Expert Panel Discussions 2017

Panel 1: What makes for a successful resettlement program?

Photo Victor Madrigal Borloz Portrait
Victor Madrigal Borloz

Moderator: Victor Madrigal-Borloz, Secretary-General, International Council for the Rehabilitation of Torture Victims (IRCT), Denmark

Panellists:

  • Paris Aristotle AM, CEO, Victorian Foundation for Survivors of Torture (VFST), VIC
  • Abdullah Alikhil, Afghan Pashtun Community, Executive Producer, SBS Radio Pashto Program
  • Violet Roumeliotis, CEO, Settlement Services International, NSW
  • Jamila Padhee, Deputy CEO, MDA QLD, QLD
  • Mary Willems, Coordinator, Anglicare, NT

Photo Paris Aristotle Portrait
Paris Aristotle

Photo Abdullah Alikhil Portrait
Abdullah Alikhil

Photo Violet Roumeliotis Portrait
Violet Roumeliotis

Photo Jamila Padhee Portrait
Jamila Padhee

Photo Mary Willem Portrait
Mary Willems

Rapporteur: Susan Maddrell, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

Moderator’s questions to panellists

1. Is there such a thing as a service model, and is it something for which we should be striving?

• MDA: use two part model – work with clients and families, and work with community. Four areas of social determinants: basic needs (housing, employment, etc); engagement; outcome of belonging; wellbeing. Identify protective and preventive factors – people can be very well received, but without community to provide context.

• SSI: takes a broad view – Australia a culture of immigrants; settlement services and programs have come much later in the process for migrant settlement. Australia usually ranks in top 5 in Migration Integration Policy Index: we have a national settlement framework to which governments committed; very localised and nationally coordinated settlement delivery model.

• SBS reaching more than two million listeners with radio program – Settlement Guidance provides very basic information about consumer rights, mental health etc in community languages. SBS acts as a bridge and medium between communities and government; they have a good digital reach, particularly targeting youth.

2. Is integration the marker of success?

• Anglicare: many ways to measure success: the question is what do refugees want to achieve? Level of participation in community/host community/employment/education; to what extent do people feel they can participate, and what constraints do they face? Varies considerably from community to community, and faith to faith. Social inclusion is very personal.

• VFST: impact of large scale movement into Europe – population unnerved about capacity to deal with it. Sweden has moved from very high acceptance of migration to very sharp resistance. Continued focus on integration criteria, with testing prior to visa grant. Australia starting to talk about as well – “enforceable integration criteria”. Should be based on integration capacity of the country, rather than integration potential of the individual. One marker of successful settlement could be the extent to which the community is no longer seen as controversial, and has gone on to be part of the broader community: can’t think of a situation where communities have not become part of the broader community. Conundrum of competitive rather than collaborative work, where funding models put pressure on collaborative activities, problematic for effective settlement.

• SSI: Everyone needs to have sense of belonging: own family/community experience included a number of families which never identified with Australia. Role of settlement organisations/programs in supporting

• VFST: a more organic process has deeper roots. Look at way whole suburbs were Greek, for example, and how this has changed over time. Better to be organic than oppositional – the more we can support an organic process and smooth out the challenges the better. Challenges for older adolescent refugees who have lived in camps for a long time, who’ve had disrupted education and are too old to be in the relevant class in the education system: how do we tackle so that we don’t leave the vulnerable behind – what issues to tackle, what support to offer, for what issues should we stay out of the way and let the communities resolve.

• SBS: need stable environment for services to work. Afghan person hides identity because of a lot of political elements – don’t mention area came from because fear will impact reception. Reconstruction of earlier work needed after adverse media stories such as Send them Back, which was interpreted as exclusionary, despite food settlement service work. Important to have media outlets and government at the same table, in order to understand each other. Feedback from Afghan interpreter working in the frontline, who noted in SBS interview that a distracting issue was the comments of some politicians which directly attacked him for things which he hadn’t done. The key thing is to change the environment, then successful settlement organisations have to become involved in advocacy.

• SSI: integration is a two way thing. Leadership is critical – has impact on community and society. Good ordinary people who very influenced by leadership – if have open, wonderful leaders, people embrace multiculturalism. Leaders of settlement organisations not going to accept “other” notion.

