Burden of Suffering Burden of Cost Poor Integration.

The WNY Center for Survivors of Torture

at Jewish Family ServiceProviding access to comprehensive and culturally competent services

Defining Our PopulationsRefugee: someone who has been forced to flee his or her country because of persecution, war, or violence. A refugee has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group. A refugee in the US is someone who has been given this legal status and access to public benefits by the USG

Asylee/Asylum Seeker: same as a refugee but still needs to prove to the US government that they have well founded fears. Does not have refugee status or benefits in the US until they are given status.

The issue we address:

Over the past 20 years, approximately 15,000

refugees have resettled in or moved to Buffalo.

Up to 35 percent of refugees who arrive in the US are struggling with the consequences of extreme refugee trauma or torture

Burden of Suffering

Burden of Cost

Poor Integration

Our Working DefinitionsRefugee trauma includes exposure to war, political violence, or torture. It can be the result of living in a region affected by bombing, shooting, or looting, as well as forced displacement to a new home due to political reasons. Some refugees have served as soldiers, guerrillas, or other combatants in their home countries, and their traumatic experiences may closely resemble those of combat veterans

Article 1.1 of the UN Convention Against Torture defines torture as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third persons has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.

Pre-Migration:Leaving Home

Pre-MigrationEmotional and Physical

Health Challenges

• Persecution resulting in loss of economic and educational statuses

• Breakdown of social support and family unit

• Illness with poor health care

• Exposure and witness to crime and violence

Torture includes….

• Blunt and Penetrating Trauma• Burns• Electric Shock Torture• Dental Torture• Asphyxiation• Sexual Violence• Falanga (Beating of the feet)• Suspension and Positional Torture• Threat of death to self or loved

one

Migration:The Journey

MigrationEmotional and Physical

Health Challenges

• Harsh and unsafe living conditions• Exposure to violence • Disruption of family and community networks• Uncertainty about outcome of migration• Malnutrition• Exposure to disease, inadequate health care

Post-Migration:The United States/Buffalo

Upon arrival:

- language barrier,- resettlement

process,- culture shock- Poverty- Safety- climate changes- dependency on

others- intergenerational

conflict- marital strife- ethnic tensions- inadequate

services

The US’s Refugee Population

69,930  Refugees Resettled in the US in 2013

3,965Refugees Resettled in NY in 2013

1,361Refugees resettled Erie County 2013

5% 3%3%

15%

17%

21%

36%

Top Seven Nationalities Resettled in 2013

Sudanese Cuban Afghani Somalian Iraqi

Bhutanese Burmese

WNYCST’s Refugee PopulationGender• Female- 45, Holocaust

Survivors-6• Male- 59, Holocaust Survivors-5

Age Group• 0-18- 7• 19-30- 17• 30-50- 54• 50 plus- 13, Holocaust

Survivors-11• Unidentified- 13

WNY Center for Survivors of Torture

Care Coordination

Forensic Exams and access to

Health care

Behavioral Health and emotional supports

Social Services

EmploymentEducation

Legal

Partnership between: Jewish Family Service UB Family Medicine

Journey’s End Refugee Services Lake Shore Behavioral Health

Catholic Family Center/ Rochester

WNY Center for Survivors of Torture at Jewish Family Service

Project Director Care Coordinators

Mental HealthRe-integration services

Volunteers/interns

Lakeshore Behavioral

Health Mental Health

Services

UB Medical School Interns

WNY Human Rights Clinic

UB School of Social Work ITTIC/IRRI

Seeking safety groups and

research

Catholic Family Center and Rochester General Hospital

UB Family MedicineMedical Director

Forensic ExamsResearch

Journeys End Refugee Services

Legal DirectorLegal Services

Language Services

Jericho RoadShelter/medical

care

Referring AgenciesPartner AgenciesForensic Exam Partner

New Partnership

Resettlement Agencies

IIB, JERS, Catholic Charities, HEAL,

Hope, etc

Draft November 2014

Physicians for Human Rights

Emotional Consequences of Torture

• Struggling to meet basic needs• Unemployment /underemployment• Permanent Loss of family,

community and social status• Concern about family members left

behind/Survivors Guilt• Difficulties in language learning,

acculturation and adaptation.• Poor access to adequate health

care in the US

Care Coordination

• Clients assigned to JFS care coordinator based on gender, language, issue and case loads

• Intensive, client centered case management

• Specialized service plans, psycho-educational support, bridges to services, advocacy

