REFUGEE READINESS TRAINING: THOMPSON-OKANAGAN

REFUGEE READINESS TRAINING: THOMPSON-OKANAGAN

RRT Training April-May 2016 Presented by: Joni Rose

Syrian Refugee Resettlement in BC The Government of Canada, through Immigration, Refugees and Citizenship Canada (IRCC) has jurisdiction over the national immigration system including refugee resettlement. On November 24, 2015, IRCC announced that 25,000 Syrian refugees would arrive in Canada by March 1, 2016. 6/6/2016 3

Syrian Refugee Resettlement in BC As of March 7, 2016: 2,267 individuals have arrived in BC to date. Preliminary estimates are for another 2,000 BC refugee arrivals in the remainder of 2016. 6/6/2016 4

Services and Supports Federally Managed Programs Resettlement Assistance Program for GARs Income support for up to 1 year Resettlement services for the first 4-6 weeks Settlement Services Interim Federal Health Care Canada Child Tax Benefit Federal Student Aid Provincially Managed Programs Health (MSP) Education Child Care Subsidy BC Early Childhood Tax Benefit BC Basic Family Bonus Employment Program of BC Canada-BC Job Fund Canada-BC Job Grant for Refugees/New Canadians Skills Connect Project Based Language Training (15/16) BC Student Aid Refugee Readiness Fund 6/6/2016 5

Refugee Readiness Fund (RRF) BC responded by creating the RRF, a $1M one time investment to assist Syrian refugees and to leverage existing federal and provincial supports BC held a consultation in September 2016 Priorities identified were to increase community collaboration and supports for refugees experiencing trauma 6/6/2016 6

$1M Refugee Readiness Fund Community Supports Refugee Response Teams (RRTs) $500K Provincial Supports ISSofBC Contract $500K Complimentary to Existing Services and Regionally-Focused 6/6/2016 7

Refugee Readiness Fund Community Supports: 5 Refugee Response Teams (RRTs) 1 Metro Vancouver 2 Fraser Valley 3 Vancouver Island 4 Thompson Okanagan 5 Cariboo MOSAIC DiverseCity Victoria Immigrant and Refugee Centre Society (VIRCS) Kelowna Community Resources Society (KCRS) Immigrant & Multicultural Services Society of Prince George 6/6/2016 8

RRT Network A provincial group that meets to discuss the work of the RRTs and make sure that there is provincial coordination and info sharing and so emerging issues are brought to the attention of government reps. The RRT Network consists of: At least one rep from each of the lead organizations from each RRT ISSofBC Rep Kathy Sherrell IRCC Rep - Darcy Bromley BC Ministry Reps Joni Rose (chair) Lucy Swib and Robyn Uhl (cross ministry) Guest speakers e.g. RSTP Trainer for BC/Alberta 6/6/2016 9

Refugee Readiness Fund Provincial Supports: ISSofBC Contract Info Hub Refugee Response Team Training Trauma Supports 6/6/2016 10

Ministry of Jobs, Tourism and Skills Training Workforce Development and Immigration Division Joni Rose 6/6/2016 11

BC REFUGEE READINESS FUND KATHY SHERRELL, ASSOCIATE DIRECTOR SETTLEMENT SERVICES, ISSOFBC

REFUGEES: GLOBAL TO LOCAL PERSPECTIVES KATHY SHERRELL, ASSOCIATE DIRECTOR SETTLEMENT SERVICES, ISSOFBC

DO YOU KNOW Worldwide, 1 in every 122 people on the planet is now either a refugee, internally displaced or seeking asylum? If this were the population of a country, it would be the 24 th largest in the world Half of the 60 million displaced are children; few are in school In 2014, 42,500 new people were displaced every single day. That is a new person forced to flee every other second Developing countries host over 86% of the world s refugees Parater, UNHCR Innovation, 2015

PEOPLE DISPLACED BY WAR: 2005-2014

UNHCR ANNUAL TRENDS REPORT (2014)

REFUGEES A GLOBAL PERSPECTIVE

According to the UN Convention on Refugees (1951) and subsequent Protocols (1967), refugees are: people who are outside their countries because of a well-founded fear of persecution based on their race, religion, nationality, political opinion or membership in a particular social group, and who cannot or do not want to return home

STAGES OF REFUGE Crisis Movement Temporary Protection Durable Solution

STAGES OF REFUGE: DURABLE SOLUTIONS Voluntary Repatriation UNHCR works with the country of origin and host countries to help refugees return home Local Integration Integration of refugees in the host community allows recipients to live in dignity and peace Resettlement An alternative for those who cannot go home, made possible by UNHCR and governments