3. What’s the impact of competition in terms of funding?

a. One tension is not only getting objective outcomes, or integration – the other is how integration is viewed by the refugee; for example, the goal for the older Bhutanese in one community was to have a local temple where they felt at home. Refugees live a transitional life: integration is not a one-way street; it’s a fluid and context-dependent process.

b. Integration is very individual: from personal experience of 17 years in a camp, the main objective is to bring children here (rather than the individual being primary). Extending funding length and cutting red tape would move the process from a quantitative tick box one to a longer-term qualitative one.

c. Gaps and possibilities in settlement services (in mental health area) – nothing seems to get better for clients in terms of mental health – would we get a better fit through gap identification?

i. Jamila – mental health is a very broad category – wouldn’t see clinical aspect of mental health as fitting their area. Working very closely with QPASTT (who are dealing with a more specific clinical focus) on project looking at bicultural identity – settlement services can’t do it on their own.
ii. Many NGOs work very well together, in a context of complex needs and insufficient numbers of services
iii. Complex grief and loss is a key gap for split families
iv. Question is around broader social determinants of health rather than just mental health: social connectedness, employment etc are critical. Organisations don’t have to be HSS providers to make a difference: it’s important to widen the vision of which parts of a person’s life can be addressed, not just the hard end of torture and trauma, by building capacity to progress in other areas. The question is who can do what best: what can we do to support settlement organisations? People look at funding streams rather than what the best outcomes could be. Gap identification leads to a complementary process and outcomes.

d. SSI adopted a consortium model in NSW in terms of SGP services – the 23 partner organisations do what they do best on the ground level, delivering services, and are able to access innovation funding from SSI

e. The question is are we giving people what they want – independence, etc? Is the government taking on all the findings of research and funding reports. QPASTT sees people who are being re-traumatised by what they are forced to do in the settlement process – employment, etc.

f. How will things like terrorism and the Donald Trump policy, which excludes some groups from entry to the United States, affect settlement and acceptance of refugees in Australia?

g. Good if the government understood the concept of business continuity in terms of funding rounds – better to have contracts which finish before the end of the financial year, to preserve service continuity.

h. Terminology is also important – labelling someone as a refugee makes it difficult for people to settle because they feel (and continue to feel) like outsiders.

i. Have to work hard alongside communities to expand understanding and dispel mythology

j. Better not to label, but to work with vulnerabilities.

Moderator’s summary
Three main areas of discussion:
1. Identification of individuals’ notions of settlement, and how much voice they have
2. More systemic reflection on gaps, to deliver a more level playing ground3.
3. Need for stronger, higher level of public policy discourse

Panel 2: What happens when people are unable to resettle? Challenges of supporting asylum seekers and TPV holders

Photo-Zachary-Steele-Rectangular-JPEG
Zachary Steel

Moderator: Professor Zachary Steel, St John of God Professorial Chair of Trauma and Mental Health, NSW

Panellists:

  • Joseph Szwarc, Manager Research and Policy Program, Victorian Foundation for Survivors of Torture (VFST), VIC
  • Bernadette McGrath, CEO, Overseas Service for Survivors of Torture and Trauma, Nauru and Manus Island
  • Shukufa Tahiri, Afghan Hazara Community, Policy Assistant, Refugee Council of Australia, Refugee Communities Advocacy Network
  • David Manne, Human Rights Lawyer, Executive Director, Refugee Legal, VIC

Photo Joseph Szwarc Portrait
Joseph Szwarc

Photo Bernadette McGrath Portrait
Bernadette McGrath

Photo Shukufa Tahiri Portrait
Shukufa Tahiri

Photo David Manne Portrait
David Manne

Rapporteur: Lachlan Murdoch, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

Panel 3: Advances in refugee trauma interventions and research: Where to from here?

Photo Stuart Turner Portrait
Dr Stuart Turner

Moderator: Dr Stuart Turner, Psychiatrist, Trauma Clinic UK

Panellists:

  • Mariano Coello, Clinical and Research Coordinator, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW
  • April Pearman, Clinical Development and Research Manager, Association for Services to Torture and Trauma Survivors (ASeTTS), WA
  • Dr Fatin Shabbar, Research and Teaching Academic, University of South Australia, SA
  • Professor Richard Bryant, Director Traumatic Stress Clinic, Westmead Millennium Institute, NSW
  • Dr Andrea Northwood, Director Client Services, Center for Victims of Torture (CVT), USA
  • Dr Jessica Carlsson, Head of Research, Transcultural Competence Centre for Psychiatry, Denmark

