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FY2020 Q1
 
Healing Focus
A Quarterly Digest from NCB
Welcome to the latest quarterly digest from The National Capacity Building Project at the Center for Victims of Torture, where we share recent news and resources on topics in torture survivor rehabilitation.

This digest contains resources for working with unaccompanied youth, it provides general background information, and working with youth trauma. This is part one of this topic. Next digest we will continue this topic and share resources around helping unaccompanied youth in other areas like school and their development. In this digest we have included a continuation on our training resources on HealTorture.org for those working at survivors of torture treatment programs. These resources can be helpful for newly hired staff or for those who would like more training in this challenging field.
In this Issue
Did You Know?
Working with Unaccompanied Youth
Resources on HealTorture.org
Highlights on Programs
From the Team

Did You Know?

Did you know that NCB offers free, remote consultations to meet pressing issues at torture survivor programs and refugee-serving organizations?

What is a consultation with NCB?
It is an opportunity for you and your program to work with an expert and seek their advice on issues or on a specific question regarding your work. NCB has experts that we can draw on to help you.

How does a consultation with NCB work?

Reach out to us by filling out this form with your specific question or issue and we will connect with you by email, phone or video conference.

Working with Unaccompanied Youth, Part 1

The U.S. has seen a marked increase in the number of unaccompanied youths arriving at the southwest border from around the world, and Central American countries in particular. Many of the youths arriving at the border have experienced severe trauma which may include gang violence, extreme poverty, gender-based violence, abuse, and discrimination based on their sexual or gender identity, and/or violence by family members. 

Relative to other youths who arrive in a host country as refugees, unaccompanied youth face unique challenges that place them at elevated risk for experiencing anxiety, depression, and posttraumatic stress. In many cases, the initial dangers and persecution that force a child to flee their country are compounded by a host of additional threats and dangers they encounter during the migration journey as well as post-migration stressors including the complexity and uncertainty of the asylum and resettlement process. Unaccompanied asylum-seeking minors might have experienced criminal victimization, physical, verbal, or sexual abuse, as well as vicarious traumatization. These experiences may vary in intensity and pervasiveness; they are often severe enough to warrant close examination and psychological treatment. Symptoms of depression may be observed once the reality of their situation begins to settle, sometimes including loss of appetite, sleep disturbances, crying, low energy, and somatic complaints. Young children may demonstrate irritability, mood swings, aggression, and hyperactivity. Consequently, mental health professionals working with this population must consider many factors including the individual’s cultural background and history, trauma story, journey of migration to the U.S., the trauma of family separations, and the complexities and the uncertainty in the asylum process. In addition, resettlement related stressors are also critical to consider which may include language-related difficulties, discrimination, bullying at school, academic challenges, and feeling isolated from their peers and alone in their experience.

Consistent, culturally competent counseling that prioritizes a felt sense of safety and incorporates evidence-based treatment strategies that are developmentally sensitive, trauma informed, and contextually and culturally adapted as appropriate, is key when working with this population. Creating a safe, calming environment in therapy sessions is crucial to building rapport and a trusting relationship and can be done in many engaging ways including through use of art, music, yoga, games, puppetry, and sand-trays to name several. 

The implementation of culturally appropriate screening methods is encouraged. Discussing the negative emotions related to experiences, unaccompanied minors should be encouraged to develop a new narrative to allow them to develop a sense of hope for the future. The use of the “Miracle Question” in which minors are encouraged to think about how things will be different if their current situation did not exist. Most importantly, the stabilization of symptoms in confidential spaces, and family inclusion in therapy by providing additional coping skills and basic needs is essential. 

