COVID 19: Something for Everyone

 

COVID 19: Something for Everyone

 

 

Everyone in our IHP community (and beyond) has experienced grief and loss over the past twelve months.   Moving classes online, changing practicum experiences, cancelling social events, adding work, teaching kids at home, not seeing friends, having too much alone time were all part of the academic and work experience.  Deeper, more profound losses, illnesses, deaths, missing family, losing out on planned weddings or memorial services, and caring for loved ones have pierced our hearts collectively.   And then there is our collective and individual angst.  Will I lose my job? Will I graduate? How can I learn this way? Will I be able to collect data? When will school reopen?  Is anyone listening? When can I see my children, parents, or grandchildren again? 

I write this post, not as a trigger, but as a reminder of what we are moving away from. COVID-19 is not gone. While we continue to have to practice physical (not social) distancing, remember the masks when we go out, and to be careful in general we are seeing increased availability of the vaccine, slow return to previous activities, and a light of positivity leading us toward the last quarter of 2021.  We will get there. 

 I have discovered that it is helpful to acknowledge what is missing and what is disappointing or painful.  This is part of the way forward for all of us.   I found this video to be so helpful as I think about this past year.  I think many of you will also find it helpful. 

 The video is a COVID 19 memorial service held at Mass General earlier this month.   It is beautifully recorded, filled with reminders of the past, and also offering a look at what is ahead.  I hope that like me, you find it to be just what you need to begin looking forward.

 

 

Soul

Soul

In his book, The Soul of America: The Battle for our Better Angels (New York: Random House, 2018), Jon Meacham discusses some of the darkest times in American history and provides an important historical narrative about the incidents themselves and the American response.   Meacham will have the opportunity to add yet another chapter very soon.  This past weekend, on Saturday-the weekly Sabbath for Jews-a well-armed attacker brutally slayed 11 people and injured several more at their synagogue in Pittsburgh.   There is no debate about the motives of the attacker.   This was hate and Antisemitism brought to its most visible terror-filled violent conclusion.  Again, the combination of guns and hatred resulted in lives lost and a beautiful community damaged.  Again, our public leaders either use it for political discussion or ignore obvious solutions.  Again, the average citizen asks “how can this happen again and again?” in the land of the free.  How can this happen in the United States where the first amendment guarantees freedom of religion?

The reality is it can and does happen, right in front of us.  According to the Anti-defamation League (ADL), there was a 57% increase in reports of anti-Semitic incidents between 2016 and 2017.  This trend line continues.  This terrible slaughter in Pittsburgh is now an amplification of this statistic.  This is the largest murder of Jews in American history.  

These data, alarming on their own, complement the violent racist, misogynistic, sexist events that we have observed in recent times.  Think about Charleston, Charlottesville, Orlando, and now Pittsburgh and more.  There are many commonalities.  Their uniqueness comes in the stories of the people killed and injured.  They are young and old, parents and grandparents.  Lives lost. Targeted ethnic, racial, or sexual minorities.   Groups that many of us embrace for the beautiful diversity that they add to our otherwise bland culture have to experience this awfulness on a regular basis. 

I hope that you are offering thoughts and if appropriate to your tradition, prayers, for those lost in Pittsburgh this past weekend.   Their families and their community need us.  At this same time, do the same for those who have been victims of events of the past few years.  Dozens of victims and their families have been innocent victims of violence and hate.  For survivors and families, the hurt from these isolated events is persistent and should also be remembered.

The reality of all of this is that any targeted violence against any group of individuals is just wrong.  There is no reason to think otherwise, and there is an opportunity to speak out and bring change to this narrative.    What is to be our collective response to this?  As a first step, using the themes Meacham raised in his book, we can ask “where is our soul?  Where are our better angels?” We need to find them now.  Thanks for the inspiration, Jon Meacham. 