Photo Mariano Coello Portrait
Mariano Coello

Photo April Pearman Portrait
April Pearman

Photo Fatin Shabbah Portrait
Fatin Shabbar

Photo Andrea Northwood Portrait
Andrea Northwood

Photo_Jessica Carlsson Portrait
Jessica Carlsson

Rapporteur: Dr Shakeh Momartin, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

-We still know too little about refugee research in other parts of the world, but Australia and New Zealand are in leading positions in research.
-What do refugees and asylum seekers say they need from us? Is a range of services enough? Why don’t we do treatment used for other kinds of general traumas? Would that work?
-Questions raised by Dr. Turner: do we ever know if an instrument is working? Do we stop using it if we know it is not working? What about the methodological problems?
-We have to have an emphasis on resettlement. What are the ethical issues for refugees for resettlement?
-Mariano – We have to be in the pursuit of new ways and finding new methods to solve problems for refugees. We have seen thousands of clients at STARTTS, policies have changed for refugees, not all favourable and this has shaped the way we have worked with refugees over the years. We have to be careful how we approach communities. We discuss with community members/leaders on regular basis to see what is the best way of approaching specific client groups. We also work in partnership with universities to initiate our own research.

Guy Coffey (Foundation House)– Do we really give psychological treatment to refugees or is it really settlement help that we provide? Torture and trauma services have previously worked in isolation which is not similar to other trauma (general) areas.
April – What makes Torture and trauma different to other trauma services? Our service provision is different, how modified is our client population is important. Is it applicable to other population groups?

Richard Bryant- Academic changes in different disciplines such as veterans affairs, child abuse etc may have similarities with main stream services. It does not work well with refugee services and populations. We can use it as a starting point but then adjust it to refugee populations and services. It has to be meaningful. The only way academics can work in a productive way is to work with service providers such as STARTTS.
Andrea- Sociohistorical context gives better understanding to what happened than a single torture event.
Fatin- Iraqi women research, framing of suffering has different dimensions of spiritual, way of understanding of trauma.

Jessica – We have ethical responsibilities for doing research in an ethical way. There are many similarities between trauma in different areas. We need to simplify things to get better results. Heterogeneous populations have to be considered.

US worker – Questions: How do you bring together power of refugees and community development model together. How to advocate for our clients best ? How can we as therapists work with academics to have better results?

Difficulties of refugees – Why are they difficult and resistant to therapy sometimes? They are complex populations, nature of trauma complicates the trauma and healing process. The trauma is also interpersonal and they have to learn to engage with the world later on.
-What is the character of the refugee? – ripple effect (Richard Bryant) therapy gets affected by complex trauma and the accumulation of trauma. Grief is very prevalent, more than PTSD might be grief. Complexity of refugee trauma are many. More research is necessary for refugees. We have to follow client’s lead for getting better results. We cannot just follow a set manual for refugee clients, we have to follow what they need and what is best for them. (Andrea), they are going through a difficult time and they need more pragmatic RCTs to get results.
-Fatin – How much are we ready to work on different client problems? Unorthodox methods for Iraqi women does not work, not ready for that and not appropriate for all. Torture and trauma therapies are not like other therapies. Grief is important for refugees to consider. Is it culture or is it trauma? How people manage their grief is different. How would refugees and veterans differ in dealing with grief?

-Difference between a trauma and grief in schools for student refugees. Things trigger grief and have to be managed. Must be contained as they have accumulated grief and trauma.
-Refugee children (Anita Data) how to have effective treatment for refugee children? It is recognized that there are child refugees effected. More studies coming out for young age trauma. Need for understanding and research for young people. Humanitarian aspect of child research. Jordan and Lebanon study by Bryant, Syrian children need help, resources, family networks.-Hard to work with cultures, because everyone brings their own culture. Therapists also has own culture so sometimes struggles to understand.
-We have to work in a system of family and community not individualistic. We have to be sensitive to culture . -We aim to get it right what cultures need, which therapy etc. but not possible all the time. We have to collaborate with communities.

US worker- In a US study, Ethiopian groups have given therapists 8 different ways that they grieve. To specify exactly way to grieve is difficult in sociohistorical content.
-Different stages of grief in Bosnian refugees. Important to pick which treatment for which client, stages of healing in the clients healing process.
-ICD- prolonged grief might have new diagnostic criteria. ICD is by WHO, it is very sensitive to cultures. Culture is the relevance point. Recognising that culture is central to grief.
It is important for people who do research and therapy/intervention to come up with a good way to deal with grief and difficult clients and treat it differently to PTSD and depression.

