+				+					+
Bastia (2014)	UK				+	+									+

Most of the studies selected for analysis focus on tools, models, approaches, theories, or perspectives and were conducted in Europe (44%) or the USA and Canada (40%). The remaining 16% were conducted in Australia or Africa. Seventeen studies were literature reviews and 28 were empirical studies. Out of these, 19 studies used qualitative methodologies, 4 used quantitative methodologies, and 5 used mixed methodologies. During the data analysis process, the following topics were identified: experiences of migration among forced migrant families; conceptualization of trauma among forced migrant families; theoretical frameworks of TIA to forced migrant trauma; approaches to trauma work with forced migrant families; and programs and interventions to support forced migrant families.

The studies describe the traumatic experiences of forced migrant families during different stages of their journey: in their country of origin, during transit, and in their destination countries (Brooks et al., 2022; Das, 2019; Thirkle et al., 2021). The theoretical frameworks used to conceptualize trauma include both risk and protection factors and the intersection of different factors such as culture, gender, and race. A number of TIAs were identified that emphasize the need to implement frameworks relating to culture, systems, individual experiences, and previous life experiences specific to the context of forced migration. Tables 2 and 3 provide a summary of the critical findings and implications for practice, policy, and research.

Table 2.

Summary of Critical Findings.

Critical Findings
- To conceptualize TIA for migrant/refugee families, it is important to understand the traumatic experiences of these families in different stages of their journey.- Understanding the family impact and context across cultural domains and intersectionality should be implemented in TIA which constructs TIC within specialized tools and activities.- TIC considers the impact of family dynamics, including separation from family members, loss of social support networks, and changes in roles and responsibilities.- TIA to migrant families and other vulnerable families should be grounded in cultural sensitivity,- Language access, flexibility and adaptability, community engagement, and trauma-informed practices.

Critical Findings

- To conceptualize TIA for migrant/refugee families, it is important to understand the traumatic experiences of these families in different stages of their journey.- Understanding the family impact and context across cultural domains and intersectionality should be implemented in TIA which constructs TIC within specialized tools and activities.- TIC considers the impact of family dynamics, including separation from family members, loss of social support networks, and changes in roles and responsibilities.- TIA to migrant families and other vulnerable families should be grounded in cultural sensitivity,- Language access, flexibility and adaptability, community engagement, and trauma-informed practices.

Note. TIA = trauma-informed approaches; TIC = trauma-informed care.

Table 3.

Summary of Implications for Practice, Policy and Research.

Implications
Practice	- It is important to understand how parents develop discourse about traumatic experiences and explore how parents connect to microsystems to develop social capital to develop adequate tolls and trainings.- Services need to be culturally sensitive, well-targeted, and appropriately timed to address the needs of parents and caregivers (in their native language if required).- Services need to empower families within their capacities and needs while respecting their heritage and wishes.- It is important to understand the important connection between trauma exposure and structural inequalities by acknowledging the social and historical layers of adversity and trauma exposure.
Policy	- Advocating for evidence-based interventions focusing on the specific needs of this population, which take into account the family as a whole, as well as the specific needs of parents and children is necessary.- Policymakers should increase their efforts to support rigorous, open-access, and self-directed training for social protection officers, field workers, nurses, and other healthcare professionals, which is also culturally competent and compassionate.- Appropriate national and international policies should also facilitate the establishment of standards for care provision for refugee families.
Research	- Innovative research is needed to better understand the training needs of health, social care professionals and volunteers to better prepare them for the care of migrant/refugee families while also being able to boost their self-care under extreme and unique circumstances.

Results of Bias Analysis

A bias analysis was undertaken for every paper using theROBVIS tool (McGuinness & Higgins, 2020) in the following five areas: D1: Bias arising from the randomization process; D2: Bias due to deviation from intended interventions; D3: Bias due to missing outcome data; D4: Bias in measuring the outcome; and D5: Bias in selection of the reported results. Analysis showed that around 40% of the analyzed papers have a low overall risk of bias according to the ROBVIS tool; around 45% have some concerns relating to bias and 15% have a high risk of bias. Papers showing the high risk of bias were thoroughly examined by both authors to establish the effect it should have on the representation of data. It was concluded that the papers showing a high risk of bias are all literature reviews that did not follow the PRISMA guidelines or were done through a non-systematic scan of the literature search, which the ROBVIS tool recognizes as high risk (Nordstrom et al., 2023). Some of the papers showed a high risk of bias due to the missing information in the text on some of the areas. Since the information was missing, the authors of this paper could not make a sound conclusion the steps were not made during the research itself to reduce the risk of bias. These results were taken into account in the representation of the data. The overall judgment of bias by the ROBVIS tool and the judgments for each paper are presented in Figures 3 and 4.

Figure 3.

