Community-Based Practice with Refugees & Survivors of Torture: Innovations in Academia, Practice, and Student Fieldwork AOTA Annual Conference, Nashville, TN, April 16, 2015 Mary Black MS, OTR/L • Jyothi Gupta PhD, OTR/L, FAOTA • Anjali Nigam OTD, OTR/L • Natasha Smet OTD, OTR/L • Yda Smith PhD, OTR/L Introduction The US is a nation of immigrants; American society illustrates cultural pluralism. As occupational therapy nears its centennial celebration, it is important to reflect on the legacy of its founders, who brought a surge of optimism and a sense of justice to the issues of their time. The current social issues that confront the nation are similar to that of our founders and include a sizeable, underserved population, a subset of which are immigrants and newly-arrived refugees. OTs are well positioned and needed to serve these populations as they transition to a new and unfamiliar cultural context. Practice with immigrant communities embodies the social vision of our founders and is aligned with the contemporary values and ethics of occupational therapy. Occupation-Centered Practice Occupations and daily life patterning (habits & routines) are socially constructed, particular and context-specific. Occupational performance, experiences, meaning, and identity are based on values of a particular sociocultural context. Immigrants’ experience transitions in their roles, identity, health, and well-being. Threats to health & well-being due to: • Occupational disruptions/Loss of culturally meaningful occupations /Self-Efficacy (Ways of doing)/ • Identity (Ways of being & belonging) /Occupational deprivation /Occupational challenges Reconfiguration of occupational lives and identity is necessary for social integration and participation (Gupta & Sullivan, 2013). Survivors of Torture Countless refugees and asylum seekers are survivors of torture. Torture is the deliberate infliction of severe mental and/or physical pain or suffering by or with the consent of state authorities. The overall goal of torture is to instill fear, control, and disempower an individual. It strips one of their roles and identity, invokes feelings of isolation, insecurity, and distrust, and deprives an individual of their freedoms. Consequently, the dehumanizing nature of torture has lasting effects on an individual’s doing, being, and becoming. An estimated 500,000 survivors, many asylees, live in the U.S. coping with the effects of torture, displacement, and uncertain legal status. Occupational deprivation and consequences of torture impact performance and affect 5 main intrinsic factors: cognitive, psychological, physical, spiritual, sensory. (Figure 1, Nigam, 2014) Figure 1. Grounding Roots through Occupational Performance: The Acculturation of Survivors of Torture An Educational Approach to Enhancing Cross-cultural Adaptation of Immigrants, Gupta, J., & Sullivan, C. (2011) Rationale: Many new immigrants have to learn English and ELL centers are good places for working with this population. Method: Community-based Participatory Research: Negotiated with community partners and matched benchmark of school district to our research themes and identified key topics. Participants’ input shaped curriculum content and delivery process. Curriculum Modules: Introduction to research, occupation, and informed consent process. /Cultural transition - self-efficacy – well-being. /Time norms, routines, scheduling stress. /Sleep, time management & health/ Healthy eating, physical activity & health. /Work: culture, norms, stress, injury, body mechanics & ergonomics. Curriculum Outcome Measures: Individual interviews & Focus groups/Pre-post content knowledge measures: On content of session/Self-report surveys: Cultural Adaptation & Adjustment Scale (CAAS), General Self Efficacy (GSE) Scale, & the Short Depression-Happiness Scale (SDHS). Work & Ergonomics Results: Significant changes noted in pre-post tests in the following modules: Routines & Habits; Sleep & Stress; Physical Activity; Nutrition. Although immigrants struggled with security and competence, they were determined in learning about host culture, seeking resources towards the goal of integration and participation. Despite day-to-day hardships participants reported (1) feeling hopeful and satisfied with their lives; (2) adequate levels of functioning; and (3) experienced high levels of self-efficacy. Conclusion: OT can impact the cross-cultural adaptation, foster social integration and enhanced participation of new immigrants. Working with Populations from a Refugee Background: An Opportunity to Enhance the Occupational Therapy Educational Experience Smith, Y.J., Cornella, E., Williams, N. (2014) Methods: The purpose of this study was to investigate first-hand perspectives of occupational therapy students who have had a 12 week, full-time fieldwork experience in this program. Results: Analysis of qualitative data resulted in the emergence of three major themes: OT at its Core “I felt like with this fieldwork experience I was able to really hit the core of occupational therapy. That is, helping people do the occupations they want or need to do. It was some of the most occupation-based, client-centered OT that I have seen yet.” Cultural Awareness and Competence “I developed a cultural sensitivity that could not have been learned anywhere else… I am [now] able to put aside my own agenda or American perspective to really understand the occupational profile of an