Stressors and Barriers to Services for Immigrant Fathers Raising Children with Developmental Disabilities
Stressors and Barriers to Services for Immigrant Fathers Raising Children with Developmental Disabilities
Nazilla Khanlou 0 1 2
Nida Mustafa 0 1 2
Luz Maria Vazquez 0 1 2
Nasim Haque 0 1 2
Karen Yoshida 0 1 2
0 Department of Physical Therapy and Rehab Science Institute, University of Toronto , Toronto, ON , Canada
1 Critical Care Services Ontario , Toronto, ON , Canada
2 Faculty of Health, York University , Toronto, ON , Canada
This narrative review examines research on the experiences of immigrant fathers raising children with developmental disabilities, and considers the findings within the Canadian context. Applying Green, Johnson & Adams' (Journal of Chiropractic Medicine, 5(3), 101-117, 2006) methodology, a step-by-step process was followed to conduct the review. Four databases (PsychINFO, PubMed, CINAHL and Sociological Abstracts) were used for the search. A total of 39 articles were found to be relevant after applying the inclusion/exclusion criteria. Also 20 articles from published reference lists and peer-reviewed journal articles, located through Google Scholar, complimented the initial search. Along with House's (1981) four dimensions of social support, an intersectional approach underpinned the analysis of findings. Four themes were identified which included: economic challenges, social influences, cultural influences, and the changing gender roles of fathers. Stressors and barriers to accessing health services in the post-migration setting were examined. Based on the review's findings, the paper recommends 1) addressing income inequality, 2) improving access to health care, social and developmental services, 3) improving cultural-sensitivity of health care, social and developmental services, and 4) increasing participation of fathers. Overall, a more systemic understanding of immigrant fathers' experiences is called for, taking into account their multiple social locations.
Canada; Developmental disabilities; Economic exclusion; Fathers; Gender roles; Immigration; Parenting; Social support
Parenting children with disabilities can embed intense and chronic caregiving responsibilities.
The experience can be both a stressful and a rewarding dimension of parenthood. A number of
factors influence the experiences of fathers, which can create a complex parenthood process
depending on the disability of the child, as well as the availability of effective and efficient
resources at the community level (Waldman et al. 2013). However, being a recent immigrant
and falling into the category of racialized minority can further complicate the fathers’
Research on the barriers faced by immigrant parents in terms of socioeconomic conditions,
acculturation, and ability to access social programs and services for their child, remains scarce
in the Canadian context (Daudji et al. 2011; Lai and Ishiyama 2004). Even more limited is
information available on immigrant fathers raising children with disabilities, who often face
unique stressors based on traditional gender roles and household responsibilities. This
narrative review explores the experiences of immigrant fathers raising children with developmental
Developmental disabilities (DDs) cover a range of disabilities which include
intellectual disabilities, autism, Down’s syndrome, fragile X syndrome and other
developmental delays. Children with DDs may have impairments and limitations affecting
their physical-bodily function, their ability to perform daily activities, and their
participation in routine behaviours such as going to school (Phillips 2012). In 2006,
Statistics Canada reported roughly 3.7 % of children under the age of 15 having one
or more DDs (Statistics Canada 2006). However, in Canada the percentage of children
with disabilities growing up within immigrant families is not known (Khanlou et al.
Additional help in the form of social support is necessary for parents raising children
with DDs (Gallagher et al. 2009; McConnell et al. 2014). However, 74 % of parents of
the 3.7 % of children with disabilities living in Canada reported that extra help was too
expensive for them, and many stated difficulty in finding and accessing appropriate
resources (Statistics Canada 2006). For example, almost 40 % of those parents reported
not knowing where to go to find help (Statistics Canada 2006). The situation for
immigrant mothers and fathers of children with DDs is further complicated, as informal
and formal social support systems are often diminished following migration. In 2011,
20.6 % of the total population in Canada was comprised of foreign-born individuals,
making the country the highest population of immigrants among all G8 nations (Statistics
Canada 2011). One in every five people in Canada is foreign born, and the numbers are
rising yearly. For immigrant men specifically, unique challenges present themselves within
the Canadian context; for example 7.5 % of recent immigrant men are not able to
converse in English, and 36 % of immigrant men work part-time, not in full-time jobs
(Chui 2011). These socio-economic factors may additionally cause further complexity for
fathers raising children with DDs.
Parenting children with DDs involves persistent and long-term challenges with associated
emotional impacts, such as stress for fathers and mothers who have limited social support.