Panel 4: Relationships and trauma recovery: How to best work with and assist refugee communities to build social capital?

Photo Susan Elliot Portrait
Susan Elliot

Moderator: Susan Elliot, Refugee Practitioner and Lecturer, New Zealand

Panellists:

  • Jasmina Bajraktarevic Hayward, Community Services Coordinator, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW
  • Fernanda Torresi, Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT), QLD
  • Esta Paschalides, Government and Manager Relations Manager, Settlement Services International, NSW
  • Om Dhungel, Association of Bhutanese in Australia
    Representative from the NSW Police

Photo Jasmina Bajraktarevic Hayward Portrait
Jasmina Bajraktarevic Hayward

Photo Fernanda Torresi Portrait
Fernanda Torresi

Photo Esta Paschalides Portrait
Esta Paschalides

Photo Om Dhungel Portrait
Om Dhungel

Rapporteur: Hamed Turay, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

As chair for the panel, Susan Elliot, informed session participants that she advocated for the establishment of STARTTS equivalent in New Zealand 30 years ago. She encouraged panellists to look at how they have assisted refugee communities build social capital, both within their communities and outside. Other concepts she mentioned included trust building, reciprocity, and compromise to find a way to live together. Social Capital she concluded “Is an invisible glue that keeps our world together” and cited neighbourhood watch as a perfect example of social capital building that keeps communities safe.

Session Objective:
To identify:
How our (work will help communities build social capital, between people and their networks. The use of strength based approaches in service delivery, a shift from focusing on deficiencies.

Key points from panelists
• That connection and empowerment are essential for recovery from trauma (Judith Herman). Building relationships is the first step to building connections.
• That state sponsored terrorism targets relationships and divides populations (Martin-Baro, 1989). State Terrorism destroys social capital in a systemic and deliberate way. Thus, a goal of collective recovery should be to help rebuild the social capital and address the direct consequences of exposure to State Terrorism. This theory led to the collaboration between STARTTS and UNSW to collaborate with refugee community leaders to develop Indicators of social capital and tools to measure those. This approach is useful when evaluating projects aiming to address the impact of State Terrorism on a community level. This research also resulted in development of the concept of Social Capital Enablers. Further information is available from STARTTS.
• That Asset Based Community Development (ABCD) as a community development model is based on focusing on the strengths and starting with what is present in refugee communities rather than what is missing. It interacts well with the Social Capital Model as even when assets are identified, they need to be connected to be powerful together. Social Capital make that link.
• Reference to the African Mental Health Learning Circle model at STARTTS, a strategy that brings together mental health service providers and African community leaders based in Western Sydney into group discussions. The aim is to discuss and raise awareness about mental health issues and suicide that affect African communities and how these issues can be addressed. The Learning Circle is based on the model of mutual learning between African community leaders and mental health service providers. It acknowledges the knowledge and wisdom both stakeholders’ possess.
• In order to build on our own social capital as Service Providers, SSI according to Yamamah works closely with different agencies such as Local Councils for the use of council facilities, so that refugees can connect and socialise with other people.
• Building programs around refugees such as Social Enterprise assist refugees build on their social capital by setting up businesses that will allow them relate with other people (SSI & STARTTS have supported the establishment of over 50 businesses, refugee kitchen and community gardens).
• That the use of bottom-up approach facilitates social capital building.
• Focus on the strengths of refugees, talk about their passions, and tap into assets that people bring.
• Identify gaps in service delivery and approach other services if you are not the right service, which encourages collaboration/partnerships.
• Focus on strengths fosters independence.

Questions
How do you work with communities with divisions?
• The essence of our work is to work with those divisions, and understand what is fuelling those divisions. After building relationships with each side, you may find out what could encourage them work together.
• Be transparent and highlight the importance of working together for the benefit of the whole community. Emphasise the power of joint approach for lobbying and advocacy.
• Respect those differences, and timing is everything (find the right time/opportunity to intervene).
• Make sure you have the permission/authority to bring people together.
• There is the potential to get aligned with one group, which further destroys community cohesion.
• Don’t force them to work together but emphasise the usefulness of this.
• Always remember that the hook that gets people together is when they have common purpose/interest.
• In Queensland and South Australia two settlement service agencies reported organising refugee community ‘leaders’ dinner’ and ‘welcome dinners’. The Welcome Dinner in Adelaide specifically brings different people together including people from mainstream to develop authentic relationships. No political or faith conversations allowed, only see each other as people.

