Poster Presentations 2017

A day of mental health practitioners in settlement and support services

Abstract
A mental health Practitioner (MHP) has a psychology or counselling background working in Settlement and Support Services (SASS) directorate to provide mental health support to clients who are part of the MYC community SASS program; to promote emotional growth and resilience in preparation for their future; to ensure clients receive the best possible access and referrals to mental health services and support. A MHP provides activities this may include assessments, training, therapeutic services and consultancy as requested, and work across residential services and case management clients. They provide an ongoing automatic services for residential services – no referral needed, however, this service is available for the SRSS clients only based on an internal referral and are limited to short sharp interventions.

Summary of MHP’s duties and responsibility is included:
Provision of appropriate culturally sensitive support, administering Wellbeing Screening Instrument (WSI), developing a range of strategies to ensure appropriate treatment is provided in line with evidence based practice, working with the other team members and communication related living skills, assisting the client with their transition in to the community, identifying and responding to individual client needs through the development and implementation of tailored support and safety plans, and building collaborative relationships with other service providers.

Authors
Changiz Iranpour, Ariana Kenny, Mariham Basta, Marist180, NSW, Australia

Poster not currently available.

African companions: Addressing the impact of substance use in refugee communities

Abstract:
The link between experiences of refugee trauma, post-traumatic stress disorder and substance use has long been recognised and there is growing understanding of the long-term intersection between substance use and poorer resettlement outcomes (Goren, 2006; Horyniak et al 2014). Despite this, to date there have been very few interventions at the community level that have specifically addressed substance misuse behaviours so as to assist refugees rebuild and maintain healthy and fulfilling lives.

African Companions is a community-based peer education and health promotion intervention to reduce alcohol and drug harms in African refugee-background communities living in Western Sydney. Peer education has been shown to be an effective way to decrease substance use-related problems (MacArthur et al, 2015). As peer educators share characteristics with their target audience, they act as credible sources of information, are able to be powerful role models, and can have a greater community influence. Peer educators themselves also experience benefits from their role, such as increased self-confidence/self-efficacy and skill development (McDonald et al, 2003), which can assist with successful resettlement and trauma recovery.

This poster presentation will provide a brief overview of how the project has evolved to adapt to changing community needs over time and major project activities. Results from peer educators’ pre and post-training surveys and field notes that describe the impact of the project on African communities’ knowledge, skills and confidence in both preventing and responding to alcohol and drug harms will also be presented. This project was funded by Dooleys Lidcombe Catholic Club.

Authors:
Piath Machut, Drug and Alcohol Multicultural Education Centre, NSW, Emmanuel Kondok, Community of South Sudanese and other Marginalised Areas Association, Alison Jaworski, Drug and Alcohol Multicultural Education Centre, NSW, Australia

Poster not currently available.

Comprehensive assessment of refugee and asylum seeker children and adolescents: A review of Refugee Health service referrals

Abstract:
Background: Princess Margaret Hospital for Children’s Refugee Health Service (RHS) co-ordinates and manages health care for newly arrived refugee children and adolescents. Since 2012, increased numbers of asylum-seeker presentations were noted. Methods: Referral reasons were compared to diagnoses, identified following standardised holistic RHS review. Data was analysed using SPSS. Results: Between October 2013 and December 2014, 310 patients were reviewed. 81.7% referrals (254/310) were from the Humanitarian Entrants Health Service. 15.2% (47/310) referrals had previous detention experience. Analyses of RHS referrals demonstrated significant differences in mean number of issues identified by referral sources compared to the completion of initial RHS assessment (all referrers: mean 2.3  SD 1.2 issues versus RHS assessment: mean 5.1 ± SD 2.1 issues, p <0.001). Only 6/310 referrals (1.9%) had no additional problems. Detention impacted on acuity of referrals, with significantly more receiving urgent triage ratings (34/47; 72.3% urgent versus 13/47; 27.7% non-urgent, p<0.001). The effects of detention on this cohort were marked, with significant differences in the frequency of psychological, educational and parental mental concerns identified by the RHS. Conclusion: The complexity of identified issues encompassed all health. However, many referrals were for abnormal screening results without acknowledging broader psycho-social concerns. The significant difference in issues identified highlights the specialist knowledge and skill base of the RHS service. This audit demonstrated that multidisciplinary team review and improved standardised RHS assessment identified higher percentages of developmental, educational, psychological and socio-economic concerns, factors important in ensuring positive resettlement trajectories. The adverse health impact of detention highlights the need for comprehensive paediatric refugee assessment of all detained children and adolescents.

Authors:
Christine Rowcliffe, Redvers Stellenberg, Sarah Cherian, Princess Margaret Hospital, WA Australia

Asylum seekers: The question of hospitality from a decolonial perspective, disrupting Ideas of the nation and the national

Abstract:
This paper aims to examine the Australian hegemonic violence exercised against refugees and asylum seekers who are attempting to settle in Australia by seeking recognition of their claims for protection and a humanitarian response. This paper aims to expose some of the political claims arising from the refugees and asylum seekers’ presence, which disrupt the idea of Australia as an egalitarian and fair nation. At the same time, this paper wants to explore the tensions and opportunities that their claim for hospitality offers to disable Australian hegemonic violence positioning refugees and asylum seekers in particular, as mere objects, subjected to hegemonic power thus, undermining their rights to settle and to seek and attain sanctuary. However, creating ethical spaces including the right of belonging.

Authors:
Ana Maria Holas, Survivors of Torture and Trauma Assistance and Rehabilitation Service (STTARS, Adelaide), SA Australia

Australian immigration detention: How should clinicians and professional bodies respond?

Abstract:
The damaging nature of Australian immigration detention has been well established. Since the introduction of mandatory detention close to 25 years ago these environments have witnessed countless instances of violence, abuse, riots, self-harm and suicidal behaviour, in addition to having a devastating impact on the health and wellbeing of those detained. Clinicians and professional bodies have been engaged with these issues for a number of years and advocated for change, however Australia’s present policies are arguably more damaging and regressive than ever. How should clinicians and professional bodies respond? To this point the Australian government has failed to respond to advocacy, protest and even civil disobedience, but can more be done? Potential courses of action will be discussed along with the roles of clinicians and professional bodies in promoting clinical, systemic, political and social change.

Authors:
Ryan Essex, University of Sydney, NSW Australia

Bridge to Justice: A trauma informed approach to legal assistance

Abstract:
Many refugee survivors of torture and trauma struggle with legal problems, ranging from simple fines and debts through to complex matters of civil, administrative and criminal law. Most clinicians are not trained to deal with legal issues, and valuable clinical time can be lost trying to refer clients to legal services. Even when clients are connected with lawyers, the quality and effectiveness of legal service provided can be compromised by cultural barriers, communication problems and lack of awareness of the complexity of refugee trauma and its impact on mental health. Clients can be re-traumatized by the legal system and all too often, unresolved legal issues can hinder resettlement and recovery from trauma.

Bridge to Justice (BtJ) is a project of Friends of STARTTS (FOS). Established in 2015, it seeks to improve access to justice for clients of STARTTS through the provision of holistic, trauma informed and culturally sensitive legal support. Clients are provided with supported referrals to legal services and are assisted to follow through with any legal advice they are given.

