working with refugees

WORKING WITH PEOPLE FROM REFUGEE BACKGROUNDS

1. THE COMPLEXITY OF THE REFUGEE EXPERIENCE

Who are Refugees?

A refugee is a person who has been forced to leave their country because of persecution due to race, religion, nationality, membership of a particular social group or political opinion. They must be outside of their country of origin, and unable or unwilling to return. Who are Asylum Seekers?

An asylum seeker is a person who has left their country of origin and has applied for protection as a refugee to a government or the United Nations High Commissioner for Refugees. What have Refugees been through?

Refugees commonly experience trauma, deprivation and loss in the context of political violence and human rights violations. Some of these experiences include Systematic State Terrorism, torture (used as a tool of social control), bombings, killings, kidnappings, sexual assault, detention, disappearances, harassment, being forced to flee; deprivation of food, shelter, health care; loss of family, friends, community, safety, home, possessions, routine, schooling, employment, and control over their lives. Some refugees can spend prolonged periods in difficult conditions in refugee camps or living in the community without status in countries of asylum.

The Global Refugee Situation

The UNHCR estimates that there were 16.7 million refugees and 51.2 million forcibly displaced people in the world in 2013. The top 4 leading countries of origin of refugees in 2013 were: Afghanistan, Syria, Somalia and the Sudan. Most refugees are located in neighbouring countries. Of these approximately 1% was resettled in a third county in 2013 (UNHCR, 2014). Australia’s Response

The Australian government is a signatory to both the United Nations 1951 Convention and the 1968 Protocol relating to the Status of Refugees. Australia’s Humanitarian Program is divided into 2 components:

1. Off-Shore Program (Resetttlement) 2. On-Shore Program (Asylum/Protection)

In 2012-2013 Australia granted 20,019 visas under its program (DIABP website, 2014).

Handout – Trainings in the Workplace – Working with People from Refugee Backgrounds © STARTTS 2014

The Complex Interaction

One way to conceptualise the complex nature of problems faced by refugees and asylum seekers in Australia, at the individual, family and community level, is the complex interaction between the following factors:

− The impact of traumatic experiences − Seeking protection in Australia/ resettlement challenges − Normal life cycle challenges − The relationship between refugees and asylum seekers and the Australian environment − International events (see diagram below)

These factors can interact in powerful and complex ways, and the complex interface between these factors and the psychological, cultural, educational and religious attributes of the individual, family and community can be used to illustrate the complexity of the experience of refugee clients resettling in Australia or seeking protection (Aroche and Coello, 1994).

Impact of Traumatic Experiences

A trauma reaction is a common response to the feelings of helplessness, intense fear or horror associated with the types of traumatic events experienced in the context of political violence. These feelings are actually part of the healing process from trauma.

Seeking Protection in Australia

Applying for protection in Australia under the on-shore component of Australia’s Humanitarian Program, can be a protracted and uncertain process that can impact upon people in a variety of ways, and can replicate some of their past traumas. Eg. prolonged uncertainty over their protection claim, threat of return, poverty, homelessness, detention, separation from family, etc.


Resettlement Challenges

Resettlement represents a positive step towards the future for refugees, however most settlement tasks involve cultural adaptation and learning new skills and information in a new environment, whilst coping with past traumas and losses. Challenges may include new language, different customs, isolation, reduced employment options, financial concerns, racism, new education and legal systems, and new parenting norms. Normal Life Cycle Challenges

Refugees, like all of us, face challenges through the stages of the normal life cycle such as birth, illness, death, marriage, divorce, parenting and employment. The disruptive effects of trauma and relocation can often render refugees more vulnerable to the challenges associated with the normal life cycle, while normal life cycle problems can bring back to the surface or complicate issues connected to trauma. Australian Environment

The relationship between refugees and asylum seekers and the Australian environment, which includes the political system, the complex network of government and non-government service providers, the community at large and other systems, eventually determines the overall conditions for success in the processes of recovery and resettlement of refugees, and for how well asylum seekers cope with their uncertain situation.

