Working with Refugee Populations Services for Older Refugee Program (SORP) Senior Action Council June 2018 1
Who is a Refugee? Refugees are those persons of special humanitarian concern who have fled their country of origin because they have suffered persecution or have a well-founded fear of persecution on account of their race, religion, nationality, political opinion or membership in a particular social group Their governments are unwilling or unable to protect them. 2
Who is an Immigrant? A person who legally comes to live permanently in a foreign country 3
Other categories: Asylee Entrant Amerasian Certified Trafficking Victim Confirmed Trafficking Victim Unaccompanied Refugee Minor Special Immigrant Juvenile Lawful Permanent Resident US Citizen Repatriate Non-immigrant Undocumented Alien 4
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Refugees-the Global Perspective 65.6 million forcibly displaced people 22.5 million refugees in 2017 (½ under the age of 18) 86% of them are hosted in developing countries Options for refugees: ❖ Repatriation-return to own country ❖ Local Integration-incorporation into society ❖ Resettlement Origin/ Host/ Resettlement countries 6
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http://www.culturalorientation.net/providing-orientation/toolkit/providing-orientation- videos/seniors 13
Life in the Refugee Camp ➢ Security issues ➢ Employment restraints ➢ Lack of basic needs support ➢ Little education opportunity ➢ Mobility restraints ➢ Lack of health care and preventive health care ➢ Women’s issues ➢ Space created for short term stay – not reality 14
UN refugee camp, Eastern Nepal Photographs by Ben Saul (1999) 15 15 http://www.geocities.com/ben_saul/BhutaneseRefugees.html
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Security Checks and Travel Preparation ❖ Refugee Support Center (RSC) ❖ Interagency Security Check ❖ Dept. of Homeland Security ❖ Biometrics Security Check ❖ Medical Checks ❖ Local Assignment – VOLAG – Voluntary Agency ❖ Travel (IOM – International Organization for Migration) ❖ Arrival, Green Card process 18
Refugee Resettlement Web Links Center for Applied Linguistics (CAL) http://www.cal.org/ Bridging Refugee Youth & Children Services (BRYCS) http://www.brycs.org/ UNHCR - The United Nations Refugee Agency http://www.unhcr.org/ Bureau of Population, Refugees and Migration (PRM) http://www.state.gov/g/prm/ Office of Refugee Resettlement (ORR) http://www.acf.hhs.gov/programs/orr/ United States Conference of Catholic Bishops – Migration & Refugee Services (USCCB) http://www.usccb.org/mrs/ Church World Service - Immigration & Refugee Programs (CWS) http://www.churchworldservice.org/Immigration/index.html New York State's Bureau of Refugee Immigrant Assistance (BRIA) http://www.otda.state.ny.us/main/bria/default.htm Refugee Council USA http://www.rcusa.org/ 19
Resettlement Programs in the US The Bridge to Self Sufficiency Basic Needs Supports for 90 days Set up safe & suitable housing, 1 week worth of groceries furnishings, $925 per person Reception at airport, take to new home, orientation to area, cultural orientation Refer adults to ESOL, children to school, TB, medical, DSS, social security, mental health, employment, etc. Connections to other Services Volunteers, faith communities, local businesses, community advocacy groups, ethnic community groups, neighborhood associations 20
Refugee Rochester Arrivals - 703 Other 10/1/2016 - 9/30/2017 2 -Cameroon 3 - Ivory Coast Other , 11, 2% 1 - Liberia Afghanistan, 71, Ukraine, 63, 9% 2 - Nepal 1 - Pakistan 10% 1 - Sudan 1 - Tigryan Syria, 43, 6% Bhutan, 92, 13% Burma, 39, 5% Somalia, 138, 20% Burundi, 10, 1% Congo, 10, 1% Cuba, 119, 17% Iraq, 71, 10% Dem. Republic 21 Eritrea, 11, 2% Congo, 25, 4%
Challenges Language barriers Mental Health: Isolation, Depression, PTSD Lack of Education / Lack of Employment Limited life skills Lack of navigation and acculturation skills Not understanding preventive health care Medical Issues: medical issues that have gone untreated for years, not understanding how to fill medication, finding appropriate providers etc. 22
Current Challenges Specific to Older Refugees Compounded health care issues – working with pharmacies, prior poor health/nutrition, Access to appropriate adaptive equipment and/or understanding what is available Technology barriers (i.e. automated systems, internet) Lack of home care workers – primary language/culturally sensitive Compounded caregiver issues Learning language – ESL classes not geared to elders Limitations in mobility 23