Bias assessment: overall judgment.

Figure 4.

Bias assessment: individual papers.

Experiences of Migration Among Forced Migrant Families

Before and during transit to their country of destination, forced migrant families experience significant stressors including safety risks, economic insecurity, separation of family members, and discrimination, which impact their overall well-being. After reaching their country of destination, it is noted that many forced migrant families experience challenges with settling, integration, and cultural adaptation, which can lead to multiple risk factors. Some of them, along with other circumstances, might result in post-traumatic stress disorder (PTSD) among family members (Timshel et al., 2017). PTSD not only affects the individual who experiences it but also contributes to the increase in family violence. This impact extends to transgenerational transmission within families (Brooks et al., 2022; Das, 2019), affecting subsequent generations, including children (Timshel et al., 2017). Studies, (Morris et al., 2012, according to Slobodin & de Jong, 2015), have identified a positive correlation between parent and child PTSD symptoms. This association is attributed to shared genetic diathesis, parental modeling of behaviors, and reduced positive parent–child interactions. Moreover, trauma affects both the child and the parent, demonstrating a bidirectional impact (Slobodin & de Jong, 2015).

Long stays in collective asylum centers where forced migrant families lack autonomy, privacy, certainty, and often a sense of security, can add to the traumatic experiences and impact family members’ well-being (Dalgaard et al., 2016; Papadopoulos et al., 2022). Insufficient knowledge and limited access to resources can hinder parents’ capacity to fulfill the needs of their children during the acculturation process. Acculturation is a multifaceted transition where individuals assimilate the values, behaviors, lifestyles, and language of the new culture they are entering (Lamb, 2020). In addition, communication within families may be influenced by parental trauma, which can strain relationships and erode trust among family members, thereby heightening the vulnerability of children (El-Khani et al., 2020; Lamb, 2020). When coupled with discrimination from the broader community and a dearth of supportive services for forced migrant families, these factors collectively have detrimental effects on the overall well-being of such families (Slobodin & deJong, 2015).

Conceptualization of Trauma Among Forced Migrant Families

Trauma survived by forced migrant families exhibits specific characteristics and dynamics, and includes experiences of war, violence, torture, imprisonment, persecution, and family separation, both before and during migration (Brooks et al., 2022; El-Khani et al., 2020). The forced migrant journey is understood as an extended period marked by the accumulation of various stressors that interact throughout the pre-migration, migration, and post-migration phases (Dalgaard et al., 2016), impacting the overall well-being of the families (Slobodin & de Jong, 2015).

Understanding the trauma that forced migrant families experience contributes to the formulation of TIC which is derived from TIA. TIAs aim to recognize and respond to the widespread impact of trauma by integrating knowledge about trauma into policies, procedures, and practices. TIAs are especially important in working with forced migrant families as they deliver results that are genuinely healing by ensuring greater understanding, respect, and trust between the service provider and the family that receives support (Dalgaard et al., 2016). Culture serves as a protective factor, as it informs a culturally responsive TIA. This approach underscores the significance of understanding the cultural context, acknowledging transgenerational vulnerabilities, and advocating for equity. By doing so, we can address the multiple layers of disparities in accessing services experienced by marginalized communities. Recognizing the widespread impact of trauma, along with the disproportionate rates of trauma among racial and ethnic minority groups, there is an ongoing need to integrate TIAs in working with forced migrants (Meléndez Guevara et al., 2021).

TIC serves as both an organizational structure and treatment framework, especially vital within migrant and refugee contexts. It encompasses designing interventions to facilitate recovery from traumas like persecution, violence, displacement, or loss experienced in their home countries or during migration, all while integrating a cultural perspective (Brooks et al., 2022). It can be objectified under three essential domains all other domains fall under safety, empowerment, and self-worth (Timshel et al., 2017), which should be implemented in all agents of change.

The papers included in this analysis also conceptualize the traumatic experiences of forced migrant families through a framework of risks and protective factors. The risk factors are widely known and stem from forced migration experiences such as fleeing war, violence, and persecution. Studies discuss individual protective factors such as coping skills, positive emotions including optimism, and adaptability. Familial and societal protective factors include social support, family adaptability and cohesion, school attendance, and experiences of safety and security (Das, 2018; NeMoyer et al., 2019; Timshel et al., 2017; Van Es et al., 2021). By examining the specific traumas endured by forced migrant families and incorporating these experiences into the framework of TIC, researchers deepen their understanding of trauma’s complexity and its impact on marginalized populations. This integration allows for a more comprehensive conceptualization of trauma and informs effective strategies for addressing the diverse needs of individuals and families who have experienced forced migration.

Theoretical Frameworks of TIA to Forced Migrant Trauma

In the literature about TIA to forced migrant families, several theoretical frameworks were identified: a socioecological model, a holistic systemic approach, cultural humility followed by intersectionality, and a case of tragic optimism.

