martes, 15 de septiembre de 2015

CROSSROADS: The Psychology of Immigration in the New Century (Part II)



Immigrant populations in educational contexts

The size and diversity of today’s immigration flow is reflected in U.S. public schools. As of 2011, 23.7 percent of school-age children in the United States were the children of immigrants (MPI, 2011), the majority (77 percent) of whom were second-generation citizen children and the rest (23 percent) foreign-born (Mather, 2009). Approximately 10.7 percent of all public school students in the United States are classified as English language learners (ELLs)6 (MPI, 2011). There is tremendous diversity in the socioeconomic, cultural and linguistic backgrounds of these children. For example, elementary and middle school children in New York City public schools speak 167 languages and come from 192 countries (Stiefel, Schwartz, & Conger, 2003).

A resilience perspective

The pattern of high achievement among many first-generation immigrants is remarkable given the myriad challenges they encounter, including xenophobia, economic obstacles, language difficulties, family separations, underresourced neighborhoods and schools, and the struggle to get their bearings in a new educational system (V. W. Huynh & Fuligni, 2008; Pong & Hao, 2007; Portes & Zhou, 1993). Immigrant children demonstrate certain advantages. They enter U.S. schools with tremendous optimism (Kao & Tienda, 1995), high aspirations (Fuligni, 2001; Portes & Rumbaut, 2001), dedication to hard work, positive attitudes toward school (C. Suárez-Orozco & Suárez-Orozco, 1995), and an ethic of family support for advanced learning (Li, 2004). As mentioned in the introduction, immigrant youth often educationally out-perform their U.S.-born peers (Perreira, Harris, & Lee, 2006).

First-generation immigrant students show a number of positive academic behaviors and attitudes that often lead to stronger than expected academic outcomes. For example, compared with their U.S.-born peers, they have better attendance rates (García Coll & Marks, 2011), demonstrate more positive attitudes toward their teachers (C. Suárez-Orozco & Suárez-Orozco, 1995) and school (Fuligni, 1997), have higher attachment to school (García Coll & Marks, 2011; C. Suárez-Orozco & Suárez-Orozco, 1995), and earn higher grades (García Coll & Marks, 2011; Hernandez, Denton, McCartney, & Blanchard, 2011; Portes & Rumbaut, 2006). Some age groups have higher scores on standardized tests than do their American-born peers (García Coll & Marks, 2011), particularly on standardized math tests (Kao & Tienda, 1995). At the same time, a decline in academic aspirations, engagement and performance has been documented over time (C. Suárez-Orozco, Gaytán, Bang, et al., 2010) and across generations (Fuligni, 1997; Portes & Rumbaut, 2001; C. Suárez-Orozco & Suárez-Orozco, 1995).
On some measures of achievement and for some groups, first-generation students do not perform as well as their U.S.-born peers. First, because the first generation must contend with language acquisition, their performance suffers on tests of reading and English (Kao & Tienda, 1995; Ruiz-de-Velasco, Fix, & Clewell, 2000; C. Suárez-Orozco et al., 2008; N. Tran & Birman, 2010) when competing with U.S.-born peers. Second, a particularly difficult situation emerges for the group of immigrant children with interrupted or no prior education.
Immigrant students whose education has been interrupted, or who have had no prior education, face particular challenges in making a transition to U.S. schools. This includes children coming from conditions of poverty where older children are expected to work and secondary schooling is unavailable. Many refugee children arrive after prolonged stays in refugee camps, never having been in school, and some come from cultures with no traditions of literacy in any language (e.g., Van Lehman & Eno, 2003). It is estimated that 20 percent of all ELL high school students and 12 percent at the middle-school level have missed 2 or more years of schooling (Ruiz-de-Velasco et al., 2000).
Students with interrupted formal schooling arrive with limited literacy skills in their native language, and they need to master a new language, literacy and gaps in knowledge across academic subjects at the same time (Birman & Tran, in press). Lacking the expected skills to complete homework assignments or participate in most classroom activities (Cassity & Gow, 2005; Dooley, 2009) — or in extreme cases, even knowledge of how to act in the classroom and perform pencil and paper tasks (Alsleben, 2006; Birman & Tran, in press; Brock, 2007) — they face distinctive challenges in adjusting to school.
All arriving newcomer students must surmount daunting obstacles, including developing academic English skills (Carhill, Suárez-Orozco, & Paéz, 2008) and fulfilling graduation requirements (Ruíz-de-Velasco, Fix, & Clewell, 2000) in a high-stakes testing environment not designed with their educational obstacles in mind (Hood, 2003; Menken, 2008). Some of these youth may never enroll in school, arriving with the intention to work (C. Suárez-Orozco, Gáytan, & Kim, 2010). Others enroll and quickly drop out, encountering frustrations with language acquisition as well as schools not equipped to serve them (Ruiz-de-Velasco et al., 2000; C. Suárez-Orozco et al., 2008). In general, first-generation youth are about three times more likely (29 percent) to drop out of school than their U.S.-born counterparts (10 percent). That effect, however, is primarily attributed to immigrant Latinos/as, who drop out at an alarming rate of 46.2 percent. It is important to note that graduating from high school portends positive outcomes. In a longitudinal study, Fuligni and Witkow (2004) reported that the postsecondary educational attainment patterns of immigrant students who graduated from high school were similar to their native-born peers.
Immigrant-origin students face some distinctive experiences similar to those of the first generation. Both groups share immigrant parents who tend to expect respectful behaviors toward authorities like teachers (García Coll & Marks, 2011; C. Suárez-Orozco & Suárez-Orozco, 2001) but who often do not have the knowledge to navigate the unfamiliar educational system in the United States (C. Suárez-Orozco et al., 2008). Though born in the United States, if students grow up in non-English-speaking homes, they enter schools needing to acquire English just as they learn to read. This places them at a transitory disadvantage if they are not provided adequate educational supports (Bialystok, Majumder, & Martin, 2003; O. García, 2009).
On the other hand, they have some unique advantages that the first generation did not. All are automatically U.S. citizens, and some will not have the language acquisition hurdle, particularly if they live in neighborhoods where they are regularly exposed to English language models (C. Suárez-Orozco & Suárez-Orozco, 2001). Yet, the second generation may be disadvantaged, as they are less buffered by immigrant optimism (Kao & Tienda, 1995) and the dual frame of reference of recognizing that although their life may be difficult in the new context, they may have unique opportunities as well (Fuligni, 2011; C. Suárez-Orozco & Suárez-Orozco, 2001).

Context matters

The context of resettlement shapes the experience of immigrant students in their neighborhoods, families and schools. A number of factors, including family capital and school resources available to newcomer students, can bolster or undermine academic integration and adaptation (C. Suárez-Orozco, Gaytán, & Kim, 2010).
Family-of-origin capital
Immigrant students arrive in the United States with an array of parental resources (Portes & Rumbaut, 2006; C. Suárez-Orozco, Gaytán, & Kim, 2010). Although some immigrant students come from privileged backgrounds, children living in families headed by immigrant parents are more likely to be living in poverty than their nonimmigrant-origin peers (Mather, 2009). This is a significant issue to consider, as immigrant children are more likely to be raised in circumstances of poverty than any other group of children residing in the United States (Mather, 2009). Educational attainment within the first generation is closely, but not exclusively, tied to parental educational levels (Portes & Rumbaut, 2001). Youths arriving from families with lower levels of education tend to struggle academically, while those who come from more literate families and with strong skills often flourish (Kasinitz et al., 2008; Portes & Rumbaut, 2001). Highly literate parents are better equipped to guide their children in studying, accessing educational information (Goldenberg, Rueda, & August, 2006), and supporting literacy development either in their native language (U.S. Census Bureau, 2007) or in English (Páez, 2001; Portes & Hao, 1998).
School resources
U.S. schools are often not well prepared to serve immigrant-origin students. Schools that serve ELL students have chronic shortages of teachers with specialized training, and principals, counselors and other support staff rarely have such specialized training either (Ruiz-de-Velasco et al., 2000). In general, education of immigrant-origin students is conceived of “as a special or add-on activity outside what school staff often considers the ‘normal’ functions of the secondary school” (Ruiz-de-Velasco et al., 2000, p. 58). Thus programming to meet the needs of these students often happens in the absence of sufficient expertise or clear standards.
Immigrant-origin students are often segregated in neighborhoods marked by poverty and low-performing schools (Hernandez et al., 2007). Nationally, immigrant Latinos/as in particular tend to settle in highly segregated and deeply impoverished urban settings and attend the most segregated schools of any group in the United States. In 1996, only 25 percent of Latino/a students attended majority White schools (Orfield & Lee, 2006). In school, ELL students are often taught in classrooms separated from the other students (Olsen, 1997), and in many cases, they do not have much meaningful contact with their U.S.-born English-speaking peers (Carhill et al., 2008; C. Suárez-Orozco et al., 2008). Such separations have been associated with reduced school resources and a variety of negative educational outcomes, including low expectations, difficulties learning English, lower achievement, greater school violence and higher dropout rates (Gándara & Contreras, 2008; Orfield & Lee, 2006).
Through a parallel process, ELL (bilingual and ESL) teachers also experience marginalization in the broader school context (Bascia, 1996; Lucas, 1997; Olsen, 1997; Portes & Rumbaut, 2001; Stanton-Salazar, 2001; C. Suárez-Orozco & Suárez-Orozco, 2001; Trickett et al., 2012) reflected in insufficient access to needed educational resources, inadequate teaching space and facilities, exclusion from educational decision making and lack of feedback or support from colleagues who teach in mainstream classrooms (Markham, 1999; Olsen, 1997). With limited resources and support and a wide range of English-language skills and educational backgrounds, ELL teachers struggle to create individualized educational opportunities for their increasingly diverse immigrant-origin students (Trickett et al., 2012).

Language-related educational challenges and models of language instruction

Acquiring the language of the new country is a critical aspect of academic transition for first-generation immigrant students. According to an Urban Institute report (Capps et al.,2005), 62 percent of foreign-born children speak English less than “very well.” However, there is a great distinction between interpersonal communicative English and academic English. Although developing academic second-language skills generally requires between four and seven years of optimal academic instruction (V. P. Collier, 1987, 1992; Cummins, 1991, 2000), students in the United States are generally expected to transition out of second-language acquisition programs within three years.
While schools place an emphasis on learning English, research, though counterintuitive, consistently suggests that a greater degree of literacy instruction in the native language leads to greater academic success in English (Goldenberg, 2008). Goldenberg (2008) cited five meta-analyses (August & Shanahan, 2006; Greene, 1997; Rolstad, Mahoney, & Glass, 2005; Slavin & Cheung, 2005; Willig, 1985) and a comprehensive review (Genesee, Lindholm-Leary, Saunders, & Christian, 2006) that concluded that learning to read in the home language promotes reading in the second language. When students are well grounded in their native language and have developed reading and writing skills in that language, they are better able to apply that knowledge efficiently to the new language when provided appropriate instructional supports (Butler & Hakuta, 2005). Unfortunately, however, many immigrant students do not encounter robust second-language-acquisition educational programs and often face individual disadvantages and structural linguistic isolations that may hinder their adequate academic English development (V. P. Collier, 1992; C. Suárez-Orozco et al., 2008).
Cognitive effects of being bilingual
There is extensive literature on the effects of linguistic experience on cognitive performance that suggests there are positive and negative effects of being bilingual (Bialystok, 2009). Although, as Bialystok pointed out, “knowing more has never been a disadvantage when compared with knowing less” (p. 192), bilingual individuals do generally have a smaller vocabulary in each language than do monolingual speakers. Similarly, bilingual persons tend to score lower on verbal fluency and lexical access tasks and are slower in naming pictures (Bialystok, 2009). As a result, timed tests of verbal ability that are used as markers of cognitive development may erroneously suggest some degree of impairment in bilinguals compared with monolinguals.
In direct contradiction to this kind of evidence, however, it also appears that multiple language fluency leads to better executive functioning. Because being bilingual entails a constant need to control access to different language memory stores, bilingualism appears to improve controlled inhibition tasks, selective attention, attention shifting and updating of working memory (Bialystok, 2009). Thus, compared with monolinguals, bilingual populations appear better able to resolve linguistic tasks with ambiguous or contradictory meanings. In fact, multilingualism may provide protection against some aspects of age-related cognitive loss. In general, bilinguals show improved performance on tasks that require response selection decisions and conflict resolution tasks (Bialystok, 2009).
Second-language instruction
Second-language instruction is a critical component to ensuring the academic success of immigrant-origin youth (Batalova, Fix, & Murray, 2007). There are numerous models of bilingual and language assistance programs for a wide array of practices, programs and philosophical approaches (Thomas & Collier, 2002).
  • Limited pull-out instruction in ESL classrooms is most often used with learners from different countries who speak different languages; the rest of the day is spent in regular classes.
  • Transitional bilingual programs provide academic support after students transition out of their language of origin into English.
  • In one-way developmental bilingual programs, students of one language group are schooled in two languages (e.g., English and Spanish) so they can keep up with academic material in their native language as they learn English.
  • In structured immersion programs, the curriculum is simplified and is taught more slowly in English, and with a great deal of repetition.
  • In sheltered English programs, all lessons in every subject are at least in part a second-language lesson; thus a science class is also an opportunity to learn new vocabulary.
  • Dual-language immersion classes involve students learning half of the time in English and half in their native language, with half of the class being English speakers and the other half native speakers of another language. This kind of program offers greater opportunity for students to truly become bilingual and expand their academic skills by drawing on both languages.
Research suggests that bilingual education programs produce better results in terms of academic success than English language immersion programs (Goldenberg, 2008). Proficiency in the native language is related to academic achievement in the second language (Riches & Genesee, 2006). For younger students, children’s native language skills support literacy development because literacy skills transfer. When learning to read, learning to recognize phonetic symbols in their native language can speed up the literacy process (August, 2002; G. E. García, 2000; Lindsey, Manis, & Bailey, 2003). Advantages to native language instruction in later grades have also been found (Slavin & Cheung, 2005), though few published studies of educational programs are of high quality (longitudinal, randomized), and more research is needed to understand the process of second-language acquisition in school (Goldenberg, 2008).
Finally, none of the educational structures for ELL students reviewed previously are designed to meet the specific needs of students with interrupted or no prior education. Newcomers with interrupted education are generally placed in the same bilingual or ESL classrooms as other students, leaving ELL teachers to struggle with how to meet their complex educational needs without additional support. While other countries such as Australia and Israel place newly arrived students into special year-long newcomer programs, the United States has essentially adopted a “sink or swim” approach, placing these students directly into mainstream classrooms with limited pull-out ESL support. Although a range of “newcomer” programs has been tried across varied U.S. school systems, there is no systematic research describing variations among them and testing their effectiveness for “underschooled” students (R. Constantino & Lavadenz, 1993).
In general, well-designed and implemented programs offer good educational results and buffer at-risk students from dropping out by easing transitions and providing academic scaffolding and a sense of community (Padilla et al., 1991). There is, however, a huge disparity in quality of instruction among settings. While it has been well demonstrated that high-quality programs produce excellent results, those plagued with problems produce, not surprisingly, less than optimal results (August & Hakuta, 1997; Thomas & Collier, 2002). Many bilingual programs unfortunately face real challenges in their implementation: inadequate resources, poor administrative support, and a dearth of fully certified bilingual teachers who are trained in second-language acquisition and can serve as proper language models to their students (U.S. Department of Education, 2002).

