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Email: email@example.com, Website: http://www.traumaclinic.org.uk Work The clinic has three services – a refugee service, a child and family service and an adult traumatic stress service. About half of the work of the child and family service is with refugees. The clinic therefore can provide treatment for refugees and asylum seekers of all ages. The refugee service itself works with adults who present with complex traumatic stress reactions, which include PTSD, traumatic bereavement, depression, complex somatic reactions. The service does not work with people who have severe mental illness or who have severe drug and alcohol problems. If a refugee is actively suicidal or has multiple social needs the clinic may be able to contribute to management in conjunction with community mental health teams and/or other agencies. The team has a cognitive behavioural emphasis although also embraces social models and other approaches to treatment. Staff help refugees to deal with the guilt, shame and fear associated with the refugee experience, helping service users to develop coping strategies within their own belief systems. There is a bicultural therapy programme. If necessary the therapy is provided through a pool of highly trained interpreters. Refugees may be referred to other services if appropriate.
The Clinic has adopted a phased model of intervention with adult refugees:
• The first phase may involve detailed assessment, the use of supportive stabilisation techniques, medication (chiefly antidepressant drugs), interventions for housing and social needs and (if appropriate) a professional report for an asylum application.
• Where patients are ready, specific treatments, in the second phase, tend to focus on cognitive behavioural interventions including an approach called Testimony. This is a method of treatment in which an individual’s previous life history and account of their traumatic experiences is described in detail. This has been shown, in uncontrolled trials, to reduce symptoms of PTSD. The Clinic also uses a range of cognitive-behavioural and other interventions in formulation-based interventions.
• The third phase of treatment has a focus on integration and adaptation.
Staffing Those in the clinic working with refugees include psychiatrists, clinical psychologists, a bicultural therapist, a child psychotherapist, and a family therapist. There is also some on-site legal advice (outreach from ROAP). Clinic staff also have considerable expertise in the preparation of legal reports.
Training The clinic offers advice, consultancy and training events. Specific events are listed on the clinic’s web-site (http://www.traumaclinic.org.uk).
Funding The Department of Health established the clinic in 1991 as a national centre for the treatment of traumatic stress reactions and the clinical work continues to be fully funded by the NHS.
Evaluation The clinic has a commitment to rigorous evaluation. It has recently been involved in an empirical investigation of discrepant memories in refugees and a national survey of Kosovan Albanian refugees in the UK. The clinic has plans for a programme of randomised controlled trials to help develop the evidence base for refugees and asylum seekers so that services can be improved across the country.
6.22 Incomplete emotional processing, avoidance reaction, resulting in high level of distress are common, and require therapy to have a different approach (Turner 1992). Theoretical and clinical work of Horowitz (1976) and Rachman (1980) shows that progressive exposure to the processing of memories, and keeping within boundaries of personal tolerance is likely to be most effective. The work of the Traumatic Stress Clinic describes the process in more detail.
6.23 The therapeutic process should allow the client to become an active participant and should depend on self-help principles as much as possible. Describing their experience in detail may allow a client to come to terms with them and see them in context. However, some people may not be able to undertake such self-exposure until a considerable time has passed. Again, some people who have suffered traumatic experiences may need counselling before they can get on with dealing with other problems.
6.24 Multiple symptoms are often displayed, as described in the symptoms section and a whole person, holistic approach should be adopted when addressing these. Psychotropic medication (e.g. antidepressants which have been demonstrated to improve mood and decrease symptoms of PTSD) and social interventions – such as encouraging and supporting individuals to take on additional tasks or explore further education and training opportunities may play a helpful role in reducing symptoms of anxiety and sleep disturbance associated with PTSD.
Caring for Dispersed Asylum Seekers
6.25 Treatment should be explained to clients in terms that they can understand. Clients should be informed of their diagnosis, and advised of any treatment side effects, otherwise noncompliance might become an issue. For some refugee groups it may be important to have a choice of the gender of their counsellor. Mental health providers should develop a referral network of specialist agencies who can offer added support on specific issues, such as housing, welfare, immigration etc. which directly impact on the psychological well being of the client.
Medical Foundation for the Care of Victims of Torture, 96-98 Grafton Road, Kentish Town, London NW5 4BD Tel: 020 7813 7777 Fax: 020 7813 0011 E-mail: firstname.lastname@example.org, Website: www.torturecare.org.uk Medical Foundation for the Care of Victims of Torture is an independent charity that provides care and rehabilitation to survivors of torture and other forms of organised violence.
After assessing client’s needs, they may be offered one or more of the following services: medical consultation and treatment in liaison with their GPs or hospital specialists; counselling and individual psychotherapy; marital and family therapy; different group therapies; physiotherapy or one of a range of complementary therapies; or practical help and advice.
The children and adolescent team works with children who have been tortured, whose parents have been tortured, or with children who have witnessed atrocities perpetrated against their families.
A team of experienced interpreters provides sophisticated interpreting services in nearly 60 different languages. By request of solicitors, documentation of evidence of physical and psychological torture is carried out by doctors at the Medical Foundation and is used principally as part of a torture survivor’s asylum application. However, it also has a psychological benefit for clients who, perhaps for the first time, are able to tell their histories of torture to someone willing to attend to their pain.
Most importantly, the Medical Foundation is a place where survivors can feel that their experiences are recognised and accepted, and where they can safely express their grief and anger.