Interested to know how we as service providers build on our own social capital – we are stronger together mantra, how do we build that strength authentically?
• The formation of SSI is a clear example, MRCs came together to work concertedly. It increases the use of peoples lived experiences in terms of settlement and policy issues.
• Competitive Tendering processes have a direct impact on the sector social capital.

What can we do as FASTT Network to build social capital?
• This is something to put on FASTT Directors agenda.

It is inspiring to hear about your projects, which highlights the importance of making connections with mainstream society. In Scotland, refugees who easily find employment are those with established communities – are there any example of projects that assists refugees find employment?
• When people arrive we look at skills on demand, guide them to study and acquire local qualifications, and encourage them to volunteer. People studying childcare for example look after kids at community events, those studying Aged Care similarly look after older people during excursions/outings.
• We focus on what we do and identify gaps, link qualified refugees with appropriate professions to volunteer and guide them through bridging courses/programs. Example, Alliance Insurance employs ten refugees every year.
• STARTTS works closely with Bright Employment (http://www.brighthospitality.org.au/bright-employment/ ) and a good number of refugees have gained employment through such collaboration.

The work with refugees in Australia does not match the impression of Australia’s treatment of refugees internationally – How can we harness community asset to help at the global level?
• We need to change the debate at the global level from sharing the burden to sharing the opportunities, show more care by settling increase number of refugees in Australia.

We are usually funded and expected to reach targets and funding agencies are often inflexible, the reality on how long it takes to build social capital in communities makes it hard. How do we work around these?
• Try hard to have a good relationship with your contract managers and communicate with the appropriate departments. Ensure you document your approach and the reasons you want to take a particular route then negotiate with your contract managers. Make sure you have a good reporting and acquittal record in the past and are perceived as a reliable service.

Refugees mostly reside where their communities are, which makes it harder to relate with mainstream society.
• There are many examples of projects that work on Bridging Social Capital. One of STARTTS current projects involves a collaboration between Western Sydney High Schools with high numbers of refugee students and the Conservatorium of Music High School. The project builds bridging social capital via music.

• Another good example is the Cultural Exchange Project run by the NSW African Women’s Group where groups of refugee and migrant women travel to rural/regional NSW and are billeted by local women. The visit includes sharing stories, food, culture and tour of the local community venues and tourist attractions. It is a process of mutual learning and cultural sharing.
• Encourage refugee community members to participate in mainstream activities as well as celebrating internal cultural activities.

Panel 5: How can health, mental health and refugee trauma services best work together to assist individuals and families with complex needs?

Photo Roger Gurr Portrait
Roger Gurr

Moderator: A/Prof Roger Gurr, Former Director of Mental Health, Western Sydney Area Health Service, Clinical Director Headspace Youth Early Psychosis Program, NSW

Panellists:

  • Dr Ida Kaplan, Direct Services Manager, Victorian Foundation for Survivors of Torture (VFST), VIC
  • Dr Christine Phillips, Medical Director, Companion House, ACT
  • Dr Mitchell Smith, NSW Refugee Health Service, NSW
  • Raphael Manirakiza, Burundian Community, Clinical Psychologist, NSW
  • Dr Martin Cohen, Deputy Commissioner, NSW Mental Health Commission, NSW

Photo Ida Kaplan Portrait
Ida Kaplan

Photo Dr Christine Phillips Portrait
Christine Phillips

Photo Mitchell Smith Portrait
Mitchell Smith

Photo Rafael Manirakiza Portrait
Raphael Manirakiza

Photo Martin Cohen Portrait
Martin Cohen

Rapporteur: Carlena Tu, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

The panel were asked to introduce themselves and explain why they believed that integration of trauma centres, general health and mental health services would benefit clients.

Roger Gurr – STARTTS and Headspace
Roger explained that 50% of clients that presented at Headspace have experienced some form of trauma. It was evident that there were strong ties between mental health issues and the experience of trauma.

Dr Martin Cohen – NSW Health Mental Health Commission
Martin explained that the Mental Health Commission was responsible for the provision of mental health in public, private and community health. One of their key strategies was to work on racism and xenophobia in the community. They also believed that trauma impacted on a person’s ability to contribute to society which therefore enhanced the fears of society.