School belonging

In addition to language-related challenges, immigrant students must transfer their academic skills to the U.S. school environment and form relationships with peers and school adults. A sense of school belonging has been defined as the level of attachment, commitment, involvement, and belief students have in the value of their school (Kia-Keating & Ellis, 2007). This sense of belonging, in turn, has implications for increasing social involvement, motivation, school attendance, academic engagement and, ultimately, achievement (Hamre & Pianta, 2001). In addition, for immigrant students, sense of school belonging has been found to predict better mental health (Kia-Keating & Ellis, 2007), indicating the importance of feeling “at home” in their new environment.
Sense of school belonging can be fostered by social support from school peers and adults. Social support in the school has been linked to academic adaptation of immigrant students (Portes & Rumbaut, 2001; Zhou & Bankston, 1998). Positive relationships with school adults can help bridge the gap between home and school cultures and create important linguistic and cultural connections to the new society (Wang, Haertel, & Walberg, 1994). Supportive relationships with caring adults in the school context also provide emotional sustenance and practical help and advice for newcomers, sometimes sparking active participation in subject areas that may have traditionally held little interest for students. Conversely, students may lose interest in the subject matter if they perceive a diminished interest in their progress on the part of the teacher.
English language learner (bilingual and ESL) teachers play a critically important role in the school experience of newcomer students. As “first responders” to the nation’s immigrant students, they tend to spend more time, in smaller classrooms, getting to know them and becoming their advocates in the school (Birman, 2005). Bilingual teachers have the additional advantage of being able to communicate with parents in their native language and serve as a bridge between home and school. These teachers are asked to fill a number of roles inside and outside the classroom often not formally recognized or valued by school authorities (Bascia, 1996; Trickett et al., 2012). They are often asked to fill gaps in educational programs that do not meet the needs of their students, provide professional development for mainstream teachers, reach out to students’ families, and search for additional resources unavailable at school to support their students (Bascia & Jacka, 2001). They are also blamed when their students do not perform well in mainstream classes (e.g., Olsen, 1997). Despite the tremendous importance of their work for immigrant-origin students, research suggests that ELL teachers are not sufficiently supported in this role (Trickett et al., 2012).

Parental involvement

Parental school involvement (e.g., participating in parent–teacher organizations, volunteering in class and chaperoning field trips) has shown profound effects on performance and adaptation to school for U.S.-born students (Henderson & Mapp, 2002). Teachers, in turn, view those parents as supportive of their children’s learning (Moles, 1993). For immigrant parents, however, such involvement may be neither a familiar cultural practice in their countries of origin nor a luxury their current financial situation allows (Birman & Ryerson-Espino, 2007; García Coll et al., 2002). Not speaking English and having limited education may make them feel inadequate when communicating with teachers. Lack of documentation may make them worry about exposure to immigration raids (Capps, Castaneda, Chaudry, & Santos, 2007). Low-wage, low-skill jobs with off-hour shifts typically do not provide much flexibility to attend parent–teacher conferences. The impediments to coming to school are multiple and frequently interpreted by teachers and principals as “not valuing” their children’s education.
Ironically, despite the prevalence of this perception among educators, most immigrant parents describe providing better educational opportunities for their children as the goal of immigration (G. López, 2001; C. Suárez-Orozco et al., 2008). Parents may be involved, but in ways different than expected by U.S./Western schools. Many immigrant parents come from cultural traditions where parents are expected to respect teachers’ recommendations rather than advocate for their children (Delgado-Gaitan, 2004). They see their role as supporting their children’s education at home and deferring to teachers during the school day. In addition, not having gone to U.S. schools themselves, immigrant parents often do not understand how schools are organized, what they expect from children (e.g., expressing opinions rather than rote memorization), or how to deal with learning problems or communicate with the school. Thus, teachers perceive immigrant parents as disinterested, reach out to them less, and as a result, the parents know even less about school matters (Huss-Keeler, 1997). Ideally, schools will make contact with immigrant parents in positive circumstances rather than waiting for a crisis (Adams & Christenson, 2000). Immigrant parents’ knowledge of school practices has been found to predict higher grades for immigrant students (Birman & Ryerson-Espino, 2007), suggesting the unique importance of such knowledge.

In conclusion

The successful incorporation of children of immigrants into the educational system is one of the most important and fundamental challenges of our time. In a knowledge-intensive economy, how they fare educationally will play a critical role in their future, and given their high numbers, in the kind of society we will become. Our education system faces a demographic “integration imperative” (Alba et al., 2011, p. 395) to prepare immigrant origin youth for “robust membership in the host society” (Alba et al., 2011, p. 397). Understanding the specific needs that different immigrant populations face vis-à-vis the education system is critical in determining appropriate interventions. Given the diversity of the immigrant student populations entering schools, it is clear that a one-size-fits-all model will not work. A number of common factors, however, have positive implications for the school performance and educational integration of immigrant students.
Newcomer youth typically face substantial language barriers, social isolation and difficulty understanding and adjusting to new teaching styles and academic expectations. In response, some school districts have begun to adopt strategies designed to meet the specific needs of newcomer students (R. Constantino & Lavadenz, 1993). Special schools and programs within schools have been developed to support newcomer students and create a community of peers who are experiencing the same dramatic transition to a new educational system, culture and language. While some schools and programs serve newcomer students for a short period of time, working toward the goal of moving them into a mainstream school, other schools serve these students for multiple years with the same academic offerings as the other schools in the district. Many of these schools and programs have developed innovative pedagogical methods that could be useful to all schools and teachers working with immigrant students and ELLs, though research that evaluates effectiveness remains critically lacking.
Some of the fiercest debates related to immigrant education center around the issue of second-language development. Cross-country comparisons of good practice demonstrate that it is essential to make “long-term investments in systematic language support” (Christensen & Stanat, 2007, p. 2) and to provide preservice and professional development training for teachers to help them appropriately support their ELL students. Although ideology often competes with scientific evidence in determining how children should be taught to develop new language skills, some efforts are demonstrating real promise in facilitating language acquisition. The diversity of political and ideological climates means that in each district, certain programs are more or less likely to be adopted, regardless of their proven effectiveness. However, innovative approaches are being developed in divergent contexts and offer a range of options worthy of study and emulation (see Christensen & Stanat, 2007; C. Suárez-Orozco, Suárez-Orozco, & Sattin-Bajal, 2009).
To effectively educate and integrate all immigrant-origin students, every educator and support staff member in the school should consider immigrant students’ education as part of their responsibility. Instruction of immigrant-origin children resides almost exclusively in the domain of a small cohort of ELL teachers, who are marginalized along with their students and receive little guidance or support (Trickett et al., 2012). As a result, the rest of the school community may not feel sufficiently involved in ensuring these students’ academic success (C. Suárez-Orozco, Pimentel, & Martin, 2009). These students’ needs go beyond second-language development to include cultural adaptation, social support and assistance in general academic subjects. Therefore, schools should provide ongoing professional development to all faculty and staff on how to work with immigrant-origin children.
Just as teachers across academic disciplines are being called on to incorporate literacy-building activities into their lessons, the same must be true for taking on the education of immigrant-origin students as a schoolwide endeavor. School personnel will also require training in effectively communicating with parents of different national, cultural and linguistic backgrounds. The importance of family involvement in children’s education has been well substantiated in the research literature (Fantuzzo, McWayne, Perry, & Childs, 2004). Immigrant children’s need for parental involvement and support may be particularly acute, given that they are simultaneously adapting to a new country, a new educational system and often a new language (Birman & Ryerson-Espino, 2007).
Recognizing the varieties of cultural models of family involvement immigrant families bring with them will reduce some educators’ inaccurate stereotyping of immigrant parents’ commitment to their children’s education (C. Suárez-Orozco et al., 2008). Regardless of parents’ preferred form of involvement, keeping them abreast of their children’s academic progress, sharing important notices and events, and communicating information about school policies are some of the most critical ways in which school districts can work to promote parental involvement.
In many cases, however, immigrant parents face substantial challenges to engaging with their children’s school and understanding the information they receive, not the least of which are language and communication barriers. Efforts to provide professional, culturally relevant translation and interpretation services can go a long way toward improving home–school relationships, bolstering communication, and increasing immigrant families’ sense of comfort with their children’s school and their teachers’ understanding of the family’s circumstances. Ultimately, children can benefit tremendously when their parents are well-informed about their education, but this can only happen when parents have access to the information they need to support their children and intervene when necessary (Birman & Ryerson-Espino, 2007; C. Suárez-Orozco, Suárez-Orozco, & Sattin-Bajal, 2009).
Increasingly, higher educational credentials have become basic requirements for entry into the skilled labor market. Awareness of the importance of acquiring postsecondary credentials and the process it takes to access these opportunities is a key issue related to the successful integration and education of children of immigrants. Navigating the maze of colleges, universities, and vocational and technical programs that exist in different societies is a challenge for anyone who is among the first generation of his or her family to go to college, but even more so for those with parents who do not speak the language and have no familiarity with the national educational system (C. Suárez-Orozco, Gaytán, & Kim, 2010). It is critically important to assist immigrant families in the process of searching for schools, applying for admissions, and securing grants and loans. Without such assistance, a generation of youth may end up undereducated, underemployed, and unable to participate in the global economy and our society (C. Suárez-Orozco, Gaytán, & Kim, 2010).
In a knowledge-intensive economy, higher education has become more important than ever before. While immigrant-origin youth from some countries are finding themselves highly competitive in college access and completion, other groups fail to access higher education (Baum & Flores, 2011; Hagy & Staniec, 2002). The status of being of immigrant origin is not in and of itself the impediment to higher education — indeed, there is evidence that for most immigrant-origin groups, first and second generation fare better than third generation in both college access and attainment of bachelor of arts degrees (Hao & Ma, 2011). Rather, it is individual and familial characteristics (such as parental education, race, generation, country of origin) as well as school, community, and legal barriers encountered in the host setting that serve to explain the variation in higher education attainment (Baum & Flores, 2011). Notably, more immigrant students attend community colleges than any other type of postsecondary institution, as they are affordable, provide English-language courses, have open admissions policies and offer the promise of preparing students for the labor market (Teranishi, Suárez-Orozco, & Suárez-Orozco, 2011).
Meeting the needs of immigrant-origin students has not been a national priority in today’s high-stakes testing, school reform environment (Menken, 2008; C. Suárez-Orozco et al., 2008). This population is indeed continuously “overlooked and underserved” (Ruiz-de-Velasco et al., 2000). Moving forward, more systematic attention should be focused on their educational needs. This requires a comprehensive research and public policy agenda to establish efficacious educational practices addressing the specific learning needs of immigrant-origin students. 
6 Emerging bilinguals is a term preferred by some scholars (see O. García, 2009; O. García, Kleifgen, & Falchi, 2008; Reyes & Azuara, 2008) who emphasize the bilingual competencies of immigrant-origin children and advocate for educational policies that develop their home language and cultural understandings. In this report, we use the term English language learner (ELLs), as it emphasizes the common experience of acquiring English primarily (though not exclusively) in a school environment and is more inclusive of multilingual and multidialectal children (e.g., indigenous peoples from Oaxaca of Mexico speak dialects of Mixteca; for them Spanish is already their second language. Such is also the case for individuals from the Fujian province in China; Mandarin is their second language). The use of this term in no way is intended to denigrate the value of home language and cultures or advocate for the superiority of English monolingualism; in fact, ELL replaces Limited English Proficient, a term used by the federal government which did perpetuate a deficit-perspective of this population. While the term English language learner refers to a fluid category of students who do not meet levels of proficiency in school settings (variously defined across contexts) and is problematic in this respect, it is the term currently most widely used by researchers, policymakers, and school districts.