Understanding their background, status, and best practices with unaccompanied youth:
United States Conference of Catholic Bishops. (2013). The United States Unaccompanied Refugee Minor Program: Guiding Principles and Promising Practices. From the introduction: “Readers will find practical guidance gleaned from the expertise that USCCB/MRS and LIRS have honed over the past several decades on the delivery of optimal services to this particularly vulnerable population. Also included are guiding principles for programmatic design and implementation of holistic services to meet the unique needs of unaccompanied children. The best practices, service models, and insightful analysis of policy speak to an abiding commitment to the best interests of children made particularly vulnerable by forced migration.”

Walker, Chloe. (2019, November 22). Introduction to working with Unaccompanied Children [Webinar], Children’s Immigration Law Academy: Immigration & Unaccompanied Children 101 series. From the webinar description: “This webinar provides an overview of the system designed to care for children who arrive in the United States unaccompanied seeking humanitarian protections under U.S. Law.”

The National Capacity Building Project. (2016). Working with Unaccompanied Minors in the U.S. From the article summary: “An article that shares some considerations for providers working with unaccompanied minors in the U.S.”

Lutheran Immigration & Refugee Service. (2015). At the Crossroads for Unaccompanied Migrant Children. From the Executive Summary: “This report by Lutheran Immigration and Refugee Service (LIRS) offers a range of policy and practice recommendations for the care and protection of unaccompanied children, informed by a series of three “Roundtable” meetings convened by LIRS in 2014 to consider current practice and ideal practice with unaccompanied children.”

A blog and webinar are available. MacDonnell, M., Suero-Stackl, I., and Clark, D. (2016, June 22). Refugee 101: With a Special Look at Child-Specific Issues [Webinar]. MacDonnell, M. (2016). REFUGEE 101: With a Special Look at Child-Specific Issues [Blog post]. From the introduction: “This webinar aims to humanize the refugee experience and will cover some of the basics: what is a refugee and the push/pull factors of migration. Presenters discuss the pre-arrival process, including security measures, and post-arrival services. There is a special emphasis on child-specific issues.”

The National Child Traumatic Stress Network. (2015). Unaccompanied Migrant ChildrenFrom the description: “An overview of working with unaccompanied minors and the unique nature of the trauma they may have experienced. This resource describes symptoms or behaviors unaccompanied minors may display, cultural considerations for providers, and additional resources.”

Trauma-Informed care with unaccompanied youth:
HealTorture.org has an extensive section on Children and Youth, developed after a National Capacity Building Project institute, in March of 2012, which focused on child survivors. Resources collected and developed at the institute along with other articles and videos are organized here as a reference for treatment centers beginning to do this work or looking to move their work in this area in a different direction. The topics range from developing a child and youth focused program to specialized interventions for children and youth. We invite you to browse the materials with special attention to a number of webinars and videos with experts in this field. All resources are listed on the left hand side of the page, and includes: Resources from other sites:
Trauma-informed care: Understanding and addressing the needs of unaccompanied children. [4 Webinars]. (2019). From the description: “This webinar series is designed to cover the impact of trauma on children during all phases of their migration journey. Nationally recognized speakers from NCTSN are joined by experts from the Irving Harris Foundation’s Professional Development Network to provide best practices for culturally responsive and trauma-informed provision of services. This series features diverse expertise from the fields of refugee and migrant health, cultural studies, mental health, early childhood development, childhood traumatic stress, trauma-informed systems of care, and secondary traumatic stress.”

The National Child Traumatic Stress Network. (2018). Understanding Refugee Trauma: For Primary Care ProvidersFrom the description: “Describes the mental health issues for Refugee children in resettlement. This white paper outlines Refugee experiences and mental health needs including exposure to trauma, access to mental health services, stresses in resettlement, and the need for comprehensive services. It offers a review of literature including trauma-informed treatments for refugee children, strategies to improve access to care, engagement strategies, approaches to cultural competence, and interventions designed to address the stresses of resettlement.”

The National Child Traumatic Stress Network. (2018). Understanding Refugee Trauma: For Mental Health Professionals. From the description: “Outlines different considerations that mental health professionals need to take into account when working with refugee youth and their families. This fact sheet describes the cultural, child and youth, family, and provider considerations that professionals should understand when working with this population.”