Social support is important in order to alleviate stress, anxiety, and frustration (Wang and
Brown 2009). We apply House’s (1981) conceptualization of social support which entails four
dimensions of social support: structural, instrumental, emotional and perceptive. As per
House, instrumental support relates to financial help for families, as well as the
availability of other forms of tangible/care giving services and programs. Structural support in
the context of this review paper relates to the ease with which parents can access, utilize,
and gain information about their child’s DD. Emotional and perceptive forms of support
are more at the personal level in House’s model, with emotional support focusing on the
social networks (for example, family and friends) present to help reduce caregiving
demands; and perceptive support referring to the adequacy and helpfulness of support
the individual feels they are receiving.
This paper adopts an intersectional approach to account for the multiple and complex
processes which affect particular segments of the population, such as immigrant fathers of
children with DDs in Canada. An intersectional lens allows for a simultaneous analysis of
social difference and identity, which may link to Bforms of systemic oppression…in ways that
are complex and interdependent^ (Dhamoon and Hankivsky 2011, p. 16). It is also a
perspective that interrogates the power relations from which health disparities emerge
(Jennings et al. 2014).
Jennings et al. (2014) argue that in order to consider immigrant families of children with DDs
in contexts such as Canada, it is important to understand immigrant’s Bcomplex social locations^,
which are a result of various intertwined influences (p. 1648). They highlight the need to analyze
such complexity beyond the sole description of social determinants of health, and through
incorporating a more comprehensive analysis examining the Bpower dynamics^ shaping
immigrants’ experiences and disparities (Jennings et al. 2014, p. 1648). The objective of this review is
to examine these very issues. The specific question the narrative review addresses is: BWhat does
the literature tell us about the stressors impacting immigrant fathers of children with
developmental disabilities, particularly in regards to social, cultural, and economic barriers?^
A narrative review is a comprehensive narrative synthesis of previously published information
(Green et al. 2006, p. 103). By following Green, Johnson and Adams’ (2006) method, and as
described below, we applied a step-by-step procedure which includes identifying the sources
of information used, the search terms, as well as the inclusion and exclusion criteria applied to
narrow down the search.
Four electronic databases were used when completing this narrative review—PsychINFO,
PubMed, CINAHL and Sociological Abstracts. All references found within these sources were
organized and categorized using the online research management tool—RefWorks. The
specific search within each of the four main databases was delimited through the inclusion
and exclusion criteria.
Search Terms and Delimiting
First, key search terms were used within each of the four data sources. The terms Bfather*^ and
Bdevelopmental disabilities^ were used across all databases yielding 822 total search results.
Originally the term Bimmigrants^ had been added in order to limit results specific to immigrant
fathers. However, this yielded very few results (i.e., PsychINFO, Pub Med and CINHAL
presented only one article each), and therefore this term was removed. This further shows the
limited literature in the area of immigrant fathers of children with DDs. Therefore the term
Bimmigrants^ was removed and the larger result of 822 articles across all four databases was
delimited using the inclusion/exclusion criteria outlined below. Also initially, the term
BCanada^ was used to narrow the search in order to yield results within the Canadian context;
however adding this term greatly reduced the number of articles as well. Therefore the term
BCanada^ was removed, which then yielded for a greater number of results. This further
illustrates the limited research conducted on immigrant fathers’ within the Canadian context.
Next, titles of each result were scanned within each database, according to the inclusion/
exclusion criteria for the review. Lastly, paper abstracts were reviewed as a final step to ensure
the included papers met the criteria set. Since we did not specify Canada as a key word, most
of the literature reviewed was from the United States and United Kingdom. The years specified
for the search were 1990 to 2015. Key words and final search results (before and after
application of the inclusion/exclusion criteria) are shown in Fig. 1.
The inclusion criteria included literature studying the experiences of fathers, the experiences of
immigrant fathers, socioeconomic barriers of immigrant populations, and DDs in children
(including impairment in body structure or function, inability to read or move around, and/or
restriction in activity).
The selection criteria excluded literature that was not focused on fathers, literature that
focused on disabilities caused by accidents (non-developmental disabilities), research
exploring the experiences of fathers of adults as opposed to children, and non-English papers.
Using the inclusion/exclusion criteria, a total of 39 articles were found to be relevant across all
four databases. The majority of articles were published outside of Canada, however they form
part of the review to examine the various factors involved in fathering children with DDs.