Challenges in Primary Care Dr. Louise Bennett from Brown Square Health Center and the Refugees Helping Refugees agency provided the following insights after years of working in the refugee community. 24
Common health problems Children Anemia Lead elevation Parasites and worms Adults Hepatitis B TB exposure (PPD +) Malaria War injuries/amputations PTSD/ Depression 25
Differences in Health Care Systems Prescriptions and pharmacies Appointments Mostly acute care -little preventive Little counselling, mostly drugs Poor nutrition 26
New members of health care team Interpreters Case managers Volunteers and sponsors Refugee community leaders Health promoters Transportation providers *take steps to avoid staff burnout! 27
Health Outreach Challenges Developing trust Training community leaders Improving access Focusing on education Front desk, billing, nursing, and providers, administration need to be trained Cultural sensitivity – cultures, religions, holidays Different names- learning pronunciation Welcoming atmosphere – providing Trauma Informed Care 28
Challenges in Behavioral Health Appointments – keeping them and communicating Phone calls and letters Interpreters Small communities- impacts the ability of sessions to be confidential Staff comfort with interpreters Prejudices between communities Dialects Roles of males and females within the different cultures Clients not comfortable using interpreter to discuss torture and war experiences 29
Challenges in Behavioral Health Translation of Terms – self esteem, self care, internal strengths, mental health Trauma- PTSD effects all aspects of life and ability to work, the physical symptoms are connected to emotional health Prescriptions- improper use and understanding, stop taking when symptoms stop, unable to accurately report interactions/side effects Family dynamics with children as family communicators with outside world 30
Challenges of Behavioral Health Shame and Stigma Expectations of Treatment Expecting physical exam and a quick fix with medication Understanding MH treatment and how it is ongoing People stop treatment too early due to work, transportation, or loss of benefits Understanding the difference between clinician and a prescriber 31
RULE OF THUMB IN PROVIDING ANY SERVICE! Everyone is unique and has their own story. Different religions Different experiences and levels of education Different language skills Individual and family differences Different coping mechanisms 32
Bureau of Refugee and Immigration Assistance NYS – under Office of Temporary and Disability Assistance (OTDA) 3 Year opportunity to link the Aging and Refugee service systems and connect individuals to traditional senior services. 33
New Grant: Services for Older Refugee Program (SORP) Individual Service Navigation: intake, assessment, and linkage to traditional senior services Cross Trainings: service partner meetings and staff/volunteer training sessions that will help in improving the process of serving older refugees Community Education Workshops: events meant to reach refugees and their families to train them about various topics and also to educate the public about refugee populations Case Management and other direct support to current refugees 34
Rochester Resources for SORP Established Aging Services and Refugee Resettlement Services Supportive Monroe County Office for the Aging and other senior service providers interested in improving access. Established sites where refugees gather - Mary’s Place and Refugees Helping Refugees Rochester General Hospital - Refugee specific clinic with peer support and social work services Rochester Committee on Refugee Resettlement (RCORR)- monthly meetings of providers to inform each other and coordinate delivery of services 35
Grant information First Grant - $120K 83+ older people served by service navigation 104 Community Education events supported 82 Cross Trainings supported between service providers Second Grant- Changed focus - $60K 31+ achieved case management goals contract to date Other grants provided support for elder abuse prevention education , information and assistance for long term care issues (any age), transportation service and caregiver supports 36
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