CONNECTING OTTAWA Our aim is to improve access to justice for linguistic minorities; people who are not proficient in English or French or who face communication challenges as the result of a disability or sensory impairment.
CONNECTING OTTAWA ● 89,000 speak a non-official language at home ● 69 mother tongues in Ottawa ○ “Top 5”: Chinese, Arabic, Somali, Spanish, Farsi ● 50,000 residents have a hearing impairment ● 25,000 have a vision impairment. ● 5,000 have a speech-related disability.
CONNECTING OTTAWA 47 Organizations across Ottawa: ● 11 Legal Services ● 18 Community Services ● 10 Immigration/Settlement Services ● 7 Services for People with Disabilities ● 1 Interpretation/Translation Service
ConnectingOttawa.com ConnexionOttawa.com
Conference Goals 1) Introduce the concept of trauma-informed care 2) Detail the legal aspects to consider when supporting a client that you suspect may have experienced trauma 3) Present concepts, tools, and strategies to consider when supporting persons who may have lived experience of trauma 4) Discuss case scenarios through the lens of trauma- informed care
AGENDA 9:00 - Welcome & Introduction 9:20 - Keynote Presentation 10:20 - Break & Refreshments 10:30 - Panel Discussion 11:50 - Case Scenario Group Exercise 13:00 - Close, Lunch & Networking 13:15 - Bonus Presentation: ARCH
WHY TRAUMA-INFORMED CARE? Alex Derisier & Erin Fitzpatrick
THE ALI FAMILY - Grandmother, not pictured - Mother, Fatima - Father, Moustafa - Son, Omar 18 yrs. - Son, Ahmed 9 yrs. - Niece, remains in Karbala
KEYNOTE ADDRESS Dr. Azaad Kassam Psychiatrist from Queensway Carleton, University of Ottawa
Refugees and Mental Health Please see attached PDF for Dr. Azzad Kassam’s full presentation. Azaad Kassam M.D., F.R.C.P.(C) Assistant Professor, Universities of Ottawa, Lakehead and Laurentian Psychiatrist, Queensway Carleton Hospital, Ottawa
KEYNOTE ADDRESS Dr. Doug Gruner Lead physician for Refugee 613's health task force and at Bruyère Family Medicine Centre.
TRAUMA-INFORMED CARE : REFUGEE CASE STUDIES Doug Gruner, MD, CCFP, FCFP Assistant Professor Department of Family Medicine
TRAUMA- INFORMED APPROACH REALIZES: impact of trauma (the context) and 1. understands that there are many ways to recover RECOGNIZES: the signs and symptoms of 2. trauma RESPONDS : by integrating knowledge about 3. trauma into practices/care and policies RESISTS : pitfalls that lead to re- 4. traumatization.
RECOVERY AND RESILIENCE KEY ELEMENTS TO RECOVERY: ⬜ - survivors need to be respected, informed, connected ⬜ - be aware of the link between trauma and symptoms of trauma ⬜ ( depression, anxiety, substance abuse, lifestyle choices) - the need to work with family, friends and community resources KEY PRINCIPLES SAFETY ⬜ TRUST ⬜ EMPOWERMENT ⬜ COLLABORATIVE ⬜ CULTURAL/HISTORICAL/GENDER ISSUES ⬜
MESSAGES FROM CASE Mental illness is taboo in some cultures ⬜ Definition of mental illness is very narrow in some ⬜ cultures or rather very broadly defined here How crucial trust is and without it providing care is ⬜ simply not possible Being aware of your scope: as the medical ⬜ students did and call for help Challenges of cross cultural communication ⬜ complicated by language barriers, need for interpreters: cultural approaches to mental health present ⬜ challenges: male trying to protect family so does not inform his wife of the severity of depression .
KEY MESSAGES - anger: refugees have often have been rendered ⬜ powerless, lost their homes, jobs, social status, respect, social networks. There is a real need to regain that power. When things don’t work out as hoped or expected anger can result, that anger can be turned outwards resulting sometimes in violence, risky behaviour like drugs, unsafe sex, etc and when turned inward can lead to depression and self- harm self- esteem issues. --missed appointments: why is this happening, ⬜ how can we accommodate you better. Is there something we can do to help you make it here because we care.