Part 6: Child Detainees- A Statement from Key Leaders

In this final contribution to this blog series, Dr. Inge Corless (Professor, School of Nursing) has shared a document that was prepared late last month by an interprofessional group of leaders to express concern over the separation of children and families.   Thanks to Dr. Corless for her leadership and willingness to share.  My hope is that this series of contributions adds to our collective understanding of the current situation affecting those being detained and separated.   As always, feedback is welcome!  Alex Johnson

Statement Concerning the Incarceration of Children and Adults

June 27, 2018

As an interdisciplinary, international group of health care practitioners, scholars, and experts in the field of loss and grief (including U.S. citizens), we are adding our collective voice in opposition to the current, continuing incarceration of children and their parents. The removal of children from parents can never be justified as a means of deterring migration, regardless of the driving forces. 

The family, in all of its different manifestations, is a core foundational unit of a stable society.  Separating children from their parents is known to have detrimental psychological effects for both children and their parents.  The effects of such traumatic stress can last for generations. 

Attachment, fostered within family systems, is a key factor in the physical, emotional and psychological growth and well-being of its members. Therefore, it is essential that all societies recognize their legal, moral and social responsibilities to respect, protect and fulfil children’s rights and needs within families. 

As members of the International Work Group on Death Dying and Bereavement we have extensive expertise in the areas of loss and grief. For children separated from their families, the resultant trauma has been shown to have profound, prolonged and intergenerational effects. For parents, the uncertainty of when or whether they will see their children again creates unbearable stress and grief.  The loss of a child is recognized as one of the most devastating losses one can experience. Families need safe and stable environments in which to effectively care for their children. Further, separation of children from their families has an impact on all inhabitants and is traumatizing not only for the affected individuals but also for the on-lookers; the children and adults for whom the current practice can also be traumatizing. The impact on law enforcement officers and other people charged with implementing a practice in violation of the Universal Declaration of Human Rights and the UN Convention on the Rights of the Child must also be considered.

We urge all governments, including the United States, to:

1.      End the human rights violations of vulnerable people, including separation of

       children from their families

2.      Rapidly reunite children with their families

3.      Treat asylum seekers with the customary care and respect heretofore given to such individuals.

We call on governments everywhere – including the United States Government- to fulfill their obligations under the United Nations 1951 Convention on the Status of Refugees towards all peoples who seek shelter and support outside their own countries of origin and, in particular, towards the most vulnerable of all: children. 

This statement was written by a group of concerned professionals in response to the separation of children and families entering the United States. This statement represents solely the opinions of the authors and signatories.

You have full permission to translate the document into other languages, and to distribute it via websites, blogs, the media, and other venues. It is our intention that the message be shared widely.

Contact information:  Inge B. Corless Icorless@mghihp.edu; 617 726-8018

Authors

Inge B. Corless PhD RN FNAP FAAN Professor, MGH Institute of Health Professions,

        Boston, MA. USA

Susan Cadell PhD Professor of Social Work, University of Waterloo, Waterloo, Canada

Debra Wiegand RN PhD FAAN Associate Professor, University of Maryland, Baltimore,

          MD. USA

Stacy S. Remke Professor, School of Social Work, University of Minnesota,

          Minneapolis, MN. USA

Irene Murphy M.Soc.Sc., C.Q.S.W, Director of Bereavement & Family Support Services,

        Marymount University Hospital and Hospice, Curraheen, Cork., Ireland. 