International Events

International events will influence how refugees and asylum seekers react to their new environment in Australia, and may contribute to the re-emergence of trauma symptoms. Protective Factors

How well refugees and asylum seekers cope with the complex interaction discussed in this section will depend on individual internal and protective factors such as those listed below (Aroche and Coello, 1994). Internal − Balanced, well regulated brain − Positive outlook − High self-esteem − Sense of safety − Sense of identity

External − Supportive family − Supportive school − Friends − Fun activities − Status − Resources − Reference group − Safe environment


2. ISSUES AND STARTTS’ INTERVENTIONS TO FACILITATE REFUGEE RESETTLEMENT

It is important for service providers to be aware of the complexity of the refugee experience and its traumatic impact, in order to appreciate the types of issues and behaviours that refugee clients may present with. Some of these behaviours that were adapted to life in a war or conflict situation can become maladaptive, and can develop into substantive barriers to regaining control of their environment and overcoming trauma. The Bio-Psychosocial-Systemic Intervention Model

The bio-psychosocial model recognises the impact of trauma at the biological, psychological, interpersonal, and social levels of the individual.

Trauma not only impacts on individuals; it also impacts on families, social support networks, refugee communities and Australian society and institutions.

This translates into a culturally aware Bio-Psycho-Social Systemic Approach to service provision focusing on assisting people’s RECOVERY from refugee trauma that contemplates early intervention, secondary prevention and capacity building strategies alongside clinical interventions at individual, family and group levels.

STARTTS Bio-Psychosocial Model

Biological

Psychological

Social

Interventions

Trauma

Individual

Family Support Network

Refugee Community Mainstream Society and Institutions

Trauma

STARTTS’ Bio-Psychosocial Systemic Model

Interventions

Bio

Psycho

Social


Issues – Refugee Individuals

STARTTS Bio-Psychosocial Model

Biological

Psychological

Social

Trauma

Biological

Changes to the brain

Injuries, illnesses

Somatic pain, chronic pain

Headaches

Appetite and digestive problems

Nightmares, other sleep disturbances, terrifying memories

Not attentive, distracted

Difficulty understanding and remembering things, confused, difficulty with simple decisions

Being hyper-vigilant, tense

Psychological

Frustration, anger, irritability, mood changes

Emotionally numb, avoiding things that remind them of the trauma

Distrustful, suspicious, wary, sensitive to not being believed

Excessive worry, fear and anxiety

Guilt, loss of self-esteem and shame

Depression, sadness, not interested in normal activities

Post-traumatic symptoms, including PTSD

Changed sense of self, beliefs

Disempowerment, being under or overly compliant

Self-harming behaviours, using alcohol or drugs to feel better

Social

Social withdrawal

Difficulties with personal relationships

Interpersonal conflict

Practical problems faced:

Difficulty learning English

Difficulties finding work

Financial difficulties and poverty

Legal problems


Impact of Extreme Stress on the Brain

A person’s brain can be changed by their experiences. This is called ‘neuroplasticity’. Prolonged and multiple situations of extreme stress which are associated with excessive and prolonged levels of stress chemicals can have a negative impact on brain structure, function and physiology, and lead to disruptions in brain self-regulation. Post Traumatic Stress Disorder (PTSD)

Some refugee survivors of torture and trauma will have symptoms consistent with PTSD. A smaller percentage, particular those with experiences of torture and being in captivity, may have symptoms of Complex PTSD. PSTD is characterised by four key symptom areas:

1. The traumatic event is persistently re-experienced through intrusive thoughts, memories, flashbacks and nightmares.

2. Negative thinking and mood – includes a distorted sense of blame on self and others, estrangement from others, lack of interest in activities, unable to remember key aspects of event.

3. Avoidance and numbing – Avoiding thoughts, memories, people and situations that trigger traumatic memories, numbing behaviour.

4. Persistent symptoms of increased arousal – Sleeping, memory and concentration problems, startle responses and irritability.

