Refugee Trauma and Resilience Center Supporting the Health and Well-being of Refugees and Immigrants: Building Resilience Through Collaboration, Compassion, and Inclusion AM Saida Abdi, LICSW Refugee Trauma and Resilience Center May 17, 2017

Who are refugees? -A refugee is a person who has been forced to flee their country due to war and violence. They are persecuted because of their race, religion, nationality, or social group. There are currently 21.3 million refugees worldwide Since 1975, the US government has resettled 3 million refugees from all over the world. Approximately 50% of refugees are children under the age of 18 -An asylum seeker is someone who has formally applied for legal and physical protection in another country -An immigrant is someone who voluntarily leaves their country to make a new life in another country. While status might be different, experiences are often similar The United States resettlement program is the largest in the world. UNHCR works closely with U.S. governmental agencies and NGOs responsible for resettling refugees in the U.S.

Refugee Experience and immigrant experience and Trauma Pre-migration, Migration, and Resettlement Direct exposure to or witnessing of violence Sexual assault and gender-based violence Torture and detention Disruption of family and community Lack of access to basic resources (food, water, medical care, shelter) Long journeys on foot, living in refugee camps Refugee Experience and immigrant experience and Trauma

Life in the Refugee Camps Luna Desert like, starvation initially, wfp food, basic needs.

Refugee Core Stressors

Social-Ecological Model School Peer Group Neighborhood Culture Family Individual The Neurons to Neighborhood model is grounded in the social ecological theory talked about by Bronfenbrenner, Elbedour, and others. This model begins to address the complexity of the social envrionment that surrounds an individual. AN indvidual’s culture, as well as the surrounding culture of resettlement, the neighborhood, the school, the peer group, family. . . All of these layers surround a child, a disruption in any one area of the social ecology, may create problems in others. By that same token, interventions in one area may positively affect other parts of a child’s life. Under the neurons to neighborhood model, interventions work both from the outside in--addressing problems in the social environment that surrounds and contains the child--as well as from the inside out, bolstering the child’s skills and resources to navigate a less-than-perfect environment.

Trauma-Informed Service System Is one in which agencies, programs and service providers: Routinely screen for trauma exposure and related symptoms; Use evidence-based, culturally responsive assessment and treatment for traumatic stress and associated mental health symptoms; Make resources available to children, families, and providers on trauma exposure, its impact, and treatment; Engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma; Address parent and caregiver trauma and its impact on the family system; Emphasize continuity of care and collaboration across child-service systems; and Maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff wellness.

What is Culture? “Culture is a society’s style, its way of living and dying…attitudes towards women, children, old people and strangers, enemies and allies; eternity and present; the here and the now and beyond” octavio Paz

What is Cultural Competence? “Cultural and linguistic competency is a set of congruent behaviors, attitudes, and policies the come together I a system agency, or among professionals that enable effective work in a cross-cultural setting” Terri Cross, 1989

What color are your glasses?

Cultural Humility A commitment to self- evaluation and self- critique Recognize, acknowledge and change power imbalances in relationships Develop mutually beneficial partnerships with communities; work towards institutional accountability

Cultural Humility Video by Vivian Chavez

Strategies for Self Reflection and Life Long Learning Understand your own worldview and be willing to challenge your paradigms Be willing to unpack your own privilege and power

Why Won’t They Take the Help? Reluctance to engage in services Is this a service they need or you think they need? Do the services connect with their world view Different explanatory model/different solution Do you and they have same understanding of the problem? Unaware of what services are provided/Services not helpful Lack of linguistic and cultural accessibility

The Goal of Support is Independence Be helper but remember boundaries Refugees have spent many years in camps Some times the need to help can become a barrier We need to allow families to be families/parents to be parents and individuals to be independent Ask if help is needed, where it is needed and when Be aware what you see as helpful might not be Remember you see the problem through a different lenses Ask, listen, ask, repeat

Cultural Brokering Is… The act of bridging, linking or mediating between groups or persons of different cultural backgrounds for the purpose of reducing conflict or producing change (Jezewski, 1990)

Partnership Building Questions How do you begin to engage communities? What are community hopes and concerns? How do your services align with other services in the community? How do you explain your services to the community? What community strengths can be engaged in the services?

Questions to Ask Depending on your Role Providers: Do you provide trauma-specific or trauma-informed care? If so, how do you determine whether the refugee/immigrant needs trauma-specific care? Are you paying attention to cultural practices, values and help seeking behaviors of your client? Are you integrating those into your practice? Are your staff trained in cultural humility and are they practicing it? Are you forming partnerships with the community, are you engaging them, including them? Are you using cultural/brokers and interpreters effectively? Schools Systems: Are you training your staff about the unique experiences of refugee and immigrant children? Are you providing support in the classroom so that they can be effective in their work? Are you using linguistic and cultural support available in that community to enhance understand of those students experiences and how they might affect their educational progress? Are you engaging families? Are your staff practicing cultural humility? Are you supporting families to help them support their children? Communities: When that new immigrant/refugee moves in next door do you see a problem/project or a great potential? Are you practicing a compassion? Do you practice cultural humility? Are you able to face your biases? Your neighbor’s biases?

Health Care to Refugees Strategies to Address Barriers Barriers to Mental Health Care to Refugees Strategies to Address Barriers Distrust of Authority/ Power Community Engagement Linguistic & Cultural Barriers Partnership of Providers & Cultural Experts Stigma of Mental Health Services Embedding Services in Service System Primacy of Resettlement Stressors Integration of Concrete Services

Provider Patient

Patient Provider

Resources For more information on resources related to supporting refugee children and families, please visit our NCTSN’s Refugee Trauma webpages : http://nctsn.org/trauma-types/refugee-trauma/learn-about-refugee-trauma Refugee Immigrant and Assistance Center website: Website: http://www.riacboston.org/ Boston Center for Refugee Health & Human Rights at Boston Medical Center Website: http://www.bcrhhr.org/aboutus OI