A7. Service Delivery – Oral Paper Session
Thursday, 30 March 2017
A Memoir of Making a Complex Care Clinic with refugee families in mind
BACKGROUND: It is estimated that of the 59.5 million people who are refugees from around the world, over half are under the age of 18 years . Despite forced migration being one of the dominant narratives in Australia and worldwide at present, the psychological health of refugee children remains poorly understood. Further, there is limited evidence base on the development and delivery of comprehensive mental health services for refugee children and their families. . This presentation outlines a pilot service model for a consultation and liaison service in partnership between a Sydney based CAMHS team and local NGOs to provide specialist mental health care to child and adolescent refugees and asylum seekers with trauma related illnesses.
OBJECTIVE: The aim of the presentation is to promote discussion around how to provide ethical and effective mental health care for refugee and asylum seeker children within our existing framework of mental health services and the wider political climate.
METHOD: A narrative description of the service from its conception through to the present state is provided using a multi-systemic framework. Particular attention is paid to the challenges, barriers, successes and surprises alongside issues of feasibility, acceptability, cultural sensitivity, adaptability and effectiveness. This is supplemented by a case study and a literature review of service models from around the world.
CONCLUSION: Innovative models of care informed by transcultural and systemic perspectives incorporating resilience framework, community collaboration, and focussed ethnography are critical in delivering specialist CAMHS services to refugee and asylum seeker children and their families.
Anita Datta (Liverpool-Fairfield CAMHS)
Toward an integrated service system for refugee and asylum seeker mental health
This presentation describes a systems level project that promotes an integrated model of mental health care for refugees and asylum seekers in Melbourne’s west. The initial hypothesis for the project was that improved integration of all systems responsible for the mental health care of refugees and asylum seekers would improve service quality and care outcomes for these clients.
Since late 2013 this project has brought together providers of public mental health services in Melbourne’s metropolitan west to collaborate with settlement services, specialist refugee health agencies and other providers to address systems delivery challenges associated with the need for more highly integrated care. Our initial focus has been on systems providing trauma informed mental health care for adult refugees and asylum seekers, and on mental health and wellbeing pathways. More recently the project has sought to build the capacity of the associated workforces. Increasingly we are looking to incorporate mental health promotion and community participation, with a focus on younger people.
Our primary target group has been the staff involved in the process of designing, and delivering trauma related mental health services. Our early interventions addressed the low levels of cross-sector knowledge and the fragmentation in the service system, and asked why, in this important endeavour an integrated service model was not evident and how to improve the system for the clients.
This presentation reports on our progress towards an integrated service model, and the benefits to the staff, organisations and clients when effective partnerships are created. Through our project we have demonstrated that client access and care options can be improved; that staff knowledge, skill levels and confidence increased and referral pathways are expedited more effectively. This work is on-going.
Tanya Sofra (HealthWest Partnership), Laura Ribarow (HealthWest Partnership)
Resettlement experiences and support needs of people living with disabilities from refugee backgrounds
The 2010 Inquiry into Migration Treatment of Disability by the Joint Standing Committee on Migration, found health requirements in the 1958 Migration Act unfairly discriminated against people who are refugees living with disabilities. In November 2012 the Australian Government responded to the Inquiry’s recommendations stating that from 1 July 2012, “a humanitarian visa processing officer will not consider any costs for health or community care services undue.” Refugee and Humanitarian Programme entrants were provided access to a waiver of the health requirements.
Since 2012 increasing numbers of people living with disabilities have arrived through the offshore Refugee and Humanitarian Programme.
People living with disabilities from refugee backgrounds have diverse support needs which have placed new demands on service systems. The absence of data for service planning, systemic and structural obstacles to timely assessments, unsuitable housing stock for people with mobility issues, newly arrived communities’ lack of familiarity with service systems and disability service providers’ lack of experience of working with people from refugee backgrounds, are some of the themes that have emerged.
The Victorian Refugee Health Network is conducting a needs assessment and gap analysis including reviewing policy, reports and literature, and interviewing service providers to better understand the resettlement experiences and support needs of people living with disabilities from refugee backgrounds. Preliminary findings, case studies and next steps will be discussed in this presentation.
Philippa Duell-Piening (Victorian Foundation for Survivors of Torture (Foundation House)), Assunta Hunter (Victorian Refugee Health Network, Foundation House)
The impacts of adversity: Understanding the complex social and psychological reasons for asylum seekers and refugees attendance at primary health care services
Primary Care physicians in Australia are increasingly seeing asylum seekers and refugees with complex issues given the current political climate of uncertainty for this vulnerable patient group.
To describe the attendance patterns of refugees and asylum-seekers to primary care, and understand the specific heath needs of this population as they settle into Australian society.
Descriptive study of health care consultations of all patients of a refugee primary health service (1 July 2011 – 31 June 2013), until they left the service, or until 28 February 2014. The types of health presentations including psychosocial issues were identified and described in comparison to Australian population presentations.
471 patients (69.4% male), had 2527 consultations over 447.8 patient-years of observation. The main differences between attendance by refugee/asylum seeker patients and the overall Australian population to general practices are attendances for psychological reasons (27.2/100 encounters), endocrine and metabolic (12.11/100 encounters), and social reasons, including issues related to housing, family disruption, poverty (39.37/100 encounters).
Attendees to a refugee health service in the post-settlement period have markedly higher rates of attendance for catch-up primary health care, and social and psychological care. Asylum seekers as a specific group can have different health issues to those settling under permanent humanitarian visas. The forty-fold increase in attendance for social problems and three-fold increase in attendance for psychological reasons indicates the vulnerability of this population who often live in conditions of destitution. It is important to understand specific health needs so as to provide whole person care.
Christine Phillips (Companion House and Australian National University)