What makes BtJ unique and innovative is that a lawyer is placed within a clinical service and works closely and collaboratively with clinical staff to identify and assist clients with legal issues. In keeping with the STARTTS framework of client empowerment, BtJ seeks to build client trust in the legal system and to improve client knowledge of legal rights so that in the future, legal problems can be approached with enhanced confidence and capacity. BtJ also seeks to build the capacity of lawyers to work effectively with refugees and asylum seekers by providing education and training on trauma informed legal practice.

Drawing on the different perspectives of clients, clinicians and lawyers, this presentation will review the first 12 months of BtJ and discuss future initiatives.

Authors:
Anne Mainsbridge, Friends of STARTTS, NSW Australia

Capturing the skills and knowledge of children from asylum seeking and refugee backgrounds

Abstract:
Narrative therapy is a post-structuralist therapeutic practice that views people’s lives as multi-storied and endeavours to assist people to richly develop stories of their values, survival and commitments while addressing and acknowledging problematic stories of trauma or difficulties. Narrative therapy positions people as experts in their lives and views them as having skills, knowledge, abilities, values, and commitments.

Therefore, if people are viewed as having skills and knowledge on how to survive, thrive and overcome challenges, it is the role of the Narrative Therapist to draw out this wisdom through asking questions and enquiring into a person’s history. As Narrative therapy views therapeutic work as collaborative, this type of enquiry is defined as co-research, between therapist and client.

The process of co-research into the insider knowledge of people who have survived trauma create rich landscapes for recovery and healing from traumatic events. Further, through the articulation, documentation and witnessing of these knowledges, survivors are not only supported in their own recovery, but are able to contribute to the recovery of others.

“When persons are established as consultants to themselves, to others, and to the therapist, they experience themselves as more of an authority on their own lives, their problems, and the solution to these problems” (Epston & White, 1992).

Narrative therapy has a long history of documenting the knowledge of clients in therapeutic conversations and Chanelle and Emma will present, in poster form, documentation co-created with people from refugee and asylum seeking backgrounds that detail survival skills, recovery skills and settlement knowledge. This presentation of unique insider knowledge of we hope will demonstrate the value of consulting and documenting the skills and knowledge of survivors of refugee trauma.

Authors:
Emma Preece Boyd, Chanelle Burns, Victorian Foundation for Survivors of Torture (VFST), VIC Australia

Chameleons at the gate – The integration experiences of young refugee women in Aotearoa New Zealand

Abstract:
At the Mangere Refugee Reception Centre in Auckland, refugees from many parts of the world begin their journey of integration into a society which is often vastly different from the one which they have recently left. Integration into a new society can be confusing, is sometimes difficult and few traverse the terrain without acquiring a good few bruises.

For some the journey is more difficult than for others. In order to support young people to integrate more comfortably into what is sometimes a strange and even conflicting new culture, RASNZ, facilitates a group programme for adolescents aged between 13 – 18 years. However, from observation, it appears that adolescent girls from some cultures may experience particular difficulties in their integration journey.

In clinical sessions, adolescent girls often express frustration, grief and anger at their position in their own society. However, they will often conclude with, “But what can we do? This is our culture.”

This study considers the role of identity development and bicultural identity switching in the process of integration, and its place in the process of resilience, with particular reference to the integration of adolescent girls.

It is hoped that by identifying the skills, resources and processes of resilience used by adolescent girls as they move between cultures, that this information may be utilised to further develop the adolescents’ programme to more closely meet the needs of this population.

Authors:
Ana Sharpe, Refugees as Survivors New Zealand (RASNZ), Auckland New Zealand

Poster not currently available.

Community support – A vital tool in educating young people of refugee origin. Short Film – Wings

Abstract:
This short film showcases the benefits of Community support in education for young people with a refugee background and is seen as an integral part of settlement for young people in a new country. It investigates vital support systems necessary to assist these young people to become successful in their academic studies. They are most often caught in a web of persistent negative assumptions that are deleterious to their desires and motivation for high achievement in educational institutions. courage, determination and perseverance have been noted in some research studies, but are mostly not given prominence (Cassity and Gow, 2005; Earnest, Housen & Gillieat, 2007).

The project is based on an empirical research, and it collaborated with four young people from different parts of Africa, resettled in Lismore, New South Wales. Wings was produced using three stages of engagement; discussions/analysis, filming and editing. Each stage was directly informed by attributes of a participatory research paradigm. It breaks language barriers and can be easily accessed. It serves as an exemplar and reference for other researchers dealing with refugee issues.

Volunteers provided assistance with homework and assessments in a social and friendly atmosphere. They asked questions, chat and laugh and make mistakes with no fear of judgment. The young people socialized with their peers with similar cultural background where they felt more comfortable. The more support they received, the more they developed an inquisitive mind; seeking answers and gaining knowledge and understanding of their studies. We see a sense of community, friendship, self-sacrifice, resilience and mutual gains.

Authors:
Sarah King, Richmond Tweed Regional Library, NSW Australia

Ethical dilemmas in a time of border control

Abstract:
In 2015, in the name of ‘border control’, the Australian Government passed legislation banning all practitioners from speaking out publicly about anything they see or hear in immigration detention centers in Australian and the offshore centers on Nauru and Manus Island. As a result any practitioners speaking out can be charged with a criminal offence and face up to two years imprisonment. The law limits freedom of speech and government accountability, and sets a dangerous precedent for the treatment of asylum seekers in developed countries.

Prior to the introduction of the Australia Border Force Act 2015, staff working within detention regularly advocated for asylum seekers on an individual and systemic levels. On a systemic level, ASeTTS partnered with university researchers to analyse and publish clinical data collected in immigration detention, contributed to inquiries and consultations on asylum seeker wellbeing in detention, publically participated in events of support and maintained a presence on social media advocating support of asylum seekers. ASeTTS can no longer publish research from clinical data or draw on experiences as evidence in advocacy work.

On an individual level staff can continue to advocate for their clients inside immigration facilities but cannot speak publically on behalf of their clients. If a client discloses abuse or witnesses human rights abuses, the staff member risks imprisonment if they speak out publicly. This new law further allows or even invites human rights abuses to occur without public awareness or consequence.

For practitioners the new law forces them to re-assess their ability to behave ethically under these conditions. For the agency, without the capacity to publicise mistreatment the question remains, should counselling services continue to be delivered under these circumstances?
The enforcement of secrecy also beg the question, how different is the Australian government from those which refugees are escaping?

Authors:
April Pearman, Association of Service for Torture and Trauma Survivors (ASeTTS), WA Australia

Evaluation of the effectiveness of neurofeedback in treating PTSD and associated cognitive deficits in traumatised adult refugees

Abstract:
This pilot study aims to evaluate the effectiveness of neurofeedback treatment for traumatised refugees presenting with high levels of post-traumatic stress, using objective and subjective measures under relatively controlled conditions. Subjects consisted of 30 adult clients referred to STARTTS’ Neurofeedback Clinic. The participants were split into two groups. Fifteen participants received 20-30 neurofeedback training sessions while 15 participants continued to receive counselling treatment by their referring counsellors while on the waiting list for neurofeedback.

