Trauma-Informed Peer Support for a Diverse Population

Transcription

1 Trauma-Informed Peer Support for a Diverse Population October 7 th, 2016 Cameron Macauley Assistant Professor Justice Studies JMU 1

2 About Me 1984: Thailand (refugee camp) 1985: Indonesia (surgery) : Guinea-Bissau (Peace Corps) : Mozambique (surgery) : Angola (public health) : Brazil (MSF) : Angola, Mozambique (CDC) 2006: Bosnia, El Salvador (peer support) 2007: Ethiopia, Jordan (peer support) 2008: Vietnam, Cambodia, Colombia 2009: Uganda, Rwanda (peer support) 2010: Burundi (peer support) 2011: Lebanon (peer support) 2014: Iraqi Kurdistan, Vietnam (peer support) Currently: Professor, Justice Studies, JMU 2

3 CISR s Work with Trauma Survivors Since 1996 CISR has worked with victims of landmines and explosive remnants of war. CISR uses peer support methodology with survivors of all forms of psychological trauma: War-related violence Genocide Torture Forced conscription Sexual abuse with a special focus on persons with disabilities. 3

4 What Does Trauma-Informed Signify? An appreciation for the high prevalence of traumatic experiences in persons who receive mental health, physical health, and substance abuse services. A thorough understanding of the effects of trauma and violence on the individual (neurological, biological, psychological and social).

5 The Refugee Experience Oppressive regimes: Bhutan, Burma, Burundi, China, Cuba, Eritrea, Ethiopia, Iran Arrests, disappearances, imprisonment, torture, forced labor Violent Conflict: Afghanistan, DRC, Iraq, Syria, Somalia, Sudan, Ukraine Combat, conscription, anarchy, hunger, crime, disease, terrorism 5

6 Sources of Psychological Distress in refugees Traumatic experiences related to: Persecution Discrimination and marginalization Imprisonment and torture Trauma inflicted on friends, family Loss of home, goods, assets Ongoing stress related to: Safety of friends or relatives still at home Employment and security in the USA Cultural & linguistic adaptation in the USA 6

7 The Nature of Traumatic Experience What traumatic experiences have in common: 1. Threat of death or bodily injury to self or others 2. Overwhelming of the victim s coping skills (horror) 3. Sense of powerlessness 4. Moral injury : the belief that the event is immoral or unfair 7

8 High probability of long-term mental health problems People / Intentional Sexual abuse Military service Imprisonment Kidnapping Refugee camp Rape Assault Robbery fight Chronic Accident resulting from Negligence / Incompetence People / Accidental Sequential / Intermittent High-stress job: Police Health worker firefighter Drought Famine Epidemic Earthquake Hurricane Avalanche Flood Tsunami Nature / Accidental Single / Abrupt Adapted in part from Naomi Breslau et al, "Trauma and posttraumatic stress disorder in the community,

9 Behavioral Effects of Psychological Distress Anxiety Self-isolation Loss of self-esteem, self-confidence Mood swings: depression and anger Poor decision-making, impulsive behavior 9

10 The Normal Coping Process Avoidance and intrusion are part of the normal internal processing of an experience. When avoidance and intrusion interfere with an individual s social life and mental health, then they are considered to be PTSD. Social support plays a key role in the coping process. 10

11 SAMHSA s Six Principles of a Trauma-Informed Approach 1. Safety 2. Trustworthiness and Transparency 3. Peer support 4. Collaboration and mutuality 5. Empowerment, voice and choice 6. Cultural, Historical, and Gender Issues From 11

12 Safety Manage expectations so that refugees know what is happening at all times, and what behavior is expected from them. Even with a language barrier, we read nonverbal cues to determine safety: Tone of voice, body language, gestures and facial expressions all send messages. Giving a person choices and time to make them indicates trust and respect.

13 Collaboration Between staff and refugees Among staff at all levels Among refugees, even from different countries Between staff and all others who support refugees in the community Healthy relationships promote healing.

14 Trust and Transparency Do what you say, and say what you do. Keep your promises. Explain each step of the process (as needed). No false hopes or unrealistic expectations. Allow refugees to take responsibility when possible.

15 Empowerment Loss of freedom is a main reason that people become refugees. Refugees must be allowed to take control of their lives, with appropriate guidance and support. Encourage refugees to help each other.

16 Culture, Gender and History Learn from refugees that you work with about their own culture and history. Teach with compassion: learning to live in a new culture takes years; acknowledge the challenges and stress of the transition process. Be sensitive to culture-based gender differences.

17 Peer Support SAMSHA s Six Principles fit well within the framework of peer support. A trained peer support worker (PSW) who has already adapted to the US can: Make refugees feel safer by managing expectations bring staff, refugees and community together. can explain and advise refugees, based on his or her experience, and enhance transparency. can help refugees develop self-confidence and autonomy. can facilitate adaptation to US culture, especially as regards differences in gender roles.