Findings have been applied within the Canadian context, as there is a lack of literature in this
The above search was complemented by additional search strategies. We used published
references recommended by our peer scholar networks, as well as peer-reviewed journal
articles located through Google Scholar. Key phrases used for this complimentary Google
Scholar search were, Bimmigrant economic barriers Canada^, Bimmigrant employment
Canada^, and Bimmigrant labor force Canada^. Through this step a total of 20 additional
academic journal articles were included.
The first part of the findings presents the challenges fathers face in general while parenting and
caring for their children with DDs (BRaising Children with Developmental Disabilities^
section). Along with these general challenges, immigrant fathers experience additional barriers
that we present in the second section (BImmigrant Fathers: A BDouble Burden^?^ section) due
to their immigration status in Canada.
Raising Children with Developmental Disabilities
Fathers of children with disabilities experience differing levels of stress as they care
for their family which is strongly linked with gender (Samadi et al. 2014; Oelofsen
and Richardson 2006; Dyson 1997). Parents of children with disabilities living in
Canada reported that their daily stress level varied from Ba bit^ to Bextremely
stressful^ (Statistics Canada 2006). Added pressure on parents to balance personal
and work life resulted in over 60 % of parents reporting Bsometimes^ to Balways^
feeling under stress. This strain affects all aspects of family life including parental
marital satisfaction, parental physical and emotional health, as well as the ability to
perform care giving tasks and responsibilities (Statistics Canada 2006).
The stressors that most commonly affect fathers of children with disabilities are both
informational stress as well as practical stressors. Informational stress refers to the ongoing
quest by fathers for medical information, in order to better understand the disabilities of their
child. In one study it was found that not only do some fathers feel responsible for seeking
information, but they also have pressure to balance family, work and routine daily tasks–
leading to practical stress (Huang et al. 2012).
Some fathers have also expressed concern in regards to health care professionals viewing
them as intrusive, assertive, and less competent than their wives (Huang et al. 2012). One
reason given for the bias felt by men is the domination of women in the care giving field (e.g.,
hospital staff, nurses). Many fathers feel health care professionals are not supportive and depict
fathers in a negative light (Pelchat et al. 2007). This causes further frustration and stress.
Fathers live more in the public domain, in which employment is a strong priority—to fulfill
the Bbreadwinner^ role (Darling et al. 2011; Gray 2003). In one study, it was found that some
fathers show to be a strong power in the household, and a main authority in the family—in
terms of financial support for the child in care (Huang et al. 2012). Taking on this role forces
them to repress emotions, in order to be strong for the family and provide additional support
for their wives. Huang, Chen and Tsai (2012) also found that some fathers tend to suppress the
difficulties of adjusting to the new role as a father of a child with disabilities, as well as the
difficulty of balancing work and family life—in order to be strong for the whole family.
A fear of loss of employment and financial support creates worry and guilt for fathers, related
to the child’s medical care and treatment (Huang et al. 2012; Pelchat et al. 2003, 2007). Since most
men in the household see their occupational role as primary, there is increased job stress in order to
further support medical expenses (Darling et al. 2011; Brown and Barbarin 1996).
There are also structural limitations felt by fathers who want to be more involved in the life
of their child with disabilities. Fathers feel a restriction by their employers, who are less
flexible with their work schedule and give fewer accommodations in taking time off from
work, compared with mothers. This leads to the stress of balancing family and work life, and at
the same time fearing a threat of job loss (Darling et al. 2011).
Marital stress is experienced by both mothers and fathers of children with disabilities
(Kersh et al. 2006). According to some researchers, the lack of intimacy, time, and
communication, causes increased frustration between the spouses—who begin to view their
relationship as a business (Goble 2004; Huang et al. 2012). As wives want to spend more time with
their spouse, husbands tend to spend time away from home in order to strengthen their
relationship (Darling et al. 2011). However, and conversely, having children with DDs can
also lead couples to be more interdependent on each other, as they take turns in caregiving and
providing temporary respite to each other.
The stigma felt by fathers in regards to their children’s disabilities, and the negative perception
from outsiders, are among the stressors that fathers endure (Darling et al. 2011; Brown and
Barbarin 1996; Shin et al. 2006). The specific characteristics of the child’s DD as well as worry for
his/her future are also causes for great tension (Goble 2004; Pelchat et al. 2003, 2007; Gray 2003).