The clients receiving neurofeedback were taught to enhance alpha brainwave activity and/or sensory-motor rhythm activity to promote calm and relaxed states. Post-training changes in EEG/ERP activity, psychological functioning and cognitive performance were assessed and compared to the results collected at baseline. The participants on the waiting list were assessed at baseline and again after 3 months of waiting. The post-training test results compared to the baseline measures indicated positive changes in several domains, while the results of the participants on the waiting list showed minimal or no change. Our findings suggest that neurofeedback can be an appropriate and efficacious treatment modality for PTSD in refugee population that warrants further investigation.

Authors:
Mirjana Askovic, Anna Watters, Mariano Coello, Jorge Aroche, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Anthony Harris, University of Sydney, NSW Australia

Facilitating sustainable resettlement through enterprise facilitation

Abstract:
People from refugee backgrounds have skills that can contribute to the Australian economy but face significant barriers to obtaining employment such as poor English language skills, inadequate knowledge of Australian business culture, limited access to capital and existing services such as the New Enterprise Incentive Scheme (NEIS). They require a long-term investment which mainstream services may struggle to provide at a reasonable cost.

Enterprise Facilitation (EF) which aims to promote local economic growth in Western and South Western Sydney – are being adapted for people from refugee backgrounds. Yet how successful are these programs in meeting the needs of these communities and providing sustainable employment pathways? What is good practice and is it possible to engage in these programs but also be profit driven? The presentation aims to explore these questions.
The EF project assists would be entrepreneurs in establishing new businesses by providing a one stop advice and support service for all refugee entrepreneurs; tailored training appropriate for target groups; and mentoring and networking support to ensure establishment of a strong business.

Preliminary findings of the qualitative evaluation using the Social Capital methodology suggest positive outcomes and have benefitted the refugees who participated in the project. Improved self-esteem due to increased knowledge of Australian systems, improved financial status, increased self-confidence as a result of exposure and experience in doing business, feeling happy and less anxious, enhanced self-worth were some of the outcomes put forward by the project participants.

The project suggests that providing adequate support to refugees through enterprise facilitation is much needed in reaching out to refugees who fall between the gaps, and left out of mainstream government services related to self-employment. It is important in their resettlement process and attaining general well-being.

Authors:
Chuladej Dejrangsi and Ma Antonina Ortega, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

Poster not currently available.

Facing the challenges of regulation problems in 0-5 year old’s from refugee backgrounds

Abstract:
Regulation, in 0-5 year olds from refugee backgrounds, is affected by many interconnected factors. Unhelpful labels can be given to the child and their behavior, when the refugee experience is not taken into account, and this can affect the responses of caregivers and professionals.
Clinical observation and assessment at STARTTS, which are consistent with the trauma studies of Perry, Porges and Van der Kolk, show that children who come for therapy present with health issues, sensory processing problems, aggression, irritability, controlling behaviors, lack of focus, and speech delays. These presentations can all stem from, the brain’s survival system.

These children have not just faced one adversity but several layers of traumatising experiences. Of the ten adverse childhood experiences (ACEs) some of the children seen at STARTTS have experienced all ten of them, in addition to displacement, organised persecution, and deprivation. These symptoms can also be passed from one generation to the next.

The children’s lives have been chaotic and unpredictable from the moment of their conception, much earlier than their language development. Hence the common triggers are at an unconscious and nonverbal level. The impact of these layers of experiences means that normative development is delayed so they are continuing to rely on earlier skills. Rather than developing new competencies, their energy is invested in survival. The children referred to STARTTS are generally considered to be a problem for others, such as care givers, child care or schools.

A mix of therapeutic interventions is used, to include modalities such as play, music and movement, sensorimotor activities, and mindfulness. Repetitive, patterned, sensory, rhythmic activities (Perry) as well as other techniques.
Our aim is not just to improve the symptoms but enhance and build on safe caregiving systems, by working respectfully with the parent who is then informed and empowered to work with the child.

Authors:
Naila Hassan, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

Hazara young people with refugee backgrounds in Australia: Psychological distress and help-seeking

Abstract:
Background and Purpose/Objectives: Little Australian research has investigated the explanatory models (EMs) of psychological distress and help-seeking among young adults with refugee backgrounds. Many young people with refugee backgrounds continue to experience high levels of psychological distress in the settlement country; however, it is not clear how they describe their own subjective health or the strategies they use to seek help. While there has been research on EMs among refugees from other ethnic backgrounds, little research has investigated EMs for young Hazaras.

Methodology: This qualitative study uses an EM framework to describe psychological distress and help-seeking strategies among Hazara young adults with refugee backgrounds in Australia. Semi-structured interviews were conducted via Skype or telephone with 18 Hazaras (9 males and 9 females) aged 18-30 years residing in Victoria, Sydney and Perth.

Results/Impacts/Outcomes: Psychological distress was described as thinking about your problems, loss of control over one’s future, cultural concepts of mental health and illness and stress and worry experienced differently by men and women. Seeking help for their psychological distress was shaped by different styles of coping used by men and women, barriers and access to services, patterns of use and satisfaction with services.

Conclusions and Discussion: The current study offers insights into the subjective experiences of distress among this group and their experiences of seeking help including barriers and facilitators. This work will be helpful to service providers and others working with young Hazaras with refugee backgrounds.

Authors:
Cathy Copolov, Swinburne University of Technology, VIC Australia

Identification of health risk behaviours among adolescent refugees resettling in Western Australia

Abstract:
Aim: To analyse the frequency and range of health risk behaviours in adolescent refugees resettling in Western Australia utilising an adolescent health questionnaire.
Background: Psychosocial assessments can enable early identification and management of health risk behaviours in adolescents. Adolescent refugees encounter traumatic stressors and are at risk of developing psychosocial problems. However, limited data exist nationally.

Methodology: Refugees aged ≥12 years attending the Princess Margaret Hospital Refugee Health Service (RHS) over 12 months were recruited. Sociodemographic data were obtained. Psychosocial assessments based on the “Home, Education/Eating, Activities, Drugs, Sexuality, Suicide/mental health” framework were undertaken. Adolescents were offered to be interviewed independently. Health concerns identified were managed by the RHS.

Results: 122 adolescents from 20 ethnicities participated; 65% required interpreters. Median (range) age was 14 (12-17) years. Many had nuclear family separation (80%) or at least one deceased/missing family member (49%). A third (37%) had lived in refugee camps. Most (86%) had residency visas and 20% had experienced closed detention. The median (range) time since arrival to Australia was 11 (2-86) months. 77% had lived in at least one transit country previously. Frequency of health concerns identified in each domain were: Home 87%; Education 66%, Eating 23%; Activities 85%; Drugs 5%; Sexuality 88%; Suicide/mental health 61%. Most adolescents (66%) required follow-up including referral to medical, educational and allied health services. 42% required education and counselling for specific health risk behaviours.

Conclusion: This study highlights the significant burden of psychosocial problems in resettled adolescent refugees, identified using a standardised psychosocial assessment tool. There is a need to engage early intervention and preventative strategies to address health risk behaviours in this cohort.

