Date Presented 04/02/2022

This study examined whether a person-centered evaluation template generating occupational profiles of middle-school-age refugee youth was useful for guiding services at a community-based nonprofit. Analysis of data across participants revealed common challenges these youth face in their migration journeys and revealed key areas that, if addressed, could support positive occupational identity formation. Results may assist OTs who may encounter forcibly displaced youth in their practice.

Primary Author and Speaker: Rebecca Lord

Additional Authors and Speakers: Jaime P. Muñoz

PURPOSE: This study examined whether a person-centered evaluation protocol generated occupational profiles of middle school aged refugee youth that a community-based non-profit could use to guide services that facilitated successful sociocultural, academic, and occupational outcomes for youth.

BACKGROUND: By the end of 2020, the number of forcibly displaced persons rose to over 82.4 million, over 35 million of which were under the age of 18 (Trimboli et al., 2021). Displaced youth face acculturation stress, language barriers, unmet health needs, discrimination, xenophobia, and economic instability. When these factors converge, they negatively impact youths’ ability to participate in meaningful occupations, often leading to psychosocial distress (Khan et al., 2020; Sleijpen et al., 2016). Youth who are forcibly displaced experience prolonged periods of occupational apartheid, deprivation, and imbalance, which often continues even after resettlement (Whiteford & Townsend, 2005). Scholarship in OT examining the habituation and meaningful occupations of refugee youth is limited despite practitioners encountering this population in various settings. This study aimed to understand the OT needs of refugee youth utilizing a person-centered evaluation process. The broader intent was to consider service delivery at a community non-profit through an occupational lens and to inform practitioners working with this population.

DESIGN: Mixed methods multiple case study.

METHOD: The evaluation protocol was implemented over 5-weeks and included a demographic survey, the Child Occupational Self-Assessment (COSA), Preferences for Activities of Children (PAC), the Comprehensive Occupational Therapy Evaluation Scale (COTE), the KAWA River Model and researcher defined role checklist and time use tools. Aggregate descriptive statistics of the sample were generated and quantitative scores were recorded in a comprehensive database on Microsoft Excel. Qualitative data analysis was analyzed using a process of line-by-line microanalysis, open coding, and iterative code-recode analysis.

RESULTS: 11 participants between the ages of 9-13, whose families were from the Democratic Republic of Congo and Myanmar, participated in the study. Assessments determined to be the most culturally responsive and effective were the KAWA River Model, the COTE Scale, and a modified role checklist. Qualitative data analysis revealed key challenges faced by refugee youth including living with/through trauma, the experience of bullying, finite access to resources required for daily living, and diminished social capital. Interventions focused on psychosocial well-being and habituation, when tied to the participants’ interests, were found to be most effective in disrupting unhealthy habits and increasing positive social participation in these participants.

CONCLUSION: Data from this study reflect the benefits of employing a person-centered evaluation framework with refugee youth. Findings may inform practitioners working with this population about barriers that negatively impact participation in meaningful occupations. The results provide insights into cultural considerations OTs should take when evaluating and intervening with refugees. The results demonstrate the importance of ensuring occupational therapy is person-centered and approached holistically despite language and/or cultural differences.

IMPACT: As the number of those forcibly displaced continues to rise, the OT community needs to continue to respond to the significant occupational deprivation, role loss, and barriers to occupational participation that this population faces. Occupational therapy and occupational science can help illuminate the value of occupation for those who are forcibly displaced.


Khan, F., Eskander, N., Limbana, T., Salman, Z., Siddiqui, P. A., & Hussaini, S. (2020). Refugee and migrant children’s mental healthcare: Servicing the voiceless, invisible, and the vulnerable global citizens. Cureus, 12(8), 1-12.

Sleijpen, M., Haagen, J., Mooren, T., & Kleber, R. J. (2016). Growing from experience: An exploratory study of posttraumatic growth in adolescent refugees. European Journal of Psychotraumatology, 7, 1-10.

Trimboli, C., Parsons, L., Fleay, C., Parsons, D., & Buchanan, A. (2021). A systematic review and meta-analysis of psychosocial interventions for 6-12-year-old children who have been forcibly displaced. SSM-Mental Health, 1(2021). 1-16.

Whiteford G. E. (2005). Understanding the occupational deprivation of refugees: A case study from Kosovo. Canadian Journal of Occupational Therapy. 72(2), 78–88.