STARTTS’ Interventions - Supporting the Recovery of Individuals

STARTTS is a specialised rehabilitation and treatment service for refugee trauma survivors. STARTTS offers free counselling services to people from refugee and refugee-like backgrounds (and asylum seekers) to support them in the recovery and healing process, free of charge, and it doesn’t matter how long a person has been in Australia. There is a waiting list for services, but it is managed and those with the highest needs are prioritised. Children and asylum seekers are allocated a counsellor within two weeks.

Assessment

Short-term, medium-term and long-term counselling

Referrals to internal STARTTS programs such as psychiatry, Neurofeedback clinic, physiotherapy, acupuncture, therapeutic and support groups, youth camps and other youth programs such as Capoeira

Referrals to other services and support

Important note

Refugees may present with multiple and complex problems which intersect across many different services and therefore there can be the need for good casework and referral skills. Service provision should focus on assisting the client’s recovery from their experiences.


Issues – Refugee Families

The family is the fundamental social unit across all cultures. The wellbeing of each family is dependent on the physical and mental health of the individuals within it. Most refugee families come from collectivist cultures where the individual’s identity derives primarily from their role in the family and community. In refugee communities the nature of extended families and kinship ties can be highly complex. Refugee families may be affected in many ways such as:

− Family members may have been separated or killed – breakup of support systems − Family breakdown − Attachment relationships altered − Change in family roles – children take on increased responsibility, the power of women is

increased − Domestic violence − Intergenerational conflict – altered position of children in Australian society − Unemployment and economic hardship for the family

Traumatised parents face challenges which can impact on their capacity to nurture and raise their children:

− Parenting challenges due to trauma (eg. emotional availability), culture, skills, knowledge and disorientation

− Guilt and overprotective parenting − Limited understanding of parenting norms, child protection system and laws in Australia − Poor coping skills − Mental illness

STARTTS’ Interventions - Supporting the Recovery of Refugee Families

− Individual counselling − Families in Cultural Transition (FICT) program − Other types of groups − Referral and link-up to other services such as family support programs, community health

services, drug and alcohol services, etc Issues – Social Support Networks

− Lack of social support − Isolation − Loneliness − Lack of trust in others

STARTTS’ Interventions – Development of Supportive Social Networks

− Self support groups − Youth program including youth camps and Capoeira − Other activities, eg. community gardens


Issues – Refugee Communities

Community relationships, structures and institutions in the home country may have been disrupted as a result of organised violence perpetrated for example by rebel groups, external forces or the government. Trauma impacts on communities as much as it impacts on individuals. Communities can be destroyed by creating a state of chronic terror and alarm, by damaging bonds of trust and connections to families and friends, and religious and cultural systems. Renewed conflict in the country of origin can affect the whole community (Martin-Baro, 1989). The considerable challenges for refugee communities in settling in Australia threaten those connections that may exist. This may result in:

− Internal conflict and fragmentation within the refugee community

− Polarisation and distrust within the refugee community

− Distrust of authorities

STARTTS’ Interventions – Supporting Refugee Communities and Building Social Capital

Building on the connections in refugee communities that may exist and using the strengths of refugees – resilience, adaptability and motivation, help communities overcome their trauma, empower themselves and create a better life in Australia.

Helpful interventions could include and STARTTS offers many of these:

− Community partnerships with community groups and associations undertaking their own projects, events and initiatives

− Supporting the development of businesses that benefit the community, eg. Enterprise Facilitation

− Providing expert advice on organisational, media, legal and other issues

− Assisting in processes such as strategic planning, lobbying and advocacy

− Providing links to influential people in politics, media and academia (Aroche and Coello, 2012, STARTTS Annual Report, 2012)

Issues – Mainstream Society and Institutions

Mainstream society and institutions are a major part of the recovery and coping environment of refugees resettling and asylum seekers claiming protection in Australia. This recovery and coping environment is sometimes more supportive than others. Issues can be related to services not being trained or being unsure about working with people from refugee backgrounds, unsupportive community attitudes, a highly charged and politicised public debate, and unsupportive public policies. STARTTS’ Interventions – Fostering a Positive Recovery and Coping Environment