Dr Mitchell Smith – Refugee Health Services
An Early Childhood team was recently established at Refugee Health Services. He believed that the entire Mental Health system needed to be fixed. More patients were presenting with “complex needs” but what was the definition of that?

Dr Ida Kaplan – VFST
Ida believed that service expansion has occurred rapidly in recent years but there was also the danger of siloing into different areas. Clients should receive integrated healthcare and early intervention.

Dr Christine Phillips – Companion House
There was only 1 GP at Companion House 22 years ago but there are now 6 GPs and 1 Paediatric Registrar. Funding and resources is always a problem.
Raphael Manirakiza – USYD, Parramatta MRC, FACS, Together for Humanity, STARTTS (FICT)
Raphael arrived late and noted his various positions at different organisations. He also explained that his professional background is Clinical Psychologist but he is not qualified in Australia

Issues Raised
1. Lack of flexibility
a. Clients were excluded due to walls of criteria
b. Referral criteria was too strict for both Torture & Trauma centres and Acute Mental Health
i. Raised by Refugee Health
c. Clients often fell between Torture & Trauma centres and Acute Mental Health
i. There mental health symptoms were too high for the T&T centre but not high enough for Acute MH
d. Service delivery – not enough home visits

2. Lack of case management
a. This should not be relied upon settlement case workers
b. Should be by a health professional
c. GPs should case manage but the load is too high for complex cases
i. GPs need extra support
ii. They need at least 20 minutes per patient but can often only see patients for 6 minutes
iii. Darwin GPs are great at case management but boundaries become an issue due to the small population

3. Seeing each other as competition for funding

Strategies Suggested
1. Network and learn more about each other
a. Even if it isn’t across disciplines but just within the discipline
i. E.g. if GPs can’t liaise with T&T centres, they can liaise with each other to discuss the problems they are having with their patients and support each other

2. Establish MOUs
a. Companion House had established one with Public Health

3. Engage with private psychologists
a. Companion House found that they were more willing to participate than expected

4. Work on constrained purposes

5. Co-location
a. Health is described as being spiritual, mental and physical.
b. Why are T&T centres, health and mental health located at 3 different places?
c. Advocate for co-location
i. Illicit funding and economic viability
ii. Supervision for clinicians
iii. Currently activity based
iv. Easier for smaller services
d. Primary Care Headspace is a consortium of services
e. Talk to Public Health Networks
i. T&T centres have no initiative to speak to PHNs but it isn’t too late
ii. Multi-dimensional approach
iii. Pilot and show results
iv. Leadership is required
v. Advocate and drive change

6. Culture awareness competency
a. Faith Leaders should play a part
b. Community based and culturally diverse workers

7. Outreach
a. 202 visas mean that clients are already linked to people in Australia
b. These people may not be in a position to refer
c. Change your points of access
i. English classes
ii. Schools

8. Case conferencing
a. Use Skype

Success Stories
Perth
1. Complex holistic approach – medical, dental, mental, interpreters, caseworkers and teachers.
2. Less returning clients.
3. Perseverance is vital to achieve holistic care.
4. You need to be flexible  change, review and audit
5. They receive funding by different streams

Aboriginal Health
1. Prime example of how cultural and holistic approach has worked within a community of people.

Panel 6: Children and the school environment: How do we ensure interventions are trauma and attachment informed?

Photo Elizabeth Pickering Portrait
Elizabeth Pickering

Moderator: Elisabeth Pickering, School Counsellor, NSW Department of Education, NSW

Panellists:

  • Samantha McGuffie, Coordinator Schools Support Program, Victorian Foundation for Survivors of Torture (VFST), VIC
  • Naomi Brown, Children’s and Youth Coordinator, Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT), QLD
  • Mikhail Kallon, Sierra Leonean Community, School Learning Support Officer, NSW Department of Education, NSW
  • Kim De Deckker, School Counsellor/Psychologist, Refugee Student Support Team, NSW Department of Education, NSW
  • Stephen Said, Head of Student Wellbeing and Pastoral Care, Sydney Catholic Schools, NSW

Photo Samantha McGuffie Portrait
Samantha McGuffie

Photo Naomi Brown Portrait
Naomi Brown

Photo Mikhail Kallon Portrait
Mikhail Kallon

Photo Kim De Deckker Portrait
Kim De Deckker

Photo Stephen Said Portrait
Stephen Said

Rapporteur: Lucrecia Cardona, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

Intro: Elizabeth Pickering
• There was little information about the effect of war in children and the relationship between trauma and attachment before 1990.
• Rehabilitation and recovery an also take place in non-clinical settings like schools.
• Non-clinical environments that are trauma informed could also work for recovery.