Kamya, H., and Fontes, L. (2017, November 29). Managing Trauma: Tips for Supporting Refugee Teens in Schools, Refugee Resettlement, & Other Contexts. [Webinar]. From the description: “Hugo Kamya, PhD, Professor and Fulbright Specialist Roster Scholar at the Simmons College School of Social Work and Lisa Fontes, PhD, Senior Lecturer at the University of Massachusetts will discuss some of the dilemmas facing refugee teenagers, how to converse helpfully and meaningfully with refugee teens, as well as ways to intervene more effectively with refugee teens, their families, and schools. This webinar builds off of BRYCS previous webinar on Understanding Trauma in Refugee Youth.”

Furman, B. (2019, Oct 15). Insoo Kim Berg: The miracle questions. [Video file]. From the description: “Insoo Kim Berg, one of the founders of solution-focused therapy, speaks about the miracle question, at the Asian Pacific conference  on solution-focused therapy in Singapore in 2006.”

Bellinger, G. A. (2016, September). To Speak or Not to Speak about Past Trauma: Shifting the Focus to the Present Impacts of Current Events and Assimilation on Immigrant Children. [Webinar]. From the description: “BRYCS Consultant, Goli Amin Bellinger, MSW, LCSW-C, focuses on how to assess and respond to a child’s current difficulties arising from assimilation and tragic events in news reports. An emphasis is placed on avoiding the experience of a toxic trauma story by completing it with stories of resiliency from the past and present. The webinar includes how to recognize stress induced reactions in children and what to recommend to both children and their parents to support adjustment and healing.”

Masten, A. (2016, December). Resilience in Children Exposed to Trauma, Disaster and War: Global Perspectives. [Online course]. From the description: “This free online course from Coursera covers how trauma can affect children and the systems they depend on, and how research is being applied in the real world through interventions that promote resilience. Participants can engage in discussions with others who are working with children at risk around the world.”

Cohen, J., Frymier, S., Abdi, S., and Rosado, J. (2018, July 10). Giving Immigrant Children a Voice: Understanding Traumatic Separation. [Webinar]. From the description: “Focuses on helping providers, current caregivers, and others understand and recognize the effects of traumatic separation in immigrant children of different ages, understand immigrant children’s prior trauma experiences, and provide practical suggestions for how to support immigrant children who have been separated from parents and siblings.”

Power, E. (2014, November 19). Trauma, Spirituality, and Faith: An Overview of the Interplay as Survivors Risk Connection and Recovery[Webinar]. From the description: “Spirituality and faith can be leveraged to increase mental health for survivors of torture, displacement, immigration and other traumatic experiences by assisting in the process of rebuilding one's sense of self through strengthening self-capacities, such as managing feelings, positive inner connections, and feeling worthy of life. This webinar will provide a broad overview of the role of spirituality and faith in recovery from trauma, and in fostering mental health.”

The National Child Traumatic Stress Network. (2013). Child Welfare Trauma Training Toolkit. From the description: “Teaches basic trauma-informed knowledge, skills, and values about working with children who are in the child welfare system who have experienced trauma. The Child Welfare Trauma Training Toolkit also provides information on how to support children's safety, permanency, and well-being through case analysis and corresponding interventions tailored for them, their biological, and resource families.” 

The National Child Traumatic Stress Network. (2005). Culture and Trauma Brief: Promoting Culturally Competent Trauma-Informed Practices. From the description: “Highlights the need for clinicians and policy makers to understand the links between trauma and culture. This brief outlines cultural competence in trauma treatments and practices to encompass race, ethnicity, immigrant status, sexuality, urbanity and rurality, and disability. Data from the National Child Traumatic Stress Core Data Set are summarized, demonstrating the significant differences between refugee/non-refugee, racial, and ethnic groups in lifetime exposure to trauma.”
 