Andrea Warnick RN MA Andrea Warnick Consulting Guelph, Canada

Carrie Arnold PhD MED RSW CCC FT Thanatology, King’s College, London, Ontario,     

         CA

Lauren Breen PhD Associate professor Curtin University, Perth, Western Australia

Signatories

Jane Skeen MD Auckland,  New Zealand

Phyllis Kosminsky PHD LCSW, New York, New York, USA

Donna Schuurman EdD Portland, Oregon, USA

Janice Nadeau PhD Private Practice, University of Minnesota, Minneapolis, MN, USA

Kathleen Gilbert PhD Professor Emerita, Indiana University Bloomington, Indiana, USA

Janet McCord PhD FT Chilton, Wisconsin, USA

Ida Martinson RN PHD Bemidji, Minnesota, USA

David Roth Funeral Director Bergisch Gladbach, Germany

Gerry Cox PhD University of Wisconsin-La Crosse, Salina, Kansas, USA

Andy Hau Yan Ho PhD MFT FT, Nanyang Technological University, Singapore

Mary L Vachon RN PhD RP, University of Toronto, Toronto, Canada

Catriona Macpherson EdD, Children and Family Services, Scotland

Daniela Reis E Silva MCP FT Associacao de terapia Familiar de Espirito Santo, Vitoria,

         Brazil

Ronit Shalev PhD The Center for Academic Studies. Israel

Emmanuelle Zech, Professor, Universite catholique de Louvain, Belgium

Signatories (continued)

Wendy Bowler PhD, La Trobe University, Melbourne, Australia

Tammy Bartel MA RCC CT, Private Practice, Surrey, British Columbia, Canada

Danai Papadatou Professor of Clinical Psychology, National and Kapodistrian University

           of Athens, Athens, Greece

Chris Paul Trauerinstitut Deutschland, Bonn, Germany

Regina Szylit Professor of University of Sao Paulo, Sao Paulo, Brazil

Betty Davies,RN PhD University of Victoria, VictoriaBritish Columbia, Canada

Leslie Balmer PhD Psychologist Missisauga, Canada

Astrid Ronsen Assistant Professor NTNU Fjellhammer, Norway

Resources

American Academy of Nursing  https://higherlogicdownload.s3.amazonaws.com/AANNET/c8a8da9e-918c-4dae-b0c6-6d630c46007f/UploadedImages/docs/Press%20Releases/2018/2018-Acadeny_Statement_on_Separation_of_Children-Parents_at_Border-B.pdf

American Association of Colleges of Nursing  https://www.magnetmail.net/actions/email_web_version.cfm?ep=6xX3RWT_y-Zgujfys_wwVkRGGCsKXlDaepEmTtUbLptDKLu3Ttt1eYpB-vas2C2h7aqIonSWtTH3UkUNao2TEpWs86W4Vj14RWvuVMkfF5p1sZQZM_N2fxlRUMC1ms9j 

American Family Therapy Academy  https://afta.org/2017/01/afta-stands-opposition-trumps-executive-order-immigration/

Canadian Nurses Association https://www.facebook.com/198399493508835/posts/2228154517199979/

International Family Nursing Association https://conta.cc/2I8XFwB

National Council on Family Relations (NCFR)

 https://www.ncfr.org/news/negative-effects-separating-families-us-mexico-border

Physicians for Human Rights:  http://physiciansforhumanrights.org

United Nations Health Commission on Refugees (UNHCR).

http://www.unhcr.org/news/press/2018/6/5b27fea84/unhcr-urges-family-unity-southern-border.html

Detained Children-Part 5: Response to Confinement-Children and Parents

This is part 5 in a series of blog contributions from faculty members at the MGH Institute of Health Professions.   

Detainment. Separation. Neglect Abuse. Confinement. Cages.

Julie Keysor, PhD and Elise Townsend, PhD

Department of Physical Therapy
Andrea Fairman, PhD
Department of Occupational Therapy

None of these words are okay when it comes to people, and are even more deplorable when applied to children in the context of the recent U.S. policies about immigration. To see and hear the cries of detained children removed from their parents is heartbreaking. The stress from this situation will undoubtedly have long lasting effects on children and their families. Others in this blog are writing about the socio-emotional and psychological effects of this type of activity on children—the risk for significant short and long-term effects in these areas is crystal clear. My colleagues and I in our contribution to the blog are sharing a few thoughts on the physical health effects such situations can trigger.