General Questions:
1. . Do we need trauma informed schools?
2. Do we need to start using trauma and attachment informed observations?
3. If yes, who is responsible for implementing these?

Panel Discussion:
1. Explain your connection with refugees at schools:
• Teachers capacity building

2. Clarify your understanding of trauma and attachment informed environment/interventions:
• Trauma and attachment informed environment/interventions means the need to look at Neurological parts of trauma and understanding what happens in the brain.
• It involves looking at the impacts of trauma through “neurological lenses”.
• Understanding that trauma impacts everything and how students could respond to traumatic experiences, keeping in mind what happens in their brains and how that impacts their responses/behaviours.
• It is important to understand attachment in the context of refugee trauma. The way that children develop attachment is different when traumatic experiences like death, separation, losses, etc. are present.
• Also, it is important to take into consideration that recovery after trauma it’s closely related to connection and attachment.
• Teachers need to access the information like the one is being discussed in this panel, so they can understand what is behind their student’s behaviours. If teachers are trained and understand behaviours coming from students that had been exposed to traumatic experiences, they will stop reacting and start responding to student’s behaviours and needs.

3. What sort of interventions can be classified as trauma and attachment informed?
• Interventions orientated to reflecting and restoring connections.
• Interventions that create new relationships based on trust.
• It is important to go back to basic brain talk; it works for children and teachers.
• Recommended resources to check:
– Calmer classrooms: a guide to working with traumatised children: http://education.qld.gov.au/schools/healthy/pdfs/calmer-classrooms-guide.pdf
– Mind up: mindfulness program

– Proactive program from Westmead Hospital (I found a book only, not the program, maybe that is what they were referring to)
– https://kidshealth.schn.health.nsw.gov.au/proactive-young-people-therapist-instructions-and-activities-treatment-program-young-people-anxiety
– Cool kids program, Macquarie University
– http://www.mq.edu.au/about/campus-services-and-facilities/hospital-and-clinics/centre-for-emotional-health-clinic/programs-for-children-and-teenagers/expandable-information/cool-kids-program

4. What are the different levels of T&A (trauma and attachment) informed interventions?
• One on one
• School interventions
• Group work
• You could really do anything!
• The real need is for a T&A informed system that includes: government, local governments, schools, health system, etc. however, “while we wait for that to happen, we need to start somewhere.”

5. How schools can provide T&A interventions?
• Definitely not alone, there is a need for more people in the field with the necessary expertise, more interagency work, more networking.
• Schools need more psychoeducation about the power of attachment and what trauma does to bodies and brains, not only teachers, but everybody, principals, admin staff, etc.
• We can only do it if schools are safe, and inclusive.
• There is need for a T&A framework that guides all the interventions at schools.
• REST (Refugee…. support program) It is a recovery framework based on dignity and values (I couldn’t catch the complete name of the program, it was mentioned by Samantha)

6. Please describe T&A informed interventions that you are personally involved in and are/were successful:
• Diversity program (?)
• Sports work really well when students don’t speak English. Also arts, and telling stories through art, it is empowering and encouraging for young people and brings awareness to the audience.
• Bridging program: 1 group of students form IEC and 1 group of students form other schools do activities together to know each other.
• A program that collects educational materials and send them to kids in Sierra Leona. Students are aware of what is happening in other parts of the world.
• Refugee Camp in My Neighbourhood/School: very successful because it creates awareness.
• Tree of life.
• Capoeira
• Very simple things like changing the bell for music, it’s a perfect example of T&A informed interventions/practices that are successful.
• “When designing programs for schools it is important not to patronise refugee students as children/teenagers that only need to be saved, they also have so much to offer too”.
• Whatever program you do at school, use a “kind approach”, not a “charity approach” as charity approaches are conditioned to doing something to have something back.