Care Coordination Goals• Work with partners to provide

comprehensive services for clients as needed• Assist clients with making and

attending health care appointments• Support clients in obtaining mental

health, employment, and language services• Connect clients to culturally specific

resources• Provide psycho-education about the

consequences of torture

Physical Consequences of Torture• Headaches• Head trauma with changes in

memory• Scars• Stomach pain• Sexual dysfunction• Nerve pain• Musculoskeletal pain• Broken bones

Medical Services • Forensic evaluations conducted to establish credibility

of torture story• Istanbul Protocol standards/Physicians for Human Rights• Led by UBFM Kim Griswold, coordinated by UBMS student

interns (Human Rights Clinic)

Medical treatment now provided by Jericho Road

Logistics: Before the Forensic Examination• Case requests obtained from Physicians for Human Rights• When evaluators available: student scheduling coordinator

contacts PHR for case requests• Scheduling coordinator sends specific request to evaluator,

based on urgency of case and evaluator interest• If evaluator takes case, coordinator contacts PHR• PHR calls client’s attorney, who must provide draft affidavit to

evaluator at least 1 week before evaluation• Student coordinates logistics of meeting and ensures presence

of interpreter• Students designate student scribes available for forensic exam

The Forensic Examination• History• Reasons for Seeking Asylum in the US• Torture-Related History• Typical relevant events that require elaboration

• Death threats/accusations/slurs/claims- what words were used? By phone, email? Direct or indirect (to family, friends?)

• Beatings/hittings/attacks- with what? Where on the body? How many times?

• Physical Exam• Scars- measure size, hyper- or hypopigmented • Skeletal or soft tissue deformations• Mental Status Exam - depression, PTSD, anxiety symptoms • Client’s attire and interview behavior

After the Forensic Evaluation• Students and evaluator de-brief• Student draft of affidavit is due to evaluator within 1

week of evaluation• Evaluators complete their official affidavit, they send a

copy to the lawyer, PHR, and student evaluation coordinator• +/- Testimony in court

The Istanbul Protocol• Identifying survivors• Scheduling the forensic exam• Coordinating with attorney, students, interpreter and

detention center (if necessary)• The exam

Behavioral and Emotional Support Services

• Psychological Forensic exams- Objective evaluation for consistency of a survivor’s account• Psycho-educational supports- 1:1

or in group sessions• Specialized mental health referral

and follow up where care is needed• Referrals to culturally competent

practices with hx working with trauma and torture survivors

• Clients are oriented to the American mental health system

Legal Services

Legal Services • Advocate for client in the US

asylum application process and other legal rights

• Assist clients with miscellaneous immigration matters to support successful resettlement

Legal Status of Clients Served

• Refugee- 31

• Asylee-1

• Asylum Seeker-33

• Lawful Permanent Resident- LPR-6

• US Citizen-1

• Legal Visa-11

• Other or unknown-10

Social Services at JFS• ACCES-VR: employment services for

immigrants and refugees with disabilities• Project Integration: bridges refugees to

basic need service providers and employers, such as SNAP, TANF, WIC, HEAP, employment, and banking• The Incredible Years: training for

parents, teachers, and children to address multiple risk factors known to be related to the development of conduct disorders in children

Common Challenges• Not enough care coordinators for the need• Language and cultural barriers• Clients reliving torture through forensic exams

Future Direction

• Establish affiliation with the Office for Refugee Resettlement, the United Nations, and Physicians for Human Rights• Strengthen and maintain existing partnerships while

establishing new partnerships• Start peer mentorship program in addition to support

culturally specific care coordination• Establish support groups and child and family services• Expand training and outreach

ContactsAnna Skop

o Care Coordinatoro Jewish Family Service of Buffalo & Erie

County 716.883.1914 x329 askop@jfsbuffalo.org

Ali Kadhum Care Coordinator Jewish Family Service of Buffalo & Erie

County 716.883.1914 x329 akadhum@jfsbuffalo.org

Pam Kefi Director of Program Development and Integration Jewish Family Service of Buffalo & Erie

County 716.883.1914 x314 pkefi@jfsbuffalo.org

Karen M. Andolina Scott Managing Attorney- Immigration Legal Services

Program Journey’s End Refugee Services, Inc.

716.882.4963 x317 kscott@jersbuffalo.org

Dr. Kim Griswold Medical Director UB Department of Family Medicine

716.816.7247 griswol@buffalo.edu