Authors:
Dr Kajal Hirani, Princess Margaret Hospital for Children, WA Australia

Integrated counselling and art therapy

Abstract:
This presentation shows examples of material from counselling and art therapy sessions with a male client, age 29 attending University in Regional NSW as an overseas student (refugee-like category). Client had experienced imprisonment and trauma in his home country for political/religious reasons. He is not religious. He also experienced loss of an idolized sister through accident at at an early age for which he blames himself. The client presented with depression, suicidal intention, anxiety, low self-esteem and social isolation.

Counselling and art therapy were integrated to work with ‘being stuck’ in a fixed mindset and to increase safety from suicidal intention. Referrals to and collaboration with psychiatrist and body therapist contributed to positive change. Clinical goals included change in links between mental health, failure in exams and suicide. The counselling and art therapy integrated approach was shown to result in improved self-belief, inner flexibility and optimism. This was measured through meeting clinical goals, client verbal statements of change and clinical observation.

The practical art therapy sessions included observing flow forms in a water tray, studies of these forms in nature and Form Drawing as a therapeutic tool using crayon and large paper. This exercise was used with the client as a process of metamorphosis and change to address ‘fixed’ thought processes. The client worked with poetry which helped him express inexpressible emotions. Identity was another topic and the final session was a portrait session where the client sat for a pencil portrait drawn by the therapist. This was a process of ‘being seen’ reflected through the eyes of another which proved a positive therapeutic intervention. The presentation aims to show how art therapy can support client change and inner growth in a counselling practice.

Authors:
Amanda Labron Johnson, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

Key elements of program development and service delivery for young people of refugee background at risk

Abstract:
Young people of refugee background are inherently at risk of self-harm behaviour and/or suicidal ideation due to a number of risk factors existing both pre and post arrival to Australia. Fortunately, they also tend to have many protective factors as well that can be identified and strengthened. Due to this unique combination of factors, program development and planning requires a range of soft entry points with a focus on prevention, targeted early intervention activities and flexible, yet responsive crisis management strategies.

Historically, funding for young people of refugee background at high risk of suicide and/or self-harm has neither incorporated the various targeted strategies nor the time required to adequately manage such vulnerable young people and the chronic elevated risk associated with their cases. Funding has been structured more traditionally for individual face-to-face counselling sessions without flexibility to be more available for the young people who have crises in between sessions.
Twenty five years of experience together with research in this area has given QPASTT vital information and skills in how to best support such vulnerable young people. QPASTT’s programs for young people have been developed based on a trauma recovery model framework (i.e., Judith Herman and Ida Kaplan (VFST)), primarily focusing on creating a sense of safety, fostering connections with others and helping increase meaning and purpose in life. Services for the young people must also be culturally appropriate, have multiple points of contact and types of interventions, and be specific in addressing the particular risk factors these young people face.

This presentation will illustrate the key elements of program design and will include a short case example to demonstrate effective strategies used to help manage young people at risk anywhere along the spectrum from prevention to early intervention to crisis management.

Authors:
Megan Leitz, Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT), QLD Australia

Poster not currently available.

Learning from the voices of Families in Cultural Transition (FiCT) bicultural facilitators

Abstract:
Families in Cultural Transition (FiCT) is one of STARTS’ foundational group based psychosocial education programs that has assisted people from refugee backgrounds over many years to increase their social connections and understanding of Australian systems and way of life.
The program’s strength lies in its delivery by bicultural workers drawn from the same community as the refugees, speak their language and understand both their culture and the Australian environment. Most of the facilitators come from a refugee background, practised their profession in their country of origin but had difficulty finding employment for the same field when they came to Australia. Since the program began, a total of 186 facilitators from more than 27 ethnic communities, were trained as bicultural facilitators.

They receive a 4-day intensive training to equip them with the proper mindset and practical skills in facilitating the FiCT sessions. They are also mentored by the project officers, and attend a professional development session yearly, to help enhance their skills in dealing with refugees.

Evaluation outcomes using the Social Capital methodology suggests that the facilitators’ involvement in FiCT opened up opportunities to employment, education and community engagement. Through FiCT, the facilitators gained insights on communicating with refugee groups, which led to their further understanding of the community’s needs, strengths and potentials. This changed their way of thinking, becoming more receptive to other perspectives, and respectful of people’s culture. As a result, this has increased their confidence and self-esteem, and motivated them to be involved in community development either as volunteers, community leaders, support workers, or resource speakers. This has further led to new job opportunities, or aspirations for further studies. FiCT has not only benefitted refugees, but has also provided positive outcomes for its bicultural facilitators.

Authors:
Ma Antonina Ortega, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

Limited English can be more dangerous than none at all! A critical case analysis of adverse events for refugees when accessing the health system without an interpreter

Abstract:
Refugees are more likely to have limited English proficiency (LEP). Refugee patients with LEP are likely to suffer more frequent and severe adverse events in negotiating their health needs particularly if an interpreter is not available.

Aim
The aim of this study was to describe adverse outcomes described by patients attending a refugee health service attributable to failure of appropriate interpreter use when accessing health services across the health system.

Methods
This study was a clinical audit of all patient records of those attending a community based refugee health service between 1 July 2011 and 31 June 2013. Cases of interest relating to inappropriate interpreter use were examined in further detail in a critical incident analysis.

Results
Of the 471 patients included in the study period, 357 (74.5%) were documented as requiring an interpreter. 24 separate incidents of adverse outcomes related to failure of appropriate interpreter use were reported by a total of 21 patients (two patients reported multiple incidents). The majority (62.5%) of reported incidents involved obtaining informed consent. Incidents involving inappropriate ad-hoc interpreter use (16.7%), discharge medication instructions (12.5%) and other incident types (8.3%) were also reported.

Implications
This is the first study in Australia to explore the situations surrounding and repercussions of failure of health professionals to use appropriate interpreter services, from the unique perspective of a LEP patient’s description of events at a refugee health clinic. This research highlights the urgent need for proactive service policies and health staff education around appropriate use of interpreter as well as identifying ways in which refugee support services can empower clients to improve encounters with the health system after arrival in Australia.

Authors:
Katrina Anderson, Companion House and Australian National University, Janine Rowse, Christine Phillips, Australian National University, ACT Australia

Poster not currently available.

Literacy: A human right – “ABC-ESL” = English language and literacy group

Abstract:
“Group was created on identified needs from counselling Muslim female clients reporting husbands do not allow them to attend mainstream English classes. All participants had witnessed war or terrorist violence, presenting with PTSD, depression, anxiety, and significant acculturation issues due to language and cultural differences. All lived 2 years in refugee camp in Middle East.
Regardless prior educational level, by not speaking, reading, and writing English all participants had become illiterate with two core problems: Inability to help their children with school tasks. Inability to incorporate into Australian main stream society and culture.
Analysis Instruments: 1) General Self Efficacy Scale to assess self-coping mechanism, goals and resourcefulness in hardship. 2) Tailored ABC-ESL Survey to determine benefits and achievements. 3) Thematic analysis of counselling conversations.

Results
Self-Efficacy Scale results, participants see themselves, before arriving to Australia, as resourceful, pro-active and full of goals, once here scale decreases in relation to refugee experience and lost expectations. Low self-esteem, depression, anxiety, and helplessness increased with resettlement challenges.

