Maahir, a 5-year-old Somali boy, born in Portland, was referred to the youth and family clinic by his mother, due to concerns about his anger. His mother, a refugee from the Somali civil war, receives psychiatric care at the IPP adult clinic. His father is still living in a Kenyan refugee camp.

Mya, a 15-year-old Burmese girl, born in a Thai refugee camp and living in Portland since she was 3 years old, was referred to the clinic by a psychiatric hospital for outpatient care after a suicide attempt. Her parents are not involved with the IPP.

Farzad, a 14-year-old boy born and raised in Afghanistan, was referred to the clinic by his English-as-a-second-language (ESL) teacher, after he had lived in Portland for one year, due to concerns about his distractibility and impulsivity. His mother receives care from the IPP adult clinic.

The youth and family clinic dovetails with the individual services provided to parents who participate in IPP, further explores the systemic dynamics that promote resilience and contribute to stress, and expands community collaboration through coordination of services with schools, child welfare services, and youth social service programs [22]. Youth and families access the IPP clinic for a diverse range of services including explicit trauma-related symptoms, neurodevelopmental and general psychiatric disorders, and intergenerational cultural conflict. Furthermore, given the sociocentric stance of the families accessing IPP services, attention to family welfare is an expected and integral part of individual care. School staff is always involved to provide collateral information, perspective on the effectiveness of treatment, and additional data on youth function. Primary care providers are included to coordinate health care services. Youth social service agencies are often recruited to provide extra support after school. Finally, Oregon Child Protective Services (CPS) becomes involved when there is concern about the capacity of parents to provide specialized care to children with high needs due to neurodevelopmental disorders, and when there is concern about the appropriateness of parenting practices. While this collaboration with community providers is not unique to the IPP youth and family clinic, the IPP tends to have a greater role in facilitating these collaborations for youth and families due to language, cultural, and educational barriers.

In addition, the generational dynamics of cultural expectations, acculturation differences, parent–child role reversals, and unique trauma experiences complicate the position of the children of refugees.

Because many of these additional specialized services typically do not exist in the families’ home countries, and most of them carry significant social stigma, refugee families warrant even stronger collaboration and support than required for average US families. Our youth and family program relies upon existing community programs and services for primary care, academic support, after-school programs, parenting groups, and therapy groups for youth. Because of the trusted relationships formed in IPP, we often know more about the home dynamics, the family stresses, family cultural practices, and the family capabilities than other service providers who have less intimate relationships. Sharing this information is essential for facilitating coordinated and effective support, and linking the perspectives creates solutions. Furthermore, these collaborations can have significant impact on the health of the family. The work with each family exemplifies the reciprocal benefit for both CPS and the family for working collaboratively.

The IPP youth and family clinic, similar to our adult clinics, has two primary providers who collaborate in a multidisciplinary fashion. A therapist who works full-time at the clinic provides case management and individual and family psychotherapy and is the primary person to coordinate care with the family and community providers. The child and adolescent psychiatrist, who works at the clinic part-time, comprehensively evaluates the youth, including exploration of family system dynamics, devises the primary treatment plan, and helps advocate for services. Treatment often involves medication, along with systemic and symptom-targeted psychotherapy, and collaboration with community providers as warranted. The youth and family clinic is the only IPP clinic that is not based on specific cultural groups; therefore, translators are also relied upon as the case manager cannot provide language and cultural translation for all youth and families. A large percentage of the youth speak English, which shifts the majority of the translation challenges to communication with parents rather than the specific clinician/youth therapeutic relationship. The close collaboration between the therapist and the psychiatrist provides continuity for both the families and community partners. The primary challenge is creating the time to engage in these collaborations.