The National Child Traumatic Stress Network.  (2017). Data Collection Offers Opportunities for Unpacking the Refugee Experience. From the description: “Offers information about risk and protective factors as related to suicide and refugee children and adolescents. This fact sheet gives strategies for talking with refugee children and adolescents about suicide.”

Another resource for information on working with youth is the CVT's PATH Bibliography on healtorture.org and go to the Children and Youth section. Click here to view their latest bibliography.

A special thanks to all of our contributors on this topic including: Thomas Berkas our volunteer at NCB, Switchboard, BRYCS, and CVT's PATH project. Without their assistance we would not have been able to put this together.
 

Highlights on Programs

This section features survivors of torture programs that received funding from the Office of Refugee Resettlement. The purpose of this section is so that you can learn about other organizations that are doing the same work and build your network. 

We asked the programs we are highlighting for any articles or other pieces that they might want to share and celebrate with others working with survivors of torture. In this digest Utah Health & Human Rights provided us a few newsletters and an article on their knitting circle group and how it is helping their clients. Ohio Center for Survivors of Torture has provided us with a few of their program highlights from 2019. Thank you for sharing with us your work and accomplishments!
Ohio Center for Survivors of Torture (OCST) provides holistic, strengths-based, trauma-informed services to survivors of torture. The OCST is a multidisciplinary team of lawyers, social workers, licensed mental health providers, employment specialists, and a partnership of community organizations. OCST services are available to any individual who has experienced torture outside of the United States. This includes:
  • Refugees
  • Asylees
  • Asylum seekers
  • Immigrants / Displaced persons
  • US citizens tortured abroad
Services can be extended to family members and others affected by torture according to individual case composition.

A few highlights from OCST in 2019:
  • Expanded our Testimonial Therapy project thanks to additional funding from the Caresource Foundation and the United Nations. Testimonial Therapy is a cross-cultural psychosocial approach that reframes a survivors trauma narrative utilizing storytelling and community support.
  • Started a new program to provide medical and legal services to detained survivors seeking asylum in Ohio detention centers.
  • Continued growth of our support groups empowering Swahili speaking survivors and their families, with a special focus on women and single-mothers.
  • Hosted 30 outreach events reaching over 1,100 immigrants, refugees, attorneys, social workers, medical providers, and asylum seekers.
The mission of Utah Health & Human Rights (UHHR) is to promote the health and well-being of the world’s torture survivors. At the core of torture, the trust between two human beings is destroyed. Our services focus on restoring trust and helping a survivor rebuild emotional, physical, social, and spiritual bonds. Our work also aims to prevent the effects of intergenerational trauma.

UHHR was founded in 2003 in response to the unmet needs of torture survivors in our community. Today, UHHR is the only organization in Utah that specializes in serving torture survivors. To date we have served over 4,000 individuals and we serve over 350 individuals each year: men, women, and children who have fled their homes because of torture and severe war trauma.

Services
UHHR's evidence-based and holistic services are guided by profound respect for the resiliency of our clients. All UHHR’s services are provided free of charge and include:

• individual, couple, and family psychotherapy • group therapy  support, and education • intensive case management • medical assessment, advocacy, and referral  • on-site psychiatric care • preventative, wellness, and complimentary care •  pharmacological/medical case management • legal referral for torture survivors seeking asylum • interpretation • on-site massage therapy • occupational therapy • comprehensive client assessments and evaluation • outreach and consultation to physicians, educators, and social workers who encounter torture survivors in their practices.

Heidi Justice shared with us a few of their recent newsletters as well as an article about their knitting circle group:

The survivors: A story about coping with a tortured past from DeseretNews By Gillian Friedman. This article talks about UHHR and the success of their knitting circle program on their clients' lives.