Immigrant populations in clinical contexts

Many immigrants adapt well to and thrive in their new living circumstances. They do so by navigating multiple sociocultural contexts in positive ways that contribute to their well-being and success in the United States. Studies suggest that first-generation immigrants may actually experience less psychological distress than second-generation immigrants (Alegría, Canino, Stinson, & Grant, 2006). While the “immigrant paradox” (see the Introduction) may lead to the conclusion that the first generation has reported lower than expected negative mental health outcomes, several caveats should be considered. It may be that the first generation is healthier than subsequent generations, but it may also be that several different issues are artificially deflating or confounding these prevalence rates. It may be possible that first-generation persons
  • experience different disorders than ones included in Western psychiatric classification systems (e.g., neurasthenia) (S. Sue & Chu, 2003);
  • have different idioms of distress (e.g., ataque de nervios) (Guarnaccia et al., 2007; I. López, Dent, et al., 2011);
  • experience their symptoms in culturally different ways (e.g., fatigue or malaise instead of “depression”) (Pumariega, Rothe, & Pumariega, 2005);
  • are less likely to report their symptoms if they feel self-conscious about doing so (Nadeem et al., 2007); and
  • are less likely to avail themselves of services either because this is not a culturally normative practice or because they simply do not trust outsiders (Whaley, 2001).
In addition, the tools used to assess clinical symptomatology are usually not calibrated for immigrant populations either linguistically or culturally (Dana, 2005).
It is important to note that while those who immigrate voluntarily may, on the whole, be hardier or more resilient than nonimmigrant comparison populations, there are particularly vulnerable immigrant subpopulations (e.g., refugees, older adults and LGBT populations) that are likely to constitute a very different profile with additional stressors that can have a negative impact on their mental health. Whether there is evidence to support the notion that immigrants are less likely than U.S.-born populations to experience mental illness, there is no evidence in the literature that immigrants are any more likely to experience mental illness or psychological distress than nonimmigrants, taking into account who does and does not seek treatment.
When immigrants do experience mental health difficulties, however, many are particular to the immigration experience. A wide range of mental health problems, including anxiety, depression, PTSD, substance abuse and higher prevalence of severe mental illness and suicidal ideation, have been observed among immigrant populations in the United States (Desjarlais et al., 1995; Duldulao et al., 2009). Recent studies have also noted the unique presentation of psychological problems among immigrant children, such as a relationship between ataques de nervios and somatic complaints (I. López, Ramirez, Guarnaccia, Canino, & Bird, 2011).
The immigration process has the potential to serve as a catalyst for the development of a great variety of psychological problems and has been conceptualized as consisting of different phases (Akhtar, 2010; Tummala-Narra, 2009). Each of these phases involves negotiating loss and separation from country of origin, family members, and familiar customs and traditions; exposure to a new physical environment; and the need to navigate unfamiliar cultural contexts. Given such experiences, many first-generation immigrants, particularly those individuals emigrating from countries in which the sociocultural context sharply contrasts with that of the United States, experience a variety of psychological problems, including stress.
At the same time that many immigrants experience considerable psychological distress in the face of unique stressors, it is worth noting that they also demonstrate resiliency, often making use of protective factors rooted within their specific cultural contexts. For example, some studies with Mexican-born immigrant adults found they have better mental health profiles than subsequent generations despite significant socioeconomic disadvantages. Possible explanations include greater use of protective traditional family networks, a lower set of expectations for ‘‘success’’ in America, and lower substance abuse (Escobar, Nervi, & Gara, 2000).
Some studies have noted the ways in which ethnic identity is negotiated in the face of discrimination. For example, Hallak and Quina (2004), in their focus group study of young immigrant Muslim women in the United States, found that the women experienced both pride in their identifications with Islam and considerable hostility and prejudice directed against them. They coped with their distress by seeking spiritual meaning through religious faith support from their families and other members of their communities. These collectivistic coping strategies (e.g., seeking help from family or similar ethnic peers) have also been noted among Chinese and South Asian immigrants (Yeh, Inman, Kim, & Okubo, 2006).
When immigrants do require clinical treatment, a resilience and coping perspective is important to incorporate into the treatment process. Some immigrants may draw strength from family structures that U.S. therapists may judge negatively or misunderstand (Hong & Domokos-Cheng Ham, 2001). For example, a client who closely identifies with her Sri Lankan roots may be concerned about whether a mental health professional will be able to understand her distress concerning conflicts with her husband and her in-laws. She may find that a Western therapist judges her to be overly enmeshed with her husband and her extended family, rather than helping her to negotiate her position within her family, which she deeply values as a source of pride and self-esteem.
The present state of knowledge suggests that the therapist should attend to her distress in a way that recognizes and mobilizes her strengths as an individual who values her position and role in her family. It is important to note that what may be considered a strength in one cultural context may be considered deviant or undesirable in another (Harvey, 2007; Tummala-Narra, 2007a). Culturally competent treatment therefore requires an understanding of the complex interplay of pathology and resilience for immigrant clients.

Context matters

This report focuses on understanding the immigration experience from a contextual perspective, with attention to the impact of cultures, societal institutions and local settings. Consistent with the ecological perspective (Bronfenbrenner & Ceci, 1994), the report highlights the interaction of person and environment and related intersections of social identities (e.g., gender, race, ethnicity, age, sexual orientation, social class, disability/ability and immigration status) in addressing mental health needs among immigrant communities.
From a cultural perspective, the experience of immigrants can be understood as encompassing efforts to fit between cultural frameworks. Immigrants bring with them cultural values, beliefs, and attitudes that may fit well or clash with those in the United States. From a contextual perspective, difficulties that immigrants may experience as a result of such cultural differences are viewed as a dissonance that exists between their cultural frameworks and those of the receiving society. For example, a 19-year-old male immigrant may receive conflicting messages concerning his career plans. His parents may believe he has an obligation to follow the wishes of older members of the family concerning his career choice, while his peers tell him he should not feel guilty for diverging from his family’s plans for his career. In such a case, there is dissonance between the value of family interdependence and the broader societal values of autonomy and independence.
With respect to mental health, the executive summary of the report of the surgeon general on mental health (U.S. Department of Health and Human Services, 2001) called attention to the importance of culture in the clinical context. Specifically, cultural context shapes the ways in which clients conceptualize and express psychological distress and resilience, cope with distress, and seek help. The report further states that the significance of culture is relevant not only to the client but also to the mental health professionals who provide help and the care system in which it is provided.
The societal and local community context can also be a source of stress for immigrants. One example of the interaction between macrolevel stressors and mental health is the intersection of high levels of poverty and a greater risk for mental disorders in immigrant communities. Other stressors that can affect immigrants’ mental health and use of mental health services include the reception by the mainstream society (macrosystem), policies that restrict access to health care for immigrants (exosystem), limited networks of social support and opportunities (microsystem) and lack of knowledge about mental health services (mesosystem) (Pumariega & Rothe, 2010). Individual factors such as exposure to trauma during the migration process can further shape the ways in which immigrants experience, express and cope with psychological distress.
Family cohesion and support from extended family have been associated with psychological well-being (Lueck & Wilson, 2010; Masood, Okazaki, & Takeuchi, 2009). A positive ethnic identity or a sense of belonging and involvement with one’s ethnic community has also been associated with self-esteem and general psychological well-being (Phinney & Ong, 2007). Bearing in mind the complex interplay between person and context, the following sections describe some major presenting problems experienced by many immigrants: barriers to treatment, assessment and diagnosis, and intervention.

