A2. Clinical – Children and Adolescents – Oral Paper Session
Thursday, 30 March 2017
Supporting children’s recovery from refugee trauma: Systemic and holistic work with children, families and schools
Trauma is healed in the context of safe, supportive relationships. This paper will present a rationale for the importance of working systemically and in partnership to support children’s recovery. The evidence base for the importance of working with systems will be outlined.
Given the importance of safe, positive relationships in healing from refugee trauma the paper will emphasise how important it is for those around a child to support the child’s recovery from trauma and dislocation; the role of parents or caregivers, a connected family and supportive educational context where the child feels safe and engaged will be discussed. A framework for recovery using a relational approach to healing will be outlined and this will be supported by a case example detailing evidence from both a clinical and school perspective.
Evaluation outcomes will be discussed using both qualitative and quantitative data.
Those working therapeutically with children need to consider the child, family and school in their interventions. Working holistically can allow them to implement broader system changes which promote engagement and success for individual children as well as others in school, both now and into the future. The paper will highlight the importance of counsellors and school staff bringing together their collective expertise to support children and young people and highlights how this helps to ensure positive settlement outcomes in the school setting and beyond
Esme Dark (Victorian Foundation for Survivors of Torture and Trauma)
Giving yourself a “brain freeze”- reducing self-harming behaviour in refugee children and young people with complex trauma presentations
Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT) counsellors have observed relatively high rates of self-harming behaviour in children and young people from refugee backgrounds. These vulnerable clients describe self-harm as a way to manage dissociative symptoms or cope with intense emotional distress.
Concurrently, Dialectal Behavioural Therapy (DBT) has emerged as an evidence-based intervention for clients with complex trauma presentations and self harming behaviours (Granato et al, 2015; Landes et al, 2016). However, the use of DBT strategies with refugee background young people requires flexibility and cultural sensitivity. An adapted version of DBT has been applied to a small cohort of refugee children and young people with the aim of reducing self-harming behaviours. These children and young people are from a variety of cultural and religious backgrounds, ages and genders; however they all presented with complex trauma history, severe PTSD symptoms, regular self-harming behaviours and/or high risk behaviours. These complex trauma symptoms were exacerbated by experiences of intergenerational conflict, domestic and family violence and experiences of neglect.
This paper will outline and explore the effectiveness of adapted DBT strategies with this vulnerable client group, including inclusion in safety planning. Case studies will be provided to illustrate the cultural and systemic complexities facing at risk refugee children and young people who self-harm. While our work has seen a reduction of self-harming behaviours, increased distress tolerance and improved emotion regulation there are also some cases where recovery has been limited so far.
We will look at the inclusion of stakeholders, parents and carers to assist the children and young people in their recovery, and the importance of advocacy in reducing shame.
Sarah Kristensen (QPASTT), Katie Brooker (QPASTT)
Strengthening Cultural Relationships & Improving Emotional Regulation through Drumming
Children from refugee backgrounds present with symptoms such as hyperarousal, social isolation, acculturation issues and low self-confidence. This paper describes the use of Holyoake’s DRUMBEAT program, an evidence-based intervention that engages people through rhythm. Research shows that drumming impacts the primal brain structures damaged through trauma and provides an avenue for creative self-expression and dialogue. In particular, the intervention aimed at breaking cultural barriers and allowing the participants to develop positive and trusting relationships with others. It also aimed at helping them learn about emotions and ways of self-regulation, increasing their self-confidence, and sense of belonging. A number of techniques harnessing fundamental cognitive and sensorimotor skills were incorporated into the group sessions. These included creating group goals, problem-solving, group games, opportunity to lead the group, working with analogies and teamwork. The program was delivered over 10 sessions, to two groups of Primary School children belonging to refugee backgrounds. There were 15 participants from diverse cultures, with the majority being new arrivals from Syria. The outcomes of the interventions were measured by qualitative and quantitative pre and post evaluation tools, including feedback from teachers and other staff at the school. Quantitative findings suggested an improvement in children’s self-esteem. This enhanced their level of participation in the group, especially for the Syrian cohort. Participants reported that they enjoyed being part of the group and valued the rules about listening and respecting others. It was also observed that over time, the children were more tolerant and compassionate towards others in the group.
Mehak Khandeparkar (Survivors of Torture and Trauma Assistance and Rehabilitation Service (STTARS, Adelaide)), Nellie Anderson (Survivors of Torture and Trauma Assistance and Rehabilitation Service (STTARS, Adelaide))
Sandplay Therapy with Young Refugees
Sandplay is nonverbal form of therapy that allows the person to connect with the preverbal level of the psyche. In this modality, children or young people are asked to create scenes or abstract designs in tray of a specific size, using sand, water and miniatures. The therapist holds the space and allows for the creation to happen in a safe location.
Sandplay springs from Jungian theories and the principle that given the proper conditions, there is a tendency for the psyche to heal itself.
The use of this therapeutic modality has been particularly effective with refugee children and young people. Its nonverbal principle allows the therapist to work with limited language skills and verbalisation as well as reach the traumatic experiences that are often stored in the body and may not be accessed through verbalised memories.
In this presentation, we will briefly touch on the theoretical framework behind this model will be discussed and case vignettes that illustrate the benefits of sandplay in working in the trauma field with young people of refugee background will be presented.
Chiara Ridolfi (STARTTS (NSW Service for the Treatment And Rehabilitation of Torture and Trauma Survivors)), Sanja Stefanovic (STARTTS (NSW Service for the Treatment And Rehabilitation of Torture and Trauma Survivors)