The WNY Center for Survivors of Torture at Jewish Family Service Providing access to comprehensive and culturally competent services
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 [email protected]
Ali Kadhum Care Coordinator Jewish Family Service of Buffalo & Erie
County 716.883.1914 x329 [email protected]
Pam Kefi Director of Program Development and Integration Jewish Family Service of Buffalo & Erie
County 716.883.1914 x314 [email protected]
Karen M. Andolina Scott Managing Attorney- Immigration Legal Services
Program Journey’s End Refugee Services, Inc.
716.882.4963 x317 [email protected]
Dr. Kim Griswold Medical Director UB Department of Family Medicine
716.816.7247 [email protected]