From the most immediate and acute perspective, heart rate, blood pressure, and one’s ‘fight or flight’ nervous system will be triggered. These physiological changes may cause anxiety and behavioral responses. Limited opportunities to engage in play may result in global developmental delays including deficits in social, cognitive, sensory processing, gross and fine motor ability abilities. More specifically, prolonged restricted activity and movement will cause developmental delays in young children and could lead to abnormal bone growth and muscle development. Children will be at increased risk of developing chronic conditions such as diabetes, arthritis, and chronic pain, and these detained children have the risk of being under diagnosed or misdiagnosed leading to lifelong chronic disability, underemployment, and deprivation. The stress from this situation will impact health—no doubt—this is a health situation and affects health of the individual and our entire public health system.

And What about the Parents? 

Janice Goodman, PhD, 

Professor, School of Nursing

Most of the news has focused on the traumatic effects of separating parents and children at the border on children.  But, imagine also the anguish that a mother or father must feel to have their child ripped, crying and screaming, from their arms. Imagine not being able to comfort your child, to not even know where they are, who they are with, what is happening to them, if they are okay, when and even if they will ever see them again.  Just as with children, trauma and stress increases an adult's risk for mental illnesses such as depression, anxiety and post-traumatic stress disorder. Thus, it is heartbreaking, though not surprising, to know that Marco Antonio Muñoz, a Honduran man who crossed the border in May with his wife and 3-year old son, was so distraught that he kicked, screamed, and could not be calmed after his son was forcibly taken from him. Mr. Munoz was taken to a detention center and, less than 12 hours later was found dead in his cell, apparently having taken his own life. This is how this horrific policy affects parents!  It is beyond cruel. It is shameful and unacceptable.  

Instead of offering compassion and safety, by forcibly separating children and parents we are inflicting further trauma and suffering on vulnerable families who have already experienced extreme suffering -- in their home countries, and during their migration to what they hoped would be a safe place.  As health care providers, our purpose is to alleviate suffering – both physical and emotional.

Detained Children -Part 4: Interruptions in Nursing Bonding During Early Development

In this fourth contribution prepared by clinicians who specialize in early development of young children, the effects of disruption and separation in infants and toddlers are discussed.

Interruptions in Nursing and Bonding During Early Development

Emily Zeman, OTD MS, OTR/L, Department of Occupational Therapy
 and Lesley Maxwell, MS, CCC-SLP, Department of Communication Sciences and Disorders

Regarding the news of infants being torn away from their nursing mother, and family separation in general:

An infant's development is dependent on the information they obtain from the environment.  Infants and newborns rely heavily on oral-motor, scent, taste, and touch sensory experiences in the context of the parent-infant and family bonds and daily routines in all environments.  A sudden change in the social and physical context, accompanied by negative experiences, may interfere with typical developmental trajectory. Overstimulated, neglected, and abused infants, resulting from sudden family separation, may present with negative behavioral traits later in development (Cronin & Mandich, 2016). A sudden removal of the nursing or caregiving parent may significantly endanger the rich environmental context of the parent-child bond, ideal for stimulating neuronal connections and supporting healthy socio-emotional development.  Such separation becomes an adverse childhood experience (ACE).  As infants are dependent, high quality and positive child-parent interactions are vital for healthy socioemotional development and a sense of security.  Infants require attentive parental attention and presence to ensure safety and adherence to a feeding schedule that promotes physical growth and typical attachment bonding patterns, all setting the stage for successful emotional development.  However, the stressful and sudden removal of a parent or parents from an infant may trigger an association of new feeding routines or format (to bottle), with strangers, as traumatic, and thus, not a positive experience.  Feeding and eating routines, as disrupted, may then alter not only the bonding process, but the infants typical progression in feeding milestones and expectations for nourishment.  All of this could lead to failure to thrive, a myriad of health concerns, and changed emotional affect in the child.  Even with return to parents at some point in the future, the infant will be forever changed by the stress caused by the separation.

