1. 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

2. 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.

3. 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

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

7. Refugee Core Stressors

8. 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.

9. 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.

10. 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

11. 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

12. What color are your glasses?

13. 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

14. Cultural Humility Video
by Vivian Chavez

15. 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

16. 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

17. 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

18. 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)

19. 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?

20. 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?

21. 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

22. Provider
Patient

23. Patient
Provider

24. Resources
For more information on resources related to supporting refugee children and families, please visit our NCTSN’s Refugee Trauma webpages :
Refugee Immigrant and Assistance Center website:
Website:
Boston Center for Refugee Health & Human Rights at Boston Medical Center
Website: OI