ABC-ESL surveys results: Six months after attending group: more positive attitude and confidence when shopping as clients start to read and understand signs/labels and feel confident using public transport.

At 12 months clients venturing to make driver’s license written test and talking and teaching their young children some English words. Confidence and self-esteem increasing.
TA identified themes: acculturation stress and failure to adapt to Australian culture, and effects on family roles and structure due to lack of oral and written English language.
Intra-family problems due to loss of traditional role. Significant feelings of shame and guilt when mothers and grandmothers cannot help their children with school work.

Authors:
Megan Levy, Association of Service for Torture and Trauma Survivors (ASeTTS), WA Australia

Mental health concerns and problems for age under 17 in an unaccompanied minors program

Abstract:
Children facing the complexities of trauma from an unstable, often violent history, frequently underlined by grief or loss are in the social media forefront of the refugee and asylum seekers crisis. Mental health presentation for children with trauma backgrounds can vary significantly based on variable such as resilience factors, stability of primary care and carer coping styles, as well as accessibility to mainstream health and social services (Fazel, Stein, 2002). This study aimed to explore mental health concerns and possible effective support for minors aged under 17 years for in the Unaccompanied Humanitarian Minors program. The factors explored include – mental health assessment techniques, child protection issues, behavioural issues, school attendance and access to mainstream mental health and support services. An internal retrograde file analysis from the last 2 years, as well as interviews of staff from each band. The hypothesised issues were that depending on the stream of service referral, there was a lack of standardised means of assessing mental health needs consistently employed across age cohorts, and minors with parents of varying coping styles were frequently the focus of higher level behavioural or child protection issues. Attendance at school, and access to mainstream mental health services should not be affected by band/status ‘categorisation’, however type of supports that could be engaged varied significantly. The case for evidence based consistency of practice to be able to determine mental health outcome measures of minors across bands was indicated.

Authors:
Ariana Kenny, Marist180, NSW Australia

Poster not currently available.

Moral injury

Abstract:
A study by USA Armed Forces Health Surveillance Centre found that for all military personnel medically evacuated from Iraq and Afghanistan between 2001 and 2012, the most frequent diagnosis was not physical battle wounds but “”adjustment reaction,”” presenting: grief, anxiety, depression, post-traumatic stress, mental disorders, and suicide.

Maguen and Litz forerunner researchers in moral injury, report that military personnel in combat and war operational experiences are confronted with ethical and moral challenges that may transgress deeply held beliefs undergirding a service member’s humanity. This serious inner conflict born from an experience at odds with core ethical and moral beliefs is called Moral Injury.
Nakashima believes:

-The most serious blind spot in military suicides is an absence of discussions about the moral impact of military training and its implementation in combat, e.g.: soldiers are trained to kill, which is regarded as criminal behaviour in civilian life.
-Moral injury is not PTSD. PTSD is an immediate injury of trauma, presenting: flashbacks, nightmares, dissociative episodes and hyper-vigilance.
-Moral injury has a slow burn quality that often takes time to sink in. To be morally injured requires a healthy brain that can experience empathy, create a coherent memory narrative, understand moral reasoning and evaluate behaviour.
-Moral injury is a negative self-judgment based on having transgressed core moral beliefs and values or on feeling betrayed by authorities.
-Moral injury is reflected in the destruction of a moral identity and loss of meaning.
-Symptoms include shame, survivor guilt, depression, despair, addiction, distrust, anger, a need to make amends and the loss of a desire to live.

There is a possibility , though not yet explored by author, that Moral Injury could also be present in T&T survivorswho have faced e.g., moral choices, and suffered, witnessed or perpetratedviolence, rape, sex-slavery, human traffic, etc. In which case it is presumed,it could negatively impact resettlement, health and wellbeing.

Authors:
Megan Levy, Association of Service for Torture and Trauma Survivors (ASeTTS), WA Australia

Process and case management in deal with the clients and collaboration with other service providers in various aspects

Abstract:
Every client has universal and unique needs and existing skills. The case management process plays a major role in identifying those needs and using the client’s existing skills and strength to fulfill those needs and provide all additional resources in consultation with other service provider and government agencies. Assessing the client’s needs takes place through conversational interviewing, and at times formal assessments, these assessments helps in identifying any areas of risk and safety concern which would be included in the development of a Safety and Support Plan (SSP) in consultation with a Mental Health Practitioner to assist staff and clients develop consistent and safe working strategies. Case planning in consultation with the client is a critical component of case management as is address their unique needs by clearly identifying their strengths, goals, and steps to get there. By involving the clients in this process and keeping them informed of its structure, clients feel empowered and in control of what is happening for them and as a result start taking some responsibility for the services they require and starting setting goals for themselves in consultation with their case manager and delegated guardians. As the case management evolves, more information usually becomes available to the case manager which is usually due a number of factors including; additional conversations with the client, changing circumstances, and the client achieving the goals set out. This paper will explore how different case planning styles (collaborative consultation versus standard case planning) impact on the client’s level of motivation and engagement in the case management process and working towards their goals.

Authors:
Mariham Basta, Marist180, NSW Australia

Poster not currently available.

RAHATT – Supporting and empowering mature aged women from Iraq

Abstract:
Rahatt means rest or relief in many languages, including Arabic, Assyrian and Chaldean. To a group of mature aged (55years – 85 years) Arabic speaking refugee women in Sydney, RAHATT also refers to Reconnection And Healing after Trauma and Transition. These women are victims of the violence and human rights violations following the conflicts in Iraq and the recent offensive launched by militants of Islamic State (ISIS) and other Sunni insurgents in Iraq and Syria.

In addition to coping with issues related to refugee trauma, grief related to death of family members, pain and loss of one’s homeland and witnessing its destruction, the women are also grappling with the challenge of transitioning to a new country, a new culture and adjusting to a new stage of life; growing old gracefully.

This presentation will bring together snapshots of interventions that were creatively included to engage the group and assist reflections. Metaphors such as “The Umbrella of Anger” and “The Suitcase of Emotional Baggage” and the “Tree of Life” assisted the group to share experiences and cope with the impact of the dominant grief and trauma narrative. The group have developed bonds and connections with each other and have simultaneously begun to find new meaning in their common values and way of life.

Authors:
Yvette Aiello and Pearl Fernandes, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

Reflections from the field: Drawing the context of Rohingya refugees and their education

Abstract:
In this paper, we draw on the first presenter’s fieldwork in Bangladesh and Malaysia with the Rohingya people to examine the historical and current context of their flight from Rakhine state in Burma. During the last four decades, many Rohingya people have fled from Burma due to severe forms of discrimination, persecution and trauma. Historically, the Rohingya (Muslim) people have been the victim of riots and anti-Muslim violence by the Buddhist Rakhine in 1930 and 1938; followed by Buddhist nationalism in 1978, 1991, 1997, 2001 and 2012. Consequently, many of them have had to flee the country especially in 1978, 1992 and 2012. Following the violence that erupted in 2012, which caused several hundred deaths, 180,000 people took shelter into temporary displacement camps or isolated villages. From 2012 to 2015, many Rohingya people fled the country by sea hoping for refuge in neighbouring counties. There are 29,000 registered, and 14,000 non-registered Rehingya refugees, as well as 300,000 illegal Rohingya people in Bangladesh.