Young Develop in an Environment of Relationships

Suggested citation: National Scientific Council on the Developing Child (2004). Young Children Develop in an Environment of Relationships: Working Paper No. 1. Retrieved from

https://developingchild.harvard.edu/resources/wp1/ (link to working paper and references)

“An “environment of relationships” is crucial for the development of a child’s brain architecture, which lays the foundation for later outcomes such as academic performance, mental health, and interpersonal skills. However, many of our nation’s policies fail to consider the importance of adult-child relationships for child well-being. This working paper from the National Scientific Council on the Developing Child explains how these relationships shape child development, and identifies ways to strengthen policies that affect those relationships in the early childhood years.”

The Science of Neglect

“Young children who experience severe deprivation or neglect can experience a range of negative consequences. Neglect can delay brain development, impair executive function skills, and disrupt the body’s stress response. This working paper from the National Scientific Council on the Developing Child explains why neglect is so harmful in the earliest years of life, and why effective interventions can improve long-term outcomes in learning, health, and the parenting of “the next generation.

Suggested citation: Center on the Developing Child at Harvard University (2012). The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain: Working Paper No. 12. Retrieved from www.developingchild.harvard.edu.

https://developingchild.harvard.edu/resources/the-science-of-neglect-the-persistent-absence-of-responsive-care-disrupts-the-developing-brain/ (link to working paper and references)

Toxic Stress

https://developingchild.harvard.edu/science/key-concepts/toxic-stress/

• “Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.

When toxic stress response occurs continually, or is triggered by multiple sources, it can have a cumulative toll on an individual’s physical and mental health—for a lifetime. The more adverse experiences in childhood, the greater the likelihood of developmental delays and later health problems, including heart disease, diabetes, substance abuse, and depression. Research also indicates that supportive, responsive relationships with caring adults as early in life as possible can prevent or reverse the damaging effects of toxic stress response.”

The Importance of Serve and Return Between Parent and Child

https://developingchild.harvard.edu/science/key-concepts/serve-and-return/

“Because responsive relationships are both expected and essential, their absence is a serious threat to a child’s development and well-being. Healthy brain architecture depends on a sturdy foundation built by appropriate input from a child’s senses and stable, responsive relationships with caring adults. If an adult’s responses to a child are unreliable, inappropriate, or simply absent, the developing architecture of the brain may be disrupted, and subsequent physical, mental, and emotional health may be impaired. The persistent absence of serve and return interaction acts as a “double whammy” for healthy development: not only does the brain not receive the positive stimulation it needs, but the body’s stress response is activated, flooding the developing brain with potentially harmful stress hormones.”

https://developingchild.harvard.edu/science/deep-dives/mental-health/

Detained Children Part 3: Why do families flee?

This is part 3 in the continuing discussion of childhood detainees and its effect on their development.  One question that can be asked is "why are these people bringing their children to the U.S?"  What motivates immigration in this way.
In today's contribution , Professor Antonia Makosky (School of Nursing) describes her experience in dealing with a woman and her children in the Congo, while serving with Doctor Without Borders.  Antonia draws an important parallel to the current crisis in the US, citing the United Nations High Commission for Refugees' position on family unity.  I found the statement to be an important beacon in this discussion.  Thanks to Antonia for sharing this important message and for her service in the Congo.

Childhood Detainees, Part 3

Antonia Makosky, DNP, MSN, MPH, ANP-BC

Assistant Professor, School of Nursing

In my last trip to the Eastern Congo with Doctors without Borders I was posted in an area where the war had just recently ended.  Rebels still hid in the forests with their families.  One day, as we prepared to head home from a community health center, the nurse manager asked if we could take a family back to our hospital.  The family consisted of a woman and her three children; the woman was the wife of one of the rebels.  They had been hiding in the forest but now her middle daughter, age 3, was severely malnourished, and would die without special care.  The woman, her 8-year-old, and her infant son, were also malnourished.  The woman and her 8-year-old daughter were quiet and shy. 