− Training of services providers, volunteers and TAFE and university students

− Community education − Events such as Refugee Week, the Refugee

Ball, community festivals − Publications such as Refugee Transitions

magazine, STARTTS’ website − Media stories − Lobbying and advocacy − Policy submissions


3. DIFFICULTIES FACED BY ASYLUM SEEKERS

Some relevant examples of issues faced by asylum seekers and their consequences not mentioned in the previous session can be summarised as follows:

Issues

− Helplessness and powerless over the outcome of their protection claim and/or being denied their freedom

− A strong sense of injustice and high expectations of life in Australia, frozen anger (unable to express it)

− Dependency on services

− Hopelessness in services and workers being able to genuinely assist

− Boredom and lack of purpose

− Alienation, loneliness, no family support

− Distress - telling of their traumatic story, witnessing the distress of others

− Difficulties telling their story of persecution for their protection claim in a chronological and convincing way due to the impact of trauma on memory

Consequences

− Poorer health overall

− Intensification and worsening of trauma related symptoms and behaviours (eg. Suicide ideation and self harm, anti-social behaviours)

− Further reduced prospects for a successful and secure future due to long periods without employment and education

− Decreased ability to cope with the demands of resettlement if their protection claims are approved

− Decreased ability to cope with being sent home if their claim is rejected

Strategies to Help Asylum Seekers Cope

Service provision for asylum seekers should focus on assisting them cope with their situation and containing their emotions and trauma-related symptoms, by meeting their basic needs, addressing their health issues, assessing the risk of suicide and self-harm, building their strengths and resilience and encouraging activities that may positively contribute to their future. Services would not normally be focused on assisting their recovery, as asylum seekers are not yet in a position of safety. Services offered by STARTTS to Asylum Seekers

− Individual counselling support − Group information sessions about managing trauma symptoms − Group projects such as art groups − Assessments for eligibility to the Asylum Seeker Assistance Scheme which looks at the client’s

torture and trauma symptoms and the capability to work (for those living in the community) − Psychological assessments and reports on the mental health of the client for asylum seekers

detained at the Villawood Detention Centre (Carramar office only and must be referred by the detention centre mental health team)


4. WORKER SKILLS: KEY PRINCIPLES AND TECHNIQUES

It is important that professionals and volunteers appreciate that their skills and experience in their field are relevant to working with people from refugee backgrounds. Workers need to make the link between the refugee experience and its traumatic impact, with practical things they can do in the workplace that promote recovery and coping skills and minimise potential triggers, and hence the risk of re-traumatisation.

Know how to Identify People from Refugee Backgrounds

It is not always obvious if a person has survived traumatic experiences, and people rarely identify themselves as refugees. You can assess if your client may be a refugee by knowing generally from which countries people from refugee backgrounds have come to Australia, gathering data about the age of the client, country of birth, year of arrival in Australia or the visa number. A little bit of research about the country of origin and culture will help you greatly. Use Good Cross-Cultural Skills Relevant to the Refugee Trauma Context

− Awareness of one’s own cultural worldview

− A positive attitude towards cultural difference

− Knowledge of different cultural practices, worldviews and the socio-political context which caused them to flee

− Effective cross-cultural communication

Be Guided by the Key Recovery Principles

1. Restore a sense of safety and control 2. Restore connections to others 3. Restore meaning and purpose to life 4. Restore dignity and value (VFST, 1998)

Minimise Triggers in the Work Setting

A trigger is a stimulus that provokes a memory or reaction. Different stimuli will be a trigger for different people. For refugee clients they may be stimuli that remind them of war, being detained or interrogated (eg. being questioned, authority figures, confined spaces, closed doors, writing things down, etc).

− Meet the client at the door if possible; see

the client promptly and explain if there is a delay

− Ideally meet in the same room at a regular time

− Offer the option of a trusted person being present

− Make the room set-up less formal if possible (ie. not sitting behind a desk)

− Avoid closed-in spaces, barred windows, bright lights

− Offer choice about the door being open or closed

− Explain any room peculiarities to the client beforehand

− Minimise other triggers if possible


Create Strong Professional Boundaries

− Explain simply and clearly the service and options, your role and its limits, when and how they can communicate with you, and what to do if you see each other in other settings, so they know what to expect from the beginning. You may need to repeat things several times and clarify your client’s understanding. Recognise when your client’s expectations are unreasonable.