These stressors are reported by some researchers to be tied to decreased life satisfaction for
fathers (Darling et al. 2011; Huang et al. 2014). Also among some fathers, increased
depression due to the disabilities of the child may lead them to distance themselves or become stoic
towards the child as a way of coping (Barak-Levy and Atzaba-Poria 2013). This social
isolation (retreating from child, family, and friends), can harbor feelings of shame, sadness,
anger and disappointment. The father can feel overwhelmed with a loss of control in his life,
leading to poor physical health (Goble 2004; Huang et al. 2012). Avoidance and isolation have
been linked with lower levels of wellbeing over time (Glidden and Natcher 2009; Glidden
et al. 2006). In contrast, fathers who display emotional stability and agreeableness have
decreased parenting stress (Vermaes et al. 2008).
There also is limited professional help offered for fathers living with a child with
disabilities, and many fathers request more details of the DD (Boström and Broberg 2014). This lack
of knowledge leads to feelings of discomfort, and can further cause a stressful environment
(Darling et al. 2011). Table 1 summarizes these findings, as well as the number of relevant
articles found within each thematic area.
Immigrant Fathers: a BDouble Burden^?
Along with facing the stressors highlighted above, immigrant fathers experience additional
stressors which can affect the way they deal with the DD of their child. We present below
Table 1 Sources of stressors on fathers
literature review findings on the contextual experiences of immigrant fathers who, we argue,
carry a Bdouble burden^. In addition to parenting and caring for their children with DDs,
immigrant fathers experience unique stressors and barriers due to their immigrant status.
There are structural socioeconomic constraints that immigrants in Canada navigate on an
everyday basis. Approximately 78 % of immigrants arriving to Canada within the last ten years
are identified as a visible minority—individuals who are non-white in colour or who are
nonCaucasian in race (Statistics Canada 2013). Being both a new immigrant and part of a visible
minority group limits individuals and their families in terms of employment and income. In
Canada, 1 % of recent immigrants live below the poverty line; this population has three times
more probability to live in poverty than people born within the country (Affiliation of
Multicultural Societies and Services Agencies of BC 2013). In addition, over a period of a
decade after their arrival, the poverty rates remains high for this population, the rates are two
times as high as non- immigrants (Ibid).
The literature points towards two socioeconomic characteristics of children with DDs in
Canada: they are Bmore likely to live in poverty^ than children without any disability, and they
are Bmore often being raised in single-parent families^, particularly by single mothers
(Jennings et al. 2014, p. 1650). The effects of living in families with lower income on young
children include negative outcomes such as decreased educational attainment, and increased
behavioral problems (Mayor 2010). These effects can be seen to carry on into adulthood, with
children from low income families earning less as adults themselves (Mayor 2010).
Immigrant fathers of children with disabilities have increased stress through financial
barriers and social isolation (Welterlin and LaRue 2007; Waldman and Perlman 2008).
Goldring and Landolt (2012) argue that the Blabor market incorporation of immigrants is
important for social inclusion because it determines employment income and shapes material
well-being^ (p. 10). However, immigrants’ insertion into the labor market is one of the most
Bhardest tasks^ (Statistics Canada 2005, p. 72). Scholars have highlighted the difficulties
immigrants encounter in their job search as well as the lower earnings they receive compared
to the non- immigrant population (Frank 2013; Walters et al. 2006; Teelucksingh and Galabuzi
2005). Precarious, unstable, and low pay jobs have negative impacts on immigrant families’
psychological, material, and physical health and well-being (Zeynep and Berry 1996). Fathers’
unstable employment may also have a direct impact on their ability to provide care to their
children with DDs. For example, in precarious work environments, it is unlikely that fathers
will get support from their supervisors to skip job hours in order to attend their children’s
health, education, or developmental services appointments.
Economic and material constraints affect how parents manage and provide care to their
children with DDs. For example, basic practical tasks such as attending medical visits and
doctor appointments may become an obstacle due to transportation limitations, or lack of a
valid driver’s license for fathers (Welterlin and LaRue 2007). This is of special relevance as
new immigrant families may settle in peripheral areas of cities (where rent is cheaper), while
services are mainly located centrally.
