Stanford researchers and Nest Global are working with migrant communities in Tijuana to address the trauma of migration and promote healing for children and parents alike.

By Gia Mukherjee, for CIGH

In the summer of 2021, Dr. Xin She, a Stanford pediatrician and Global Health Faculty Fellow, found herself profoundly moved by the work of Nest Global, a Los Angeles-based nonprofit, which offers transformative early childhood education in refugee camps, migrant shelters, and other transitory contexts. While volunteering for the program, Dr. She witnessed how Nest’s services provided a sanctuary for young children to thrive, away from the violence, hunger, and uncertainty that often defined their lives.

Wanting to help in a more sustained way, she began discussing ways to contribute with the Nest Global leaders and staff. Together, they identified a significant gap: the need for socio-emotional support for the parents of the children in Nest’s programs. Many parents struggled with their own trauma, which often colored their interactions with their children.

“Many parents come from a place of love, but also fear that their kids might get hurt in a world where violence threatens their everyday safety. That protective instinct can come out in unintended ways,” Dr. She explained. “We saw that kids were very happy learning at Nest, but they’d go home to their tired parents who just tried all day to survive in a resource-poor shelter, reacting negatively to normal childhood behaviors, often without self awareness or how to change these reactions. Parents also felt frustrated and expressed guilt for not being able to handle difficult interactions with their children.”

Nest Tijuana, situated close to the US-Mexico border, had created a nonviolence  parenting program for migrant parents to address this need. The program actively engages parents in meeting their specific mental health challenges and priorities through interactive teaching, creative activities and group discussions. The pilot program had been well received by parents, but lacked the funding and research evidence necessary for broader expansion. 

Inspired by the program’s potential and positive qualitative feedback, Dr. She collaborated with Nest Global and Dr. Erika Clairgue of the local Universidad Iberoamericana in a randomized controlled study to explore the effectiveness of trauma-informed, community-participatory migrant parenting intervention. This project was supported by her 2023 Fulbright fellowship and a Stanford Global Health Seed Grant. Stanford Global Health Medical Student Research Fellow Lillie Reed joined the project through the Stanford Global Health Medical Research Fellowship and the Stanford Medical Scholars Research Program (MedScholars) in the fall of 2023.

Reed was excited to contribute to an absence of robust, qualitative research about the mental health needs of refugees. 

“Having conversations with the community to understand what they need and want is so important — and it’s something that hasn’t really been done,” she explained. 

Together with Dr. She, two Mexican psychologists, and the Nest Tijuana team, Reed conducted focus groups with over 40 parents in a large Tijuana refugee shelter. Within the sessions, the parents spoke of their fears, doubts, uncertainties, and anxieties regarding both their children’s well-being and their own, often precarious circumstances. “It was the first safe space a lot of them had been in for quite some time, which made expressing those tough feelings difficult,” Dr. She noted.

The interviews revealed a significant unmet need for mental health support. “Many people were really struggling. Many had fled difficult situations that they may have been dealing with for a very long time. Now they were in the first place where they had nothing but time to think and sit with their emotions, and for some, those emotions were really difficult,” Dr. She elaborated.

In response, the team introduced concepts and practices on healthy childhood development, mindfulness, empathetic communication, self-compassion and self-efficacy building and positive psychology in their parenting classes, nurturing the healthy skills parents need to navigate interactions with their children during periods of heightened stress and uncertainty. Through a method named “Learning by Observation and Pitching in” using collaborative exercises such as community rules writing, resource mapping, small group discussions, role plays, and participatory art making, the participants began to embrace self-love and practice self-care as a vital opportunity to recharge and reconnect with both their children and themselves.

Dr. Xin She recalled an “emotions workshop” that had become a cornerstone of the program. Parents practiced mindful awareness to focus on specific emotions tied into bodily sensations, using prompts like drawing bodies with different colors representing different emotions to articulate their stories. This creative process helped them tune into their own emotions, making them more adept at noticing reactions before they become automatic, and understanding their children’s emotional landscapes to better respond to unmet needs.

“Many of the parents have had difficult upbringings in some way, shape, or form, either because their parents lacked the necessary skills or resources, or because their communities were unsafe. There’s just a lot of trauma in this community,” says Reed. The classes aimed to break this cycle by teaching coping skills that help parents stay calm in moments of stress, identify their children’s unmet needs, and uphold healthy boundaries.

The impact of the interactive parenting class was profound. Dr. She recalled a mother who confided that the program had completely transformed her approach to parenting. She felt as though she had become more present, patient, and understanding with her child’s emotional outbursts. By encouraging, rather than repressing emotions and practicing compassion for themselves as well as their children, parents learned to cultivate patient, loving home environments critical for their children’s well-being.

To ensure the longevity of these critical skills as families migrate to new locations, Dr. She is crafting a parenting intervention manual in partnership with Nest Global. This manual is designed to serve as a template for adaptation for both newly arrived migrants to the United States and other migrant families in transit in the world, applying lessons learned from Tijuana’s refugee parenting community. The Nest team is also working to create an online resource directory to disperse the wisdom gathered from their early childhood programs in Mexico, Los Angeles, Zimbabwe and D.R. Congo. Universidad Iberoamericana and Stanford University team members will collaboratively publish up to eight articles based on all the mixed-methods data from this unique study. Further, a Facebook page,“Crianza con Amor” (parenting with love) was created exclusively for past and present graduates of this parenting intervention. It seeks to continue to communicate participatory art and published results in order to maintain a community of mutual support, and to share resources on both sides of the border.

Ultimately, Dr. She and Reed hope the evidence they gather about the program can be used to help replicate and share this transformative compassionate parenting approach with groups serving refugees far and wide. 

Acknowledgements
Dr. She’s work is supported by a Fulbright Fellowship and a Stanford Global Health Seed Grant supported by the Office of Community Engagement and Center for Innovation in Global Health. Research partners include Lindsay Weissert, MS, and Kristina Brittenham, JD, MA — co-CEOs of Nest Global, Lisa Chamberlain, MD, Stanford Medicine Pediatrics; Erika Clairgue Caizero, MA, Universidad Iberoamericana. Dr. Clea Sarnquist is Lillie Reed’s co-mentor for her Med Scholar project. Lillie’s work in Tijuana is supported by the Global Health Medical Student Research Fellowship in partnership with the  Stanford Medical Scholars Research Program (MedScholars) as well as an Art + Justice grant.