Culturally Competent Practice with Refugees with Disabilities. Kris Balfanz-Vertiz, MSW, LSW Emily Wheeler, MSW, LSW

Transcription

1 Culturally Competent Practice with Refugees with Disabilities Kris Balfanz-Vertiz, MSW, LSW Emily Wheeler, MSW, LSW

2 Objectives Learn about local refugee population Increase awareness of refugees with disabilities (RWD) Discuss barriers faced by RWD Outline resources available for this population Brainstorm solutions

3 Who are refugees? According to the Office of Refugee Resettlement, a refugee is any person who is unable to return to their native country because of persecution or well-founded fear of persecution on account of: Race Nationality Religion Political Affiliation Group Membership

4 Process of Resettlement United Nations High Commissioner for Refugees determines legal refugee status 1% of all legal refugees are referred for resettlement in a third country The Department of State's Bureau for Population, Refugees and Migration (PRM) oversees Refugee Resettlement program. Refugees, who meet the criteria for application to the US program, are interviewed by an INS officer According to U.S. Committee for Refugees and Immigrants

5 Where are refugees from? Iraq-934 Burma/Thailand -865 Burundi-119 Somalia- 66 Iran- 48 Liberia- 28 Ethiopia-12 Democratic Republic of Congo/Congo- 35 Cuba-47 Total # of refugees resettled in Illiniois in 2008 = 2,429 *Data from Office of Refugee Resettlement Fiscal Year Report

6 How do refugees get here? Two ways for refugees to enter USA: Through family reunification, where refugees join relatives already living here As free cases, where the United States accepts individuals with legitimate reason to fear persecution in their home country

7 How do refugees get here? All refugees are connected with a refugee resettlement agency Their agency provides immediate services (e.g., finding housing, facilitating medical appointments) and more long-term services (e.g., ESL classes, employment assistance) Most refugees in Chicago live on the north side of the city (Rogers Park, Albany Park)

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9 Why talk about refugees now? World Health Organization estimates that between 2.3 and 3.3 million of displaced people have a disability Mt. Sinai s specialty clinic began in 2007 Schwab s program specifically created for refugees with disabilities

10 What types of disabilities? Amputations- due to war Congenital disabilities- MR, CP Cerebral Vascular Accident/Stroke Back Pain- some from torture Deaf or Hard of Hearing Blindness or Visual Impairment

11 Refugees Health Issues Illnesses and disabilities induced or complicated by war, torture, and poverty in home country Majority of refugees have had little or no therapy or medical treatment Many have chronic pain, vision and hearing problems, orthopedic problems, and PTSD

12 All refugees with documented disabilities prior to arrival in the US FY 2003: 879 FY 2004: 2,466 FY 2005: 2,670 FY 2006: 2,700 or more This includes people with mobility, sensory, vision, speech and cognitive/developmental disabilities. This does not include those with learning disabilities, mental illness or other hidden disabilities.

13 Office of Admissions Refugee Processing Center Arrivals with Disabilities Illinois:

14 About 19% of the refugees that have documented disabilities upon arrival resettle in Illinois 1 in 5 people have a disability

15 Monthly Clinic In 2008, there were 23 refugees with disabilities* seen at Touhy Clinic There were 86 refugees total who were seen that had a medically complex need If 1 in 5 new refugees have a disability, how many go without medical services?

16 Services Offered Rehabilitation Medical Management Physical/Occupational Therapy Orthotics and Prosthetics Adaptive Equipment- wheelchairs, crutches, walkers Community Disability Resources

17 Team Approach Refugees with disabilities can access treatment and care for their disability Physical Medicine and Rehabilitation Program Coordinator- social worker Orthotist/Prosthetist Medical Supplier Interpreters

18 Barriers Language & Communication Perceptions of Disability & Illness Mental Health Meeting Physical Needs Cultural Assimilation

19 Language & Communication Language and Communication are 2 different things A nod of the head does not imply the patient understands In many cultures, eye contact is impolite Being direct & forthright may be considered rude Detailed information can be difficult to obtain on a first visit Patients are oftentimes more comfortable with an interpreter/provider of the same sex Use hand and arm gestures with caution, along with physical touch

20 Tips for Communication Use of a live or telephonic interpreter Repeat, repeat, repeat Speak directly to a patient-not the interpreter Everything said in the presence of a patient must be translated Ask open-ended questions Provide translated medical consent forms

21 Translated Outpatient Forms in Arabic and Burmese

22 Culture & Disability For many refugees, Western concepts of disability and illness are hard to understand Disability and illness may be tied to personal or religious experiences/beliefs Some concepts within the U.S. rehabilitation system, such as independence, self-determination, and self-advocacy may be foreign to a refugee deriving from a collectivist culture