The intersection of migration status and access to services is determined by variables such
as gender, age, class and ethnic background (Oxman-Martinez and Hanley 2011). Along with
their economic exclusion or instability, studies have shown that immigrant legal status
determines the quality of and access to public services. Villegas (2013) argues that migrants
with precarious legal status Bhave insecure access to a range of goods and services that in
Canada are considered essential and linked to the basic rights and entitlements of citizenship^
(p. 222). Even though health and developmental services for children with DDs exist,
contingent factors such as fathers’ legal status determine their right to access and use
services. Therefore, as Jennings et al. (2014) argue, Bimmigrant status is itself a social
determinant of health^ (p. 1647).
Along with the above material and economic constraints, the literature points towards new
immigrant families experiencing social barriers. For example, immigrant families leave strong
social networks (i.e., close family and friends) in their home countries, and therefore can feel
isolated and alone in navigating through a new environment of services. Jennings et al. (2014)
explain that Bsociety stigmatizes disabled children and views disability in childhood as a social
problem^ (p. 1649); and parents feel this strong stigma of their child’s DD by their own
support systems—who tend to blame the parents for the child’s condition (Daudji et al. 2011;
Kramer-Roy 2012). Therefore, immigrant families may be hesitant to readily seek out support
in their new country of resettlement.
Language and Cultural Barriers
Other important intersecting factors affect not only access to services but also act as barriers to
immigrant fathers’ full enjoyment of the benefits of such services. Discrimination at the
structural level is quite often felt by immigrant fathers who have children with disabilities
(Lindsay et al. 2012). Experience with health care professionals has been highlighted as a
barrier to care for immigrant parents, who may view providers as superficial and uncaring
(Kramer-Roy 2012). They can feel alienated by the health care system, mainly due to
communication barriers and cultural differences (Fellin et al. 2013; Ali et al. 2001; Waldman
and Perlman 2008).
The language barrier is one of the main obstacles in accessing, receiving, and utilizing
health care services for parents of children who have disabilities (Lindsay et al. 2012). For
many immigrant fathers, English is not their first language; in addition medical language is in
itself complex, potentially leading to deficient communication between fathers and health care
professionals. This may impact on the ways fathers understand the condition and diagnosis of
their children; and may also prevent them from accessing and using necessary services for their
children (Ali et al. 2001; Lai and Ishiyama 2004; Waldman and Perlman 2008; Fellin et al.
2013; Kramer-Roy 2012; Welterlin and LaRue 2007). Despite the use of translators, families
who have limited proficiency in English may still feel uncomfortable and frustrated trying to
obtain information about their child’s DD.
There is potential for miscommunication by health care professionals due to differing
concepts of medical diagnosis and treatment. Immigrant fathers can often have difficulties in
understanding the BWestern^ definition of their child’s condition, the medical reasons behind
it, and the treatment regime necessary (Lindsay et al. 2012). According to Greeson et al. (2001)
there is a subtle fear felt by immigrant parents towards ‘Western medicine’—as these beliefs
may conflict with non-Western ideals. For example, a child’s disability in one specific culture
may be viewed as a punishment from God rather than an entirely medical condition—a more
spiritual perspective rather than medical (Welterlin and LaRue 2007; Kramer-Roy 2012).
Therefore, some immigrant fathers may be unwilling to accept the Western medical diagnosis
of a condition, and may see their child as mis-labelled (Daudji et al. 2011). This discrepancy
can lead to a lack of knowledge about the child’s condition and about the health care system
including available programs and services (Ali et al. 2001; Welterlin and LaRue 2007; Fellin
et al. 2013).
Finally, another important factor is the process of acculturation for some first generation
immigrant families. Families who migrate to a new country tend to preserve their unique
cultural values, norms and traditions (Ali et al. 2001; Lai and Ishiyama 2004). The process of
migration to a new host country comes with challenges in terms of adaptation to a set of
differing beliefs, ideologies, and practices. Immigrant fathers may experience increased stress
through this process, having difficulty with relocating and adjusting to a new environment (Lai
and Ishiyama 2004). The pressures of adapting to a new culture, along with taking care of
children with DDs, increase the burden of care for these parents.
Gender roles tend to shift for mothers and fathers after migration. Mothers become involved
within the family in new ways through working, earning money, and playing a vital role in
hospital visits and appointments. This change in roles can bring stigma to fathers, who are
viewed within their own communities as not being strong and dominant in their family unit—
by not subscribing to traditional gender norms of being the family breadwinner (Wolff et al.
2010). Balancing these external stressors can make immigrant fathers even more vulnerable, as
compared to non-immigrant fathers. Table 2 summarizes the findings of this section, as well as
the number of relevant articles found within each thematic area.