individual, which so often is incredibly influenced by culture, and use that information to develop meaningful treatment.” Basic Skills for Any Setting “I was surprised at how much the skills I developed during this FW transferred over to traditional practice areas… There were different barriers, different goals, and different types of treatments, but… this FW provided me opportunities to develop the basic skills that any therapist needs in any setting: clinical reasoning, being occupation-based, being client-centered, documentation writing, rapport building, treatment planning, designing and leading groups...” Results demonstrate that this is program provides occupational therapy students the opportunity to develop the core skills necessary to become effective and competent occupational therapy practitioners along with cultural awareness strategies. Students develop the ability to work with diverse and under-served populations, which is a necessity in our growing and changing world. While participating in this program, students are able to practice and provide client-centered, occupation-based training that promotes client engagement in meaningful occupations. Community Practice Examples AACI Center for Survivors of Torture (CST), San Jose, CA Therapeutic Photography Project Level II fieldwork at the Kovler Center inspired the development of a practice model (see Figure 1) and to seek out an OTD apprenticeship at the San Jose CST. Only OT at CST was a challenge and opportunity to introduce activity-based treatment through a trauma-informed lens. Created & implemented a therapeutic photography project for survivors coping with isolation, occupational deprivation, PTSD, anxiety, and depression. Therapeutic photography allows one to visually capture experiences, environments, and emotions through photos. When accompanied by a caption, story, or poem, they can be used as a means to communicate thoughts & feelings otherwise masked in verbal expression alone. Group workshop over 5 weeks culminated in a public photo exhibit and reception, “A Lens of Hope”. OT-facilitated and participant-driven with focus on visual, verbal, and written expression. Emerging themes in discussions: homesickness, missing loved ones, everyday struggles, and importance of hope. Outcomes: improved ability to ascribe meaning, identify stressors, communicate with others, and express selves, with carryover into talk therapy with psychologists. Clients reported feeling “confident”, “creative”, and “relaxed”. OT at The Heartland Alliance Marjorie Kovler Center, Chicago OT at The Heartland Alliance Marjorie Kovler Center is concerned with how torture, trauma, displacement, and acculturation affect the occupations & roles of survivors. Survivors waiting for political asylum often have no work authorization, live in substandard housing, “think too much” about past horrors and feel a profound diminishment of their roles and status. Our imperative is to create safe environments and build on existing skills and strengths to support meaningful occupation. An occupational history and adapted COPM are used to assess client’s strengths, interests, and performance. Individual OT work concentrates on skill adaptation and development, with a pervasive need for prevocational and vocational support. Client inspired programming for the past 10 years includes our international cooking group, urban gardening, rural farm visits and more recently, “Photovoice”. Groups offer the continuity of familiar rituals that clients can look forward to, providing a powerful source of safety, predictability, and meaning. Many survivors have reclaimed their voice and personal spirit that the torturers sought to destroy and are now enriching and shaping their new found communities References Black M. (2010). From Kites to Kitchens: Collaborative Community Based Occupational Therapy with Refugee Survivors of Torture In: Kronenberg F,Pollard N, Sakellariu D (eds) Occupational Therapies without Borders, Volume 2 Towards an Ecology of Occupation-Based Practice, 217-225. Gupta, J. & Sullivan, C. (2011). Enhancing Participation and Health in New Immigrants: Translating Occupational Science into Occupational Therapy Practice. Presented at Society for the Study of Occupation, October 19-22nd, Park City, UT. Gupta, J., & Sullivan, C. (2013) The Central role of occupation in the doing, being and belonging of immigrant women, Journal of Occupational Science, 20:1, 23-35. Nigam, A. (2014). Grounding Roots through Occupational Performance: The Acculturation of Survivors of Torture. (Unpublished doctoral model of practice). Washington University in St. Louis. Smith, Y. J., Cornella, E., & Williams, N. (2014). Working with populations from a refugee background: An opportunity to enhance the occupational therapy educational experience. Australian Occupational Therapy Journal, 61:1, 20 - 31. Smet, N. (2014). Advocating the role of occupational therapists with immigrants and refugees. (Unpublished doctoral capstone dissemination). The University of Toledo, Ohio. Also see OOFRAS- Occupational Opportunities for Refugees & Asylum Seekers Inc http://www.oofras.com/ Contact Information Anjali Nigam <[email protected]>, Yda Smith <[email protected]>, Natasha Smet <[email protected]>, Jyothi Gupta < [email protected]>, Mary Black <[email protected]> This information is the copyright of the authors and use of any information from this poster must be credited to the authors. Thank you!