Both the socioecological model and the holistic systemic approach emphasize the importance of considering the multiple systems that impact individuals including the microsystem (individual relationships), mesosystem (interactions between systems), ecosystems (external systems), and macrosystems (culture and society). Ecological system theories refer to culturally appropriate services and support systems that strengthen the capacity of families and the community to look after forced migrant children (Davis et al., 2021; Grant & Guerin, 2014). These approaches do not refer to the specific dimension that is required to be implemented in the individual approach or understanding of the need for integration of traumatic experiences. TIAs informed by ecological systems theory recognize the influence of systems on the forced migrants’ experiences and well-being.

Trauma is deeply intertwined with cultural context, as cultural and societal factors often shape and even precipitate traumatic experiences (Rajnbar et al., 2020). Cultural humility is considered an approach rather than a fixed mindset or set of guidelines because it involves ongoing self-reflection, learning, and adaptation. Unlike a static approach, cultural humility recognizes that individuals and communities have diverse backgrounds, experiences, and perspectives that shape their understanding of the world (Tervalon & Murray-García, 1998). Therefore, cultural humility involves continuously examining one’s own biases, assumptions, and privileges, as well as actively seeking to understand and respect the cultural beliefs, values, and practices of others. It involves a commitment to lifelong learning, humility, and openness to diverse perspectives, rather than assuming expertise or superiority in relation to other cultures. Ultimately, cultural humility emphasizes the importance of building authentic and respectful relationships across cultural boundaries (Ranjbar et al., 2020). TIAs that incorporate cultural humility acknowledge the necessity of cultural sensitivity, humility, and responsiveness in delivering care to forced migrant populations. This approach underscores the significance of comprehending the effects of systemic inequalities and discrimination on mental health outcomes, emphasizing the importance of TIAs that advocate for social justice and equity.

Intersectionality refers to the interconnected nature of social categorizations such as race, class, gender, and sexuality, as they create overlapping and interdependent systems of discrimination or disadvantage. This concept highlights how various forms of oppression and privilege intersect and compound, leading to unique experiences of discrimination and marginalization for individuals who occupy multiple marginalized identities (Crenshaw, 1991 according to Bastia 2014). Intersectionality emphasizes the importance of considering the complexity of social identities and power structures in understanding and addressing issues related to social justice and equality. Intersectionality, as a reflection of cultural and societal structures, profoundly shapes trauma experiences, encompassing racial-based stress, discrimination, hate crimes, and subtle yet pervasive occurrences like everyday exclusions and microaggressions. Intersecting with race and ethnicity are elements such as gender, sexuality, and sexual identity, each influencing an individual’s vulnerability to face trauma (Bastia, 2014). A TIA acknowledges these multifaceted layers and the cumulative emotional and psychological impacts on well-being, advocating for a systemic and holistic strategy that considers the person within their broader environment (Bastia, 2014; Grant & Guerin, 2014; Lee & Choi, 2022; Ranjbar et al., 2020).

The theory of resilience is mentioned in some papers analyzed in this study as an important theory for creating interventions that are trauma-informed. There is a significant body of research that demonstrates the impact of multiple traumatic experiences and severe stressors on everyday life and, in the case of refugees, their ability to recover. A risk and resilience framework establishes the notion that human development is impacted by experiences of trauma, but these experiences can be tackled by personal assets and external resources, which can promote healthy adaptation in the context of adversity (NeMoyer et al., 2019). The theory of resilience has also been used as a framework for TIA with communities. These approaches are aimed at developing community resilience through community sensitization and psychoeducation (Ellis et al., 2013; Groeninck et al., 2020). In addition, several authors discuss the use of resilience theory as a framework for creating interventions for families, where this theory, in combination with a family system approach, considers how the whole family can foster resilience (Groeninck et al., 2020; Huntley et al., 2021).

Tragic optimism, as defined by Frankle (Leung, 2019) is “optimism in the face of tragedy” that can lead to affirmation via accomplishment and achievement, transformative growth, and purposeful responsibility. Five components have been identified: (a) Affirmation of will to meaning and value of life; (b) Courage to face adversity; (c) Acceptance of what cannot be changed; (d) Faith or trust in God and others; and (e) Self-transcendence in serving a higher purpose complementary to one’s decision to move from trauma to healing is one’s courage to face adversity.