7. How about T&A assessment for children, families and young people?
• There is a need for more education about assessment and the difference between assessment and intervention, as it can be problematic to do one without the other.
• When assessing children at schools, include parents, other family members, carers and community organisations, it is essential to work together.
Final comments
• Practices and policies need to be review in every single school: there is a need for observations in policies and practices to identify gaps and improve T&A informed interventions everywhere form the canteen, to the bell, outings, camps, admin staff, etc.
• The way that language around trauma and attachment is used at schools needs to be reviewed too.
• There needs to be more work to be done around policies for children with “difficult behaviours”.
• In terms of helping kids reinforce healthy attachment, schools are a great opportunity as teachers, counsellors, etc. are around them for a long period of time.
• Capoeira Angola program it’s a great example of T&A informed intervention in terms of a long term relationship with kids. Specifically in Cabramatta High School where young people are still coming back together after 10 years of the program starting.

Panel 7: English acquisition and employment: How does knowledge of the impact of trauma on the brain inform service delivery?

Photo Jorge Aroche Portrait
Jorge Aroche

Moderator: Jorge Aroche, CEO, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

Panellists:

  • Sejla Murdoch, Neurofeedback Counsellor, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW
  • Reverend John Jegasothy, Tamil Community, Vaucluse and Tamil Uniting Church, NSW
  • Belinda Liddell, Neuroimaging Program Director, Refugee Trauma and Recovery Program, University of NSW, NSW
  • Felix Ryan, Director, Training for Change, NSW
  • Navitas NSW representative

Photo Sejla Murdoch Portrait
Sejla Murdoch

Photo Rev John Jegasothy Portrait Approved
Rev John Jegasothy

Photo Belinda Liddell Portrait
Belinda Liddell

Photo Felix Ryan Portrait
Felix Ryan

Rapporteur: Mirjana Askovic, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

The purpose of this panel was to brainstorm on how we can bring together expertise and knowledge accumulated through our clinical practices, education and settlement services and research findings to inform and improve the learning and employment outcomes for refugee clients.

Discussion was focused on identifying barriers to learning and employment and looking at the strategies that can improve learning outcomes and enhance employment opportunities for clients from refugee like backgrounds.

It was recognised that resettlement process itself requires ongoing learning and acquisition of new skills, including English language skills. It was also recognised that trauma impacts on learning and cognitive functioning. Problems with working memory, verbal memory and attention can be expected.

There is a growing body of evidence coming from our clinical practice and neuroimaging research that indicates that trauma changes brain structure and functioning. Neuroimaging project led by researchers from the UNSW indicated that torture survivors have difficulty in regulating emotional stress. However, current stressors are also impacting on the brain processes and should also be considered in further neuroimaging research. STARTTS EEG assessments also indicate under activation of brain areas responsible for language processing and executive functioning.

Experiences of teachers and employment services in regards to issues that refugee students might experience were discussed. Refugee students are frequently experiencing difficulties in attending English language classes, gaining work experiences or keeping their jobs.

Trauma experienced by refugee students might not be always manifested as PTSD. In working with young TPV holders issues related to domestic violence, self-harming, addiction and difficulties keeping jobs were also raised.

Looking at the complexity of needs and issues that refugee students are presenting with, the panel members were discussing strategies that might help achieve better educational outcomes:
– English language classes should be more engaging. Music, art and dancing could be useful in engaging students.
– Teachers can help by creating a safe environment and help to reduce potential triggers.
When in stress mode we cannot learn. Anxiety can hijack capacity to learn. It’s important to monitor level of stress and help to reduce triggers and anxiety to create the environment that can support learning. Triggers are highly individual – some students learn better in one on one environment, some are less threatened in a group.
– Refugee students need a lot of support, understanding of their needs and empathy
– Apart from achieving learning outcomes, teachers should also help students re-connect and help them develop a sense of belonging
– Crucial to set the achievable goals. Reduced KPIs and reduced expectations can help to motivate students for learning
– Learning English is a social skill – addressing social issues in teaching, the environment is important
– Strengths based approach is important – support students to do things that they know how to do well will increase social engagement.
– Auditory training, FastForWord and other neuroscience based programs can support language acquisition as well
– More experiential and practical skills principles of adult education ( sitting, listening learning not appropriate)
– Having more teachers from non-English speaking background might also improve the engagement

Looking at the creating better pathways to employment, the following strategies were discussed:
– Need to be cautious about culturally appropriate placements to ensure students safety and reduce triggers.
– Finding jobs for non-English speaking people where they can develop practical skills and later learn English in working environment
– Importance of identifying and targeting psychological factors that interfere with learning was emphasised as well as a need to increase partnerships between specialised trauma services and employment services.