− Be friendly towards the client, but don’t be your client’s friend.

− Be consistent. − Only reveal your personal information

to the client if it is relevant to your client’s needs. Too much self-disclosure can shift the focus from the client to you.

− Sensitively address boundary issues or warning signs as they arise with your client by re-clarifying your role and the limits of it.

− Don’t take your client’s reactions personally. It isn’t necessarily about you. It’s important to have a certain amount of detachment from unpleasant situations that may arise.

− Discuss and debrief with your supervisor and/or other colleagues about boundary issues to help reduce stress and get feedback and support.

− Take care of yourself. Maintain good physical, emotional and mental health (see session 5).

Communicate Effectively

How and what you communicate to refugee and asylum seeker clients will have an impact on how they trust you, and how safe and in control they feel with you. Don’t underestimate the power of being nice. The positive connection you make with your client can contribute in a meaningful way to restoring their dignity and value as a human being.

Some things that can be helpful include:

− Use the principles of working cross-culturally in the context of refugee trauma

− Use interpreters (see box) − Use a calm voice and open body language − Take time to ease into the conversation.

Take care not to ask questions in such a way that it appears like an interrogation

− Explain simply and clearly the service and options, your role and how any information collected will be used so they know what to expect

− Emphasise confidentiality and its limits − Be patient and be willing to repeat

information several times. Confirm the client’s understanding

− Be flexible and allow the client to lead. Empower the client to make informed choices

− Set clear limits and don’t promise things you can’t do

− Actively listen − Be sincere, convey respect, care and belief


Use Interpreters When Necessary

Some general principles when using interpreters include:

− Always use professional interpreters. − Don’t assume which is the appropriate language. − Be aware of gender issues. Women may prefer a female interpreter. − Be aware of different ethnic groups and tensions within the same country. − Brief and debrief the interpreter before and after sessions. They can be affected

by the powerful stories and emotions of the clients too. − Always introduce the interpreter and explain their role. − Always ensure you inform the client that the interpreter is bound by the same

confidentiality that you are. They may be concerned about their private details being shared within their own community by the interpreter.

− Address and make eye contact with the client, not the interpreter. − Assess the interpreter’s ability to convey non-verbal content and the connotations

of the client’s responses. − If possible request the same interpreter each time you see the client.

Provide Practical Assistance

Offers of practical assistance are highly valued amongst refugees and asylum seekers and can be very effective at building trust, and enhancing feelings of safety and control. It is important to ensure basic needs are met given there are many barriers to accessing services. Help Build the Client’s Strengths and Resilience and make Connections

− Acknowledge the client’s journey so far. − Help the client identify their strengths, how have they coped before, what have they done

well and what has motivated them. − Encourage the client to recognise that they are responsible for how they are feeling and how

they see their life. Encourage them to reframe their life focusing on their qualities and strengths, not just the deficits.

− For asylum seekers especially, it helps to keep focused on the present and what they can control right now. Assist the client to get organised and in control of what they can.

− Encourage and resource the client to do activities which are constructive and could make a positive contribution to their future. This is especially true for asylum seekers.

Normalise the Client’s Experience

Refugees and asylum seekers can feel unsafe in their own bodies, feeling as though their mind and emotions are out of control. They may feel as though they are losing their mind and the symptoms they are experiencing can themselves cause a lot of anxiety. You may notice that refugee and asylum seeker clients can be emotional and overly reactive. Helping clients understand and manage their symptoms and behaviours to make them feel safer and in control of their bodies and better able to deal with the challenges of resettlement or seeking protection.


