The NSC Wellness Center

Nature of the Problem

Nationalities Service Center (NSC) supports more than 600 vulnerable newcomers annually through our case management programs for newly arrived refugees, survivors of torture and victims of crimes and human trafficking, many of whom have and continue to experience high levels of trauma and stress. Refugee Health Screener-15 (RHS-15) data indicates that 62% of our clients screen positive for anxiety, depression and PTSD symptoms. Implicit in the experiences of our clients is loss, trauma, and the major disruption of systems and supports. This is compounded by the more immediate acculturative stress of adjusting to new culture, finding employment, learning English, establishing financial security, living in a threatening and uncertain political climate and an upsurge of discrimination and xenophobia. Critical to building a secure life is the ability to access proper health care including mental health services. Too often, however, our clients are unable to attend to their mental health needs because of socioeconomic and cultural barriers including time, cost, language, transportation, insurance, stigma, unfamiliarity, and lack of provider cultural sensitivity. At the foundation of successful adjustment is reclaiming self-dignity, establishing health and well-being, and community integration, which makes effective healing opportunities critical in direct service programming.

Program Description

The NSC Wellness Center is an integrated multi-modality program designed to address the well-being of our clients as they manage the challenges of reestablishing their lives in the U.S. Since its inception, Wellness services at NSC have grown with each year. Today, the Wellness program has a full-time MSW Wellness and Intake Coordinator and has expanded its free services to include an onsite therapy partnership with Council for Relationships (CFR), Wellness Wednesday (weekly acupuncture, yoga and massage, mindfulness walks, client-led service projects, knitting/crochet circle and more), and private trauma-sensitive yoga and meditation sessions. Most recently, NSC hired a part-time trauma-informed bilingual therapist and is in the process of hiring a part-time onsite art therapist. This collaborative Wellness treatment team comes with years of unique experience in the fields of clinical and holistic wellness. Language interpretation is provided for all clinical therapy. As the Wellness program has grown, so has our vision for what is possible. With the mission of providing centralized linguistically and culturally sensitive therapeutic services for immigrants, refugees and asylum seekers in the Philadelphia region, we are committed to expanding clinical and holistic offerings so that we can support more of our clients during their adjustment.

Disruption

This program disrupts the traditional model of siloed case management and mental health services by providing collocated, integrated, collaborative, no cost, culturally sensitive, and trauma-informed clinical and holistic services with language access. A diverse menu of Wellness services (supporting materials) offers clients direct involvement in their treatment plan and promotes empowered and comprehensive understanding of healing and wellbeing. This program also disrupts traditional approaches to mental health care by integrating holistic complementary therapies with talk therapy. Complex trauma sequelae, including somatization such is chronic pain, is not always addressed through talk therapy alone. Complementary treatments integrate physical, psychological, and social healing which is more acceptable to many clients. These therapies are normally prohibitive to our clients due to cost, language and location. The Wellness Center provides a familiar environment that is safe, consistent, and accommodating to each client’s needs, especially important in this uncertain political environment for immigrants and refugees.

Leadership

NSC is committed to establishing a fully-integrated, trauma-informed, culturally and linguistically sensitive case management and wellness service model that can be replicated in other agencies serving refugees, asylum seekers and immigrants. A comprehensive and team-led approach will enhance the case-management services that we provide and ease the adjustment process for our clients. NCS has invested in a full-time staff member to coordinate Wellness services and to ensure the quality, consistency, and sustainability of the program. A research assistant will gather quantitative and qualitative data such as changes in participants’ stress levels and coping mechanisms as well as their responses and feedback about the activities, which NSC will disseminate to other organizations. Additionally, NSC will develop a program implementation model including training manual, in-person training, and webinar that can be shared with the broader community.

Scalability

Scaling will include three primary modalities: 1) internal capacity building, 2) internal quality improvement and 3) replicability models. Internal capacity building includes expanding clinical services to all NSC clients including ESL students and those receiving legal services. This would allow us to reach more clients, many of whom also have mental health needs. Current funding precludes us from offering clinical services to those outside of our Survivor Services team. As part of quality improvement, we plan to provide compensation for our holistic providers. Programs of this type often rely on volunteers, which can lead to turnover and inconsistency. We do have a no-cost partnership with Council for Relationships that defrays cost for clinical therapy. Current funders include Pat Kind Foundation, Pa. Refugee Health Program, Philadelphia Health Partnership, Geneva Global, Mural Arts and Office of Victims of Crime, and we are engaging with potential funders that support integrated wellness programming.

Results/Outcomes

In 2017/2018, we conducted qualitative interviews with clients that demonstrate the acceptability and positive outcomes of our program (supporting materials). To further evaluate effectiveness, we will conduct a multi-faceted, layered evaluation to gather quantitative and qualitative data including: Tracking change in waiting time for clinical services (date of referral to date of first appointment) in order to improve immediate referral Tracking and analyzing attendance and demographic data across Wellness services Administering pre + post questionnaire evaluating changes in distress levels and positive coping strategies (RHS-15 and Coping Strategy Cover Sheet) Conducting in-depth client interviews using structured interview guide and free list activity to document range of multi-dimensional outcomes possible with integrated wellness therapies and identify culturally-specific concepts and language that capture individual explanatory model of healing Conducting focus groups to garner critical client feedback needed to make changes and improvements