STAGES OF REFUGE: FOCUS ON RESETTLEMENT UNHCR Resettlement Criteria Legal & physical protection needs Voluntary Repatriation Local Integration Medical needs Survivors of violence & torture Women at risk Family reunification Children & adolescents Elderly refugees Refugees w/o local integration prospects 1.150 million in need of resettlement in 2016 74,000 refugees were resettled in 2014 Resettlement 28 resettlement countries Top countries: USA, Canada, Australia & Germany

WHAT RESETTLEMENT IS NOT A right An immigration / migration tool to reach the country of choice A tool to only improve a person s economic / social situation The solution for all problems and challenges that a refugee is experiencing

REFUGEES LOCAL PERSPECTIVE: CANADA

CANADA S REFUGEE PROGRAM Privately Sponsored Refugee (PSR) Blended Office Referral (BVOR) Government Assisted Refugee (GAR) Refugee Claimant (RCs) Private Sponsor Support (12 months) Federal Government Support (6 months) Federal Government Support (12 months) May be eligible for Provincial Social Assistance Sponsorship Agreement Holder (SAH) / Constituent Group / Community Sponsor / Group of 5 Private Sponsor (6 months) Subcontracted to a Settlement Service Provider Organization via the Resettlement Assistance Program (RAP) Navigates Refugee Determination Process and Settlement simultaneously Eligible for IRCC funded settlement, language or employment services Eligible for IRCC funded settlement, language or employment services Eligible for IRCC funded settlement, language or employment services Eligible for BC funded Settlement and Integration Services Convention refugee status granted overseas Inland Claim

REFUGEE CLAIMANTS Inland claim for legal recognition as a Convention Refugee Flow Chart of Refugee Claim process in Canada Immigration and Refugee Board (IRB) can accept or reject a refugee's claim, or the claimant may withdraw/abandon a claim Refugee Claimants are eligible for: Settlement Services such as orientation, information and referral services, assistance to navigate IRB and immigration processes and work permit applications, and community connection activities and English practice/conversation circles. They may in some communities also receive short term crisis and/or trauma counseling (or referrals to trauma counseling) Labour Market Services including education on local job market, workplace rights and responsibilities, work safety, workplace culture, and connection to appropriate authorities in the event of workplace safety, employment standards violation etc Refugee Claimants are not eligible for IRCC-funded services Refugee Hearing Preparation Guide multiple languages - http://kinbrace.ca/rhp-guide/

PRIVATELY SPONSORED REFUGEES Overseas recognition as a Convention Refugee Arrive with right to permanent residence They are referred for resettlement by a private sponsor in Canada who agrees to provide financial and other support for the refugee for one year Approximately 90% are family reunification Sponsors provide support for 12 months, including financial, social and emotional supports, as well as help with housing, clothing and food Eligible for IRCC funded settlement, language and employment services

BLENDED VISA OFFICE REFERRAL REFUGEES Overseas recognition as a Convention Refugee Arrive with right to permanent residence Convention refugees referred by the UNHCR who are matched with a private sponsor in Canada The Government of Canada provides up to six (6) months of income support through the Resettlement Assistance Program (RAP) Private sponsors provide another six (6) months of financial support and up to a year of social and emotional support While federal funding is provided through the Resettlement Assistance Program, BVORs are not eligible to access RAP services Eligible for IRCC funded settlement, language and employment services

GOVERNMENT ASSISTED REFUGEES Overseas recognition as a Convention Refugee Arrive with right to permanent residence Convention refugees referred by the UNHCR (individuals cannot apply directly) Convention refugees whose initial settlement (for up to one year) is entirely supported by the Government of Canada or by the province of Quebec Upon arrival receive Resettlement Assistance Program services, including temporary accommodations and assistance in finding permanent housing Eligible for IRCC funded settlement, language and employment services

RESETTLEMENT ASSISTANCE PROGRAM RAP IS. A short-term intervention focused on first 2-6 weeks after arrival Plus - one year of financial support equivalent to provincial social assistance to help them settle RAP IS NOT. Focused on: Community connections (e.g. mentoring, field trips) Language acquisition (e.g. LINC classes, conversation circles) Employment supports (e.g. resumes, career counselling) Long-term resettlement needs

GOVERNMENT TRANSPORTATION LOANS Sponsored refugees (GARs, PSRs and BVORs) arrive in Canada with a Government Transportation Loan covering: The cost of pre-entry medical exams Transportation documents Transportation costs Loans can be to a maximum of $10,000 per family unit Adult children (19+ years) receive their own GTL Repayable after 6 weeks, interest bearing after 3 years Highest repayment rate of all Government Loan programs Note: Syrians arriving November 4, 2015 February 29, 2016 are exempt.