The affirmation of the will to meaning and value of life is essential for forced migrants and refugees as they navigate the challenges of displacement. Despite the adversity they face, many individuals in this situation continue to seek meaning and purpose in their lives, often finding strength in their cultural, spiritual, and personal values (El-Khani et al., 2020). Second, the courage to face adversity is a hallmark of the refugee experience. Fleeing conflict, persecution, or environmental disasters requires immense bravery and resilience. Forced migrants often demonstrate remarkable courage as they confront the unknown and navigate unfamiliar and sometimes hostile environments in search of safety and security (Groeninck et al., 2020). Acceptance of what cannot be changed is a crucial aspect of coping with displacement. Forced migrants must come to terms with the loss of their homes, communities, and often, their loved ones. Embracing acceptance allows individuals to focus their energy on rebuilding their lives and adapting to their new circumstances (El-Khani et al., 2020). Faith or trust in God and others can provide solace and support to forced migrants and refugees during their darkest moments. Many individuals draw strength from their religious or spiritual beliefs, finding comfort in the notion that they are not alone in their struggles (Zegarac et al., 2021). Finally, self-transcendence in serving a higher purpose is exemplified by the resilience and resourcefulness of forced migrants and refugees. Despite their hardships, many individuals in these communities demonstrate remarkable altruism and compassion, supporting and caring for one another in times of need (Papadopoulos et al., 2022).

In the context of TIC for forced migrants and refugees, the components of tragic optimism underscore the importance of recognizing and honoring individuals’ resilience, strengths, and coping mechanisms. By integrating TIAs that acknowledge the profound challenges faced by forced migrants while also affirming their agency, dignity, and capacity for growth, practitioners can support healing and empowerment within these communities.

Approaches to Trauma Work with Forced Migrant Families

The papers analyzed in this systematic review reflect on the outcomes of the various interventions provided for forced migrant families. Most of the papers focus on cognitive behavioral approaches (Alaoui & Scruby, 2019; Ellis et al., 2013; Franco, 2022; Genç, 2022; Slobodin & de Jong, 2015) including eye movement desensitization and reprocessing (EMDR) (Genç, 2022; Slobodin & de Jong, 2015) and narrative exposure therapy (NET) (Alaoui & Scruby, 2019; Fragkiadaki et al., 2020; Franco, 2022; Genç, 2022; Slobodin & de Jong, 2015; Uy & Okubo, 2018). In addition, there are systemic-based approaches such as culture-informed care (Beaini & Shepherd, 2022; Davis et al., 2021; Franco, 2022; Im et al., 2021; Rousseau et al., 2014); community-based interventions (Beaini & Shepherd, 2022; Ellis et al., 2013; Im & Swan, 2021, 2022; Uy & Okubo, 2018); and family-based approaches (Beaini & Shepherd, 2022; Ellis et al., 2013; Franco, 2022; Huntley et al., 2021; Im et al., 2021; NeMoyer et al., 2019; Slobodin & de Jong, 2015; Uy & Okubo, 2018).

Cognitive behavior approaches (CBA) to interventions were the most common approaches found in this analysis and include cognitive behavior therapy (CBT), NET, and EMDR. These approaches are relatively well-researched and have shown meaningful results when working with refugees who have survived traumatic experiences. It has been shown that CBA has success when working with refugees with PTSD, as they target catastrophic thought processes and behaviors that stem from these thoughts (Alaoui & Scruby, 2019). CBT approaches are usually modified to accommodate the needs of refugees, and those most commonly mentioned in the studies are trauma-focused CBT (Ellis et al., 2013; Genç, 2022) and culturally adapted CBT (Alaoui & Scruby, 2019).

Trauma-focused CBT is presented as one of the common and most successful treatment methods (Genç, 2022). It is designed as a short-term intervention to reduce symptoms of anxiety, PTSD, depression, and some behavioral problems. This treatment includes three phases: establishing safety and trust, treatment, and reintegration (Genç, 2022). Even though these approaches have shown great success in families, most studies included small samples without a control group. This indicates the need to take the data on the success of these approaches keeping in mind the information on the size of the sample and that they are not to be generalized on the entire population.

Culturally adapted CBT is another form of approach that has benefits for refugees with PTSD. This approach incorporates specific cultural beliefs and practices, taking into account refugees’ perceptions of their symptoms, causes of illness, and meanings of healing (Alaoui & Scruby, 2019). The main point of success for this approach is that therapists are from the same cultural background as the refugees they work with and speak the same language, which eases discussion of emotional issues and helps to create a relationship of trust.

EMDR is a cognitive behavior technique that is used frequently with survivors of traumatic experiences. It focuses on desensitizing negative memories and the emotions and thoughts attached to these memories and replacing them with positive ones (Genç, 2022). While some authors argue that refugees should be treated according to the standardized protocols of this treatment, others claim that the treatment should be adapted to focus on stabilization and restoration of coping skills first (Slobodin & de Jong, 2015). This discussion is left open in the literature, and further research is needed to establish the best method of working with people who are forced migrants.