The first presenter worked from 2012 to 2015 as a core staff-member of Muslim Aid-UK Bangladesh Field Office, an international NGO involved in providing humanitarian support to the 14,000 non-registered Rohingya refugees in Bangladesh. During that period he was also part of a four-member team that conducted an assessment of the Rohingya refugees in Malaysia. One of the key concerns that the Rohingya refugees living in these two countries faced was their limited access to formal education.

This contextual work provides the backdrop for PhD research examining the educational aspirations, experiences and outcomes of young adult Rohingya people who have been resettled in New Zealand.

Authors:
Md Chowdhury, Auckland University of Technology (AUT), Auckland New Zealand

Poster not currently available.

Refugee and asylum seeker children and families in Australian ‘alternate’ places of detention

Abstract:
The detention of refugee and asylum seeker children and families has been a particularly controversial aspect of Australia’s mandatory detention regime. The devastating impact of these policies have been well documented, often with a focus on children detained offshore on Nauru. While this attention is warranted, often overlooked are children detained in ‘alternate’ places of detention (APODs) and community detention on mainland Australia. Drawing on a number of years’ experience working with asylum seekers in these environments the impact of these policies will be discussed. Although preferable and superficially more appealing than other forms of detention, these environment remain unsuitable for children and families, doing little to buffer against the systemic harms promoted by Australia’s policies. Implications for clinical practice and advocacy will be discussed.

Authors:
Ryan Essex, University of Sydney, Poonkulali Govintharajah, Kidpsych, NSW Australia

Responding to suicidality: Considerations for effective suicide risk management when working with asylum seekers

Abstract:
Working therapeutically with asylum seekers can present particular challenges and ethical dilemmas. There are a multitude of factors which can contribute to the development of psychological distress and emotional suffering in those who are seeking asylum. The experience of refugee trauma, displacement, dangerous journeys to escape their country of origin, detention and separation from family members can all result in a negative impact on mental health. In addition, resettlement challenges and uncertainty regarding the future further compound the history of trauma, culminating in a high level of psychological distress for those seeking asylum. The addition of stress associated with waiting for a protection visa determination, and limited access to services associated with visa conditions can create further complexity for therapeutic work. Ethical and professional challenges which may arise during therapeutic work with asylum seekers will be explored in this poster presentation, specifically relating to duty of care and suicide risk management. The potential impact this has on the therapeutic alliance and ultimately therapeutic outcomes for the clients with whom we work will also be discussed. Strategies for clinicians to continue to cope within this space will be addressed, and reflections and recommendations for future practice will be highlighted.

Authors:
Tess Reddel and Emma Boles, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

School’s In for Refugees: A whole school approach to supporting students and families of refugee background (VFST 2011)

Abstract:
Schools, and their inherent context of bringing children and young people together, play a vital role in supporting the recovery and aspirations of students and families of refugee backgrounds whose prearrival experiences include disruption to education and experiences of violence and other traumatic events. School’s in for Refugees: a whole school approach to supporting students and families of refugee backgrounds 2nd ed (VFST 2011) ( updated 2016) is a resource for school staff (administrators, teachers and non-teaching personnel) in recognition of their unique position to aid the resettlement process for people whose lives have been disrupted by conflict, persecution and long term displacement.

The first part of this resource describes the refugee experience, including the complex transitions and challenges of resettlement for young people and their families. Each area of action of the whole school approach is also outlined: school policies and practices; curriculum, teaching and learning; school organisation, ethos and environment; partnerships with parents and carers; and partnerships with agencies. The second part includes good practice examples, professional learning activities, tools and resources. This unique resource informs professional learning workshops delivered by the VFST School Support Program and successfully supports all developmental work with schools to enhance their capacity to support students and families of refugee background.

The resource is available on the VFST website and those working in and with schools are able to adapt tools to their particular context.

Authors:
Maureen O’Keefe, Victorian Foundation for Survivors of Torture (VFST), VIC Australia

Service efficacy: An evaluation of counselling for refugee survivors of torture and trauma

Abstract:
It is important to be able to provide culturally-appropriate and effective interventions to assist survivors of torture and trauma in their country of resettlement. Counselling is a major form of treatment provided to survivors globally. This study investigated the effectiveness of a counselling intervention for 124 clients presenting at a torture and trauma service based in Western Australia. The Association of services to Torture & Trauma Survivors (ASeTTS) has sought to systematically evaluate the effectiveness of counselling interventions with torture and trauma survivors and demonstrate positive mental health outcomes, through the embedding of evaluation and research into core centre work. In 2011 ASeTTS instigated the use of a standardised instrument, the Hopkins Symptom Checklist- 25 (HSCL-25), as part of clinical practice. This study involved the analysis of pre-existing non-identifiable data that was collected as part of routine clinical counselling assessment and intervention. A variety of standard client sociodemographic data was also collected. Clinicians administered the HSCL-25 during the client’s assessment phase to identify symptom severity. The HSCL-25 was administered again after approximately six counselling sessions, every further six sessions and at the point of case closure. Results were analysed to determine if there was a change in symptom severity from the Initial Assessment to Subsequent and Closure Assessments. Correlations between symptomology demographic factors and a range of other factors were investigated. In this study a high proportion of participants were symptomatic for anxiety and depression at initial assessment. This shows the high prevalence of mental health disorders among torture and trauma survivors accessing counselling services. The data analysis indicates that counselling has had a positive impact for anxiety and depression.

Authors:
April Pearman, Association of Service for Torture and Trauma Survivors (ASeTTS), WA Australia

STARTTS Capoeira Angola program evaluation

Abstract:
STARTTS Capoeira is an alternative intervention program that introduces Afro-Brazilian art form to young people from refugee backgrounds. The project combines the healing potential of music and physical expression to provide a range of social and learning outcomes. The Aims of the programme are:1) To examine effectiveness of the programme, 2) enhance self-esteem and confidence 3) reduce school truancy.

The proposed evaluation will incorporate both qualitative and quantitative methods, including
• Student self-report and teacher-report questionnaires
• Student focus groups using creative activities
• Brief student interviews

The proposed evaluation will incorporate both qualitative and quantitative methods, including:Student self-report and teacher-report questionnaires;Student focus groups using creative activities;Brief student interviews

Method
-Baseline pre-intervention assessment
-Demographic data
-Teachers: brief teacher-report questionnaires
-Follow-up assessment after end of each term depending on the length of terms.
-Brief student interviews conducted with varying timelines for different groups, including a ten minute interview to explore their attributions about the program.

Measures:
-Self-report Strengths and Difficulties Questionnaire (SDQ) (Goodman R., 1997)
-General Self-Efficacy Scale (GSES) (Schwarzer, R., & Jerusalem, M. (1995)

Qualitative mode: 1) Social capital questions/activity 2) draw a picture to express their feelings about Capoeira, explain and elaborate.

The programme overall promotes empowerment and the goal of the evaluation is to demonstrate whether the intervention group can be attributed to the development of resilience, improved interpersonal relationship with peers and teachers, self-esteem and confidence, school attendance and self-discipline and the development of developing individual strengths to resettle and adjust to the school environment.

