Tele-Therapy for Refugees
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The Need
The US and Canada are experiencing a steady flow of refugees being resettled from regions of conflict and turmoil around the world. Many come from nonWestern countries and very different cultures, and have little or no English language skills. An increasing number arrive suffering from psycho-emotional trauma due to violence and profound loss, as well as culture shock.
At the same time, particularly for those speaking nonWestern languages who are resettled in small or medium size host cities and towns:
- service providers – 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.
- Interpreters in these same communities who can speak any of these native languages are also scarce or nonexistent. Those that do exist rarely have the training and orientation to perform as confidential mental health interpreters.
Organizations and community representatives in host communities assisting refugees consistently point to major and often debilitating mental health symptoms as the main obstacle to a refugee successfully making the transition from being uprooted out of their previous lives and sense of place, to adapting and moving forward to a new life in a very different society, culture, language, and geography.
The life changes refugees face permeate every aspect of daily life. The emotional and psychological toll of these multiple disrupting life changes, occurring all at once, can cause substantial strains and drains on the energy and resilience required of a person to adequately adjust to these significant changes. For those also impacted by trauma this challenge can become particularly overwhelming, and often insurmountable, if the trauma is not healed.
Humanitarian assistance to refugees typically tends to focus more on the most visible and concrete needs, such as food, clothing, shelter, medical, economic, and education. Most 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 and self-identity, and increasingly emerge as blocks to daily functioning that undermines progress in all other areas of support.
Trauma recovery and being able to regain balance, stability, and security in a person’s sense of connection to self, others, and the world better allows for a steadier, healthier, more successful adjustment to even difficult life changes. The continuing pattern of a lack of treatment for refugees struggling with trauma that is needed to enable them to achieve this level of healing and recovery is primarily due to the challenges of language and cultural gaps that preclude accessing English-language-only based mental health services.
While there may be some local or regional efforts to address this need to varying degrees, these are typically in larger urban areas where there are more skill options. No current service delivery system exists nation-wide to address this need for refugee mental health services in most host communities, and particularly in medium to small cities and towns.
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 refugee and the community they are becoming part of.
Tele-Therapy For Refugees
An initiative to addresses the need for mental health services to nonEnglish speaking refugees through an innovative and collaborative tele-therapy model of service delivery, that can gather together the requisite resources to bridge the language and cultural gaps, and reach anywhere in the US or Canada.
There are three categories of resources required to establish and successfully operate this service delivery network: tele-health technology, human resources, and insurance coverage/funding.
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 confidentiality for service delivery, interpreter training and orientation, service provider support, and coordination across any distances, whether by computer, pad, or mobile device.
Human Resources for Service Delivery
Key, mutually supporting Human Resource components include:
1) Direct Service Providers:
A growing national pool of therapists, coping skills trainers, and translators offering:
- individual, couples, and family therapy,
- self-help coping skills training to instill self-care abilities in refugees that further support treatment and re-empowerment, as well as equip refugees themselves with the ability to potentially offer emotional support to others in their family and community.
- psycho-education
- confidential translation
Although ideally there will be therapists and skills trainers who have the language skills to enable communicating directly with refugees in virtual sessions, as well as hopefully cultural orientation and experience working with war trauma, mental health professionals who do not have the requisite language skills can utilize a resource of prepared translators to allow them to provide treatment through 3-way tele-therapy sessions.
As an essential adjunct to professional therapy services, where ever possible selected members of a refugee community will be provided with 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 their community helps to promote a sense of re-empowerment, and strengthen individual and communal esteem, confidence, and dignity.
Service can be provided from any location to any other location.
Time commitment for direct service providers can be flexible and based on each individual’s availability to be part of an overall service schedule.
2) Coordinating Body:
A central coordinating task group made up of health care and social service professionals and organizers, for coordination, guidance, and monitoring of the service delivery system, and support of parties involved in providing services.
Those with experience training mental health translators will be available to conduct certified training and orientation sessions for translators focused on:
- understanding and committing to confidentiality, and their role as confidential and unbiased consecutive translators.
- emotional support and self care skills to manage and debrief from the expected stress and emotional impact of exposure to translating traumatic content, and avoid burnout.
A support group is advised for all translators (in-person or virtual), as well as the availability of emotional support and guidance as needed from coordinating group members and available therapists. Coordination group members will assist translators in setting up such support groups, with an option for mental health professionals or para-professionals to be present in such support groups to offer further guidance.
Another human resource is graduate students in mental health and social work fields who can assist in supporting therapists and facilitating support groups, with the possibility of this involvement counting toward supervised field work. In addition to any official credit approved by academic institutions, students receive formal documentation of their professional fieldwork experience from participating organizations and institutions, including CBI and International Humanistic Psychology Association (IHPA).
3) Host Community Representatives:
An ongoing pool of local stakeholders – individuals involved with resettlement support by organizations in each host community who can be available to assist refugees in accessing and participating in the virtual therapy sessions that are arranged for them.
This will involve being in regular contact with individual refugees to ensure they have access to using Zoom and remember to keep their scheduled virtual therapy appointments.
An advisory network of community organizations from host communities will provide insights, feedback, and advice to the coordinating group.
Funding Support for Sustainability
1) Insurance and Health Care Reimbursement:
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: Investigation of possible payment through one or more of these health care insurance programs, or from other funding sources, for essential health care related translation services.
2) Grants:
Government and foundation grants, as well as resources within host communities