Referring Clients for Counselling Support

Workers may need to refer refugees and asylum seekers for counselling support if they have distressing symptoms that are impacting on their daily functioning. It is useful to check whether the client has seen or is seeing a doctor or other health care professional to address their issues. The client may also ask to be referred for counselling. Explain counselling in a way that is meaningful for the client. Referring Clients to STARTTS

Referrals to STARTTS

STARTTS has offices in Sydney in Carramar, Auburn, Liverpool and Blacktown, and outside of Sydney in Coffs Harbour, Newcastle and Wagga Wagga. Outreach services are offered across many locations in Sydney, and in some regional areas such as Lismore, Armidale and Wollongong.

Call: (02) 9794 1900 (Ask for the intake counsellor)

Email: [email protected] (Referral form available www.startts.org.au)

Fax: (02) 9794 1890 (Referral form available www.startts.org.au)

-Provide information about: demographics, refugee story, psychological and physical health symptoms/difficulties, treatment received, social supports, and current status

STARTTS does have a waiting list, but it is managed, so that people in greatest need will be seen first. Children are given priority. STARTTS is not a crisis service and therefore does not see clients for acute psychotic episodes or suicide threats or attempts. STARTTS’ services are free of charge. Visit our website for more information about referrals (www.startts.org.au).


mailto:[email protected]

http://www.startts.org.au/

http://www.startts.org.au/

4. VICARIOUS TRAUMA AND SELF CARE

While working with refugees and asylum seekers can be inspiring and rewarding, hearing their stories of traumatic experiences or being exposed to their distress, can have a significant impact on you as a worker, and can cause some reactions similar to those experienced by survivors. You therefore need to be aware of the risks for you, what signs and symptoms to look out for, and some of the strategies to take good care of yourself. Vicarious Trauma

As a witness to your client’s responses to past traumatic experiences, you may experience distress, anxiety and sadness. This is called vicarious trauma, or trauma felt at second hand through the experiences of another. Vicarious trauma is normal and unavoidable. It does not mean that there is anything wrong with you or that you cannot do your job. However it is important that you don’t ignore your feelings of distress. These are real and you may need some help. Otherwise you are at risk of burnout. Look after your own Needs

You need to look after yourself if you are going to be able to help your client. Accept your own powerful reactions and know the self care strategies that can support you to take good care of yourself when working with traumatised clients. Personal Self Care Strategies

− Make your personal life a priority − Eat well, exercise, get adequate sleep

and rest − Nurture all aspects of yourself –

emotional, physical, mental, spiritual, interpersonal, creative

− Debrief or talk about your feelings with someone – your supervisor, colleagues or a counsellor

Professional Self Care Strategies

− Make use of supervision, consultation, support

− Exert control if possible over your workload − Find a good balance and do a variety of

tasks − Receive education or training − Set and honour reasonable boundaries

Organisational Self Care Strategies

− Provide clinical supervision opportunities − Offer adequate professional development − Foster a culture in which work-related

stress is accepted as real and legitimate − Offer an Employee Assistance Program

(EAP) − Ensure adequate resources are available − Allocate time for peer support and

consultation − Assist workers to maintain realistic goals

and boundaries in their work − Structure roles around realistic case loads

and task variety

References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Ed, American Psychiatric Association Aroche, J. and Coello, M. (1994) Towards a systematic approach for the treatment and rehabilitation of torture and trauma survivors: The experience of STARTTS in Australia, STARTTS Website of the Department of Immigration and Border Protection, 2014 Martin-Baro (1989) ‘Psychological consequences of state terrorism’, transcript of presentation at the Symposium on The Psychological Consequences of Political Terrorism, California, sponsored by the Committee for Health Rights in Central America. Rothschild, B. and Rand, M. (2006) Help for the Helper: The psychophysiology of compassion fatigue and vicarious traumatisation, W.W. Norton & Company UNHCR (2014) UNHCR Global Trends 2013, www.unhcr.org Victorian Foundation for Survivors of Torture Inc (1996) Rebuilding shattered lives, VFST Inc.

This handout is designed to be used in conjunction with STARTTS’ introductory workshop ‘Introduction to Working with People from Refugee Backgrounds’ given in outreach locations around NSW. It contains key messages only and the information has been summarised to suit a brief handout.


working with refugees

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