Presenting problems

While most immigrants adapt well to their new lives, some face considerable psychological distress that may go unnoticed for various reasons, including cultural differences in views of psychological distress and coping. Differences in perceptions of mental health, preferred sources of help, and alternate coping styles have been thought to contribute to the underutilization of mental health services by immigrants (S. R. López & Guarnaccia, 2000). For example, informal sources of support, such as relatives, authority figures, community members, friends or religious leaders, are an important resource for immigrants from collectivistic cultures (Yeh, Arora, & Wu, 2006). Further, some immigrants may express distress through somatic symptoms, which family and friends may not perceive as psychologically driven. In this case, a primary care physician or someone familiar with traditional Western conceptualizations of psychological distress may note the individual’s distress. Many of the mental health problems particular to the immigrant experience can be linked to experiences of acculturation, discrimination, and trauma.
Acculturation-based presenting problems
Acculturation is a naturally occurring process that can result in either positive or negative outcomes, depending on existing contextual conditions (see Adaptation: Acculturation, Cultural Identity, and Civic Engagement). A variety of outcomes can ensue from the process. For example, acculturation processes can shape the expression of psychological distress, including culture-bound syndromes. In other instances, immigrants’ experiences of gender roles can vary significantly between the country of origin and the new culture, at times characterized by feelings of increased sexual freedom and less adherence to traditional roles, and at other times by feelings of increased oppression and demands.
Changes in gender roles are at times connected with economic demands in the new environment, presenting opportunities for improved psychological well-being in some cases and psychological distress in others (Tummala-Narra, in press; Vasquez, Han, & De Las Fuentes, 2006). For example, a woman who might have had limited experience outside the home in her country of origin may be exposed to new ideas and gain greater independence now by working. At the same time, her husband may resent her freedom and independence and attempt to tighten the reins of his authority when she returns home. In another case, a child who immigrates to the United States may suddenly notice that the parents are working in different roles in the home when compared with their life in the country of origin. These shifts in gender roles can contribute to conflicts within families and affect an individual’s adjustment to school and workplace.
As individuals negotiate their identities in a new cultural environment and find ways to cope with immigration-related stress, they may experience increasing tensions among family members. Intergenerational conflicts are common in immigrant households, reflective of an acculturation gap between parents and children and spouses and partners (Birman, 2006). Some manifestations of these conflicts are verbal arguments between parents and children regarding friendships, dating, marriage and career choices and between spouses about gender role expectations (Varghese & Jenkins, 2009). In some cases, second-generation children and adolescents may experience role reversal when they are in a position to translate for their parents from their native language to English or to help their parents and/or grandparents navigate mainstream culture (C. Suárez-Orozco et al., 2008). Many older adult immigrants, particularly those who immigrate late in life and have limited English proficiency, experience loneliness and isolation related to difficulties in navigating a cultural context in which they may no longer be revered or sought out as respected elders by family and younger members of their communities (McCaffrey, 2008; Ponce, Hays, & Cunningham, 2006).
Intergenerational conflict can be experienced as a threat to the parent–child relationship, particularly when collectivism and interdependence within the family unit are valued. Several studies reveal that greater conflict with parents, particularly mothers, is associated with psychological distress, such as depressive symptoms (Varghese & Jenkins, 2009). Acculturative conflicts are often at the root of what brings immigrant families into treatment.
Trauma-based presenting problems
A significant number of immigrants have had previous, recent and/or ongoing experiences with traumatic stressful immigration-related situations. Traumatic experiences can occur at various stages of the immigration process: premigration trauma or events that are experienced just before migrating; traumatic events that are experienced during the transit to the new country; ongoing traumatic experiences in the new country; and substandard living conditions in the new country due to unemployment, inadequate supports, and discrimination and/or persecution (Foster, 2001). Any of these traumatic events can affect the ways in which immigrants adjust to their new cultural context. For example, a woman who leaves her country of origin with her children to escape ongoing community violence and poverty and is raped while in transit faces not only the challenges of adjusting to a new cultural context and caring for her children but also the traumatic aftermath of the rape, involving overwhelming states of anxiety and hypervigilance.
Research on interpersonal violence among immigrant communities in the United States has focused primarily on intimate partner violence (Raj & Silverman, 2003). Several studies with immigrant women have documented the relatively low rate for reporting domestic violence. The likelihood of reporting abuse incidents and seeking help may increase only when the violence reaches a severe level (Abraham, 2000; Krishnan, Hilbert, & VanLeeuwen, 2001). Other studies indicate that immigrant women experiencing more severe abuse may be the least likely to disclose the abuse to others (Yoshioka, Gilbert, El-Bassel, & Baig-Amin, 2003). These divergent findings may be accounted for, at least in part, by the prevalent use of shelter samples and the tendency to lump together groups of ethnically diverse women (e.g., using a Vietnamese sample to represent Asian Americans as a group) (Liang, Goodman, Tummala-Narra, & Weintraub, 2005).
Aside from emerging research in the area of domestic violence, research on childhood sexual abuse, physical abuse, rape, and political and racial trauma in immigrant communities is sparse. Traumatic experiences place immigrants at risk for mental health problems, including depression and anxiety disorders, and particularly posttraumatic stress disorder (Maddern, 2004; Radan, 2007). Risk factors affecting the degree of symptomatology and impairment include poverty, education, subsequent unemployment, low self-esteem and poor physical health (E. Hsu, Davies, & Hansen, 2004). The research and clinical literature has noted the ways in which interpersonal and collective violence compromises immigrant adults’ and children’s identifications with both the country of origin and the adopted country. In addition, such violence can impact the way psychological distress is manifested in culturally specific ways (e.g., anxiety can be expressed through somatic symptoms) (Radan, 2007; Tummala-Narra, 2007a). Culture-bound illness expression, culture-bound syndromes and cultural bereavement in response to the stresses of the acculturation process are significant problems that can resemble, but are distinct from, Western-oriented psychiatric symptoms and disorders (Davis, 2000).
Undocumented immigrant children and youth are frequently subject to particularly traumatic experiences (Capps et al., 2007), including racial profiling, ongoing discrimination (Parra-Cardona, Bulock, Imig, Villarruel, & Gold, 2006), exposure to gangs (Passel & Cohn, 2009), immigration raids in the community, the arbitrary checking of family members’ documentation status (e.g., Arizona SB 1070, Secure Communities Act), forcible removal or separation from their family for an indeterminate period of time (Capps et al., 2007), discovery upon returning home that their family has been taken away, violation of their home by authorities, placement in detention camps or in child welfare, and deportation to their country of origin.
A report by the Urban Institute (Chaudry et al., 2010) titled "Facing Our Future: Children in the Aftermath of Immigration Enforcement" documents the effects of these traumatic experiences on children. The report indicates that the vast majority of children whose parents were detained in U.S. Immigration and Customs Enforcement raids in the workplace and home exhibited multiple behavioral changes in the aftermath of parental detention, including anxiety, frequent crying, changes in eating and sleeping patterns, withdrawal and anger. Such behavioral changes were documented 2 to 3 months after the arrest, as well as at a 9-month followup. It is disturbing to note that the children also experienced dramatic increases in housing instability and food insecurity, which are both dimensions of basic well-being (Chaudry et al., 2010).
Such traumatic and challenging experiences and transitions can produce a range of psychological problems (Capps et al., 2007), including poor identity formation, inability to form relationships (R. G. Gonzáles, 2010), PTSD, acculturation stress, intergenerational conflict (Kohatsu, Concepción, & Perez, 2010), feelings of persecution, high distrust of institutions and authority figures, fear of school, inability to concentrate, acting-out behaviors, eating disorders, loss of motivation (i.e., lowered aspirations and expectations), depression, anxiety, difficulties in school performance and matriculation (C. Suárez-Orozco et al., 2008) and dropping out of school (Capps et al., 2007). Research on various types of traumatic exposure—interpersonal, political, and racial — within different immigrant communities is sorely needed to better understand how sociocultural context supports and/or burdens trauma survivors.
Discrimination- and racism-based presenting problems
Immigrants, especially those of color, are often the targets of discriminatory practices (M. H. Lopez et al., 2010) or at least the victims of microaggressions (D. W. Sue et al., 2007) (see the Social Context of Reception and Immigrant Adaptation section). Whether subtle or overt, the negative impact of discrimination on the psychological well-being of an individual is still the same (D. W. Sue et al., 2007). Both overt and aversive forms of racism and microaggressions have important implications for immigrant individuals’ sense of well-being and belonging (Dovidio & Gaertner, 2004; D. W. Sue, 2010). Specifically, experiences of racial/ethnic discrimination have been associated with mental health problems, including depression, anxiety, substance abuse, and suicidal ideation (Alegría et al., 2004; Cheng et al., 2010; Gee et al., 2007; A. G. Tran, Lee, & Burgess, 2010; Tummala-Narra, Alegría, & Chen, 2011) (see the APA Resolution on Prejudice, Stereotypes and Discrimination; APA, 2006).
Negative and potentially hurtful stereotypes, when ascribed to immigrants, can further result in a loss of personal control, especially for young immigrants (Flores & Kaplan, 2009). Profiling contributes to a social atmosphere that produces fear and anxiety for those immigrants, especially those of color, who might possibly live in fear of being spotted and deported. This is especially relevant in the context of some highly publicized laws that allow law enforcement to actively seek out perceived immigrants (e.g., Arizona SB 1070). A unique factor relative to undocumented immigrants is that they may experience guilt and shame and are often treated as “second-class” persons (M. M. Sullivan & Rehm, 2005). In summary, the racial and political contexts of the adopted country affect immigrant adults’ and children’s (both authorized and unauthorized) sense of safety and belonging and their ability to trust that systems of care will be able to help them when they are facing mental health challenges.
Research has also demonstrated a relationship between perceived discrimination and decreased use of mental health services, as well as the use of collectivistic coping strategies (Gee et al., 2007; Jang et al., 2010; Tummala-Narra, Inman, & Ettigi, 2011; Yoshikawa et al., 2004). Considering evidence for the role of racial discrimination in psychological distress, future research is necessary to investigate the unique ways in which discrimination is experienced by immigrants and differences across gender, generation (first vs. second vs. third) and social class. Additionally, future research can address the intersectionality of social identities (e.g., race, culture, language, immigration status, age, gender, sexual orientation, social class, religion and ability/disability status) and its relationship to immigrants’ experience of and ability to cope with discrimination.

Barriers to treatment

While an increasing number of immigrants are seeking mental health services, most immigrants underutilize these services. A number of barriers to culturally sensitive and appropriate mental health services for racial/ethnic minority and immigrant populations have been well documented in the literature. Both distal and proximal barriers (Casas, Raley, & Vasquez, 2008) affect the use of mental health services by immigrants. These barriers can be broadly grouped into the following categories: social-cultural, contextual-structural and clinical-procedural.
Some important social-cultural barriers include differences in symptom expression (e.g., somatic symptoms) (Alegría et al., 2008) and conflicting views about the causes of (i.e., attributions) and ways of coping with mental problems (Atkinson, 2004; Koss-Chioino, 2000). For example, some immigrants may view self-help as the best means of dealing with mental health problems (Donnelly et al., 2011) or may lack an understanding of how psychological problems can be treated from a Western perspective (Inman & Tummala-Narra, 2010; Leong & Lau, 2001; M. C. Wu, Kviz, & Miller, 2009). Others may prefer alternate sources of help rooted in their cultural contexts (e.g., curanderos, Ayurvedic healers, priests, and imams) (Comas-Díaz & Greene, in press; McNeill & Cervantes, 2008).
  • Another social-cultural barrier involves stigma, which some cultures associate with mental health problems (Brach & Fraser, 2000; Leong, Wagner, & Tata, 1995; Nadeem et al., 2007; Wu, Kviz, & Miller, 2009). More specifically, some cultures that maintain strong family ties see individuals with mental health problems as bringing shame to the family, destroying the family reputation, exemplifying an overall family weakness or a retribution for family wrongs (Hong & Domokos-Cheng Ham, 2001). In some cases, individuals may believe that mental health care should be sought for more severe problems, such as psychosis, but not for problems thought to be less serious (e.g., anxiety, depression).
  • Contextual-structural barriers include lack of access to appropriate and culturally sensitive mental health services (Lazear, Pires, Isaacs, Chaulk, & Huang, 2008; Wu et al., 2009), lack of knowledge of available mental health services (Garcia & Saewyc, 2007), shortage of racial/ethnic minority mental health workers and/or persons trained to work with racial/ethnic minority persons (APA, 2009a), older persons and culturally diverse elders (APA, 2009b), lack of access to interpreters, and lack of resources (e.g., lack of child care, transportation, finances) for accessing services (M. Rodríguez et al., 2009).
  • Unauthorized immigrants face additional challenges related to documentation status (e.g., ineligibility for services provided by the county or state, fear of identification as undocumented, and deportation) (Yoshikawa, 2011). Those who live a migrant existence typically do not seek help, either due to fears related to unauthorized status or to moving from place to place in search of work (Hadley et al., 2008). Immigrants in rural areas may face additional barriers including lack of access to culturally competent services and service providers (Cristancho, Garces, Peters, & Mueller, 2008).
  • Clinical-procedural barriers include lack of culturally sensitive and relevant services (Maton, Kohout, Wicherski, Leary, & Vinokurov, 2006); “clinician bias” (Maton et al., 2006); communication problems related to language differences and cultural nuances (Kim et al., 2011); misdiagnosis of presenting problems (Olfson et al., 2002); failure to assess cultural, linguistic, and procedural appropriateness of tests for targeted populations (Dana, 2005; Kwan, Gong, & Younnjung, 2010; Suzuki et al., 2008); lack of attention to culturally embedded expressions of resilience (Tummala-Narra, 2007a); and failure to use the most efficacious mental health interventions (McNeill & Cervantes, 2008) (e.g., evidence-based interventions adapted for use with minority and immigrant populations). Clinicians may also use Western-based theories of development that may not be suitable when working with immigrants from collectivistic cultures (Zeigenbein, Calliess, Sieberer, & Machleidt, 2008). For example, a clinician may downplay the role of religion and spirituality in the client’s life (McNeill & Cervantes, 2008) and overemphasize autonomy and independence as therapeutic goals (Dwairy, 2008).
While contextual-structural and clinical-procedural barriers can be found across varied regions of the United States, they are becoming ever more prevalent in small towns and rural communities of the South and Midwest, where a growing number of immigrants from Mexico, Central America and South America in search of low-skilled labor opportunities are settling. Unfortunately, these communities particularly lack the service infrastructure that is necessary to meet the mental health needs of Latino immigrants (e.g., access to health care, immigration assistance, and breaking down language barriers) (Buki & Piedra, 2012).

Treatment considerations

Assessment and Diagnosis
There is extensive literature suggesting that assessment and diagnosis are challenging when working with immigrants in clinical settings (Comas-Díaz, 1997; Park-Taylor et al., 2010; Vazquez-Nuttall et al., 2007). Having previously addressed these challenges in some detail in the section on Assessment in Clinical Settings, we now highlight a few that are directly tied to the culturally encapsulated assessment instruments themselves: a lack of standardized translations of assessment instruments, as well as a lack of appropriate normative standards and studies concerning the reliability of test scores with various immigrant groups. From a more comprehensive perspective, it is important that the role of sociocultural context be comprehensively understood and seriously dealt with in the clinical process in order to provide ethical and appropriate standards of care in assessment, diagnosis and treatment.
A challenge in assessment with immigrants is the lack of valid and culturally appropriate diagnostic tools sensitive and comprehensive enough to capture cultural variability in the symptomatic expression of and coping with psychological distress. This presents significant challenges to psychologists who may rely on established testing and assessment strategies and instruments. For example, failure to take culture into consideration can result in “clinician bias,” which may be manifested in the tendency to universally apply Eurocentric models of illness, contributing to overpathologizing and a lack of attention to resilience (Dana, 1998) (see Assessment With Immigrant-Origin Adults and Children).
It is important to note that the system of diagnosis outlined in the fourth edition (text revision) of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR; American Psychiatric Association, 2000) has been thought to have universal applicability even though this diagnostic system is culturally constructed in a way that privileges Western or Eurocentric notions of mental illness (Pieterse & Miller, 2010). While the most recent edition of the DSM does offer guidelines for culture-specific diagnosis, it fails to acknowledge that the diagnostic system in the DSM–IV–TR is culturally specific (Pieterse & Miller, 2010). The diagnostic process itself can emphasize pathology and weakness over resilience and resources (Atkinson, 2004). Although it is true that the DSM–IV–TR includes a culture-specific section in the text, an appendix of culture-bound syndromes, and an outline for cultural formulation to enhance the cross-cultural applicability of the manual, it continues to be insufficient in addressing cultural variability (Park-Taylor et al., 2010; Roysircar, 2005).
Alternative diagnostic methods that supplement traditional psychiatric diagnostic approaches can be used to better assess and describe immigrant clients’ psychological distress (Pedrotti & Edwards, 2010), such as looking at disorders as lying on a continuum as opposed to being “present” or “absent” (Oldham & Morris, 1995). Further, it is important that clinicians self-assess the extent to which their socialization informs their evaluation of the racial and cultural data of the client (see Suzuki et al., 2005).
Because of the limitations of existing diagnostic systems, scholars recommend that all phases of assessment and diagnosis, including the clinical and/or diagnostic interview, test administration, interpretation, report writing and feedback to the client, consider the social, cultural and linguistic context of immigrant clients and the coexistence of pathology and resilience (Harvey, 2007). Clinicians should consider the fairness and utility of diagnostic tests in the context of language, educational background and cultural norms. It is also important that clinicians understand the implications of psychological testing and diagnosis on an individual basis and recognize that many immigrant clients are concerned about diagnostic labels due to cultural stigma and/or immigration status. Additionally, routine consultation with colleagues who may be more familiar with the client’s sociocultural context, the specific diagnostic tests being considered, and culture-bound syndromes would be especially helpful in tailoring a culturally competent approach to assessment and diagnosis (see Assessment Challenges).
Up to this point, assessment has mainly and quite appropriately been addressed in reference to educational and traditional mental health settings. However, given the increasing number of contacts that a significant number of immigrants are likely to have with such institutions as law enforcement, the judiciary system, and immigration services (i.e., Immigration and Customs Enforcement), it behooves us to address assessment issues and challenges that exist in these settings.