Findings of this narrative review indicate that immigrant fathers of children with DDs in
Canada are impacted across all House’s (1981) four dimensions of social support. Immigration
affects the availability of instrumental support for families due to under-employment and job
insecurity following migration. Prevailing policies in the host country regarding access to
Table 2 Unique stressors and barriers for immigrant fathers
services intersect with language barriers, as well as with unfamiliarity of available services,
resulting in diminished structural support. Gender strongly impacts available emotional
support for fathers in general and immigrant fathers in particular, as fathers’ social networks
are dually reduced due to their children’s DDs and post-migration disruptions in family and
friendship networks. Fathers of children with DDs in general may perceive services are biased
towards favoring mothers (however, there is limited literature to ascertain whether immigrant
fathers of children with DDs also feel this way in the initial phases of their resettlement in
contrast to long-term immigrants).
Studies have associated the immigration process with health decline for immigrants after
they arrive to Canada (Fuller-Thomson et al. 2011). Raising children with disabilities can also
negatively impact parents’ health. This review supports the notion that while raising children
with DDs can be emotionally and physically challenging, the task becomes more overwhelming
when there is a lack of social support, such as is the case for new immigrant families. As
Jennings et al. (2014) assert the main issue causing difficulty is not mothering (and in this
review’s case fathering) children with disabilities, but rather the lack of support for the parent
caregiver. New immigrants may not be aware of their basic rights to health and education, and
therefore may not necessarily seek out these resources for their child (Khanlou et al. 2014).
The following recommendations are proposed in relation to: a) income inequality and
unemployment; b) access to health care, social and developmental services; c) cultural-sensitivity of
health care, social and developmental services; and d) participation of fathers.
Reduce Income Inequality and Unemployment/Underemployment
The increasing wage gap and employment differential between immigrants and native-born
populations are among the important policy issues highlighted in the literature. Teelucksingh
and Galabuzi (2005) show that in Canada, during the period 1996–2001, racialized
groups and newcomers sustained Ba double digit income gap and a higher rate of
unemployment^ than native-born workers (p. 3). Reitz (2007) also confirms that since
the 1970s and until late 1990s immigrants’ employment rates and earnings have
declined. These groups are also overrepresented in precarious low paying occupations
(Teelucksingh and Galabuzi 2005). As Walters et al. (2006) explain the earning and
employment gaps are important for immigrant populations in Canada and around the
world, which has implications for entire populations.
Promoting the insertion of immigrant workers in stable, well paid and full time jobs will
benefit immigrant families and the economy of the receptor country (Friedberg and Hunt
1995). Immigrants Brepresent important economic, social and demographic assets to their host
country^ (Asanin and Wilson 2008, p. 1271). The exclusion of this population from the
economy has negative impacts on both immigrants and the host country since the latter is not
being benefitted from immigrants’ productivity and professional skills (Teelucksingh and
Galabuzi 2005). Immigrant’s employment may also impose a burden for the host economy
Bfor dealing with poverty and its impacts on health and social well-being^ (Teelucksingh and
Galabuzi 2005, p. 3).
Improve Access to Health Care, Social and Developmental Services
Disparities in access to health care services are determined by gender, age, race, income,
language, and immigrant status—among others (Stewart et al. 2006). The lack of equitable
access to health care, social and developmental services prevents disadvantaged groups to fully
enjoy, participate and exercise their rights as citizens. Scholars highlight the need to reciprocate
the benefits that immigrants bring to the host society in terms of accessing to their entitled
social benefits (Asanin and Wilson 2008). Among the barriers identified to access health care
services are language, cost, location, transportation and culture.
Policies in the host country shape the trajectories of inclusion and exclusion of its
immigrant population (Stewart et al. 2006). Therefore to reduce barriers to accessing health
care, social and developmental services for immigrant families raising children with DDs, as
funders of these services, government policies need to promote funding of inclusive practice
strategies, and equitable organization of delivery of services.
Improve Cultural-Sensitivity of Health Care, Social and Developmental Services
Health care, social and developmental services professionals need focused education and
training on providing gender-appropriate, culturally sensitive care for immigrant parents
of children with DDs. Targeted education should be given on how to interact with groups
who have language barriers, and help to empower parents to navigate through the
multiple systems of services. Despite language and knowledge barriers, it is still
important for service providers to build rapport and trust with immigrant fathers in support of
the optimal development of their children with DDs. For example, health care providers
should educate themselves on the economic and language barriers of newcomer
immigrant families, and gendered perceptions felt by fathers, and take extra time to make
parents feel comfortable. This will create a better relationship, impact the way parents
perceive and interact with the health care system, and ultimately benefit the health of the
child (Lindsay et al. 2012).