MENTAL HEALTH As health care providers we need to be on the ⬜ alert and highly vigilant for the early signs. However the evidence suggests that we should ⬜ not be screening for PTSD, depression and other mental health concerns in otherwise asymptomatic individuals for a number of reasons. 1. Bringing this up can cause harm especially if ⬜ the individual is not ready to discuss this. 2. It is crucial to ensure there are adequate ⬜ resources in place to deal with the issue.
TAKE HOME MESSAGES Be aware of concerning signs: withdrawn, flat ⬜ affect, sad, somatising, anger, self harm Make a connection: build trust ⬜ Assess protective factors: helps to understand ⬜ severity (relationships (their kids), future planning, other attachments to this world) Remember a major factor in psychological ⬜ distress stems from whether the refugee is able to find work that is close to what they were doing in their home country.
While every refugee's story is ⬜ different and their anguish personal, they all share a common thread of uncommon courage – the courage not only to survive, but to persevere and rebuild their shattered lives. Antonio Guterres, U.N. High Commissioner for Refugees, 2005 Photo: UNHCR/ R. LeMoyne http://sangam.org http://womenshealthfoundation.org
PANELLIST DISCUSSION Laïla Demirdache Lawyer - Community Legal Services Ottawa Centre Yedida Zalik Lawyer/M.S.W with ARCH Disability Law Centre Farah Nojoumi Clinical Counsellor - Ottawa Community Immigrant Services Organization - OCISO
PANELLIST DISCUSSION Laïla Demirdache Lawyer - Community Legal Services Ottawa Centre
PANELLIST DISCUSSION Yedida Zalik Lawyer/M.S.W with ARCH Disability Law Centre
Rethinking what trauma means for legal and social work
About ARCH Disability Law Centre • Specialty legal aid clinic, dedicated to defending and advancing equality rights of people with disabilities in Ontario. – Free summary legal advice and information to people with disabilities across Ontario. – Representing individuals and disability organizations in systemic litigation in specific areas of law. – Rights education, community development and law reform – New! Social work program
ARCH’s work with survivors of trauma • Using “trauma and violence informed approach” to emphasize acts of violence (article by Ponic, Varcoe and Smutylo, forthcoming from Department of Justice in Victims of Crime Research Digest, No.9) • People with disabilities experience higher rates of violence and abuse (Canadian Human Rights Commission, 2012, Report on Equality Rights of People with Disabilities) • Also singled out and not accommodated by policing and corrections (Ontario Human Rights Commission, 2012, Minds that Matter: Report on the Consultation on Human Rights, Mental Health and Addictions)
ARCH’s work with survivors of trauma • Many of our clients have had experiences as both victims and accused • Recently we have been working with survivors of institutional abuse at facilities for people with disabilities (similar to residential schools) • In that process, we tried to develop materials that considers disability related needs, including needs related to trauma, while discussing the trauma itself
ARCH’s work with survivors of trauma • Experiences of trauma can compound other disability related needs • In our work with survivors of institutional abuse, many clients are people with intellectual disabilities • Legal processes can themselves traumatize or re-traumatize and clients must recount some of their trauma to claim compensation
Trauma as disability • Some kinds of trauma are recognized as a disability for purposes of requiring accommodation in the human rights context, e.g. PTSD Krieger v. Toronto Police Services Board , 2010 HRTO 1361 (CanLII) • An American lawsuit argues that the Compton Unified School District has violated federal laws, including the Americans with Disabilities Act, because it has ignored students trauma related needs . The lawsuit recognizes the impact of trauma on learning and seeks trauma- informed school practices similar to those used to address other barriers to learning (website for case: www.traumaandlearning.org)
Social Model of Disability • Focus on societal barriers: society’s reactions or inactions, the built environment and attitudes that promote discrimination, exclusion, ableism • Barriers in society prevent persons with disabilities from being included and participating equally; society can be designed to include people with various abilities • Ending discrimination, segregation and removing barriers is the way to achieve greater equality, including through universal design
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