Intervention

The present state of knowledge concerning clinical practice suggests that to provide the most effective mental health services to immigrants, clinicians should apply the following guiding principles:
  • Use an ecological perspective (Bronfenbrenner & Morris, 2006) to develop and guide interventions.
  • Integrate evidence-based practice with practice-based evidence.
  • Provide culturally competent treatment.
  • Use comprehensive community-based services.
  • Use a social justice perspective as a driving force for all services.
While these principles are referenced throughout the report, they are presented here in more detail to underscore their importance in guiding clinical interventions.
Ecological framework
In line with one of the underlying perspectives inherent in this report and with recommendations put forth by various multicultural psychologists (e.g., Casas et al., 2008), it is recommended that clinicians give serious consideration to the use of an ecological framework (Bronfenbrenner & Morris, 2006). As previously noted in this report (see the Introduction), such a framework is based on the belief that the human experience is a result of reciprocal interactions between individuals and their environments, varying as a function of the individual, his or her contexts and culture, and time. Each context offers particular risks as well as protective factors that either detract from or enhance healthy adaptation. They need to be understood in framing the immigrant experience and considered in the development and implementation of mental health treatments.
Using this framework, a clinician should gather relevant information from the five systems that subsume the client’s contexts and culture (i.e., the micro-, meso-, exo-, macro- and chronosystems) (see the Introduction). As noted in Resilience and Recovery After War: Refugee Children and Families in the United States (APA, 2010c, p. 4), the information that should be gathered to inform interventions includes effects of migration (before, during and after), legal/documentation status, acculturation, risk and resilience, cultural and religious beliefs, age of migration/developmental stage, race, ethnicity, gender, social class, sexual orientation, disability/ability, experiences of racism and discrimination, language and educational barriers and access to services and resources. This information is often critical to developing a complex understanding of the individual’s experiences of distress.
Evidence-based practice and practice-based evidence
An important dialectic in mental health intervention research involves evidence-based practice and practice-based evidence. Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise. The purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship and intervention (Kazdin, 2008).
Evidence-based practice approaches psychological treatment with the assumption that individual characteristics and sociocultural context both play important roles in assessment and intervention (La Roche & Christopher, 2009; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). There has been growing discussion in the field about prioritizing evidence-based treatments (EBTs) over practice-based adaptations of these treatments or practice approaches judged appropriate by clinicians but not empirically tested in randomized clinical trials.
Efficacy research that identifies EBTs incorporates randomized controlled trials and focuses specifically on outcomes that result from care provided by well-trained mental health professionals. To make causal inferences about intervention effectiveness, randomized clinical trials use tightly controlled designs, carefully select their client populations, maintain strict fidelity to the intervention model, and use well-trained mental health professionals proficient in the service model being tested (La Roche & Christopher, 2009). But many such studies have been criticized for limited generalizability outside the university clinic settings where they are developed and particularly to ethnic minority and immigrant populations.
A few studies have examined the effectiveness of evidence-based practice with immigrant clients in treatment. For example, Duarté-Veléz, Bernal, and Bonilla (2010) described a culturally adapted cognitive–behavioral therapy (CBT) for a Latino adolescent coping with depression. This adaptation of CBT involved the consideration of specific cultural values concerning sexual orientation, masculine identity, spirituality and family. Two other examples of treatments that have demonstrated effectiveness with immigrant populations include the Culturally Informed and Flexible Family-Based Treatment for Adolescents (Santisteban & Mena, 2009), which combines family and individual CBT with educational interventions to treat intrafamily stress and conflict, and Cuento Therapy (TEMAS; G. Constantino et al., 1988), a culturally sensitive cognitive therapy-based intervention aimed to reduce anxiety and improve academic self-esteem and performance with Latino/a students.
Despite these studies, research documenting the effectiveness of EBTs with diverse communities is still in its infancy. In fact, much of what is known about the use of EBTs with immigrants has been drawn from research on the impact of evidence-based mental health treatments on ethnic minorities, particularly African American and Latino/a American clients. Miranda, Bernal, et al. (2005) found substantial evidence demonstrating that evidence-based treatments for depression (e.g., CBT) improve outcomes for African Americans and Latinos and that these results are equal to or greater than for White Americans. Research on the EBTs with Asian Americans has been very limited, and the evidence that does exist seems to suggest that cognitive therapy is effective for the treatment of anxiety and depression (C. G. Hall & Eap, 2007; Miranda, Bernal, et al., 2005).
C. G. Hall and Eap (2007) caution, however, that “this evidence is based on relatively few patients” (p. 455), and that these studies have been criticized for their methodology. Implementation of EBTs in real-world settings, such as community clinics and schools, involve numerous challenges. In particular, extensive adaptations to the intervention are often required, though researchers reporting on intervention effectiveness rarely report on the various adaptations made in the implementation process.
In recent years, another approach has been evolving in the field among those advocating for learning from practice-based evidence (Birman et al., 2008). While empirically based researchers generally treat existing community practices, or “treatment as usual,” as substandard practices, many clinical programs have developed creative ways of working with immigrant populations that have not yet been documented in the literature. For example, the Latino Mental Health Clinic, the Haitian Mental Health Clinic, the Portuguese Mental Health Clinic and the Asian Mental Health Clinic at the Cambridge Health Alliance are outpatient clinics staffed by immigrant and multilingual mental health practitioners who have provided direct clinical services (assessment, psychotherapy, and psychopharmacology) to immigrant communities for over a decade.
Rural areas also have needs for these types of services, though access can be difficult. In Maine, for example, the Maine Migrant Health Program provides integrated primary care from a mobile van to address this barrier. Although several clinicians have written about their experiences with clients in these clinics (Desrosiers & St. Fleurose, 2002; Halperin, 2004; Tummala-Narra, 2009), a lack of resources for systematic research has precluded documentation of the lessons learned in clinical practice with these different immigrant communities. Nonetheless, it is important to learn from the wisdom of these clinicians and how they have modified traditional approaches to treatment in their work with immigrant clients. Thus, the practice-based evidence approach seeks to understand “practice as usual” and gather evidence on its effectiveness (Beehler, Birman, & Campbell, 2011; Birman et al., 2008).
Research on culturally adapted interventions indicates that interventions in clients’ native languages are more effective than those conducted in English, culturally adapted interventions are more effective than those not targeted to specific cultural groups, and ethnic matching in the therapeutic dyad is likely to improve client retention and therapeutic outcome (Alegría, Vallas, & Pumariega, 2010; T. Smith, Domenech Rodríguez, & Bernal, 2011). As such, it is particularly important to understand “practice as usual” because when evidence-based treatments are implemented, they are integrated into existing practice settings. With increasing pressure to implement evidence-based treatments, providers who have been serving immigrant communities for many years are faced with integrating their existing practices with intervention approaches developed for different populations than the ones they serve.
For example, the mental health clinics at the Cambridge Health Alliance have developed ways to provide psychotherapy that integrate psychodynamic and CBT approaches with the client’s specific cultural beliefs and practices. These clinics have also implemented these practices with clients coping with mental illness and immigration-related stress within constraints of limited economic resources and managed-care models.
It is worth noting that evidence-based treatments frequently target a particular constellation of symptoms. Although in a university clinic, where such interventions are developed, clients are selected to fit the intervention criteria, in community-based clinics, providers must find treatments that work for a range of clients seeking services. This is particularly true for clinics that provide culturally sensitive services to immigrants because referral to other clinics or treatments may not be an option. As a result, evidence-based treatment must be implemented into an overall practice model.
Research is also needed to support the continued use of those interventions rooted in practice-based evidence. In addition, while some graduate students in psychology are exposed to training in community-based clinics that provide services to immigrant communities, it is important to consider that most graduate and postgraduate students in psychology do not have access to training specific to immigrants’ concerns or practice-based interventions.
Culturally competent treatment
According to APA, cultural competency should be an inherent principle that underscores all work performed by psychologists. This position is aptly presented in the APA mission statement as well as in varied documents and publications, including the APA Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change (APA, 2002). The fact that these guidelines were developed not only for individuals from minority ethnic and racial groups but also for other groups, including immigrants, makes them quite relevant in reference to the targeted populations of this report.
For the sake of clarity and consistency, the definition of culturally competent used here is the same as the one provided in the APA’s (2010c) report on refugees: “the capacity of programs to provide services in ways that are acceptable, engaging, and effective with multicultural populations” (Birman, Ho, et al., 2005, p. 12). Over the past 2 decades, numerous researchers have addressed cultural competency from a variety of perspectives and across differing contexts (APA, 2002; Marmol, 2003; Mason, Benjamin, & Lewis, 1996; Nastasi, Moore, & Varjas, 2004; Pedersen, 2003; Vargas & Koss-Chioino, 1992; Vera, Vila, & Alegría, 2003) and have clearly shown that to obtain effective clinical outcomes, both clinicians and the services provided need to be culturally sensitive and competent.
Cultural competence involves three broad dimensions: therapists’ cultural knowledge, therapists’ attitudes and beliefs toward culturally different clients and self-understanding, and therapists’ skills and use of culturally appropriate interventions (Helms & Cook, 1999; D. W. Sue, Arredondo, & McDavis, 1992). Cultural competence in practice includes attending to actual treatment practices and promoting access to services, such as interpreters and legal assistance. In addition, in recent years scholars from different theoretical orientations (e.g., cognitive–behavioral, psychodynamic, family systems, humanistic, and integrative) have increasingly addressed issues of diversity and cultural competence.
For example, cognitive–behavioral scholars have noted the importance of the client’s cultural context in evaluating thought patterns and behaviors (Hays, 2008; Newman, 2010). Psychodynamic scholars have focused on the analysis of culturally and racially based transference and countertransference in the therapeutic relationship (Ainslie, 2009; Comas-Díaz & Jacobsen, 1995; Tummala-Narra, 2007b). As different types of therapy (e.g., cognitive–behavioral and psychodynamic) have been found to be efficacious (Newman, 2010; Shedler, 2010), future research should address the ways in which clinicians from different theoretical orientations can further develop cultural competence to meet the mental health needs of immigrant clients.
Comprehensive community-based services
To ensure positive outcomes for the client, clinicians must find ways to collaborate with the various contexts/systems that are a part of the client’s life, thereby validating and empowering the client. In line with systems of care models (Casas, Pavelski, Furlong, & Zanglis, 2001), an outcome of such collaboration is the establishment of comprehensive community-based services that provide mental health, social, legal, and educational assistance and are located in settings where the target immigrant population is likely to be found (e.g., schools, churches, and community centers) (Birman et al., 2008; Hernandez et al., 2007). These services offer an alternative to clinic-based services (Birman et al., 2008). From a contextualist perspective, comprehensive community-based services are critical because they address the larger context of immigrants’ lives. For them, therapy in a clinical setting is but one component of the overall treatment model.
Educational settings, including public, parochial and community colleges, have been identified as effective sites from which to provide diverse mental health services to immigrant children and their families (Ehntholt, Smith, & Yule, 2005; Fazel, Doll, & Stein, 2009; Kataoka et al., 2003; O’Shea, Hodes, Down, & Bramley, 2000; Rousseau, Drapeau, Lacroix, Bagilishya, & Heusch, 2005; Rousseau et al., 2007; Stein et al., 2003). Educational sites are effective sites to reach adults, families, and their children because services (like ESL classes) are often already in place, helping to facilitate ready bonds of trust within the community (Kataoka et al., 2003). Further, schools are frequently spaces in which familial acculturative and adjustment struggles unfold (Birman et al., 2007).
One example of an effective intervention is Cultural Adjustment and Trauma Services (CATS), a school-based mental health program for immigrant children and adolescents (Beehler et al., 2011). This program provides a range of clinical and case management/support services to students and families (e.g., food pantries, job placement, afterschool support groups and guidance regarding class schedules and college admissions), their teachers (e.g., consultation on classroom practices, assistance in academic placement decisions and phone calls with parents in their native language), and administrators and staff (e.g., orientation to immigrant students’ cultures and translation services). The intent of this program is to intervene to prevent relatively simple adjustment problems from progressing to more serious psychological difficulties.
By attending to mental health concerns, such services can reduce barriers to learning (Adelman & Taylor, 1999). Mandatory school attendance ensures access to a broad range of children, creating opportunities for screening and early intervention (Birman & Chan, 2008). Stigma surrounding mental health services can be reduced when provided as an educationally connected intervention in a safe, familiar setting, and schools have natural access to families who may be reluctant to seek mental health services for their children in more traditional settings. There is evidence that when varied services are provided together, there is an increase in the use of mental health services.
Social justice perspective
The social justice perspective in psychological treatment is rooted in the belief that all people have a right to equitable treatment and a fair allocation of societal resources, including decision making (Crethar, Torres Rivera, & Nash, 2008). Psychologists committed to a social justice perspective must work toward making society a better place for all by challenging systemic inequalities (Corey, Corey, & Callanan, 2011). The social justice framework requires a paradigm shift in the way psychologists, counselors, and other service providers perceive the therapeutic process (Herlihy & Watson, 2007).
Counseling or psychotherapy may not necessarily be a one-on-one, in-office encounter, nor do the client’s presenting problems necessarily originate within the self. To this end, Atkinson (2004; Atkinson, Thompson, & Grant, 1993) suggested that in the process of selecting roles and strategies when working with racial/ethnic minority and immigrant clients, counselors need to take into consideration three factors, each of which exists along a continuum: (a) client level of acculturation to the dominant society (high to low), (b) locus of problem solving (external to internal), and (c) goals of helping (prevention, including education/development, to remediation). Therapists may take on a variety of roles depending on client needs and points of intersection along the continuums of acculturation, locus of problem solving, and goals of helping: advisor, advocate, facilitator of indigenous support and healing systems, consultant, change agent, counselor and psychotherapist (Atkinson et al., 1993).
To successfully follow a social justice perspective, clinicians must make use of the ecological framework to conceptualize all of the contributing factors associated with a presenting problem. By so doing, clinicians will have the kind of sociocultural information necessary to develop and/or identify the most appropriate and potentially effective EBTs and interventions. Successful implementation of such interventions with immigrants and other groups that share similar characteristics will require that clinicians be prepared to assume new and diverse helping roles. Therapeutic interventions should seek to help individuals both change themselves and take steps to change the conditions contributing to the problems they face (Homan, 2008). Change must occur not only within the client but also across the systems, structures, organizations, and policies that impact them (Yeh & Kwan, 2010). Such changes are necessary to improve access and equitable conditions for oppressed and marginalized groups (Goodman et al., 2004).