Family-focused interventions have been suggested to benefit immigrant communities,
because of their focus on family behaviors and parenting styles (McCubbin et al. 1993). It
may therefore be beneficial to engage in a whole family-approach when providing care to these
communities. Research has also shown that home visits to families who have children with
disabilities may be better for them, rather than the hospital setting (Fellin et al. 2013).
Immigrant families can feel more comfortable at home, and may not be as intimidated by
medical professionals within their own home environments.
Increase Participation of Fathers
Fathers who challenge traditional gender roles tend to be more involved in their child’s life.
Fathers who are actively involved with their child, and who provide positive care and support,
have shown to benefit from the father-child relationship. Taking on nurturing roles for the
child, in a playful manner, creates a stronger bond, and increases positive family coping
(Simmerman et al. 2001). Fathers who take on this Bplaymate role^—as provider, protector,
and observer—have better outcomes in terms of emotional satisfaction, in addition to better
outcomes for their child with DD, and for the entire family (Huang et al. 2012). It has been
recommended for fathers to work as a team with their spouses, rather than in a dominant
manner, to provide for their child. By breaking these gender norms, husbands and wives
increase support for one another, resulting in increased well-being (Wolff et al. 2010).
Social programs and services available solely for fathers are rare. Fathers report being ignored
during family therapy activities, having their wishes ignored, and feeling excluded from the
diagnostic processes for their child (Huang et al. 2012). Fathers can also feel anger towards
receiving second-hand medical information, as some health care professionals choose to disclose
information to mothers, without the presence of the father (Pelchat et al. 2007). This lack of
education leaves fathers feeling uncomfortable, and causes them to distance away (Goble 2004).
Tailored counseling and support programs should be initiated for fathers only, focusing on
stress management techniques, self-esteem, education, resources for coping, and emotional
expression (Thompson et al. 2013; Trute 1995). Such approaches have shown to increase
father involvement in the care of the child, as well as empowering them to feel significant in
the family unit (Darling et al. 2011; Willoughby and Glidden 1995; Laxman et al. 2015).
Individualized counseling approaches for immigrant fathers may also be necessary,
recognizing the particular structural and instrumental social support barriers this population is facing
(beyond the personal realm).
Limitations of the Review
The findings and recommendations of this review are limited in light of a number of caveats:
1) The review integrated different types of DDs without distinguishing between them as well
as their level of severity and associated caregiving intensity for fathers; 2) A specific search for
the category of Bsingle fathers^ was not conducted, which may have provided us with the
particular barriers faced in this context of parenting and caregiving of children with DDs; 3)
Immigrants were examined as one category (due to the limited literature available on refugee
fathers of children with DDs); however, we recognize that migrants are not a homogenous
group; and 4) Immigrant families’ specific pathways to Canada and their prior home country
experiences may differently shape their experiences with the Canadian systems of support for
families of children with DDs. It was not possible to individualize the review findings to this
level of specificity due to a lack of sufficient numbers of ethnoculturally specific studies on
immigrant parents of children with DDs.
Gender roles, divisions of labor, and parental responsibilities create unique experiences for both
mothers and fathers. Most research has focused on the role of mothers as caretakers of children
with disabilities; and fathers have often been unobserved in this realm (Johnson and Simpson
2013). By conducting a narrative review of the literature, we provide an analysis of the stressors
and barriers experienced by fathers of children with DDs in general and immigrant fathers in
particular. Immigrant fathers experience additional stressors and barriers compared to their
nonimmigrant peers due to post-migration related disruptions in social support. Future research is
needed that unpacks broad categories of Bimmigrant^ identity and DDs so to translate findings
into specific policies and practices. Also while most of the research to date has focused on the
challenges of parents raising children with DDs, day-to-day narratives of service providers and
families point toward the tremendous resilience of parents in the context of raising children with
DDs. Future research is called for that documents the families’ agency in light of ongoing
parenting-caregiving demands, despite limitations of available social support.
Acknowledgments This review was made possible through Start-Up funding to Nazilla Khanlou at York
University and as part of her Women’s Health Research Chair in Mental Health.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons license, and indicate if changes were made.
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