It was against the usual policy to admit a family with multiple children unless the woman was pregnant.  However, the staff felt very strongly that we must take in and provide shelter and care to this whole family.  The staff said to me repeatedly, “they have nothing.”  There was never a question of separating the family; of only taking the sickest child to care for.  In African hospitals, the patient is always accompanied by a family member. 

Initially the hospital staff was concerned for the life of the 3-year-old child.  She was cared for in the pediatric ICU.  Slowly she improved.  Meanwhile the health of the woman and her other two children improved as well.  The eldest daughter became less shy and more interactive. 

This family was fleeing from violence, as so many Central American families are now.  These families have suffered untold hardships and trauma as they make their way north to escape drug and gang violence in their home countries.  The United Nations High Commission for Refugees (UNHCR) espouses a policy of family unity.  According to the UNHCR:  The right to family life and family unity is a right that applies to everyone, including asylum seekers whose status has not yet been determined.  There are many benefits to maintaining the family unit, including returning a sense of normalcy, easing a sense of loss, attempting to ensure safety and protect against danger.  In particular, keeping the family together helps protect against human smuggling trafficking, common in both the Eastern Congo and along the Mexico-America border. 

I am relieved by the recent decision to end this cruel and dangerous policy of separating parents from children on our southern border.  We must do our best to reunite those children already separated from their parents, and prevent this practice from recurring in the future.

Reference: 

Nicholson, F.  2018.  The “Essential Right” to Family Unity of Refugees and Others in Need of International Protection in the Context of Family Reunification.  United Nations High Commission for Refugees.  Retrieved from http://www.unhcr.org/en-us/protection/globalconsult/5a8c413a7/36-essential-right-family-unity-refugees-others-need-international-protection.html?query=family%20policy

Detained Children: General Health Issues- Part II

This is Part II  of this blog, devoted to child detainees and their health issues.  First, Christopher Sim,  a faculty member in our Department of Physician Studies further describes some of the medical concerns for immigrant populations.   The second contributor is Dr. Mary Thompson, a pediatric nurse practitioner and faculty member at the IHP.  She continues with more specific information that may be useful to providers concerned with care of children who are in refugee situations.  

Note: In Part III we will begin to focus on some of the specific developmental concerns and mental health issues facing these children and their families and caregivers.

From Christopher Sim, MPAS, PA-C, DFAAPA

Whether children arrive in the United States as part of a prearranged immigration with advanced notice, in a more urgent refugee crisis, or as undocumented emigres, they typically are at risk from multiple health factors.  Approximately 3.7% of children living in the US were born in other countries. This includes 7.7% of Latino children and 16 % of Asian children (Yun, 2016).

Hepatitis B, tuberculosis, parasites, anemia and high lead levels are the most commonly encountered diseases in children new to the United States (McBride, 2016). This is complicated by the countries of origin from which these children travel from. Although some children from refugee populations benefit from government or non-governmental organizations in terms of nutritional support and preventive health services, most refugee children from Central American countries have not been as fortunate. These children would be susceptible on their own, but also pose the risk of transmitting disease amongst themselves in the housing environments currently operated by Immigration Control and Enforcement in the US. It is also conceivable that children who arrived without such infections may, if returned to their countries of origin, transmit preventable new infection in those settings.

Failure to address these issues when children are under the care of the United States is unethical, irresponsible, and contrary to acceptable standards of humanitarian treatment of refugees. At the very least, these children require baseline testing for the most common parasitic diseases, hepatitis, tuberculosis, and lead screening. In identifying preexisting disease, public health authorities would be able to make insights into epidemiologic patterns and document current health states amongst these populations. Vaccination among these children is also either difficult to verify, if not impossible. Such children should also receive the same immunizations required of native-born US children, in the common interest of public health.