REFUGEES A LOOK AT THE NUMBERS

REFUGEE CLAIMANTS KEY FIGURES Between 2005 to 2014, the IRB received almost 100,000 refugee claims, with an overall acceptance rate of 41% for finalized claims In 2014, the acceptance rate was 49%, the highest since 1995 In the first 6 months of 2015, IRB data shows the board accepted 5,006 claims and rejected 3,091 The acceptance rate increased to 56% The rejection rate was 35%, down from the 43% over the previous 10 years * figures are for all of Canada Source: CBC.ca

REFUGEE RESETTLEMENT TO CANADA (JANUARY 2010 MARCH 2015) Canada admitted 61,300 refugees, including: 34,775 GARs and BVORs (57%) 26,535 PSRs (43%) 9.4% destined to BC Intended destination of 95% of PSRs and GARs/BVORs in this time period was Metro Vancouver

Refugee Resettlement to BC by Intended Destination (Jan 2010 Mar 2015) Data from Immigration, Refugees, and Citizenship Canada (2015)

INTRODUCTION: SETTLEMENT, PRIMARY CARE AND MENTAL HEALTH CONCERNS OF REFUGEES KATHY SHERRELL, ISSofBC MARTINA SCHOLTENS, VANCOUVER COASTAL HEALTH KIRBY HUMINUIK, VAST

A REFUGEE IS NOT AN IMMIGRANT REFUGEES Forced to flee homeland Departure usually secretive little time to plan departure Often no closure emotional impact of leaving friends and family very high especially if they are in danger; leave property and belongings behind Would return if they could unable to because of danger Usually do not have friends/family in Canada, interrupted education / work IMMIGRANTS Choose to leave their country Planned departure in advance time to prepare Have closure said goodbye to family and friends, disposed of / made arrangements for care of property; contact with people in destination country before arrival Can return if they wish to have choice Often arrive with resources, networks, education, transferable skills

STAGES OF SETTLEMENT & CULTURAL ADAPTATION

STAGES OF SETTLEMENT & CULTURAL ADAPTATION Stage 1 - Honeymoon An initial reaction of enthusiasm, fascination, admiration, and cordial, friendly, superficial relationships with hosts. (note refugees may not come to Canada by choice and therefore less enthusiastic) Stage 2 Challenge and Crisis (Culture Shock) Differences in language, concepts, values, and symbols lead to feelings of inadequacy, frustration, anxiety and anger.

STAGES OF SETTLEMENT & CULTURAL ADAPTATION Stage 3 - Reconstruction and Recovery The crisis is resolved as the person learns the language and culture of the host country. Stage 4 - Adjustment / Adaptation Newcomers begin to work in and enjoy the new culture, though there may be some instances of anxiety and strain, they are better able to manage the emotions.

SETTLEMENT EXPERIENCES: PROFILE Changing profile of refugees admitted to Canada owing to shift from ability to establish to need for protection : Protracted refugee situations Larger household sizes Little/no proficiency in English/French Low levels of formal education Physical and mental health issues Seniors Changing source countries: New and few Shift to multi-year commitments

FIRST YEAR IN CANADA KEY SETTLEMENT OUTCOMES Settlement has a sense of belonging to their own and broader community feels more confident to handle daily life Employment is employment ready / has secured employment is able to explore different options for employment understands BC employment standards / employees rights and responsibilities has obtained full-time / part-time work understands the importance of volunteering / volunteer in the community

FIRST YEAR IN CANADA KEY SETTLEMENT OUTCOMES (CONT D) Health has secured a family doctor and dentist is receiving treatment for health issues is aware of premium assistance for MSP has a plan is in place for responding to mental health issues Housing has found appropriate housing has applied for rental assistance for housing

FIRST YEAR IN CANADA KEY SETTLEMENT OUTCOMES (CONT D) Skills Enhancement has obtained a BC driver s license (if necessary) understands the procedures / commenced the procedure for recognition of foreign credentials is exploring options / obtains additional training / skills enhancement is improving English language skills level of improvement dependent on their initial level of English language skills and literacy levels is exploring volunteer opportunities

FIRST YEAR IN CANADA KEY SETTLEMENT OUTCOMES (CONT D) Other Milestones has clarity regarding their documentation life skills revisit credit cards / personal financial system understands the legal system / resources civic participation / registered to vote in municipal elections Parents understand the school system / available supports has started to repay transportation loan (if applicable) understands all provincial / federal subsidy programs has transferred to provincial support systems has filed their income tax returns (date will depend on when in the fiscal year the client arrives)