Refugee Resource Hooper House, 2nd Floor, 3 Collins Street, Oxford OX4 1XS, Tel. 0845 458 0055, E-mail: email@example.com An inter-agency strategy This joint strategy between statutory and non-statutory agencies provides an overall framework for developing services. It has a three-tier approach for identifying vulnerable individuals and facilitating access to existing services. A group of refugee advisors also provides advice and guidance on all aspects of service planning and delivery.
The project has trained refugee interviewers to identify skills and aspirations amongst members of their communities and the barriers to employment and training opportunities. As a result, one current initiative in partnership with training providers and local employers is a ‘work preparation’ scheme involving work placements and an employment-related training package.
A psychosocial project targeted at 12 – 25 year olds Refugee Resource has recently started a ‘Woodpath’ project aimed at meeting the mental health needs of 12year olds, with a particular focus on the significant number of young separated refugees in the county.
The project’s aims are to provide:
This project incorporates the following elements depending on the needs that are presented:
• An approach that combines practical assistance with primary needs (e.g. housing, asylum process, socio-economic difficulties) with mental health support.
• Youth mentoring.
• Youth counselling (both transcultural and mother-tongue counselling).
• Therapeutic group activities, e.g. writing groups, art projects.
• A therapeutic allotment project, which combines a horticultural project with a psychotherapeutic approach, enabling refugees to grow organic produce to increase their level of self-sufficiency and to develop a sense of community with other allotment holders.
Staff Structure Director, Access First Project Co-ordinator, Woodpath Project Co-ordinator, Employment Advisor, Administrator and Youth Counsellor.
Funding The project is funded by the Diana Princess of Wales Memorial Fund.
Caring for Dispersed Asylum Seekers
The Haven Project A National School Based Refugee Mental Health Programme Action for Children in Conflict, Silverbirch House, Longworth, Oxon OX13 5EJ, Tel: 01865 821 380, Fax: 01865 822 150, E-mail: firstname.lastname@example.org For the past seven years, Action for Children in Conflict (AfC) has provided a school-based mental health service for asylum seeker/refugee children who speak little or no English at Hallfield School in the Paddington area in London. This project is now regarded as a Centre of Excellence/Good Practice. Many of these children have displayed mental health problems associated with the traumas they have experienced, and the Hallfield project has been developed by AfC to help them overcome these problems. A similar programme involving six schools in the city of Oxford was launched in 2000 and has produced excellent results. Additional funding from The Diana, Princess of Wales Memorial Fund has financed new projects in Leicester, Manchester, Glasgow and Cardiff, which began in Summer 2002. Further projects are now planned in Hull, Liverpool, Rochdale, Bristol and Newcastle. This programme is known collectively as “The Haven Project”.
In some cases, an experienced interpreter will be provided by AfC to ensure that meaningful communication is established from the outset. One key aspect of the operation is to ensure continuity of treatment by having one further session per week available for the therapist to follow the child to a new school (even if not either of the two designated schools) or carry out further therapy on an outreach basis.
Children are seen for periods varying from 3 to 6 months, and then the case is reviewed and the SDQ repeated to see if further treatment is required, or if the child needs to be referred. In the latter case, the project will attempt to fast-track the child to a specialist at a local mental health clinic. In all cases the therapy will continue until some kind of positive outcome is identified.
Objectives The principal objective is to improve access to mental health services and support for asylum seeker/refugee families which, at present, they find very difficult. Further objectives of the project are split between educational and mental health issues. Educationally, the project aims to assist the children in maximising their learning capabilities to assimilate themselves into the educational system as smoothly as possible. This will only occur if an experienced therapist in the school environment treats the traumas they have experienced, which is often the only place where the child and their family are comfortable. Parents are frequently updated and often involved. Indeed, it is sometimes found that the whole family needs to be treated in order for the child to show improvement. A key issue here is preventative treatment, as the results of the London project indicate this type of therapy will often prevent these children from being alienated by the system and becoming the subjects of disciplinary codes or even exclusion orders. The school environment has been identified as the most appropriate location for this kind of therapy. The advantage of providing this service within the school is that the child is always available and in familiar surroundings where they and their families feel secure. Attempts to provide assistance outside the school have resulted in non-attendance and a disrupted and expensive therapy programme. Previous attempts have also been shortterm; the minimum commitment made to the schools in this project is 3 years.
Monitoring and Evaluation The use of the SDQ enables the teachers and the therapists to monitor the progress of the child and make adjustments as necessary to their treatment. The project is monitored and reviewed at the end of each school term and annually by monitoring, and a report is issued to the funders and other interested parties, such as the LEA.
Funding The programmes in all areas are funded by the charity AfC who utilise the support of grant-making trusts such as the Diana, Princess of Wales Memorial Fund, the Esmée Fairbairn, and Children in Need.
Hundreds of children are now assessed and approximately 40 children and their families will enter a longer tem course of therapy during the term in each location. The cost of providing 3 to 5 sessions per week of therapist’s time, interpreter services, administration and expenses is approximately £30,000 – £35,000 p.a.
for a pilot project in each city.
Caring for Dispersed Asylum Seekers
6.28 In order to maximise the impact of counselling, there is a need for work within the wider asylum seeker/refugee community (to promote better understanding of the nature of counselling) and with professionals working in counselling services (to promote a better understanding of how other cultures perceive health and illness). Development of an understanding within communities would avoid individual users becoming stigmatised and/or discouraging potential users from accessing the service.