In conclusion

There is a growing body of research that documents life experiences (e.g., the immigration experience itself) and contextual conditions (e.g., poverty and discrimination) that put some immigrants and their families at risk for experiencing diverse mental health challenges. Further, some types of challenges faced by immigrants, such as interpersonal, racial and political trauma, are especially important for clinicians to recognize, as they tend not to be discussed openly and yet often compromise positive adjustment and well-being (APA, 2010c). It is also important to recognize that various factors (e.g., social-cultural, contextual-structural and clinical-procedural) contribute to an underutilization of mental health services among immigrant populations. Evidence from research and clinical practice calls for increased attention to the interplay between resilience and pathology to better understand the nature of mental health challenges and intervention effectiveness.
Much of what is known about the use of evidence-based treatments with immigrants has been extrapolated from research on ethnic minorities (Miranda., et al., 2005); only a few studies have examined the effectiveness of evidence-based treatments with immigrant populations (Beehler et al., 2011; G. Constantino et al., 1988; Duarté-Veléz et al., 2010; Kataoka et al., 2003; Santisteban & Mena, 2009). While research on the utility of evidence-based treatments with immigrants is clearly needed, clinicians and researchers can benefit from attending to practice-based evidence that offers important lessons in culturally competent interventions (Birman et al., 2008).
This report outlines five recommendations regarding ways in which practitioners to increase the accessibility and efficacy of services: (a) use an ecological perspective (Bronfenbrenner & Morris, 2006) to develop and guide interventions, (b) integrate evidence-based practice with practice-based evidence (Birman et al., 2008), (c) provide culturally competent treatment (APA, 2002; Birman, Ho, et al., 2005; Marmol, 2003; Nastasi et al., 2004; Pedersen, 2003; Vera et al., 2003), (d) partner with community-based organizations (Birman et al., 2008; Casas et al., 2001), and (e) incorporate social justice principles in providing service (Crethar et al., 2008). Additionally, we underscore the importance of providing accessible and affordable mental health services for immigrant communities.
Evidence suggests that awareness of context at every stage of planning and implementation of assessment and intervention is necessary for ethical and effective practice with immigrant clients. Attention to context is also essential to accurately assess pathology and resilience, as exemplified in the unique presenting issues and approaches to coping with distress among immigrant clients. Thus, it is recommended that clinicians and researchers consider the critical role of social, cultural, economic, and political contexts in the experience of immigration, acculturation and psychological well-being.
Clinicians would benefit from using knowledge from multiple sources of evidence in their approaches to assessment and treatment with immigrant clients. In particular, evidence from empirical studies and from practice that is adapted to suit the mental health needs of specific groups can be used to guide the development of innovative clinical practices in clinics and community settings. It is important that research be conducted to ascertain the generalizability of findings emanating from EBT research to diverse populations (National Implementation Research Network, 2003; Miranda, et al., 2005). As in all interventions, cultural competency must be an inherent part of EBPs. As noted succinctly by Isaacs, Huang, Hernandez, and Echo-Hawk (2005),
evidence-based practices could exacerbate and deepen existing inequalities if they are implemented without sufficient attention to cultural competence and/or if policy makers fail to take into account the many practices within diverse communities that are respected and highly valued by these groups. (p. 5)

Research that focuses on systematic application and measurement of operationalized indicators of cultural competence is needed to improve access to services and reduce mental health disparities across diverse groups in general (Isaacs et al., 2005).
Although the field has made important strides in adopting cultural competence as a core value in clinical practice and research, the implementation of the Multicultural Guidelines has met with varied challenges (Vasquez, 2010). There is a dearth of literature on the specific ways in which cultural competence is implemented in clinical practice with specific immigrant populations and, more important, the actual impact that such implementation has on outcomes (Miranda, Bernal, et al., 2005). Thus, there is a need for research that addresses the unique applications and outcomes of cultural competence within different immigrant communities.
At the present time, mental health practitioners have limited access to the lessons learned in clinical and community settings in which traditional approaches have been modified effectively with immigrant clients. Furthermore, there is limited knowledge about psychological tests and assessment procedures (e.g., clinical interviews) that are contextually driven (see Assessment With Immigrant-Origin Adults and Children). To improve the assessment of immigrants, future research can address the need for relevant psychological tests and procedures that address contextual factors.
Most training programs do not offer cultural-competency training specific to the needs of immigrant clients (APA, 2010c). In addition, most practice settings are not staffed by clinicians of immigrant backgrounds or by interpreters. Clinicians are also not trained in how to work through and in tandem with interpreters (APA, 2010c). The lack of access to immigrant practitioners is of particular concern, as many immigrant clients prefer to work with a therapist of a similar background and/or with a therapist who is fluent in their native languages. The growing gap between the increasing need for mental health services among immigrant communities and the disproportionately low number of immigrant and ethnic minority mental health practitioners is a problem that needs to be addressed at the systemic level. At present, there is a dire need for more immigrant-origin, multicultural, and multilingual clinicians. To address this need, the APA’s commitment to provide needed resources to recruit and train mental health service providers that can understand and effectively address the diverse social and psychological needs of immigrants is especially important. It is not sufficient to recruit trainees to programs. Rather, provisions for financial and professional support and mentoring are essential to ensure successful training.
These recommendations address the research, training, and practices that must be put in place to effectively and equitably meet the mental health needs of the immigrant populations that now constitute a significant part of the total U.S. population. Overcoming barriers to services can and should build on the inherent strengths and resources of this complex population. By better meeting the needs of this country’s immigrant-origin population, not only will psychologists step up to the APA mission to “improve people’s lives” but help strengthen the very foundation of this diverse nation.
Considerations for the field
The United States today is host to its largest number of new immigrants in history. But as a nation of immigrants, the United States has successfully negotiated larger proportions of newcomers in its past, and it is not alone among OECD nations in encountering immigrant populations today (see The Why and Who of Immigration). In this time of economic crisis, immigrants are routinely becoming the subjects of negative media coverage, hate crimes, and strict legislation on the municipal, state and federal levels (see Introduction). This adverse climate can have negative repercussions for immigrants themselves and for their citizen children, many of whom, as previously mentioned, are U.S. citizens (see the Social Context of Reception and Immigrant Adaptation).
In comparison to the disciplines of sociology, demography, and economics, psychology has been slow to recognize the growth in the immigrant population over the last few decades (C. Suárez-Orozco & Carhill, 2008; C. Suárez-Orozco & Qin, 2006). Yet these individuals and their children are an ever-growing presence in U.S. schools, communities, clinics, and the larger society. Scholarship in psychology has only recently acknowledged this demographic shift, often confounding immigrants with other ethnic minority populations and rarely considering first- or second-generation distinctions (see the Introduction). Given the demographic imperative, the field of psychology is long overdue to take stock of the situation.
In this report, the APA Presidential Task Force on Immigration aimed to provide an account of what is known and what needs to be known about immigrant adults (including older adults), children and adolescents, and families. We were particularly interested in addressing the psychological experience of immigration by considering factors that both facilitate and impede adjustment and using ecological and strength-based perspectives. We concurred with the surgeon general’s recommendation that a culturally congruent perspective is essential when working with diverse populations. The intent was to provide clear guidelines to frame research, practice, education, and policy agendas. The literature, however, revealed that evidence in the field is flawed for a variety of reasons. Summaries of these limitations and recommendations to move the field of psychology forward in its approach to immigration follow.
Methodological challenges
In many studies, immigration status or generation is ignored or omitted. When it is considered at all, it is often confounded with race or ethnicity or used as a “controlled variable.” To do so is misleading, as immigration, culture, race and ethnicity are separate categories and are embedded within the context of several potential mediators, moderators, and outcomes (APA, 2010c). While constructs may be shared across groups, their expression may be culturally and socially defined. Thus, it is not sufficient to conduct research on ethnically diverse populations without documenting the diversity of patterns across groups.
Further, much of the research with immigrants has not considered the heterogeneity within different immigrant communities (García Coll & Marks, 2011; C. Suárez-Orozco & Carhill, 2008). Research should examine similarities and differences in mental health and use of services across immigrant generations (i.e., first, 1.5, second and third), and by gender, race, heritage, age, sexual orientation, religion, social class, education, English language proficiency and disability/ability, as well as country of origin. To conduct valid research with immigrant-origin populations and develop a robust evidence base for practice and policy interventions, researchers must address a number of issues.
Sampling
Research must not focus solely on clinical samples (i.e., individuals demonstrating adaptational problems or reactions that require clinical attention). Relying on such samples makes it impossible to get an accurate picture of the distribution of mental health and adjustment problems in the general U.S. immigrant population (APA, 2010c). Drawing from clinic populations will lead to overestimates of pathology (APA, 2010c). On the other hand, drawing from large-scale national studies that have not parsed out generational status or national origins will underestimate prevalence rates.
Further, accurate estimates of characteristics of diverse immigrant populations are impossible to draw from national studies unless they purposely oversample from the smaller immigrant communities. A representative, comprehensive general population survey of first- and second-generation immigrants is difficult to conduct for a variety of reasons, including funding, the difficulties of validating and translating instruments across groups,  and obtaining widely representative community samples, and historically low rates of participation. Without such research, however, knowledge about this important and growing population will remain limited. Concomitantly, such research should incorporate a strength- and resilience-based focus (Vasquez, 2010).
Cultural validity and reliability of constructs
Valid and meaningful assessment of mental health constructs within and across different cultural groups and settings is essential to educational outcomes and the mental health of immigrant-origin adults (including older adults), children and adolescents, and families. To construct valid and culturally meaningful research, psychology must further the understanding of how different cultural groups vary in beliefs and cultural practices around well-being, distress, and healing (see APA, 2002, for a discussion of multicultural issues in the context of assessment). Contributions from cultural psychology and anthropology are particularly instructive in this regard (see Kleinman’s [1987] work on “category fallacy” for an example).
In addition to identifying cultural-specific expressions of well-being and distress, researchers must critically examine constructs developed in a Western middle-class context before applying them to non-Western, non-middle-class participants (APA, 2010c). Combining “outsider” (etic) and “insider” (emic) approaches to diverse populations is important in both data collection and analysis (APA, 2010c; Cooper, Jackson, Azmitia, & Lopez, 1998; C. Suárez-Orozco & Carhill, 2008). Bicultural and bilingual researchers are better able to establish rapport and trust within immigrant communities and gain entry into populations that might otherwise be difficult to access.
Further, insiders are essential for appropriate linguistic and cultural translations of protocols. Their perspective is also necessary for accurate and culturally relevant interpretations. Expressions of distress may vary considerably from one cultural group to another, with somatization or malaise being the predominant presentation of depression rather than the “classic” sadness or difficulties with concentration. Once culturally specific measures are developed, they can be assessed for validity through a number of strategies, including the measure’s correlation with similar measures, assessment of its relationship with theory, and assessment of its capacity to reliably discriminate between the populations it is intended to assess (APA, 2010c; K. E. Miller, Omidian, et al, 2006).
Triangulation of data and the use of multiple informants
Using triangulated data collected from a variety of perspectives and including a variety of strategies is crucial when conducting research with groups of diverse backgrounds. Such an approach provides more confidence that data are accurately capturing the phenomenon under consideration. By gathering a variety of perspectives — self-reports, parent reports, teacher reports (in the case of youth), and community member reports (in the case of adults) — and considering these alongside researcher observations, concurrence and disconnections can be established among what informants say they do, what others say they do and what the researcher sees them do. Researchers should consider various levels of analysis in their research, including the individual, interpersonal relations (e.g., peers and family), context-specific social groups (e.g., work, school, neighborhood, and place of worship) and cultural dimensions (APA, 2010c; C. Suárez-Orozco & Carhill, 2008).
Developmental and longitudinal perspectives
The majority of available studies with immigrants are cross-sectional in nature. While valuable in their own right, these data by nature limit the ability to detect changes over time. For example, under what conditions do patterns of distress diminish or worsen as immigrants adjust to life in the United States? Though time consuming and expensive, longitudinal research has much to offer and should be pursued when possible (Fuligni, 2001; C. Suárez-Orozco & Suárez-Orozco, 2001; C. Suárez-Orozco et al., 2008). Future studies should also examine mediating (variables that explain the relationship between two other variables) and moderating (variables that explain the strength between two other variables) factors related to mental health and psychosocial adaptation and development (APA, 2010c).
Use of mixed methods
A wide range of methodological strategies is required to identify cultural variations in the expression of well-being and distress (Betancourt & Williams, 2008). Research with culturally and linguistically diverse populations requires a fundamental alteration of the most common investigative frameworks (i.e., rather than approaching culture through a pre-set middle-class American framework, the researcher should use methodologies to understand the worldview of the immigrant population) (APA, 2010c). Using multiple methods will help address these complex methodological challenges (APA, 2010c; Betancourt & Khan, 2008; C. Suárez-Orozco & Carhill, 2008).
When working with immigrant-origin populations, research methodologies should include:
  • Qualitative data: Collecting data to describe meaning (e.g., ethnographic observation, interviews and focus groups).
  • Quantitative data: Collecting data with an emphasis on statistical inference (e.g., questionnaires, surveys and experiments).
  • Mixed methods: Combining qualitative and quantitative strategies in varying sequences depending on the research questions and intent of the study (APA, 2010c; Creswell, 2008)
Well-designed large-scale quantitative surveys can make it possible to generalize findings to particular immigrant populations; however, without qualitative research it can be difficult to interpret that data. Qualitative methods provide better understanding of local terms and cultural norms of well-being, mental distress and the meanings of what is considered “normal” and “abnormal” (APA, 2010c; Betancourt, Speelman, Onyango, & Bolton, 2009). Expressions of distress are not uniform across cultures (APA, 2010c; Hinton & Good, 2009). By recognizing the cultural expression of symptoms for the population under consideration, appropriate interventions can be developed. The potential for client engagement, retention and treatment success will, in turn, be much improved (APA, 2010c; Bernal, 2006; K. E. Miller, Kulkarni, & Kushner, 2006).
Ethical considerations
There are particular ethical considerations when working with immigrant-origin populations. Power dynamics between researcher and participant are always a concern but are accentuated (APA, 2010c) between the researcher and immigrant participant, particularly when the participant is less educated or undocumented. Researchers must articulate how a study may contribute to improving the lives of its participants and/or the larger community and delineate any potential risks. Researchers must also take steps to protect participants.
Since some portion of first-generation participants may be undocumented, researchers must give thought to that issue when formulating the study, recruiting participants, and conducting the study. In the current climate of deportation, extra precautions must be taken to shield the identities of participants. We recommend the use of the usual research protections, including assigned numbers to de-identified records, locked paper and digital records, and consent forms signed with a pseudonym. If psychologists think they might be in contravention of federal or state laws, they should consult the Ethical Principles of Psychologists and Code of Conduct (APA, 2010a) to resolve conflicts. The strictest ethical standards must be upheld to maintain the trust of the community and not place the research participants at risk.
If psychologists’ ethical responsibilities conflict with the law, regulations or other governing legal authority, they should clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights (see press release).