A few of their recent newsletters, What's new at Utah Health & Human Rights:
May 2019: During the month of Ramadan
September 2019: UHHR's Medical Director, Dr. Mara Rabin, awarded outstanding achievement award
October 2019: Parenting group helps strengthen families

Resources on HealTorture.org

Below is a selection of training resources for staff at survivors of torture treatment programs and refugee-serving agencies who are new to working with torture survivors. This list is a continuation of resources, see the full list.
 

Assessment
Enhancing Empathy by Measuring Torture Symptoms with Survivors
This webinar focuses on the range of screening tools available to clinicians working with survivors of torture and how they can be used to improve clinical practice, improve evaluation practice, and enhance the capacity for empathy in their work. A list of screening tools is included in the Resources section on the webinar page. 
 
Holistic Care Planning
This eLearning module is part of the Fundamentals of Providing Services to Torture Survivors online course available on HealTorture.org. You must sign in as either a member or eLearning Subscriber to access thismodule.

Survivors of Torture Integrated Care Continuum (SOT-ICC) The Survivors of Torture Integrated Care Continuum instrument (SOT-ICC) is a self-assessment of integrated care practices and systems designed for programs delivering services to torture survivors.
 
Evaluation
Planning, Evaluation, Monitoring and Research eLearning Series
This five-lesson series, developed by CVT's Partners in Trauma Healing (PATH) project in collaboration with the National Capacity Building Project (NCB), explains Planning, Monitoring, Evaluation, and Research (PMER), giving participants a shared understanding of the basics of PMER.  You must sign in as either a member of HealTorture.org or as an eLearning subscriber to access this series.

Self-care
Healthy Organizations: Beyond Individual Self-Care
Burnout, secondary trauma, vicarious trauma, and compassion fatigue may be intimately familiar to clinicians, but they can also intersect in ways that seriously impact organizations. Torture affects us all. How do you stay healthy while doing this work? What organizational mechanisms and policies should be in place to promote wellness? What tools are available to measure organizational health?  

Working With Survivors of Torture - The Mind-Body Connection
Many clients seen by programs that work with survivors of torture experience chronic pain, anxiety, and other symptoms long after their traumatic experience. This two-part mini-course focuses on the role of the mind-body connection in the treatment of survivors of torture in both individual and group settings. 
Part 1: Working With Survivors of Torture - The Mind-Body Connection
Part 2: Working With Survivors of Torture - The Mind-Body Connection: eConsultation

Legal
Who Is a Torture Survivor: Understanding the Legal Definitions of Torture
This webinar concentrates on the legal frameworks of the U.S. and U.N. definitions of torture, as well as the refugee definition. It includes examples to illustrate cases that rise to the level of torture and cases that do not.   

Psychological Issues and Techniques in Navigating the Asylum Process
This measured impact webinar is designed to help mental health service providers understand the important role they can play in the successful adjudication of the asylum process for traumatized migrant population and how to navigate the complex issues that can arise in providing these services.
 
Boundaries in the Electronic Age
This webinar examines ethical and professional practice issues related to the evolution in methods of communication in our electronic age. 

Resources for Refugee Services
There are resources for refugee service providers at Switchboard. They provide research, elearning, tools and materials on topics concerning refugee resettlement. Here is a link to their latest newsletter: New podcast and resources from Switchboard!

From the Team

Healing Focus is a quarterly digest from The National Capacity Building Project at the Center for Victims of Torture that shares news and resources on torture survivor rehabilitation. Meet our team.

We would love to share work that you have been doing or resources that you have found helpful. Please  email Sara Bracewell with this information!

Also, if you would like to suggest a topic you would like us to cover in one of these digests, please let us know! For additional tools, resources, and trainings on working with survivors, visit HealTorture.org.

 


Yours,
The National Capacity Building Project
 
Advancing the science of torture survivor rehabilitation by promoting integrated, sustainable care for survivors across the United States.
CVT's National Capacity Building Project received $400,000 through competitive funding through the U.S. Department of Health and Human Services, Administration for Children and Families, Grant #90ZT0187. The contents of this website are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services, Administration for Children and Families.

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