Authors:
Edielson Miranda, Mariano Coello, Lina Ishu, Shakeh Momartin, Helen Bibby, George Pearson, Laura Chappell, Kedar Maharajan, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

STARTTS student’s placement and student clinic

Abstract:
STARTTS has been involved in the provision of university student placements and professional internships for many years through its Student Clinic. The Clinic started as a strategy to improve the knowledge and experience of social and behavioural sciences students wishing to work in the area of torture and refugee trauma. Once their application is approved, students have very similar duties to those of counsellors and psychologists at STARTTS.

STARTTS provides placement opportunities for students currently engaged though not exclusively in the following disciplines: Forensic Psychology, Social Work, Counselling, Art therapy post-graduate programs of Masters in Psychology (Clinical), Doctor of Clinical Psychology or other appropriate Masters Programs in Psychology or students who are currently completing a Psychology Registration Program.

Placements enable interns to provide individual therapy to clients as well as group interventions where appropriate. The nature of shorter internships is usually exclusively focused on client assessments and facilitation of psychoeducation groups. Those participating in longer internships may also have the opportunity to engage in longer term therapy with clients. Opportunities also exist to become involved in clinical research projects where appropriate. Regular supervision by experienced Clinical Psychologists and Psychologists is provided, following induction and training program.

Since the inception of the student clinic in 2003, approximately 150 students have had the opportunity to provide assessments and psychotherapeutic interventions to our clients, who come from diverse backgrounds. While interns gain the opportunity to work with an experienced team of professionals in a multidisciplinary treatment setting, they also bring their own skills, experiences, perspectives and enthusiasm, making a significant contribution to STARTTS. The clinic has mutual benefits for students, the organisation and clients, whilst at the same time increasing the number of professionals who are skilled and confident in the provision of services in the field of refugee trauma and health.

Authors:
Mariano Coello and Lucrecia Cardona, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

Syrian colloquial Arabic idioms of emotion. An assessment and therapy tool to promote cultural formulation

Abstract:
Background: Many displaced Syrians are in need of psychosocial support, yet there are very few culturally appropriate therapy tools for Syrians. There is a need to support local mental health workers to provide sustainable, evidence-based interventions for Syrians living in countries of first asylum. These workers possess the cultural knowledge needed to adapt therapy tools.

Objective: Design and implement a training program of a culturally tailored cognitive behaviour therapy (CBT) among Syrian and Jordanian psychologists working with Syrians in Amman, Jordan in order to collaborate to adapt therapy tools within the process of training.

Methods: On the basis of our qualitative research into Syrian cultural factors affecting attitudes to mental health care in Jordan (2013-14), participatory techniques were used to determine a focus for skills training. Participatory group activities were used to adapt and translate a wheel of emotions using Syrian colloquial idioms of distress and wellbeing.

Results: Participants in Jordan collaborated to develop an emotion identification tool, using local idioms of distress. Conclusions: The cultural knowledge and field experience of Jordanian and Syrian psychosocial workers are invaluable for understanding how to tailor treatment approaches to the needs of displaced Syrians. Practitioners working with Syrians worldwide can employ the emotion wheel to encourage clinical encounters which enable Syrians to speak about their experiences in familiar idioms, and use this as a springboard to explore constructed social meanings which inform clients’ explanatory models and experience of displacement.

Authors:
Ruth Wells, University of Sydney, NSW Australia, Manar Hasan, Afifa Al Shafie, Fayza Abu Jado, Bright Future Jordon, Zachary Steel, University of New South Wales, Caroline Hunt, University of Sydney, Australia, Catalina Lawson, Rush Medical Centre, USA

The experience of pain among asylum seekers and temporary visa holders attending STARTTS

Abstract:
STARTTS receives approximately 3000 refugees and asylum seekers annually some of whom will be subject to the newly re-introduced Temporary Protection Visa (TPV) policy. Psychosomatic complaints have been identified as a common psychopathological outcome of exposure to trauma where clients may communicate distress in atypical ways, attributing them to physical ill-health with common presentations being headaches, chest pains or gastrointestinal complications. As most health assessments for TPVs occur at the primary care level, and given their limitations of access to mainstream health services, it is vital to have an efficient pathway to medical professionals.

AIMS:
1) To examine the relationship between pain and trauma related symptoms.
2) Identify predictors of pain (e.g.pre-existing conditions).
3) To explore individual’s comparison of how their pain was managed in their country of origin and in Australia.

Method
Preliminary results from a group of Tamil female participants will be presented in this paper, including demographics, pain management history, questionnaire completion and focus group discussion to examine current management of pain. We are aiming for groups of Arabic, Farsi, Hazaragi and Tamil speaking participants in the next phase of the investigation.

Materials
1) Harvard Trauma Questionnaire (HTQ) (Mollica et al.,1992).
2) Five-item Somatoform Dissociation Questionnaire (SDQ-5) (Nijenhuis et al., 1997).
3) Short-Form McGill Pain Questionnaire (Melzack 1975).
4) Faces visual analogue scale (Hicks et al., 2001), Body Map (Melzack, 1975).

Outcomes
Preliminary results revealed high incidence of pain symptoms, sufficient awareness of past trauma and current pain link, although few reported seeking psychological help for pain. Moreover, it was revealed that most participants were satisfied with their pain management in Australia compared to their home country.

Authors:
Mariano Coello, Shakeh Momartin, Jorge Aroche, Helen Bibby, Lucrecia Cardona Velez, Sinead Berry, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

The experience of traumatic injustice – A systematic review and meta-narrative synthesis

Abstract:
Background
Refugees often express a profound sense of injustice about experiences encountered during their pre-migration and post-migration journey. Some reported sense of injustice can be debilitating. However little is known about sense of injustice itself, the characteristics and risk factors, the association of injustice with mental health, as well as the extent to which therapeutic interventions can address disabling feelings of injustice.

Methodology
The research conducts a systematic review and meta- narrative synthesis of the injustice literature. Applied Protocol- Realist and meta- narrative evidence synthesis (RAMESES) methodological guidance in meta-narrative reviews. For the study we found the key articles in this filed. Formed the search terms. The research implemented a systematic review using six main data bases Medline, PsycINFO, Pubmed, Embase, Scopus , CINHAL, look for search terms which specified to find the articles with injustice content in different traditions.

Results
The optimized search strategy identified seven different research traditions that have looked at the experience of traumatic injustice since the 1980s. These traditions are Social Psychology, Post Conflict Mental Health, Moral Injury, victims of crime, transitional justice, and miscellaneous papers. We present an overview of these research tradition and key findings in relation to the phenomenology of injustice experiences and where available approaches to management.

Conclusion
The results demonstrate that injustice is a key issue of many people who have been exposed to organised violence and forced disablement. An important body of research has developed to understand this experience but the various traditions have only limited inter traditions citation.

Authors:
Haleh Abedy, University of NSW, NSW Australia

Poster not currently available.

