I dont see them in my practice The et ethics s of servin ving g - PowerPoint PPT Presentation

Clinical Lecture Series “I don’t see them in my practice…” The et ethics s of servin ving g refugee ee and immigr igrant ant surviv vivor ors s of torture and trauma Laura a Garloc ock, , MSW Josh Hins nson, on, MSW, LCSW Septemb ember er 21, 1, 2015 U N C G l o b a l Tr a n s m i g r a t i o n R e f u g e e M e n t a l H e a l t h & W e l l n e s s I n i t i a t i v e

UN N HI HIGH H COMMI MMISSIONER SSIONER FOR REFU FUGEES GEES ANT NTÓNI ÓNIO GUTERR TERRES ES H T T P : / / W W W . U N H C R . O R G / P A G E S / 4 9 C 3 6 4 6 C 8 . H T M L

OBJECTIVES • The refugee gee experie erience nce in North Carolina na • What is a refugee? • Trauma in the refugee experience. • An eviden ence ce-based ased refugee gee mental al health th screen ening ng instru trumen ment • Refugee Health Screener – 15 • Strateg egie ies for mental al health th providers ers to work effecti ectively y with h interpret preter ers. Princip iples in in profess ssion ional codes of et ethics cs pertain ining ng to providin ding g services ices • to re refugees gees in need of menta tal health th service ices.

REFUGEE MENTAL HEALTH  Prevalence  Greater levels of psychological disturbance (Fazel, Wheeler, & Danesh, 2005; Porter & Haslam, 2005)  Half of all refugees have mental health concerns (Brundtland, 2013; Rousseau, 1995)  PTSD 10-40%  Major Depression 5-15% (RHTAC, 2011)  Anxiety and stress-related disorders  Chronic physical illnesses, mental illnesses, and substance abuse (Palinkas et al., 2003)  Prevalence rates of torture range from 5-35% (Baker, 1992)  40% of refugees in the United States need mental health services but cannot access them (Ehntholt &Yule, 2006)  Failure to involve trained interpreters can disrupt services to refugees (Miller, Martell, Pazdirek, Caruth, & Lopez, 2005; Bischoff et al., 2003)  Impact: Higher healthcare costs, persistent and severe mental illness, and worse acculturation outcomes (Priebe et al., 2011; Pumariega, Rothe, & Pumariega, 2005)

UNC Global Transmigration Refugee Mental Health And Wellness Initiative

REFUGEE RESETTLEMENT

RESEARCH PROCESS Referral Schedule Screening Intake Treatment Rescreening

PATHWAYS TO WELLNESS: VISION

THE TRIPLE TRAUMA PARADIGM trauma in flight trauma from trauma in country of new country origin Trauma Narrative

SETTING THE CONTEXT WHO HO can n admi minist ister er the RHS HS-15? 5?  Self-admi dmini nist stered red  Health h work rkers (medica cal assistants sistants, nurses, ses, doctors, nurse se practi titione oners, , social work rkers), , resettl ttleme ment nt case work rkers WHE HEN should uld the RHS HS-15 5 be admini nist stere ered?  At the same time me as ot other r health h scree eeni nings ngs or inta takes es to reduc uce sti tigma ma  Timing ng may differ r based on the group, up, screen ening flow, time constraint straints s or ot other r consi sidera derati tions ns. .

SETTING THE CONTEXT Introduc oductio ion  During program intake or other case management meeting  Emphasize that screening will involve questions about how they are doing both in their body AND in their mind. Timing ming  Before administering the RHS-15, remind the individual/group that each person aged ed 14 4 and over er will be asked the questions about sadness, worries, body aches and pain, and other symptoms that may be bothersome to them. Normal alize ze  Lets the individual/group know that many refugees have a hard time because of the difficult things they have been through, and because it is very stressful to come to a new country.