FROM CRISIS TO COMMUNITY: Syrian Refugees and the BC Economy (Vancity Report, Dec 2015) 2,500 Syrian refugees expected to arrive in BC by end of February 2016 Estimate these refugees will contribute a minimum of $563 million in local economic activity by 2035 Consumption of goods and services will strengthen local economy

FROM CRISIS TO COMMUNITY: Syrian Refugees and the BC Economy (Vancity Report, Dec 2015) Immigrants tend to be highly entrepreneurial as they are about 30% more likely to start a business than nonimmigrants. Refugees report higher rates of self-employment than both other immigrants and those born in Canada. Significant immigration does not necessarily decrease wages or increase unemployment, and when it does the effects are small.

FROM CRISIS TO COMMUNITY: Syrian Refugees and the BC Economy (Vancity Report, Dec 2015) The long-term fiscal impact of accepting refugees is typically positive Enhanced supports and settlement services provided to refugees including income support) allows sponsored refugees to delay their entry into the job market Improved language proficiency and increased confidence Over time, the level of labour-market participation and earnings for this group tends to be more favourable than might be expected, given their lower level of education upon arrival

REMEMBER. Individuals arriving in British Columbia as refugees have survived conditions abroad that many of us in the room cannot comprehend. They are no longer victims, they are survivors, and their resiliency and strength is to be admired and celebrated.

Caring for Refugees in Primary Care How do you best care for patients that have newly arrived to your community?

Workshop Overview Day 1 Morning: Pre-Arrival Issues Afternoon: Post-Arrival Health Assessment Day 2 Practical Issues o Health insurance o Interpretation

Immigration Medical Exam (IME) Prior to departure Purpose is two-fold: o Cursory evaluation for communicable disease that would put Canadian public at risk o Fitness to fly assessment

Immigration Medical Exam (IME) Refugees are excessive demand exempt - they will not be refused entry to Canada base on excessive medical needs

Immigration Medical Exam (IME) History & physical exam Investigations: o Urinalysis (>5yrs) o Chest x-ray to rule out active TB (>11yrs) o HIV (>15yrs) o Syphilis (>15yrs)

Follow-up of IME Results: Tuberculosis Active TB treated overseas Local public health officials notified of individuals who require follow-up o previously treated TB or inactive pulmonary TB 1 Refugees referred for post-landing medical surveillance required to report to their local public health unit within 30 days (or 7 days if urgent) From: http://www.health.gov.on.ca/

Follow-up of IME Results: Syphilis & HIV Syphilis: Occasionally treated overseas. Not reported to public health. HIV: Local public health is notified of positive results. http://www.microbiologysociety.org/ http://journeytosolidarity.org/2009/07/hiv-chiropractic/

IME Results Syrian refugees destined for Canada have their IME in Jordan or Lebanon, and are given a paper copy of the results Historically, Canadian physicians never see the IME results Consider repeating the HIV and RPR

Common Issues in New Migrants Canadian Guidelines for Immigrant health

Health Factors Unique to Refugees Pre-Migration Genetic or environmental exposures During Migration Exposure to war and trauma Post Migration Loneliness and social isolation, change in diet, poverty, acculturation, loss of identity

Kirby Huminuik, MA, PhD (Cand)

The Complexity of Refugee Mental Health Forced migration usually occurs after a prolonged period of danger, violence, loss, and uncertainty State violence is often related to discrimination and oppression (ethnicity, religion, gender, sexuality, indigeneity, age, poverty) Exposure to violence predicts higher rates of trauma-related mental health disorders Violence effects individuals, families, communities, societies Unmet or unrecognized prior mental health needs

Complexity of Refugee Mental Health Stressors of Resettlement Resettlement is life changing: Opportunities and Loss Loss of community and social network Loss of important life projects Concerns about economic survival Loss of meaningful structure and activity Loss of meaningful social roles Loss of power and control over life

Effects of Overwhelming Change Stress can affect all areas of life Psychological distress and dysfunction Physical symptoms Changed behaviour Problems in relationship

Strength and Resilience Survival, resistance and dignity Resilience Traumatic growth Functioning while suffering Fluctuating sx in response to stress Sources of strength, resilience and support Personal, relational, cultural, spiritual

Session Outline Refugee Readiness Workshop Mental Health Concerns for Newly Arrived Refugees Screening for Vulnerability Brief Psychosocial Interventions Working in a Community-based context Self-awareness and Self-care