The journey to a healed mind

Abstract:
In this presentation, we will explore the benefits of neurofeedback treatment in addressing the mental health issues of a 54 year old female from Iran. The following will be discussed:

• The client presentation, trauma background and resettlement challenges
• The use of psychotherapy alone compared to counselling combined with neurofeedback

Summary of Presentation Outline:
“The aim of this presentation is to explore the role of neurofeedback treatment in the context of working with torture and trauma survivors. A case study of a 54 year old female from Iran will be used to illustrate how neurofeedback can enhance the outcomes of psychotherapy. We will describe changes in the client’s symptoms following a course of psychotherapy in comparison to the outcomes achieved after neurofeedback was introduced later in the treatment. We also aim to raise the awareness to the complexity of this clientele group, who are not only impacted by their history of torture and trauma, but face immense stress throughout their resettlement period. The value of neurofeedback when treating clients with such complex issues will be discussed. “In this presentation, we will explore the benefits of neurofeedback treatment in addressing the mental health issues of a 54 year old female from Iran. The following will be discussed:
• The client presentation, trauma background and resettlement challenges
• The use of psychotherapy alone compared to counselling combined with neurofeedback

Authors:
Shaheen Kohsar, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia

The social work response to the discourse of ‘othering’ when working with asylum seekers

Abstract:
This research paper is based on interviews with front line social workers in Melbourne who work directly with asylum seekers. The study explores the social workers’ professional experience working in the sector, as well as their understanding of the discourse of ‘othering’ and the impacts it has on both their professional practice and the asylum seekers wellbeing. Grove and Zwi (2006) describe ‘othering’ as a process of defining and securing one’s own identity by distancing and stigmatizing another. This can be seen as the predominant discourse surrounding the issue of asylum seekers in the Australian political and media landscapes.

Our analysis explored the social workers’ understanding of the historical policy context and political representation of asylum seekers. It explored the impacts that these policies and discourse are having on their professional practice as well as the wellbeing of the asylum seekers they work with. The results of the study highlight evidence of positive direct practice and pro-active community engagement, with workers demonstrating creative ways to address trauma and challenge the discourse within their professional practice.

Grove, N, & Zwi, A 2006, ‘Our health and theirs: Forced migration, othering, and public health’, Social Science & Medicine, 62, pp. 1931-1942, ScienceDirect, EBSCOhost, [viewed 12 September 2016]This research paper is based on interviews with front line social workers in Melbourne who work directly with asylum seekers. The study explores the social workers’ professional experience working in the sector, as well as their understanding of the discourse of ‘othering’ and the impacts it has on both their professional practice and the asylum seekers wellbeing. Grove and Zwi (2006) describe ‘othering’ as a process of defining and securing one’s own identity by distancing and stigmatizing another. This can be seen as the predominant discourse surrounding the issue of asylum seekers in the Australian political and media landscapes.

Our analysis explored the social workers’ understanding of the historical policy context and political representation of asylum seekers. It explored the impacts that these policies and discourse are having on their professional practice as well as the wellbeing of the asylum seekers they work with. The results of the study highlight evidence of positive direct practice and pro-active community engagement, with workers demonstrating creative ways to address trauma and challenge the discourse within their professional practice.

Grove, N, & Zwi, A 2006, ‘Our health and theirs: Forced migration, othering, and public health’, Social Science & Medicine, 62, pp. 1931-1942, ScienceDirect, EBSCOhost, [viewed 12 September 2016]

Authors:
Shannon White, Deakin University, VIC Australia & Dr. Kim Robinson

Use of EEG and neurofeedback in treating trauma related symptoms in refugees

Abstract:
People leaving in the aftermath of trauma suffer profound deficits in both physical and emotional regulation. As trauma therapists, we are constantly searching for ways to help our clients deactivate fear, rage and shame. From a neurobiological perspective, ability to self-regulate is tightly linked to the communication patterns in the brain. These patterns can be measured and altered in real time using Electroencephalogram (EEG).

In this presentation we will explore the benefits of implementing use of EEG at the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) to assess the refugee clients with trauma related complex and chronic symptoms. Preliminary data identifying dysfunctional brain patterns underlying Post-Traumatic Stress Disorder and data supporting the effectiveness of neurofeedback interventions aimed to alter these dysfunctional patterns will be presented. In addition, case vignettes will be used to illustrate how EEG assessment and neurofeedback intervention are used in the context of trauma treatment.

Authors:
Mirjana Askovic, Anna Watters, Mariano Coello, Jorge Aroche, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Anthony Harris, University of Sydney, NSW Australia

What makes people vulnerable to developing Posttraumatic Stress Disorder? A study of the beliefs of resettled Iraqi and Afghan refugees

Abstract:
This study aimed to report on beliefs regarding the causes and risks of developing Posttraumatic Stress Disorder (PTSD) amongst two groups of refugees resettled in Australia, one that originate from Iraq and the other from Afghanistan. Utilising a culturally adapted mental health literacy (MHL) survey method, 225 Iraqis and 150 Afghans of refugee background who had resettled in Australia were surveyed. The majority of the Iraqi participants (52.9%) believed that being exposed to a traumatic event was the most likely cause for developing the problem described in the vignette, whereas the majority of Afghan participants (31.3%) believed that originating from a war torn country was the most likely factor for developing PTSD. Regarding risk factors associated with vulnerability, having been born in a war torn country was considered by one third of Iraqi respondents (34.3%) as the most likely risk factor in making a person vulnerable, while being rich was seen as the second most important risk factor (18.8%). Amongst Afghan participants the likely risks for developing PTSD were being born in a war torn country (48%), followed secondly by having fled Afghanistan prior to 2001 (22%). The results of this study indicate the need for health promotion and early intervention programs, and for mental health services to recognise that variation in MHL may be a function of many factors including the cultural origin of a refugee population. Such recognition is needed to develop more sophisticated approaches that address the actual beliefs of resettled refugee populations.

Authors:
Dr Shameran Younan, Mental Health, School of Medicine, Western Sydney University, NSW, Maria Gabriela Uribe Guajardo, Anita Yaser, Western Sydney University, Jonathon Mond, University of Tasmania, Mitchell Smith, Diana Milosevic, NSW Refugee Health Service, Caroline Smith, Western Sydney University, Sanja Lujic, University of New South Wales, Anthony Francis Jorm, University of Melbourne, VIC Australia

Poster not currently available.

Working effectively with asylum seekers on a negative pathway: Developing a best practice model

Abstract:
The number of asylum seeker applicants undergoing refugee status determination in Australia has recently increased. It is predicted that instances of applicants receiving negative outcomes will also rise. It is common that asylum seekers with significant trauma presentations have difficulty engaging in the refugee determination process. Anecdotal evidence also suggests that negative outcomes on clients’ protection visa applications exacerbate psychological distress and contributes to the maintenance of PTSD symptoms. The wellbeing of individuals on a negative pathway may be further impacted by visa restrictions, lack of work/study rights, ineligibility for services, Medicare and/or financial aid. A broad array of knowledge and skills are required to work effectively with negative pathway clients. The results of a multi-disciplinary nation wide survey completed by counsellors, caseworkers, managers and lawyers working with negative pathway clients will be presented. Data gathered from the survey will assist in planning effective approaches to working with this client cohort, identify areas of training needed and consider the advantages/disadvantages of working collaboratively among service providers.

Authors:
Dominica Dorning, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Ferdinand Spangenberg, Australian Red Cross, Helen Bibby, NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), NSW Australia