NET is an approach that addresses multiple and complex traumatic events across an individual’s lifetime (Franco, 2022) through the individual autobiographical narrative of incidents of war, torture, or other types of organized violence (Genç, 2022). This approach has been criticized as being Western-based and not considering cultural differences (Fragkiadaki et al., 2020; Uy & Okubo, 2018); however, a recent evaluation of this approach shows a reduction in symptom burden (Alaoui & Scruby, 2019).

Many papers describe approaches to forced migrants’ trauma based on systems and socioecological theory, mainly culture-informed care, community-based interventions, and family-based approaches. All of these approaches have in common the engagement of a family as a system, the cultural systems of countries of origin (language, customs, preferences), and the broader refugee population (Im et al., 2021). The primary focus of these services is on providing basic needs for survivors such as food, information, referral to other services, and providing basic emotional and counseling support. There is special attention given to children’s trauma and the services that enhance children’s well-being. Most of the services focus on parent–child relationships, family functioning, and social support. Services are community based and they introduce a cultural component which is highly important regarding establishing connections of trust between families and professionals.

Since existing protocols for different approaches to treatment of refugees do not include cultural differences, some authors (Beaini & Shepherd, 2022; Davis et al., 2021; Franco, 2022; Im et al., 2021; Rousseau et al., 2014) discuss the forms and possibilities of including cultural background in different approaches to TIC as it adds a new level of complexity to their treatment and a lack of it can lead to misdiagnosis (Beaini & Shepherd, 2022). Culture-informed care is being recognized as an important component of refugee mental health treatment, as care that is informed by the refugees’ culture, language, customs, and preferences provides an additional opportunity to design a treatment that is mostly adapted to the refugees’ needs (Yohani et al, 2019).

Community-based interventions provide comprehensive services by integrating mental health services with services that address resettlement stressors (Ellis et al., 2013). This approach is based on the socioecological theory developing the model on the fact that mental health issues of forced migrants are beyond individual levels, as multiple traumatic experiences that they survive are not only affecting inter- and intra-personal domains, but the entire socioecological systems (Im et al., 2021). The most common models of community-based interventions mentioned in the papers in this analysis are community-based advocacy and learning interventions, faith-based, lay-led interventions, community and cultural sensitivity, community-based interventions for families, and community-led early intervention and prevention approaches (Im et al., 2021).

Family-based approaches are developed to foster family resilience as a protective factor of family adjustment to new circumstances. These approaches usually base interventions on the theory of resilience and family system therapy (Ellis et al., 2013; NeMoyer et al., 2019). The use of family-based interventions is argued based on the importance of family in the aftermath of trauma but also on the possibilities that this type of approach provides in using social and cultural context in a systemic approach to therapy (Slobodin & de Jong, 2015). Family system therapy may also be an effective approach for refugees arriving with the cultural background of family unity being more important than individuality, or that these two are interconnected. In addition, a family-based approach can also be useful in situations of recent settlement, or in families that have specific complexities, where meeting the needs of the entire family may be necessary (Beaini & Shepherd, 2022).

Programs and Interventions to Support Forced Migrant Families

References in the selected papers to programs and interventions that provide services for families primarily focus on two target groups: the professionals who work with refugees (mostly health professionals) and the refugees themselves. Training for professionals who work with forced migrants is mostly presented in the analyzed studies as practical training aimed at mental health professionals. Some of the training that is described aims to develop the skills of professionals through personal experiences of trauma (Rousseau et al., 2014), while others build knowledge and skills (Im & Swan, 2020; Fragkiadaki et al., 2020), or aim to build and enhance cooperation and partnerships among mental health professionals and refugee community leaders (Im & Swan, 2020).

“House of Stories,” developed by Rousseau et al. (2014), is a training exercise within the clinical-oriented seminar series “Working with culture.” It focuses on personal traumatic stories to develop trust among participants. The exercise is performed in small groups, starting with contents that are usually distant to the participants but evolving into participants themselves sharing their personal stories of traumatic experiences via media of their choosing (a written story, a drawing, etc.). This process has shown to develop strong connections among participants and it helped understand different traumatic experiences, thus improving the competencies of professionals to work with people with traumatic experiences.

Cross-cultural TIC training for mental health professionals (Im & Swan, 2020) is based on a psychoeducational manual on trauma and culturally specific mental health topics when working with refugees. It includes knowledge building (e.g., of mental health terms, refugee mental health issues, refugee trauma and its consequences, and cultural expressions of distress) and skill building (e.g., psychoeducation, listening skills, how to deliver systems of care and multi-tiered or community-based interventions, grounding and mindfulness, and self-care).