                                                                    References

Yun, K., Matheson, J., Payton, C., Scott, K. C., Stone, B. L., Song, L., . . . Mamo, B. (2016). Health Profiles of Newly Arrived Refugee Children in the United States, 2006–2012. American Journal of Public Health,106(1), 128-135. doi:10.2105/ajph.2015.302873

Mcbride, D. L. (2016). Large Study of Health Issues for Newly Arrived Child Refugees. Journal of Pediatric Nursing,31(2), 222-223. doi:10.1016/j.pedn.2015.11.014

From Mary Thompson, PhD, RN, CPNP-PC

The American Academy of Pediatrics (AAP) has adopted a Toolkit to inform health providers of “common matters” related to the healthcare needs of immigrant children, which can be accessed here: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Immigrant-Child-Health-Toolkit/Pages/Immigrant-Child-Health-Toolkit.aspx

According to the Toolkit, many children who are newly immigrated have not had regular medical care in their country of origin. They require specialized healthcare screening for: exposure to infectious diseases (such as tuberculosis, HIV, and parasitic infections), immunization history (if known), medical history (including birth history), nutrition history, medications and use of complementary and alternative treatments, environmental hazards (including lead exposure), exposure to (tobacco, opium/heroin, and other drug use), dental history, social history, educational history, and sexual or other abuse.  Children who undergo forced separation due to immigrant enforcement may not be able to provide this information.

Many children who have newly immigrated have faced ACE’s prior to immigrating from their country of origin, or during their immigration. Separation from parents further exacerbates the negative effects from the exposure of ACEs. These children demonstrate a number of health problems, including anxiety, depression, poor school performance, sleeping and eating disruptions. Table 1 from the Toolkit includes a list of Mental Health and Developmental Screening Instruments and Resources that can be used to assess the mental health needs of immigrant children separated from their parents.

The United Nations High Commissioner for Refugees (UNHCR) document titled: Refugee Children: Guidelines on Protection and Care  offers insight in how to be responsive and acknowledge the needs of children affected by separation from their caregivers during immigration. In the immediate, children should be provided with appropriate:

Play: “Play is vital to the healthy development of a child. It is a child's way of coping with what has happened, of relaxing and relieving tensions and of assimilating what (s)he has experienced and learned. . . Playgrounds Refugee camps, settlements or reception centers should have play areas from the outset.”

Infants: “Breast feeding should be facilitated. . . Children of about 10 months (who are just about to develop speech, crawl and walk) are particularly vulnerable. In such situations the integration of infant stimulation programmes in other emergency services, such as feeding programmes, has proven helpful.”

Developmental Screening: “. . . is needed to identify children whose development is delayed. This involves knowledge about what normal development in this specific culture means. A group of refugee mothers may be able to help you. - Intervention if there is abuse or neglect.”

Counseling and Support Groups: “Children will become anxious when they do not understand what is happening to them. . . When a child becomes depressed, anxious or upset, the right to participate may effectively be lost: a child may not be able to process the information, and may not be able to make realistic decisions. Counselling to reduce stress may be necessary before children can focus on and absorb information fully. - Support groups: Encourage the creation of support groups where children have an opportunity to talk about problems and ways of addressing them. It is important that they understand that they are not alone and that they are not responsible for what has happened.”

Restoring Normalcy: “Restoring normalcy for unaccompanied children requires that tracing for parents begin immediately. When parents or relatives are located, children need help in maintaining communication with them until they can be reunited. . . The threat to psychosocial well-being is inevitably increased when lengthy or permanent disruptions occur between child and primary care-giver, or child and family. The loss of the mother, or substitute mother figure, particularly at an early age, places a child at a higher psychological risk. Arranging for substitute family care or immediate family reunion is critical.”

Perhaps most important of all:

Helping children by helping the family “The single best way to promote the well being of children is to support their family.”  This includes preserving family unity, tracing parents who have been separated, providing family support, establishing parental support networks, and helping families prepare for reunion by offering counseling.