18 Empowerment Trust & Transparency Peer Support Safety Collaboration

19 Peer Support What Peer Support is: Encouragement and assistance provided by a colleague who has overcome similar difficulties. What Peer Support does: Engenders self-confidence and autonomy Enables the survivor to make his or her own decisions and implement them. 19

20 What makes Peer Support work? Social Support consists of: emotional support (esteem, attachment, reassurance) instrumental support (material goods and services) informational support (advice, guidance, feedback resulting from experiential knowledge. Social learning theory: we learn from our peers. Social comparison theory: we emulate our peers. Helper-therapy principle: we benefit from helping. 20

21 What makes Peer Support work? 1. Peer support workers should receive training prior to, and during, their work. 2. Peer Support is more effective if the Peer Support Worker and the peer are closely matched in terms of: Age Gender Cultural & socio-economic background Trauma history 3. Peer support workers must be supervised by professionals with a background in psychology and social work.

22 Harrisonburg Peer Leader Program Partnership: Church World Service, James Madison University, and Harrisonburg High School Program: Peer support for newly-arrived adolescent refugees from Eritrea, Ethiopia, Sudan, Congo, and Iraq (including Kurdistan) Purpose: To assist students in adjusting to school and social life Trainings: 2-3 day trainings in Feb 2015, Aug 2015 & June 2016 Implemented at Harrisonburg High School, Feb 2015 June

23 Purpose of the Peer Leader Program The program was intended to: assist students in building a peer network quickly feel welcomed and accepted in the school environment accelerate social integration improve academic acclimatization prevent disciplinary offenses (fighting, bullying, and substance abuse) improve emotional and psychological health A Peer Leader does not solve problems but helps peers manage problems and cope with stress. 23

24 Harrisonburg Peer Leader Program Selection of Peer Leaders (PLs) based on: Teachers recommendations Length of time in US Level of socio-cultural adjustment English language skills Diverse personalities, family backgrounds Prior experience with social programs 24

25 Participants Were in the 9th, 10th, or 11th grades Had been in the US from three months to almost six years Were proficient in English to varying degrees Many had been engaged in other social service programs, such as tutoring, mentoring, assisting teachers or coaching sports 25

26 Participants Iraqi Kurdistan 7 Iraq 16 Congo 8 Eritrea 7 Ethiopia 2 Sudan 1 Total 41 Male = 19 Female = 22 26

27 Training of Peer Leaders (2 Days) Topics: 1. Program structure 2. Understanding a peer s state of mind 3. Building trust 4. Managing emotions 5. Active listening & asking questions 6. Building self-esteem 7. Conflict mediation & resolution 8. Confidentiality Violence Substance abuse Sexual harassment Depression 27

28 Training of Peer Leaders Participants also discussed their experiences as refugees, describing: war-related violence their first weeks in the US difficulties in learning English and socializing coping with anxiety and grief over past events and family members left behind.

29 Training Methodology Participatory: trainees were encouraged to ask questions discuss issues tell personal stories Games helped trainees think about their own support network. Role plays allowed trainees to practice active listening, trust-building, dealing with strong emotions, advocating for yourself and for others, developing healthy coping techniques, and getting help in school. 29

30 Program Activities PLs were assigned peers, newly-arrived students from refugee families. Most meetings took place in school. Peers and PLs sometimes met in groups. Monthly meetings for PLs and supervisors to discuss issues and challenges. Picnics and baseball games 30

31 Harrisonburg Peer Leader Program Opinion Survey Among Participants, scale of 1 to 10 Participants expressed: Satisfaction Survey high satisfaction with program (average 9 out of 10) that the work of Peer Leader was not difficult (4 out of 10) confidence in their abilities as Peer Leaders (7.6 out of 10) that school was somewhat stressful (6.3 out of 10) that home life was only mildly stressful (4 out of 10), that the Peer Leader Program was useful for newly-arrived students from refugee families (9.6 out of 10). 31

32 Peer Support Studies with Refugees Study Date & country Origin of refugees & study size Results Salem-Pickartz 2008, Jordan Iraq, Syria (N=35) Improved problem-solving Yeh, Ching, et al 2007, US China (N=27) Improved social integration Trickett & Birman 2005, US Russia (N=110) Improved school performance Behnia 2004, Canada Bosnia, Cambodia, El Salvador, Iran, Somalia (N=36) Reduced stress Berthold 2000, US Cambodia (N=144) Reduced depression Bankston & Zhou 1997, US Vietnam (N=402) Improved school adjustment Demetriades 1996, UK Various (N=139) Reduced bullying Tsui & Sammons 1988, US Vietnam (N=45) Improved self-confidence, self-esteem 32

33 Advantages of Peer Support Conforms culturally & linguistically to refugees own backgrounds Inexpensive Promotes socialization & social integration Refugees participate in caring for others Reduces stress, may reduce suicidal ideation Builds confidence & self-esteem, helps refugees with problem-solving Promotes recovery from psychological trauma Often benefits family members Peer support workers benefit, too. 33

34 Conclusions Trained peer support workers can fill a service gap for refugees and other trauma survivors in Virginia. Peer support is effective & inexpensive. Peer support is culturally & linguistically appropriate. Peer support encourages people to care for themselves & for each other. 34