Train the Trainer developed by Fragkiadaki et al. (2020) is a seminar that is designed to develop knowledge of trauma-informed practices among healthcare workers to achieve three goals: to improve their knowledge of traumatic events and the potential mental health impact on refugees; to introduce them to TIC; and to train them in trauma-specific interventions. The training lasts for 2 days with the focus on information about traumatic experiences, common mental health issues as a result of trauma, introduction to TIC, screening and assessment for mental health issues, and narrative interventions focusing on human dignity.

The refugee and immigrant core stressors toolkit developed by Davis et al. (2021) is a free web-based toolkit that provides an overview of the Four Core Stressor Framework, which illustrates the domains in which stress is usually experienced by refugees: traumatic, acculturative, resettlement, and isolation. It was developed together with refugee and immigrant mental health professionals and it provides opportunities to those who do not have enough knowledge to familiarize themselves with concepts of TIC when working with refugees.

Interactive training for cross-cultural TIC in the refugee community, developed by Im and Swan (2021), aims to improve the mental health of refugees through TIAs that focus on the cooperation between mental health professionals and leaders in refugee communities. It focuses on the trauma experiences of refugees in general, including pre- and post-resettlement traumas and cultural practices; the impact of traumatic experiences on the mental health of refugees, their families, and communities; the role of culture, how it impacts refugees’ experiences and trauma symptoms, resettlement and acculturation stress, and their impact on integration in the host society (Im & Swan, 2021).

Training and programs for forced migrants are developed and implemented with individuals and families who have experience of migration and aim to develop individual capacities for integrating and dealing with traumatic experiences by building personal capacities for emotional regulation, self-identity, and relationships (Luzzatto et al., 2022), and competences for building relationships and social support (Franco, 2022). The most discussed programs are multi-tier mental health program (Ellis et al., 2013); trauma treatment through art therapy (Luzzato et al., 2022), and trauma systems therapy for refugees (Franco, 2022).

The multi-tier mental health program developed by Ellis et al. (2013) includes (a) prevention and community resilience building for communities at large; (b) specific interventions in schools for at-risk students; and (c) direct interventions for those with significant psychological distress. At the base, the broadest type of services is implemented with the communities and parents (Tier 1) and includes community resilience building through engagement, education, and outreach. The second Tier is intended for Somali-speaking students in schools and intervention is focused on building individual resilience through school-based skills group. In the third tier, which presents the targeted services for those in psychological distress, students receive a phase-based model of trauma treatment (Ellis et al., 2013).

Trauma treatment through art therapy developed by Luzzatto et al. (2022) is an intervention aimed at patients suffering from severe PTSD, which focuses on their needs in six areas: emotion regulation, self-identity, relationships, gradual exposure to trauma, integration of trauma, and personal resources. The authors developed six Art therapy workshops that address all of these needs through several art-based workshops. These workshops are specially designed to build a safe environment in which families can re-experience traumatic events and become aware of the resources they have to manage these experiences.

Trauma system therapy for refugees developed by Franco (2022) addresses the needs of refugee children to build social support and close relationships. It is a four-tier approach aimed at treating traumatic stress in refugee children and adolescents. Tier One focuses on community and parent engagement through education about culture and mental health, understanding community needs, and de-stigmatizing mental health services. The focus of Tier Two is on increasing self-regulation skills, decreasing acculturative stress, and increasing social support. Tiers Three and Four focus on children and adolescents who have demonstrated significant mental health needs. These Tiers include individual therapy (focused on emotional regulation, increasing environmental stability, and cognitive restructuring) and home-based family therapy (developing skills to promote safety if they live in threatening environments and enhance family stability) (Franco, 2022).

Discussion

A number of the papers that were analyzed for this review discuss forced migrants’ trauma through the experiences of forced migrant families; fewer papers discuss ways in which forced migrant trauma can be treated (Allan et al., 2015; Greene et al., 2018). The papers analyze multiple experiences of trauma in forced migrant families, among both parents and children and at different stages of their migration journey including before and during migration and when they reach their country of destination, and the impact of trauma on the well-being of forced migrant families (Greene et al., 2018). Experiences of forced migrant families inform TIA and TIC.

Trauma is perceived through a framework of risk and protective factors and the studies establish several risks for traumatic experiences such as fleeing war, persecution, and violence, while protective factors are mostly analyzed as individual, familial, and societal (Davis et al., 2021; Grant & Guerin, 2014; Huntley et al., 2021; NeMoyer et al., 2019). Intersectionality theory (Al Hamad et al., 2022; Beaini & Shepherd, 2022) conceptualizes trauma through the intersection of gender, race, culture and the political, legal, and economic situation. The intersection of different forms of oppression and discrimination, such as racism and migration status, is recognized by other authors as an important aspect of TIA to forced migrants as it recognizes the unique experiences of each individual (Bastia, 2014; Lee & Choi, 2022).

