Teletherapy For Refugees
Bridging the Treatment Gap
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The US and Canada are experiencing a steady flow of refugees being resettled across both countries from regions of conflict and turmoil around the world. Many arrive suffering from severe mental health symptoms, including psycho-emotional trauma, due to experiencing profound violence and loss, with little or no ability to communicate in English, and come from cultures where mental health treatment is uncommon.
At the same time, particularly for those coming from nonwestern cultures and speaking nonWestern languages who are resettled in medium or small size host cities and towns:
- Mental health service providers in most of these communities – including mental health service providers – do not speak the native language of these refugees, or have a cultural understanding of the societies they come from. Added to this is the scarcity of therapists experienced in working with war trauma.
- Translators with the required languages skills are also scarce or nonexistent in these same communities. Those that do exist very often do not have the training and orientation to adequately perform as mental health translators, particularly in the areas of strict confidentiality, unbiased translation, and self care to avoid burnout
The wide-ranging life changes a refugee faces permeate every aspect of daily life and experience. The emotional and psychological challenges of these changes, occurring at multiple levels and all at once, effecting all aspects of normalcy, places substantial strains on the energy and resilience required of a person to adequately adjust to them. For those also impacted by trauma this challenge is particularly overwhelming, and often insurmountable, if the trauma is not healed.
Humanitarian assistance to refugees typically tends to focus primarily on the most concrete and visible needs, such as food, clothing, shelter, medical, economic, and education. More often this leads to the neglect of less immediately visible psycho-emotional wounds; wounds that over time can become embedded in a person’s consciousness, body, self-identity, and world view, and increasingly emerge as blocks to daily functioning that seriously undermines progress in all other areas of support.
Organizations and community representatives in host communities assisting the resettlement of refugees consistently point to major and often debilitating mental health symptoms as the main obstacle to an individual successfully making the transition from being uprooted out of their previous lives and sense of place, to adapting, integrating, and moving forward to a new life in an often very different society, culture, language, and geography.
The continuing lack of treatment for refugees struggling with trauma that is needed to achieve this level of healing, recovery, and stability is primarily due to language and cultural gaps that preclude accessing English-language-only based mental health services.
While there are some local efforts to address this need to varying degrees, these are typically more limited in access, languages offered, and numbers served; and most often located in larger urban areas where there are more skill options.
No multi-lingual service delivery system currently exists nation-wide to address this growing need for refugee mental health services in most host communities, and particularly in medium to small cities and towns spread across the country.
The result is that severe mental health needs go unattended and are allowed to become chronically dysfunctional in a person’s life, to the detriment of both the individual and the community they are becoming part of.
Teletherapy For Refugees
Bridging the Treatment Gap
A service provided from any location to any location in the US and Canada
This initiative addresses the need for critical mental health services to nonEnglish speaking refugees through a national teletherapy service delivery system tailored to bridge language and cultural gaps, and reach recipients anywhere in the US or Canada.
Three categories of resources are identified to establish and successfully operate this service:
- tele-health technology,
- human resources for service delivery and coordination,
- and funding resources.
- tele-health technology,
Tele-Health Technology is an already well established resource, with the prevalent availability and use of services like Zoom that can be secured for confidential service delivery, interpreter orientation and training, service provider support, communication with host community representatives, and coordination of the overall service delivery system.
Necessary elements include:
- An integrated virtual platform to host the on-line service capable of meeting the technical needs of the service.
- Client access to virtual technology equipment and the internet
2) Human Resources for Service Delivery and Coordination:
A. Direct Service Providers:
A national registry of therapists, coping skills trainers, and trained translators offering:
- Trauma informed Individual, couples, and family therapy,
- Self-help coping skills training to instill self-care abilities in individuals to further support treatment and re-empowerment, as well as equip them with the ability to potentially offer emotional support to other family members and friends.
- Psycho-education to counter stigma and promote normalization of mental health needs
- Confidential, unbiased translation
Although in many cases there will be therapists and skills trainers within the national network who have the necessary language skills to enable communicating directly with clients in virtual sessions, mental health professionals who do not have the requisite language skills utilize a resource of prepared translators to allow them to provide treatment through 3-way tele-therapy sessions.
As an adjunct to professional therapy services, where ever feasible selected members of a refugee community will be offered paraprofessional skills training and support in taking on psychosocial support and advocacy roles for their community. They are also seen as a natural resource for providing translators.
The visible presence of members of the refugee community itself involved in providing support services for it’s members helps to promote a sense of re-empowerment, and strengthen individual and communal resilience, confidence, esteem, and dignity.
B. Coordinating Body:
A central coordinating task group made up of mental health and social service professionals for management of the service delivery system and support of parties involved in providing services. Functions include:
- Ongoing coordination, guidance, monitoring, evaluation, and further development of the service delivery system,
- Support of service providers,
- Providing certified orientation and training to translators. Certification ensures consistency in quality of translation services and supports seeking funding for translator reimbursement.
- Liaison with resettlement support organizations in host communities,
- Coordination and evaluation to meet requirements of potential funding sources.
Those with experience in training mental health translators conduct orientation and training sessions, and offer support for translators focused on:
- Understanding and commitment to confidentiality, and their role as unbiased, objective translators.
- Emotional support and self care skills to manage and debrief from the expected stress and emotional impact of regular exposure to translating traumatic content.
C. Host Community Representatives/Partners:
Local stakeholders representing community organizations in host communities involved with resettlement support who are available to:
- Identify and refer individuals for treatment,
- Support and assist clients in accessing and consistently participating in virtual therapy sessions arranged for them.
- Ensure they have the needed equipment and internet access for using the virtual platform
An advisory network of representatives of resettlement organizations from host communities across the country will provide insights and feedback to the coordinating group on the overall effectiveness of the service and possible improvements.
3) Funding Support for Sustainability:
A. Insurance and Health Care Reimbursement to Direct Service Providers:
- Payment to therapists: Available sources: Medicaid, Refugee Medical Assistance (RMA), the Children’s Health Insurance Program (CHIP), or the Health Insurance Marketplace.
- Payment to translators: Research and advocacy for possible payment for essential health care related translation services through one or more of these health care insurance programs, and/or from other funding sources.
Government, foundation, and corporate grants, as well as funding resources within host communities, to support overall operations.