SETTING THE CONTEXT The case worker explains … “ Some e refu fugees gees have mind nd and body y symptoms ms becau cause se of f difficult cult things they have been en throu rough gh, , and because cause it is very y stress essful ful to come e to a new w countr try. . The questi tions ons we are aski king ng help us find d people ple who are e having g a hard time e and d who might need ed extra ra suppo pport. t. The answ swer ers s are not ot shared ed with anyone one else e without ut your permis missi sion. on. ”

RHS-15 INSTRUCTIONS Read instruct tructions ions out t loud: : “How much in the last month have the symptoms below been bothersome to you?”  Point nt to the numb mbers/i /ima mage ges s for the scale  Create a vi visual al aid that shows ws patients ents the differenc ence e in the amoun unt. .

SYMPTOMS “How much in the last month have the symptoms below been bothersome to you?” 1. Muscle 1. cle, , bone, , joint nt pains ns 2. Feeling ng down, , sad, or blue most of the time 3. Too o much think nking ng or too many y though ughts 4. Feeling ng helples less 5. Suddenl nly y scared for no reason 6. Faintne ness ss, , dizzine ness, ss, or weakness ess 7. Nervousn ousness ss or shakiness ss inside 8. Feeling restless, can’t sit still 9. Crying g easily

TRAUMA SYMPTOMS The following symptoms may be related to traumatic experiences during migration. How much in the past month have you: 10. Had the experienc ence e of reliving ng the trauma; a; acting ng or feeling ng as if it were happeni pening ng again? n? 11. 1. Been having ng PHYSI SICAL AL reactions ons (for r examp mple, le, break out in a s sweat, heart beats fast) ) when remind nded d of the trauma? a? 12. Felt emot otion onall lly y numb mb (for r examp mple, le, feel sad but can’t cry, unable to have loving ng feeling ngs) s)? 13 13. Been jump mpier, , more easily y startled ed (for r examp mple, le, when n someon one wa walks s up behind nd you) u)?

COPING 14. Gener erall ally y over er your r life, e, do you feel el that at you are: e: Ab Able le to handle e (cope pe with th) ) anything hing that t come mes s your way ..............................................0 Ab Able le to handle e (cope pe with th) ) most st things ngs that t come me your r way ...............................................1 Ab Able le to handle e (cope pe with th) ) some me things ngs, but not ot able e to cope e with th ot other er things ngs.....................2 Un Unabl ble e to cope e with th most st things ngs.........................................................................3 Un Unabl ble e to cope e with th anyth thing ng ......................................4

DISTRESS THERMOMETER

SCORING THE RHS-15

REASSURANCE THAT THIS WILL WORK Ask sking ing these se que questi stion ons s can ident ntif ify y someon one wh who needs s suppor pport t and help get et them connec nected ed to care. e. Scree eening ning is s th the e veh ehicle cle th that t connect nects s someone one to a more e comprehe prehensiv nsive e evalua luation ion and d suppor port. . The e res esett ettle lement ment agency ency tea eam is s th the e link to that conne nect cts s the client nt to this resour urce ce.

CONSIDERATIONS Will ask sking ng about ut sy symptoms ms of an f anxiety, , depress ession ion or PTSD re-trigger rigger so someone ne making ng it diffic icul ult t to get et through ugh the exam? What are avai vailable lable reso sour urces ces sh should d so someone ne need immediat iate care? e? Wha hat ha happen ens s if som f someo eone ne disc sclo loses ses somet ethin ing g that is painful nful for me to hear? Wha hat othe her res esour urces ces are e the here e for me me?

HOW TO REFER TO REFUGEE WELLNESS Offer er Ref efugee ugee Wel ellne ness coun unseli seling ng ser ervic ices es to the e clie ient  Suggested script on referral form If clie ients s consen sent, t, fax ref efer erra ral l form rm to 919-962 962- 755 557, 7, atten ention ion: : Josh h Hin inson Cal all Lau aura a Gar arloc ock: : (9 (919) 9) 334-00 0072 72 ext. 4013

RESEARCH PROCESS Referral Schedule Screening Intake Treatment Rescreening