A metadisciplinary reflection

Psychology needs to consider an important metadisciplinary issue. While the field’s imperative to look to evidence in guiding decisions for practice and policy is commendable, when it comes to immigration, psychologists must pause and ask a series of fundamental questions:
  • What is the nature of our evidence when we have, by and large, failed to adequately consider the rapidly growing immigrant population over recent decades?
  • What is the nature of our evidence when we have not framed research questions with the immigrant population in mind?
  • What is the nature of our evidence when the research questions do not carefully delineate exactly who is and is not included within that population?
  • What is the nature of our evidence when many of our research tools are not culturally sensitive?
  • What are the trade-offs when quality data are simply unavailable to make what are otherwise ethically urgent and clear recommendations?
To date, the answer is that “evidence” is limited in scope and requires cautious interpretation. It is urgent that psychologists make immigrant-origin populations a key population in psychological research agendas at every phase of development. Only in so doing will the field discover the kinds of meaningful findings needed to inform practice and policy.
Summary of recommendations
Recommendations to ensure and maintain positive outcomes for immigrant-origin adults (including older adults), children and adolescents, and families are embedded throughout this report. Positive outcomes require stakeholders within clinical practice, research, education, and public policy sectors to become culturally competent as well as cognizant of an array of diverse interacting factors (e.g., immigrant generation, gender, race, age, sexual orientation, religion, social class, education, English-language proficiency and disability/ability) that may influence immigrants' mental health and adjustment. Stakeholders should collaborate with family members, community members, and one another to provide effective and ethical mental and behavioral health and educational support for immigrant-origin adults (including older adults), children and adolescents, and families.
The following recommendations focus broadly on ways the field of psychology can address the need of this population across practice, research, education and policy domains. These recommendations require further communication and collaboration within psychology and in interdisciplinary collaboration with other fields involved in the care and adaptation of immigrants across the life span.

Research

The field of psychology should make immigrant-origin populations a population considered in research agendas at every phase of development. Only by doing so will the field discover the kinds of meaningful findings needed to inform practice and policy. To advance the mental and behavioral health of immigrant-origin adults (including older adults), children and adolescents, and families, the task force recommends that APA advocate for support of research that does the following:
  • Examines the broad range of migration, acculturative and family stressors that can affect the mental and behavioral health of immigrant families and identifies culturally specific definitions of well-being, distress, and healing, as well as coping strategies and strengths that immigrant adults (including older adults), children and adolescents, and families use.
  • Uses qualitative, quantitative and mixed methods in a complementary fashion to improve validity and cultural significance of research.
  • Examines the feasibility, adaptation and efficacy of evidence-based interventions, including clinic-, community- and school-based interventions and evaluates practice-based evidence using rigorous scientific designs for use with immigrant adults (including older adults), children and adolescents, and families. This research should include the role of factors that enhance treatment access, engagement and retention.
  • Encourages culturally competent, multicultural and multilingual research teams to improve the validity and cultural significance of findings.
  • Uses both longitudinal and cross-sectional design to identify trajectories of risk as well as resilience in immigrant-origin individuals across the life span from a variety of origins.
  • Examines the ways in which various settings (e.g., schools, community centers, neighborhoods) serve to enhance and impede acculturation, language acquisition, identity development, academic performance, peer relationships, and mental and behavioral health for immigrant-origin individuals across the lifespan.

Services and supports

Immigrant-origin adults (including older adults), children and adolescents, and families may need supportive services to promote and maintain health and well-being after migrating to the United States. Such services may address a range of needs, including basic daily living, education, and physical and mental health, across the numerous contexts in which they function. Such services should be accessible and affordable, as well as culturally and linguistically appropriate. To promote this standard of care, the task force recommends that APA:
  • Support opportunities for the sharing of practice methods and theories within the field of psychology that are developed to address the special needs of immigrant-origin individuals and their families across the life span, recognizing there may be methods of treatment that incorporate culturally syntonic techniques into practice.
  • Advocate for the implementation of comprehensive, community- and school-based mental health programs and interventions that demonstrate clinical effectiveness with immigrant-origin children and adolescents.
  • Support and advocate for federal policy initiatives that assist in the adjustment and self-sufficiency of immigrant-origin adults (including older adults), children and adolescents, and families.
  • Advocate for initiatives that provide case-management services for immigrant-origin individuals across the life span that address basic needs and access to essential resources (e.g., physical health care, mental and behavioral health care, job placement and housing).
  • Support the development of and access to a range of services for unaccompanied immigrant minors, such as physical and mental health services, adequate housing and provision of daily needs, and school placement and support.
  • Support the development and dissemination of culturally and linguistically appropriate evidence-informed practices for prevention, intervention, and treatment of mental and behavioral health problems among immigrant-origin individuals across the life span in both traditional and nontraditional settings (e.g., home, community, school, and detention facilities).

Education and training

To significantly improve and enhance education and training opportunities related to immigrant issues for students in psychology and encourage education and training for, and retention of, professionals who work with immigrant adults and children across the lifespan, the task force recommends that APA:
  • Promote education and training on methods to ensure that research and assessment are conducted in a culturally competent manner.
  • Continue to promote psychology education and training in multicultural practice and research.
  • Advocate for federal policy initiatives that support education and training opportunities in psychology to work with diverse populations such as:.
    • - Minority Fellowship Program: Train immigrant-origin minority mental health professionals to provide culturally and linguistically competent and accessible mental health   services for diverse populations.
    • - Graduate Psychology Education Program: Support the interdisciplinary training of psychology graduate students while the students provide supervised mental and behavioral health services to underserved populations (e.g., immigrant populations, other diverse populations, and victims of abuse and trauma).
  • Encourage continuing education programs for practicing psychologists and mental health professionals that include information on multicultural practice and the importance of effective collaboration between psychologists and interdisciplinary colleagues, resource agencies, community leaders, paraprofessionals, and cultural brokers to address the needs and strengths of immigrant-origin individuals and their families across the life span.
  • Provide training and effective supports to teachers and other service providers in the fields serving immigrant populations, including prejudice reduction.
  • Support policies and practices in testing and assessment of immigrant-origin individuals consistent with APA’s standards for educational and psychological testing.

Collaboration and advocacy

To improve collaboration and advocacy between and among individuals, organizations, and systems that provide care to immigrant-origin adults (including older adults), children and adolescents, and families in need, the task force recommends that APA:
  • Support opportunities for dialogue and formal collaboration between researchers and practitioners who work with immigrant-origin adults (including older adults), children and adolescents, and families to enhance the evidence base for effective treatment with this population and strengthen the effectiveness of clinical services being offered.
  • Advocate for systematic collaboration and communication among the interdisciplinary systems (i.e., health care, education, legal/immigration, refugee resettlement and social services) that provide services to immigrant-origin adults (including older adults), children and adolescents, and families to enhance service effectiveness, reduce redundancy of care and create strong networks of support for this vulnerable population.
  • Provide opportunities for collaboration and bidirectional training between psychologists and community leaders, paraprofessionals and cultural brokers.
  • Continue to support relevant United Nations (UN) initiatives that are consistent with APA policy, such as the UN Convention on the Rights of the Child, which recognizes the rights of every child, including immigrant and refugee children, to human dignity and the potential to realize their full capacities.
  • Continue to raise awareness of the mental and behavioral health effects of detention and deportation processes on immigrant adults and their families, including policies that promote humane detention requirements, and the importance of family reunification in immigrant proceedings as consistent with the APA Resolution on Immigrant Children, Youth, and Families (1998).
  • Continue to highlight the psychological implications of racism, discrimination and racial profiling on individuals, families, communities, and society as consistent with APA’s Resolution on Racial/Ethnic Profiling and Other Racial/Ethnic Disparities in Law and Security Enforcement Activities (2001), APA’s Resolution on Prejudice, Stereotypes, and Discrimination (2006), and the recommendations of the report of the APA Presidential Task Force on Preventing Discrimination and Promoting Diversity (2012).
  • Continue to promote the full equality of LGBT persons and families in federal immigration laws and policies, including the recognition of “permanent partner” status eligibility for same-sex couples in the Immigration and Nationality Act as consistent with the APA Resolution on Opposing Discriminatory Legislation and Initiatives Aimed at Lesbian, Gay and Bisexual Persons (APA, 2007b).
Glossary