This study highlights the interconnectedness between TIAs and the cultural, systemic, and narrative contexts specific to forced migrant families. Culture, encompassing beliefs, practices, language, and customs, influences emotional responses to trauma and must be central to TIA development for this population (Yohani et al., 2019). Culture acts as a mitigating factor shaping individual responses to trauma. TIAs recognize the diverse influences of previous life experiences, encompassing physical, social, and cultural environments, on trauma response and care interactions. TIAs are being embraced across diverse sectors, spanning healthcare, education, legal, and governmental domains, as a collective societal response to trauma. The reviewed papers underscore the importance of understanding cultural dynamics in supporting forced migrant families. By integrating cultural wisdom into trauma healing practices, TIAs aim to address both individual traumatic experiences and transgenerational trauma (Huntley et al., 2021; Ranjbar et al., 2020). This holistic approach acknowledges the multifaceted impact of trauma within migrant communities and emphasizes the importance of culturally sensitive interventions for effective healing and resilience-building.

In the context of TIAs toward migrants and refugees, it is imperative to recognize how forced migrants’ traumas are communicated within their present circumstances. The attachment paradigm underscores the importance of parental affective communication and open dialog regarding migration-related stressors, particularly concerning refugee children who have experienced traumatic events (Dalgaard et al., 2016). In addition, another perspective examines how intrafamily trauma communication occurs through parental disclosure of past traumatic experiences, often conveyed as family stories. These narratives serve as powerful tools for shaping individual and collective identity within the family system (Dalgaard & Montgomery, 2015). By acknowledging and understanding these communication dynamics, TIAs can be better tailored to address the specific needs of migrant and refugee populations.

It seems that across the analyzed papers, the terms TIC and TIA have been used interchangeably. While TIC focuses specifically on the provision of care and interventions, TIAs provide a more comprehensive framework that encompasses the principles and values that guide the provision of care. TIC focuses predominantly on the actual delivery of care and interventions (Das, 2019; Meléndez Guevara et al., 2021; Sangalang & Vang, 2017; Thirkle et al., 2021). It is concerned with how services and interactions are provided to individuals who have experienced trauma (Meléndez Guevara et al., 2021). TIC places a focus on creating an environment that is sensitive to trauma survivors’ needs, minimizing re-traumatization, and fostering a sense of safety and empowerment.

On the other hand, TIAs extend beyond the immediate care provision. It constitutes a more comprehensive framework encompassing the overarching principles and values that guide the entire process of delivering care. TIA involves not only the specific interventions but also the organizational culture, policies, and practices that integrate trauma-informed principles into all aspects of service delivery (Dalgaard et al., 2016; Meléndez Guevara et al., 2021).

In essence, while TIC addresses the practical aspects of care, TIA provides a broader perspective that considers the foundational principles shaping the approach to care within an organization or system. The interchangeability of these terms in the analyzed papers might indicate a need for clarity and consistency in distinguishing between the specific interventions (TIC) and the holistic framework guiding those interventions (TIA). Both concepts are used specifically when approaching forced migrants’ trauma and both are important in addressing the complex needs of forced migrant families who have experienced trauma.

TIAs have been extensively documented and successfully applied in healthcare and psychological interventions, spanning individual, family, and community sectors (Critelli, 2014; Das, 2019; Sangalang & Vang, 2017). These approaches emphasize understanding and responding to the impact of trauma on individuals’ well-being and mental health. However, despite their prevalence in certain sectors, there is a noticeable dearth of comprehensive findings regarding the extent of implementation and awareness across diverse regions and organizations. In some sectors and regions, there remains a notable lack of awareness and standardized implementation of trauma-informed principles (Van Ee, 2018; Weine et al., 2021). This variability can be attributed to factors such as differing cultural contexts, varying degrees of training and education, and disparities in organizational structures. Moreover, certain sectors, particularly within governmental or administrative systems, may still face challenges in fully integrating TIAs.

A number of approaches to TIC were identified through this analysis. Regardless of the background to these approaches (cognitive behavioral, culturally competent, or systemic), all the identified approaches to TIC use standardized protocols for targeting traumatic experiences to process and integrate trauma in forced migrant family life. All these approaches to trauma are based on the notion that the multiple traumatic experiences that force migrants to survive, not only affect inter and intrapersonal domains but also entire socioecological systems (Ellis et al., 2013; Im et al., 2021). The identified approaches present a number of programs and training for both professionals and refugees that focus on improving knowledge and skills that support the implementation of TIC. Training for refugees focuses on developing personal capacities to integrate and deal with traumatic experiences, as well as building competencies in creating relationships and seeking support in the community.

