As mentioned before, some refugees may require psychosocial support. Psychosocial support is offered in order to prevent refugees from relapse by promoting their self-reliance and resilience. Psychosocial support can be offered through Psychological First Aid (PFA; link Psychological First Aid pocket guide: http://mhpss.net/?get=188%2F1363792683-PFAPocketGuide-Final.pdf; links to versions in different languages are available). This third chapter of the e-learning will offer you:
- Information on offering psychosocial support, starting with ways to address refugees;
- Insight in how to promote self-reliance in refugees, such as offering psycho-education and finding ways to cope;
- The type of information that is important to offer refugees;
- Information on the mental health issues of children and adolescents and how to address this vulnerable group.
3.1 How to address refugees
Firstly we present how to address refugees in order to offer psychosocial support.
- When addressing refugees it is important to act in a client-centred, culture-informed and non-stigmatizing manner.
- To initiate the first contact, begin by introducing yourself and your institution. Ask them how they would like to be called.
- Ask if and how you can offer help or what their immediate concern is.
- When listening to their answer, it is important to stay calm and understanding.
- During the conversation, try to make the person you’re speaking with feel as comfortable as possible, for example by offering them a glass of water.
- When approaching refugees, it is important to ensure their physical safety and comfort by providing a safe environment and trying to address their urgent needs.
- After introducing yourself, provide the refugee with information on what to expect.
- It is possible that the refugee wants to share his or her story. However, do not pressure them into telling you about their experiences.
- It is possible that a refugee needs practical assistance. In this case, see what you can do, for example in order to satisfy their basic needs or by helping them contacting family or friends.
- Be clear and transparent: say what you do, and do what you say.
3.2 Promoting self-reliance
Here, we describe ways to promote self-reliance. In order to promote the resilience of the client, it is important to offer psycho-education.
- When offering psycho-education, it is important to describe common reactions to traumatic experiences as described earlier, such as somatic complaints, symptoms of distress and anxiety and depressive feelings.
- In describing reactions, try to avoid using the labels “symptoms” or “disorder” in order to avoid stigmatization.
- Explain that what they are feeling and experiencing is an expected reaction to an abnormal situation.
- Together with the client, try to establish what will help them cope with their current situation. A question that might help in establishing this is: “How did you handle distressing situations in the past?” You can also discuss simple coping strategies and try to find out what might work for them. For example, coping strategies include simple muscle relaxation exercises, orientation to problem solving, seeking social support, seeking professional advice, physical exercise, breathing exercisescommunity involvement, increasing life skills, or going to church.
For an example of a muscle relaxation exercise, see: http://www.dummies.com/how-to/content/reduce-stress-and-belly-fat-with-progressive-muscl.html
Sources that may be helpful in aiding people that have been exposed to distressing events:
This is a link to Psychosocial First Aid, a manual for providing stress-relief to vulnerable populations. It has translations in many languages.
This site presents links to all kinds of resources that may be relevant in the aftermath of violence, disruption, upheaval or flight. Different target groups can be chosen.
This site is hosted by the International Society of Traumatic Stress (ISTSS), therefore the focus is on traumatic stress. There may be useful links for information on coping with traumatic stress, on short term and in longer run.
3.3 Offer information
It is important to offer information that is needed and wanted by the client.
- For example, let them know where to seek the help they need, such as family reunification services. Explain how to access key communities, such as support groups and youth groups. (fill in country specific contacts).
- If necessary, you can choose to refer someone, for example to an institution that offers trauma-focused treatment. When referring a refugee, try to emphasize the benefits of the referral and explain how you ensure confidentiality.
- When offering information on where to go, try to address the barriers to seeking the help they need. For example, someone might be worried about child care and money for transport. Try to discuss ways to overcome these barriers.
- If possible and only if the refugee gives you permission, share important information on their wellbeing with the institution you refer them to.
3.4 Children and adolescents
Finally, we offer information on an especially vulnerable group: children and adolescents. After being exposed to distressing events and having to leave their homes, the world of children and adolescents will have been changed forever. Places, habits and people that they used to rely on might not be there anymore. How children respond to a distressing event, is partly determined by their developmental level and age. For example, young children are vulnerable as they are not able to provide for their own basic needs and therefore completely rely on others. Some parents can be so overwhelmed by everything they have been through and the consequences that they are not sufficiently able to take care of their children. Young children can relapse into their old behaviours, such as bed wetting and clinging to their caregivers. Older children can be at risk of sexual abuse, which is a risk factor for several consequences, such as a risk of STDs and HIV, stigmatization and an increased risk of mental health issues (Betancourt et al., 2013). In addition to this, older children can develop feelings of guilt, anxiety or loneliness. Adolescents and young-adults can experience feelings of numbness or show risky behaviour. Another factor that determines how children respond to distressing events is how their caregivers respond to the event and how caregivers respond to the child. Overall, children will have a better chance of recovering over time when there is a stable, calm adult to rely on. As family is an important source of care, try to refer children without parents to an institution that can offer help, such as (fill in). If children are with their family, try to support the adults in taking care of their children.
Finally, a growing number of refugee children, sometimes very young, arrive without relatives. These unaccompanied minors form a vulnerable group because they don’t have their parents or other responsible, caring adults, such as adult relatives, to rely on for support. On their route to what they sometimes have been told to be “a promising country” and “better future” they have at times come across severe events of violence, kidnapping, corruption. Many of them have become distrustful towards others, including health care professionals. This distrust will be obstructing communication in health care encounters. Communication with these youngsters will benefit from extra time, transparency (“doing what you say; saying what you do”) and possibly, regular appointments.
Additionally, you can use the Refugee Services Toolkit (RST), a web-based tool designed to help service system providers understand the experience of refugee children and families, identify the needs associated with their mental health, and ensure that they are connected with the most appropriate available interventions. Furthermore, RST helps to assess the level of risk for a child in several domains, such as their environment and their emotional wellbeing. Link: http://learn.nctsn.org/mod/book/view.php?id=4518&chapterid=16.
Things you can do to help children:
Infants:
- Keep them warm
- Keep them away from chaos
- Talk to them with a calm voice
Young children:
- Offer them time and attention
- Explain to them that the current situation is safe
- Explain that what happened is not their fault
- Give simple answers to their questions, avoiding scary details
- Try to create an opportunity to play
Older children and adolescents:
- Offer them time and attention
- Allow them to be sad
- Listen to them when they want to talk
- Offer them information on what is happening
- Talk about ways to cope
All ages:
- Try to offer them structure during the day
- Try to keep children together with their family
- Keep them safe, for example from media images
In sum:
- Address refugees, trying to establish a basic trusting relationship
- Assist refugees in promoting self-reliance
- Offer information that is needed and wanted
- Be aware of how to address children and adolescents