Rochester takes in more than 700 refugees annually from countries often devastated by wars and regional conflicts. And though the refugees are screened for mental and physical health issues, new research out of the University of Rochester shows that the screenings don't always detect developmental delays in children because of cultural differences and communication issues.
Roughly 30 percent of the 70,000 refugees who resettle in the US annually are children. The standard developmental screenings used to evaluate them sometimes lead to misdiagnosis, occasionally for serious disabilities, says Dr. Abigail Kroening, assistant professor of neurodevelopmental and behavioral pediatrics at the University of Rochester Medical Center. Kroening led the study.
The two standard screening tools for children are the Parents Evaluation Developmental Status and the Ages and Stages Questionnaire. Both rely heavily on parents having strong communication skills, but most of the refugees do not speak English well.
And there are other barriers, too. Parents may not know that their child has a delay, for example, or they might not think treatment is needed.
For example, in some cultures, a child's disability could be viewed as retribution for some offense, or even a curse, Kroening says.
A disability that slips past early detection can cause longer-term problems for the child and the family, making it difficult for the family to successfully integrate into a new society, she says.
Resettlement is hard enough for even the most resilient refugees, so identifying issues quickly is important, says Mike Coniff, executive director of the nonprofit Rochester Refugee Resettlement Services.
The goal is to help them settle and become self-sufficient, he says. And health care is a big part of it, especially for the children, he says.
"These are very vulnerable people," Coniff says. "They're citizen-less; many of them are without a country."
As a result, there's not often a huge emphasis on wellness and prevention, he says.
"They [parents] don't have an understanding of childhood developmental stages, so delays and illnesses can progress," says Ayan Abdi, a job placement specialist with the nonprofit. "By the time they come here, they're very confused."
If they have a sponsor in Rochester, it can make their resettlement much easier, Coniff says.
"There are health requirements to be met before their kids can enter school," he says. "Parents are able to work with someone they know and trust who can help them just by reassuring them that their child may need services, get them to doctor appointments, and navigate the various agencies."