Acculturation: A bilinear process occurring with respect to both the new and the heritage culture.
Acculturative stress: Stressful life events thought to be associated with the acculturation process.
Adultification (or Parentification): Occurs when children or adolescents prematurely take on mature adult or parental roles, possibly before they are emotionally or developmentally ready.
Assimilation: Refers to a particular type of acculturation that involves adopting the new culture while simultaneously letting go of attachment to the heritage culture.
Assimilation ideology: Belief that the best approach to managing differences across cultures is for immigrants and other minority groups to assimilate to a dominant culture. Assimilation toward the common norms and rules is the desired end state. Eliminating ethnic group boundaries thereby eliminates intergroup prejudice.
Assistive technology: Refers to any rehabilitative device for individuals with disabilities.
Asylum seekers: Individuals who travel to the United States on their own and apply for asylum, which they may or may not be granted. These individuals arrive in the United States via student, tourist, and business visas or may be unauthorized. Asylum seekers apply to the U.S. Department of Homeland Security in the hope that they will be approved for refugee status based on their previous, often traumatic, experiences prior to migration.
Authoritarianism: A form of social organization characterized by submission to authority. In politics, an authoritarian government is one in which political authority is concentrated in a small group of political elite, typically unelected by the people (but not necessarily), who possess exclusive, mostly unaccountable, and arbitrary power. Authoritarianism differs from totalitarianism in that social and economic institutions exist that are not under the government’s control.
Aversive racism: Refers to a theory proposed by Gaertner and Dovidio (1986) based on the idea that evaluations of racial/ethnic minorities are characterized by a conflict between Whites’ endorsement of egalitarian values and their unacknowledged negative attitudes toward racial/ethnic outgroups.
Ayurvedic healers: Individuals who practice a traditional medicine native to India.
Behavioral acculturation: The extent of immigrants’ or foreign-born individuals’ participation in their culture of origin and/or new culture.
Bilingual Education: Any form of education in which academic content is taught in two languages (usually a native and a secondary language), with varying amounts of each language used in accordance with the program model.
Children of immigrants: Parents are immigrants; it includes both first- and second-generation immigrant children and adolescents (used interchangeably with immigrant origin; see C. Suárez-Orozco & Suárez-Orozco, 2001, for rationale).
Clinician bias: Failure to take culture into consideration when attempting to service the mental health needs of individuals outside of clinician’s own culture.
Collectivism: Any philosophic, political, economic, or social outlook that emphasizes the interdependence of every human in some collective group and the priority of group goals over individual goals.
Culture-bound syndrome: Any combination of psychological or somatic symptoms that are only considered a recognizable disease by a particular culture or society.
Culture brokering: When children of foreign-born parents act as an aid for their parents to help them with culture and language of a new society (e.g., doctor appointments, parent–teacher conferences, financial and legal situations).
Cultural identity (also known as ethnic identity): Immigrants’ or foreign-born individuals’ sense of belonging to, positive regard for, and pride in their native culture.
Curandero: Traditional folk healer in Latin America who works to cure physical and spiritual illness.
Conservatism: Political or social philosophy based on the disposition to preserve or restore what is established and traditional and to limit change.
Day laborer: Any worker who is hired but only paid one day at a time, with no agreement between employer and employee that future work/pay will be available.
Discrimination: Unfair treatment of a person, racial group, minority, etc.; action based on prejudice.
Diversity immigrant visa: Also known as the Green Card Lottery. Congressionally mandated lottery program for receiving a U.S. Permanent Resident Card.
Downward assimilation: Process of assimilating or integrating into a new culture that results in foreign individuals finding themselves in a poor community.
Ecology: The study of the relationships between living organisms and their environment.
Employment-based immigration: Situations in which individuals migrate from their country of origin to seek employment. This can apply to those who cannot find work in their country of origin, as well as highly skilled individuals who are sought after by companies outside their country of origin.
Essentialism: Belief system in which “races” are considered distinct entities with immutable biological differences.
Evidence-based practice (EBP): Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. This definition closely parallels the definition of EBP adopted by the Institute of Medicine (2001, p. 147), as adapted from Sackett and colleagues (2000): “Evidence-based practice is the integration of best research evidence with clinical expertise and patient values.” The purpose of EBP in psychology is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. Retrieved from APA Policy Statement on Evidence-Based Practice in Psychology (PDF, 126KB)
Family preference system: Refers to a replacement system for simple “quotas” of visas distributed to immigrants from various regions. This system places immigrants into different groups called “preferences,” which are based on their relationship with U.S. citizens, and each of these groups is allotted a certain number of visas that can then be distributed to those who qualify.
Fictive kin: Kinship that is not based in genetics or marriage.
First generation: Born abroad to non-U.S. citizen parents [used interchangeably in the literature with foreign-born andimmigrantImmigrant is the generic term of choice in this report unless referring to others’ research or making a distinction between generations].
Some researchers distinguish between several subcategories, as each has distinct acculturative, linguistic, and educational advantages and challenges (see Rumbaut, 2004, for details). Few studies provide this level of analysis, however, and these categories are generally subsumed under the first generation:
1.75 generation (born abroad, arriving prior to school age)
1.5 generation (born abroad, arriving after school age but prior to adolescence)
1.25 generation (arriving after adolescence but before adulthood)
Foreign-born: Born abroad to non-U.S. citizen parents [used interchangeably in the literature with first generation andimmigrant].
Full immersion or native-language education: Any form of education in which academic content is taught only in one language.
Gender-based asylum claims: Refers to requests for asylum (see Asylum Seekers) based on violence related to one’s own gender. For example, women may request asylum in an effort to escape female genital mutilation, rape, forced marriage, domestic violence, sexual slavery, and many other acts of violence committed against them because of their gender.
Green card: A U.S. Permanent Resident Card (USCIS Form I-551), formerly an Alien Registration Card or Alien Registration Receipt Card (INS Form I-151), is an identification card attesting to the permanent resident status of an alien in the United States. It is known informally as a green card because it had been green in color from 1946 to 1964, and it reverted to that color again in May 2010.
Human capital: Competences, knowledge, and personality attributes embodied in the ability to perform labor that produces economic value; attributes gained through education and experience (A. Sullivan & Sheffrin, 2003).
Humanitarian relief: Material or logistical aid presented in response to an event that represents a critical threat to the health, safety, security, and well-being of a particular community or region.
Imam: Islamic leadership position, frequently the spiritual leader of a mosque or a particular Islamic community.
Immigrant health paradox: Also referred to as epidemiological paradox or Latino paradox. Pattern of research findings that indicate that first-generation immigrants demonstrate the best performance on a variety of physical/behavioral/and educational outcomes, followed by a decline in subsequent generations.
Immigrant: Born abroad to non-U.S. citizen parents [used interchangeably in the literature with first generation andforeign-born].
Immigrant-origin: Includes both first- and second-generation immigrant children and adolescents with immigrant parent(s).
Implicit Association Test (IAT): A social psychological measure meant to gauge the strength of an individual’s automatic association between two or more concepts.
Legal permanent residence: A noncitizen of the United States authorized to live, work, and study in the United States permanently. These individuals are holders of what is commonly referred to as the “green card.”
Microaggression: A theory that examines aggressive behavior between different cultures or races in the form of subtle, nonaggressive actions.
Migrant worker: Can refer to (a) individuals who work outside their country of origin or (b) individuals who migrate within a country to pursue work, such as seasonal employment.
Minority stress: Chronic social stress that results from stigmatization from being part of a minority group.
Mixed status: Some members of the family are authorized/documented while some are not (Fix & Zimmerman, 2001).
Multicultural ideology: Belief that all cultures should retain their basic cultural norms, style, and language within a greater cultural framework. Individuals learn to adapt to other cultures. In multicultural models, an appreciation for group differences reduces prejudice and enhances self-esteem.
National identity: Immigrants’ or foreign-born individuals’ sense of belonging to a new society.
Naturalized citizen: A foreign-born individual who has become a U.S. citizen by fulfilling requirements set forth in the Immigration and Nationality Act, including, in most cases, having resided in the United States for at least 5 years.
Neurasthenia: A psychopathological condition in which an individual may feel fatigue, anxiety, headache, neuralgia (generalized pain), and depressed mood.
Newcomer: First-generation immigrants arriving within the last 4 years.
Posttraumatic stress disorder (PTSD): A severe anxiety disorder experienced after traumatic events, particularly those involving psychological trauma. Typical symptoms include flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal (through difficulty staying or falling sleep, anger, or hypervigilance). Formal diagnosis through DSM-IV-TR requires that symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning.
Prejudice: Unreasonable feelings, opinions, or attitudes, especially of a hostile nature, with regard to a racial, religious, or national group.
Protective factors: Conditions in families and communities that, when present, increase the health and well-being of children and families. These attributes serve as buffers, helping parents find resources, supports, or coping strategies that allow them to parent effectively, even under stress (U.S. Department of Health and Human Services, 2011).
Racial profiling: Authority figures use race or ethnicity as a basis for deciding whether or not to enforce laws or regulations.
Racism: The belief that some races are inherently superior (physically, intellectually, or culturally) to others and therefore have a right to dominate them.
Reactive identification: Immigrants or foreign-born individuals who embrace their cultural identity (from country of origin) while rejecting the new culture, after having been rejected by it.
Refugee: A person outside of his or her habitual residence who has a well-founded fear of persecution because of race, religion, nationality, or membership in a particular social group or political opinion and who is unable or unwilling to avail himself/herself of the protection of that country or return there for fear of protection (APA, 2010c).
Refugee status: A legal status granted by the United States to refugee adults and children admitted for permanent resettlement. These individuals receive social, English-language, and job-placement services during the initial 4–8 months in the country through a system of voluntary agencies and with funding from the Office for Refugee Resettlement, U.S. Department of Health and Human Services.
Second generation: Born in the United States of foreign-born parent(s). Currently, all second-generation immigrant adults and children are citizens as mandated by the 14th Amendment (1868).
Selective assimilation: Assimilation to a new country in which foreign-born individuals maintain their native culture in strong ethnic enclaves but successfully participate in the new culture as well, particularly economically.
Social dominance orientation: A measurable personality trait that indicates the amount of preference an individual has for hierarchy in any society.
Social justice perspective: Psychological treatment that is rooted in the belief that all people have a right to equitable treatment and a fair allocation of societal resources including decision making. To this end, social justice addresses issues of oppression, privilege, and social inequities. Psychologists committed to such a perspective direct efforts toward making society a better place for all by challenging systemic inequalities.
Third-generation: U.S. citizen of immigrant grandparent(s).
Somatization disorder: A psychiatric diagnosis given to patients who present physical symptoms that have no underlying physical cause.
Undocumented: Individuals without legal authorization who reside in the country. These individuals are not U.S. citizens, do not hold current visas, and have not been permitted admission under a specific set of rules for longer-term residence and work permits (Passel & Cohn, 2009) [interchangeable term is undocumented; legal but pejorative term isillegal].
U.S. Citizenship and Immigration Services (USCIS) H1-B program: Used by U.S. businesses to employ foreign workers in specialty occupations that require theoretical or technical expertise in specialized fields, such as scientists, engineers, or computer programmers; capped annually at low numbers by country.
U-VISA in the Violence Against Women Act II (VAWA II): The VAWA II created a new type of nonimmigrant visa known as the U-VISA. To be eligible for this “U” visa, the applicant must have suffered “substantial physical or mental abuse” because of a variety of crimes, including domestic abuse and involuntary servitude. The applicant must have information relating to this crime that would be of assistance to law enforcement in investigating or prosecuting it. There is an annual limit of 10,000 U visas. U visa holders are work authorized and able to apply for adjustment of status after 3 years.
One of the eligibility requirements is that a self-petitioner must demonstrate he/she is a person of good moral character. A VAWA-based self-petition will be denied or revoked if the record contains evidence to establish that the self-petitioner lacks good moral character. The inquiry into good moral character focuses on the 3 years immediately preceding the filing of the self-petition, but the adjudicating officer may investigate the self-petitioner’s character beyond the 3-year period when there is reason to believe the self- petitioner may not have been a person of good moral character during that time. A self-petitioner’s claim of good moral character is evaluated on a case-by-case basis, taking into account the provisions of section 101(f) of the act and the standards of the average citizen in the community. Other provisions in the VAWA II allow people who have adjusted status under it to apply for naturalization in 3 rather than in 5 years.
Visa: A document (or in many cases a stamp in a passport) showing that a person is authorized to enter a territory. Typically a visa is attached to several conditions, such as the territory it applies to, and the dates for which it is valid. A visa does not generally give a noncitizen any rights, including a right to enter a country or remain there. The possession of a visa is not in itself a guarantee of entry into the country that issued it, and a visa can be revoked at any time. The visa process merely enables the host country to verify the identity of the visa applicant before, rather than coincident with, applicant entry. Visas are associated with the request for permission to enter (or exit) a country, and are thus, for some countries, distinct from actual formal permission for an alien to enter and remain in the country.
Xenophobia: Hatred or fear of foreigners or strangers or of their politics or culture.



(Source: apa.org)
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