Clinical assessment and programme evaluation are crucial for monitoring the effectiveness of interventions, whether in individual clinical work or in group programmes, with 0-6-year olds from refugee families. A multitude of assessment tools exist, some only in English, that have been found to be valid and reliable in other contexts, but not with refugees. Very few assessment tools have been reliably translated into the languages that refugee families speak or read. Cultural, contextual, literacy and stigma issues can impede effective assessment and programme evaluation with this target group, as well as issues relating to appropriate language support, and the need to modify the formatting of some tools.
In this paper we will explore these issues and present a multi-tier approach to assessment and evaluation, embracing a biopsychosocial systemic approach. We will describe our progress towards developing a new, brief, early childhood screening questionnaire specifically for refugee clients (first tier), and present an in-house clinical assessment tool that was developed and trialled at STARTTS to explore nine health and development domains (second tier). This tool is used in addition to the perinatal history, and key traumatic event history for the child and their family.
We will also discuss the third tier of more detailed assessment tools, which enjoy wide usage with other groups (including those experiencing other sources of trauma). We will present suggested criteria and indicators for using these more detailed tools, discuss the qualifications needed to administer them, and consider the scant literature which explores their cultural sensitivity and appropriateness.
We will discuss the relevance of these issues when applying for recognition as an Evidence-Based Programme for refugees, and the implications for funding. We will also outline future directions for this initiative, and make suggestions for research in this area.