Training programs for mental health staff play a vital role in enhancing their proficiency in delivering TIC. The overarching objective of such training is to augment staff knowledge, awareness, and skills, with a specialized focus on addressing the unique challenges presented within the context of trauma. These programs aim to equip care providers with the tools necessary to navigate the complexities associated with inadequate treatment and referral processes (Das, 2019; Van Ee, 2018; Fragkiadaki et al., 2020; Im & Swan, 2020).

In particular, the training emphasizes the importance of recognizing and understanding the specific issues presented by individuals who have experienced trauma (Das, 2019; Lamb,2020; Sanglang & Vang, 2017). This includes a heightened sensitivity to the diverse manifestations of trauma and an awareness of potential triggers that may contribute to re-traumatization through the course of mental health interventions. A key focal point of the training is to empower mental health staff to navigate the delicate balance between providing effective care and mitigating the risk of re-traumatization for service beneficiaries (Greene et al., 2018). This involves honing the skills necessary to create a therapeutic environment that is sensitive to the unique needs and vulnerabilities of trauma survivors while avoiding practices that may inadvertently perpetuate or exacerbate their trauma.

This review has limitations due to the context and type of research. First, the search strategy only revealed studies that specifically referred to approaches as “trauma-informed.” It is possible that some TIAs to services and support for forced migrant families were not recognized in this review because they were not explicitly referred to as “trauma-informed.” Second, the diversity of the cultural backgrounds of the families being studied may make generalizations less valid, as it is possible that different approaches could lead to divergent effects in different cultural groups. This study aimed to comprehensively grasp the concept of TIA for forced migrant families, with a particular focus on the last decade, given the heightened intensity of forced migration during this period. Nevertheless, it is plausible that certain studies predating this inclusion criteria may have explored forced migration within the frameworks of TIA and TIC. In addition, only studies published in English were included in this review. Relevant findings published in another language may be missing. The limited sample sizes and diverse designs of the studies that have been analyzed compromise the generalizability and comparability of findings. Finally, the results of the risk of bias assessment should be taken into consideration when interpreting the findings of this review.

Addressing these gaps in implementation and awareness is crucial for fostering a more inclusive and effective approach to TIC, ensuring that the benefits of such practices are realized across diverse contexts and for a wider range of individuals affected by forced migration.

Conclusions and Recommendations

This research emphasizes the contexts for understanding the trauma experienced by forced migrant families and the conceptualization of TIA for them. Understanding the trauma that is experienced by forced migrant families, as well as the impact on the family, the cultural context, and intersectionality, should be implemented within TIA that construct TIC within specialized tools and activities. A family-based approach to forced migrants’ trauma highlights the importance of communication in transgenerational understanding of migrant trauma. TIC should consider the impact of family dynamics, including separation from family members, loss of social support networks, and changes in roles and responsibilities. TIA for forced migrants and other vulnerable families should also take into consideration other specific characteristics to provide effective and culturally responsive support. They should be grounded in cultural sensitivity, language access, flexibility and adaptability, community engagement, and trauma-informed practices so that service providers can better support the unique needs and experiences of families and promote healing, resilience, and well-being.

It is important to remember that care providers do not come from a neutral position but rather must have self-awareness of their own culture, personal history, and implicit biases to better understand forced migrants’ needs and enhance their capacity to promote healing. Rather than operating from the assumption that forced migrant families need special treatment because they come from a given culture or social context, care providers should consider that forced migrants’ culture may serve as a source of strength and provide them with valuable resources for healing.

Supplemental Material

sj-docx-1-tva-10.1177_15248380241266161 – Supplemental material for Systematic Review of Trauma-Informed Approaches and Trauma-Informed Care for Forced Migrant Families: Concepts and Contexts

Supplemental material, sj-docx-1-tva-10.1177_15248380241266161 for Systematic Review of Trauma-Informed Approaches and Trauma-Informed Care for Forced Migrant Families: Concepts and Contexts by Anita Burgund Isakov and Violeta Markovic in Trauma, Violence, & Abuse

Footnotes

Acknowledgments and credits

The authors extend their gratitude to the University of Sheffield, the Department for Sociological studies.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This article is part of the project MIGREC (Migration, Integration and Governance Research Centre), funded through Horizon 2020 program, grant contract number 857261.

ORCID iD

Anita Burgund Isakov

Supplemental Material

Supplemental material for this article is available online.

Notes

Author Biographies

Anita Burgund Isakov, PhD is an associate professor and the head of the research center for social policy and social work at the Faculty of Political Science University of Belgrade. Her research focus is on child protection, child trauma, resilience, and family support.

Violeta Markovic is a social worker, teaching assistant, and a PhD Candidate at the Faculty of Political Science University of Belgrade, Department for Social Policy and Social Work. Her research focus is on the topics of migration, specifically the protection of children and families in migration, crisis interventions, and social work. Her PhD focuses on Child Labor among unaccompanied and separated children in migration.

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