23 Eliciting Health Beliefs What do you call your problem? What name does it have? What do you think caused your problem? Why do you think it started when it did? What does your sickness do to you? How does it work? Source: Dr. Arthur Kleinman, Patients and Healers in the Context of Culture. The Regents of the University of California

24 Eliciting Health Beliefs (cont d) How severe is it? Will it have a short or long course? What do you fear most about your disorder? What are the chief problems that your sickness has caused for you? What kind of treatment do you think you should receive? What are the most important results you hope to receive from the treatment?

25 Eliciting Health Beliefs (cont d) Health Related Beliefs & Practices Are there any practices in your religion that help you stay healthy (such as prayer, wearing of talismans or charms, massage, medicines)? If you were sick at home, who would care for you? How does a person from your culture view a person who has emotional or mental problems? Socioeconomic Considerations Who do you consider to be the most important members of your family? Who makes most of the health care decisions for your family? Who is the principal wage earner in your family? Are there other sources of support for your family?

26 Disability & Stigma How is disability perceived in the U.S.? Is there more or less stigma than other countries? Refugees with disabilities not included in U.S. government numbers Finding appropriate jobs for refugees with disabilities is oftentimes not a priority

27 Mental Health For refugees with disabilities, mental health treatment is oftentimes equally important as physical health Due to nature of disability (war, torture, etc), there may be a great deal of emotional pain People with PTSD/depression/anxiety are more likely than those without PTSD to experience problems with pain (Roth, Geisser & Bates)

28 Mental Health (cont d) Finding culturally-appropriate mental health services can be a challenge- High demand, low supply A refugee may not be familiar or receptive to the option of mental health treatment (counseling, medicine) In some cultures, mental illness may be looked down upon Mental Health vs. medication

29 Physical Needs Transportation Inaccessible apartments Financial Strains Lack of vocational opportunity SSI/SSDI Mobility aids (wheelchairs, walkers, etc)

30 Cultural Assimilation Among program participants, there is a high degree of social isolation Difficulty getting out of the home (depression can increase difficulty) Little interaction with Americans or other refugees from same country Unemployment can make assimilation more difficult

31 Now What? In response to these barriers, what do you see as a practical solution(s)? Is it possible for refugees with disabilities to reach a level of independence and cultural assimilation? What appears to be the most pressing barriers they face?

32 Resources Paratransit/Reduced Fare transportation Homemaker Services Day programs Free ESL classes through city colleges Schwab shuttle Head Start program (for children) Wheelchair Clinic

33 Burma Composed of many ethnic groups (about ½ newly arrived refugees are Karen) Burmese is the official language Political turmoil and military government; thousands of refugees leave every year Source: Burmese Refugees (powerpoint), Gwyneth Leighton, Janelle Hazlett, Suzanne Gamelin. University of Colorado Denver, February 24, 2008.

34 Working with Burmese Refugees Impolite to sit higher or at same level as an older or more respected person Pointing finger/hand/foot at someone is considered rude In Karen culture, it is more typical to give something rather than offer verbal praise Some don t make eye contact with people, especially elders

35 Somalia Composed of a single, homogenous ethnic group Since Somalia s government fell in 1991, civilians have suffered from rampant violence, famine, and death from starvation. The Somali language is an Afro-Asiatic language closely related to Oromiffa, and Arabic is a common second language

36 Working with Somali Refugees Attitudes and social norms are based primarily on Islamic tradition Ask patients about any dietary restrictions, and take them into account Circumcision is an important and sensitive issue for many Somali women; try to keep communication open Somali beliefs include the evil eye, where praise can bring harm or illness to the person being praised

37 Arabs Inhabitants of the Arab World who speak various dialects of the Arabic language Share the values and beliefs of the Arab culture The Arab World includes 22 countries in the Middle East and North Africa. The majority are Muslims

38 Working with Arab Refugees Arabs may see the nurse as a helper, not a health care professional. Doctor may need to explain nurse s role to patient Arabs may look down on people who are mentally ill. Discuss conditions of a mentally ill patient Many Muslim Arabs follow certain dietary laws. Ask patients about their diet, especially if they are to be hospitalized Welcome the support of patient s family and friends

39 Working with Families Collectivist cultures An individual is seen as part of a larger family system or ethnic community Essential to communicate with family members Not uncommon for cousins, aunts/uncles, and siblings to be involved

40 Case Examples

41 Questions?