There has never been more knowledge about trauma and its recovery, yet organizations serving newcomers including immigrants and refugees, often fail to fully incorporate these best practices. Over the past year, NSC has incorporated best practices of trauma-informed care and clinical intervention in order to best support our clients and our mission even within existing systems of resettlement support services.
We started with two key quesitons: (1) Does providing Forward Facing Trauma Support (psycho-education on trauma, somatic experience awareness and self-regulation strategies) to immigrant survivors of interpersonal violence increase self-sufficiency for clients and (2) Does providing Forward Facing Trauma Support ease service provision and/or reduce non-clinical staff's anxiety? We have found that through implementation of this model that Forward Facing trauma interventions have achieved both goals increasing quality of life for our clients and staff alike.
Research shows that refugee populations experience significant rates of Post-traumatic stress disorder (PTSD), Depression and Panic Attacks (Refugee Health TA Center). Yet language barriers, stigma, lack of legal status, and varying conceptions of mental health can create a sea of challenges to connecting clients with mental health services. Furthermore, many clients may be hesitant to engage with clinical mental health services due to stigma. By providing accessible Forward Facing trauma interventions, alongside standardized coping assessments, we have successfully introduced concepts of wellness, while providing information and resources on additional services available. For example, clients participating in trauma-informed yoga on-site engaged in free yoga classes citywide, promoting personal wellness as well as community integration.
By providing Forward Facing trauma education to our clients, including psycho-education on trauma, somatic experience awareness and self-regulation strategies, we have better prepared our clients to engage with mainstream behavioral health services. During initial needs assessments, many of our clients expressed concerns and anticipated challenges in accessing mental health services. By providing education on trauma and self-regulation skills, we have better prepared our clients to engage in mainstream clinical services. Furthermore, we have developed resource guides for clients and for providers, which allow clients to know what to expect within clinical services and encourage providers to connect with NSC case management staff as part of their clinical service planning process. While we still struggle to find adequate lingistuically appropriate clinical services, we have developed strong partnerships with existing resources.
By providing these services, we have also reduced overall behavioral health costs. This process was initiated with our implementation of the Refugee Mental Health Screener - 15 (RHS-15) in 2014. The RHS-15 is traditionally utilized in clinical settings during refugee health screening. By integrating the tool as a key component of our case management services, we have opened the door to converstaions with our clients about wellness, coping and available resources. For us, available resources include not only clinical resources, but also community based referrals, such as women's groups, English classes and related activities. By engaging in measured conversations with our clients about their well-being and developing tailored, often low-cost strategies, to meet their wellness needs, we have reduced overall costs.
For NSC the implementation of this vision and strategic plan has been near revolutionary. Previously, clients were screened and when identified with a mental health need, were referred to a series of unknown providers, based on geographic location, funding sources, and whenever possible, the availability of a bilingual provider or interpreter. The results of this strategy were generally unsatisfactory, and at times, disastrous for our clients. This model, on the other hand, has liberated NSC and its clients through the ability to offer culturally-relevant, client-centered, truly meaningful opportunities for healing and recovery.
NSC built the foundation from which this work has springboarded in a very short time frame, less than one year. Under the supervision of a new Executive Director, NSC updated its organizational structure to prioritize wellness, systematically incorporated the use of a mental health screener and hired a Licensed Clinical Social Worker-all in the 12 months! NSC’s nascent Health and Wellness Team has implmented these program activities transcending vision into action. We believe that organizations, particularly those serving refugees and immigrants, can take significant and impactful steps toward incoporating Forward Facing trauma supports into their services swiftly and with high impact, not only on clients but also on staff.
NSC recognizes that many of our clients have experienced significant and sometimes ongoing trauma. Over the past year, we have taken critical steps to become more trauma-informed, to build a network of culturally meaningful mental health providers and to offer creative, holistic services in order to support the wellbeing of our clients. We have implemented programs for acupuncture, yoga, mindfulness walking groups; all volunteer led. In fact, we have come to see this “wellness programming” as central to the healing needs of our clients. These supports, exclusively provided by volunteers, combined with Forward Facing trauma supports have been implemented agency-wide and could easily be replicated in other service organizations, particularly those serving immigrants and refugees. We continue to engage in a process of continuous improvement including engaging in an agency wide trauma informed self-assessment in the coing year.
The program activities described above have been achieved with limited investment. Key ingredients included: commitment at all levels of leadership, an initial investment for a staff salary for a part-time Mental Health Specialist and a true recongition of the needs of our clients. The program activities outlined here have haad a real cost of less than $50,000 annually. Wellness supports, exclusively provided by volunteers, combined with Forward Facing trauma supports have been implemented agency-wide and could easily be replicated in other service organizations, particularly those serving immigrants and refugees. Furthermore, the momentum developed undre this project has sparked a movement. We continue to engage in a process of continuous improvement including engaging in an agency wide trauma informed self-assessment in the coing year.
In addition to positive impacts on client, this project has had a profound impact on staff. Take for example, this account from a staff member: “I was working with an asylee, trying to get him to tell his story, to talk about the details of his experience, so that I could pursue his legal case. He became really distressed, fell on the floor, crying, like someone was actively hurting him. It’s like he wasn’t in my office at all. I had no idea what to do. I felt so helpless! And-it feels horrible to say, but I felt frustrated, because I wanted to be able to win his case.” By educating staff on trauma responses as well as providing key supports to clients, we have reduced feelings of anxiety for all. Staff have recieved training on trauma, mindfulness and related topics to better meet the needs of our client population.